I am currently on prac at an aged care facility. This particular patient had come into physio for problems she was having with her balance. It was not a new patient to the clinic but as its our first week it was a new patient to me so i was doing a full subjective assessment for practice and to get a better idea of the patients history.
As i was going through my set of questions i found the patient didnt mind to have a bit of chat regarding my questions as well as anything thing else she thought of and although i was retreiving most of the information that i was seeking i was also having trouble keeping the patient on track with the session and was concerned at the length of time that i was taking to do the subjective assessment but i did not want to continually interupt the patient even though their stories were not always relevant.
I realise that in the first session it is important to build rapport but the subjective assessment ended up taking over 30 minutes and this meant that the patients actual treatment time was severly reduced and this was not in the best interest of the patient.
This particular patient lives on their own and does not get out of the house a whole lot and therefore this is not only there physio session but it is one of their only, if not only, social outing for the week and so they are going to want to make the most of it. But i think it is important to try in a polite way to continue with treatment as much as possible while still maintaining rapport and allowing the patient to be content in the fact that it is both a treatment session and a social outing. As the patient would be quite likely to not be half as willing to attend physio if it was purely hard work without the social aspect to it.
I do not believe i was effective in getting the most out of the patient in a treatment sense and i am to continue with working on this throughout my placement, but i do believe i will be able to find more surreptitous ways of getting the patient back on track without being overly blunt or rude but would appreciate any stratergies other people use?
Thanks :)
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3 comments:
In my last placement at RITH I had similar difficulties. Many elderly patients are practically house bound due to their health leading them to become very isolated. Sometimes the community physios are the only real outside contact they have, other than family, on a weekly basis which leads them to be inclined to chat, excessively. I found that if I didnt have a clear plan on what I needed to ask before I went in I myself would get side tracked by the chatter and would forget to ask all relevent questions. Therefore at least having a list to refer to at hand, I could quickly get back on track. Also, making the questions as precise as possible also helped so they were limited in how they could answer. Never ask these patients "how have you been since I last saw you?". There is a line between building rapport and staying for brunch.
I was at SCGH at the Day Hospital on my first placement and had many similar experiences. I learnt from pretty early on that asking really open questions lead to huge responses and all this info that i didnt really need. Like kellie has said trying to make them a little more concise seemed to keep them on track a bit more. If i did need to stop them at some point i always tried to be polite about it and just explain that they've told you me all i need to know about that question
i agree with the other comments also but you could maybe try just for time management sake to encorporate you subjective more into your treatment session. ask all the specific neccessary questions to begin i.e anything changed since last session, VAS etc then begin your exercise or treatment session allowing them to add anything in as the session develops. i found this most usefull with my chatty patients in my musculo placement, just to get the importatnt stuff out the way first then come back to the other bits if neccessary. and as my supervisor told me it's ok to re- direct a patient by getting them back on track by saying " ok, so just coming back to your knee specifically" or what ever their problem may be and mention that you will talk about the other stuff after you just jot these few things down... it's all about finding ways to be more efficient with our assessment and treatment allowing for the most amount of patient contact time.
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