Hello Joe and others: I hope readers enjoy these discussions!
Joe, I like what you've written in your second paragraph, however, I don't believe it stands up in the real-world perceived needs of the majority of our patients/clients. What we have is a dichotomoy between our theory and the perceived needs of clients and referral/pay sources we serve. Clients seek care/therapy because they perceive or are told that they have a problem. They seek skilled intervention to ameliorate their problems. So, what are some typical perceived problems that our client's have. Well, certainly they have muscle weakness, paralysis, cognition deficits, reduced ROM, decreased mobility, poor eyesight, shortness of breath, decreased endurance, etc. This list can go on for ever but I think you get my point. What is noticeably missing from the above list are the things that OT's will often theorize about. Things like occupation, activity, dressing, grooming, self-care, productivity, etc. So what we have is some gobble-gook theory (please don't misunderstand, I LOVE theory and have written several theory courses) that just doesn't mesh with the perceived needs of our clients. I mean, how many clients think that they have problems with "the external features of human functioning, i.e., the physical/ emotional- mental/ socio-cultural/ spiritual aspects of living as an "occupational" being" In all the patients that I have treated over 8 years, I bet I can count on one hand the number of patients saying their *primary* concern was one of the things that OT theory talks about. Now, I know that we do treat the basics in order to address the loftier goals, but much of our rhetoric is not about the basics but about the loftier goals. Again, this is the dichotomy of OT - we say one thing but do another. Why is that? Well, the reality is that most practicing OT understand that clients and payers want therapy that addresses what is perceived as being broken. So, they go about doing that. Unfortunately, in an effort to remain an OT, they begin crossing-over some of the theory which doesn't fit in the first place. The end result is bunches of OT's addressing UE function using a variety of contrived treatments. As I'm typing I just want to mention that I am growing to believe that there is a large segment of OT practitioners not suffering from the woes that are often discussed on OTnow. These practitioners are pediatric therapists! Like I said, I love theory. Ever profession needs a strong theoretical base. BUT, the theory must fit with the mode/method/environment of delivery, and vise versa. The absence of congruity between theory and practice is killing our growth and maybe even survival! Ron ----- Original Message ----- From: Joe Wells <[EMAIL PROTECTED]> Sent: Monday, July 11, 2005 To: [email protected] <[email protected]> Subj: [OTlist] Army OT/PT Descriptions JW> Jimmie: ."....you poll nurses, you will generally get those that feel OT JW> does the upper body and those that feel OT does ADL" JW> I like that comment. I do see us at times 'pigeon-holing' either in just JW> biomechanical aspects without respecting the "occupational" needs of the JW> patient (sorry, "client") or just at times not even training but performing JW> the "true occupations" (ofcourse, you have known those AM care OTs that JW> nurses love, too) with utter disregard to the biomechanical or other JW> performance componential/ skills (motor, process, comunication/ interaction JW> skills), patterns, context, activity demands or client factors that are JW> required to do that function/ occupation in an 'appropriate' manner. In this JW> process, we either become a glorified nurse's aide or, a bad imitation of a JW> 'non-function oriented' PT, may be more like a non-skilled activities person JW> doing one of those "sit-ercies" with colorful bands and those pink "dumb" JW> bells. Could this also be because we do not always ask our clients or we JW> (when they cannot tell us, based upon our professional 'expertise' on human JW> occupation/ life- stages) cannot or do not determine as what should be JW> "occupationally" appropriate for our client and then correctly articulate it JW> to the client/ family/ other health providers/ insurance companies? I know, JW> I am avoiding the words "asking the patients what is meaningful