To the list:
Here's an interesting dilemma: My new 82 y.o s/p acute MI, old CVA (Left
hemi) and old MVA with right hand contracture and peripheral nerve inj.pt
arrived today from another SNF, ( he can't really use either hand very well) He
was very pleased with his last OT because she/he adpated a way for him to
still keep smoking cigarettes with use of a univeral cuff and button hook. (Pt
still needs someone to place the cig and lite it up for him). This was very
adaptive and client-centered. Pt had a goal to keep smoking! "I'm 82 and I'm
not quitting now"
So...the dilemma arises in comtemplation of the OT role in facilitating
function but also promoting health. The contrast of being client centered and
goal oriented for the patient and facilitating an ultimately destructive health
habit. The pt is please with his OT--and a way I was impressed with the
creativity of the adaptation however, should we be in the business of having
medicare pay for services that facilitate destructive health habits?
I felt a little weird lighting the pt's cigarrette to see how ("safely") he
useed the adaptive equipment. Granted he also had an adapted cup for drinking
(Vodka?) and utensils etc..
As the theory goes, occupation include activities that the client finds
meaningful and purposeful and all that jazz. Evidently all not all occupations
are inherently promoting of health and well being. Does our theorectical
literature account for occupations that are essentially destructive, unhealthy,
antisocial, unproductive? Is it the therapists place to judge the pt's desired
goals and occupations related to providing or withholding treatment/expertise?
In my practice I try not to be too judgemental, I the pt wants to smoke, it
is their right, and if I can find a way to help them, I'd probably do it, BUT I
also don't think medicare should be paying for me to facilitate behavior that
will lead to further healthcare expenditures.
I'd be interested to see how others feel about this issue. Run with it people.
Dr, Jeckyl.
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