Hey!
I wanted to write a little comment about Doctor's - now I know they have a lot of work to do and they are often stressed for time, but I think Physio's are just as squeezed for time.
I was working with a pt who has had a stroke who suddenly started complaining of acute back and lateral leg pain, of notable severity, which was limiting her ability to participate in physio. Obviously the pt had notified the nursing staff of her pain and so during the physio session the doctor came in to Ax her. I had already assessed her and been unable to reproduce her pain on palpation over the muscle belly, but had found her pain was easily reproduced on right side-flexion and extension and reduced with left-side flexion and flexion. Central and unilateral PPIVM's of her right facet joints revealed hypomobility and tenderness of L1-4 especially L2, which also increased her lateral leg pain. So from my Ax I thought it was due to a sprain of the right L2 facet joints and I had commenced gentle mobilisation.
The doctor then came in, assessed her strength, DTR's and tapped over her spine and came to the conclusion that she had torn her Glut Med muscle and advised her to take it easy in physio, despite me telling him what I had found - and he quickly bypassed my suggestion!
I was so annoyed because clearly, it would take severe force to tear a Glut Med muscle and my assessment findings made logical sense. Not only this, but this pt is difficult to motivate at the best of times, and thus the doctor's advice did not help!
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2 comments:
Oh no rach! wht did you do? do you think he may have valued your opinion more if you'd been a 'real' physio? i'd hope so, because i'm pretty sure we know a little bit about back/leg pain!
its hard to ignore what the doctor tells the pt, especially if she's looking for an excuse to get out of physio anyways, its playing into her hands!
I would have talked it over with my supervisor to reinforce that i'd thought the right thing, then maybe approach the doctor together?? Hard to explain to the pt though - can u imagine... "Sorry your doctor is completely wrong, you actually have..." haha, not sure how that'd go down!
I had a similar experience on my geriatric placement... my patient had severe Lx pain which was referring to the lateral thigh, the consultant diagnosed her with... trochenteric bursitis.
You need to be a bit diplomatic with the doctors, but I think it is important to sell yourself as the expert in these matters to the patient. Easier said then done with some patients who put doctors on pedestals, but just try to emphasise to them that this is your field of expertise.
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