My very first patient i saw with my curtin supervisor on my outpatients clinic was very frustrating over the course of his treatment sessions. He had been referred to outpatients after undergoing a THR and was 6 weeks post op. The two things that you notice about him initially is that he had a pathological gait (looked like one leg was longer than the other) and that he had some underlying mental problems.
The patient explained to me that he had been in a car crash more than 30 years ago and since ten had ben walking funny and it was because of his long leg which did this. After measuring ASIS to medial maleolous - both legs were exactly the same length but you could notice a Lx spine scoliosis which was probably the main problem in regards to the patients walking and posture. After showing him the measurements, the patient sad this was not true and said there was 5cm difference between them. This discussion took up half the treatment session and became frustrating as i could only half do the S: and O: and only game him one home exercise.
The following session, the patient said that one of his legs was longer than the other - which we had already discussed beforehand. After showing him the measuring tape and assessing the length properly with the supervisor - it was again the same length. This discussion again took up most of the session.
This patient became very frustrating as he kept thinking he had one leg longer than the other, but kept forgetting about this on a weekly basis, but more importantly, it was impeding on his Rx session.
After a discussion wih the supervisor, we decided that we should reinforce this every session to him - but only for 5 mins - so a full and proper treatment session could be had. I felt rude initially about donig this but the patient needed to know and he slowly started to understand after using the mirror. The remaining two sessions with him were a lot easier, the issue was discussed at the start of each session for 5 mins then we went on with the session, so I could get the most out of the session with him.
Its hard working with patients who have a mental disability as you don't know to except their thoughts on what us happening to their body, or do you step in and be rude by telling them what is actually going on. This issue was impeding on treatment time so had to be dealt with.
Next time, if a simialr patient was to present to me in an oupatient setting, i would have to way up whether or not to let the patient except their wn self diagnosis or actually tell them what is going on. This should be done in a strong but empathetic manner and should not take uup valuable treatment time.
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2 comments:
top blog hendo, i've had a similar pt that was so focussed on different leg lengths they thought it was effecting everything, even bed mobility. I think pt's just get defensive when they realise they cant do something properly, or you point out a fault, so they pick something they had no control over. In this way, they are not to blame. For my gero pt, i just said "it could be involved, but it could also be this ..." The pt seemed satisfied with this, and Rx conitinued. You may have to humour them a little haha.
It was really good that your kept telling the patient that truth and didnt just agree with his way of thinking. I had a prac t Brightwater where there a a lot of dementia patients nd it is extremely hrd to get through any treatment session! I think in this situation I had to enter their world just to gain there interest. Its really amazing the type of people we come across doing prac! and I guess its just going to continue to become more and more interesting.
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