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?

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.

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!

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?

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!!

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