Prior to my ortho inpatients placement i had only ever had outpatient placements so it took a bit of adjustment for me to get used to the frequent interaction between the many members of allied health and fast pace of the system. I have never enjoyed being in a hospital environment and have always maintained that once i graduate i might do a short stint in a hospital but would ultimately not end up in one. However since working at the hospital i have found that my views have changed slightly, and as such i feel that it wouldn't be such a bad thing if i ended up in a hospital.
I think the main factor that has swayed my opinion is the interaction with other members of the allied health. At first the thought of this made me quite nervous as i did not know haw to interact with the other staff was worried that i might make an idiot of myself by showing how little i knew about the hospital system. These concerns have since passed and i now find that i thoroughly enjoy the interactions with the other staff. When working in inpatients you are part of a massive group of staff and it is a very social environment. Obviously you get a few not so friendly types but generally i have found that most of the staff i work with are pretty nice and are easy to get along with. I think the social stimulation that you get from inpatients is something that you miss out on a bit when working in outpatients. Although there are obviously some other physios that you will get to know you don't gertt a chance to work as closely with the doctors, nurses and the OTs. I actually thoroughly enjoy the inpatients environment and find that i'm always in a good mood, as there is nothing that makes you feel better than walking past someone in the corridor and getting a friendly greeting. Also you're constantly making new relationships as there is steady influx of new staff to the ward.
Sorry if my post is a bit short but i think it pretty much sums up how i feel about the social environment when working in inpatients. I don't know if anyone else has noticed the same thing??
Thursday, June 19, 2008
Code Black
The other day at my ortho inpatients placement there was an incident that made me think about a couple of things. The first was personal safety and the second was whether we're doing the right thing by not allowing people to leave hospital if we don't think they are safe.
The incident involved a patient on theward who desparately wanted to go home. The patient had sustained a head injury but was independent and could walk around without any walking aids. I don't know the exact reason why this patient wasn't allowed to leave as he wasn't my patient, but i assume that the staff involved did not believe that he would be safe to go home or thathe didn't have a safe home to go to. Anyway after one of many loud attempts at convincing the nurses at the nursing station to allow him to leave the patient began to throw files off the desk. When his watcher (this patient had to have some one watching him in his room to prevent him from wandering) tried to stop him the patient swung out at the watcher. He then picked up a large metal drip stand and tried to hit the watcher with it. After chasing his watcher away he substituted the drip stand for a portable O2 tank stand and began hitting the walls with it and chasing anyone who came close to him. His aggression was not directed at anyone in particular but he seemed to pick people at random to chase after. A code black was called as soon as the man had thrown the first file but it took about 20 minutes for security to arrive. Once security arrived the man seemed to calm down and the security guardxs were able to subdue him quickly and without much more fuss.
The first thing that occurred to me following the incident was how strange it was to feel like my safety was threatened while i was at work. I will admit that in my younger years i was involved in quite a few brawls and never really gave it much thought, but the difference is that previously i have never expected anything like this incident to happen while i was at clinic. I've seen all the posters that discourage violence towards staff but always thought it was to protect the smaller nurses and didn't really think that a patient in an inpatients ward could pose much threat. It had never occurred to me that a patient might try to use a weapon capable of inflicting serious injury.
After i got over the initial excitement of the incident i began to feel extremely sorry for the patient involved. I personally don't enjoy being in hospitals and would hate to have to live in one.
Other factors that would have compounded the issue were the fact that the patient was a smoker and was being denied access to ouutside areas to smoke, and the fact that i never once heard anyone explain to the patient why he was being kept there despite the patient constantly asking the nurses why they wouldn't let him go home. From the perspective of the patient it must have literally felt like he was being kept prisoner for no reason. I assume that the patients head injury must have lead the staff to believe that he was not mentally fit to make his own decisions, as surely the final decision to stay or go would otherwise lie in the patients hands.
I found this incident quite disturbing, as to me the patient didn't seem to be mentally impaired and yet the medical staff clearly weren't allowing him to make his own decisions. Even if this man had been to confused to make his own decisions i can think of other incidents where medical staff have bullied patients into staying at the hospital when they are desperate to leave.
The incident involved a patient on theward who desparately wanted to go home. The patient had sustained a head injury but was independent and could walk around without any walking aids. I don't know the exact reason why this patient wasn't allowed to leave as he wasn't my patient, but i assume that the staff involved did not believe that he would be safe to go home or thathe didn't have a safe home to go to. Anyway after one of many loud attempts at convincing the nurses at the nursing station to allow him to leave the patient began to throw files off the desk. When his watcher (this patient had to have some one watching him in his room to prevent him from wandering) tried to stop him the patient swung out at the watcher. He then picked up a large metal drip stand and tried to hit the watcher with it. After chasing his watcher away he substituted the drip stand for a portable O2 tank stand and began hitting the walls with it and chasing anyone who came close to him. His aggression was not directed at anyone in particular but he seemed to pick people at random to chase after. A code black was called as soon as the man had thrown the first file but it took about 20 minutes for security to arrive. Once security arrived the man seemed to calm down and the security guardxs were able to subdue him quickly and without much more fuss.
The first thing that occurred to me following the incident was how strange it was to feel like my safety was threatened while i was at work. I will admit that in my younger years i was involved in quite a few brawls and never really gave it much thought, but the difference is that previously i have never expected anything like this incident to happen while i was at clinic. I've seen all the posters that discourage violence towards staff but always thought it was to protect the smaller nurses and didn't really think that a patient in an inpatients ward could pose much threat. It had never occurred to me that a patient might try to use a weapon capable of inflicting serious injury.
After i got over the initial excitement of the incident i began to feel extremely sorry for the patient involved. I personally don't enjoy being in hospitals and would hate to have to live in one.
Other factors that would have compounded the issue were the fact that the patient was a smoker and was being denied access to ouutside areas to smoke, and the fact that i never once heard anyone explain to the patient why he was being kept there despite the patient constantly asking the nurses why they wouldn't let him go home. From the perspective of the patient it must have literally felt like he was being kept prisoner for no reason. I assume that the patients head injury must have lead the staff to believe that he was not mentally fit to make his own decisions, as surely the final decision to stay or go would otherwise lie in the patients hands.
I found this incident quite disturbing, as to me the patient didn't seem to be mentally impaired and yet the medical staff clearly weren't allowing him to make his own decisions. Even if this man had been to confused to make his own decisions i can think of other incidents where medical staff have bullied patients into staying at the hospital when they are desperate to leave.
The trooper
I am always amazed by the effect that an optimistic patient can have on their own outcomes. I have completed a neurology placement and am currently on an ortho inpatients placement. During these placements there have been several patients that have greatly impressed me with their optimism and ability to see positives when their situation appears bleak. I belive that it is incredibly beneficial for patients to have some level of optimism, as these patients generally achieve far better results than others who let their disabilities get to them.
There are two patients that spring to mind, who are perfect example of the trooper patient.
The first was a man who suffered from multiple sclerosis, who was treated by another student and myself. This man had very little power in his lower limbs, could not stand and struggled to maintain sitting balance when unsupported. Despite having this disability and knowing that it would only get worse this man had the most positive outlook on life. It would be totally understandable for someone in his position to sink into depression and become completely dependent on others, however this man was completely independent. He lived in a caravan with his wife in which they had done a lot of travelling, and as he was unable to walk my patient used to crawl around on the floor of the caravan. For transport outside of the caravan this man drove a gopher. When the other student working with him commented on some large cuts on the patients knee, he casually reported that he'd rolled his gopher that morning which "took a bit of bark off".
The other patient is a 67 year old lady who i have been treating at my ortho placement, who has just had a total replacement of her (R) femur and a revision of her (R) total knee replacemet. She also has recently had her (L) hip replaced. Prior to the replacement of her femur she had a "girdlestones" operation on her (R) hip, which i still don't fully understand but apparently it is an out of date operation where thay remove the head of the femur and just allow the shaft to float around in the hip joint. Doesn't sound too good, anyway before this lady had her total femur replacement the surgeons removed her femur and she had to live for a week with no femur in her (R) leg !!!! Can you imagine how difficult that would be. She then underwent an enormous operation where they put an entire prosthetic femur in her leg and revised her total knee replacement. Such an operation would knock about the most healthy of us let alone a 67 year old lady, yet this lady is one of the most calm and cheerful patients i have come across. When i first went to see this patient my supervisor warned me that she would be very slow progress and that we probably would struggle to stand her given her history (Hasn't been full weightbearing on her (R) leg for years) and her operation. When we visited her we found her to be in a great mood although feeling slightly ill. She calmly vomited into a bag and then told us that she would be happy to try to stand. As we got ready to stand her i noticed that she had the most deformed feet i've seen and i remember wondering how she was going to be able to stand on them.Any way we stood and walked her with a pulpit frame, asfter which my tutor informed me that this lady should not be able to walk after what she has been through.
Three days after my initial visit the patient had progressed to being able to walk independently and safely with elbow crutches. I put her success down to her optimism and her willingness to try to improve despite everything that was against her. I have seen other patients that are youngerand stronger but have had less than positive attitudes and have progressed slower.
From my experiences with these patients i've learnt how how much a persons rehabilitation potential depends on their attitude towards life. As a physio I thinks its important to recognise patients who are more likely to allow their situation to get the better of them, and to try to steer them away from the type of thinking that suggests that they have no control over their outcome.
There are two patients that spring to mind, who are perfect example of the trooper patient.
The first was a man who suffered from multiple sclerosis, who was treated by another student and myself. This man had very little power in his lower limbs, could not stand and struggled to maintain sitting balance when unsupported. Despite having this disability and knowing that it would only get worse this man had the most positive outlook on life. It would be totally understandable for someone in his position to sink into depression and become completely dependent on others, however this man was completely independent. He lived in a caravan with his wife in which they had done a lot of travelling, and as he was unable to walk my patient used to crawl around on the floor of the caravan. For transport outside of the caravan this man drove a gopher. When the other student working with him commented on some large cuts on the patients knee, he casually reported that he'd rolled his gopher that morning which "took a bit of bark off".
