So I live in Chicago. A fact that anyone who knows me would say I'm acutely proud of. And here in the Windy City, we have a saying during our election cycle: "Vote early, vote often." Now this post isn't going to be about Chicago or voting or politics. No, this week, I'm going back to my old standard harping point: education (I'll tie it all together by the end... I promise!).
Earlier this week, results were released from last year's math, science and reading exam administered by the Organisation for Economic Co-Operation and Development to more than half a million students from all over the world. Now you might think here in one of the richest, most powerful nations in the world with more access to education for students than many industrialized nations let alone the third-world, the US probably faired pretty well, right? Wrong!
Of the 34 countries where the exam was administered, the US ranked 26th in math, 17th in reading, and 21st in science. East Asian nations ranked the highest with China and Japan near the top in each of the three categories. Many smaller European nations also placed higher than the US, including big jumps for Ireland, Finland and Poland (all nations that used to be ranked near or below the US, and have now surpassed us). Now how much do I read into these rankings and statistics? Not a whole lot. Education systems are obviously different all over the world, and even in my brief research on this subject, there are many people out there who are critical of the Asian education systems and policies. So there is no perfect system, but all of this got me wondering... where does health education play into this?
When I was in high school, I was required to take three semesters of physical education and one semester of health education. I looked into the education standards for the Chicago Public School system, which serves more than 400,000 students, to see what their health education requirements were. Sadly, they were the same, with one semester of classroom-based health education. Now I'm not going to advocate that young students be put through the rigors of medical school-like health training, but I do think there should be more availability for furthering health education in our schools. The data is out there, children in this country are heavier than ever before and despite the vast amount of resources available, it doesn't seem like anything is slowing this alarming trend.
I wonder what would happen if we adopted that Chicago voting mentality and applied it to health education -- educate early, educate often. Can we change physical activity levels, alter poor eating habits, or even influence positive life decision-making? If we start teaching age-appropriate material to students early on and make it a standard part of a curriculum in our schools, do you think it would make a difference? I'm not sure, but tens of millions of students attend school every day in this country, and for the most part, we have their attention for 7-8 hours a day. Shouldn't we spend a little time educating them on their own health?
I'm going to take a stab this week at a rather touchy subject. If you haven't already figured it out, one of my passions in life is being active. I'm not some sort of gym-rat or anything like that, but I try to eat healthy and work out regularly. I was also blessed with some pretty good genes when it comes to weight (lots of skinny Irish-folk in my family!). I've never had a problem with my weight, so I want to preface this post by saying this: "No, I don't know what it's like to struggle with my weight. I don't know firsthand how hard it is to lose weight. And no, I don't know what it's like to deal with the social stigma of being overweight." I'm going to try to approach this discussion from a "healthcare perspective" so please don't think I'm writing this as "just another skinny guy who has a problem with obese people."
When I was in PT school, one of my professors showed our class maps of the United States that had each state shaded a specific color to represent the prevalence of obese adults in that state. Each year the map was updated and as she flipped through the annual maps, more and more states were shaded darker and darker (representing an increasing percentage of obese adults). These maps were created by the Centers for Disease Control and can be viewed here. If you scroll down this page, there's an animation that will flip through the maps so you can see the startling progression. I've always found these maps such a simple, yet powerful demonstration of the obesity epidemic in America.
So we know it's a problem, what do we do about it? Well I can tell you, in my hospital, the answer to that question is: "not much." I've treated my fair share of morbidly obese patients, and as a healthcare team, we do very little to help people manage their weight. Most times, we don't even acknowledge that their weight is a problem. It seems that every other day we're learning obesity is a risk factor for another disease. Heart disease, diabetes, cancer, osteoporosis -- obesity is involved in them all. And yet, when I see a patient who just had a knee replacement and has a BMI over 45, and I look at his lunch tray with a cheeseburger, fries, two cans of pop, a cup of ice cream and a side of mac and cheese, I ask myself, "Doesn't this seem counterintuitive?" How can we stand by and let this happen?
