A challenging first patient

I am presently on my musculoskeletal placement and had an interesting case for my first encounter with a patient presenting with a new problem. The patient was familiar to the permanent team at the clinic and I was told that the patient was the “attention-seeking” type of patient.

After the session, I wondered if there were some real concerns that have been overlooked over the years. Patient mentioned in passing that the elbow problem was the cause of the jobless situation for the past 5 years and is presently volunteering. Patient has been looking in vain for jobs through the network for disabled. From a physio’s point of view, I do not feel that his problem is disabling. However, it is manifested to the patient as such even though irritability and severity of the problem is mild. Coupled with a diagnosis of mild fibromylalgia, we might have been guilty of dismissing his authentic problem as attention seeking.

I brought up these concerns with the supervisor and the issue about jobs was new information that has never been mentioned. Supervisor was reluctant to get too caught up with that and advised me to just focus on the physical impairment.

I wondered if being told that the patient was attention seeking actually affected my assessment of the patient. I could have dismissed some the patient’s real concerns as attention seeking which would definitely have some negative bearings on investigating the root of the problem. Or it could have swung my assessment the other way, where I try to find a “real” reason for the attention seeking.

I suppose I should have given the patient the benefit of doubt in the first session and after seeing the patient for a few more sessions, I would be able to make a better judgement. Even if the eventual judgement would still be that of an “attention-seeking” patient, at least I would have gone through the rigours of identifying a patient with special characteristics which would definitely be a valuable part of my learning.

I feel that this is a very challenging experience because often when we do our subjective assessments, we tend to focus on the problem instead of looking at the person as a whole. We fail to acknowledge that there are many other issues that can perpetuate or even be the trigger for the physical problem. This is especially hard for me because I came previously from a gerontology placement where the idea was the direct opposite, not to treat impairments rather look at the big picture and identify ways to modify activities for them to be functional.

I guess it is still the first week of my musculoskeletal placement, hopefully by the end of this placement, I would be able to develop a more balanced thinking in my approach to treating different kinds of patients.