The Health Quality Council of Alberta (HQCA) works alongside the public to ensure that Albertans experience safe health care that is person-centered.1 Recent work by the HQCA has focused on educating members of the public on how to make the most of their health-care experiences and teaching people how to advocate for themselves when discussing their or their family’s health-care needs.
Physiotherapists recognize that patient views, experiences, and characteristics create differences between patients and that each patient must be treated as an individual. Each individual may have differing perspectives on what they value and what their goal of care is.
However well-intentioned a treatment plan, if you don’t agree with your physiotherapist there will be conflict. Luckily, there are options in how you can deal with that. This article will highlight how to manage a disagreement with your physiotherapist regarding your proposed plan of care and will link you to several resources the HQCA has regarding working with health professionals.
The Working Relationship
A therapeutic alliance is a professional relationship between the physiotherapist and the patient. Together they discuss treatment options, and the physiotherapist helps the patient to make informed decisions rather than imposing a treatment plan. The physiotherapist and the patient work together to identify goals and create a treatment plan with the physiotherapist utilizing their knowledge and experience and the patient providing their values, goals, and lived experiences. The patient-physiotherapist relationship should be patient-centered so that the focus is on the patient’s individual needs to assist the patient in reaching their goals. In these working relationships, both the patient and the physiotherapist have a role to play.
The Patient’s Role
As the patient you have a critical role in the therapeutic alliance as you are bringing your perspective, goals, and values to the conversation. Your role includes:
- Identifying Your Goals: What is your reason for attending physiotherapy? Can you identify the things that you are currently missing out on or what your main motivation is to see a physiotherapist? Sometimes it is easy, such as breaking your leg and needing to get back to work or sport. Other times it can be more challenging to identify what you need but providing goals and identifying “the why” allows the physiotherapist an opportunity to understand your perspective and helps with treatment planning.
- Identifying Your Values: This can assist your physiotherapist in identifying what you value in your current lifestyle. Do you have a remarkably busy life with little time for “extra stuff”? Do you enjoy spending time exercising? Is work a bigger priority or is it spending time with your grandkids? Your physiotherapist can utilize this information to create a plan of care that suits your lifestyle and reduces the impact of illness or injury.
- Engaging in Your Care: Patients who attend physiotherapy are often engaged in their care. You have an injury or issue that is limiting your ability to participate in all the things you want to do and you most likely are engaged in the process to get you back to those things. Being engaged in your care leads to better results from physiotherapy. However, there are times when your ability to be engaged is challenged. It could be mental health issues like depression or anxiety that limit your ability to be engaged in the process. It could be anger at your situation and what brought you in to see a physiotherapist such as a car accident caused by someone else or your employer if you got injured on the job. The physiotherapist has the responsibility to work with you to help you get engaged and to assist you with addressing the underlying issues that are preventing you from being an active part of the patient-physiotherapist relationship.
The Physiotherapist’s Responsibilities
The physiotherapist also plays a critical role in the therapeutic alliance as they bring their knowledge and expertise to help you reach your goals. The physiotherapist has the following responsibilities.
- Listening: The physiotherapist should be inquiring about your goals, your values, your injury, your past medical history, etc. all to gain a better understanding of what brought you to them. A large part of being able to deliver quality care is creating an environment which allows the patient to be heard.
- Creating an Individualized Plan of Care: Once the physiotherapist has gathered all the information on your injury and how it is affecting your life and discussed your goals, they need to work with you to create an individualized plan of care. This means that they have used their knowledge, their experiences, the best available evidence, and tailored them to your current situation. The plan of care should include options with the ability to amend it as your condition changes and according to your preferences.
- Providing Options: Person-centered care recognizes that you may have preferences in the care that you receive. The physiotherapist should provide you with a plan of care that they think will work best for your condition and align with your priorities and discuss other treatment options available. As mentioned above you have a role to be engaged in the process of your care and part of that would be to discuss how the physiotherapist’s proposed plan of care would fit into your life.
