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Toni Talks about PT Today

Don't Forget the OT in That Order

Published August 26, 2008 12:48 PM by Toni Patt
An OT friend of mine likes to point out that "O" comes before "P" in the alphabet. Yet physical therapy comes before occupational therapy everywhere else. She is joking when she says this. It is her way of reminding people that OT is separate from PT and makes a unique contribution to patient care. Even though she speaks in jest, there is truth in what she says.

Everyone thinks of PT first. I know why that is. I don't remember ever seeing an order for OT/PT. I've seen many for PT/OT. I can't remember working anywhere that OT staff outnumbered PT staff.  The PT caseload always seems to be larger. PTs commonly receive PT without OT but rarely the opposite.  PTs frequently ask for OT consults.  Seldom do OTs request PT services.  This trend is present in both IP and OP settings.

I'm not sure how this came about. One explanation may be that physicians don't know the difference so they only order one. Another is that they know the difference but see the need to have both disciplines involved.  I frequently have to explain what OT is and why it is necessary when I request a consult.  PTs have also been around longer. Back in the day there was no OT to consult and medical schools barely mentioned therapy period.  Only recently have I seen this changing. Younger physicians now enter practice with some knowledge of what rehab does and when to order it.  I think the simplest reason is that too many PT and rehab departments have the same meaning despite significant difference. Many times rehab departments are referred to as PT departments even when both OT and ST are also present.

Regardless, OTs provide a valuable service. A patient receiving both disciplines gets twice the therapy. Yes, treatments overlap at times. But the goals are different. Sure, PTs learn many of the same things, but not all of the same things. I couldn't make a splint to save my life. Nor am I trained to assess cognition as they do.  If a treatment is 30 minutes, I have to prioritize what I do.  Things get skipped. If I have 30 minutes and OT has 30 minutes, we accomplish more while reinforcing each other's treatments.

When I have to explain the necessity of OT, I have a simple explanation. I can only work on so much at any one time.  With PT and OT involved, it takes fewer treatments and less time to prepare the patient for discharge. Without OT it takes longer, thus increasing the length of stay and costs to the facility. For example, PT gets the patient walking. OT gets the patient toileting.  

The bottom line is both disciplines are needed. I've apologized to my friend for the alphabetizing error. She understands. I think all OTs do. They just want to be recognized for the contribution they make. Therefore I challenge you. Tomorrow, go to work and thank an OT for working with you. We can't change the medical alphabet and we can't do it alone.

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