Rapport building

Whilst treating a patient this week I learnt the benefit of being polite but firm with patients. I was seeing an older lady who was day 4 post routine TKR. She was only getting about 20 degrees of active knee flexion but should have had around 50 or 60 by then. She was complaining of severe pain however refused pain medication as she preferred more natural remedies. My supervisor had warned me that she was difficult and very particular about her treatment and not to bring up some of her PMHx as she would argue that none of it was true. If things weren’t done her way then they weren’t done at all – hence the lacking ROM.

So the first time I went to take her down to the gym, I tried extra hard to be nice and build some rapport with her so that she would be compliant. Which meant that I let her brush her hair, put on some hand cream, helped her walk very slowly to the toilet etc. However this meant that I had already spent 25 minutes with her by the time she got into the wheel chair to go down to the gym. She was extremely friendly with me and did as I asked and increased her AROM, albeit very slowly. By the time I got her back to her room, a treatment that should have taken a maximum of 30 minutes had taken just over 1 hour. I still had so many patients to see and therefore was rushed the rest of the day.
From this I learnt that whilst building rapport with the patient is essential, we still have to be in control of the treatment session because our time is very precious, especially next year when it would have been just me on the ward. The next time I went to see her I popped in 15 minutes earlier to say she had to be completely ready by a certain time and we had to be back to the room in 20 minutes. This worked effectively and taught me that yes you need to build rapport with the patient but this should not mean using up all our time just to keep ‘fussy’ patients happy.