I think that if you are doing client-centered treatment and the
patient's goal is not illegal, you should not impose your judgement on
the patient's goals. I realize it can be a tricky issue and a hotbed
of discussion though. Is it not better to ensure that the patient is
doing this safely even if you don't agree with the activity? It seems
pretty clear that he is going to continue smoking. If he doesn't learn
correct and safe ways to do this, you may see him again as a patient
after he has burns or worse.
Very interested to see what others think!
Mary Alice
Mary Alice Cafiero, MSOT/L, ATP
[email protected]
972-757-3733
Fax 888-708-8683
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On Apr 22, 2009, at 4:52 PM, Brent Cheyne wrote:
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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