Surgeons expectations

On my rural prac i treated a man post shoulder replacement. I had been treating the man for 2 weeks with minimal gains. Both myself any the senior physio tried multiple approaches to regain ROM. These included mulligans techniques as well as PAMS and a home exercise program.
The main problem was the patients compliance. During the sessions he claimed the pain was very high and refused the majority of treatment. any movement we did do were very restricted by the pt resisting the mvts. He also openly refused to do any of the shoudler AROM exercises at home as part of the HEP. We attempted to get the pt taking adequate pain relief but still refused. We tried as many options as possible and explained the consequences of his actions on his recovery.

After the pt went for his surgical review, the pt presented back to the clinic with a letter from his surgeon. It was an extremely angry letter blaming the poor physiotherpy treatment and management for the slow recovery of ROM. We sent a letter back explaining the situation and how the pt was self-managing. Another letter was recieved the next week from the surgeon with a very clear lack of concern about the pt's lack of self-management and a quote stating the "either you do something to move his shoulder or ill manipulate it myself".

In the end we tried referring the pt to the OT, social work and counselling services at the hospital plus the exercise groups to try and increase his participation. I dont know the result of this as my placement finished, but it was a very frustrating scenario as the surgeon was being very unreasonable and clearly had very minimal knowledge of the pt prior to the operation.