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Toni Talks about PT Today

Secondary Gains

Published July 24, 2013 11:04 AM by Toni Patt

If you work in physical therapy, sooner or later you're going to encounter a patient, friend or relative who is making secondary gains off the patient's illness. In my experience, this usually revolves around money or special attention. I have a patient now whose wife is behaving this way. We all get the behavior but no one has figured out what her payoff is.

She is demanding and demeaning to the staff. She insists her husband be seen three or four times daily. She constantly lowers his oxygen to a level that causes his breathing to be labored. Until this week she has refused to allow a wheelchair in his room, stating he doesn't need to rest. This is a man who gets short of breath moving in bed. He had major cardiac surgery and tolerates very little activity.

The wife is a retired nurse who believes she knows more than everyone else about her husband's care. She refuses to discuss anything with anyone but a physician. I am the lone exception because I walk with him. She will speak to me long enough to clarify her expectations for the day and then ask how he did. I think he would do much better in general if there was a way to prevent her from entering the building.

In the course of one week, more time was devoted to managing her behavior than therapy spent with the patient. Even when she gets her way, she isn't happy. She simply makes an even more outrageous demand. I believe she has had only one telephone conversation where she didn't hang up on the caller and that was with the rehab doctor. No one wants to go into the room when she is visiting. No one understands what she is getting out of this.

My first thought is an underlying psych diagnosis. My second is that she is used to bullying people to get her way. Every demand includes a statement along the lines of, "He won't get better unless you do this." Either she is in denial about how sick he really is or she needs him to be even more ill.

I feel sorry for the man. He works hard with therapy. Today we didn't accomplish anything because she turned off his oxygen before leaving for the day. He couldn't even stand up, he was so worn out from trying to breathe with no air. This is one of those situations that makes you want to call Adult Protective Services. I ran into a similar situation one time previously. Then it was the wife of a patient with TBI who did the opposite of everything we recommended.

Everyone in the facility is aware of her. The OT and I watch over him while he is in therapy. The nursing staff checks on him regularly. I hope it's enough.

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I had a similar situation, APS was called and stated there was nothing they could do. Of course that varies state to state. I would try an ombudsman

Brian July 25, 2013 4:46 PM

As I understand it, if you don't know if a situation is appropriate for APS, that means it is. APS needs to be notified in this case. She is being abusive, not only to her husband, but to staff as well. Neither of which is legal. If nothing else happens, APS will investigate. Then determine if it is abuse or not. But why risk your license if someone else reports it? If I were you I would be reporting to the admin (mandatory for us in Nevada) and then the admin would have to report to the state.

Michelle Merritt July 25, 2013 3:10 PM
Sparks NV

That is interesting. I have encountered this in outpatient but in the opposite form.   I had a pt who had a moderate ankle sprain and his wife was so nervous she would not let me do any weight bearing exercises . His PA basically called me after speaking to her and begged me to discharge him from therapy because the patient kept calling her complaining that  therapy was making his ankle swell. The patient on the other hand wanted to do more aggressive things. Another therapist saw this same woman's mother for balance issues and she did the same thing! She couldn't quite get that you can't treat balance issues without balancing.

Toni July 24, 2013 10:44 PM
Evanston IL

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