Does your clinic permit young children to accompany patients into the exam room? We are considering a policy and would like to hear additional opinions.
Most outpatient settings allow the patient to decide whether family members or others accompany them during their medical exam. There are certainly exceptions, such as sensitive exams or subject material or when there are suspected abuse issues, when the provider may ask the exam room to be private. However, in general, patients benefit from the support of their family and loved ones, so involving them in patient care is considered a positive.
Considering Occupational Medicine – small children accompanying patients has additional implications:
The Stroller Sign
Case History:
CC & MOI:
Olivia B. a 33-year-old who presents to the occupational medicine clinic with history of back pain after lifting wet laundry from a bathroom floor.
Work History:
The patient is an employee of the Hillman Hotel. LOE: employed for 14 months. Her job description is guest room housekeeper.
Treatment Course:
The patient was diagnosed with lumbar strain and prescribed nonsteroidal anti-inflammatory medication, physical therapy, and modified duty. Today’s intake note indicates the patient did not go to work today because of severe, 9/10, back pain. Review of her PT notes shows she has missed 3 of 6 sessions.
Before you enter the room, your medical assistant alerts you that the patient has brought three children with her today: a two-year-old in the stroller and a four-year-old and a five-year-old.
The physical exam shows the patient with tenderness to light touch to the paravertebral area and midline, L3-S1. She has a decreased range of motion with flexion at the waist limited to 45°.
However, during observation, you noted the patient picking up her children, sitting them on a chair when they got off, and bending over to arrange the blanket for the child in the stroller.
What is your assessment of her current condition, and her prospects of recovery?
Discussion:
Multiple studies show that injuries acquired at the workplace take up to four times longer to resolve than similar non-work-related injuries. Increasingly, it has been recognized that biopsychosocial determinants play an important role in occupational medicine, and may be the explanation for delayed recovery in many of our patients.
For today’s patient, her children accompanying her to the provider appointment may indicate that childcare issues interfere with her recovery. Early recognition that a lack of social support, specifically loss of childcare resources during work hours, is an important factor in the patient’s poor compliance with postinjury treatment and lack of progress toward recovery.
The team approach is necessary to treat this patient. A good place to start is to contact the adjuster and nurse case manager assigned to the case. These parties can bring additional resources to address the issues identified by the provider. Additional support, such as help with transportation, can help alleviate some of the biopsychosocial stress impacting this patient’s care.
The first step in understanding that biopsychosocial determinants of health, if not addressed, will result in a failure of medical management, resulting in a long recovery time, with unnecessary diagnostic and treatment modalities.
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