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

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.

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……

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

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?

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

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