The other patient is a 67 year old lady who i have been treating at my ortho placement, who has just had a total replacement of her (R) femur and a revision of her (R) total knee replacemet. She also has recently had her (L) hip replaced. Prior to the replacement of her femur she had a "girdlestones" operation on her (R) hip, which i still don't fully understand but apparently it is an out of date operation where thay remove the head of the femur and just allow the shaft to float around in the hip joint. Doesn't sound too good, anyway before this lady had her total femur replacement the surgeons removed her femur and she had to live for a week with no femur in her (R) leg !!!! Can you imagine how difficult that would be. She then underwent an enormous operation where they put an entire prosthetic femur in her leg and revised her total knee replacement. Such an operation would knock about the most healthy of us let alone a 67 year old lady, yet this lady is one of the most calm and cheerful patients i have come across. When i first went to see this patient my supervisor warned me that she would be very slow progress and that we probably would struggle to stand her given her history (Hasn't been full weightbearing on her (R) leg for years) and her operation. When we visited her we found her to be in a great mood although feeling slightly ill. She calmly vomited into a bag and then told us that she would be happy to try to stand. As we got ready to stand her i noticed that she had the most deformed feet i've seen and i remember wondering how she was going to be able to stand on them.Any way we stood and walked her with a pulpit frame, asfter which my tutor informed me that this lady should not be able to walk after what she has been through.
Three days after my initial visit the patient had progressed to being able to walk independently and safely with elbow crutches. I put her success down to her optimism and her willingness to try to improve despite everything that was against her. I have seen other patients that are youngerand stronger but have had less than positive attitudes and have progressed slower.
From my experiences with these patients i've learnt how how much a persons rehabilitation potential depends on their attitude towards life. As a physio I thinks its important to recognise patients who are more likely to allow their situation to get the better of them, and to try to steer them away from the type of thinking that suggests that they have no control over their outcome.
Monday, June 16, 2008
Just Pondering
I’ve noticed a number of other students are posting and commenting about having to deal with death and disease in our line of work (placement, at the moment), and finding a balance between emotional attachment and detachment. I’d also like to mention that my placement is making me think a whole lot more about the value of life, and figuring out when enough’s enough..
I’m on a post-acute/long term rehab neurosurgery ward where there are numerous cases of patients with head injuries who have hugely varied impairments and level of dependency. I’m finding it intriguing the way patients who have experienced similar motor vehicle/bike accidents, can recover at completely different rates – some with simply a few scratches, and some that can’t even hold the weight of their own head. I saw a patient last week who has no voluntary movement, contractures so extreme that a bone in his foot is almost breaking through the skin, and he can only communicate occasionally via eye blinking ‘yes’ and ‘no’ in response to pain. This patient has been in this condition for eight years.
What surprises me in this situation is that this patient’s parents are present at just about every physio session and are always in a bright and happy mood, and discuss their son’s condition openly and with no hint of sadness. Obviously, the couple have had eight years to come to terms with their son’s condition and have learnt to manage and care for him and I think it’s really encouraging the way they handle the situation. I’ve not come to any conclusions about these issues, but I’m certainly wondering about the quality of life these patients and their family have. Of course, if something similar happened to one of my family members, I would not think twice about caring for them in the same way, but this prac has certainly made me ponder whether, say, if I was in the same situation, I would want to be kept going if I was living life completely dependent on others and unable to communicate or get my personality across in any way. I do not want to sound pessimistic or discouraging, simply putting down some thoughts that this placement has evoked in me…
I’m on a post-acute/long term rehab neurosurgery ward where there are numerous cases of patients with head injuries who have hugely varied impairments and level of dependency. I’m finding it intriguing the way patients who have experienced similar motor vehicle/bike accidents, can recover at completely different rates – some with simply a few scratches, and some that can’t even hold the weight of their own head. I saw a patient last week who has no voluntary movement, contractures so extreme that a bone in his foot is almost breaking through the skin, and he can only communicate occasionally via eye blinking ‘yes’ and ‘no’ in response to pain. This patient has been in this condition for eight years.
What surprises me in this situation is that this patient’s parents are present at just about every physio session and are always in a bright and happy mood, and discuss their son’s condition openly and with no hint of sadness. Obviously, the couple have had eight years to come to terms with their son’s condition and have learnt to manage and care for him and I think it’s really encouraging the way they handle the situation. I’ve not come to any conclusions about these issues, but I’m certainly wondering about the quality of life these patients and their family have. Of course, if something similar happened to one of my family members, I would not think twice about caring for them in the same way, but this prac has certainly made me ponder whether, say, if I was in the same situation, I would want to be kept going if I was living life completely dependent on others and unable to communicate or get my personality across in any way. I do not want to sound pessimistic or discouraging, simply putting down some thoughts that this placement has evoked in me…
educating patient
As I posted before, currently I am on gerontology placement. Most of patients have balance problem and fall but recently I have a patient who has LBP without any neurological symptoms. Her main problem is localized pain on (R) low back. Before this time she has been several physiotherapy clinics. However, she reported that the treatments were too expensive and she didn’t have any improvement.
I found that she is doing too much for house working and the patient is really diligent and active everyday. She is doing all the house working for her husband and herself. Sometimes she cooks for her whole family which is really big meal. That’s why I recommended her to reduce house working and shear with her husband for her LBP. And I tried to teach Low Back care and correct posture etc.
One week later I checked her for LBP, unfortunately no improvement. She still complains LBP that I think she is doing too much working in poor posture and poor working pattern. I thought the best way to reduce her symptom is education for her posture and reducing her working load but I think it is really hard to change her working pattern and posture even though she feels LBP.
Because she is old lady and has been house working in poor posture since long long time ago. Recently I gave her handout and showed demonstration for correct posture and working pattern but still I am not sure she is going to change her working pattern and poor posture.
Is there any good way to change her working pattern or reduce working load that is really affective for this kind of patients?
I found that she is doing too much for house working and the patient is really diligent and active everyday. She is doing all the house working for her husband and herself. Sometimes she cooks for her whole family which is really big meal. That’s why I recommended her to reduce house working and shear with her husband for her LBP. And I tried to teach Low Back care and correct posture etc.
One week later I checked her for LBP, unfortunately no improvement. She still complains LBP that I think she is doing too much working in poor posture and poor working pattern. I thought the best way to reduce her symptom is education for her posture and reducing her working load but I think it is really hard to change her working pattern and posture even though she feels LBP.
Because she is old lady and has been house working in poor posture since long long time ago. Recently I gave her handout and showed demonstration for correct posture and working pattern but still I am not sure she is going to change her working pattern and poor posture.
Is there any good way to change her working pattern or reduce working load that is really affective for this kind of patients?
Positive Thinking
Whilst on an international prac in Fiji the third world health standards and lack of resources meant that patients would die of conditions that would have been medically managed in Australia. Due to this death was a regular occurrence on the daily ward round.
However another aspect that compounded this already difficult issue was the cultural difference from what we are accustomed to in Australia. Personally I found it extremely confronting to see the Indian/Fijian people grieving from the loss of loved ones. After the death of a patient on my ward it was extremely difficult to carry on as normal whilst the late patients wife was sobbing behind the patients curtain cradling the body. Fijian hospitals don’t have the luxury of private/ separate rooms, all patients are in a large room separated only by a thin curtain. This makes it extremely hard for other patients and staff when somebody passes away as the mourning of the family is witnessed by the entire ward.
Due to the poor Fijian health standards the hospital is regarded as a death sentence by patients. With so much death around the role of the multidisciplinary team relies heavily on morale boosting. I have learned the importance of a positive outlook in such a challenging environment. Although personally tis positive attitude is extremely difficult to maintain the benefits gained by the patients was enough reward to continue my struggle. I have so much admiration for the Fijian physios for their ability to deal with the daily challenge to maintain this patient hope and motivation.
However another aspect that compounded this already difficult issue was the cultural difference from what we are accustomed to in Australia. Personally I found it extremely confronting to see the Indian/Fijian people grieving from the loss of loved ones. After the death of a patient on my ward it was extremely difficult to carry on as normal whilst the late patients wife was sobbing behind the patients curtain cradling the body. Fijian hospitals don’t have the luxury of private/ separate rooms, all patients are in a large room separated only by a thin curtain. This makes it extremely hard for other patients and staff when somebody passes away as the mourning of the family is witnessed by the entire ward.
Due to the poor Fijian health standards the hospital is regarded as a death sentence by patients. With so much death around the role of the multidisciplinary team relies heavily on morale boosting. I have learned the importance of a positive outlook in such a challenging environment. Although personally tis positive attitude is extremely difficult to maintain the benefits gained by the patients was enough reward to continue my struggle. I have so much admiration for the Fijian physios for their ability to deal with the daily challenge to maintain this patient hope and motivation.
Resources Lacking
Whist on an international prac in Fiji travelling with an Australian surgical team we would frequently attend the morning ward rounds with the local doctors and surgeons. At ward rounds we would get the history of patients and develop rapport seeing them each day. Due to te poor health conditions in fiji a patient with a fractured NOF was put on 3 weeks bed rest. This management was decided upon due the lack of anaesthetic drugs available for surgery. Due to this patients who were is need of surgery were put on bed rest until the country was able to aquire a new supply of surgical drugs.
This man who was put on bed rest died after 3 days due to the inability to receive the level of medical management he required. As a student in a first world country this was extremely hard to comprehend that people were dying due to a lack of resources.
This experience made me appreciate how fortunate we are to have the resources we do in Australia. It demonstrated how much of a difference resources can make to peoples lives. The Fijian physios are inspirational with the level treatment they can provide with the limited resources they have available. This experience taught me to think on my feet and utilise the environment around me taking nothing for granted.
