Well, here I am, half way through my musculo placement, and loving it! It is great to get the hands on experience with patients in the area of physiotherapy soon to be my career.
Things are all starting to flow a lot easier with the assessment, patient handling, and treatment. One thing that is still taking a while to establish is 'time management'.
It is amazing how quickly time moves during your time with a patient. Those of you who have finished, or currently doing, your musculo clinic will know that we get 1.5 hr for new patients, and 1 hr for ongoing pts. I currently need all of that time, and it is scaring me, due to me starting work in a private practice in May. In a private practice 'time management' is essential, as an initial will only be 45 mins MAX, and a subsequent 30 mins MAX, and the rate I am going, I will only see 4 patients/day when working.
I am currently really trying to get the subjective (initial) completed within 15 minutes, and find a structure to complete it in this time frame. For ongoing pts, I am really only focusing on certain aspects of the objective to use to also save time
This is the main focus for the remainder of the placement, as everything else is going well, so any comments will be hugely appreciated. Ideas on how others have structured their INITIAL SUBJECTIVE (PHx, Current Hx etc) in the past would be great.
I guess all this comes with experience, but I would like to have this sorted as much as I can come May. My supervisor has given me some ideas, but is there any one who may have experienced what I am saying and have any wisdom on the matter?
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2 comments:
The dreaded “T” word
I definitely agree Troy. It is a scary thought to be looking down the barrel of 45’ sessions in three months when we are struggling to squeeze it into 90’.
I also agree that the subjective is the hardest thing to get efficient. Any students who have been on a musculoskeletal placement with Michelle Kendall may have received a summary of her S and O. Under each of the normal headings you would find on the S of a standard initial consult sheet she has listed 3 to 4 main points of what to ask. I found it very useful committing to memory each of these main points to allow me to adapt my S from it. Although some of this was outlined in our guide Michelle provided a very clear layout for a musculoskeletal Ax. Unfortunately not all students received one of these and I feel this would be a disadvantage. I am sure Michelle would be happy to share more copies if approached.
I found my time management improved dramatically between the end of week two and the finish of the placement. I found that I began to have the confidence in my examination skills, both S and O, and could then cut out some components to save time. I was assured by my supervisor who has now been practicing for 15 years she never thought she could do 40’ and 20’ consultations but from an early stage she could. It all comes down to time she said. It may come easy to Steve but we have to start somewhere and you can’t rush the process.
Never fear the time management will come
Leslie
Hi Troy,
I think everyone will gradually find & develop their own preferred structure as to how to have the subj Ax done. You will also probably find trends/ patterns to certain conditions.
As for me, I like to ask about the CHx, as to why the pt is here to see a PT, the mechanism of injury etc. I will then cont to ask more abt the pain, i.e. the body chart. Next, wld be aggravating & relieving factors, the am & pm behaviour, the irribility of the prob. Followed by any related PHx & general health. Finally, clearing of any of the red flags.
I can understd the frustration of having a long S/E, and not being able to fit everything into that limited time frame. So its really impt to have the pts get down to the relevant points. Altho I wld really like to have an easy chit chat with them, time doesnt allow so. With saying that, I believe as u r more comfortable with all the S/E, I am sure u can make it into an easy conversation.
With a f/u pt, I find that it helps to really identify if ur previous Rx works and therafter determine which obj signs to re-Ax & how to modify ur Rx or keep the Rx. Thus, I feel its always better to stick to one Rx as that gives u a better indication what's working & what's not.
Hmm..I hope I made some sense to u..if I dun..pls let me me noe.
Cheers
have a great wk!
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