A patient had an appointment for neck problems. Prior to this, the patient has been seen by 2 other therapists. Due to cancellations made by the patient, it was only the second time I am seeing the patient.
When asked about the progression of the problem, patient stated that it has plateaued and that was coupled with a tone of disappointment. Although the patient stated that there has been some much improvement since the very first assessment, the last few sessions did not seem to have helped. I probed further with leading questions, but the patient grew frustrated and said that I seem to be putting words into her mouth and that there are more stresses in life than just work stress.
I was taken aback and was lost for a second or two not knowing how to react or what to do. I then apologized to the patient for making her feel that way but reiterated that it wasn’t my intention. The patient was probably having a bad day as well because she apologized for what she said and we continued the session as normal and i decided to be more aggressive with treatment to really push the plateuing condition.
Firstly, it was probably the first time I experienced the patient coming back without feeling much improvement. Hence, I was not prepared for it and might have used too much leading questions to the extend that I was trying to get the answer i wanted to hear from the patient. Secondly, it was only the second time i was seeing the patient and the first session was spent more on getting to know the patient for myself.
I believe the next time a patient comes with no improvement, I will be better prepared to handle it by expecting that to be one of the treatment outcomes and just to progress the treatment. I will also be more aware with questioning to ensure that the leading questions are used to prompt patients to looking at areas that they might have overlooked but balancing on a fine line to make sure that it does not make the patient feel like this patient did.
Besides that, I feel that transfer summaries are very important as the first session with a patient that you are seeing for the first time is usually spent knowing the patient for yourself. Having a good transfer summary aids the therapist a fair deal in that process. Having said that, even with the best transfer summary, it will be difficult to be as effective as having the patient seen by the same therapist. Therefore, i feel it will help by adding in the transfer summary the most effective treatment for the next therapist to carry on with.
1 comment:
I experienced a similar difficulty with patients who had plateaued in terms of deciding whether to continue with the line of treatment other therapists had used or whether different contributing factors needed to be addressed. It can be quite frustrating as the physio and is clearly even moreso for the patient when their improvement hits a wall. From my experience you should progress your treatment as you said you were doing, however if you don't get an improvement after another session or two maybe consider other underlying factors which might now be the main factor. Provided you explain to the patient why you are trying different things (not just guessing!) it helps keep their spirits up about their problem and compliance with treatment.
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