STARES 2 – Communication

SITUATION
I had a patient transfer to me from a previous student. I read in the notes that she had been suffering from headaches caused by increased tension in the cervical spine (primarily due to increased muscle tension through trapezius, rhomboids and levator scapulae). Her headaches were better when the muscles were relaxed, however she had not been very compliant with her home program and her headaches gradually got worse again following each treatment session (after her feeling really good at the end of each session). As a result of her not doing her home exercise program (HEP) the muscles would tighten up after treatment and she would not do anything to help it until the next time she came in for physio.

TASK
My task was to perform a follow-up assessment for this patient and a treatment session. I had the job of telling this patient that is she wasn’t complying with the HEP then we couldn’t do much else for her.

ACTION
I began the subjective assessment by asking how her headaches had been. When she said they were good after the last treatment session but got worse again as time went on I asked her if she had been doing her HEP. She replied that she hadn’t been doing it every day, only occasionally as she had been busy. I took this opportunity to remind her that I could do a treatment for her but she needed to continue it at home to have a long-lasting effect from it. I didn’t want to have a go at her but I needed to make my point. I then performed my objective assessment and started my treatment by working on the muscles around the shoulders and neck. As I massaged I explained again how she could prolong the benefits of this treatment session at home. I thought that if I explained this to her while I was performing a hands-on treatment, she would realize I was still going to treat her and not just send her away to deal with it at home by herself. I tried to make her understand it was a two-way street. I could only help her if she was going to help herself. After I had finished my treatment and was winding up the session I explained to her that we knew what her problem was and we know how to get rid of the pain and headaches, it was just a matter of her actually doing her exercises at home. I put it back on her, saying SHE had to do the hard work to get rid of the pain, rather than expecting our physio session to be a miracle cure.

RESULTS
My patient seemed to understand the point I was trying to make without me having to be too blunt about it. I have given her the idea that if she doesn’t do her HEP then we will not continue with her treatment at the hospital as it was just wasting everyone’s time. The patient agreed to do her program and admitted she needed to lift her game a little. I think she now understands the consequences if she does not actively participate in her treatment. I was able to get this point across to her without ruining my rapport (or the rapport developed with the patient by the previous student). If I had been blunt about it she may have felt that I was blaming her and decided she didn’t want to attend physio. This would have been a shame as physio is definitely something that can help her problem if she complies with her exercises.

STRATEGIES
It can be difficult to have to tell a patient off for not doing their exercises and that if they don’t do them then there is nothing else we can do. Some ways of dealing with this are:
1. Say you don’t want to waste THEIR time coming into hospital when it’s not a very effective treatment by itself. This is better than you saying it’s wasting YOUR time.
2. Be sensitive and sympathetic – find out if there is a reason they haven’t been doing their exercises before you assume they are just non-compliant.
3. Be strong and as forceful as necessary to make your point but avoid being tactless or overly blunt.
4. Compromise – see how many exercises they think they can commit to doing if they think the whole lot you prescribed is too much. This is better than them doing none at all.