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Toni Talks about PT Today

My Therapeutic Pet Peeve

Published November 25, 2008 1:26 PM by Toni Patt

I have a pet peeve. Actually I have several. This is one that pops up while I'm at work. What is my pet peeve? It's patients who think going to therapy means going to the bathroom. I'm not talking about those who I bribe with the bathroom to get them out of bed. Nor am I referring to those who would have gone earlier if someone would have come to assist them. In the first case, I'm using the bathroom for therapy. In the second case, it takes only a few minutes to resolve, then we're off to therapy. I'm talking about those patients, who despite what I say or try to do, insist on going to the bathroom. Instead of doing therapy they use the bathroom.

I had a good example of this last week. I had a spine patient. OT had already worked with him. I needed to do bed mobility, transfers and gait. Since he was up in a chair we did gait first. That was all we did. As soon as he was up, he headed for the bathroom. It took 10 minutes to walk 15 feet. He wouldn't stop. He wouldn't rest. He wouldn't sit down. I couldn't leave him because he would have fallen. By the time he made it there, urinated and walked back, he refused to continue therapy because he was in too much pain. The most annoying piece of this was the urinal hanging off his chair. He'd been using that all day.

There were so many other things I needed to work on. Log rolling is very important for spine patients and we didn't do it. So is transfer training, but we didn't do that either. Ten minutes of the time I spent with him was therapeutic. In most facilities, therapy time is limited, case loads are long, staff is short. Coming back to a patient isn't often an option. Even if I had the time, it's very possible the patient would be gone for a test or procedure. This happens all the time with neurological patients.

So, I get frustrated. I have limited time and lots of therapy to provide. I have to cover the big stuff first.  Later, if there is time I can do more involved therapy. Patients aren't in acute care hospitals for therapy. They're there to become medically stable so they can move to the next level of care. My job is to get a patient as functional as possible by the time that happens. This isn't ideal. It's probably one reason many therapists don't like to do acute care. It still has to be done.

I'm not unsympathetic to these patients. I'd want to use the bathroom too. The problem is conflict of priorities. I want to do therapy. They want to use the bathroom. Taking someone to the bathroom isn't necessarily skilled or therapeutic. My job as a PT is to provide skilled and therapeutic interventions. If the need is urgent, BSCs are a good alternative.  The transfer doesn't take long and can be used as training for other transfers.  That way I still get plenty of time to do other things. Even changing a diaper while less therapeutic, unless rolling is a goal, is quicker and uses little energy.  I can't stop patients from ignoring me and heading to the bathroom. Short of forcing them into a chair, which I can't do, I have little choice. I think the psychology of using the bathroom would be a fascinating research topic. There might be a solution in there somewhere. In the meantime I will continue to have this pet peeve.


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