How To Manage Pessimistic Patients

Memory can be a highly selective version of events that fit neatly with particular outlooks on life

We all see and remember things differently. This difference has the potential to lead to frustration especially if your patient is a natural pessimist and you’re focused on what to do to help them. So what can you do to manage pessimistic patients?

It is important to recognise and take into consideration an individual’s natural tendency towards pessimism because it may be directly related to their ‘supposed’ lack of motivation.

I want to take a look at how pessimism can create what seems like a lack of motivation.

This is a quote from Elaine Fox’s book Rainy Brain Sunny Brain:

“Our affective mind not only influences what we notice but also determines what we remember.”

What Fox found through her extensive research was that: “…it is the reactivity of our rainy brains and sunny brains that is the primary course of our selective perceptions.”

Putting this into context of the patient/clinician management.

The clinician completes the assessment and treatment, gives the patient an overview of what is going on and what they need to do to help themselves.

A patient who has a tendency towards pessimism may place their attention on the information relating to how bad things are. They may not even notice that they have been told how to take control and can implement actions that will help their recovery.

A Common Scenario

The patient goes away and does nothing. They come in for the next treatment and say they’re the same. They haven’t done any of their home program. The clinician naturally gets a bit frustrated. And it’s very easy to label the patient as one who is unmotivated

The reality from Elaine Fox’s work is perhaps they didn’t even remember any of what you, the clinician asked them to do. Their focus was elsewhere:

  • On how bad things are
  • How this injury is going to adversely affect their life
  • Any limiting beliefs they may have with regards to the injury they have

So what can you do to help a patient who has a natural tendency towards pessimism?

First and foremost, you need to recognise a tendency towards pessimism early in your interactions with your patient. This can be reflected in the language they use when talking to you. So listen for negativity.

Your aim is to shift your patient’s attention to where you need it. That is, on what they need to do to get better. To do this try any or all of the following:

  • Ask the patient what they understand of their injury. Notice where their attention lies and the words they use
  • Get them to explain to you what you have asked them to do and how this can help them improve
  • Ask them how they plan to fit their home program into their daily schedule
  • Adjust your program accordingly to ensure they experience success
  • Get the patient to describe how they will know that they are improving. Focus on small achievable gains. This is far more useful than you objectively seeing improvements and relating them to your patient
  • Ask them to note any daily progress related to their evidence for improvement. Relying on memory isn’t going to work with this group of patients. Memory can be a highly selective version of events that fit neatly with particular outlooks on life. Not good with pessimistic patients.

Remember, you won’t need to use these language tools with every patient you see. There will be many who’s focus is exactly where you need it. This is another language tool that you can use when needed just like any other treatment tool.

It is worth taking into consideration that what we notice and remember plays a disproportionate role in shaping what we believe and our actions.

Not all patients who lack motivation do so consciously. Help your patient place attention where needed to improve decision making.

How to manage the patient who fails to see any improvement

There are times when you’re treating patients and no matter how much objective improvement you see, their response to your question regarding improvement is: “It’s the same. There’s no change.” It can be difficult to know how to manage the patient who fails to see any improvement.

This response used to make me extremely frustrated. How could they not see the improvements that I was seeing?

I’ve since learnt that I was the problem, not my patient.

I stayed in my world of the physio looking at changes in signs, symptoms and irritability. I didn’t recognise early in my career that objective changes that didn’t equate to the functional changes they wanted, then they were in fact, “The same”!

How can you avoid making the same mistake as me?

  1. Find out from your patient how they will know when they are getting better
  2. Clarify the evidence they need too see, hear or feel so they can recognise the improvements they’re making
  3. You then relate to the information they have given you to discuss whether or not they are getting any improvement in your follow up sessions

You may not initially recognise a patient who is naturally pessimistic. You are never going know why they see the world as they do but you can adapt the way you communicate to people like this simply by listening, not judging and asking questions that shift the attention of the listener.

Adapt your communication accordingly and try some of the language tools discussed in this article.

To learn more about motivational tools through effective communication download my eBook

“Improving Patient Motivation In Physiotherapy”

I wrote this eBook in response to the most common question I get asked and that is “How do I motivate my patients?”

If you would like to fine-tune your communication skills when working with resistant patients, you might consider working with a coach or mentor.

Or perhaps your staff would benefit from training in this area.

Contact us, and find out more about what we can offer you

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