Ron We're overlapping responses the discussion is so hot and heavy. Your report to the physician is great except for the last sentence. You said to me "the patient and I opted to withhold treatment for one week and then reassess. The patient feels her situation is resolving on its own". Would you be comfortable replacing your last sentence to the doctor with "After evaluation the patient and I opted to withhold treatment for one week and then reassess. The patient feels her situation may resolve on its own." This indicates that you did assist the patient to a level of comfort and understanding of her own self efficacy. In other words you addressed her occupational deficit to her satisfaction and satisfied yourself and the doctor that she is not doing things to make her shoulders worse. "She desires to forgoes therapy at the moment." feels like a cop out to me and could be read as though you think he didn't need to make the referral.
Joan Riches > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf > Of Ron Carson > Sent: Thursday, April 27, 2006 6:53 AM > To: Joan Riches > Subject: Re: [OTlist] Occupation > > 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? > [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: 268.5.0/325 - Release Date: 4/26/2006 > -- No virus found in this outgoing message. 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