Dealing with difficult patients

I have recently had a chronic LBP patient (mentioned in my previous blog entry) who had a lot of psychological yellow flags. Firstly, he was ignoring my advice to decrease his activity levels and continuing to garden for 6+ hours nonstop lifting heavy loads because he was "competing" with his neighbour to have the best garden. Thus every time he came in, his pain levels hadn't improved and the treatment that I had done previously had been undone. 

His expectations of physiotherapy were also quite unrealistic. The hospital only offers a maximum of 8 outpatient treatment sessions and he wanted a lot more. He also expected that I would give him an in depth maintenance program incorporating hydro and a gym program. I explained to him that his Dr referred him to outpatients as a trial to see if it would help his pain because his other option was to have spinal surgery. I also explained that outpatients didn't really have the resources to give him an in depth program and that we should sort out his problem of immediate pain first before thinking of anything further. 

My patient was also unavailable for afternoon appointments, as he had to work as a crossing guard in the afternoon for an hour. I asked him if he could schedule an afternoon off to get physio but he said he had to work (which is understandable). Due to this factor and his uncompliance, physio wasn't going to be very successful in addressing his problem. After I explained this to him (not using those exact words), he self discharged (fortunately) and from this experience I have learnt how to tactfully deal with difficult uncompliant patients.