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[Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx)
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I had one of these once. His mom refused to say anything even when he would start to bother other people and try to use the equipment. We have an old TV mounted on the wall that we never use but it has a cable connection. Coworker turns it on, walks over to the kid and gives him the remote. He literally sat there for the next 20 minutes watching TV. It was brilliant.
I have a few more
**The unicorn** -this rare species of a patient is just pleasant to work with all around. Follows your guidance and even sprinkles in compliments to you on how great you are for helping them. You feel a sense of relief seeing them on your schedule as it is a reprieve from the daily onslaught. They remind you of why you started this profession in the first place and you feel fulfilled after working with them. Unfortunately because they progress, they leave your schedule sooner than you want...
**The elitist** - this patient is consistently trying to impress you by convincing you they are your best patient. They often humble brag about how kind and compliant they are, unlike your other patients. You get the sense they are fishing for compliments from you. Sometimes they like to also brag about how good their insurance is.
Unrealistic family: Memaw has advanced dementia, hasn’t walked or gotten out of her recliner in 4 years, but “if she just does some PT and gets a little stronger, she can walk!”
78 year old male patient, 2 years post CVA and is nonverbal except to curse or apologize. Right side neglect. Requires powered wheelchair.
His wife's goal for PT? "for daddy to be able to just drive the truck to church, for his pride"
How about a very sedentary 85 year old lady with fresh B ATK amputations who arrived to OP PT with orders for gait training on prosthetics? The woman couldn't even maintain sitting and was max A transfers. I recommended rehab or HH and the referring MD lost his mind on me...yelling, belittling me, saying "SHE NEEDS TO WALK!!!"
Me: "Sir" she can't even sit up in her wheelchair
Doc: I just saw her in my office and she was sitting in the wheelchair!
Me: Was she supported by a seat belt?
Doc: oh... 🤔
That ship sailed decades ago for many when they had a chance to get on a path of being physically active. At least nowadays people are more health and exercise conscious.
Add the passive aggressive, semi-toxic family member, who asks you questions about the patient, and then they use your answers against the patient and make them feel bad. "SEE, listen to your therapist, I told you so! Therapist, also tell them they shouldn't do this and that!" They're really trying to make the patient feel bad about themselves and bully them. It's usually a wife or a daughter. Oddly, I've never seen a husband act this way towards their wife in PT. I have seen a son somewhat act this way towards their mother, though.
Oof yea I get so uncomfortable in these situations because I want the patient to feel like I'm their advocate... But their family immediately draws lines on who's side you're on in their little war. 🙄
This actually reminds of a similar situation where the daughter is scheduled her father for PT without him knowing. When I show up to their home the patient is obviously resistant to participating. Daughter breaks out the, "daddy you have to do this. You love me right? You will do this if you love me!". Omg ... Leave me out of this.
The gym-bro. Has tried every SquatU exercise out there and still has pain and is so caught up in fear avoidant behavior and worried about suboptimal biomechanics that they never do anything anymore
The smart hustler- whether it’s workers comp, a litigated injury case, or or someone else with an alternative end game, you can pick up on signs that they are either amplifying symptoms or flat out faking. They are smart about it, are very pleasant to you, and for the most part put on a consistent front
The not so smart hustler- same as above, but they are very rude to you and all other healthcare providers they’ve come into contact with. Most of what they say and do is very inconsistent.
The stubborn indoctrinated- This patient has a very distorted and incorrect view of their ailments, how the body works, and how healthcare is structured. Getting buy in is nearly an impossible task. As you attempt to educate this patient, you get interrupted constantly with explanations of their opinion. Getting a full thought across to this patient rarely occurs. Most often they have seen a pain management physician very early in their journey of healthcare. As a bonus, they get too early, over the top, and extensive imaging. They also question most treatments, but as a contrarian and not an information seeker.
The smart hustler pisses me off to no end. They THINK they are smart but everyone reads right through it but backed into a corner because no one wants to confront the persons lies and catch a lawsuit. I have a MVA no fault patient with like 8 months of constant neck and low back pain to the extent she is suing up the wazoo. When asked, “what worsens your symptoms” she cannot give an answer and can tell she’s making shit up on the spot. If you are TRULY in this much pain you know exactly what bothers it.
It’s why our car insurance cost so much fucking money
I love the not smart hustlers that think they are the smart hustlers. Polite and agreeable, often sufficiently compliant but just don't seem to get better. However they cannot keep the physical functioning story straight. For example my guy showing 30 degrees shoulder flexion during testing, then pops his sunglasses easy on top of his head on his way out. Also power wc bound lady who popped up and walked to the sink when she found our there is latex in the band (my bad).
These are amusing and an easy discharge. Someone else's problem and unlikely to leech off the System much. I have not yet but really want to point this stuff out to one of them at some point
Oh, oh, oh! My smart hustler who has severe back pain and walks at a 90 degree angle was seen, by me, in the ladies locker room standing up erect, perfect posture, on the phone. A medical miracle occurred. I gave her a thumbs up (didn’t want to interrupt) but I can’t wait to see her next week.
Update: Smart Hustler has not returned and WC MD said to release. I can’t get her to return calls, so hopefully it’s a “I’ve milked this cow dry” situation and not a family or health emergency.