As physical therapists, we have a fair knowledge of most aspects of weight management -- physical activity, diet and nutrition, physiology, even some of the psychological components. And yet, why are we so afraid to address this? Why don't nutritionists in our hospitals educate patients on better eating habits? Why don't physicians restrict patients to low-fat or decreased-calorie diets? Can't we treat heart disease by prescribing more physical activity instead of more medications? Can't we improve muscle and bone health by improving nutrition instead of implanting more metal? Can't we try to reverse diabetes by educating patients on better eating habits instead of injecting more insulin?
Now obviously, it's more complicated than this. Way more complicated! And I don't know where the path to fix this problem even starts. But I truly believe PTs can be big players in this game. Maybe it's a matter of time or maybe it's getting more comfortable with not just talking about obesity, but actually doing something about it. What do you think? Can PTs play a role in this fight?
I'm sure it's been written about before, but I'm going to throw my two cents into the mix on the "D" in "DPT."
Last weekend I was out of town and stayed with a cousin of my mom's. At some point during their phone conversations before I arrived, my mom must have told them that I was a "doctor of physical therapy." So needless to say, when I arrived, they asked me a whole host of questions about being a "doctor." I found it a little awkward trying to explain that I wasn't an MD or a PhD, but rather a DPT. I'm not sure they entirely understood, and to be honest, I don't blame them. Medical titles can be confusing.
I have coworkers who run the gamut of educational degrees: older therapists who have the "lowly bachelor's degree" (as we so affectionately call it at work) to the more recent "master's" degree and then of course the DPT. I'm not sure what the opinions are of other "DPTs" on this, but it's been my experience that once I got into the workplace, the "D" didn't really matter. In the acute setting where I work, the knowledge base of older therapists who don't have their doctorate was still beyond mine. Their clinical skills and even knowledge of special populations or situations is at or beyond the doctorate education I received in school.
Now obviously, the longer I work, the more skills and knowledge I'll gain as well. But if after working for 30 or 40 years (God willing), I have the exact same knowledge base and skillset as therapists who went to school for three fewer years and only got their bachelor's degree, then what the heck was the point of the "DPT?" I went to a pretty expensive private school, I'm sure I could've spent that tuition money elsewhere!
The DPT degree requires students to be in school longer, and the longer students are in school, the more money they have to pay in tuition. For many students, myself included, this money comes from student loans. There's been a lot in the news lately about how national student loan debt has reached a crushing one-trillion dollars. While I'm all for furthering our profession, I wonder if there aren't more cost-effective ways of doing it. Can we cut more advanced knowledge or skills from the curriculum, leaving students to garner that knowledge in the workplace if they so desire, and maybe in doing so, cut a semester off their education and save them a few bucks (or few thousand)?
I guess it boils down to this... is being a doctor of physical therapy worth the cost when in the end, it may not leave you in a better position than therapists who don't have their "D?" What do you think?
Does anyone like writing notes? I mean really enjoy sitting down at a computer or desk and writing out an evaluation or writing down goals for your patient? I feel like it's the bane of most therapists' existence sometimes.
At our hospital, we use an EMR system that I actually had used before on one of my clinical rotations as a student, so I was pretty familiar with it when I started working. It's a massive piece of software that integrates imaging software, telemetry data and vital signs, and of course notes from members of the healthcare team. Despite being a pretty comprehensive system, it seems that our note-writing process is getting more and more complicated. And if I may be so bold as to use a reference from mathematics... it appears the complexity of our note-writing process is directly proportional to the time required to produce said notes.
As it stands right now, every time I evaluate a new patient, I have to type up his evaluation, write out some goals, document education that I provided, fill out a discharge form that offers my recommendations for discharge and the patient's current level of function, and then put in my charges. Top to bottom, this takes me about 7-10 minutes. Treatment notes don't take quite as long. If I'm really on top of my game, I can get those done in just a few minutes. Now, we don't have any time blocked during our day to write notes. There is a sort of untold expectation that we'll be able to review a chart, see a patient and do all the necessary documentation within the 30-minute time block we have for each patient. It can be a daunting task, but getting all my documentation done before I leave for the day is a personal priority.
