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!!