Monday, November 5, 2007
Frozen Shoulder??
The other day a patient presented to the hospital outpatients with a referral from the Doctor for treatment of her frozen shoulder. Upon Ax the patient had full shoulder AROM - with a apinful arc, and full PROM of GHJ (90 degrees flexion, 90 degrees abduction, 70 degrees ER). At this stage I was confused.. The pt wasn't presenting like she had adhesive capsulitis. Upon completing my Subjective and Objective Ax, I presented my findings to my supervisor because I was confused how the Dr could think it was froen shoulder, but assuming that it must be, even though I thought it was biceps tendinopathy resulting in secondary subacromial impingement. My supervisor questioned me about what a frozen shoulder presented like? what this patient was presenting like? and did I think this was frozen shoulder? If not, what do I think it is? Feeling silly that I needed his confirmation I answered all these questions then he said GOOD, now go treat her. I shouldn't have needed my supervisor to confirm what I thought, I should have just trusted myself. Moral of the story... Don't always trust what the Doctor has written on the refferal and trust your instincts, we know more than we think we do :) This is not the only time on this prac where I have had a referral from a Doctor with a wrong diagnosis. Has anyone else been in a simialr situation?
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3 comments:
Heya!
I've come across situations where what the Dr has written has either been wrong, or the referrals given a very vague idea of what the problem is. Sometimes Drs have even recommended treatment options, which after seeing the patient, turns out to be not so appropriate for them. Drs definitely arent spending the same amount of time assessing patients like we are. So definitely follow in the general direction the Drs guiding us tp, but if our assessment suggests somethg different, then go wiht it. I suppose as long as your able to justify why, its all gd! :)
Hi Kelly
I've definately had my share of doctors giving wrong diagnoses and treatment recommendations! One example on my current prac was 'whiplash - please manipulate neck', despite the fact that there is no manips qualified physio at the centre where we currently are!
It definately reinforces the idea of checking everything yourself.
Mel
Hey Kelly,
I agree with you- never blindly trust what the doctor has written on a referral, always do your own assessment and treat as YOU see fit. However, as my supervisor on my current prac pointed out to me in regards to shoulder injuries they did some kind of research thing where 100 specialists assessed different shoulders... then they compared what the specialist thought with what the scans showed... and it was something like 8/10 were wrong (I don't remember the exact details)... anyway trust your own assessment and trust yourself.. BUT it may be possible that the physio is wrong, not the doctor... or that we are all wrong!! Very tricky!! Ezza
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