The patient’s role in healing.
The patient’s role in healing is possibly one of the most overlooked factors in patient care. As a practitioner, I have seen over time that the human body is not as predictable as we would like or hope it to be. Early on in my career, I would try to figure out all diagnoses that I would face with a concrete solution. I went through training with NAIOMT immediately to learn what the best therapists in the profession were using and take from them all to make it my own. I also mentored many therapists at Olathe Medical Center and KU Medical Center sharing my knowledge and skills sets. After years of gathering ideas and techniques, I thought that I would have been able to master any situation or diagnosis that came to me.
“Over two decades into my profession,”
I still can see very basic diagnoses that I have treated many times in the past with great success and still fail. When assessing the patient, each finding starts to help me form a working hypothesis. Now with experience, it is taking significantly less testing to come to a conclusion of a diagnosis with a high level of confidence. Pattern recognition is happening at a rapid rate. The patient’s role in healing is being identified.
When a practitioner has seen a pattern many times over, it is easy to assume that anytime you see those signs and symptoms that a similar treatment should also fit and be effective.
“It starts to become second nature and almost effortless to the practitioner.”
But what happens when you encounter a patient that does not respond as predicted? Everything is pointing in a specific direction. You have seen many times over and the answer is predictable as it has been many times before. This time is different. Nothing adds up when you intervene with your treatment. With pattern recognition A + B = C, always. This time it is not adding up to C. Everything says it should be a slam dunk but the patient does not respond to your treatment of the diagnosis. What could be the potential reasons for this situation? The patient’s role in healing?
First off you could be wrong with your diagnosis. By using pattern recognition, you may be biased into certain techniques. Tests that prevent you from something that is not seen due to you limiting your vision of the pathology. It is very common to see that each practitioner has their favorite tests and treatments that are not consistent throughout the profession. This process can happen with continued success with multiple different approaches. The main limitation, when your common approach does not work,
“is the recognition that your approach is not going to benefit the patient and another approach is necessary.”
It is limited to a specific situation and this situation is not it. The diagnosis is wrong and beings you have streamlined your assessment you are no longer able to explore other options due to the lack of information.
Secondly, it could be the right diagnosis but you are not factoring in the significant component of the patient. Even though we can generalize and stereotype to become more efficient in our abilities to diagnose a problem. If the patient is resistant to that diagnosis or treatment they can prevent the success of the treatment. This happens many times in medicine when a patient goes in for treatment and does not like the diagnosis that has been made. It may not fit into their beliefs or wants.
“They do not want to accept that they could have that diagnosis so they are in denial.”
A patient can be in such denial that they can prevent the body from responding to your treatment. When this happens, no matter how accurate you are on your diagnosis the treatment will be less than great due to their ability to resist the benefits of the treatment or straight up deny that the treatment has helped.
As a practitioner, it is important to understand that you are an ancillary aspect of a patient’s ability to heal. You can provide the patient with the best evidence-based care and doing what is by your profession is an amazing job. This is a relationship. A relationship between the practitioner and the patient. There has to be trust and cooperation to make any type of relationship work. If you have not taken the time to gain the trust of the patient then you are at great risk of failure due to the lack of confidence or trust from the patient.
Can you think of a time in your life when you did something and the outcome was completely different than you expected? Did it involve a relationship? What was the cause of the outcome being different? Is there anything that could have been done differently to change the outcome?
Take some time to break down a situation in your life that did not turn out as you planned. See if you can identify the issues that limited success. The more you can identify these traits the more you become aware of your place in getting the response you are looking for.
Rajesh Khemraj is a Physical Therapy Consultant that has been trained at the highest level in Lenexa, KS. Rajesh is also a Corporate Consultant with NeuroChangeSolutions.