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!
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2 comments:
Hi Meghan
I can absolutely feel for you as I had a very similar patient on my musculo placement (blog entry about vague answers). Like you, I tried all the tricks with more direct, closed typed and leading questions which didn't get me there either. I found myself becoming very frustrated and ending up not listening to her answers anymore when she would go off track again. On the subsequent visits though I found that the communication got a lot easier, maybe because the first assessment had been so extensive (especially the subjective part). I found that the patient would answer my questions a lot more precise which made the treatment easier.
So keep your head up, I think it's going to pay out that you've spent so much time on the initial assessment.
And for the near future - as a new grad and under more time constraint - you might have to interrupt and cut a patient short and integrate subjective into objective examination, focusing on the presenting problem.
Hope this helps,
Edith
Meghan,
I also had this problem on my placement....to which my supervisor was very blunt and direct with this patient who was referred for her knee pain, however also complained of neck pain, and really really pushed for her neck to be treated.
My supervisor quite simply said 'you have been referred here for your knee pain, so that is our main concern right now'. Any discussion about her neck pain was quite 'aborted' by asking closed questions like you did.
I found this patient really difficult to treat becuase she wanted her neck treated as well....and claimed that her neck (which was a chronic probelm) was only sore as a result from using crutchers for 1/52 after her knee surgery.
So....closed questions...and be REALLY direct with your questions....also I think we can't be too scared to cut people off like Edith said...like saying you don't have the time at the moment, and would prefer to focus on the main problem.
Madeleine
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