During my musculoskeletal placement, I was assigned a patient with chronic low back pain who also suffered from severe depression and obstructive sleep apnoea. I was aware of the “yellow flags” involved initially yet I still found it difficult to treat this patient as the previous home program put into place was not being followed. The patient simply stated he did not have the motivation to do basic exercise and ADLs as he was not sleeping well because he found his CPAP mask uncomfortable.
Throughout the number of times I saw this patient, I was required to basically do the same treatment each time which involved a management approach consisting of patient education and constant reinforcement of the home program/CPAP. Until the patient became compliant with his home program I was schooled not do perform manual therapy to prevent the patient becoming dependant on physiotherapy to “fix” his back pain. After a couple of treatment sessions I began to become frustrated with the patient’s depressive state, wanting to tell him to just snap out of it and realise what his life has to offer! I felt that whatever I did was inconsequential as he was not going to comply anyway. However I decided at the time that regardless of compliance, if I was inwardly irritated and bored, the patient would sense this and lose what motivation and hope he had. I realised that he needed me to be supportive and not lose faith in him as he had in himself, in order to achieve any progress. I decided to set him small one or two achievable goals each week, which he responded quite well to. I also constantly tried to encourage him and highlight the small gains he achieved.
I have realised from this encounter that treating the whole person is important and that some patients need much more empathy and patience than others. It is also crucial as a physiotherapist, to be able to put your personal feelings aside and consider what approach is best for the patient.
1 comment:
It is true that we face patients that become totally dependent on us as physios. It is also our responsibility to help them through this period and help them regain functional independence. I think you did well by maintaining a positive attitude towards this patient. Without a right attitude, it is really hard to be able to work well to help these patients. Motivation is a thing that both us and the patient need to have. It is the motivation that we have that drives us to achieve the best for our patient. Also, the patient needs motivation to drive them to achieve the best out of the treatment and for them to recover faster. Setting goals and working towards them is a very good way to engage your patient and i think you made a very good decision by doing that! Continue to work towards achieving the best for the patient!
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