When stressful situations arise in future I will try to consciously calm my body, not just my mind (this is starting to sound new agey!) In a hands on job makes this an essential skill to ensure patient safety.
Tuesday, June 3, 2008
Panicky hands
Whilst on a placement in ICU, I was carrying out MHI on a patient with sepsis and multi-organ failure. The technique was chosen to facilitate AW clearance and improve lung volumes. In order to recruit atelectatic lung tissue (to increase LV), the bag is held squeezed for a moment after fully squeezing. This mimicks an inspiratory hold, which like SMIs, uses interdependence and collateral ventilation to aid re-expansion. In order to shear secretions, after the squeeze you release your hands to allow the bag to deflate as quickly as possible, which increases expiratory flow. When combined, the sequence is slow squeeze, hold, fast release, but you also have to watch for when the patient attempts to initiate a breath, so you can synchronize with them. If their respiratory rate is too fast, you hyperinflate on every second or third breath. Sounds simple? Being about my third attempt, I was starting to gain confidence that the patient won't die while I'm responsible for breathing for them. I just got into a rhythm, when the patient (who has a history of anxiety) started having an anxiety attack and her respiratory rate skyrocketed. Being someone who usually fakes calmness quite well, I managed to look reassuringly at the patient and with a calm voice encourage her to breath slowly and deeply. On the other hand (no pun intended) my hands reflected my true state of utter panic. I could remember squeeze/release, but timing and technique went out the window. My supervisor advised me to go consistently with every third breath so the patient knows what to expect, which will help calm her. I eventually managed this, and the with continued verbal reassurance, the patient settled. We could then swap her back onto the ventilator.
Monday, June 2, 2008
Convincing ain't Easy
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?
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?
Impatient Clients
On my musculoskeletal outpatients placement I was required to treat a previous patient who was presenting with a new complaint. This patient had been identified by the previous student as demanding and difficult, which I soon came to realise myself. Prior to commencing the session the patient complained about the lengthy sessions and the discussions with the supervisor which interrupted the session. She demanded the session should be short with no interruptions. Throughout the subjective assessment the patient was impatient and uncooperative and presented with “yellow flag behaviours”- such as being very pain focused and assuming her problems could be fixed by manual therapy alone.
Initially this patient needed to be managed by explaining the reason for the lengthy sessions and the discussions with supervisors and that we would not compromise on these issues. An explanation as to the importance of subjective assessment was also required, which I explained repeatedly throughout the session. Throughout the session I gave the patient detailed explanations to the rationale behind my assessment, treatment and management. By the end of the session the patient was pleased with her treatment and management plan.
The behaviour of the patient posed a challenge for me as I knew it would be difficult to gain the confidence of this patient. It was also difficult to be confronted with a patient who was impatient and did not see the value of assessment.
This incident raises the issue of how to deal with patients who are very demanding and those who come to physiotherapy with a very clear idea of what their treatment should involve. This is important because if these patients do not receive the treatment they were expecting without having a very thorough explanation to the reasoning behind it, their confidence in your skills may be affected and they may not return.
I believe it is necessary to identify patients who may present with barriers. It is essential to identify strategies to break down these barriers to ensure patients are satisfied with your treatment. Also it is important not to allow a patient to bully you into certain treatments. It is vital to come to a compromise with these patients to ensure both therapist and client are happy. Thorough explanations are also important as the patient may receive treatment that they are not expecting and include a management plan that is just as vital to decreases pain as the treatment.
A thorough explanation about the importance of assessment is particularly important with impatient clients. Thorough explanations into rationale for treatment and need for ongoing patient management is also vitally important.
IF I WAS TO ENCOUNTER AN IMPATIENT AND DEMANDING CLIENT I WOULD ENSURE I TAKE THE TIME TO EXPLAIN THOROUGHLY THE IMPORTANCE OF EACH ASPECT OF MY SESSION SO THE PATIENT DOES NOT LEAVE DISSATISFIED WITH YOUR TREATMENT. I WOULD ALSO IDENTIFY WAYS TO BREAK DOWN THEIR INDIVIDUAL BARRIERS.
Initially this patient needed to be managed by explaining the reason for the lengthy sessions and the discussions with supervisors and that we would not compromise on these issues. An explanation as to the importance of subjective assessment was also required, which I explained repeatedly throughout the session. Throughout the session I gave the patient detailed explanations to the rationale behind my assessment, treatment and management. By the end of the session the patient was pleased with her treatment and management plan.
