The Busy PT's Guide to Finding Balance : Ethics & Legal Issues

Your Life is an Occasion – Rise to It!

Janey Goude — Wed, 11 Nov 2009 15:39:00 GMT

Your Life is an Occasion – Rise to It! --Dustin Hoffman as Mr. Edward Magorium in Mr. Magorium's Wonder Emporium If you haven't seen "Mr. Magorium's Wonder Emporium," you are missing a gem. I love this movie. In so many ways, it embodies what this blog...(read more)

It’s All I Know

Janey Goude — Wed, 07 Oct 2009 13:17:00 GMT

Watching the movie Mr. Magorium's Wonder Emporium , I couldn't help but feel sorry for Mutant. He enters an environment where he is the outcast. In a world of imagination and creativity, he speaks a language of rules and regulations. When difficult times...(read more)

Gardasil Vaccine

Janey Goude — Wed, 30 Sep 2009 12:07:00 GMT

Why is this "cervical cancer" vaccine not being advertised honestly? I watched a commercial with my teen daughter several weeks ago. When it was over I asked her, "Based on this commercial, should you receive the vaccine?" Her response was along the lines...(read more)

Bringing Balance to our Activism

Janey Goude — Tue, 20 Jan 2009 21:16:00 GMT

Do pleas for help flood your inboxes and mailboxes? Just this week I received such an email, outlining the present plight and giving a call to action. This email even went so far as to include links that provided contact information, making it easier to jump into action.

My immediate reaction is to feel the need to click on the links and respond. After all, it is my civic responsibility. What if everyone thinks someone else will respond, so no one does? The reality is many will respond. I do believe each voice makes a difference. I don't believe my voice always has to be heard.

I get dozens of these calls to action a year...usually multiple each week. How should I use my time with respect to activism? If I respond to each and every call to action, is that a wise utilization of my time? What criteria do I employ when deciding to get involved?

Well, first, it isn't my responsibility to save the world. I can't do everything. No one (but me!) expects me to do everything. When I fall into the mentality of I have to respond to every plea to keep the world from spinning off its axis, then I am allowing the Superwoman Syndrome to creep back in. So first, I give myself permission to NOT respond.

Second, I have to be discerning -- discerning about what the present plight and call to action are, and what they are not. In our age of media sensationalism, the "good guys" are as guilty of overstating their cause as the "bad guys". Who you deem "good" and "bad" will depend on your particular world view...but the reality is everyone has a tendency to skew literature to their benefit. So I rarely take anything at face value. Before I decide to act, I try to make sure I have all the information, asking the right questions to the right people.

Third, I listen to the little nudge that says, "You need to pay attention to this." If I don't get that nudge, I hit delete without another thought. I can now actually throw away mail without even opening it! Remember, I've already given myself permission to NOT respond!

So many activities vie for my time and attention. When we bring balance to our activism we have more time and energy to truly make an impact for the organizations that we do choose to become involved with.

A reader suggested "Bringing Balance to our Attitudes" would be a good start to this series. An excellent idea, but since we discussed attitudes recently, I thought we'd cover another topic. Please keep your ABC ideas coming!

Living and Loving Well

Janey Goude — Wed, 25 Jun 2008 13:15:00 GMT

Two weeks ago our friends received the call to go comfort a newly widowed expectant mother. At 1am that morning our friends embraced a woman--six months pregnant--who was facing the funeral plans of her husband while her baby--their baby--unassumingly kicked about from inside her womb.

I remembered a conversation I'd had with this mother-to-be just three months earlier. She was in the process of changing locations to reduce overhead. She seemed hurried and curt. "Not the way to speak to someone trying to give you their business," I mused.

But her tone didn't fit at all with our previous encounters. Whether on the phone or in person, she had always been upbeat and pleasant, going out of her way to be accommodating. I wondered what might be going on in her life that could be reason for this change. The first possibility that floated through my head, besides pregnancy hormones, was marital difficulties. The stress of a new baby on the way, combined with whatever financial issues were causing her to reduce overhead, could challenge even the best marriage.

As I heard the news of her husband's death, our phone call flooded my thoughts. Had I just caught her at a tired, hormonal moment? Or had her marriage been struggling? Whatever was going on three months ago, today she was facing her third trimester, the labor and delivery of her child...every waking minute for the rest of her life...alone.

Had she lived the last hours of her husband's life well? Had she loved him well when that last opportunity unknowingly presented itself? Or did she grieve her last moments with him?

Had he lived and loved his final hours well? Did he leave her with a warm embrace and a soft kiss? Or will her last memory of him forever be a stern look and cross words?

We are all dying...none of us knows when. How am I living my life? Am I letting little annoyances rob me of simple pleasures? I don't want a terminal illness to be my motivation for getting my priorities right.