I've had friends bring their work home with them. I've known therapists who dictate their notes and would bring their dicta-phone home to finish them up. I've also known therapists who are able to access their various EMR systems from their home computers, so they often do all their notes from home. I've even known outpatient therapists who come into work on a weekend and spend hours catching up on notes, all off the clock. The latter sounds a little extreme to me, but one must do what one must do.
How do you manage your "note time?" Do you have time set aside to get all your documentation completed during your work day? Does note time count toward your productive time? How simple or complex is your note-writing process?
For anyone who lives in or near a big city and has any meaningful commute to work, you have no doubt endured the dreaded "rush hour." Bumper-to-bumper cars, honking horns, the occasional road rage -- it's all part of the daily ritual of millions of people trying to get to and from work. I live in Chicago, where this rush-hour period seems to have extended hours. My hospital is about 20 miles away. On a good day, it can take about 30-45 minutes to make the morning drive. In the afternoons, it can take closer to an hour to get back home.
My own commute, however, is a bit more challenging. About a year ago, I was in a pretty bad car accident and totaled my car. I was able to hitch rides with coworkers for a while, but for the past several months I've been taking public transportation. My day starts with a brisk 12-minute walk (when taking public transportation, every minute counts) from my house to the Brown Line train. I take that a few stops to a station where I can transfer to the Purple Line train. This train then takes me up to one of the other hospitals in our system. From this hospital, we have a free employee shuttle that will take me to my hospital. I make the reverse trip in the afternoon. All told, my daily commute time is about 3 hours and 15 minutes.
Now that may sound absurd to some, but there are some perks. First, and most obvious, is my bank account has never looked better! I was spending upwards of $300/month on gas when I had my car. Now, I spend less than half of that on public transit fares. Secondly, I'm an expert at sleeping while traveling. I can fall asleep on buses and trains faster than you can imagine, so I can catch some extra Z's along the way (and I've never missed my stop, in case you were wondering).
So what's my point? It's this... how much of this do you think someone can take? I've had friends who have driven almost two hours, one-way, to get to work. I've known people who have literally driven across state borders to get to work. The US Census Bureau produced a report earlier this year that said the average American will spend more than 200 hours a year commuting. Is this healthy? Why do you think we put ourselves through this? What are your commutes like? Do you think it's plausible and/or reasonable to want to search for a new job, solely to make the commute shorter?
The Affordable Care Act has endured many tests. Since being passed in 2009 by the Democratically controlled congress and signed into law by President Obama, it has arguably endured more scrutiny than any other piece of legislation in recent memory.
In the 2010 congressional midterm elections, Republicans took back control of the House of Representatives, but couldn't break the Democratic hold on the Senate.
The law survives.
During the summer of 2012, in one of the most closely watched sessions of the Supreme Court, by a narrow 5-4 majority, the Court found the law constitutional.
The law survives.
And in the fall of 2012, after months of campaigning and literally billions of dollars spent, President Obama is re-elected to a second term as President.
The law survives.
Like something out of an 8th grade social studies book, the Affordable Care Act survived tests from all three branches of our government. And yet, it wouldn't be until this very month, October 2013, that the Affordable Care Act would face its largest and most influential opponent: The American People.
October 1, 2013, was the launch date for Healthcare.gov, the website envisioned by the Affordable Care Act where individuals could register, shop for, and enroll in healthcare coverage. What was supposed to be a triumphant day for the Affordable Care Act turned out to be weeks of nightmarish stories about a doomed website. Literally you can turn on any cable news channel, and even most local news broadcasts, and there will be some story about flaws on the website and how Kathleen Sebelius, secretary of the Department of Health and Human Services, should resign because the website didn't work. Republicans are calling for extensions and delays to the implementation of the law. Computer techs are coming out of the woodwork offering their opinions and ideas on how to fix the website.
Since its launch at the beginning of October, I have intentionally stayed off the website. I figured it was the least I could do to not add to the traffic already slowing it down. But tonight, I caved. I went onto healthcare.gov and signed up.
