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Toni Talks about PT Today

Letting Go is Hard

Published December 4, 2008 8:02 AM by Toni Patt
I've finally made up my mind. My 3-year-old horse is going to his first show this January. This was a tough decision for me. I want him to be ready.  I want him to do well. So I waited until the last minute to make a decision. I know he'll make mistakes. This will be a new experience for him. I can't protect him forever. He was bred to be a show horse. Sooner or later he has to go to his first show and make mistakes. The longer I wait, the longer it will take for him to mature into a well-trained horse.

I do the same thing with some of my patients. I don't want to let them take chances. I want to protect them. In a sense I'm reluctant to let go of the gait belt because there is a chance of falling once I do. I want everyone to be completely safe. Most of the time I don't have a problem letting go. Other times I have a patient who doesn't look completely stable but can walk. Or I have a patient who can walk but doesn't have the best pattern.  These are the ones I want to keep working on. They're almost ready. Like the half-empty or half-full glass, I see a fall risk while the patient sees independence. Just like with my horse, I have to stop protecting them.

I'm not going home with any of my patients. I can make safety recommendations. I can request home health.  I can do family training. That's all I can do. Once the patient leaves the hospital I can't make him use a RW. I can't stop her from furniture walking. If I couldn't convince someone to something in the hospital, I surely can't make it happen at home.  All I can do is get someone as safe as possible and then step back. No one wants to fall. No one is going to deliberately do something that will result in a fall.  Patients do things at home that aren't completely safe but I've yet to have one back the next day after falling. This is my problem. If I don't let go, I never give the chance to move forward.

The ones I worry about the most are those elderly who live alone. They are used to taking care of themselves and being independent. Sometimes that clouds their judgment about what is safe. I frequently recommend SNF prior to DC home for these individuals. Usually it's a good idea. Sometimes it's not necessary. I don't think I'm seeing the full individual. I see a person who looks unstable and uses a RW and thus requires as much therapy as possible. The patient may see the hospitalization as inconvenient and therapy unnecessary. As I've been told many times "I get around just fine." As much as I want to worry I have to let those people try.

In the case of my horse, the worst that happens is we don't win anything. I'm not expecting to win. He doesn't care. The stakes are a little higher with a patient, except instead of winning they don't expect to fall. I think that belief goes a long way. Positive thinking is said to promote positive action. Thinking I won't fall may very well prevent falling. When I ride I don't worry about falling off. If I did I could be seriously hurt.  If I'm willing to take such a chance why wouldn't a patient be willing to take the safe risk to live independently?  I can tell all the fall prevention and safety awareness training I've had trying to block out common sense.  I usually catch myself and obviously need to keep working on this. Letting go of a patient may seem risky to me but it's a necessary risk.

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