I have just started my neuro placement, which is in a rehab setting, and thought I would share an issue that I have been introduced to. The focus at my facility is on a Bobath approach to treatment which is about encouraging normal movement as much as possible.
However, before patients are admitted they are treated in a more acute area, who often take a different approach. In these settings patients may be allowed to use whatever pattern or muscles possible to achieve a task e.g. rolling. This can hamper the rehabilitation process, as the brain relearns the wrong movement patterns, and can also result in increased overactivity in the "unaffected" side.
I believe it would be in the patients best interests to communicate between facilities in order to acheive the optimum outcome, although I'm sure I am not aware of all the issues involved, or the evidence behind it (but I'll save that for another post). Anyone?
Monday 27 August 2007
rural prac...
Hi everyone, i just wanted to say a little bit about our rural placement...
i am on mine at the moment and really enjoying it. I am finding that the patient load is a mixture, and even though its not a specialist area i am enjoying practicing a range of treatments - from womens health to cardio, neuro and musculo. i think that working in the country as a physio would be very rewarding, and as long as you have a good support network with other physios, your skills in all areas are maintained.
Occasionally it would be quite challenging as you have nobody to gain a second opinion from, but it would definately make you attend as many continuing ed sessions as possible and keep up to date with the latest treatments available.
i hope everyone else has enjoyed their country placements also, and has found the mixture of patients great practice also!
i am on mine at the moment and really enjoying it. I am finding that the patient load is a mixture, and even though its not a specialist area i am enjoying practicing a range of treatments - from womens health to cardio, neuro and musculo. i think that working in the country as a physio would be very rewarding, and as long as you have a good support network with other physios, your skills in all areas are maintained.
Occasionally it would be quite challenging as you have nobody to gain a second opinion from, but it would definately make you attend as many continuing ed sessions as possible and keep up to date with the latest treatments available.
i hope everyone else has enjoyed their country placements also, and has found the mixture of patients great practice also!
Sunday 26 August 2007
FINISHING!
I just wanted to talk about how much I am looking forward to finishing prac this year and starting work next year. I have enjoyed prac so much this year and it feels like I have learnt more in this year then the three years we spent learning at uni! But I must say I am looking forward to not being asked questions every two seconds and just concentrating on my treatment sessions. I know that learning never stops and that you can never know enough but it will be good to be a bit more independent next year. It will also be good to finally earn some money- I’m sure that everyone feels that way after being poor for 4 years. Even though initially he pay isn’t that brilliant- but I suppose as long as you enjoy your job then the money doesn’t matter so much. I just wanted to say that I think that the physiotherapy course has been really great and will set us up for a solid career with exciting prospects!
Purchasing a gopher?
I sometimes have been told that patients will teach you more valuable things than what you would have learnt from the books.
Part of my prac consists of pulmonary rehab program. It's not the exercise part that is interesting. It's the 'health topics open discussion' which I find rather valuable not only for the patients, but also for me. During this session, the patients can either ask the physio about issues of their concerns or share their own experience.
One of the topics which came up from last week's session was the motorised gopher. One of those topics which you didn't expect to know or matters. And I thought I would share some of the things I learnt.
Here are some practical gopher-related facts:
1. max speed of a gopher is 40km/hr.
2. battery power duration depends on how often you go up a slope and the steepness of a slope.
3. patient gets only 1/2 price rebate (can't remember which type of rebate) if they are taking normal taxi, whereas they only need to pay 1/4 of the cost to call a maxi taxi so that they can bring along their gopher.
4. sunroof for a gopher costs extra.
5. sheep skin cover makes the seat more comfortable.
6. patient can also fit customised foam cushion on the seat via an OT if the seat is not suitable.
I hope that at some point these facts will assist you when your future patients do ask you about a gopher.
Part of my prac consists of pulmonary rehab program. It's not the exercise part that is interesting. It's the 'health topics open discussion' which I find rather valuable not only for the patients, but also for me. During this session, the patients can either ask the physio about issues of their concerns or share their own experience.
One of the topics which came up from last week's session was the motorised gopher. One of those topics which you didn't expect to know or matters. And I thought I would share some of the things I learnt.
Here are some practical gopher-related facts:
1. max speed of a gopher is 40km/hr.
2. battery power duration depends on how often you go up a slope and the steepness of a slope.
3. patient gets only 1/2 price rebate (can't remember which type of rebate) if they are taking normal taxi, whereas they only need to pay 1/4 of the cost to call a maxi taxi so that they can bring along their gopher.
4. sunroof for a gopher costs extra.
5. sheep skin cover makes the seat more comfortable.
6. patient can also fit customised foam cushion on the seat via an OT if the seat is not suitable.
I hope that at some point these facts will assist you when your future patients do ask you about a gopher.
