Rude neuro patient

one of the patients in my neuro outpatients prac was a 50 year old man who had suffered an right mca a few years ago. his rehabilitation had plateaued and if anything he was digressing. he had no standing balance, dependent with all transfers and chronic shoulder pain. from the start of our rehabilitation sessions he refused to let his wife watch the sessions or for her to be involved in any of his rehab at home such as stretches which were vital to improving his everyday function. he was combative during sessions and very unmotivated. to try and get him more involved with the rehab we set a goal to to work towards in my 4 week prac which was for him to be able to use the toilet independently, with this aim in mind we started our rehab sessions together. the patient was focused during the first few sessions although still refused to let his wife be involved in the rehab process. in my second last week, he came in and rudely told his wife to go and come back in 2 hours and then told me that he was getting a divorce because he couldnt live with her anymore. i took the patient over to the plinth where another patient was waiting for one of the physios with his wife, they had beeen having rehab in the same time slot for years. my patient loudly said to the patient next door how he had no idea how he could have married such an unattractive lady and stayed so long with her. he went on to say that the man's wife looked like a witch and how his life must have been hell married to a woman like her. i was so shocked, i wasnt sure how to react, i immediatley told my patient that that was completely uncalled for and and very rude and that he should apologise to the couple who were very upset at what he'd said. i transfered my patient to the plinth next door to the couple and i apologised for my patients rudeness and then my patient started having a go at me saying how i had no idea what his life had been like since the stroke and i had no right to tell him that he was being rude and to apologise. my patient said that he needed someone to support him in his rehab and not someone to tell him how to behave. the couple's physio arrived and calmed them down and my supervisor heard the commotion and called me over.

we talked about what had happened and i can see that there are many ways i could have handled the situation better. as soon as my patient had been rude to the couple, i should have taken my patient to the other side of the gym instead of transfereing him to the plinth next door to the couple where the insults kept flowing. i could have gone over to the couple then and apologised for my patients rudeness and then carried on with my patients treatment. instead i chastised my paitent for his rudeness and ended up losing the rapport we had made during our earlier sessions and thus our following sessions were not as productive as i feel they could have been. after the talk with my supervisor, i ended up taking my patient to the other side of the gym to finish off the session but instead of being focused on the tasks as hand my patient remained uncooperative and defensive. in the following sessions, as soon as my patient arrived we immediatley went to the other side of the gym to the couple to work but we never managed to reach the same level of rapport and from this experience i learnt that its very important to show your patient 100% support and alliegance and a much better way to handle a difficult situation.