The behaviour of the patient posed a challenge for me as I knew it would be difficult to gain the confidence of this patient. It was also difficult to be confronted with a patient who was impatient and did not see the value of assessment.
This incident raises the issue of how to deal with patients who are very demanding and those who come to physiotherapy with a very clear idea of what their treatment should involve. This is important because if these patients do not receive the treatment they were expecting without having a very thorough explanation to the reasoning behind it, their confidence in your skills may be affected and they may not return.
I believe it is necessary to identify patients who may present with barriers. It is essential to identify strategies to break down these barriers to ensure patients are satisfied with your treatment. Also it is important not to allow a patient to bully you into certain treatments. It is vital to come to a compromise with these patients to ensure both therapist and client are happy. Thorough explanations are also important as the patient may receive treatment that they are not expecting and include a management plan that is just as vital to decreases pain as the treatment.
A thorough explanation about the importance of assessment is particularly important with impatient clients. Thorough explanations into rationale for treatment and need for ongoing patient management is also vitally important.
IF I WAS TO ENCOUNTER AN IMPATIENT AND DEMANDING CLIENT I WOULD ENSURE I TAKE THE TIME TO EXPLAIN THOROUGHLY THE IMPORTANCE OF EACH ASPECT OF MY SESSION SO THE PATIENT DOES NOT LEAVE DISSATISFIED WITH YOUR TREATMENT. I WOULD ALSO IDENTIFY WAYS TO BREAK DOWN THEIR INDIVIDUAL BARRIERS.
Not just one role
I am currently treating a patient who I have worked with on two occasions but the latest session she did not attend. The PT informed me that in the past this lady can be tardy and has not showed up to two of her scheduled appointments without notice. On this particular day I was encouraged to emphasise the importance of punctuality to the pt. The pt attended her appointment 20 mins late and answered a telephone call as soon as the session started. Once she finished her call she then began talking about her week and how she has been forgetting to wear her hand splint.
I was slightly annoyed by the pt’s actions and I felt like she had no respect for her hand or other people. I remained polite about the attendance matter and further discussed that I would prefer if she could take future calls after the treatment sessions seeing she had already missed a large portion of the session. A second past and the lady burst into tears. I suddenly felt guilty and wondered if what I said or how I said it was too harsh. I the felt quite awkward and was not sure how to respond. I apologised about sounding like a nag but there are other pts waiting which is why being on time is vital. The crying slowed down and said “my best friend died last weekend and she has 3 children. I was just speaking to her husband...”. I felt very emotional and apologised on what had happened and advised her to keep wearing the splint as much as possible, and to give the clinic a call to reschedule another appointment in a few weeks once the situation has settled down a bit.
I HAVE LEARNT THAT WORKING IN AN OUTPATIENT SETTING YOU ARE SOMEWHAT DEPENDENT ON THE PUNCTUALITY OF YOUR CLIENTS TO ALLOW FOR EFFICIENT ORGANISTION. HOWEVER WE HAVE TO REALISE THAT OTHER THINGS GO ON IN THE PT'S LIVES. IT WAS UNFORTUNATE THAT THE SAME PT THAT I NEEDED TO ADVISE ABOUT ATTENDANCE ALSO HAD ANOTHER BIG ISSUE GOING ON IN HER LIFE. I BELIEVE THAT THIS SITUTAION HAS MADE ME REALISE THAT WE ARE NOT JUST PEOPLE WHO TREAT PHYSICAL PROBLEMS. AT TIMES, WHILST WE MAY HAVE TO TAKE A MANAGERIAL APPROACH TOWARDS OUR PT'S, WE MAY ALSO HAVE TO EXERCISE COMPASSION WHILST MAINTAINING A DEGREE OF PROFESSIONALISM.
I was slightly annoyed by the pt’s actions and I felt like she had no respect for her hand or other people. I remained polite about the attendance matter and further discussed that I would prefer if she could take future calls after the treatment sessions seeing she had already missed a large portion of the session. A second past and the lady burst into tears. I suddenly felt guilty and wondered if what I said or how I said it was too harsh. I the felt quite awkward and was not sure how to respond. I apologised about sounding like a nag but there are other pts waiting which is why being on time is vital. The crying slowed down and said “my best friend died last weekend and she has 3 children. I was just speaking to her husband...”. I felt very emotional and apologised on what had happened and advised her to keep wearing the splint as much as possible, and to give the clinic a call to reschedule another appointment in a few weeks once the situation has settled down a bit.
