Hi all
Been ages since I blogged but i doubt any of you were that interested in "what I did today on my SDP", so I have had to wait to get my first clinical exposure in 9 weeks. Rusty is an understatement. So here I am in Tom Price. The weather's nice and warm so all is good. My issue is one that stems from the difficulties of being a primary care provider. Most of the stuff I'm doing is outpatients musculo, which is cool cos I'm interested in the area. My previous experience in this area was a positive (even successful) one, but I don't feel prepared for what I'm seeing now. Alot of acute backs (as in patients screaming in pain type acute backs) and other conditions that I'm finding difficult to work out. One particlular patient has pain radiating down the back of his leg and some lumbar flexion restriction, but otherwise his back was pretty clear to other examination. Huh? Going through all the pivms and paivms and all of that didn't produce anything. I had tried to be as thorough as I could but still no idea. My supervisor gave me a hand and it was decided that the problem was neural tension (the slump test I forgot to do...). Anyway the supervisor took over a bit which I'm ok with and went through a bunch of Mulligans neural mobilisation techniques that I've never seen before. They seemed to work ok and I'll be giving them a crack next time. Anyway, treatng people who have just walked off the street (without referral etc as with alot of the things I've seen) is proving a real challenge. Go Cats
M
Friday, September 28, 2007
Thursday, September 27, 2007
Forgetting
Hi everyone.
I am on my rural placement at the moment & I have suddenly become aware of everything I have forgotten since my first prac already! My first prac was a stint in neuro out patients & I did a heap of gait retraining. Since I have been on my rural prac I have come across some people who need gait retraining & Ive forgotten heaps of techniques I was taught at royal perth!
It is so frustrating because I assumed I wouldnt forget them, seen as they were so indented in my mind at the time!
I realise now I should have written more of them down at the end of the day, because in a rural setting the physios often have forgotten stuff about that too! Especially where I am and there is only one physio who has worked by herself for the last 20 odd years...
So this is more of a reminder to everyone to write things down if you are as forgetful as me.. Has anyone else experienced this on their rural prac where you get all different types of patients coming in? I hope im not the only one forgetting!
Caris
I am on my rural placement at the moment & I have suddenly become aware of everything I have forgotten since my first prac already! My first prac was a stint in neuro out patients & I did a heap of gait retraining. Since I have been on my rural prac I have come across some people who need gait retraining & Ive forgotten heaps of techniques I was taught at royal perth!
It is so frustrating because I assumed I wouldnt forget them, seen as they were so indented in my mind at the time!
I realise now I should have written more of them down at the end of the day, because in a rural setting the physios often have forgotten stuff about that too! Especially where I am and there is only one physio who has worked by herself for the last 20 odd years...
So this is more of a reminder to everyone to write things down if you are as forgetful as me.. Has anyone else experienced this on their rural prac where you get all different types of patients coming in? I hope im not the only one forgetting!
Caris
Friday, September 21, 2007
It's nearing the end!!!!!
Hey guys,
I got so caught up with the holidays that I realised I forgot to post this final blog! Oops!
I've had so much fun in my last Musculoskeletal prac, that I've been having so many problems figuring out what to write in this blog!
I'd might as well write something about the course as a whole...Can you believe it guys? One more prac and that's going to be over! I've have to say that these past four years have been long and tedious, with bouts of stressful OSPEs and endless exams. But good things come to those who wait.
I wish everyone the best for their last prac and PCR! Enjoy your last few days as a student! :)
Mark
I got so caught up with the holidays that I realised I forgot to post this final blog! Oops!
I've had so much fun in my last Musculoskeletal prac, that I've been having so many problems figuring out what to write in this blog!
I'd might as well write something about the course as a whole...Can you believe it guys? One more prac and that's going to be over! I've have to say that these past four years have been long and tedious, with bouts of stressful OSPEs and endless exams. But good things come to those who wait.
I wish everyone the best for their last prac and PCR! Enjoy your last few days as a student! :)
Mark
Running the ward
Hi everyone,
The last week of the Burns placement was very exciting. The ward was extremely busy and there were very few physios (as they were busy with conferences). I was being supervised by someone who never saw burns patients.
What made the last week exciting was that I was able to liase well with the nursing staff (mind you - they are our best friends on the ward when we choose to work in public hospitals), the physios (by dividing up the workload myself), asking the doctors about the patient's situation, giving the 3rd year patients to see (for the supervisor) and telling some cross patients how good exercise is (which most believed).
It was good practice and by the end of it all - i was able to give a verbal handover to the physios in charge and write the weekend list.
My supervisor gave the feedback that my communication had improved and it was a great opportunity to run the ward.
So my advise is this - take every opportunity to run the ward by the end of a placement. Not only do you gain confidence, but you are able to consolidate how everything works in the big picture.
The last week of the Burns placement was very exciting. The ward was extremely busy and there were very few physios (as they were busy with conferences). I was being supervised by someone who never saw burns patients.
What made the last week exciting was that I was able to liase well with the nursing staff (mind you - they are our best friends on the ward when we choose to work in public hospitals), the physios (by dividing up the workload myself), asking the doctors about the patient's situation, giving the 3rd year patients to see (for the supervisor) and telling some cross patients how good exercise is (which most believed).
It was good practice and by the end of it all - i was able to give a verbal handover to the physios in charge and write the weekend list.
My supervisor gave the feedback that my communication had improved and it was a great opportunity to run the ward.
So my advise is this - take every opportunity to run the ward by the end of a placement. Not only do you gain confidence, but you are able to consolidate how everything works in the big picture.
