Patient with withdrawal symptoms?

I saw a patient who came in with exacerbation of COPD with my supervisor. On reading patient's notes, we got the impression that it might not be an easy patient in terms of compliance with physio and because patient was still smoking, supervisor mentioned that patient might be feeling cranky because of the inability to smoke. Moreover, I had approached patient in the morning to ask if I could see her with my supervisor. Patient's reply was short saying that we could but she will not be getting up for walks. Patient was known to the team and staff have not had an easy time with her. Nevertheless, we still headed in and surprisingly managed to have a very successful subjective and objective assessment with her. We were even able to get her to ambulate for quite a distance!

The next day however, patient was the total opposite. The smiley patient of yesterday had become grumpy. She was not willing to even sit out of bed. I tried selling the benefits and persuading her to do so. Suddenly, patient bolted out of bed and sat at the edge and loudly snapped saying she'll do it if that's what I want even though she's hates it. I calmly assured her that I acknowledged her discomfort and that I would not push her further than sitting out of bed for a while. I also mentioned that I will leave her alone for now and come back later in the afternoon to see if she's up for a walk just because it is really important for her. Patient then soften her stance and said alright in a extremely nice tone (in comparison to when she snapped)

Later that afternoon, I came back and patient smiled on seeing me saying that she is ready for a walk but the doctors were just going to see her. I said that I would take her on a walk after the doctors have seen her. The doctors took a fairly long time with the patients and it had long been past my knock off time. My supervisor suggested that I do it the next day, however I felt it was now more to do with patient's trust than the benefits of the treatment.

That decision paid off as we had a very collaborative treatment plan thereafter. Patient and I decided that late afternoons were the best times for me to see her as she feels much better at that time of the day as compared to the mornings. I did not have any problems with that patient thereafter. In fact one day when I was off in the afternoon, patient gladly agreed to have her treatment in the morning instead.

I learnt from this experience that it is important to also listen to what the patient wants. A collaborative effort will definitely reap more results than a one way traffic treatment. It gives patients a sense of control and autonomy over their treatment and recovery. This is definitely a valuable experience as I will not be startled when I get shouted at by the patient in future.