April 2011

Out on a limb: Image is everything

by Jordana Bieze Foster, Editor

Patients have multiple reasons for not complying with a practitioner’s recommendations. Most of them are familiar by now: inconvenience, discomfort, aesthetics, forgetfulness, failure to understand the consequences of not complying.

But there’s another factor that many practitioners are only just starting to consider: Sometimes compliance simply makes patients feel lousy about themselves.

It isn’t just that the prescribed therapeutic shoe is unattractive or uncomfortable. It isn’t even that the not-so-stylish shoe can’t be worn with a cute sundress or formal wear. It’s that wearing that shoe, from the patient’s perspective, is essentially advertising their defects to the rest of the world.

Dealing with pain, pathology, or impairment is no fun. Hearing from a practitioner about all the things you should and shouldn’t do is no fun. Having to think about all the ways a particular condition can affect your future is no fun. All of these issues can make a patient feel not just unhappy but unworthy, as if they’ve somehow become less of a person.

But many patients prefer to keep those struggles as private as possible. When everyone can see you have a problem, that’s much more difficult to do. And making your health issues public takes those feelings of unhappiness and unworthiness to yet another level.

In this issue of LER, we explore patient self image and compliance with regard to therapeutic shoes and other O&P devices (see “Sensitivity to self image boosts O&P outcomes.) But issues of self image and compliance affect other aspects of lower extremity medicine as well.

Sports medicine practitioners routinely struggle with patients who chafe at the idea of missing practice or game time, and strategies for dealing with this resistance were a popular topic of discussion earlier this month at the IOC World Conference on Injury and Illness in Sport. Of course, multiple factors affect athletes’ insistence on returning to sport against a practitioner’s recommendations: pressure from coaches or parents, fear of losing one’s spot on the team, financial considerations for professionals or those with hopes of going pro. But self image undoubtedly plays a role as well.

An athlete sitting on the sidelines in street clothes during a game is just as much a public statement as another type of patient wearing therapeutic shoes or a prosthetic limb. From the athlete’s perspective, it’s a public admission that a large part of his or her identity has been rendered irrelevant, that he or she is letting down the team, that he or she may never return to top form.

For someone who lives for a sport, simply not being able to play is difficult enough. If not playing makes that athlete feel like a quitter or a failure, as if they’ve somehow become less of a person, it can be unendurable.

One of the worst things about having a negative self image is the feeling that nobody understands. That’s why practitioners say a little empathy goes a long way toward improving patient compliance. Better compliance leads to better outcomes. And that, not coincidentally, leads to a more positive self image.

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