Transcript
mmateri: Hi, I'm Miranda Materi.
Shannon Skowbo: And I'm Shannon Scalbo and we are Hand Therapy Academy.
mmateri: All right, guys, welcome back. We have Shannon on again today. And she is going to be asking me some questions. So why don't you go ahead and get started with the first one?
Shannon Skowbo: Okay, my first question is what's the worst patient case that you've ever had?
mmateri: Yeah, and I think when we're talking about the worst pacing patient case, I think there's like, the level of injury, right? Like how bad and how severe is the injury, but then also the um other dynamics that go into the patient therapist, you know, relationship and things like that. So is the patient or their unique circumstances, I should say so. um I think I've had a lot of people that have had very severe injuries and so that's not what makes them difficult though. I think what makes them difficult is the unique patient circumstances. So I had one gentleman in particular that um had just graduated um
mmateri: Well, he was had just graduated high school. He had moved out to Arizona. He didn't have any um family support whatsoever. And he had cut um his hand so pretty severely, like he got some digital nerves and attended. And um during our therapeutic, um or when he was in therapy, he ended up becoming homeless. And then also, he ended up um having some other issues that where he was like hearing voices and stuff when you would come into the clinic. And I think that was why it was so challenging was all those other spec aspects. And then not just like thinking about him as his hand injury, but as a whole person and how to get him the resources he needed with no family support around. Um, so that was really difficult and challenging and, um,
mmateri: really hard to see him go through because you know he was such a ah great it was such a great fun like he was a fun patient he just was going through so much and he was so young um so it was like having to figure out can I call his mom because he's he's not he's an adult, you know, like all of those things. And then getting him admitted to an inpatient psych, you know, and having them come when he was in I don't know, it was very sad.
Shannon Skowbo: Mmhmm.
mmateri: So ah that's probably no, that's probably not what you're asking me was.
Shannon Skowbo: It sounds like it.
mmateri: So let me go to more of a therapy where you want a therapeutic case.
Shannon Skowbo: No, no, that's fine. I feel like whatever comes to mind, you know, as like, I don't know, just as like preparation of like what I could, like one day maybe run into, right?
mmateri: the
Shannon Skowbo: And that is one of them is just like, there are going to be situations that you are going to have to try and feel right.
mmateri: Yeah, that keep you up. it I've had you know someone where there you know they told me they were being abused by their father. That was another one. you know There's all those um cases, I think, that make it way more harder than our daily treatment so or the just the black and white of hand therapy, I guess.
Shannon Skowbo: Mm hmm.
Shannon Skowbo: Right Garbage disposal
mmateri: Yeah, so and so let me talk about a case that I thought was extremely difficult. And it was a patient that um got his hand stuck in the sink disposal. with the garbage disposal. So he like somehow like turned the switch on when his hand was down in there and it absolutely chewed up his hand like he had several digits amputated. And then he had to get a flap put on to cover like all the the skin he lost.
mmateri: ah um And so that was the challenging one as well.
Shannon Skowbo: Yeah, those are the kinds of cases, right?
mmateri: Yeah.
Shannon Skowbo: Those are the kinds of things that I just haven't, like, when you haven't had any time, you just haven't, like, I don't know, I've seen a lot of, I think, more PG things.
mmateri: and
mmateri: And... Yeah. So I would think, so like when you do see those patients, so I'll try to be more helpful, when you do see those patients, I like to make a list of all their problems. And I make the list of problems from like an orthopedic standpoint, like, okay, tendon injury, nerve injury, artery injury, like I make them and I list them kind of in a hierarchy. So I know what I need to protect first, you know, and what's going to be okay, and like make my timelines based on those things. And then I make a timeline based on what the patient thinks his
mmateri: you know, his or her, their worst deficits are. So that way I'm addressing it objectively from that healing standpoint. And then I'm also addressing it from the patient standpoint as well. So I think that's a powerful tool as a new grad when you're going through stuff. And when you're going through more complicated cases, otherwise you can get lost in the weeds of trying to address everything in one session, right? So I think I'm just going to address as much as I can and the time we have, and then I'm going to keep chipping away at that list.
Shannon Skowbo: Right, mm -hmm.
Shannon Skowbo: I'm chipping away at it, yeah.
mmateri: Cause there's no way you're going to get it all done in that first session.
Shannon Skowbo: Mm -hmm.
mmateri: Same with evaluations, right? Like how do you measure all those, when they have multiple joints and multiple problems, how do you do that all in one eval?
Shannon Skowbo: Definitely.
mmateri: You don't.
