A lady in her 26 weeks pregnancy presented at the women’s outpatient with a low back pain 2 weeks ago. The last two treatment sessions demonstrated significant objective improvement and decrease in pain, with treatment effect lasting incrementally up to 2 days.
As this was her 3rd session, I expected the symptom to have reduced significantly. However, the patient walked in reporting that the pain had again returned over the course of the week. I further questioned to find out if the patient had done anything that could have aggravated the symptom. Initially, she said she had followed my advice and did the prescribed exercises daily. With probing, she revealed that she was doing all the house-chores and shopping (which aggravated the pain/strain due to instability around the pelvis and spine from hormonal effects), as well as sitting for long hours at work (which placed prolonged strain on posterior structures of the spine).
She looked at me with a guilty look, as she knew these were the aggravating factors and had been advised in the first session to avoid these activities. As she explained, I realised that the problem was more than just her back pain. She was facing financial pressures and the condition at home was not helping. As I listened, my supervisor (being a mother and a wife) started relating to the patient’s situation and gave her sound advice. The patient started tearing, expressing her frustration. After 5-10 minutes of counselling with the patient, her face lit up as she gave consent to commence treatment. The difference: she was then ready to take initiative to find help with her home situation.
At first I wasn’t sure what to do besides listening. Although I sympathised with her, I could not fully relate to her situation as I’m neither a mother nor a wife. Then I realised that the first 5-10 minutes of listening and counselling (from supervisor) was highly necessary. If I were to jump straight into treatment, the problem could have persisted and her pain could have repeatedly returned. Being a physiotherapist (student), my role is not just to treat the physical problem. My supervisor had confirmed with me that we also have an important role in counselling.
If similar events recur, I will ensure to take into consideration both external and internal factors that could affect the patient as a whole, as well as to give time listening and appropriately addressing the factors. If my supervisor is not there, and I have little experience and knowledge about counselling, I will seek opinion from my colleagues. The next approach will be to refer the patient to a counsellor.
Does anyone have any other approach in such situations?
1 comment:
Hey!
I was previously in RITH which required us to really understand the social situation the pts were in. I guess in a clinic setting its hard to gauge how the pts are coping compared to if you see them in their home. It is important to empathise and as a health professional we must realise that there are services available that offer support for almost every kind of issue. I think that your plan is appropriate. At times suggesting a counsellor may not be the best option as many find it stigmatising. I would suggest approaching the problem itself, as like your supervisor has done. A lot of it is education as well, education on whats available out there and generally giving them an ear to talk it all out.
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