Final Entry

1. Final thoughts and feelings finishing this unit.
This prac has been the best physio experience I have had! I absolutely loved this placement and just learned so much. Treating and assessing other students in labs is very different from treating real patients. It was great to get out there and have a go at everything and try to apply all the theory we have leant. It’s funny because while I used the theory we have learnt, I found so much had to be adapted to each client and there are so many different ways of doing things. I feel I did well on this placement and learnt a lot of things that would be difficult to learn at uni.

2. Things I have learned.
I learnt that there are so many ways of doing manual therapy techniques, and they all get results.
I learned how to use older electrotherapy machines, the theory is the same, the buttons are different!!
I have learned how to adapt my treatment for individual clients.
Another thing I have learned is the importance of setting goals with clients and discharge planning.

Tuesday - Handovers and Discharges

Today went very slowly as one client cancelled and one client didn’t show up for her appointment. This meant I only saw one client in the morning, and the one I was meant to see in the afternoon cancelled too. Such a slow day!! I did take the Peripheral Conditioning Class as well. I filled the rest of the time studying and writing handover summaries and discharge letters. I didn’t realize so much paperwork was involved in physio!! As we cannot discharge all our clients we are handing them over to the other physios. My handover summaries were brief but contained the relevant information. It was certainly handy having done them at uni in the labs (thanks Jo!). For the clients we are handing over, but they will probably only come in once or twice more, we have to start discharge letters for them. It would be hard for the physio we hand them onto to write a good discharge letter if they only see them once (although they would have all our notes). For this reason we start the letter now, with initial findings etc, and they will finish it when they discharge the client.

Compromises with Clients

I was involved in a situation today where one of the physios had made a compromise with the client. Even though it was not an ideal situation it worked for the client, which is the most important thing. This particular client has had 2 previous strokes and struggles to walk at all. His aim is to walk his daughter down the aisle in her upcoming wedding. The physio showed me how his gait was anything but normal, and usually she would not allow a patient to walk like that in rehab. The client doesn't care how he walks, as long as he is walking. His gait pattern is not something she would encourage, but as the client only wants to participate in physio if he can walk his daughter down the aisle, she has agreed just to get him walking, no matter how it looks. I suppose this is better than the alternative (him not participating in rehab at all). I guess with experience it gets easier to make the call as to whether it is appropriate to make a compromise with a client or not. In the end it is up to the client what they do or don't do, and we should just try and get the best possible outcome we can with what they are willing to put in.

Another week is over...

Well the past week has been the busiest so far!! We learnt how to do discharge letters. It was pretty simple as there was a template on the computer for us to copy. We didn't put enough detail in our first attempt but with a few pointers from our supervisor they have been getting better. We were aiming to discharge as many of out clients as possible. We have discharged 3 so far and are planning to discharge some this week. We will have to do handovers for the other clients which will take a bit of time to get sorted.

We have started seeing more clients each day and I prefer it when we are busy. I found I am getting better at doing the objective assessment and a lot faster with it. We easily managed to see 6 clients the other day. I asked my supervisor and he said it would be normal to see around 12 clients a day if that was all you were doing (i.e. no meetings or paperwork etc). I feel as if I could handle a few more a day but certainly not 12 just yet!!

There was one situation that occured in the past week that left me a little upset. One of our clients had a TKR and was told by the surgeon he could go back to work in approx 6 weeks. We gave him rehab and he was doing really well. I thought he could definatley go back to work. Unfortunately he went back to see the surgeon and was told he couldn't go back to work at all. He has had to retire. The surgeon said that the knee replacement was not made for work. The client said he would have liked to have known this before hand. He still would have had the op but would have been in a different mindset. The client said he was too scared to ask the surgeon why he had changed his mind. I just found this unfair and the client was clearly upset about it.

3 Weeks Over

The end of the third week finished well. On Thursday I got to go into surgery! It was such a great experience!! I saw 2 procedures – a knee arthroscopy and a lateral release. The surgeon was very friendly and explained everything to me. As the images came up on the screen he explained what everything was and went through the anatomy. I found it really interesting to see this – it was very different from seeing it on cadavers. I had to change into scrubs and wear a hairnet and facemask. There were quite a few people in the operating room but they didn’t seem to mind that I was there too. It was such a great opportunity to see surgery and I’m hoping that sometime in the next two weeks I will get to go in again and see a different procedure.

A guy came in on Thursday and did a little presentation on braces and orthoses etc, that the physio staff may be interested in buying. He bought a heap with him and let us have a fiddle with them. He explained how most of them worked and what they were best used for. It was really interesting. The only problem was some were very expensive and some clients might not be able to afford them. On Friday we had a guy come and talk to us about a machine that assists with coughing. I didn’t understand fully how it worked but it used positive and negative pressure and helped with coughing. It’s been great how we have been able to see these little presentations, the braces and machines we have seen have been really interesting.

We are still getting new clients, so it is unlikely we will be able to discharge them all before we finish the placement. We will aim to do this but we may have to hand some over to the other physios. We are starting to see more clients each day so have been busier than when we started. I much prefer this, even if it means we don’t have as much time to prepare before seeing a client.

We had a client come back on Thursday (it was her second visit). She had damaged her Achilles and has now been out of plaster for a few weeks. She is going very well, which was good to see. There is the added problem that both her legs are very swollen. We didn’t really address this last time (apart from giving her tubigrip and advising her to elevate it) so I was keen to do more about it this time. I did some DTF on her Achilles before Matt and I did effleurage to both her legs. I felt this was very effective, but not a permanent solution in this case. We only did it to the calf muscles and around the heels, but next time I’d like to do it to the front of her legs and tops of her feet as well (as there was quite a lot of swelling in her feet). I felt like I did the massage well (I have plenty of experience after my 4P hours!) I have never really done effleurage on someone who has some much swelling before, it has generally been massage on athletes. It was amazing how much difference it made, I could feel the fluid moving under the skin. While I was doing the DTF if I lifted my fingers off there were indents of where they were on the skin. This gives an idea of how much fluid was in there! I think massage in the future will definitely be a good option to help with the swelling, as long as she is still doing her part with wearing the tubigrip and elevating the leg. She is starting to do some active movements (like cycling and calf raises) which will also help pump the swelling. She comes in for an exercise class (sometimes twice a week) as she has COPD, which will also be beneficial. I just feel there is so much more we can do for her. Her Achilles is healing well and we were able to progress the exercises. The hands-on massage experience with someone with so much swelling was a good experience.

Notes

I will never underestimate the importance of client notes!! We are only seeing a few clients a day yet still have trouble remembering everything we did with them previously. Writing down clearly what treatment we did and what we plan to do next time is so important! It will be so much harder when we are working as physios and are seeing so many more clients a day and have less time to write up the notes. It is definitely something I will not be taking short cuts on!