I started by creating a log-in username and password. Then I put in my contact information. Then I put in my social security and income information. Then some more security questions and after about 15 minutes, I received an email stating I was approved to continue with enrollment. So, I went back to healthcare.gov and within just a few minutes, had 71 options for healthcare coverage. Different plans from different insurance companies. I was able to do side-by-side comparisons of all the plans that looked appealing to me. I could see what premiums were, how high the deductibles would be and what specifically each plan covered. There were links to the insurance companies' websites so you could further investigate what each plan offered. There were also links to find which physicians were networked with each plan. If I wanted to, I could print the comparisons and study them further to determine which plan was right for me.
Now, let's slam on the brakes, shall we? I'm employed by a decent-size healthcare corporation, and I have health insurance through my employer. I make a good amount of money, so I don't qualify for any government subsidies. The plans offered to me through the Affordable Care Act were more expensive than my current employer plan, so I won't be changing insurance companies. (I should note, several of the plans were fairly comparable to my employer's insurance, but still slightly more expensive).
I did this more as an exercise to see the functionality of the website. I have to admit, it was remarkably easy to use. The site didn't crash. The longest I waited for any page to load was maybe 5 seconds. The features on the website were very helpful and the overall design was pretty clean. Are there things I think could be better? Of course. But do I think we need to delay one of the most sweeping healthcare reform laws this country has ever seen, that has the potential to affect hundreds of millions of Americans and change the way individuals deal with insurance companies in both the public and private sectors, all because a website has been slow... a little dramatic, don't you think?
I will concede that I am fairly learned when it comes to computers and websites, so my experience on healthcare.gov may not have been typical. And I will grant that there are probably a bunch of people out there who have struggled to navigate the website or even get it to work. But I will end by saying this: We've never done anything like this in America before, nothing even remotely close to this scale and scope. It's big, very big. And there are going to be problems -- today, tomorrow, next week, next month and next year. But this isn't a reason to panic, run and hide, or back down. If you or someone you know has struggled with this website, my best advice is, don't get jaded and give into the pundits and politicians. Simply dust yourself off, and try again.
We all know that in a hospital, we work as a team. And within that team, certain relationships develop. Now this isn't going to be a post about "Grey's Anatomy"-like activity in the on-call rooms. No, this is going to be a post about navigating relationships with various members of the healthcare team to best serve the patient's needs. Specifically, I'm going to address three groups: doctors, nurses and social workers/discharge planners.
Doctors are tough to figure out, I think. They come in with different practice backgrounds, treatment philosophies and general opinions about what is in their patients' best interests. Their age, gender and ethnicity also play a role in how we as therapists interact with them. At my hospital, we have physicians who have been practicing medicine longer than even my parents have been alive (my mother wouldn't appreciate me telling you this, but my parents are in their 60s). On the flip side, we have new residents who look like they're barely old enough to be out of high school, let alone medical school! I've found that when interacting with physicians, regardless of what "baggage" they come in with, communication is key.
I've found most older physicians don't like a lot of information; they would rather me just tell them the "need-to-know" stuff so they can make whatever medical decisions are necessary. Younger physicians tend to want more information. They tend to ask more questions and sometimes even want to hear the "story" behind the patient rather than just what my recommendations are. So communicating the right information in the right way, I think is a critical part of developing a strong relationship with a physician.
Nurses: the "saints" of health care. Without them, well... can you imagine a physician handing out morning medications or helping change a patient's soiled diaper? I don't think so. Now, of course, nurses are blessings to all of us for many more reasons than just these. In my hospital, our therapy staff works hand in hand with nurses to ensure our patients aren't just getting up and moving around when a therapist is present. They're often the first to recognize the need for PT or other rehab services and can alert physicians to this need. I can't even begin to count the number of times they've helped convince patients to actually participate during a therapy session or offered physical assistance to me during a difficult transfer or even helped ward off unrelenting family members. Their services are invaluable and I think this relationship, in order for our patients to have successful recoveries, is paramount.
Finally, our social workers and discharge planners. For those who work in acute care, I'm sure you've all felt, at one time or another, that you're nothing more than an evaluation machine who spits out discharge recommendations, then moves on to the next evaluation, and so on and so forth. These can make for long days and sore backs for sure, but by cultivating a solid relationship with these social workers and discharge planners, I think we can ensure our patients are set up for the best chance to recover and avoid readmission.
