Lumbar Procedure Reflection Paper

I received a complaint about a failed lumbar puncture (L.P). The patient was not happy with the multiple attempts done by me to get the CSF. When I was first told about the complaint by my consultant, I felt frustrated and disappointed. My first opinions were that; although I was trying to assist the patient by reaching correct diagnosis, the patient misinterpreted that as if I was only hurting her back. Later on this initial stage I realized that I was unconsciously going through the stages of responding to bad news with shock, denial, anger, Etc.
I was required to write a statement of the incident and began to delve into my memory to remember all the details, and by behaving that I came to understand that my approach to this complaint was not the correct one. I was responsible for carrying out the procedure and I should test to imagine the patient feeling at that time and adequately empathize with her, as this shall help me to understand not only why the situation ended the path it acted, but also what I may ascertain from the experience.
The patient was a woman in her 40s, presented with acute thunder-clap headache. Head CT was normal and LP needed to investigate for possible SAH. Her BMI was on the higher side and the consultant expected a difficult L.P and wanted a medical
registrar to manage it. I was bleeped by the medical SHO who informed me about the patient’s account and that the consent was obtained.
When I arrived the equipment was ready by the patient bedside and a nurse was waiting to help me.
I promptly introduced myself to the patient and as she was already consented I did not get into any details about the process. I can recollect right away that she was nervous about it, and not happy with various other facets of her upkeep in the hospital since admission. She took the left lateral position of L.P, and although she was not relaxed enough, I worked along and carried the L.P. I needed to put in local anaesthetic twice, and after two failed attempts the patient got very uncomfortable and I had to break off and referred her to our anaesthetic team to perform the L.P in the
theatre.
When I reflect on that I clearly understand today that I did not arrive at any attempt to communicate with the patient or try to ascertain why she was nervous. Although the consent was signed I think I should have talked about the details of the procedure with her and explained details further. It is recognized that people usually feel anxious about L.P because of expected pain or due to misunderstanding about the procedure and if I was to explore her beliefs at that time, I would have got the situation less uncomfortable for her.
Moreover, as all the current evidence confirmed U.S guided L.P decreased the number of needle insertion attempts in patients with expected difficult procedure due to high BMI or spinal disorders, I commenced guessing about how to improve my L.P practice by applying this technique hopping for a better effect and avoiding similar scenarios. I talked about this with my educational supervisor, and we agreed that I will attend a US assisted L.P course and I will also plan to conduct a study to measure patient experience after having an L.P done under U.S guidance.