In my last clinical placement at Royal Perth, I came across a situation in which I found myself reluctant to discharge a patient. I was not in fact concerned about the patient's health and safety once out of hospital but the safety of the general community. The patient had come in due to a history of falls, a surprising number of these at the local pubs. Alcohol was not suspected as a factor until his daughter visited and informed the staff that her father did in fact have some alcohol related issues.
In all aspects the patient from a physiotherapy point of view was safe to go home, with only outpatient physiotherapy for rotator cuff damage. During one of our conversations I mentioned that he probably would not be safe enough to drive due to some ROM limitations in his trunk preventing him from checking his blind spot. The patient also had coordination impairments which would not affect him unless he got behind the wheel of a car, where a quick response time is needed. On top of this the patients had the alcohol problem mentioned above.
After this discussion the patient still refused to rule out the chance that he would drive again. This stalled my decision to declare him safe for discharge as I believed he would be a danger to himself and others if he was on the road. I bought this up with the OT who informed me that the patient had been given a pamphlet detailing the legal ramifications if he chose to drive against medical advice.
I still had doubts about whether he would actually follow our advice or just keep on driving anyway. I bought this up with my supervisor and asked her what authority we had in this matter, apparently a new law means all the onus is placed on the patient to report any condition that prevents him from being safe driver. In light of this I made sure that I talked to as many of the team as possible about the patients intention to drive so that the issue was made aware of and was included more specifically in his discharge planning.
Ultimately when it comes to a situation like this, which is not usually considered the PT's domain, we are limited in what we can do about it. This doesn't mean we don't try, a pro-active attitude is needed so that issues such as these can be communicated to the medical and allied health team. We shouldn't assume that someone else will bring the topic up, it is more effective to expose them yourself as soon as you become aware of them.
1 comment:
I suppose it's hard to ascertain whether or not any patient will follow the advice that we (the allied health team)provide them with and can only hope that they make good judgements with the information they have been given. If they have been cleared psychologically and physically, it would be hard to keep someone in hospital on the basis that they wont do as we say. I think you were right in saying all we can do is be pro-active in letting the appropriate staff know and informing the patient on the dangers of ignoring such information.
I think the scary thing is the amount of elderly people that are on the roads with medical conditions that would prohibit them from driving, however they just dont get it checked out because they know their doctor wont allow them to drive anymore!
Post a Comment