During this week’s prac I was working on the surgical ward, which gave a great opportunity to treat patients after cardiac and various abdominal surgeries. Just want to express how much I have enjoyed working in the surgical ward. I sow a guy day one post cardiac surgery and followed the rehab protocol until he got discharged. It’s amazing that day one post operation we sit them over the edge of the bed and walk them in afternoon.
My supervisor let me to do the whole assessment and treatment on this patient (of course she was present at the time). Anyway was really daunting to begin with as this guy had attachments everywhere.
I took a big breath and started my subjective assessment following an objective assessment and so on. In went really very well, I was really pleased that I remembered all the things we have been taught at uni in terms of how to safely mobilise and treat surgical patients.
It was such a good practice in terms of problem list and also to have a real visual picture what the patients look like day one post operation. I am glad to have this experience, as it wasn’t planned. Now I feel that I am ready to do my cardio PCR.
Monday, February 26, 2007
An interesting neural round at RPH
I wanted to share with you a very positive grand neural round experience. A 30 year old patient had a stroke secondary to violent dancing (and possibly connected with ½ an estacy pill). The exact cause of the stroke was not definite. The distribution of the stroke was vertebral basilar, first affecting the vertebral artery and moving rostrally to the basilar. Thus, her symptoms were initially Wallenberg syndrome (AKA lateral medullary syndrome) developed into locked-in syndrome (medial pontine syndrome). Personally, this is most scary condition I have ever heard of. Suffers are conscious and aware of their surroundings but can only respond by eye movement or blinking. The corticofugal, corticospinal and other extrapyramidal systems have been infracted. Their only response to the outside world is the cold binary language of affirmative or negative. The good news is that she started to slowly recover. It has been roughly 9 months post stroke and she is responding well to physiotherapy. Currently, she is able to transfer with 1X assist, and is mobile on an electric wheelchair. Our supervisor believes she will be able to walk independently one day. The patient attended the round and gave a stirring thank you speech. It was one of those moments I thought it was great to be a physio because we can make vast differences in people’s lives. The ability to have positive effects on others is inspiring. On a slightly negative note, the patient’s speech was cut short because she took too long to do it. One other person (surgeon I presume) made the comment to the presenting registrar that he was ‘speaking to those already converted and believed in rehab, and that promotion material was unnecessary and redundant. He believed time was better spent discussing the challenges of rehab. I was initially surprised and even somewhat disappointed with the comment. But after some thought, I felt there was much truth to what he spoke and that a grand round was perhaps not the best forum for ‘promotion’ of rehabilitation.
Sunday, February 25, 2007
Laid back
I thought I’d reflect on a colleague that seems to be very laid back but is not in some respects.
One of the supervisors I have been on placement at would regularly arrive at the workplace a few minutes late and usually it would be 10 to 15 minutes before actually being ready for work. I have no problem with that…what I find rather surprising though is the same person having a go at one of my peers when she came back from her lunch 4 minutes late.
I know that being punctual is a sign of respect towards our patients and is an important issue. What I find a bit frustrating is that there seems to be a double standard…it seems to be ok for some people to be late, but not for others.
Anyway, thought I’d share this experience with you and see what you guys think.
Edith
One of the supervisors I have been on placement at would regularly arrive at the workplace a few minutes late and usually it would be 10 to 15 minutes before actually being ready for work. I have no problem with that…what I find rather surprising though is the same person having a go at one of my peers when she came back from her lunch 4 minutes late.
I know that being punctual is a sign of respect towards our patients and is an important issue. What I find a bit frustrating is that there seems to be a double standard…it seems to be ok for some people to be late, but not for others.
Anyway, thought I’d share this experience with you and see what you guys think.
Edith
'The Other Side of the System'
Hi All....
I've had an interesting week this week.....being a family member of someone on a major teaching hospital in Brisbane. My brother had the unfortunate event of being hit by a car late Monday night.....and apart from a open, communited distal femur fracture - is fine.
I have had the frustrating experience of trying to get information from the medical staff looking after him. I decided to phone the hospital on Wednesday as he had surgery on Tuesday regarding his fracture etc etc. SO I got the nurse who was supposedly looking after him.....I told her that I was in Perth, nearly graduated physio etc etc and that I did not have a very clear picture from my parents. Turns out the nurse didn't either - she told me he had an ORIF on his R hip the day before (it's L distal femur) and when I said I'd heard distal femur...she said 'yeah, ORIF'd femur - very informative.....I asked her if she was aware of the plan for treatment as my parents had said it was to be a series of surgeries.....she was very honest and said 'nuh'. I then asked her if she could put me through/give me information as to who were the doctors looking after him.....to which she didn't know if he was under the 'trauma' team or the 'orthopaedic' team....again - very helpful.
I can not tell you how frustrated I was when I got off the phone to this lady...and how hard it was to convince myself that Dylan's getting decent care in Brisbane....even though I've worked on the ward of the 'Perth equivalent' and know that ppl do get good care. It is so upsetting to even myself and as a health professional I suppose I didn't really realise how upset I'd be if something traumatic happened to one of my family......so I have a little more empathy (and time) for family members of patients now!
Anyway, I will call again and hopefully find out some more information!
Madeleine
I've had an interesting week this week.....being a family member of someone on a major teaching hospital in Brisbane. My brother had the unfortunate event of being hit by a car late Monday night.....and apart from a open, communited distal femur fracture - is fine.
I have had the frustrating experience of trying to get information from the medical staff looking after him. I decided to phone the hospital on Wednesday as he had surgery on Tuesday regarding his fracture etc etc. SO I got the nurse who was supposedly looking after him.....I told her that I was in Perth, nearly graduated physio etc etc and that I did not have a very clear picture from my parents. Turns out the nurse didn't either - she told me he had an ORIF on his R hip the day before (it's L distal femur) and when I said I'd heard distal femur...she said 'yeah, ORIF'd femur - very informative.....I asked her if she was aware of the plan for treatment as my parents had said it was to be a series of surgeries.....she was very honest and said 'nuh'. I then asked her if she could put me through/give me information as to who were the doctors looking after him.....to which she didn't know if he was under the 'trauma' team or the 'orthopaedic' team....again - very helpful.
I can not tell you how frustrated I was when I got off the phone to this lady...and how hard it was to convince myself that Dylan's getting decent care in Brisbane....even though I've worked on the ward of the 'Perth equivalent' and know that ppl do get good care. It is so upsetting to even myself and as a health professional I suppose I didn't really realise how upset I'd be if something traumatic happened to one of my family......so I have a little more empathy (and time) for family members of patients now!
Anyway, I will call again and hopefully find out some more information!
