In a message dated 2/23/01 3:38:26 PM Pacific Standard Time,
[EMAIL PROTECTED] writes:
JD> I do not make the rules I just see the patients that are on my schedule.
JD> Now, if I have an eval that is a RTC repair I will certainly look at the
JD> person from our O.T. perspective in a holistic manner but I also will
JD> treat that patient according to protocol.
To me, this statement is backward. The OT perspective might be better
expressed by saying; I will treat this person from a holistic perspective
and certainly look at following the treatment protocol.
******In my reading of John's response, he is saying the same thing you are,
just stated in reverse order. You are making an assumption that his thought
process, and ultimate emphasis with his patients is "backwards" as well. You
do not have enough information, from reading one post, to know how he treats
his patients, or how much of an emphasis he puts on occupation. In order to
make a fair judgement, it would be necessary to observe his treatment
programs, read his documentation, and examine the outcomes he achieves.*****
To me it's a matter of emphasis. John's statement is very medical-based
(treat the injury and look at them from our OT perspective) versus
occupation based (treat their occupational deficits and look at their
medical problems)
*******Ron, the reality is that John is practicing in a medical model
environment. A therapist who chooses to ignore the model within which
he/she works is doing his patients a disservice and increasing the
likelihood of not being reimbursed for services. It is VERY possible to
bring our occupation based focus to the environment within which we work
and apply it to our treatment programs, while at the same time recognizing
that very model and functioning effectively within it. You stated in the
past that you did not feel comfortable doing this, and chose to withdraw
from this environment, and seem to infer that those of us who choose to
continue working within the medical model have somehow abandoned our
occupation based approach, but in my opinion you are missing the point.
The most effective OT's who work within the medical model are those who
understand this model and are able to communicate effectively with the rest
of the medical team, while at the same time, bringing their unique
occupation based focus to their tx. planning and programming***
JD>� but� in� O.T.� I� prefer� to� call� it� adjunctive methods based on the
JD> Occupational� Performance Model which is procedures that prepare patient
JD> for occupational performance ie. exercise and modalities.(See Pedretti).
Doing� something because it MAY prepare someone to do occupation is only 1/2
of� the� picture.� The� other� half is that one must actually facilitate the
client� to� engage� in� the occupation. To best do that, one should identify
meaningful occupations which are impaired by the client's injury. Meaningful
occupation�� should�� be�� the�� treatment� outcome� and� therapists� should
self-evaluate treatment efficacy by how the client is able to complete their
occupation.
************Again, you are making an assumption that John does not follow
through with his treatment programs to engage the patient in occupation,
and relies SOLELY on adjunctive methods. There is nothing in his post that
suggests this. Actually, in a later post you state "Often,� professional�
domain� of� concern� is spelled out in State practice� acts� but� they are
also delineated with the profession's Practice guidelines. Behavior or
treatment falling outside the profession's domain is at best considered
unethical and at worse illegal" In his response above, John is stating the
primary model of practice outlined and developed by the AOTA, yet you have
decided that what he is doing is not OT**
I� think� the concept of doing something because it allows someone to engage
in occupation highly misrepresents the OT profession. Almost all health care
professions� do� things� so� people� will� be� better� able� to take care of
themselves,� be� productive� and have fun (i.e. occupational performance) My
wife, a nurse, gives people pain medication so they can get up and go to the
bathroom� and� not� use� a� bedpan.� So,� by the above definition, she is in
essence� doing� a� procedure� which� prepares� the� client� for occupational
performance.� Certainly,� though, no one would construe her actions as being
occupational� therapy.� Why, because her goal is not the client going to the
bathroom (i.e. an occupation), her goal is to decrease pain.
*******Ron, this is where I disagree with you the most. WE as OT's could
define almost anything that any discipline does as being done for the
ultimate goal of occupation, because that IS our focus. As you stated, the
nurse's goal for pain meds is to decrease pain, NOT to improve toilet
transfers. It does not always or even oftern occur to the nurse, the doctor,
the dietician, even many speech and physical therapists how the goals they
set relate back to occupational performance. The strength of OTs within the
medical model is the very fact that occupation is at the very core of our
philosophy and thought process. While we may work on the same ROM that PT
does, we are doing it with an eye towards the functional performance of
occupational tasks that will be facilitated by this work, (and yes, also
actually work on those occupationally based skills, dressing, bathing, caring
for home environment, work and community life skills, etc)
Likewise,� if� an� OT's goal is to increase ROM, strength, balance, etc so a
client� can� engage in occupation then I have a hard time seeing how this is
OT.� However, if the OT increases occupational performance by increasing
ROM,
strength,� etc then they have probably done OT. Why, because the goal is the
occupation not the ROM, strength, et
******I would argue that in probably 99.9% of the occasions that you have
criticized another therapist of doing the first thing in your statement
above, or doing PT instead of OT (John included), they have actually been
doing EXACTLY what you state above in your second statement, in other
words, setting a goal of increasing a patient's occupational performance
and then deciding what aspects of performance need to be improved in order
to accomplish this goal.
*******Ron- I have to say that I agree completely with Evan's well expressed
response to
this thread. While I understand your expressed desire to
foster discussion and thought within our profession about what it means to
be an OT, (and by the way, I happen to believe that is a good thing), the
tenor of every one of your posts is that you are the only one who has THE
answer to the question of what is the meaning of OT, and any one who you
perceive deviates from your narrow definition is misguided and lacking the
revelationary knowledge that you have. Further, while I happen to be a
stickler for being precise in language when trying to communicate a
thought, I perceive your responses to get caught up in the semantics of the
way someone(like John) expresses him/herself in a post. In my opinion, you
then use it to judge that person's overall approach to being an OT. I
find this disappointing and devisive, at a time when OT's should be
supporting each other and pulling together to promote our profession.
Ann Skinner
OT Coordinator
ECRC
