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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