Madeleine
Saturday, February 24, 2007
Treating Referrals
I have had a couple of patients this week that have presented via referral for a specific condition. However upon arrival, they describe an entirely different picture. One patient in particular comes to mind in that she was referred due to Achilles tendinosis but on presentation she stated that it was in fact her shoulder which was her main problem, not her ankle. I asked my supervisor what I should assess since her main complaint was her shoulder pain and not her ankle pain. My supervisor explained to me (and to the patient) that we can only legally treat what we have been referred, otherwise this patient would need to come in a second time (privately) and pay for her shoulder to be assessed.
I found this to be a bit of a ethical struggle as the patient presented with her primary pain as something other than her referral and yet we can only treat the referral (leaving her to her own devices for her shoulder pain as she is a pensioner and unable to pay for private physiotherapy services). I’m a little dismayed at the same time as to why the doctor how wrote the referral would not have also referred for the shoulder pain she is complaining of? I can’t imagine her not mentioning it to him as it was the first thing out of her mouth during her subjective exam. I guess as physios we always aim to resolve the patient’s presenting problem, but in the situation where you are not legally allowed to do so, it can become a very frustrating and disappointing experience.
I found this to be a bit of a ethical struggle as the patient presented with her primary pain as something other than her referral and yet we can only treat the referral (leaving her to her own devices for her shoulder pain as she is a pensioner and unable to pay for private physiotherapy services). I’m a little dismayed at the same time as to why the doctor how wrote the referral would not have also referred for the shoulder pain she is complaining of? I can’t imagine her not mentioning it to him as it was the first thing out of her mouth during her subjective exam. I guess as physios we always aim to resolve the patient’s presenting problem, but in the situation where you are not legally allowed to do so, it can become a very frustrating and disappointing experience.
Wednesday, February 21, 2007
mental health
Hey all,
Reflecting on this week it seems my musculo placement is turning more into a psychiatric practical, something that indeed I feel a little unprepared for. I’ve had 3 patients, just this week, burst into tears during their subjective history. Listening to some of their stories makes the exercise prescription and treatment I am providing seem slightly insignificant in the big scheme of things. I know that the chat I have with them is far more beneficial than any hands on therapy I provide.
Many of these patients have been in the “system” for years, with out clear diagnoses and it seems that they end up at ‘out patient physio’ once doctors can’t figure out what is wrong or how to help them. I have heard countless times that they have been told there is nothing wrong with you. I can only imagine how frustrating this must be for them.
My question to you is how can we help these patients, who clearly do need physio, when they have such major psycho social issues that traditional physiotherapy will be ineffective if we are unable to provide some psychological intervention/support during treatment. And if this is required of us, then why are we not taught strategies to deal with and understand such conditions/disorders at uni???
Do not say refer to social worker/pyscholgist/psychiatrist as this is not going to help me half way through my assessment when a patient has a massive panic attack and is screaming in a fetal position on the floor (which actually happened today!!). Obviously it is unethical to refuse to see a patient until their mental health is under control…
Jess
Reflecting on this week it seems my musculo placement is turning more into a psychiatric practical, something that indeed I feel a little unprepared for. I’ve had 3 patients, just this week, burst into tears during their subjective history. Listening to some of their stories makes the exercise prescription and treatment I am providing seem slightly insignificant in the big scheme of things. I know that the chat I have with them is far more beneficial than any hands on therapy I provide.
Many of these patients have been in the “system” for years, with out clear diagnoses and it seems that they end up at ‘out patient physio’ once doctors can’t figure out what is wrong or how to help them. I have heard countless times that they have been told there is nothing wrong with you. I can only imagine how frustrating this must be for them.
My question to you is how can we help these patients, who clearly do need physio, when they have such major psycho social issues that traditional physiotherapy will be ineffective if we are unable to provide some psychological intervention/support during treatment. And if this is required of us, then why are we not taught strategies to deal with and understand such conditions/disorders at uni???
Do not say refer to social worker/pyscholgist/psychiatrist as this is not going to help me half way through my assessment when a patient has a massive panic attack and is screaming in a fetal position on the floor (which actually happened today!!). Obviously it is unethical to refuse to see a patient until their mental health is under control…
Jess
Monday, February 19, 2007
Perhaps to the dismay of some, I will bring up the topic of Bobath techniques again. Nonetheless, the subject of my reflection is not exactly Bobath itself. I am merely using it as an example. I apologise if it appears I am beating about the bush.
I was searching the literature on the efficacy of Bobath techniques (AKA neurodevelopmental technique) and discovered that there is limited support for its use. A couple recent systematic reviews found nil evidence to support (or refute for that matter) its clinical value. One randomized trial found Bobath to be just as effective as motor learning based neural rehab (I think Carr and Sheppard methods), and another RCT found Bobath to be less effective. My search was by no means exhaustive. I simply typed in ‘Bobath’ under 'search' on the Pedro website. As I have mentioned in my last Blog, my neural placement is heavily Bobath based.
If Bobath is not the gold standard, why is it used as gospel? The issue that I’d like to discuss is how much of our hospital clinical experience is dogma, perpetuated by very experienced practitioners who have specialized in one philosophy of treatment? The use of the word dogma is likely too strong, but I am just trying to illustrate a point. If the clinical experience is based on one school of thought, my concern is that it prevents integration of other possibly effective neural rehabilitation techniques. Maybe the gold standard of neural patient treatment is a combination of motor learning and Bobath methods. However, if we are taught to believe one particular method of treatment is the best, where is the incentive to research new methods or a combination of methods?
I used Bobath as the example, but I think it can be with anything we are taught. It makes me appreciate Anne teaching us an integrated approach. Just a thought!
I was searching the literature on the efficacy of Bobath techniques (AKA neurodevelopmental technique) and discovered that there is limited support for its use. A couple recent systematic reviews found nil evidence to support (or refute for that matter) its clinical value. One randomized trial found Bobath to be just as effective as motor learning based neural rehab (I think Carr and Sheppard methods), and another RCT found Bobath to be less effective. My search was by no means exhaustive. I simply typed in ‘Bobath’ under 'search' on the Pedro website. As I have mentioned in my last Blog, my neural placement is heavily Bobath based.
If Bobath is not the gold standard, why is it used as gospel? The issue that I’d like to discuss is how much of our hospital clinical experience is dogma, perpetuated by very experienced practitioners who have specialized in one philosophy of treatment? The use of the word dogma is likely too strong, but I am just trying to illustrate a point. If the clinical experience is based on one school of thought, my concern is that it prevents integration of other possibly effective neural rehabilitation techniques. Maybe the gold standard of neural patient treatment is a combination of motor learning and Bobath methods. However, if we are taught to believe one particular method of treatment is the best, where is the incentive to research new methods or a combination of methods?
