Dr. Breines, You replied: "However, please do not conclude that you are fully apprised of what OTs know and believe"
Thank you for joining the discussion. I guess the reason I mentioned a merging of the PT/OT profession, was because I do think beyond the physical impairment. I thought I had a good idea of how OTs think, and thought maybe more PTs did also....I do see your point. What is amazing to me, is I am not so sure OTs know what they think. I have been working in an acute care/SNU lately, and I ask the OTs and COTAs about this issue. They seem to be lost when I bring up the idea of the occupational model, and what is interesting, they are a part of this UE/LE territory issue. My impression was they thought occupation went only to the basic ADL level of toileting and personal hygiene....I never saw any reference to occupational goals that went beyond the getting ready for the day issues. Another responder to this discussion said the academic world should stay out of this discussion, because they felt the UE/LE issue was created in academics and perhaps that we perpetuate this problem. Perhaps you are right....but, what academic institution started this and how did it take off? I agree with you in a sense, for I know many OT students are educated in UE and LE techniques such as PNF, etc...but, they are not required but to demonstrate UE techniques for practical exams. The reason? Because there is not enough time for there are other important areas for the student to learn such as cognitive, psychosocial areas.... Good day. > David A. Lehman, Ph.D., P.T. ~ ~_/) ~ > Assistant Professor > University of St. Augustine > 1 University Blvd. > St. Augustine, FL 32086-5783 > (904) 826-0084 ext. 227 > [EMAIL PROTECTED] > > -----Original Message----- From: Vickie Patterson [mailto:[EMAIL PROTECTED]] Sent: Saturday, July 20, 2002 4:21 PM To: [EMAIL PROTECTED] Subject: Re: FIM - OT/ PT and who gets there first Elka wrote: > > David, welcome aboard to the "whole person" thinkers. I have > appreciated reading your posts, and your openmindedness. However, I > think it is important that you recognize that occupational therapists do > not work with physically disabled people alone. The notion of merging > OT and PT into one profession would not satisfy the needs of OTs, except > in the narrow range of phys. Dis. Practice. As an OT educator, I focus > on much broader issues. If you value OT's beliefs, that's terrific. > However, please do not conclude that you are fully apprised of what OTs > know and believe. Let's keep the door open for further dialogue. > > Estelle Breines, PhD, OTR, FAOTA > Professor and Chair, Dept of OT > Seton Hall University > > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf > Of David Lehman > Sent: Thursday, July 18, 2002 10:50 AM > To: '[EMAIL PROTECTED]' > Subject: RE: Re: FIM - OT/ PT and who gets there first > > Good day. At times I wonder if the professions of OT and PT may one day > end > up merged into one. I understand the concept of a "Rehabilitation > specialist" or the POT exists. > > I cannot apologize because I, as a PT, feel the occupational model > means > more to me than the place where "PTs" fit in, at the impairment > (physical > movement) level. This just seems to restrict my desire and ability to > look > at the greater picture and want to focus on Occupation. Rather I should > think just physical impairment and then send to someone else (i.e. OT) > when > I have reached a particular point in my treatment. I think that the > Occupational model is synonymous with the mind, body, and soul concept > to > health versus just a movement/physical model. > > OK, so does this mean I should abandon PT as "my" profession (I actually > consider "my" profession as a professor/teacher) and become an > occupational > therapist, in order to permit me to think globally; more like the > occupational model? > > I hope not. I appreciate my expertise in movement, yet, I also consider > myself a therapist of the whole person. I do not consider myself to be > abandoning a profession or intruding on another. Perhaps there is a > place > for PTs who "think" like OTs and for OTs to become more proficient in > their > abilities to think like a PT and understand movement impairments. > > It all seems silly to me to have to give credit to one or the other > "profession" for my way of thinking and my belief system. Could it be I > thought about all of this by myself without ever considering who this > line > of thinking "belongs" to? > > Once again....maybe I should sign up for the OTD program? > > All in good discussion, > > David > > > David A. Lehman, Ph.D., P.T. ~ ~_/) ~ > > Assistant Professor > > University of St. Augustine > > 1 University Blvd. > > St. Augustine, FL 32086-5783 > > (904) 826-0084 ext. 227 > > [EMAIL PROTECTED] > > > > > > -----Original Message----- > From: Ron Carson [mailto:[EMAIL PROTECTED]] > Sent: Thursday, July 18, 2002 10:33 AM > To: David Lehman > Subject: Fwd: Re: FIM - OT/ PT and