Redirecting a Bad Experience

By Roy Rivera Jr., PT, PhD, DPT

In any line of work, especially when providing a service, there will always be patients and clients who are difficult or present a challenge.

Physical therapy, and health care in general, is no exception to having patients who are combative, hostile, or in a bad mood.

Most of the time, this is not something you should take personally. There is usually an underlying reason for them acting this way toward you, and there are always ways to change the course of the visit and your relationship with them. When it comes to physical therapy, the rapport you have with your patients is integral to the rehabilitative process and plays into compliance for returning treatment sessions. A bad experience could put them off from following through with their plan of care or even doing their prescribed home exercise programs. This can ultimately drive therapeutic outcomes in either positive or negative directions.

Thankfully, there are some ways that you can redirect a bad patient experience to ensure your patient is getting the best care.

STAY CALM

In these situations, it is easy to get upset and frustrated. We are, after all, only human, so when people raise their voices or are short with us, it is easy to respond hastily or take things to heart. We should be careful not to be dragged to that emotional place or to mirror the attitudes of our patients. The problem that the patient is having is usually not about us at all.

The patient could be dealing with any number of issues, and we should not immediately think their anger or frustration is directed toward us. The patient has a life outside of physical therapy, and, especially with what seems like an inordinate amount of social tensions surrounding us in the world right now, there could be any number of reasons why someone may be in a bad mood:

• Their underlying issues could be family or personal-relationship related.
• They could be worried about finances. It’s no secret that the cost of health care has been steadily increasing over the years and coming to physical therapy could be a financial burden in the moment.
• Medications can cause the patient to act out in certain ways or raise aggression. Therefore, a thorough pharmacologic history is vital in the evaluative process.
• Something could have happened during the day that left them in a bad mood.
• Their injury may be causing them pain or their physical therapy is not giving them the results for which they were hoping.

It’s hard to keep in mind that the way they’re acting is nothing personal because in the moment it can feel like it is. However, once we stop and make sure we are calm in that situation, it is easier to help them and redirect the situation into one that is more constructive and positive.

COMMUNICATION

One of the most effective ways to redirect a situation with a patient that is in a bad mood, angry or frustrated is through communication. By asking questions and being an active listener, you can get to the root of the problem to try to guide the situation to a better place. If the cause of their distress is unrelated to physical therapy, one technique to diffuse their anger is to redirect their attention to their care. Your role as a health care practitioner is also to provide recommendations or resources for healthy outlets for their anger, for example, exercise for stress management. But also know, there are certain situations where you may not be effective in redirecting because the circumstance is outside your control.

However, in other instances, a patient’s poor attitude may be related to their physical therapy plan, in which case, it is your duty to ask questions, listen, and collaborate on solutions to ensure they receive the necessary care they require.

For example, if a patient is argumentative over an instruction or particular intervention, you may try gently showing the patient that you understand they are frustrated and encourage them to elaborate on why they don’t want to keep going. It could be that they are in more pain than perceived, and this is the driving force behind their behavior.

You could also ask the patient for their feedback on what you could do to improve. Perhaps there is something they need from you or that they are not getting from physical therapy. It can also help you figure out if it is something irrelevant to their physical therapy session without seeming intrusive into their personal life.

If it is something personal to them and not something that a physical therapist can help with, being an active and supportive listener is always the best way to make the patient feel heard and safe, as well as a great way to build trust so that they return for future treatments.

FIND A SOLUTION

Once you have gotten to the root of the issue and have determined that you can help the patient, you can become part of the solution. You can make the decision to change up their treatments by altering the plan of care, especially if they are experiencing more or a different type of pain. Hopefully by adjusting their prescribed exercise routines, you will put them at ease a bit more so that their mood improves. If your patient is not seeing the results they would like or have other reasons for being frustrated with their physical therapy, take a moment to figure out why.

If they had seen a previous physical therapist at another location or had a prior bad experience, it can leave them jaded toward the idea of physical therapy in general. Perhaps they saw little to no results in the past so taking the time to explain your rationale for what you are doing might help improve their attitude and understanding of your chosen intervention. This extra step will help them understand why they may not be seeing immediate results as well as explaining to them that it will have an impact in the long run.

STAY ENGAGED AND WORK TOGETHER

If their issue is related to the physical therapy treatment, one of the best things you can do is to collaborate on your ideas and exercises. Involve them in the process. That way, they feel like their ideas and wants are valued, and they feel more cared for as an individual instead of “just another patient.”

Including their input is also a great way to set clinical goals and stay in touch with their own personal goals as well. Some people may not tell you what their personal goals are unless you ask so this is a great way to set intentions for your appointments and let them know what and why they are working towards.

By involving them in the process, they will begin to better understand the reasons behind what they are doing, and hopefully will lessen the anger or frustration and create a better working atmosphere. This will also strengthen the patient-therapist relationship.

If they give you feedback, make sure to keep it in mind. If they express certain limitations, make sure to take note of that while changing up their flowsheets or plan of care.

If they do not like a certain exercise, try to work through it with them and understand why they do not, and if it still does not feel right to them, figure out a new approach or new exercise altogether.

Doing all these things lets the patient know you are invested in their success and recovery, which means they are more likely to trust you, your staff, and your company. This translates into them being a repeat patient and more likely to return because they had a positive and successful experience.

STAY CONNECTED

Remember, there are always ways to redirect situations so that not every visit is tense and unproductive. Following up with a patient either through a phone call or at their next visit is a way to remind them that they are cared about and not just “another number” that gets lost in the crowd.

It can be hard to get those difficult or skeptical patients to come back for their subsequent visits, so taking the time and effort to make sure they feel their opinions are valued is an important part of getting them to return. When they do, you can follow up and ensure the techniques and exercises you prescribed are working, and if not, you can work together to find the best fit for their needs.

Keeping in touch with your patients and their overall wellbeing and success is a great way to maintain those relationships, which is vital to growing your business. A good relationship with your patients can lead to positive word-of-mouth testimonials or satisfied clients leaving glowing recommendations on your business’s website.

Last, remember you are human, too, and if the appointment gets out of hand and they become verbally or physically abusive, you should respectfully remove yourself from the situation and ask them to leave your clinic. Not every client, particularly an irate one who is beyond civil communication, is a good fit or a desired client. However, in most cases, with the right attitude, a calm demeanor, and willingness to help, you can diffuse and redirect a tense visit to help create a more positive outcome for you and your patient. 

Roy Rivera Jr., PT, PhD, DPT, is a PPS member and CEO and Director of Rehabilitation for Crom Rehabilitation in Houston, Texas. He may be reached at rrivera@cromrehab.com.