Monday, September 17, 2007
Plateauing Patienits
On my recent musculoskeletel prac I have come across patients who take on a very passive role to treatment. I had a quite a few pts who i saw weekly over the couse of the 4 week prac who would come back every week with no progress made. They were still in pain and there was no change to their impairments such as mm length and strength , yet when you asked them how they went with their Home Exercise Program they report that they didn't have time to do it this week. (yet again).
Post treatment they make gains and subjectivelt report that they feel better, however when they come back the next week they report that post treatment they felt good then experienced a gradual decline throughout the week and were back to the same level.
This really frustrates me, and ethically I feel that it can t be right for us to continue treating these patients when they are not making any preogress. The patients are not taking any repsonsibility for their injuries at all.
I tried expalining to the patients that the reason they are plateauing is becaause there is only so much we can do as a physio in a 1 hr treatment session, once a week, and now the rest is up to them to work on their exercises and stretches to make improvement s and to maintain gains amde in the treatment session. I said this quite firmly and it worked quite well with a couple of them, But as this was in the 4 th week I wasnt able to stick aroudn to see if they made any gains by doing their home exercises.
Similarly, I had a pt who injured his disc doing "dead Lifts" at the gym, yet continued to go to the gym, lifting weights week after week, even though his back was not getting better, and some week s even worse. In thsi situation simple education didnt work.. quite firm encouragemtn not to go to the gym, and expalining to him that he needs to take more responsiblity for his injury had a better effect.
I guess as physios we will come across these patients wuite frequently. Teh question is if they are not taking responsibility for theri injures and taking on a very passive role in their recovery where do we draw the line and stop treating th epatinet, or do we continue treating the pt even though they are not making any progress weeek by week ( although they are making progress by the end of the treatemt session)
Post treatment they make gains and subjectivelt report that they feel better, however when they come back the next week they report that post treatment they felt good then experienced a gradual decline throughout the week and were back to the same level.
This really frustrates me, and ethically I feel that it can t be right for us to continue treating these patients when they are not making any preogress. The patients are not taking any repsonsibility for their injuries at all.
I tried expalining to the patients that the reason they are plateauing is becaause there is only so much we can do as a physio in a 1 hr treatment session, once a week, and now the rest is up to them to work on their exercises and stretches to make improvement s and to maintain gains amde in the treatment session. I said this quite firmly and it worked quite well with a couple of them, But as this was in the 4 th week I wasnt able to stick aroudn to see if they made any gains by doing their home exercises.
Similarly, I had a pt who injured his disc doing "dead Lifts" at the gym, yet continued to go to the gym, lifting weights week after week, even though his back was not getting better, and some week s even worse. In thsi situation simple education didnt work.. quite firm encouragemtn not to go to the gym, and expalining to him that he needs to take more responsiblity for his injury had a better effect.
I guess as physios we will come across these patients wuite frequently. Teh question is if they are not taking responsibility for theri injures and taking on a very passive role in their recovery where do we draw the line and stop treating th epatinet, or do we continue treating the pt even though they are not making any progress weeek by week ( although they are making progress by the end of the treatemt session)
Sunday, September 16, 2007
Aggressive patients
Hi guys,
Im at the Burns ward and I found that several patients were aggressive. One of the reasons is that several of them were smokers and/or used illicit drugs. My supervisor had warned me and went through a tutorial about dealing with difficult patients (which was really very helpful).
Knowing that I would be a having an unusually verbally aggressive patient, my supervisor took me through my first session with that man. Although the man seemed very keen in the beginning, he did seem to get agitated as the session went on. The man kept on asking repeatedly how the assessment would help him and how physiotherapy would help (even if we answered him with the necessary reasons).
What made it even more difficult was his lack of compliance with the medical treatment. He started to become aggressive (passively at first) and then yelled out that he was going to discharge himself against medical advise.
This is the point when my supervisor said no and we took him back to the room. She said that she felt very cornered in by the patient and had no room for her to run, had the patient lost control and physically become violent (could sense it with his agitation).
Hence, it's important to watch out for some warning signals before we keep trying to persuade a patient about how important physiotherapy is for them. We can only persuade them to a certain extent. At the end of the day, they will be making their own decisions.
I guess this has been an incident to realise the above.
Im at the Burns ward and I found that several patients were aggressive. One of the reasons is that several of them were smokers and/or used illicit drugs. My supervisor had warned me and went through a tutorial about dealing with difficult patients (which was really very helpful).
Knowing that I would be a having an unusually verbally aggressive patient, my supervisor took me through my first session with that man. Although the man seemed very keen in the beginning, he did seem to get agitated as the session went on. The man kept on asking repeatedly how the assessment would help him and how physiotherapy would help (even if we answered him with the necessary reasons).
What made it even more difficult was his lack of compliance with the medical treatment. He started to become aggressive (passively at first) and then yelled out that he was going to discharge himself against medical advise.
This is the point when my supervisor said no and we took him back to the room. She said that she felt very cornered in by the patient and had no room for her to run, had the patient lost control and physically become violent (could sense it with his agitation).
Hence, it's important to watch out for some warning signals before we keep trying to persuade a patient about how important physiotherapy is for them. We can only persuade them to a certain extent. At the end of the day, they will be making their own decisions.
I guess this has been an incident to realise the above.