What about you? Are you living and loving your final hours well?

Microchipping: It's Not Just for Fido Anymore

Janey Goude — Tue, 15 Apr 2008 13:13:00 GMT

I'm not a big news buff, but by now my husband would have clued me in on something this sensational. Amazingly, he hadn't heard of it either. I just read an article on the use of microchips in Alzheimer's patients. Yes, I said IN. The same technology that has been used in pets since the 1980's is now being used in humans.

I did a quick search to gather a bit more information. Not surprisingly, Florida, a state well known for retirees, is pioneering this effort. To date, at least 100* Florida residents (humans with Alzheimer's and their caregivers) have been implanted with an RFID microchip, similar to the one used in man's best friend. I haven't seen a clear reason for implanting the caregivers--maybe as a control group or perhaps to lessen the blowback of using invasive technology on an unwitting patient?

Another murky area is what this chip will and won't do. In reading the articles it is easy to get the impression that the microchip acts as a tracking device, a sort of human GPS. But to date, that is not the case. The people in Florida have microchips that only contain personal data, like a traveling medical history. If a patient wanders off and happens to be taken to one of a handful of Emergency Rooms equipped with a scanner, they can pull up the patient's name, personal information, and medical history from a database where it has been stored and updated since implantation of the RFID microchip device.

But there are states that have entertained human GPS systems--for prisoners. As early as 2004, the Ohio Department of Rehabilitation and Corrections had plans to fit 44,000 inmates and guards with wristwatch-sized transmitters. These transmitters have GPS tracking capabilities and would also sound an alarm if they were being tampered with or if a guard fell to the ground. In 2007, Oklahoma legislators upped the ante when they introduced a bill to implant microchips into prisoners convicted of violent crimes in order to monitor them after their release from prison. Articles are unclear whether these devices would be informational or tracking in nature. The House of Representatives in Oklahoma sent the prisoner microchip bill back to committee, but only after the Senate passed it! Reportedly the House was concerned that the forced implantation of the microchip might potentially violate the prisoners' constitutional civil liberties. Perhaps if we called it a "clinical trial"?

*some reports say 100, some 200, some as high as 400.

Most Embarrassing Moment

Janey Goude — Tue, 08 Apr 2008 11:22:00 GMT

Everybody has those days. With four kids, I probably have more than my share! This particular day, it had nothing to do with my kids. I went through a drive-thru for a milkshake. A seemingly simple feat, but I'll admit I'm not your run of the mill milkshake orderer. I'm high maintenance with my food, like Meg Ryan in "When Harry Met Sally." But I try to be reasonable. There are some things I can roll with, like the wrong ingredients on my hamburger. I can pick off the onion. I can live without the mustard. But there are unforgivable food mishaps, like cold French fries. Not preparing my milkshake to specifications also falls in the realm of unforgivable, meaning I'm going to request a do-over or a refund.

Because there was someone behind me in the drive-thru, I pulled forward before I took my first sip. I had requested extra thick with no syrup, only milk and ice cream. The milkshake was like water. If I'd have paid $2 and hadn't really had a taste for it, I would have passed it off to my kids. But this milkshake was over $4 and I really, really wanted it. So, I wheeled back thru the drive-thru of this family owned business. The teenage daughter had taken my order, made and delivered my milkshake. She contended that I had not made those specific requests and she could do nothing. In essence, "Lump it."

Perhaps if this was the first time I had wanted a milkshake prepared precisely this way, I would have questioned myself. But I have been ordering my milkshakes this way for years. It is the only way I drink them. Plus, I had eight other ears in the car that said I did order the milkshake that way...and at least four of those ears were trustworthy, given to correcting me when I misspeak. So I asked to speak with her supervisor, aka her mother. Her mother told me her daughter didn't lie, that for all she knew I could have been sitting in the parking lot while the milkshake melted. The inference, of course, is that I was lying.

I was livid. Keeping a calm exterior, I requested she make me a new milkshake or refund my money. She refused. As I tried to reason with her, appealing to her apparently absent customer service skills, she began to shut the window in my face. That closing window was like the red cape waving in front of a bull. In a moment that can only be likened to a psychotic break, I tossed my milkshake at her through the closing window and drove off. My kids sat in momentary disbelief before exclaiming, "Mom, you rock!"

I've never done anything like that before. I like to think I'll never do anything like that again. I wish I could say I regretted the act. I didn't. But I did have remorse. I hated the example I had set for my children. And I was sickened thinking this woman might attribute my behavior to prejudice against a foreigner. Her ethnicity had no bearing on my actions-her being an unreasonable jerk was my only motivation. It bothered me that she could deny her own culpability by pawning off my actions on perceived prejudice.

