Paeds

I am currently on a paeds placement. After 2 weeks of observation, I was given my first patient, a 5 year old who was referred after sustaining a supracondylar fracture. The instructions on the referral were to do only active movements.

What I found challenging was the coordination of the subjective examination with the patient and her dad, mum and mum’s partner. In addition, my supervisor was also sitting in for that session.

After the introduction, I began by directing all my subjective questions to my patient. I asked about the pain and its severity (using the kid’s version of the VAS). All I got was a blank look. After a couple of tries, I decided to direct the question to her parents and guardian. While talking to her parents and guardian, the patient became a little restless (I only took a few seconds!). Talking to her parents and guardian was also tricky, as all 3 were talking at the same time.

From this I realized that I needed to improve on my multi-tasking skills. I needed to be able to listen to the information from the parents/guardians and also the patients’. From that, I need to filter the given information and decide on what’s relevant and what’s not. Secondly, I needed to be more flexible with conducting a treatment session esp in paeds. I could have performed my subjective and objective exam concurrently. In this case, keeping the child occupied while I directed the subjective questions to her parents and guardian. Or I could direct my questions to my patient first. If the patient does no answer or gives an inappropriate question, I will direct the question to the parents/guardian. Lastly, I need to give the patient time to “warm up” to me. I realized that this patient was quite shy at first, but once I started on a couple of games (secretly disguised as exercises) she was quite keen on participating.