This is message #2 from John with my reply #3 interspersed.
RC
====== Begin my message to John D: =======================
Hello John and Thanks for Responding:
I want to offer the proverbial olive branch to John and others who may be
offended, mad or anything else because of my comments. Based on previous
experience, I know it is easy for these professional debates to digress or
be misconstrued as personal attacks.
Please understand that my comments are NOT directed to any person and are
not meant to be an attack on the person's worth or dignity. Instead, I hope
to discuss issues relating to the practice of OT. It is however, difficult
to talk about OT practice without occasional reference to individuals doing
the treatment.
All this being said, I have interspersed my comments with John's original
message.
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On 2/23/2001, John Duffy Said:
JD> This is in response to the comments from Ron Carson and Adrienne C.
JD> Lauer. First of all I'm glad I sparked your interest. I would like to
JD> clarify a few things since you clearly have no idea what kind of O.T. I
JD> am. The original writer wrote that PT was intercepting orders for O.T.
JD> and changing them. The reality is that in some facilities ortho patients
JD> are split up based on their diagnosis Upper Extremity is seen by O.T and
JD> for the most part the rest of the body is seen by PT and in fact, many
JD> doctors are becoming use to this fact.
I worked in acute care rehab where this was common practice. The reason for
this was primarily because of the SENIOR OT's position that OT should treat
UE and PT should treat LE. She conveyed this belief to the physician who
naturally referred to OT for UE. I fought unsuccessfully to change this
perception and practice.
All this said, I don't see any problem with OT treating people with UE
injury. Heck, I don't think there is a problem with OT's treating LE injury.
My concern, however, is that OT's are doing just that, treating UE injury
instead of occupational performance deficits. And, as far as philosophy is
concerned OT's primary domain of concern is NOT treating injury, whether
it's brain, UE or LE.
I think doctor's are becoming used to the fact that OT treats UE because
some OT's are making them used to the fact. I find it difficult to believe
that doctors view OT's as UE experts until they are told by an OT that OT is
the UE expert.
On a side note, I personally don't consider OT's to be UE experts. Most of
the OT's at my previous employer would get assistance from PT's to treat
difficulty UE problems. And, knowing what I know about OT education and
practice, I would almost certainly recommend a PT over an OT for a STRICTLY
orthopaedic UE injury with the exception of a hand injury in which case I
would recommend a CHT (either a PT or and OT)
JD> I do not make the rules I just see the patients that are on my schedule.
JD> Now, if I have an eval that is a RTC repair I will certainly look at the
JD> person from our O.T. perspective in a holistic manner but I also will
JD> treat that patient according to protocol.
To me, this statement is backward. The OT perspective might be better
expressed by saying; I will treat this person from a holistic perspective
and certainly look at following the treatment protocol.
To me it's a matter of emphasis. John's statement is very medical-based
(treat the injury and look at them from our OT perspective) versus
occupation based (treat their occupational deficits and look at their
medical problems)
JD> Yes, some of the treatment that I perform could be considered To PT,
Well, in all seriousness, any OT doing PT is practicing illegally. This
statement opens up the potential for litigation. And, any OT practicing PT
must certainly be outside OT's domain of concern.
JD> but in O.T. I prefer to call it adjunctive methods based on the
JD> Occupational Performance Model which is procedures that prepare patient
JD> for occupational performance ie. exercise and modalities.(See Pedretti).
Doing something because it MAY prepare someone to do occupation is only 1/2
of the picture. The other half is that one must actually facilitate the
client to engage in the occupation. To best do that, one should identify
meaningful occupations which are impaired by the client's injury. Meaningful
occupation should be the treatment outcome and therapists should
self-evaluate treatment efficacy by how the client is able to complete their
occupation.
I think the concept of doing something because it allows someone to engage
in occupation highly misrepresents the OT profession. Almost all health care
professions do things so people will be better able to take care of
themselves, be productive and have fun (i.e. occupational performance) My
wife, a nurse, gives people pain medication so they can get up and go to the
bathroom and not use a bedpan. So, by the above definition, she is in
essence doing a procedure which prepares the client for occupational
performance. Certainly, though, no one would construe her actions as being
occupational therapy. Why, because her goal is not the client going to the
bathroom (i.e. an occupation), her goal is to decrease pain.
Likewise, if an OT's goal is to increase ROM, strength, balance, etc so a
client can engage in occupation then I have a hard time seeing how this is
OT. However, if the OT increases occupational performance by increasing ROM,
strength, etc then they have probably done OT. Why, because the goal is the
occupation not the ROM, strength, et.
JD> If my department wanted to they could not allow O.T. to treat the Upper
JD> Extremity and as aresult referrals would decrease and so would O.T.
JD> positions.
Seems like the facility has a very LIMITED concept of OT.
JD>That is why I feel fortunate to work in my facility because O.T. is not
JD>onthe chopping block like so many other hospitals. My point is that if
JD>you are an O.T. and you have a job in which you must treat Upper
JD>Extremity pathology you better learn how to treat your patients correctly
JD>or the patient is at risk. Mr. Carson and Ms. Lauer I am not trying
JD>to be a PT. I am proud to be an O.T. and in fact I am actively involved
JD>in fighting for our profession in Florida. I think with the medicare
JD>changes that are requiring all documentation to be related to function,
JD>this is a perfect time to educate our representatives on the definition
JD>of O.T. and believe me I plan to do so. I apologize if I increased your
JD>BP with my comments that was certainly not my intension.
JD> Sincerely,
JD> John E. Duffy OTR/L CCCE,
JD> Occupational Therapy Department Mercy Hospital
JD> Miami,Florida
Thanks for the dialogue. I sincerely look forward to your reply and I hope I
have not offended you.
Ron Carson
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