Private Outpatient Care in Australia

I am absolutely loving my outpatient experience! I definitely feel more comfortable with my scope of understanding in this setting compared to the acute care. Many things, we do similarly to the Aussies. However, many things are different. Here are some things I have learned during my 1.5 weeks at this site.

1. In Australia, physio's cast fractures. I have a tutorial on this tomorrow and I am so excited. Just think of all the patients you have had post-cast removal that would be more functional if they were casted in a better position.

2. In Australia, each treatment session is worth the same value. Therefore how you spend your time with the patient is in no way influenced by "units" or reimbursement for specific techniques. A followup treatment session should typically take 30-45 minutes. There is an amendment where you can charge more money for the really complex patient that takes 1 hour or is receiving therapy for more than one condition/joint (hand and knee, back and shoulder, etc), but these situations tend to be rare.

3. They do quite a bit of manual therapy. Although I believe they already hold this steriotype in the US, I was surprised to learn that the majority of manual therapy they perform consists of soft tissue mobilisation, joint mobs, and "muscle energy techniques." They do use manipulation, but only when the others don't or wouldn't work.

4. They hold the 'athletic trainer' position on sports teams. I spent last Saturday "strapping" or taping ankles and knees and fingers, providing first aid services, and referring people to the nearest medical center for radiographs. And that was just for "boring and dull" netball! I am hoping to do the same for a rugby or an Australian football team before I leave here.

5. Tearing tape is really hard. (At least with the brown, nonelastic tape) I spent 15 minutes trying to tear my first piece. I am better now though. If only I had practised with Dr. Malone...

6. They do not worship McKenzie. They are like our UK education taught us to be: objective with each patient, utilizing different methods as would best help the patient. Such good advice. Thanks Dr. English and Dr. Harrison.

Also, I have learned many more Aussie phrases:
Good-on-ya! = good job!
Full on= high intensity, no holds bar, straight to the chase
Flat out=super busy (this may be a repeat)
Grizzling=complaining (quit your grizzling!)

:)

Fun stuff.

long time no write

I just wanted to put a quick note on here apologizing for my long absence. I have been on "holiday" for the past two weeks, exploring Australia with Woody. It has been lovely except for the fact that I have been sick for almost 3 weeks now (I do think I am getting better though). I am glad that my hospital experience has taught me so much about chest physiotherapy as I am probably more adept at taking care of my upper respiratory condition--now if it would just go away.

Yesterday was my first day in the outpatient clinic in Blacktown. The outpatient clinic has a diverse range of patients and I am already learning so much. Today I participated in a pilates class for our patients and tomorrow I am going to a nearby pool to lead some "hydro" or aquatic therapy sessions.

I do plan to write more tomorrow and also put up some pictures. Woody posted some of our pics from Vacation '09 on facebook, so you can check those out if you so desire.

I really miss everyone from class. (I wish I could get in on some of those study sessions Amanda mentioned in her email! :) ) Hope you are all doing well and learning bunches as we push through these final days of grad school. Almost there!

Mark Elkins

This week I had the pleasure of spending an afternoon with the one and only Mark Elkins. Mark is internationally known for his research in respiratory physiotherapy. I am pretty sure that we read one (or more) of his articles during cardiopulmonary class. Most of his research centers around treatments for those with Cystic Fibrosis. Basically, he was the first one to test hypertonic saline (salt water) as a treatment/managment technique way back in 1999. So now, his research continues to explore the use of hypertonic saline in the management of CF.

During our afternoon together, I was able to observe his current study. I shant tell you too much about it, but I am sure it will be published soon enough.

Not only did this afternoon increase my appreciation for research and respiratory physiotherapy. It made me realize how lucky we are to have Prof. Darbee as a faculty member at UK since she apparently is known internationally for her research in this area.

Oh, and professor Darbee--He says hello. :)

Radiographs

So, I have been trying my hand at reading chest radiographs. Now I know most of us have become efficient at reading them from the ABC perspective that Dr. Nitz teaches, but this is a bit different. I can't remember if we looked at chest radiographs in Cardiopulmonary, but if we had we would be focusing on the characteristics of the lung fields instead of the bone.

I learned early in my internship that the lung (on radiograph) should extend down to the 6th anterior portion of the rib or the 8th posterior portion of the rib. It is normal for the right to be a few cm's higher than the left. But yesterday I learned how to identify a pleural effusion. The key is the very white substance in the lung base and the meniscal or crescent sign which looks almost like the waves (of the pool or ocean) you used to draw when you were 6 years old.

I found an article that has different pictures of plueral effusions. The purpose of the article was to determine how effective onlookers were at identifying plueral effusions in the supine position, but I used it more for the radiograph practice.

http://www.ajronline.org/cgi/reprint/142/1/59.pdf

Also, I found a great tutorial for reading chest radiographs. If you plan to go overseas for an internship or for work, I recommend this site.

http://www.med-ed.virginia.edu/courses/rad/cxr/

Always learning something new...

busy busy busy

This week went by so fast and I got so little sleep.

The Simon and Garfunkel concert was awesome! I felt very groovy...it was weird though because they have aged so much.

Much of my time this week was spent thinking about death. A friend of mine from UK died last week. She was so young and had so much going for her...

One of the patients undergoing a CABG had an asystolic event in the ICU this week. They were able to resuscitate him, but it was still so crazy. He was an avid runner, fairly young, and a "low risk" surgical candidate.

