Hi Cherie
Could you please tell me how you managed to go straight into private practice after qualifying?
Thanks
Sarah
>From: "cll"<[EMAIL PROTECTED]>
>Reply-To: [EMAIL PROTECTED]
>To:<[EMAIL PROTECTED]>
>Subject: OT practice in Nova Scotia and Disability Management
>Date: Sun, 5 Aug 2001 10:21:51 -0400
>
>
>Hi Ron :)
> >
> > Thanks for your post. Will you please share a little information about a
> > couple of things:
>
>Sure!
>
> > 1. What is it like to practice OT in Nova Scotia?
>
>Well, I graduated from OT School (at Dalhousie University) where Liz
>Townsend was (and still is) the director of the School of Occupational
>Therapy. So our program was excellent in educating re. Enabling Occupations.
>I went directly into private practice so my experience in the hospital based
>practice is limited to the past month. Unfortunately in private practice
>where it is primarily economy driven, it was much more difficult to
>incorporate Enabling Occupations theory into everyday practice. Various
>factors (in my opinion) impacted this problem.
>
>1. Most of my clients had legal representatives and were involved in ongoing
>legal suits so it was difficult to identify what was "meaningful" to them.
>Essentially you could be working "with" your client toward a goal they
>identified as important to them, when in fact they had no real desire to
>obtain that goal. It was difficult to discuss this with them, again because
>of the legal involvement - if you said the wrong thing, the client would
>claim you were "on the side of the insurance company" and their lawyer would
>get heavily involved putting up roadblocks to communication and
>rehabilitation. As I gained more experience with the legal reps this was
>easier to handle - they knew me and weren't worried that I was being
>underhanded in any way. Still though, this was almost always a factor with
>every client.
>
>2. Most of the insurance companies I worked with had a fairly good
>understanding of Occupational Therapy and the benefits of our services.
>However, not all insurance adjusters were open to addressing the client's
>issues re. occupational performance. So again the roadblocks on what was and
>was not approved for treatment.
>
>Now that I'm in the hospital based practice I'm finding roadblocks, albeit
>different roadblocks, to practicing Occupational Therapy. As I mentioned in
>my previous post I'm on an acute unit (actually it's a teaching unit for
>physicians). On the one hand this is a great opportunity to educate up and
>coming physicians to occupational therapy and our role in the health and
>well being of our clients. On the other hand it's sometimes difficult to
>implement the Occupational Therapy plan when the teaching physicians oversee
>the students. The goal of the physicians (from my perspective) is to get the
>client out of the hospital as quickly as possible (one more day in hospital
>= $1200). Thank god I'm outspoken :) and already in the past month I've gone
>head to head with a few physicians in advocating for the client. I've also
>had to be creative in trying to find loopholes in the system or alternate
>pathways to send my client so that his/her needs are met in addressing the
>occupational performance issues.
>
>Our Occupational Therapy Dept. is trying to ensure the OT staff use the COPM
>in everyday practice. The Dept. is very supportive and excellent in
>advocating for OT and the client. Right now our team (general medicine) is
>working on the goal of addressing the barriers to using this tool - as many
>feel that it's difficult to use (i.e., why use the COPM when we're not able
>to address all of the performance areas identified). Hopefully we'll
>brainstorm and come up with a solution.
>
>Ok, I rambled on quite a bit on that question :)
>
> > 2. What is disability management? It sounds very interesting.
>
>Essentially insurance companies (auto, life), WCB, Canada Pension or legal
>representatives of the client, often hire people to help coordinate,
>evaluate and direct the rehabilitation of their clients = disability
>management. The goal (from the referral source) is to maximize
>rehabilitation in a cost effective way. In some instances, a successful case
>(again to the referral source) means the client returns to pre-disability
>function. In other cases this means that the rehabilitation potential of the
>client has been deemed not likely and the referral source is able to close
>their active file. It can be a cut throat industry and again is very
>medical-legal based.
>
>Most of the clients have been injured or have disease/disorder, etc. which
>impacts their ability to return to work or return to their previous level of
>functioning on a day to day basis. The disability management person meets
>with the health care professionals and develops an appropriate
>rehabilitation plan for the client. Traditionally, in Nova Scotia, this
>person was a nurse. However, over the years more and more Occupational
>Therapists have been getting involved. The referral sources seem to like the
>Occupational Therapy frame of mind when approaching rehab and in general
>have been more open to addressing rehab in a holistic manner. Of course,
>there is plenty of red tape as well as policies which influence how you can
>direct rehab, but I have noticed a change (for the better) in terms of what
>the referral source will cover or address.
>
>I was the Clinical Supervisor in a Disability Management company which
>staffed physiotherapists, kinesiologists, psychologists, and occupational
>therapists..as well as the more experienced nursing rehab consultants. We
>performed functional capacity assessments, ergonomic assessments, pain
>management programs, return to work programs, independent medical
>examinations, as well as disability management.
>
>Ok, rambling again :)
>
>Hope this provides some info though.
>
>Cherie
>
>
>
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