Goal setting....
Image: Estee Janssens (via Unsplash)
Patients
Goals
Write down your answers to the following questions:
When
you were last a patient and sought treatment from a chiropractic
colleague, or a medical professional, what was your motive for
seeking help?
My
motive was:
What
was your greatest fear about having the problem?
My
greatest fear was:
Was
there any worry that the problem would prevent you from being able to
do something?
Did
the practitioner understand your concerns?
Did
they ask you any of the above questions?
Could
any of these questions help a practitioner crystallise some treatment
goals for the treatment plan?
Practitioner’s
Goals
Remember
our job description?:
‘To
get the whole body functioning as well as possible’.
Lets
revisit our made-up patient from earlier, Lucy, the lady with
right-sided LBP that we felt was a consequence of her knee
degenerative changes…….
What
would a practitioner want
to achieve when treating and rehabilitating this patient?
Goals:
1.
2.
3.
When you have written some goals, carry on......
Of
course, this is a fictional patient, so there are no rights or
wrongs, but here are some possible functional treatment goals:
1. To be able to squat without pain in the right knee
2.
To increase the strength of the right quads on resisted testing
3.
To improve balance time when standing on the right leg
If
you are able to make those goals SMART, so much the better (specific,
measurable, achievable, relevant, time-bound)
eg:
‘to be able to hold a right-legged wall-squat for 30 seconds in one
months time’
It’s
very tempting to dismiss a patient from our care prematurely, when
they come back very happy with their pain reduction. Many of us are
people pleasers, after all!
We
have to remember that our job description includes optimising
function. It is not just
about pain relief.
Our
functional goals will help us to remember this, and we should not be
dismissing patients who have not achieved their functional goals (as
long as those goals are reasonable).
Remember:
If its only about pain relief, then they might as well just take
pain-killers, it’ll probably be cheaper!
Think
about the downsides to a patient not achieving any of their
functional goals:
Write
your thoughts down
When you’ve written your thoughts, carry on…...
In
my opinion, the main problem with a patient not achieving their
functional goals is that their pain (back pain) will come back!
Additional
goals
Let’s
go back again to Lucy, our patient with the right-sided LBP. Remember
that when you first examined her you found that her right lower
abdominal quadrant was tender?
What
are you going to do about that?
Write
your ideas down.....
When
we first pick up an issue like this, we can easily assume that it is
a problem. It may or may not be.....
It
makes sense to monitor this tenderness and see if it goes away. So we
will need to check the abdomen on subsequent visists
If
it persists (particularly if the back pain also persists), then it
may warrant further investigation by the patients GP.
So we can set ourselves a task in our management plan:
‘Reassess the abdomen. If tenderness persists, seek opinion from GP’.
This then gives you an opportunity to correspond appropriately with the patient's GP, and impress them with your modesty and sagacity….
Homework:
Have a look at your last 10 new patient files.....
- Did you write down what the patients fears were?
- Did you write down what the patient was hoping for (their goals)? (Hint: you have to ask the patient what both of these are......)
- Did you write down (and explain to the patient) what your functional/medical goals were, (so that the patient, and you, both know when you have reached the end of the immediate course of care)?
Any advice that you can give yourself for your next new patient?
