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The Busy PT's Guide to Finding Balance

Clients' Rights

Published April 13, 2011 10:36 AM by Janey Goude

I saw a woman wearing an ACL knee brace... and two-inch wedge heel shoes. It would seem to me that if I had to wear a monstrosity on my leg just to stay upright, common sense would dictate I would also wear flat shoes. Perhaps I assign reason and logic to "common sense" that is really "medical training sense."

Takeaway Lesson #1: Do not assume my client has what I would consider common sense. It may only be common sense to those who have had the same training as I have.

As I contemplated my role in opening a conversation with a complete stranger, I realized that my responsibility as a health care professional is to educate my client. That seems like a common-sense statement, doesn't it? On par with, don't wear heels when you can't stand up without help! But the truth is that I often forget the sweet simplicity of my job; and in the process I complicate life for me and my client.

I don't just want to inform my client; I want to present the information in such a way that the person makes the "right" decision - the only decision that makes sense given the facts. I take personal responsibility for my client's decisions. If the patient makes a wrong decision, I think it is my job to convince that person to do it the "right way."

At the point that I demand a particular decision from my client, I have overstepped my bounds. In the "ACL-brace-with-high-heels" case, I expect the stranger to start wearing flat shoes; but she may still choose to wear high heels. I do not have any control over the decisions someone else makes. But I want to do everything in my power to make sure those decisions are informed ones. I want this complete stranger to know the impact her feet have on her entire body, but especially on her injured knee. The client (or in this case, the stranger), a consenting adult, is within her rights to make decisions that I disagree with. Those decisions may lead to what I consider an inferior outcome.

I think sometimes I mistake my purpose. I put too much responsibility on myself. I think my job is to get the right outcome for my client. While that is certainly my goal, it is not my responsibility. My responsibility is to provide accurate information and respond professionally to the decisions my client makes. As long as I have met those obligations, the outcome is the client's responsibility.

Takeaway Lesson #2: The outcome is contingent upon variables outside of my control. The sooner I embrace that reality, the better I will retain sanity and reduce my risk of professional burnout.

4 comments

When you say "my client", in what regards is that meant since you write your blog as a "retired" PT?   .... just wondering....

Sue June 5, 2011 8:52 PM

Anyone ever heard of serial casting??   We don't increase flexibility as we age, do we?

Jeanne April 22, 2011 5:46 PM

Dean,

Thanks for your comment.  I remember that conversation.  The overarching principle is far reaching - healthcare, government, religion...to name a few.

Excellent point about flats versus heels.  In this particular instance, I saw her take off her shoes and stand bare (and flat) footed, so contractures weren't an issue.  That said, I'm sure I would have made that assumption, since it never crossed my mind until you mentioned it.  Thanks for reminding me how crucial an open mind is!

Janey Goude April 14, 2011 10:26 PM

Great insights! You bring up a common thread in the area of public health...paternalism, the idea that we (professionals, health care workers, medical staff) know better and should be able to tell people how to life their lives better. You and I had a brief discussion about that regarding the First Lady's breast pump campaign. It all comes down to who knows better about us than us? That is not as easy an answer as one would think, no matter where one stands on the anarchistic - paternalistic spectrum!

The other issue that comes to mind is you made an assumption about this stranger without knowing her history. I had a client once who doctors and hospital physios said couldn't walk and would never walk again. I went to see her at home and found she had fixed plantarflexion contractures in both feet from NEVER wearing flat shoes in all her years of life. I put her in her 3" heels and she walked just fine. Everyone had put her in "better" flats which her feet would never conform to.

Your conclusions are spot on and well said.

Cheers!

Dean Metz April 13, 2011 11:27 AM

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