Another uncooperative patient!

Hi everyone- apologies for the late entry!

This is another from my ortho in-patients prac. When my supervisor gave me a handover of this particular patient, he was described to me as a male post TKR in his late 60's, an ex-Naval officer with a tendency to be extremely stubborn, uncooperative with Rx and impulsive. At one point he walked across the gym with one crutch and began using the weight machine, even though he was never shown how to use it! I came to the conclusion early that he may be difficult to keep to task.

This patient was particularly difficult to educate in the use of his elbow crutches. When moving from STS, he constantly put the crutches on his arms, placed them out to the side and put his weight through them to stand. Each time I corrected him, he begrudgingly did as I instructed whilst muttering under his breath. He later told me that he had used crutches before, he knew what he was doing and didn't like being told what to do. I explained the reasons why he needed to use the technique I was showing him, but he was convinced he was right. The final time I saw him, he told me 'Don't treat me like a child' and refused to attend the PT gym.

Even though I had treated difficult patients before, I had never encountered a patient like this gentleman. I asked my supervisor what I should do, as I felt I had done absolutely everything I could think of. His reply was to document every detail about the Rx or attempted Rx that I had done, because if this patient had an accident, he was much more likely to blame me than himself and to take legal action against me and the hospital. Otherwise he said I had done the right thing, and there was not much more I could do as the pt was being discharged that day and all other Ax was completed.

Looking back on this, I feel that I did do everything I could to assist this patient and went to great lengths to build a rapport with him in order to make the Rx easier for both of us. However, his attitude toward me did not help. I have realised that there are some patients that are so stubborn that they will not be willing to see the physio point of view, even when their point of view is taken into consideration. In future, I think that I should spend more time in educating the pt, whether it be through demonstration or explanation, so that I know I have shown the safest way to move/ambulate etc.

Has anyone else had a patient as stubborn as this one?