Communication

Left 1 week to end of placement!

The past 1 week had been slightly challenging, esp in the areas of communication. Few examples:

1. Patient (41/female) from Somalia
Was asked to see a patient with (R) lateral malleolus #. Patient is a 41 year old lady from Somalia. Although she could speak simple English, it was slightly challenging doing my subjective assessment and patient education. It was difficult getting her to describe her pain. During the treatment, I also had to rephrase various of my sentences so that it is simple for her to understand. Seemingly easy, quite effortful actually -- to think quickly and talk at the same time…asking specific questions that will elicit the info I want.

2. Patient (45/male) with Down’s Syndrome and (R) ear deafness

Usually, we get to know who our patients are for the next day, so that we can prepare in advance. Reading the referral letter (patient referred for rehab for post-ORIF (R) patellar #) and checking the x-ray, I did not think that the patient would be someone with Down’s Syndrome. While checking the x-ray, I was appalled to find that he had a previous patellar # before in his (L) knee. Hence, I was curious to find out what had happened to have resulted him in having both patellar #.

I must admit I had a ‘tiny’ shock when I saw the patient arrived with his carer.

Due to poor memory, the patient was not able to account for his injuries. Hence, my initial-planned-detailed S/E became a short concise one. Compared to the lady from Somalia, my questions became even simpler, shorter and close-ended ones:

“Does it hurt?” “tight?”

I wanted to ask how much on a scale. Then he gave me a blank look. Even getting him to grade “mild, mod, severe” was difficult for him. I then realize my mistake. So it became “a little hurt? Or a lot?”

I wanted to ask what movements/ activities bring on the pain/ worsen the pain? Again, I got a blank look. So I had to give examples to help him along.

Could not get any related past history as well due to his poor memory. As his carer just started work 1/52 ago, I could not get any info on patient’s WB status, history of injuries (both patellar #) and any other related medical history.

During the treatment, I was spending more time talking to his carer, educating his carer on how to guide patient with his HEP. During the process, I realized I had the tendency to talk more to the carer, and forgot to interact/educate the patient too. I noticed that the patient kept looking at me and it dawned on me that the patient needs to know what’s my plan too.

Due to his ® ear deafness, I also realized that I need to take into consideration where I should position myself and him for treatment.

Due to his med condition (DS, poor memory), I need to make my explanation very simple. It was actually quite challenging explaining what the ultrasound machine was and wat the ultrasound gel was for when he asked at first :P The exercises taught also had to be simple at first, with lots of guidance, facilitation, visual/verbal/tactile feedback.

And… throughout the whole session, I had to make a lot of observation – looking at his facial expressions for any signs of pain, observing his walking closely to see how much weight he’s putting through his foot.

So in conclusion? … it was a week of meeting the “unexpected” and (more) modification of S/E, patient education, type and complexity of exercises taught to each individual.Despite similar conditions, every individual is unique!