Week 4.3 Entry

Today we saw the disappointment that can occur when a patient’s return is not as quick as they would have hoped or that they were promised.

I have spoken about the patient with bilateral calcaneal fractures after falling from a height several weeks ago. His progress has been steady but as expected slow which he understands to a certain extent but is very keen to get back to work since he is not receiving any workers compensation and is self employed. His work involves him working at height and at some points he needs to jump down from scaffolding that is up to 1m off the ground. He thought that this may be possible sooner rather than later but with an injury such as a fracture and particularly on a constantly weight bearing structure as the calcaneus this is not going to be happening in a hurry. As well the soft tissue damage may not be sufficiently strong and stable enough to allow him to land from such a height. He controls his emotions very well and but it was obvious that he was annoyed that his return would be delayed. To make the matter even worse we made a comment that he should stop drinking everyday….well before midday anyway. This seemed ridiculous to him but when we told him that alcohol is not helpful for improving his injury he seemed to realize that he may need to make the change.

Another patient of ours was recovering from a TKR approximately 8/52 ago and was doing really well when we first saw him and had only improved from there. He could walk well and was affected more by pain in his other knee. Last week we had progressed him to low grade WB ex’s which he was managing very well and was expecting to move him onto some higher grade ex’s and include some more functional ex’s. This session was to be after his visit to the surgeon to see how his knee was going and also decide if he was able to return to work (just gardening and maintenance at a primary school). All 3 of us had expected for him to be able to return to work and were anticipating this by organizing a more extensive exercise list for him to leave us with. Unfortunately the surgeon rejected his request to return to work! This was after the surgeon said originally that he should be able to return to work. His reasoning was….wait for it….the prothesis he had put in was not designed for work such as his!! Bec and I were as amazed as the patient (our supervisor couldn’t believe it as well) and decided that we would keep seeing him but 2/52 apart from now on. The patient is needing to get the other knee done in the near future so was not as forceful with getting an explanation out of him but we expect him to get pretty fired up after the second operation. It was important that we assured him that he was doing really well and to look on the brightside that he gets a permanent holiday on retirement but he really wanted to keep busy.

I realized that it is important to not promise too much to patients and give them false hope on where they will end up by the end of their rehabilitation. Giving a conservative opinion is the best option and possibly avoiding giving a stead fast answer is even better. Everything health professionals say is often taken as gospel by patients and people will base their life around the predictions we have made.