Head Injury Patient
Hi All,
At the moment, I am on a neurosurgical ward in RPH. I have come across a few difficult situations and would like to share some of my experience with all of you.
On the first day, my facility supervisor had clearly stated she was a big fan of Bobath technique and she wanted me to treat patients with this technique. As a student, this was a really good learning opportunity and I was more than happy to learn this new technique from my supervisor. I had used the Bobath technique to treat my patient and things went pretty well until I met my Curtin tutor.
When I first met my Curtin tutor, she asked me what I had done for the last few days. I gave her a quick handover on patient’s condition and reported what sort of treatment I had given to my patient. She was not really impressed on my choice my technique and she gave me a big lecture on Bobath technique and said this technique was not appropriate for most patients (Head Injury) on this ward.
During the three hours with my Curtin tutor, I had treated all my patients with ‘Carr and Shepherd’ approach and when she was not there, I had to use the Bobath technique to treat my patients.
I understand every clinician will have his/her own way to treat a patient but I just wonder will this inconsistency of treatment affect patient’s recovery. Is it better to stick to one approach than using different techniques on head injury patient?
At the moment, I am on a neurosurgical ward in RPH. I have come across a few difficult situations and would like to share some of my experience with all of you.
On the first day, my facility supervisor had clearly stated she was a big fan of Bobath technique and she wanted me to treat patients with this technique. As a student, this was a really good learning opportunity and I was more than happy to learn this new technique from my supervisor. I had used the Bobath technique to treat my patient and things went pretty well until I met my Curtin tutor.
When I first met my Curtin tutor, she asked me what I had done for the last few days. I gave her a quick handover on patient’s condition and reported what sort of treatment I had given to my patient. She was not really impressed on my choice my technique and she gave me a big lecture on Bobath technique and said this technique was not appropriate for most patients (Head Injury) on this ward.
During the three hours with my Curtin tutor, I had treated all my patients with ‘Carr and Shepherd’ approach and when she was not there, I had to use the Bobath technique to treat my patients.
I understand every clinician will have his/her own way to treat a patient but I just wonder will this inconsistency of treatment affect patient’s recovery. Is it better to stick to one approach than using different techniques on head injury patient?
Private Practice
Working in a private practice is at times very challenging. It is a constant balance between physiotherapy and business. What makes effective physio does not make effective business. For ethical reasons effective physio always comes first, but to be successful business has to come a close second. Ways to make good business include having a variety of equipment such as fit balls and orthotics to sell. Investing in good gym equipment, this is handy for treatment and during after hours you can run a public gym. Good, effective physio treatment will always bring the clients back. However, if you offer not only symptom relief physio but exercise prescription/training and add pilates in to the mix you can establish a large clientele which will continue to return over long periods of time. Private practice is a challenging place to work but I find it very rewarding. If anyone else has any other ideas of how to balance physio and business please share.
Dickie
Dickie
Tuesday 21 August 2007
PPIVMs and PAIVMs
Hi everyone,
I have just recently had my musculo placement and am now on my rural. I have been lucky to have had a pretty broad selection of patients, however i have been treating quite a few Cx, Tx and Lx problems. I was just wondering if everyone else finds that it takes a lot of practice to get PPIVM (and also PAIVM) findings completely accurate?! I found at first that although i was fairly accurate it was difficult to work out what levels had the worst restriction... all of us on the same prac had the same difficulty, so just seeing if anyone else has had their musculo and agrees! i think that it definately just takes practice with 'feeling' different necks and backs, and am now finding it easier on this placment as i have already had 5 weeks practice. When speaking to other physios, they say that unless you try and get your hands on as many necks as possible you may be second/third year out of uni and still be unsure with your assesment!
So we had all better get PPIVMing if wanting to work in musculo!
Stace
I have just recently had my musculo placement and am now on my rural. I have been lucky to have had a pretty broad selection of patients, however i have been treating quite a few Cx, Tx and Lx problems. I was just wondering if everyone else finds that it takes a lot of practice to get PPIVM (and also PAIVM) findings completely accurate?! I found at first that although i was fairly accurate it was difficult to work out what levels had the worst restriction... all of us on the same prac had the same difficulty, so just seeing if anyone else has had their musculo and agrees! i think that it definately just takes practice with 'feeling' different necks and backs, and am now finding it easier on this placment as i have already had 5 weeks practice. When speaking to other physios, they say that unless you try and get your hands on as many necks as possible you may be second/third year out of uni and still be unsure with your assesment!
So we had all better get PPIVMing if wanting to work in musculo!