This man who was put on bed rest died after 3 days due to the inability to receive the level of medical management he required. As a student in a first world country this was extremely hard to comprehend that people were dying due to a lack of resources.
This experience made me appreciate how fortunate we are to have the resources we do in Australia. It demonstrated how much of a difference resources can make to peoples lives. The Fijian physios are inspirational with the level treatment they can provide with the limited resources they have available. This experience taught me to think on my feet and utilise the environment around me taking nothing for granted.
Cultural understanding
I was treating a 51 year old aboriginal lady on an acute neurology ward who had suffered a brainstem stroke. On the initial assessment the patient was compliant with treatment but not interested in physiotherapy. After seeing her a couple of times I entered her room and 7 members of her family had come to visit her. This included children, grandchildren and people from the community that she lived in. in an effort to gain rapport with the patient and encourage an interest in physio I invited the patient to bring her family and friends to the gym during therapy. Although it was challenging to fit the whole group in to the gym, and control the children playing with the equipment the patient performed much better and her attitude towards physio greatly improved.
As I was able to respect her cultural values she returned the favour by respecting the physio goals I was trying to achieve. Each session folloeing this one the patient was enthusiastic towards physio and her family were included in each session when present.
From this situation I have understood the importance of respecting cultural values. It has demonstrated that you are able to gain rapport and respect of the patient from acknowledging their personal values
As I was able to respect her cultural values she returned the favour by respecting the physio goals I was trying to achieve. Each session folloeing this one the patient was enthusiastic towards physio and her family were included in each session when present.
From this situation I have understood the importance of respecting cultural values. It has demonstrated that you are able to gain rapport and respect of the patient from acknowledging their personal values
Refusing Treatment
I was treating 75 year old male on an acute neurology who has suffered a brainstem stroke. The patient had an extremely motivated wife who was a maternity nurse who frequently encouraged physio by explaining the benefits to the patient. As the patient was admitted from ICU he had a tracheostomy. Once arriving on the ward the trachy was removed. The patient struggled to talk post trachy removal as students were required to interpret what the patient was saying. On numerous occasions one student would suggest that the patient was refusing treatment. This however was not the case but once this option was realised by the patient he would then frequently refuse treatment.
Two students both morning and afternoon would spend time convincing the patient that physio is essential for returning to function post stroke. From this point on the patient would consistently refuse treatment on one out of every two daily treatments and his rehab suffered. 5 weeks post stroke static sitting balance remained the primary focus of treatment as the patient was not improving due to his lack of physio. When we were able to get the patient to the physio gym he would not comply with the planned session and the patient would dictate what he felt like doing.
Understanding post stroke patients will be debilitated both mentally, emotionally and physically it is important to realised the boundaries for aggressive treatment. However in this case the patient initially the patient had no issues with motivation, nor did he realise refusing treatment was an option until suggested by the student. Stroke rehab is challenging but rewarding when the patient has put in the work necessary to recover. It requires massive amounts of motivation and hard work from all aspects of the multidisciplinary team.
I realise now the importance of motivation an encouragement in stroke rehab. This also has taught me the importance of communication. Through this miscommunication the patient was able to take the easy way out and his rehabilitation was severely delayed. It is important to realise truly when a patient refuses treatment, but also not to give this as an option when facing the difficult task of rehab post stroke.
Two students both morning and afternoon would spend time convincing the patient that physio is essential for returning to function post stroke. From this point on the patient would consistently refuse treatment on one out of every two daily treatments and his rehab suffered. 5 weeks post stroke static sitting balance remained the primary focus of treatment as the patient was not improving due to his lack of physio. When we were able to get the patient to the physio gym he would not comply with the planned session and the patient would dictate what he felt like doing.
Understanding post stroke patients will be debilitated both mentally, emotionally and physically it is important to realised the boundaries for aggressive treatment. However in this case the patient initially the patient had no issues with motivation, nor did he realise refusing treatment was an option until suggested by the student. Stroke rehab is challenging but rewarding when the patient has put in the work necessary to recover. It requires massive amounts of motivation and hard work from all aspects of the multidisciplinary team.
I realise now the importance of motivation an encouragement in stroke rehab. This also has taught me the importance of communication. Through this miscommunication the patient was able to take the easy way out and his rehabilitation was severely delayed. It is important to realise truly when a patient refuses treatment, but also not to give this as an option when facing the difficult task of rehab post stroke.
Allied... not always allies
On my first placement this year I was working in an inpatient role. As I was seeing patients post-surgery it was always my aim to get patients up and out of bed as early as possible to ensure a speedy recovery, as well as a speedy discharge. In my first week at the hospital I had an experience with a nurse that left me quite shaken! I had not consulted with my patient's nurse before seeing him to get him out of bed. Later on in the day his nurse approached me and gave me a dressing down for not liasing with her beforehand and now the patient was too tired to get out of bed for a shower and a bedding change.
Although I was very upset by the appraoch that she took to discuss the matter, I managed to stay calm and reasonable in front of her. I felt very silly and dissapointed that I hadn't liased with her earlier like I should have. I knew though that I couldn't be too hard on myself as it was my first placement and I was only just beginning to understand how a ward works.
Im glad that this happened at the beginning of the year as I learned very early on the importance of working closely with all allied health staff in order to make the whole ward run smoothly. I am now not shy or hesitant to approach nursing staff with questions or plans because I know that they appreciate our efforts to help them... which in turn helps ourselves!!! I have a friend who is a nurse and she once told me that if you can become friends with your patients nurses your life will be a whole lot easier. After my encounter with the nurse on my first placement I realise just how true her statement was!
Although this situation involved a particular nurse, it has also taught me the importance of communication with all allied health professionals. This will enable the best results for not only the patient, but also our own professional development as students.
Although I was very upset by the appraoch that she took to discuss the matter, I managed to stay calm and reasonable in front of her. I felt very silly and dissapointed that I hadn't liased with her earlier like I should have. I knew though that I couldn't be too hard on myself as it was my first placement and I was only just beginning to understand how a ward works.
Im glad that this happened at the beginning of the year as I learned very early on the importance of working closely with all allied health staff in order to make the whole ward run smoothly. I am now not shy or hesitant to approach nursing staff with questions or plans because I know that they appreciate our efforts to help them... which in turn helps ourselves!!! I have a friend who is a nurse and she once told me that if you can become friends with your patients nurses your life will be a whole lot easier. After my encounter with the nurse on my first placement I realise just how true her statement was!
Although this situation involved a particular nurse, it has also taught me the importance of communication with all allied health professionals. This will enable the best results for not only the patient, but also our own professional development as students.
TB
Prior to going to Fiji my knowledge of the pathological process of TB was not huge. I knew that it mostly affected the pulmonary system and that initial symptoms included haemoptosis. I was however very unaware of the effect it has on the musculoskeletal system. I patient presented to the hand clinic in Lautoka with a sore wrist. The wrist Xray was put up on the light box and it was obvious to see severe pathology in the wrist joint. The treating doctor then began asking questions to gain information on pulmonary symptoms. The patient had a long standing cough and had been coughing up bloody for the previous three weeks. I thought that you guys might be interested in the affect TB has on the musculoskeletal system so I looked it up.
Joint pathology caused by TB is called TB arthritis or Spondylitis, and is cause by prolonged infection in the joint.
Tuberculosis arthritis symptoms include:
Low-grade fever
Excessive sweating especially at night
Weight loss or loss of appetite
Joint swelling with warm, tender joints
Decreased joint mobility
Spinal mass, some times associated with numbness, tingling, or weakness of the legs
Long standing infection stimulates growth. You can imagine the pathology that would occur in a joint space with destruction of normal tissue and abnormal, weak tissue laid down in its place. Bone tissue growth is stimulated, fibrotic tissue is laid down and eventually, similar to rheumatoid arthritis, the joint space decreases and the joint fuses. On Xray the joint space will be decreased, look hazy or in late stages fused.
Joint pathology caused by TB is called TB arthritis or Spondylitis, and is cause by prolonged infection in the joint.
Tuberculosis arthritis symptoms include:
Low-grade fever
Excessive sweating especially at night
Weight loss or loss of appetite
Joint swelling with warm, tender joints
Decreased joint mobility
Spinal mass, some times associated with numbness, tingling, or weakness of the legs
Long standing infection stimulates growth. You can imagine the pathology that would occur in a joint space with destruction of normal tissue and abnormal, weak tissue laid down in its place. Bone tissue growth is stimulated, fibrotic tissue is laid down and eventually, similar to rheumatoid arthritis, the joint space decreases and the joint fuses. On Xray the joint space will be decreased, look hazy or in late stages fused.
I wanted to make a comment about the politics and hierarchy in the medical world that is never really talked about but everyone knows about. So as physiotherapy students it can be thought that we are pretty low on the food chain. If you think like this I think it would hinder your communitcation with other professionals. You would be too nervous to talk to anyone more experienced than your self such as surgeons. In the past, I must admit, that I have been too nervous to ask questions just in case I am meant to know the answer already, save myself the embarressment. This is a shame as it is people of this professional calibre that we can learn the most from. I have recently been in Fiji on my self directed placement. I was travelling with a very well respected hand surgeon from Sydney and his team which included an anaethasits and a hand physiotherapist. It was a fantastic experience to work so closely with the team and be involved in medical management from diagnosis to early rehabilitation. It was a great feeling to be respected for our high level of anatomical knowledge and clinical opinions. It was a mutual relationship, we learnt things from each other. It has changed my mentality toward surgeons, I am no lonkger afraid to ask questions and enquire into medical management options. My attitude has change in that all health professionals can learn from each other, two way relationships.
