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Toni Talks about PT Today

We Just Don't Get Along

Published February 19, 2008 7:15 AM by Toni Patt
What do you do when you have a patient you don't like? I don't mean one you are unsure how to treat or one who drives you crazy. We've all had those. We've all learned to take a deep breath and just do it. I think we all have patient types we prefer to avoid. Mine is whiners followed closely by those who always want something. If I never hear the phrase "I can't" again I won't feel deprived.  These patients are a part of life. If you get a group of therapists together everyone will have had at least one patient from hell.

Over the course of a career, a PT will come into contact with many people. Some are patients. Some are family members. Some are co-workers. Mixed in there will be those you don't get along with. Contact can be limited with co-workers and family members. I've worked with people I didn't like. Patients are different. Providing treatment is the reason you come together. I have one of these patients. I don't want to see him or talk to him. I can barely listen to him. He is not a happy man and doesn't have a positive affect on those around him. I think he is depressed. I know he has some confusion.  I'll call him Mr. B (not his real last initial).

Mr. B broke his ankle. He is now NWB on that leg. He is overweight and deconditioned. When I look at him I wonder how he got around before he fell. We got off on the wrong foot when he exaggerated his prior functional status. His son corrected that. He ignored me when we first met because he wanted a male therapist. He only comes to therapy when he wants to and complains he didn't do enough. He is a challenging patient without the personality conflict. I like challenging patients, just not this one.

I've tried several different interventions with him: chair exercises, bed exercises, group exercise, the restorator, sliding board transfers and assisting with dressing to work on bed mobility. I've had him a week. We've made no progress. I keep asking myself what else can I attempt? How can I adapt things to a level where he can do them? What else can I try? Meanwhile Mr. B tries my nerves.

I think this is difficult for PTs. It's frustrating to have a patient I can't work with. The obvious solution is to trade patients. I'll have to do that. I'm running out of ideas. Many a different mind will have a better approach. I don't like to trade patients but this isn't working. Did I fail? I tried everything I could think of. Nothing worked. I don't think you fail in therapy if you give it your best effort and rely on clinical judgment. Right now my judgment is telling me to try someone else. I doubt I'll my opinion of Mr. B will change. My obligation is to provide the best therapy possible. It looks like the best way to do that is to let someone else give it a try.


Everybody has patients we don't get along with. I used to dread going to certain patients' houses. Now that I work with a PTA I give her patients I can't seem to work with. It's not that I'm 'dumping' patients on her, but a new approach from somebody else may just do the trick. After 25 years of this I will meet anybody 75% of the way, but they do have to want to get better too.............Jim PT%0d%0a%0d%0a%0d%0a%0d%0a

James February 29, 2008 12:55 AM

You did not fail.  

Sometimes the best thing we can do for our patients is to allow someone else to see them, that way they will still recieve the best therapy possible, just not by us.

Countless times patients have been difficult for me yet will do everything with another therapist, why?

Who knows, as long as they participate and get better I don't mind that they didn't participate fully with me.

Jason, PTA February 22, 2008 11:51 PM

I agree, we all have experience these types of Pts, however what criteria do we use to define a "good Pt?". We do get  frustration when Pts will not cooperate especially when  potential to improve is there. We need to step back and look at the whole picture. You had mentioned he was depressed and confused, were these or any underlying issues addressed?

Some clinicians simply "click" better with certain Pts and yes personalities do clash. Some patients especially men with a past Hx of an authority position do not like to be directed and have a sense of lost control when institutionalized. I would suggest investigating several options; Try appoaching different times of the day, give him the option to set his goals and time to be treated maybe he just wants some control over his care. Get other disciplines involved such as social services, rec therapy etc, a team approach works better. Have a medication and psych review performed. There is no shame when switching Pts if you do not, you may offer a disservice to your client. The focus is providing the best service possible for positive outcomes.

Tom, Rehab Dir. February 19, 2008 5:41 PM

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