Hi Guys
I thought i'd dicuss a situation I had with a difficult patient. I was on placement at Hollywood Hospital in the Rehabilitation Unit (Geriatrics). We had a new admission the previous day and I was to go see her with my clinical tutor. She was 60 (which was very young for the ward-the average age being approx. 85 yrs), a double below knee amputee which had resulted from an extensive history of PVD and very poorly controlled diabetes. From reading the notes, I already knew she was only having a short stay in the Rehab ward (4 days) which is unusual. She was flying home to Queensland the following week. From liasing with nursing staff, her transfers were requiring physio input (currenlty t/f with a slideboard to and from WC) and had been reported as unsafe and requiring 2 max assistance which wasn't adequate considering she was leaving soon to go home. Anyway, we had organised with her a time suitable in the afternoon. When the tutor arrived, we went in to take her to the gym, however her family was there. She was not happy to see us, slammed her book down and refused to have anything to do with us (she didn't even know why she was in Rehab in the 1st place whats the point-she could do it in quuensland!) Since I was with my tutor, I sort of felt i didn't have the authority to push the importance of correcting her transfers and went silent ,which looking back now, was probably the worst thing to do. My clinical tutor and I left the room to rethink our approach. I explanined to her that I didn't feel i had the authority to push the issue (i.e "student" status). My tutor said the patient was MY patient and I was responsible and must get over that thinking and take charge. After a few minutes of dicussion and getting some ideas with the tutor, we reentered the room where I approached the patient again, explained over and over the importance of safe transfers (and consequences of unsafe transfers) and the need for practice. I told her it would only be a short session concentrating soley on the transfers and invited her family to come and watch/be involved. I related it back to the need of safe transfers for her in the car, on/off the plane and at home. The session went well and her daughter was actively involved. We practiced t/fs from chair to bed, commode and shower chairs, and talked through car seat to chair (with OT the next day). The patient was compliant with following sessions and was discharged a few days later, safe with her t/fs. Anyway, I did find it difficult initially to negoitate and get the patient to be compliant with physio but in the end, it was successful. Does anyone have any other ideas that they would of employed in the same situation or even had been in a similar situation?
Monday 28 May 2007
Feedback Issues- Better Late Than Never??
Hi guys,
this is an issue that I had on my first placement and although it has already been and gone I still want to discuss it and what I could have done differently, as due to nerves and lack of confidence I feel that I handled the situation poorly. My first prac was neuro (lucky me!) on a stroke rehab unit and I found it to be an extremely daunting process. As i had never seen a stroke pt before the biggest thing i struggled with was knowing when to progress the pt to more difficult tasks/exercises. Each stroke pt is so varied, as is their rate of recovery.
As you can imagine I was desperately needing feedback from my supervisor as to how i was travelling and what exactly i needed to improve on. My supervisor, however, was extremely busy and had her own patients to treat (simultaneously to us treating our patients). There was mention of an informal mid-placement assessment but it never actually happened. I received some feedback from the curtain tutor when they came out for their allocated time spot, but this was based on them supervising me on a single occassion and as you know your facility supervisor has a better idea of how you are travelling in general. The afternoon before our final assessment our supervisor only had time to give feedback to one of us and I was not that lucky person! So as you can imagine I was pretty worried going into my final assessment having had no feedback at all over the entire course of the prac from my facility supervisor. I was finally given feedback after I had completed my final assessment. Although this feedback was still helpful, I felt that the areas I needed to improve on, were things i could have worked on over the course of the prac if I was only aware of them.
Myself and the other student did let our supervisor know that next time it would be helfpful if she gave more feedback during the prac, and I also expressed this in my opinion of teaching form, but this of course is no longer beneficial to us.
As a result of this I do not feel totally confident that I could walk into a neuro job tomorrow, although I passed and was competent in all areas I don't feel that I developed as much as I would have liked to on this prac. Partly because of the supervisor not giving me feedback, and partly because I did not act on this situation. Can anybody make any suggestions about how they would have approached the situation?
this is an issue that I had on my first placement and although it has already been and gone I still want to discuss it and what I could have done differently, as due to nerves and lack of confidence I feel that I handled the situation poorly. My first prac was neuro (lucky me!) on a stroke rehab unit and I found it to be an extremely daunting process. As i had never seen a stroke pt before the biggest thing i struggled with was knowing when to progress the pt to more difficult tasks/exercises. Each stroke pt is so varied, as is their rate of recovery.