who gets there first > > Hello > > ============================================== > This message originated: > > ON: Wednesday, July 17, 2002 > FROM: McNeely [EMAIL PROTECTED] > SUBJ: FIM - OT/ PT and who gets there first > > M> I am not sure who Mary McNeely is, but I will reply to your post. > > M> I don't question your uncertainty, so I will answer your questions > within > M> your text for clarity. > > M> ----- Original Message ----- > M> From: "David Lehman" <[EMAIL PROTECTED]> > M> To: <[EMAIL PROTECTED]> > M> Sent: Wednesday, July 17, 2002 10:08 AM > M> Subject: RE: FIM - OT/ PT and who gets there first > > >> Mary McNeely stated in her last post:... > M> ...snip... > >> I am not fully sure what you are saying, so could you please clarify > so I > >> may respond appropriately. Are you saying that PTs would be > neglecting > >> "their" profession if they give credence to the OT profession by > following > >> the occupational model? > > M> PTs do give credence to the occupational model by following the > occupational > M> model well developed by the profession of Occupational Therapy. > > M> I am not saying PTs "would be" neglecting "their" profession. I am > saying > M> that they are and do neglect "their" profession when they try to be > M> Occupational Therapists. I would add that I think PTs are better > suited > to > M> act like OTs than Nurses, Social Workers or unskilled workers, > however, > PTs > M> fall far short of delivering Occupational Therapy (or "follow the > M> occupational model" if that terminology makes you feel more > comfortable) > as > M> well as actual Occupational Therapists. > > M> Knowing that payors will only pay for so much therapy, when PTs don't > defend > M> their areas of expertise while trying to market themselves as a > M> jack-of-all-trades or one-stop-shopping they do their clients and > over-all > M> healthcare a disservice. Payors are often fooled into this view and > are > M> driven by saving money rather than preserving quality of care. When > PTs, > M> for the sake of preserving PT jobs, nod and smile to payors who > pressure > for > M> cutting service they contribute to the problem of declining > healthcare. > M> When PTs try to act like OTs who is doing what PTs are specially > trained > M> for? > > >>And, are you saying that this "imitation" is more > >> powerful than valid research on our profession's effectiveness? > >> > >> I am not sure how you are tying in the two concepts of research and > >> imitation. > > M> When PTs adopt OT research ("the occupational model" ) and try to > practice > M> as OTs, while leaving behind their own specialized skills and > training, > they > M> appear to choose imitation of OTs over their own profession's > research. > So > M> you tell me, have PTs lost the sense of importasnce and value of > their > work? > M> I certainly haven't. > > M> And let me emphasize and remind you of my previous post in which I > spoke > of > M> my great respect for the skills of PTs. Don't ignore my sincere > words of > M> support in favour of a battle. A team of OTs, PTs and other health > M> professionals work well from their unique knowledge base, training > and > M> skills. But when any of the professions turn to cheap opportunism or > M> aggressive self promotion they damage healthcare with regressive > M> competition. > > >> > David A. Lehman, Ph.D., P.T. ~ ~_/) ~ > >> > Assistant Professor > >> > University of St. Augustine > >> > 1 University Blvd. > >> > St. Augustine, FL 32086-5783 > >> > (904) 826-0084 ext. 227 > >> > [EMAIL PROTECTED] > > M> In days gone by in some Canadian programs, professionals were trained > as > P > M> and O Ts (POTs). The combination was found to be too broad and was > rejected > M> for streamed training as OTs or PTs. > > M> The fundamental problem is that there are obvious limits to resources > M> including time and money. In a four year program of PT what is being > left > M> out to teach the "occupational model"? When PTs are taking on OT > work in > M> the community, who is providing the PT service? If PTs are going to > take > on > M> OT work, then will we have Kinesiologists or Chiropractors perform > the > M> physical therapy that Physical Therapists are not doing? > > M> I am a strong advocate for Physical Therapy. I am a strong advocate > for > M> Occupational Therapy. I don't believe in territorialism. If there > is > M> someone better suited to do the job then they should do it. I have > seen > PTs > M> assume they can do what OTs do and fail at it. They not only > compromise > M> their reputation as clinicians, but also the quality of healthcare of > their > M> clients and the over-all health system. > > M> I hope that clarifies things. > > M> Greg McNeely > >> > >> > >> -----Original Message----- > >> From: McNeely [mailto:[EMAIL PROTECTED]] > >> Sent: Tuesday, July 16, 2002 10:09 PM > >> To: [EMAIL PROTECTED] > >> Subject: Re: FIM - OT/ PT and who gets there first > >> > >> > >> My experience with PT in school