now obviously, due to professional reasons we spend a lot of time looking at bodies and what they tell us. often this is becoming impaired as the people we look at are very aware of our gaze. we can ask them to relax but i doubt they will spontaneously forget us. i think even people who are looked at a lot for whatver reason, find it difficult. i guess because it involves an element of judgement – or they presume this anyway.
in reality of course, when i see a patient, i am aiming to puzzle them out in a manner of speaking, or to make some sense of them. in very young people i often find this hard, there are fewer signs of a life lived, fewer scars, fewer flabby bits – just a lot less obviousness.
another aspect of observation is asking a patient to walk. i have yet to do that. i surreptitiously watch them as they get up from their chair in the waiting room, i walk next to them as we get to the consulting room, i try to remember what my impression was. it’s interesting: if i have no impression, they are probably ok and maybe they are coming in with a shoulder problem anyway!
incidentally, i often find that my clinical judgment is based on these glimpses, did the patient get to the treatment room with relative ease? great, they are probably ok!
what i’m finding interesting is how much i get to look at people in the street, when people aren’t so aware i’m watching them. i love these small observations. i watch women in heels and how they tend to wriggle their ankle as they walk. i always wonder if all this instability is compensated in knee or hip. i watch people’s pelvic movements as they wander along. the other day i watched a very bow-legged man walk. i wonder what kind of pain these people might have, would they appreciate me asking? it’s intrusive, isn’t it? hey, you seem to be walking funny, are you ok? but i have done so in the past, not in the street tho.
i was working in a care home somewhere and one of the staff seemed to rotate around her hip or flex one knee more, i couldn’t decide what i was seeing (this is a very frequent complaint i make to myself, all you can say for definite is that it looks ‘funny’ but how and why??!!). so i asked her about it. she told me about knee problems and how she was receiving treatment. she was interested in what i did and so i ended up telling her about the knee and the strain she was likely to experience. not much else, it’s work, not a consultation.
so, i pick things up, definitely.
what i feel in clinic is that i’m so busy ‘having’ to see things, that i have no real space to appreciate what i’m actually seeing in front of me. so, i’m busy looking but there’s no seeing. i had a patient recently where a mechanical problem suggested itself and yet i couldn’t figure it out. it was very stressful and vexing, essentially i asked the tutor to do the work for me. and he did and when he pointed it out, i could see it. but it was hard to look at her and think, i’ve been doing this for 3 years now and yet i cannot see a thing.
in fact, for a long time in clinic, my impression was often, ‘i’m seeing a person in their underwear’ – as if my mind simply refused to work with me. things that stress do to you.
when i feel freer in my approach and i feel that i’m allowed to make mistakes, i am more relaxed and open to the -for lack of a better word- experience of a patient and their body. it’s an intimate thing and i try to let them feel that i appreciate this intimacy and that i’m respectful of their body. i often see other students stood observing their patients with a clipboard. i find that very weird and dehumanising, as if we are appraising cattle.