Renée’s Rule

[Guest guest]

Renée's rule: You cannot reason with a person who cannot reason.

Corollary: If you try to reason with a person who cannot reason the person

just gets mad.

(There are other corollaries.)

I am fortunate to work with Renée , PT a clinician with decades of

experience in neurorehabilitation. Years ago she developed this rule and has

passed it along to the professional staff. The following are two clinical

examples where this rule applies:

#1: At a recent family conference OT, PT, and Speech each presented a brief

synopsis of the status and progress of our patient, a very intelligent middle

age woman with a right intracranial hemorrhage. After our brief presentation,

she began discussing how she wanted to regain her independence by discontinuing

the aides that supervised her whenever she was not at our outpatient

rehabilitation facility. Her son, a young up and coming attorney, presented

clear and logical rational why this was not possible and why she needed 24 hour

supervision. After over an hour and one-half of fruitless back and forth

between the mother and son, the social worker brought the meeting to a merciful

ending. The patient left mad but with supervision intact.

#2: The next case regards a middle age patient from a rural setting with a

traumatic brain injury whose care was managed by his primary care physician. At

the family conference, we raised the topic of obtaining a PM & R physician to

manage his rehabilitation. He did not see the value of seeing another physician

and rejected the idea immediately. I then proceeded to use wonderful analogies,

perfect logic, and illuminating patient examples to convince him why seeing a

PM & R doc was so beneficial. Despite my eloquent arguments, he stubbornly

refused to accept the idea. My presentation went on far too long, and just as I

launched into another monologue my speech therapist colleague looked at me and

asked, " Renée? " I took the hint and moved on immediately. Fortunately, the

patient did not get mad.

I can go months between situations where Renée's rule applies, but when it does

apply, knowing Renée's Rule is very helpful. Is this rule universal enough in

patient care to make it Renée's Law?

(cross posted to NeuroPT listserve)

Hansen, PT, PhD

Physical Therapist

Rehabilitation Institute of Kansas City

Kansas City, Missouri