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Toni Talks about PT Today

Just Do What the Family Wants

Published May 7, 2014 4:46 PM by Toni Patt

Earlier today I had a conflict with a demented, agitated patient's wife. She wanted me to get the man out of bed with a gait belt and hoist him over into the chair. I declined, stating I didn't feel comfortable doing that and it wasn't very therapeutic. She insisted. I apologized and told her I would assign the patient to someone else tomorrow who was strong enough to complete the transfer. She was still upset.

I spent the rest of the morning defending why I didn't want to "fling" a patient into a chair who didn't want to go there. He might have been confused but he knew he didn't want to get out of bed. Somewhere along the line, one of my OT coworkers told me I need to learn better customer service. Just do what the family wanted to keep them happy. I was too proud and pride comes before the fall.

There is nothing therapeutic or safe about flinging a person into a chair. Sitting up in a chair might have been therapeutic except for the fall risk from his restlessness. I used my clinical judgment and decided getting him into a chair wasn't a great idea. Being told to do it anyway is wrong on so many levels. Being told to do something simply because the family wants it without consideration of therapeutic value or skill is ridiculous.

We are supposed to be providing skilled therapies. There was nothing skilled about flinging someone into a chair. Charging a service as skilled when it isn't is a form of fraud. Doing something contraindicated because the wife wants it is not only unsafe but wrong. It also eliminates any chance of transfer training, neuromuscular reeducation and motor learning.

When did keeping the family happy become more important than providing therapy? More and more, PTs are being asked to bypass the skills we worked so hard to master and become lifting services. There's so much more to what we do. In this case, standing up for myself and my profession made me the bad guy.

There's more to good customer service than simply doing whatever the family demands. All that does is encourage them to become more demanding. Not only will those people never be happy, but all the other patients who aren't seen will also be unhappy. How does that help patient satisfaction?

In this case, I think the man is deteriorating mentally and physically and his wife is refusing to see it. She isn't going to be happy unless he does whatever he was doing before he was hospitalized and that isn't going to happen. I was wrong because I put safety first. I was wrong because I stood up for my profession.

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I can completely relate to what you are talking about. I am employed in a SNF which of course is governed by Medicare and the facility in which we contract to. We are also contracted through a Rehab Company. All 3 "Chiefs" can almost completely wipe out your rights to utilize your own professional clinical judgement and reasoning when dealing with patients. In my 25 years of experience, there have been MANY times where I have been pulled or tried to be "persuaded" to do something that just wasn't warranted or safe. Everyone else seems to like to drive your treatment plan. Stand firm, because after all it is your license on the line and when "something" hits the fan, you will probably stand alone to explain. I do agree with Steve though. As a professional, just tell them why and not deflect the issue.

Blindsided, Rehab manager May 22, 2014 6:46 PM

you mentioned that you would assign the pt to a stronger person who would be able to do the transfer.  if i were a family member, i would also be upset because you basically just told her that you are not capable to do what she is asking you to do but another therapist would be.

i would have explained why it was not indicated for the pt to get up rather than assigning the pt to a "stronger" therapist.

but i do agree with you that PTs should speak up for our profession. we are not a lift service.  

steve cabrera, Acute Care, Spine Unit - PT May 10, 2014 12:10 AM

Is there a social worker, psychologist, or other team member that can be contacted to assist this family in this difficult time?

Jeanne May 8, 2014 2:08 PM

You definitely did the right thing. Many years ago as a new PT, I transferred someone out of bed at a family member's request. That patient was confused and also did not want to get out of bed. She used her strong arm to land a blow right at my right AC joint in mid transfer. Dislocated it. Never again will I do anything that would put me in a dangerous position like that.

Although the patient's wife was still unhappy after your explanation, you may have finally started her down the road to acceptance when nobody else was willing to go there. It will put her, eventually, in a better place to make better decisions about her and the patient's futures. By not having those difficult conversations we are doing a disservice to all the parties concerned.

Dean Metz May 8, 2014 1:55 PM

Toni is right. More and more I see customer service becoming whatever the family wants instead of educating. We worked hard and studied hard to become professionals, management seems to be gearing more towards least resistance than safety these days. Standing up is the right thing to do, unfortunately it is also the thing that could put you on "the short list."

Sally, Acute care - PT May 7, 2014 10:45 PM
Winston Salem NC

I disagree that it is the physicians responsibility to talk to the spouse.  Toni did the right thing by educating the family member and taking a stance because she used her professional judgment to determine what was in the best interest of the patient.

Dan Curtis May 7, 2014 7:44 PM
Orlando FL

The doctor is the one that should be talking to the spouse unless they are also too afraid to speak up. And your therapy head needs to reiterate the purpose of rehabilitation. You are taking on roles that management is being paid for. Have them do their job.

dean reinke, stroke - survivor, home May 7, 2014 6:17 PM
east lansing MI

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