Thursday, September 13, 2007
Walking Aids in Neuro
Hi All,
I learnt something this week that seems really obvious now but wasn’t at the time. One of my patients had a right MCA stroke about two months ago and for a variety of reasons, my supervisor and I thought that it was best for her to use a stick in her right hand during ambulation and transfers. Over the first three weeks of my placement, the patient had marked tone in her left UL, especially in the wrist and finger flexors, but also in the biceps, pecs and lats. I had been doing a lot of work trying to reduce this tone, but did not feel like I was making a lot of difference. Then my patient was offered a place on a Bobath course being run at the hospital. At this course she was treated by an extremely skilled Neuro Physio from the UK as well as other Physio’s who have spent years specialising in Neuro PT. When I saw her after the week long course, the tone in her arm was significantly reduced and they had told her to stop using the stick for walking and transfers. What I hadn’t realised but makes sense now, is that when using the stick in her R UL, she was getting carryover into the left UL and the tone in that arm was being encouraged. Now she is managing transfers without the stick, although I haven’t had the opportunity to see her gait yet, and the tone in the UL is much better. While we still may have to get her using the stick so that she can be discharged safely within a given timeframe, I found this a really interesting learning experience. When I first heard that she was managing without the stick and that the people on the course had managed in five days to achieve what I hadn’t been able to in three weeks, I lost a bit of confidence in my Physio skills. But then I realised that these people were specialists who have been working in Neuro for years and that I have only had four weeks of clinical Neuro experience, so I shouldn’t be so hard on myself. I have realised though that when providing aids to Neuro patients you really need to consider what compensations or other problems they might cause.
Mel
I learnt something this week that seems really obvious now but wasn’t at the time. One of my patients had a right MCA stroke about two months ago and for a variety of reasons, my supervisor and I thought that it was best for her to use a stick in her right hand during ambulation and transfers. Over the first three weeks of my placement, the patient had marked tone in her left UL, especially in the wrist and finger flexors, but also in the biceps, pecs and lats. I had been doing a lot of work trying to reduce this tone, but did not feel like I was making a lot of difference. Then my patient was offered a place on a Bobath course being run at the hospital. At this course she was treated by an extremely skilled Neuro Physio from the UK as well as other Physio’s who have spent years specialising in Neuro PT. When I saw her after the week long course, the tone in her arm was significantly reduced and they had told her to stop using the stick for walking and transfers. What I hadn’t realised but makes sense now, is that when using the stick in her R UL, she was getting carryover into the left UL and the tone in that arm was being encouraged. Now she is managing transfers without the stick, although I haven’t had the opportunity to see her gait yet, and the tone in the UL is much better. While we still may have to get her using the stick so that she can be discharged safely within a given timeframe, I found this a really interesting learning experience. When I first heard that she was managing without the stick and that the people on the course had managed in five days to achieve what I hadn’t been able to in three weeks, I lost a bit of confidence in my Physio skills. But then I realised that these people were specialists who have been working in Neuro for years and that I have only had four weeks of clinical Neuro experience, so I shouldn’t be so hard on myself. I have realised though that when providing aids to Neuro patients you really need to consider what compensations or other problems they might cause.
Mel
The STRESS at the end of a prac...
Hey guys,
Well here is my last whinge, oops I mean Blogg, for a few weeks (I’ve got 5 weeks off before rural prac, yeah!) Has anyone else had this experience this year… getting into the last week of prac, feeling pretty good about how you’ve done on the prac etc… then getting a few comments from a supervisor (curtin or facility) that make you start thinking “Holy c**p, they’re going to fail me! AHHH!). I don’t know if it’s just me, but towards the end of every prac I start to get the impression that I’m about to be blindsided and fail the prac… causing a massive amount of STRESS!!! I’m not sure if this is a personality trait of mine, or if it is something that other students also experience?? I’ve had a few pracs where I have been pretty confident I’m going to pass, but a couple that I’m been chewing my fingernails with nerves up until the last day… which makes the last few days of prac HELL and not very enjoyable at all. I can see why a supervisor doesn’t want to tell you you’ve passed until the last day or so (because I assume that if you knew you were going to pass you MIGHT slack off a bit) BUT sometimes I think it would make the last week so much more relaxed and enjoyable if we were told early in the week that we were going to pass. Anyway that’s my whinge/blogg for today. Hope prac has been good to everyone!
Ezza
Well here is my last whinge, oops I mean Blogg, for a few weeks (I’ve got 5 weeks off before rural prac, yeah!) Has anyone else had this experience this year… getting into the last week of prac, feeling pretty good about how you’ve done on the prac etc… then getting a few comments from a supervisor (curtin or facility) that make you start thinking “Holy c**p, they’re going to fail me! AHHH!). I don’t know if it’s just me, but towards the end of every prac I start to get the impression that I’m about to be blindsided and fail the prac… causing a massive amount of STRESS!!! I’m not sure if this is a personality trait of mine, or if it is something that other students also experience?? I’ve had a few pracs where I have been pretty confident I’m going to pass, but a couple that I’m been chewing my fingernails with nerves up until the last day… which makes the last few days of prac HELL and not very enjoyable at all. I can see why a supervisor doesn’t want to tell you you’ve passed until the last day or so (because I assume that if you knew you were going to pass you MIGHT slack off a bit) BUT sometimes I think it would make the last week so much more relaxed and enjoyable if we were told early in the week that we were going to pass. Anyway that’s my whinge/blogg for today. Hope prac has been good to everyone!
Ezza
Wednesday, September 12, 2007
Discharging DNA patients
Hi Everyone,
I hope you are all enjoying your final week of this placament. I am writing this week about a new patient given to me in my first week here in the outpatient department and of which I have still not managed to actaully assess. This particular patient was referred to me by an surgeon for rehabilitation after he performed a laminectomy on her 2 months previously. The patient did not attend three times in a row, each time stating that she got her appointment times confused. On speaking with her after the initial DNA, I was fustrated bacuase she was not very apologetic and lacked concern about the hassle it had caused but yet still wanted to make anoother time to see me. On the third DNA I rang the patient to find out what had happened and to discuss the problems associated with continually DNA'ing (i.e. three DNA's and your out policy) and came across a difficult situation. (NOTE: I had discussed the events with my supervisor and he said if, after speaking with her, she agreed to show up for another final appointment genuingly, it was my call whether or not I agreed to try and see her again). The woman sounded very upset about her lack of organisation and when I asked her about her motivation for physio, she was very keen to make another appointment.
