By Tom Fontana, MSPT
It’s with a heavy heart that we part ways with patients, particularly those with whom we have worked with for a long time and gotten to know so well. So, if it’s so hard, why do we do it?! Much as we’d like to, we can’t just treat patients forever.
In the last 25 years (or so), there has been both an increasing focus on containing medical care costs and more research on outcomes. Both these forces encourage less care than was given in decades past. There was a time when we could treat patients until they were “all better,” meaning their condition had 100% resolved. But, sometimes 100% is not always achievable while other times more treatment does not mean a better outcome than with less treatment.
There are two metrics which we use to determine when’s the right time to say goodbye. First, we get a patient to a level of improvement where their abilities (i.e., strength, range of motion, balance, pain level) are substantially better along with a corresponding improvement in functional activities (i.e., walking, reaching, balancing) AND we believe that what we have taught them through education and exercises, stretches, or activities will get them to their maximum potential provided they are carried out.
In the second instance, we say goodbye when we have used all of the tools in our toolbox and a patient’s condition is worsening despite our efforts or has hit a plateau. This is never a situation any health care practitioner likes to be in (despite our knowledge, in the abstract, that we won’t help everyone) but we strive to be honest with ourselves, and you, if at that point we feel we may be wasting your time and money. In that event, we will recommend possible avenues to pursue within the healthcare system (e.g., return to PCP, possible specialist referrals, 2nd opinions) or complementary health practitioners.
At the end of the day, while we enjoy the time we spend with our patients, we know that the window of time we have with each of you is finite and that, if we are doing our job well, we will spend less time with you. As hard as it is to admit, you all have better places to be than to hang out with us! It doesn’t mean saying goodbye is easy, though.