Ron, I can't help wondering if it's not so much that the patient has no goals, as that they don't know how to express their goals, or that they don't recognize what they want or need as even being a goal or something that an OT could, or would, work with them on.
Pat At 07:07 AM 10/30/2008, you wrote:
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]
