On my current musculoskeletal prac, time management has been the main issue as I often spend extra 10-20 mins on each treatment to make sure the patients are happy, especially private patients who need to pay for their treatments. I recently had feedback from my supervisor regarding this issue and he made some good points that I like to share with you guys here. Firstly, the patients should know that they will be treated by students in the first place plus they are paying a lot less than seeing a qualified physio, I therefore should not feel guilty as students often provide more thorough assessments on patients. Secondly, a good treatment is not about quantity but quality, I should not underestimate the quality of the treatment that I am giving to my patients, especially not underestimating the value of home exercise program and education. For example when seeing a new patient, I should focus on one intervention to treat the main problem (e.g. either soft tissue massage or PPIVMS or PAIVMS etc), and then focus on HEP and education (e.g. postural re-education), rather than providing 3 interventions to treat all the problems. After discussing with my supervisor, I became more confident when treating my next new private patient who suffered an acute shoulder pain. I spent 8 mins on ultrasound, 7 mins on her HEP (active-assisted shoulder ex etc), and 5 mins on educating her about the mechanism of injury, use of ice, importance of exercise etc. The patient was actually very pleased with the outcome of the treatment eventhough I did not do much manual therapy.
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I agree that we should not feel bad about being student, since they are paying far less. unless of course, we have no idea what we are doing, we should not comprimise the patient's well-being. But since we have supervision, they patients are recieving a fantastic assessment, and sound treatment, so that is a good thing.
I also agree, that we cant expect ourselves to do too many treaments in one session, as we are doing a thorough assessment, but i think it is still important, to have done something, of given the patient enough sound information for there to be an improvement during the week.
I just thought I might share a tip I recieved on my musculo prac from one of the supervising physios. This came from a physio who worked primarily in the chronic conditions, mainly chronic pain or arthritic conditions. They stated that as new grads or students you should never feel the need to stick multiple interventions in one treatmetn session. For instance, in a patient with Ant. knee pain you could apply PFJ taping, glides, VMO ex, lateral structures stretches, the list goes on. If you were to give a patient all of that 1) you run out of time, 2) you may compromise the quality for quantity and 3) you will have no idea which of the multiple interventions have been effective. If the patient returns next week improved, then you could continue with all of the interventions every week until they are better. However the more realistic approch was to build up. For instance, if a positive response occured after say PFJ taping, then you could continue with that in addition to VMO recreuitment ex. This became apparent to me after I gave a patient multiple interventions in one session and they represnted in much more pain. I was unsure which of the interventions it was, and basically guessed. it turns out that my guess was correct, however it was quite risky. As such i have taken on board what my supervisor told me.
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