I am currently doing my musculo placement. It has been interesting so far, but sometimes I am unsure whether discharge a patient. Most of my patients are referred from public hospital and they don’t need to pay for treatment. Some are private patients who need to pay. Interestingly I found that private patients’ pain level is relatively lower than public patients’. Regardless of a public or private patient, patients report that pain is decreased and get better after treatment. When it comes close to discharge I asked to patients to discharge them who is from public hospital, public patients seems to be a bit more reluctant to be discharged due to high pain level. I provide same treatment to both groups of patients, private or public. Private patients stop making appointment once pain level is lower.
It may be not correct for all the patients from public hospital but sometimes I felt strongly from some patients.
Do you have any good idea to discharge that sort of patients?
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For the patients that I see who will have a baseline pain for most of their life, the protocol to discharge them is when they can either self manage their pain independently or maybe refer them to a community exercise group. If their progress has reached a plateau, it is another reason for discharge. I know it is hard to discharge a patient especially when you see how much pain they are in, but sometimes (depending on the situation) there is only so much we can do!
I think this confidence will come with clinical experience with pain levels. It is a hard to read signs of pain and trust subjective report of pain. I found this especially hard in paediatrics, when are the kids telling fibs and when is it real. It is often the objective signs that are more trust worthy when assessing pain.
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