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Case

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Naren

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?

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Patient-Clinician Interaction: The Therapeutic Alliance

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Patient care is a partnership between the patient and the healthcare practitioner—a collaborative effort toward a meaningful goal. The development of a positive therapeutic alliance is consistently correlated with improved patient outcomes and experiences.1,2 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—to empower them to reach their goals.3 Patients should never be asked or manipulated to serve the physical, emotional, or psychological needs of the therapist.

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As noted previously, in each patient–clinician interaction, two worlds come together—the two people, patient and professional, both with their 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.

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The Person

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Because patient care is not something a clinician does to a patient but rather with a patient, the quality of your interactions affects the quality of your patient-care techniques. Patients who perceive that they are individually valued and respected generally have better clinical outcomes4–6 and are less likely to manifest their dissatisfaction in legal actions against healthcare workers.4,7 Even when mistakes are made, expressing empathy during an apology or explanation may reduce the likelihood of a lawsuit.8 It is not surprising, then, that clinical experts in rehabilitation recognize establishing patient rapport as the foundation on which all subsequent patient care takes place.9

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The Clinician’s Perspective

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Professionalism
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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.

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Becoming a healthcare professional carries with it the expectation of embracing the values of the chosen ...

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