Weak as it might have been, I told the patient that yes, I would make another appointment with her and she was very grateful. I discussed with her that this was her final opportunity for physio and she agreed to my terms. I feel that in this situation I appeared weak and that through my actions, I was disadvantaging other patients who are on our waitlist and are not being seen due to lack of availability of physio's. My problem was that I felt that this patient would benefit from physio and I don't feel comfortable turning people in need away from our profession. Perhaps if she doesn't show up for the final appointment, I will know that I made the wrong decision. Would any of you guys have handled this situation differently? Do you think that in order to get respect from patients we have to portray a tougher policy approach in regard to the consequences of DNA'ing?
Thanks for your input,
Kate.
I hope you are all enjoying your final week of this placament. I am writing this week about a new patient given to me in my first week here in the outpatient department and of which I have still not managed to actaully assess. This particular patient was referred to me by an surgeon for rehabilitation after he performed a laminectomy on her 2 months previously. The patient did not attend three times in a row, each time stating that she got her appointment times confused. On speaking with her after the initial DNA, I was fustrated bacuase she was not very apologetic and lacked concern about the hassle it had caused but yet still wanted to make anoother time to see me. On the third DNA I rang the patient to find out what had happened and to discuss the problems associated with continually DNA'ing (i.e. three DNA's and your out policy) and came across a difficult situation. (NOTE: I had discussed the events with my supervisor and he said if, after speaking with her, she agreed to show up for another final appointment genuingly, it was my call whether or not I agreed to try and see her again). The woman sounded very upset about her lack of organisation and when I asked her about her motivation for physio, she was very keen to make another appointment.
Weak as it might have been, I told the patient that yes, I would make another appointment with her and she was very grateful. I discussed with her that this was her final opportunity for physio and she agreed to my terms. I feel that in this situation I appeared weak and that through my actions, I was disadvantaging other patients who are on our waitlist and are not being seen due to lack of availability of physio's. My problem was that I felt that this patient would benefit from physio and I don't feel comfortable turning people in need away from our profession. Perhaps if she doesn't show up for the final appointment, I will know that I made the wrong decision. Would any of you guys have handled this situation differently? Do you think that in order to get respect from patients we have to portray a tougher policy approach in regard to the consequences of DNA'ing?
Thanks for your input,
Kate.
Monday, September 10, 2007
Conflicting treatments
Hi Everyone,
I have found on numerous occasions when discussing treatment options with my supervisor on prac that she well disagree with treatments we have learnt at uni. My supervsior will then go on to say suggest "the best treatment option" for me to do. I repsect that my supervisor has studied alot more than me and had alot more experience so I learn alot from her and trust alot of the things she tells me; howver I thought our lecturers have too. So when I suggest a treatment that we have learnt at uni and she tells me that "she wouldn't do that", this frustrates me because it conflicts with what we have previously studied.
When I try to explain to her why I'd prefer a treatment or why I thought a certain treatment is more indicated, she dismisses it with out a good reason. My supervisor believes her way is the best way, and thats that. I dont want to appear defensive so my solution to the problem is just to agree with her and go with her ideas, when I find myself in this situation. When I finish I can take away what I have learnt from her, what I have learnt at uni and combine it with my personal experince to decide what I beleive will be the best for my patients. (Not forgetting evidence based practice :) )
I have found on numerous occasions when discussing treatment options with my supervisor on prac that she well disagree with treatments we have learnt at uni. My supervsior will then go on to say suggest "the best treatment option" for me to do. I repsect that my supervisor has studied alot more than me and had alot more experience so I learn alot from her and trust alot of the things she tells me; howver I thought our lecturers have too. So when I suggest a treatment that we have learnt at uni and she tells me that "she wouldn't do that", this frustrates me because it conflicts with what we have previously studied.
When I try to explain to her why I'd prefer a treatment or why I thought a certain treatment is more indicated, she dismisses it with out a good reason. My supervisor believes her way is the best way, and thats that. I dont want to appear defensive so my solution to the problem is just to agree with her and go with her ideas, when I find myself in this situation. When I finish I can take away what I have learnt from her, what I have learnt at uni and combine it with my personal experince to decide what I beleive will be the best for my patients. (Not forgetting evidence based practice :) )
Having to say it's finished
Hey guys,
I am currently on my Musculo prac, and due to administrative changes that are to be made (no students in between rotations, physiotherapist there having to work alone), we are having to discharge as many patients as we can. A lot of these patients we are discharging are able to self-manage and are ready for the discharge (they have been told that being back at 100% is a low possibility).
However, I've come to realise that most of these patients have been clients to the department for probably 3-5 months (having been passed on from one student to the next). I found it quite hard especially in this past week to begin the discharging process. Some of the patients actually looked sad, probably with uncertainty how they would be able to handle it themselves. Educating about empowerment and self-management is key, but still...
I found it quite helpful to develop a program for them, and told them that I'd put them on hold. They will have to call up in a month's time to inform the clinic of their ability to self-manage, and probably arrange for a last check-up for the older patients.
Am I wiping my hands too cleanly? What else can I do to better manage the situation?