Stace
Sunday 19 August 2007
Good supervisors and tutors
Hi All
I have just finished a placement at SCGH - musculoskeletal outpatient (curtin clinic) and I must say, I agree with everyone else who have said it is by far the best placement ever. It made me stop to think why exactly everyone was thinking the same thing about the placement and it was quite clear that it was because of the supervisor/tutor who made the placement a fantastic experience.
No matter how easy or hard the placement is, the supervisor/tutor can turn the tables right around. Even if you struggle with the area of expertese, having a very supportive and encouraging as well as an understanding supervisor/tutor, the placement becomes highly enjoyable and the learning experience is phenomenal. Whereas, having a supervisor who puts a lot of pressure on you and expects the entire world from you, makes the placement very "unlikeable".
I have indeed come across placements and have heard from others of difficult supervisors/tutors who are very inconsistent and don't give the best support...if only they could be like the supervisor/tutor we had at SCGH musculooutpt, fourth year would perhaps not be so stressful in the end.
I have just finished a placement at SCGH - musculoskeletal outpatient (curtin clinic) and I must say, I agree with everyone else who have said it is by far the best placement ever. It made me stop to think why exactly everyone was thinking the same thing about the placement and it was quite clear that it was because of the supervisor/tutor who made the placement a fantastic experience.
No matter how easy or hard the placement is, the supervisor/tutor can turn the tables right around. Even if you struggle with the area of expertese, having a very supportive and encouraging as well as an understanding supervisor/tutor, the placement becomes highly enjoyable and the learning experience is phenomenal. Whereas, having a supervisor who puts a lot of pressure on you and expects the entire world from you, makes the placement very "unlikeable".
I have indeed come across placements and have heard from others of difficult supervisors/tutors who are very inconsistent and don't give the best support...if only they could be like the supervisor/tutor we had at SCGH musculooutpt, fourth year would perhaps not be so stressful in the end.
patience & education
I have just finished neuro prac in an outpatient setting where many pts arrive via voluntary transport. These drivers are generally very accomodating to different peoples needs, and many pts get along well with them. Ive noticed, however, that some (newer) drivers show strong frustration and a lack of patience with people who ambulate very slowly. I understand that the drivers are working to a schedule and always allow time for my pts to walk to the car at the end of the session. Several times ive had drivers try and force a pt into being wheelchaired out to the car (about 30m away) as its faster than waiting for them to walk the distance.
I explained that its really important the patients get the benefits of a longer walk, and how trying to rush someone with reduced mobility may be unsafe (and will just make them more anxious and slower). Two of the newer drivers said they thought it was better for the pt to be wheelchaired and werent aware that a longer walk was indeed a good thing.
I've since realised that often its simply a lask of understanding by people in the community that leads them to appear impatient towards people with disabilities. The driver i spoke to said he was greatful for my explanations and hoped he would learn more and be more understanding in his job. I think that if we take a little extra time to explain goals, limitations and treatments to family / friends / carers (where appropriate) it can be of great benefit to the patients.
I explained that its really important the patients get the benefits of a longer walk, and how trying to rush someone with reduced mobility may be unsafe (and will just make them more anxious and slower). Two of the newer drivers said they thought it was better for the pt to be wheelchaired and werent aware that a longer walk was indeed a good thing.
I've since realised that often its simply a lask of understanding by people in the community that leads them to appear impatient towards people with disabilities. The driver i spoke to said he was greatful for my explanations and hoped he would learn more and be more understanding in his job. I think that if we take a little extra time to explain goals, limitations and treatments to family / friends / carers (where appropriate) it can be of great benefit to the patients.
Smokers
My supervisor made a very good point about smokers. Our first thought, even though a bad one, when we read in the notes smoker for 40+ years diagnosed with COPD is that, this is thier fault. My supervisor said that when these pts started smoking they had no idea of the consequences so you do feel sympathetic and this really changes your perspective of the pt. It is the young people who started smoking when the consequences were well known who have no excuse. These are the respiratory pts that we are going to see, so is our attitude going to change (less sympathetic) and will this affect our approach to treating them. I myself think that this is the case and our approach will change. The thought of them doing this damage to themselves will stay at the back of your mind and it will be harder to treat these pts to the best of your ability.
Saturday 18 August 2007
Androgen-deprievation therapy's side effects
Not too long ago, I had a patient who was being referred to me by a gerontology doctor for a Balance Assessment. This is patient has a PMHx of Depression, Prostate cancer and Breast Liposarcoma. He complained that he doesn't feel that his walking is as steady as pre-cancer. The initial assessment results showed that his manual muscle testing of lower limb as well as Berg was almost full score. So I assumed perhaps it has to do with depression and did not think too much about other possibilities.
During a follow-up session, he brought an article about the type of cnacer treatment which he received -- "androgen-deprievation therapy for prostate cancer patient." The article explained that this testosterone reducing therapy can cause side effects such as reduced muscle strength, reduced bone mass and increased body fat. This then made me becoming more aware of the side effects of this type of therapy.
