Patients unmotivated or faced with ineffective treatment will drop out

Dear Colin: I’ve been a physical therapist for 15 years and continue to appreciate your emphasis on proper exercise technique. How­ever, I can’t help but think you’re too idealistic, since most patients don’t seem to care enough about their health to follow through with exercises. In fact, most physical therapists I work with struggle to get their patients to even show up regularly to their appointments. Don’t you think the larger problem is patients not being compliant with what they’re being told?

Tom, Portland


We as health care providers (especially physical therapists) can benefit from taking a critical look at ourselves before casting blame on patients for being noncompliant with our treatment recommendations.

When a patient doesn’t show up for an appointment or doesn’t follow through with a home exercise program, it’s not necessarily because they’re lazy or don’t care. It could be because they haven’t been sold on why they should perform the exercises in the first place.

For example, in my clinical experience, when patients don’t show up for their physical therapy appointments or follow through with a treatment plan, it’s often because they believe their exercises are too complicated, ineffective, take too much time and/or involve equipment they don’t have access to.

It’s up to us as licensed physical therapists to provide effective, feasible and time-sensitive programs that meet patients’ needs and skills. When a physical therapist gives a patient a handout consisting of 15 exercises that are poorly described and not clearly understood, motivation is destroyed.

Then, when the patient doesn’t show up or doesn’t perform the exercises, it’s “the patient’s fault,” a perfect example of how ego can perpetuate health care mediocrity.

Physical therapists have the luxury of seeing patients multiple times per week and having insurance cover it. We need to take better advantage of this by getting patients more excited about their treatment program. To this end, our exercise programs must be highly effective and time sensitive so that patients are motivated. I’ve always believed that when a patient doesn’t follow through with my plan of care, it’s largely my fault because I didn’t do an adequate job getting him/her to buy into the program.

This does not mean patients are absolved of any responsibility. Quality health care depends on health care providers and patients working together to accomplish purposeful, measurable and meaningful goals.

The outdated white-collar perspective, “I know best, follow me blindly,” suggests health care providers shouldn’t be questioned, which is not true. Questioning us on any treatment recommendation (especially if the patient believes he is unlikely to follow through) is essential for optimum health care delivery.

We insist patients accept personal responsibility in managing their health, so shouldn’t we do the same by being continuously critical of our own recommendations?

For example, physical therapists’ erroneous belief that we are therapeutic exercise experts by virtue of our license continues despite the fact that physical therapy schools in the United States do not have a standardized therapeutic exercise curriculum.

We should be experts given our extensive training in anatomy and orthopedics, but are forced to learn their application specifically to exercise outside of our formal training. This is definitely an area where the physical therapy profession could use introspection so that we are better able to provide more consistent, effective and time-sensitive programs that could dramatically improve patients’ willingness to follow through.

Adopting this perspective can be uncomfortable, but is necessary for professional growth.

Colin Hoobler is a licensed physical therapist, hosts a live health segment on KGW Channel 8 and has written two books on exercise as treatment for disease and injury

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