I used Bobath as the example, but I think it can be with anything we are taught. It makes me appreciate Anne teaching us an integrated approach. Just a thought!
Good Supervisor
I just want to share the experience that I am currently having during my cardio prac in Fremantle Hospital.
The physio staff and our supervisor is so supportive and friendly, treating us like colleagues, it’s a nice change in comparison to the neuro placement, were I felt inadequate in my knowledge or basically, that’s how my supervisor made me feel.
Anyway it’s funny because I thought that I would enjoy my neuro placement the most, but it turned out the opposite, where is cardio placement I wasn’t that keen on and its turning out the best one. My cardio supervisor is very knowledgeable and the way she explains things it’s so clear and precise. I look forward to our tutorials every week. It’s amazing what a difference it makes when a supervisor is not intimidating, you feel relaxed and able to perform the task so much better.
I suppose I its hard to compare neuro with cardio placement, as they are so different. Cardio, as long as you know ten problems list you are fine, it’s like following the instructions to make a cake. Neuro is not black or white it can also be a little grey. What I can compare is the supervisors and the way they relate to students and sometimes not in the friendliest manner. I thing you guys know what I mean…
The physio staff and our supervisor is so supportive and friendly, treating us like colleagues, it’s a nice change in comparison to the neuro placement, were I felt inadequate in my knowledge or basically, that’s how my supervisor made me feel.
Anyway it’s funny because I thought that I would enjoy my neuro placement the most, but it turned out the opposite, where is cardio placement I wasn’t that keen on and its turning out the best one. My cardio supervisor is very knowledgeable and the way she explains things it’s so clear and precise. I look forward to our tutorials every week. It’s amazing what a difference it makes when a supervisor is not intimidating, you feel relaxed and able to perform the task so much better.
I suppose I its hard to compare neuro with cardio placement, as they are so different. Cardio, as long as you know ten problems list you are fine, it’s like following the instructions to make a cake. Neuro is not black or white it can also be a little grey. What I can compare is the supervisors and the way they relate to students and sometimes not in the friendliest manner. I thing you guys know what I mean…
Sunday, February 18, 2007
Learning opportunity
I’m at my neuro placement at present, which provides me with a great opportunity to learn. To learn how to perform a content based assessment on a patient, to learn how to do a problem based assessment and choose the appropriate treatment option and so on. It’s both challenging and demanding, and at times I would love to have more time to digest all the things that happen throughout the day. And then to be able to go into the next session and do it all better.
What I want to get to actually is, that we had an in-service on a very interesting topic over lunch time last week. It was very well presented and had also a practical aspect about it but all I could think sitting there was…I would love to have a lunch break and digest what I’ve learned this morning rather than being fed more stuff. Do any of you guys sometimes feel we get a ‘learning opportunity’ overload?
Edith
What I want to get to actually is, that we had an in-service on a very interesting topic over lunch time last week. It was very well presented and had also a practical aspect about it but all I could think sitting there was…I would love to have a lunch break and digest what I’ve learned this morning rather than being fed more stuff. Do any of you guys sometimes feel we get a ‘learning opportunity’ overload?
Edith
Being Safe
Hello all!
Just wanted to voice something that is quite challenging for me in my neuro prac at the moment. This is the issue of being "too safe" with the patients. I am having a hard time with this as it has been grilled in to us time and time again that if we are unsafe with our patients that we FAIL! SO now that I am being extra cautious with them, ensuring that I am VERY close to them and ready to catch them when need be (especially with the patients who have poor balance- which is most of them) I am struggling to (and getting feedback) to step back and let them find their own center of gravity. I definitely understand that these patients do need to feel this and need to re-establish their equilibrium responses, but there is a fine line, at the moment for me as a student, in "letting them go" and "letting them fall". I am sure this is something that will come easier to me as I get experience but I am finding it very challenging to "let go" of it.
Nicole
Just wanted to voice something that is quite challenging for me in my neuro prac at the moment. This is the issue of being "too safe" with the patients. I am having a hard time with this as it has been grilled in to us time and time again that if we are unsafe with our patients that we FAIL! SO now that I am being extra cautious with them, ensuring that I am VERY close to them and ready to catch them when need be (especially with the patients who have poor balance- which is most of them) I am struggling to (and getting feedback) to step back and let them find their own center of gravity. I definitely understand that these patients do need to feel this and need to re-establish their equilibrium responses, but there is a fine line, at the moment for me as a student, in "letting them go" and "letting them fall". I am sure this is something that will come easier to me as I get experience but I am finding it very challenging to "let go" of it.
Nicole
Friday, February 16, 2007
'Annoying' Patients
Hi All......
I know we've all had it....but at the moment I'm quite sick of some of the sexual harrassment I've received from patients whilst on clinic.
At the moment, we have one elderly, homeless aboriginal man who is a care awaiting placement - so really....he's not even entitled to receive physio, however as our ward is very quiet....I've been asked to see him regarding his chest care. He does have a mental illness, and he can be quite incoherent at times, has a huge PMH, but has presented with an exacerbation of COPD.
Anyway - I'm not quite comfortable stating exactly what happened with this pt when I saw him yesterday.....but I'm just angry and appalled that there are people like him, that try to take advantage of every system that's out there...then abuse staff! It's not just sexual harrassment he dishes out....he's very verbally abusive, yells the most colourful language at staff...can be really bossy - and just plain rude. I really really try not to judge people who are in hospital and just try to think that their lives have certain circumstances that we probably don't know about and can't possibly understand.....but I can not stand this pt!! I really really do not like his nature and attitude I don't like that our hospital system is forced to take care of people like him.
I feel like it's a bit of a cop out to tell my supervisor that I don't want to see him.....but I'm going to because there's no way I'm going to have contact with this man again.....and I realise that through his actions and perhaps cultural differences....I'm unable to provide optimal physio treatment for this pt. BUT I'm sooooo angry with this man, for thinking that he can just say and do whatever he likes just because he's in hospital.........and I really wish sometimes that we could be 'people' instead of 'professionals' when it comes to pts and I had the nerve to tell some pt's what I think! (it might be in language he understands.....but it might be 'unprofessional' as well :))
Hopefully he gets a placement over the weekend.
Mads
I know we've all had it....but at the moment I'm quite sick of some of the sexual harrassment I've received from patients whilst on clinic.
At the moment, we have one elderly, homeless aboriginal man who is a care awaiting placement - so really....he's not even entitled to receive physio, however as our ward is very quiet....I've been asked to see him regarding his chest care. He does have a mental illness, and he can be quite incoherent at times, has a huge PMH, but has presented with an exacerbation of COPD.
