Respect for Clinical Judgment
Once in a while I work with patients who have a diagnosis other than stroke. Two or three weeks ago, I evaluated a young man who'd had a TBI and was in the ICU. I later re-evaluated him following transfer to the rehab unit. Last week his rehab doctor noticed he had some ROM issues and decided to address them. Because I was the evaluating therapist, I was included in the discussion.
The treating PT acknowledged the deficits but denied functional impact. A discussion ensued. In an ideal world, one would hope since the PT denied functional impact that would be the end of it. Instead the physician insisted something be done and wrote an order for serial casting. The PT's opinion was ignored because the doctor disagreed.
This raises some questions. Why treat something that isn't causing a functional impairment? Better yet, why ask the PT's opinion if you're not going to listen to it? The PT told the doctor the deficit wasn't enough to cause a problem. She also didn't think the patient would tolerate that treatment. The doctor wrote the order and as of today is continuing to insist the casts be continued.
For all the good it did, the PT might as well have not been there. It would have cut down on her anxiety level. This isn't the first time this particular doctor has done something like this. I'm actually kind of surprised the PT was allowed to voice an opinion at all. The point of having interdisciplinary meetings is to enable everyone to work together to decide what is best for the patient. That means recognizing and respecting each person's clinical knowledge.
I've worked with many physicians who don't understand what I do yet they respect me for doing it. If I tell them a patient needs something, or conversely doesn't need something, my opinion is respected. I don't think the rehab doctor has much respect for therapies. Maybe this was some sort of power play to prove who is in charge. Or maybe our rehab doctor doesn't have a clue. It sounded like a good idea at the time and now it's too late to back down.
This is a lose-lose situation with the patient coming out on the bottom. He is undergoing a painful treatment he doesn't like to treat a deficit that wasn't causing a functional limitation. The doctor has lost even more respect. The PT feels disrespected because her opinion was ignored. Management isn't doing anything, including confronting the doctor.
I think we know where I stand on the issue. It's probably a good thing I'm not in management. It wouldn't be so bad if some good could come of this. Unless someone in authority addresses this with the doc, that won't happen. It's just a matter of time before it happens again.