Miles Callum on identifying Cauda Equina Syndrome in telephone assessments with patients
The start of the Covid pandemic brought quick and challenging changes to the normal way of working in MSK physiotherapy.
We adopted initial telephone consultations and soon after video link appointments. Obviously, this negated normal objective assessment and took away that person-to-person contact which is more and more evident as a key factor in assessment and treatment.
No longer – especially over the telephone – are we able to observe, assess body language and connect with patients like in the past.
Probably the most important part of our assessment is the patient’s narrative. From this we develop hypotheses and in more experienced clinicians pick up on patterns.
Over three weeks our outpatient physiotherapy department have seen how important this is. All three of us have had patients who we suspected as having Cauda Equina Syndrome (CES).
All three patients were assessed over the phone. It was their narrative and deeper, quantifying questioning that led us to signpost them to same day presentation at A&E. In two of these cases it was confirmed and resulted in same day spinal surgery. One was from a disc prolapse and one, more rarely, a cyst. In both cases the patients are doing well.
To close the loop we partnered with our local CCG and delivered a webinar through Zoom, attended by 28 GPs, outlining assessment and recent research around CES. This was well received and has resulted in further presentations in the pipeline.
All in all a good example of how we can still make a big difference to patients and patient journeys despite the current challenges and changes with the skills we all have.
Other team members are Deborah Jenkins, Kristina Withers and Wendy Hebron.
- Miles Callum, physiotherapist, Whitby Hospital, Humber Teaching NHS Trust
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