It has taken several occasions with similar circumstances for me to realise the importance of being on the conservative end of the realistic spectrum when it comes to patient outcomes.
There have been many musculoskeletal outpatients that I have treated this year who are very motivated and have very high expectations, for example chronic low back pain that will completely resolve if they do all the exercises and follow the advice I have given them. In a case such as this it may be clear that an important part of managing the patients problem is just that - educating them that managing the problem is likely to be the best outcome due to an element of irreversible damage. There have been other times however where patients have been unrealistic about their prognosis in terms of function and time taken to reach the function, and it is much easier to reflect their optimism than to "bring them down" to the most likely outcomes, trying not to reduce their enthusiasm and compliance.
It has been in my current neuro prac working on a rehab ward with stroke patients that the importance of being realistic, and even conservative with the way I influence a patients expectations. I have found that being overly optimistic and even saying "The way you are progressing at the moment you should have more movement in your hand by next week" - the type of statement several patients are clearly looking to hear can have a detrimental effect. Although in the short term it may help with compliance and motivation, I have found that when I am wrong about these types of prediction the patient loses confidence in me as a therapist and/or themself in terms of recovery.
From these many experiences I have learnt to keep certain goals for patients to myself and when I do give them my opinion on likely outcomes (which is still important), I think longer before answering to stop myself being caught in that desire to reflect their optimism and give a more cautious, considered response, erring on the conservative timeframe or level of recovery expected for their condition.
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2 comments:
I've been caught doing the exact same thing as you just described. A way I found to get around these difficult questions (especially if there is a poor prognosis) was to give a realistic view of their recovery, but then add in that everyone is different and their has been amazing cases of recovery of function. That way, they get a realistic view but can still maintain hope for a better outcome if they hear that it has happened to people before.
I think as new grads we have an urge to want to cure everyone and have a good outcome for every patient. Unfortunately this is never going to be the case and the sooner we realise this then maybe the better we can treat patients keeping this in mind.
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