STARES #3 (FH OPD)

Situation:
This entry relates to a 62 year old female patient whose treatment I had taken over from a previous student. The patient had developed a unilateral 'foot-drop' following a L4-S1 spinal fusion, which the specialist acknowledged was a direct result of the procedure. The specialist referred the patient to physiotherapy to assess the effectiveness of therapy in improving the 'foot-drop'. Two months into fortnightly therapy, including a home exercise and hydrotherapy program, the patient situation had not changed, and the foot drop remained. Consequently the patient was becoming increasingly concerned about her long term prognosis and was requesting more information about the probability of her 'foot-drop' improving with conservative management.
Task:
My task was to undertake a literature review so I could provide the patient with relevant information regarding her prognosis.
Action:
I performed a literature search using the Notre Dame databases.
Result:
After reading through the relevant articles I was able to impart a considerable amount of information to the patient, who was subsequently very grateful. However, as I was not able to find an article directly relating to 'my' patients situation I was not able to give her the information she desired most, relating to her prognosis.
Evaluation:
On reflection, although I was not able to give my patient the concrete answers she was seeking I was able to provide her with a lot of useful information relating to her situation. I believe I conducted a thorough literature search and managed to collect most of the available relevant information. Further, I feel I was able to interpret the confusing terminology and medical 'jargon' used in the articles, into a much clearer form so that the patient could understand it. I believe this was my greatest strength as the patient admitted that when had tried researching the area but couldn't make any sense of the information. In hindsight, I probably could have expanded my search to include other sources such as the library at Fremantle Hospital, at the time of my search I was not aware of this resource. Another area I could have improved was my handling of the patients enquiries into my opinion of her prognosis. I tried to remain impartial and constantly reminded the patient of my lack of experience, however on reflection I should have been more assertive and possible instead referred her to the much more experienced head of department.
Strategies:
From this case I have learnt some very useful strategies which I can use in the future. Firstly, not only was this literature search useful for the patient, it was also useful for me. I should have conducted this search after my first session with the patient, rather than waiting for her to ask. In the future I am going to endeavour to perform a similar search when I have a case which I know little about. I know evidence based practice is constantly drummed into us at university, however it is only since I have had a real case/patient demanding such information that i have realised the importance of keeping up to date with the latest information. Another strategy which I can use in the future relates to answering patients questions about their prognosis, I have learnt that although you can never give concrete answers it is important to be confident with my responses, and I can only be confident if I am up-to-date with the latest research.