During my neurology inpatient placement, I was assigned to treat a patient with a left sided stroke who also had a very long past medical history which included chronic behavioural problems. This patient was very difficult to engage generally, but was particularly difficult when his wife was in the room. On every occasion she was present during one of his treatments, he was more intent on abusing her and yelling obscenities at her than listening to what I was asking of him.
The last occasion I saw both of them together his wife asked me if he was allowed a certain type of food. I spoke with his speech therapist who said he could not have it, and I explained to the patient and his wife that it was because of his swallowing and feeding difficulties that he wasn’t allowed to. He then proceeded to tell his wife to bring it in ‘one piece at a time’ so no one would notice, and she refused. He proceeded to verbally abuse her in front of me, causing her to become very upset and leave.
This was not the first time that this had happened. Previous times when he had spoken to her or about her like this I asked him what did he hope to achieve by speaking to her in this way, and was it really necessary. I also spoke to my supervisor to see what I should do in the future and I was told it would be best to ignore it or ask his wife to leave the physio sessions. I had attempted these but the patient was very persistent in his ridicule of his wife, whether or not she was there. I found the situation quite distressing because I felt he was behaving very inappropriately, but felt unable to tell him without becoming argumentative.
I was wondering if anyone else had encountered a situation similar to this, and what your thoughts were.
Subscribe to:
Post Comments (Atom)
3 comments:
Elise,
perhaps you could inform future patients that such comments and behaviours make you feel uncomfortable. He was not concerned about his wife's feelings but may have acknowledge yours if you rely this. It is also important to explain to patients' that PT Rx should not be disrupted (if situations get out of hand) and constant reinforcement in regaining focus may be required in the early stages to change long-term behaviour.
Do you think 'I' sentences regarding how you feel / find it hard to treat/ concentrate may be useful here.
Do you think it may be worth treating him a bit by himself as well?
For the future, using statements like 'I find it difficult to treat you when you behave this way' would be useful. From what I remember I did do this one or two times, but with his behavioural problems he would act in other ways such as turn away from me and ignore me or pretend to fall asleep in an attempt to make me go away. The only way he would particiapte in any Rx is if I said 'please.' His behaviour generally was very manipulative.
Also, when I did treat him on his own it was hard to get him to focus on the task. He'd would begin to tell me about how 'useless' the other Allied Health professionals were, he'd start complaining about his wife and so on.
He was a very hard patient to deal with, and he had lots of other issues going on. I probably should have mentioned all this in my original entry! But for the next patient, what both of you have mentioned will be of great help. Thanks!
Post a Comment