Hey all...two pracs down two to go!!! Hope your all surving.
I’m on to my neuro placement at the moment and the patient in this case isn’t my own but a patient I was sitting in with, with another student.
The man is a 50 year old MS patient who is a ‘frequent flyer’ in the hospital system. Socially, he is in the middle of a separation, and is on the waiting list for a Homeswest home as he has exhausted any other options for accommodation on d/c. He was admitted 6/7 ago with incontinence (bowel and bladder) that had been rectified 1/52 before this admission (i.e there was a week between admissions). On speaking to the nursing and other medical/allied health staff, it appears they believe his symptoms are not legitimate and he is trying to ‘buy time’. In other words, medical staff believes he is soiling himself on purpose to stay in hospital. His Dr’s told him he was staying in hospital for 1/12.
On initial PT Ax, he was x2max A with transfers on/off bed, and in/out of chair. He was unable to stand independently because his legs were giving way. Long story short, two days later, he was STS independently, walking with a stick with standby assistance, had fantastic saving responses, and caught smoking in his room (nursing staff informed).
Ethically we have to treat this patient and obliged to give care to him, but at what point do you say…we know this isn’t legitimate. How much Rx do you give this man knowing the fact that he’s there because he’s scared to go anywhere else and therefore exaggerating his symptoms to stay put and also knowing that there are so many people in the community that are in desperate need of that bed. He is essentially wasting valuable medical (and physio) resources. As I said before, he isn’t my patient, but watching on, I find this unbelievably frustrating that something like this is allowed to happen. Where would you guys go with this?
fan
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4 comments:
Hello Fan
This is an interesting situation. I also had an experience on a ward where a patient had been flown back from a holiday in Thailand with a suspected spinal cord injury. However, on examination his muscle and sensation assessment made no sense at all. It was soon evident that he was only in the hospital for drugs. He conveniently walked out of the hospital during the night when he realised the staff knew what he was up to. Another common situation are elderly patients in musculoskeletal outpatients. Many are lonely and tend not to get better so they can make a regular social outing to the physio, even if they are better.
From a physio point of view if these are your patients it is your job to assess the mobility status of the patient, in terms of ADLs and safety. If you feel they are fit for discharge then you can report this back to the doctors who will make the final decision.
Hope this helps.
Heidi
Hi Fan.
This is a difficult case. As you said, he is taking up valuable medical resources and therefore should be discharged if there is no medical reason to keep him. As I understand it every patient in the inpatient setting undergoes discharge planning to some extent or another. They don't discharge patients unless they have somewhere to go or can organise an appropriate facility.
If this was my patient I would be involving the social worker as soon as possible (if they aren't already involved). From what I'm reading there seem to be some social factors that mean he is unable to be discharged at the moment regardless of medical situation. Therefore the quicker those factors are addressed the quicker he can be discharged from the hospital into a safe environment.
Hope that helps,
Anna
Hi all,
I'm in agreement with Anna here. In dealing with patients with chronic problems, and most markedly - chronic neurological problems, it is extremely important to take all factors into consideration. In this case, this patient's psycho-emotional and psycho-social indicators are huge factors in determining assessment and treatment.
The fact that he is going through a separation, as well as having no housing, is obviously causing immense stress on top of a chronic condition. These factors can and do manifest physically and all medical staff should be aware of this.
Fan - it would be interesting to know whether a psych team has assessed this patient, and also whether a social worker is on the case helping to organise urgent accommodation.
I also agree that hospital beds are at a premium and not to be 'wasted' - but be careful about jumping to conclusions before considering psycho-social/emotional factors too. I would also be very careful about using terms such as 'frequent flyer' or the like when addressing any patient.
Trudi
Hi Fan...
This is a very interesting situation. As Heidi has said, if he is fit for discharge from physio point of view, then the most you can do is report this back to the MDT. It would also be beneficial to ensure his psycho-social issues are being dealt with. Contacting social work, if they're not already involved, and/or suggesting a psych review. As his physical impairments seem to have improved the next step would be to ensure he is mentally prepared to be discharged and that he has accomodation to go to.
I am curious as to how he has been handled. How did your supervisor feel about this patient and what was his/her views on the situation. Maybe a part 2 blog is in order to let us know how the situation was resolved.
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