When we have the flu, or a sprained ankle, or a bruised knee, we have different levels of alarm, concern, expectancy and different ways of responding, varying from mild concern to extreme disappointment. Equally important, we are different individuals with different levels of tolerance for pain, suffering, inconvenience, fear, apprehension and compliance.
We cannot depend upon a physical diagnosis to tell us what the patient “wants and plans to do.” One patient with carpal tunnel syndrome may have been ready for a career change while another may feel that this limitation is a major burden.
We cannot depend upon a physical diagnosis to tell us what the patient expects from care. One patient with a lumbar strain may anticipate that oral medication and limited bed rest will ameliorate all discomfort while another may realize that he/she is grossly de-conditioned, sedentary and needs to comply consistently, putting forth maximum effort in physical therapies.
We cannot depend upon a physical diagnosis to tell us what impact the patient’s economic, educational, and interpersonal history has upon his/her desire and willingness to mobilize. One patient may be 46 and worked since she was 16 and see the limitations as a justification for finally having others care for her. Another may feel that limitations limit his male image and that he must resolve this or be seen as weak and ineffectual by his peer group…or his wife.
Since the SAME injury, can express itself DIFFERENTLY in EACH person, we simply need a better psychological understanding of each patient. Pathoplasticity.