Week 3.2 Entry

Almost half way and still getting along with my sidekick…who would have thought.

Once again even though we were referred this patient we weren’t completely sure of what was going on due to the ineligible nature of the doctors hand writing. We were aware of the patient’s presenting condition but beyond that we were clueless. Turned out the patient had 2 x THR approximately 2yrs ago which greatly affected our initial thoughts on what direction to take the assessment in. For example we wanted to determine if glut med was tight and playing a part in the discomfort the patient was feeling but the stretch required had the patient in F, and Add…big C/I for people with THRs. Another complication was that the patient experienced pain very easily which made assessment and subsequent treatment very difficult. The subjective part of the assessment was also long and time consuming but covered all major aspects. We were able to pin point where the Rx and HEP should be directed based on the patient’s concerns and the objective findings. The patient was revisiting the surgeon in 2/52 so we held back on progressing her too fast until the surgeon had an opportunity to assess her progress and complications.

We found difficulty working with the patient due to her sensitivity to mvts. We did not want to push her too far beyond her pain threshold since we could see that she was very apprehensive about troubling her hip. I suspect there may have been some exaggeration with regards to pain so that we did not test her too much. As to be expected during an initial consultation where everything is being assessed the patient’s primary issue becomes quite irritable making all further assessment and treatment at the time a bit more difficult. This was the case today and hopefully our next session will be a lot more targeted and streamlined towards the main problems. We have seen a quite a few THR and TKR patient’s and have started to build up a list of assessment objectives and exercises for the different stages of recovery. To make this knowledge second nature would make prescribing and progressing treatment more effective.

As I mentioned being able to target the session more next time will give me more confidence in what we have found out and that our intervention is progressing in the correct direction. A lack of information leaves holes in the findings and possible problems with the intervention. The patient needs to know throughout the whole process what is happening and be assured that they will be able to return to what they are limited in doing…..I need to make an extra special point of attempting to find out about the patient’s social history and showing an interest in helping them return.
I can imagine from a patient’s point of view they have already been to see Drs, surgeons, other physios and been through the whole assessment process many times before so that, to certain extent, expect all follow up professionals to know exactly where they are at and what the main issues are and how things should progress. This is very much not the case! For this reason the subjective questioning needs to be targeted and succinct but still be able to gain a clear picture of what we are dealing with. I feel that I have developed this over time by not spending excessive amounts of effort on enquiring about information that will in effect not be a major factor in the intervention thus making the entire process as simple and straight forward as possible for the patient.