Uncompliant patient

I received a private referral this past week stating that my patient required a fitness assessment as he needs to lose weight for surgery. Initially I was excited about this situation as this was something different and created different challenges, although I questioned whether or not Physio referral was the best situation for him. Would he not have been better off sent to a dietician and an exercise physiologist??

"Sabrina, you're 10 o'clock patient is here" was how it all started. I went to the patient waiting room to greet my patient and he was in a wheelchair. Oh, he must have some sort of LL impairment was my first thought. Wrong!! As it turns out, he uses a wheelchair all the time because he gets short of breath and chest pain due to angina and a hernia compressing onto his heart. 6 minute walk test was the initial plan for him. I went through my spiel and he understood that he could take as many breaks as he required. Then, just as we were about to begin the test, he suddenly became uncompliant and very aggressive. There were no warning at all. Prior to his break out he was agreeing and understanding why we had to complete this fitness evaluation. He just kept saying that he did not want to do this and did not understand why people were always tyring to make him exercise. He's too short of breath to do anything and just wants to be left alone. All he wanted to do was go home and watch tv.

After calming him down and explaining that he may not be eligible for surgery if he doesn't lose some weight. I even tried negotiating and skipping the 6 minute walk test and doing a time up and go instead. He still refused. At that point, there was nothing else I could do.

As I was pushing him back to the waiting room I realised that he was a private referral, which meant that I am suppose to charge him. I don't think anyone told him that he was going to be charged prior to coming to physio. He didn't even know why he had to come in the first place. Luckily my supervisor told me not to charge him. Thank goodness because I did not even want to go there.

I think this whole scenario was not approached correctly and a lot of people's time was wasted that day. Not really mine, but the patient's and the carers who had to drive him and pick him up from physio. It should have been made clear to the patient why he was coming in and there should have been patient consent prior to him coming to physio. This was a good learning opportunity for me, to learn how to deal with non-complaint patients.