Therapists Should Determine Frequency
Last week I had a situation at work that caused some controversy. A patient's wife was insisting her husband be seen twice daily. There were no orders for this. Nothing supporting this was present in the chart. However she was adamant her husband be seen twice daily. Even this week I have no idea where the idea came from. The situation was complicated by nursing. Rather than tell her our rehab policy was once daily, they obtained BID order for therapy. I'm not sure which part of this makes me more upset.
I understand nursing was caught in the middle. They were receiving the majority of her complaints. However, I think they should have reinforced hospital policy and let rehab deal with the problem. The order was obtained without consideration of the appropriateness of the patient. This particular patient ambulates with SBA. He is nearly beyond needing skilled intervention. Obtaining an order for a treatment because a family member wants it is not my idea of good nursing. It's also determining a piece of the PT POC. Since no nurse would appreciate a PT telling him or her how to perform nursing, we should be given the same respect.
This isn't the first time I've run into this sort of thing. Attitudes of patients and families in hospitals have changed. They are demanding more; more care, more time and more therapy. At the same time hospitals-rehab departments in particular-are able to provide less. Somewhere along the line it has become okay for a non-medical person to tell health care professionals how to provide care. I've seen doctors "fired" from caring for a patient because they didn't comply with family or patient demands. I believe nurses go along with this to reduce the number of complaints they receive.
I have a problem with this sort of thing. When I have a heavy caseload, I'm usually racing to make sure everyone gets seen. If I see one patient twice it may result in someone else not being seen at all. I can't justify that in my therapist heart. I'm old school. Everyone needs to have a chance to be seen once before anyone is seen twice. I can't make exceptions. This isn't a problem if I have a lighter case load, but that isn't always an option. Sure, exceptions can be made. The problem with that is it starts us on a slippery slope to somewhere we don't want to go.
Back in the day things were different. Patients were seen twice daily. Nowadays total joint patients are the only exceptions, and then only because their length of stay is so short. Therapy has to be optimized. I certainly understand how this woman feels. She wants her husband to get better. It's logical that being seen twice is better than being seen once. I don't blame her. I wish the nurse would have handled this differently. This is a nice example of the need for teamwork rather than turf battles. I solved the problem this time. It'll happen again. This isn't an easy fix. There are too many contributing factors for a global cure all. I think this is a symptom of what is wrong with health care.