At our hospital, our social workers are fantastic individuals who don't just care about discharge plans, but rather actually show a general sense of caring for the patient's needs. They can often be seen sitting in a patient's room having difficult conversations with patients and families. Or they will be on the phone with rehab facilities or acute rehab centers trying to coordinate bed availability. Or perhaps the most daunting task of all, dealing with the dreaded insurance companies to see what coverage is available for a patient. Regardless, much like PTs they are constantly moving. They are constantly active and by working closely with them, we as PTs can help reinforce the safest plan for our patients once they walk out our doors.
Developing positive relationships in the workplace is essential, regardless of what setting or field you work in. In healthcare, it's my biased belief that these relationships are more important than any other field, because the decisions we as the healthcare team make and plans we develop for our patients ultimately exist to improve our patients' lives. To improve human life... isn't that worth taking the time to cultivate healthy, positive relationships with our coworkers?
I'm going to take another break from the business of healthcare to talk about my running of the Bank of America 2013 Chicago Marathon on Sunday. This was my big race this year. Everything I've done has been in preparation for this. One goal: run under 3:30. The conditions were primed for a good day. Start time temperatures were in the low 50s, sunny skies and Chicago's famously flat course. After a moment of silence to honor those killed and injured in the tragedy during the Boston Marathon, we were off.
Chicago's course is one loop through 29 neighborhoods and as mentioned before, epically flat. With more than 12,000 volunteers manning aid and support stations, and close to 2 million spectators (not an exaggeration) screaming and encouraging runners along every inch of the course, this city comes alive on race day, which also serves as a great distraction for runners who don't want to think about how much they have left to run or how much pain they're in.
My run started off pretty well. I kept a steady pace between a 7:45-7:50/mile for the first 18 miles. Then, right on cue, my stomach started acting up. I've had issues in other races with my stomach; it's not a fun feeling, but fortunately, I've learned how to manage the problem. After getting some more salt in my body and some extra fluids, I was able to keep running, albeit at a slightly slower pace.
Around mile 24, I heard a spectator scream out, "Go 3:30 Pace Group!" This group has a pacer who holds up a sign that says "3:30" and runs a perfect pace to hit 3:30 at the finish line. I ran ahead of this group the entire time, but we started the race at the same time too, so I knew if this group got ahead of me, I wouldn't meet my goal. So for the last 2 miles, when my stomach still wasn't 100% and my legs were already burning, I had to actually run faster to get to that finish line before the clock said 3:30.
Mile 25 and I was right even with the 3:30 pacer. The crowd was electric, fans screaming and music blaring. Half a mile to go, and we hit what some consider the hardest part of the course. In the last 0.2 miles, after already running 26 miles, you hit the "hill." It's really the only significant incline on the entire course, and to call it a "hill" may be a misrepresentation. It's less than a 1% grade, and only lasts about 0.1 miles, but when your legs are barely hanging and the thought of having to go uphill makes you want to throw up, any incline seems like it might as well be a mountain. Needless to say, I made it up and rounded the last turn into Chicago's Grant Park, 100 meters to go. The finish line was right in front of me. I looked down at my watch, as I crossed the line: 3:29:28!
The race was a success! On Monday, I could barely walk (a good sign that I ran hard). The elite runners had good days too! The top woman, Rita Jeptoo of Kenya, came in at 2:19:57, earning her a coveted place among the "sub-2:20" female marathoners. While the top male, Dennis Kimetto of Kenya, came in with a new course record at 2:03:45 (just 22 seconds off world-record pace, and the third-fastest marathon ever). All in all, it was a great day. I feel great about my time and nearly 39,000 other runners crossed the finish line within the 6 hour, 30 minute cut-off. Great running, Chicago!
And on a lighter note to end with, spectator signs are always a highlight of marathon running. My top three:
3. "PR or ER!" (I've been to the ER after a race, so I can relate!)
2. "Run Like There's a Sharknado Behind You!"
1. "You Run Better than the US Government!"
