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Toni Talks about PT Today

Let's All Be on the Same Page

Published May 27, 2014 5:39 PM by Toni Patt

Last week as I was preparing to do an evaluation, I overheard one of our case managers talking to a family member of one of my patients. Nearly everything the case manager said started with, "Rehab will take care of that." They were discussing gait training and preparing the patient for discharge home. That would have been wonderful except for one small problem.

The patient's chart was talking about end-of-life issues. The patient was not expected to survive long enough to be discharged and if she did, it would be to another care facility due to vent dependence and dialysis. There was a palliative care consult in the chart. Everything I read implied the patient wasn't going home.

Now, I can understand the family asking those questions. Patients and families always believe they will be the one out of a million who gets better. What I don't understand is why the case manager, who should have also read the chart, wasn't redirecting the conversation somewhere else. At least she could have prefaced her responses with, "If the patient improves" or "If the patient goes home." Give them hope but try to be realistic.

Now I, meaning therapy, will be the bad guy here. I'm not going to be doing what the family expects because the patient won't tolerate it. Someone with a resting heart rate over 120 isn't going to jump out of bed and walk to the bathroom. She didn't even tolerate transitioning to sitting.

It isn't that I don't want to progress the patient. Walking to the bathroom would be great. It just isn't going to happen any time soon, if at all. However, since the case manager talked about therapy walking the patient to the bathroom, the family probably thinks it is possible. Sooner or later, I'm going to be explaining why I'm not doing something with a patient who couldn't do it in the first place, because someone thinks it should be done.

I wish the case manager would have limited what she said to, "If that happens" or included a timeline to keep the expectations in line with reality.

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