Walking with a Patient to Your Clinic Space

You’re now walking with your patient to your clinic room or your cubicle, the walk maybe a few seconds or maybe a few seconds longer, and it may well be long enough for the persons mind to start offering them negative thoughts or feelings about what's happening. It can be important in this moment to occupy the persons thoughts with something. To mitigate that thought direction of travel. Try to fill the time by saying something very simple. To new patients I used to point out that the corridor that we walking down had those plastic crash barriers either side to guide beds down the middle of the corridor, because the building used to be an elderly care inpatient unit. But we haven't had any inpatients for nearly 20 years, but for some reason those barriers are just been left there. It wasn't anything important. I was saying just something to fill the moment with something which felt appropriate for the moment. I would try to present as though this wasn’t just something which I said every single time- to every single patient, I would attempt to make it appear that to some degree it had just occurred to me to say it upon seeing this in front of me. But walking in silence, is like walking to the gallows, allowing the person’s mind to run riot would not be advisable. Be careful what you do say, and make sure what you say it's the sweet spot of being friendly, very mildly interesting, appropriate for the situation and neutral in that it is not going to trigger any further negative thoughts. For example, if you were to make a comment about it being quiet today.  All of a sudden person might be thinking about what you may normally be able to hear from the corridor, can you hear everything which is being said? Now you’ve opened up the fear of lack of confidentiality.

Consider whether you walk in front of the person, by the side of the person, or behind the person. It may seem polite to open the door for somebody let them walk through and say “just head straight down there” and then you follow them down the corridor but now you're walking behind somebody, they can't see you, but they can certainly feel your presence behind them, and that can certainly be threatening. It’s just a little something else to creep their flight or fight system creeping closer and closer to that tipping point where the appointment will fail.

I would suggest, as a general rule, walk, just in front of your patient while calmly turning your head to look around while you're chatting away. Emphasis there on the word calmly when turning your head and turn your head back slowly and casually, don't suddenly turn your head back, suddenly initiated movements will again begin to trigger the persons flight or fight system.

Traditional advice given to physios when working with mental health patients has often been never walk in front of someone with them behind you because that puts your risk. I think this is over simplistic thinking. It is incredibly rare for a patient without warning to suddenly attack a clinician because you're vulnerable. It is certainly more likely if you're working in an inpatient unit with patients who are acutely unwell or in locked wards or on forensics units. Know your patient, and if a risk has been identified before you see them you may wish to be more careful and avoid placing yourself in physically vulnerable situations. Too often I have seen a clinician over prioritise their own safety towards a patient who is not a threat, and the patient sees this and takes offense. This can be interpreted as dehumanising as the implication is that you think the person is akin to a wild animal who may attack. How little must you think of them that you are doing this? You clearly see yourself as more important. For the vast majority of patients, especially when working in the community the act of the winding up their sympathetic system when walking behind would potentially put you at greater risk and as a minimum chip away at a positive therapeutic relationship.

Consider your manner and temperament when walking towards your clinic space. Your behaviour can again stimulate. Try to walk as though you have all the time in the world. Try to walk as though you don't have a care in the world. You don't have to walk slowly but don't move suddenly, speed yourself up gradually. If there's a corner, slow down, then gradually speed up, don't suddenly change direction, trying to glide all the way there.  When you get to the door, don't hurriedly type in the code for the door, calmly press the buttons, but not agonisingly slowly, and calmly push down the handle and calmly open the door. Keep any sudden movements for an emergency. If it's a cubicle with a curtain, calmly reach for the curtain, calmly pull it back and calmly invite the person in don't suddenly yank the curtain back, creating that horrible screeching noise of curtain hook on curtain rail and then hurriedly gesture your patient to enter the clinic space. Everything should be wonderful, calm and laconic, slow and smooth and graceful. You have all the Time in the world for this appointment and this appointment is going to go smoothly.