Who Is In Charge?

When a relationship develops between a patient and a physical therapist, the question pops up, who is in charge? This always depends upon the responsibilities among the parties involved. The therapist is responsible for the appropriate instructions, and the patient is responsible to follow up on these. The success of this relationship is dependent on complete execution of the duties of both parties, just like in any other contract obligation.
However, the responsibility of “healing” lies with the patient. How is all of this done? First, it is important to have a goal in anything we wish to accomplish. If we wish to become better swimmers and do not know how to swim, the goal should be to learn how to first stay afloat. Similarly, if one wishes to be able to walk briskly but has a hard time standing up, he should concentrate on building up the necessary strength for that activity. There is a strong relationship between muscle strength and the ability to perform physical activities.
Maintaining certain physical activities allows us to live our lives at some level of personal satisfaction. If one is not happy with that activity level, then do something about it. Set a new goal. It is really all about what we are willing to do to achieve that what we desire. Many of us try to place that responsibility onto others.
In my profession as a physical therapist, I encounter many patients who come to me for a specific purpose to improve their ability to walk. The first thing I do is to give them the “Home Exercise Program” (HEP). What happens next is pretty common. On subsequent visits when asked how the HEP is working, most of them confess that they did not follow my instructions, and after continuing like that for a few weeks they determine that the therapy is not working and stop coming.
Common excuses are fatigue, my aide is not reminding me, not having enough time, or interference by social activities. People need to take charge of their lives. If one does not know what to do, that’s where we as professionals come in, but only as a guide. The working part firmly sits with you, the patient.
Most of these patients do not have any underlying medical malady which precludes them from being able to walk normally. Typically, the problem is long-standing physical inactivity which leads to general muscle weakness. These patients are somewhat active but not enough to maintain a steady physical regimen. Rather, they are active below the level to sustain this minimal physical fitness and therefore over a period of a few years they slowly weaken to the point where even the simple effort of getting up from a chair becomes nearly impossible.
The good news is that most of this can be fixed. It takes a tailored plan for an individual with set achievable goals spread over an appropriate period of time. When starting with physical therapy to improve walking, these patients can move out of the physical therapy program after one to two months, depending on the level of initial weakness. One needs to understand that this can be only achieved if the plan is followed completely.
The physical therapy function is to get the person to a sufficient level of physical ability in order for that individual to become independent enough to continue on his own. Our profession is strictly guided by the criteria of “medical necessity.” This means that a person requires our professional knowledge and ability to work on their disability. We are not supposed to get one to the highest level of his or her ability, but rather to bring one up to the lowest point of their independence. There is no stopping after this initial plateau is achieved.
Remember, to be strong you must work for it. The control of your well being must be yours, so take charge. If you need professional help, get it, and if you do, keep your end of the bargain. We are all aware that when both parties fulfill their duties there is a “win win” situation.