Prison procedures

Many of us don’t really think of what our patients do in their normal day-to-day lives or what type of person they are, but with one of my patients I had an extremely interesting shock into reality. The patient, on my first day at prac, was wheeled into physio on his wheelchair shackled by his ankles. My initial reaction was ‘Cool, this will be interesting,’ but on reflection I thought what am I signed up for? I had a brief read of his notes, the normal gun shot head wound, lives in prison, IVDU… Despite my reservations the patient is really nice (despite potential frontal lobe behavioural alterations anyone?) and responds well and appropriately during treatment sessions. This leads me to my ethical issue: Following procedures this man requires being shackled to his wheelchair and has been whilst he has severe LL tone, no voluntary control of his LL (now progressing to minimal-mod control) and doesn’t have the ability to STS or stand let alone walk without assistance. Is this cruel? Apart from this I had a brief but momentous reflection on what my own limits of safety were. Obviously, this patient caused me no problems, but it got me thinking that in some situations certain patients could inflict serious harm especially when working in such close proximity to them, and even more so when treating in ways that may be challenging to their psychological situation or physical situation. It also begs to differ whether or not the university should allow some sort of reprieve for students in treating certain patients. So just a word or warning- always be on your toes, because unfortunately looks can be deceiving.