I am increasingly finding when I do subjectives on new patients that while they have been referred for PT post knee replacement say they also have pain in the contralateral knee, both shoudlers, an elbow and a big toe. When you ask "from your perspective what is your main concern at the moment?" a lot of the time it's actually "my shoulder pain" or "the fact i cant do the washing" when it was actually the knee they came to see you about. This is where I get stuck.
For the sake of being a wholistic PT I feel you shoudl really be treating all these problems but you cant even properly assess all the different problems let alone treat them in the allocated time. At the place where I am the general sugestion is just treat what they have been referred for and once thats fixed they can come for the other problems if they need. Time constraints wont let you treat everything at once but I would have thought coming to 2 seperate sessions in a week for two different problems could be a solution but that doesnt seem to happen.
I suppose my comment is just that I have really just discovered how complicated these patients are. The rules we are taught at uni for treatment and assessment seem to need modifying more times than they work. I always knew that patients are complicated but I would have thought that at least some patients for example 2 weeks post TKR might be easy.
A lot of the time I query my ability to actually make a difference to the patients' function when short of general advice on rest, activity and the use of heat and cold I am not even able to get around to treating the joint taht gives them the most concern. Has anyone else faced this dilema?
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I have faced this on several occasions, especially on Musclo prac. As you said, the tutors insist on treating the problem the patients are referred for, even if while they have been on the waiting list for the current problem a new one has arisen. The patients are then faced with the dilemma of having to be put on the waiting list again for the new problem, so it would be really good if we could treat it then and there. I can see the point of this restriction, from the health departments’ point of view. However I agree with you, in that two sessions a week would be of much better benefit to the patient, and in the long term save us time. If we treat as problems arise, they don’t become chronic and therefore stay manageable. The patients are also generally less compliant with their current programs and less motivated to come back to physio if we insist on treating the less important problem in their eyes.
I too have faced this dilemma on musculo prac and agree that sometimes treating the problem that the patient has been referred for is often not their main concern. I would explain to them that you do prepare for each patient on the basis of what info you have recieved and that if another area is of greater concern they should try and book another appointment later in the week so that you can focus your preparation on that area for next time. I feel that focusing Rx on one area at a time does have a greater benifit than trying to treat everything at once. It is important that they then maintain whatever benifits have been gained from treatment by completing their home exercises daily otherwise your weekly meetings with them may become an ongoing saga! I would advise them in the future that they see physio as soon as a new problem arises, rather than letting many little problems build up to eventually become chronic.
Hi Ali,
HEAPS of my pts on musculo prac had more than one area of pain and referred for areas which weren't as troublesome as others. I was advised to fill out all of the areas of the body cart, documenting all pt pain (as per usual) but then only focus on one area for the rest of the subjetive/obj Ax. We were told to give the patients the option of which area was treated first. Once this pain reduced, we (or the following student) then treated the next. For every 'new' area of pain to be examined a longer treatment session was used. Although tgis isn't the optimal situation, at least you are giving the pt the choice of which area they want treated first. hope this helps.
The only other thing I'd like to add is that as long as the patient understands the need to focus on one problem area at a time, there is no harm in giving a little advice in regards to pain manangement, activity modification as you are treating them for the original problem. Acknowledge the patients pain and build that rapport with them but without getting to overwhelmed trying to directly treat 3 different painful areas.
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