Communication

During my orthopaedic inpatient placement I was treating a patient named Tom* who had quite a complicated hospital stay after a fairly simple tibia fracture. His fracture was complicated by compartment syndrome resulting in a fairly lengthy hospital stay.

I saw Tom day 1 post LCL and biceps femoris repair. The post op orders were mobilise as able NWB, hinged knee brace locked at 10 degrees for 6 weeks. So I went and saw tom who was lying in bed, I started off with the usual questions and assessment. Tom seemed slightly anxious, as was understandable due to his long hospital stay and complications. I explained to Tom that the doctors had given us the okay to start mobilizing as able. Tom then told me that the consultant had just been around and told him that he was to stay in bed for the next 3 days. I told Tom that that wasn’t what i had been told and what was written in his notes but I would talk to the doctors and find out what they wanted.

I paged the registrar but received no response. I then chatted to my supervisor who said she would try and get in contact with them. The following day I met with the registrar who said it was okay to mobilize and to follow the post op orders. So I went and told Tom who was a little reluctant but was willing. I explained to tom our plan and how I wanted him to transfer and ambulate etc. and just as we were about to sit over the edge of the bed the registrar whom I had just talked to and had given the okay for mobilization came into Tom’s room. The doctor ignored me and starting talking to Tom, she then explained to Tom that he was not to listen to what the physio or nurses told him and was to stay in bed for the next two days. I was shocked, because about half an hour ago she had told me it was okay to mobilize and now she was making me look completely incompetent.

After the registrar had left I told Tom that we would do as the registrar and consultant says and wait as we didn’t want to cause any damage. The next day we walked with axillary crutches with no problems.

This situation made me think about communication and how important it is in effectively treating patients. There seemed to be not only miscommunication between me and the registrar but also between the registrar and her consultant. I talked to my supervisor about this situation and she told me that this was a fairly common occurrence. Upon reflection of this situation I should have tried to have a talk to the registrar about how she could have talked to me about the situation outside of Tom’s room to avoid undermining me and physio in front of Tom.

*Fictitious names used