An Open Letter to My Physical Therapist

Alright, first things first: I presume you want to help. You probably wouldn’t have gotten this job if you weren’t interested in helping people with injuries and other physical issues. That’s great.

With that out of the way, I have some issues I’d like to bring up with you. Not everyone in your profession is guilty of doing every one of the things I’m about to bring up, but a lot of you are guilty of a lot of them, and it really needs to stop.

So, without further ado, some constructive criticism from a patient who has, regrettably, become somewhat of a connoisseur of practitioners in your domain:

Dear Therapist,

First, let’s get something straight: I want to get better. I’m pretty fucking sure that I want to get better more than you want me to get better, because I am the person who actually has to deal with the issues that we are trying to address day in and day out. I am the person who decided to set up these appointments with you. I am the person paying for them. If I didn’t want to get better, then I wouldn’t be coming to see you. Proceed with this assumption. If you aren’t making this basic assumption in dealing with me, we are going to have problems.

Second, on a related note, if you ever, ever feel the impulse to remind me that “We really need to start seeing some improvements”, consider that another option is to shut the fuck up. If I think that my problem is bad enough that I am paying money to come to see you, you can safely assume that I am well aware of the benefits of seeing improvements. You can also safely assume that if you decide to remind me of that fact as though the problem is a lack of motivation to get better on my part that I will spend the rest of our appointment fantasizing about stabbing you in the face with a protractor. Repeatedly. Forcefully.

Third, if I’m not reliably doing all of the exercises you prescribe, consider the possibility that it is not because I lack motivation to get better. Consider the possibility that if you prescribe 10 different exercises five times a day, you are prescribing the impossible for most people, and if you can’t acknowledge that, then you probably don’t understand enough about people to be doing a job that involves working with them. Consider, as an alternative to insisting on an absurdly complex exercise regimen, that you could collaborate with me to figure out why a particular regimen poses the challenge that it does, and how we might modify it to make it realistic to expect me to keep up with it.

Third and a half, if you can’t do that, consider that you are giving me (and probably all of your other patients) a tremendous incentive to lie to you about whether or not we are doing the prescribed exercises. Deciding to change physical therapists is a big step, and generally a scarier step than deciding “Maybe I can just do a few of these and say I’m doing all of them and hope for the best.”.

Four, be able to explain and defend the treatment decisions you make. If you prescribe something I have already tried that didn’t work the first time, you had better be able to give me a damn good reason why it’s worth trying again. If you prescribe something that sounds like bullshit, and can’t explain why it’s not, I’m going to lose confidence in you very quickly. Because I have been dealing with the problems I deal with as long as I have, it is not uncommon for me to go to therapists who recommend things that I have tried before, and that I know more about than they do. If it seems like I have done more research on the treatments you are recommending to me than you have, we’ve got problems.

Five, for God’s sake take accurate notes! I will know if you don’t, because when you tell me that things are looking better or worse and I know that the opposite is true, I have no recourse but to assume you are incompetent. This is especially true if I tell you that you are wrong and you refer to your oft-inaccurate notes to back up your claim. It is astonishing how often some therapists have told me things about my own health history in appointments with them that are blatantly inaccurate.

Six, don’t insist on finding a silver lining in a lack of improvement. You aren’t the one in pain, you don’t get to decide for me if the glass is half-full. If I ask you for ways to keep my chin up about stuff, then by all means help me out, but your thoughtless optimism is obnoxiously patronizing coming from the person who does not actually have the affliction. If things aren’t working, then let’s form a new strategy rather than wasting time trying to cobble together hope about the failed one.

Six and a half, for fuck’s sake don’t take your frustration about a lack of improvement out on me. If you get frustrated at me because of the fact that I’m not feeling better, you are complete and total asshole, and I will ditch the protractor fantasy for one involving fire ants and your sensitive parts.

Seven, and I can’t believe this is something I actually need to make explicit, but history has shown that it is: if I ask you what things I can do without aggravating my issues, do not, under any circumstances respond by giving me a list of things I should not be doing. When I ask you about my options for physical activity, I am looking for a list of things that I don’t have to be afraid of doing, and if you respond to that question by giving me a list of things I should be afraid of doing, I hate you.

Eight, ask for my input. ask me what I think about how I’m doing, and about the treatments and exercises you are prescribing. Ask me if I think there are ways the regimen will be hard or easy, and could be improved. You are the professional, and while some of your patients, myself included, will put effort into adding our own input to your ideas on how to move forward, it is entirely within your power to make that easy or difficult. You can ask questions and deliberately give openings for my input, or you can hope that I will find a conversational opening to do so. And you had better want my input, because while you may be the expert on physical therapy, I am the expert on me – on what I can do, what I can’t do, what I have time to do, etc. As I’m sure you’ve figured out by now, every patient and every physical issue is different, and my input is how you know what is different and how it is different.

Nine, if the exercises you give me to do are not working, do not assume that it’s because I’m not doing them. Consider the possibility that maybe your exercises are not working because people are different and what works for one person will not necessarily work for another.

Ten, assume that I am always doing my best. If I’m not keeping up with the exercises, assume that something is making the routine impossible for me to keep up with, and let’s collaborate on modifying the routine. If you think I’m lying to you about whether or not I’m doing the exercises, assume that you have failed to make our therapy sessions feel sufficiently collaborative for me to feel comfortable communicating to you about what I can and can’t do and what I am and am not actually doing. If we really can’t figure out a way to make everything doable, then let’s go over all of the available options for treatment again and figure out what possibilities we have missed.

This concludes our prickly open letter of the day. I hope we’ve all learned something.


Your Patient


One comment on “An Open Letter to My Physical Therapist

  1. OMG! Thank you so much for writing and posting this! I stumbled on it because I’m getting ready to write one of my own about an experience I watched my mother have with one of these “fantasy land” therapists. I decided to research a little and see if anyone else has possibly written about the frustration.
    Your letter made me feel a whole lot better and confident that my mom’s experience was not an isolated occurrence.
    I hope you are doing ok, and thanks again for posting this. I sincerely appreciate the effort it takes to actually write something so heartfelt even when you know that it may never be fully understood by anyone else.

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