As you can imagine I was desperately needing feedback from my supervisor as to how i was travelling and what exactly i needed to improve on. My supervisor, however, was extremely busy and had her own patients to treat (simultaneously to us treating our patients). There was mention of an informal mid-placement assessment but it never actually happened. I received some feedback from the curtain tutor when they came out for their allocated time spot, but this was based on them supervising me on a single occassion and as you know your facility supervisor has a better idea of how you are travelling in general. The afternoon before our final assessment our supervisor only had time to give feedback to one of us and I was not that lucky person! So as you can imagine I was pretty worried going into my final assessment having had no feedback at all over the entire course of the prac from my facility supervisor. I was finally given feedback after I had completed my final assessment. Although this feedback was still helpful, I felt that the areas I needed to improve on, were things i could have worked on over the course of the prac if I was only aware of them.
Myself and the other student did let our supervisor know that next time it would be helfpful if she gave more feedback during the prac, and I also expressed this in my opinion of teaching form, but this of course is no longer beneficial to us.
As a result of this I do not feel totally confident that I could walk into a neuro job tomorrow, although I passed and was competent in all areas I don't feel that I developed as much as I would have liked to on this prac. Partly because of the supervisor not giving me feedback, and partly because I did not act on this situation. Can anybody make any suggestions about how they would have approached the situation?
who has young siblings??
Hi guys - i need some advice on this one please! Im currently on paeds prac and one of my pts is a 6yo aboriginal boy from up north who sustained a transfemoral R amputation after a traumatic accident in march. Following the initial treatment at the local hospital he is now at in perth for stump management and preparation for prosthesis fitting - im seeing him twice daily to strengthen the stump and for gait retraining once its fitted on friday. My problem is that he is an absolute terror at times... and thats on a good day! While bribing him with stickers and computer time seems to get us through some PT sessions im needing advice on how to control him when we visit shents as it will take a few hours for the initial fitting session.
His parents are coming to shents as well (no other hospital staff that i know of) but they are likely to make him worse. In addition to police involvement following the "accident" there are social issues with the parents as they were discharging him from the local hospital against medical advice and not tending to his wound care. They also dont discipline him at all and let him run around as he wishes.
Is it ok that i resort to bribes just to get through each session?? am i allowed to use verbal discipline to assist compliance? so far ive been quite firm with him when needed but it only works sometimes - im reluctant to pick him up (and not sure im allowed to) to make the session easier as he tries to bite staff (and has been diagnosed with alot of nasty bugs) but im at a loss for other strategies to get through each session. He also has urinary and fecal "accidents" on occasion as he knows it will stop the gym session which as you can imagine are frustrating. Should i try and be firm with him and make him comply at the prosthesis fitting infront of the parents when they dont care how difficult he is? So if anyone has young relatives or perhaps works in childcare please offer up any suggestions as to how i might get through PT sessions easier and especially our visit to shents this week. Ok im open to literally ANY suggestions you guys may have, thanks in advance! Em
His parents are coming to shents as well (no other hospital staff that i know of) but they are likely to make him worse. In addition to police involvement following the "accident" there are social issues with the parents as they were discharging him from the local hospital against medical advice and not tending to his wound care. They also dont discipline him at all and let him run around as he wishes.
Is it ok that i resort to bribes just to get through each session?? am i allowed to use verbal discipline to assist compliance? so far ive been quite firm with him when needed but it only works sometimes - im reluctant to pick him up (and not sure im allowed to) to make the session easier as he tries to bite staff (and has been diagnosed with alot of nasty bugs) but im at a loss for other strategies to get through each session. He also has urinary and fecal "accidents" on occasion as he knows it will stop the gym session which as you can imagine are frustrating. Should i try and be firm with him and make him comply at the prosthesis fitting infront of the parents when they dont care how difficult he is? So if anyone has young relatives or perhaps works in childcare please offer up any suggestions as to how i might get through PT sessions easier and especially our visit to shents this week. Ok im open to literally ANY suggestions you guys may have, thanks in advance! Em
Too much beer
While on placement in a general surgery ward earlier this year, i was treating patients who were placed in a special observations area. One particular patient was a 23 yr old guy from up north who was addmitted with pancreatitis due to alcohol abuse. After 1 wk in this ward, he was transferred to ICU as his condition became critical due to the fact that his stomach was so distended that he basically could hardly breathe. After 5 days in ICU he began to improve and came back to the ward, very lucky to have survived. My supervisor at the time told me that the survival rate for severe alcoholic pancreatitis is extremely low, especially if the pt ends up in ICU, as there is no treatment other than waiting for the pancreas to being to heal on its own.
