Whilst on my cardio prac, I encountered a very sick 78 year old man who really challenged me. He had been admitted after NSTEMI and had had a CABG surgery. After this he was in intensive care for a few days longer than normal due to lots of complications. When he was finally admitted to the ward he was so badly deconditioned, and adding to this was the fact that he had to be on daily dialysis. So I started treating him and was able to help him clear his chest quite nicely, but I was not able to get him to ambulate. He would just tell me he was far too tired, and sometimes I would convince him to just take a few steps up and down the room with me, but other times he would just refuse. However, when my supervisor came in, he would agree with everything. So over the time he spent in hospital, he developed a pneumonia on top of everything else, and I felt really bad seeing as he was my patient.
This man also became very depressed, and started showing signs of some sort of neurological insult, but we were not quite sure what was going on and he was having head scans the day I left so I wont ever know. But I just felt that he was very untrusting of me because I was a student, and he would always comply with my supervisor. I also had times where I felt so bad going in there and waking him up for physio as he hardly slept during the night so I felt like he really needed any sleep he could get.
I spoke with my supervisor about it and she helped a lot. She said that with time you find out which patients are really really sick and those are the ones you back off on a bit. But you also learn how hard you can push someone within the limits of safety, and that this was a clinical judgement skill that would come with practice. She also said that unfortunately some patients just did not feel safe in students hands, and that was just a personal thing. And she reminded me of how much success I had had with my other patients and said that even for her there are some people she hasn’t had great success with. So in future, I will always talk over difficult patients with my supervisor along the way so that they can give me any handy hints for increasing patient compliance as a student. And I have also realised that in time I will be able to know which patients I can push a little harder than others.
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I think that all of us have experienced this problem on at least one of our pracs. There are a whole lot of different reasons why one person may have greater compliance with a patient compared to another. The student thing is a big factor for all of us at the moment but personality and approach are also key factors. I think it is important to try to think of all of the possible reasons a patient is not willing to comply with treatment and attempt to adapt to this so that the patient recieves the best possible treatment.
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