I HAVE LEARNT THAT WORKING IN AN OUTPATIENT SETTING YOU ARE SOMEWHAT DEPENDENT ON THE PUNCTUALITY OF YOUR CLIENTS TO ALLOW FOR EFFICIENT ORGANISTION. HOWEVER WE HAVE TO REALISE THAT OTHER THINGS GO ON IN THE PT'S LIVES. IT WAS UNFORTUNATE THAT THE SAME PT THAT I NEEDED TO ADVISE ABOUT ATTENDANCE ALSO HAD ANOTHER BIG ISSUE GOING ON IN HER LIFE. I BELIEVE THAT THIS SITUTAION HAS MADE ME REALISE THAT WE ARE NOT JUST PEOPLE WHO TREAT PHYSICAL PROBLEMS. AT TIMES, WHILST WE MAY HAVE TO TAKE A MANAGERIAL APPROACH TOWARDS OUR PT'S, WE MAY ALSO HAVE TO EXERCISE COMPASSION WHILST MAINTAINING A DEGREE OF PROFESSIONALISM.
Discharge Expectations
Whilst on a neurosurgical rehabilitation ward, I was treating a 22 year old male who had multitrauma after being hit by a truck 3 months prior. He had mild dyspraxia, moderate cognitive issues and significant fractures in the pelvis and both legs that were surgically managed (NWB). Treatment consisted of muscle strengthening, stretching and coordination games, restricted by his NWB status. Over 3 weeks of seeing him on a daily basis, he showed great improvement in his strength, communication, slide board transfers and dyspraxia.
When he was finally permitted to WB, his mother immediately wanted to discharge him home to their farm. He was unable to walk, unsafe to stand independently and his strength and balance were far from adequate to be discharged. I was concerned that the mother thought she could cope at home and disturbed that his rehabilitation would be cut short, as a result a return to his pre-accident status would be highly unlikely. I was irritated that the mother was persistent on discharging him so soon.
A team meeting and a family meeting were arranged quickly to discuss this patient and his family. The patient and his mother expressed the reasons for wanting to discontinue rehabilitation so soon. It turns out they were pleased with health professionals treating him but were sick of sharing a room with one particular patient who had significant behavioural and cognitive issues. The situation was resolved with moving the other patient to a single room. He was able to continue his rehabilitation and his mother was much more settled. Despite the patient’s mother previously mentioning that she didn’t like her son sharing a room with the other patient, it was never apparent to any staff that this caused her so much frustration (since all patients complain about sharing rooms!).
To us health professionals, whether a patient is ready for discharge from a functional point of view can be obvious, but to the family/friends it may seem that the patient is ready to go home when in actual fact they aren’t. This may lead to family and patient frustration and wanting to stop treatment against all medical opinion.
I HAVE LEARNT THAT FAMILY AND TEAM MEETINGS ARE VITAL IN THE REHABILITATION SETTING AS THEY GIVE A FORUM FOR ISSUES TO BE MADE CLEAR, PLANS MADE AND ACTIONS CARRIED OUT. IN FUTURE, I WILL DISCUSS DISCHARGE PLANNING WITH THE FAMILY SO THAT WE ARE ON THE SAME PAGE AND EXPECTATIONS ARE MADE CLEAR.HOPEFULLY WITH THE CONCERNS COMMUNICATED BETWEEN YOU AND THE PATIENT/FAMILY, A SOLUTION CAN BE MADE, WHICH ULTIMATELY IMPROVES THE PATIENT’S RECOVERY.
When he was finally permitted to WB, his mother immediately wanted to discharge him home to their farm. He was unable to walk, unsafe to stand independently and his strength and balance were far from adequate to be discharged. I was concerned that the mother thought she could cope at home and disturbed that his rehabilitation would be cut short, as a result a return to his pre-accident status would be highly unlikely. I was irritated that the mother was persistent on discharging him so soon.
A team meeting and a family meeting were arranged quickly to discuss this patient and his family. The patient and his mother expressed the reasons for wanting to discontinue rehabilitation so soon. It turns out they were pleased with health professionals treating him but were sick of sharing a room with one particular patient who had significant behavioural and cognitive issues. The situation was resolved with moving the other patient to a single room. He was able to continue his rehabilitation and his mother was much more settled. Despite the patient’s mother previously mentioning that she didn’t like her son sharing a room with the other patient, it was never apparent to any staff that this caused her so much frustration (since all patients complain about sharing rooms!).
To us health professionals, whether a patient is ready for discharge from a functional point of view can be obvious, but to the family/friends it may seem that the patient is ready to go home when in actual fact they aren’t. This may lead to family and patient frustration and wanting to stop treatment against all medical opinion.
