Physio Talks – Who’s in charge?

One of the questions I am asked very frequently, most often by athletes anticipating an upcoming important event is “Can I play”? My answer is always, “Of course. It is your (shoulder, back, knee)”. Then I give the best estimate of some of the likely outcomes of competing on a partially recovered injury, and have the client decide. It simply demonstrates who is in charge.
In all cases, the person in charge must be the one with the greatest investment in the outcome, and the one with the greatest control over the intervention. In all cases that is the person with the problem, the patient if you will. Some people come to the clinic with the intention of having a professional “fix” them. Some come with a problem poorly understood and wanting information and recommendations. Some come simply because the doctor, or spouse, or friend or whomever said they should, without much of an agenda.
In all these situations, and many, many more, the person with the problem must be the person in charge of carrying out the agreed solution. When this happens, the physio (or the GP, the specialist, any healthcare professional) becomes the helper, assistant, consultant to the patient. Why? Because the person who owns the problem is the one who can change the situation and make it better. People working in mental health, drug and alcohol rehabilitation, weight control programs all have known this for generations. Sometimes, professionals, and patients, in physical rehabilitation forget that. But, it is still true.
I saw this very clearly when I was dealing mostly with paediatric patients and their families. This is what brought me to the understanding that all children come with parents attached. If I was not able to connect with the parents of the disabled children, working with them on shared goals, usually nothing important came from all my, and the children’s efforts. The exact same situation happens now with adult clients in the clinic, except that there are usually no intervening adults/parents with whom I need to connect. There still may be families that need to understand the situation, particularly of the adult is completely dependent upon their assistance, like in nursing homes or house bound patients. But, for the most part, people come to see me as independently functioning individuals, and when we can reach an accommodation where they “own” the problems they bring to me, then I can usually help. But, I am still the helper and they are the owners and instigators of a management program. What I offer must fit into their situation, and they must trust me, at least a bit, that my advice is worth attending to. When that happens, people usually get better, unless I have missed on the diagnosis or they have decided not to give it their full effort, or both. That does not happen much, in my experience. I like to think it has to do with who we decide is in charge.

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