In this case, I probably would have written goals related to social participation and attempts to participate in such. I possibly have a pet owner visit the patient to encourage more participation in life's activities. Just my two cents. Audra Ray, OTR/L
--- On Thu, 10/30/08, Ron Carson <[EMAIL PROTECTED]> wrote: From: Ron Carson <[EMAIL PROTECTED]> Subject: [OTlist] D/C'd Patient For Lack of Goals To: [email protected] Date: Thursday, October 30, 2008, 6:07 AM Yesterday, I d/c'd a patient because she is unable to verbalize ANY OT-related goals. It was a very strange and difficult case and I'm not 100% comfortable with the d/c, but it seemed to be the best choice. I'm VERY interested to hear others' opinions. I evaluated a patient last week. Without going into a lot of detail, the patient has mild arthritis, recently fell and had kyphoplasty. She had been very active until about 5 years ago when she "suddenly" became very sedentary. There assorted history and eval findings, but this is basically a women who has disengaged from life. She essentially lives on her couch and that's about it. When I evaled her last week, she was unable to identify ANY OT goals. Against, my better judgement, I "made up" a couple goals and scheduled her for only two visits. At the end of my second visit, I indicated that I was d/c'ing the patient for lack of goals. The patient was OK with it but the husband talked and asked me to stay on. After a long conversation with the patient, one in which I was apparently "mean", the patient agreed that she wanted me to come back. So, I signed her up for 5x/week therapy. On the next visit, I was told that the patient "did not like me" because I was mean. I promptly apologized to her, expressed my concern and methods and asked for forgiveness, which she readily gave. After that, I again started talking about the patient's life and goals. Her son had mentioned that the family had a pet that died and that was sort of "the beginning of the end" for the patient. The son had mentioned possible pet ownership which I followed up on, but the patient denied wanting it. I came back two more times, with each visit focused on identifying goals. We did a mini life review but no matter what avenue I took, the patient denied any goals. So, I reluctantly told her that in the absence of goals, d/c was the only option. She agreed and said she was sad because she was "starting to like me". She and I agreed that my time had not been wasted but that continued visits would be a waste. Without doubt, this is one of the hardest and strangest cases I've ever had. I've never met a person who was so unmotivated and yet able to articulate the same. I know all the bases are not covered in this message but it hopefully provides enough information to peak everyone's interest. Thanks, Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
