It is said that 106,000 patients or more die each year from adverse prescription drug reactions.  Although there are a growing number of people disillusioned with the “pill-popping” culture there is still limited awareness of the services that Physiotherapists provide.

There are many reasons why people are resistant to seeking treatment and today I would like to look at some of these reasons which are barriers to treatment.

1. Health is how you feel – Most of us were taught to judge our health by how we feel.  People only show up when they have an ache of pain and discontinue their care when the pain goes away. This is a universal healthcare problem.

2.  Maybe it will go away – As many health problems have gone away on their own the first inclination maybe to wait and see.  This notion maybe driven by several possibilities: it maybe attempt to avoid looking foolish for a problem which isn’t really a problem or a desire to avoid being a patient and getting caught up in a medical system which may ultimately be driven by profits rather than patient need. (I hope readers have resolved this potential conflict!!)

3. The isolationist view – Many people consider different parts of their bodies as separate systems without fully understanding the integrated function of the musculoskeletal system knowing that “the dodgy knee” ultimately distributes pressure to the hip, lumbar spine or opposite leg would alter the perception of significance of problems which are not sought to be treated.

4. Lack of clarity – Given the vast number of available treatment options for low back pain it is often difficult for patients to make an informed decision as to where the appropriate first port of call is.  We are all aware of the patients who have become somewhat disillusioned with the routine of GP’s prescribing anti-inflammatory medication and ultimately end up searching for their own solutions, which can be off on tangents unlikely to solve their problem.  It is therefore only people who had a positive experience of Physiotherapy intervention who are likely to recommend / refer and perceive this as the first port of call for musculoskeletal conditions.  This also raises the important issue of how do patients know what types of conditions are musculoskeletal or not.  This is relatively straightforward in the back or a limb or joint related problem but much less clear-cut in a transient neuropathic problem e.g. headaches, TMJ pain of myofascial pain syndrome.

5, The mind/body dis-connect – More and more healthcare professions discover the mind/body connection although most patients remain oblivious to how their thoughts and emotions affect their health.  In fact most patients divorce their minds from their body.  This maybe a product of social conditioning from our perceptions and expectations and of course the medical model of the Cartesian separation of mind and body, which has dominated medical thinking for hundreds of years until the last few decades.  We have discussed this in previous posts.

6. Cost of treatment – This is a significant barrier to many patients and unfortunately the Public Health System is frequently dysfunctional. The option to rely on effective and efficient delivery of care can be compromised by long delays in accessing the system and significant pressure on treating clinicians dictated by staff shortages and constraints on treatment numbers /frequency.

7.  Convenience – Patients may perceive that self-direct treatment is more convenient without questioning the effectiveness. Look at the vast array of ancillary products available such as hot packs, cold packs, gels and numerous devices all sold as solutions to problems without knowing the factors causing breakdown in the musculoskeletal system. It is difficult to make an informed choice as to the appropriate types of interventions necessary.

8. I  hate doctors – This is a very common opinion to verbalise in a subjective examination and may well be reflective of an attitude in seeking assistance for healthcare matters.  There are many possible reasons for this attitude which could include the following: painful childhood vaccination experiences, class envy, low self-esteem, fear of the unknown, being touched by a stranger or wanting to avoid the feeling of dependency.  There are probably also many other reasons.  It may also perhaps be a badge of honour to claim independence that we don’t need the assistance of others in the management of our health.

9.  Short term planning/living for today – The more complex and busy lives get the ability to prioritise priority tasks can become more challenging and it’s simply easier to maintain the status quo and do nothing than to take positive action and seek care.  Often this decision to seek treatment is driven simply by the progressive loss of function and the inability to participate in activities, which are part of normal daily function.

10. Technology will save me – There is a false but wide perception that the latest scientific research will reverse self inflicted damage and live for today lifestyles.  Observing some of the marvellous developments in areas such as organ transplants, miracle drugs and surgical breakthroughs this can substantiate this viewpoint.  We all know this is not the case in reality.

11. Victimisation – Any effective treatment plan requires the patient to assume significant amounts of responsibility.  This can run counter to the prevailing attitude of expectation that somebody else will provide the cure.  This responsibility extends to the frequency of visits, the early recognition of symptoms and following treatment programmes through until they have reached a full conclusion.  For some patients it is simply easier to relinquish their responsibility to an insurance company, an employer or the Social Security System rather than taking direct responsibility of care.  In other words they adopt victim behaviour.

12. Fear of dependency – This is a legitimate fear that many patients have and is partially driven by the apparent conflict between private healthcare which is part of business organisation and the recognition of clinical need. This indeed is a conflict that many clinicians wrestle with whereby patients are  not informed of the  prognosis, are still pursuing a cure for a problem which essentially is a management issue or are brought back for continuous reviews when their condition has resolved..  This damages the credibility of the therapist and creates a barrier for intervention.

Acknowledging these issues requires a deep evaluation by the clinician in terms of how they deliver their message / skills, and how to impart appropriate knowledge so that patients can make an informed decision. The clinical aspects are sometimes the easiest!!

Enjoy the clinical challenge.
David

© David for PhysioDigest - an educational resource for the musculoskeletal rehabilitation community, 2010. | Permalink | One comment | Add to del.icio.us
Post tags: attitudes to health, becoming a patient, compliance, dependency, fear of treatment, healthcare, Patient compliance, Previous response to treatment, therapist attitude, treatment

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