Physio at St Helier

Today saw me at the local hospital - St Helier - for another day's fizzio. Must admit I was a bit dubious about it - I'd done enough to write my personal statement, and felt that I'd got a decent idea of the job. Still - a lot of what I'd done had been outpatients and at a private hozzie where ops were generally elective (knee replacements etc) so I perhaps hadn't seen much of in hospital type NHS stuff.

The day started badly when I arrived an hour early (doh!) due to not keeping accurate notes of appointments! I found a coffee bar (nice coffee for a hozzie) and killed an hour texting and generally watching the world go by.

Then it was back to the physio department and onto a general rehab ward. Here I met Claire and Faye, Faye is a student at St George's and ever so nice amd enthusiastic, as was Claire. Our first job was to try and get a woman to stand and walk a bit - she had dementia which is often an issue with elderly patients. I did however feel that we were itneracting properly which does make the job more than just pushing people's knees back into alignment and stuff. Then onto another patient who really didn't seem to be "On the planet" and it was actually rather uncomfortable watching as he kept yelling "no", but it was impossible to work out what was wrong. I think we all felt distinctly uncomfortable with it, and there was a mini-case conference about whether a psych assessment should be sought to see if the patient could make his own judgements and if so we should respect his wishes not to have physio. It's a tricky one, which has impact - his wife didn't want him home until he could walk, and if he didn't have physio then it was unlikely to happen. Plus of course he couldn't stay in hospital for ever.

Then it was off to neuro rehab - which means a lot of stroke patients. I saw three, but this really was enormous fun - it started off slowly with an Asian woman (not sure how the name was spelt but it sounded like Nancyelle). She seemed quite out of it still, and standing was "new" to her, but the physios got her standing for several minutes, and after looking totally blank she suddenly had a big grin on her face.

It was a great department - Helen (I think) who was a mature student like me, two students from St George's, and Edmond, a locum physio (who seem to get paid lots of money for beign physios!). We then had three patients on the go and I was watchign two of them - who were far more lively. Fascinating how after a stroke re-awakening the senses is - hand washing, rubbbing with a towel, running a comb over the arm and so on. We had a couple of real characters here and had a great laugh chatting but still gettign some great physio done. Ben was an old guy but rather liked the attention of the females, who went along nicely with it. Great to watch and really made me smile watching some "lively" people who responded.

Then lunch - and I chatted to the St George's students (Anne and Gemma) who were great and told me more about the job, the course at St George's and so on. After that I headed back to base to find out where respiratory was. I'd heard that this involved lots of snot and gunk and was quite unpleasant! Anyway - turned out there was a big meeting with the big boss of the trust coming down. It sounded interesting, but origianlly meant I'd miss out on resp, which was a shame, so I asked if I could do resp after the meeting instead of outpatients. Not that that isn't interesting, but I'd seen plenty of it. It was all agreed, so I went into the meeting happy, managing to score a number for the community physio team - to speak to them about the nature of their work (and possibly more shadowing).

The meeting was odd - lots of complaints about understaffing etc, and I got the impression the boss peep was actually wanting to help but didn't have the money. It seemed that the physios are employed by a different trust (or was it PCT?) to the doctors etc, and had not been paid for services - so we had the daft situation where they had a Service Level Agreement but weren't gettign paid for providing that service! The boss peep, to be fair, did seem to be tryign to help, but I guess everyone's strapped for cash and it seems like they're all havign to cut corners even if it just ends up passing problems onto someone else (namely the physios). Lots of stories of not enough equipment (hoists) so physios get injured, so can't work, and so locums have to be paid to come in, which costs far more than the hoist before a few weeks is up! The boss said thayt if the hoists came under her bduget that she'd order them straight off, but they might be the shared responsibility of her and the other trust so it might get more complex! What a way to run the NHS! I suspect it wasn't her fault to be honest - more the way the sytsem was set up.

Then a protest about how the sheer numebr of patients meant that the physios couldn't give treatment as often as desired. Getting patients safely mobile again is all part of agreeing to them being discharged, so regular physio can shorten the stay in hospital. It's a real false economy as in the end it lengthemns their stay which costs hundreds per night! Again it seemed that the parties involved couldn't work together but the bean counters were just worried about the columns of figures in the short term with no regard for the bigger picture - just my impression. The boss wanted evidence collected that she could take to a meeting to show how it was costing more in the long term, but as the physios put it, if we have't got time to treat peeps, we havn't got time to collect wodges of figures! They did go off into another meeting afterwards, so I hope something was resolved.

Then it was time to head to resp with Mark - all good stuff - we got to see a guy who had gunky lungs, and Mark did what I think was postural drainage (vibrations not thumps, although Mark said this was also an option he could use). Not too much sputum was produced (tries not to look disappointed), but there was some lovely wheezing and coughing! Then off to see a lady who ended up being an inappropriate referral - itnerestign to see the notes and all the chemical readings, and how Mark had to know how to read these.

Finally - onto the ITU (or is it ICU?), to see someone who was completely comatose after several operations - not exactly sure what had happened as I didn't think an ileotomy was that serious. Anyway - her sats (oxygen saturation had dropped), so we did some bagging (like on casualty) to make her breathe deeper and hopefully clear some muck from her lungs. After some of this, Mark fiddled with a long tube and seemed to be shoving about two feet of it into another tube that went down her throat. He said afterwards that this was a suction tube that was used to suck out any loose gunk as the patient couldn't cough it up.

A somewhat less lively end to the day than say the neuro rehab, but damn good fun, and I had an awful lot of good bits that I could use in the interviews. I really felt a lot more enthusiastic after today then I did after the day at St George's :oD