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.
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I had a read of your situation and I found it frustrating myself. I had a similar exprience on my musculo placement as well. My suggestion is to try to contact the referring doctor immediately to see if the situation could be resolved right there and then. If he/she cannot be found, then someone will be unhappy. In this case, it is the patient because we have to follow the hospital rules and procedures. What it brings up in my mind is how limited we are in power and autonomy. We are encouraged to think we are primary contact health care practitioners with the ability to access and refer patients as deamed appropriate. Obviously, this is not the case. At the end of the day, the GPs and government write the rules and determine what we can and cannot do! What we need to do is form lobby groups and announce our distaste for being told what to do and fight for greater legislative professional freedom! (This is my rant for the day)
Hi Megan, may be would had been good idea to talk to that doctor who referred to you this patient, as he may tell you a bit more about the patient and what was the reason for his decision. May is still not too late to do so, so you can give this patient the intervention that she wants.
I've had a similar situation at my musculo clinic. I had a guy that was in for lower back pain, and was pretty much at the point of being discharged. His back wasn't limiting his activity, it was his ankle that was now limiting his activity. He said he wanted me to treat it, but I had to tell him that for that to happen he had to go back to his doctor and get a new referal for his ankle. Anywho long story short, he decided his ankle was bad enough to limit his walking but not bad enough to go and get another referal.
I guess my case wasn't as frustrating as yours cause my patient wasn't in need of desperate treatment for his non referal problem.
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