“Ground, Open Up Please”

Week Two

I am now well versed in the process of placements. I know roughly what to expect and what is expected. I am surprised, however, that those awkward moments and uncomfortable ‘fears’ which would usually visit me by week four or five have reared their head already in week two. I have made a concerted effort to keep my educator abreast of my thoughts and verbal reflections as I go along. I find it helpful to know they are aware of how I feel about my appointments and most importantly why I feel that way. This week made me particularly grateful I have been regularly sharing. I had just experienced what I would describe as an abomination of an initial assessment. My confidence had taken a massive hit and I felt angry and frustrated at how badly things had gone. We left the client’s house and jumped back in the car. As I started to explain how I felt and why I was so cross with myself my educator added some valuable new angles to the situation. Yes, it wasn’t perfect. Yes, I had missed some things. However, I was feeling these uncomfortable fears because, this time, much earlier than in previous placements I was getting ‘out there’ and challenging myself with more complex patients. ‘True’ I thought, but this particular appointment will stay with me for some time to come. Picture the scene…

The Scene

I approached the front door with confidence and clarity in my plan. I was leading the appointment and felt comfortable in doing so. Then my educator reminded me I was seeing a retired healthcare professional. “Eeeek” went my little inner voice, “I will be sussed in a flash, I am a fraud!”. I tried to gather myself and put my worries to one side, but on reflection I was by now wearing the ‘cloak of fear’. Within two minutes of the subjective, the patient was describing their symptoms like no layperson would ever do. Medical language was thrown in left, right and centre and frankly not all of it was familiar. I could sense the patient’s partner intently looking at me from out the corner of my eye. In the other eye, I could see my educator busy himself in a pile of papers in a bid to be discreet and nonchalant, but I knew I was being watched. The pressure was beginning to mount. I needed to carry out a balance assessment as a baseline outcome measure for my patient but I was unfamiliar with the one I had been recommended to use. My patient mentioned previous transient ischaemic attacks (TIAs) and sometimes found tripping up a problem. I enquired into these symptoms to clarify whether they were potentially linked to footdrop but parked the information for later, in my mind. My educator interjected at this point with a prompt to follow-up on the footdrop clues with a physical assessment of the ankle joint. Damn, I had received a prompt. I should have followed this up straight away. I am an idiot. I ploughed on, feeling an increasing sense of urgency to ‘get to the end’ of the assessment in one piece. I assessed gait, balance and various transfers and had enough findings to prescribe some basic balance-based exercises. We ventured together to the kitchen so I could impart the suggested exercises to the patient and I felt my educator lingering in the background, positioned so he was able to assess my delivery. I removed one exercise and justified why I made this decision to my educator. He disagreed and explained why. Of course, his clinical reasoning was obvious and transparent once he had explained why the exercise should stay. Again, I messed up. ‘This patient is going to have no confidence in me soon – I already have none left for myself’ I thought, as I tried my best to continue on. As I finished explaining the last exercise, the patient shared how they often did this one ‘in the shower’. ‘My goodness’ I thought, ‘what the hell are you doing that in the shower for? That is not a safe thing to do!’ That was my mistake; thinking it and not acting on the thought. I needed another prompt from my educator to view the bathroom and assess the handrails for security. Would I even get out of this house alive…? I did get out alive, but with zero self-confidence and a huge sense of failure. I was crazy mad with myself – and just when I was beginning to think things were coming together. This is where you joined my story so, by now, you know I ‘debriefed’ with my educator and gained a sense of perspective on the situation. It is true that, despite how uncomfortable and awkward it feels, these kind of experiences really do provide the best learning experiences. I can observe a qualified physiotherapist all day long in appointment after appointment and take some lessons onboard; but nothing works to cement knowledge quite like that hideous and excruciating feeling! I can hope to learn all my lessons before I qualify – but I am realistic that this isn’t going to be the case. It will be forever before I know it all…

Mental Health & Long Term Conditions

I was fortunate enough to be invited to a training session on this topic. I was fascinated in this area and it was clear how much more there is to be done to address the needs of those with long-term conditions (LTCs) such as diabetes and arthritis. Motivational Interviewing was touched upon and this further made me sure I had chosen the right area to explore for my dissertation. The basis of Cognitive Behavioural Therapy (CBT) principles were explained and opportunities to use some of these in practice were described. I had to remind myself I had a degree course to complete before I run away with ideas of post qualification courses! It did prove though, there is a wealth of opportunity out there and I am keen to get going! I duly made sufficient notes to later explore my areas of interest and joined the e-mailing list for further information.

Looking To Week Three

My hope is that next week starts better than the last ended. I know it is unrealistic to expect everything to go swimmingly. I also know I am perfectionist in my attitude and anything less is a disappointment. I am well aware how many more disappointments lay ahead but I am OK with that because it means I am heading in the right direction. Each mistake is a lesson, each lesson makes me a small step closer to where I want to be.