The relationship between a physiotherapist and the patient is essential to the future treatment of the patient because a physiotherapist may treat a patient for an extensive duration. Effective communication is an integral soft skill that a therapist should utilise with each patient. Coiera and Tombs (1998) state it is essential that both parties achieve a shared understanding of meaning for communication to be considered successful. Hugman (2009), maintains an effective two-way communication occurs when the sender transmits the message and the receiver responds to the sender. Hugman (2009) continues that when we transmit body language, we reveal an unconscious state of mind and attitude towards another person. In the following example, there was a mixture of verbal and non-verbal communication, as well as problem solving involved. The first centre of discussion shall be in reference to a situation that arose between me and another individual who will be identified as Mrs X to maintain confidentiality as per Data Protection and Confidentiality Policy standards, Chartered Society of Physiotherapy (2018).
Mrs X entered the Musculoskeletal (MSK) outpatient clinic and I was assigned to assess her in the presence of the clinical educator. The assessment involved observation of the affected limb before palpating around the total knee replacement scar to check for swelling or abnormality. I asked her to sit on the plinth in long sitting with her lower limbs exposed. As I had gained informed consent, I resumed with the assessment by gently palpating the medial aspect of the affected knee and Mrs X exclaimed – likely in anticipation of pain – ‘If you touch it again I will smack your hand’.
How did you feel?
Immediately following Mrs X’s outburst, I felt extremely distressed (although I did not demonstrate this outwardly). However, this experience has since led to me being overly cautious when working with patients and has caused a dip in my confidence. Whilst I am aware that I should acknowledge that the patient’s hostility may be due to the discomfort they are experiencing, I am now aware how important it is to manage an individual’s emotions and recognise how they may be feeling in that particular moment; in order to help diffuse the situation, effective communication skills need to be utilised: through verbal interaction (reassuring the patient and explaining what to expect), whilst simultaneously interpreting the patient’s non-verbal cues.
What did you do?
I apologised profusely for pointing at the wound and accidentally touching it and attempted to use effective communication skills to explain that the palpation of the site, although uncomfortable, was nevertheless necessary to detect abnormalities such as increased temperature as this may be indicative of infection or the presence of deep vein thrombosis. I chose to adopt a co-operative approach to manage the presenting problem. I compromised with the patient by using active listening skills and reacting appropriately as I felt this approach would encourage the patient to place her trust in me. Owen (2013) asserts that when attempting to resolve conflict, one should consider compromise, which may ultimately lead to greater satisfaction for both involved parties. Owen (2013) goes on to state that it is the most desirable approach to resolving conflict when managing patients because it results in finding a mutually agreeable solution. To ensure a professional approach, it is imperative that the therapist is focused on solutions that are patient centred and achievable. Being in an outpatient setting, the kind of problem-solving that I was actively involved in was with long term issues as opposed to short term problems. However, each patient is different, I devise a subjective solution. I have learnt that the problem solving process of regression and progression of treatment to be particularly effective and it informs me to make the correct decision based on the individual. Furthermore, I have learnt to reflect on my decision so that I can assess if I could improve the next time I am faced with a similar situation. To assist with more complex situations, I asked my educator to provide a number of problem-solving stimulations – such as practice case studies with different scenarios.
What could have gone better?
On reflection, there is a recognition that more effort needed to go into using appropriate communication skills, which would have enabled me to take control of the situation by reassuring Mrs X, whilst engaging in active listening and responding appropriately. Allender et al., (2006) state that communication is a two-way flow of information that should nourish the service user and professional relationship and establish the base of information upon which health care treatment planning decisions are made and developed (p.453). Alder et al. (2009) suggest that a health care professional should be able to form an impression of a patient’s personality and assess how the patient reacts in specific situations. To be more effective as a health care professional, it is vital that I endeavour to understand a number of factors: the expression of anger; the specific problems arising from the anger; the function the anger serves, and the underlying source of the anger.
What have you learnt from this experience?
This experience has taught me that anger and aggression may be used to disguise a deeper-rooted problem and is not always personal. Moreover, McCracken (2013) suggests that anger may disguise fear; therefore, it is being used as a defence mechanism, whereby they feel safe from the risk of exposing their perceived weaknesses to others.
My action plan for further clinical practice is that I would learn how to listen effectively and actively, instead of getting flustered so that I only hear part of the patient’s problem and this ultimately leads to a less than effective service. Therefore, to deliver the best practice for the patient, it is essential that I communicate effectively. With regards to problem solving, I will carry on reflecting and creating case scenarios so that I can be as prepared as much as possible.
Alder, B., Abraham, C., Van Teijlingen, E. and Porter, M. (2009). Psychology and Sociology Applied to Medicine. 3rd ed. London: Elsevier Health Sciences UK.
Allender, J., Rector, C., Warner, K. and Spradley, B. (2006). Community health nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, p.453.
Chartered Society of Physiotherapy (2018) Data Protection & Confidentiality Policy V2. London: Chartered Society of Physiotherapy. Available: https://www.csp.org.uk/system/files/documents/2018-08/csp_data_security_confidential_information_policy_may_2018.pdf
Coiera, E. and Tombs, V. (1998). Communication behaviours in a hospital setting: an observational study. BMJ, 316(7132), 673-676. Available: https://www.bmj.com/content/316/7132/673.full.pdf+html [Accessed 16 Dec. 2018].
Hugman, B. (2009). Healthcare communication. 1st edition. London: Pharmaceutical Press, p.32-33.
McCracken, L. (2013). Anger, injustice, and the continuing search for psychological mechanisms of pain, suffering, and disability. Pain 154(9)",1495-1496. Available: https://journals.lww.com/pain/toc/2013/09000 [Accessed 16 Dec. 2018].
Owen, G. (2013). Managing Conflict. Frontline, (17). Available: https://www.csp.org.uk/frontline/article/managing-conflict [Accessed 06 Jan. 2019].