ICU

I am currently placed in one of Perth's Intensive Care Units as my cardiopulmonary prac. It has been my first time in such a ward, and I admit I was very confronted at first. Seeing patients completely ventilated and with so many lines coming in or out of them that I have heard them called "Christmas trees" was a shock to me at first. The crying family members and tenuous hold to life that some patients have also added to my unnerving experience. So many drug overdoses and horrible accidents and stories can be depressing.

From being in ICU so far I have learnt to adapt my personality to suit. For those that don't know me so well I'm quite an outgoing person, and tend to laugh a lot (and loudly). I realised within 1-2 days in ICU that although I should not be depressed by my surrounds it is also important to respect the grief of family and patients, and control my sense of humour at times. I still joke with the nurses and other staff as per usual, (no need to be glum!) but am much more controlled and focused when family are around or when walking around the ward. I still smile as much as ever, but I have realised it is inappropriate for me to laugh at times. I feel it is very important as a health practitioner to realise that yes it is a 'job' for me and I do want to have fun/an enjoyable time at work, but at the same time it is also an emotional and upsetting time for many patients and family members and I need to repect this and treat it with the control it requires!

Little kiddies

On the first week of my Paediatric placement, I didn’t realize how confronting it would be to see children with such significant disabilities. Having had very little previous exposure to children with disabilities, I felt quite overwhelmed on my first few days and had no idea how to deal with it. Since starting our course, I had always thought I would be interested in a career in paeds, but was always unsure how I would handle treating children with significant, lifelong disabilities on a daily basis.

On my first few days, I didn’t really get the chance to interact with any children, and felt like I was purely observing. I found this really hard, as all I had to think about while watching these children was how ‘unfortunate’ their situation seemed. However over the next couple of days, I got to see more kids and interact with them. It was then that I started to realize these kids had the same gorgeous personalities that I love in all kids. And even though some of them cant verbalise what they want, you can see they still have the same ambitions as would any other child.

I hope the more I get to interact with and feel that I am helping these kids, the more I will enjoy my time with them. I hope it will allow me to bond with them and admire their special abilities rather than just focusing on their disabilities. And hopefully I will find that Paeds is somewhere where I could one day work, and make a difference to their lives.

Discharging patients

On my recent Musculoskeletal Outpatient placement, I often found it difficult knowing when to discharge patients. I found patients were generally kept on longer than they may traditionally be in a private practice setting, with patients often been re-booked on a weekly basis for months on end, and for ongoing, follow up appointments every 2, 3 or 4 weeks. While I realize these patients are often kept on for our own good, so that we get as much exposure to as many patient conditions as possible and that we may not achieve improvements as quickly as experienced Physio’s, I often felt guilty for continually booking patients in, especially when they were private patients paying by session. I didn’t however feel so bad when they were public patients who weren’t paying for the service.

I started to think, that we should really be giving patients a more ‘acute’ bout of physiotherapy in order to see if we have a positive effect on their condition, and should they not be showing ongoing improvements over a month or so, they should probably be referred onwards. While not all patient conditions fit this criteria, it seemed quite obvious that many of the public patients especially were being kept on for much longer than required. I don’t know how right my way of thinking is, and I guess booking patients for more rather than less sessions is always going to be better, although it may not be the best practice.

Weighty Issue

On my Musculo Outpatient placement, I encountered a rather overweight patient who presented with lower back pain. During my assessment of PPIVMs (especially flexion and extension), even after taking all the biomechanical measures I could to protect my back, I still found the assessment extremely challenging on my back.

Although we are constantly reminded and well taught about our biomechanics and protecting our backs, it seems there is sometimes only so much you can do. When faced with an overweight patient in an outpatient setting, there is often little opportunity to have assistance with manual handling (as may occur in a hospital with an extra person/ lifting equipment etc). While in hospitals, there are normally strongly reinforced ‘no lift polices’, it makes me wonder at what point do we have the right to refuse certain manual handling for assessments and treatments in order to protect our backs. While I don’t think it is fair to refuse appropriate assessment or treatment of patients, I can see how important it is for us to be looking after our backs and be constantly aware of our biomechanics. After all without our backs, we don’t have much of a career.

Treatment effectiveness

Whilst on my Musculo Outpatient prac, I have been finding it very rewarding having patients comment on how much better they feel upon leaving their session. It’s much more different than within a hospital setting, where patients often see you as the ‘evil’ one who is making them get out of bed/ move their limb post-surgery, when it is often the last thing they feel like doing.

However having experienced patients leaving their session feeling worse, or much the same as when walking in, is something I hadn’t been prepared for. We are often taught that “this treatment is used to improve this condition”, so it can sometimes come as a surprise when a patient returns with little improvement. This happened to me when I had a new patient, already diagnosed with subacromial bursitis. Although I already knew her diagnosis, I went through a full examination of her shoulder and treated her as appropriate. However, the more assessment I did, the worse her pain would get, and therefore on re-assessment (post-Rx) her pain came on earlier in range although still at the same intensity. My supervisor assured me that some post-treatment soreness was common in this condition (especially since she had hardly been moving her arm for 3 months) and also due to the inflammatory nature of her problem.

After discussing this with my supervisor and feeling reassured my treatment had not caused any harm, I still felt almost guilty that my patient’s pain was seemingly worse. I think it is important to remember we can’t always offer ‘magical cures’ to our patients, especially when there are other processes going on (in this case a strong inflammatory response), although this can still sometimes not seem enough to help your confidence.