Tired of patient’s visitors asking you for free treatment?

Have you ever been asked by a visitor (who accompany your patient) for treatment of his/ her problem? I was asked this morning by a very good friend of mine, who faces this problem timely.

In Nepal we often come across this situation when a visitor of your patient approaches you and asks you for the solution of his or her own problem(s). Now, is it good to treat them without an appointment or is it better to ask them to come to you with an appointment is an important question/ decision to make. While doing one of the two, you should be careful enough to consider the ethical aspects. Remember that, (1) providing a brief exercise protocol without assessment may not do good (or may even do harm) to them, (2) in-depth assessment and treatment without an appointment (or payment) may be a burden to you in terms of time and money (you should charge fair amount of remuneration for the services that you provide to the patient, please refer to WCPT Policy Statement, point number six), and (3) charging them for a minute of your time can be too much for them to pay and they may have to go through a long and tiring process, so this can be avoided.

These are few things that I think will be good to look at this problem.

1. Educate them. Remember that most individuals do this because of lack of awareness of importance of physiotherapy assessment and treatment. They think that it will only take us a minute to TELL them one or two exercises without carefully looking at their problem. Community needs to know that physiotherapy treatment involves an in-depth knowledge of the condition and a complex clinical reasoning process. This post can be a good read for understanding this.
2. By a brief history you may be able to figure out if the person will require your consultation or just one simple advice will be helpful to them. If the question/ problem is a simple doubt which does not require you to assess the patient, just answering to the person’s question will be good enough. For example, I remember a patient asking me if he can continue jogging despite of his mechanical low back pain, I replied to him saying, “yes, jogging is in fact good for low back pain.” You may not need the person to come to you with an appointment and payment for this when he is fit enough to jog, unless he feels he requires a consultation.
3. If the person’s question/ problem is complex, that may require investment of your time for complete assessment, and prescribing exercises that require your time for motor learning, then YES, I think you should ask the person to come to you with a time that best suits both of you. I am sure the problem isn’t severe enough that requires urgent management. However, the person should be explained why he/she requires an appointment for this problem.

This post is written by Saurab Sharma.

As this is my personal opinion, and nothing here can be a complete “right” or “wrong”, so I would be happy to hear your opinion or perspective on this. Please share the post with your friends to hear more comments and answers.