I am glad that he brought my attention to the article. This has taught me to always investigate further with the type of co-mordity treatment which the patient is receiving and whether it has side effects towards physio related problems.
During a follow-up session, he brought an article about the type of cnacer treatment which he received -- "androgen-deprievation therapy for prostate cancer patient." The article explained that this testosterone reducing therapy can cause side effects such as reduced muscle strength, reduced bone mass and increased body fat. This then made me becoming more aware of the side effects of this type of therapy.
I am glad that he brought my attention to the article. This has taught me to always investigate further with the type of co-mordity treatment which the patient is receiving and whether it has side effects towards physio related problems.
Friday 17 August 2007
Bilat wrist pain
Hi all
another late post...had a patient with bilateral wrist pain due to prolonged typing/writing as she is a TEE student. On physical assessment, she was TOP over the anterior surfaces of the radiocarpal joint, no restriction in range, positive NTPT (median nerve test), no restriction on PPIVM assessment and on PAIVMs she was TOP as she couldn't quite take the pressure from the PAs of central and unilaterals so no real objective measure was taken from the PAIVMs. Her mom likes to join in the session as she doesn't quite pay attention during the physio session.
is this a case of the patient making an excuse to not clean her room or something or is it really an issue as I couldn't quite seem to gauge where the problem was coming from, taking into consideration that she was quite hypersensitive to the objective assessments and so the accuracy of the measures is questoinable.
another late post...had a patient with bilateral wrist pain due to prolonged typing/writing as she is a TEE student. On physical assessment, she was TOP over the anterior surfaces of the radiocarpal joint, no restriction in range, positive NTPT (median nerve test), no restriction on PPIVM assessment and on PAIVMs she was TOP as she couldn't quite take the pressure from the PAs of central and unilaterals so no real objective measure was taken from the PAIVMs. Her mom likes to join in the session as she doesn't quite pay attention during the physio session.
is this a case of the patient making an excuse to not clean her room or something or is it really an issue as I couldn't quite seem to gauge where the problem was coming from, taking into consideration that she was quite hypersensitive to the objective assessments and so the accuracy of the measures is questoinable.
Wednesday 15 August 2007
Sexual Harrassment?
Hi all,
Sorry for the late entry.
I have a question mark in the title because I am not too sure if it was being considered as a sexual harrassment or not.
Situation 1 - I walked past a regular-visiting outpatient the other day. He was not my patient but we would bump into each other weekly, and would say "Hi" only. He commented: "Hm you smell very nice today". That comment stunned me a little. I was a bit slow at responding to that comment, but came up with "oh, i have just got back from the hydro pool". I am normally not very conservative but I feel he was being a "tad" too flirtatious. That comment was unneccesary and too personal/intimate (even if it's true that I smelt nice).
Situation 2 - I was treating an elderly lady, his son accompanied her to the session. I was trying to explain what she could wear to attend the hydro class. And he jokingly said "in birthday suit, and everyone goes there in birthday suit." "jennifer hawkins has a new bikini range coming out, maybe mom can wear that". I failed to get the joke, so I responded with a cold smirk and hoping he would get the hint and stop the 'joke' right there. I am not too sure if it is his usual way of conversation with his mother or with others.
I normally take the approach of not responding/reacting to those sort of comments on the first occassion and hopefully that will discourage such comments, so that if there is a follow-up appointment, at least the atmosphere will not be awkward. But I would either tell the person directly that I don't find it acceptable or inform my supervisor if that person is re-offending.
Am I being too sensitive towards the situations above?
Chin.
Sorry for the late entry.
I have a question mark in the title because I am not too sure if it was being considered as a sexual harrassment or not.
Situation 1 - I walked past a regular-visiting outpatient the other day. He was not my patient but we would bump into each other weekly, and would say "Hi" only. He commented: "Hm you smell very nice today". That comment stunned me a little. I was a bit slow at responding to that comment, but came up with "oh, i have just got back from the hydro pool". I am normally not very conservative but I feel he was being a "tad" too flirtatious. That comment was unneccesary and too personal/intimate (even if it's true that I smelt nice).
Situation 2 - I was treating an elderly lady, his son accompanied her to the session. I was trying to explain what she could wear to attend the hydro class. And he jokingly said "in birthday suit, and everyone goes there in birthday suit." "jennifer hawkins has a new bikini range coming out, maybe mom can wear that". I failed to get the joke, so I responded with a cold smirk and hoping he would get the hint and stop the 'joke' right there. I am not too sure if it is his usual way of conversation with his mother or with others.
