At the moment, I am currently on a placement for rheumatology. It is very interesting and I have come across many different conditions that affect multiple joints and all the patients have chronic pain. With ankylosing spondylitis , exercise and physiotherapy is very important to prevent long term contractures and joint deformities. One of the patients that I am looking after in the outpatient clinic has missed her last 3 appointments and hydrotherapy sessions. I have called her many times but cannot get her because she is very busy. Because she has not turned up for her last few appointments, it is protocol to discharge the patient due to lack of commitment to the appointments and adherence to exercises.
I feel bad discharging this patient because even though she did not attend the appointments and was not very keen on doing any exercise, without the physiotherapy she will be in more pain and more functionally limited in the long run. It made me feel helpless, because although I wanted to help her, I could not do anything because she was not willing to make an effort. When I saw her initially, we educated her on all the advantages of exercise and gave her all the normal handouts and educational sheets we give to all the AS patients but obviously this had not made a difference.
In this situation, I know we are not wholly responsible for patients health and improvements but when there is a patient that CAN be helped what more can we do to try and motivate them? I guess some people do not see the need for exercise or might think they are beyond help or might just be very busy. Next time I see a patient who is not very eager, I will try and pick this up from the initial assessment and maybe set shorter term goals, create an exercise diary or maybe more education. Hopefully this can make the difference!
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2 comments:
Yeh this is a tricky situation as a physio hey, but we can only do as much as we can from our side but the patient has to want to help themselves in order to make any progress. As long as we do the best we can to motivate the patient then the rest is up to them. Sounds like you've got a good plan for potentially difficult patients in the future, so good luck!
What's the deal if the patient wants to return for treatment? i guess when the patients condition starts to worsen drastically they will be knocking on physios door, or at least the doc will be sending them in the direction of a physio.
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