On my prac in the geriatric area, I had a patient a 78 y/o lady who attended outpatient due to her chronic lower back pain. She is physically independent and mentally alert. She walks with a 4WW due to her LBP and bilateral knee pain. As part of her physiotherapy treatment, I felt that she would benefit from hydrotherapy exercises. I discussed with her about the class and how it will help ease her pains. She seemed happy to participate and so I assumed that she had agreed to attend. I then went on to fill out the papers required for the hydrotherapy classes. The following week she had failed to attend the class and so I rang to find out why. She just said that it wasn’t a good day for her that day so she did not attend. Then the 2nd week came and again, she was absent from the class. I then suspected something is not adding up to her reasons. Initially, I was not sure how to pursue the matter without making her feel like I don’t trust her words. I just felt terrible at the fact that this lady has an ongoing problem with pain and has not received any treatment for the past 2 weeks and the thought of it turning into a vicious cycle and all that really bugged me.
I then organised for her to come for treatment with me, I thought it’ll be better dealing with the issue face to face rather than over the phone. So I rang her and asked f she could come in within the next few days for physio and she agreed. So I saw her two days after that and gave her some education on how a chronic pain can become a huge problem and impact her functional levels. At this stage it is really important that we do whatever it takes to try and preserve whatever function she has in her daily life. And some of the things that can help was hydro, I subtly brought the topic up again and she begin to tell me how she is afraid of the water as she doesn’t like the cold and also she does not own a swim wear. I assured her that the pool is heated and we will be able to loan out a swim wear. She seemed more convinced this time around and I was sure in a way that she will be attending the next hydro session. When the day came, she turned up. I was glad to see her and she seemed to have enjoyed her first hydro session. She then made it again the following week and reported having had a bit of relieve from her pains after the first session.
From this encounter, I have learnt never to assume that we have patient’s compliance just because we have given them a good run down on all the benefits of doing the things we ask them to (just like how I’ve assumed here) .To a certain extend I think we are in an industry that we have to be able to sell and it can be very challenging especially when we do not understand our buyers needs. If I just took a step back and asked a few more questions I would have been more successful the first time around and that would have meant that the patient started hydro 2 weeks earlier rather than later. This was yet another experience for me to take on board and help me be a better advocate of exercise and treatment as a qualified physio one day.
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i have had similar incidences where a patient wasn't complying with a home exercise program, but when I asked her about it, we were able to easily fix the problem. Quite often there are reasons why people are not compliant with what we want them to do (exercises, hydro etc) and like in your case if you address these issues the patient can continue with the program and therefore improve their condition.
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