Final entry (FH OPD)

When I look back on my initial entry for this placement I realise I was fairly accurate with many of predictions. As expected, the majority of my patients were over 65, however I did have one seven year old patient and a few twenty something year old patients which I was not expecting. Further, as expected many of my patients were post joint replacements or post fractures, however the majority of my patients were chronic lower back pain patients and this is something I definitely had not expected. On the contrary I had expected to see more acute injuries, ankle sprains and shoulder dislocations, which in reality I saw very few of. I now realise that due to factors, such as waiting lists, it is very rare to see acute injuries in outpatients and in fact the
chronic patients are the norm. Although, prior to starting the placement I was aware of the importance of an accurate assessment I still think I underestimated just how critical an accurate and thorough initial assessment is in a musculoskeletal setting. On several occasions, after completing an initial assessment I was still left with unanswered questions and holes in my analysis because my initial assessment was not thorough enough. However, I have also learnt that due to time restrictions an initial assessment may not cover all areas and that an assessment may continue over the first two or three consultations. On this placement I was given an independent caseload from the first day and although I had expected to be working independent midway through the first week, this was earlier then I had expected. However, although I had an independent caseload I always felt support was nearby if needed. My case load initially consisted of 4-5 patients per day however by the fourth week I was consistently seeing 7 patients per day, which is what I had expected prior to beginning.
Prior to beginning this placement the two areas that were causing me most concern was my ability to make a diagnosis and secondly, the pressure of time management. Having now completed the placement I now realise that forming a diagnosis is not the be-all-and-all but rather forming a problem list is more important. This is because regardless of the diagnosis, if an accurate problem list can be formed by the end of an assessment, then a treatment plan can be created to address each problem, such as pain, reduced ROM or misalignment. The second issue of time management, was something that I initially struggled with but gradually improved throughout the placement. My initial problems with time management were associated with spending too much time writing notes, however as my documentation improved and became more concise, my time management also improved.
I have decided that the number one take home message from this placement is related to evidence based practice. On this placement more than any of my previous placements, I understood the importance of having an up to date knowledge base, as in the musculoskeletal field treatment guidelines are constantly changing as new research is published to support or reject a particular idea. So I now realise just how critical it is to keep updated with the latest published research, as this can determine if my treatment is valid or not.