I normally take the approach of not responding/reacting to those sort of comments on the first occassion and hopefully that will discourage such comments, so that if there is a follow-up appointment, at least the atmosphere will not be awkward. But I would either tell the person directly that I don't find it acceptable or inform my supervisor if that person is re-offending.
Am I being too sensitive towards the situations above?
Chin.
Tuesday 14 August 2007
Patient Confidentiality
Hey guys,
just a quick question on patient confidentiality. Aside from the obvious, if you don't mention names do you think its appropriate to discuss other patients in front of patients? For example, i find it sometimes helpful with kids to say, "this other boy I'm treating blow's 20 lots of bubbles, i wonder if you could do that". That is one example but basically i find it helpful to use other kids as motivators or to let the pt know what they can work towards which is particularly helpful when two kids have the same condition. In such a small hospital I'm wondering whether this is appropriate and am a little unsure about whether I am breaching confidentiality or not? Any thoughts?
just a quick question on patient confidentiality. Aside from the obvious, if you don't mention names do you think its appropriate to discuss other patients in front of patients? For example, i find it sometimes helpful with kids to say, "this other boy I'm treating blow's 20 lots of bubbles, i wonder if you could do that". That is one example but basically i find it helpful to use other kids as motivators or to let the pt know what they can work towards which is particularly helpful when two kids have the same condition. In such a small hospital I'm wondering whether this is appropriate and am a little unsure about whether I am breaching confidentiality or not? Any thoughts?
Sunday 12 August 2007
Impingement
Hi Everyone, this is a very late post sorry
I've been having difficulty thinking of things to add so I thought I'd add something useful I learnt. When classifying shoulder impingments, (primary or secondary) most of us kept getting it wrong when confirming it with the clinical tutor before treating the patient. Initially we thought primary impingment was due to the structure of the acromium process compromising the subacromium space i.e. osteophyte or congenital bony formation. Rather, a primary impingment is any pathology that is compromises the subacroumium space which includes inflammation from the bursa, or torn supraspinatus etc as well as the bony formations. Secondary impingment is due to an impairment in thiei motor control of the GHJ e.g. weak supraspinatus or external rotators etc.
So for instance, a person with a torn supraspinatus tendon would be both primary and secondary shoudler impingment as there is swelling from the tear and poor motor control due to pain/weakness.
Seeing as though most of us had thought the other classification, it appeared that it wasn't very well explained when taught the shoulder. Just thought this may be useful for those who weren't as sure as I was.
I've been having difficulty thinking of things to add so I thought I'd add something useful I learnt. When classifying shoulder impingments, (primary or secondary) most of us kept getting it wrong when confirming it with the clinical tutor before treating the patient. Initially we thought primary impingment was due to the structure of the acromium process compromising the subacromium space i.e. osteophyte or congenital bony formation. Rather, a primary impingment is any pathology that is compromises the subacroumium space which includes inflammation from the bursa, or torn supraspinatus etc as well as the bony formations. Secondary impingment is due to an impairment in thiei motor control of the GHJ e.g. weak supraspinatus or external rotators etc.
So for instance, a person with a torn supraspinatus tendon would be both primary and secondary shoudler impingment as there is swelling from the tear and poor motor control due to pain/weakness.
Seeing as though most of us had thought the other classification, it appeared that it wasn't very well explained when taught the shoulder. Just thought this may be useful for those who weren't as sure as I was.
Late patients
In an outpatient setting how late is too late? On my prac i have had numerous late pts which has meant i am working over time. I am constantly working till 5 pm where i should only be working till 4:30. I find it tough to turn pts away so i attempt to modify my session to at least give them some sort of intervention but with a prescribed outline of the session already in place its tough to cut it down to fit in to a shorter session. On top of that there is the paper work. I mentioned to one pt that for the next appoinment can they get here on time which they responded positively to so will now just have to wait and see. Does anyone have any other ideas on how to approach a late pt?
Motivation
Hi all! Im currently treating a 62yo lady who suffered a L MCA stroke in nov 06 and is attending outpt rehab to improve mobility. She is motivated to attend the physio twice weekly and participates in all activities well, but is very reluctant to commence a home exercise program. She says its because she is afraid of falling while doing exercises, but with further questioning (and suggestions of exercises done in bed or sitting in a chair) she seems reluctant to even attempt one. She seems to be quite strong in her viewpoint that she will work hard "with me" and that will make her better. I feel that she is relying on me as her cure, and that its entirely my responsibility to fix her. I would like to find ways to help her realise she has to take ownership of her rehab and whilst im there to guide and assist her, ultimately she must take the responsibility. If anyone has suggestions of how to help patients realise they need to take control of their rehab i'd love to hear them, as i feel without daily maintenance stretches/exercises done at home my ability to progress this lady will be limited. Thanks!
