The patient in a holistic view

On my current placement I visited a patient post laparotomy on two occasions. He had a complicated previous medical history. His presenting complaint was yet to be diagnosed. The medical staff had changed trialled and changed his medications a number of times. He had lost 30kgs over the last 6 months, and was now 50kg. He had undergone a huge amount of investigations. He had been on a nasogastric feed for a number of days, every time he tried solids diarrhoea would follow. His gut couldn’t hold anything in.

My supervisor had asked me to check on his chest and mobility. On the first occasion his nasogastric tube was in and no diarrhoea was present. He felt confident to comply with physiotherapy treatment, which included a chest review and ambulation. On the second occasion he had trialled solids the night prior and had diarrhoea all morning. He was not confident to leave the bed. He was not compliant with physiotherapy. Initially he told me to ‘go away, I don’t need physiotherapy’. I proceeded to explain that it was only a procedural check-up, he told me ‘physiotherapy is the last thing on my mind’. His wife and I stepped aside for a moment, and she apologised, saying how he usually not like this, and usually very compliant.

At this point I considered him more as a holistic being. In my mind, the best thing for this man would be to review his chest, and maintain his ROM/strength through ambulation and strengthening exercises. But all he wanted was to understand why he had lost a third of his bodyweight in a matter of months, why he can’t eat and why his stomach hurt so much.

My decision was to assess his chest only. He was compliant with this as it did not require him moving from his bed. After this, I educated him on maintaining his breathing exercises, strengthening exercises and walk on the ward when he felt able. I left the treatment there.

In the future, I want to read my patient notes and attempt to picture my patients in a holistic view, prior to approaching them. Physiotherapy may not necessarily be top priority for them, and as much as I would like to assist, I must never force treatment on to them.