Over the past three years we have been given anatomical knowledge and treatment techniques to equip us as best as possible to treat a variety of outpatient problems and injuries. Recently on my musculoskeletal placement I had a lumbar spine patient with CT scan evidence of discal and facet problems, as well as having hypermobility and motor control issues. After seeing him three times and trying a variety of treatment techniques he still came the following session reporting little change and seemingly not very enthused with physiotherapy.
Upon closer examination and questioning however, (after thinking how disheartening this was!) I realised he now was pain-free on active ROM (previously 6-8/10 pain). Furthermore the pain had stopped radiating down his buttocks and legs completely when at work during the week. Once I realised this, I made sure to inform this patient (as enthusiastically as possible) that out treatment plan is indeed working and told him exactly the differences he was getting in pain compared to the first week. Finally he seemed happy and with renewed faith in the treatment (hopefully) at the end of the session.
I must admit the fact that he had reported absolutely no chance since beginning treatment really disheartened me, as I'm still hopeful that my treatment will 'fix' patients first go. It reminded me that don't neccessarily 'work miracles', and that it does take time sometimes to find the right treatment combination for each individual patient. Furthermore I was later informed by a supervisor that you can usually "talk better" up to %60 of patients. By explaining to this patient why I was using certain techniques and enthusiastically telling him how they were helping him and decreasing his pain, I felt he was far happier with the service and furthermore more motivated to continue his HEP. For future patients that are a bit difficult to treat I will definately have faith in my own abilities and treatment rationale and make sure I convey to my patient their results and improvements in each session.
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its also really important at the outset of treatment to work on mutual goals (both short term and long term). A patients judgement of the effectiveness of treatment could be very different from ours, so having the goals set and understood is very important to their percieved effect of the treatments. If they can see themselves closer to the goals then hopefully they'll come back and pay us again!!
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