Tuesday 7 August 2007
different cultures
hi guys,
at the moment I'm on my rural prac in port hedland. Very different place with a very different patient caseload. My first patient was a young aboriginal man who lived in a nearby aboriginal community. He had been stabbed by his partner under his left clavicle and consequently developed a pneumothorax in his left upper lobe. He was also a heavy smoker and had had multiple previous admissions for intoxication, domestic violence and psych issues. Well, this was definitely something new to see. I treated him with the usual chest management i.e subjective, objective assessment and ambulation, deep breathing+ supported cough, but i found myself altering my assessment as the patient wasn't very receptive (focusing on the absolute necessities i.e pain, sputum, smoker history and leaving other questions ie. ex tol, previous chest conditions until the next day). I found the patient prefered he experiment himself with getting out of bed and the supported cough, rather than i showing him (though guiding him through it). Has anyone found similarities when working with the indigenous population?
at the moment I'm on my rural prac in port hedland. Very different place with a very different patient caseload. My first patient was a young aboriginal man who lived in a nearby aboriginal community. He had been stabbed by his partner under his left clavicle and consequently developed a pneumothorax in his left upper lobe. He was also a heavy smoker and had had multiple previous admissions for intoxication, domestic violence and psych issues. Well, this was definitely something new to see. I treated him with the usual chest management i.e subjective, objective assessment and ambulation, deep breathing+ supported cough, but i found myself altering my assessment as the patient wasn't very receptive (focusing on the absolute necessities i.e pain, sputum, smoker history and leaving other questions ie. ex tol, previous chest conditions until the next day). I found the patient prefered he experiment himself with getting out of bed and the supported cough, rather than i showing him (though guiding him through it). Has anyone found similarities when working with the indigenous population?
Monday 6 August 2007
Difficult Parents
Hi guys,
currently on an inpatients paeds prac and finding the hardest part about it is dealing with the families! One of the kids i'm treating has an extremely controlling mother who is constantly asking millions of questions! I try to answer as much of them as i can but once i answer one, she asks another and i find myself stuck trying to answer questions i don't know the answer to! I have tried to tell her when i don't know the answer to her question but then she just repeats it in another way and i find myself repeating myself over and over again!! and over! I'm finding it a really difficult situation to be in and me and my supervisor are constantly talking about different ways i can deal with things, which is really good because I feel really supported. I just feel i'm not gaining as much respect because I can't answer half of her questions! There's a lot more to it but it'll take too long to explain, just wonder if anyone has some tips from a past paed pracs on how to deal with anxious parents!!
currently on an inpatients paeds prac and finding the hardest part about it is dealing with the families! One of the kids i'm treating has an extremely controlling mother who is constantly asking millions of questions! I try to answer as much of them as i can but once i answer one, she asks another and i find myself stuck trying to answer questions i don't know the answer to! I have tried to tell her when i don't know the answer to her question but then she just repeats it in another way and i find myself repeating myself over and over again!! and over! I'm finding it a really difficult situation to be in and me and my supervisor are constantly talking about different ways i can deal with things, which is really good because I feel really supported. I just feel i'm not gaining as much respect because I can't answer half of her questions! There's a lot more to it but it'll take too long to explain, just wonder if anyone has some tips from a past paed pracs on how to deal with anxious parents!!
shifty issues...
hi all! my shifty issue that id love some advice on is good old weight shift - something that almost every student will come across at some time on neuro prac! Im currently treating a pt who suffered a R thalamic stroke about 2 years ago who is currently recieving outpt rehab to improve his mobility.
At the time of his stroke he was visiting family in a 3rd world country, thus the first 4 months of acute medical treatment involved little (if any) physio. He currently ambulates with the assistance of a walking stick and whilst his gait is functional he displays many compensations.
One of his biggest issues is a reluctance to weight shift to the left, and he actively resists any kind of hands-on facilitation with any task(resisting and fixing to such a degree that even the supervisor was suprised!). I believe some cultural issues are also affecting our ability to have close contact with him. So far ive tried to limit hands-on contact as he dislikes this so much, and opted for verbal cues which sometimes work (he also has limited english).
To assist with weight shifting activities ive tried giving him a target to reach for so he uses internal displacement over my external facilitation, and also prone standing over a plinth to allow him to get some selective control of the L leg and also get him used to some weightbearing on the L whilst feeling safe and supported.
I'd love to hear if anyone else has had pts who really dislike you coming into their personal space and who activily fix throughout the trunk and upper limb when you try to displace them, and any suggestions as to how i might get my much-desired weight shift to the left side!! thanks
At the time of his stroke he was visiting family in a 3rd world country, thus the first 4 months of acute medical treatment involved little (if any) physio. He currently ambulates with the assistance of a walking stick and whilst his gait is functional he displays many compensations.