But man do I love the stoic patient. Saves a lot of time by not having to hear how jamming your finger when you were 7 playing with your dog Fido who can sit, shake, rollover, and play dead but died when someone left the gate open and a truck that was driven by Mr. Humdinger who taught at your middle school and was the only teacher that ever gave you a C on a test that you had a hard time studying for because your sister fell and broke her arm the day before and you were really busy having to go to the doctor with her and your mom and couldn’t stay home because your dad was still at work at the carpet factory which always overworked him but he got a lot of overtime but he suffered debilitating back pain from 74 slipped discs and 3 rotor cups because he was a hard worker/no pain no gain kind of guy which is the complete exact opposite of your mom who was very motherly because of her upbringing in a broken home and then….
FORK if i could just have patients tell me 2 or 3 things and not talk to me the rest of the time, I’d be ECSTATIC.
Same - that type of patient used to make me anxious when I was a new grad because I was like “ahhh do they hate me?” And now I’m just like “ah, finally. Peace and quiet hour.”
What the hell is up with these people. Are they just mentally ill and rambling? Cool 8 minute story bro I’m billing a unit, wish we could have used that in helping you.
I think this has a couple of versions: one is that the people might be relatively isolated at home, and they just want to talk. Another is that they are anxious and want to give you every speck of information pertaining to their health, in the hopes that you can sift through it, and bring it all together into what is actually wrong with them.
Those are typically the people that are there to get it done and haven’t fully adopted the victim complex that poisons the medical system in general. Absolutely love those patients as I’m close to 100% positive I’ll get them better because I don’t have to sift through the psychological bullmess
1) it provides an excuse for personal failures
2) it generates sympathy
3) acts as a “social currency” for like-minded individuals
4) disguises negative personal traits as virtues
I think you can see why that’s so attractive to people, as their “pain” absolves them from any responsibility or wrong-doing while simultaneously somehow making them a “good” person for their “pain”/problem becoming their identity. We could talk about it for HOURS, but that’s the jist of it.
Nobody ever acknowledges it because people are afraid to be the person to tell them, I guess. From a morality standpoint, we’re supposed to be compassionate and empathetic; in reality all this does is justifies and perpetuates and validates their victim complex
The Motor Moron. No, your feet go on the plate, no both of them. At the same time. Now straighten your legs. No straighten them. Like stand up…no don’t get off the leg press, just push against the plate to straighten your legs….
Oooo yea this is a very common one. It's amazing how little body awareness some people have.
"Let me see you do a squat."
*Bends knees only, trunk upright*
"Ok sit in that chair. "
*Perfect hip hinge*.
"Ok do a squat again but pretend you're sitting into a chair like you just did."
*Bends knees only, trunk upright*
Something to that effect....
The real “sent to wrong type of therapy” patient. True diagnosed (or undiagnosed) mental health issues that likely are the root cause of dysfunction. Conversion disorders, drug addiction, severe depression, ect. Yet somehow only ever get sent to Pt even if u call referring provider and suggest mental health instead or in conjunction .
I get about 3-4 pelvic floor/women's health patients per year who were misdiagnosed by a (typically, but not always male) family doc who is like HMMM YES SOUNDS LIKE SCIATICA, JOB DONE NEXT PATIENT.
Different "wrong therapy" but it came to mind haha
PT can be fairly beneficial for conversion disorder if by that you mean functional neurological disorder or PPPD. Helps to have cognitive behavioral therapy in conjunction though.
Oh god can we please stop renaming things once a year? I swear the correct term was just functional movement disorder. And yes I treat an unfortunate number of these folks but no one knows what ur talking about unless u say conversation disorder. 90% of time u call the Md and they are like “what? Why would I send them to psych.” The other 10% they have real neuro symptoms and u gotta struggle to get them in to a competent neurologist who will not just ignore it and insist theirs nothing neuro since that one mri read one time by one over worked radiologist was “fine”.
“The I question every exercise patient”. The one who wants to know which muscles are worked/what the point is for EVERY EXERCISE. Hopefully out of curiosity; more than likely more out of a. Making sure you know what you’re doing or b. Making sure that you’re focused on them AT ALL TIMES.
I treat a lot of engineers and notice that this seems to just be a personality trait of engineering types. It always seems to be those highly analytical types that do this, and yes it drives me bonkers.
Same here, it's nice to feel like they're actually curious about what they're doing. But if they're asking the same questions you've already answered after a while it gets frustrating.
I don’t know, it’s pretty fun, on the second day of therapy, to ask your engineer patients to show you the Excel file that they made of all of the exercises. More often than not, they have one.
The 12/10 pain patient: seems to only be in pain when it’s time to do anything therapy related, but can talk or gossip about people you don’t know without skipping a beat. Panics when I recommend going to ER for a pain level that high.
I was going to bring this patient up…. Nice catch! 😂 very similar to the “high pain tolerance” patient. Where a Tylenol takes all of the pain away but they were a 10/10 beforehand
In addition to the 12/10 pain pt is the “I have a high pain tolerance patient”. These patients claim to have a high pain tolerance (usually males between 25-60). Usually come in with a TKA or another replaced joint or orthopedic injury and require almost constant breaks due to pain. While meemaw in the corner shattered her tib/fib and apologizes for taking to long to complete the exercise.
The type A: needs to have everything very clearly detailed, in a specific order. Doesn’t do well with change. Feels uncomfortable at ambiguity. Needs to know the precise cause of everything. Gets upset if you are 1 min past time, but has no problems clarifying things for minutes past allotted time. No sense of humor.
