Patients – What’s their Story

What are our patient’s telling themselves when they get injured? What’s their story?

The narrative could be simple. The injury is simply an injury. With management, it’ll get better.

But, of course, there are others who tell a different story. Often a story with many layers – like an onion.

I deserve this injury because…

I think my next door neighbour had this injury and it took four weeks for him to be back at work. It’ll probably be the same for me.

Some massage and mobilisations and I’ll be right.

Today, we explore a few of the more common patient stories. When we assess and treat, we must look for common threads in how our patients presents. What language do they use? Do they engage in the rehabilitation process? What obstacles do we notice?

The Hero

Here, the patient immediately identifies as the hero in their story. They understand they are integral to their recovery. Therefore, they’re happy to take an active role.

They succeed if we…They fail if we…
Reinforce their role as heroDecide we’re the hero in their story. We dictate rather than guide
Communicate simply and clearlyOvercomplicate and confuse
Share and encourage self-management strategiesInsist on passive treatment modalities

The Victim

This patient believes others will fix their injury. In their eyes, their problem is not theirs but ours.

The common traits of the victim include poor engagement in rehabilitation, insistence on massage and other forms of manual therapy and perhaps even language to suggest that we’re at fault when their pain lingers.

They succeed if we…They fail if we…
Can convince them that their involvement is integral to their recoveryFail to assert that they are the hero in their story
Use different information sources to reinforce the key rehab messagesUse only one method of communication
Help them understand that passive treatment will only help in the short runYield to their need for passive care

The Combative Patient 

Cynicism towards us and the profession are key features of this patient. They may have had a bad past experience with a health professional. Or, their general life experiences have shaped their sceptical outlook.

They’ll be defensive early on. They’re not convinced about what we do (or even if we can help them).

They succeed if we…They fail if we…
Share key messages from different angles. For example, online resources from experts who reiterate what we’ve saidButt heads and insist that what we’re saying is law
Persevere. Time is a key factor to break these hard nutsLose heart and the will to persist
Can demonstrate positive change (improving their symptoms)Stick to the facts and data and don’t demonstrate meaningful change

Also, it’s a good idea to acknowledge your flaws and the inherent uncertainty. I admit, I don’t know why your pain presents like that. But I’m confident that I can find a pattern in time.

The Lazy Patient 

Do you ever get the impression that a person’s problem is not a high priority for them?

This patient routinely misses appointments. Sorry, mate! I’m flat out at work and completely forgot about it!

This patient tends to pop up on a routine – such as once a month – for a touch up. That is, a few mobilisations and cracks and they’re good to go.

In short, very frustrating.

They succeed if we…They fail if we…
Help them understand that they’re pivotal to their recovery. Analogies are useful hereExpect them to engage without first having convinced them
Give them self-managment strategies that quickly improve their symptomsGive them home exercises that don’t yield a fast tangible result (such as reduced pain or improved movement)
Take a step back and don’t over-commit. Maybe they’re happy with handing over their care to us (even if the end result is less than optimal)Over-commit and get frustrated by their lack of progress

The Time Frames Patient 

Here’s a patient whose injury tends to coincide with certain times of year or landmarks in their life. For example, a parent who hurts his back at the start of the school holidays. Or, the worker who strains a shoulder but is also thinking of quitting her job.

Their presentation lacks consistency. Many times, it resolves spontaneously (once they’re ready to be better).

They succeed if we…They fail if we…
Uncover their time frame and understand their motivationsDon’t unearth the underlying injury driver
Keep things simple and don’t overburden them with lessons and exercisesForce their recovery and over-complicate

A Tall Tale

This, of course, is only a guide.

First a foremost, we should work as expert diagnosticians. Secondly, we should have a general sense of our patient’s style and story.

There are other patient stories – and combinations of stories – too. Which ones have been missed?

Author: Andrew Cammarano

Andy writes about anything that comes to mind. Oftentimes, he repeats himself. So, if you read a post and ask yourself, "I feel like I've read this before." Chances are you have. Apart from writing, he eats a diet high in peanut butter, he exercises (and suffers from a chafed butt from performing too many sit-ups in pursuit of a six-pack) and comes up with many fantastical ideas, like his peanut butter-based chafe cream. Reach out to him to share your opinions (or if you'd like to become his chafe cream business partner).

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