Thanks Joan and Jennifer: Because the patient is on HH, she is already receiving a plethora of services; everything from social worker, RN, aide to PT.
You know the question of "why" was never answered, either by the patient, her family or myself. When I earlier mentioned mind mapping, it was because of this patient. I think something psychiatrically happened to her but she refuse my suggestion for a psych eval. One of the things that was even odder and leads me to think that maybe "I" was the problem is that the patient was doing well in PT and she took a bathe with the assistance of the aide. But, I swear, this patient would NOT verbalize wanting to do anything on her own. The only thing she said, especially in the beginning is that she wanted to be "normal". Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Joan Riches <[EMAIL PROTECTED]> Sent: Thursday, October 30, 2008 To: [email protected] <[email protected]> Subj: [OTlist] D/C'd Patient For Lack of Goals JR> Ron JR> In a case like this I think that an OT eval may be the most effective JR> part of our offering. I am left with the question, "What referrals have JR> you offered to this family?" You have gathered valuable information. JR> This is certainly an extreme case of occupational dysfunction due to JR> ......what?? JR> If you have read English novels you may have run across similar JR> descriptions of 'invalid' (emphasis on the first syllable) upper class JR> women. It is an interesting brain twig to then put the emphasis on the JR> second syllable. Thanks for all the brain twigs now and in the future. JR> Joan Riches B.Sc.O.T., OT(C) JR> Specialist in Cognitive Disability JR> Riches Consulting JR> High River, Alberta, Canada JR> 403 652 7928 JR> -----Original Message----- JR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On JR> Behalf Of Ron Carson JR> Sent: October 30, 2008 7:08 AM JR> To: [email protected] JR> Subject: [OTlist] D/C'd Patient For Lack of Goals JR> Yesterday, I d/c'd a patient because she is unable to verbalize ANY JR> OT-related goals. It was a very strange and difficult case and I'm not JR> 100% comfortable with the d/c, but it seemed to be the best choice. JR> I'm VERY interested to hear others' opinions. JR> I evaluated a patient last week. Without going into a lot of detail, JR> the patient has mild arthritis, recently fell and had kyphoplasty. She JR> had been very active until about 5 years ago when she "suddenly" JR> became very sedentary. There assorted history and eval findings, but JR> this is basically a women who has disengaged from life. She JR> essentially lives on her couch and that's about it. JR> When I evaled her last week, she was unable to identify ANY OT goals. JR> Against, my better judgement, I "made up" a couple goals and scheduled JR> her for only two visits. JR> At the end of my second visit, I indicated that I was d/c'ing the JR> patient for lack of goals. The patient was OK with it but the husband JR> talked and asked me to stay on. After a long conversation with the JR> patient, one in which I was apparently "mean", the patient agreed that JR> she wanted me to come back. So, I signed her up for 5x/week therapy. JR> On the next visit, I was told that the patient "did not like me" JR> because I was mean. I promptly apologized to her, expressed my concern JR> and methods and asked for forgiveness, which she readily gave. After JR> that, I again started talking about the patient's life and goals. Her JR> son had mentioned that the family had a pet that died and that was JR> sort of "the beginning of the end" for the patient. The son had JR> mentioned possible pet ownership which I followed up on, but the JR> patient denied wanting it. JR> I came back two more times, with each visit focused on identifying JR> goals. We did a mini life review but no matter what avenue I took, the JR> patient denied any goals. So, I reluctantly told her that in the JR> absence of goals, d/c was the only option. She agreed and said she JR> was sad because she was "starting to like me". JR> She and I agreed that my time had not been wasted but that continued JR> visits would be a waste. JR> Without doubt, this is one of the hardest and strangest cases I've JR> ever had. I've never met a person who was so unmotivated and yet able JR> to articulate the same. JR> I know all the bases are not covered in this message but it hopefully JR> provides enough information to peak everyone's interest. JR> Thanks, JR> Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
