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Holistic Patient Assessments

Discussion in 'General Issues and Discussion Forum' started by Bumblebee, Dec 10, 2009.

  1. Bumblebee

    Bumblebee Member


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    Hi all you pods out there,

    What are peoples thoughts on patient assessments?
    should we concentrait on the feet only or look at the patient in their entirety?

    As a first year pod at uni, we are discouraged from doing what I feel is a full patient assessment, alertness, BP , Radial pulses respirations etc having 13yrs experience of acute/chronic and high dependency patient care I feel it is vital that patients recieve a full assessment whenever they make contact with a "health professional" and we should not just concentrait on our own little area at the expence of the rest of the patient.

    I thought we where supposed to be all working toward collaberative patient care and not working in our own little playgroungs.....!

    just my thought and whitterings, but I would really like to hear others thought on this, and what types of assessment pod in the "real world" are undertaking on their patients.

    Regards an annoying student.:confused:
     
  2. Holistic Assessment is certainly very fashionable at the moment. I can see lots of benefits, however for the sake of a good argument (i'm in the mood) I shall argue the contrary.

    I will posit that the level of holisticnisity of an assessment should depend on what is wrong with them. In an ideal world we would have time to get to know all our patients, however in the real world we are limited. Where then should we focus our limited assessment time.

    Take a humble and everyday presentation of a corn. There is plenty around that corn and the biomechanics which caused it, to fill a standard assessment slot. The obvious tissue viability issues and medical elements are relevant. Bits of lifestyle.

    But alertness, BP , Radial pulses and respirations? Come now. What are we going to DO with that information? How will the resp rate change your treatment plan for, say, a corn?

    Ok you MIGHT find a medical issue and be able to refer the patient on, but they came to you to get their feet done, not for a medical check!

    There is a tendancy I've observed in clinicians whose relevant knowledge is weak (I'm sure you're not one of those) to look for exotic things to concentrate on. The presumption being, one assumes, that this is in some way superior to the nitty gritty.

    In biomechanics I see this all the time in vague observations about "core stability" and suchlike when the person does not have the knowledge to study the foot problem itself.
    In other elements of podiatry I see Podiatrists trying to do the GP's job, analysing medication regimes and blood glucose monitoring, but neglecting basic good quality palliative care!

    This is not to say that either core stability or medications are outside our perview. I just think that as a profession, we should concentrate on the fundamentals.

    We would be better served to concentrate on being great Podiatrists rather than Medicocre GPs.

    Kind regards
     
  3. Graham

    Graham RIP

    Agreed.

    Definately having a broad understanding of the clients general health and medical status is essential, especially with our clients with diabetes. Asking pertinent questions while attending to the complaint in hand often raises areas of concern which may need to be addressed. This approach is holistic but unobtrusive and does not take the focus away from what we are there to do.

    Help the client with their complaint.

    regards
     
  4. Bumblebee

    Bumblebee Member

    Hi,
    definatly dont want to be a Medicocre GP,

    Maybe I need to change my focus but after 13 yrs looking at the parameters as past of my patient care it is strange not to look at them when providing patient care.

    But on p aersonal level having delt with many many "Health professional" over the years with my wifes illhealth and increasing disability, we have seen countless people deal only with their little ballpark and not one of them, including two GP's has looked at our health needs as a whole issue. so why shouldn't a podiatrist? why do we then refer people for diabetes screening we only treat feet? right?

    McG
     
  5. Graham

    Graham RIP

    We should, but as an overview first. If there is something that concerns us we can evaluate it further. I grill all my clients with diabetes on their BS and A1Cs. If I have concerns I send them back to their MDs with a note, politely indicating my concerns. On the rare occasion that nothing is done I will write a slightly more "provocative" letter which usually gets the job done.

    Regards
     
  6. There should definatly be people who look at the "the big picture". I do when I'm doing my other healthcare role.

    I'm just not sure it should be the profession which is defined by the part of the body it treats (as opposed to most which are defined by the method of treatment they use).

    Regards
    Robert
     
  7. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    What we are really talking about is doing a proper "H & P" - a history and physical examination.

    Most people involved in podiatric surgery are absolutely required to do this, hence the popularity of "H&P" CPE programs for podiatrists in the US. Certianly, if you are also involved in admitting or managing acute high risk diabetic feet this should often be part of your remit also (eg acute septicaemia).

    However, the real issue that is about to change the landscape for most non-surgical podiatrists will be drug prescribing.

    If you are even thinking of prescribing a drug without at least a basic understanding of doing a concise H&P, heaven help you when the lawyers circle after you instigate a 'triple whammy' event.

    Agreed - a humble corn will not warrant such depth of examination and history taking - but the next decade will see an exponential increase in podiatric prescibers through the Commonwealth. When the corn goes septic and you reach for your pad to prescribe a 3rd generation cephalosporin - this is where your consult needs to become much broader.

    Then, it will be incumbent on us to try very hard to aim to be at least as good as the most mediocre of GP's.

    LL
     
  8. dgroberts

    dgroberts Active Member

    It's knowing when to take action, when to dig a bit deeper and, more importantly, when not to.

    This comes with a bit of experience.

    You could go all out and routinely take bp measurements, respiration, check cholesterol, check BG, monitor HR etc etc. and relay that to the GP. The GP would then ring up and ask what the bloody hell do you think you're playing at. Because, when all's said and done, we are not paid to do those things, the GP is.

    We are also not qualified to deal with the outcomes of such investigstions, this then begs the question "why bother"?
     
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