is quite different than what I have > seen > M> in > >> practice. We were very close to our PT classmates of the same > graduating > >> year at Queen's University in Kingston. I have seen in other areas > M> however > >> that there is some animosity between the professions. In Ohio, there > were > >> PTs who would take on the wheelchair assessments and the lift > training, > M> but > >> trying to learn it on the job. They leaned on the knowledge and > direction > >> of the vendors which invariably led to second rate service. > >> > >> I think PTs make great PTs and I enthusiastically refer people to > them > for > >> PT service. I think however that PTs make mediocre to poor OTs and > those > >> that try to expand their scope of practice into areas that have > >> traditionally been done well by OT and fit better with the OT > philosophy > M> and > >> skills do us all a disservice. They give compromised service to > those > who > >> require it and they neglect the areas that they have been trained > well > M> for. > >> > >> This "expansion of scope" is often a symptom of pressure from funding > >> sources. I see it with a number of professions. If a profession can > pass > >> themself off as a cure all, or one-stop shopping, then they think > they > are > >> preserving their job. A more mature, realistic and helpful approach > M> would > >> be to defend your area of expertise against cuts, instead of > retreating > M> from > >> your legitimate area of practice to try to undercut someone else. If > PTs > >> are doing what OTs are more skilled at, then who is doing what PTs > are > >> skilled at? I have seen in practice that it seems that the PTs who > do > M> this > >> are in effect ashamed of their own skills so try to move into other > areas. > >> > >> I believe the solution to better over-all healthcare is for each of > us to > M> be > >> respectful of the other professions, not undervalue their service and > try > M> to > >> work together. > >> > >> The healthcare team of Nurse, PT, Dr., OT, SW, SLP, and others > provide > >> unique and necessary service and we must be respectful of each other. > >> Sometimes, that means firmly correcting those who unscrupulously and > >> opportunistically undermine other professions. > >> > >> A PT professor who responded to this e-mail said soemthing about the > >> profession that can support itself with research will prevail. The > >> strongest compliment that can be given is imitation, so when PTs > neglect > >> their areas of practice to act like OTs, we should be proud that they > M> value > >> our contribution so much, even if they don't have the sense to see > that > >> reality. > >> > >> > >> > >> ----- Original Message ----- > >> From: "Ron Carson" <[EMAIL PROTECTED]> > >> To: <[EMAIL PROTECTED]> > >> Sent: Tuesday, July 16, 2002 11:21 AM > >> Subject: FIM - OT/ PT and who gets there first > >> > >> > >> > Hello: > >> > > >> > In the article "Adjustments to Managed Health Care: Ushing Against > IT, > >> > Going With It and Making The Best of It, (AJOT, 55(2) p. 132) a > M> therapist > >> > states the following about the Functional Independence Measure > (FIM): > >> > > >> > "There are about 12 or 15 sections that are scored ..., > probably > >> > about 10 of them are OT areas. Again, they [the payer] are > M> telling > >> > you one message, how OT is so important to the function of > the > >> > patient when they go home (by FIM scores), but OT's aren't > M> allowed > >> so > >> > see the patients as much. It's very frustrating. Or, you > come > M> in > >> > after PT, like you are second." > >> > > >> > I had these exact feelings when I worked in rehab. We used the FIM > as > M> our > >> > outcome measure. The FIM was essential to our companies > (HealthSouth's) > >> > perceptions of outcomes success, so much so that we routinely had > >> > in-services on how hospitals compared with regards to FIM outcomes. > M> But, > >> > like the above writer states, I almost NEVER felt that OT was given > the > >> > clout and authority with regard to patient care even though the > majority > >> of > >> > what we were responsible for treating was the majority of FIM. I > never > >> > heard our physician or case manager say, this client can't dress > >> themselves > >> > without assistance so let's keep working. Without exception, the > single > >> > biggest predicator of progress and discharge was clients ability to > M> walk. > >> In > >> > fact, our physiatrist held a weekly gait clinic to watch clients > walk > M> and > >> to > >> > provide treatment suggestions to the PT's. Some times the > physiatrist > >> would > >> > actually laugh a clients struggling to dress themselves. On time I > >> actually > >> > talked with the doctor about my concerns. She assured me that she > M> valued > >> > OT's contribution but I never saw any evidence that this was true. > Of > >> > course, physiatiry is a combination of physician and physical > therapist > M> so > >> > it's little wonder that physical