Ep. 19 – How to (tactfully) fire a patient

Firing a patient – not so fun.

There are so many fun parts of being a physical therapist, especially an oncology physical therapist. There are also some not-so-fun parts of being a physical therapist. One of the less pleasant experiences I’ve had so far is firing a patient. I didn’t really have this experience when I was a student on clinicals, likely because I wasn’t at a site long enough to really encounter this situation, or because maybe my patients fired me before it came down to it (hopefully not, but who’s to say at this point).

Everything was going so well.

When I first began working with this patient, we made great strides in lots of areas, hit a plateau where this patient didn’t really make any gains in anything, then rapidly declined in overall functional mobility. I was racking my brain to figure out what was happening, but it wasn’t until after extensive discussion with the patient & piecing together tidbits from other practitioners that I figured out what was happening. So I worked & worked to educate the patient on how their progress was being negatively affected by their actions – to no avail. Eventually I decided I had to fire this patient.

“Do I have to?”

There was a lot of internal conflict & dialogue back & forth between myself & I on this matter, but I couldn’t figure any way around it. So at the next re-evaluation, I sat down with this patient, outlined our journey together since beginning PT, & how I could no longer in good conscience continue treating this patient knowing that I was doing no good & may even be harming this patient in the long run. It was not pretty, &, as much as I didn’t want to, feelings were definitely hurt. But, it all worked out in the end, & both of us are in a much better place now.

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