Another day in clinic.
The weather hs turned properly autumnal after all the sunshine we’ve been having. There is now drizzle and wind.
I was scheduled to have two new patients. The first turned out to be a patient whose history my tutor had taken. No pressure then. He explained to me stomach pains that radiated to the back. I must have looked puzzled. He said this was a normal presentation (??!!) of tension in the stomach area. Ok, I said. He said he had done some visceral treatment and found sore spots in the lower thoracic spine, the logic of which I agreed with.
I generally have problems taking on someone else’s patient. I DO NOT like it. There is no doubt that I don’t always ‘understand’ my patients’ stories as fully as I would like but I strive to do that – understand what it is they have come in for. I feel the best chance for that I have is to take their history. It is the most time I’m allowed to hear them describe the problem and the most time I’m also allowed to discuss it in a student clinic obviously. This bit of discussion seems essential. I learn a lot just discussing a case.
Now I had patient whose presentation wasn’t something I had seen taking over from someone much more experienced. I DID NOT like it.
The patient, it turned out, was lovely. She was better already. Great, I thought, I have no idea how this was achieved. I asked the tutor (who had also taken her history) what to do with her. He advised to treat diaphragm and abdomen. I panicked in not the smallest way. When he checked on us a few minutes later I confessed the diaphragm seemed hard and not very much in the mood to be treated. I got very stuck with this. I had articulated her thoracic spine and now felt lost. He showed me how he had treated her abdomen and when my hands were on the patient’s belly, she directed them, which was unusual but much more helpful. She kept directing them to where she wanted me to push in and how much pressure she wanted and she was so happy!
I told her that for me it was difficult because all I had agaisnt my hands was the abdominal pulse and it made enough noise and vibration to drown anything else.
Not a great treatment.
Not because it didn’t do what it was supposed to accomplish, more because I felt so little in charge of it.
The tutor then told me he expected a treatment plan from me. A treatment plan.
A) I haven’t done much visceral treatment (read: none). I haven’t even got much liking for it which is silly, I know. I have a lot of issues with a lot of things and I need some help with them. I appreciate being thrown into the water to learn swimming but I need some input in terms of presentations I have no experience with.
B) She was my tutor’s patient. He didn’t seem to take this very serious but I did.
He thought I should reflect on my lack of treatment planning. All I could think was how much I got stuck with the scary visceral idea that I didn’t fully understand. And maybe none of these people do.
The one suggestion he also made is to speak to my class mates to learn how they would have assessed the stomach. When I did this today, I was told visceral is a bit of a sore subject.
And we have a winner.
I have met the visceral teacher they had. I have heard the stories.