Hi all.
Still slugging away at musculo outpatients and really enjoying it. My issue at the moment is the fact that my patient list is growing exponentially. I know I posted a reply giving some advice about this a few weeks ago, but the issue I have is slightly different. It is worthwhile treating the patients that I have (have I just answered my question there?) but there has got to be a time when the line is drawn discharge wise. Example: an elderly gentlement post THR. Has made great gains, independently walking, ROM good, strength more than adequate. Seeing as I felt that he was close to discharge I even asked him to go from supine lying on the floor to standing to check his safety - no problem. However, he still has a residual limp. I have added to his specific gait HEP with the aim of eliminating the abnormal gait and taking advantage of the strength gains he has made. I'm seeing him again this week.
I can totally justify the reasoning I have applied to this gentleman. I'm not unhappy that he is coming back. My issue is that by not discharging him sooner (when his main problems are well in hand) I am adding to the significant waiting list at the clinic. As a student I think I have the luxury of being this thorough with a patient and it's an excellent learning experience. Problem is, I struggle with this luxury affecting patients who are in greater need of treatment but who are still waiting.
Martin
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2 comments:
Well you dont have to discharge them entirely...you said you've given the patient specific exercises targeting gait. How you about you the send the patient away, let them carry on with their exercises, and then review them in 4 weeks time, to see how their progressing. The only problem maybe that you'll no longer be the physio, so someone else will have to take over. But if you leave a detailed hand-over or transfer summary, hopefully the new physio can pick up where you left off.
Again, its tricky knowing when to discharge patients, but if their progress has somewhat plateaued, and their managing well independently, then let them have some time off, continue HEP and review as necessary.
Rev
I agree with Rev,
I have been in the same kind of situation at SCGH..
On our placement we spread out the appointments for these types of patients so we could get new ones in. We sent them home with a detailed HEP and then asked them to come in again in a couple of weeks.
I think also confiding in the team to help make the decision is really useful. The senior physio's have been through all these types of decisions before and can really help with guiding you in a plan of attack.
caris
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