|
 When a person gets hurt seriously enough to require physical therapy, many hurdles will have to be overcome to return to normal function. The obvious things that come to mind are getting proper medical attention, getting diagnosed accurately and getting an appropriate referral for therapy. If all goes well, the person then has to call for an appointment for physical therapy. Now, here is where things can get tricky if the patient has a poor educational background, economic dilemmas or English as a second language.
I have treated several patients lately that have limited formal education, or economic problems, or speak English as a second language. I also have patients with minimal education, with no form of employment, and they don't speak English. These types of patients will present with their own subset of problems above and beyond the usual physical ailments we are used to handling in the clinic. By reviewing each category of education, economic and English issues, physical therapists can find ways to achieve better outcomes with these clients.
Education
When a patient comes for therapy at our clinic, it is our policy to have them fill out a medical questionnaire. Besides looking for what drugs they might take or if they have a history of heart disease, I also take note of the spelling, grammar and thoroughness of how they filled out the form. Without being rude, this information can give me insight into the patient's educational level.
On the one extreme, there are people with a minimal amount of formal education. I treated a middle aged man with chronic back signs and symptoms. In his medical history, it said he was illiterate, and he had to drop out of school by third grade. Whenever we discussed home programs, we had to use diagrams, arrows and numbers. When we went over his diagnosis, we used three dimensional models as opposed to anatomy books. Finally, when we exercised, we didn't go into detail about which muscles were needed for each action, but instead focused on gross movements and actual demonstrations.
Tweet This!
Like what you're reading? Tweet the following message to spread the word!
-
Good info for any OT: Cultural Awareness: The Three E's of Therapy http://tinyurl.com/2cj62fo
On the other extreme, there are people who are very educated and analytical. One patient with a right cerebral vascular accident mentioned during his verbal history that he had graduated from a prestigious Ivy League school. After I examined him, I went over my findings as I attempted to explain to him why he was having left arm weakness and left leg spasms. He quickly caught on to my explanations, and would then reiterate what I had just said. As we went over the home exercises together, he would verbalize why each exercise seemed helpful. Instead of giving him five or six exercises to focus on at home, I was able to go over nine exercises successfully during his first visit. He was so committed to doing his exercises correctly that he was able to come for treatment twice a week instead of three times a week.
Economics
Anytime someone is coming to us for physical therapy, they are sacrificing time from something else they would rather be doing. If they are athletes, they would rather be playing sports; if they are employed, they would rather be working. Coming for physical therapy will put some kind of economic drain on the patient either in time, money or both. Usually, it is worth the effort because we provide a service that helps them get back to the things they need to survive and live a productive life. But sometimes, a patient's financial situation does not allow them to come for treatment on a regular basis.
Transportation has become a major issue in the last few years, as gas prices continue to rise. Patients have called and said they couldn't afford to put gas in their cars. Others have cancelled visits because they couldn't afford to fix their cars. In our area, if we notice a patient has consistent transportation problems, we recommend a car service that is subsidized by the city. This car service will pick them up and return them to their homes on a regularly scheduled basis. This service has helped to cut down on missed and late visits significantly.
When it comes to durable medical goods, most people are on their own no matter what type of insurance they have. I have been steering patients to the big discount chains for such items as canes, braces and physioballs. For sneakers and off-the-shelf orthotics, I have developed relationships with neighborhood sports stores, which gets patients a coupon for 10 percent off purchases. Sometimes people are hesitant to use a cane or change a shoe style, but once they see how much better they can function, it's worth the extra expense.
As graduation from formal therapy grows near, patients take advantage of my clinic's affiliation with the county YMCA system. Patients are allowed to use the facilities for 3 months without charge. If they decide to join the facility, they can apply for scholarship money for themselves and their immediate family members. Because the YMCA is a nationwide organization with approximately 3,000 locations, any person of limited economic means can be encouraged to seek membership at a local branch.
English
Our country has always been a melting pot, but with the advent of Internet, cable and economic options, immigrants no longer feel as much urgency to learn English. This phenomenon becomes obvious in the clinic as patients enter speaking barely a word of English. In general, these patients are from Latin American countries, but I have treated people from Africa, Asia and Europe who do not speak English well enough to explain their medical history.
In the clinic, I need to know when, where and how an injury occurred so I can do a thorough exam and formulate a comprehensive treatment plan. I can get the information from a family member or a friend, but that information is crucial to develop a safe program. If I am not satisfied with the initial intake information, then an interpreter is necessary. As I work for a hospital system, there are interpreters on staff for a multitude of languages; one of my patients has an interpreter who was hired by workmen's compensation. This interpreter is assigned to this patient, and the consistency helps to establish treatment consistency as well.
It is always a good idea to try to communicate with the patient in their language as best as you can. I speak Spanish well enough to carry on the treatments once I get a good history, but my Spanish becomes inadequate if the patient has setbacks or new symptoms. However, by attempting to speak Spanish, I find patients are more willing to communicate with me in English to the best of their abilities. I also give them home exercises in Spanish, as our software program is capable of doing that.
Communication can take many forms, including hand gestures, demonstrations and pictures. Once a patient feels comfortable with you and the program you have devised, then it will flow quite easily with little verbal cueing necessary. If you want to improve your language skills, it is possible through books, Internet-based education and weekend courses like Spanish for Health Professionals.
Putting It Together
Despite all the obstacles people may face in their lives, they manage to get to physical therapy for the advice, support and physical challenges we are able to supply. To keep providing a great service, we must always try to understand what the patient might be going through to see us, and not take it for granted. If a patient lacks educational tools, then we are able to furnish simplified material. We know the economic times are straining everyone's budget, so we lookout for discounts for our patients. When patients don't speak our language, we are in a position to get interpreters who can help.
If we can assist patients to understand their problems, get to treatment sessions with regularity, and break the language barrier, then we are dramatically improving the odds for a successful result.
Jay Goodman is a physical therapist and sports certified specialist with 24 years of clinical experience. He currently works for WakeMed at the Alexander YMCA office in Raleigh, NC.
|