Mark
I am currently on my Musculo prac, and due to administrative changes that are to be made (no students in between rotations, physiotherapist there having to work alone), we are having to discharge as many patients as we can. A lot of these patients we are discharging are able to self-manage and are ready for the discharge (they have been told that being back at 100% is a low possibility).
However, I've come to realise that most of these patients have been clients to the department for probably 3-5 months (having been passed on from one student to the next). I found it quite hard especially in this past week to begin the discharging process. Some of the patients actually looked sad, probably with uncertainty how they would be able to handle it themselves. Educating about empowerment and self-management is key, but still...
I found it quite helpful to develop a program for them, and told them that I'd put them on hold. They will have to call up in a month's time to inform the clinic of their ability to self-manage, and probably arrange for a last check-up for the older patients.
Am I wiping my hands too cleanly? What else can I do to better manage the situation?
Mark
Selecting a walking aid (yes, just like 1st year OSPE!)
Hi all,
I’m currently finishing up my gerontology prac and have come across a few differing opinions in regards to walking aids. A lot of the gerontologic population coming into the outpatients department have recently had a fall or been ill in hospital, and have been issued a walking aid by the hospital. Some clients have even just been given a walking aid by a family member or friend. When discussing the benefits of certain WA’s for certain clients with my supervisor, I expressed my belief that what the client wants is very important, and so it is extremely important to ask them what walking aid they prefer and what their goal is. For example, are they happy using a WZF or do they want to get back to using no aid or a walking stick? My supervisor disagreed with me, saying that our job is to get the client back to the most functionally independent they can be, so if they are capable of walking independently or with a stick, we should be actively pushing for that. Reflecting back, I do agree with her, BUT I also think that if someone is happy using a frame, then we could better spend our time (and theirs) helping them be functionally independent WITH that frame, rather than spending our time (and theirs) retraining them to use a stick or nothing at all… especially if that is not one of their goals. I can definitely see my supervisors point of view, but was just wondering if anyone else had faced similar situations, and what other peoples opinions on this are. Cheers, Ezza
I’m currently finishing up my gerontology prac and have come across a few differing opinions in regards to walking aids. A lot of the gerontologic population coming into the outpatients department have recently had a fall or been ill in hospital, and have been issued a walking aid by the hospital. Some clients have even just been given a walking aid by a family member or friend. When discussing the benefits of certain WA’s for certain clients with my supervisor, I expressed my belief that what the client wants is very important, and so it is extremely important to ask them what walking aid they prefer and what their goal is. For example, are they happy using a WZF or do they want to get back to using no aid or a walking stick? My supervisor disagreed with me, saying that our job is to get the client back to the most functionally independent they can be, so if they are capable of walking independently or with a stick, we should be actively pushing for that. Reflecting back, I do agree with her, BUT I also think that if someone is happy using a frame, then we could better spend our time (and theirs) helping them be functionally independent WITH that frame, rather than spending our time (and theirs) retraining them to use a stick or nothing at all… especially if that is not one of their goals. I can definitely see my supervisors point of view, but was just wondering if anyone else had faced similar situations, and what other peoples opinions on this are. Cheers, Ezza
Sunday, September 9, 2007
Treating Aboriginal patients
Hi Guys,
Im at Burns ward and treating quite a few aboriginal patients.
In the country, people tend to light bonfires in winters and end up getting burns, especially if they are intoxicated.
I treated 2 aboriginal men. This was the first time I was treating aboriginal men and found great differences in the way they behaved around young females (my supervisor and me).The first one was young in his early twenties and the second one was in his late fifties.
The older man tended to avoid eye contact and to look away whenever I tried to politely ask him questions or explain the exercises that I wanted him to do. The strategies that I had to use was to stand at some distance, looking away from him and talk so I don't have eye contact with him. I even talked at his back in one session. This made him more comfortable. I also had to limit my explanations to very simple words and also just using diagrams for the patient to understand (as the patient's reading and writing in English was understandably not great). The patient spoke an Aboriginal dialect which was very different to the other Aboriginal patient that I had to treat.
Rapport with the younger aboriginal male patient was easier as he played football and went for Eagles (even if I go for dockers). But his writing and reading in English were understandably not great either because he belonged to a community where they spoke only an Aboriginal dialect. So I had to use very similar strategies as I had to for the older male. I had to be simple in explanations (using gestures) and write diagrams while explaining. He also felt more comfortable as I maintained distance, as I had to for the older man.
I also learnt the various ways of referring a patient to a nearby hospital when they are discharged. The patients live in communities close to the towns. Usually they are a few hundred kilometers away. So the physiotherapist at the town needed to be informed about the exact location regarding this. So direct communication by phone calls was essential with the physiotherapist who would need to travel a few hundred kilometers to reach the community.
Rapport with these patients was also easy when I talked about camping, fishing and dancing - as these are the regular activities that they enjoy.
Building rapport is essential while treating the Aboriginal patients. They also feel very isolated coming to Perth - which is a huge place to them. Approaching them as a friend can help them very comfortable and show them that the therapist cares.
On the whole, this was a great learning experience.
Im at Burns ward and treating quite a few aboriginal patients.
In the country, people tend to light bonfires in winters and end up getting burns, especially if they are intoxicated.
I treated 2 aboriginal men. This was the first time I was treating aboriginal men and found great differences in the way they behaved around young females (my supervisor and me).The first one was young in his early twenties and the second one was in his late fifties.