Sunday, June 15, 2008
It has always been a fear of mine that I may one day become completely numb and not sensitive to traumatic or emotional situations that we as health professionals see everyday. I have recently been on my self directed placement in Lautoka hospital, Fiji and I was assured that I am not yet NUMB! There were some very challenging situations emotionally and more to the point physically. I have never been physically affected by any clinical situation, until this occasion. I was working with one of the local Fijian physiotherapists in the diabetic ward in the hospital. Diabetes is a huge problem in Fiji and with the medical management the way it is, infection is their worst enemy. Delayed treatment is a strong contributor to the awful state that these patients end up in. They remain in their remote villages attempting to cure their slowly deteriorating, necrotic limbs and do not present to the hospital until it is too late and amputation is the only option. I have never really been phased by blood and guts, to tell the truth i find gory injuries fascinating! However, the men's diabetic ward in Fiji is a different story. I think when a pathology is purely visual I'm OK, touch is OK too, smell however tips me over the edge. I was treating one particular patient and everything was going along well, until they began to change the dressings on the neighbouring patients infected feet. This particular patient had maggots (not medical maggots, natural ones!) in his ulcers and the pungent odour could be smelt everywhere in the ward. Take the dressings off and my treatment with the neighbouring patient ended pretty quickly. We continued the session until the patient was safely back in bed and then I excuse my self and went to the bathroom. It can be concluded that my normally very strong stomach is not yet NUMB.
Patients Progress
During my placement in ICU, there was a young girl that I was treating and because we had spent alot of time together, we got along well and I began to look forward to my hour that I spent treating her. When I had first seen her she had just had a major operation and within the next 2 weeks, she had progressed so well and was ready to be discharged to the ward. A week later, the same girl was readmitted into ICU and looked completely different. She was intubated and her face was swollen and she was getting worse. When I noticed her name on the ICU ward list, I felt sick inside and did not know how to react. Similar situations occurred throughout my placement and by the end of the 5 weeks I felt quite emotionally drained.
When treating patients, it is hard not to become emotionally attached and I know that you are meant to be professional but it is hard to see someone go through so much especially if you expect the person to recover and it does not happen this way. I probably felt the way I did because I have not seen much death or experienced anything like that in my life, but when seeing the family and friends crying and reacting to the bad news it is very hard to not feel anything.
The question on how to empathise with your patient but not get emotionally involved is very difficult to answer. I understand it will get easier with more exposure and experience in the field but on the other hand I would not want to become someone who does not feel anything when a patient passes away. If anyone has any views or advice on how to keep this balance, I would be very grateful.
When treating patients, it is hard not to become emotionally attached and I know that you are meant to be professional but it is hard to see someone go through so much especially if you expect the person to recover and it does not happen this way. I probably felt the way I did because I have not seen much death or experienced anything like that in my life, but when seeing the family and friends crying and reacting to the bad news it is very hard to not feel anything.
The question on how to empathise with your patient but not get emotionally involved is very difficult to answer. I understand it will get easier with more exposure and experience in the field but on the other hand I would not want to become someone who does not feel anything when a patient passes away. If anyone has any views or advice on how to keep this balance, I would be very grateful.
Setting a bad example
During a placement I was working with a patient in a busy physiotherapy gym. The session was running smoothly and nothing seemed out of the ordinary. Until…….
a patient started screaming and crying and screaming – very loudly! The commotion got the attention of everyone in the gym. I looked over to where the fuss was and saw that one of the most well respected senior physiotherapists was with the patient who was yelling and crying and red in the face and obviously upset and distressed. I thought that the patient must be in safe hands if the well respected senior physiotherapist was there and in charge. However, just after this thought crossed my mind I witnessed the senior physiotherapist say “F*%^ off to you too” to the distressed patient before wheeling them out of the gym. The patient I was working with had his back turned to the situation but was trying to turn around to see what the fuss was about and began asking me who was making all the noise. I redirected his and my attention back to what we were doing.
That situation has entered my thoughts a few times since it happened and I feel bothered by witnessing it. It was my understanding that it would never be professionally or ethically acceptable behaviour for a physiotherapist to swear at a patient. I don’t know the details of the situation that lead to the patient becoming upset and the physio swearing at the patient, but it disappoints me that a senior I would look up to as a mentor and to learn from would behave in this manner, regardless of the circumstances. I have definitely lost respect for this senior physio and will think twice before following their advice. Also I will make an effort for my own professional behaviour and integrity to continue to improve as I become more qualified.
a patient started screaming and crying and screaming – very loudly! The commotion got the attention of everyone in the gym. I looked over to where the fuss was and saw that one of the most well respected senior physiotherapists was with the patient who was yelling and crying and red in the face and obviously upset and distressed. I thought that the patient must be in safe hands if the well respected senior physiotherapist was there and in charge. However, just after this thought crossed my mind I witnessed the senior physiotherapist say “F*%^ off to you too” to the distressed patient before wheeling them out of the gym. The patient I was working with had his back turned to the situation but was trying to turn around to see what the fuss was about and began asking me who was making all the noise. I redirected his and my attention back to what we were doing.
That situation has entered my thoughts a few times since it happened and I feel bothered by witnessing it. It was my understanding that it would never be professionally or ethically acceptable behaviour for a physiotherapist to swear at a patient. I don’t know the details of the situation that lead to the patient becoming upset and the physio swearing at the patient, but it disappoints me that a senior I would look up to as a mentor and to learn from would behave in this manner, regardless of the circumstances. I have definitely lost respect for this senior physio and will think twice before following their advice. Also I will make an effort for my own professional behaviour and integrity to continue to improve as I become more qualified.
Bullying
I'm kind of running out of ideas because my clinics where some time ago now. But thinking back to occurances which have had the most effect on me since beginning clinics one thing comes to mind which is a bit different so I thought I'd discuss it.
I'm the sort of person who likes everyone to get along, don't like confrontation and don't respond well to people who I think are being rude or judging prematurely and unfairly. It really bugs me when people don't like me, I think the main reason is because I like most people and TRY and treat everyone with respect. I guess in my life I have had it quite easy when it comes to making friends quickly and have been treated fairly well by other people throughout my school years and early uni years and didnt really end up on the receiving end of many negative comments or bullying. This probably makes me more sensitive when things like I will explain occur.
However since returning from a semester off I started to experience things I never really had experienced before, such as not been listened to when I speak and my opinion just been pushed off to the side, as well as rude comments, unfortunately this was coming from my new fellow students. I was quite dissappointed about this, I guess anyone would be but for me it is something I really wasn't used to. This did improve a lot as 3rd yr progessed and I got to know people better and they got to know me. However I recently was on a clinic together with a fair amount of students, and I experienced some treatment from some of the students which I felt and feel was quite undeserved (but maybe not :P). Anyways I was made to be the centre of a some peoples really rude jokes on a few occasions in front of the whole group of students and supervisors, and on top of this I was made aware by others that I was also been discussed quite harshly by some people when I wasn't present on a daily basis.
I felt quite sad and upset about this, as I felt people where making assumptions, listening to others negative comments and really not taking the time to get to know me or understand why I made a few decisions I had. Also I felt quite angry at the people who had been doing this and really wanted to have it out with them in unprofessional ways :P.
When this began I dealt with it quite poorly and would ignore it and then later let off my steam in private with friends and basically did the same as what the others where doing towards me, back to them and have still actually done it a few times since. However on one occasion after a lot of thought the night before I asked to discuss a situation which had occured the day before in which myself and another student, had a disagreement. I think we both had good points, and neither of us approached the situation well. I think the major reason was that we both underestimated how important something was to each other and didnt communicate our points honestly or fully. And just ended up getting annoyed at each other. The person then discussed this and tried to stir up trouble against me with the others whilst I wasnt present. On discussion the next day we still didnt come to a good understanding but I think the person appreciated that I asked to discuss it again and I believe this person gave me a break when others where been rude while I wasnt present on following occasions.
So all in all I think it was a good result.
I learnt a lot from this new to me sort or situation.
Firstly I guess it reinforces what I have slowly been learning, that is I can't expect everyone to like me :P.
With us all be fairly intelligent and compassionate physios I wasn't really expecting the behaviour which I have witnessed and experienced(maybe from notre dame students not curtin :P). However I guess even good people do stupid things, so I think now I am more prepared for negative behavior from fellow phyios in the work force and will deal with it better and also to have a thicker skin and not let these things take my attention away from what is important (patients).
I dont believe the best way to deal with work place bullies is to ignore them, it wont put an end to the bullying and the person on the receiving end will just dwell on it. I believe that the best way to deal with any sort of problem in a work place is to confront it and discuss it honestly, maturely and professionally.
I believe if we all tried to do this we would have much less stressful and more pleasant work and 4th year experiences.
Thanks guys have a good week
I'm the sort of person who likes everyone to get along, don't like confrontation and don't respond well to people who I think are being rude or judging prematurely and unfairly. It really bugs me when people don't like me, I think the main reason is because I like most people and TRY and treat everyone with respect. I guess in my life I have had it quite easy when it comes to making friends quickly and have been treated fairly well by other people throughout my school years and early uni years and didnt really end up on the receiving end of many negative comments or bullying. This probably makes me more sensitive when things like I will explain occur.
However since returning from a semester off I started to experience things I never really had experienced before, such as not been listened to when I speak and my opinion just been pushed off to the side, as well as rude comments, unfortunately this was coming from my new fellow students. I was quite dissappointed about this, I guess anyone would be but for me it is something I really wasn't used to. This did improve a lot as 3rd yr progessed and I got to know people better and they got to know me. However I recently was on a clinic together with a fair amount of students, and I experienced some treatment from some of the students which I felt and feel was quite undeserved (but maybe not :P). Anyways I was made to be the centre of a some peoples really rude jokes on a few occasions in front of the whole group of students and supervisors, and on top of this I was made aware by others that I was also been discussed quite harshly by some people when I wasn't present on a daily basis.
I felt quite sad and upset about this, as I felt people where making assumptions, listening to others negative comments and really not taking the time to get to know me or understand why I made a few decisions I had. Also I felt quite angry at the people who had been doing this and really wanted to have it out with them in unprofessional ways :P.
