When treating an individual, it is actually OK to not know what you are facing in this individual. However, don't let your ego get in the way my follower. We will talk specifically how ego can destroy your ability to provide the best care later.
Early on a Monday morning a few years back I received a message from one of the receptionists asking if I can fit in an emergency consult. It was a young teenager who played hockey 8 hours away and hurt his shoulder when he got knocked into the boards. I think to myself, "sure! I can do that, I hate when I am hurt and can't play my sport, I want to check this kid out to get him back in the game ASAP." You will soon learn that it takes an awful lot for me to take someone out of their sport - there leg or arm literally has to be falling off...joking, but kindaaaa not!
I decided to take him on my only break of the day. He arrives with his mom, and I immediately get to work. He reports that he was hit into the boards with his shoulder right where the board meets the glass - if you are unaware of what hockey boards look like, the glass is recessed about an inch or so from being flush with the actual board. His mom proceeded to tell me that they went to the emergency in this small town post injury to get some x-rays. All was good. However, he had a lot of pain, swelling, decreased range of motion and strength. If it will better equip you with picturing this injury, it was his right arm for reference! He is right handed, and he is holding that arm as close to him as he possibly can.
Initially I thought some soft tissue damage, or the classic AC joint separation or sprain due to impact straight on the arm.
If something is not significantly wrong with a joint or muscle, you should start to see some improvement with muscle and fascial releases in the body part affected. After 20 minutes or so releasing, well, NOTHING released. It was just as bad as I started. How could this be, I thought I was pretty good at my job. What am I doing wrong? Instead of filling myself with self doubt, I decided to talk it out and put my thinking cap on with mom.
After much discussing with mom and a conversation with dad on speaker phone on moms cell phone, we discussed the options or how puzzled I was, and that something did not seem right. I am explained that something certainly strange was going on, but I didn't know what. There should of been result with how I treated him, I was unsuccessful. Instead of doubting myself and my abilities, I simply explained that I did not know a diagnosis for this teenager, the only thing I did know? Something was not right.
As they left, I asked them to let me know what happens and what is found. Once we get some results on imaging we can get him in again. Reflecting on this story now, I am unable to confirm whether they went to our local emergency department or had an emergency consult with their general practitioner. Regardless, days and weeks had passed and I heard nothing.
I believe it was a month or two later, I was at the grocery store - in my own little world, packing up my groceries that I just purchased. I hear two check-outs over, "Are you my son's Physio?" I looked up, I didn't know this lady. At least I didn't think I did. She said it again but this time approaching me, so my first question was, "who is your son?!"
She started with a big thank you. Then proceeded to remind who in fact her son was. She continued with telling me that on his second set of x-rays at our local hospital they did indeed find out what was wrong. He had detached his deltoid from it's insertion point at the top, was immediately sent to the province's children's hospital where he then had surgery and rehab.
I thought this was extraordinary! Wow! I helped lead them in a direction to prevent further damage and catch something that was quite massive for his development and for his sports career! The other part? The children's hospital has never seen this injury in a young teenager, so they completed a case study on his injury and his rehab journey!!! (I was told at the time less than a handful of these injuries occur within all of Canada - so it was rare! Cool I know!.. if you're a physio nerd).
Nonetheless, he was healing and recovering great at the time I spoke with her.
The message today my intrigued followers? It's ok not to know. You will never know ALL THE THINGS. But if we ask for help, a new set of eyes, a new perspective, you can help people an tremendous amount more... and that my friends, is efficient health care.
The next couple of topics we will likely talk about ego and the important of a multidisciplinary approach. It appears this may be fitting.
-KR