On one of my placements, I had a very depressed middle aged patient, who had a history of suicide attempts, and underwent a below knee amputation. He was friendly and compliant with physio, but occasionally he would make comments that I did not know how to respond to.
He was very concerned about the future, and would constantly ask if the below knee amputation will pass as disability, because he was worried about not getting disability pension. He would then ask “will an above knee amputation be considered as a disability?” He continuously made comments which were indicative of depression. At the time, I had no idea how to respond to such comments. Luckily for me, one of the senior physiotherapists was with me, and she dealt with the situation very well. She would respond by reassuring the patient, and also saying something along the lines of "I understand that you're worried about the future, but for now, we will do your exercises so you can have a better outcome, and we will get a counselor or psychiatrist to discuss these issues with you". Through this reassurance, the patient was making more of an effort in physio.
DEPRESSED AND SUICIDAL PATIENTS WHO ARE ANXIOUS ABOUT THE FUTURE REQUIRE A LOT OF REASSURANCE. THIS WILL HOPEFULLY LEAD TO THE PATIENT MAKING A GREATER EFFORT DURING THE PHYSIO SESSION, THEREFORE MAKING IT BETTER FOR THEM IN THE LONG RUN. IF I EVER COME ACROSS A SIMILAR PATIENT, I WILL ENCOURAGE HIM/HER TO FOCUS ON THE PRESENT DURING THE PHYSIO SESSION, SO HE/SHE CAN ACHIEVE A BETTER OUTCOME FOR THE FUTURE, AND TRY TO ORGANISE A MORE QUALIFIED PROFESSIONAL TO DISCUSS HIS/HER DEPRESSION ISSUES.
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I have come across numerous depressed patients in the hospital settings. One strategy which I used to get a pt motivated to come to physio was where I found a topic of conversation that we had in common and used to both as a way to side track the patient away from his ongoing issues and as a motivator to come to physio. In subsequent physio sessions I found the pt was more willinging and motivated to attend and participate in physio.
I am currently seeing a pt that had a self harm injury. She constantly makes comments about the future and what she can and can’t do. I have found that focusing on what the pt has achieved in the current sessions is vital for the confidence of the pt. Weekly goals have further shown success as it makes the pt have something to work towards.
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