From my second year at university we were encouraged to reflect on every clinical encounter so that as students we could develop our clinical reasoning.
The following piece is a reflection I wrote after a patient encounter at Tygerberg Hospital (TBH). This was back in a time where I named all of my posts, Lynettes buzz, as though I was writing a column in a newspaper.
This very dramatic post is dedicated to my lecturer Farhana Karachi, who was the one who taught me about goniometry and my dear friend, Mohammed Sonday, where everyday is a decent day if you know what the buzz is.
Mission: Perform appropriate subjective and objective relevant to condition; develop better clinical reasoning skills. In other words-be awesome!
The atmosphere of all the students at TBH was laxy-dazy. A cloud of confusion swept the physiotherapy nation and all it took was Farhana the piranha to utter a simple: “Why does everyone look so confused and scared?” to get everyone to halt! Our group then proceeded in spectacular fashion to critically analysis every inch of the patients file as we felt empowered by Mrs Karachis authority!
Our patient was a 34 year old male who sustained an iliac crest fracture by means of blunt force trauma as well as a fracture of ribs 3, 6, 7, 8 and had an ICD inserted due to a right heomothorax.
With mother hen, our facilitator, we took a look at the x-rays and found rib 9 to be fractured as well-interesting. We also discussed why the iliac crest is left to heal conservatively as opposed to surgery. Mother hen then asked us about the origin and insertion sites of muscles around the crest. We deduced that quadratis lamborum and iliopsous were at play. They hold the crest in place which ensures effective conservative management. We proceeded with our subjective and we found another shocker! Mr H was knocked over in his drunken state by a car which the community of Khayelitsha had ordered due to his hustling activities! My group did not allow that to become an ethical issue as we listened to Mr H talk about lawyers; we instead negotiated more time with our patient by coercing mother hen into giving us 2 minutes extra.
We found the pelvic area to be read, swollen and warm to the touch. During auscultation we found that his breathing was sporadic, this made sense as Mr H was given a peep bottle to use 10 times a day. Mr H is also a smoker. We also found that the bed rest management of the patient was sorely lacking which is understandable due to the state setting but still rather upsetting as complications such as bed sore, DVT, urinary tract infections, muscle weakness and bowel movement complications could result.
Mr H was quite forthcoming with information and interactive to the tee despite being obligated to bed rest and in an insurmountable degree of pain.
Overall, in the words of Mohammed Sonday, It was a decent visit.”