Reflection three week 5

REFLECTION THREE – WEEK 5

S/
I was given my first opportunity to undertake a subjective and objective examination today. The patient had already been receiving treatment for his low back pain at the private practice, so my task was not to undertake an initial assessment, but get an opportunity to practice under a mock situation.

T/
The task to be undertaken was a subjective and objective examination of a patient presenting with low back pain. I was required to perform an appropriate subjective exam in order to plan and undertake an appropriate objective examination. Whilst I already understood this patient’s diagnosis and prognosis I was required to pretend that it was his first consult so I could demonstrate some clinical reasoning.

A/
With guidance of the UNDA assessment proforma’s, I conducted a subjective examination asking all the appropriate questions for a patient presenting with low back pain. Following my subjective I planned and carried out an appropriate objective exam.

R/
The result of the assessment allowed me to hypothesise a diagnosis for this patient. I was able to ‘subgroup’ him into a peripheral neurogenic with compromise. The asterix movement was extension and Left side flexion. The motion Segment L4/5 reproduced the patients symptoms on palpation.

E/
Overall I felt as though I performed the assessment very well, considering it was my first go. The result of my assessment could have been impacted on by a few weaknesses. Firstly my technique for some of the objective techniques was poor. This was mainly because I was rushed and so was forgetting about the small things. Secondly, on reflection I forgot a few times on enquiring about symptoms and resting symptoms. Finally I had my patient moving around too much, I needed to plan my physical exam in order (i.e standing, sitting, supine, prone etc.). Finally this experience allowed me to see how important it is for musculoskeletal physiotherapists to think on the spot in order to conduct a full soapier in the 40 minute timeframe allowed for an initial consultation in a private practice.

S/
While I am learning, a strategy I would like to implement in the future as a student is to take a moment to plan an appropriate physical examination following the subjective. This would allow me to consider technique and what measurements are most appropriate on the initial consult, resulting in better outcome for myself and the patient.