The HQCA
As mentioned previously, the HQCA is a provincial agency that has a legislated mandate to improve patient safety, person-centered care, and the quality of health services across Alberta.1 It has many useful resources that the public can access, including the more recent initiative “Working with Your Healthcare Team”. There are resources available such as advice on talking with your health-care provider, potential questions you should ask your provider or questions to ask about the treatment options offered. There are resources offered in languages other than English.
The College recommends patients access these resources even if they are not having any issues with their physiotherapist as it can make their experiences in health care more positive or fulfilling. One of the specific resources available on the HQCA website is “Tips for Talking with Your Healthcare Team”. To build on that topic we have put together a section on how you can be an advocate for yourself if you disagree with your physiotherapist. Again, being an engaged part of the process will help you get the most out of your care, but your physiotherapist has the responsibility to address your concerns.
What Does it Mean If There is a Disagreement?
The therapeutic alliance is a relationship and there are inevitably disagreements that will arise when one is in any form of a relationship. Sometimes there are challenges in recovering from an injury or dealing with a chronic condition and it is ok to disagree with what your physiotherapist is suggesting. The physiotherapist will hopefully have noticed that there are issues in the therapeutic relationship and will be actively working to address them. As mentioned previously, both the physiotherapist and the patient have ownership over the therapeutic relationship and so both should be taking steps to address a disagreement. The following are suggestions that may help you, as a patient, work through a disagreement and frame a conversation with your physiotherapist.
Identify the issue and reflect on where it could have arisen.
What is it that you feel is being missed or are there certain aspects of your care that aren’t being addressed? Was there miscommunication between you and your physiotherapist? Is there an expectation that you had that isn’t being met? Most often, once you can identify and express your concerns to the physiotherapist you will start a discussion that can result in a mutually agreeable solution. Communication is a common source of problems in any relationship, so reflecting on both your style of communication and the physiotherapist’s could result in fewer issues moving forward.
Create a goal of what you would like to happen and plan out your discussion in advance.
Prior to the conversation outline what you would like to have happen. Do you need the physiotherapist to listen to your concerns? Are there goals that you have expressed that you feel haven’t been identified in your plan of care? Starting the conversation without a desired end point reduces the likelihood of having your concerns addressed.
Be honest and upfront during the conversation and try to keep the discussion to your outlined plan.
It is easy to become flustered, anxious, or hesitant during a conversation about something that has been bothering you. Patients can shy away from these types of conversations because they can see that their physiotherapist is doing their best and they don’t want to upset them. However, having a patient talk about their concerns is essential so that the physiotherapist can adjust their approach to help them get better. Rehearsing the conversation can be helpful, but if the conversation is steered in a direction you weren’t prepared for try to bring it back to the reasons you had laid out. It is best when communicating with someone regarding a challenging situation to be honest with them about how you are feeling and what you wish to have happen. The physiotherapist should be able to address your concerns once they are made aware of them.
Listen.
During the conversation there should be moments when you express your concerns and what you would like to have happen. Within a therapeutic relationship there should also be moments where the physiotherapist can explain their thought process, the assessment findings, and other things that led to their clinical recommendations initially and be able to address your concerns. Active listening needs to occur to make a conversation work well, there should be time for the physiotherapist to respond to your concerns as the discussion goes back and forth.
Conclusions
You will hopefully be able to wrap up the discussion in a way that you are satisfied with. There should be attainable goals set out and both the patient and the physiotherapist should have a more positive outlook on the therapeutic relationship. If this isn’t the case, then you need to evaluate your desire to continue with the therapeutic relationship.
Ending the Therapeutic Relationship
Sometimes things just don’t pan out the way we expected them to. You or your physiotherapist may choose to end the therapeutic relationship if there have been some identified problems that aren’t being resolved. Know that you are free to choose to move on to another provider if your concerns have not been resolved. If your physiotherapist thinks that the therapeutic relationship needs to come to an end, they should provide you with the rationale for making that choice.
Your physiotherapist is expected to assist you with transitioning your care to another physiotherapist by providing information on other physiotherapists within the practice or at other practice locations where you can receive physiotherapy services.
Sean FitzGerald, PT
