After seeing numerous patients throughout the day, and performing standard exercises and instructions with them, I find that I (unfortunately and unintentionally) can become slightly slack and form certain predetermined expectations of a patient.
I noticed this occurred the other day when teaching a young girl NWB with crutches. I taught her the basic gait pattern for crutches, but did not demonstrate to her how to sit down with crutches. After a few laps up and down the room, we headed towards the chair and as I wanted her to increase her independence, I removed my hands from her pelvis and instead moved to a close stand-by position. As she neared closer to the chair, she hopped too closely to the chair, subsequently overbalanced and landed awkwardly on her weight-bearing ankle. Fortunately, as I was still close, I was able to prevent her from falling but she still appeared visibly upset. It’s never a good feeling when you may have compromised a patient’s safety… especially when your supervisor is watching!
Even though the patient had a tendency to be slightly impulsive and overdramatic, the fact that she almost fell was probably a reflection of me not providing sufficient instructions and not leading enough in the treatment session. As I had taught patients NWB with crutches prior, I guess I expected her to be at the same level as my other patients and therefore did not provide as thorough instructions throughout the session. It was wrong of me to do this, as each individual is different and I should never compromise their safety by my assumptions. Even though complacency occurs subconsciously, I need to make a more conscious effort to be alert and provide each patient the same opportunity to learn. I know I will be trying to do this from now on.
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I know how you feel about becoming complacent, and I think it is our human 'slack' nature to do so! As well as to generalise patients conditions and think that if someone has a certain issue then the next person is probably the same.
That is something I have also become very aware of during prac, is that each individual is very different and although they may have the same issue, then can present completely differently!
I had a similar experience with 2 patients having undergone TKR's on the same day. The first patient I saw was progressing in leaps and bounds and I assumed the other would be too. Unfortunately the other pt's pain levels were through the roof (which i initially thought was an exaggeration as I had just been walking with the other) However, it did make me realise I needed to approach each patient 'more conciously and alert' as you said! and tailor the Ax and Rx to the individual.
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