The quote “The quality of your life depends on the level of your commitment” made me realise that what I have said to my patient may have been too harsh for words of encouragement. From my clinical viewpoint, ‘the quality of your life…’ could imply the quality of a patient’s recovery or rehabilitation in order to enjoy normal activities of life (Shiel, 2018), while ‘…depends on your level of commitment’ may refer to the patient’s determination and dedication (Miller & O’Toole, 2003) to treatment and exercise for recovery, with or without the therapist’s presence. Furthermore, depending on the patient’s adherence to exercise, his or her recovery could have two outcomes. This relates to the two pathways in the picture. If the patient commits to the rehabilitation programme, he or she will have a better recovery outcome that could be represented by the pathway on the right where the sun strikes the path. On the other hand, if the patient does not commit to the rehabilitation programme, his or her recovery will reach a plateau and further recovery might be difficult, representing the pathway on the left where the shadows of the trees strike the path.  

While I was on general block, I had a patient with an intercostal drain (ICD). During his treatment session he asked me “How long will I have to stay here?” and my immediate response was “It all depends on you”. Afterwards I thought I could have said it in a better way, but once ones words are spoken, there is no turn back – only ‘cover ups’. What I mean by this is that as soon as we realise that we may have said something ‘wrong’, we try and justify what we’ve said. For example, I tried to justify what I have said by saying “There is a certain amount of fluid that must be drained before the doctor would decide you are good to go” which is true; however, that is not the only criteria for the removal of chest drains. The criteria include the following: drainage of less than 100mℓ within 24 hours; minimal swinging indicating that the lung re-expanded; an x-ray showing full lung expansion; breath sounds over the whole thorax on auscultation; and an absence of any air leak (Farrel, 2019). I could have added that I can see progress in his rehabilitation, by comparing the amount of fluid he drains per day, and his determination to continue with his exercises after his session. I do not think that what I have told my patient encouraged him enough to coninue with the exercises I have suggested to do while I was not present.

According to a programme presented by Plack at the American Physical Therapy Associate’s annual conference in 2012 (Ries, 2016), there are 7 ways to improve a patient’s commitment to therapy. Plack states that a patient has to be motivated, a common goal has to be chosen and focused on, a change in the patient’s behaviour has to be facilitated, determination and commitment has to be enhanced, factors standing in the way of the patient’s commitment must be identified and prevented, knowledge on the patient’s condition and the benefits of therapy and exercise must be improved, and lastly, change must be maintained and improved through behaviour therapy (Ries, 2016).

Trust and motivation are some of the key elements in a patient-therapist relationship. First you gain your patient’s trust, thereafter you motivate him to stick to the treatment plan in order to reach the common goal. The above quote made me realise how important encouragement, apart from the patient’s own commitment, is. We are taught to improve our patients’ knowledge on their condition and motivate them to keep up with the good work; however, we sometimes forget how important it is to link the benefits of the treatment to the recovery from or delay in worsening of the condition. 

At this point in my clinical experience I have to admit, I normally focus on providing the necessary treatment and exercise for my patients, and do not always build the typical caring-compassionate relationship with them. In my opinion, I do not fully adhere to the principle of beneficence as I am supposed to in a health care profession, such as physiotherapy.

References

• Farrel, A. V. (2019, May 30). Chest Drains. Retrieved August 20, 2019, from Physiopedia: https://www.physio-pedia.com/index.php?title=Chest_Drains&oldid=212633
• Ries, E. (2016, December). Extending Adherence. Retrieved August 25, 2019, from American Physical Therapy Association: https://www.apta.org/PTinMotion/2016/11/Feature/ExtendingAdherence/
• Miller, K., & O’Toole, M. T. (2003). Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health (7th ed.). Saunders: Elsevier.
• Shiel, W. C. (2018, December 27). Medical Definition of Quality of life. Retrieved September 12, 2019, from MedicineNet: https://www.medicinenet.com/script/main/art.asp?articlekey=11815