Perspectives and Client Care: "Abnormal" Abnormals

A letter from a disgruntled OT set the backdrop for a discussion that began on 12/11/07. The fact that she appeared to be lumping all PTs in with the few she had encountered bothered me. In the initial blog post, I asked, "Have you ever lumped a whole group into one category-either good or bad?"

I do it all the time. To an extent, our education teaches us to lump clients together, the same way this OT did. First we learn what normal looks like: normal ROM, normal strength, normal gait. Then we are taught to observe the "normal" abnormals: ROM patterns that indicate orthopedic dysfunctions; strength deficits that predict movement disorders; movement patterns that indicate neurological deficits. But what about clients who don't fit into the "normal" abnormal? Do we try to make their symptoms fit, throwing out whatever symptoms aren't congruent with our picture? Do we discard the client altogether as a malingerer? Do we just treat what we know and hope the rest will go away?

The human body is an awe-inspiring creation. Sometimes a perfect healthy person has a structural anomaly, an "abnormal" normal. Is it any wonder that some of the clients we see have "abnormal" abnormals? As we go about treating our clients, we have to adjust our perspectives to allow for the "abnormal" abnormals: the client who isn't responding to treatment the way they "should", the client who exhibits excessive pain qualities, the client whose symptoms don't match our schooled version of what a diagnosis "should" look like.

Each client has a unique make-up. Our clients entrust us with their health. We owe it to them to search until we find the variable that unlocks the key to their recovery. Even if the answer is beyond our grasp, our client will be better off knowing someone cared enough to invest effort on their behalf.

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This has been a five week discourse on "Perspectives and Client Care". For anyone just now joining the discussion, I thought you might appreciate a recap.

First, we considered that each of us only has one perspective through which to see the world: our own.  As clinicians we have to be willing to acknowledge that we see the world through a very narrow lens that has been colored by our experiences, both good and bad.  We have to be willing to accept that just because someone evaluates a situation differently than us, that doesn't make their opinion wrong, simply different. I laid down the challenge for you to identify one area in your life where you were having difficulty allowing another person the right to their perspective, insisting yours was the only "right way".

Next we looked at how repetition affects our perspective. When one person is grappling with a situation for the first time, while the other person either deals with the situation repeatedly or has already mastered the challenge, the stage is set for conflict. This week's challenge was to lay your perspectives aside and look at the situation through the other person's eyes, as if you were looking at the situation for the very first time. This process helps us to validate the urgency the other person feels and put their concerns into perspective.

Finally, we examined one of the most important aspects of accepting different perspectives: understanding that the person in authority gets to decide whose perspective to act upon. When it comes to goal setting, the client is the boss. No matter how hard you try or how great a motivator you are, you'll never get a client to meet your goals. But if you encourage them to meet their goals, you may inspire them to set a new goal that was initially beyond their greatest dreams. We also explored how you can graciously submit to authority without being in agreement; you are simply acknowledging their right to make the final decision because they bear the ultimate responsibility for that decision. Whether you are the one in authority or the one who is under authority, how you exert or receive authority may pave the way for others to accept your perspective later.