For my orthopaedic inpt prac i covered a number of wards, one of which was trauma. One pt i began seeing with my supervisor the very first day, was handed over to me completely by the end of the 1st week. This pt had a complicated Hx the result of which were #'s of the sup and inf rami unilaterally, coccyx, L5 and multiple sacral #'s (amongst other UL and rib #'s). The sacral and L5 #'s were managed with internal fixation and fusion, the rami #'s managed with a pelvic ex fix. The post op orders were strictly RIB with no WBing through LL's.
On one occasion on treating the pt, when i was performing a quick subjective Ax, the pt reported that during the night they were feeling restless and decided to stand. She reported that her muscles were not taking the weight well and she was unable to stand for long. I immediately reminded her of the post op orders and the importance of how not following them may result in another 6 weeks of bed rest or possibly permanent damage. Following this the pt became defensive emphasising she had not been standing for long, and there was no ill effects. She also repeatedly told me not to tell anyone.
Following this encounter, i remember thinking 'i wish she hadn't of told me that', though knowing is obviously better as measures can be put in place to reduce risk to the pt. Not knowing exactly how to handle the situation, i told my supervisor and was instructed to put an entry in the integrated notes descibing what had happened, and pass on to the physio of the ward to let the consultant know. When i next saw the pt, she quickly defended her actions and said i had gotten the wrong impression.
I think the real issue in this case was as the pt was about my age and we got along well, she may have seen me more as a friend than a physio. This could have lead to her being more comfortable to tell me things that she may not have told others, but also thought that i would not pass this on. So in this case it has good and bad points; both that i got the information, but also that i had to pass it on, and betray the 'friendship' we had made.
Beginning with this pt, i have been more professional, and although being friendly, giving the impression of physio first. Prior to this encounter giving a friendly approach i thought was equally as important, but i think pt's must know that your Rx is for their benefit even if that means possible comprimising your 'friend' relationship. I would love comments on this situation.
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2 comments:
Sounds like a tricky situation. On one hand if you passed on the information it's as if you're breaking the trust you have gained. But on the other hand it would be unprofessional of you to not say anything to the other staff consdiering she was strictly rest in bed.
I think you handled the situation well tho. Maybe it would be good to explain to her just why you had to mention something and she may have understood more about the position you were put in?!?
I agree with Erin....definitely a tricky situation. I think working on a trauma ward is not the easiest ward to work on for starters (in my limited experience of one prac). Most people who come onto this ward have quite a complicated history, both medically and also emotionally/personally. There are many issues with these patients that we may only begin to scratch the surface of.
This patient sounds like she wanted to talk and I think as students we have alot more clinical time and therefore appear to "care more" because we don't have to run the whole ward and do administration. This is purely the impression I've got when talking to patients on a trauma ward. They feel like we give them the time they need in rehab, that we're patient and we listen.
I don't think you could have kept that information to yourself because it presents too many ethical dilemmas. Not too mention the fact that if something had happened to the patient you would have undoubtedly considered what the outcome would have been had you told someone. I think rationalising your decision to the patient might have helped but at the end of the day you have to do your job even if it doesn't always feel 'nice'.
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