Do you care too much?

How far will you go for your patients?

Yes, you can enjoy patient’s company.  Yes, you can desire to give them the best possible care and yes, you want to act in their best interests.  But remember it is ultimately the patient who controls the relationship.  Smothering with care can produce resentment, poor compliance and appear unprofessional (desperate) from the patient’s perspective.  Of course it is also a serious drain on your personal time and energy.

Sometimes the desire to over deliver, is driven out of the need to produce meaningful change in as short a period of time as possible.  In practice this typically means combining assessment and treatment simultaneously.  If we reflect on how many other medical consultations are conducted, it is rare for assessment and treatment to be delivered on the same day.  It is far more common to plan a treatment schedule, arrange for tests as part of a differential diagnosis and formulate a working hypothesis from which to administer care.  Patients expect and accept this from other medical colleagues. Is this not a reasonable model to adopt in physiotherapy practise?

When a patient observes that they are not making the progress that they expected, do you feel responsible or threatened?  Are you comfortable about revising your working hypothesis and modifying your prognosis as your interactions with patients evolve over time, the greater complexity of contributory factors emerging as you dig deeper or get exposed to more of the patients thought processes?  For most in the caring professions, empathising, connecting, well wishing and relating to patients on an emotional level is a natural reaction – but it does pose an occupational hazard.  As with many things in life “moderation is the key”.  Remain aloof and patients feel isolated and neglected.  Overwhelm patients with your interest and you can suffocate them producing guilt, suspicion or both.  Finding a balance is the art of successful therapist/patient relationships.

Is your heightened sense of caring the result of investing your self-worth in the apparent effectiveness of your treatment?  The gratification achieved from positive outcomes is heavily countered by the effect of negative experiences, which can drain the therapist, produce tension between patients and therapist and generate a reciprocating blame situation – you’re not better because you haven’t done your exercises”  only to be countered by “your exercises don’t make any difference”  or “I paying you to fix me” Of course frequently this may not be openly verbalised but intimidated or interpreted.

The caring continuum has two defined end points.  Engulfment (care too much) and indifference (care too little).

So what is the key to finding the middle ground?

1. Recognise boundaries.
2. Acknowledging the importance of balance.
3. Look to the patient for guidance.
4. Remain flexible.

Enjoy the clinical challenge.

David.