medicine and physical therapy were > her > >> > primary concerns. > >> > > >> > Now, with PT's expanding scope of practice including training in > M> community > >> > reintegration and home management skills and them having first-line > M> access > >> > to Medicare home health clients, what the heck is OT going to do? > If > PT > >> can > >> > "do it all" and they are there first, when and why will they refer > to > M> OT. > >> > And, let's not forget the dog-eat-dog aspect of this situation. > >> > > >> > *********RC*********** > >> > > >> > Unsubscribe? Send a message to [EMAIL PROTECTED] > >> > > >> > In the message's *body*, put the following text: unsubscribe OTlist > >> > > >> > ** List messages are archived at: > >> > > >> > http://www.mail-archive.com/[email protected] > >> > > >> > *********RC*********** > >> > > >> > > >> > >> *********RC*********** > >> > >> Unsubscribe? Send a message to [EMAIL PROTECTED] > >> > >> In the message's *body*, put the following text: unsubscribe OTlist > >> > >> ** List messages are archived at: > >> > >> http://www.mail-archive.com/[email protected] > >> > >> *********RC*********** > >> > >> *********RC*********** > >> > >> Unsubscribe? Send a message to [EMAIL PROTECTED] > >> > >> In the message's *body*, put the following text: unsubscribe OTlist > >> > >> ** List messages are archived at: > >> > >> http://www.mail-archive.com/[email protected] > >> > >> *********RC*********** > >> > >> > > M> *********RC*********** > > M> Unsubscribe? Send a message to [EMAIL PROTECTED] > > M> In the message's *body*, put the following text: unsubscribe OTlist > > M> ** List messages are archived at: > > M> http://www.mail-archive.com/[email protected] > > M> *********RC*********** > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > > *********RC*********** > > Unsubscribe? Send a message to [EMAIL PROTECTED] > > In the message's *body*, put the following text: unsubscribe OTlist > > ** List messages are archived at: > > http://www.mail-archive.com/[email protected] > > *********RC*********** > > *********��*********** > > Unsubscribe? Send a message to [EMAIL PROTECTED] > > In the message's *body*, put the following text: unsubscribe OTlist > > ** List messages are archived at: > > http://www.mail-archive.com/[email protected] > > *********��*********** I would like to refer ALL of you to the HIM-11... Healthcare Intermediary Manual, or the BIBle of home health. Page 14.4a Section 204 J....Sequencing of services. I cannot quote, my copy is at the office, but it very clearly states that if a patiet's care plan clearly indicates the need for a qualifying service and other medical services, the individual pt's need can dictate what service begins the episode of care as long as a visit is done by the qualifying service before the patient is transferred or discharged. The example given was a pt. requiring both physical therapy and occupational therapy. This says to me the OT's can do the admission to home health, as long as 1 visit is accomplished by PT, SN or SLP. In Texas, the OT and PT state licensure board is shared by both professions. OT's and PT's need to stop quibbling about who's does what, join forces and become an extremely powerful political entity. Nurses in home health are the 'enemy' if there is one.... Not the sisterhood/brotherhood of occupational and physical therapists. With the declining power of physicians, the growth of nurse practitioners, the scattered political structure of nurses (what exactly IS a nurse??? Diploma, license, registered, 2 year, 3 year, 4 year, Bachelor's degree, Master's degree?????????????? If you say you're a nurse, you have to then launch into a dissertion about what kind!! With OT's and PT's you can rest assured that at the very least you get is a Bachelor prepared person. And in a few years, when all us old people are retired, then you can be assured that we are ALL Master's Prepared!! Joining forces equals political POWER in this country and Political POWER equals MONEY!!!!!!!! Isn't this what all this is about anyway!! Wake up and smell the green. Join your boards in your states, join your PAC's join forces, and let's win this healthcare battle for dollars! After all, with PT's doing wound care, OT's getting into diabetic teaching and training, the nurses role is diminishing. Just look at the way the OASIS is scored and the diagnosis the pay the most, ortho, neuro and diabetes. Not to mention all the ADL items, ambulation, transfer items. That's where the money is. *********��*********** Unsubscribe? Send a message to [EMAIL PROTECTED] In the message's *body*, put the following text: unsubscribe OTlist ** List messages are archived at: http://www.mail-archive.com/[email protected] *********��*********** *********��*********** Unsubscribe? Send a message to [EMAIL PROTECTED] In the message's *body*, put the following text: unsubscribe OTlist ** List messages are archived at: http://www.mail-archive.com/[email protected] *********��***********
