I am still on my geriatric placement at SCGH. I was treating my patient with alcohol induced 'MS' (symptoms similar to multiple sclerosis). He is not the most enthusiatic of patients and he does not talk much, which has made it hard for me to build repoire with him. It was his second treatment session and his carer had mentioned that he had not want to attend today, but felt obliged. During the treatment he did not say much, and alluded that he did not see the point to his treatment.
I decided to explain to him what our aims of treatment are and that he has a choice with regrads to his treatment. I told him that if there is anything that he does not like or want to do, to tell me and we can discontinue it or think of something else to do. The patient seemed to become more complient from then on, and agreed to come back for another session next week.
My supervisor had overheard this and told me that I had handled the situation very well, but that his carer did not think so. The carer beleived that he should not be given the choice because he will use it as an excuse not to attend physio, and that he should be attending physio because it is doing him good, even though he doesn't want to come. I beleive I did the right thing, that the patient always has the right to decline treatment. But it got me thinking: what if you had, for example, a stroke patient, that you knew had a lot of potential, but they had no motivation or interest in their treatment or recovery. Would you keep treating them if their carer/family wanted you to, as it would make the patients's and the carer/families life easier?
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For the patient that you'd worked with (alcoholic MS), I'd like to think my approach would be similair to yours, in that convinving the patient that therpay will benefit him in the long term while also allowing the patient to feel like he has some control over his situation. I can only assume that if a person had a condition that was affecting their quality of life, that they would not also want to be told what to do and when to do it. In that case they would be physically limited, and also feel as if they had no / little control over thir choices. That would possible just cause the patient to lash out and attempt to regain any control they could (or at least, I think I would).
However for the patient such as a stroke patient with a potential for significant recovery, ultimately you would hope to push them to maximise their treatment sessions and make the most of the facilities available to them while in hospital. It would be understandable if a patient in that condition was depressed or not compliatn due to low mood after such a potentially life changing event, but you would still hope that you could convince them of the potential benefits of rehab. Ultimatley it could be as important to try convicing the patient to accept treatment or getting his/her families support as opposed to treating them agains their will.
Although ultimatley, it is the patients right to refuse treatment, you would jut hope that they could be convinced to see the positive side of therapy
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