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Toni Talks about PT Today

Losing Control

Published November 4, 2008 11:32 AM by Toni Patt
Last weekend I worked on a rehab unit. While we were eating lunch someone pointed out that being admitted to the hospital is a loss of control. In exchange for receiving care at the hospital, the patient gives up control of making basic decisions. We quickly realized one of the appeals of being a therapist is being in control. None of us could imagine what it would be like to wake up one morning with a stroke and no longer be independent. From the minute EMS arrives onward you lose control of the decision-making process. I hate losing control. I can't image what it would be like to suddenly be a patient and dependent on someone else.

Everyone knows health care workers make lousy patients. I think therapists would make worse-than-average patients. I know I would.  As a therapist I know the inner workings of hospitals. I know who does what. I know the order in which things happen. I know how quickly things should progress. I would always be asking why or when something was happening. God help the rehab staff if therapy were ordered. If how I am now is any indication, I'll be biting my tongue to keep from telling someone how to do something.

At least I know the system and therefore how to work it. Think about an average patient. All control is lost.  A severe injury, such as a stroke, puts the patient in the hands of hospital personnel for all wants and needs. The need for help takes most decisions out of the hands of the patient. A patient may need to go to the bathroom. A nurse, therapist or other worker determines when, where and how.  I may be continent but if assist takes too long to arrive, it may be too late. No one wants to use a bedpan, but that may be the only choice. Toileting issues are a significant cause of falls as patients try to get to the bathroom in time.

Hospitals follow their own schedules. To a patient it can seem disorganized and out of control. Except for the rehab unit, none of the facilities I've worked for have scheduled times for therapy. Therapy happens when the therapist arrives. This can be very frustrating to a patient. Knowing what time PT is coming is a form of control. If I know what time therapy is, I can make decisions about what I'll do before and after. I can tell my visitors when to come. I don't think anything is more frustrating for a patient than having therapy arrive at the same time as visitors.

Despite HIPPA there is also a loss of privacy. All it takes is one door left unopened or one curtain not pulled. I frequently joke with my patients about being on a heart floor and not wanting to excite anyone by covering up. The truth is no matter how hard we try, things are still exposed.  Toileting is one of those things. I'll take patients to the bathroom but I also help with the transfer.  A private person is put between a rock and a hard place if assist is needed to toilet. Which is option is least embarrassing?

I can't imagine what it must be like to be on the other side of the patient/therapist relationship. Some things I would take in stride because I know that's how it's done. Other things I would have trouble with. Hospitals don't give patients a crash course at admission on being a patient. All they know is their world isn't the same. I try to remember that while I work. It helps me be patient. It helps me remember to explain everything and answer questions. Sometimes I'm the only one who will. I can't imagine how that would feel.

posted by Toni Patt


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