This week I was put in an awkward situation with one of my patients. I have just started treating a 53 year old lady on my neurology outpatient placement. This particular lady has been a long term patient in outpatients due to several neurological events, and has been treated by a number of students. The same day as our initial session I came home and went on Facebook (as we all do!) to find that this patient had requested to add me as a friend. I also noticed that she was already friends with two other students who had treated her previous to me.
This put me in an awkward situation, I felt obliged to accept this patients request. I felt that if I didn’t she may become offended, especially as other students had accepted her as a friend, and this could affect future treatment. It wasn’t that I didn’t like the patient; in fact I think she is a remarkable lady who is extremely independent despite her deficits. I just felt uncomfortable, like I was doing something wrong or breaking a code of conduct.
After some thought, I came to the conclusion that I had done the right thing. In this particular situation there was nothing suspect, she was a 50-something old lady who wanted some friends (on looking at her Facebook page she only had 16 friends). Had I ignored the request it may have hurt her feelings, and with all the terrible things that had occurred in this ladies past that was the last thing I wanted to do. It did get me thinking though, had this been an 18 year old female, would this be acceptable? Probably not. When I was on practical at PMH, I was told that when treating an adolescent female that I should always have someone else present in the room. In the past female patients had been known to have “crushes” on their male therapists, and even made accusations against those therapists. Accepting them as a Facebook friend could easily be misconstrued by the patient, their parents, and even the physios’ employer. But then again, if it was an 18 year old male it would probably be ok…
I’m sure this situation has happened to many therapists. When I was on a previous prac, a young male patient had mentioned to me in conversation that he was Facebook friends with a female physio. At the time I remember thinking that this was inappropriate; in hindsight the female physio may have been put in same situation as me and did not want to offend. The only conclusion I can make on this is that there is no right or wrong, it depends on the circumstances, and it is up to the therapist to carefully consider these. It would be great to hear others thoughts on, or experiences with, this matter.
Wednesday, October 29, 2008
Tuesday, October 28, 2008
MET call
Today on my neurology outpatient placement I experienced my first MET (medical emergency team) call. We were just finishing lunch in the office, and a couple of patients had already arrived and were waiting in the outpatient gym. Our supervisor was describing to us a task he wanted us to perform before the end of the week when we heard someone scream, followed by large thud +++. We all ran out of the office and into the gym to find one of the patients lying on the floor having a seizure. There was also a small pool of blood developing on the floor, from the patient hitting his head. Our supervisor ran to the patient, supported his head and spoke comforting words while the patients’ seizure continued. In the meantime, the students ran around grabbing the first aid kit etc. to stem the bleeding, while another physio called the MET call.
The patients’ seizure lasted almost four minutes, during which he was conscious and talking. Once the seizure had subsided he continued to lie on the floor while we attended to the cut on his head, checked his pulse, and asked him what had happened The patient reported that his arm began “shaking” before he went into a full body fit causing him to fall off the plinth he was sitting on, onto the floor. He seemed quite calm and was making jokes and apologising for causing a scene. The patient was being treated in neurology outpatients for a stroke he had in January, from which he was making a good recovery. He had no past history of seizures or epilepsy. The MET took almost 10 minutes to arrive; they couldn’t find the location of neurology physio outpatients despite being given a clear description of the location. When they did arrive they turned up without the MET trolley, and no one seemed to be taking charge. Thankfully this event did not turn out to be serious enough to warrant a MET call; however I still found their response time, professionalism, and general organisation disgraceful.
This event was very confronting, particularly on initially finding the patient on the floor. The situation did not seem so serious upon seeing the patient conscious and talking during the seizure, but it was shocking nonetheless. After all the drama had finished and the patient had been taken away on a stretcher, our supervisor made the point that he was debating whether or not to call a MET call (the other option would have been to call the neuro ward and get a doctor to attend), but erred on the side of caution. I think if I was in the same situation again, and I was a senior physio taking charge, I would definitely make a MET call even if the situation did not seem serious enough to warrant one. We have a duty of care to our patients, and I would rather get in trouble for making a MET call when it was not indicated than for harm to be caused to a patient after neglecting to do so. I would hope that the response was more rapid and organised than the shambles I witnessed today though!
Anyone else had a MET call/code blue called on a patient??
The patients’ seizure lasted almost four minutes, during which he was conscious and talking. Once the seizure had subsided he continued to lie on the floor while we attended to the cut on his head, checked his pulse, and asked him what had happened The patient reported that his arm began “shaking” before he went into a full body fit causing him to fall off the plinth he was sitting on, onto the floor. He seemed quite calm and was making jokes and apologising for causing a scene. The patient was being treated in neurology outpatients for a stroke he had in January, from which he was making a good recovery. He had no past history of seizures or epilepsy. The MET took almost 10 minutes to arrive; they couldn’t find the location of neurology physio outpatients despite being given a clear description of the location. When they did arrive they turned up without the MET trolley, and no one seemed to be taking charge. Thankfully this event did not turn out to be serious enough to warrant a MET call; however I still found their response time, professionalism, and general organisation disgraceful.
This event was very confronting, particularly on initially finding the patient on the floor. The situation did not seem so serious upon seeing the patient conscious and talking during the seizure, but it was shocking nonetheless. After all the drama had finished and the patient had been taken away on a stretcher, our supervisor made the point that he was debating whether or not to call a MET call (the other option would have been to call the neuro ward and get a doctor to attend), but erred on the side of caution. I think if I was in the same situation again, and I was a senior physio taking charge, I would definitely make a MET call even if the situation did not seem serious enough to warrant one. We have a duty of care to our patients, and I would rather get in trouble for making a MET call when it was not indicated than for harm to be caused to a patient after neglecting to do so. I would hope that the response was more rapid and organised than the shambles I witnessed today though!
Anyone else had a MET call/code blue called on a patient??
Monday, October 27, 2008
Expanding Communication Skills
Hey guys
It is clear from reading these blogs that there have been many lessons learned by each of us this year. The biggest lesson I have learnt this year, by far, has been the importance of developing strong communication skills. In my opinion, you could be the smartest student in your year, but this will not necessarily translate to being a good physio without good communication skills.
Communicating with patients has always come very naturally to me, while the academic side probably hasn’t! In most of my placements my supervisors have noted that one of my greatest strengths is building rapport with patients. However there has been two placements in particular that I have found harder than the others, and these placements have highlighted to me that perhaps my communication skills aren’t as good as I thought they were. These two placements have been in paediatrics and neurology. These placements were more difficult to me because my greatest strength, rapport building, was taken away from me.
