Appropriate OR not !

[emad]

hi all ;

In fact , this question come out from my mind while i was assessing a pain patient .

I belive most of pain consumers are chroinc ,who visit before us many doctors ,physios ,chiro........So that we are not their first /initial health carer , I believe to aske them this question is worthy .

In you own view ,Was the treatement you received before appropriate to your complaint/problem ?


Regards
Emad

[nari]

Hi emad

It is estimated that 70-80 % approximately of patients have chronic pain; excluding those who attend sport clinics, probably.

I think it is a perfectly reasonable question to ask, but you may not get an honest answer. I have found quite a few people have attended physiotherapy for a long time with no results; but they say it helped a bit. Some had improved, but report the "pain came back" later. Quite a few say words like: "The pain is the same, but the physiotherapist was very nice".
If they have been to many clinicians with no results, it is hard to draw any conclusions -something is wrong somewhere, though.

Nari

[Luke Rickards]

Isn't this is essentially asking patients about their expectations for treatment (in the past at least)?

Just thinking quickly: If you do it this way, what will you say if they then ask you if their treatment was appropriate, and you don't think it was? This could be a tricky situation, unless you are good at bending the truth.

Why not find out what the treatment was and judge for yourself. Then find out what the patient's expectations for treatment are. Matching these two up should give you enough info to decide if unmet expectations have played a role.

Luke

[bernard]

Why not find out what the treatment was and judge for yourself.

That is the way I take. You'll get many information and avoid "nasty" options about your future treatment.

[JaneS]

Hi Emad, Luke, Nari
That is a very interesting question.
The treatment focus now is very much on self-management. Depending on your treatment preference, the active/passive ratio varies between therapists & patients.

When you make your treatment plans, are they done in conjunction with the patient? (I'm sure they are to some extent). When the patient comes to you from another therapist/discipline, perhaps another question to ask was "what was the agreed goal of treatment?" and, perhaps "Were you given home exercises or activities - did you do them?" and "Did you keep doing them after treatment finished?"

I am very familiar with Nari's quote of the pain being the same but the physio nice. By going back to some of those other questions - asked in a non-judgemental way - answers might be uncovered. Such things as motivation/stage of change, expectations, participation level could be considerations in the new therapist's plan.

Rather than ask if the previous treatment was appropriate, I would probably ask if the patient thought it helped. (The patient supposedly came to you because you are the 'expert' and would know what is appropriate). If the patient doesn't think a treatment helped - however nice the therapist-- what are the chances of success? Your goal and the patient's may not be the same but a negative perception along the way makes a successful outcome harder to achieve.

Getting honest answers to questions about participation and motivation may take a bit more finesse.

As an occ rehab consultant, I tried to employ these principles - with varying success. Part of the problem for me was having to balance the patient need with a financially interested 3rd party. Without that encumbrance, I wonder how you guys would get on? Of course, I should add that many of you probably do just this anyway.

Jane

[emad]

Hi Nari , luk ,Ber, Jane ;

The topic has gone very fast , i hope i could catch all .

yes, extremely difficult to get honest answers from those patients , however , sometimes i feel the sick peson is weak , can not bend through discussions , and they give accurate knowledge ,as well , they appear sometimes to give falsified /pretending answers to get as s/he sees.

Any way , we can ,simply , passthe trick of the question saying , that during the last /previous treatement the patient believed it was appropriate ,now he does not because it did nothing .

Luk ;
If the patient asked me was it appropriate or not , i will reply honestly as i see , daily i am in trouble because of that problem .
very strang e why bending the truth ??


Nari ;
You get for us a very interesting point ,the social health carer ,usually females /ladies are good at social skills , but males are good at professional skills , i think i put myself in trouble now .;) :zip:

Jane ;

The patient supposedly came to you because you are the 'expert' and would know what is appropriate

yes , Jane it was silly question to ask ! why then he came to me ??He would not come to me if i do not answer that question that , s/he thought iot WAS NOT appropriate.
Regards
Emad

[nari]

emad

Many of us ask: "Why are you here"? which can be a can of worms, as the reply is often: "My doctor told me to come" which means the poor doctor was running out of places to send this problem patient.

