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March 8, 2010

Patients Need to Remember to Ask "Why?"

My mother-in-law has a friend who had become quite ill and her condition declined dangerously by the time she had surgery. As a result of her general debility, she was assigned to in-patient physical, occupational, and speech therapy. This woman assumed that being in physical therapy, she would be up and walking around and could not understand why she was relegated to moving pegs from one hole to another. As a result, she became quite depressed and found it difficult to muster the motivation to comply with her therapy.

I had my theories about the peg board exercise, but not being trained in occupational or speech therapy, I'm no expert. I assume that many of these "low level" activities involved assessing upper body function, stamina, and dexterity while also checking to see if there is any decline in mental function due to the patient's illness. The ability to read, write, and follow directions all measure cognitive ability. Many people do not realize that when they become quite debilitated or undergo surgery, the brain can be starved of vital nutrients or oxygen. Malnutrition can have a great impact on the electrolyte balance in the brain, resulting in low mental function. Certain medical procedures may compromise blood flow to the brain, especially if the operation takes many hours, and could cause short-term or long-term deficits in function. This is why no surgery where the patient is put under anesthesia is ever called "simple" surgery.

Not being one hundred percent certain why the therapists were having this woman do these tasks, I encouraged my mother-in-law to have her ask "why?" Many people who have been working in the same field for a long time (11, 17, 25 years) may forget that people are curious or may assume that nobody cares, so they don't bother to explain their rationale for why they have the patient move a peg from one hole to another.

It is always important that patients remember that they have permission to ask and a right to know what practitioners are doing with them. My mother-in-law's friend took the advice and asked to have the therapy explained to her. This allowed her to understand and "buy into" the therapy provided. I'm happy to report that she is home now and is feeling much better. Her depression has lifted and she is being treated by home-health until she is strong enough to resume her physical therapy at an out-patient clinic.

Posted by linda at March 8, 2010 5:27 PM