The older man tended to avoid eye contact and to look away whenever I tried to politely ask him questions or explain the exercises that I wanted him to do. The strategies that I had to use was to stand at some distance, looking away from him and talk so I don't have eye contact with him. I even talked at his back in one session. This made him more comfortable. I also had to limit my explanations to very simple words and also just using diagrams for the patient to understand (as the patient's reading and writing in English was understandably not great). The patient spoke an Aboriginal dialect which was very different to the other Aboriginal patient that I had to treat.
Rapport with the younger aboriginal male patient was easier as he played football and went for Eagles (even if I go for dockers). But his writing and reading in English were understandably not great either because he belonged to a community where they spoke only an Aboriginal dialect. So I had to use very similar strategies as I had to for the older male. I had to be simple in explanations (using gestures) and write diagrams while explaining. He also felt more comfortable as I maintained distance, as I had to for the older man.
I also learnt the various ways of referring a patient to a nearby hospital when they are discharged. The patients live in communities close to the towns. Usually they are a few hundred kilometers away. So the physiotherapist at the town needed to be informed about the exact location regarding this. So direct communication by phone calls was essential with the physiotherapist who would need to travel a few hundred kilometers to reach the community.
Rapport with these patients was also easy when I talked about camping, fishing and dancing - as these are the regular activities that they enjoy.
Building rapport is essential while treating the Aboriginal patients. They also feel very isolated coming to Perth - which is a huge place to them. Approaching them as a friend can help them very comfortable and show them that the therapist cares.
On the whole, this was a great learning experience.
Saturday, September 8, 2007
Confidence
Hi All,
This week I had to review a patient’s short and medium term goals for a team meeting. I have been working with this lady, who is 2 months post right MCA stroke for 3 weeks now and have seen good gains in the muscle activation of her upper limb. So, one of my goals was to improve the fractionated movement of her upper limb to enable some use in ADLs over the next 4-6/52. Before the meeting, I had to discuss the goals with my supervisor. She told me that this goal was unrealistic and it was unlikely that the patient would ever have very good function of the limb. I was quite surprised and confused because the patient is already able to use the arm with minimal-moderate facilitation and has been improving. But with such little experience, I wasn’t confident enough to say this to the supervisor because I thought that maybe I was just being too optimistic. Later in the week, after I had the afternoon off and my supervisor had to treat this patient, she told me that she thought that the goal was realistic and that she hadn’t realised the current status of the upper limb because she hadn’t seen the patient since I had started treating her. From this experience, I have realised that I need to improve my confidence in explaining my assessments and thought processes. I may still be wrong, but at least I’ll know why I am wrong and be able to learn from the process, rather than just being confused.
Mel
This week I had to review a patient’s short and medium term goals for a team meeting. I have been working with this lady, who is 2 months post right MCA stroke for 3 weeks now and have seen good gains in the muscle activation of her upper limb. So, one of my goals was to improve the fractionated movement of her upper limb to enable some use in ADLs over the next 4-6/52. Before the meeting, I had to discuss the goals with my supervisor. She told me that this goal was unrealistic and it was unlikely that the patient would ever have very good function of the limb. I was quite surprised and confused because the patient is already able to use the arm with minimal-moderate facilitation and has been improving. But with such little experience, I wasn’t confident enough to say this to the supervisor because I thought that maybe I was just being too optimistic. Later in the week, after I had the afternoon off and my supervisor had to treat this patient, she told me that she thought that the goal was realistic and that she hadn’t realised the current status of the upper limb because she hadn’t seen the patient since I had started treating her. From this experience, I have realised that I need to improve my confidence in explaining my assessments and thought processes. I may still be wrong, but at least I’ll know why I am wrong and be able to learn from the process, rather than just being confused.
Mel
Friday, September 7, 2007
Allied Health Support
Hi guys,
My post this week refers to my astonishment at the poor relationship between the OT and PT department. This week I had a patient who is 91yrs old and living at home with his wife. He came into see me in a wheelchair post-fall (only soft-tissue injuries) with reduced mobiulity. Prior to the fall the man was ambulting with a WZF and transferring independently. Now however, he can only be transfered from wheelchair to recliner chair and back (unable to get into bed). On arriral to the session I noticed the terrible condition of his wheelchair (uneven foot plates, broken back rest, very poor brakes and lots of rust). The wife stated that they have no rails in their house and no aids to assist with washing/ADLs. When I asked about seeking assistance from an OT, the wife stated that she had alreadly been referred to the OTs and when they refused to provide her with a better wheelchair, she declined their services all together. After treating the patient personally, I discovered that the need for OT intervention was paramount, so I referred the patient back to the OTs.
The relationship between OT and PT is not very healthy in my particular facility: the OTs do not like to associate with the PTs and they have a particular dislike of students all toghether. Thus after I referred the patient back to the OTs they were less than impressed. The OT involved told me that the patient would go straight to the bottom of the wait-list and that she would get to it in a month or perhaps later. I felt particularly hopeless in this situation as I know my patient is in desperate need of help but a) they already declined the service and b) I feel that the OT does not trust in my clinical judgement. I went about organsising silverchain as an interim to the problem and have had to accept the wait-list for OT.
In this situation I feel that students are not taken seriously enough. Given that we are given patients to manage independently I feel that the system ends up affecting the patient the most. Have any of you guys out there experienced similar problems and do you think there would be a better way to deal with more experienced health professionals more equally.
Kate.
My post this week refers to my astonishment at the poor relationship between the OT and PT department. This week I had a patient who is 91yrs old and living at home with his wife. He came into see me in a wheelchair post-fall (only soft-tissue injuries) with reduced mobiulity. Prior to the fall the man was ambulting with a WZF and transferring independently. Now however, he can only be transfered from wheelchair to recliner chair and back (unable to get into bed). On arriral to the session I noticed the terrible condition of his wheelchair (uneven foot plates, broken back rest, very poor brakes and lots of rust). The wife stated that they have no rails in their house and no aids to assist with washing/ADLs. When I asked about seeking assistance from an OT, the wife stated that she had alreadly been referred to the OTs and when they refused to provide her with a better wheelchair, she declined their services all together. After treating the patient personally, I discovered that the need for OT intervention was paramount, so I referred the patient back to the OTs.