Shannon Skowbo: I know, i've I've gotten lost in the sauce a few times from the stiff shoulders, stiff this, stiff that. this It's like, oh, what do I do?
mmateri: Yeah. So what, I guess, let me ask, turn it back to you, what have you done that um has helped you as a new grad?
Shannon Skowbo: in terms of priority. Well, I feel like you yeah well i feel like um because I work with all of the people you mentor that I do um exactly that.
mmateri: Like in in managing that.
Shannon Skowbo: um They ah have all taught me right with our EDS ah patients. or um It seems like there's ever you could do anything and everything to help um is to make a priority list. um and try and get like your top three things done um in that eval and then it's like you will always have more time later and like trying to I think what ends up happening um is I feel a lot of pressure in the moment and because of that I'm not as efficient because I like you know a lot of times you're having to redirect the conversation and I think the more pressure you feel it's harder to like
Shannon Skowbo: keep what you want to do on track. So I think kind of in just mindset, like letting that pressure go kind of also helps me prioritize a bit too is like, it's okay.
mmateri: Yeah.
Shannon Skowbo: Like you're going to do something to help and you're like, you're going to get things done. And, um, just really all that matters is that you're being, you're trying to be a good therapist at the end of the day.
mmateri: Yeah.
Shannon Skowbo: Right.
mmateri: Right. So I think, too, in those cases where you're talking about redirecting or, you know, sometimes patients have a lot to share or maybe they're even maybe they're even hyperverbal for various reasons.
Shannon Skowbo: Right.
mmateri: um And then how do you handle those patients?
Shannon Skowbo: the hyperverbal um right i feel i feel like um
mmateri: Yeah, like what do you do? the chatty Kathy, you know, like you're trying to get all this subjective information. What do you do?
Shannon Skowbo: I, for some reason, I just feel like I'm good at redirecting. I don't, I don't know like how to, what I can pinpoint there, but like, okay, like, can we save that for later?
mmateri: and
Shannon Skowbo: And like, can I get through these questions real quick, like without it being rude, but just like, ah um here, like, here's my time constraints.
mmateri: Yeah.
Shannon Skowbo: Here's what I want to do today. Like kind of like tell them my goals for this and then kind of maybe that helps them like, um you know, say only what they need to say, but sometimes that doesn't help either. Right. And then you're just kind of redirecting the whole time.
mmateri: yeah does it help
Shannon Skowbo: um I don't know, but I feel like that's what I kinda do.
mmateri: I know, because I feel like that's a hard one for new grads to get, is getting the balance between being a good listener and really hearing it, but also getting the information that you need to get in that evaluation. So I think, yeah, you did probably exactly what I did. Be like, hey, would you mind if we save that for the very end? we have And then I'll even say, hey, I have have five minutes left with you. Can you tell me all your questions? And then you know if you think of questions when you're not with me, go ahead and write them down and all'll you know we'll address them at your next session as well.
Shannon Skowbo: Right. like Or even like before, I think like sometimes a redirecting statement can feel a little harsh when you're like saying things that maybe are vulnerable, or or even a story about yourself, right? I think usually I'll try and comment on whatever they're saying. like Either make a joke about it, or like if if a joke's appropriate, um or like so you know some kind of reassuring, a normal comment, um and then add the redirecting where it's like, I am hearing you, and also I need to get this done.
mmateri: Uh -huh. Yeah, I think that's good advice, great advice, but sometimes you just can't get through it either.
Shannon Skowbo: Sometimes it's not gonna happen. but Sometimes I'm hyperverbal.
mmateri: Yeah, it's not gonna work. Okay.
mmateri: Too much coffee, too much coffee for sure, yeah.
Shannon Skowbo: Yes, over caffeinated.
mmateri: Yeah and I think too reassuring patients at that first like visit too because I'm like hey today I'm going to be doing a lot of measurements and a lot of assessing and we may not have time to get through all of the stuff that I want to get through with exercises right because patients come and they want exercises.
Shannon Skowbo: Mm -hmm.
mmateri: So I always try to make sure I have time to give them one thing piece of homework to do at home but sometimes you know that doesn't always happen.
Shannon Skowbo: Right.
mmateri: because you can't give them the homework and tell you fully assessed them, right? So, because you don't know what's going to be safe or what's not going to be safe, so.
Shannon Skowbo: Right. Right.
mmateri: Okay, Shannon, well, thanks for coming on, and it was great having you today, and we're looking forward to having you back again. um If you have want more information, check us out, info at Hand Therapy Academy, um or you can also see our Instagram and at Hand Therapy Academy.
