Sunday, January 14, 2007
Fighting the system.......
Hi all, just joing the long line of people writing their post at the last minute... I'm at the curtin clinic this month doing musculo, which is the area of physio that i'm aiming towards. This clinic is a mix of 50% private patients made up of staff & students and local residents, and 50% referrals from the bentley health service. My post is about the limitations of this system, and how it affects the treatment of your patients. In a normal private practice, when a patient comes in with a problem, you can treat the whole body if necessary (it's all connected, as we know). On the other hand, on a referral....... I had a patient who has been a patient at the clinic for a long time (>6 mths), referred by his GP for chronic neck pain. He presents as the typical neck pain patient: terrible posture (extremely kyphosed, stiff thoracic spine, protracted chin) tight SCM/scalenes/LS/UT, weak cervical flexors, poor endurance in a good posture & decreased awareness of position & posture. His Rx to date has consisted of cervical mobilisations, stretching & soft tissue massage, with minimal effect on his overall pain levels. In my first session with him, I basically continued this line of treatment, as we were being directed by our supervisor as to how we should plan our Rx for different patients. Post Rx he was very sore, his pain levels having increased, with a small improvement in range of motion. Before seing him for a second time on friday, I asked my supervisor if I could direct my treatment more towards improving his throacic spine mobility and postural awareness. She said excellent idea, but because his referral is for his neck I really have to work on his neck, not his thoracic, even though thats basically whats causing a lot of the problems. In the end we planned to treat his upper thoracic stiffness, and keep going with the soft tissue treatment and deep neck flexor exercises concentrating on posture a lot more. Has anyone else in musculo now or in the past had this problem with public patient referrals?? thoughts????
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2 comments:
Hey Neil,
I haven’t had my musculo placement yet but I reckon you can be a bit “creative” with your interpretation of the referral. I think that by treating the patients Tx spine and modifying their posture you are in effect also treating their Cx spine. This is creating a platform for you to be able to have the best results when mobilising or massaging the Cx area. As you note, it seems silly not to be able to consider the patient as a whole even though the area of pain may quite specific. I also think that you make a good point of noting that you tried various other methods that weren’t working and have looked outside the square to find a solution without just referring the patient back to Bentley.
Mike
Mr Neil, I think your patient is very lucky to have scored you as their physio because you DO think outside the square. I had my musculo outpatient clinic at Charlies before Chrissy and my supervisor was great in that she was more than happy for you to come up with as many different treatment options as you thought were possible 'goers'. I think its totally reasonable to treat the Thx spine as a way of also trating the neck pain-makes perfect sense to me and I would've thought that the GP/referrer would want you to use your expertise in this area to treat the patient effectively????
So I say, good on ya!
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