I have had quite a fair amount of complex patients where either they present with more than one symptom or present with a totally different problem that I was told they are coming in for. This has proved to be very challenging even with two weeks before the end of this placement.
I will usually prepare by planning a standard assessment and reading about the involved joint or area. This has proved to be very helpful in straightforward cases, I am able to be very efficient with time and the session tends to flow seamlessly. However, reality is that people are dynamic creatures and they do not usually fall directly into presentations of conditions that we learn in theory.
With more than one symptom involved, we will have to establish if there is any relationship between the different symptoms which requires detailed questioning about the aggravating factors, fill up the body chart and map the pain pattern throughout the day for the different symptoms. Many a times it feels as though I am seeing 3 or 4 patients combined into one!! This is compounded by the fact that we have to work out all these within a certain period of time which always seems to be too little for me. It also does not help the situation if patients give you random information from everywhere that does not direct the investigation of the symptoms.
Although it is very challenging especially within a set amount of time, I actually welcome the challenge. I believe I need to be a bit firm with patients who tend to ramble, to interrupt them without seeming rude. This is also good practice for me to think on the spot, having all the random information in my head to and being able to organise them into information that forms a clinical picture of the patient in front of me. I guess I might have been too concerned with recording all the details of P1s, R2s, quantity of P2s instead of relying a bit more of my active memory to add all these to the clinical picture that is forming throughout the session. This is a good pit stop to reflect on how I can improve by making full use of the remaining time at this placement to develop the above strategies.
Subscribe to:
Post Comments (Atom)
2 comments:
I think that was one of the really great things about that prac (I had it first up this yr). It's a real challenge when so many patients present with problems you aren't expecting, or a new patient with a "shoulder" problem turns out to be a Cx spine problem..
You're absolutely right about having to guide the subjective and even "cut them off" sometimes or you won't get anywhere. I found that if you clarify what the main/worst 1 or 2 symptoms are as soon as you realise there is a lot going on, and focus on them for that treatment it can help with time management.
A similar problem I found on that prac was when public patients referred through the hospital system for, say, a TKR and then complained of elbow pain as their main problem. As the patient is not paying and was not referred for that problem I had to explain that we had to focus on the knee and she would need to come in as a private, paying patient for her elbow.
This is the sort of practical information (amac's comment) that makes chatting over issues with colleagues good use of your time.
Post a Comment