Sunday, May 25, 2008
AKA
I was doing my paediatrics placement and I had a patient with tumour in the proximal tibia. She is unable to weight bear of on the affected leg. The medical plan with her is to trial chemotherapy for 6 weeks and then if there is no success, an AKA. Things I have been doing with her is maintanence exercises and also encourage ambulation with her elbow crutches while she is undergoing chemotherapy. I have developed a very good rapport with her and her family during her stay in the hospital. Towards the end of my placement (4th week), she had done 2 rounds of chemo (in 2 weeks) and there was no improvement shown in the MRI scan, so the medical team decided to go bring forward the amputation scheduled to be at my final week of placement. The patient and the family too had agreed with it saying that she will be more functional without her current leg. Patient was allowed to go home for the week and is to be admitted the day prior to the surgery. However, when she attended outpatient clinic for review two days before her surgery, her parents approached me and said, they are planning to not go ahead with the surgery and asked me what do i think? Her family believed that the next round of chemo will be a miracle and her limb will be saved. However from my point of view, the tumour is malignant and its huge (visibly and radiographically) and it is better of to be amputated as she will be able to function better with a prosthetic. Patient and her family had disagreements with medical team and asked me what do I think. I was put in a situation in which I don't really know what to say. And all I said was "it is the medical teams decision'. I didn't tell them what i really think (which is to amputate), maybe i should have? I approached my supervisor later and she said, saying that its the medical teams decision was the right thing to do. What do you all think about this? Should i have just said, go ahead with the amputation as what is planned by the medical team? or should i not say what i think and be neutral?
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2 comments:
hey AKA,
I think that you did do the right thing in saying that its the medical teams decision. As much as we know about the condition and pathophysiology our role is limited in these situations. Even though as a physio we establish a healthy rapport with our patients and their family our qualifications don't really extend to psychological support or medical based decisions. I guess it puts into perspective the limits of our profession. You shouldnt doubt your knowledge but at the same time one must realise the limits of our role as a Physiotherapist. How that gives you a bit of moral support. It is hard when you establish a really good relationship with the family, but we do not want to encourage false hopes.
I agree what you did was the right thing. Sometimes we have to keep what we really think to ourselves and go along with what the medical teams has decided in order to give the family confidence in the decision. We are not always the best people to discuss decisions with the family even though we develop a good relationship with the patients and their family so they want to talk to us about it.
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