Patient compliance

On my rural prac I was treating a 22 yr old male who required musculo outpatient treatment following his # distal tibia. The fracture had occurred 2 months ago but such was the waitlist that this was his first opportunity for treatment. When it occurred, he was in hospital for 13 days before it was operated on as the swelling hadn't reduced to a satisfactory level. When he came to me he was complaining of pain with walking and into all ranges of ankle motion and stiffness. It was also still slightly swollen compared to the other side.

As he hadn't performed any strengthening or ROM exercises since he had come out of hospital (and he stated he hadn't done anything much whilst in hospital) this was the major cause of his problem. It also meant that a large focus of the treatment was prescribing a suitable program of exercises in order to address the loss of range and strength. However, as part of my treatment consisted of mobilisations and soft tissue techniques the patient approached physiotherapy with the attitude: 'can't you just fix it for me?' He openly admitted to me that he did the exercises I had given him on 2 days out of the month that I treated him over, and then complained to me that he wasn't making very much progress.

As much as I alternately ancouraged and bullied him, he was next to impossible to motivate. I would do my best, and by the end of a session think that he might be going to do them, only to be disappointed the next time I saw him. In the end, I discharged him to my supervisor, and after discussing his behaviour with her I felt that she might be able to get through to him. This experience taught me that as much as you want to treat someone sometimes there is no way that you can get through to them and you need to ask for help. I think it is difficult as an undergrad to be really tough on patients as you don't have the experience to know how far you can go but in this situation i needed to perhaps be even firmer in order to get any results.