This is based on a situation I encountered during my clinical practice, where my CVA patient refused treatment because he felt that I was ignoring his wishes and was delaying him with all the exercise programmes I planned for him simply because he just wanted to walk again.
Though asking patients their goal is a good thing so that they feel involved in the treatment process, it can be very difficult to convince them that you have the same goal as theirs but things won’t happen miraculously as there are steps to follow in the journey to recovery. First time I met my patient, I went through the subjective assessment and there came the last part where I asked him his goal, he replied and said “I want to walk again”. My response was ok I will do whatever I can to help you sir but we have to first learn how to move from lying to sitting and from sitting to standing independently so that we move to walking . He seemed to understand and we completed the first session working so well together. The next day I came in with an exercise program planned for him as I saw he was really struggling to just move from lying to sitting, in the middle of the exercise my patient asked “what’s the use of these exercises I told you I wanted to walk”, I tried explaining how these exercises will help reach that goal but that didn’t help, he asked for a rollator to show me that he could walk with it I knew that wouldn’t work as he could barely stand even with maximum assistance. I tried explaining again but that didn’t work, he just laid in bed covered himself with a blanket, and told me he I was not honoring his wishes and there was I, standing in astonishment and didn’t know what to do.
I found myself debating each time I had to go to him, whether should I attend him or just leave him because I was tired of explaining and begging him to cooperate and he just refused the treatment either way. On the other side I was thinking of the ethical principles in place which include respecting the rights of patients to decline treatment especially now that I had laid down all the pros and cons of treatment and implications of rejecting it (Jonsen, Siegler, & Winslade,2010) . From this situation I realised it is important to have good communication skills with your patient and also work with the family as they could be of good help in situations like these. You can ask your clinician who can better convince the patient but don’t give up on them. Patience is key.
References
Jonsen AR, Siegler M, Winslade WJ. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. 7th ed. New York, NY: McGraw Hill; 2010:74.
3 thoughts on “I just want to walk again”
The text of the topic does link well with your picture and also with the ethical dilemma you were facing. It also made me think what its possibly like to be a patient and not be on the same page as your physio. However I feel like the situation could’ve been avoided if a more firm approach was taken with regards to getting the patient to do activities. I feel like there also could’ve been a little more referencing to back up your argument. The grammar used also needs a little work as the sentence structure is off in some paragraphs. Other than that, it was good. Well done 🙂
Hey, Xola. I found this to be very interesting and relatable as I’m sure most of us have had a run in with a “difficult patient”. We sometimes forget that our patients will not fully understand the rehabilitation process, and expect instantaneous results. Perhaps next time use a firmer approach in getting your point across as I’ve noticed that patients will believe you if you believe in yourself. But you are right in noting that patience is key. Other than a few grammatical errors, I feel that this post was well done.
Loved the approach you chose to use to try and involve your patients in their treatment ,that is, asking them what their goals at the end of the process are. Really helps put things in perspective for the physio- in terms of deciding how to get a patient to a particular level in the treatment process (first mentally and then physically). Though, I feel you should’ve maybe explained to your patient(BEFORE treatment started) the realistic step by step mini goals, straight after he mentioned his goal to walk again, so that the patient has a better understanding of how and why steps need to be followed.
You mentioned your reluctance to attend to him ,days following his refusal, I feel that each day one should enter the workplace with a clean new mind-set, as he may have caught on to your reluctance to his reluctance to participate and thrived on that.
Other than the above mentioned and a few grammatical issues, your article was very informative and related well to personal issues physio’s experience in the work place, well done!