My Patient Ran After I Recommended They Don’t Run…

One of the most common scenarios you will encounter as a physical therapist is a patient doing something you explicitly advised them not to do. It happens frequently, so it’s crucial to understand that this will occur, know how to view the situation, respond appropriately, and adjust your communication going forward.

If you haven’t faced this situation yet, you soon will… I promise.

Case Study

A 35-year-old female, 6 weeks post-op from a right hip labral repair, is recovering well. She reports no pain and only occasional minor tweaks. She has two young children—a 3-year-old and a 1-year-old. Despite her progress, she’s not yet ready for any impact exercises due to the continued healing process. You explain this to her, and she verbalizes understanding. Great.

However, at her next appointment, she admits she had to run when her 3-year-old darted toward a busy street.

How Should You Respond?

Believe it or not, some therapists might react with frustration, saying something like, “I told you not to do this, and you’re not ready!” in an angry tone. In my experience, this is the worst possible response.

Here’s a better approach:

1. Understand the Scenario

In many situations, patients may need to act against your advice for valid reasons. In this case, the patient prioritized her child’s safety over her surgical recovery—an obvious choice for any parent. Responding with frustration can harm your relationship and reduce trust. Instead, acknowledge the reality of the situation and show empathy.

2. Reframe It as a Positive Sign

Counterintuitive as it may seem, a patient doing something against your advice can actually be a positive indicator. In this case, the fact that she felt comfortable enough to run suggests that her hip was feeling strong and stable. Had she been in significant pain, she likely wouldn’t have made the same decision.

This doesn’t mean you should ignore the potential risks, but it’s a sign that her recovery is going well. Use this as an opportunity to assess her readiness for more advanced activities while reinforcing why certain restrictions are still in place.

3. Respect Patients’ Autonomy

Patients are individuals with their own agency. They come to you for advice and recommendations, but they won’t always follow them perfectly. Instead of reprimanding them, take the opportunity to understand their perspective. Educate them on the potential risks and work collaboratively to create a plan that aligns with their goals and circumstances.

Think of it like a hospital AMA (Against Medical Advice) scenario. Whether you agree with a patient’s decision or not, it’s crucial to respect their autonomy. If you want to build long-term relationships and trust, support them even when they don’t strictly follow your advice.

4. Be Mindful of Your Reactions

When patients act against your recommendations, how you respond matters. Are you going to be the therapist who gets frustrated, vents about it to colleagues, and risks damaging the patient relationship? Or will you see it as a learning opportunity and a sign of recovery, and work with the patient to find a path forward that meets both your goals?

The latter approach will lead to better outcomes, stronger relationships, and more referrals from that patient’s friends, family, and doctors.

Final Thoughts

When a patient inevitably does something against your advice, stay calm, empathize, and use the situation as an opportunity to learn and collaborate. By adopting a positive and supportive mindset, you’ll foster trust, improve patient outcomes, and build lasting relationships that benefit both your practice and your patients.