Let me preface this by saying that I absolutely love working in healthcare. I truly believe that helping people is what I was put on this earth to do. I couldn’t imagine myself doing anything else. But, oh boy, that doesn’t mean that there aren’t times where I could easily just dramatically exit to a closet to scream my lungs out. Not because of the stress of the job, but the perils that come along with a…let’s say “difficult” patient.
Rehab therapy works for individuals who are suffering from pain and/or disability that hinders the normal routines and tasks of their day-to-day lives. Most patients hobble in hoping to turn their life around and be able to return to their normal tasks in their jobs, leisure time, and so on and so fourth as quickly as possible. The typical patient wants nothing more than to get their recovery show on the road and hopefully not have to see my pretty face again anytime soon.
However, some patients find that when a they suffer from a legitimate disability their lifestyle changes are kind of comfortable. Maybe their family or significant other are helping them a lot more around the house or catering to their needs, more attention from others, they’re receiving financial gain, getting hooked to medication or they don’t have to return to work. I mean, who can really blame someone for getting used to being treated well and getting a nice long time without working, right?
Malingering therapy patients are a nuisance because they are wasting time, attention-starved, or trying to illegally receive disability checks. Also, quite frankly, ignoring patients that exaggerate or fake symptoms is bad for other patients.
Here’s how to tell when a patient isn’t focused on actual recovery:
Find yourself wondering why a particular patient isn’t seeming to get any better? Do they seem to want only their way or the highway when it comes to treatment methods?
If a patient gets angered when a certain method (the one they may have had in mind) wasn’t chosen or alternative methods were chosen, they probably are malingering. A patient that becomes familiar with therapy (and been around the block a few times) starts to know what works for them and what doesn’t. If they’re very surly about potentially trying out a new treatment that could possibly help them recover, they might be trying to prolong their treatment.
How to handle a patient that isn’t recovery focused:
According to Janey Goude, PT, there’s two main ways to cope with those persistent patients that clearly have a secret agenda to stay disabled, either watch them when they don’t know you’re observing or give them tough love.
1. Watch them when they don’t know they’re being observed.
The first option is a way to get an honest idea about how a patient is doing. If they are truly there to put “on a show” then you can’t expect to see their true state when they know you are paying attention. You might have to make a point of being in your office when they arrive for their appointment so you can watch them getting out of the car. Then, when you’re in the office compare the test you did when they know they’re being paid attention to. “Given enough rope, the patient will hang themselves.” Listen carefully to their complaints and do not speak up about you knowing their exaggeration or faking of the dysfunction until at the end when you inevitably hang them.
2. Give them some tough love
With tough love, you are essentially giving them the benefit of the doubt in case they are lying. However, they can suffer in their own prolonged recovery if they don’t follow instruction. Ask them what they’ve already tried and what their goals are. From there, you can design a course of treatment that addresses their goals (whether they are your goals or not.)
After that, explain why past treatments might have helped them in the past but will no longer work now. Then, calmly and firmly let them know that it is their choice to refuse your proposed plan to reach the goal. However, explain that if they do, you will refuse future treatment and they must seek a new therapy practitioner.
The bottom line with malingering patients? Just tell them no.