Hello Joan:

I think I understand what you are saying about OT's being specialists in
occupation,  but the system in which we work (system includes: patients,
referral  sources,  payers,  other  providers)  does  NOT recognize this
speciality.  Having  a speciality that is not recognized by others is of
little  value.  In  our  beginning,  OT's  speciality  in occupation was
recognized  and  highly  valued, but over the years, this speciality and
valuation  has  been  lost.  Again,  I  think this is our problem and is
exactly why SOMETHING must be done by AOTA.

You said:

quote > Part  of our problem is that occupation is present in EVERYTHING
quote > that  anyone  does.  Our  special expertise is that we see that.

then   went  on  to  say:

quote > Many people can do their own OT interventions.

On  one  hand,  it seems that occupation is OUR speciality and the other
hand,  it  seems  that almost anyone can do it - these statements appear
conflicting.

Joan,  I  understand your dentist example, but I don't think that is how
most people think. Most people, including me, think; my tooth hurts, who
can  help me? I wish things were the way you described but my reality is
that they are not.

One  of  OT's  claim  to fame is the use of therapeutic occupation (i.e.
using  teeth  brushing  as  the  agent to improve dynamic standing) Your
comments  seem  to  point against the use of occupation as a therapeutic
agent, at least in the below example.

Great dialogue,

Ron

----- Original Message -----
From: Joan Riches <[EMAIL PROTECTED]>
Sent: Thursday, April 27, 2006
To:   [email protected] <[email protected]>
Subj: [OTlist] Occupation

JR> Right Ron
JR> The dentist is a person with a profession who has a specialised expertise
JR> just like us. The dentist looks at a toothache with dentist eyes. The
JR> occupational deficit is implicit in the dental problem but it is not her
JR> expertise to address it - just as (unlike the OT/PT confusion) it is not
JR> part of our expertise to address the toothache per se.
JR> Part of our problem is that occupation is present in EVERYTHING that anyone
JR> does. Our special expertise is that we see that. I am remembering my own
JR> frustration when in Home Care I kept walking into situations where VERY
JR> OBVIOUS simple things were working against the client or compromising
JR> safety. Finally I realised that those things were not obvious to either the
JR> nurse or the client. It took OT eyes to see them and make them explicit and
JR> that is why I was there. Value your OT eyes. They are special. They are what
JR> make us specialists in occupation.  They have become so much a part of us
JR> that we take them for granted. 
JR> There is a problem our profession has that many others do not have. Many
JR> people can do their own OT interventions. You have described a lot of them.
JR> We do go to the dentist so we can eat corn on the cob. We've unconsciously
JR> done the assessment and identified the component that needs to be addressed.
JR> Then we name the component as the problem in order to access the specialty
JR> that can address it.
JR> The difference between us and the dentist is that dentistry is not embedded
JR> in all of life. The people who need us are those whose unconscious
JR> assessments are incomplete; for whom return to 'normal' is compromised by
JR> factors they do not have the expertise to consider; or whose present
JR> distress can be alleviated by practical means while natural or medical
JR> healing takes place.   
JR> Quote from Michael "When given the choice of brushing their teeth standing
JR> at the sink (or) performing resistive standing exercises in parallel bars in
JR> most cases pt choose the exercises."  I would too. I want to get my mouth
JR> feeling fresh and it's easier and more satisfying to do with the
JR> environmental modifications of sitting down with a glass and kidney basin.
JR> Struggling to do it standing at the sink compromises my occupational goal of
JR> a clean mouth and makes me feel inadequate. I'd sooner work on the standing
JR> separately in a social atmosphere where it is the prime concern. Someone
JR> (like us) needs to notice when I can stand well enough to use standing to
JR> support teeth brushing and encourage it. At that point standing ceases to be
JR> an occupation that requires my full attention and becomes a component to
JR> support dental hygiene. As I recover, dental hygiene will cease to be an
JR> occupation and become a component as well.  This is called client centred
JR> practice.  It's about not confusing our goals with the client's and then
JR> getting frustrated because we think our goals are more important. Lots of
JR> people will progress to standing at the sink on their own. We can help them
JR> by noticing and making the progress explicit since most of them will be
JR> focusing on the things they still cannot do 'nornally'.
JR> Wow has this discussion ever taken off. It's hard to keep up. Such a joy to
JR> have a place to struggle with these questions and others to 'listen ' with
JR> OT ears. Sorry if I'm pontificating. It's exciting to be so stimulated.
JR>  Joan Riches
 




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