Anyway - I'm not quite comfortable stating exactly what happened with this pt when I saw him yesterday.....but I'm just angry and appalled that there are people like him, that try to take advantage of every system that's out there...then abuse staff! It's not just sexual harrassment he dishes out....he's very verbally abusive, yells the most colourful language at staff...can be really bossy - and just plain rude. I really really try not to judge people who are in hospital and just try to think that their lives have certain circumstances that we probably don't know about and can't possibly understand.....but I can not stand this pt!! I really really do not like his nature and attitude I don't like that our hospital system is forced to take care of people like him.
I feel like it's a bit of a cop out to tell my supervisor that I don't want to see him.....but I'm going to because there's no way I'm going to have contact with this man again.....and I realise that through his actions and perhaps cultural differences....I'm unable to provide optimal physio treatment for this pt. BUT I'm sooooo angry with this man, for thinking that he can just say and do whatever he likes just because he's in hospital.........and I really wish sometimes that we could be 'people' instead of 'professionals' when it comes to pts and I had the nerve to tell some pt's what I think! (it might be in language he understands.....but it might be 'unprofessional' as well :))
Hopefully he gets a placement over the weekend.
Mads
Thursday, February 15, 2007
Hello all,
As you may remember my last blog was about Dug, the guy who wouldn’t share his PMH with me. Thanks to Minh and Nic for your advice, you brought up some important issues that I hadn’t really considered. To keep you up dated Dug came back in today, I decided that I would explore the PMH issue. I was quite firm and clinical in my approach, I avoided “dabbling” around the issue and just simply told him that I was a health professional, all information is confidential and that I wasn’t prepared to treat him if he couldn’t be honest with me. This worked better than I could have hoped for. He told me that he had been diagnosed with schizophrenia 10 years ago and had spent a substantial amount of time since then in grey lands hospital, he has also spent time in prison and has battled depression since he was a child. I think once he told me he relaxed, I guess once that was out in the open he felt that I was more likely to be able to help him. I was very pleased with how the situation ended, I think the lesson to be learnt is to… know clearly what you want and why you want it, be confident about getting it, and respect it once you have it. (guess this can be a metaphor for anything you want in life)
Jess
As you may remember my last blog was about Dug, the guy who wouldn’t share his PMH with me. Thanks to Minh and Nic for your advice, you brought up some important issues that I hadn’t really considered. To keep you up dated Dug came back in today, I decided that I would explore the PMH issue. I was quite firm and clinical in my approach, I avoided “dabbling” around the issue and just simply told him that I was a health professional, all information is confidential and that I wasn’t prepared to treat him if he couldn’t be honest with me. This worked better than I could have hoped for. He told me that he had been diagnosed with schizophrenia 10 years ago and had spent a substantial amount of time since then in grey lands hospital, he has also spent time in prison and has battled depression since he was a child. I think once he told me he relaxed, I guess once that was out in the open he felt that I was more likely to be able to help him. I was very pleased with how the situation ended, I think the lesson to be learnt is to… know clearly what you want and why you want it, be confident about getting it, and respect it once you have it. (guess this can be a metaphor for anything you want in life)
Jess
Trying to be Superman
On my musculo clinic, I've been finding it hard to stick to the time limit for each patient. The main reason for this I think is that as a student I tend to assess everything, adn then in turn try to treat everything I can. Rather than doing the logical thing and assessing what's relevant to the patient's complaint, and then only doing one or two treatments that will have the greatest affect. When I teach tennis I always pick the one thing that I know that if I change it, it will create the greatest change in the persons performance. I guess I need to get over the immature idea that the best thing to do for a patient is treat every problem they present with, and start to think like a physio and now that the best thing to do for any patient is to focus on only a couple things at a time. What are your thoughts my fellow physios?
Wednesday, February 14, 2007
Energy Boost
Hi Everyone!
I started this week purely exhausted... I slept nearly the entire weekend. I joked with a friend of mine the other day that I woke up late Sunday afternoon after a 2 day nap!! And after speaking to a few people in the course, and reading blogs entitled "mental health" and "brain drain" I am comforted by the notion that I am not alone.
I was afraid that by being completely worn out, I would struggle to get through the week, but today, Wednesday, I had a patient who gave me the strength to go foward. My patient is two months post subscap and supraspinatus full thickness tears and has been limited in her AROM due to pain and her arm feeling "heavy". Unfortunately for me she has so much guarding that determining PROM seemed nearly impossible. Today though we had a breakthrough. I set up some slings and did some hold relax and at the end of the session she actively brought herself from her previously ROM of 95 degrees shoulder abduction to FROM! The look on her face was priceless... she couldn't stop saying "wow"! She could hardly believe that she had the range available in her shoulder to do this on her own, especially because up until now she has not been able to get full range. I think today was the breakthrough we needed to help boost her confidence.
After she left, I realized that this session was exactly what I needed also. This patient gave me the energy I needed because I was so happy to see that I had helped to initiate such a big change. I think in the midst of all the chaos of the last two years, I have nearly lost sight of the big picture and why I decided to become a physiotherapist in the first place. Thanks to this patient, I remember.
Megs
I started this week purely exhausted... I slept nearly the entire weekend. I joked with a friend of mine the other day that I woke up late Sunday afternoon after a 2 day nap!! And after speaking to a few people in the course, and reading blogs entitled "mental health" and "brain drain" I am comforted by the notion that I am not alone.
I was afraid that by being completely worn out, I would struggle to get through the week, but today, Wednesday, I had a patient who gave me the strength to go foward. My patient is two months post subscap and supraspinatus full thickness tears and has been limited in her AROM due to pain and her arm feeling "heavy". Unfortunately for me she has so much guarding that determining PROM seemed nearly impossible. Today though we had a breakthrough. I set up some slings and did some hold relax and at the end of the session she actively brought herself from her previously ROM of 95 degrees shoulder abduction to FROM! The look on her face was priceless... she couldn't stop saying "wow"! She could hardly believe that she had the range available in her shoulder to do this on her own, especially because up until now she has not been able to get full range. I think today was the breakthrough we needed to help boost her confidence.
After she left, I realized that this session was exactly what I needed also. This patient gave me the energy I needed because I was so happy to see that I had helped to initiate such a big change. I think in the midst of all the chaos of the last two years, I have nearly lost sight of the big picture and why I decided to become a physiotherapist in the first place. Thanks to this patient, I remember.
Megs
Monday, February 12, 2007
Two very different patients
The patient that I sow this week was a 48year old female who had the last stage of bronchiectasis and was admitted to the hospital due to exacerbation of the COPD. Tis week the doctors told her that there was nothing more they could do in terms of her treatment, as they couldn’t get rid of the bacteria that had invaded her lungs even with the strongest antibiotics.
