As a physiotherapist, my scope of practice is quite wide. My field covers cardio-respiratory, musculoskeletal, neurological, paediatrics, geriatrics and other specialities. We are the jack of all trades in healthcare so it means we have the skills and training to assess and treat multiple medical conditions competently.
I have been treating stroke patients since 2008 so stroke is nothing new to me and I am pretty competent in rehabilitating them. In fact, I had a big interest in neurological rehabilitation when I was a student and my personal tutor was a Professor in Rehabilitation Technology so I was always grilled with neuro questions. Recently, I had a new ischemic stroke patient that did a cranioectomy (skull removal) and I thought that this would be a straightforward case until I visited him.
Mr Z is big; he is my biggest patient at around 140-150kg. On top of that, he had CRE (a strong bacteria that is resistant to most antibiotics so I had to treat him in full PPE). He had low muscle tone on his left side which meant that he had no muscle power on that side. This was a huge challenge to me because there were so many restrictions for me to facilitate his recovery. I advised his family to get a battery operated FES machine (muscle stimulator) to prevent cross infection and to redo his CRE blood culture. I told his family that it is at Mr Z’s best interest to admit him into a rehabilitation hospital because physiotherapy at home will not be sufficient to meet his rehabilitation goals.
As we were waiting for his blood culture results, we started stroke physiotherapy and his left hip and knee were regaining power. Me and his wife sat him up as best as we could over the edge of the bed and we were making progress. He was able to lift his left leg when he was sitting and he could somewhat keep himself in the seated position with assistance. Later on, his blood results returned and he was cleared of CRE.
Here’s why I advised his family to admit him into a rehabilitation hospital:
He is a big man and he is bed ridden/ semi paralysed so it is difficult for one physiotherapist to rehabilitate him.
He will need special equipment and extra assistance during his rehabilitation session.
I am physically limited (I am around 55kg and the heaviest patient I could handle was probably 110kg).
His home environment wasn’t conducive.
Mr Z’s recovery is my top priority and advising his family to send him to a rehabilitation hospital was the right thing to do. I may lose a paying patient but the patient gets to maximise his stroke recovery potential. Sometimes, we as healthcare professionals need to recognise our limitations, it is not right to over promise or to give false hope if we can’t deliver because the livelihood of the patient is at stake. In this situation, it was clear that my role was a temporary physiotherapist and an advisor to the family. I wished I could work with Mr Z more because he was showing positive signs of recovery. Nonetheless, I know the hospital he is at will do a good job too.
Bottom line:
We should not let our personal or professional limitations affect the recovery of our patients. So, we need to reflect and evaluate our abilities and limitations in order to benefit our patients. Don’t only look out for our own interest but also protect the interest of our patients.
Thank you for reading!
Lian Yun-Perng
Chartered Physiotherapist
Ace Physiotherapy
Photo was taken and used with permission from the patient.
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