“Do I really need PT?”

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Recently, I had an initial evaluation for a patient with right shoulder pain. She had previously attended physical therapy for the left shoulder after having injured both UEs when trying to assist her husband in attaching a hitch to their car. At the time of the injury, the L shoulder hurt more than the R, so the focus was on restoring the L shoulder’s function. Now that it had been multiple months after the initial injury and the L shoulder had improved the patient arrived to PT hoping to focus on the R shoulder.

Early on into the evaluation, the patient noted that she wanted to “know what was wrong” with her shoulder. I responded by telling her that I would need to do some tests and measures to determine that. During the objective portion of the evaluation, I told her some of the findings as we went and gave her a short summary of what I found at the end. At the time, I was a little unsure of exactly what I thought was going on so I intentionally left my description vague and focused on assuring the patient that it was okay to use and move her R arm/shoulder. Her immediate response was relief that she was not further damaging her arm by moving it.

After giving the patient some preliminary exercises, I went over the schedule and walked her to the front. As we got to the front desk, the patient turned to me and said, “Do you really think I need to come back?”. I was taken aback and the pt continued stating, “If the muscles and stuff are just irritated can I just use it at home and it should get better?”. I immediately realized that I had not done a great job of explaining her condition. Since the pt was on her way out the door, I quickly told her the benefits of PT and why she needed more visits all while deeply hoping she decided to come back.

Reflecting back on this situation, I realized that I was lucky. The patient did return and was clearly still not understanding what was “wrong” with her shoulder; however, because she returned, I was able to give her a better explanation of her impairments and possible diagnoses. Having learned from the previous encounter, I pressed further to make sure she actually understood what I was saying. From this situation, I realized that while sometimes being vague in explanations is helpful to patients, there are clearly situations that need more specifics or at least confirmation of understanding. I also realized that there is such a thing as being too nonchalant and leading a patient to think that nothing is wrong and that they don’t need PT. In the future, I need to be more cognizant of the deeper meaning behind a patient’s words. I took what the patient was saying about “needing to know what was wrong” at face value, likely thinking “okay, right everyone wants to know why they are hurting”. In reality, I should have realized the persistence of this comment and used it as an educational moment for the patient to ease her anxieties and fears that something truly was “wrong”.

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