As this pt lives and works up north, he is part of a community where socialising means drinking. All people his age head to the local pub each day after work for a 'few' beers, and on weekends do the same. This guy originally told myself and his doctors that he was consuming aound 4 beers every weeknight and up to 30 every friday or saturday night. Considerng his condition was so extreme, this didnt sound like the whole story, and only after his stint in ICU did he confess to drinking nearly a carton of beer every night of the week, which is masssive!
During his entire stay in hospital, just over 1 month, he was very non-compliant when it came to any physio input, and basically just wanted to stay in bed and not move. It was really difficult to get him to take a few deep breaths let alone get up for a walk around the ward, and this contributed to his slow recovery.
All of the medical team were having difficulty convincing this guy that he had to quit drinking if he wanted to get better, and all basically gave up on him because he was ignoring their input.
What i am asking you all is how do you make a 23yr old guy realise just how serious this situation is, and prevent him from going back to his social ways and becoming what the docors call a 'frequent flyer' in and out of hospital for the rest of his life? or is this just one of thise times when you say that you have tried everything and its just up to him to make his own decisions about his life?
As this pt lives and works up north, he is part of a community where socialising means drinking. All people his age head to the local pub each day after work for a 'few' beers, and on weekends do the same. This guy originally told myself and his doctors that he was consuming aound 4 beers every weeknight and up to 30 every friday or saturday night. Considerng his condition was so extreme, this didnt sound like the whole story, and only after his stint in ICU did he confess to drinking nearly a carton of beer every night of the week, which is masssive!
During his entire stay in hospital, just over 1 month, he was very non-compliant when it came to any physio input, and basically just wanted to stay in bed and not move. It was really difficult to get him to take a few deep breaths let alone get up for a walk around the ward, and this contributed to his slow recovery.
All of the medical team were having difficulty convincing this guy that he had to quit drinking if he wanted to get better, and all basically gave up on him because he was ignoring their input.
What i am asking you all is how do you make a 23yr old guy realise just how serious this situation is, and prevent him from going back to his social ways and becoming what the docors call a 'frequent flyer' in and out of hospital for the rest of his life? or is this just one of thise times when you say that you have tried everything and its just up to him to make his own decisions about his life?
Sunday 27 May 2007
Another difficult situation
On one of the occasions when my Curtin clinical tutor came to visit, my patient was not ready so a new patient unknown to both of us had to be seen instead. After the session with the patient, my clinical tutor advised me to handover on the following Monday to the physiotherapist who was initially treating the patient we saw, about the details of what we did in that particular session only and to not bother about any other information, and my tutor had informed my supervisor that I would be doing this on Monday. So, the first thing on Monday I was asked by my supervisor to handover to the physiotherapist.
We sat down together and I did a quick handover of who the patient was and what we did in that particular session. I was interrupted a few times to be told that I did not know what I was talking about and had said that I knew nothing. I was quite embarrased when that particular comment was said and heard by other staff members around and I had tried to explain that my clinical tutor had only asked me to give a quick handover of what our intervention was and the plan, however my supervisor had thought I was required to do a full detailed handover. I tried to explain myself but unfortunately I was too "shocked" from those comments said to me.
At that present time I felt that the best thing to do was to agree with the supervisor and convince the supervisor that I will do better next time. In the end the relationship between myself and the supervisor was resolved and everything was back to normal, however I am still having difficulties understanding whether I did the right thing or not, was I in the wrong all this time? If so, what should I have done?
We sat down together and I did a quick handover of who the patient was and what we did in that particular session. I was interrupted a few times to be told that I did not know what I was talking about and had said that I knew nothing. I was quite embarrased when that particular comment was said and heard by other staff members around and I had tried to explain that my clinical tutor had only asked me to give a quick handover of what our intervention was and the plan, however my supervisor had thought I was required to do a full detailed handover. I tried to explain myself but unfortunately I was too "shocked" from those comments said to me.