I was so impressed with her mental strength and her attitude towards life, because if it was me in her situation I don’t think I would cope as well as she does. Every time I would come to her room to do the treatment she would always have a smile on her face and positive attitude towards her intervention. I wish all the patients were like her. Unfortunately is not the case. I have got another patient who is completely opposite to the lady I have just described. He doesn’t want to do anything he just lies in bed and sleeps for hours. Every time I would ask him to get out of bed and go for a walk, he claims is too tired and that I would come back later. Once I managed to get him to show me how he does sit to stand, he claimed that he couldn’t do it. Anyway I had to give him nearly max assist to stand him up. Funny thing was, later that day I was passing his room, when I sow him getting out of bed and walking to the bathroom. He looked that he had no problem in achieving the task. No wonder why hospitals have shortage of beds, because the patients like this man who doesn’t want to help himself to get better and getting discharged sooner.
It’s just amazing how different the patients can be, one who is dying and still trying anything possible to prolong the life and another who is just lazy and lack of motivation to do anything to help himself. As a physio is so frustrating having a patient like this man, when you know you could help him to get better, but without his input its not possible.
I was so impressed with her mental strength and her attitude towards life, because if it was me in her situation I don’t think I would cope as well as she does. Every time I would come to her room to do the treatment she would always have a smile on her face and positive attitude towards her intervention. I wish all the patients were like her. Unfortunately is not the case. I have got another patient who is completely opposite to the lady I have just described. He doesn’t want to do anything he just lies in bed and sleeps for hours. Every time I would ask him to get out of bed and go for a walk, he claims is too tired and that I would come back later. Once I managed to get him to show me how he does sit to stand, he claimed that he couldn’t do it. Anyway I had to give him nearly max assist to stand him up. Funny thing was, later that day I was passing his room, when I sow him getting out of bed and walking to the bathroom. He looked that he had no problem in achieving the task. No wonder why hospitals have shortage of beds, because the patients like this man who doesn’t want to help himself to get better and getting discharged sooner.
It’s just amazing how different the patients can be, one who is dying and still trying anything possible to prolong the life and another who is just lazy and lack of motivation to do anything to help himself. As a physio is so frustrating having a patient like this man, when you know you could help him to get better, but without his input its not possible.
Sunday, February 11, 2007
Feelings of neurological inadequacy
I started my neuro placement this past week and I found it fairly daunting. From the get go, our clinical supervisor says: “at this clinic, we use integrated techniques, but roughly 90% Bobath based”. Needless to say, I felt unprepared for the placement. From a safety standpoint, I felt fine. I knew I wasn’t about to endanger any of the patients. However, as most students would agree, there is an inherent preoccupation to impress the clinical supervisor with the limited knowledge we have, to ensure that we pass the placement at the end of the day. I was gob-smacked when she mentioned “90% Bobath”. I have only heard of Bobath in passing and essentially have no clue what philosophy or manual techniques it involved. Of course, I tried to read up on some Bobath material during night, but it was tough after a full day of working with neural patients. Some of the concepts were also tough to visualize without a patient in front of you, such as ‘key points of control’.
As much as I thought our neurology courses were taught well, I was quite disappointed with how under prepared I felt during the first week. If Bobath techniques are used so prevalently, shouldn’t we spend more time in class and labs learning and practicing it?
As much as I thought our neurology courses were taught well, I was quite disappointed with how under prepared I felt during the first week. If Bobath techniques are used so prevalently, shouldn’t we spend more time in class and labs learning and practicing it?
Easily Solved Problems Made Difficult
Hello all,
Yet another note discussing the matter of being burnt out and stressed affecting our performance.
I am in my neuro prac at the moment and had a difficult patient for two days who would say some inappropriate things and make false jugments on some things that I was saying to him. I have over ten year of experience dealing with many difficult people (both mentally ill and "normal" public patrons) and situations. I would like to say that as the supervisor in my old job that I was always quite responsive to these people and could deal with all different kinds of people (ie; ill, angry, panicked, depressed, stupid) and was always quite good at getting them to calm down and resolving (or dissolving) the situation. In this situation, however, I found myself to be very tired and so "over it" that it was too much energy for me to sum up to try and resolve (or deal with) a problem that, I could say, would have been most likely solved by me. Instead, I passed the patient on to my supervisor who passed him on to a male physio.
This would normally bother me as I enjoy a good challenge and like to try solving my own problems before I rely on someone else. But this time I don't care. It's really too bad that I have come to this point in which I am no longer displaying my own personality because I am so burnt out. A shame really....
Nic
Yet another note discussing the matter of being burnt out and stressed affecting our performance.
I am in my neuro prac at the moment and had a difficult patient for two days who would say some inappropriate things and make false jugments on some things that I was saying to him. I have over ten year of experience dealing with many difficult people (both mentally ill and "normal" public patrons) and situations. I would like to say that as the supervisor in my old job that I was always quite responsive to these people and could deal with all different kinds of people (ie; ill, angry, panicked, depressed, stupid) and was always quite good at getting them to calm down and resolving (or dissolving) the situation. In this situation, however, I found myself to be very tired and so "over it" that it was too much energy for me to sum up to try and resolve (or deal with) a problem that, I could say, would have been most likely solved by me. Instead, I passed the patient on to my supervisor who passed him on to a male physio.
This would normally bother me as I enjoy a good challenge and like to try solving my own problems before I rely on someone else. But this time I don't care. It's really too bad that I have come to this point in which I am no longer displaying my own personality because I am so burnt out. A shame really....
Nic
Past Medical History
Hi guys,
As I take time to reflect on my first week of musculo prac, one patient stands out in my mind. Let me introduce “Dug”…(obviously not his real name).
Dug was a “newy” and also my very first patient. I collected him from the waiting room and introduced myself, something about him was odd but I couldn’t really put my finger on what. I proceeded to take his subjective history and nothing made sense. He had had a horrible childhood, was covered in scars and burns from various accidents and abuse. I started to feel really sorry for the guy. To give you an idea he had been involved in 7 MBAs, 2 MVAs, 1 dog attack, been thrown into a wall while roller-skating and fallen 3 meters off a ladder in the past 5 years. He had weird symptoms and pain in his shoulders, left elbow, low back, calf, neck and both feet. Pretty much a nightmare case (remember this was my first patient). Then we got to his past medical history and medications. He would not tell me any of his medical history or what meds he’s taking (by this stage I’m pretty certain he has some kind of mental illness). Obviously for physio treatment we have to be sure that there is nothing in our patients PMH that contraindicates our intervention. I found it hard to ask questions about his medical history when he was so adamant to avoid the subject. It’s difficult to extract information about relevant medical history, without him thinking that I thought he had mental illness (he obviously didn’t want me to know this and thought that it was nothing to do with physio). As a health worker I do believe that we need to see the whole picture in order to treat a person, as it was our initial consult I felt it best to not push the subject. I guess I could have asked if he was more comfortable with me discussing the matter with his GP. He’s coming back this week maybe as I build more rapport with him he will feel more comfortable discussing his medical history with me. Dose any have any ideas on how to approach this kind of situation??
