Not All Refusals Are Created Equal
Last week I heard something that made me stop in my tracks. A PTA was going to treat a CVA patient who was new to her. When the PTA attempted to initiate the treatment the patient refused the standing frame. The PTA sent the patient back to the room, threw up her hands and said she didn't know what else to do with the patient. That really bothered me. I don't know what made me madder, the PTA not knowing what else to do or the PTA not even trying to convince the patient to work with therapy.
Patients refuse. It is a fact of life for a PT. There are many reasons: pain, fatigue, the BR, dislike of a specific treatment, laziness and not wanting to miss "The Price is Right". A confused patient is as likely to refuse as participate. Often a patient can be convinced to participate with therapy after refusing. It is the responsibility of the therapist to try. Not all refusals are a set in stone, no. By asking questions the reason for the refusal can be uncovered. If I know why a patient doesn't want to do therapy, I can do something about it. The reason may be as simple as needing an extra blanket or to go to the restroom. The point is, if you don't ask, you don't know. The PTA I overheard didn't ask. She just gave up and moved on.
Compromise is an important part of therapy. This patient didn't want to use the standing frame. She may have been agreeable to doing exercise or balance activities in sitting. Patients who don't want to walk may still be willing to get up and do therapy, just not walk. As therapists we know the importance of moving patients pushing them. If the choice is between no therapy and a little therapy, I choose a little therapy. I've had patients who won't do anything for me, happily work with someone else and vice versa. Some people are just not morning people and being in the hospital won't change that. You have to at least give it a try.
Sometimes patients refuse because they don't feel well. Not feeling well can run the gamut from mild nausea to a racing heart rate and V-fib. Patients don't always accurately verbalize what they are feeling. Have you ever tried to describe dizziness? It is the responsibility of the therapist to find out if there has been a change in medical status or another reason the patient might be ill. Therapy is supposed to help the patient recover, not send them to the ICU. Of course there are those who just don't want to do anything. I've long given up on arguing with those. If someone refuses to do something, nothing will make them.
When I say refusals I'm not talking about those who will participate with constant cooing and encouragement. I'm also excluding those who are confused and don't know what they're saying. Confused patients will refuse one minute and agree five minutes later. Depressed patients will participate. They might suck the life out of you, but they will work with you. I've had days where if I walked away from everyone who refused, I could be home in two hours. It's our responsibility as therapists to try. I wish the PTA would have made the effort. Her patient would have benefited from some sort of intervention.
Okay, I have the reputation as being mean and I'm proud of it. Refusals don't mean anything to me. I talk them into therapy. There are days when I don't try too hard to convince someone. But I try. At the end of the day I feel good about what I've done or attempted to do. I wonder how that PTA feels.
*My apologies to all PTAs who read this. I'm not picking on you. You have my respect. I would have written the same thing if it were a PT.