On my rural prac I had a patient who had a bowel resection. I saw the patient on day 1 and he had evidence of mild lower lobe collapse (as is expected), his cough was weak but limited by pain and his SpO2 were excellent. When I got the patient up, he was completely independent and looked strong on his feet so I encouraged him to ambulate to the tea room etc.
The instructions from the doctor were apparently for "chest physio" 3x per day (even though the nurses who did the referral couldn't read what he had written). I thought that this was complete overkill since he was going well for day 1 and I also have seen patients with even bigger surgery getting only 1x per day physio when in Perth and did just fine. So I had only seen him once on day one and after the weekend there was a meassage left from the doctor who was irrate that his patient had not got 3x per day chest physio over the weekend. I then saw the patient 3 times on the next day to keep the peace. After that I commented that he was fine, so I stopped seeing him because he didnt need to be seen.
This whole situation made me fairly angry that I was forced to see this patient 3x per day when he didnt need to be just to please that one doctor. I could have easily spent that time with the stroke patients who actually needed more than I could give them in one session. The point i am trying to make is that I think we need to use our clinical judegement and be prepared to stand by that, even if it means upsetting someone because there are other patients that need our services as much as anyone else.
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3 comments:
I have had similar problems in the past. It can be quite frustrating especially as a student as you don't really have the respect of the other staff to be able to stand up for your opinions really. Maybe in a few years once we have abit more experience under our belts and maybe know the doctors etc that we are working with we can sugest elsewise. It doesnt help that as a new grad you get shuffled around so much that you don't really get to know the other colleagues as well. That is how I see it anyway.
I have also witnessed similar situations. It seems that some medical staff seem to think that physiotherapists are only there to do what the doctors ask. I believe it is important to be able to prioritise your time to those patients that need it the most, especially ina rural settings when you may be seeing outpatients and have community based commitments as well.
So have I team. However, even as a student I explained that given they are amblating that is already going to improve there lung function. maybe see them twice, then approach the doctor.. at the end of the day, and especially on rural.. you have to prioritse and who you see, and in what capacity is your decision.
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