to them"! I JW> and most in medical settings agree that we need to be paternalistic at JW> times. An acute TBI cannot tell you what is meaningful, their family might JW> not really know what to expect either. They rely on the doctors, nurses and JW> yes, OTs, amongst others to do what is "meaningful" for the client based JW> upon what is biologically (age, gender, physically, mentally), culturally/ JW> socially thus, also morally appropriate or close to the so called "normal" JW> as possible. JW> My view of OT is that while physicians/ dentists (MDs, DOs, DPMs, DDS, ND) JW> address the biochemical/ physiological aspects (via pharmacotherapeutics/ JW> dietitics, etc.) and anatomical structures (via surgery, radiotherapy, etc.) JW> of human functioning, i.e, internal aspects of life - enabling a person to JW> live as a human being (as defined in all states expect I believe NJ as until JW> the whole-brain ceases to function); OTs addresses the external features of JW> human functioning, i.e., the physical/ emotional- mental/ socio-cultural/ JW> spiritual aspects of living as an "occcupational" being. (When does one JW> cease to be an "occupational" being, is a good question for the JW> philosophers and ethicists). As no one physician can address all aspects of JW> life by himself/ herself, no one OT can possibly handle all aspects of human JW> occupation either. That is why we have formal specialists or at least ones JW> specially trained. JW> Joe JW> ----- Original Message ----- JW> From: "Jimmie Arceneaux" <[EMAIL PROTECTED]> JW> To: <[email protected]> JW> Sent: Monday, July 11, 2005 9:23 AM JW> Subject: RE: Re[2]: [OTlist] Army OT/PT Descriptions JW> Hello Joe, JW> I believe that one of the major obstacles facing OT is that quite a few OTs JW> are providing misleading information to referral sources, patients, other JW> professionals and the general public regarding exactly what they do as a JW> profession. If you poll nurses, you will generally get those that feel OT JW> does the upper body and those that feel OT does ADL. It is a direct JW> consequence of occupational therapists framing themselves in a context not JW> based in the framework of their profession. How many times have you seen JW> physician referrals regarding OT for upper extremity ROM? How many times JW> have you heard reports of lackluster interest in past OT coupled with JW> enthusiasm for PT with the stated reason, "I just want to walk." Could it JW> be that the PT goal of improving the ability to walk has a more tangible JW> benefit to the patient (sarcasm intended)? Don't get me wrong, I'm not JW> stating that there can't be a tangible beneift to OT, but patient's don't JW> see that benefit if the OT only marches in to do UE exercise and help them JW> get dressed. JW> Jimmie JW> -----Original Message----- JW> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] JW> Behalf Of Joe Wells JW> Sent: Monday, July 11, 2005 7:42 AM JW> To: [email protected] JW> Subject: Re: Re[2]: [OTlist] Army OT/PT Descriptions JW> Hi Ron: JW> OTAs can enlist in the army. Additionally, the army does train its own OTAs JW> as well. http://www.cs.amedd.army.mil/dms/otbranch/default.htm. They are JW> usually called OT specialists in the army. I agree that our product is JW> diverse and thus, the scope is wide. I am convinced that if we all accept JW> that with different settings our practice mode may differ (i.e. one aspect JW> of the domain may take precedence over the other, e.g. a hand clinic versus JW> a shelter-home versus an acute care hospital) although not deviating from JW> our core principles that thread us together, we will still be able to JW> package our product. Our profession may be fluid but we can give it the JW> shape of a container. Barring just a few inconsistencies, I felt the AOTA JW> framework is a commendable tool to introspect our own practice similarities JW> and differences (explain what we do internally), find that 'thread' that JW> binds the OT community together and then externalize it as an easily JW> identifiable product (1). I hope that this could be a part of the OT JW> curriculum as well, so that all new grads can identify with a common JW> practice framework versus what one school wanted to follow over the other. I JW> believe it is now is a part of the ACOTE standards. JW> Other links: JW> http://www.goarmy.com/amedd/army_health_care_corps.jsp- Recruiting as an OT JW> http://usmilitary.about.com/library/milinfo/navynec/blhm8467.htm Recruiting JW> as an OTA JW> 1. AOTA (2002). Occupational therapy practice framework: Domain and JW> processs. American Jouranal Occupational Therapy. 