Get unstuck treating hard patients

I don't know about you, but I find that it’s almost automatic to put patients into categories. We have our easy patients and we have our hard patients.

Someone who is young, motivated, body aware and has healthy beliefs about movement and pain can easily fall into the easy category.

But what constitutes a hard patient? There can be a number of factors, but for the most part, I've found it can include a combination of all four of these factors:

• Inactive

• Unmotivated

• Unrealistic expectations

• Less than adaptable body structure (poor posture, poor muscle tone, etc)

This patient archetype can be a real challenge for even the most experienced of clinicians.

I was just talking to a physio friend last week about this type of patient and how draining and hopeless she can feel after seeing these patients. In her situation, they come in with neck pain and are looking for a magic cure. They tolerate very little hands-on treatment and can flinch at the first sign of body contact.

It can be really disheartening to have this patient archetype on your caseload. It's easy to feel like the situation is hopeless and as therapists we can easily resign ourselves to going through the motions with doing half-hearted treatments.

In this newsletter, I want to help you get unstuck with this patient archetype and help you reframe your approach to treatment. My goal is to move you from a place of disillusionment and despair to a place of flow where you can be curious, collaborative, and creative. While these patient archetypes will still likely be challenging, my goal is to give you a fresh perspective to help you avoid the drain, frustration and exhaustion.

Before we dive into going through treatment strategies, I think it's important to look at some common pitfalls that impact our ability to engage fully with our patients. Before we talk about how to approach different treatment ideas, it’s important to review our headspace. Shifting our thinking will matter more than any specific treatment, exercise or modality used with the patient.

There are four pitfalls that I believe we make with these patients:

Pitfall #1: We put everything on our shoulders

It is very easy to believe that it's 100% up to us to get our patients better. With this patient archetype, I’ve found they can often assume that the onus is all on the therapist to get them better- that's why they've come to see you. Feeling like everything is up to us can really stifle creativity, communication and collaboration with this type of patient.

Pitfall #2: We try to manufacture motivation for them

As physiotherapists, when we come across an unmotivated patient, all too often our first instinct is to try and manufacture motivation for them. We might think that we can muster up enough motivation to build momentum for them in their recovery. But as I’m sure you’re aware, this is impossible to sustain and often times our own efforts to instill motivation in our patient can actually create resistance in our patients.

Pitfall #3: We chase symptoms

As a physiotherapist, it can be tempting to focus exclusively on treating symptoms. And the further we slide into a place of frustration with this patient archetype we can easily stop being curious. We then stop exploring the other potential drivers of their pain and dysfunction.

Pitfall #4: We ignore patient resistance

One of the biggest pitfalls we can make when engaging with this patient archetype is ignoring their resistance.

• We pretend that they’re motivated.

• We pretend that they’re on board with doing exercise.

But reality paints a different story.

They exhibit limited motivation. They aren’t doing any of the exercises they’ve prescribed. They talk about how they find manual treatment helpful, but wince when you touch them.

Are you ready to improve your clinical presence?

Tomorrow, I’m going to paint a path forward so we can begin to approach treatment with increased clarity and structure. I have organized treatments into three themes or buckets that will help you get results no matter what patient archetype you are dealing with.

To better flow,

Andrew

PS Released my latest podcast episode where I talk about clinical agility: