Doctor's can be Deceiving ... (not intentionally)

While on my musculoskeletal placement earlier in the year, I had a patient who was a young 12 year old girl who’s reason for coming to physio was knee pain. I had the doctor’s referral and had read through it, discovering that the doctor thought girl’s knee pain was indicative of patellofemoral dysfunction and I was asked to treat as appropriate. Simple! Or not…

When the patient presented to physio, she walked into treatment from the waiting room with a very peculiar gait pattern. I went through the subjective with the patient and although the patient was a bit vague with her answers, it was sounding like PFJ dysfunction. Then, when running through the general health questions towards the end of the subjective, I was ticking off my checklist and came to Arthritis. I was expecting this 12 yo to give a simple ‘No’ in response, but instead she said ‘Hmm yeh I think I do have arthritis”. I was puzzled and explained to her that it generally affects the older population when it suddenly hit me that she may have Juvenile Arthritis. I mentioned this term to her and she nodded and said that yes doctors had told her in the past that she had this condition. So after further investigation and discussion with the girl’s mum, I discovered that she had been diagnosed with JA a few years ago but after a few attempts at treatment, nothing had been successful and the family were experiencing difficulties with medical staff and decided to stop any ongoing treatment.

I was disappointed that this young girl was not receiving treatment for her condition. She had contractures in both legs which limited her dorsiflexion range so much that it affected her gait and was contributing to her knee pain – it wasn’t simply PFJ dysfunction. I was shocked that the diagnosis wasn’t mentioned in the doctor’s referral. So anyway, in the short time that I had to treat the patient before finishing my placement, I treated her to the best of my ability and worked hard to build a good rapport with her in hope of convincing her and her mother that we health professionals aren’t so bad and to seek further treatment, as it would benefit her greatly. There were other factors involved too, like diet issues and possible psychological effects which were understandable, so it was important to get the appropriate referrals for these issues as well.

This situation taught me a few things. One: Never assume the doctor’s referral is correct (I knew this already, but I didn’t expect a diagnosis of JA would be left out…). Two: Always include all of the general questions in the subjective, even if you assume the answers to be ‘No’. I hope the students after me were able to continue this patient’s treatment effectively and achieve some good results.