Delivering Bad News to a Patient
Now that I am starting to take on more of the CI's caseload, I'm faced with decisions that I previously didn't have to make. On all of my other placements, I wasn't heavily involved in reevaluation or discharge planning. This time around, I'm seeing patients from the onset of their care through to the end. Unfortunately, the "end" isn't always where we want it to be, and that's a very difficult lesson to learn as a student.
I suppose it all starts at initial evaluation when I'm trying to set goals. It's so hard to estimate where someone will be, and without much experience I have found the task of setting "realistic" goals to be very burdensome. It becomes more apparent when you see that same patient for a reevaluation and try to make a decision regarding his continuation of care based on goals you set for him at the onset. All of a sudden, I'm realizing the responsibility that I'll have as a practicing clinician and how much more I need to learn.
The hardest part is deciding what to do with a patient who has not met his goals, but will likely not progress any further with physical therapy. In a way, it feels like I have failed that person. Did I set the wrong goals? Could I have done more to help him recover? I can't figure it out. I struggle most with delivering the news that a patient will be discharged. I honestly can't do it. I know it's a communication skill that I'll have to develop (both for life and for PT), but I just can't bring myself to tell people bad news. I get really awkward, stumble over my words and likely make the situation worse than it needs to be. If you have any advice, please feel free to pass it along!