Hi all,
My post this week relates to my musculoskeletal outpatient prac. I had a very elderly patient come to me yesterday with hip pain following a total knee replacement three months earlier. On the subjective examination however, she came armed with a list of her medical conditions and another with all of her current pains and problems that she is experiencing currently. By the end of the assessment, she told me she had ongoing post-op-related knee pain and weakness in her left knee, pain in her right knee (which is awaiting to be replaced), new hip pain, long-stnding lower back pain, aching/painful feet and neck and shoulder pain. (It must be noted, this lady did not present as a psychological chronic pain patient, I do believe that the pathologies would be very easily indictaed on any exam - she is just very very old and over worked!!)
In order for me to actually get the assessment completed and some direction in my treatment for today, I simply asked the patient to pick the most severe pain that is causing her the greatest problemstoday. Luckily she was able to pin point her hip pain and I thus went about managing this problem. All of my objective measures were limited by her multiple array of 'pains' and it bacmae very clear to me that a very general rehab program would be the most effective way of managing her problems.
Therfore, even though I treated her hip pain on the first treatment, I now intend on giving her a general strengthing and stretching exercise program which I hope will assist to reduce many of her aches and pains. It just concerns me slightly that I am not focussing on her individual problmes and that perhaps these problems could be better improved by using more specific techniques. My question to anyone out there, is do you think that treating this patients problems individually at separate times would be more effective than the path I have actually chosen?
Thanks,
Kate.
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2 comments:
Hi Kate,
I think you did well to identify the most severe problem and treat only that in the first instance. Were the pains related to each other, if so treatment of just one may change the others and since you've only treated one pain, you’ll know exactly which techniques were responsible for the changes. Is the patient a private or public patient? I guess that would also guide how much time you had to focus on her individual problems.
Good luck with her!
Mel
Hi Kate I ve experienced similar probelms on my prac. Often the patient has numerous complaints at which point I do the same as you initially did and treated the "most problematic" from the pt s perspective. There has been a couple of cases where my patient has had 2 + complaints so I have booked them in for a double time slot and Ax and treated the 2 main problems. This could be an option for you with your pt if you want to be more specific, as well as a general exercise HEP?
Hope you are enjoying your prac! :)
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