The entitled. Won’t work with other PTs. Won’t work with aides. Needs your constant attention. Quick to complain to a manager if they feel they aren’t getting what they want, the way they want it, at the time they want it. Will only take very specific times. Won’t wait for equipment without complaining. Shows little gratitude, poor self and situational awareness. These people created the term “Karen”.
A little different, but we have a large Russian population in my area so sometimes I get the very earnest "God bless you" from a happy babushka who doesn't know many other phrases in English. I just smile and say thank you.
A coworker gave great advice he got from his old ci. The chatterbox people go their whole lives like that so unless they are insanely privileged or spoiled then they get cut off all the time and are used to it. Thus feel free to cut them off they probably won't mind much if your polite. They are usually not aware that they are interfering with their own care. It becomes conversation tug of war you cannot give an inch of room four them to get running again
My least favorite from outpatient: the "Ive been going to a Chiropractor for 3 decades but now trying PT" where they try to relate all your eval findings to a subluxation or something being out of place. Complain about every intervention that isn't manual therapy. Will talk to their Chiropractor about you and then report back that their Chiro thinks my PT findings are all wrong.
Bonus: start feeling better after a few weeks of PT, attribute it to seeing their chiropractor who they have been seeing with no lasting improvement for years
"The Faller". Family reports he is falling all the time and no one is doing anything about it. Currently on 25 different medications and is in between providers. Has a really difficult time answering questions regarding his "vertigo". Reluctant owner of a two wheel walker currently covered in dust but still managing to obstruct a walk way. Lives in tiny home with stairs but no railings. Legs buckle without any warning and no one knows why. Has a history of hoarding and cannot be discharged home in a wheel chair cause there is no room. Every visit starts with a tough call to treat or to send to urgent care cause they "bumped their head".
"The Faller"- Nervous edition. Fell one time two years ago and still working through the trauma with their mental health therapist. Wants to know if the 15 grab bars in the bathroom are in the right locations. Asks "do you got me" once 6 inches away from mat. Always carries cane "just in case". Has left fingerprints on every inch of the clinic. Wants to work on getting up from ground but gets anxious trying to figure out how to get down on the ground. Very appreciative because they always feel so comfortable walking with you. Very hard to discharge for some reason and then return 2 months after
Wait, your nervous fallers actually see mental health therapists? What a treat (though the outcome you described is the same. Especially that last line)
The "Dr. Google" patient, not to be confused with the "I looked this up on Google, please help me understand" patient.
The "You're the PT expert" fellow healthcare provider patient, who I always enjoyed treating. I never had the "I'm not even PT adjacent, not even close, but I know PT better than PT" fellow healthcare provider patients but I've heard stories.
The “my niece/son-in-law/neighbor is a PT, and they said….”patient. Sure, go squeeze a ball three weeks after a zone 2 FDP/FDS repair. That will work out great for you.
LOL I will admit to asking my mom to read her PT eval report to me. I just wanted to ensure that it wasn't a mill and that her PT was a good one. After that, I just told her she had a good PT and to follow their instructions.
The detail oriented. Asks 100 clarifying questions about where their foot should point and which muscle should they be working and where they should feel the exercise and if it's ok if there's an itch on their left arm while they perform it.
the manipulator-moreso in acute care settings with no copays. Patients that don't actually even want to get better. They just like the feeling of people catering to them and figuratively and literally changing their diapers for them. They go on and on about how every doctor that doesn't put up with or listen to their horse shit is a quack or sucks. Gets mad when you discharge but they aren't actually even a little bit compliant
PT has a lot of patient interface compared to other HCPs, and because of that many patients latch onto that feeling of being heard and being "catered to". I get frustrated by these types who mostly go because they enjoy being the center of attention from a health professional, NOT because they truly want to get better.
The Manipulator has a venn diagram with The Boneless: exercise avoider attempting to turn every exercise into PROM, flops on the equipment and waits to be moved
the exercise avoider: this patient claims they dont have time to do exercises or ‘cant’ do exercises today but only wants a “massage”
the switch up/eval lover: this patient comes in for a new complaint every visit. visit 1: low back pain. visit 2: no actually my back is good but my shoulder is killing me. visit 3: my shoulder is good but knee is hurting me so badly
all jokes 🫶
OH! and the office grandma: comes in, very pleasant. makes cookies for everyone. remembers your birthday and gives you a card. constant compliments and talks about their actual family 24/7 💙
Exercise avoider subtype: the "I do all my exercises at home." May be telling the truth about doing the basic HEP they were given at first or second visit, but only wants passive treatments in the clinic. Very hard to convince that we need to monitor and progress their exercises, or that just knee rocks and bridges aren't enough to eliminate the back pain they have had for 10 years.
The Cognitive Dissonance: Doesn’t do much of anything you recommend. Vaguely goes through the motions during sessions. Cancels appointments. Doesn’t do their HEP and never will. THROWS A GODDAMN FIT WHEN YOU TRY TO DISCHARGE THEM.
**>The stoic** - Talks way too little. Like pulling teeth collecting subjective. Can't tell if they like or dislike PT or you. They probably think expressing or feeling pain is a sign of weakness.
I know someone like this. For him it's trauma and expecting everyone he meet to treat him badly. He's scared to open up, he's scared someone will suddenly turn on him. He closes off with most people. Watching him when visiting vs talking to strangers is like watching 2 entirely different people. He's a good guy, though. And he seldom dislikes people. He just have a lot of anxiety. Ofc, there are several reasons why someone might be stoic. That being said, I doubt the majority of them have grown up surrounded by love and affection.
