I am currently on the general surgery ward doing my cardiopulmonary placement. Most of the patients I treat have undergone abdominal surgery for resections of internal organs from cancer.
A patient under my care had undergone what was planned to be a liver resection due to metastases from their colonic cancer. Upon reading his notes it was found that the operation was abandoned due to multiple metastases which would have caused more damage on removal; the end result being an open- close surgery.
I found myself in a sticky situation on the initial assessment. The topic of his operation was brought up and he was asking me what had happened and why they didn’t take anything out. Being put on the spot I wasn’t quite sure what to say. So I explained to him that it was an open close surgery and to ask the medical team for further details. By this time I was sweating and panting, trying to avoid the topic and any further questions of prognosis and what they found during the surgery. The reason I was so uncomfortable broaching the subject was because I was on unfamiliar ground.
Having a patient rely on you for very important information concerning their health and future was something that I wasn’t very comfortable with. Even so, is it my place to even disclose this information?
So it brings me to question the limitations we have as a physiotherapist. As much we study three years on the conditions we treat the scope of our practice is limited. How much are we allowed to disclose to the patient their medical prognosis? How much are we allowed to tell our patients about their condition and its course? Or is this out of the question and it should be left in the hands of the medical team?
As physiotherapists develop a rapport with our patients that enables us to give them confidence to regain their mobility and to keep positive about their post operative condition. In doing so a trust relationship is developed, they trust that you know what you are doing and what you are talking about. Would be wrong then to deny them of information they seek on their long term prognosis when you know the answer? More so is it appropriate for us to tell them? Of course the right thing to do is leave it up to medical professionals. I would just like to share how difficult it is to face a situation where you are caught on the spot. Where a patient you get along with quite well asks you questions you know the answer to but they aren’t answers the patient would be happy with.
2 comments:
This situation is probably one of the most difficult that we will face. I agree with you as physiotherapist, we build a good rapport with our patients and they actually will approach us to get their questions answered and sometimes it is not easy for us to answer it ( and we wil question as students, is it within our responsibility to do so) and i guess it is one of the most common weakness in almost every ward (why is the med team rarely involved in patients psychosocial?? and why do patients never get their questions answered?)
Yeah sounds like a tough situation to be in. I suppose after this situation you have valuable experience in dealing with patients when they ask hard questions that we shouldnt answer. Maybe if we had a default response to questions like that we could remain confident and calm. soemthing that doesnt let on that we know much about the situation but reinforces the need for the patient to talk to the surgeons and medical staff.
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