During my placement in the Women’s Health area, I had a small load of outpatients that presented mainly with musculoskeletal problems during pregnancy. I had a patient who had a history of MVA 10 years ago which resulted in residual chronic LBP. Her LBP was worsening due to her pregnancy at 32 weeks at that time. She had been seeking chiropractor treatment for the past 10 years and had very strong believes that only chiropractic treatments could help ease her pain as long as she had regular visits. On subjective examination, she revealed that she frequently feels that her spine is out of place and needed to be “cracked” and therefore sees her chiropractor to re-align the spine so that it feels normal again. Ever since she became pregnant, she has not been visiting her chiropractor as her gynecologist had advised against spine manipulation. She therefore was referred to physio for treatment of her LBP.
She really appeared to have very strong beliefs about chiropractic and that there was no other fix to her back pain apart from spine manipulation by a chiro. She made it really difficult for me to convince her that physio can also help treat her LBP. She had also revealed that she only came to physio because her doctor had referred her and not because she thought that it would help. She was a challenging patient and I had to take a different approach in treating her compared to the rest of the patients I have seen. One of it being that I had to convince her that physio has something to offer for her condition. I gave her lots of education on the reason for her back pain and that if she does what I asked her to do then there is a good possibility her symptoms can be relieved. She did not looked too convinced and she said that she might just see her chiro and seek his opinion on it as well. When she said that, I really thought to myself that without patient’s compliance there was really not much I can do to help. The fact that she was going to seek chiro treatment just after that session really made me feel that there was no point in me treating her but I did leave her the option of booking in for a physio appointment if she ever changed her mind. At the end of the treatment, I was really frustrated because I felt like I have failed in some ways in convincing the patient of how much she will benefit from physio.
WHEN I LOOK BACK ON THIS EXPERIENCE I HAD WITH THIS PATIENT, I REALISED THAT SHE HAD BEEN TO CHIRO FOR THE PAST 10 YEARS FOR TREATMENT OF HER LBP AND NEVER BEEN TO A PHYSIO AT ALL. SHE WAS SOMEONE THAT NEEDED A LOT MORE CONVINCING THAN WHAT I GAVE HER. I COULD HAVE PROBABLY DONE MORE IN EXPLAINING TO HER THAT TECHNICALLY, HER SPINE CANNOT BE “OUT OF PLACE” AND IF THE SPINE WAS PHYSICALLY OUT OF PLACE, SHE WILL DEFINITELY HAVE NEURO SYMPTOMS THAT WILL CORRELATE TO THE SPINAL LEVEL. IN FUTURE IF I HAD A PATIENT LIKE THAT, I WILL BE MORE CONFIDENT IN MY EDUCATION AND WILL ENDEAVOR TO GIVE A THOROUGH EXPLAINATION BY USING A MODEL TO HELP ASSURE THEM THAT PHYSIO CAN HELP SO THAT THEY BECOME MORE COMPLIANT WITH TREATMENT. JUST WANDERING IF ANYONE WOULD HAVE DONE THINGS DIFFERENTLY IF THEY HAD A PATIENT LIKE THIS?
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2 comments:
Another approach might be to calmly highlight that treatment is not compulsory... that she can opt to deal with the pain until her gynaecologist advices chiro treatment is safe again. Maybe once a patient confronts the fact that her options are limited, she will be more open to learning about the available option. I had a similar patient on my women's health placement, (although not as strong-minded) and she seemed less 'defensive' and more approachable once I acknowledged her right to decide on her own treatment. I presume patients occasionally mis-interpret our willingness to help as forcing unwanted interventions on them. Once they regain their sense of control over their own outcome... input might be better tolerated.
I have not been in this situation myself, its a tricky one! Perhaps you could have pointed out that since she has been visiting a chiropractor for 10 years, that the treatment is targeting purely her symptoms and not attempting to correct or manage the problem. Although the client may just see this as "chiro bashing" and just increase her hostility towards physio.
I agree with you that education at this point was very important. You could have also suggested that the chiro and physio could be carried out to complement each other. That the physio concentrates on muscular control and stability, whilst the chiro attends to the vertebral column. This may be a compromise that would suit a patient such as this.
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