Do You Know What Your Patient’s Health Goals Are? You May Be Over Treating Them And Losing Their Trust In The Process

[tweetmeme source=”Healthmessaging” only_single=false]A 69-year-old woman who swims in my Master Program came back to the pool after a total knee replacement.   I asked her how she was doing.   She said she is still in a lot of pain because of her physical therapy.   She said that her physical therapist was disappointed that she still was still unable to achieve full flexion of 120 degrees.   Why 120 degrees?   Did you set that goal I asked her?  No she said…the therapist did. 
She went on to tell how she already had more range of motion in her knee than she did before the surgery.   My friend was quite satisfied with her progress and wanted to stop physical therapy.  The pain from the PT was worse than anything she had experienced before the knee replacement.  I knew she and her 80-year-old boy friend were going on a cruise and she didn’t want to still be hobbling around.
It turns out that patients and physicians disagree on quite a few things.  We hear a lot about patient centered care.  You know that is where the provider is supposed to consider the patient’s needs, preferences and perspective when diagnosing and treating health problems.  But medicine is still very provider centered.
Disagreements between patients and providers like this happen all the time. By way of example, there was a recent study that looked at the issue of physician-patient agreement among patients complaining of low back pain. Researchers found that of the 336 patients, 12% disagreed with their physicians’ explanations for the cause of their problem, 9% disagreed with the physician’s diagnostic plan (some wanted an MRI), and 13% disagreed with the physician’s treatment plan.  Overall, 29% of patients disagreed with their physician on at least 1 key aspect of their care.
Providers are in a tough spot in these kinds of situations.  They have limited time during the appointment to spend chatting with patients about their thoughts, fears and concerns.  It has to be easier to just treat patients knowing that they will be happy with the results down the road.  The patient will get over not being “heard.”
Maybe they will and maybe they won’t.   But aren’t patients entitled to at least be asked what goals they would like to set for their treatment? Turns out that when patients feel that they and their physicians are in agreement, good things happen.   It the case of the low back pain study, patients report much higher levels of satisfaction and measurable improvement in their symptoms at 12 months.
As for my friend, I don’t think she will be going back to her physical therapist again anytime soon.  After all, she was back in the pool and going on a cruise with her boyfriend.   She had already met her rehab goal whether the physical therapist knew it or not.


Staiger, T., et al., BRIEF REPORT: Patient-Physician Agreement as a Predictor of Outcomes in Patients with Back Pain. Journal of General Internal Medicine. 2005 October; 20(10): 935–937.


2 responses to “Do You Know What Your Patient’s Health Goals Are? You May Be Over Treating Them And Losing Their Trust In The Process

  1. Geesh, that is so sad! Physical therapists have *way* more time to talk and communicate!

    An old study done by Laubenthal, K.N. et. al. way back in 1972 quantified the amount of motion necessary for activities of daily living. In that study, the knee was required to have 117 degrees for the person to bend down to pick an object up off the floor.

    It sounds like your friend is an active individual, which is great. The one area research is indicating patient unhappiness with knee replacements is in the area of strength deficits (even 2 years after surgery). If you happen to get a chance, when you see her next, ask how well she is able to climb up and down stairs. If that knee doesn’t have the strength to do the activity normally, it would probably be a good idea to have more strengthening of the muscles. I worry about these sort of things… strength deficits can lead to decreased function which can lead to falls. (Okay, I always think worst case scenario… but still.)

    I don’t know where you are located, but if the swimmer changes her mind about physical therapy, she can always fire that physical therapist. If she would like to do that and switch to a different one, let me know – I’m sure I can recommend a physical therapist that communicates better.

    As a side note… when it comes to communication, sometimes patient’s perceptions and interpretations interfere with the message delivered. I always wonder how I do with communication. Did the patient really hear what I said or did my message get lost?


    • Great comments! My friend’s therapist should have done exactly what you told me. He should have explained to her why it was important for her to achieve 120 degrees flexion. How it would allow her to swim better, walk faster, and leap small building in a single bound. Lol. She would appreciate that given how active she likes to be. Thanks again for the great reply.

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