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Toni Talks about PT Today

Preferred Patient Types

Published November 4, 2009 9:19 AM by Toni Patt
This morning while doing the schedule board, we started talking about what type of patients each of us prefers to treat.  It started when one of the PTAs asked to change one of her patients. She explained the patient in question was a back patient and she couldn't work with that type of patient.  I had a similar request for a patient I had evaluated over the weekend.  I asked she be given to a different therapist because she wasn't my type of patient.  That led to everyone present commenting on what type of patient they preferred or didn't want.  The good news is everyone had different likes and dislikes.  The bad news is everyone was adamant about the one type of patient they didn't want to work with.

There are two issues with patient preference.  I wouldn't last 10 minutes in a pediatric setting.  Others would last less than that in a hospital.  Just because I have some idea how to treat a patient doesn't mean I should.  It makes sense that I should be assigned patient types I'm comfortable with and knowledgeable about.  It also makes sense that I shouldn't work with a patient I don't get along with.  It doesn't matter what the diagnosis is, sometimes personalities clash.

The other side of that coin is not wanting to work with a patient I know how to treat.  That patient will probably get better treatment from someone else.  No matter how hard I try, it won't be my best effort.  Is that a bad thing?  Part of me thinks it is.  Another part says no, if I know I won't work well with the patient someone else should be the therapist.  

Sometimes it's the patient who makes the decision.  I'm known as one of the "harder" therapists.  I make my patients work.  Not everyone buys into that philosophy.  Someone who was inactive premorbidly isn't going to suddenly change after a stroke. That patient will do better with a different approach.  I can think of 10 different examples of a patient doing better with another therapist than they would have with me in the last week alone.  None of the reasons had anything to do with me specifically.  We wouldn't have been good fits.

It's easy to scoff at someone who says I don't like this kind of patient.  When I say that it doesn't mean I couldn't work with the patient, just that I would prefer not to.  I don't think the issue should be pushed.  If it's not a good fit, let someone else see the patient.  I'm not talking about patients no one wants to work with because of personality or psych issues.  That needs to be sucked up and dealt with. It's rarely a problem in my department. A patient should get the best care possible. Assign the patient to the therapist who will do just that.

2 comments

I hope, that as professionals, we can treat patients because we care enough to help them progress to higher function, despite the "personality problems" we may encounter.  It is our job to help, not judge.  We can't please every patient, but just because they are difficult to work doesn't mean we can blow them off to someone else.  Maybe we need to figure out why there is difficulty...is it cultural, is it fear, is it the desire for the patient to feel in control of something?  Yes, each clinician has specialty areas and if you are incompetent in an area it is best to find another clinician to take your place.  But, if it is truly a personality problem, you might need to address your own professionalism.

Kim, , Physical Therapist URMC November 20, 2009 3:55 PM
Rochester NY

In the end, one of the issues comes down to a specific skilled set. Some may argue that we should be able to treat any patient that comes across our path.  After all, we are physical therapists and should be able to do physical therapy, right?  Well, let's put it this way, my orthopedic surgeon is a surgeon, but does it make sense that he should take our a brain tumor (heaven forbid).  

It's good to have a specialized skill set and have the comfort level to say "I believe this patient would be better off with someone else."  Otherwise, we become a "jack of all trades" but master of none.  We need more masters, not more jacks.  

Christie ,, November 5, 2009 10:03 AM

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