When this began I dealt with it quite poorly and would ignore it and then later let off my steam in private with friends and basically did the same as what the others where doing towards me, back to them and have still actually done it a few times since. However on one occasion after a lot of thought the night before I asked to discuss a situation which had occured the day before in which myself and another student, had a disagreement. I think we both had good points, and neither of us approached the situation well. I think the major reason was that we both underestimated how important something was to each other and didnt communicate our points honestly or fully. And just ended up getting annoyed at each other. The person then discussed this and tried to stir up trouble against me with the others whilst I wasnt present. On discussion the next day we still didnt come to a good understanding but I think the person appreciated that I asked to discuss it again and I believe this person gave me a break when others where been rude while I wasnt present on following occasions.
So all in all I think it was a good result.
I learnt a lot from this new to me sort or situation.
Firstly I guess it reinforces what I have slowly been learning, that is I can't expect everyone to like me :P.
With us all be fairly intelligent and compassionate physios I wasn't really expecting the behaviour which I have witnessed and experienced(maybe from notre dame students not curtin :P). However I guess even good people do stupid things, so I think now I am more prepared for negative behavior from fellow phyios in the work force and will deal with it better and also to have a thicker skin and not let these things take my attention away from what is important (patients).
I dont believe the best way to deal with work place bullies is to ignore them, it wont put an end to the bullying and the person on the receiving end will just dwell on it. I believe that the best way to deal with any sort of problem in a work place is to confront it and discuss it honestly, maturely and professionally.
I believe if we all tried to do this we would have much less stressful and more pleasant work and 4th year experiences.
Thanks guys have a good week
Monday, June 9, 2008
Oops
I’ve just passed half way at my neuro placement on a neurosurgery ward. I’ve been thoroughly enjoying learning about the treatment and management of head injury patients as there are many fascinating cases on neurosurgery wards. Apparently though, my interest in the prac hasn’t been obvious to those around me…
I received some feedback last week from my supervisor and senior physio’s regarding my progression with the placement. They commented on the fact that my body language is suggesting that I am bored and disinterested when treating patients. I was shocked to hear this because, as I’ve mentioned, I am actually really interested in my patients and their histories and feel motivated to help rehab them so they can be discharged as early as possible. I’ve never had any problems in the past with my involvement with patients so I was very surprised when they told me this.
So, I told my supervisors that I wasn’t aware that I was coming across that way and assured them that I felt lucky to be on such a good placement and was really enjoying it, regardless of what my body language was indicating. Since then, I’ve been working on my body language and trying to express more enthusiasm. I think a lot of what I was displaying was due to a lack of confidence with some of my treatments. I should have asked my supervisors directly about a few queries I had, but they didn’t seem too approachable because, as most physio’s are, they all seemed busy and stressed with their own patients and issues… I also discussed this with my supervisors and they agreed to be a bit more open, and I agreed to be more upfront with anything I’m unsure of on the placement.
It was hard to hear some of the negative yet constructive feedback from my supervisors, but everything they said was completely fair. I’m glad we were able to discuss the issues and work through them and am hoping to show improvements for the rest of my time on my neuro placement.
I received some feedback last week from my supervisor and senior physio’s regarding my progression with the placement. They commented on the fact that my body language is suggesting that I am bored and disinterested when treating patients. I was shocked to hear this because, as I’ve mentioned, I am actually really interested in my patients and their histories and feel motivated to help rehab them so they can be discharged as early as possible. I’ve never had any problems in the past with my involvement with patients so I was very surprised when they told me this.
So, I told my supervisors that I wasn’t aware that I was coming across that way and assured them that I felt lucky to be on such a good placement and was really enjoying it, regardless of what my body language was indicating. Since then, I’ve been working on my body language and trying to express more enthusiasm. I think a lot of what I was displaying was due to a lack of confidence with some of my treatments. I should have asked my supervisors directly about a few queries I had, but they didn’t seem too approachable because, as most physio’s are, they all seemed busy and stressed with their own patients and issues… I also discussed this with my supervisors and they agreed to be a bit more open, and I agreed to be more upfront with anything I’m unsure of on the placement.
It was hard to hear some of the negative yet constructive feedback from my supervisors, but everything they said was completely fair. I’m glad we were able to discuss the issues and work through them and am hoping to show improvements for the rest of my time on my neuro placement.
Working With Parents
I realised recently whilst on my paediatric patient that one of the most important skills to learn when treating children is how to deal with their parents.
On one particular occasion I was treating a young girl who was day one post surgery on her lower thigh. Before even entering her room her mother warned me that she wasn't happy for me to be seeing her daughter that day due to the amount of pain that she was in. I tried to assure her that her daughter had adequate pain relief and that I would be very gentle with her leg. The young girl was obviously distressed and I felt like the problem was only compounded by the fact that her parents were so anxious and always questioning what I was doing with their daughter, even though I was only doing gentle passive movements. I did not feel like I got much done in that session and felt like I had not done a good job.
For my next session with the girl that afternoon, I organised for one of the nursing staff to have a chat to the parents outside of the room whilst I did my session. I thought that I might be able to build more of a raport with the girl and allow her to become more calm if her parents were not in the room. I ended up having a very productive session and by the time her parents entered the room we had achieved good ROM on her affected leg and I was able to run through her exercises with her parents.
Although it can be EXTREMELY adventagious to make use of parents to help during a treatment session, I have also realised that on occasions it is better for parents not to be present. If they become too emotional and distressed it greatly influences the child's mood and how well they are going to participate. I realise though, that asking a child's parents to leave during a session could seem rude and confrontational and would need to be approached with a lot of tact and respect. By asking other staff to help to take the parents away for a while I did not have to ask the parents directly to leave, which I found to be a good approach to the problem.
I would be very interested to see if anyone else has encountered a problem like this on any of their pracs and to see if they used a similar approach to mine. I would also be interested to know if anyone has had to directly ask any parents to leave and how they went about this!
On one particular occasion I was treating a young girl who was day one post surgery on her lower thigh. Before even entering her room her mother warned me that she wasn't happy for me to be seeing her daughter that day due to the amount of pain that she was in. I tried to assure her that her daughter had adequate pain relief and that I would be very gentle with her leg. The young girl was obviously distressed and I felt like the problem was only compounded by the fact that her parents were so anxious and always questioning what I was doing with their daughter, even though I was only doing gentle passive movements. I did not feel like I got much done in that session and felt like I had not done a good job.
For my next session with the girl that afternoon, I organised for one of the nursing staff to have a chat to the parents outside of the room whilst I did my session. I thought that I might be able to build more of a raport with the girl and allow her to become more calm if her parents were not in the room. I ended up having a very productive session and by the time her parents entered the room we had achieved good ROM on her affected leg and I was able to run through her exercises with her parents.
Although it can be EXTREMELY adventagious to make use of parents to help during a treatment session, I have also realised that on occasions it is better for parents not to be present. If they become too emotional and distressed it greatly influences the child's mood and how well they are going to participate. I realise though, that asking a child's parents to leave during a session could seem rude and confrontational and would need to be approached with a lot of tact and respect. By asking other staff to help to take the parents away for a while I did not have to ask the parents directly to leave, which I found to be a good approach to the problem.
I would be very interested to see if anyone else has encountered a problem like this on any of their pracs and to see if they used a similar approach to mine. I would also be interested to know if anyone has had to directly ask any parents to leave and how they went about this!
gerontology
I am currently at a gerontology outpatient and my patients normally have balance, fall history and short term memory problem. Recently a lady came to the clinic with her husband. The patient has same problem as other patient such as balance. She also has heart problem that reduce her endurance. It was not first visiting for her to the clinic. She came in Jan and Feb in this year and refused further treatment and management for her balance because previous physio introduce using 4 wheel walker to her but she thought she didn’t have any problem with her balance and walking.
It is clear that she has poor balance and poor endurance of her cardiovascular system from the result of Berg scale and from her medical history. Her mobility capacity is very low such as walking distance and she has potentially 90% risk of fall resulted from Berg scale. Currently she has used a walking stick that improves her dynamic walking balance. However, her balance is still not steady enough. That’s why a previous physio introduced her using 4 wheel walker that allows her much safer than her stick and her to sit on the small seat of the walker when she feels short of breath. She declined at the time and didn’t come to next session.
I am very sure she needs to start using more stable and supportive walking aid that reduces her risk of falls. On the other hand, I caution that she refuse and is not coming to a treatment session again. That’s why I didn’t mention anything about her walking aid in first session with me. I am planning to introduce a 4 wheel walker again after 2 or 3 treatment sessions.
If you have any good ideas please shear with me.
It is clear that she has poor balance and poor endurance of her cardiovascular system from the result of Berg scale and from her medical history. Her mobility capacity is very low such as walking distance and she has potentially 90% risk of fall resulted from Berg scale. Currently she has used a walking stick that improves her dynamic walking balance. However, her balance is still not steady enough. That’s why a previous physio introduced her using 4 wheel walker that allows her much safer than her stick and her to sit on the small seat of the walker when she feels short of breath. She declined at the time and didn’t come to next session.
I am very sure she needs to start using more stable and supportive walking aid that reduces her risk of falls. On the other hand, I caution that she refuse and is not coming to a treatment session again. That’s why I didn’t mention anything about her walking aid in first session with me. I am planning to introduce a 4 wheel walker again after 2 or 3 treatment sessions.
If you have any good ideas please shear with me.
Anxiety
The senario I'm going to discuss today, happened on my first clinical placement of the year quite some time ago (I did an early placement) and I'm not sure if any of you guys will find it too interesting, however it had a huge positive effect on me so I'd like to discuss it.