One of his biggest issues is a reluctance to weight shift to the left, and he actively resists any kind of hands-on facilitation with any task(resisting and fixing to such a degree that even the supervisor was suprised!). I believe some cultural issues are also affecting our ability to have close contact with him. So far ive tried to limit hands-on contact as he dislikes this so much, and opted for verbal cues which sometimes work (he also has limited english).
To assist with weight shifting activities ive tried giving him a target to reach for so he uses internal displacement over my external facilitation, and also prone standing over a plinth to allow him to get some selective control of the L leg and also get him used to some weightbearing on the L whilst feeling safe and supported.
I'd love to hear if anyone else has had pts who really dislike you coming into their personal space and who activily fix throughout the trunk and upper limb when you try to displace them, and any suggestions as to how i might get my much-desired weight shift to the left side!! thanks
Mood Swings
I have this pt who goes from happy go lucky and willing to do what ever you ask, to swearing, stubborn and non co-operative. The nurse's have told me he is like that with everyone and just to ignore it, but, i find it hard to ignore because i am unwilling to get him up and walking on oxygen if he is going to become abusive halfway down the corridor. He is too unpredictable to be considered safe to walk on oxygen and it wouldn't be safe for me because you have to be close to him when walking. On the other hand this is pretty much the only treatment i can do for him so if i don't do it he gets no physio intervention at all, which he badly needs. What i would like to hear from you guys is would you walk him or not?
Real World 101
Hi all,
I have been discussing about fitting in workplace during the placements with one of my friends lately. I am from Malaysia and finding it difficult to fit in, however I wasn’t aware of the cultural difference at work until my friend pointed it out for me.
From where I come, the ‘students’, ‘newbies’ or ‘lower level employees’ would see the seniors as superior. We may show either respect or feel intimidated depending on the attitude displayed by the superior, and the superior rarely speaks to the rest of the employee as a friend. Over there, we’re expected to do exactly as told, whereas the superior here will guide you towards the direction or indirectly hint what they expect of you and they expect you to be proactive or even take initiative to do more than as told. Of course, not all Asian employees are like what I have just described (or maybe it's just me).
So initially when I have been marked down in assessment form on those areas, I could not comprehend why I have been marked down when I have done my job. I am being told that I’m not proactive enough in seeking feedback etc. Only after my friend has advised me about how to behave in the ‘western’ workplace, then I had that ‘oh my god I have been so silly’, there I was, been feeling like an alien, and not knowing the most basic thing about how to behave at a workplace.
It would have very helpful if someone has told me about what to do and what not to do before I got thrown into the deep end from a completely naïve, unrealistic university environment to a big intimidating real hospital with a huge team to work with. It has been too often that most people take it for granted that it’s common sense or it’s something that ‘u should have it built-in’. If the school can include that into health communication 101 or other similar units, I feel that a lot of students who are not familiar with the workplace culture will be thankful for that.
I have been discussing about fitting in workplace during the placements with one of my friends lately. I am from Malaysia and finding it difficult to fit in, however I wasn’t aware of the cultural difference at work until my friend pointed it out for me.
From where I come, the ‘students’, ‘newbies’ or ‘lower level employees’ would see the seniors as superior. We may show either respect or feel intimidated depending on the attitude displayed by the superior, and the superior rarely speaks to the rest of the employee as a friend. Over there, we’re expected to do exactly as told, whereas the superior here will guide you towards the direction or indirectly hint what they expect of you and they expect you to be proactive or even take initiative to do more than as told. Of course, not all Asian employees are like what I have just described (or maybe it's just me).
So initially when I have been marked down in assessment form on those areas, I could not comprehend why I have been marked down when I have done my job. I am being told that I’m not proactive enough in seeking feedback etc. Only after my friend has advised me about how to behave in the ‘western’ workplace, then I had that ‘oh my god I have been so silly’, there I was, been feeling like an alien, and not knowing the most basic thing about how to behave at a workplace.
It would have very helpful if someone has told me about what to do and what not to do before I got thrown into the deep end from a completely naïve, unrealistic university environment to a big intimidating real hospital with a huge team to work with. It has been too often that most people take it for granted that it’s common sense or it’s something that ‘u should have it built-in’. If the school can include that into health communication 101 or other similar units, I feel that a lot of students who are not familiar with the workplace culture will be thankful for that.
Sunday 5 August 2007
Complicated
Hey everyone,
Got a patient who has had a long history (> 3 years) of neck pain referred to the shoulders and arms/hands (bilat). Occasionally he would get pins and needles down the left arm and rarely in the right arm. His pain is greater on the left than the right.