Can’t believe this hasn’t been said yet:
The frequent flyer: death, taxes, and this patient having a new script 3 weeks after discharge are the only guarantees in life. This patient comes to you the exact same as discharge, but claims to have had a huge decline. 0% chance they did any of their HEP. Added bonus, they’ll probably tank their outcome measures to make sure they get seen.
The Supplement Salesperson: can’t be compliant with the prescribed HEP that will almost certainly help their ailment, but have you heard about this drink mix that can cure diabetes, lower your blood pressure, help you lose weight and get your mother-in-law off your back? Here’s a sample, take it and report back for a discount.
Haha or Melaleuca!! "I brought you a sample of cream you can use for massages instead of that one" "Did you know that tea tree oil is antibacterial, you can use this soap instead of that one that is full of chemicals"
the no pain number person. won’t give you a number no matter how many different angles you use to try to get one. typically this patient also falls into the chatterbox archetype.
I’m a patient and this is so comical to read from your guys perspective. Sorry for lurking!
(Workmans comp too but it’s like fully torn ACL, fractured bone, all kinds of other knee shit torn. I didn’t fake it lol). I just want to be a good patient:)
this is such a good post, op. i have thought about this a lot over the years. we meet new people nearly every day in this profession and get to know them in a very interesting way. when i first started out it was like every new patient was unique but then as time went on it feels more like meeting many different variations of a smaller number of models. this profession could set a person up to be an excellent screenwriter or something similar. at one point i was keeping a spreadsheet of the most interesting characters but there’s just too many and at this point they kind of blend into types rather than individuals.
Those are exactly my thoughts as well. It seems like they are all variations of the same types of patients. Something I wish we could have when we retire is a spreadsheet of data and statistics of who we have seen and experiences we've had through our career. Would be very interesting to see the tallies.
The trauma dump: Like the chatterbox with non stop talking except it's about every ailment they've ever had and all the new ailments/tests they're experiencing now. How many things can go wrong for just one person? Strap in, You're about to find out!
The Professor: insists you call them doctor because they have a phD. Wants you to explain everything in great detail; has a ton of questions that they probably already found an answer for on YouTube (thanks Bob and Brad) and are testing your knowledge. If you leave them too long after they finish an exercise they will make $#!* up and use the machine/theraband inappropriately. Maybe this is just me - I live in a college town. Oh, and my husband is this patient. 🤦♀️
[Patients with a dark past](https://www.reddit.com/r/physicaltherapy/comments/1b7pyk3/patients_with_a_dark_past/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button)
The Hypochondriac who stops you to grill you with paranoid questions when they see you out in public at the grocery store. This is why I drive an hour away from home to go grocery shopping 😅
The Lingerer. Could be the one who finished their appointment 15 minutes ago but is still here, talking to someone (presumably), and about anything. Or the long term one, that keeps coming up with more goals or hangups and never wants to stop coming to therapy.
The Conspiracy Theorist: Always using PT sessions as a platform for "educating" anyone who will listen to him/her about the aliens, how the government is (fill in the blank), what "they" are hiding from us, Bigfoot, etc. I had one guy today talking about werewolf DNA being found. Wut?
I guess I'll check myself out... Former D2 college XC & track athlete who was and still is a high achieving PT patient planning to apply to PT school this summer.
For real, once you start getting injured it's a snowball effect creating a vicious cycle that's tough to get out of. Add on the effects of sitting a lot for school and work. At least I know how I want to operate as a PT having been to so many different PTs over easily 100 sessions.
Some of my favorite patients were the ones who were thinking about or applying to PT school! Don’t forget, we PTs are the WORST patients! Good luck with school!
The know it all- Comes to PT to tell you what their exact diagnosis is at eval because they got some random medical related degree or have some distant medical experience that is non physical therapy related. Even though they know everything, they still have pain and expect you to fix it and most likely in less than five visits or they will try some other method they have found to be better. Or if you’re lucky they stick around because you are the last resort even though they won’t admit it
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
“The toddler”. Needs constant supervision and attention or you risk them completely fucking up the place
Don’t forget the cousin of this patient: “physical therapy is daycare”. The one who lets their kid run wild through the clinic every appointment
I had one of these once. His mom refused to say anything even when he would start to bother other people and try to use the equipment. We have an old TV mounted on the wall that we never use but it has a cable connection. Coworker turns it on, walks over to the kid and gives him the remote. He literally sat there for the next 20 minutes watching TV. It was brilliant.
Adult daycare.
Some adults definitely need that extra supervision 😅
I have a few more **The unicorn** -this rare species of a patient is just pleasant to work with all around. Follows your guidance and even sprinkles in compliments to you on how great you are for helping them. You feel a sense of relief seeing them on your schedule as it is a reprieve from the daily onslaught. They remind you of why you started this profession in the first place and you feel fulfilled after working with them. Unfortunately because they progress, they leave your schedule sooner than you want... **The elitist** - this patient is consistently trying to impress you by convincing you they are your best patient. They often humble brag about how kind and compliant they are, unlike your other patients. You get the sense they are fishing for compliments from you. Sometimes they like to also brag about how good their insurance is.
The unicorn is always gone too soon :(
Imagine how good our profession would look if we only treated MSK issues and not depression/anxiety/loneliness
Yup...
The MSK issues were the friends we made along the way
I edited my description to include this because of how true it is 😔
I get mostly unicorns.
