Today I had two new patients in the afternoon and both case histories went very well. I was pleased with myself how I managed them and I especially as I had time to both treat them at the first appointment!!!?
When I cam back to the team point my tutor gave me a very positive and encouraging feedback... He raised that I have improved massively in my communication skills when dealing with patients. That makes me so happy!!
I asked him to provide me his feedback written so that I can add it to my blog.
| feedback_for_communication_improvement.pdf |
| File Size: | 65 kb |
| File Type: | pdf |
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Today we had a tutorial in clinic on general feedback from our first CCA. There were common mistakes and issues that came up between students. To avoid those for the next CCA and future practice we all agreed that it would be great to get a tutorial on those points.
The suggestions want to list here are not in any order,...
We were told that we often ask our patients to relax so that we can perform for instance a passive examination. However in doing so we jiggle the patient's limb and this would not facilitate any relaxation. Especially as our patients are in discomfort and seeking for help from us. For the future it is important to work on this as engaged surrounding tissue can provide false negative findings on passive assessments.
The next point that was risen was that we need to be sure with our working diagnosis for our returning patient, especially as we have seen them before for treatments. Also are we required to know all diseases they also suffer from and their pathology possibly having an influence on the current symptoms.
When taking a new case history 'listen to' was the patient is saying. Often we tend to repeat things that patients already expressed. Additionally is it advised not to ask 'leading' questions like 'do you?'. Patients are likely to answer with yes or no to give a favor rather than proving them with details. However there are cases when 'leading' and 'closed' questions are very helpful and in the situation of a CCA we are advised to tell our examiner why we have used this questioning style. When patients find it hard to express themselves these questions are very helpful. However a balance not to take over the whole discussion is beneficial.
We should only consider diseases/illnesses if our patient complaints of all the typical signs and symptoms (text book presentation) rather then guessing they could have ....
If we consider any pathologies or referrals from for instance viscera a GP referral will bring further clearance. Then we are sure and no longer work on suspicion.
We were also advised this morning not to say 'I ruled out' as we are not able to rule out just only from palpation there and there will always be clinical uncertainty we are dealing with. Another phrase we should avoid is 'its not a disc because there are no neurological symptoms'. It is necessary to provide further details why we are not considering a disc being the cause for a patients discomfort. Therefore details about the onset, progression, and nature of pain would be useful to explain during the CCA presentation process. Only on disc prolapse and herniation we would definetly get neurological symptoms, however chemical irritation, annular strains and discal tears could also give neurological symptoms-which make it even harder to distinguish the cause!!!
Considering questions on accidents and injuries it would be relevant to ask more in depth if they seemed to be relevant to the case. considering road traffic accidents (RTAs) it would be good to know the speed during the collision and direction of impact.
One other point was raised before be finished this tutorial was that when a patient complains of pain/discomfort in the posterior thigh on the straight leg raise test (SLR) this should not be considered as a postive test. There are other likely causes for this discomfort that need to be explored.
This was a really helpful precise tutorial. I will come back to those raised point so that I can avoid those during my next CCA and future practice.
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