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??
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2 comments:
Hi Jess,
Sounds very....interesting and challenging for a first patient! especially cause I found it hard enough to get a hold on asking all of the subjective! Maybe just try explaining to him why you need to know certain things- ie; meds and not striving to know everything (ie; you can leave out the things that you feel are not relevant so he sees that you are not prying).
Nic
I also believe establishing good rapport is important to get any results with this patient. I think getting his full PMH is important not only to determine contraindications, but also for you to gain perspective on his behaviour and how to establish his treatment plan. For example, knowing he has If he has bipolar disorder MAY help you understnad why he cancels his appointments. He may require a referral to a psychologist or social worker. Lastly, I think it important from a safety point of view. You may want someone to be a around if he has a history of violence and hostility, or if he easily picks up flirtatious innuendoes that are non-existant. Hope that doesn't sound scary!
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