Saturday, June 13, 2015

Starting or Shutting Down Conversations

Rebecca Dutton
Home After a Stroke
June 4, 2015

Clients who hear an oncologist (cancer specialist) say "this drug has a 70% chance of working" have hope as long as they do not think about what is left unsaid.  Doctors often do not know why some people do not respond to a drug.  Doctors also cannot predict how a brain will reorganize after a stroke.  Therapists can tell if treatment is producing change.  What is unclear is if that progress will have a significant effect.  It is easy for oncologists to measure the desired outcome -- either a tumor shrinks or it doesn't.  How much change has to occur after a stroke to declare rehab successful is more subjective -- it depends on what the client considers valuable and what his or her life situation demands.

Therapists who answer a question with "all strokes are different" may shut down the conversation and waste an opportunity to ask clients what they want.  Therapists can plan how to achieve progress, but clients know about their personal situation that answers "Why I am doing this?"  Questions can be as simple as "What do you want to do when you get home?"  I had roommates who watched loud, violent TV shows in the evening so I could not wait to get home to my quiet bedroom.  Clients and caregivers may not answer the 1st time they are asked what they want, but it is important to plant the idea that tackling meaningful goals can significantly affect the outcome.  Orthopedic surgeons are beginning to acknowledge this truth by shifting their focus from what the doctor views as success to what the client views as success (1).  Knowing my in-patient, home health, and out-patients OTs were addressing my current concerns helped me focus instead of obsessing about long-term outcomes.

  1. Kirschenbaum, Ira. A surgeon's 20-year perspective of orthopedics. Accessed May 29, 2015.

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