I HAVE LEARNT THAT FAMILY AND TEAM MEETINGS ARE VITAL IN THE REHABILITATION SETTING AS THEY GIVE A FORUM FOR ISSUES TO BE MADE CLEAR, PLANS MADE AND ACTIONS CARRIED OUT. IN FUTURE, I WILL DISCUSS DISCHARGE PLANNING WITH THE FAMILY SO THAT WE ARE ON THE SAME PAGE AND EXPECTATIONS ARE MADE CLEAR.HOPEFULLY WITH THE CONCERNS COMMUNICATED BETWEEN YOU AND THE PATIENT/FAMILY, A SOLUTION CAN BE MADE, WHICH ULTIMATELY IMPROVES THE PATIENT’S RECOVERY.
COMPULSIVE PATIENTS
On orthopaedic inpatient placement I treated a male pt a following tib fib # post MVA. On reading the pt’s notes several other physios and nursing staff described the patient as compulsive and continually ignoring nursing and physiotherapy advice post surgery, NWB 6/52 in below knee brace.
The pt was a middle-aged fit martial arts instructor so the D/C planning for the pt was 2 days post op. My aims for day 1 physio session were to mobilise the pt using elbow crutches. On talking to the pt prior to mobilising he told me he had been up and out of bed already hopping around his room. I encouraged him that after my session to start using the elbow crutches depending on wether he was safe enough after the trial.
I wheeled the patient down to the physio gym on the ward and began measuring up elbow crutches. I gave him the elbow crutches and got a pair for myself to demonstrate to the patient. While I turned my back for just a few seconds the pt got up and started ambulating using them. The pt appeared unsteady so I asked him to stop but he continued ambulating. I closely guarded him while he ambulated although continued to instruct him to stop. He eventually returned to his chair and I immediately took the crutches off him.
Once I had the crutches I felt more in control of the pt and was able to give him a demonstration. By the patient not having crutches I felt more in control of the pt and he was too an extent forced to listen to me.
THIS INTERACTION WITH THIS PATIENT HIGHLIGHTED THE IMPORTANCE OF GAINING CONTROL OF THE PHYSIO SESSION BOTH FROM A SAFETY PERSPECTIVE AND ENCOURAGES THE PATIENT TO ENGAGE IN THE PHYSIO SESSION. IN THE FUTURE, WHEN I AM ASKED TO TREAT COMPULSIVE UNCOOPERATIVE PATIENTS IT IS IMPORTANT PARTICULARLY AS A STUDENT TO GAIN CONTROL OF THE SESSION SO THE PATIENT IS SAFE DURING THE SESSION AND GIVE A THOROUGH EXPLANATION AND DEMONSTRATION OF WHAT I EXPECT OF THE PATIENT.
The pt was a middle-aged fit martial arts instructor so the D/C planning for the pt was 2 days post op. My aims for day 1 physio session were to mobilise the pt using elbow crutches. On talking to the pt prior to mobilising he told me he had been up and out of bed already hopping around his room. I encouraged him that after my session to start using the elbow crutches depending on wether he was safe enough after the trial.
I wheeled the patient down to the physio gym on the ward and began measuring up elbow crutches. I gave him the elbow crutches and got a pair for myself to demonstrate to the patient. While I turned my back for just a few seconds the pt got up and started ambulating using them. The pt appeared unsteady so I asked him to stop but he continued ambulating. I closely guarded him while he ambulated although continued to instruct him to stop. He eventually returned to his chair and I immediately took the crutches off him.
Once I had the crutches I felt more in control of the pt and was able to give him a demonstration. By the patient not having crutches I felt more in control of the pt and he was too an extent forced to listen to me.
THIS INTERACTION WITH THIS PATIENT HIGHLIGHTED THE IMPORTANCE OF GAINING CONTROL OF THE PHYSIO SESSION BOTH FROM A SAFETY PERSPECTIVE AND ENCOURAGES THE PATIENT TO ENGAGE IN THE PHYSIO SESSION. IN THE FUTURE, WHEN I AM ASKED TO TREAT COMPULSIVE UNCOOPERATIVE PATIENTS IT IS IMPORTANT PARTICULARLY AS A STUDENT TO GAIN CONTROL OF THE SESSION SO THE PATIENT IS SAFE DURING THE SESSION AND GIVE A THOROUGH EXPLANATION AND DEMONSTRATION OF WHAT I EXPECT OF THE PATIENT.
The depressed patient
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.
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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