Patient expectations

I am currently on my musculoskeletal placement. During the last week I observed many of the senoir physiotherapists at work and tried to absorb all the knowledge I could!! During this last week I observed one of the senior physiotherapists treating a 34 year old women following a left total hip replacement. This patient was born with a left hip dysplagia. She was only diagnosed at 5 years old, following the local GP watching her run in a sports carnival. She then received 4 surgeries in the next 3 years to correct her dysplagia. She has lived a normal active life since then and is mother of two young children. In the last 8 - 10 years her left hip has become increasingly more painful. She is very young to be receiving a total hip replacement, but due to her history she was advised by her orthopaedic surgeon to have the hip replacement. The aim of the hip replacement was to decrease her pain and increase her activity.

Since having the total hip replacement the patient has experienced increased pain in her right hip, knee and lumbar spine. Following the surgery she has also been left with a 1.5cm leg length descrepency (her left leg is now longer than her right.) The patient was refered to the physiotherapy department by her orthopaedic surgeon for treatment for her hip, knee and back pain. The patient was told by the orthopaedic surgeon that she would be receiving lots of physiotherapy treatment and that it should help her. Therefore the patient arrived at the department with very exact ideas of what her physiotherapy treatment should be like.

After the senior physiotherapist had assesed her, the only appropriate treatment for the patient at this time was increasing her active range of motion of her left hip and gait re-education. The gait re-education was to show the patient how she can deal with her leg length descrepency. Once the patients gait was changed her lumbar spine pain reduced. The physiotherapist told the patient that she should continue with her exercises and come back to the physiotherapy department once she had been reviewed by her orthopaedic surgeon in 3 weeks time.

The patient was very dissapointed with this because she thought she would be having multiple physiotherapy sessions per week. The senior physiotherapist took a very motherly approach when reassuring the patient that she was capable to continue with her own rehab at home. Explaining that she was a very clever person, that she was not dumb and could cope on her own. The physiotherapist did suggest that the patient call the physiotherapy department if she needed to talk to her.

I felt that the patient left the treatment session feeling very disapointed and even slightly belittled. Maybe this is my lack of experience shining through, but I'd hate for a patient to leave a treatment session with me feeling that way. With future patients I would like to explain to them more thoroughly why I would not need to see them more often. If the patient is still upset about this I could always see them for a shorter follow up session and use this time to further reassure the patient. I don't know if sending a letter to the patient orthopaedic surgeon would be appropriate, but I would like to send them a letter explaining what treatment I was able to supply and why.


Has anyone experienced in situations when a patients expectations don't match up to the appropriate treatment you used for them?