Whist on an outpatient’s placement I treated a lady who had neck pain for 14 years and had been coming to Physio for 2 months. The previous treating students ceased trigger point release as that is all the patient said improved her pain and had nil compliance towards HEP. When I Ax her she said there had be no improvement. I decided to do trigger point releases as they were indicated as well as postural re-education and other exercises. Over the course of the 4 weeks her pain improved to nil neck pain. When I told her that I was going to D/C her, the lady got quite defensive and said that her pain was back and she made a mistake. I was taken back by this and spoke to my supervisor. We decided to discharge the lady due to her improvement- Subjectively and objectively.
Initially I felt like I was did the wrong thing by using trigger point release and then felt bad for D/Cing the lady but now I am aware that sometimes some people can lie about their symptoms to either gain their desired treatment ‘massage’ or for social interaction. If faced again with a situation like this I will ensure that I am clear with my objective examination findings so I will have more confidence when deciding that PT Rx is no longer indicated. Further I will investigate her social hx and suggest social groups they could go to. You cannot please everyone.
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2 comments:
I think some patients and families can start to rely and become attached to the hospital if they are being seen often. I know this is the case in paediatrics, guessing these situations occur in adults? I think the situation also showed the benefit of making goals from a pt and therapist POV, that way you can refer to the goals in each session so the patient is aware how far down the track they are, and are not surprised when they are to be D/C.
I think that some patients can become dependant on physiotherapy. I feel that an active approach where possible, can help avoid this. Also, giving the patient an estimated time frame and setting goals from the first session can also help avoid this.
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