Physiotherapist or psychiatrist?

There is something I have noticed this week about neuro outpatient that hasn't happened before in my other placements. People want to talk. Mostly about themselves or their impairment.

In paeds the kids communicate with body and facial expression and aren't concerned or interested about the condition too much, they just want to play the game and learn the new skill or want to know that they are doing well and how many points they have in the game. Once in a while if they are really comfortable they will tell you about their family life (usually an embarrassing story the mom or dad cringes over)

In acute care a lot of the time the patients are pretty out of it or they just want you to go away. There is the odd one now and again who will divulge their entire history of how they came to be in the hospital. But usually the visit is so short that there is just not enough time.

But in outpatient rehab there is a lot of time the model we are set up with allows us to spend up to an 1 hour with the patients.

And so these patients who have usually been through the acute ward and rehab wards in which you see several health care professionals a day. Usually the staff doesn't have too much extra time to chat and sincerely ask the question how are you really doing and even when they want to they may not have time to hear the answer. They they are discharged and have appointments here and there with GPs and specialists who are very busy, so when they come to us they are really looking for someone to listen to them and to gain reassurance from.

That's where public out patient physios come in (an the rest of the out-patient team as well). Now that they have you to themselves for an hour. Many of them want to relay their story. I once asked my sister why people do this and she said its for a couple of reasons:
1. Maybe you have had a similar experience to them and will be able to share in your common experience
3. Many are looking for acknowledgement and validation of their experiences.
2. You know about their condition and will be able to assist them.

In the case of the physio its usually the latter 2 points the clients are looking for. And so I have had patients tell my preceptor and myself things beyond the scope of a physio's practice and beyond the scope of the team's practice (ie. psychiatric issues).

This is part of the job, right. Listening to the patient, validating their feelings, bulding rapport, establishing trust, letting them know what you can address and what you can refer them to for their other concerns. I am finding that this is part of the job, if it take a client 15 minutes to tell you all of the information that they want to tell you, you have often gained their trust. Afterwards the sessions flow more smoothly as the patient feels a connection and is more likely to buy into the exercise program because they feel like the physio understands them and is in tune to their needs and concerns and has their best interests in mind.

If physios aren't psychiatrists, they still can provide some comfort and reassurance simply by listening and providing thoughtful responses for the patient.