During the last week of my cardio prac, I had a post-laparotomy patient who also happened to be a practicing physio. It was a great opportunity to talk to someone who understood all the different facets of our treatment and I took the opportunity to get some extra feedback on my skills. The patient was quite fit and healthy before the procedure and had little complication afterwards.
A situation did arise where the patient disagreed with one aspect of my management. They requested to be discharged with a pair of elbow crutches, something that I would not normally do in my usual management of this type of patient. I had sent home patients much older and in worse shape home with nil gait aids and was quite justified in doing so. Why prescribe a gait aid which could negatively affect the patients posture and the quality of their gait? Isn't it optimal to get the patient walking as "normally" as possible as earliest as we can?
These are the reasons I used to justify my choice to the patient. Conversely, the patient had reasons of their own, based on past medical history, the complicated situation surrounding their surgery ( x4 misdiagnosis in ED before the procedure was undertaken) and differing views on how to best undergoe their rehab.
Now usually I am quite happy to recieve a few little negative responses from patients if I know without doubt my management strategy is the right one. If it was any other patient I would have discharged them with nil aids. With this particualr patient I had no real problems prescribing elbow crutches because they had justified why they needed them. I was confident that the patient understood the impairments that could arise from relying to heavily on them because of their education and experience as a physiotherapist.
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Hey Ivan, in my opinion you made a good choice because I suppose that comes done to 'treating the patient as a whole' and not just doing the same thing for every patient. If he felt more confident with using the crutches in the short term and as a PT is aware of the effects prolonged use can have, then there is no harm in discharging him with them. Nicely done, I imagine it would be hard treating another PT who has more experience and is challenging what you say!
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