Ron: I am going to take a shot at answering this question as candidly as I can:
Some of us practice as non- therapists (note: I am not calling them UE therapists- I hope to clarify that later), because some of us are : 1. Too scared to touch the LE that the PT claim they own as they own "mobility" (or, so we perceive). Or, at least they have been by and large been accepted as the primary providers in this area 2. Division of labor, productivity issues, issues related to reimbursement...(e.g. SNFs- OT and PT both required to be categorized "Ultra") 3. Therapists and clients often find or anticipate that once "mobility" is regained (especially in LE conditions), they often regain function spontaneously notwithstanding other limiting factors, e.g. decreased cognition, prior dysfunctions, etc. 4. And, with no other complicating factors, if the biomechanical aspects are already being addressed by another discipline, the second discipline (in your example, and as often seen the OT) becomes rather recreational (which has its own therapeutic value, but is not reimbursable), or simply nonsensical (that's where I will place it). So we let the "actual" therapy to be done by someone else, and start doing "time-fillers" disguised as OT. 5. While the "division of labor" ensures everyone a share of the pie, we forget that function is beyond just walking or able to move our joints through the whole range of motion. Thus, while somebody may be working on LE Strength/ ROM; they may be other aspects to work on. If the need is there and there is no duplication of goals (per payor source's requirements), I would hope that an OT with the right expertise addresses that as well- well, yes, that's another discussion! 6. Some us think of OT just as a "compensating" service. Therapy is applicable/ deliverable at all stages. If we expect a remedy in pathological conditions, instead of aiding in the correction/ reduction of the pathology or its manifestations, why do we in the name of "occupation" start teaching them compensatory techniques and issuing them adaptive ADL aids that get thrown out as soon as precautions/ limitations come- off. 7.Playing subordinate/ non-confronting roles. This may actually be because of our "upbringing" as OTs. We often hate to make splashes, at the cost of getting drowned. I, however, think/ hope this is changing, and I view the " Centennial Vision Statement" as the collective talk before the walk. In summary, I do think it is mainly because of reimbursement/ productivity issues, arbitrary divisions of roles (set mainly through unwritten traditions and facility politics), and personal attributes of practitioners lead to such incongruent practices. If OT is to be considered "truly" valuable, we must ask ourselves if clients will choose us for our services as the provider of choice, or the only provider for their particular condition, if they were paying through their own pockets.... Can our services be provided by some one else? I am sorry for my long posts. That's one reason, I try to post minimally. Joe Wells, OTD, OTR/L -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Thursday, August 16, 2007 3:27 PM To: [email protected] Subject: [OTlist] Marketing Results Just got back from a marketing call with an in-patient rehab facility. I am seeing one of their patients for the second time so this is a great time to call on them. I met w/ the admissions/discharge planner and explained myself, OT and my company. I explained that in rehab OT is typically used for above the waist and PT is below the waist but doing this was just a matter of convenience. Everything is going good, right. So, I ask her about patients being discharged with OT. Her reply?.... Very few of our patients are discharged with OT! As many times as I've marketed, I should be prepared for this, but I still shake my head in bewilderment at the state of our profession. But you know what, give the type of OT that this person received, it's no wonder the facility doesn't order OT. My patient, a personal friend, said that the OT did nothing but arm exercises, both standing and sitting. The patient's diagnosis? Right hip fracture, s/p ORIF. Her arm strength prior to accident 5/5. Was her arm strength so greatly diminished by her 1 week hospital stay that she needed two WEEKS of UE strengthening? NO! I told the patient to d/c the OT but she didn't see any harm in it. Now isn't that a sad statement! I know some of you probably think I embellish or make up these scenarios, but I don't!! Now, compare the above example of an OT's in-patient rehab for a hip fracture (which by my observation is pretty common) to what Fred Somers' says in part about our profession. "... as a profession that offers unique services that are ideally suited to meet the health, participation, and quality of life needs of people of all ages, occupational therapy is well-positioned to succeed and flourish in the 21st century." [Fred Somers, AJOT, April, 2005, p. 127] I'm not picking on Fred but come on. Why are our leaders saying we are well-positioned to flourish? Why does our Framework say one thing and many of us do something totally contrary? How does this make ANY sense to anyone? And you know what's REALLY sad, we CAN do the above but we have a LOT of work to do! We have so many barriers, both external and internal, that need to come down. We MUST figure out what we are doing and then do it!! We MUST figure out how to establish our services in a manner that both fits and is understandable to doctors, insurance companies and referral sources. I think PEDS and HANDS have already wedged themselves into the market, but those of us working in general adult rehab are getting hung out to dry! -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] **************************************************************************** ********** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************** ********** No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.5.476 / Virus Database: 269.11.15/949 - Release Date: 8/12/2007 11:03 AM No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.5.476 / Virus Database: 269.11.15/949 - Release Date: 8/12/2007 11:03 AM -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