At that present time I felt that the best thing to do was to agree with the supervisor and convince the supervisor that I will do better next time. In the end the relationship between myself and the supervisor was resolved and everything was back to normal, however I am still having difficulties understanding whether I did the right thing or not, was I in the wrong all this time? If so, what should I have done?
Family Assistance
I am currently on my neuro placement where I have been treating a stroke patient. He has very low function and cognitive problems and is unlikely to recover much at all. We are looking to discharge him to home and not a nursing home, but to do this we need to educate the patient’s wife on how to safely transfer him.
The first time we attempted to introduce his wife into the treatment session the patient got upset and aggressive saying he didn’t want her there and refused to let her sit in and learn/help. So what I ask of you guys is strategies that you may have used or seen done to get a patient to except help from a family member.
Strategies that I have thought of are having the family member watch from across the gym to start off with so they can see the gross movements of the transfer. Then at a later stage teach the wife to learn the finer points of the transfer by practicing on you. This may not be optimal because it is not going to be the same feeling moving a completely dependent patient and someone acting dependent, also you would need to watch her transfer her husband before you send them home just to make sure she is safe. A slow progression of introducing the wife into the treatment session where at the start she is only there to drop him off and pick him up so she can see the transfers in and out of the wheelchair. Then progress to her assisting you, to her doing it on her own. Along with this, when the wife is not there, I would be reassuring and educating the patient on how important it is for him to accept his wife’s help. Any advice would be much appreciated.
Dickie
The first time we attempted to introduce his wife into the treatment session the patient got upset and aggressive saying he didn’t want her there and refused to let her sit in and learn/help. So what I ask of you guys is strategies that you may have used or seen done to get a patient to except help from a family member.
Strategies that I have thought of are having the family member watch from across the gym to start off with so they can see the gross movements of the transfer. Then at a later stage teach the wife to learn the finer points of the transfer by practicing on you. This may not be optimal because it is not going to be the same feeling moving a completely dependent patient and someone acting dependent, also you would need to watch her transfer her husband before you send them home just to make sure she is safe. A slow progression of introducing the wife into the treatment session where at the start she is only there to drop him off and pick him up so she can see the transfers in and out of the wheelchair. Then progress to her assisting you, to her doing it on her own. Along with this, when the wife is not there, I would be reassuring and educating the patient on how important it is for him to accept his wife’s help. Any advice would be much appreciated.
Dickie
DIFFICULT SITUATION
While on placement recently I encountered this patient:
Patient A, a 14 yr old who had presented with a 6 month hx of increased frequency ad intensity of headaches, increasing dizziness, balance disturbances, vomiting and right sided visual disturbances. On CT a large posterior fossa/cerebellar medulloblastoma was found. This particular type of tumour is highly aggressive and given the location of the tumour not all of it was able to be removed with surgery. The patient had a rough course in ICU with 3 further operations being conducted.
I began to treat this patient when she was transferred to the wards 1 month after the first surgery with the aim of treatment to improve her strength and mobility before commencement of radiotherapy. At this point the patient was given 1-2 months to live (even with radiotherapy), as the tumour was so aggressive. This prognosis in its self I found to be hugely confronting and upsetting as the patient was only 14 years old. Watching the parent’s reactions to the situation and changing condition was also distressing.
Upon commencing treatment with this patient it was evident that the patient’s severe fatigue, frequent nausea/vomiting and dizziness was effecting our treatment sessions. Although small improvements were made I found it really hard to push a patient who was obviously very nauseous (vomiting nearly every session) and fatigued. I mean, this patient only had 1-2 months to live. So my question is- is it really necessary to push her to doing 1 more minute on the treadmill or should she be out enjoying the little time she had left?
Patient A, a 14 yr old who had presented with a 6 month hx of increased frequency ad intensity of headaches, increasing dizziness, balance disturbances, vomiting and right sided visual disturbances. On CT a large posterior fossa/cerebellar medulloblastoma was found. This particular type of tumour is highly aggressive and given the location of the tumour not all of it was able to be removed with surgery. The patient had a rough course in ICU with 3 further operations being conducted.
I began to treat this patient when she was transferred to the wards 1 month after the first surgery with the aim of treatment to improve her strength and mobility before commencement of radiotherapy. At this point the patient was given 1-2 months to live (even with radiotherapy), as the tumour was so aggressive. This prognosis in its self I found to be hugely confronting and upsetting as the patient was only 14 years old. Watching the parent’s reactions to the situation and changing condition was also distressing.
