What to Do When Someone Is Not Getting Better

Let’s face it—there will be times when a patient just doesn’t improve, no matter how hard you try. This is a reality every healthcare professional faces, and the sooner you accept it, the less frustration you’ll feel walking into the clinic each day.

That said, every clinic operates differently, and available resources can vary widely between organizations. What I’m sharing here is based on my personal experience working in clinics across Chicago and San Francisco. While the general approach can be adapted, it’s always best to consult with your manager to understand the specific protocols in your workplace.

Step 1: Explore Every Avenue of Treatment

Before concluding that nothing more can be done, make sure you’ve tried every treatment direction possible. Too often, therapists stop at strengthening the painful joint when they find muscle weakness, but this approach can fall short.

Instead of simply treating impairments, be more creative and comprehensive in your treatment. Try a variety of methods, such as:

• Hands-on techniques: soft tissue massage, cross-friction massage, active release techniques

• Joint work: mobilizations, manipulations, and flexibility exercises

• Addressing neighboring joints: sometimes the issue stems from above or below the painful joint

Explain your approach to the patient to keep them engaged and informed. For example, you could say: “Your symptoms don’t align perfectly with a specific diagnosis. While one test points toward [insert diagnosis], another suggests something different. Since there’s no clear pattern, we’ll take a trial-and-error approach to see how your body responds. If things improve, great! If not, we’ll adjust our strategy.”

Step 2: Have a Direct Conversation with the Patient

If you’ve exhausted your options and the patient isn’t improving, it’s time for an honest conversation. Here’s an example of how you might approach it:

“Clearly, your body isn’t responding to physical therapy as we’d hoped. Despite trying X, Y, and Z treatments, your symptoms have persisted or worsened. At this point, I recommend seeing an orthopedic specialist for further evaluation and imaging to get a clearer picture of what’s going on.”

Step 3: Facilitate the Referral Process

Don’t stop at just recommending a specialist—help the patient through the referral process. Many patients have never seen an orthopedic specialist before and may feel overwhelmed. Offer to provide a list of trusted providers or assist with scheduling if necessary.

Additionally, educate them on what to expect during their visit. You might say:

“It can take a few weeks to get an appointment, so it’s best to schedule as soon as possible. Typically, a PA or nurse will see you first to gather your history. Make sure to mention that you’ve been in physical therapy for eight weeks without significant improvement. When you see the orthopedic doctor, they’re usually quite busy and get straight to the point, so have specific questions ready. Depending on their findings, next steps could include imaging (like an MRI), cortisone injections, PRP injections, or even surgery.”

This guidance not only empowers the patient but also reinforces that you care about their well-being, even if physical therapy didn’t resolve their symptoms.

Step 4: Reassess and Plan Accordingly

Once the patient returns with new information from the specialist—such as imaging results or treatment recommendations—you can use this data to formulate a new plan. This renewed approach may lead to better outcomes and renewed trust.

Summary

When a patient isn’t getting better, there are still plenty of ways to provide value:

1. Try multiple treatment approaches and carefully assess their response.

2. Have a direct, compassionate conversation when progress stalls.

3. Facilitate the referral process and educate the patient on what to expect.

4. Reassess the situation once new information becomes available and create a new plan.

By following this process, you can continue to support your patients, even when results aren’t immediate. Ultimately, this approach ensures they feel cared for, respected, and well-guided—a win-win for everyone involved.