What do you do when a patient comes in and is disappointed that they are not better? When they are unhappy with the progress and are still in pain? When they seem to be losing faith in you and your treatment? This is something I’ve experience recently, and it got me thinking about the importance of setting progress expectations with patients right from the start. It also had me considering how best to proceed on a positive path, when the patient feels we have hit a wall.
In my experience, a patient will start having increased pain a day or two before their appointment. And since pain is a reminder to most that they are not healed and that there has been no improvement, naturally, they’re concerned and frustrated. So the first question I ask is, “what makes you think you’re not getting better?” Then I ask them to quantify the pain. Typically, the pain is less intense and frequent, but again, pain is pain when the patient is looking to have none. And because most patients feel better immediately following treatment, I ask them to recall how they felt after leaving the last treatment. I ask them how long the relief lasted. Was it hours or days? How did they feel during that time? Did they enjoy it? And almost immediately, I begin to see a shift in their focus. It becomes less about the fact that there is still pain, and much more about the fact that there is also an ability to change it. Their outlook on the whole process starts to become more positive.
I also tend to explain how the body likes to be in dysfunction. No, I know that doesn’t sound right, but just think about every time you get a patient functioning well and then within minutes or hours, they go right back to the same issues or problems. I try to explain this as the “habitual mind of the body.” We all have bad habits. Things we do that we know are probably not doing us any good but they bring us comfort. This is the same with the body—it knows how to function in dysfunction. When you get it out of dysfunction, it doesn’t know what to do. Kind of like an animal that is being freed sometimes would rather be in a cage than experience the new world.
Overall, patients will tend to be happy with treatments, and many can see the benefits and the improvements without you having to remind them every time. But some require more guidance. And then there will be those who just do not make the shift. And in most cases if that doesn’t happen, the chance of success is severely diminished. In that case, take it easy on yourself, because the gratitude and joy is not going to be there from the patient or yourself. Recognizing this state is important in determining continuation of care.
-Rajesh Khemraj, PT, OCS, COMT, FAAOMPT
Clinical Faculty Instructor at The North American Institute of Orthopaedic Manual Therapy
About the Author
Rajesh is a Physical Therapist, who is passionate about health and wellness. He is interested in all aspects of general well being including fitness, nutrition and mindfulness. He continues to learn and grow from the profession he loves.
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