Empathetic Communication: Navigating Prognosis Discussions with Patients

Doctor, will I ever get better?

What is my future going to look like?

Will I be able to walk?

I don't see any improvements even after 1 month of Physiotherapy, why is that so???

Getting stuck talking to your Neuro patients about their prognosis?

Let’s figure out how to deal with that.

We had a patient with C6-C7 level complete SCI coming to us for almost 1 year of treatment. In the beginning he would ask us when he would start walking. Later as he started progressing with his physiotherapy treatment (mind you, the progress came slowly), he would be talking positively about future plans and how he would start walking.

As a physiotherapist who understands the prognosis of SCI and as an ethical practitioner I felt it was my duty to give him information about what his future would look like, and what would be the maximum level of achievement for him. It was not easy- balancing the real picture of his disability along with still trying to be positive and having hope myself about his positive progress, I would give him a reality check. After that he would be much more aware about his condition and what his future will look like.

How do we do this? How do we make the balancing act successful?

Let's go through some ways to deal with that:

1. Know the disease yourself: You should be reading about the possible outcomes, prognosis, whether physiotherapy will be helpful to the patient (99% it is helpful), but you should be knowing how helpful it would be. Whether it is for maintenance, or whether you have goals pertaining to progress. Always have goals!
2. Visual feedback helps: You can take videos and photos of day 1, and every 10 days take the same videos and show them to your patient. This gives them visual feedback as if it is a 3rd person who is progressing. This will help with patient satisfaction. This will help you to track where things are going right and where you need to be working.
3. Use the online platform: Search for any similar content, eg. videos of a quadriplegic walking with assistive devices, and show them to your SCI patient. You can also download graphic images of an individual with Parkinson’s disease and send it to them to inform them of how their disease progression may look and how Physiotherapy can help to avoid or delay that. Send them articles, research papers, pictorial form of guidelines (if they are inclined to read).
4. Take outcome measures: using an outcome measure like UPDRS for Parkinson’s disease will help the patient and you to track the progress. It will also help the patient understand what are the significant impairments they are having. Most of the time, they are not fully aware of what is going on. I can't tell you how many times there have been individuals with Parkinson’s disease coming to me with a significant cognitive impairment and them not being aware of it. There would also be individuals with hemiplegia coming with a chief complaint of lower extremity weakness but would not be aware about the impairment in their upper extremity and balance. So always take outcome measures.

As you progress in your journey as a clinician, you will be able to give better patient advice and your soft skills will enhance. Do not be afraid of making mistakes and admitting to the patient that you will “read about it”

So that's it from my end. What is your “Go-to” technique of patient education? I would love to know!?

See you next week with another soft skill topic. Stay tuned.