Joan, I don't really know what I meant by "not warranted". I shouldn't have said it!
You asked many good questions, some of which I addressed in my eval and others I didn't. At the end of our eval, the patient and I opted to with hold treatment for one week and then reassess. The patient feels her situation is resolving on its own and that therapy may not be indicated - I concur. Honestly, when a doctor refers a patient to therapy (OT or PT), I believe they are expecting the therapist to address the situation at hand. In this case the referral was for rotator cuff problems and I believe that the doctors expects that therapy will address THAT problem. I don't really think that U.S. doctors take time to even consider the various problems that something like a rotator cuff injury might cause. They are medical professionals and they are trained to TREAT medical problems. IF a doctor identifies a problem that he can not address, they they refer the patient. If they identify a social problem, they might refer to a social worker, if the identified a mental health problem, they might refer to a psychiatrist. If they identified a musculoskeletal problem, they might refer to a PT or OT if it's an upper extremity issue. And as you say, they really don't identify ADL problems and I don't think they have any expectations that we will either. Keep in mind that if you are in Canada, things may be a LOT different than in the U.S. The language of our profession is critical to binding it together. I do not generally talk about occupation with my patients because doing so generally leaves them with a glazed look. I address occupation in the majority of my goals, maybe even to a fault because I often don't make ROM, strenght, etc my goals. For example, if I treat the lady with rotator cuff injuries, I will measure her ROM and I will probably include it as a goal, but I will also include obtaining clothes as part of her goals. Or, I might just skip over the ROM and only include the more "functional" stuff. In fact, here's an excerpt from the doctor's report that I'm drafting: quote> Patient evaluated at her ALF residence. Patient complains of quote> decreased bi-lateral shoulder ROM and pain, but identifies pain quote> and limitations as being primarily in her right shoulder. Reports quote> difficulty with some self-care. Denies any difficulty using quote> rolling walker or with sit to stand. She reports no history of quote> falls. Patient has obvious limitation with bi-lateral shoulder quote> ROM.. She has difficulty with some ADL's secondary to these quote> deficits. She desires to forgoes therapy at the moment. I don't have any goals because the patient is not being seen at the moment. Joan, what I'm looking for is smoothness and consensus between our language and our application. At the moment, I don't think that it exists and for me, it's very frustrating and for the profession, I think it's very damaging. Thanks, Ron (not at all irritated) <smiling with you> ----- Original Message ----- From: Joan Riches <[EMAIL PROTECTED]> Sent: Wednesday, April 26, 2006 To: [email protected] <[email protected]> Subj: [OTlist] Occupation JR> What do you mean 'such recommendations are not warranted'? If they are JR> feasible even on a temporary basis, won't they help? Did you ask what her JR> living situation was like? How did she damage her shoulders? Was it repeated JR> strain over time, result of a fall, what? Is she short or tall? Is the rod JR> in her closet actually too high for her? or is she trying to reach a higher JR> shelf? Is a lower shelf available or feasible? JR> What is it she cannot reach on the table? Can you help her think about her JR> living environment and how it might be adapted so she could manage with less JR> pain? Does the culture of the Assisted Living Facility allow her to ask for JR> help? Is she willing to do so or is she forcing her shoulders to show she JR> can manage? Is she cognitively able to understand consequences in the JR> future? Are there requirements for independent abilities to stay there? Is JR> she afraid of transfer to Long Term Care? What do you think her prognosis JR> for biomechanical recovery is? Depending on the injury sometimes older JR> people have to adapt to loss of range with rotator cuff injuries. Is her JR> medication adequate for pain control? Is she taking it? Does she understand JR> about maintaining a therapeutic level? Is there any reason to be concerned JR> about the side effects of medication? Does she get up to go to the bathroom JR> in the night? Is her way lighted? JR> I assume that when a doctor refers to OT it is because that is what is JR> expected. The reason OT is needed may be an injury but the physician expects JR> us to mitigate to the best of our ability and with all the resources we can JR> muster the occupational effects of that injury. Of course they don't refer JR> for difficulty in ADLs they don't assess for the practical consequences of JR> injury but they certainly expect us to do so. JR> Try to let go of your semantic preoccupation with occupation. Look at JR> people and ask yourself and them what they want, need or are expected to do JR> and what you know that may help them. You'll find you are writing notes JR> about restored occupation. (normal life - thanks Carmen) Stop telling JR> yourself that there is nothing you can do that isn't PT and just do it. JR> Joan (with some irritation) >> -----Original Message----- >> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf >> Of Ron Carson >> Sent: Wednesday, April 26, 2006 8:21 PM >> To: Joan Riches >> Subject: Re: [OTlist] Occupation >> >> Hello Joan: >> >> It's funny how things sometimes fall into place. Just today, I evaluated >> an older adult living in an ALF. The referral was secondary to a >> doctor's report of bilateral rotator cuff injuries. Notice that the >> referral wasn't for difficulty bathing, eating, dressing, etc. >> >> Anyway, in talking with the client we identified obvious limitations >> with ROM and she reported quite a bit of pain. BUT, she also stated that >> she had difficulty obtaining clothes from the closet and reaching items >> on the dining room table. So, like you said, in listening to the >> patient, she identified occupational deficits. But, here's the confusing >> part. >> >> If the goal is occupation, then I only need recommend a higher >> chair/lower dining table and that she place her clothes on a lower >> shelf. Thus, her occupational performance is restored. Obviously, such >> recommendations are not warranted but isn't this what you are >> saying? >> >> Instead, shouldn't I address the cause of her occupational limitation >> which of course are biomechanical in nature. But addressing her >> biomechanical problems so that she might better complete her occupations >> is no different than what a PT or in the case you gave, an RT might do. >> They might not call them occupations but that isn't the point. >> >> It seems that looking at these situations kind of leaves OT stuck in a >> vise. We say we are about occupation but when the rubber hits the road, >> we are only about occupation as an ancillary byproduct of our therapy. >> >> Ron >> >> ----- Original Message ----- >> From: Joan Riches <[EMAIL PROTECTED]> >> Sent: Wednesday, April 26, 2006 >> To: [email protected] <[email protected]> >> Subj: [OTlist] Occupation >> >> JR> Do you see your clients in their homes? Most people will tell their >> JR> troubles to an empathetic listener and even if the problem is a >> JR> 'medical' one the 'troubles' will include the things they are >> JR> prevented from doing. >> >> >> >> -- >> Unsubscribe? >> [EMAIL PROTECTED] >> >> Change options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/[email protected] >> >> Help? >> [EMAIL PROTECTED] >> >> -- >> No virus found in this incoming message. >> Checked by AVG Free Edition. >> Version: 7.1.385 / Virus Database: 268.4.6/324 - Release Date: 4/25/2006 >> -- Unsubscribe? 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