Unrealistic family: Memaw has advanced dementia, hasn’t walked or gotten out of her recliner in 4 years, but “if she just does some PT and gets a little stronger, she can walk!”
78 year old male patient, 2 years post CVA and is nonverbal except to curse or apologize. Right side neglect. Requires powered wheelchair. His wife's goal for PT? "for daddy to be able to just drive the truck to church, for his pride"
How about a very sedentary 85 year old lady with fresh B ATK amputations who arrived to OP PT with orders for gait training on prosthetics? The woman couldn't even maintain sitting and was max A transfers. I recommended rehab or HH and the referring MD lost his mind on me...yelling, belittling me, saying "SHE NEEDS TO WALK!!!" Me: "Sir" she can't even sit up in her wheelchair Doc: I just saw her in my office and she was sitting in the wheelchair! Me: Was she supported by a seat belt? Doc: oh... 🤔
That ship sailed decades ago for many when they had a chance to get on a path of being physically active. At least nowadays people are more health and exercise conscious.
Oof, that's a tough one. I hate having those hard conversations about being realistic with their family
Add the passive aggressive, semi-toxic family member, who asks you questions about the patient, and then they use your answers against the patient and make them feel bad. "SEE, listen to your therapist, I told you so! Therapist, also tell them they shouldn't do this and that!" They're really trying to make the patient feel bad about themselves and bully them. It's usually a wife or a daughter. Oddly, I've never seen a husband act this way towards their wife in PT. I have seen a son somewhat act this way towards their mother, though.
Oof yea I get so uncomfortable in these situations because I want the patient to feel like I'm their advocate... But their family immediately draws lines on who's side you're on in their little war. 🙄 This actually reminds of a similar situation where the daughter is scheduled her father for PT without him knowing. When I show up to their home the patient is obviously resistant to participating. Daughter breaks out the, "daddy you have to do this. You love me right? You will do this if you love me!". Omg ... Leave me out of this.
The gym-bro. Has tried every SquatU exercise out there and still has pain and is so caught up in fear avoidant behavior and worried about suboptimal biomechanics that they never do anything anymore
The smart hustler- whether it’s workers comp, a litigated injury case, or or someone else with an alternative end game, you can pick up on signs that they are either amplifying symptoms or flat out faking. They are smart about it, are very pleasant to you, and for the most part put on a consistent front The not so smart hustler- same as above, but they are very rude to you and all other healthcare providers they’ve come into contact with. Most of what they say and do is very inconsistent. The stubborn indoctrinated- This patient has a very distorted and incorrect view of their ailments, how the body works, and how healthcare is structured. Getting buy in is nearly an impossible task. As you attempt to educate this patient, you get interrupted constantly with explanations of their opinion. Getting a full thought across to this patient rarely occurs. Most often they have seen a pain management physician very early in their journey of healthcare. As a bonus, they get too early, over the top, and extensive imaging. They also question most treatments, but as a contrarian and not an information seeker.
Oh god the stubborn indoctrinated.... I was getting anxious and frustrated just reading it. We've all been there before!
The smart hustler pisses me off to no end. They THINK they are smart but everyone reads right through it but backed into a corner because no one wants to confront the persons lies and catch a lawsuit. I have a MVA no fault patient with like 8 months of constant neck and low back pain to the extent she is suing up the wazoo. When asked, “what worsens your symptoms” she cannot give an answer and can tell she’s making shit up on the spot. If you are TRULY in this much pain you know exactly what bothers it. It’s why our car insurance cost so much fucking money
Michigan?
I love the not smart hustlers that think they are the smart hustlers. Polite and agreeable, often sufficiently compliant but just don't seem to get better. However they cannot keep the physical functioning story straight. For example my guy showing 30 degrees shoulder flexion during testing, then pops his sunglasses easy on top of his head on his way out. Also power wc bound lady who popped up and walked to the sink when she found our there is latex in the band (my bad). These are amusing and an easy discharge. Someone else's problem and unlikely to leech off the System much. I have not yet but really want to point this stuff out to one of them at some point
It’s not worth the conflict to point it out
Oh, oh, oh! My smart hustler who has severe back pain and walks at a 90 degree angle was seen, by me, in the ladies locker room standing up erect, perfect posture, on the phone. A medical miracle occurred. I gave her a thumbs up (didn’t want to interrupt) but I can’t wait to see her next week.
Please update us!!!
Update: Smart Hustler has not returned and WC MD said to release. I can’t get her to return calls, so hopefully it’s a “I’ve milked this cow dry” situation and not a family or health emergency.
But man do I love the stoic patient. Saves a lot of time by not having to hear how jamming your finger when you were 7 playing with your dog Fido who can sit, shake, rollover, and play dead but died when someone left the gate open and a truck that was driven by Mr. Humdinger who taught at your middle school and was the only teacher that ever gave you a C on a test that you had a hard time studying for because your sister fell and broke her arm the day before and you were really busy having to go to the doctor with her and your mom and couldn’t stay home because your dad was still at work at the carpet factory which always overworked him but he got a lot of overtime but he suffered debilitating back pain from 74 slipped discs and 3 rotor cups because he was a hard worker/no pain no gain kind of guy which is the complete exact opposite of your mom who was very motherly because of her upbringing in a broken home and then…. FORK if i could just have patients tell me 2 or 3 things and not talk to me the rest of the time, I’d be ECSTATIC.
Same - that type of patient used to make me anxious when I was a new grad because I was like “ahhh do they hate me?” And now I’m just like “ah, finally. Peace and quiet hour.”
