too many supervisors

I am on prac at the moment and we have three supervisors each week, and things are becoming a bit confusing. I realise that every physio is different and they treat patients based on personal experience. But the problem comes when you learn something really great from one supervisor and think you are on the right track, only for the next supervisor to come along and ask you why you are doing something a certain way. This has happened a number of times. I was treating a patient with another student, and we were practicing sit to stand with the patient resting one arm on a large bolster to encourage him to make more use of his lower limbs during the task. Things were going really well, and the patient was happy with how he was going. One of the supervisors then came along, and right in front of the patients asked us to explain the rationale of using the bolster. When the other physio had explained it and had been using the bolster, it made perfect sense to us students and the performance of the task looked pretty good. The second supervisor then went on to explain all the reasons why we should not use the bolster. We did not want to say that the first physio had suggested we use it, because we did not want to sound rude. So we carried on the treatment session without the bolster, and the patient really struggled for the rest of the session. In my personal judgement, it gave him a sense of security knowing the bolster was right there in case he lost his balance, and once it was removed he really struggled to complete the task well. Due to this fact, extra load was placed on me and the other student trying to facilitate sit to stand and I needed the rests more than the patient.

This happened two or three other times last week, and I am feeling a bit confused. Who do you listen to? I have not spoken with any of the supervisors about this because I know they will just say that its all a matter of personal choice. But then isn’t it also our choice based on our capabilities as students. Is it not fair that we choose the option that we feel most comfortable with. I have spoken to another student who had this same prac and she said she experienced the same problem all the way through her prac. I think it probably wouldn’t hurt speaking to one of the supervisors at some stage and just voicing my concerns, just so that they are aware that I am willing to try different treatment options from all of them, but that we just may vary which ones we use. The other student and I have also decided that we will choose techniques based on which supervisor is there, and be able to rationalise why we are changing if we decide to do so.

Patient presence... and presents?

On my rural prac, I was treating a male outpatient for shoulder pain. On my initial assessment, he came across as a very friendly man and we chatted throughout the session. I was trying to be polite and show an interest in his hobbies etc. On the second session he was much more open, telling me about his life and interests and asking about my life and future plans etc. While still taking the conversation quite lightly, after the session I began to question whether it was apprpopriate for him to go into so much detail about his life with me. I brushed this off and just thought if he needed someone to talk to, there probably isnt any reason why it cant be me and that he was probably just trying to be nice to me as I was still very new to the town.
I was still a little unsure as to his intentions in the third session, but told myself just to listen passively and not reveal too much about myself in any answers I gave. At the end of this session, he gave me a gift of a CD which we had discussed and invited me to come and watch him and his band play on the weekend. I tried to politely refuse the CD, but he insisted I take it and just put it on to listen to in the office if we wanted. Thankfully I was able to think of a quick excuse as to why I wouldnt be able to go and thanked him politely for the offer.
This situation made me feel really uncomfortable as I was still unsure as to whether he was just being genuine and friendly or if he had other intentions. It made me realise that while it is good to build rapport with patients to earn their trust, you should have a definite 'line' set in your mind about what does and doesnt make you feel comfortable and to advise the patients of this should they approach this line.

OT vs PT

I've never really understoof why there is sometimes this rivalry between OTs and PTs. I went to China to work in a childrens rehab centre with 8 other occupational therapists. To be honest some of them had no idea what a physio does and just assumed I would be treating the patients with massage! Throughout my previous placements this year I tried to make an effort to recognise what an OT did because I didn't really understand their role. I attended my patients OT and speech sessios and began to become familiar with what my patients did outside of the physio and medical management. So i was a little bit offended that the OT students weren't familiar with our role because surely they had been exposed to a bit of it during their placements this year. Anyway on the trip I realised how well the two professions can complement each other. For example I would work with one of the children with another OT student. I would focus on the posture/positioning and challenge the child this way, whilst the OT did some UL work.
It made me realise that we shouldn't be so stubborn about our roles and who does what.
Working together, made the session so much easier, the child got more out of it and you could bounce ideas off each other to make the task more challenging etc.

family members..

