P4R1W5: Trouble in paradise

This week was a bit of a roller coaster. We're halfway through our first rotation, and I'm not ashamed to say that all is not always well. I'll detail this in a paragraph at the end. Anyway, here's a spiel about the week that has just been.

But before I get into it all, you should all check out Touch Compass dance company. 

https://www.youtube.com/user/touchcompass

http://www.touchcompass.org.nz/

I got to observe a treatment by an OT specialist in skin care. I also got to sit in on a doctor's neurological assessment. My supervisor loaned me a DVD "The brain that changes itself" to have a look at in my own time (it's about neuroplasticity). I got to sit in on an Allied Health meeting, which unfortunately had a theme of 'underfunding and coping with under-resourced services'. We had a physio team meeting too, which was pretty interesting to sit in on - a wide range of topics were covered (too much to go into). All of these experiences were pretty cool - as a fly on the wall!

Multidisciplinary team (MDT) meetings are a bit of an emotional roller coaster. Each team member usually has some input for each patient, and we all really get involved to understand the patients life - how best to get them home and to understand the requirements / constraints of their life situation. There is usually a good laugh about somebody, usually a family member of a patient or the patient themselves, who has a good sense of humour. Then there are the heart felt discussions about patients who have a less optimistic prognosis. The team really cares for each patient. It's such an inspiration to be involved in the rehabilitation, although I'm dreading growing old!!

On Monday we spent some time with a Richmond Physiotherapy Clinic recapping Mechanical Diagnosis and Therapy (also abbreviated as MDT). All of the physiotherapists at this clinic have done some training in MDT, in fact it's fair to say that this is a speciality clinic of MDT therapists. One physio there has her diploma in MDT, which is a lot of additional training! Only two people had their Diploma in MDT in the South Island; her and a staff member at the UoO School of Physiotherapy. MDT was developed by Mr  Smith and Robin McKenzie - he's the 'Treat your own back' legend... I've mentioned him in a previous blog post before. I hope to spend some time during my community placement at the clinic.

Physio banter.

• There is a lot of banter that goes on at the hydrotherapy pool. The quote of the week is from an older lady to the older gentleman (another patient using the pool) within ear shot of us staff (two females and myself) "Why do you get two lady's and I only get one man? to which the gentleman replied "it comes with experience". Classy! 
•  I had a patient with expressive dysphagia. When asked how they thought their walking was, their reply was "looks stupid", then they back tracked and they really meant to say "looks good"... their sentences are all jumbled up.
• I heard from another physio who receives semi-precious rocks (gem stones) from a patient. The patient makes the rocks shiny by rubbing 'nose fat' on the rocks.... I think we all know there's no such thing as nose fat... 
• It was entertaining to briefly join a group of Drs sitting out in the sunshine and exclaim (with a joking undertone) that you've lost a patient... they generally like a bit of humour.

Top five fashion accessories for physiotherapists

1. Walking (transfer) belt... a bit like hand-cuffs, watch out! We might take you for a walk!
2. Personal protective equipment... whole body camouflage / blending in with other health professionals
3. Stethoscope... when worn around the shoulders, it is like wearing a very smart suit jacket.
4. Stopwatch... the sports medallion, hanging around your neck on a piece of string.
5. Pens... they fit nicely into shirt button holes or clipped on pockets.

I'm a karate black belt, red tip... naa, just got my walking belt on!

Lunch out in the rehabilitation outdoor area is always nice, sunny and we bring out the walking frames with the built in seats. Perfect! Morning tea is usually had on the go. On Wednesday I caught up with a patient of mine in her room before her rehab session, taking the time to make myself a hot Milo and yarn with her whilst she had her own morning tea. I joked that I was hidden, and that I should use her room to escape doing any work. The other quiet spot on the ward is the Breakfast Club room.

Breakfast Club room!!

And sometimes food or hot drinks are left on my desk - I love it!

We're half way through rotation one now (week three of placement in AT&R). We've had our mid-way review from our clinical supervisors (the people on the ward with us everyday). In addition, we have completed our peer review (our peers observe us perform an assessment or treatment and provide feedback too). I haven't really had the opportunity to assess many new patients with my supervisors watching, so I hope to cram as many as I can in to the last three weeks! In order to fill my working day up, I've made a timetable which will stay on my student desk so I can book in outpatient and inpatients there, and my supervisors can add more patients (if I haven't already done so myself). That way, we all know that I'm experiencing lots of new stuff, managing my time effectively and have the opportunity to improve my clinical and professional skills.

To elaborate more on my progress so far... three weeks in and I feel that I haven't learned much at all. The team; my supervisors, physio aides, OTs, medical staff including nurses are super kind. They make turning up for placement each day worthwhile. The patients, the ones I can effectively communicate with, are lovely too. The main bee in my bonnet is that the quality of new patient assessment experiences I have had have been poor (or non-existent), especially with people that cannot communicate effectively. I would love to get better at this. Although neuro isn't my favourite aspect of physiotherapy, I would still like to be a pro - one day I would like to work in a hospital. Lets hope I can bring myself back on track to pass the paper and more importantly assess and treat people with severe and acute neurological conditions... I'm feeling pretty glum, which isn't like me at all. I'm choosing to filter the details out of this blog to keep everything above board, other than to say let me watch few real new patient assessments, talk me through why you're doing what you're doing, and then let me complete a new patient assessment myself (then give me feedback). I've had enough patient follow ups - I'm already good at these! Frustrating stuff, lets sort it out already.

We farewelled a new graduate physiotherapist (she's been working for NMDHB for over a year). We went out to Stag and Fern on Thursday for pizza and drinks, and on Friday (her last day) we had a morning tea for her. She's our sock poster girl! Best of luck in Wellington Alex!!

I might need some red socks for this neuro rotation...


This weekend I'm volunteering as a massage therapist at the Nelson Relay for Life.

7pm Saturday to 1am Sunday, non-stop massage. ...And there were 10 of us massaging!