Reaching an Agreement !

[emad]

Hi all:

Sometimes i deal with the patient who wants me to do that certain treatment ,may be due to :
his/her pervoius history of physio expereince
culture
his carers .

Even , i will go far to say:
some persons ( at least here where i live) beleive as they spend more time in treatment(Physio) this is of benefit ,will make the recovery more faster ,i mean if the session/setting takes 30 minutes or more thus will be very beneficial regardless of it is acute ........

Even i will go more far (here where i live) ;
There are a lot of unethical practices ,some physio go on the rule DO what the CONSUMER wants ,putting him on the apparatus 30 minutes ,you will gian the consumer ,you will gain money [in my own view sometimes it is a placebo treatment ,however they (other physios) do not know ] .

Of course always i lose what is called consumer in the market of money .
may be thus in the developing countries only . :evil:
Is that has meaning for you :?:

cheers
emad

[nari]

Emad

Yes, the same thing happens probably around the world. Patient requests machine - physio has the option of 'obeying' or not. If we obey, we are being just technicians, particularly if we have no opinion whether it will work or not.
Same with doctors - they want a machine for the patient because the patient wants it. We can either agree, or disagree; if we lose the patient, there are always more.
It is an opportunity for doctor / patient education.

[Green Hornet]

In the USA, too, I see patients with specific requests and doctors ordering specific modalities.
Sometimes our expertises are not considered at all.

All I would do is to educate them in "If I were you and in your position, I would offer myself this ....." If they don't buy it, either give them what they want or send them to somebody else.

Typically machine/modality seekers are not self-responsible for their health. They need revolutionary education or stick to thier dependency with continual suffering.
I hope someone everybody has personal power and take action for transformation.

As Nari says, as long as you are good, just move on. Many people find a way to find you for YOUR skills.

A good topic!

[emad]

Hi Nari ,Bernard &Takao:
Thank you for yr replies

yes ,it is a chance to educate patient/doctor ,but i feel the illetracy extremly washing thier brains ,they need to do something regradless os scienific evidences , they are going on one rule here :

take a lot lot even it is harmful.
Also ,i would say that generalising the whole issue is not completely true ,there are peoples who are could be negitioated ,particularly people who had tried /expereinced me before.

I feel this issue is no more than culture,because the last week i had a patient with some glenohumeral pain ,cervical invloving that pain referr to the limb and numbness , the first session i have applied a lot of time 30 minutes , she came back second time complain of great pain ,i told here we have applied a lot time ,then i insisted no more than what i want ,no more than 10 minutes ,then come back with great result ,but she expressed not thoughtful/accepting doing just 10 minutes ,

Oh oh , what i am going to do !!!

By the way
every week i have at least one doctor/physician as a patient to treat himself ,but he refuses to send his patients to physio (extremly unethical ).
Also , i think the health strategy here has main part ,there is no strict legislation to govern here the one who make mistakes , you can kill people here as you want , the issue for physio is simple ,but for others as surgons is bad , but i think people can take care themselves , thus the nature they may kill doctors, of course here and there all over the world there are more serious issues .

Let us come back to our main topic patient education!

Bernard
thank you for your apprectaing words ,
I hoped to help people here , but i am in my way in a registration process as physiotherapist in different country , they assess my competencies , i hope i could pass ,this process since one year i am on , they are considering who come from non-english speaking countries needs more refinment , and i think they are true , before the Internet i was completely different ,working on the subconscious level,knowing no thing more than practice as i have learnt during my undergraduate ,which was very difficent , there is not anyony who can tell you what to do with the patient , they told us there is something called physiotherapy ,we are going to be physiotherapists using machines , handling skills we have not hear about :arrow: :arrow:

if i speake the issue will be very long ,but i think i feel great/happy/glad /better as i write and there are people believe me , have the same values .

cheers
emad

[emad]

Bernard:

My main intention of that topic is that :

Somatic education is very simple , may take short time in the session
so consumers will need more time .
how we could agree between
?
I think i have read before that soma saession may take 60/90 minutes !!!
cheers
emad

[bernard]

An actual session takes around 30 minutes for me.

[Chancellor Mobley]

The other day I turned into a machine. Client comes in for her 6/7 session clearly stating that she wants me to only work with her neck and shoulders for they had given her such trouble over the weekend. Inside my knee jerk reaction was to tell her no and to talk to her about pain physiology, but I had already done the latter at least a few times. We did what she so clearly asked of me and she left a happy camper.

Chance

[nari]

Chance,

A classic context.
Patient knows what hurts; patient knows how to be rid of the pain; PT obeys; patient happy. Patient returns a week later for more of the same. (I would have done as you did, because all pt wanted was pain relief as perceived by her.) Strong placebo response. etc (Not denigrating what you did, in any way).

50% of the cynics at large would argue that the patient knows best; the others claim only the PT knows best.


Nari

[JaneS]

Emad, Nari etc,

I agree it is unethical to provide Rx at patient request if the therapist knows that it is not the best option. I have focused on education & activity, but only earn dissatisfaction from the patient and a determination that what they wanted was the 'right' treatment. In my case management role in occupational rehab, I have also seen high levels of resentment towards 'unfeeling' doctors and physios who do not give the patient what he/she wants. Based on these experiences, I started thinking along the lines of mutual compromise on a sliding scale. Here is an example;

Pt comes in and wants specific apparatus or passive techniques.
I tell him that his choice by itself will not be enough. He will end up paying a lot of money over time to be about the same as he is now.
I suggest a compromise; He can have, say, 10 minutes of his choice, providing he also participate actively in an activity I think is most appropriate. Possibly also activities to do at home between sessions.
Pt has option to compromise or find someone else. If he agrees to arrangement, then I hold him to it. If he does not fulfil his part of the agreement, nor will I. This is an opportunity to introduce graded activity, education etc while utilising the placebo response to get him to accept the more appropriate Rx.
As pt starts to see benefits of my preferred Rx, I shift time allocation so time spent on his initial request progressively decreases in respect to more effective therapy.

It doesn't work for everyone, but quite a few will swallow the 'bait' and then realise it is helping them. The ones who don't try to follow homework tasks are the ones who are dependent on a dose of their ideal treatment. They are unlikely to respond to your treatment methods, however good you area.

I have no empirical proof or literature support. This balance - gradually phasing out their idea of the right treatment - struck me in my occ rehab case management role. I am now trying it out as a therapist.

Jane

[Chancellor Mobley]

Nari, what I've learned here about placebo and the fractal nature of the nervous system allowed me to follow through with the session as we did. I often feel that it is a balancing act between what the client knows and wants and what I have to offer as a consequence of my knowledge and experience. We'll find out in a couple of weeks if she returns asking for more of the same.

Chance

[Diane]

I don't get people doing this very often, but when it happens I do my best to comply. After all, it's not me living in their body, it's them, and I'll give a little to get a lot. I don't take offence, or see it as a battle of wills; rather I see me following their direction as a way to re-establish or reinforce rapport. There will usually be enough to treat wherever it is they want me to go to keep me busy... for a while at least, then I move on after checking with them to see if they feel OK with the idea. (When I need a bit of human primate social grooming myself, I'M usually very directive... ;) )

[Baecker]

After reading Maitlands book on vertebral manipulation I do what the patient tells me if they want me to press here or there with more or less strength. Like Diane said I am not living in hteir body.

E.g. When you want to scratch yourself and you cannot reach the spot and you ask someone to do it for you and they don't do it on the right area it is very unsatisfactory. Maybe the patient sees it the same way?