Whilst on my hand therapy placement I was treating a young woman who had fallen on a broken bottle and subsequently had lacerated a great portion of her anterior forearm and palm, completely severing the majority of her flexor tendons and median nerve. She had been sutured and plastered initially for 3 weeks before doctors had decided to transfer her from Fremantle to Royal Perth to receive surgical repair. As such, she was immobilised in plaster for a total of 8 weeks prior to receiving therapeutic treatment.
She presented to hand therapy with tethering of the flexor tendons and a hypertrophic scar on the palmar aspect of her right hand that was severly restricting any movement into digital extension or wrist extension. I discussed with one of the senior hand therapists whom I was treating her with whether or not ultrasound would be an option to assist with breaking up the scar tissue as previous treatments with vibration and firm massage was having little effect. My supervisor seemed to think it was worth trying and was happy for me to proceed.
The ultrasound machine that was used at the clinic was old, one of the sonopulse ones, a model that we hadn't used at uni. I had reviewed my settings for ultrasound and selected the settings that would be most appropriate to use to break up scar tissue. Just to be sure I got one of my supervisors to check the machine settings and she was happy for me to proceed. I had gone through all precautionary questions and had performed the necessary sensory tests.
The patient displayed intact sensation and consented to continue treatment. As I was performing the treatment over the area of scar tissue on the palm one of the other hand therapists asked to speak to me outside. The PT asked me abruptly if I thought what I was doing was safe and I replied that I thought it was. He asked me why I thought so and I replied by saying that I had reviewed the unit and parameters, had checked with another PT and had permission by the other senior therapist whom I was treating the patient with as well as going through necessary precautionary sensation tests and questions. He harshy told me that the treatment was not safe and I was putting the staff in an awkward position of responsibility. I was so taken aback that and when I asked why it was unsafe he turned the question back onto me and did not respond. The only thing he said was that I was going too fast and should be moving the ultrasound head in circles. At uni we were taught not to move in circles but rather longitudinally. If the only thing I was doing wrong was going a little too fast, he could have told me in a much more professional way rather than pulling me out of the treatment room and yelling at me in front of all the other hand therapists. He then told me to continue with the treamtent, making no changes to the parameters.
To this day I am still not sure what I did wrong so if anyone can fill me in I would love to know. I know that not all therapists agree with the use of US, however in this instance it was worth giving it a go. I have gone over and over the parameters and still agree with what was chosen as did 2 of my supervisors. I was so embarassed and taken aback by this instance I am not as confident with using US, however I believe that what I did was not irresponsible or endangering the patient in any way.
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2 comments:
I totally know how you feel when people make you question what you are doing even though you are sure it's not wrong. Yes we are still students but that also means that on some things we have the most recent knowledge esp in regard to things like US. The bizarre thing is that even if he didn't like your technique, going a little too fast or longitudinally is by no means unsafe. Maybe it would have been worth asking him how he would have done it differently just to put your mind at ease that you weren't being unsafe or to maybe understand what his rationale was. At least if the other PTs said you were fine it couldnt have been anything too bad!
That was a difficult situation and one that would have been worth discussing with your Curtin clinical tutor. You didn't talk about how that made you feel nor about how you could deal with the way you were spoken to and how you could deal with someone talking to you in that way in future. These are important things to reflect upon. Good luck with other communication stressors.
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