On my Muscol prac, my very first patient on my very first day was a new patient with a Doctors referral including the following things: pt has RA, ?OA of the knee, ?McConnels as X-ray shows evidence of maltracking patella, “however I feel this is not the whole story!”
I went about trying to find what the whole story may be. Subjectively she did not have a very positive opinion of physiotherapy, and being her first session, and my first patient the session took a while due to having to report to my supervisor several times.
The patient subjectively reported minimal irritability, so I planned my session accordingly, trying to be thorough. She was rather a large patient, observation revealed apparent genu valgus. Her quadriceps and hamstrings were very weak, and she was in need of VMO strengthening, and taping to help correct the problem of her painful knee. By the end of the session she was starting to report an increase in pain levels, so rather than give an extensive home program on the first session I decided to only give her IRQ exercise (with bias on VMO), and told her we would go into greater detail in the second session. I also suggested taping, but she said she didn’t want it, as she could not go around with taping for the rest of her life, as well as her sensitive skin. Even when I explained the tape would do the job until the muscles were strong enough to take over, and that Fixamol would decrease the likelihood of skin reaction, the patient declined. When asking her when a suitable time for the next appointment would be she replied she was unable to make a second appointment at that time and would have to ring back. She never rang back, nor did she answer letters or calls from the clinic.
From this experience I have learned that future patients presenting in this way primarily want decreased pain. I really should have spent more time educating her on pain relief rather than focusing on VMO, even though I believe that would have helped her in the long term, short term solutions would have meant I could have seen her again to work on the long term problems.
3 comments:
Hey Jess
I agree if patient has lots of inflammatory signs you want to work on the anti-inflammatory like using US, TENS (which is great for Knee as i know) and re-access which is an important way for you to build up a rapport with patients. That is how I suck patient in :)
But did you say she has minimal irritablity to start with? Therefore she shouldnt become too bad at the end of the exercise unless you tried to run too much exercise in one section? I usually start on a very low grade exercise and progress it graduately. Just thought in this way you can keep patient coming back and also quality of the exerciese can be ensured better in this way (for better monitoring). HOwever, if she is a largish lady, she probably know that the ultimate solution for her is losing weight or live on the moon!
Hope this helps?
Whilst what you have said is true,if you'd have sent your pt home with only education advise that wouldn't have sat very well with your supervisor. Also, if your pt came back with no improvement, she would have possibly been more disgruntled with physio due to been given no exercises to help her- i know i have been annoyed paying physio bills for seemingly common sense type advice.
I also found that MANY pts on musculo prac just wanted a 'quick fix' solution. In this case, I just educated them on why a quick fix was impossible. I figure that if a pt has the type of attitude that your pt seemed to have had, they will not turn up to treatment sessions sooner or later and there's nothing you can do about it becuase its the pts choice.
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