Sunday, 27 May 2007
Motivating Patients
On my last clinic (cardio), I was finding it difficult to be able to motivate some of my patients. My supervisor advised that we need to educate patients so that they know why we treat people and the benefits of physio treatment. Often I would educate my patients, and they would still refuse. One particular patient was especially difficult. He was an 87 yo man admitted to hospital with pneumonia, the main problem being impaired airway clearance. This was the second time he had been admitted in a few weeks, and the second time that I had seen him. He told me several times that he was very stubborn, which he certainly was. On one particular occasion, I wanted him to go for a walk, however he was flatly refusing, because he said that he didn’t want to waste his breath. I taught him ACBT and dyspnoea strategies as well (as he also was having trouble with SOB), however, he flatly refused to go for a walk no matter how much education I gave him about the benefits of ambulation. I found it quite frustrating because I had done all I could in giving him the information, and I felt as though I was failing in being able to motivate patients (as in that particular week I had many patients who being very difficult). However, I got talking to this patient, developing rapport with him, and after having more of a conversation with him he was more compliant with going for a walk, and we actually were able to go for a walk. When we did go for a walk, he was quite surprised that he was able to do as much as he could. This experience showed me that rapport with patients is very important. Getting to know your patients is a really good way of increasing compliance. They are much more likely to do what we want when they see us as more of a person rather than just a physio come to annoy them when they’re sick.
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3 comments:
HI liz
it sounds like you have done really well with this patient. i too have experienced the difficult patient in a cardio-respiratory patient at PMH. From what i learned from children. which can be applied to adults, simply walking into a room as a student and expecting compliance doesn't necissarily happen. I too spent had to spend time getting to know patients in order to gain trust and raport. You did the right thing in allowing this gentleman to get to know you and allowed him to trust you. If you dont get this, a difficult patient will simply not do the treament you want. It is our responsiblity to do everthing in our power to gain consent and complaince, but sometimes, it is also important to comprimise. You did well to try ACBT in the hope that next time he may have been more compliant. keep up the good work!!
elle
Hi Elizabeth, wow this is really an issue that comes up so much. I must say the most upsetting thing I have noticed this year is how many patients' faces fall when you walk into their room. I have had a cardio placement with patients with chronic dyspnoea and now I am on my Rheumatology prac dealing with patients with cronic pain, arthritis and fibromyalgia and there are actually a lot of similarities between the patient groups. In both cases you are completely right building rapport and changing your communication style to suit each patient is the only way to get a result. You cant assume just because exercise is right for them and they know it they will go along with it. I think selling our treatment is definately a skill we will all have a chance to learn this year- sounds like you are there already!
Alison
I agree with all the comments so far. I don't know about everyone elses tactics, but generally before going into the room I try to know something presonal about the patient (from their notes/family/friends). Where did they live? "Albany...oh its beautiful, I have friends who live there and love it", Hobbies? knitting "my grandma still knits scarves for me in a different colour each year, what kind of things do you knit, who do you give them to?" I.e. whats my conversation starter.
Granted it doesn't work all the time but mostly you can convince someone to get out of bed or walking by "tell me about that (topic of conversation) as we go for a walk"
Any other tactics that people use? I know I have a patient at the moment who my normal tactics aren't working for...
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