How about we call it "client directed care"

Recently I heard the phrase "client directed care" and it really struck a chord with me because we are always talking about 'client centered care' or 'client focused care'.

But when I heard the term "client directed care", it really made me think about how important it is that the patient lead the assessment and treatment. I think many times in healthcare, we have our own agenda and understanding of what should happen during the appointment.

This is something we were taught, or I certainly was, to listen for certain phrases or cues. But the temptation is always to jump in and make an assumption about what's going on. That assumption can lead us down a path where WE ARE leading and WE ARE deciding what their goals are.

For example, the client who cannot reach behind their shoulder, we assume that needs to be improved on, but didn't realize that what they actually want to be able to do is pick something up with more strength! And why did we not realize this, because we made our own agenda.

When we think about being client focused, we are putting our clients first, but are we really letting them lead the way? When a patient comes and says to you, I'm not feeling any better, how often do we change what we do and how often do we continue in the hope it will change with time?

I challenge you as a health care practitioner to change what you're doing if it's not helping your patient. Even if that means passing that patient on or advising them you no longer think you can benefit them.

If a patient says to you, I simply can't come. I can't afford it or I'm not putting in enough effort, give them the autonomy to make a decision regarding how long they're to continue coming. Let them know you're there for them, but let them go. I spend a lot of time worrying about the clients I haven't helped. But now, I think I just wasn't either the right person, or the right time. And that's okay because to be truly effective as a physiotherapist, I have to respect people's personal decisions about care.

It is your choice what you eat for breakfast in the morning, it's your choice what clothes you wear, and it's your choice which therapist you see. And it's your choice to do your exercises, and if you don't like them, you need to tell me so I can change them, or find something totally different for you or a different way.

My assessments are focused on listening to you, and finding out what's going on in your world. What's important, what's not important, what things you like to do and what things you don't. How busy you are, where your stress level lies, where your fears lie, and where your beliefs lie. This may sound intrusive and personal, but to really help, you have to share certain aspects of your life. I cannot push my own feelings and thoughts onto you, but I can explain myself and see if you agree, or how you feel about the view.

But my ultimate job is to let you lead the way. I'm going to be there, backing you up, holding you up and helping you move on, when YOU ARE ready.

NIcola Robertson

Registered Physiotherapist