This reflection examines my experience of identifying inconsistencies between a patient’s self-reported abilities and observed function during a home visit, highlighting the importance of environmental assessment in gaining an accurate clinical picture.
My educator and I attended an at home patient appointment where the patient and his daughter were present. Although the daughter was present, she chose to stay outside due to feeling unwell. This visit's purpose was to carry out an initial assessment of the patient, assess the standard of living, whether he needed adaptations and if so, which ones were most appropriate. In this case, the patient was independently mobile but lived with his son who helped him clean and shop. He also reported that he was able to independently carry out tasks such as showering, toileting and cooking his own meals in the kitchen using an air fryer. He also said he was able to complete his own washing/dressing. Throughout this conversation I was instructed by my educator to observe and make notes of key information during the interaction.
Throughout this encounter the patient repeatedly referred to the fact that he had an extremely positive mindset and was able to do much more for himself due to this mindset which ‘kept him going.’ I immediately sense that this may not be the case entirely and that the patient perhaps felt that he was coping better than he was or that he was trying to give the impression of coping well. For example, he said he was fully continent and always made it to the toilet on time however the house had a distinct smell of urine and when pressure sore checks were carried out, this patient had opened his bowels without releasing which then led us to understand he possibly was covering how able he was and how well he was managing independently.
Although this positive mindset was admirable, upon reflection it has shown me the significance and importance of visiting the patient in their own home environment. Physical checks and observations are often a necessity to reveal the full extent of the patient’s abilities and whether further support is required. The patient’s home environment can allow inference regarding this also (eg the smell of urine that was present). I have now seen firsthand that a patient may not express an accurate picture. This may be because the patient is not fully aware of his/her circumstances or that dignity prevents full disclosure. Whatever the reason, I understand that it is vital to treat the patient with respect but to carry out the required checks which will give the essential information allowing the necessary care options to be offered.
This appointment also confirmed to me the necessity of occupational therapists within the community attending home visits and not just seeing individuals in a hospital environment. Within a hospital environment it is easier for the patient to tell the therapist what they think they want to hear or perhaps be more positive than the situation really is. However, being within the home this is nearly impossible as there are clear signs which allow the OT to infer otherwise.
I feel as though I have taken much away from this home visit and realise that inference skills are crucial in order to read between the lines when what a patient reports do not match his/her environment/physical appearance.