Lessons Learned: Clinical Education 2, weeks 5-8

The span and tardiness of these updates have decreased in an exponential manner. I have returned. The span for the next three rotations will be every five weeks to make two posts per rotation.

 

      1. Healthcare access in rural areas is a problem.

I’ve lived in Arkansas the majority of my life and barely knew any of the towns my patients were coming from. Arkansas is of course a fairly rural state and our largest city doesn’t even have 200,000 people. I’m not sure why there is such a disparity in patient education and am not sure if it is more about lower socioeconomic status or those people living in a rural area. I’ll let the people who do that for a living study that. We had multiple patients with “red flag” cardiac symptoms or neuro symptoms who stayed in their houses and stayed with their loved ones for days. Actual days before seeking medical help. Not only can this increase their mortality rates, it removes valuable opportunities and early time to start rehabbing. I’m curious about if this decreases their rehab potential.

     

      2. Diffusion of responsibility is rampant.

This wasn’t even a big facility. The most we ever had was maybe 26 if that. Now, no single profession had an abundance of employees. There were only a couple PTs, several OTs because most worked part time, one speech, two social workers, a dietician, two doctors who came on different days and the nursing staff. Having that many professions together without a true manager of the facility in place led to confusion, ambiguity and frustration about delegation of responsibilities. Of course the doctor dictates medical care, but he/she cannot manage patients and everybody else at the same time. I’m curious if diffusion occurs more with an increase in units or if it occurs more with an increase of people within a unit. (Purposefully leaving out specifics)

 

      3. Never give up on a patient

Many have limited time at the facility because of health insurance and limited financial resources. You throw on limited family support and the stress of being away from home, then it is clear to see that the patient has an uphill battle. By far the most disappointed I’ve been was when I was handed a patient who another therapist had been working with for about a week. He had trace movement of his left lower extremity and could not move against gravity. The upper extremity he had a very small range of shoulder movement against gravity. No spasticity, but extremely flaccid. Very disheartening to work with and it was hard to manage his wife being there during the treatment when we were struggling so much. Long story short we were able to get nearly full range against gravity with multiple muscle groups. We were able to go from an all out total transfer level to max transfer and go from a total assist with standing to a weak mod assist level. If I had given up, this patient wouldn’t have even had a fighting chance to go home with his wife out in the boonies. At least now he and many of the others that we treated are given that chance. The bottom line, is you never know what someone’s outcome will be until after the fact. For that reason, never give up.

 

      4. Coordinate care

You want to tick off an OT? Forget that they see the same patient right after you and put the patient in bed. Works every time.
Collaborating helped me get a better feel for the patient, their family, and their living situation. There’s always some extra detail that may be meaningful that the patient might have forgotten to inform me of. Discussing with others led me to better figuring out patient motivation and led me to other treatment ideas that I probably wouldn’t have worked on otherwise. Also, while a patient is supposed to be able to tolerate three hours of rehab at these facilities, some certainly have better endurance than others. I frequently kept an eye on the schedule and what OT was doing to make sure that the patient got the most out of their day and wasn’t just completely exhausted after one of our morning sessions.

 

      5. Make your inservice meaningful

At least once a week, on one of the physical therapy Facebook groups I see some student asking for someone to give them an inservice topic. The notion of asking for this is so foreign to me. You’ve been at this facility for probably at least five weeks and have had interactions with all kinds of patients and you can’t pull on those experiences to come up with something? Come on. I think a good strategy to take to make it meaningful is to take something typical, that people frequently don’t question and see if there is any evidence of people doing it differently. For example, we had a decent amount of total hip arthroplasties (hip replacements). I did my inservice on hip precautions. Write up to follow on that.

 

So concludes my inpatient rehabilitation rotation. I’ve already been assigned my other ones so I know this will be my one and only. Overall, solid educational experience and good use of problem solving and assistive equipment placement and measurement skills. Would I want to work in rehab. Probably not, but I could see myself doing it. Spending 1.5 hours with a patient per day and seeing them get better is incredibly rewarding. The pace is rather slow and I’d imagine the pay is in line with that so I might not start out there. I am confident that I could work at these facilities as a new grad and so all in all, an effective rotation.

 

Ramble on,

Sam

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