Faking it

I have been treating a patient now daily for the last week, who I admit has frustrated me to no end, and is the first one who has really gotten under my skin.

J is a 14 year old girl with a diagnosis of reflex sympathetic dystrophy (another name for complex regional pain synddrome). She was admitted following a 2 week hx of increasing pain, resulting in fainting episodes due to pain for 2 weeks of intense physiotherapy and psychosocial review.

On first seeing J, she reports she is unable to walk without her leg shaking uncontrollably and 'collapsing' frequently. Our walk to the physio department took 20 min (a usual 2-3min walk). Over the following days she proved to be a handful, a really nice kid but attention seeking and completely disrespectful towards me and other medical staff. She would put on "performances" where suddenly she could not walk anymore and would cry and loudly abuse me in front of other staff. Whilst I was well supported by other staff who too knew she could walk normally and was just performing for the crowd I became increasingly frustrated and her undermining, manipulative manners. In addition she was absorbing far too much of mine and other staffs time at the detriment of other patients.

However despite numerous psych consults nothing within her family life, school life etc that would provoke such a performance. Her family is sick of her performances too, as they have observed J doing all the normal things she says she can't when unawares (as I too have) so my question was what do we do as physios, when she can do it all ok but just chooses not to???

My supervisor and I have spent a lengthy time discussing this and her comment was physio isn't going to change her, but it may allow her an opportunity to 'get out of this hole that she has dug". she has dug so deep that how can she just turn around now and do it normally. Because that would make her look stupid and open for ridicule.

She is unaware that we all know that she can do these things normally, because calling her a liar would just make the situation worse. So despite my frustrations (which have been at times very near the surface) we have had to use heaps and heaps of positive reinforcement so she can prove to herself and give her opportunities to do the normal things.

So, start of the week this girl couldn't walk...end of the week "lisa, look how well I can walk!" was her comment to me. I only hope this continues and she doesn't relapse into old habits or I don't know if I can keep up the very enthusiastic feedback!!