My sister Annie and myself after the race. I ran a 3:29:28 (PR by 6:56). Not to be outdone, my sister ran a 4:56:39 (PR by 1:04:40 -- she'll be the first to admit her training for her previous races was less than adequate).
I had a teacher in PT school who told us the best first job he ever had was working in an inner-city hospital treating patients with low incomes or limited financial resources. He liked the job because this lack of resources challenged him to think outside the box to ensure his patients had the equipment and assistance they needed prior to discharge. Now I work in a hospital as well, but it's in a fairly well-off suburb of Chicago. We have a fairly high Medicare population, but on occasion, we'll get a patient or two who don't have any insurance and have some serious medical conditions.
Over the past two weeks, I've treated two patients in particular who had no insurance and very limited personal financial resources. Our hospital system has a free clinic that can offer basic pro-bono medical care and both these patients were part of it, but specialty care and services is where things become dicey.
The first patient I treated this week was diagnosed with extensive myonecrosis resulting in bilateral foot drop. Due to the myonecrosis, this is not a problem that's going to resolve, so I recommended the patient follow up with an orthotist to obtain AFOs. The problem is, he has no insurance, and after contacting two social workers, two doctors and our discharge planner, no one seemed to know if AFOs would be covered or how the patient would obtain them. His gait was significantly impacted by the foot drop and AFOs would be of great benefit to him, but there seemed to be a lot of red tape and unknown standing in the way.
The second patient was admitted for what ended up being a pretty significant gout flare-up. When I treated him, we were able to get him standing upright with a walker, but it required maximal assistance of the therapist and an aide. He was unable to walk or move once standing because he lacked the strength to do so and was in too much pain. Enter the lack of insurance again. He no longer has any outstanding medical issues according to the lead physician, so he's ready for discharge. He wants to get home, but again, he needs two people for basic bed mobility and transfers. He doesn't have the financial resources to go to a rehab facility or pay for caregiver assistance at home.
So I'm the one recommending the AFOs and increased assistance at home for these patients. I seem to be the one throwing all the proverbial wrenches in everyone else's discharge plans. I have these patients who need things but can't afford them and no one seems to be stepping up to advocate for the patients' needs except me?
What do I do? Any suggestions? How do others deal with patients who don't have insurance coverage and need specialty services/care set up?
Some have asked how my reading of the Affordable Care Act is going. To be honest, much slower than expected. Real life has gotten in the way of a lot of my reading time. So it's coming along, I keep chugging through it. I've got a few out-of-town trips coming up with some serious airport layovers, so hopefully I can get up to speed!
It's Monday night, and as I sit here watching CNN's coverage of the impending government shutdown, I started to write a post about the shutdown and the Affordable Care Act and how they're all related and not related etc. But then I started hearing congressmen from both sides of the aisle and pundits with varying personal political ideologies go on and on about how they were absolutely right and everyone else was absolutely wrong... well it started to get my blood boiling. So instead, I'm going to write about something different. Something far more benign, I will grant you, but something that I still think is important: the impending annual review!
I had my annual review last month. Our corporation uses a fancy spreadsheet with various "service values" and departmental policies listed that we as employees self-grade and our supervisors grade, with the overall rating given by our supervisors. This rating typically correlates to percentage of wage increase announced in October each year (although this year with budget cuts and layoffs, no one will be holding their breaths on a wage increase).
Now, this was the fourth time I've done one of these reviews, and for the first time I realized something new -- what little emphasis was placed on clinical skills. There are multiple sections about making sure I'm courteous to patients. There are other sections about following the corporation's code of ethics and my state's practice act. There are even more sections about corporate responsibilities and working as part of the healthcare team.
Don't get me wrong, I completely agree all of these things are important. But I've been thinking a lot lately, why did I become a physical therapist? It surely wasn't to show everyone what a nice guy I am. It wasn't to prove to corporate administrators that I can play by the rules. It also wasn't to show everyone I can be a team player. Now again, I feel I need to qualify this by saying, I do all of these things anyway. But it still comes down to one thing for me, I became a PT to provide interventions that help people get better. That word, "intervention" appears once on the entire review form. Once. I think this is pretty absurd, personally.
