The Monday Memo
June 30, 2014 PITT DPT STUDENTS
“All You Have to Do is Ask Why”
Last week we started our full time six-week clinical rotation. The inpatient setting was new to me, and I was going to be at the VA working with veterans. After the first day in the hospital I was instantly aware of the overwhelming amount of mutual respect that existed between the veterans and the care staff. I knew I could never relate to what some of the veterans have been through, but what I could do was thank them and make sure I provided them the best care I could.
This brings me to one patient encounter I wanted to share. My patient was a gentleman in is early 90’s who had suffered a fall back in April. He was advised to come to the hospital by his primary care physician with the main diagnosis of increasing lower extremity edema. Physical Therapy was being consulted to help determine the next course of action for the gentleman. Physicians and nurses had already seen the veteran and we were the last to talk to him. I conducted a brief history with this gentleman, and found that he had stayed seated in a chair for almost 6 weeks after the fall. I wrapped up my history by asking him one simple question:
“So, tell me, why did you sit in the chair for six weeks after your fall?”
His response was simple:
“I was simply afraid that it would happen again”.
I asked if he would be willing to try and use a walker and if he may be more inclined to get up and move around to which he replied with enthusiasm
“Well Yea! Can you do that for me?”
As I ask the veteran to wait one moment while I get a wheeled walker his wife comes around the corner to which he commented looking at her with a big smile, “Now that right there is the only therapy I will ever need”. I asked the gentleman to hold tight one moment and to just sit there as he attempted to stand again indicating, “Absolutely not, I need to give my wife a hug. This is the longest we have been apart in 69 years”. I bring the walker over; he grabs hold of the rails, gets a feel for the grip and then takes a few steps. He proceeds to look at me, and with a laugh and a smile, and says, “This is amazing, this is absolutely amazing, it feels good to stretch my legs and move”. We complete a lap around the floor and the whole time he is amazed and says he feels good.
After the session I spoke with my CI about the interaction. I was amazed that no one had asked “why”, because up to that point, that was all I really needed to ask. This man’s motivation was being at home with his wife. He didn’t need a skilled facility or care; he needed his companion and the walker to feel empowered and safe.
This experience taught me a lot about the power of open-ended questions and what it means to truly listen. The simplest of questions was consistently overlooked; by talking to this man as a person with purpose, I was able to determine his barriers to movement.
It is always important for us to remember that our patients are people who have a wide range of backgrounds and experiences. We must always be conscious of the patient’s concerns, and not to assume function based on a written impairment, diagnosis, or age.
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