Low activity day at my last placement on a general surgery ward.
An intern calls for support with a patient, myself and ward physio enter the room to find the patients brother(ptb) had fallen in the patients(pt) toilet.
(For ease of description patient = pt /// patients brother = ptb).
Arrived to find ptb 4pt kneel in bathroom and can't independently t/f to standing.
pt was RIB, pt daughter and ptb wife present.
Myself and the ward physio assisted ptb from 4pt to stand. (2x assist)
o/e (ptb):
Cognitively Intact
Nil Pain
Independent with all ADLS lives with wife.
Hx of frequent falls - Tries to pick things up from the floor and can't stand back up.
Ptb was not confident to walk to his car.
PROBLEM: I wasn't not happy for ptb to drive home.
d/w intern about the ptb driving home, The intern was not happy to remove ptb's licence, I agreed with him, but perhaps we could persuade them to find an alternative way home.
I was offered no support from intern, ptb's wife, pt or pt daughter on the matter.
Instead I was asked to push ptb in a wheel chair to his car and 1x assist transfer from w/c to drivers seat.
I felt really powerless in this situation but worse than that I went against my own judgement, ptb could have killed someone when he drove home that afternoon and I would have just been a spineless physio student who didn't put his foot down. (luckily he didn't kill anyone)
One positive is that you guys can learn from my mistake and stand up for yourselves.
4 comments:
Hi Deeks,
This is obviously a very difficult situation. I did some fact finding and apparently as a Physiotherapist we are legally powerless to stop someone driving. Ultimately it is the Doctor who has the power. They can do this by writing to the Police and then they take the licence away. This is a common situation Physiotherapists might face when they are doing Outpatient treatment on an elderly population, particularly when treating those with deteriorating Neurological conditions. With this in mind what do you think you would do differently next time?
Rob Waller
It is hard being a physiotherapist to determine whether one should drive or not, and it is even harder for a physiotherapy student to actually voice out his/her opinion. i think the issue now from a PT point of view is not whether or not ptb should drive but to sort out his 'frequent fall' issues, it may be worth planting the seed to him saying that physiotherapy do offer falls clinic to help him with that problem. Hopefully he will be motivated enough to look into it and help himself in preventing further damage.
Deeks. That is a horrible position to be in as a student. I find it especially disturbing that you were instructed to 1x assist someone from a w/c into the drivers seat of a car!
Not having support from the intern would make it very difficult to convince the patient of anything.
You didnt mention where your supervisor was when you were having that discussion with the intern. Maybe with the support of your supervisor you could have had more leverage in changing the mind of the intern...?
I think you did well in this situation. I think it's important to remember that there is a limit to what we can achieve and change.
Cheers for the comments,
Rob, next time I would just stress my concern further and not agree to push ptb down to his car.
Clee, they didn't think the falling was a problem and thus didn't see the need for any intervention. I did manage to convince the pt daughter that ptb needed to see someone about his falling.
Luca, supervisor had to return to treating a patient who was desaturating, hindsight I should have asked for their support and input.
Cheers for your input.
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