56, 609-639. JW> Joe JW> ----- Original Message ----- JW> From: "Ron Carson" <[EMAIL PROTECTED]> JW> To: "Joe Wells" <[email protected]> JW> Sent: Monday, July 11, 2005 1:56 AM JW> Subject: Re[2]: [OTlist] Army OT/PT Descriptions >> Hello Joe: >> >> Good idea to do further investigating and great links, thanks! >> >> The Army brochure that I used for my quoted does contain comprehensive >> info about OT. Perhaps I should have included some quotes relating to >> group therapy, alcohol rehab, etc. >> >> Maybe I missed it, but I haven't read anything about the Army using >> OTA's. I am interested to hear if they in fact, they do. >> >> One of the reasons I posted my original message is because of the recent >> discussions about marketing "out product". I am convinced that our >> product is too diverse, inconsistent and misunderstood to market. Until, >> the profession of OT's internal structure is more clearly defined, I >> think that marketing is not a good use of resources. >> >> Somehow, AOTA and practicing OT's, must develop a model of theory and >> practice that is specialized, understood by both internal and external >> audiences, deliverable and practiced. To date, in my opinion this has >> not happened. >> >> ----- Original Message ----- >> From: Joe Wells <[EMAIL PROTECTED]> >> Sent: Sunday, July 10, 2005 >> To: [email protected] <[email protected]> >> Subj: [OTlist] Army OT/PT Descriptions >> >> JW> Hi Ron: >> >> JW> Just out of curiousity, I checked the Walter Reed Medical Center >> website >> JW> >> http://www.wramc.amedd.army.mil/departments/Ortho/PhysMed/otscope.htm. >> The >> JW> OT scope explained there is a little more comprehensive. I also >> checked the >> JW> PT scope at >> JW> >> http://www.wramc.amedd.army.mil/departments/Ortho/PhysMed/ptscope.htm >> and >> JW> found the scopes to have a lot of areas overlapping. In the military, >> my >> JW> guess is that the model is very transdisciplinary. I believe the >> student >> JW> appointment is an internship (level II fieldwork) affiliation since >> there >> JW> are no OT academic programs in the Army, although as you mentioned, >> they do >> JW> have a DPT program at the US Army- Baylor University >> JW> (http://www.amsc.amedd.army.mil/training.asp). The army does train >> its own >> JW> OTAs. More on the OT internship program >> JW> http://www.amsc.amedd.army.mil/Doc/otintership.pdf. Do we have any >> army OTs >> JW> on the board ? It would be nice to hear about their army expeeiences. >> >> JW> Other Army sites: >> JW> http://www.wramc.amedd.army.mil/departments/Ortho/index.htm >> JW> http://www.amsc.amedd.army.mil/about.asp >> >> JW> Joe >> >> >> >> >> >> -- >> Unsubscribe? >> [EMAIL PROTECTED] >> >> Change options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/[email protected] >> >> Help? >> [EMAIL PROTECTED] >> >> JW> -- JW> Unsubscribe? JW> [EMAIL PROTECTED] JW> Change options? JW> www.otnow.com/mailman/options/otlist_otnow.com JW> Archive? JW> www.mail-archive.com/[email protected] JW> Help? JW> [EMAIL PROTECTED] JW> *** NOTICE--The attached communication contains privileged and confidential JW> information. If you are not the intended recipient, DO NOT read, copy, or JW> disseminate this communication. Non-intended recipients are hereby placed JW> on notice that any unauthorized disclosure, duplication, distribution, or JW> taking of any action in reliance on the contents of these materials is JW> expressly prohibited. If you have received this communication in error, JW> please delete this information in its entirety and contact the Amedisys JW> Privacy Hotline at 1-866-518-6684. Also, please immediately notify the JW> sender via e-mail that you have received this communication in error. *** JW> -- JW> Unsubscribe? JW> [EMAIL PROTECTED] JW> Change options? JW> www.otnow.com/mailman/options/otlist_otnow.com JW> Archive? JW> www.mail-archive.com/[email protected] JW> Help? JW> [EMAIL PROTECTED] -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED]
