Everyone makes predictions. Doctors give a prognosis, based on how they think the pt. will heal. Therapists set goals, which they believe the pt. will achieve in a set period of time with skilled intervention. This is part of the professional's training, and if they are not reasonably accurate with their predictions, they will not be very respected by their peers or able to do the job as well. (sidenote- it is perfectly reasonable as a student to not make these predictions very well. it is all about developing experience, understanding reasonable expectations, understanding probability, creating new schemas, etc)

So we all make predictions about our patients. These can be helpful- if you predict that your pt will not use AE at home, it's helpful to plan your interventions otherwise. Sometimes they cause us to be jaded about our patients or their capabilities. Right now, I have a pt on the skilled floor that the general consensus prediction is that she is going to die. Soon. She's 92 s/p hip fx & ORIF (thank goodness that she doesn't have hip precautions). MAX Ax2 for anything resembling mobility, during which she moans and cries. She won't eat anything except pudding/applesauce to take her pills. She has a distension the size of my fist, protruding from her abdomen. She has been talking to her deceased relatives. Unable to don a button-up sweater due to weakness and confusion. Medically, her H&H is quite low, but she has religious objections to blood transfusion. I seriously worry every time I see her that she will die while I am there. Sometimes joint replacements and orthopedic surgeries can be the beginning of the end for a person, which is awful. A few months ago, a Mrs H had a second TKR which started her downward spiral... last time she was on her feet was on our skilled floor. I hate to watch people go downhill, I hate to know that there's nothing I can do, I hate that I don't know more medical information so that I could understand what is causing the decline and fix it!

Predictions can be quite depressing... maybe it's better sometimes to just not worry about the future.

No comments: