It's not you or your expertise, it's just not working.

This week I received the physio version of the dreaded, "It's not you, it's me." email. A patient and I had been working on her desk work related arm pain for a few months now and we weren't making the progress we had hoped for. Like any break up, I racked my brain to figure out what went wrong. And also like any break up, there were signs I should have picked up on before things got to this point.

I knew our progress had been a bit rocky but I let my ego and stubbornness cloud my judgement. I was convinced I could figure out how to alleviate her pain. As the weeks wore on, she became frustrated and I grew more determined to throw every technique I knew at her. I was so fixated on her problem with her arm (which was actually her neck) that I couldn't see that our program wasn't working for her.

My biggest failure in this whole situation had nothing to do with my treatment or my expertise. It was not asking for help when I needed it. If I had called in the cavalry a bit sooner and referred her to another practitioner, the entire situation would have ended differently. Instead of being the physio that didn't help her, I would be part of the health team that did. It sounds a bit funny, but some of my most grateful patients are the ones that I've referred elsewhere. I knew I was out of my depth and I think they appreciated my honesty.

The rule of thumb that I try to follow is the three visit rule. If we aren't making progress by then, something has to change. That change can be a re-assessment and overhaul of our treatment plan, a second opinion, or a referral to another type of therapist. When I stick to this rule I find I am less complacent and more honest with myself about progress. It's a tough one to stick to, but it works.

The reality is that my methods don't always work for everyone. If I looked at each of those patients as a personal failure or shortcoming, I'd be miserable. These experiences help to shape me as a physiotherapist. With each patient I continue to hone my skills and figure out what does and doesn't work. And with each patient I have a better idea of when to ask for help. All I've got to do now is work on the ego!