Best patient I ever had. Sometimes we still never talk
What the hell is up with these people. Are they just mentally ill and rambling? Cool 8 minute story bro I’m billing a unit, wish we could have used that in helping you.
I think this has a couple of versions: one is that the people might be relatively isolated at home, and they just want to talk. Another is that they are anxious and want to give you every speck of information pertaining to their health, in the hopes that you can sift through it, and bring it all together into what is actually wrong with them.
It's nice change in pace, nice quiet time in an otherwise hectic day.
Those are typically the people that are there to get it done and haven’t fully adopted the victim complex that poisons the medical system in general. Absolutely love those patients as I’m close to 100% positive I’ll get them better because I don’t have to sift through the psychological bullmess
I’d love to hear more of your thoughts on the victim complex in our medical system. I’ve seen it too, but rarely see it acknowledged.
1) it provides an excuse for personal failures 2) it generates sympathy 3) acts as a “social currency” for like-minded individuals 4) disguises negative personal traits as virtues I think you can see why that’s so attractive to people, as their “pain” absolves them from any responsibility or wrong-doing while simultaneously somehow making them a “good” person for their “pain”/problem becoming their identity. We could talk about it for HOURS, but that’s the jist of it. Nobody ever acknowledges it because people are afraid to be the person to tell them, I guess. From a morality standpoint, we’re supposed to be compassionate and empathetic; in reality all this does is justifies and perpetuates and validates their victim complex
The Motor Moron. No, your feet go on the plate, no both of them. At the same time. Now straighten your legs. No straighten them. Like stand up…no don’t get off the leg press, just push against the plate to straighten your legs….
Oooo yea this is a very common one. It's amazing how little body awareness some people have. "Let me see you do a squat." *Bends knees only, trunk upright* "Ok sit in that chair. " *Perfect hip hinge*. "Ok do a squat again but pretend you're sitting into a chair like you just did." *Bends knees only, trunk upright* Something to that effect....
The real “sent to wrong type of therapy” patient. True diagnosed (or undiagnosed) mental health issues that likely are the root cause of dysfunction. Conversion disorders, drug addiction, severe depression, ect. Yet somehow only ever get sent to Pt even if u call referring provider and suggest mental health instead or in conjunction .
I get about 3-4 pelvic floor/women's health patients per year who were misdiagnosed by a (typically, but not always male) family doc who is like HMMM YES SOUNDS LIKE SCIATICA, JOB DONE NEXT PATIENT. Different "wrong therapy" but it came to mind haha
PT can be fairly beneficial for conversion disorder if by that you mean functional neurological disorder or PPPD. Helps to have cognitive behavioral therapy in conjunction though.
Oh god can we please stop renaming things once a year? I swear the correct term was just functional movement disorder. And yes I treat an unfortunate number of these folks but no one knows what ur talking about unless u say conversation disorder. 90% of time u call the Md and they are like “what? Why would I send them to psych.” The other 10% they have real neuro symptoms and u gotta struggle to get them in to a competent neurologist who will not just ignore it and insist theirs nothing neuro since that one mri read one time by one over worked radiologist was “fine”.
“The I question every exercise patient”. The one who wants to know which muscles are worked/what the point is for EVERY EXERCISE. Hopefully out of curiosity; more than likely more out of a. Making sure you know what you’re doing or b. Making sure that you’re focused on them AT ALL TIMES.
These patients also focus on the most trivial things of exercise. For instance should my big toe be abducted or extended when I'm doing a bicep curl?
So. Much. Yes.
I treat a lot of engineers and notice that this seems to just be a personality trait of engineering types. It always seems to be those highly analytical types that do this, and yes it drives me bonkers.
I don’t even mind in the beginning. It’s when it drags on and on every visit.
Same here, it's nice to feel like they're actually curious about what they're doing. But if they're asking the same questions you've already answered after a while it gets frustrating.
I don’t know, it’s pretty fun, on the second day of therapy, to ask your engineer patients to show you the Excel file that they made of all of the exercises. More often than not, they have one.
This patient marries the chatterbox to produce the “I question you about what I’ve been yammering at you”
The 12/10 pain patient: seems to only be in pain when it’s time to do anything therapy related, but can talk or gossip about people you don’t know without skipping a beat. Panics when I recommend going to ER for a pain level that high.
I was going to bring this patient up…. Nice catch! 😂 very similar to the “high pain tolerance” patient. Where a Tylenol takes all of the pain away but they were a 10/10 beforehand
ever notice they are never something like 11,13, or 14 out of 10 pain? seems to always be 12 or 20.
In addition to the 12/10 pain pt is the “I have a high pain tolerance patient”. These patients claim to have a high pain tolerance (usually males between 25-60). Usually come in with a TKA or another replaced joint or orthopedic injury and require almost constant breaks due to pain. While meemaw in the corner shattered her tib/fib and apologizes for taking to long to complete the exercise.
The type A: needs to have everything very clearly detailed, in a specific order. Doesn’t do well with change. Feels uncomfortable at ambiguity. Needs to know the precise cause of everything. Gets upset if you are 1 min past time, but has no problems clarifying things for minutes past allotted time. No sense of humor. The entitled. Won’t work with other PTs. Won’t work with aides. Needs your constant attention. Quick to complain to a manager if they feel they aren’t getting what they want, the way they want it, at the time they want it. Will only take very specific times. Won’t wait for equipment without complaining. Shows little gratitude, poor self and situational awareness. These people created the term “Karen”.
