Physical Examination

This is not from what I have done for the intervention, but something what I have learnt from PE on one of my patient.

I had a nice and generous patient to do the initial evaluation this week. The main presentation the patient brought in on the day was general weakness with no pain associated in anywhere else. The investigation was still under going, so there was no specific Dx at that time.

After conducting usual SE, PE was begun without paid any special attention. At the muscle power section of LL, the patient was asked to do the heel raise in standing. From SE, this patient did not have complaint regarding walking and running, and used public transportation to come to the hospital, so I would not think this heel raise was going to be difficult for this patient.

All of a sudden, this patient started into tears. I thought the task was in pain, but it was not. The patient was never asked to do this task before and thought to be no problems. Thus this patient was very disappointed and this patient thought to fail the test. Only one leg had difficulty doing it (could not even do it once) and that made the patient more into disappointment.

I explained to the patient these tasks were not the test or exam to evaluate whether pass or fail, and it was very important info to obtain for us and must be done before starting of physio Rx. I thought the patient was well explained beginning of PE, but I assumed it was not clear enough. After the 2nd explanation, I was told the patient understood clearly, but not satisfied the result from the task. The patient was explained the reasons behind in detail, however the patient was not ready to accept the condition yet at that time.

I assume the patient’s personality is involved in part. According to the patient, if there is an issue, it should be solved or cured right away. Since the condition started, the patient tried to find the solution via lots of trials but seemed not working well. So the patient was struggled, and the heel raise was now another thing the patient realized could not do.

As this patient is still in the process of acceptance the condition, I agree that finding the activities this patient is now unable to do which was no problems before is distress. So what I have learnt from this experience, well explanation and the way of conducting the muscle power or neurological examination should be more sensitive depending on the conditions what you are dealt with. Even though it is part of our PE to go through, the result from PE might impact on our patient.