I am currently at a musculoskeletal outpatient clinic and treat a large variety of patients who all have different views on their pain and the management of their condition. I recently treated a lady who booked an appointment for shoulder pain. When I treated her I discovered that there was a number of yellow flags and there was numerous other areas of pain. After talking to this patient, it was evident she contributed her shoulder pain due to carrying and caring for her young child and was thinking that all the areas of her body that had pain could be solved by a couple of visits to the clinic. She did not expect to do any work, instead expecting the manual techniques that physiotherapists perform to do everything. During the whole treatment session every change or education that I attempted was rebuffed straight away, she complained of not being able to do it and that she was too overweight and other excuses. I kept motivating her and tried different cues to help with her change in posture. At the end of the session, I wrote down the home exercise program and tried to emphasise the importance of these changes. Hopefully this will have made an impression on her and she will make a change.
Many patients that come into the outpatient department have the attitude expecting to do no work and expecting physiotherapy will make everything better without having to lift a finger. When they come into physiotherapy with this attitude it makes it very hard to treat the patient especially when the compliance to any home exercise problems, posture changes or changes in activities will be poor. I think that education on the emphasis of the importance of the changes is important but really there is only so much that you can do for the patient before they have to make some changes themselves.
Apart from education and showing the importance of the home exercise program, if anyone has any other ideas on how to motivate patients to adhere to the exercises and changes made during the treatment session I would be happy to learn!
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I agree that it is frustrating when patients do not want to take the responsibility for their own recovery as we try to assist them to do this. It would be unacceptable in the public sector to continue treating a patient with techniques that were passive on their behalf and perhaps less effective in the long term than things that require patient input such as postural re education and a home exercise program.
However, in a private practice, patents such as this may not be so frustrating and may help provide a good chunk of the food on a physiotherapist’s table. If a physiotherapist has explained the benefits of a client taking a more active role in their recovery and provided a client with this option but they still willingly come to a private practice (and pay for treatment out of their own pocket) and want passive treatment that would perhaps be of a smaller benefit to them, then I would say it is completely acceptable practice to provide the client with this for as long as they are willing to keep coming and paying (providing they clearly understand the risks and benefits associated with the treatment you are providing).
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