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.
5 comments:
I agree, during my musculo placement I found that when treating patients, even with raising plinth heights and out knowledge of biomechanics, by the end of the day I was 'slumping' around and ended up with Lx pain. Posture and care of our own backs is something we constantly need to be aware of! "Practise what we preach"
Absolutely should we all be thinking of our own body mechanics and 'practising what we preach'. Dealing with the obese patient outpatient is just another situation where we may need to tailor or limit our assessment for the condition and /or underlying pathology but as a student may not feel confident in voicing that.
My last placement was at charlies and one of the PDs was about dealing with and treating people who are overweight. One of the first things that was pointed out and repeated over and over again was that you are entitled to refuse treating a patient if you don't think you can physically handle them and know that by treating a patient it will put your health at risk. Putting yourself at risk during treatments can also make it unsafe for the patient.
i think once we get real-life experience with these factors it will be easier to tailor (and in the worst of cases refuse) treatment. We all have the mentality as students that we can change the world 1 massage at a time. I know that i had trouble coming to terms with possibly having to refuse treatment... somehow it doesnt seem right!
I've also had a couple of patients who were seriously overweight and completing a thorough assessment was a challenge. My solution was to modify the assessment and not include the PPIVM's. PAIVM's were done in side-lying a position selected because I didn't think the patient would be able to lie prone. I'm not sure about refusing treatment in the case of an overweight patient but I think there are always modified techniques we can use. It will come with experience.
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