Appropriate treatment progression

I am currently on rural prac based in a hospital which treats many indigenous and fly-in/fly-out patients. As well as working on the ward I am seeing many musculoskeletal outpatients, which has presented an issue that I have not come across in metropolitan areas. The frequency of non-attendance is very high for appointments, as patients forget, organised transport is unreliable and appointments are often not a high priority.

I have found it difficult to establish ongoing treatment programs with time-specific goals with most of my patients for one reason or another. The low attendance as mentioned before means that when I see someone, although we can book another appointment in, say one week, there is a good chance I won’t actually see them for two weeks for various reasons. Similarly, it is difficult to book appointments with the patients who fly in and out of town for work as they are often not here yet not based in the metro area either, so referring on doesn’t necessarily work either.

Yesterday I had a specific example of this where a 24 year old female had sprained her MCL one week earlier and I was seeing her for the first time. She was then flying to Perth a couple of days later for two weeks, which I could see would make it difficult to give ongoing advice and intervention that was progressing at the appropriate rate.

My approach to this problem was to recommend that she see a physio back in Perth during her time there, and to give advice for the next two weeks as much as possible. For example I told her she needed to keep trying to improve her knee flexion range guided by pain, however also information about what she would be best doing if the pain resolves within a week in terms of graduated return to activity. I found this difficult with all the “what-ifs” and felt frustrated that she could easily come back from Perth with an aggravated injury or a lack of progress.

I think it is important with these patients to always explain the plan beyond the next week or two as future appointments at the ideal times may not be possible. Does anyone else have any suggestions to provide the best management for patients in these circumstances?