The Big Physio Survey - Example of Clinical
Communication. Clinical reasoning. Biopsychosocial.
Who or what is my case report based on?
I made a shared decision with a patient to refer them to see an Extended Scope Practitioner for further assessment and consideration of further investigations.
What is the physiotherapy event or episode of care?
I have been seeing a patient who is complaining of a 5 month history of neck pain with associated left arm pain and paraesthesia. I first started seeing the patient at approximately 2 months post onset of symptoms and the patient reports no significant change in her symptoms in this time depsite physiotherapy and using tricyclic medication. Due to the ongoing symptoms suggestive of a peripheral neurogenic nature I agreed to discharge from physiotherapy and refer to see an ESP for further assessment and consideration of whether imaging is currently indicated. Hard neurology testing has been normal throughout the duration of her symptoms and no red flags are reported.
What were the aims of the physiotherapy event or episode of care?
The aim was to monitor this patients progress and to explore the patients thoughts, or concerns about the progress to date and what her current expectations are. Based on this the aim was to establish whether an onward referral was currently indicated.
What did I do?
I reassessed the patients subjective and objective markers and spent the session asking what the patients thoughts about her symptoms were. I also spent a lot of time discussing the management options that we had available. The patient was concerned about the lack of progress and the duration of her pain was getting her down. She reported that she would like to be investigated further. I agreed that she will benefit from being referred to see an ESP and the shared decision was made to refer this patient on.
What was the outcome or effect?
The patient felt happy that she could express her thoughts or concerns about her symptoms. She reported feeling reassured by the findings of the assessment and she was happy that she was going to be referred for further assessment.
Why did I do this?
I agreed to refer to an ESP for further assessment due to the duration of symptoms and the failed response to physiotherapy in this time. I spent a lot of time educating the patient about her problem and about the available options as its important to understand how the patient is feeling and what her expectations are.