Refusing Treatment

I was treating 75 year old male on an acute neurology who has suffered a brainstem stroke. The patient had an extremely motivated wife who was a maternity nurse who frequently encouraged physio by explaining the benefits to the patient. As the patient was admitted from ICU he had a tracheostomy. Once arriving on the ward the trachy was removed. The patient struggled to talk post trachy removal as students were required to interpret what the patient was saying. On numerous occasions one student would suggest that the patient was refusing treatment. This however was not the case but once this option was realised by the patient he would then frequently refuse treatment.

Two students both morning and afternoon would spend time convincing the patient that physio is essential for returning to function post stroke. From this point on the patient would consistently refuse treatment on one out of every two daily treatments and his rehab suffered. 5 weeks post stroke static sitting balance remained the primary focus of treatment as the patient was not improving due to his lack of physio. When we were able to get the patient to the physio gym he would not comply with the planned session and the patient would dictate what he felt like doing.

Understanding post stroke patients will be debilitated both mentally, emotionally and physically it is important to realised the boundaries for aggressive treatment. However in this case the patient initially the patient had no issues with motivation, nor did he realise refusing treatment was an option until suggested by the student. Stroke rehab is challenging but rewarding when the patient has put in the work necessary to recover. It requires massive amounts of motivation and hard work from all aspects of the multidisciplinary team.

I realise now the importance of motivation an encouragement in stroke rehab. This also has taught me the importance of communication. Through this miscommunication the patient was able to take the easy way out and his rehabilitation was severely delayed. It is important to realise truly when a patient refuses treatment, but also not to give this as an option when facing the difficult task of rehab post stroke.