At the moment, I am currently on a placement for rheumatology. It is very interesting and I have come across many different conditions that affect multiple joints and all the patients have chronic pain. With ankylosing spondylitis , exercise and physiotherapy is very important to prevent long term contractures and joint deformities. One of the patients that I am looking after in the outpatient clinic has missed her last 3 appointments and hydrotherapy sessions. I have called her many times but cannot get her because she is very busy. Because she has not turned up for her last few appointments, it is protocol to discharge the patient due to lack of commitment to the appointments and adherence to exercises.
I feel bad discharging this patient because even though she did not attend the appointments and was not very keen on doing any exercise, without the physiotherapy she will be in more pain and more functionally limited in the long run. It made me feel helpless, because although I wanted to help her, I could not do anything because she was not willing to make an effort. When I saw her initially, we educated her on all the advantages of exercise and gave her all the normal handouts and educational sheets we give to all the AS patients but obviously this had not made a difference.
In this situation, I know we are not wholly responsible for patients health and improvements but when there is a patient that CAN be helped what more can we do to try and motivate them? I guess some people do not see the need for exercise or might think they are beyond help or might just be very busy. Next time I see a patient who is not very eager, I will try and pick this up from the initial assessment and maybe set shorter term goals, create an exercise diary or maybe more education. Hopefully this can make the difference!
Monday, July 28, 2008
Thursday, July 24, 2008
A physio-wat?
I went abroad earlier this year to China to complete a placement at a sports institute in conjunction with a supervisor and student from Hong Kong. I found it quite interesting to learn about the way the Chinese manage their injured athletes as it is very different to the way we do it here in Australia. The Chinese appear to have little to no concept of rehabilitation… And physiotherapists do not exist.
If an athlete injures themselves and requires surgery, they go through pretty much all the same steps leading up to surgery as we do here in Australia. However, once a patient has surgery, there is then no rehabilitation program that is followed in the recovery stage. We spent quite some time learning the phases of rehab following different surgeries and are taught that it plays an important part in minimising a patient’s recovery time and optimising return to function/sport. But this doesn’t exist in China’s approach to recovery. They basically have an all or none approach in that an injured athlete will rest completely if they cannot participate in sport, and once they do not need to rest anymore, they must give 100% to their training.
All injured athletes in China are managed solely by the Sports Doctor, who often has a background in a mix of Chinese and Western medicine. Next in the hierarchy is the coach, who pretty much tells the athlete when they can be in pain and when they should suck it up and train – the latter being more common. So you can imagine, it was quite a task for us as outsiders to go into the institute and try to implement rehab based injury management, by simply using out bare hands! It was an enjoyable challenge, we often had patients who we would have preferred rested but the coaches would not allow it and they simply had to train on through pain. There were times though, when the sports doctors were watching over our treatments and asking our opinions on how to manage some injuries. We learnt a lot from the doctors too, who introduced us to some intriguing chinese remedies including acupuncture and an array of herbal concoctions and injections!
In Australia, physiotherapists tend to be considered quite knowledgeable and earn a well respected position in the medical hierarchy. It was interesting to experience the difference over in China, where we were almost considered ‘nobody’s’. It’s good to be back in Oz, where other health professionals know that we at least kinda know what we’re talking about…
If an athlete injures themselves and requires surgery, they go through pretty much all the same steps leading up to surgery as we do here in Australia. However, once a patient has surgery, there is then no rehabilitation program that is followed in the recovery stage. We spent quite some time learning the phases of rehab following different surgeries and are taught that it plays an important part in minimising a patient’s recovery time and optimising return to function/sport. But this doesn’t exist in China’s approach to recovery. They basically have an all or none approach in that an injured athlete will rest completely if they cannot participate in sport, and once they do not need to rest anymore, they must give 100% to their training.
All injured athletes in China are managed solely by the Sports Doctor, who often has a background in a mix of Chinese and Western medicine. Next in the hierarchy is the coach, who pretty much tells the athlete when they can be in pain and when they should suck it up and train – the latter being more common. So you can imagine, it was quite a task for us as outsiders to go into the institute and try to implement rehab based injury management, by simply using out bare hands! It was an enjoyable challenge, we often had patients who we would have preferred rested but the coaches would not allow it and they simply had to train on through pain. There were times though, when the sports doctors were watching over our treatments and asking our opinions on how to manage some injuries. We learnt a lot from the doctors too, who introduced us to some intriguing chinese remedies including acupuncture and an array of herbal concoctions and injections!
In Australia, physiotherapists tend to be considered quite knowledgeable and earn a well respected position in the medical hierarchy. It was interesting to experience the difference over in China, where we were almost considered ‘nobody’s’. It’s good to be back in Oz, where other health professionals know that we at least kinda know what we’re talking about…
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