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Toni Talks about PT Today

The Family Issue

Published May 7, 2008 8:46 AM by Toni Patt
Last weekend I was reminded of why I hate visiting hours. I went to treat a patient who had family in her room.  Usually I let the patient decide if the family can stay. This time the family decided for the patient. Not only did they decide to stay they interfered with what I was trying to do. The patient was an elderly woman with multiple medical problems. This wasn't her first hospitalization. She was admitted with AMS to rule out a CVA. She was very lethargic when I was trying to work with her. She was trying to work with me but couldn't stay awake. She was able to do some exercises but when I stood her up her eyes closed and she slumped to her left. I returned her to bed.

I explained to the family why I wasn't going to attempt gait and why I put the patient back in bed. Now you would think they would be happy that I didn't take any risks and was carefully monitoring what was happening.  Wrong. As soon as I sat the patient EOB they berated her for not trying. She was trying. The task was difficult. When I didn't walk with her she was scolded for not working with therapy. One of the daughters told me I was wrong. I should have tried to walk. She proceeded to lecture as to why her mother could walk stressing that they would walk with her later. I had to bite my tongue.

Families are a part of life for a PT. They come in all varieties. Some are good and supportive. Some are absent. Some are difficult. Most of them mean well. Usually I'm glad to have family present. But sometimes families get on my nerves. What aggravates me the most are the ones who fail to see that their loved one isn't progressing the way they expected. They don't see the situation the way a PT does. I don't think they realize that scolding someone for not participating doesn't help the situation. All it does is make the patient feel worse.

I can understand where these people are coming from. They want their loved one to return to normal. Maybe they think they're helping. Last weekend I wanted to set that family straight. Therapists are in a tough place.  We can see the probable outcome. Yet, we have to wait for the physician to discuss prognosis with families.  We're asked to work with patients who won't be returning to prior functional status. Meanwhile we have families pushing us to get their loved one out of bed, walking, etc. I don't want to practice medicine. I would like to be able to be up front about the therapy prognosis instead of hedging by saying we'll have to wait and see. We don't know what will happen. Once I had a patient who was unresponsive. His functional status was identified as dependent on the communication board. His wife had a fit because I used that word. I found myself caught in the middle of her and administration telling me to change it. The board was left blank because nothing was acceptable to her. 

Sometimes I want to tell families to leave the room when I'm working with someone. I've learned to avoid ICUs during visiting hours. I used my clinical judgment when I decided not to walk that patient. My decision was based on safety. I wish the family would have understood that. It's very hard to step back and be objective about someone you love. It's also very hard to accept that a loved one won't be the same again. I wish there was a way to show families that getting in the way with therapy doesn't help.



Families can be demanding.  One family was the perfect example of fitness, with most of them personal trainers who "knew" more about fitness than the whole therapy dept.

What a joy they were.  Grandma was there for a TKA, in extreme pain and had difficulty with all activity.  Family didn't care, "You can do better, take a bigger step" they told her, practically yelling.

They went against the PT dept and went ahead and walked her.

I will wait until family leaves, I don't need the headaches and hassel of answering all their questions.  I usually repeat myself and tell them, "Thats a good question for your nurse, doctor social worker, etc."  

Its not that I don't know the answers but the family may interpret what I say wrong (its happened before).  I don't need to explain to administration (again) exactly what I said.

Jason , PTA May 8, 2008 10:52 AM

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