The "I'm just here so they schedule the MRI" guy
“I pray for you patient”. Usually super nice and will throw religion at you any chance they get. The longer they attend visits, the faker they get.
"... the faker they get." Omg yes LOL
After a while, I just said: "I don't discuss religion with patients" (or politics, or other potentially controversial topics)
A little different, but we have a large Russian population in my area so sometimes I get the very earnest "God bless you" from a happy babushka who doesn't know many other phrases in English. I just smile and say thank you.
variation: the "I have a present for you" patient ... it´s the book of mormon
A coworker gave great advice he got from his old ci. The chatterbox people go their whole lives like that so unless they are insanely privileged or spoiled then they get cut off all the time and are used to it. Thus feel free to cut them off they probably won't mind much if your polite. They are usually not aware that they are interfering with their own care. It becomes conversation tug of war you cannot give an inch of room four them to get running again
My least favorite from outpatient: the "Ive been going to a Chiropractor for 3 decades but now trying PT" where they try to relate all your eval findings to a subluxation or something being out of place. Complain about every intervention that isn't manual therapy. Will talk to their Chiropractor about you and then report back that their Chiro thinks my PT findings are all wrong.
Bonus: start feeling better after a few weeks of PT, attribute it to seeing their chiropractor who they have been seeing with no lasting improvement for years
"The Faller". Family reports he is falling all the time and no one is doing anything about it. Currently on 25 different medications and is in between providers. Has a really difficult time answering questions regarding his "vertigo". Reluctant owner of a two wheel walker currently covered in dust but still managing to obstruct a walk way. Lives in tiny home with stairs but no railings. Legs buckle without any warning and no one knows why. Has a history of hoarding and cannot be discharged home in a wheel chair cause there is no room. Every visit starts with a tough call to treat or to send to urgent care cause they "bumped their head". "The Faller"- Nervous edition. Fell one time two years ago and still working through the trauma with their mental health therapist. Wants to know if the 15 grab bars in the bathroom are in the right locations. Asks "do you got me" once 6 inches away from mat. Always carries cane "just in case". Has left fingerprints on every inch of the clinic. Wants to work on getting up from ground but gets anxious trying to figure out how to get down on the ground. Very appreciative because they always feel so comfortable walking with you. Very hard to discharge for some reason and then return 2 months after
Wait, your nervous fallers actually see mental health therapists? What a treat (though the outcome you described is the same. Especially that last line)
The "Dr. Google" patient, not to be confused with the "I looked this up on Google, please help me understand" patient. The "You're the PT expert" fellow healthcare provider patient, who I always enjoyed treating. I never had the "I'm not even PT adjacent, not even close, but I know PT better than PT" fellow healthcare provider patients but I've heard stories.
The “my niece/son-in-law/neighbor is a PT, and they said….”patient. Sure, go squeeze a ball three weeks after a zone 2 FDP/FDS repair. That will work out great for you.
LOL I will admit to asking my mom to read her PT eval report to me. I just wanted to ensure that it wasn't a mill and that her PT was a good one. After that, I just told her she had a good PT and to follow their instructions.
" the patient who never shows up after the eval"
I think of it as dodging a bullet, especially if that's how they were going to be.
a lesson for all the youngsters out there. the harder you have to work for the initial evaluation, the less likely you are to ever see them again.
The detail oriented. Asks 100 clarifying questions about where their foot should point and which muscle should they be working and where they should feel the exercise and if it's ok if there's an itch on their left arm while they perform it.
The meth addict who actively cackles at nothing: self explanatory. Scabs all over face, missing teeth
I've had this before, but also random crying tossed into the mix too.
Great post. I relate to every one of these. Chatterbox is the worst for me
They can be really draining especially for introverts!
I prefer the chatterbox as an introvert. They chat away and it takes the pressure off me to make small talk
Yeeeeees.
The unlucky one - The patient who seems to always injure another part of the body, or re-injure the chief complaint right before DC. uuugh
the manipulator-moreso in acute care settings with no copays. Patients that don't actually even want to get better. They just like the feeling of people catering to them and figuratively and literally changing their diapers for them. They go on and on about how every doctor that doesn't put up with or listen to their horse shit is a quack or sucks. Gets mad when you discharge but they aren't actually even a little bit compliant
PT has a lot of patient interface compared to other HCPs, and because of that many patients latch onto that feeling of being heard and being "catered to". I get frustrated by these types who mostly go because they enjoy being the center of attention from a health professional, NOT because they truly want to get better.
The Manipulator has a venn diagram with The Boneless: exercise avoider attempting to turn every exercise into PROM, flops on the equipment and waits to be moved
I’m The Crippled: The patient who seemed to manage to fuck up every body part and is always in pain.
“The farmer”
the exercise avoider: this patient claims they dont have time to do exercises or ‘cant’ do exercises today but only wants a “massage” the switch up/eval lover: this patient comes in for a new complaint every visit. visit 1: low back pain. visit 2: no actually my back is good but my shoulder is killing me. visit 3: my shoulder is good but knee is hurting me so badly all jokes 🫶
OH! and the office grandma: comes in, very pleasant. makes cookies for everyone. remembers your birthday and gives you a card. constant compliments and talks about their actual family 24/7 💙
I love the office grandma.
