Whilst treating my patient with pernickety tendencies on my gerontology patient, I was frequently asked to assist one of the physios in treating a man with a dense L MCA. He was originally from the former Republic of Yugoslavia (from an area that is now part of Croatia) and spoke little English. As a result he was impulsive as he couldn’t understand us, and his family frequently came in to translate. This proved difficult too, as he was easily distracted by his loved ones and treatment could be a bit challenging.
One session the physio and the physio assistant were doing gait retraining with him, and he was ambulating with a walking stick. His daughter was watching in absolute amazement, and was almost in tears. She began to explain to me that when he was originally admitted to ED and then ICU, the doctors told them that he was going to die. When he spoke up and was being weaned off the ventilator, the doctors said that he was going to be a vegetable and would need to be in a nursing home. Later during rehab, they were told he’d never walk again. She then told me that back in Croatia the medical staff would never do this, rather they would say that they didn’t know what would happen and that there were multiple outcomes. For her, after being told her father would die, this was a miracle and that we, the physios, were her father’s saviours.
Thinking about this later on, I felt that perhaps the medical staff were being criticised a bit heavily because in Australia doctors tend to prepare families for the worst so that the shock is reduced if the worst does happen. However, I think that as medical and allied health professionals, we should be realistic and not give false hope but never eliminate hope. If you handle it in the most pragmatic and blunt way possible, patients and their families feel they are given no options when that isn't necessarily the case. Issues such as this need to be handled which the utmost care and sensitivity, because you never know when someone may give this news to you.
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I completely agree. A stroke patient on my neuro placement who was being treated by my supervisor, had a couple of seizures. His wife was told after by the doctor that he probably wouldn't be able to walk again and would be discharged wheelchair bound rather than once he could walk independently or with an aid which was the previous aim. This absolutely devastated an already emotionally fragile woman, still trying to come to terms with her husband having a stroke. However the patient was up and walking with assistance in a week. So I think as health profesionals we should not deal in definites, not crush hope as you say but maybe instead let family members know worst as well as best case scenario. Simply state that the functional aims haven't changed they just might not be as attainable or realistic as they once were and that compensations or other functional aims may have to be introduced in the future.
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