The relationship between OT and PT is not very healthy in my particular facility: the OTs do not like to associate with the PTs and they have a particular dislike of students all toghether. Thus after I referred the patient back to the OTs they were less than impressed. The OT involved told me that the patient would go straight to the bottom of the wait-list and that she would get to it in a month or perhaps later. I felt particularly hopeless in this situation as I know my patient is in desperate need of help but a) they already declined the service and b) I feel that the OT does not trust in my clinical judgement. I went about organsising silverchain as an interim to the problem and have had to accept the wait-list for OT.
In this situation I feel that students are not taken seriously enough. Given that we are given patients to manage independently I feel that the system ends up affecting the patient the most. Have any of you guys out there experienced similar problems and do you think there would be a better way to deal with more experienced health professionals more equally.
Kate.
Tuesday, September 4, 2007
PPIVMS AND PAIVMS
Hi All!
I'm currently on my msc sk prac and am having to do alot of Ax of PPIVMS and PAIVMS in the Lx, Thx and Cx region. I am getting really frustrated that I cannot pick out the segment/s that are most restricted. No matter how hard I try, or how much I think "maybe I can feel this segment is stiffer" I am never sure. My supervisor then comes in and picks out all these levels that are 'more resticted' and they are most often not the ones that I have nominated. It really disheatens me becasue if I can't do it by the end of the prac what am I supposed to do once we start full time work if I am working in the msc sk area!?
I have been told that research now days shows that you should treat multi levels as oppossed to one anyway, but it still disheartens me that I cannot "feel it". Is any one in the same boat? Or was any one the same as me but have found something to asssit them in being able to feel the most resricted segments?
Thanks
I'm currently on my msc sk prac and am having to do alot of Ax of PPIVMS and PAIVMS in the Lx, Thx and Cx region. I am getting really frustrated that I cannot pick out the segment/s that are most restricted. No matter how hard I try, or how much I think "maybe I can feel this segment is stiffer" I am never sure. My supervisor then comes in and picks out all these levels that are 'more resticted' and they are most often not the ones that I have nominated. It really disheatens me becasue if I can't do it by the end of the prac what am I supposed to do once we start full time work if I am working in the msc sk area!?
I have been told that research now days shows that you should treat multi levels as oppossed to one anyway, but it still disheartens me that I cannot "feel it". Is any one in the same boat? Or was any one the same as me but have found something to asssit them in being able to feel the most resricted segments?
Thanks
Monday, September 3, 2007
What patients say about other physios, they'd probably say the same thing about you.
Hi guys,
I am currently on my musculo outpatients at Charlies, and I'm just enjoying it! I had a patient last week who came in for mechanical neck pain, and it was her 2nd visit when she came to me. She presented rather guarded and quite wary, so I guessed she probably was still in a lot of pain/fear.
During my assessment, I explained what I was doing as I went through, especially when it came to PPIVMs. Halfway through, she started to compare my manual skills with others, and said that the student before was pushing her neck through range, and that our supervisor had really good guiding hands. So she mentioned that I was roughly in the middle. I was in a dilemma, cause I couldn't agree that the student before was not as skillful, so I tried explaining relativity in light that she was probably very acute and was in a lot of pain during her initial assessment. I knew that if I agreed that it was probably due to a lack of skill of my previous colleague, it will somehow come back and bite me one day. What patients say about other physios, they'd probably say the same about you.
I mediated the situation by explaining how difficult this technique is, and how is takes roughly 20 years to get good at it. So she decided it was all due to practice, and that it all takes a matter of time. She responded really well to the treatment thankfully! She also mentioned that she was wary of turning up that day, fearful of being handled inappropriately (manual).
This was not the 1st incident when patients asked me whether what their physio did previously was correct. Just remember, unless it's unsafe or unethical, I feel it's not in our best interest to undermine the reputation of our profession, and it's really important to defend one another. Even though you do not totally agree with what other physio may have done, never appear like they have done the wrong thing - tell them instead how good the physio was before, and how you can see the direction they have taken.
That's my two cents worth. :) What do you guys feel? Have you been in a similar situation?
Mark
I am currently on my musculo outpatients at Charlies, and I'm just enjoying it! I had a patient last week who came in for mechanical neck pain, and it was her 2nd visit when she came to me. She presented rather guarded and quite wary, so I guessed she probably was still in a lot of pain/fear.
During my assessment, I explained what I was doing as I went through, especially when it came to PPIVMs. Halfway through, she started to compare my manual skills with others, and said that the student before was pushing her neck through range, and that our supervisor had really good guiding hands. So she mentioned that I was roughly in the middle. I was in a dilemma, cause I couldn't agree that the student before was not as skillful, so I tried explaining relativity in light that she was probably very acute and was in a lot of pain during her initial assessment. I knew that if I agreed that it was probably due to a lack of skill of my previous colleague, it will somehow come back and bite me one day. What patients say about other physios, they'd probably say the same about you.
I mediated the situation by explaining how difficult this technique is, and how is takes roughly 20 years to get good at it. So she decided it was all due to practice, and that it all takes a matter of time. She responded really well to the treatment thankfully! She also mentioned that she was wary of turning up that day, fearful of being handled inappropriately (manual).
