On my musculoskeletal placement, I had a patient who came in with knee pain. However, due to an intellectual disability, she was not able to specifically tell me about her pain or its history. All I got out from the subjective exam, was that there was pain all over the knee. When I asked a question to clarify, she always said “yes it hurts” or “yes that makes the knee hurt” etc. Basically, everything I suggested seemed to make her pain worse…
During the objective exam, everything I did made the pain worse and she did seem to like the idea that I was touching her knee. I was getting quite frustrated as I had no idea how I could help her, especially if the patient was not giving any hints!! Her carer started talking to the patient about what they would do after physio, that seemed to make the patient less interested about her knee. I was then able to do PAM’s on the knee, and palpate! Following the example of the carer, I started chatting to the patient about her interest and at the same time getting her to do some of the objective exam (AROM, fx tasks etc). She was more cooperative with physio and did not seem too caught up with her knee pain.
In future, if I do get a similar patient, I am able to handle the situation better. I will not focus the patient’s attention on their pain. Instead, I will use distraction while performing the objective exam. In these situations, an objective exam would give me more information than a subjective exam.
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2 comments:
As I have also found it quite difficult to communicate with a disabled patient in a subjective examination, I agree with how you chose to over come the barrier. I found that distraction and a thorough objective examination, then response to treatment as the best clinical indicators. Well done with your prsistence.
It sounds like you dealt with this situation really well! I guess when it comes to patients such as children, teh elderly and the disabled you can't be as structured with subjective and objective as you would like to be. Some things you have to prioritise as essential for an assessment and others you can let slide fi it will only provide added detail. good job.
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