Firstly I should say I have never liked public speaking etc and ALWAYS get soooooo anxious for OSPE's because of my fear :P. Oh maybe its also applicable to mention for some reason I haven't had the same sort of anxiety levels on clinic with real patients so far, I guess we can debate the OPSE stuff till we go blue in the face, but the reality is I think it is really the only way students can be assessed, but for me with many discussion's with lecturers regarding OSPE's and how nervous I would get with them I have found that clinically it has been completely different, I can't explain why, thus again I am no closer to making suggesting anything to improve OSPE's :P. So now to the point and my senario. For my elective placement I completed a teaching placement, in which we assisted the staff in anatomy labs and basic PT skills labs for the incoming GEMs who joined the 2nd yrs this sem. At the beginning of the Pt skills component of the course, myself and my fellow student teacher thingo met with the staff member who would be teaching the GEMs, this person gave us a list of possible things we could be asked to demo to the GEms (ie passive mvts, goni, MMT, walking aids etc). So each morning myself and the other student would step out for 20 mins to prepare incase we were asked to demo these senarios, so normally been prepared we handled it quite well and usually did quite a good job. However one day toward the end of the clinic the Tutor in charge told me I would be demonstrating a senario in 20 mins which I didn't know I would be doing and thus I was not prepared for. Some of you might be thinking whats the big deal? however for someone who suffers from anxiety in these positions, let me assure you it is a big deal :P. So anyways when I was told this, I really was quite angry and was cursing under my breath , whilst i madly tried to prepare for it in a few minutes. the senario was fairly easy in terms of techniques (MMT both heads of pec maj- if you remember that far back we are taught to test in gravity elimated position 1st, then when it is established muscle strength is greater than grade 2 we test in gravity resisted position, so when you add all this together with testing both sides and the 2 different heads of pec maj the whole demo becomes a bit more complicated). Anyways after so long of trying to 'impress' the GEMs with my skills :P haha my biggest fear was looking like a non-competant fool infront of them! So I quickly planned what I was going to do in my head and performed it fairly well (the point for demonstrating these senarios was to show the GEMs what would be expected in OSPE's throughout the course).
Ok now to my point, even though at the time I was hating the tutor who asked me to do it, after finnishing and reflecting on this situation I REALLY appreciated it and felt very grateful, I felt like it really helped me over come my anxiety in situations like this, i also feel it set me in good shape for the coming years clinical based placements.Now due to this occurance I really am looking to put myself in uncomfortable situations as to improve myself as a PT as well as a person. So if anyone who is reading this suffers from anxiety and self doubt in these sorts of situations (probably not at this stage of the year) I really encourage them to put themselves out there and have confidence in their abilities because to get this far in a quite demanding course we must be doing something right. I just wish I had the guts to force myself or been forced to put myself in REALLY uncomfortable situations earlier in my studies as this would have saved me a lot of stressful nights and wasted meals which i threw up :P thanks for reading I hope that wasn't to boring or confusing. take care guys :)
Firstly I should say I have never liked public speaking etc and ALWAYS get soooooo anxious for OSPE's because of my fear :P. Oh maybe its also applicable to mention for some reason I haven't had the same sort of anxiety levels on clinic with real patients so far, I guess we can debate the OPSE stuff till we go blue in the face, but the reality is I think it is really the only way students can be assessed, but for me with many discussion's with lecturers regarding OSPE's and how nervous I would get with them I have found that clinically it has been completely different, I can't explain why, thus again I am no closer to making suggesting anything to improve OSPE's :P. So now to the point and my senario. For my elective placement I completed a teaching placement, in which we assisted the staff in anatomy labs and basic PT skills labs for the incoming GEMs who joined the 2nd yrs this sem. At the beginning of the Pt skills component of the course, myself and my fellow student teacher thingo met with the staff member who would be teaching the GEMs, this person gave us a list of possible things we could be asked to demo to the GEms (ie passive mvts, goni, MMT, walking aids etc). So each morning myself and the other student would step out for 20 mins to prepare incase we were asked to demo these senarios, so normally been prepared we handled it quite well and usually did quite a good job. However one day toward the end of the clinic the Tutor in charge told me I would be demonstrating a senario in 20 mins which I didn't know I would be doing and thus I was not prepared for. Some of you might be thinking whats the big deal? however for someone who suffers from anxiety in these positions, let me assure you it is a big deal :P. So anyways when I was told this, I really was quite angry and was cursing under my breath , whilst i madly tried to prepare for it in a few minutes. the senario was fairly easy in terms of techniques (MMT both heads of pec maj- if you remember that far back we are taught to test in gravity elimated position 1st, then when it is established muscle strength is greater than grade 2 we test in gravity resisted position, so when you add all this together with testing both sides and the 2 different heads of pec maj the whole demo becomes a bit more complicated). Anyways after so long of trying to 'impress' the GEMs with my skills :P haha my biggest fear was looking like a non-competant fool infront of them! So I quickly planned what I was going to do in my head and performed it fairly well (the point for demonstrating these senarios was to show the GEMs what would be expected in OSPE's throughout the course).
Ok now to my point, even though at the time I was hating the tutor who asked me to do it, after finnishing and reflecting on this situation I REALLY appreciated it and felt very grateful, I felt like it really helped me over come my anxiety in situations like this, i also feel it set me in good shape for the coming years clinical based placements.Now due to this occurance I really am looking to put myself in uncomfortable situations as to improve myself as a PT as well as a person. So if anyone who is reading this suffers from anxiety and self doubt in these sorts of situations (probably not at this stage of the year) I really encourage them to put themselves out there and have confidence in their abilities because to get this far in a quite demanding course we must be doing something right. I just wish I had the guts to force myself or been forced to put myself in REALLY uncomfortable situations earlier in my studies as this would have saved me a lot of stressful nights and wasted meals which i threw up :P thanks for reading I hope that wasn't to boring or confusing. take care guys :)
Sunday, June 8, 2008
Empathy
On a neurology placement at the moment there are patients who attend physio who have had a stroke and as a result have expressive and / or receptive dysphasia. We learnt about this at uni, but when we did it seemed more like an idea or concept than something that is actually real. When I first began treating a dysphasic patient it took me a little while to actually even realise the person had a language impairment as I was focussing more on the physical limitations and impairments. After realising the patient was dysphasic it was quite a challenge to work out the best way to communicate with them. Three weeks into the placement this has become easier by getting to know patients and through this gaining some degree of an idea about how much they can understand and how much they can express themselves accurately and by asking questions that give the patient options such as “Is your shoulder sore?” “Do you have pain in your shoulder?” Is your shoulder ok?” and looking for consistency with yes / no answers. However I still find it challenging subjectively assess patients who are dysphasic as they can not describe things including their pain.
Last week I was lucky enough to have the opportunity to observe a speech therapy treatment session of a patient who has expressive and receptive dysphasia. During the session the patient was re-learning the ability to understand and make sense of a shopping receipt. I don’t feel my communication skills with patients who have dysphasia has improved as a result of observing this session, but I definitely did develop some empathy for the people who have this with regards to the huge challenge they face when communicating. It seems to me as if it would be similar to being spoken to in a foreign language, having to communicate in this foreign language and then having to write with your non-dominant hand! Talk about everything being out of your comfort zone! How exhausting! This abstract concept we learnt about actually became concrete for me.
Last week I was lucky enough to have the opportunity to observe a speech therapy treatment session of a patient who has expressive and receptive dysphasia. During the session the patient was re-learning the ability to understand and make sense of a shopping receipt. I don’t feel my communication skills with patients who have dysphasia has improved as a result of observing this session, but I definitely did develop some empathy for the people who have this with regards to the huge challenge they face when communicating. It seems to me as if it would be similar to being spoken to in a foreign language, having to communicate in this foreign language and then having to write with your non-dominant hand! Talk about everything being out of your comfort zone! How exhausting! This abstract concept we learnt about actually became concrete for me.
Wednesday, June 4, 2008
Patient Problems
I am currently at a musculoskeletal outpatient clinic and treat a large variety of patients who all have different views on their pain and the management of their condition. I recently treated a lady who booked an appointment for shoulder pain. When I treated her I discovered that there was a number of yellow flags and there was numerous other areas of pain. After talking to this patient, it was evident she contributed her shoulder pain due to carrying and caring for her young child and was thinking that all the areas of her body that had pain could be solved by a couple of visits to the clinic. She did not expect to do any work, instead expecting the manual techniques that physiotherapists perform to do everything. During the whole treatment session every change or education that I attempted was rebuffed straight away, she complained of not being able to do it and that she was too overweight and other excuses. I kept motivating her and tried different cues to help with her change in posture. At the end of the session, I wrote down the home exercise program and tried to emphasise the importance of these changes. Hopefully this will have made an impression on her and she will make a change.
Many patients that come into the outpatient department have the attitude expecting to do no work and expecting physiotherapy will make everything better without having to lift a finger. When they come into physiotherapy with this attitude it makes it very hard to treat the patient especially when the compliance to any home exercise problems, posture changes or changes in activities will be poor. I think that education on the emphasis of the importance of the changes is important but really there is only so much that you can do for the patient before they have to make some changes themselves.
Apart from education and showing the importance of the home exercise program, if anyone has any other ideas on how to motivate patients to adhere to the exercises and changes made during the treatment session I would be happy to learn!
Many patients that come into the outpatient department have the attitude expecting to do no work and expecting physiotherapy will make everything better without having to lift a finger. When they come into physiotherapy with this attitude it makes it very hard to treat the patient especially when the compliance to any home exercise problems, posture changes or changes in activities will be poor. I think that education on the emphasis of the importance of the changes is important but really there is only so much that you can do for the patient before they have to make some changes themselves.
Apart from education and showing the importance of the home exercise program, if anyone has any other ideas on how to motivate patients to adhere to the exercises and changes made during the treatment session I would be happy to learn!
Tuesday, June 3, 2008
Difficult Patients
On my cardiopulmonary placement I was presented with an extremely difficult patient as my final assessment patient. Although I had prior warning of this patient's past difficult behaviour I felt confident in my ability to find an approach that would work with him in order for us to achieve what I wanted in the session. As soon as our session began, however, I realised that this was going to be a lot more difficult than I had anticipated. The patient was moody, difficult, inappropriate and verging on aggressive. As it was an assessment situation I felt like his behaviour was causing me to feel even more flustered than I would usually have felt, which compounded the situation.
