Hey guys, I owe you a couple of those blog things!
I’m on a musculo OP department at the moment. The list of stories about my difficulties on this placement is endless… *sigh* But I’ll begin with this.
My trouble lies in the fact that I admit my own inexperience, and often simply… don’t trust my findings. When you consider that, for example, in PPIVMs, it is normal for C1-2 to have more rotation than C2-3. Or that C5-6 is apparently supposed to have more flexion than C3-4. How do you know that when you feel one segment to be stiffer than the next, that the difference is normal, expected for age, or actually a finding? This comes largely with experience, right?
Here’s another thing I have trouble with. Assessing PAIVMs, and trying to ID stiffness, pain onset (1/4 range, ½ range etc), pain limitation (so P1 vs P2), muscle spasm onset (??). Yeh. Double you tee eff. Often, I’m still working on being confident that I AM on the right segment (only in the Cx area, John. Only in the Cx), or working out whether the pain is joint or muscular.
Problem to me is the system of this musculo OP clinic. You go in, do your S and your O, then report to your supervisor, who in fact doesn’t really see the patient, and doesn’t double-check your findings. I find it hard then, when I report my findings to my supervisor, and he asks me questions about them. Sometimes, I say, “To be honest, I don’t really know, because I don’t trust my own findings 100%… I’m not sure when I find some stiff segments, whether this is normal age-appropriate findings for this particular lady, or really of concern”. Because these findings are directly impacting treatment decisions, I think honesty here is important. I have a very intimidating supervisor who is not easily impressed by such honesty. I feel like I’m often met with some disapproval.
Fortunately, my supervisor usually does come through with some wisdom about what I should assess further and helps me clarify my findings, so the embarrassment is more tolerable. But this has stressed me out initially on this placement. Regardless, I’ve tried to stick to this approach, even though time and time again, I am looking like an idiot. At the end of the day, I am learning lots this way, right? But sometimes I wonder if I would learn more by having a supervisor verifying your assessment techniques and findings.
Anyone with similar stories they'd like to share?
2 comments:
I encountered similar on my musculo prac- especially in regard to PPIVM/PAIVM findings! It is going to take us years to really develop a feel for what is within the scope of normal and what is not- and even then no one is perfect! There will always be differences in opinion since these assessments are quite subjective. Until the time comes when we have seen enough patients to gain more confidence in our findings, I think your approach is definitely the way to go. Be honest and ask for a second opinion- even if it means looking somewhat foolish. I'm sure your patients will similarly respect the fact that you are making the effort to ensure they get effective treatment.
I was extremely happy to read this blog because I empathise strongly with your experience. Assessment skills, particularly regarding the cervical spine, take time, practice and experience to acquire. It is not an area that comes naturally to me.
Whilst it may not inspire your Supervisor, I think the physio who is honest with their self-reflection will ultimately become very effective. Certainly, there are challenges at the moment, because assessment findings impact greatly on your clinical reasoning.
Aim to identify large differences at the moment between sides and between patients. Over time, your assessments will become more subtle.
John
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