hope all is well.
Whilst on prac earlier this year I was treating an 65yr old lady for a fractured neck of humerus, which was caused by a fall. When performing my subjective assessment with this lady i asked her to recount her her fall. She told me she had fallen whilst sorting the washing in her daughter's room. Having previously read the emergency and follow up reports written by doctor's of her story about how she had fallen, it remained vague and varied quite significantly with each account.
Whilst I was primarily treating her fracture I noticed from her history that she had had another fall the previous year. I mentioned to her that given she had several falls it would be a good idea to work on her balance also during her hospital stay. With this comment she became very defensive and said she had not fallen and had not had several falls, however quickly retracted this comment and said that would be a good idea. Given the closeness of this ward and the open rooms i would be walking to the gym and frequently see her in her room. She would be crying and looking quite depressed. This all did not seem quite right to me especially how defensive she was in denying having a fall.
My supervisor later bumped into me and said her daughter to whom this lady was a full-time carer had dropped in when whilst I wasn't there. She appeared to bully her mother and would huddle over and whisper to her mother whilst looking agitatedly at the staff. I noticed my patient would also clam up and get upset at the mention of her daughter. My supervisor later asked if I thought it was possible that the daughter had pushed her over. I thought this was quite possible as there were many things about the situation which didn't quite add up. I have tried to include the main things in this blog but it was more a gut feeling something wasn't quite right.
This was quite a new situation for me and I hadn't dealt with this before. In previous treatments due to her teary and depressed state, I had been more compassionate with treatment and tried not to push her to hard, whilst also making sure to veer the topic of conversation whilst treating her onto subjects which made her happy. However due to my inexperience I discussed this situation with my supervisor, she told me that I should mention casually to my pt that if she wanted anyone to talk to there was the chaplain or a clinical psychologist who were able to help out and gave me some pamphlets to leave on her table. I didn't think me delving into this situation would be any use given how defensive and withdrawn she would become at any mention of the fall.
If I was in this situation again I think I would still find it very difficult to deal with. I think you have to read each patient in this situation as an individual as some people may be more willing to open up to you, however there are probably people better qualified to provide advice or counselling in this situation then us.
Sorry for the long post and any comments would be much appreciated.
1 comment:
Rach
I think your actions here are appropriate. Each circumstance is unique. On occasions, a patient may be quite open and in others, the patient may be quite insular or defensive. I suggest trying to protect your involvement in such situations to a level at which you feel comfortable. This may mean some gentle probing for more information in some instances or quick referral to other health professionals in others.
Regards
John
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