I tried to use a number of different approaches with the patient. It felt like every approach I tried was inneffective, and often led to the patient being even more stubborn and irritated. Despite this, my supervisor and I managed to get the patient to do ALMOST everything we wanted him to in the session. It took a lot longer than it should have and I left the session feeling like I had not done a good job with him and that I had not achieved what I had set out to do, which was get the pt up and walk as he was day 1 post-op.
On reflection, however, I realised that with some patients there you will just never achieve EXACTLY what you want to achieve. There are occasions when, despite your best efforts, your patients need to make the choice to help themselves and let you help them. Once you have exhausted all avenues of trying to convince a patient to do what you would like there comes a point when you need them to realise that you are only there to help them and they need to make the choice to accept that help.
At first I felt that this was a defeatist attitude, but now I realise that all we can do as physiotherapists is offer our services and our expertise. Not all patients will be perfect and we can never know fully why a patient is difficult or angry. I feel like this was an important lesson to learn as i am sure I will encounter many more difficult patients throughout my career and I will be better equiped to deal with them.
I tried to use a number of different approaches with the patient. It felt like every approach I tried was inneffective, and often led to the patient being even more stubborn and irritated. Despite this, my supervisor and I managed to get the patient to do ALMOST everything we wanted him to in the session. It took a lot longer than it should have and I left the session feeling like I had not done a good job with him and that I had not achieved what I had set out to do, which was get the pt up and walk as he was day 1 post-op.
On reflection, however, I realised that with some patients there you will just never achieve EXACTLY what you want to achieve. There are occasions when, despite your best efforts, your patients need to make the choice to help themselves and let you help them. Once you have exhausted all avenues of trying to convince a patient to do what you would like there comes a point when you need them to realise that you are only there to help them and they need to make the choice to accept that help.
At first I felt that this was a defeatist attitude, but now I realise that all we can do as physiotherapists is offer our services and our expertise. Not all patients will be perfect and we can never know fully why a patient is difficult or angry. I feel like this was an important lesson to learn as i am sure I will encounter many more difficult patients throughout my career and I will be better equiped to deal with them.
Where to draw the line
I recently did a neurology placement at shenton park in the outpatients department. During my time at shenton park I worked very closely with each of my patients and got to know them quite well, as i'm sure other students have done also. I tried to establish good relationships with my patients as i believe that having good rapor will help to get the most out of treatment. However during this placment there were times where patients were speaking to me in confidence, as "friends" rather than patients, where i had to decide to either build better rapor by engaging with these patients, or maintain my professionalism by not engaging in certain areas of conversation.
The incidents i have referred to generally involved male patients making inapropriate jokes or remarks or telling me inapropriate information. Some of the comments were racial, some were sexual, some involved making a joke and some involved telling me about their past experiences. These patients must having seen me as a fellow male and as someone who would share their views and humour. I did not approve of many of the comments that were made however there were some comments that were made that had i not been the physio, i would have been happy to joke about. This was where found it difficult to draw the line, when patients were discussing things that as a professional are innappropriate for you to discuss, when in actual fact you personally have no problems with what is being said (i.e. if it were you and a mate just joking around). In these situations i had to choose to distance myself from the patient by not engaging in the area of conversation (and thereby maintaining my proffesionalism), or to build good relationships with the patients by relating to them as i would with any other friend.
In the end i generally opted to refrain from engaging in conversations that i thought may offend other staff or patients even though i personally was not offended. I found that this was most easily done by maintaining friendly conversation but simply redirecting the topic of conversation to something less offensive. In this way i was able to maintain my professionalism without making the patient feel that i was offended or disapproved of them. In some situations the patients would continue to revert back to the innappropriate topic in which case i would have to tell them as politely but firmly that it was not appropriate for that particular time and place.
As physio's we are required to be the patients friend (especially in settings where there is a lot of contact time) whilst still maintaining a strictly professional realtionship with them. As such I think that deciding where to draw the line can be quite difficult.I did make genuine friendships with some patients and would have loved to joke around with them, but felt that i had to maintain a level of professionalism.
The incidents i have referred to generally involved male patients making inapropriate jokes or remarks or telling me inapropriate information. Some of the comments were racial, some were sexual, some involved making a joke and some involved telling me about their past experiences. These patients must having seen me as a fellow male and as someone who would share their views and humour. I did not approve of many of the comments that were made however there were some comments that were made that had i not been the physio, i would have been happy to joke about. This was where found it difficult to draw the line, when patients were discussing things that as a professional are innappropriate for you to discuss, when in actual fact you personally have no problems with what is being said (i.e. if it were you and a mate just joking around). In these situations i had to choose to distance myself from the patient by not engaging in the area of conversation (and thereby maintaining my proffesionalism), or to build good relationships with the patients by relating to them as i would with any other friend.
In the end i generally opted to refrain from engaging in conversations that i thought may offend other staff or patients even though i personally was not offended. I found that this was most easily done by maintaining friendly conversation but simply redirecting the topic of conversation to something less offensive. In this way i was able to maintain my professionalism without making the patient feel that i was offended or disapproved of them. In some situations the patients would continue to revert back to the innappropriate topic in which case i would have to tell them as politely but firmly that it was not appropriate for that particular time and place.
As physio's we are required to be the patients friend (especially in settings where there is a lot of contact time) whilst still maintaining a strictly professional realtionship with them. As such I think that deciding where to draw the line can be quite difficult.I did make genuine friendships with some patients and would have loved to joke around with them, but felt that i had to maintain a level of professionalism.
Monday, June 2, 2008
neuro placement
My first placement was on placement at RPH Shenton Park inpatient, ward 2. As you know about the placement, the therapists over there are only using Bobath approach. Because of that, the supervisors didn’t expect the student to treat the patients as other placement.
Basically what they want to do from a student is learning from other therapists in ward 2, practice and start to treat in 2nd week from Foot Mobs. Actually the experience about Bobath approach was really great for a student who really interested in learning new handling technique.
That’s why I thought “why Uni. is not teaching these kinds of stuffs.”I heard the reason from one of my supervisors she said it is because the uni doesn’t have enough time to teach students for all of the stuffs we need to know in real clinical situation.
Therefore, Uni only can teach students basic one and if the students want to know further probably the students need to take the course for neuro stuffs. It makes sense for me because I though we learnt a lot of stuffs at uni., especially in terms of neuro theory.
If students learn about the techniques at uni, everybody will be really stressed out in end of semester and a lot of students might be failed due to the working load, Moreover, I found that it is really hard to feel the muscle tone such as hypertonia and hypotonia. I thought it is because we practice each other. All of the students have normal muscle tone and normal pattern of movement even though they were acting as patients.
Here are some of key points that I learnt from the placement. Firstly, physio have to check whether the patient have hypertone in unaffected side, especially when the patient is trying STS such as fixed arm and elevating of unaffected shoulder. Secondly, physio needs to check the tone in neck position such as hyperextended. For the last one, usually the stroke patient use distraction and depression of unaffected shoulder during gait to compensate weak and hypotone in the affected side. There are enormous things we need to look at in terms of the movement pattern of stroke patients.
P.S If anyone learn any new technique that we didn’t learn at uni. let share in this blog~
Basically what they want to do from a student is learning from other therapists in ward 2, practice and start to treat in 2nd week from Foot Mobs. Actually the experience about Bobath approach was really great for a student who really interested in learning new handling technique.
That’s why I thought “why Uni. is not teaching these kinds of stuffs.”I heard the reason from one of my supervisors she said it is because the uni doesn’t have enough time to teach students for all of the stuffs we need to know in real clinical situation.
Therefore, Uni only can teach students basic one and if the students want to know further probably the students need to take the course for neuro stuffs. It makes sense for me because I though we learnt a lot of stuffs at uni., especially in terms of neuro theory.
If students learn about the techniques at uni, everybody will be really stressed out in end of semester and a lot of students might be failed due to the working load, Moreover, I found that it is really hard to feel the muscle tone such as hypertonia and hypotonia. I thought it is because we practice each other. All of the students have normal muscle tone and normal pattern of movement even though they were acting as patients.
Here are some of key points that I learnt from the placement. Firstly, physio have to check whether the patient have hypertone in unaffected side, especially when the patient is trying STS such as fixed arm and elevating of unaffected shoulder. Secondly, physio needs to check the tone in neck position such as hyperextended. For the last one, usually the stroke patient use distraction and depression of unaffected shoulder during gait to compensate weak and hypotone in the affected side. There are enormous things we need to look at in terms of the movement pattern of stroke patients.
P.S If anyone learn any new technique that we didn’t learn at uni. let share in this blog~
Frontal Lobe Behaviour..
This week on my prac on a neurosurgery ward, I’ve had to deal with a 30 yo male patient, SP, who is presenting with the late effects of an ABI which he sustained at age 3. He has lived a relatively normal life growing up in the country, attending mainstream schools, playing sport and working on his family’s farm. He now presents with an abnormal gait pattern due to impairments including decreased muscle length & muscle strength. He is also displaying signs of frontal lobe behaviour, which has become an issue over the last week.
During some of my one-on-one treatment sessions with SP, he made a few unsuitable comments. The comments were not aggressive or overly offensive, but between a female therapist and male patient, they were indeed inappropriate. My initial reaction was to ignore the comments and change the subject as if they hadn’t been said. Later when I was chatting with a senior physio about frontal lobe behaviour, she said that she had overheard a few of SP’s inappropriate comments to me. She told me that the patient was displaying frontal lobe signs with such comments and that it was not to be tolerated.
Soon after this conversation, I was seeing a 17 year old female patient, SB, in a joint treatment session with the same physio. The patient mentioned that SP had also made some inappropriate comments to her and that it made her feel uncomfortable. The senior physio then instructed me to inform the nurse in charge of the ward, which I did. SP has since not made any inappropriate comments towards myself, SB or any other staff or patients.
