Beyond The Adjustment- True Client Centred Care

I see an average of 100 clients a week. I also work with people of all ages, currently from 14 months old to 88 years old. I also work with people from all sorts of backgrounds. Some of my more complex clients include people recovering from traumatic brain injuries or brain aneurysms, but I also work with everyday people just wanting to get rid of their back pain. 

Because I have such a varied client list each week, there is also a lot of other work that goes on behind the scenes to make sure every client gets the best possible care. Sometimes, this includes writing referral letters. On average, I write around 5 referral letters a month. 

One of the most common referral letters I write is for high blood pressure. For an adult, a normal healthy blood pressure should be around 120/80mmHg. There is a degree of flexibility with this, as age and gender also plays a role, but a healthy adult should be close to that figure. 

Last week, I measured a client's blood pressure and it was 193/118mmHg. This figure is very alarming to see, as it can be an indication of a hypertensive crisis that can require immediate medical intervention. We retested, and the figure came down to 172/103. Although the figure came down, it is still much higher than a healthy blood pressure should be. 

Understandably, the client was concerned. The client bought himself a blood pressure monitor so he could check it at home too, and I wrote him a referral letter to take to his GP to try to speed up the process of it being investigated. 

Another common referral letter I write is for an x-ray. It’s not something I do too often, as I do not agree with imaging just for the sake of imaging. The functional assessments we do with clients provide me with enough information to create a tailored recommendation for their health, and it's very rare that imaging would change that recommendation.

Normally when I do refer someone for an x-ray, it is because we've already been working together for a few months and now want further clarity on a particular issue. This week, it was for a client that I've been working with for 3 months for a shoulder complaint, but they have a bony growth on their foot that has recently  started hurting again. They had an x-ray on it 3 years ago, but it didn’t reveal much. It wasn't relevant to their recommendation at the start of their journey, but as we progress through care and move towards optimal, rather than away from bad, these things start to become a bigger priority. 

The final letter I've written this week was to support a client's application for a disability badge. The client is in their 80’s and struggles with foot pain, which makes walking very difficult and their balance is poor. At their request, I wrote a letter summarising what care they've had so far, as well as the functional testing findings that indicate what the problem is. Although the council will do their own assessment to determine if the client needs a disability badge, my letter will help give some background to the clients struggles and how it is affecting them.

Writing referral letters is only a small part of my role. But it is a very important part. I am a specialist in my field, but I am not a specialist in all fields. So for some conditions, co-management with other professionals is the only way to provide the client with the best care possible.