Clinic Day 8 and Inservice

The midway day of the week was an eventful day. All of the mentees were late so we started by mentoring OMT therapists. Once the two mentees arrived, two others also showed up who were not on the schedule. This lead to a hectic morning.

I was happy to mentor Anthony who is a past OMT graduate. The SU students mentioned he liked to take some short cuts and use similar treatments for many patients.  His patient that we were seeing had been to therapy 11 times before this visit. Anthony explained his diagnosis and treatment plan.  I asked the patient his progress since starting therapy and he reported 30% improvement.  I asked Anthony if he thought he was on the right track or needed to reassess. He was open to reassessment.  I had Anthony look at objective impairments and check strength which is something he had not done prior to today. The patients symptoms occurred with lumbar extension.  With movement pattern changes and addressing impairments the patient was able to extend pain free post treatment. The emphasis with my mentorship with Anthony was to provide exercises, reflect constantly with each patient, and to reassess treatment effects to determine plan of care changes. 

When the first resident arrived we started the evaluation quickly to try to make up time.  This patient was post operative for a shoulder arthroscopic procedure in May. He had been in therapy but was still in pain, had limited with function, and limited range. After the subjective I asked the student if they noticed any yellow flags. He picked up on the fear avoidance to movement and hyper fixation on pain.  We worked on how to educate about tissue healing after surgery, emphasis on load to improve function, and use vs disuse. The patient appeared less tense and guarded after this education.

The objective portion of the exam worked on handling and technique for range of motion and joint mobility assessment. He learned quickly and by the end the patient said the handling was very close to my technique.

Exercise prescription was lacking in his education so I also put a strong emphasis on teaching exercises, technique, and dosing to help improve his concept of how and why to give exercises.

The second student has been strong so far in residency and choose to pick a complicated patient to challenge herself. I admired her desire and was excited for the session.The patient reported with low back, leg, neck, and shoulder pain. She has had 18 surgeries in the past 8 years along her neck, lumbar spine, shoulder, and abdomen. She would be what we call a complicated patient at home. I could tell the student was overwhelmed, so I jumped in a little to try to help her out.  I worked on trying to address function and patient beliefs to help drive the session. Her biggest aggravating factor was standing in place and her relieving factor was walking. This did not make sense to the student so I had to act out and think about this to come to a hypothesis of what could be driving symptoms. She began with 9/10 standing pain and burning down her leg after 3 minutes of standing. After addressing the abdominal region with some manual therapy and motor control training in supine and standing we reassessed her standing.  She was able to stand with 1/10 pain and no burning symptoms down her leg after over 18 minutes of standing.  The big take home point for this complicated patient was to listen to her story, educate and give hope, find impairments, and work on function. The case could not have gone any better and I was so happy to have had this teaching moment with her.

With such a busy morning, I worked way past lunch so after a short time to clear my mind, I started to set up for my inservice presentation. My topic was clinical reasoning and evidence based practice. This lecture is an expansion of a lecture I gave in Ghana a few years ago and their national physiotherapy conference. The topic and style of presentation challenged everyone’s thinking and wrapped up the large emphasis I had been placing in mentorship all week. I was worried how it would be received, but I had 3 questions during the talk and over 45 minutes of discussion after I was finished.  I loved to see they took the challenge and were thinking of ways to improve their practice.

After a busy day we went out to dinner with the head of the therapy department for goat.  We wanted to try something new, but he had decided we would do this meal again and so it was the final say. At the meal his friend, Wilson, presented us with tea from his company to bring back and share with our American friends. It was such a nice gesture and we were very grateful.