Learning Experience
A few nights ago I picked up an extra evaluation at the end of the day. It was a very active 88-year old woman admitted for a GI bleed. She volunteers weekly and is completely independent at home. No device used. Upon introducing myself and my purpose for visiting her, she stated she didn't need physical therapy but was agreeable to our evaluation. She had a history of falling, both mechanical, not balance related. By the time I saw her, she hadn't eaten any food in nearly 30 hours in preparation for many GI examinations.
During our ambulation trial, I nudged this patient laterally to see if she could recover independently. With a history of falling and a request to be discharged from PT, I wanted to verify this woman was not a fall risk if she would be bumped in the hallway. I did not warn her that my perturbations were coming.
The patient became very upset. The perturbations had scared her and she and stated "If I had fallen, you wouldn't have been able to catch me". She was hungry, uncomfortable, and I had literally pushed her past her mental/emotional limits. She did, however, recover independently and didn't demonstrate any unsteadiness or safety concerns.
She then talked with our patient care manager, who paged my supervisor, to inform them of this complaint.
My stomach sank. I think I do a fairly decent job of reading my patients and knowing what is/is not appropriate for them. It is difficult for me to think I was helping someone, when it was actually hurtful. Furthermore, I never want my coworkers to think of me as a bad therapist.
Luckily, my supervisor was more than understanding. She explained that we all need reminders to slow down and take our time with each patient rather than rushing through an evaluation just to get them discharged. She also understands my "style" of treating patients, and knows I had the best of intentions but need to forewarn my patients if a treatment includes something to challenge their balance.
All-in-all it was a good learning experience. I should have warned the patient that I was going to challenge her during our walk. Even though it was a very bad day, it turned out to be a good situation.