I was recently confronted with a pt who has suffered a TACS – and 10 mths post CVA still has v marked activity limitations. She is the sole carer of her teenage son, yet she can no longer work/drive/do housework. She is able to walk with a very poor, inefficient gait pattern, with a quad stick for short distances. She is having to sell her house due to financial and accessibility problems. She has a mental health history of 3 ‘emotional breakdowns’ and her mother committed suicide whilst depressed..
During one of our sessions, she was very down – she often presents like this but I am usually able to motivate her to work throughout our session, but this day seemed a lost cause. She was fixated on the progress of others and just wanted to ‘walk normally., now’. She began telling me her life story and how she was terrified of depression because of “what it did” to her mother. She also intimated suicidal tendencies.. When I alerted my supervisor to this situation I was forced to make a decision about whether I thought this patient needed psych intervention immediately – this would basically have been outpatient suicide watch. On this occasion I deemed it unnecessary. However I didn’t get much sleep that night and nearly cried with joy when she arrived for physio the next day! This day she was motivated, hard working and more realistic about her goals. She is in touch with the state head injury whom I contacted to discuss my concerns and was told they are very much aware of the situation.
However, had there not been a case manager, who was aware of and was co-ordinating her psych intervention, this situation would have been much more difficult. I am extremely thankful that the outcome was good, but in retrospect, I think I probably should have erred on the side of caution – even if only for my own sanity. It is often difficult to draw on services we have little knowledge about, but I have made an effort to make myself more informed, should this situation arise again. I also realise that we are sometimes called upon to make judgement calls outwith our expertise and that in these situations it is probably best to proceed with caution. I was the only health professional that this patient came into contact with on this day and if something had happened to her I would have felt forever responsible, or at least as if I could have prevented it.
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I hear you, Amber. I am on my rural placement now and am really appreciating the allied-health team approach that is taken here. Handover meetings for all allied-health members of each ward occur daily which means you receive much more holistic information about your patients but also the ways in which the other members contribute to various patient situations. I think it is so important to understand how social work, psych, speech, dietetics, OT, patient liaison, doctors, nurses, and ACAT/TCS/outpatient services relate to patient current and ongoing care. Otherwise, how do we know how and when and who to turn to for assistance of an issue out of our field? It is something I think we could also benefit from having more information on at university, say in third year before we begin fourth year. I know it still confuses me about regs and residents. The allied team we hear about as a catchy name but as a real tangible and interactive group of professionals we really only learn about on the job. Yet it is so important!!!!
I agree Amber it is very difficult in a outpatient setting to be aware of any other allied health team members involved in the care of your patient. I have had a patient suggest suicide also and I think you're right that we must treat on the side of caution as even though it isn't our job to offer advice we may the only people that our patients talk to on a regular basis.
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