I had a pt on my rural placement who was referred to me by the OT student who told me that he was a bit of an angry man. He had a thalamic stroke 2years ago and functionally he is independent with ADLs, he was referred to physio because he was getting pain in his buttock when cycling on his static bike. When I saw him he gave me a long story about when he had his stroke and the current symptoms he experienced. He told me at the time of the stroke he was out in his shed and when he started feeling the symptoms of the stroke, which he didn’t know was a stroke at the time, he went to his car and tried to get in and struggled due to the weakness but managed to get himself in. He felt that the pain in his buttock was from when he was trying to get in his car he thought he injured his leg, he thought ‘a sinew had been detached’ and he wanted an x-ray to show whether or not this was true. He was not too happy with the treatment he got when he was in hospital and said no one would do an x-ray for him. After doing the whole S/E I did the O/E and he had no musculoskeletal problems causing the pain, his pain was on his ischial tuberosity which was why he thought he had a sinew detached. I told him there was no treatment I could do for him to relieve his pain but I could give him a home exercise strengthening program as he had slight decrease in strength. His reply to this was that he didn’t want an exercise program as he was happy with his static bike cycling he was doing. His expectations in coming to physio were for a referral for an x-ray. I told him that I couldn’t refer him for an x-ray and if he wanted an x-ray he had to go to his doctor to get a referral.
This case showed me that pt expectations of what we can do for them are sometimes unrealistic and there are times that there is no treatment that we can offer the pt to help their condition. Sometimes all we can do is give them education and advice.
In the future I will take note of pt expectations and beliefs and treat the pt as I see appropriate trying to get to their expectations while still being aware that some expectations may be out of our scope as physiotherapists and possibly unrealistic and therefore pt education may be the only management I can offer the pt.
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2 comments:
Hi Brenda,
Patients like this can be very difficult but it is important to listen to their story like you did. What jumps out at me is he gets pain on his ischial tuberosity while cycling. There is a whole market of bike seats of varying widths designed for different anatomy, for eg females IT's are much wider than in males. One manufacturer even designed a templete which the customer sat on to see what would be the appropriate seat to purchase. In his case it would ideal to question about the bike seat and amount of cycling he does.
Regards
RobW
I also had a pt with unrealistic expectations, when he came to the physio OP department and expected to get a prescription and advise on anti- inflam drugs. When pts have expectations like this it is difficult to correct them as often these are long standing thoughts.
I agree with you that it is important to find out (and correct) pt expectations asap or else they may become disappointed with their treatment or outcome
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