• Lian Yun-Perng, Physiotherapist

Stroke: I don’t want to be a patient forever!!!


Background:


Mr. A has had right upper limb and lower limb weakness for sometime, probably mid to late 2019. I only see him occasionally when he is in town. His walking was much better after we started physiotherapy as he was tripping less. His writing also improved since he had to write many cheques. At that time, Mr. A was healthy and had no intention to check his right hand and leg weakness.

We didn’t continue our physiotherapy programme when the Covid-19 pandemic started and Mr. A felt that his right arm was getting weaker as he couldn’t write or hold his stylus any more. That experience led him to consult a hand micro-surgeon in June 2020. The consultant ordered a brain MRI and a tumour (meningioma) was found on the left side of his brain. It was a shocker to us because I was only expecting a stroke at most.


The consultant advised him to see a neurosurgeon and to start physiotherapy asap which he did. His brain surgery was scheduled around mid July 2020. He brain surgery was successful but he had a small bleeding in the brain so he was in ICU for around a month before he was moved to HDU for about 2-3 weeks. I saw him in HDU around 4 times and he could barely sit; there was also minimum response on his right leg and hands. At that point, he had already started physiotherapy in his room and at the gym.


Finally, he was transferred to a normal ward and that’s when all the hard work started for us. We were working really hard to re-train his right hand to push and pull. He also put in a lot of effort to move his leg. He was having hospital physiotherapy twice daily and he saw me 2-3 times every week. Around September 2020, he was able to activate his right leg more and he could stand up with a maximum support of 1. By mid October 2020, he was allowed to be discharged. Prior to his discharged, he made the decision to continue his physiotherapy at a private centre daily and he will only see me twice weekly.


Subsequently, he paused all his physiotherapy sessions because there was a second wave of Covid-19. He then resumed his sessions at the private centre when things got better. He was having treatment for at least 3 times a week as he really wanted to recover from his brain procedure. Mr. A contacted me in Feb 2021 for some advice and then he resumed his physiotherapy sessions with me twice weekly on top of his regular sessions elsewhere. At that time, he was already able to walk unaided and he could use his right hand for most ADLs.


One month after our session, he told me that he does not want to be a patient any more by May 2021. I was really happy for him because I told him that he didn’t require so many sessions of physiotherapy treatment and he has been pushing himself quite intensely. As you can read from his background, he has had many weekly physiotherapy sessions from August 2020 till now March 2021. Can you imagine how tiring and frustrated he was? He wanted to leave the rehabilitation routine he had and to rejoin the workforce.

I don’t want to be a patient any more resonates strongly with my practice in a few ways:

1. Cost effectiveness


I strive to help my patients recover fast with the least amount of physiotherapy sessions. This might not be good for business but it’s the right thing to do. I will assess my patients’ needs and then determine if they will require long term, short term or minimal care. I have told some of them to just do their prescribed home exercises and keep me updated through whatsapp. To me, money is hard earned so I would want them to use it for my service only if they really have to.

2. Not everyone is a patient


Not everyone that sees me for consultation and assessment is made into a patient. I view my patients as individuals that is seeking help for their health. In my opinion, they do not need to be made into patients if they don’t have to. What do I mean by that? Everyone that sees me is bound to have a physical medical issue. What a physiotherapist would do is to diagnose the condition, treat it and then you will be labelled as a patient. But I think otherwise because we humans are not perfect and I have minimal intentions in making all of them into a patient. Being a patient would mean that he or she will have to:


a. Seek treatment

b. Be given a medical impression/ diagnosis

c. Feel like they are broken/ weak and needs treatment

d. Give control over to the physiotherapist to treat them

3. Professional integrity


How long should I keep my patients as patients? When will they be discharged from my care? Why should I hold my patient as a “hostage”? If I can’t help them, maybe they should seek help elsewhere?


These are things that a clinician should consider. Why should you keep holding your patient back and not discharge them from your care? If they are well and fit then they should be discharged and only return if they need treatment. This really angers me because some clinicians would encourage their patients to return weekly or monthly in the name of “maintenance”. I call that bull crap because we are not cars and we do not need maintenance. The only maintenance I offer is for the elderly to remain active and not some routine joint manipulation/ adjustments, massage, electrotherapy, or muscle release work. This “maintenance” will mean that the patient will forever be a patient unless they can’t afford it anymore.


To end, when it’s time to let go you let go so discharge your patients accordingly. It will be good for your patients’ well-being. It allows them to resume control over their life without the need of seeking “treatment” regularly. We need to allow patients to live their lives without us!

Thank you for reading!

Image credits: https://www.consultant360.com/articles/wandering-woman-meningioma

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Editor

Lian Yun-Perng  

UK Qualified Physiotherapist
Bachelor of Physiotherapy

Keele University, United Kingdom
Diploma in Physiotherapy

AIMST University, Malaysia

Taman Seputeh  Physiotherapy Clinic

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Malaysia

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