On my placement at the moment, I was treating a patient with my supervisor in the gym. We invited his wife to come along to watch so that she became familiar with the activities that she will be doing with him once he is discharged. Throughout the whole session she would speak for her husband and say things like the poor baby can't stand up it will hurt him. She would also interfere during the session by helping her husband with the activities/exercises even though he was perfectly capable of doing them independantly. We decided that the next time we brought the patient to the gym for treatment we would tell the wife that it was now protocol that no family members are allowed in the gym during treatment session. She was compliant with this but still hovered at the door watching. Luckily for us, this patient was very motivated and willing to do anything we asked him so minimal education/motivation was needed for him. Most of the education was directed at the wife to ensure the patient becomes fully independant at home.

This situation made me realise how important family members are to the patient. Sometimes however you have to be strict on visitors because they can impact on treatment sessions and the progression of the patient's function.

Trying different approaches

Whilst on my rural prac i had the oppertunity to explore some different methods of communication and also treatment strategies with patients. A patient that started attending the clinic was a young girl with a history of chronic lower back pain approx 75% of her life sofar. From an early age she was told be her doctor that she had a serious back condition (as seen on CT scan- which was actually just a sacralisation of L5. A condition that has no significant evidence to attribute increased LBP). This developed into a very heavy fear-avoidance cycle where she was not going to school very often, not doing any physical activity and not working.
One of the senior physiotherapists started treating the young girl but with very limited results both emotionally and physically. The young girl then got handed to myself to treat and i got told to try some different approaches.
Being closer to the age of the patient i was able to develop really good rapport and achieved some drastic emotional and physical results. Initially we developed an exercise program that we would both do together. The rules for this program were that we were not allowed to mention her back pain (unless it increased significantly during) and that we would do the program no matter how she was feeling. I was able to use conversation and lots of distraction techniques to stop her focusing on the back pain. One of the biggest break throughs was when she started to understand that even if the back is sore, if exercise doesnt make it worse then its getting better!

This is a very long-winded example of how utilising different treatment approaches can be very beneficial, expecially in chronic conditions. Also, its an example of how we should not be afraid to refer to a different therapist if we are not getting the results/rapport that we need with a patient.

Juggling placement and curtin tutors expectations

Whilst on my last prac i had some definate difficulties satisfying the expectations that the placement and the curtin supervisors wanted. This wasnt because i was not competent and was not satifying the workload, it was for a different reason.
Whilst on the placement i was expected to work independantly with my own patient load and treat the patients as the other physiotherapists were. This consisted of quite short and very functional treatment sessions where you go in, address a problem and then leave. This approach worked very well in this scenario as it was a private rehab ward.
The difficulties arose during the 3 hour per week curtin supervisor period. As part of the prerequisite to demonstrate my competence i was required to assess, treat the impairments, treat the functional tasks and write-up goals and show how these goals were progressing. This approach required approx 1.5-2hour session with the patient. This would have been fine if i had the oppertunity to practice this approach during the week.
It turned into the most stressful prac because i was being assessed on things i havent had the oppertunity to practice in full. When i talked to the tutor about this, the solution included full write-ups for each patient. This made it easier but meant that every night i was knee deep in paperwork for each patient.
I got through the placement alright but it just emphasises the difficulties that arise when the placement and clinical tutors are on completely different wavelengths!

You know more than you think.........

My last clinical placement was with community physiotherapy services and on this placement I had to run several exercise classes. This was fine and I had no problem planning and executing the classes at the right level and achieving what I had set out to schieve.

The most important aspect of the classes I did have to work on....... the education segments........ I got some great advice from one of the physiotherapists that I was working with and it was 'you know more than you think you do'. By this she meant that we as physiotherapists (even us as students) have aquired a large amount of information over the last 4yrs, even though we may not think so. The general public are not as well informed. Her advice to me for my classes was to just throw in various pieces of advice as they came to mind, even if I thought that everyone in the class already knew the information I should just say it as it it would be more than likely that most people did not know and even if they did a reminder is always a good thing. Just as an example posture, everyone knows that they should maintain a good posture but how much do the general public actually know about how and why they should be doing this???

I just thought I would give this advice as I have found it very useful not only for exerise classes but for individual treatment sessions as well.