On my current prac, a patient was admitted with severe hip pain, which was due to his hip replacement prostheses becoming loose (it was 10 years old). The patient had too many co-morbidity's to undergo surgery, so the doctor's decided to treat it conservatively: appropriate pain management and walking with a frame to unload the hip joint. The patient lived alone, had no family, with a cleaner coming in to see him weekly. The doctors were ready to discharge him, from a pure physio point of view he was also ready for discharge, and the OT was happy to discharge him as well (with a few additional services).
My supervisor, who is very experienced and caring (she always asks herself if her own family was in the same position as a patient of hers, how would she want them to be treated), was concerned that the patient may not take his new pain medications a s needed (he had some memory issues), and that he may become so overcome with pain that he may collapse and not be able to get up. She believed that he needed to have someone come to see him daily, at least for the first week or so, to monitor that he is coping. She told the OT about his, the discharge was delayed, and the OT contacted the social worker, who organised this. If my supervisor had not thought about this the patient may have ended up back in hospital, possibly with a new injury.
This made me realise that even though there is a pressure to discharge patients asap, sometimes it is better in the long term to delay discharge until all aspect of the patients welfare are organised. It is now also more clear to me why, even though each health professional has a distinct role in the health care setting, you are a better health professional if you think 'outside the square'. If you really care about your patient you do not just think of discharging and caring about the patient from a physio point of view, you must consider their social circumstances, their cognitive function, how the condition that brought them into hospital may effect them when they go home (will they cope?), etc. Like my supervisor said, think of your patient as a member of your family, or, at the risk of sounding preachy, treat your patients as you would want to be treated yourself.
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I had similar experience however in a different clinical setting and I also had a different outcome. When I was doing my cardio prac, I had a patient who the doctor was ready to discharge, and from the physio point of view, she was not safe to go home, as her saturations persistently dropped to 82% during ambulation & patient also reported dyspnoea 7/10. I did a 6MWT to show that she may need oxygen to go home with, however the doctor only said they will keep monitoring during her follow-up appointments. I consulted my supervisor however she did not comment much about this matter and being a physio student, I just gave in and had to say the patient was safe to be discharged from physio POV (I then told the patient to have many rests during ambulation, rather than using oxygen). What your supervisor said was very true, we should always try to provide the best for our patients, however still keeping in mind that sometimes the decision may be out of our hands.
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