In paediatrics I felt just a little uncomfortable when it came to communicating with infants. I had no problem with handling these children, or knowing how I was going to treat them, but I felt extremely silly talking in a baby voice and singing! Building rapport with primary school aged children was fine because I could have a conversation with them and play games. As a result, my treatment of these infants was often ineffective because I did not engage them, and they were therefore less inclined to stay still for any length of time. In neurology, my current placement, I have also found that I need to expand upon the ways in which I communicate. Many of you will know how hard it can be to have a conversation with a dysphasic stroke patient, and not having any neuro exposure before has meant that I have found this quite difficult. This has sometimes been to the detriment of treatment effectiveness as I have been unable to describe to the patient exactly what it is I want them to do.
The point of this blog (or the take home message if I were Tom Briffa) is that you can’t use the exact same method of communication for every single patient you see. It is important to develop good communication skills (both verbal and non verbal) for different age groups, different racial backgrounds, for those who can’t speak English, and for those with dysphasia, to name a few. Like most things, this is developed with experience and exposure to these types of patients, and I have since learnt to use different strategies to communicate with these patients (including singing! Poor kids).
It is clear from reading these blogs that there have been many lessons learned by each of us this year. The biggest lesson I have learnt this year, by far, has been the importance of developing strong communication skills. In my opinion, you could be the smartest student in your year, but this will not necessarily translate to being a good physio without good communication skills.
Communicating with patients has always come very naturally to me, while the academic side probably hasn’t! In most of my placements my supervisors have noted that one of my greatest strengths is building rapport with patients. However there has been two placements in particular that I have found harder than the others, and these placements have highlighted to me that perhaps my communication skills aren’t as good as I thought they were. These two placements have been in paediatrics and neurology. These placements were more difficult to me because my greatest strength, rapport building, was taken away from me.
In paediatrics I felt just a little uncomfortable when it came to communicating with infants. I had no problem with handling these children, or knowing how I was going to treat them, but I felt extremely silly talking in a baby voice and singing! Building rapport with primary school aged children was fine because I could have a conversation with them and play games. As a result, my treatment of these infants was often ineffective because I did not engage them, and they were therefore less inclined to stay still for any length of time. In neurology, my current placement, I have also found that I need to expand upon the ways in which I communicate. Many of you will know how hard it can be to have a conversation with a dysphasic stroke patient, and not having any neuro exposure before has meant that I have found this quite difficult. This has sometimes been to the detriment of treatment effectiveness as I have been unable to describe to the patient exactly what it is I want them to do.
The point of this blog (or the take home message if I were Tom Briffa) is that you can’t use the exact same method of communication for every single patient you see. It is important to develop good communication skills (both verbal and non verbal) for different age groups, different racial backgrounds, for those who can’t speak English, and for those with dysphasia, to name a few. Like most things, this is developed with experience and exposure to these types of patients, and I have since learnt to use different strategies to communicate with these patients (including singing! Poor kids).
Understanding other disciplines
Hey guys, I got back from my rural prac about two weeks ago, which I was lucky enough to do in India through the OT school. There were 10 students that went, myself, four OT’s, 3 speechies and 2 pharmacy students. We worked for about 4 and half weeks at an orphanage/institute for children and adults who had some form of disability or mental illness or may be developmentally normal but orphaned. It was an incredible experience and one I’ll never forget.
One thing I noticed whilst I was over there was how little knowledge both myself and the others had on what each other’s professions actually do. We always talk about working within a team and how important the multi-disciplinary team is. We do learn and experience this to a certain extent this year on prac, but as we all know every prac is different and some may get this experience more than others. It shocked me when one of the speech therapy students, for whom India was her final placement, expressed that she didn’t really know what physiotherapists did. I also realised that I didn’t really understand exactly what speech pathologists did, or the exact role that pharmacists play in the hospital. I felt like I had a bit better an understanding of OT, but even then whilst over there I learnt more about other areas they work in, for example working with children with autism and social interaction and sensory integration. My only interaction with SP this year has been on my neuro prac, so I thought they were all about swallowing, but they also do a lot of work in other areas, like social interaction, encouraging turn-taking and communication.
I realise now how important it is to know the exact role of each person within the multi-disciplinary team and how this really values the patient. The students I went to India with, including the pharmacy students now have a better idea of when it might be important to refer to a physio. One of the pharmacy students even made a comment that if someone with a certain condition comes into their pharmacy now they know that they can refer them to a physiotherapist. I am also much more aware now of the role of the other health professionals and am much more confident that I can recognise when i might need to involve the SP or OT or even the pharmacist in the treatment of a patient, which I feel will enhance the care the patients receive.
One thing I noticed whilst I was over there was how little knowledge both myself and the others had on what each other’s professions actually do. We always talk about working within a team and how important the multi-disciplinary team is. We do learn and experience this to a certain extent this year on prac, but as we all know every prac is different and some may get this experience more than others. It shocked me when one of the speech therapy students, for whom India was her final placement, expressed that she didn’t really know what physiotherapists did. I also realised that I didn’t really understand exactly what speech pathologists did, or the exact role that pharmacists play in the hospital. I felt like I had a bit better an understanding of OT, but even then whilst over there I learnt more about other areas they work in, for example working with children with autism and social interaction and sensory integration. My only interaction with SP this year has been on my neuro prac, so I thought they were all about swallowing, but they also do a lot of work in other areas, like social interaction, encouraging turn-taking and communication.
I realise now how important it is to know the exact role of each person within the multi-disciplinary team and how this really values the patient. The students I went to India with, including the pharmacy students now have a better idea of when it might be important to refer to a physio. One of the pharmacy students even made a comment that if someone with a certain condition comes into their pharmacy now they know that they can refer them to a physiotherapist. I am also much more aware now of the role of the other health professionals and am much more confident that I can recognise when i might need to involve the SP or OT or even the pharmacist in the treatment of a patient, which I feel will enhance the care the patients receive.
Saturday, October 25, 2008
Rural placement
Hi guys, sorry for the late entry because I have just came back from my rural placement, as if I have disappeared from the cyber network. Anyway, I would like to share my experiences I earned during my rural placement.
First of all, my rural placement was really enjoyable and rewarding. I mainly did outpatient so that MS outpatient and class works were something that I need to handle in a regular basis. It was my second time to do MS outpatient apart from the actual MS outpatient placement. In comparison to the actual one, I found the true enjoyment of MS outpatient in my rural placement. I used to dislike outpatient because of my poor clinical reasoning and manual handling skills and lack of degree of freedom. During my rural, my feeling towards MS outpatient was vastly different from what I found previously. The facility allowed much more degree of freedom in treatment options that gave me a good training ground to practice and consolidate my knowledge and skills. In addition, there was a wide range of patients’ condition in the rural, and I have treated almost every major joint as compared to the knee joint I mostly treated in my actual MS placement.
In addition to the MS outpatient, I involved in different classes (plum, cardiac, hydro, chronic disease, community class rehab) as well. Those classes sharpened my communication and instruction as well as exercise ideas in different levels of clients.
Therefore, the rural placement was my favorite placement throughout this year as I can truly apply my knowledge into a real practice.
First of all, my rural placement was really enjoyable and rewarding. I mainly did outpatient so that MS outpatient and class works were something that I need to handle in a regular basis. It was my second time to do MS outpatient apart from the actual MS outpatient placement. In comparison to the actual one, I found the true enjoyment of MS outpatient in my rural placement. I used to dislike outpatient because of my poor clinical reasoning and manual handling skills and lack of degree of freedom. During my rural, my feeling towards MS outpatient was vastly different from what I found previously. The facility allowed much more degree of freedom in treatment options that gave me a good training ground to practice and consolidate my knowledge and skills. In addition, there was a wide range of patients’ condition in the rural, and I have treated almost every major joint as compared to the knee joint I mostly treated in my actual MS placement.
In addition to the MS outpatient, I involved in different classes (plum, cardiac, hydro, chronic disease, community class rehab) as well. Those classes sharpened my communication and instruction as well as exercise ideas in different levels of clients.
Therefore, the rural placement was my favorite placement throughout this year as I can truly apply my knowledge into a real practice.
Friday, October 24, 2008
Womens Health 1 Cultural differences
I am currently completing my women’s health placement, focusing largely on inpatient obstetrics, so… post-natal, mostly. My newfound… “insight” this week pertains to the conversations that go on during the lunch breaks in the staff room. The sorts of informal conversations, as per usual, revolve around patients’ cases, situations, social circumstances, decisions etc. Some of the comments that had been flying around made me stop and think for a bit.
One physio was explaining the case: “She had a vaginal delivery, one Caesar, 3… 4… maybe 5 more vaginal deliveries, then this recent one was a Caesar”. In case you’re lost, that means she has 8 kids. At which point most people in the room gasped (which I’m sure you all are too, and which is not too surprising). But then the myriad of comments flying around were along the lines of “You’d think she’d learn after the first 2!” This reaction made me stop, because I found it a little… judgmental? I’m sure they were meant in light humour, and I personally wasn’t that offended but I realised that this reaction wouldn’t be a common one if the conversation was amongst my family, or in my country. I am the oldest of 5 girls, and we actually have one of the smallest families in my extended family. My mother is one of 9. I guess my point is we see nothing “wrong” with large families, and this is largely a culturally different attitude.
Another example from this week revolved around a young patient, a 17 yr old woman who had just given birth to a baby girl, and who she had decided to give up for adoption. The conversation between one staff member and I was regarding this choice. One comment was “Wouldn’t it be easier at that age to just end the pregnancy? Especially if she was going to give it away anyway. Surely that’s the easiest thing.” This one made me stop again… I replied “maybe she’s catholic”, and felt this was dismissed as a “silly” reason. Other than that, I think it pays to remember how hard this situation is for a 17 yr old, who not only has to face the social stigma of an unwanted pregnancy, who may find it hard to tell people, before having to make the decision of what to do with it…. I found that comment unnecessarily judgmental.
Those examples made me reflect on the differences in values present in such a place as a physiotherapy staff room. This is no doubt more likely to surface in a hospital caring for patients with a range of highly sensitive cultural and personal issues. But they made me ponder on the power of how comments we make, driven by our cultural and personal values, have the potential to offend people who hold different values to our own. They risk appearing judgemental, insensitive and… arrogantly western, quite frankly. Of course, this can happen anywhere but I guess I was surprised that I saw it happen so readily in a professional environment. These reflections made me more aware of the importance of my showing respect for others’ cultural differences in professional settings.
One physio was explaining the case: “She had a vaginal delivery, one Caesar, 3… 4… maybe 5 more vaginal deliveries, then this recent one was a Caesar”. In case you’re lost, that means she has 8 kids. At which point most people in the room gasped (which I’m sure you all are too, and which is not too surprising). But then the myriad of comments flying around were along the lines of “You’d think she’d learn after the first 2!” This reaction made me stop, because I found it a little… judgmental? I’m sure they were meant in light humour, and I personally wasn’t that offended but I realised that this reaction wouldn’t be a common one if the conversation was amongst my family, or in my country. I am the oldest of 5 girls, and we actually have one of the smallest families in my extended family. My mother is one of 9. I guess my point is we see nothing “wrong” with large families, and this is largely a culturally different attitude.
Another example from this week revolved around a young patient, a 17 yr old woman who had just given birth to a baby girl, and who she had decided to give up for adoption. The conversation between one staff member and I was regarding this choice. One comment was “Wouldn’t it be easier at that age to just end the pregnancy? Especially if she was going to give it away anyway. Surely that’s the easiest thing.” This one made me stop again… I replied “maybe she’s catholic”, and felt this was dismissed as a “silly” reason. Other than that, I think it pays to remember how hard this situation is for a 17 yr old, who not only has to face the social stigma of an unwanted pregnancy, who may find it hard to tell people, before having to make the decision of what to do with it…. I found that comment unnecessarily judgmental.
Those examples made me reflect on the differences in values present in such a place as a physiotherapy staff room. This is no doubt more likely to surface in a hospital caring for patients with a range of highly sensitive cultural and personal issues. But they made me ponder on the power of how comments we make, driven by our cultural and personal values, have the potential to offend people who hold different values to our own. They risk appearing judgemental, insensitive and… arrogantly western, quite frankly. Of course, this can happen anywhere but I guess I was surprised that I saw it happen so readily in a professional environment. These reflections made me more aware of the importance of my showing respect for others’ cultural differences in professional settings.
Monday, October 20, 2008
Rural 1 Friday afternoon panic
I thought I’d share with you a situation that occurred on a medical ward that, to me, really hit home the importance of interdisciplinary approach and good communication, as well as respect for others’ medical opinion. The patient was an elderly gentleman who was day 7 post a dynamic hip screw as he had sustained a NOF fracture due to a fall. He had also developed mild post-op complications which had resolved but left him weak.
He lived at home alone. He did not receive any home services but had 2 supportive grand-neices. They held strong values against the idea of nursing home or hostel care and they were to help with all ADLs. However, one of them had very recently undergone abdominal surgery. As it was, he was 2 mod assist for transfers and ADLs, and he suffered from dementia and was often very confused. However, his medical condition was stable, so the medical team was pushing for discharge.
Wednesday, the social worker had started an ACAT and had entered in the notes that there were a few home services she deemed appropriate that she couldn’t get organized before the following Wednesday. Thursday, the physio (my supervisor) had entered in the notes his mobility status and had written “not at pre-admission level”. Friday, this patient is on my list, and (very unfortunately for me) I get around to him at around 3.30pm. An entry for Friday from the medical team says amongst other things “For physio mobility r/v” and “planned for discharge Saturday”. I go to do this mobility r/v but the drowsy and confused patient refuses treatment. I turned to my supervisor for help. The medical team had somewhat put her in the awkward position of asking for her medical opinion of his mobility status, even though her entry of the previous day said “not at pre-admission level”, while at the same time pushing for discharge the following day. And the patient wasn’t cooperating. At 4.00pm on Friday. My supervisor and the social worker are a little concerned at this stage about discharging this patient, who was 2 mod assist, didn’t yet have home equipment, and had a carer who had just undergone abdominal surgery. Paging the medical team at what is now close to 5pm on Friday is fruitless. It turns out that the social worker knew of the medical team’s impending discharge as early as Wednesday and had tried to page them on Wednesday, again with no reply.
The eventual outcome was really… not much. Both the social worker and the physio documented that they had tried to page the medical team, but had received no response. The physio also documented that the patient was drowsy, confused, had refused physio and was not at pre-admission level. On Monday, we found that he was indeed discharged on Saturday, and I really have no idea whether this family coped or not.
I reflected on this situation searching for some ideas on what any of us could have done better. It was very unfortunate that I got around to this patient so late. If I had gotten to this patient sooner in the day, I’d like to think that the medical team may still have been contactable. I’ve since learned to try my best to read all the notes in the morning, talk to the nursing coordinator, and prioritise my day’s load. Since doing that, I’ve managed to avoid another sticky situation. I think sometimes it’s difficult as a student because your presence is not really noticed as much as the physio, and the nursing coordinator may not keep you in the loop as he/she may (or may not) have done with the physio. I’ve learned to talk more to nurses, doctors etc, and they’ve responded well, including me in latest developments by word of mouth, rather than my finding out through notes.
He lived at home alone. He did not receive any home services but had 2 supportive grand-neices. They held strong values against the idea of nursing home or hostel care and they were to help with all ADLs. However, one of them had very recently undergone abdominal surgery. As it was, he was 2 mod assist for transfers and ADLs, and he suffered from dementia and was often very confused. However, his medical condition was stable, so the medical team was pushing for discharge.
Wednesday, the social worker had started an ACAT and had entered in the notes that there were a few home services she deemed appropriate that she couldn’t get organized before the following Wednesday. Thursday, the physio (my supervisor) had entered in the notes his mobility status and had written “not at pre-admission level”. Friday, this patient is on my list, and (very unfortunately for me) I get around to him at around 3.30pm. An entry for Friday from the medical team says amongst other things “For physio mobility r/v” and “planned for discharge Saturday”. I go to do this mobility r/v but the drowsy and confused patient refuses treatment. I turned to my supervisor for help. The medical team had somewhat put her in the awkward position of asking for her medical opinion of his mobility status, even though her entry of the previous day said “not at pre-admission level”, while at the same time pushing for discharge the following day. And the patient wasn’t cooperating. At 4.00pm on Friday. My supervisor and the social worker are a little concerned at this stage about discharging this patient, who was 2 mod assist, didn’t yet have home equipment, and had a carer who had just undergone abdominal surgery. Paging the medical team at what is now close to 5pm on Friday is fruitless. It turns out that the social worker knew of the medical team’s impending discharge as early as Wednesday and had tried to page them on Wednesday, again with no reply.
The eventual outcome was really… not much. Both the social worker and the physio documented that they had tried to page the medical team, but had received no response. The physio also documented that the patient was drowsy, confused, had refused physio and was not at pre-admission level. On Monday, we found that he was indeed discharged on Saturday, and I really have no idea whether this family coped or not.
I reflected on this situation searching for some ideas on what any of us could have done better. It was very unfortunate that I got around to this patient so late. If I had gotten to this patient sooner in the day, I’d like to think that the medical team may still have been contactable. I’ve since learned to try my best to read all the notes in the morning, talk to the nursing coordinator, and prioritise my day’s load. Since doing that, I’ve managed to avoid another sticky situation. I think sometimes it’s difficult as a student because your presence is not really noticed as much as the physio, and the nursing coordinator may not keep you in the loop as he/she may (or may not) have done with the physio. I’ve learned to talk more to nurses, doctors etc, and they’ve responded well, including me in latest developments by word of mouth, rather than my finding out through notes.
Musc 4 Harsh Criticism
First of all, I have to apologise to my fellow students and Peter G for the lack of blogs throughout both semesters. As my final blog for my musculo placement, I thought I’d try and reflect on my biggest learning experience so far this year. This has taken me most of the year to think back upon, digest and finally accept it in a way I can discuss it, hence why it is so late. I really underwent a hard time with my supervisor. I wouldn’t even call it a personality clash, simply a learning style clash. With a lot of other external factors in the mix, for sure. I’ve discussed some of the difficulties I’ve had on this placement in a previous blog.
Firstly, I think the first impression my fellow student and I made on him may have had something to do with it. Maybe he’s just not down with 2 outgoing, cheerful girls, and we may have seemed like airheads to him. The prac unfolded such that both the other student and I felt we were on the receiving end of some slightly hurtful remarks and eye-rolling to our apparent lack of knowledge.
My frustration developed further by other factors such as the very structure of the placement. Time, or lack thereof, was a MASSIVE issue. With so many patients being seen and very little time to reflect on anything learned, or NOT properly learned, blogging became a real nightmare. The 4 to 1 student:supervisor ratio felt very restrictive. I felt like I wasn’t given the support I required for my learning. I fully admit that I was confused a lot of the time (from a musculo knowledge point of view) and have discovered I’m actually not the strong musculo student I thought I was. I felt like reflection was impossible.
At my final Ax with him, I was told that my first week was disastrous and that I looked like I hadn’t studied at all for the prac. I was left feeling really angered at this. First of all, if anyone knows me: so not true. Admittedly, I may not be a strong student and I do think on reflection that I hadn’t prepared the RIGHT things. But I prepared as I thought was necessary and it wasn’t for lack of trying. But really the issue for me was: what does one gain from telling a student that?? I wasn’t left inspired to “redeem” myself and study my butt off. HE doesn’t even really win anything by telling me that.
What I learned from this? Unfortunately, not all the positive ending we all hope for. I walked away from my musculo placement with overwhelming relief that it was over, a massive sense of incompetence in musculoskeletal physiotherapy and a whopping blow to the self-esteem. I guess one positive thing I took away from the experience was my need to work on dealing with tough situations and not get put down by comments at times when I feel frustrated. I wholeheartedly wish I could undergo my musculo placement with this insight and be left with a more positive perspective of musculo. My reduced self-confidence in dealing with supervisors is apparent and has been remarked upon by my current supervisor. As she quite rightly brought up, people are going to be more than happy to criticize us along our career, and sometimes it will feel unfair or not very insightful. I’m glad I had this early exposure to it, and can learn to not let it affect me so much once I’m a graduate.
Firstly, I think the first impression my fellow student and I made on him may have had something to do with it. Maybe he’s just not down with 2 outgoing, cheerful girls, and we may have seemed like airheads to him. The prac unfolded such that both the other student and I felt we were on the receiving end of some slightly hurtful remarks and eye-rolling to our apparent lack of knowledge.
My frustration developed further by other factors such as the very structure of the placement. Time, or lack thereof, was a MASSIVE issue. With so many patients being seen and very little time to reflect on anything learned, or NOT properly learned, blogging became a real nightmare. The 4 to 1 student:supervisor ratio felt very restrictive. I felt like I wasn’t given the support I required for my learning. I fully admit that I was confused a lot of the time (from a musculo knowledge point of view) and have discovered I’m actually not the strong musculo student I thought I was. I felt like reflection was impossible.
At my final Ax with him, I was told that my first week was disastrous and that I looked like I hadn’t studied at all for the prac. I was left feeling really angered at this. First of all, if anyone knows me: so not true. Admittedly, I may not be a strong student and I do think on reflection that I hadn’t prepared the RIGHT things. But I prepared as I thought was necessary and it wasn’t for lack of trying. But really the issue for me was: what does one gain from telling a student that?? I wasn’t left inspired to “redeem” myself and study my butt off. HE doesn’t even really win anything by telling me that.
What I learned from this? Unfortunately, not all the positive ending we all hope for. I walked away from my musculo placement with overwhelming relief that it was over, a massive sense of incompetence in musculoskeletal physiotherapy and a whopping blow to the self-esteem. I guess one positive thing I took away from the experience was my need to work on dealing with tough situations and not get put down by comments at times when I feel frustrated. I wholeheartedly wish I could undergo my musculo placement with this insight and be left with a more positive perspective of musculo. My reduced self-confidence in dealing with supervisors is apparent and has been remarked upon by my current supervisor. As she quite rightly brought up, people are going to be more than happy to criticize us along our career, and sometimes it will feel unfair or not very insightful. I’m glad I had this early exposure to it, and can learn to not let it affect me so much once I’m a graduate.
Musc 3 The importance of picking up at the right place
One of the initial difficulties I found on my musculo placement was picking up patients who were handed over to me. This related to my ability to read someone else’s notes and develop a good picture of where a patient is at. I found that quite difficult, and I would go in and assess quite a few things until I understood what was going on and where the patient was at. This would then leave me very little time to do any treatment, and invariably what suffered was my checking that they were doing their HEP correctly, and progressing it as necessary.
Looking back, I can think of one particular patient whose treatment suffered because of this. She is a 41 yr old woman who presented with knee pain. A thorough Ax revealed that she was very deconditioned in lower limb muscle groups, particularly gluts, had some mild joint hypermobility, and poor muscular control of loaded joints. I hypothesized that this contributed to poor lower limb biomechanics, and as such her treatment consisted of strengthening and gait retraining. This woman also had some cognitive difficulties, the nature of which I am not too sure. Basically, she presented with very poor body awareness, very poor memory and performance of her exercises, poor insight in how strengthening would help her, and poor motivation to do her HEP or apply ice as required. She displayed quite strong catastrophising behaviours, and would report 10/10 pain with everything.
Now, as obvious as it may seem now, I was so focused on working out for myself the cause of her knee pain, that I overlooked that this had really already been worked out by the previous student. Although it doesn’t quite state “patellofemoral syndrome” anywhere in the notes, my clinical reasoning skills should have been sufficient to put the clues together when reading through the notes.
On reflecting back, I saw how I essentially wasted my AND her time because I hadn’t spent enough time reading the notes. I learned through this experience to actively read the notes to really create an image in my head of the patient and the condition before even walking into the cubicle. I also focused on developing my assessment skills to target the specific things the notes suggested to be important, rather than assessing everything under the sun. Thankfully, when I saw a few patients the Ax becomes quicker and I developed more efficiency. But this taught me a lesson to trust the previous therapist’s thinking a bit more, and I applied this to the subsequent patients on my placement. This has also taught me to make sure I am clear in MY notes, to make the next person’s job of picking up after me easier. So a word of advice, please be kind to the people following your place!!
Sunday, October 19, 2008
Differences of opinion
On my pediatrics placement I was supervised by three different physiotherapists, spending varying amounts of time with each depending on their schedules. I initially thought this would be a great learning opportunity, and while it was, it was also very difficult because each physiotherapist approached their job in a different manner.
At Curtin we are taught to assess, treat and document in a certain way in each clinical area. On the first day of this particular placement I assessed, treated and documented in the way that we were taught, and was criticised by my supervisor (physio 1) for certain aspects of what I had done. The fact that my supervisor had criticised me did not bother me at all, after all I was there to learn and gain more clinical experience. The next day I was with a different physio (physio 2), and seeing the same patient as the previous day, I took the advice of physio 1 and adjusted my treatment accordingly. Once again I was criticised for certain aspects of the session, however the points of criticism were different than before, and some conflicted with those of physio 1. A similar pattern continued over the next couple of days until I had a firm grasp of what each physio expected and preferred, and from that point I adjusted my approach to suit each supervisor. The differences between the approaches of each supervisor were minor, however they were all quite set in their ways and it was therefore in my best interest to conform to these rather than argue.
My placement did turn out to be a great learning experience, more so for the fact that I learnt how to approach the same thing in different ways. What I did in those treatment sessions was not necessarily wrong, however each of my supervisors had different opinions of what was right. I believe the difference in their opinions was based not only on the fact that they were of different ages and studied in different places, but also that they had found that certain things work for them from past experience. I now realise that what works for one person, may not work for another, and while we have been taught to do something a certain way, there is no reason why you can’t do it differently provided you follow the basic principles.
At Curtin we are taught to assess, treat and document in a certain way in each clinical area. On the first day of this particular placement I assessed, treated and documented in the way that we were taught, and was criticised by my supervisor (physio 1) for certain aspects of what I had done. The fact that my supervisor had criticised me did not bother me at all, after all I was there to learn and gain more clinical experience. The next day I was with a different physio (physio 2), and seeing the same patient as the previous day, I took the advice of physio 1 and adjusted my treatment accordingly. Once again I was criticised for certain aspects of the session, however the points of criticism were different than before, and some conflicted with those of physio 1. A similar pattern continued over the next couple of days until I had a firm grasp of what each physio expected and preferred, and from that point I adjusted my approach to suit each supervisor. The differences between the approaches of each supervisor were minor, however they were all quite set in their ways and it was therefore in my best interest to conform to these rather than argue.
My placement did turn out to be a great learning experience, more so for the fact that I learnt how to approach the same thing in different ways. What I did in those treatment sessions was not necessarily wrong, however each of my supervisors had different opinions of what was right. I believe the difference in their opinions was based not only on the fact that they were of different ages and studied in different places, but also that they had found that certain things work for them from past experience. I now realise that what works for one person, may not work for another, and while we have been taught to do something a certain way, there is no reason why you can’t do it differently provided you follow the basic principles.
Tuesday, October 14, 2008
Learning Opportunities
Hey guys
Sorry i just wanted to finish my blogs off for the year so im posting this early. Through out the year, there have been pracs which i look back on now and just cant help but think that i didnt make the most of them when i was there. I think at different points in the year i lacked some motivation or was just feeling burnt out and didnt extend myself as much as i could have. Sometimes this was the case of not having the opportunities available and quite frankly not asking for them on my behalf either.
I am currently on my rural prac at the moment and i absolutley love it. Every day the effort is made to teach us something and anything i want to learn whilst i am there i can do i just have to ask. The orthopaedic senior will give us tutorials whenever we ask on any joint, has taught us heaps of mulligans and mckenzie techniques and stuff, plus im on inpatients but i prefer outpatients so ive been allowed to spend extra time in OP if i ask, if i want to do more community trips im allowed. Basically i just find it so much more relaxed, before i was worried i would look like a pain if i asked to try different things, now i realized instead of just waiting and hoping the learning opportunities will be presented to you, that sometimes you have to go out and seek them yourself. I have found that the pracs that i have made the effort to really extend myself, i have enjoyed much more as i have not been getting bored from just doing the same thing, or feeling im not learning that much. Which at times has left me quite frustrated.
I think this is the perfect time to try and learn other things were not taught at uni and expand our knowledge as much as we can. It is much easier to give new things a go when there are other people around to give you feedback and tell you how to improve what you are doing. So I guess if anyone has a proper prac left rather than SDP, try and make the most of it and see as many different things as you can and just take responsibility for your own learning, because i think you get a far better feeling of accomplishment for it.
Good luck with the rest of your placements
Sorry i just wanted to finish my blogs off for the year so im posting this early. Through out the year, there have been pracs which i look back on now and just cant help but think that i didnt make the most of them when i was there. I think at different points in the year i lacked some motivation or was just feeling burnt out and didnt extend myself as much as i could have. Sometimes this was the case of not having the opportunities available and quite frankly not asking for them on my behalf either.
I am currently on my rural prac at the moment and i absolutley love it. Every day the effort is made to teach us something and anything i want to learn whilst i am there i can do i just have to ask. The orthopaedic senior will give us tutorials whenever we ask on any joint, has taught us heaps of mulligans and mckenzie techniques and stuff, plus im on inpatients but i prefer outpatients so ive been allowed to spend extra time in OP if i ask, if i want to do more community trips im allowed. Basically i just find it so much more relaxed, before i was worried i would look like a pain if i asked to try different things, now i realized instead of just waiting and hoping the learning opportunities will be presented to you, that sometimes you have to go out and seek them yourself. I have found that the pracs that i have made the effort to really extend myself, i have enjoyed much more as i have not been getting bored from just doing the same thing, or feeling im not learning that much. Which at times has left me quite frustrated.
I think this is the perfect time to try and learn other things were not taught at uni and expand our knowledge as much as we can. It is much easier to give new things a go when there are other people around to give you feedback and tell you how to improve what you are doing. So I guess if anyone has a proper prac left rather than SDP, try and make the most of it and see as many different things as you can and just take responsibility for your own learning, because i think you get a far better feeling of accomplishment for it.
Good luck with the rest of your placements
Monday, October 13, 2008
Documentation
During one of earlier my placements I came under scrutiny for my documentation in the integrated notes. I was a little confused as I was still using the SOAPIER format but I was just missing out the A and the P, as this tended to be just a rewritten list of the above assessment. The other physio’s had written even briefer entries tending to write only the most essential things and often taking up less than 4 lines ( I was taking up about ¾ of a page). I discussed this with the supervisors and agreed to write out full SOAPIERs for every patient to further my understanding of the patients problems, my entries were now well over a page.
During subsequent placements I managed to shorten the length to about ¾ for a new patient and about half a page for continual patients. I dropped the A and P and focussed on the other areas.
I was still writing more than most physios and it made me wonder if I was writing too much. I talked to a couple of physio’s about this and they had differing opinions. Some would say that it would always be better to write too much than not enough, while others would say that you should write the bare essentials as doctors, nurses etc often get annoyed at having such thick files for patients integrated notes.
This made me think and reflect on not only my own notes but what the purpose of writing integrated notes was. Surely we need to describe our assessment we have performed and the treatment we have carried out not only for legal reasons but to enable other health professionals to gain a greater understanding of just exactly what we are doing and have done with the patient. Giving a 4 line entry not only gives false impressions as to what we are doing with the patients but undermines our role as it portrays a simplistic and seemingly unnecessary treatment. This situation made me realise that we need to be thorough with our documentation to ensure our continued role in the health profession as well as to ensure the safety of the patient.
