Too much of a good thing?
Mrs. Smith is a retired 62 year old widow with 3 children who live out of the city. You are a physiotherapist working at a private practice. Mrs. Smith and you have a lot in common – your mom and Mrs. Smith were nurses at the same hospital for years. Mrs. Smith hurt her back in an MVA 2 years ago. She was covered by MPIC for the maximum number of treatments and has continued to attend on her own. She made good progress with therapy and has been able to resume all previous activities, however, every time you broach the subject of discharge, she reports that if she doesn’t come in for a regular “tune up” and to “catch up” with you, she “just doesn’t feel as good”. The problem is that your clinical exam is essentially normal. You believe she isn’t doing her exercises because doesn’t demonstrate them well. You’ve explained to her that it is normal to have intermittent low back pain and that these types of episodes usually spontaneously resolve. But Mrs. Smith says she always feels better for weeks after she sees you for treatment. From a biomedical perspective, you don’t think that your physical treatment is changing anything, yet Mrs. Smith insists on booking her regular tune-ups. How do you deal with this?
This case study was published in CPM’s In-Touch newsletter June 2019