My initial approach to dealing with the matter was to simply ignore it, but I now understand that the comments were unacceptable and had to be dealt with immediately and professionally before the situation went any further. So I’m glad that the senior physio taught me the correct way of handling the issue and I will aim to apply what I’ve learnt, when dealing with other patients with frontal lobe behaviour.
During some of my one-on-one treatment sessions with SP, he made a few unsuitable comments. The comments were not aggressive or overly offensive, but between a female therapist and male patient, they were indeed inappropriate. My initial reaction was to ignore the comments and change the subject as if they hadn’t been said. Later when I was chatting with a senior physio about frontal lobe behaviour, she said that she had overheard a few of SP’s inappropriate comments to me. She told me that the patient was displaying frontal lobe signs with such comments and that it was not to be tolerated.
Soon after this conversation, I was seeing a 17 year old female patient, SB, in a joint treatment session with the same physio. The patient mentioned that SP had also made some inappropriate comments to her and that it made her feel uncomfortable. The senior physio then instructed me to inform the nurse in charge of the ward, which I did. SP has since not made any inappropriate comments towards myself, SB or any other staff or patients.
My initial approach to dealing with the matter was to simply ignore it, but I now understand that the comments were unacceptable and had to be dealt with immediately and professionally before the situation went any further. So I’m glad that the senior physio taught me the correct way of handling the issue and I will aim to apply what I’ve learnt, when dealing with other patients with frontal lobe behaviour.
Different approaches to treatment
On my neurology placement I am working with many patients who have hemiplegia due to stroke. I find myself employing some techniques we leant at uni, some learnt in tutorials and continuing education sessions on clinic and sometimes an adaptation or a combination of techniques is appropriate for a particular patient. I’m pretty sure the treatment techniques we learnt at uni and those employed in the facility are a combination of treatment approaches. However I often hear people mention specific approaches and wondered if at this stage, my choice of treatment techniques would be any different if I was using a specific neurological treatment approach to guide my reasoning and intervention choices.
I was doing an exercise with a patient who has left hemiplegia. The patient was perched asymmetrically (almost sideways) on the plinth so that the left foot was in contact with the ground and right was not. With my hands on the pelvis providing and downwards pressure on the left and an upward pressure on the right, I was asking the patient to “stand” on the left leg and “straighten the left knee.” I chose this intervention because the patient was not weight bearing on the left leg during sit to stand, standing and walking.
If I was a Rood therapist I suppose I could do the same exercise in order to activate normal postural responses through sensory input. If I was coming from a Bobath point of view I suppose I could do a similar thing because I was facilitating a normal pattern of movement using the pelvis as a central key point. If I was coming from a motor learning point of view I could also do the same exercise as I was getting the patient to simplify the functional task and do part practice.
So there we go – the same exercise could be used for the same patient to improve the same function even if the therapist was thinking along the lines of a different approach. I think now that using a combination of approaches is probably effective as long as the therapist is clear about their reasons for choosing the technique. For me this highlights the importance of continual assessment and reassessment of the patient to ensure that the intended outcome is being achieved.
I was doing an exercise with a patient who has left hemiplegia. The patient was perched asymmetrically (almost sideways) on the plinth so that the left foot was in contact with the ground and right was not. With my hands on the pelvis providing and downwards pressure on the left and an upward pressure on the right, I was asking the patient to “stand” on the left leg and “straighten the left knee.” I chose this intervention because the patient was not weight bearing on the left leg during sit to stand, standing and walking.
If I was a Rood therapist I suppose I could do the same exercise in order to activate normal postural responses through sensory input. If I was coming from a Bobath point of view I suppose I could do a similar thing because I was facilitating a normal pattern of movement using the pelvis as a central key point. If I was coming from a motor learning point of view I could also do the same exercise as I was getting the patient to simplify the functional task and do part practice.
So there we go – the same exercise could be used for the same patient to improve the same function even if the therapist was thinking along the lines of a different approach. I think now that using a combination of approaches is probably effective as long as the therapist is clear about their reasons for choosing the technique. For me this highlights the importance of continual assessment and reassessment of the patient to ensure that the intended outcome is being achieved.
Sunday, June 1, 2008
;)
On the final day of my musculoskeletal clinic I had a new patient booked in with a description of “11 year old boy with knee pain”. I had completed 4 and a half weeks of the clinic and just had my assessment the day before so I felt quite happy with myself and confident in my abilities. On top of that I have had a lot of young boys grow up around me and felt confident of my abilities to connect with patients in this bracket. So basically this was the first patient I wasn’t at least a little bit nervous for before hand. I am sure we all suspect the same things with a boy presenting with knee pain, so I was basically preparing myself to be treating Osgood schlatters. Anyways the first lesson I learnt which I must say I learnt many times on this clinic is never try and predict what your patient will present with until you see them. This young boy came in and on subjective examination, he pointed to about 6 different locations and the knee pain which I was expecting had only been felt on one occasion and not a major issue at all. So yes I recommend on your musculo clinics yes of course have some diagnosis’s in mind prior to seeing your patients and also between your subjective and objective exams, but never get tunnel vision b/c for one it might be a completely different area of the body but also you may mis-diagnose b/c you have talked your self into it been something you want to treat :P.
Now for the second thing I want to discuss, as I mentioned I was quite confident prior to seeing this patient. However as time progressed I started to get more and more frustrated. The reason for this is firstly he was more interested in telling me about all the things he does, playing chopsticks with his mum and wanting to see how high the plinth could go, than been focused on my priority which was to diagnose and treating the condition in the already reduced time. I was trying really hard to keep him focused on what I was trying to do and his mother wasn’t helping at all. Secondly every time I touched him for the physical assessment he would giggle for ages and fling his body every where, which made it really hard to assess accurately and quickly. Eventually along with my supervisor we came to a conclusion for the given complaint which we decided to make the priority at this stage, which had many contributing biomechanical factors.
I reached the peak of my frustration and the end of my patience during treatment and I think the child sensed this and deliberately tried to make my job harder. During STM he squealed etc no mater how gentle I was, and b/c I am so focused on improving the patient as much as I can, it annoyed me that I couldn’t get the best out of my chosen treatment. Then I taped his feet for excessive pronation and I continually questioned him whether it was too tight and if it hurt etc, and made sure I took extra care with my taping. However as soon as I asked him to stand up and walk he began to “cry” and say it hurts. I could feel the steam coming out of my ears: the turned up late, not helpful at all in my attempt to speed up the session for their benefit and now I was going to have to remove my carefully done taping which was going to help him a lot :P. So yer I was really fuming inside. Then after this I had to teach him stretches and b/c I had let this all get to me I really didn’t do a good job and it took much longer than it should have.
The lessons learnt from this patient and the things I will aim to improve in the future are; I will try not to let me emotions show even in the slightest and especially not around children as they sense it in a second, also I guess I expected a lot and had unrealistic expectations of the child and need to remember children all develop at different rates and I should be respectful of this. I also need to not take things so personally and so harshly b/c I was really disappointed and beat myself about the areas I lack in which resulted in me not been able to the best things for this child. However we also need to recognize that also we should not blame our patient as well, as there is always something WE can do better. Finally a lesson which I think many of us need to take on board is we can’t always make drastic improvements in all patients and we should recognize our limitations as well as the limitations of physiotherapy and not let that get to us to much. Saying that, of course we should always try to aim to improve ourselves as well as our chosen field. Haha thinking about it now physio and how we handle patients is quite confusing :P Thanks guys have a good week
Now for the second thing I want to discuss, as I mentioned I was quite confident prior to seeing this patient. However as time progressed I started to get more and more frustrated. The reason for this is firstly he was more interested in telling me about all the things he does, playing chopsticks with his mum and wanting to see how high the plinth could go, than been focused on my priority which was to diagnose and treating the condition in the already reduced time. I was trying really hard to keep him focused on what I was trying to do and his mother wasn’t helping at all. Secondly every time I touched him for the physical assessment he would giggle for ages and fling his body every where, which made it really hard to assess accurately and quickly. Eventually along with my supervisor we came to a conclusion for the given complaint which we decided to make the priority at this stage, which had many contributing biomechanical factors.
I reached the peak of my frustration and the end of my patience during treatment and I think the child sensed this and deliberately tried to make my job harder. During STM he squealed etc no mater how gentle I was, and b/c I am so focused on improving the patient as much as I can, it annoyed me that I couldn’t get the best out of my chosen treatment. Then I taped his feet for excessive pronation and I continually questioned him whether it was too tight and if it hurt etc, and made sure I took extra care with my taping. However as soon as I asked him to stand up and walk he began to “cry” and say it hurts. I could feel the steam coming out of my ears: the turned up late, not helpful at all in my attempt to speed up the session for their benefit and now I was going to have to remove my carefully done taping which was going to help him a lot :P. So yer I was really fuming inside. Then after this I had to teach him stretches and b/c I had let this all get to me I really didn’t do a good job and it took much longer than it should have.
The lessons learnt from this patient and the things I will aim to improve in the future are; I will try not to let me emotions show even in the slightest and especially not around children as they sense it in a second, also I guess I expected a lot and had unrealistic expectations of the child and need to remember children all develop at different rates and I should be respectful of this. I also need to not take things so personally and so harshly b/c I was really disappointed and beat myself about the areas I lack in which resulted in me not been able to the best things for this child. However we also need to recognize that also we should not blame our patient as well, as there is always something WE can do better. Finally a lesson which I think many of us need to take on board is we can’t always make drastic improvements in all patients and we should recognize our limitations as well as the limitations of physiotherapy and not let that get to us to much. Saying that, of course we should always try to aim to improve ourselves as well as our chosen field. Haha thinking about it now physio and how we handle patients is quite confusing :P Thanks guys have a good week
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