When the doctors are still arguing...

On a medical ward, I was allocated to assess a patient for a mobility review, following his admission for fatigue and lethargy, and shoulder pain with UL weakness. The mobility assessment was quite simple – I provided the pt with a WZF whilst his balance an confidence improved. The medical team entertained the possibility that the pt had had a CVA, and this appeared to be the case from a physio assessment of his motor function (affecting his UL only), and hence physio treatment commenced based on this assessment. However, following some imaging, the consultant decided that it was not a CVA, but rather a rotator cuff tear. As this did not fit the clinical picture of distal had weakness and altered sensation, we approached the registrar on the team to ask how they had come to this conclusion. She informed us that she agreed with us, believing that it was a CVA. So, we continued to treat this patient with UL retraining exercises – it did not really matter what his diagnosis was, as we were treating impairments as they were assessed, however it would have been more comforting, especially for the patient, to have a diagnosis. Unfortunately my placement finished before a diagnosis was established, as it would have been interesting to find out. The lesson I learnt from this is to treat the patients impairments that you identify in your assessment (provided this will not have an adverse effect on the patient), rather that waiting for a team of doctors to decide exactly what is wrong with a patient, as it is best to start treatment as early as possible, so that they can return home as quickly as possible.