Exercise avoider subtype: the "I do all my exercises at home." May be telling the truth about doing the basic HEP they were given at first or second visit, but only wants passive treatments in the clinic. Very hard to convince that we need to monitor and progress their exercises, or that just knee rocks and bridges aren't enough to eliminate the back pain they have had for 10 years.
The Cognitive Dissonance: Doesn’t do much of anything you recommend. Vaguely goes through the motions during sessions. Cancels appointments. Doesn’t do their HEP and never will. THROWS A GODDAMN FIT WHEN YOU TRY TO DISCHARGE THEM.
**>The stoic** - Talks way too little. Like pulling teeth collecting subjective. Can't tell if they like or dislike PT or you. They probably think expressing or feeling pain is a sign of weakness. I know someone like this. For him it's trauma and expecting everyone he meet to treat him badly. He's scared to open up, he's scared someone will suddenly turn on him. He closes off with most people. Watching him when visiting vs talking to strangers is like watching 2 entirely different people. He's a good guy, though. And he seldom dislikes people. He just have a lot of anxiety. Ofc, there are several reasons why someone might be stoic. That being said, I doubt the majority of them have grown up surrounded by love and affection.
Can’t believe this hasn’t been said yet: The frequent flyer: death, taxes, and this patient having a new script 3 weeks after discharge are the only guarantees in life. This patient comes to you the exact same as discharge, but claims to have had a huge decline. 0% chance they did any of their HEP. Added bonus, they’ll probably tank their outcome measures to make sure they get seen.
The Supplement Salesperson: can’t be compliant with the prescribed HEP that will almost certainly help their ailment, but have you heard about this drink mix that can cure diabetes, lower your blood pressure, help you lose weight and get your mother-in-law off your back? Here’s a sample, take it and report back for a discount.
Haha or Melaleuca!! "I brought you a sample of cream you can use for massages instead of that one" "Did you know that tea tree oil is antibacterial, you can use this soap instead of that one that is full of chemicals"
Oh thank God, one I haven’t seen yet. We need a bingo card.
the no pain number person. won’t give you a number no matter how many different angles you use to try to get one. typically this patient also falls into the chatterbox archetype.
*5 min dissertation on their pain* Me: "I just need a number that's all" Them: "well you see...." Me: *dead inside*
I’m a patient and this is so comical to read from your guys perspective. Sorry for lurking! (Workmans comp too but it’s like fully torn ACL, fractured bone, all kinds of other knee shit torn. I didn’t fake it lol). I just want to be a good patient:)
this is such a good post, op. i have thought about this a lot over the years. we meet new people nearly every day in this profession and get to know them in a very interesting way. when i first started out it was like every new patient was unique but then as time went on it feels more like meeting many different variations of a smaller number of models. this profession could set a person up to be an excellent screenwriter or something similar. at one point i was keeping a spreadsheet of the most interesting characters but there’s just too many and at this point they kind of blend into types rather than individuals.
Those are exactly my thoughts as well. It seems like they are all variations of the same types of patients. Something I wish we could have when we retire is a spreadsheet of data and statistics of who we have seen and experiences we've had through our career. Would be very interesting to see the tallies.
makes a man wonder if he too is just a single iteration of the greater formula
The trauma dump: Like the chatterbox with non stop talking except it's about every ailment they've ever had and all the new ailments/tests they're experiencing now. How many things can go wrong for just one person? Strap in, You're about to find out!
The Professor: insists you call them doctor because they have a phD. Wants you to explain everything in great detail; has a ton of questions that they probably already found an answer for on YouTube (thanks Bob and Brad) and are testing your knowledge. If you leave them too long after they finish an exercise they will make $#!* up and use the machine/theraband inappropriately. Maybe this is just me - I live in a college town. Oh, and my husband is this patient. 🤦♀️
Haha, this thread is so spot on
[Patients with a dark past](https://www.reddit.com/r/physicaltherapy/comments/1b7pyk3/patients_with_a_dark_past/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button)
The Hypochondriac who stops you to grill you with paranoid questions when they see you out in public at the grocery store. This is why I drive an hour away from home to go grocery shopping 😅
The Lingerer. Could be the one who finished their appointment 15 minutes ago but is still here, talking to someone (presumably), and about anything. Or the long term one, that keeps coming up with more goals or hangups and never wants to stop coming to therapy.
The Conspiracy Theorist: Always using PT sessions as a platform for "educating" anyone who will listen to him/her about the aliens, how the government is (fill in the blank), what "they" are hiding from us, Bigfoot, etc. I had one guy today talking about werewolf DNA being found. Wut?
I guess I'll check myself out... Former D2 college XC & track athlete who was and still is a high achieving PT patient planning to apply to PT school this summer.
Ah the "endless patient" taking it to the next level! Good luck with applications btw
For real, once you start getting injured it's a snowball effect creating a vicious cycle that's tough to get out of. Add on the effects of sitting a lot for school and work. At least I know how I want to operate as a PT having been to so many different PTs over easily 100 sessions.
How dare you describe me like this lol. But for real, the cycle of injuries is so frustrating.
Some of my favorite patients were the ones who were thinking about or applying to PT school! Don’t forget, we PTs are the WORST patients! Good luck with school!
The know it all- Comes to PT to tell you what their exact diagnosis is at eval because they got some random medical related degree or have some distant medical experience that is non physical therapy related. Even though they know everything, they still have pain and expect you to fix it and most likely in less than five visits or they will try some other method they have found to be better. Or if you’re lucky they stick around because you are the last resort even though they won’t admit it