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Toni Talks about PT Today

The Squeaky Patient Gets the Attention

Published December 26, 2012 12:50 PM by Toni Patt

There's an old saying the squeaky wheel gets the oil. In healthcare that translates to the patient who complains the loudest, is the most uncooperative or makes the most unreasonable demands, also gets all the attention. Often this means other patients are ignored. It never fails to amaze me how this happens over and over again.

Last weekend was a good example. I worked at one of my part-time jobs. On Friday, I received a call to give me a heads-up about a patient on my schedule. Seems he was very difficult. He would only participate in therapy at times of his choosing and would only do what he wanted to do. As a result, the department was running around in circles trying to accommodate him. The phone call to me was to warn me a specific time had been scheduled and give me the background information.

I wonder what would happen if we said no to those people. What if instead of bending over backward, we listed the options and told them to pick one. In this case, the man survived having his therapy in the morning instead of the afternoon.

We've all had patients like this. It may take four or five attempts to complete the treatment. Meanwhile, we spend the day running all over trying to squeeze others in around the multiple refusals. I'm not sure why. In my experience, even when these people participate in therapy they rarely do enough to make the treatment worthwhile.

I don't remember being taught I must make multiple attempts to accommodate difficult patients. Nor do I remember being told I should. Facilities want to avoid complaints because they fear it will affect utilization. They pander to those individuals who complain, which frustrates staff and encourages the behavior. I think that the word "no," said in the most pleasant of voice, would be just as effective.

A few weeks ago, we had a man who refused to get out of bed to go to meals, which is the facility policy. He demanded that food be brought to him. My suggestion was to stop bringing him food. Tell him to go to the dining room if he is hungry. Once he realized we weren't going to bring him food, he might be more willing to get up. I was told no, that wouldn't be right. He might starve. None of the other residents were allowed to eat in their rooms, though many wanted to. So all this did was create resentment.

PT departments are chronically understaffed and overworked. They don't have time for such nonsense. There's a difference between someone who is confused, scared, demented or in severe pain refusing therapy compared to a manipulator. I realize this may be one of the few ways those people can control their lives.

What's the worst thing that would happen if one of these people missed a treatment or two? It wouldn't be any worse than what happens to the patients who miss therapy because the therapist is running around trying to accommodate the squeaky patient.

1 comments

Oh how right you are with this blog.  One facility bought KFC to a pateint because he threw his tray into the hallway.  He finally left AMA so all the accommodations the facility went through did not benefit the patient or the staff.

Another place accepted everyone including homeless patients.  Motivation was not a priority for some of them because they had no where else to go.  Yet we were told to treat them and not get refusals.  

Jason Marketti December 26, 2012 3:13 PM

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