Then of course there was Farah and Michael and Ed.

Life goes by so fast. It really challenges me to be a good steward of my time and to really show love to those around me--even my patients.

New words:

Avo= shortened form of afternoon.
I learned this when one of the male PT's asked me how my avo looked. I was soo confused. Awkward.

Giddy=dizzy
After getting out of bed, one of my patients told me that she felt giddy. I told her I didn't understand and she quickly clarified " I think I am going to faint." A good term to know when mobilising patients.

Studying for boards:
I took 1/2 of a practice test this morning. Since it was on paper and didn't really similate the test taking experience, I thought I would just use it to shape my studies for the week. I am really struggling to stay focused and of course I am afraid I will not pass our comps or the boards. Do you guys have any suggestions or effective study strategies?

TODAY was my first live Netball experience--and let me tell you, I LOVE NETBALL! It is similar to basketball in that there is a basket (or "goal" in Netball) on each end of the court and the objective is to shoot the ball through the goal. I tried to watch netball on youtube before I arrived in Australia, but following the game without knowing the rules was frustrating. Some basic concepts:
-There are 7 players on each team.
-Each goal is worth one point.
-Play starts at "centre" court after each goal is made.
-Possession rotates between teams (every other start) regardless of who scored the most recent goal.
-Players may pass the ball to any part of the court, but may only take one step with the ball.
-Depending on your position, the area of the court in which you are allowed to play is restricted (the "goal keeper" may only play in the 1/3 of the court closest to the basket she is defending.)
-Only two designated players from each team are allowed to shoot for a goal.
-When you shoot you much keep one foot on the ground and you are still only allowed to take one step.
-When you are defending the goal, you must keep one foot on the ground at all times, you must not touch the ball or the opposing player until they shoot. If you do touch the ball or the player you must stand next to the shooter and do nothing while they take the shot.

and there are a bunch of other rules that structure the game too...if you are interested you can

read the real rules: http://www.internationalnetball.com/netball_rules.html

or watch: http://www.youtube.com/watch?v=DxZOGU5DCvw&feature=related


This weekend has been really busy. We have a morbidity and mortality meeting with the hospital surgeons on Tuesday. In order to make sure we are adequately prepared, I went in today to analyse some data that we (the physio's) will be presenting.

Tuesday night I am also going to a simon and garfunkel concert! ahhh!

The hospital responsibilities and terms are becoming more natural for me. I am learning to use S's instead of Z's and the word "mobilise" instead of "ambulate"---although I still use the term "gait training" when specific instruction/teaching is required to "mobilise."

terminal knee extensions (open chain) or short arc quads are called "inner range quads"
quad sets are called "static quads"
eva walker is called a "forearm support walker"

I really like the hospital where I am working. We have been REALLY busy lately because there are few rehab beds available in the area. There is no rule to dictate what percentage of diagnoses are allowed into a rehab facilities in Australia. This is good because it allows everyone who needs rehab to get rehab. However, it is bad because people who need rehab are waiting in hospitals until a bed opens up. Personally, I don't mind this, because I have gotten to do some neuro rehabilitation.

Also important to mention. At Westmead private, every patient gets seen 2 times a day. I find this a wonderfully refreshing concept because all of the hospitals I have been in in the US give precedence to orthopaedic patients and then prioritise from there.

Just an interesting approach.

Anywho. Off to bed.

Thanks for reading. I know I am an awful speller. I apologise for all the grammatically annoying errors and typos. Also, let me know if you have any questions.

WEEK 2

Just for fun

Last weekend, I got to go to Sydney CBD (central business district--the term "downtown" does not exist in Australia--except when I repeatedly say "downtown" instead of CBD). It was loads of fun! We went to the botanical garden, the opera house, looked at the government house, did lots of shopping, and ate lots of food.


Explanation of the above pic

So, it is winter. Not a very cold winter, but cold enough that I wished I had brought some gloves and a scarf. Fortunately, there is a great UGG store that houses all the winter apparel you could possibly want! As you can see in the picture, Judith, Travis, Meredith, and I found some awesome hats at the UGG store.



More on Coffee

This is a mocchiato. It looks nothing like a caramel mocchiato. Basically, it is a shot of espresso with a splash of milk and some foam (and a packet of sugar in the raw that I added to take off the edge).














More new words:

They pronounce cervical like this: serve eye kul...with an emphasis on the second syllable. They think it is ridiculous that we do not differentiate between the two cervical regions of a female's body.

"she'll be all right" = everything will be okay, we'll get through it.

"How long is a piece of string?" = a saying that my CI uses often to address questions that have no good answer. I guess it approximately equals the UK favorite, "It depends."

"You've got buckley's." = There is absolutely no chance of that happening.

...and there are a lot more that I don't feel like writing at the moment but I will include them next post.

Why I am tired.

Today, I observed a CABG. It was really, really cool. I got to stand at the head of the bed, chat with the cardiothoracic surgeons, and watch their work up close and personal. Live hearts and lungs are so much cooler than dead ones. The surgical time lasted almost 4 hours. With the prep and the recovery, I observed for more than 6 hours. A very awesome and very tiring opportunity.

I am still learning a whole bunch at the hospital. I think I landed in a top location with some top PT's. The other student with whom I work told me that Westmead Private rarely takes students. All students are specially selected and referred by personal friends of the company. So, way to go Lynn English! (thank you!)

There are many more stories to come. I wish Woody could write this for me. He tells stories much better than I do.