Upon commencing treatment with this patient it was evident that the patient’s severe fatigue, frequent nausea/vomiting and dizziness was effecting our treatment sessions. Although small improvements were made I found it really hard to push a patient who was obviously very nauseous (vomiting nearly every session) and fatigued. I mean, this patient only had 1-2 months to live. So my question is- is it really necessary to push her to doing 1 more minute on the treadmill or should she be out enjoying the little time she had left?
Bone-patellar tendon-bone (BTB) vs. hamstring tendon
Hi everyone,
When I was on my musculoskeletal placement in Curtin Physiotherapy Clinic, I had two patients with ACL reconstruction, one with bone-patellar tendon-bone (BTB) graft and another with hamstring graft. The interesting thing was, they were operated by the same surgeon, so I would like to use this chance to have a look on different types on ACL reconstruction.
There were four types of ACL reconstruction:
1) BTB reconstruction
2) Quadruple hamstring reconstruction
3) Quadriceps tendon reconstruction
4) Allograft reconstruction: BTB, hamstrings, Achilles tendon, quadriceps
Of the above, Quadriceps tendon is not an acceptable way of treatment and allograft reconstruction is rarely done in Australia, but more common in United Kingdom and the United State.
Chapman et al (2006) had done a systematic review to compare the pros and cons of different types of ACL reconstruction (BTB vs. hamstring) and he suggested BTB graft offered the most stable knee post reconstruction and therefore was the most appealing in the elite athlete and the general population.
Characteristics of BTB graft:
- More sturdy and quads strength will not be compromised in a long run
- Take less time to heal
- Have a higher chance to develop anterior knee pain
Characteristics of hamstring graft:
- Less Sturdy
- Take longer time to heal
- Fewer complications than BTB graft
Both of my patients were young (both in their late 20’s) and had a very active life style, I had consulted my supervisors and we were not quite sure why they had a different type of reconstruction since most surgeon would have a preference when performing an ACL reconstruction. The only thing I could pinpoint was one patient was a private patient and another was a public hospital patient, I assumed the difference was related to hospital policy. Any thought on this?
Warm Regards
Kent
When I was on my musculoskeletal placement in Curtin Physiotherapy Clinic, I had two patients with ACL reconstruction, one with bone-patellar tendon-bone (BTB) graft and another with hamstring graft. The interesting thing was, they were operated by the same surgeon, so I would like to use this chance to have a look on different types on ACL reconstruction.
There were four types of ACL reconstruction:
1) BTB reconstruction
2) Quadruple hamstring reconstruction
3) Quadriceps tendon reconstruction
4) Allograft reconstruction: BTB, hamstrings, Achilles tendon, quadriceps
Of the above, Quadriceps tendon is not an acceptable way of treatment and allograft reconstruction is rarely done in Australia, but more common in United Kingdom and the United State.
Chapman et al (2006) had done a systematic review to compare the pros and cons of different types of ACL reconstruction (BTB vs. hamstring) and he suggested BTB graft offered the most stable knee post reconstruction and therefore was the most appealing in the elite athlete and the general population.
Characteristics of BTB graft:
- More sturdy and quads strength will not be compromised in a long run
- Take less time to heal
- Have a higher chance to develop anterior knee pain
Characteristics of hamstring graft:
- Less Sturdy
- Take longer time to heal
- Fewer complications than BTB graft
Both of my patients were young (both in their late 20’s) and had a very active life style, I had consulted my supervisors and we were not quite sure why they had a different type of reconstruction since most surgeon would have a preference when performing an ACL reconstruction. The only thing I could pinpoint was one patient was a private patient and another was a public hospital patient, I assumed the difference was related to hospital policy. Any thought on this?
Warm Regards
Kent
Communication Issues
I found the first week of my placement in a very acute setting quite confronting, as it is so different from any of my past clinics. Communicating with patients is a lot more difficult than in your standard outpatient setting. Many of the patients that are not sedated have trachys in situ so are unable to verbalise their concerns or feelings. Subsequently, I found myself in an intensive one week lip-reading course. It is very easy for patients to get frustrated if people don't take the time to decipher what they are trying to say. And whilst writing and alphabet boards can be helpful, they aren't an option for all patients. For example an elderly woman with GB (in hospital for over 4 months) communicates mainly through nodding, as she has little motor recovery apart from some neck flexors. I found that in trying to speak with her, you had to take the time to ask her questions that she was able to answer in this manner. She also had issues with pain, and some treatments she had to undergo (manual hyperinflation and suctioning) were quite unpleasant. When doing this we were able to tell from her facial expressions when she was uncomfortable or in pain and adjust the treatment accordingly, which helps to build trust and patient confidence. I'm learning to have a more overall view of the patient during treatment, which is difficult when you are suctioning or bagging for the first time and just trying not to look completely incompetent.
