Offended patient...

Hello all

My blog this week is about the conflict between doing very thorough assessments and frustrating the patient who just wantsto move on to treatment. I am on a Neurology ward at the moment, and I have been seeing a particular patient for a week. The first few days were predominantly assessment based with only about half the session time being dedicated to treatment, also justifying to myself that the assessments are often treatments in themselves. The assessments were pretty standard including mm strength, sensation, tone, reflexes, UL function, alignment, cranial nerves, sitting balance, standing balance, Berg Balance Scale; and examining the functinal things of rolling, supine to sit, sit to stand and ambulation. Because there were two of us responsible for this patient we would verbalise our observations as we made them. When our Curtin Clinical tutor came she would help us to analyse the functional tasks in particular and help us to break them down into impairments to help us figure out what was going on. I was aware that some of the assessment procedures had already been documented in the notes by the doctors but we are always encouraged to do our own assessments. In particular for this patient I had to write a full neuro SOAPIER on him and so I had to be very clear in my mind about what was going on and have good measures for re-assessment

Then on the Friday, whilst I was sitting in the patient's room by myself waiting for the other student to organise a wheelchair and come in, the patient snapped. He began to yell at me that he feels like a guinea pig with people assessing him all the time, that everyone is looking at the same things and he has to do the same tests over and over, that the Curtin tutor continually points out and talks about what is wrong with what he is doing in front of him, and that he does not feel like he is being 'treated like a human being'. He yelled at me for about 5 min. I think I handled his outburst well, by acknowledging his point and saying that it was good of him to let us know so we can change the structure of the sessions, and by trying to point out that we are still some students and need guidance from the Curtin Tutor, that we have to do lots of assessments to break the problems down so we know how to treat them, and that the assessments are all now completed and so the sessions would be treatment based only. We informed the Curtin tutor so the teaching sessions with her could be altered.

I empathised with what the patient was saying, and I understand that he is dealing with a lot at the moment being in hospital. Although I didnt like his method of delivery (shouting!), some of his points were valid. It is hard however for us to strike a balance between having lots of assessments as outcome measures, and discussing the findings with each other and the Curtin tutor to understand his impairments, and offending the patient. For that sessions and future sessions with this patient we are not discussing any thoughts in front of him, the Curtin tutor has backed off a bit (as a lot of his problem was with her), and obviously we are not needing to do any more assessments. The situation in general was quite stressful for me but I still feel that I have learnt from it, and perhaps in future will try to take more assessment info from the notes instead of redo-ing it myself, and making assessments more subtlely integrated into treatment, and also not correlating my ideas with the other student ntil after the treatment session if I feel the patient is likely to become offended.