Repeat Patients -- Same Approach?
For the first time ever, I'm treating a patient who returned for repeat therapy after being discharged a month or so ago. This patient, who is impaired following an anoxic brain injury and transfemoral amputation, has been through the medical ringer in the past six weeks.
His first course of care was very challenging, however we made some great progress prior to his discharge. Knowing that multiple medical complications occurred while he was away, I was honestly scared to see how he was functioning when he came into the clinic on Friday.
The evaluation was interesting. I knew what we had measured and worked toward in the past, so I collected similar outcomes. But I couldn't help but think that I needed to be doing more. Unfortunately, I correctly predicted that this patient would be well below his previous performance.
Bed mobility, contracture management and sitting balance were back to pre-PT days. In the middle of the evaluation, it occurred to me that I might have to take a very different treatment approach this time around rather than plugging away at the same old goals that we set last time. A new episode of care with a new focus.
I think it may be hard to phase out the old program and start a new one. It took so long to develop an effective and efficient treatment plan for this patient, and I fear that he and his family may not be interested in taking a step back to work on some basic functional skills that seem more important this time around.