So, a week later, after explaining to my kids how much I didn't rock, I went back to the restaurant to apologize, kids in tow for them watch me eat crow. The restaurant was closed. Not for the day, for good. I'll admit we all basked in the righteous vindication the world had to offer at that very moment. You can't treat people poorly and expect them to keep coming back. She learned that the hard way. Or she learned nothing as she sat oblivious to her own actions in a pool of self pity for a perceived prejudice that was so wrongly thrust against her.

That day, I couldn't understand how a business owner would risk losing a customer over a $4+ milkshake that probably only cost her $1 to make. Even if she had made me another milkshake, at worst she would have broken even. Now her refusal to make me a new milkshake made more sense. Either she was fighting for her survival and every penny counted, or she had already lost her fight and didn't care about losing a customer. Either way, there was something below the surface I couldn't see. I didn't give her the benefit of the doubt.

How often do I assume someone is just being a jerk for the pure joy of annoying me? A co-worker, a boss, a spouse, a child, a relative, another driver? How often are my actions driven by the sentiment that I deserve to be treated better by those around me? How often do I treat others poorly and expect them to react graciously to me because I'm having a bad day?

You never know what personal battle someone is fighting. Even on my worst day, someone who is irritating me may actually be having a worse day than I am. Hopefully I can remember that the next time I get a watery milkshake!

Who is Doing Your Job?

Janey Goude — Tue, 18 Mar 2008 14:45:00 GMT

I'm transferring my kids' care from the pediatrician to my family doctor. As with anything medical, paperwork precedes productivity. So, I took the completed release forms to the pediatrician.

The next day, I received a call saying I'd have to pick up the records. Apparently after nearly five years, the records were too bulky to mail or fax. I'm pretty sure it would have been cheaper for me to mail them a check for postage than to pay for the gas to go get them. But, we got them and took them to the family doctor.

The family doctor asked me to call the shot nurse and have her review the transferred vaccination records to determine if any of the kids would need a vaccine during their well visits. The shot nurse informed me that the shot records were incomplete, either missing altogether or missing the patient's name. Then she asked me to phone the doctors' offices where the records had originated and get the necessary information. I asked her for her fax number so I could have those few records transmitted quickly. Not only did she not know the number, she didn't offer to get it for me.

At this point, I realized I was agreeing to do her job for her. In fact, I'd been doing a couple of people's jobs in this process. As the patient, my responsibility should have ended when I hand delivered the release form requesting the medical records be transferred.

I'm pretty sure my co-pays for four children over the last four+ years would more than cover any postage that may have been required. My kids' haven't been that sickly; one priority mailing box, costing less than $10, should have sufficed. At a minimum, they should have given me the option of being charged for the postage if the $10 was really going to bankrupt them.

I have the utmost respect for my doctor, but I shouldn't have been giving his shot nurse tasks to complete...either the doctor or his nurse should have followed up on that.

As far as the shot nurse asking me to call to get completed records, there are two obstacles. First, she had the records and knew exactly what she needed. I didn't have any copies. More significantly, when was the last time a doctor's office responded more effectively to a discharged patient than to another doctor's office?

A more rudimentary issue is her not knowing the fax number, or at least offering to find it, especially since she originated the call to me and knew she was going to ask me to acquire information for her. She should have been prepared to give me the tools I needed to do her job for her. Don't you think? Honestly, if she had been able to give me the number, I don't think it would have dawned on me that she was asking me to do her job.

So, who is doing your job?

Human Error or Negligence?

Janey Goude — Mon, 03 Mar 2008 17:41:00 GMT

Recently I received an email rejoicing that an unborn child had saved the mother's life. My joy was short circuited by my anger. The unborn child should never have been called upon to save her mother's life...that task was the responsibility of the ER physician who couldn't be bothered to do his job.

I've made my share of mistakes. We all have. If you haven't, give it time, you will. We need to have procedures in place to minimize the risk and consequences of human error, but we will never eradicate it. This wasn't human error.

Human error is altogether different from negligence. Human error can happen to the most dedicated caregiver. Negligence is arrogant and self-indulgent. Negligence assumes it knows the answer without conducting the appropriate tests. Negligence dismisses complaints it deems excessive. Negligence is more concerned with the caregiver's convenience than the patient's outcome.

We've all had bad days, annoying patients and patients who are taking advantage of the system. The problem comes when we think we have some sort of at-a-glance superpower that allows us to distinguish sincere patients from phonies with a minimal intake history. When we get to this level of arrogance, we are a disservice to our patients and our profession.

