Importance of a Holistic Approach to Treatment

I am currently on my Cardiopulmonary placement on a surgical ward. The patients I see are typically post-op patients with decreased lung volumes and impaired airway clearance and therefore my treatment mainly revolves around ambulation and ACBT’s.

Recently I had a day 2 post-op patient who had an abandoned Ivor-Lewis procedure (removal of lower oesophagus and upper stomach due to carcinoma). Upon examination the patient was found to have decreased breath sounds bibasally. We went for a walk which the patient managed well without pain or breathlessness. The patient had nil attachments and his obs and haemoglobin were stable, so I encouraged him to ambulate regularly by himself explaining it would help to prevent post-op complications. On subsequent days I would visit the patient for treatment, each time he would report to me that he had not ambulated since the last time I saw him.

I could not understand why the patient was not ambulating despite my encouragement and rationale for the importance of doing so. I became frustrated with this so brought up the issue with my supervisor. She suggested it may have something to do with the fact that his operation was abandoned because it was inoperable, the tumour was attached to his abdominal aorta also and therefore the prognosis wasn’t good. The patient may be finding it hard to cope with such a prognosis.

I think that because patients in the surgical ward typically have the same cardiopulmonary problems it can be easy to become programmed to treat every patient the same. Since this patient I have made an effort to read more into the history of the patient prior to seeing them in order to see if there are any considerations for treatment. It is important to have a holistic approach to treatment, taking into consideration psychosocial factors, rather than just treating the patient as an impairment or group of impairments. Sometimes for a treatment to be effective, psychosocial issues may have to be dealt with first.

Have a good week :)