“Can you have a look at my back when you visit us tomorrow?” A friend sends me a text on Saturday. My phone rings, it’s my mother calling: “My ankle hurts. I am already unable to walk normally for the whole week now. What do you think it is?”
I am sure that I’m not the only one who gets these questions from friends, family or neighbours. An old wisdom among physiotherapists says never to treat family or friends. It is difficult however to say no to these requests and I still struggle with it. It also intrigues me though. With all the extra information you have about your mom, dad, partner or friend, it seems the ideal situation to understand the whole biopsychosocial context of the patient, thus being an opportunity to bring out the best possible version of you. So why the advice to say no? A couple of weeks ago I had some sort of epiphany about it. I suddenly understood more than ever why one should (best) refuse to treat “framily”.
It is precisely this extra information that makes it extremely difficult, if not impossible, to give these patients (and your treatment) a fair chance.
These days, we are all familiar with the biopsychosocial model. Every patient that walks through your door has a different psychosocial context, has accessed different information, has his/her own unique feelings and thoughts on what’s going on etc. Let’s therefore say that every single patient carries a different backpack. Whether or not this backpack contains the right equipment to tackle whatever is bothering him/her, that’s for you to find out (a see-through backpack would be too messy, right?).
You, as a physiotherapist, as a person, also have your own unique perspective on things. What you think about one’s pain or illness isn’t necessarily the truth. It is merely your –skilled- interpretation of what is presented to you. You interpret the information you get, the signals you receive, combined with the knowledge and (professional and/or personal) experience you have. By means of asking (the right) questions, observing and especially listening, the patient slowly reveals what’s in his/her backpack. And what’s in there can possibly be the key to success. So when a member of your “framily” becomes your patient, you already have an explanation at hand. You have already interpreted the situation, without first listening to the perception of the patient, starting from scratch.
And here we are. With all the prior information we have, we easily forget to look at the patient, or should I say listen to the patient? We do not ask the same questions, because we are convinced that we already know the answers. But can we not learn a great deal about the patient’s perceptions precisely based on their answers or interpretation or wording?
Therefore, I try to be honest with myself and disappoint my parents when they ask me to treat them or when they ask for my opinion, without a proper history taking or biopsychosocial assessment. Disappoint them by referring them to a highly skilled colleague, who doesn’t know them. Out of love for them and our trade.
Educational developer at the Faculty of Movement and Rehabilitation Sciences at KU Leuven – PhD student at VUB and UAntwerp – PiM member – Personal trainer – Physical therapist – Dancer – Daughter – Mother – Wife – Friend
2021 Pain in Motion
References and further reading:
doi: 10.1016/j.cpr.2010.11.002. Epub 2010 Nov 12.