I've been thinking a lot as well about what might serve as a good model for a physical therapist's annual review. And I keep coming back to the CPI for students. All of the things about following laws/ethics, being courteous to patients, being a team player, it's all in there! But the emphasis of the CPI is by and large on clinical skills. There are sections about evaluation skills, tests and measures, examination tools, critical thinking, patient/therapist safety etc.
Shouldn't this be what I'm graded on? I'm a licensed physical therapist. I was hired to provide physical therapy interventions. Why must the emphasis of my personal annual review be on protecting the interests of the corporation? Isn't that the job of the corporate administrators? (And for the record, I'm well aware of the fact that if the corporation didn't exist, neither would my job. What I'm talking about here is more of whose job description this falls under).
Has anyone else experienced anything like this? Any thoughts/suggestions?
It's that time of year again. The dreaded "influenza" is back to wreak havoc on the health of millions of Americans. As healthcare professionals, we're going to be on the front lines, working daily with people who have the flu (whether they're aware of it or not). Since I began working at my hospital, I've treated a number of patients with the flu, including some more dangerous strains (you'll recall the H1N1 strain that was around a few years ago).
Now, I have to admit something: I have never had a flu shot. Our hospital offers them free to employees, but I've never gotten it. In my defense, since I started working at my hospital, I've also never had the flu. I haven't been to a doctor in about three years, and the most sick I've been has been a mild sinus infection. When I see patients who have the flu in the hospital, I obviously use whatever personal protective attire is required (for our hospital, it usually consists of an isolation gown, gloves and a mask), as well as ensure my hand hygiene is being attended to properly.
My logic has always been this: I don't like putting things in my body that aren't supposed to be there. I obviously know how vaccinations work and that our hospital uses an inactivated vaccine, so the risk of getting the flu from the vaccine is negligible. But the fact still remains, I'd be putting stuff into my body that doesn't belong there.
Our hospital doesn't require employees to get the flu vaccines, but it is, of course, highly recommended. I'm leaning toward not getting it again this year. Unless someone can provide me with compelling evidence to sway my opinions. What are your thoughts on the flu vaccines? Are you required to get the vaccine for work? If so, what are the repercussions if you choose not to get it?
So every quarter, our rehab department does what we call "Performance Improvement." Essentially, we do chart audits and look at different population groups (orthopedic, neuro and wound care) and collect data about the care they received from the rehab department while in the hospital. I've been in charge of this project at my hospital for the past few years.
We're in the midst of changing which patient populations we look at and what specific criteria we look at within those patient populations. This is something that desperately needs to be done, but in all the meetings I've had and all the side conversations I've been a part of, there is one essential question that keeps popping up in my head: "What's next?" (I'm a big fan of the television show "The West Wing," where Martin Sheen played the President of the United States and "What's next?" was his mantra throughout the series).
So we collect all this data, crunch some numbers to see if we're meeting our goal percentages, and then report it to a corporate manager who oversees our department's data collection. That's it. If we don't meet our goals, nothing happens. If we do meet our goals, nothing happens. And as each quarter passes by, my frustration level rises ever so higher.
If we don't take this to the next level, then what's the point? I've seen other departments in the hospital and how they do their own data collection. Regardless of what their data shows, they make sure to put a plan into place to correct problems or enhance successes. It seems the logical thing to do. But our department just doesn't seem to get that this next piece is so vital.
Now, I've had meetings with supervisors and directors to try to get my point across, and I know they hear what I'm saying. But we keep getting stuck in this pattern where other things end up taking priority and our data collection gets pushed to the backburner, which again, causes my frustration level to rise even higher. I can be an unbelievably patient person, but on this my patience is starting to wear thin.
Does anyone else do anything similar to this? How do I keep pushing my superiors to take this project to the next level without seeming, well, pushy? Any thoughts?
I work in a hospital, and like most people who work in hospitals, once you step through those doors in the morning, you generally don't have time to go outside again until you're leaving in the afternoon. I remember in PT school it seemed like any hospital we visited, the PT gym was always in the basement (it's amazing there isn't an epidemic of vitamin D deficiency among PTs)!