This was not the 1st incident when patients asked me whether what their physio did previously was correct. Just remember, unless it's unsafe or unethical, I feel it's not in our best interest to undermine the reputation of our profession, and it's really important to defend one another. Even though you do not totally agree with what other physio may have done, never appear like they have done the wrong thing - tell them instead how good the physio was before, and how you can see the direction they have taken.
That's my two cents worth. :) What do you guys feel? Have you been in a similar situation?
Mark
Expectations
One thing that has become very apparent to me this year is the importance of establishing with your supervisor early in the clinical placement what their expectations are of you. I am currently 2 weeks into my gerontology prac. For the first week I wasn’t given a very big workload and was left to do my own thing quite a lot, but I put it down to my supervisor sussing me out to decide if I could handle a bigger workload and that I would be safe with patients. I was quite unsure of what expectations she had of me for this first week, so I bought this up with my curtin clinical tutor on the Friday thinking the 2nd week would be better. After watching one assessment early in the first week, I was left to do my own thing all week (ie assess and treat some patients). At the end of the week my supervisor sat my down and basically ripped me apart with regards to what I had been doing… however I’d had NO feedback throughout the week and had no idea what was expected of me, so it all seemed to come out of the blue. Anyway, being the professional that I am I took everything that she said on board and went into the second week thinking all would be rosy. However, last week was almost exactly the same as the first! I still have absolutely no idea what my supervisor expects or wants from me… and everytime I ask a questions she looks at me like I am the biggest idiot to ever walk through the door. Its driving me bonkers!! Anyway I think I have the place and my supervisor sussed out now (ie how they like things done) so I’m sure things will pick up this week and next week… but I can’t help feeling that if my supervisor had sat me down at the beginning of the prac and gone through everything she expected me to be able to do ie. By the end of the first week, second week, end of prac… at least I would have known the standard I’d need to be at, and wouldn’t have had to feel my way through things for the first 2 weeks!! Has anyone else had a similar situation? Do you think I would be better off at the start of a prac asking the supervisor directly what her/his expectations are of me? All of my other supervisors have been very very clear on this from the get go, so it if frustrating to be somewhere that doesn’t seem to have any guidelines or expectations.
Chronic Pain
I’m sure it’s a situation we are all familiar with… a patient with chronic pain. Current patient- elderly lady, chronic back pain, in rehab hospital due to decreasing mobility and falls, focuses on pain, catastrophizes etc My job is to increase her bed mobility so that she can return home rather than off to a hostel or NH. Her pain is increased +++ with any bed mobility tasks. The first time I saw her and got her to show me how she gets in and out of bed, she cried due to pain, and could not get in or out of bed or roll without x2mod/max assistance, refusing to initiate any rolling herself. Obviously a rapport was not developed between us (as she then associated me with making her to do things that cause her pain). Over the next few days I gradually developed a rapport with her and starting building up to getting her to get in and out of bed independently ie. Activities on the plinth, weight shifting, going down onto her elbow, lifting legs a little bit independently etc. I thought I was doing quite well with her, and we were making progress… however, when my curtin tutor came in on Thursday she told me I wasn’t pushing the patient enough! This was really frustrating because I feel as though I have developed a rapport with the patient and know her quite well and feel that if I pushed her to get in and out of bed she would flatly refuse, cry, catastrophise and refuse any further physio. It seems like such a fine line with these patients… when do we push and when do we take it slowly? I thought I made good clinical judgement with regards to this patient, only to have my judgement questioned by my tutor. Now do I start pushing this patient like my tutor has suggested, or stick to my guns and my own clinical reasoning and do things the way I have been as it does seem to be working (but maybe not working fast enough??). Obviously I want to pass my prac so I will probably do whatever my tutor asks of me, but we are final year students now, almost at the end of the road, so when does our clinical judgement become regarded as highly as an actual physios?? There are 2 students at the hospital who were in the GEM program alongside us (ie graduated a few months ago so don’t really have all that much more experience than us) and I have noticed that their clinical judgements are never questioned!! Geez it’s going to be nice to not be a student…
Saturday, September 1, 2007
Stimulating environments
Hi All,
This week I have been working with a patient who is very motivated in physiotherapy and works really hard for the whole 3 hour session. As a result, he is making noticeable gains in his balance leading to improvements in gait - which is his major goal. On Thursday, he came to Physio really agitated after a disagreement with the nursing staff and left after about 10 minutes because he was still really angry. We left him for 20 minutes and then my supervisor went and convinced him to return to Physio. I expected the session was going to be really ineffective due to his mood. But I was really surprised that he was able to do most of his exercises with a lot more control than usual. In reflection, I wonder whether perhaps this was because he had been stimulated by the disagreement which made his muscular activity more accessible. If so, I wonder if by making the patient’s environment in the hospital more stimulating we could get better treatment results. Has anyone had a similar experience with their patient’s?
Mel
This week I have been working with a patient who is very motivated in physiotherapy and works really hard for the whole 3 hour session. As a result, he is making noticeable gains in his balance leading to improvements in gait - which is his major goal. On Thursday, he came to Physio really agitated after a disagreement with the nursing staff and left after about 10 minutes because he was still really angry. We left him for 20 minutes and then my supervisor went and convinced him to return to Physio. I expected the session was going to be really ineffective due to his mood. But I was really surprised that he was able to do most of his exercises with a lot more control than usual. In reflection, I wonder whether perhaps this was because he had been stimulated by the disagreement which made his muscular activity more accessible. If so, I wonder if by making the patient’s environment in the hospital more stimulating we could get better treatment results. Has anyone had a similar experience with their patient’s?
Mel
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