As I take time to reflect on my first week of musculo prac, one patient stands out in my mind. Let me introduce “Dug”…(obviously not his real name).
Dug was a “newy” and also my very first patient. I collected him from the waiting room and introduced myself, something about him was odd but I couldn’t really put my finger on what. I proceeded to take his subjective history and nothing made sense. He had had a horrible childhood, was covered in scars and burns from various accidents and abuse. I started to feel really sorry for the guy. To give you an idea he had been involved in 7 MBAs, 2 MVAs, 1 dog attack, been thrown into a wall while roller-skating and fallen 3 meters off a ladder in the past 5 years. He had weird symptoms and pain in his shoulders, left elbow, low back, calf, neck and both feet. Pretty much a nightmare case (remember this was my first patient). Then we got to his past medical history and medications. He would not tell me any of his medical history or what meds he’s taking (by this stage I’m pretty certain he has some kind of mental illness). Obviously for physio treatment we have to be sure that there is nothing in our patients PMH that contraindicates our intervention. I found it hard to ask questions about his medical history when he was so adamant to avoid the subject. It’s difficult to extract information about relevant medical history, without him thinking that I thought he had mental illness (he obviously didn’t want me to know this and thought that it was nothing to do with physio). As a health worker I do believe that we need to see the whole picture in order to treat a person, as it was our initial consult I felt it best to not push the subject. I guess I could have asked if he was more comfortable with me discussing the matter with his GP. He’s coming back this week maybe as I build more rapport with him he will feel more comfortable discussing his medical history with me. Dose any have any ideas on how to approach this kind of situation??
Mental Health
Hi guys,
I wanted to raise the issue this week of our sanity!!!
I'm hearing more and more of fellow collegues (not unlike myself) feeling VERY stressed and some are wondering about burn out and depression. I think that a lot of us are facing some huge issues in the next couple of months, one hurdle is the PCR, some of our colleagues are moving home to Canada, and quite frankly, a HUGE change is ahead for all of us.....
Personally I absolutely hate change most of the time....the worry of getting a job is starting to get to me.....and I feel like I have pretty much no time and really can't be quite bothered to get my resume out yet....I'm wondering things like....what differentiates us as new grads? we've done the same physio degree.....apparently grades don't matter....clinic performance is marked as competent/not competent....and I'm thinking it wouldn't be as professional to include our clinic reports in our resume etc...so I kind of feel like I'm going to have to be plain lucky to get a job! Surely the 'selectors' for interviews wouldn't be able to remember if we've been on placement in their hospital and be able to ask appropriate people about you.
So what do you guys think?? and what are you doing about it?
Madeleine
I wanted to raise the issue this week of our sanity!!!
I'm hearing more and more of fellow collegues (not unlike myself) feeling VERY stressed and some are wondering about burn out and depression. I think that a lot of us are facing some huge issues in the next couple of months, one hurdle is the PCR, some of our colleagues are moving home to Canada, and quite frankly, a HUGE change is ahead for all of us.....
Personally I absolutely hate change most of the time....the worry of getting a job is starting to get to me.....and I feel like I have pretty much no time and really can't be quite bothered to get my resume out yet....I'm wondering things like....what differentiates us as new grads? we've done the same physio degree.....apparently grades don't matter....clinic performance is marked as competent/not competent....and I'm thinking it wouldn't be as professional to include our clinic reports in our resume etc...so I kind of feel like I'm going to have to be plain lucky to get a job! Surely the 'selectors' for interviews wouldn't be able to remember if we've been on placement in their hospital and be able to ask appropriate people about you.
So what do you guys think?? and what are you doing about it?
Madeleine
Friday, February 9, 2007
Subjective History
Hi Everyone… Hope the new clinics are going well.
I just started my musculo outpatient, and had a new patient referral the other day. It was my second new patient that I have had on this prac (the first having gone relatively smoothly), so I was confident that I would be able to handle this patient who I knew was referred for left ankle/heel pain.
This patient was more complex than I had originally anticipated, mostly because she had an extensive history of bilateral, hip, knee and ankle pain. I tried to steer the subjective history so that we could mainly concentrate on her presenting problem, her left ankle. But with every question, her answers became more and more off the course. So in the end, a 90 minute first assessment turned out to be a two hour appointment.
I tried everything from asking more direct, closed typed questions to almost leading questions. Nothing worked. Has anyone had this problem? I’m not sure how to deal with it for future. She was a very lovely lady and I didn’t want to be rude and interrupt while she told me about all other issues (pain in her knees, hips…), but at the same time, I couldn’t seem to find the right way to word the questions to avoid her going off topic.
Any advice would be greatly appreciated!
I just started my musculo outpatient, and had a new patient referral the other day. It was my second new patient that I have had on this prac (the first having gone relatively smoothly), so I was confident that I would be able to handle this patient who I knew was referred for left ankle/heel pain.
This patient was more complex than I had originally anticipated, mostly because she had an extensive history of bilateral, hip, knee and ankle pain. I tried to steer the subjective history so that we could mainly concentrate on her presenting problem, her left ankle. But with every question, her answers became more and more off the course. So in the end, a 90 minute first assessment turned out to be a two hour appointment.
I tried everything from asking more direct, closed typed questions to almost leading questions. Nothing worked. Has anyone had this problem? I’m not sure how to deal with it for future. She was a very lovely lady and I didn’t want to be rude and interrupt while she told me about all other issues (pain in her knees, hips…), but at the same time, I couldn’t seem to find the right way to word the questions to avoid her going off topic.
Any advice would be greatly appreciated!
Expressive Aphasia
On my neuro outpatient placement I came across a few people with expressive aphasia. Needless to say that a conversation doesn't take place in the usual way. Most of the patients I have seen are only able to say one or two words at a time and a lot of the times it seems like they are saying a word related to the one they want to say but just do not quite hit it. So it usually takes them about three trials before they can say the one word.
I find it very hard not to put words in their mouth by guessing what they want to say but just be patient and waiting for the right word to come out. Another challenging aspect of communication with those type of patients I find is not to give up (patient or physiotherapist) trying to talk and listen because it is important what they have to say.
I think it is imperative to find the right balance with helping them out with the word they are looking for without being patronising or impatient. Who knows, I might improve my ability to communicate with aphasic patients over the next three weeks. And I hope that the times where I have to say:"I am sorry, but I can not understand what you are saying" are becoming less frequent.