I remember as a student visiting a hospital that had an outdoor "healing garden" that patients and families could use at their discretion. Likewise, on one of my clinical rotations as a student, my CI was working with a younger patient who had undergone rotator-cuff surgery and was trying to rehab to be able to play baseball again. I remember they went outside and spent 10 minutes playing catch, focusing on range of motion and proper throwing mechanics to prevent further injury. I've often thought this is such a nice thing, that patients can go outside, breathe in some fresh air and don't have to feel so trapped.
But alas, it seems that in many hospitals, we therapists are trapped inside. Now don't get me wrong, I'm well aware that many patients aren't appropriate to go outside for therapy. But I do think there are patients who need to work on higher-level activities and maybe walk on different surfaces for higher-level balance. Over the past few years at my hospital, I've been asked a few times by patients if they can go outside. I've regrettably had to tell them no.
While I can appreciate that there are safety and liability concerns, I wonder where patient satisfaction comes into play. I've never been a patient in a hospital, but I can only imagine there is a feeling of being trapped in their room. I think one of the primary goals, especially of an inpatient PT, is to maximize our patients' independence. Shouldn't that include giving them a little more freedom to venture out and test their mobility skills in a more challenging and real-world setting? As therapists, shouldn't we be advocating for this?
What do you think? Have you ever worked with patients outside, either as an inpatient or an outpatient? Where do you think a patient's satisfaction and overall mood come into play, especially when weighed against safety?
Within my hospital system, we have two hospitals where our orthopedic surgeons perform total joint replacements (primarily hips and knees). Their surgical volume is a few thousand cases at each hospital per year. Typically patients stay in the hospital for "three midnights" to qualify for Medicare to pay for their SNF stay. However, many private insurance companies are now only approving patients for two nights in the hospital. While I'm all for shorter hospital stays, I find we are running into some problems with our total knee patients specifically.
Our surgeons use femoral nerve blocks, which are one-time blocks given in the PACU by an anesthesiologist. The effects typically wear off within 24 hours and the pain relief patients get is great. The problem is the block's effect on the quadriceps. Having little to no quad function for 24 hours can wreak havoc on the inpatient PT plan of care. I even have a friend who's an outpatient therapist and sees many of our joint patients, who says the quads are still weak even several weeks after surgery. Regardless, trying to walk on an unstable leg is often very difficult for patients, to the point that things like walking longer distances (outside their hospital room) or performing stairs often get pushed back to the second day. But wait! They might be leaving the second day!
What's a therapist to do? I'm part of an email group for acute-care therapists that specifically talks about total joints. Email chains range in topic but lately there has been a focus on different blocks other than the standard femoral block. For instance, the most prevalent alternatives seem to be the adductor or saphenous blocks. Other PTs on the email say their patients still get great pain control without the negative effect of losing quad function. Eureka! Now, how to get to surgeons and anesthesiologists on board? Looks like some "evidence" will be needed! To the journals I go!
Does anyone have any experience with any of this -- different types of nerve blocks, looking not only at PT journals but medical journals as well, convincing the entire healthcare team to at least look at something new?
This week, my healthcare corporation announced that for the first time in a long time, there would have to be staff reductions in order to meet our fiscal year budget. Approximately 1% of the total corporate workforce is going to be let go. Our supervisor told us that every department is going to be affected, including the rehab department. So needless to say, everyone is a little on edge.
Earlier this year, the corporate administration announced that we were facing a significant deficit if we didn't cut costs dramatically. They were able to cut a significant portion of this deficit by offering early retirement packages and eliminating positions that were unfilled. But alas, it wasn't enough. There's no doubt the Affordable Care Act has people nervous about future reimbursement cuts and changes to insurance coverage, so while it's sad that people will lose their jobs, one might argue that when it comes to keeping hospitals up and running, the needs of the many outweigh the needs of the few.
I know many other hospitals and healthcare systems in the Chicagoland area have also had "staff reductions" over the course of the past three to four years. Are your hospitals and clinics affected in a similar manner? What are your healthcare systems doing to rein in spending and maintain their bottom lines? Does anyone have any "grand" ideas about how to reduce costs while maintaining staff levels?