On my rural prac in Kalgoorlie I was introduced to a patient suffering from Parkinson's Disease who had recently undergone cardiac surgery in Perth. He had been transferred back to the rural hospital and was in need of basic post-op physiotherapy that would also take his PD into consideration.
The physio treating him before me was not having much luck, as the patient would often feel depressed, not willing to do exercise and fearful during any treatment. Subsequently he was not achieving his goals as well as was hoped for.
My initial assessment with the patient was with the physio's supervision and we were not able to persuade the patient to partake in our treatment plan. He got tearful and requested to go back to bed. The next time I saw him it was by myself and the treatment session consisted of ambulation and basic bed mobility. Even though it was quite a short session, the patient was performing the tasks set by me with relative ease and was enthusiastic about them. I saw him for a total of 2 weeks for twice a day and was able to observe improvements that would impress even the most disillusioned physio or physio student. I was quite happy with the thought that I had succeeded where working physiotherapists had failed.
During the remaining time I had left in my prac I realised I might have been a little full of myself during that time. I was able to observe my supervisors deal with patients and situations that had left me baffled and frustrated and also see which patient's responded the best to each of us. What I'm trying to highlight is the fact that how well your patient is improving might not always be a direct reflection of the quality of physiotherapy you are providing. Sometimes a patient may not be responding well due to factors out of your control. In this case the patient and myself automatically 'clicked', we had similar senses of humour and were also able to discuss our aims of treatment in ways that we both understood and were happy about. In no way was this a reflection of any superior physiotherapy skills I might have compared to my experienced supervisor but rather an example of two personalities that worked well together.
In conclusion, palming off a patient to a fellow physio might sometimes actually be the right thing to do, as a last resort. Not with the aim to reduce your workload and make life easier for yourself but with the realisation that for reasons out of your control, a different physio with a different personality might be better for the patient and his well being.
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2 comments:
Great insight ivan!
We have been taught that building rapport is the most impt ingredient when it comes to successful intervention. It is very mature of you to pick out that not everyone will be able to get along with everybody. I guess the opposite is true as well, sometimes interventions do not work because you are not able to build rapport and achieve compliance, not because your skills are not good enough. Just a point to keep at the back of our minds when we evaluate our own performance.
You raise an excellent point ivan - the bottom line is if the patient doesn't want to listen to your advice or engage in your treatment, it won't work no matter how good your skills are. Conversely if the patient has confidence in you and is compliant with treatment, the outcomes are likely to be positive even while our skills are still at the 'novice' stage. Being able to quickly identify patients as you did who are not responding to you as a physio and arranging a different therapist is an important skill that can save you a lot of wasted time and effort.
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