week 5 STARES

COMMUNICATION

S- My patient, A young girl who had previously fractured her ankle and then suffered from RSD, came in to see me with recurrent ankle pain. She came in with her mother and they had SUCH a bizarre relationship. The mum answered every question for her daughter and kept cutting in. For example, when I asked her the intensity of the pain the girl answered only a 3, but then her mother cut in and said its definitely more like a 9. Then mother then continued to rattle off every disease under the sun that her daughter had, including rheumatoid arthritis which was causing the ankle pain.
T- My task was to assess the girls ankle and provide treatment as required. However, all of the mum's information was making me think that she just wanted a sick child for attention and I felt it was a bit of a red flag for Münchhausen's. We sent the girl home with a program and booked her in for 3 days later. My supervisor then rang the specialist at PMH and sure enough the mother has been flagged for potential Münchhausen's (but non harmful) and her dependency on PMH was noted. Our task then became to really utilise our communication skills to try and explain this to the family.
A- I asked my supervisor to come in with me as I didn't want to say the wrong thing and make it worse for the child. We then chose to speak only to the daughter so that the mum could not butt in as much. We explained that she did not have a disease process in her ankles, but that she has some hypermobilty, which is completely normal. We emphasized that she should not be having days off school and that she can play sport (originally her mum was even letting her walk far) We talked about her ankles for about half an hour, and hopefully it helped to drive home to her that there was nothing wrong!
R- I think that my education and communication skills were to the point as the daughter was responding to questions on her own rather than looking to her mum. She was glad to hear that she was normal! I showed her my knees just to prove that having some hypermobiity doesn't make you abnormal!
E- I was really glad that I asked my supervisor to come in with me. I think I did a good job but sometimes I'm not quite strong enough in my convictions and I think the mother could have bullied me into changing what I said. My supervisor is reviewing her once a week to ensure she is doing everything that a normal 13 year old should be doing!
S- The main strategies I used were communication and education, which is definitely what the family needs the most. Also, her dad (a totally normal guy) will bring her n next time under the guise of also having to review his knee...getting her away from her mum will also be the key!