During subsequent placements I managed to shorten the length to about ¾ for a new patient and about half a page for continual patients. I dropped the A and P and focussed on the other areas.
I was still writing more than most physios and it made me wonder if I was writing too much. I talked to a couple of physio’s about this and they had differing opinions. Some would say that it would always be better to write too much than not enough, while others would say that you should write the bare essentials as doctors, nurses etc often get annoyed at having such thick files for patients integrated notes.
This made me think and reflect on not only my own notes but what the purpose of writing integrated notes was. Surely we need to describe our assessment we have performed and the treatment we have carried out not only for legal reasons but to enable other health professionals to gain a greater understanding of just exactly what we are doing and have done with the patient. Giving a 4 line entry not only gives false impressions as to what we are doing with the patients but undermines our role as it portrays a simplistic and seemingly unnecessary treatment. This situation made me realise that we need to be thorough with our documentation to ensure our continued role in the health profession as well as to ensure the safety of the patient.
The anxious patient
Hey guys! My apologies, I owe you multiple blogs…
Supervision & Independence
My neuro placement was quite an interesting one. The hospital I attended did not have a specific neuro ward and instead was to be move and see neuro patients all around hospital. In addition to this I didn’t have a set supervisor, instead I was to report to the physio on the ward I was currently treating a patient on.
Initially it was quite disorientating, as I was constantly changing wards and supervisors. But eventually as with most placements you become accustomed to the routine and the structure. Due to the fact that I was on many wards and had many different supervisors it was often unfeasible to have a supervisor present with every patient. Although it was made clear that if I needed help or was unsure of something with a patient I was to come and get the supervisor on that ward, it was often hard to gain feedback on how I progressing on my handle skills and alternate treatment methods that I could employ with different patients.
Although this situation gave me independence and lead me to develop my organisational skills it left me a little unfulfilled as I felt I was learning as much as I could. I spoke to my curtin tutor about this and she suggested that I try and get at least one supervisor to see me with a patient at least once a day. I tried this but realised that it was unrealistic to get seen everyday, so I managed to get seen a couple of times a week by a supervisor. This initially worked well as I picked up a few incidental things that helped me to deliver a better treatment and assessment, but I still felt that it wasn’t enough. So I asked specific supervisors if I could observe them with some of their patients, and arranged times that I could have a chat to supervisors about patients regarding possible alternative treatment methods. This turned out quite well, enabling me to get a few different perspectives on treating similar patients.
Reflecting back on this placement I think I got the best of both worlds, by developing my independence (and finally feeling like a real physio) as well as still having that support there to be accessed (with some organisation on my part-which was also a learning experience) if needed. I think often we are “spoon fed” a little bit as a physio students by being told how to do everything with step by step instructions that often leave little room for creativity which can stifle us in the long run. With that in mind I think it is important to develop a little bit of independence while still keeping the training wheels on.
Initially it was quite disorientating, as I was constantly changing wards and supervisors. But eventually as with most placements you become accustomed to the routine and the structure. Due to the fact that I was on many wards and had many different supervisors it was often unfeasible to have a supervisor present with every patient. Although it was made clear that if I needed help or was unsure of something with a patient I was to come and get the supervisor on that ward, it was often hard to gain feedback on how I progressing on my handle skills and alternate treatment methods that I could employ with different patients.
Although this situation gave me independence and lead me to develop my organisational skills it left me a little unfulfilled as I felt I was learning as much as I could. I spoke to my curtin tutor about this and she suggested that I try and get at least one supervisor to see me with a patient at least once a day. I tried this but realised that it was unrealistic to get seen everyday, so I managed to get seen a couple of times a week by a supervisor. This initially worked well as I picked up a few incidental things that helped me to deliver a better treatment and assessment, but I still felt that it wasn’t enough. So I asked specific supervisors if I could observe them with some of their patients, and arranged times that I could have a chat to supervisors about patients regarding possible alternative treatment methods. This turned out quite well, enabling me to get a few different perspectives on treating similar patients.
Reflecting back on this placement I think I got the best of both worlds, by developing my independence (and finally feeling like a real physio) as well as still having that support there to be accessed (with some organisation on my part-which was also a learning experience) if needed. I think often we are “spoon fed” a little bit as a physio students by being told how to do everything with step by step instructions that often leave little room for creativity which can stifle us in the long run. With that in mind I think it is important to develop a little bit of independence while still keeping the training wheels on.
Sunday, October 12, 2008
Rest Time
Hi guys
Where i am currently on prac, there is a 3 hour rest period for patients, which runs between 12&3. We get lunch during 12-1, however when we come back from lunch all the lights are still switched off on the wards. It is impossible however to get through a very full caseload if we abide this time and therefore the rest time is only intended as no visitors are allowed. The other day i went to go and treat a patient, and a nurse was quite aggressive with me she told me i couldnt see any patients till 3 oclock and that it was rest time.
I tried explaining to her that to get through a full caseload we cannot just not see people for 2 hrs, however she kept being stern with me and so i went and sat down for about an hour and a half and tried to use my time effectively doing paper work etc.
I ended up finishing half an hour late that day as i didnt see any one during that 2 hours. The next day i told my supervisor about the situation as i was quite angry i finished late, and i was quite sure we were allowed to see patients during rest time. She had been told the same thing by a fellow nurse a week earlier.
The physiotherapy department was very upset with this and sent one of the seniors up, to speak with the nursing coordinator, who was very angry at the staff that had told us this, another message was sent out to all nursing staff that we were allowed to see people in rest time, and i was told if anyone else tried to tell me that whilst i was there to come and tell them immediatley.
This situation again has just shown to seek out help if there is a situation you cant deal with. I didnt want to start an argument with the nurse and being a student didnt feel like i had much authority and didnt want to get offside with the nurse.
Where i am currently on prac, there is a 3 hour rest period for patients, which runs between 12&3. We get lunch during 12-1, however when we come back from lunch all the lights are still switched off on the wards. It is impossible however to get through a very full caseload if we abide this time and therefore the rest time is only intended as no visitors are allowed. The other day i went to go and treat a patient, and a nurse was quite aggressive with me she told me i couldnt see any patients till 3 oclock and that it was rest time.
