On my current musculo placement i have a number of on-going pts that have been coming for anywhere up to 2 yrs. One pt in particular has had several complaints and has been coming for about this long with a shoulder complaint, LBP and recently hip pain. His first Rx from me was an initial Ax for his hip and continuation of his LBP Rx. He presented the following week with much improved hip symptoms and pain free AROM for his Lumbar spine. His shoulder gains were also maintained. This was a great outcome, so i decided to suggest him to come back in a fortnight instead of a week, and because he had a good grasp of his HEP this seemed to be logical. Upon my suggestion he quickly replied with "but ive been coming weekly". I then proceeded to explain that he was progressing well and if he continues to do so hopefully we can lead to a d/c. The pt seemed surprised by this and accepted, though appeared nervous and ensured that if he had any symptoms he could be seen next week.
I found this situation interesting as this pt appeared to have gotten into a physio routine, and thought that if he wasnt coming in weekly, he would start deteriorating. He seemed to be settled when i explained he had a good grasp of his exercises and if he kept them up he would continue to improve. Prior to this encounter i thought musculo out pts was not so long term and pt's would be eager to self manage with checkups that became fewer and further in between until d/c. This pt and others i have had that are longer term appear quite dependent on weekly sessions that have been given by many students. I think this has to be kept in mind when considering d/c, and a full explanation with self management and coping is vital. I will try and keep this in mind for future pts.
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3 comments:
I have a few patients who have been coming for a while but 2 years is pretty amazing. It's probably the longest length of treatment i've heard. I think some of my patient's come for a confidence boost, especially in the more senior population. They know their exercise program, they don't have anymore pain but still they come!! And I think you're right...they have this idea that they'll deteriorate if they don't see you. And they need someone else to reinforce that they're doing their exercises right. But the fact is we wouldn't discharge if they couldn't do manage their HEP correctly. I think you're right as far as sitting and explaining to them that discharge doesn't equal deterioration but if they adhere to their HEP they will be fine.
Good blog Steve. I too had similar scenarios at Charlies. Its routine for the patients, similar to going to grocery shopping weekly for example. However, i've noticed that it mainly applies to public patients because they are not having to pay for their treatment. They will just continue to have problems over and over again, and then develop other problems that they expect you to fix. Though i think it's important to take note of their initial referral, what they were referred to physio for. I'm not saying to deny their other problems and not treat it, but our main focus is on the issue that is stated on the referral.
Imagine the health burden/cost invovled for the patient coming to physio weekly for 2 years! AND the fact that he/she could be denying someone else treatment time. I know there's a waiting list for musculo outpt here at Charlies.
As you said, let them know what the plan is and the progression of physio treatment, that's a good idea me thinks!
Heya Steve! I absolutely agree that it is important to map out a timeline based on their diagnosis to not only give us something to work towards but to the patient as well. it gives them something to look forwrad to in terms of their rehab and where they should be and also communication between the physio and patient is important such that the patient with constant support an push from the physio will be able to reach their treatment goals independently and be able to manage themselves thus inproving their quality of living.
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