Communication and recovery
By Don Williams
B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation Cert DNS. Memb: FICS, CEA
When I sat down to write this article it was initially intended as a discussion piece for a forum and website that I contribute to for elite athletes, however, after thinking about the issues involved, I really think it applies to the general population equally as much.
One of the challenges when managing patients/clients is ensuring that communication is adequate between all the parties involved in the management of the person with the complaint. For the general population this may include a GP, a surgeon, a Chiropractor, a personal trainer and a Remedial Massage Therapist, as well as the personal with the complaint. For athletes, there could be additional players including technique coach, strength and conditioning coach and team managers etc.
So let’s imagine a scenario where Michelle injures her knee. She has been training with a trainer at her local gym and gets regular massage with a great therapist.
After the injury she ends up seeing Jakob at Institute of Sports and Spines who diagnoses her with a significant tear of the meniscus and refers Michelle off for an MRI to confirm his suspicions. The scan confirms the major tear and Michelle will require a surgical approach to resolve the situation. Jakob then refers Michelle to a surgeon for management and also writes a letter to the GP. Currently in our healthcare “hierarchy” in Australia, a GP referral is required for the specialist visit and surgery to be covered under medicare.
Unfortunately this GP thinks that all Chiropractors are idiots and as a result, refers the patient to another surgeon. This surgeon is unaware of the other links in the chain in regards to where the complaint was first assessed and diagnosed and does not communicate with Jakob about the surgery and what was actually done in the operation. Once the surgery is complete there is conflicting advice and Michelle doesn’t end up doing effective post-operative rehabilitation and ends up reinjuring the knee as a result of the breakdown in communication.
The above scenario is an unfortunate but common incident that we see in practice.
At the nuts and bolts level, the breakdown in communication is to blame and if all parties involved were to step back and really have a focus on what is the best way to manage the client/patient to get the best possible outcome then this sort of situation would arise much less frequently.
In an “optimal scenario”, the surgeon sends a post-operative letter and synopsis which guides an effective rehabilitation program so that Jakob can develop and implement a rehabilitation plan for Michelle to progress through the early clinical phase or rehabilitation and back into functional training and gym work. It is important to note that at times, a simple surgical intervention may be planned but once the surgeon commences the operation, the injury turns out to be far worse than anticipated or the approach may be different which can at times vastly change the required rehabilitation program. In Michelle’s case, a simple debridement of a meniscus would see a relatively simple recover and rehabilitation plan, however, if there was stitching and repair of the torn meniscus, the rehabilitation would be slower and more complex.
The healthcare landscape in Australia is rife with egos and opinions and often this ends up with the patient outcome of goal taking a backseat.
In the example given above, if solid communication was at the forefront, then the GP and surgeon would communicate back to Jakob what was done and any specific requests or advice given to ensure that early rehab was effective and targeted at getting the best outcome. This would then allow Jakob to give targeted feedback to the trainer and other therapists involved to ensure that everyone was on the same page to achieve a great outcome for Michelle.
It is important to note that the breakdown in communication is not always any particular party. I have chosen one aspect here, with a GP breaking the chain to highlight where co-referrals can compound issues. Our team at Institute of Sports and Spines have a great network of GPs, surgeons, radiologists, trainers and other therapists who we deal with regularly and have a tremendous amount of respect for. We certainly appreciate the communication and mutual respect which we have which we believe is one of the cornerstones for good patient outcomes.
The major plus of living in a big city is the ability to have a variety of practitioners with a range of specialisations and special interests available at hand to be able to better manage our clients/patients. When all the parties involved recognise their strengths and weaknesses and utilise the available pool of resources our management and outcomes of patients are greatly enhanced.