On physical examination, he was hypomobile and TOP/pain on PAIVM @ C3,4 and C4,5. He had a limitation in Cx rotation to the left but he has now acheived full rotation (R=L) He is a heavy built, tall, fit male and doesn't have the best posture. It was concluded from this and other physical examinations that it was a postural/loading disorder. The patient has attended several sessions thus far, and has improved greatly but pain still persists with the occassional P+Ns senseation. He benefits mostly from STM of UT and LS and taping of his shoulders to improve posture. I've done PAIVMs @ the aformentioned levels and now has full rotation.
In the previous session I PPIVMed him at C3,4 4,5 to off-load the joint after a discussion with the supervisor. 2 minutes after Rx, the patient experienced P+Ns on the left arm. 5 minutes later he experienced P+Ns on the right arm.
We advised the patient to come back next week (which is this week) to be re-assessed as we're unsure of what is happening. I was hoping to get some ideas of whats going on, what have I done or what have I not done.
Cheers
Got a patient who has had a long history (> 3 years) of neck pain referred to the shoulders and arms/hands (bilat). Occasionally he would get pins and needles down the left arm and rarely in the right arm. His pain is greater on the left than the right.
On physical examination, he was hypomobile and TOP/pain on PAIVM @ C3,4 and C4,5. He had a limitation in Cx rotation to the left but he has now acheived full rotation (R=L) He is a heavy built, tall, fit male and doesn't have the best posture. It was concluded from this and other physical examinations that it was a postural/loading disorder. The patient has attended several sessions thus far, and has improved greatly but pain still persists with the occassional P+Ns senseation. He benefits mostly from STM of UT and LS and taping of his shoulders to improve posture. I've done PAIVMs @ the aformentioned levels and now has full rotation.
In the previous session I PPIVMed him at C3,4 4,5 to off-load the joint after a discussion with the supervisor. 2 minutes after Rx, the patient experienced P+Ns on the left arm. 5 minutes later he experienced P+Ns on the right arm.
We advised the patient to come back next week (which is this week) to be re-assessed as we're unsure of what is happening. I was hoping to get some ideas of whats going on, what have I done or what have I not done.
Cheers
Friday 3 August 2007
Yellow flags...
Hi all,
Sorry for my late entry as i have totally got the blogging timing all confused. Luckily our fellow colleague Mark has clarified it for me today and hence i got this blog submitted the first thing i arrive home.
Now that i have got the apology out of the way.. i'll go right into the discussion.
I am currently having a placement at Gerontology outpatient of a tertiary hospital. Most of the patients are there for fall assessments/rehab. However there are a few odd cases where the patients are being referred due to social reasons (i.e. depression due to death of spouse).
I have a lady who was being referred to our department due to multifactorial falls. some sounds almost trivial. I was not aware of her social history at the time as i did not have the referral letter at the time. but only later i found out from the letter that she has been drinking sherry every night with prescribed sleeping pills since her husband's death, which now make sense to me why her 'trivial' falls occured between 11pm and 2am. Her case is also being reviewed by the social worker concurrently.
I feel that all i can do is to focus on physiotherapy problems of hers, which was to improve standing/walking balance, and i feel that there's not much else i can do. I am not entirely frustrated by me not being able to do much else as i know she is in good hands of social worker's plus i'm not an expert in social issues/psychology, but it made me feel a little bit sad somehow.
Has any of you had similar type patient? And how did you deal with the situation or how would you tackle it if you were in similar situation? And do u know of any not-for-profit organisation/services that is doing a reach-out for this type of patients?
Chin.
Sorry for my late entry as i have totally got the blogging timing all confused. Luckily our fellow colleague Mark has clarified it for me today and hence i got this blog submitted the first thing i arrive home.
Now that i have got the apology out of the way.. i'll go right into the discussion.
I am currently having a placement at Gerontology outpatient of a tertiary hospital. Most of the patients are there for fall assessments/rehab. However there are a few odd cases where the patients are being referred due to social reasons (i.e. depression due to death of spouse).
I have a lady who was being referred to our department due to multifactorial falls. some sounds almost trivial. I was not aware of her social history at the time as i did not have the referral letter at the time. but only later i found out from the letter that she has been drinking sherry every night with prescribed sleeping pills since her husband's death, which now make sense to me why her 'trivial' falls occured between 11pm and 2am. Her case is also being reviewed by the social worker concurrently.
I feel that all i can do is to focus on physiotherapy problems of hers, which was to improve standing/walking balance, and i feel that there's not much else i can do. I am not entirely frustrated by me not being able to do much else as i know she is in good hands of social worker's plus i'm not an expert in social issues/psychology, but it made me feel a little bit sad somehow.
Has any of you had similar type patient? And how did you deal with the situation or how would you tackle it if you were in similar situation? And do u know of any not-for-profit organisation/services that is doing a reach-out for this type of patients?
Chin.
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