So another clinic completed. Outpatients for me was a mixture of straight forward and challenging patients combined with rapid revision and comprehension of the courses musculo topics. I am feeling more confident although wish I had just one more week to get a better handle on it all as things only started to fall into place in the closing stages - some are quicker than others!!
Anyway my point is although some patients caused me dispair it was these particular patients I am most glad I had as the experience means I have a better understanding of how to approach similar cases in the future both for treating and diagnostically. Mostly it was a chronic patient that, unlike Troy's, was not so easy to convice to exercise, I did a lot of listening and empathising however had to be careful as he was quite manipulative and had an agenda which I was slow to pick up on but here it is:
He presented with shoulder pain and was convinced it needed surgery, scans and xrays were clear. He was extremely neurally sensitised and guarded every movement. On completion of the 3rd treatment session, when no progress, he stated that he had only agreed to come to PT as he believed we would then see that his pain was mechanical and tell the surgeon he needed Sx to fix it and that would be that!! So there I was sending him back to his GP with a suggestion to send him to the pain clinic (which I might add as an aside has a 12month waiting list!) where he will hopefully be treated for his pain.
I asked all the questions that might indicate a chronic pain disorder however he was reading into my questions and any discussion of sensitisation of pain by the CNS was scoffed at and I was told that his pain was real and he knows other people play on their pain but not him - ah he was a good challenge!
Subscribe to:
Post Comments (Atom)
1 comment:
Hey Jill
This patient does certainly sound challenging. It is not just challenging in the physical aspects, but more so when there is psychosocial involved as well. I am at my wits end with these patients. It doesn't help when pts are actually as well-informed (via internet) or more so than us!
I came across a pt with both aspects involved when I was practising in a MS outpt clinic. She had chronic pain LBP due to a Lx vertebrae stress #. She was paranoid and very emotional++. At the same time, she wanted to get well, and was very aggressive with ex's. With time,as she became more familiar with me, she trusted me, and with adequate empathyand assurance, she was able to manage her pain better. I was also firm with telling her what she can do & what she should not be doing. At the same time, she was also seeing a pyschiatrist, so it helped as well. But I also realised that keeping her physically active and preoccupied helped alot in managing her pain.
Although this scenario is slightly different to yours, I just wanted to share something positive with you.
Good luck for the nxt clinics!
Post a Comment