I always get the jitters when I see patients for the first time.
And this is because I get anxious about focusing too much on the assessment and the whole procedure that I forget to look at the big picture. Is this known as focusing on the trees and forgetting the forest? Hmm.
One good example is when I was assessing a patient with multiple sclerosis (MS), I followed the assessment form and thought that I had assessed enough and analysed it well. But when my supervisor came and saw the patient move from a position of supine to crook lying, she immediately saw something that I had completely missed out. My patient had a very subtle trunk ataxia. She went on to explain that some MS patients may seem to have no/little ataxia because they fixate the movement through the global muscles. In addition, if we work on getting them to stop the fixation, the ataxia will become more apparent and as a result, patients may think we are doing them more harm than good. Contrary to popular belief, enabling them to stop the fixation will allow us to work on their postural muscles and thus, improve their ambulation.
Being a student with no experience in neurology, I feel it is important we analyse our assessments (therefore we do a SOAPIER) and get the supervisor to go through it (important to do at least one) so from there, we know if we are on the right track and can build up on our skills.
I think it all boils down to how well individual observation skills are (that’s why we are students and trying to get more experience to train it). Apart from observing patients movements and analysing it, knowing common movement patterns are pertinent too.
Is there any other way to improve observation skills?
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2 comments:
I think it is normal to have jitters when seeing patients initially. I have also been learning quite a bit about promixal fixation in the current clinic I am in. Although we probably learnt this briefly at some stage, I dont recall ever learning it and it seems such a massive problem facing a gamet of neuro patients. I wouldnt worry that much....we have been taught a huge amount of information at uni, and have not had the opportunity to apply any of it until clinic. All of us will need to work through our assessment systematically until we conquer the basics. From what we are told, there are so many things you can work on with these patients, that you cant really go wrong when deciding what to treat. In any case, assessment is always ongoing anyway. You can never pick everything up in the first few sessions. PS who is jitterbugs?
haha thanks leah, jitter bugs is the title of my blog..
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