If I considered previous treatment inappropriate , I would simply say that there are many ways to treat and get on with the history.

It may also be that the patient is inappropriate for physiotherapy in the traditional sense, so hands-on may be out of the question anyway. I have had success simply talking, defining goals and educating. Most of these patients have not had accurate information on pain , or have poor understanding, or don't want to know. Talking sorts this out, and decisions about the next move/s are easier.


Nari

[Luke Rickards]

Emad,

I think something like Nari's answer is better, but still feel it better to avoid the situation in the first place. I was taught that is not at all helpful to the patient for them to discover that they have been led in the wrong direction by many practitioners before. This could make them angry about previous care.

I would prefer not to create this possibility.

Luke

[nari]

Luke

I don't see in my post where I suggested to the patient that previous treatment was inappropriate; just because someone did not improve doesn't equate to criticising previous Rxs.

I still think that, for the sake of historical value, it is useful to know what the patient's views are on previous interventions. Very few have any idea what was done, anyway, and one can glean a lot of pertinent thoughts about what might be appropriate for this time round. Finding out from previous practitioners is tricky, because often they are unknown to the patient by name.

Which is why I think the phrase "Why are you here?" can be enlightening. It tends to make the patient think...'well, why AM I here?' especially if they have been on a long merrygoround of clinicians.

emad, you are probably quite confused by now. ;)

Nari

[Luke Rickards]

Nari,

I didn't say that you have. That's why I said I preferred your way better.

Luke

[nari]

Sorry..we are at cross-purposes here..not to worry!:)

Nari

[emad]

yes ,nari , i have to say that ladies here on SS are professional or ....;)

Any way , you are right asking the patient why are you here ? is extremely tricky , sorry to say that high percentage here think this is to comply with the doctor suggesations , which i hate most .

Some who think , whom are few here , say the truth , because this is where i will find benefit which i pay for it money , no more , i pay money to get benefits , not speech or any other factors.

Luke :

Telling the patient regarding prevouis treatement is so tricky ?

What will you say if the patient asks you about it ? Will you bend ?Or you are going to say this out of the issue.?I am sure the patient will ask you about his/her prevous management if you did not /

Regards
Emad
Emad

[cedric]

i always ask.
my reason are that i want to knowexactly what is the problem. If i know what have been done before it can help my therapeutic decisions.
of course every people has personnal opinion and views but we have to see through all of that to find the truth

[bernard]

my reason are that i want to know exactly what is the problem.

Does it really matter? We have no real access to their brain.;)

[Diane]

One can ask for information but it's probably good to remain neutral when receiving it. Butler says, "remember as you are sampling the CNS of the patient, the CNS of the patient is sampling you." Bernard, I think we can access the patient's brain all sorts of ways, as they can access our own.

[cedric]

the idea is to be honest and explain them it is to check what has been done and what we can do to really help them now... (or try to help them)

[bernard]

Bernard, I think we can access the patient's brain all sorts of ways, as they can access our own.

You're totally right and the body's patient is already telling some story. I just meant that often, the story we are seing via their body, is largely unkwon by the patient himself.

Often, too, patient is "wearing" a magnifying armor that deforms/absorbs the real cause of their problem. Once we put away this "clothe", our patient may be more aware of his condition?

[emad]

Bernard :

I tried to understand your last post , it was not clear .

Just i want to say one comment , the body is not so important , the more is the cortex/brain and the patient ,s thinking .;)

Regards
Emad

[bernard]

the body is not so important

Body is the mirror of our soul (it reflects your un/conscious thinkings).
Body is a door to brain. Body is only the neighbour of brain. IMHO.