Over the past four weeks on rural placement I found it difficult to discuss the option of discharge with a few patients, as they where not willing to cease treatment despite being relatively asymptomatic. One patient in particular, a 68 year old male with right low back pain and right lower limb pain/weakness with the medical diagnosis of L3/4 facet joint degeneration and mild disk extrusion, received treatment for the discussed twice weekly, for four weeks. This time period was discussed at the commencement of treatment and agreed upon if he was relatively asymptomatic after this period.
At this rural placement, like a majority of rural facilities, there is quite a large waiting list so it is important that if the patients have progressed to discharge then they no longer receive weekly treatment. But over the period of the four weeks I came to know the patient quite well, and he would bring me wooden pens he made at his wood work shop and express his appreciation at having some one to talk to because he was quite lonely. His treatment included PAIVMS, trigger point therapy of glut’s and Q.L, heat pack application and HEP. After the four weeks his pain was significantly decreased to WNL and he no longer experienced the radiating leg pain.
On the conclusion of the final treatment, he refused to accept discharge and expressed interest in ongoing treatment. So I discussed with him his underlying pathology, and how we have progressed as far as I can help, which he said he understood, but he wanted to keep coming in because it gave him something to look forward to.
After much discussion, he agreed that discharge was necessary, though I did find it quite difficult to be forceful in this situation. My supervisor confirmed that my actions were correct, though I still feel a little bad having to discharge him on that note.If any one has experienced similar patients and can share how they dealt with their refusal for discharge I would appreciate it.
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On my musculo placement I had a number of clients that the supervisor asked me to discharge who were very reluctant to be discharged. For these clients we set the discharge plan early during the placement and at each visit reminded the patient of the plan. In addition we increased the length of time between appointments pushed them out to weekly then fortnightly then monthly. At each subsequent visit when the client had shown no decline in function this was reinforced to the client so they felt comfortable that not seeing a physio regularly wouldn't lead to a decline in their functional status. Having established this plan with the client we also tried to find/suggest alternative activities for the client to attend e.g. community physiotherapy class, yoga, pilates. It sounds to me like your client was lonely and perhaps an autumn group or day therapy group could work for him. Being informed about all of these issues makes us a more effective therapist for our clients.
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