Wednesday 23 May 2007
Something to Comment On
If you are reading this well done. It means that you have managed to log onto your blogsite and can start the process of reflecting on clinical placements. To start the ball rolling and give you something to think about and comment on I have a reflection below that was posted by a student in the past.
Happy Blogging
Peter
Too Sick To Stay?
The past few days I've been feeling a bit crook. So I took Tuesday off as I was throwing up Monday night. I went in today, which was Wednesday as I had my final assessment and a presentation to do. I still felt sick, and I wasn't all there, but I really thought I was well enough to not miss clinic. Well anyway in my less than normal state I missed some stuff in the notes that I shouldn't have. So my question is, as a student how do we tell when to draw the line on feeling well enough to go in to clinics, without giving the physios you work with (who you are trying to impress) the impression that you are just not toughing it out?
Comment 1:
I’m sorry to hear you’re not feeling so well. Although, it’s completely understandable as it is easy to get run down doing this course.
I think you’ve raised a very good issue. I think what you have to ask yourself is, are you putting the patient’s treatment at risk? Do you think that in the state you are in you are able to clinically reason appropriately and provide your patient the best level of care you can provide as a student? Also, are your patients who may have decreased levels of immunity while in hospital at risk for developing the “bug” you’re currently carrying? All important questions when trying to determine if you are “too sick to stay”.
Comment 2
I am so sorry to hear that you are/were sick! And I can defintely relate to what you are feeling as I too got very sick on my cardio placement. I was bed riden for a day and a half but was told by my supervisor that if I missed another day that I would have to redo the whole prac. Now, I know that there if a reason for that rule (of only missing a certain number of days) but I agree with you that's there is a thin line between needing to go into prac and knowing that you shouldn't. I was quite surprised when my supervisor said that, as she clearly new that I was sick and that if I came in I would be working closely with these immune depressed patients. So, I braved it out, because who in there right mind, or "sick mind" for that matter, would choose to stay in bed if they new they had to repeat a whole prac? I just tried really hard not to breath on the patients and washed my hands lots...hey is there any research on that?.....
Happy Blogging
Peter
Too Sick To Stay?
The past few days I've been feeling a bit crook. So I took Tuesday off as I was throwing up Monday night. I went in today, which was Wednesday as I had my final assessment and a presentation to do. I still felt sick, and I wasn't all there, but I really thought I was well enough to not miss clinic. Well anyway in my less than normal state I missed some stuff in the notes that I shouldn't have. So my question is, as a student how do we tell when to draw the line on feeling well enough to go in to clinics, without giving the physios you work with (who you are trying to impress) the impression that you are just not toughing it out?
Comment 1:
I’m sorry to hear you’re not feeling so well. Although, it’s completely understandable as it is easy to get run down doing this course.
I think you’ve raised a very good issue. I think what you have to ask yourself is, are you putting the patient’s treatment at risk? Do you think that in the state you are in you are able to clinically reason appropriately and provide your patient the best level of care you can provide as a student? Also, are your patients who may have decreased levels of immunity while in hospital at risk for developing the “bug” you’re currently carrying? All important questions when trying to determine if you are “too sick to stay”.
Comment 2
I am so sorry to hear that you are/were sick! And I can defintely relate to what you are feeling as I too got very sick on my cardio placement. I was bed riden for a day and a half but was told by my supervisor that if I missed another day that I would have to redo the whole prac. Now, I know that there if a reason for that rule (of only missing a certain number of days) but I agree with you that's there is a thin line between needing to go into prac and knowing that you shouldn't. I was quite surprised when my supervisor said that, as she clearly new that I was sick and that if I came in I would be working closely with these immune depressed patients. So, I braved it out, because who in there right mind, or "sick mind" for that matter, would choose to stay in bed if they new they had to repeat a whole prac? I just tried really hard not to breath on the patients and washed my hands lots...hey is there any research on that?.....
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