Clinical Deplacement in a NHS Podiatry Clinic essay

Our patient was a 48 year-old woman. She had Type 1 Diabetes and has been suffering from the disease for 33 years. The patient has had a chronic nonhealing ulcer for 12 month despite cast therapy. The woman had a child and refused to be admitted to the hospital until she was taken there as an emergency for IV antibiotic therapy. She had a foot infection with cellulitis. We entered the ward; the practitioner introduced me and warned her that I would be just an observer. Communication with this patient was much easier than with the previous one. She replied all the questions and did everything the doctor asked her.  It was obvious that she trusted the doctor. Johnson (2008:1) emphasizes that it is very important for a clinician to gain trust through the relationship with clients. The woman also asked him to spare her several minutes after the examination as she wanted to talk to him. He agreed. When the examination was over she asked the practitioner about the heredity of her disease as she was very anxious about her son’s health. The doctor explained her that diabetes is not likely to be inherited; however, it is obvious that some people are more at risk of developing the disease. A person may develop Type 1 diabetes if several people in his/her family suffer the disease. The practitioner advised her to watch her son’s health and follow prophylactic measures. Then the doctor promised her to provide her with more detailed information later. When we left the ward he came up to the nurse and asked her to give the woman a leaflet about diabetes.

On the other days of my experience in the clinic I did not have a chance to know so much about the history of patient’s disease and so many details about the treatment. These days were quite intensive and busy. A great number of patients and emergency cases took much of the time. The time with the patients was limited. However, I managed to observe the pre-surgery treatment. I could watch how the patient was preparing to be operated. I was a bit concerned as I learnt that betadine was used in such cases, while the practitioner was content to use phenol explaining that it destroys germs. I also had an opportunity to see how the doctor works with a child patient. It differed much from the way adolescent patients were examined and treated.  On the last days I paid more attention to communicating with other staff in the clinic and taking my own notes which would help me to develop my reflective essay.

In this paragraph I would like to describe my feelings. After my first experience of being an observer of the patient’s examination I had mixed feelings. The case was quite hard as the patient had comorbid disease of schizophrenia. It was very hard to communicate with him and to make an examination. I observed the practiner’s actions and strategy and I thought it would be very difficult for me demonstrate the same results. I realised that my knowledge was not enough to cope with such situations. From the very first moment I was surprised that the practitioner did not introduced me to the patient and did not warned him that I was an observer. I asked him about it later and he explained me that the patient did not demonstrate any reaction to people who came to see him. It was useless to try to explain him who I was. He emphasized that in our practice and our work we should not always rely on rules only but we should think what is more relevant and good for this particular situation. In case with the second patient, a woman, I felt more confident and more relaxed. Her case was not so difficult and communication with her was not problematic at all. But when she wanted to consult the doctor about the inheritance of diabetes I realized that a doctor should be ready for such things. He should not only be ready to demonstrate his knowledge but show individual approach to his patients. When I watched the doctor working with a child I thought that children required a special approach and working with them might be even more difficult than treating patients with a number of comorbid diseases. Being an observer of pre-operational treatment of the patient, I realized that what I know from my school course cannot always coincide with what is done and should be in practice, so I should be ready to adapt my experience, increase my knowledge and to be ready for lifelong learning.

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