Monday, 6 August 2007
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.
Monday, 30 July 2007
Final Frustrations
Hi guys
just wanted to open the discussion for how everyone is coping in second semester. I've just returned from rural prac where I was treating every single patient without hesitance. I loved it and felt like I was finally ready to enter the workforce! But now I've come back to perth and started my latest prac and gone back to not being really able to treat the patients but just having to observe! I understand why things are this way but I'm finding it kind of frustrating becuase I feel like i've taken a backwards step!! Just wondering if anyone else is feeling the same now that we're coming to the end of the road!
just wanted to open the discussion for how everyone is coping in second semester. I've just returned from rural prac where I was treating every single patient without hesitance. I loved it and felt like I was finally ready to enter the workforce! But now I've come back to perth and started my latest prac and gone back to not being really able to treat the patients but just having to observe! I understand why things are this way but I'm finding it kind of frustrating becuase I feel like i've taken a backwards step!! Just wondering if anyone else is feeling the same now that we're coming to the end of the road!
communication issues
Hi all, id love your advice on some communication suggestions for a 73yo patient who has global aphasia following L ACA/MCA stroke 2 years ago. From doing a few tests i think he has a more significant impairment of expressive aphasia but not so much receptive, as often he appears to understand clearly what im asking him to do. He can use a picture book when prompted to assist with communication, and verbally can only say "right" and "ok" however these are inconsistent. He is a lovely man who at times gets so frustrated with people not understanding him. So far ive tried to restrict my questions to yes/no answers which seems to work, and give him alot of time to answer me. He requires prompting to use the communication book but it doesnt have alot of options for him. If anyone has other suggestions as to how i can approach a 'standard' subjective/objective assessment i would love to hear them! thanks, Em
Sunday, 29 July 2007
Difficult Patients
Last week i had a pt who was deaf, semi blind and suffered from dementia. What i am asking of you is if you have had a difficult pt to communicate with, how have you got around this issue. What me and my supervisor tried was a lot of hands on techniques, all we need to do with the pt was to get him up and walking. The pt was very impulsive so we had to place a hand on his chest to notify him when we needed him to stay still and not move forwards. To stop him from standing up we had to place a hand on his shoulder. We stood right in front of the pt and used a lot of eye contact when we were explaining what we wanted the pt to do. Even with all this we still found it extremely difficult and more time consuming. We managed to get the pt to the shower and had to call it a day. So for next time i was hoping for some more ideas to try and make the session more effective and less time consuming.
Dickie
Dickie
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