Naren is a 20-year-old university student who has a progressive neuromuscular disease affecting the muscles of the trunk, arms, and legs. He has been referred to therapy in an outpatient general musculoskeletal and sports medicine facility for treatment of a muscle strain in the calf. Naren lives in an assisted living apartment at the university and receives assistance from a part-time volunteer caregiver. He is independent in transferring between his motorized wheelchair and other surfaces of similar height.
How might this patient's situation affect how you establish rapport with him?
What about Naren, his environment, and the task at hand do you need to keep in mind as you perform the examination and/or interventions?
Patient-Clinician Interaction: The Therapeutic Alliance
Patient care is a partnership between the patient and the health-care practitioner—a collaborative effort toward a meaningful goal. Although patients are ultimately responsible for the pursuit of their own health, it is the responsibility of the clinician to do what is necessary within ethical and professional boundaries to meet the patients where they are—physically, emotionally, and psychologically. Patients should never be asked or manipulated to serve the physical, emotional, or psychological needs of the therapist.
As noted previously, in each patient-clinician interaction, two worlds come together—the two people, patient and professional, each with his or her own purposes, personalities, sensitivities, and expectations, engaged together in a task in a particular environment. In a therapeutic alliance, the distance between these two worlds is bridged as the skills of the clinician are brought together with the needs of the patient.
Because patient care is not something a clinician does to a patient but rather with a patient, the quality of our interactions affects the quality of our patient care techniques. Patients who perceive that they are individually valued and respected generally have better clinical outcomes1–3 and are less likely to manifest their dissatisfaction in legal actions against health-care workers.1,4,5 It is not surprising, then, that clinical experts in physical therapy recognize establishing patient rapport as the foundation upon which all subsequent patient care takes place.6
The Clinician's Perspective
Professionalism should be foremost in the clinician's mind regarding behavior during every interaction with patients, their families, and the larger community. Every patient should be able to trust that you will bring your professional expertise to each interaction and will do so in a competent, compassionate, and respectful manner.
Becoming a health-care professional carries with it the expectation of embracing the values of the chosen profession commonly described in the profession's code of ethics (see Part 1, Box 1 in Establishing the Bar). Because the best clinical and functional outcomes result from interdisciplinary care,7–9 a professional commitment to excellence also means working collaboratively with ...