Edith
I find it very hard not to put words in their mouth by guessing what they want to say but just be patient and waiting for the right word to come out. Another challenging aspect of communication with those type of patients I find is not to give up (patient or physiotherapist) trying to talk and listen because it is important what they have to say.
I think it is imperative to find the right balance with helping them out with the word they are looking for without being patronising or impatient. Who knows, I might improve my ability to communicate with aphasic patients over the next three weeks. And I hope that the times where I have to say:"I am sorry, but I can not understand what you are saying" are becoming less frequent.
Edith
Wednesday, February 7, 2007
Well done so far
Hi Team Physio,
I wanted to put up a post to let you know how well you have been doing in engaging in this process. I have had a brief scan through the posts and there has been a wide range of topics that you have explored as a group with some good reflection on difficult issues encountered on the placement. Many of the posts share some fairly in depth observations from clinics. Where an issue has been raised and opened for discussion it would be great for you to consider putting up some follow up reflections later in the placement as to how the scenario may have changed through the clinical placement and what you feel you have learnt or changed through the process of reflecting on that issue.
A reminder that you might want to consider writing your post in a word document, saving it and then cutting and pasting into the Blog. It will save you time if you have technical difficulties in posting your message.
Keep up the good work
PG
I wanted to put up a post to let you know how well you have been doing in engaging in this process. I have had a brief scan through the posts and there has been a wide range of topics that you have explored as a group with some good reflection on difficult issues encountered on the placement. Many of the posts share some fairly in depth observations from clinics. Where an issue has been raised and opened for discussion it would be great for you to consider putting up some follow up reflections later in the placement as to how the scenario may have changed through the clinical placement and what you feel you have learnt or changed through the process of reflecting on that issue.
A reminder that you might want to consider writing your post in a word document, saving it and then cutting and pasting into the Blog. It will save you time if you have technical difficulties in posting your message.
Keep up the good work
PG
Monday, February 5, 2007
Bottom of the Food Chain
During the third week of my clinic something came up with my Curtin tutor that I thought I'd share. We were seeing a patient that we had seen the previous week. This patient had been in for three weeks, with infective exacerbation COPD, and was coughing up copious amounts of stuff ranging from pink to dark green, and always very runny and always lots of it with little trying to get it up. I had developed a bit of a rapport with her doctors as I was concerned with how much she was always producing. Anywho the week before when the Curtin tutor came in we got sample, cause that was the pink day, and we got in touch with te doctor and he said do a sample. Later that week (second week) when I was by myself, the sputum changed and I saw the doctor in the hall so I told him what we found and asked if they wanted a sample. He said "No that's ok, we have enough samples. Thanks". (very polite doctor)
So fast forward to third week when the Curtin tutor comes in. After we see the lady she says for me to get a sample. So I went to look up the doctors pager number to ask him if he wanted it, because in the hospital you have to get a doctor to fill out the sample request form. As I'm looking for it she says to just the sample then we'll get the form filled. So got the sample, and then she's says "Is the doctor here?" He wasn't so she says for me to just get another doctor to fill out the request form. (this is somewhat common, but still within being legal) Now at this point I felt uncomfortable getting this sample kinda behind the doctors back when I knew he wouldn't want it done. And the doctor I asked to fill out the form did so very unwillingly, and asked a million questions. Anywho after she left I was worried that when the results came back and the doctor found out that I had gone ahead and sent the sample off kinda behind his back that he may take offense. Because in all honesty it isn't my decision to send off samples and its kinda like second guessing what he's doing.
I guess by saying all that I was just wondering what do you do when the tutor who is there only a fraction of the time pushes for something you dont think should be done. Like this other time that she had me page two interns about 5 times each in a space of 10 mins, to find out if we could get a patient up. I knew that calling them was important but if they could they would have returned the call. Come to find out the phone I was paging from didnt really work so I couldnt receive the returned calls on it. I just felt like the annoying student physio. Anywho later my fellow physios. Sorry this one is a bit all over the place.
So fast forward to third week when the Curtin tutor comes in. After we see the lady she says for me to get a sample. So I went to look up the doctors pager number to ask him if he wanted it, because in the hospital you have to get a doctor to fill out the sample request form. As I'm looking for it she says to just the sample then we'll get the form filled. So got the sample, and then she's says "Is the doctor here?" He wasn't so she says for me to just get another doctor to fill out the request form. (this is somewhat common, but still within being legal) Now at this point I felt uncomfortable getting this sample kinda behind the doctors back when I knew he wouldn't want it done. And the doctor I asked to fill out the form did so very unwillingly, and asked a million questions. Anywho after she left I was worried that when the results came back and the doctor found out that I had gone ahead and sent the sample off kinda behind his back that he may take offense. Because in all honesty it isn't my decision to send off samples and its kinda like second guessing what he's doing.
I guess by saying all that I was just wondering what do you do when the tutor who is there only a fraction of the time pushes for something you dont think should be done. Like this other time that she had me page two interns about 5 times each in a space of 10 mins, to find out if we could get a patient up. I knew that calling them was important but if they could they would have returned the call. Come to find out the phone I was paging from didnt really work so I couldnt receive the returned calls on it. I just felt like the annoying student physio. Anywho later my fellow physios. Sorry this one is a bit all over the place.
Cerebellar stroke with negative tests rezults
During this week neuro prac I had a new patient to assess. This man presented to NOP following a bilateral cerebellar infarct, three months ago. His referral letter stated to provide ongoing rehabilitation for this patient’s decreased balance.
My assessment included 6MWT, 10 meter WT, Bergs Balance, proprioreception, cerebellar testing. During his 6MWT he had a classical cerebellar signs. Ataxic gait with fixed trunk, wide BOS, decreased stride length. He did look very unstable.
When I started doing cerebellar testing to my surprise all the test, including finger nose test, heel shin, asthenia, rebound phenomenon, toe tapping were negative. The proprioreception was also adequate. I was very puzzled, as I thought this patient who had cerebellar stroke would ultimately have these tests positive? Then I thought, may be may testing skills weren’t precise, so I asked my supervisor to come and help me out as I couldn’t understand why the tests came out negative.
My supervisor did exactly the same tests as I did and they also came out negative.
Then my supervisor told me that this patient may had some vestibular implications.
That day my treatment with this patient consisted of increasing the patient’s postural tone by using the exercises on trampoline, walking around obstacles, fitball exercises. After 25 min of the treatment patient became ill and started vomiting. Well I thought that next treatment session should definitely include same vestibular testing, and get a better idea what was wrong with this patient to enable us to give him the most appropriate intervention.
