Hi guys,
I have recently had my first 2 pracs on the spinal and medical wards at RPH where I have dealt with many serious acute medical conditions and with patients who are at a very large risk of mortality and serious illness. So you can forgive my surprise I'm sure that when I started this week at the Outpatients Curtin clinic at SCGH I felt unsure of how to respond to some of the patient reason's for attending physiotherapy.
One such example, is my patient of 60yrs who came into see me with a referral of lower back pain.Prior to the session, I studied up on all of the relevant subjective and objective assessments I needed to carry out and then brainstormed all of the possible intervenions I could use to help reduce her pain. However, when the the subjective examination began, I started to feel slighlty bewildered as to what her specific problems were. She reported 0/10 resting pain and at the worst 3/10 pain on movement. More interestingly, she reported only ever experiencing this pain when she slumpled momentarily awkardky on her chair and the pain instantly resolved when she sat in a better position. The only objective result that I could possibly find on assessment, was slight hypomobility on (L) L4/5 unitateral and L5 central PAIVMs and slight TOP over the (L) qudratus lumborum muscle. The only possible treatments that I could justify for that session was soft tissue massage over QL and PAIVM's over L4/5. I gave her simple HEP of ROM ex's in standing and gave some education on correct posture in sitting. The patient re-booked for another session next week, as she felt that the treatment had made her feel better.
I have several concerns about this situation. The first is that I feel lost in the treatment session as I am struggling to find significant asterick signs and therefore am not sure how to fill the session effectively. The second is that some of my other patients are not recieving regular enough appointments as all my times are booked up. The thrid is that as she is a private patient, she is paying for the treatment sessions and I am wondering wherether it is ethical to allow her to make another appointment?
My dilemma is that do I explain to the patient that I think that physiotherapy is not really required for her problem or do I continue treating based on her subjective reports of pain. If I continue treating, does anyone have any idea's what I can do to help this lady??
Look forwards to hearing some opinions,
Kate.
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2 comments:
Kate I feel like I'm in the same boat in that I too am learning to appreciate the fine art of managing the appointment diary. I have good reasons to see my patients again, but it's going to be difficult to see the one's who require most attention if my book is filled with patients I should have seen in a fortnight rather than in a week. One of the ways you might manage this patient is by giving her an expanded HEP and say you want her to work on it on her own and check on her in a few weeks. This might put the ball in her court as far as being responsible for her own treatment. You might also refer her to a massage clinic if she feels the need to have a regular appointment (?). Hope you are enjoying your placement otherwise.
Hey guys,
My opinion is that as a physio you may not think you are helping this person... BUT if the patient feels like you are helping them then hey, maybe you ARE helping them. If someone is willing to pay you for your services it means you are doing something right for them, and as we are just beginning our careers its important to maintain clients so I would keep doing what you are doing.
Ez
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