This blog concerns an outpatient whom I treated whilst on my country prac. She presented with neck pain. During the subjective she informed me that 3/12 prior she had attended the ED department of the hospital complaining of unilateral facial numbness, weakness down one side of her body and severe headaches.
She went on to tell me that investigations performed at the time and subsequent imaging revealed she had not suffered from a TIA. I spoke to her GP later regarding this information and he confirmed her story and mentioned that she is known to the medical staff in the establishment because of her frequent attendances, many unwarranted!
During my 3rd week of placement and having already seen this patient twice at that stage I received a phone call from her. She told me she was suffering from severe headaches and unilateral facial numbness . I was taken aback initially I must admit. Why did she call me to tell me about this? Isn’t this a serious matter.? Once I composed myself I asked her how long these symptoms had been present. She replied about an hour. I noticed her voice sounded normal (for some reason I would have assumed the voice of a person who is suffering from a stroke would sound different owing to the hemiparesis of the facial muscles).
I asked other screening questions and asked if she had spoken to her doctor. She replied in no uncertain terms that he would not be interested in this and that she was not happy with him treating her. I told her then to report to ED immediately. She asked if I could do something for her symptoms! I explained to her briefly the seriousness of these symptoms, that physio intervention was not appropriate and the need for urgent medical attention was required. She then reported to me that her mother would soon be home and if it worsened she would report to the ED department. I did insist on her calling an ambulance for which she declined. I asked the PT staff if I should call one on her behalf for which they said it was her decision.
The other PT staff were aware of my ongoing dialogue with this patient and were satisfied that I handled the situation appropriately. I guess in hindsight knowing what I did about this patient I still thought it necessary to ask the questions I did and then inform them to report to the ED department. Any patient that complains of symptoms like these regardless of what they have told you previously or how they present need to be taken serious. There is no doubt in my mind that it is always safer to be overly cautious.
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2 comments:
I think that you did the right thing. Regardless of prior knowledge, all pt claims of symptoms have to be taken at face value, with all possible precautions carried out to prevent further injury. The patient sounds like she has a psychological cause for her symptoms. However if medical investigation rules out any pathological origin for her symptoms there are a number of psychological disorders that may result in her fabricating symptoms or there may be the possibility that she has a conversion disorder where a psychological issue is subconsciously causing manifestation of stroke like symptoms. Just something to be aware of. Good luck
Well done. I had a patient during my musculo prac who casually told me that she had numbness in her face and arm with what she described as 'like I was having a nap but almost going unconscious' for 30-45 mins the days before. To me, huge red flag! I did the same as you. For them it's more so they know what to do in case it ahppens again, but for us it's peace of mind that they know what's happened to them. Tad scary!
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