Update: Under The Knife

For those of you who are avid readers of our blog, you may recall a previous post of mine last spring that discussed my future hip surgery, and how the process of injury and surgery might enhance my understanding as a physician. Lessons have definitely been learned from this experience, and I would like to share an update!

Last week, I was in my local physical therapy office working with my PT (physical therapist). I work once a week now on my strength, mobility and flexibility. I was curious of what my therapist thought of me and my case – my compliance, the complexity of my case, etc. As we were working, I asked him if I was a complicated patient. Being an athlete and always game to work hard at my appointments, I thought I would probably be a pretty good patient to work with; little did I know, my case is no cake-walk for my physical therapist.

The surgery I had is a newer operation and uncommon; my PT has never worked with a case like mine before. All that aside, it’s actually me as a person that’s complicated my case. This surprised me, because I know I want to get better and I am not unwilling to work and I don’t consider myself a difficult patient. He said that, because of my busy schedule as a medical student and my lack of ability to do my rehab on my own all the time, I complicate my own progress and recovery. I could have guessed this, knowing I tend to slack off for the sake of my schoolwork, but it made me think about my future as a physician.

Patient compliance is a challenge everyone in the medical world faces. We can give a patient medicine, instruction, and set follow up appointments, but it’s up to the patient to comply, put forth effort, and really care about his or her own health so that they improve and our care works. I’m certain this is something I am going to have difficulty with in my future career, and my patient outcomes reflects on my abilities as a physician. It’s one of my goals to get my patients motivated to take care of themselves. I have always thought I might be good at this role; I can motivate myself to stay healthy and perhaps I can share my methods with patients. But the past seven months following my surgery have been very difficult and I have a new respect for those who find it difficult to comply with the doctor’s rules.

There are many reasons why a patient might not listen to a doctor; I realize now that it may not just be a bad attitude and laziness, as I once incorrectly and unfairly judged. I know that I am not a lazy person; no medical student is. But other reasons have caused me to be a non-compliant patient. Over the course of our training as physicians, we learn of many other reasons why compliance is more – lack of ability to travel, lack of finances, lack of the ability to take care of oneself, or lack of insurance. Maybe they don’t see a point in trying if they have many health problems; this is understandable to me, as I’ve gotten very discouraged with my rehab. It’s much more complicated than simply not listening to the physician.

I want to be able to run again, gain back full mobility in my hip, be able to stretch and move and have balance, and more than anything I don’t want to struggle to walk a few blocks anymore; these are all things I’ve struggled with over the past several months. But sometimes, life takes over – schoolwork and the little amount of time I get to have a social life or sleep seems to come first. How can I motivate patients if I cannot seem to motivate myself?

One approach we are taught in our “stages of change” method is to give the patient the risks of their behavior – this is by far my least favorite tactic, and not one I look forward to using. It’s a scare tactic – am I a good physician if the only way I can motivate my patient is to frighten them into being better? This does work for many, as these risks can be wake up calls, but I think practice the compassion I have for my patients, I need to help them to help themselves my inspiring them. I can be better.

I don’t have a solution for this yet. It’s something I need to work on, practice, and research for the many years of training I have ahead. I am again inspired by something my physical therapist told me. He said that he finds it interesting trying to determine what makes patients work harder during their therapy session; what motivates them to care in that little room in a basement gym. It changes for each patient, and you have to find it. Perhaps it’s giving a patient who’s missing Zumba classes some up-beat music, or maybe it’s getting a retired out-of-shape swimmer to use her muscles and feel like an athlete again. I need to find what inspires my patients, and that requires me to be a caring, compassionate physician.

Laura Simon

I was born in Erie, Pennsylvania, but have lived in Greenville for the past 13 years. I graduated with a degree in Biochemistry in May 2013 at Virginia Tech, where I swam for the varsity team. My pursuit of a career in medicine began with my interest in biochemistry and physiology. I really enjoy reaching out to my community and interacting with people. I am excited to begin my medical career and make an impact at USC School of Medicine Greenville, where I can become a well-rounded, compassionate and successful physician, improving the lives of my patients.