During a previous placement I encountered a challenging situation in regards to professional communication and the role of the physiotherapist in a multidisciplinary team. The patient was a man in his mid sixties who was admitted for a quadruple coronary artery bypass graft who, among a significant list of co-morbidities, had chronic renal impairment that required dialysis. Following this surgery it is common for patients to have low haemoglobin levels and this is monitored by the medical team with daily blood tests. Usually a patient with a low Hb will be monitored and if they are symptomatic and Hb near 80 then they are likely to be transfused.
This patient had a Hb level between 80-83 for five days. During the four days the patient had been on our ward they reported dizziness, fatigue, high resting and exercise heart rates and low blood pressure. These symptoms impacted on our sessions to the point where the patient was only walking 40m sections before needing a rest and was not progressing anywhere near a rate expected after this surgery. I discussed this situation with my supervisor who suggested I talk to the medical team to see if a transfusion was possible. The RMO informed me that as the patient was having dialysis to remove excess fluid from the body, they were not interested in adding anymore. I asked if there was an alternative but was brushed off and told to continue with what I had.
I continued to treat the patient within these restraints but progress was very slow. The following week I attended the early morning ward round with the consultant, registrars and RMO. When we got to the patient, it was commented by the consultant that the patient was progressing slowly and it was suggested that the physiotherapist needed to work harder with the patient and see them more regularly. I did not appreciate this comment as I had been spending quite a bit of time with the patient and I felt quite intimidated in this situation; however I took the opportunity to express my concern about the patient’s symptoms. The consultant questioned why this had not been bought to his attention sooner and said that a solution to increase the Hb would be found with the renal team.
From this experience I have learnt that it is worth getting a second opinion from a medical team if you believe that something is not being dealt with appropriately, however you would want to make sure that you are 100% sure of what you are saying as dealing with the senior doctors is quite an experience. The RMO did not know there was an alternative but rather than asking the question they ignored the problem in the hope that it would go away.
2 comments:
Great persistance Brett! It is so easy to feel intimidated by more experienced health professionals. Its a hard situation to be in when you have an opinion, and have to weigh up whether or not to voice it.
I think as students, we are so used to having someone more senior above us, and not having a great deal of responsibility. Even the docters are still learning, and in your case, maybe that particular docter didnt want to be seen as taking advice from a physio student??? I think that this situation is a perfect example of sticking to your guns and persisting for the benefit of a patient. Hopefully we are all learning that as we gain experience, we gain clinical knowledge that other health professionals will listen too!
Good on you for speaking up! It’s really easy to become intimidated in those situations. But I guess it is important that if you have a concern for a patient, and you are not satisfied with an answer, it’s best to try the next port of call. Just the other day, I was told to teach a patient NWB with crutches post skin graft. When I saw her the next day, RMO orders had changed to FWB with crutches. As it was such a dramatic change, my supervisor suggested I check with the consultant, just to ensure there was no miscommunication between doctors. It turned out to be ok, but I guess it always pays to put the patient first… no matter how daunting it may be!
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