I tried explaining to her that to get through a full caseload we cannot just not see people for 2 hrs, however she kept being stern with me and so i went and sat down for about an hour and a half and tried to use my time effectively doing paper work etc.
I ended up finishing half an hour late that day as i didnt see any one during that 2 hours. The next day i told my supervisor about the situation as i was quite angry i finished late, and i was quite sure we were allowed to see patients during rest time. She had been told the same thing by a fellow nurse a week earlier.
The physiotherapy department was very upset with this and sent one of the seniors up, to speak with the nursing coordinator, who was very angry at the staff that had told us this, another message was sent out to all nursing staff that we were allowed to see people in rest time, and i was told if anyone else tried to tell me that whilst i was there to come and tell them immediatley.
This situation again has just shown to seek out help if there is a situation you cant deal with. I didnt want to start an argument with the nurse and being a student didnt feel like i had much authority and didnt want to get offside with the nurse.
Sunday, October 5, 2008
Mental Health
Hey guys
hope all is well. This part week i have been treating an elderly gentleman, who was in hospital for an amputated toe, he was originally discharged, however readmitted himself to hospital one day later. Over this time he has deteriorated significantly, mainly due to depression and severe lack of motivation, he is not eating and refusing to move out of the bed, previously i could get him to perform bed exercises and at least stand. Due to this increasing uncompliance with all staff members he has developed pressure sores on his heel etc. The other day i went to see him and he would not even perform bed exercises.
I had spoken to my supervisor and expressed my concern that if he didnt get up soon he wouldnt be bale to walk in the next few days. Due to his increasing non compliance she suggested i ask him if he wanted to end up in a nursing home, cause that was were he was headed as a last resort to try and get him up.
So I said this to him, even though i never felt particularly comfortable using this as a threat, this also had no effect on the situation. I know how important it was for me to try anything i could to get him up for his own welfare, however i dont think i will be using a technique like that again i felt absolutley horrible saying it, and i dont think it helped the patients current mental state either. I gave up for this treatment session and instead asked for mental health to review him. I will wait until this has been done as in the meantime my input is useless, i dont feel that anymore pushing will do anygood.
hope all is well. This part week i have been treating an elderly gentleman, who was in hospital for an amputated toe, he was originally discharged, however readmitted himself to hospital one day later. Over this time he has deteriorated significantly, mainly due to depression and severe lack of motivation, he is not eating and refusing to move out of the bed, previously i could get him to perform bed exercises and at least stand. Due to this increasing uncompliance with all staff members he has developed pressure sores on his heel etc. The other day i went to see him and he would not even perform bed exercises.
I had spoken to my supervisor and expressed my concern that if he didnt get up soon he wouldnt be bale to walk in the next few days. Due to his increasing non compliance she suggested i ask him if he wanted to end up in a nursing home, cause that was were he was headed as a last resort to try and get him up.
So I said this to him, even though i never felt particularly comfortable using this as a threat, this also had no effect on the situation. I know how important it was for me to try anything i could to get him up for his own welfare, however i dont think i will be using a technique like that again i felt absolutley horrible saying it, and i dont think it helped the patients current mental state either. I gave up for this treatment session and instead asked for mental health to review him. I will wait until this has been done as in the meantime my input is useless, i dont feel that anymore pushing will do anygood.
Friday, October 3, 2008
Displaying Presence
My next session with Tom* on my orthopaedic inpatient placement I was able to start mobilizing Tom. I saw Tom with my Curtin supervisor for this session. Because of Tom’s complicated and prolonged hospital stay I decided to take quite a cautious approach by explaining to Tom that if at any time he felt dizziness, nauseous or anything else abnormal to let me know immediately. I also explained to Tom that we would take it slow and we go to sitting over the edge of bed, stay there for a little while and then if things were okay there than we would try a stand with the pulpit frame. Tom agreed to all this. We moved to sitting over the edge of the bed and I continued to question Tom regarding dizziness etc and he said he was fine. I decided to try a stand with the pulpit frame, Tom was quite keen and seemed to be a little frustrated at how slow and cautious I was taking things. I explained to Tom how I wanted him to stand up using the pulpit frame by first pushing on the bed with both hands and then once half way up to bring his hands to the pulpit frame and take the weight through his elbows on the pulpit frame.
Tom then stood up but put his hands on pulpit frame too early, he still managed to stand but was not as safely as I had liked so I told him that I wanted him to sit down and try again. Tom was visibly frustrated but my supervisor and I tried to explain to him that it was important that he learn to transfer safely. I then re-explained to Tom how I wanted him to stand safely, and on the second attempt Tom stood safely.
When receiving feedback from my Curtin supervisor she commented that if this session was my final assessment she may be inclined to fail me on a safety issue. This obviously caused me to reflect on what I could have done to prevent this potential safety issue. I first thought about if I had explained how I wanted Tom to stand...yes I explained but I may have not enforced my presence and ‘authority’ enough. Then I reflected on why I didn’t do that and with some discussion from my clinical supervisor I came to the conclusion that it was the fact that I felt inadequate being so forceful when I was still a student. Reflecting on this made me realise that it is of the utmost importance to display confidence in what we are doing and display a sound presence to patients not only to ‘sell’ physio to our patients but to ensure safety at all times. During my next sessions with Tom and other patients I made sure that I displayed a greater presence and confidence in what I was doing.
*Fictitious names used
Tom then stood up but put his hands on pulpit frame too early, he still managed to stand but was not as safely as I had liked so I told him that I wanted him to sit down and try again. Tom was visibly frustrated but my supervisor and I tried to explain to him that it was important that he learn to transfer safely. I then re-explained to Tom how I wanted him to stand safely, and on the second attempt Tom stood safely.
When receiving feedback from my Curtin supervisor she commented that if this session was my final assessment she may be inclined to fail me on a safety issue. This obviously caused me to reflect on what I could have done to prevent this potential safety issue. I first thought about if I had explained how I wanted Tom to stand...yes I explained but I may have not enforced my presence and ‘authority’ enough. Then I reflected on why I didn’t do that and with some discussion from my clinical supervisor I came to the conclusion that it was the fact that I felt inadequate being so forceful when I was still a student. Reflecting on this made me realise that it is of the utmost importance to display confidence in what we are doing and display a sound presence to patients not only to ‘sell’ physio to our patients but to ensure safety at all times. During my next sessions with Tom and other patients I made sure that I displayed a greater presence and confidence in what I was doing.
*Fictitious names used
Subscribe to:
Comments (Atom)