I worked with an orthopedic surgeon who had seen his share of malingerers. He never treated patients like they were lying, even if he thought they were. He believed if he gave them enough rope, they'd eventually hang themselves. But if he assumed they were lying and acted on that assumption, then he might cause harm to an innocent and sincere patient. That was an unacceptable outcome.

But that is exactly what happened in the ER. The doctor minimized the patient's complaints and administered meds without performing any tests. Within a few hours, the patient was in an emergency C-section. While his 2 pound daughter was delivered breathless and his wife lay bleeding out from an unknown source, the patient's husband was escorted by the head nurse to meet with the hospital chaplain to pray. Prayers were answered. Mom was transported to ICU with a breathing tube. Their daughter was taken to NICU, her home for weeks to come. Days would pass before Mom could see or touch her newborn daughter.

How much pain could this family have been spared, not to mention medical costs, if the doctor had assumed the patient was telling the truth? If he had given her the benefit of the doubt and done a complete work-up? What would that decision have cost him? What might that decision have saved this family?

Are you acting on your assumptions instead of your assessment? Your patients and your profession deserve better.

Perspectives and Client Care - For Better or Worse

Janey Goude — Tue, 11 Dec 2007 13:36:00 GMT

I recently read a letter to the editor in which an OT called PTs on the carpet for "pushing too hard." The author was a retired OT who had undergone physical therapy and felt her physical condition had been adversely affected by PTs who aggressively forged ahead without regard to her individual physical status.

The fact that she appeared to be lumping all PTs in with the few she had encountered bothered me. But the comment that really got me hot was, "OTs wouldn't have done that." Seriously, now, could someone honestly think that one group is without redemption while another group is without fault?

My knee jerk reaction was to respond with a scathing letter. Then I checked myself, reasoning that logic would be wasted on someone that ignorant. As calm and reason penetrated my defenses, I realized this retired OT had challenged my perspective. Maybe I was the one who had something to learn. Over the next few weeks, we'll take a look at how perspective influences client care...for better or worse.

For now, consider the statement, "OTs wouldn't have done that." Have you ever lumped a whole group into one category-either good or bad? Chiropractors? The more interaction I've had with them on both personal and professional levels, the more I see that there are at least as many good apples as there are bad. Doctors? Come to find out they aren't all perfect...who'd a thought it? Government agencies? Still waiting on the verdict! Just kidding. I worked for the VA and, despite all the negative press, it was one of the most pleasurable experiences of my career. The list is inexhaustible, but you get the picture. When I make a wide sweeping statement, it is usually the result of my emotions (or ignorance) trumping reason. I end up playing the part of the fool.

In large part, finding balance is gaining perspective. Here's to gaining perspective as we close out 2007 and ready ourselves for 2008.

Janey

Balance in the Workplace: Liar, Liar Pants on Fire

Janey Goude — Mon, 26 Nov 2007 14:47:00 GMT

I was in a car wreck two weeks ago-hit broadside in the rear passenger door where two of my girls were sitting. The policeman insisted an EMT check out my girls then shared, "The lady in the other car wants the paramedic to look at her ankle. It's really swollen, but I don't know that it has anything to do with this accident." The EMT examined my daughters and informed me what to watch for. If additional care was required, he suggested a nearby urgent care would be a wiser choice than waiting in the hospital ER. Rolling his eyes, he added, "I tried to get that lady to go there, but she insists on going to Baptist ER."

Their message about the passenger in the other vehicle couldn't have been clearer: "She's taking the insurance to the cleaners." It happens. People are dishonest and in the process make skeptics of us all. I've been there. I've worked in pain clinics and industrial rehab clinics. I've seen the malingerers and I've had to fight off the skepticism.

Until I was the victim of that skepticism. I went to the ER in horrific pain that began in my low back then radiated into my right anterior thigh after a sneeze. During my eval, I did everything but say, "Hey doc, I have a herniated disc. Please give me an epidural." His treatment plan was to D/C with OTC Tylenol. I declined and requested an injection, hoping he would clue into the possibility of an epidural. Instead he gave me a narcotic injection. Within 24 hours I had the beginnings of foot drop. In 48 hours my right ankle had 0/5 strength with a Trendelenburg gait to boot. I got my epidural but to no avail. I went into emergency surgery at 9 weeks gestation.

Later I requested my ER records and found the ER doc hadn't documented my complaint of radiating anterior thigh pain, but he did state that I was med seeking. I'm not sure he listened to anything I said. He heard what he wanted to hear based upon the outcome he already knew to be true. One problem: he was wrong.

One of the balancing acts we have as therapists is when to believe a client. Sometimes it is a fine line, especially when we are talking about a subjective symptom like pain. We have to make sure our past history with malingerers doesn't take precedence over our client's medical history. If you have to err, err on the side of compassion-just in case your client really is genuine.

Until next time,

Janey