Are we willing to own our failures?
I would like to share a story about ownership and responsibility regarding rehabilitation.
The other day a patient came in for her scheduled physical therapy visit. She is always accompanied by her caregiver, her sister-in-law. I noticed they looked more serious than usual. We often have a lighthearted dialogue during her visits.
I had received notice just an hour prior to the visit that the caregiver called the PT department. The front office knew I was crazy busy and took the message. They asked if I could call them back but did not give details. I had not been able to return the call, as I was trying to catch up from my a.m. appointments.
When they arrived, I apologized for not returning their call earlier. The patient ominously said, “go ahead and tell her”. I started the visit as always with her warmup on the Nu-step (cardio), and invited them to speak.
The caregiver was clearly upset. Then the patient stated flippantly, “I don’t want to come to PT anymore”.
I realized I needed to put on my educator hat for the rest of the visit. PT is largely educational, teaching exercises and self-management techniques, to name a couple. I had been seeing this patient for a month already, so visits were more likely 25% education and 75% activity at this point.
Patient history is as follows: she suffers from a degenerative disease, has had multiple prior surgeries. And has never been a particularly active person, by her own account.
After her warmup we went to a room to talk.
The patient resumed her stance that she wanted to stop PT due to feeling it was not helpful. I questioned what she was doing outside of PT to reach her goals. I knew she would not “recover” exactly, but also that PT would help slow the process of her disease and allow her to possibly maintain her current level of function for a longer period of time, than without PT.
She admitted not being compliant with her home exercise program and generally not liking to be active. She also complained her walker was in her way and seemed to transfer some anger toward the walker.
I took a deep breath and began to process her words and demeanor. Clearly this patient was not accepting her responsibility for her part in this rehabilitation journey. She was in denial about her ownership, as well as angry now that she was now realizing the walker will be a permanent part of her life.
You walk a fine line in therapy. You are a therapist of the body, as much as the mind sometimes, but still a caregiver. You must be compassionate but also stern sometimes in order to achieve results.
I explained to the patient that I cannot make her come to PT any more than I can make her perform her home exercises. Those home exercises are given to supplement PT sessions and are essential to improving functionally.
I told her if she felt she was not progressing that was partially due to noncompliance with her homework, but also that she needed to understand that her disease was degenerative, meaning PT was not going stop her illness.
That was a hard pill to swallow.
I empathized with her but put the ball back in her court. The ownership needed to be on her at this point. If she wanted to maintain some independence and stay in her home with minimal assistance of her caregiver as long as possible, I recommended that she continue with PT.
The patient returned her focus to the walker and it being in her way as her main problem, upset that she could not just go out without an assistive device.
After an entire visit’s time slot spent in this merry-go-round like discussion, I finally gave one last home assignment.
I asked the patient to go home, write out a list of her personal goals, return for one last PT visit (if she desired), and we would discuss her goals to decide if they were realistic for PT. After that she could decide if she would discontinue PT. The patient agreed. The caregiver appeared relieved.
I knew I had done the best I could for the allotted time and the rest was up to her.
After almost three decades of treating patients with all kinds of diseases, these conversations never get easier, but they are a necessary part of the job. If you do not have these tough talks, you are not treating the patient fully in my opinion.
Patients need to understand that our roles as therapists are only a fraction of their rehabilitative process, a larger part relies on the patients themselves to follow through at home with instructions given during their sessions. They must own that responsibility, or they will likely not reach their goals.
I always say, I can only teach you, I cannot do it for you.
