Say It As It Is: Delivering unpopular messages to patients

 In Dublin Physio Clinic, Ethical Practice, Medical Ethics, Musculoskeletal Health

Once again, David Fitzgerald uses his platform to talk about a controversial topic that involves all practitioners and patients. We are talking about the right way of delivering a message to patients in the most various situations.

In this article, you can find a summary of the main points treated, however, do check out the video below if you would like to hear what David has to say about it.

Delivering unpopular messages to patients is something most clinicians must learn at some point in their career. In particular, it is essential to find the most appropriate moment to give patients the information they need to know.

There are a few different scenarios that can affect the way a clinician is supposed to disclose the information; the first one David mentions is when a patient is in too much pain to do physiotherapy. This can be caused by a series of very severe conditions, such as disc prolapse, severe whiplash or traumatic injuries and fractures. What can happen in these cases is people misjudging the severity of their injury and it is the clinician’s job to know the appropriate tests to do in order to recognise potential dangers and what needs to be done.

So, this is the first case in which the practitioner might be suspicious that the patient has a different pathology, hence the necessity not only to find the right solution to their problem but also to inform the patient about the gravity of the situation.

Other scenarios in which a practitioner needs to deliver an unpopular message

Another group of patients might include people with a history of conditions that tend to come back on a regular basis, usually responding well to treatment.

In some cases, however, the episodes can get more intense and frequent, indicating that there is progressive change happening in the tissue. The clinician’s job is to recognise when these tissues are gone beyond the point of repair, trying to restore movement. If, after conducting a series of tests, the practitioner reaches the conclusion that the tissues won’t tolerate any more loads, the hardest part is to disclose the information to the patient, who might not want to give up activities that might be even more damaging for them (playing tennis, running and other physical activities). There are of course solutions to many problems and, whether these require steroid injections or surgery, the clinician will find a solution tailored to the patient’s needs.

The main question every physician should ask themselves is “is this as good as it gets?” and, if they reach the conclusion that they have explored all the possibilities for the patient, the next step is to find a way of disclosing the information in a sensitive and appropriate way.

How to deal with delivering an unpopular message

Many people don’t recognise the difference between joint pain and muscle pain after activity but this is a fairly important thing to recognise. Joint pain, in fact, is not something that should happen after conducting an activity, while muscle pain is a much less sinister problem that can still cause discomfort but without great consequences on the long run.

So, disclosing an unpopular message is never a pleasant conversation to have with people because, while their expectations might be to go back to conducting their hobbies normally (whether this is running, playing football or going on on walks), the clinician will have to inform them that this is no longer possible due to their condition. Part of the physiotherapist’s job is to find the right worse to give someone the news they weren’t expecting to hear and, as David says, it is important to be realistic and honest.

Once all the information has been given to the patients, it is then their time to decide whether they want to follow the advice given by their clinician or seek a second opinion. Sometimes clinicians decide to avoid the conversation, denying the patients the transparency they need to better understand their problem and leaving them to deal with their problem in their own way.

Another controversial topic for today’s video. Make sure to keep an eye out for next week’s video and don’t forget to watch David vlog on Delivering unpopular messages to patients to know more about what he has to say about this difficult topic.

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