I thought would be a good idea to share with you guys my experience with this patient, as didn’t know that patient presented with cerebellar stroke can have negative cerebellar tests. Cha, neuro is definitely isn’t as simple as I thought……
My assessment included 6MWT, 10 meter WT, Bergs Balance, proprioreception, cerebellar testing. During his 6MWT he had a classical cerebellar signs. Ataxic gait with fixed trunk, wide BOS, decreased stride length. He did look very unstable.
When I started doing cerebellar testing to my surprise all the test, including finger nose test, heel shin, asthenia, rebound phenomenon, toe tapping were negative. The proprioreception was also adequate. I was very puzzled, as I thought this patient who had cerebellar stroke would ultimately have these tests positive? Then I thought, may be may testing skills weren’t precise, so I asked my supervisor to come and help me out as I couldn’t understand why the tests came out negative.
My supervisor did exactly the same tests as I did and they also came out negative.
Then my supervisor told me that this patient may had some vestibular implications.
That day my treatment with this patient consisted of increasing the patient’s postural tone by using the exercises on trampoline, walking around obstacles, fitball exercises. After 25 min of the treatment patient became ill and started vomiting. Well I thought that next treatment session should definitely include same vestibular testing, and get a better idea what was wrong with this patient to enable us to give him the most appropriate intervention.
I thought would be a good idea to share with you guys my experience with this patient, as didn’t know that patient presented with cerebellar stroke can have negative cerebellar tests. Cha, neuro is definitely isn’t as simple as I thought……
From one place to the next
I’ve really enjoyed my placement in musculo outpatients at charlies. It was in this last week that I realised that I was getting a grasp of everything, knowing the patients and being in the middle of rehabilitating them. I would have loved to stay on for another couple weeks, to progress with these patients and getting them ready for discharge.
But, as you all know, our time was up and the next placement is starting today. A new place in a different area with a new supervisor in a new team of physiotherapists (neuro outpatients). And I feel like I am starting from scratch again. Getting to know the workplace, the colleagues, the supervisor, the senior physiotherapists and of course the patients.
I think it is a great chance for us to see so many different areas of physiotherapy in such a short time but at the same time I find it challenging to switch over in such short intervals and start all over again…
Edith
Sunday, February 4, 2007
Brain Drain
A patient came in the other day and sapped all the strength out of me by the time she left. It was an outpatient musculoskeletal placement. She had a seven year history of lower back and bilateral hip pain and was on a disability pension. She also reported of a right-sided intermittent sciatica. Her attitude was not necessarily poor or negative. Rather, it was a nonchalant ‘been there, done that’ kind of attitude. She reports that she has tried physio in the past, but with limited or no success. She was quite frank in stating that she presented to our clinic because her GP had referred her. Going through the subjective with her was like pulling teeth. She was vague and inconsistent. For example, she had great difficulty with determining pain intensity levels. At times, her resting pain levels went higher than her aggravated pain levels. When directed to the inconsistency, she simply shrugged.
Hell, I simply wanted to shrug her off too. Of course, I did not… because we are professionals and our game face always needs to be turned on. As any good physio would, I wanted to help, but felt rather helpless. The patient was a chronic pain sufferer, so I thought about going through educating her on hurt versus harm, mechanisms of pain sensitization and what needs to be done to break the pain cycle. Towards, the end of the treatment session with her, I tried to encourage her to increase physical activity and how it was important to not let pain prevent her from doing the things she loved. I am not convinced at all that I got through to her. She politely agreed with all that I had to say,
By the end of it all, I felt utterly drained. Worse of all, I felt that this patient’s blasé attitude affected me to the point where it spilled over to the next patient. It would be great if all the patients that walked through the door were motivated individuals striving to take good care of themselves. Nonetheless, this is far from reality. I have heard of physios being burnt out from the accumulation of negative karma. My question and comment is how do you shield yourself from this? To be a good physio who demonstrates genuine concern for his or patients, putting up a false front would throw good rapport out the window. Do you simply put on a fake optimistic happy face? How do prevent patients from draining your vitality?
Hell, I simply wanted to shrug her off too. Of course, I did not… because we are professionals and our game face always needs to be turned on. As any good physio would, I wanted to help, but felt rather helpless. The patient was a chronic pain sufferer, so I thought about going through educating her on hurt versus harm, mechanisms of pain sensitization and what needs to be done to break the pain cycle. Towards, the end of the treatment session with her, I tried to encourage her to increase physical activity and how it was important to not let pain prevent her from doing the things she loved. I am not convinced at all that I got through to her. She politely agreed with all that I had to say,
By the end of it all, I felt utterly drained. Worse of all, I felt that this patient’s blasé attitude affected me to the point where it spilled over to the next patient. It would be great if all the patients that walked through the door were motivated individuals striving to take good care of themselves. Nonetheless, this is far from reality. I have heard of physios being burnt out from the accumulation of negative karma. My question and comment is how do you shield yourself from this? To be a good physio who demonstrates genuine concern for his or patients, putting up a false front would throw good rapport out the window. Do you simply put on a fake optimistic happy face? How do prevent patients from draining your vitality?
Knowing it all
I have really enjoyed this musculo prac and thank god for that really because it's what I thought I'd enjoy. It's amazing how much I have learnt and was able to consolidate, but at the same time you feel like there is so much more that you still don't know. This thought tends to freak you out a bit... However! I have come to a very important conclusion this week as an almost new grad! It's what you do know and the fact that you know what you don't know and that you know that you will know it...eventually. If that makes any sense. So, what I'm trying to get across on this Sunday night before I have another week of energy draining learning and consolidating is that we must have faith in ourselves and know that no one knows it all and that soon we'll know some more.
Nic
Nic
Friday, February 2, 2007
Saying Goodbye to Patients
On my neuro prac, we have had one patient in particular who has really taken to us.....She is only 46 and had a major stroke just before our clinic started, so we were the first to see her, and her and her husband have made jokes about adopting us, have bought us chocolate (despite us saying thanks, but you don't need to etc etc), and have just been so nice to us and appreciative of our help that saying goodbye to them was actually quite hard......I felt bad as they haven't had good experiences with the hospital in some areas, and we've been what they've called the only consistent positive thing in her therapy!
It has been a really positive experience to work with this pt as she has made quite large gains quite quickly with us, and although she is a heavy pt, the work we've put in has really paid off for her.....I really hope it continues!
Anyway I won't ramble either - I'm too exhausted from clinic and this week has had too much assessment time in it to write anymore!!!
Mads
It has been a really positive experience to work with this pt as she has made quite large gains quite quickly with us, and although she is a heavy pt, the work we've put in has really paid off for her.....I really hope it continues!
Anyway I won't ramble either - I'm too exhausted from clinic and this week has had too much assessment time in it to write anymore!!!
Mads
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