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PTA Blog Talk

Chairs, Stairs and Ramps: Part II

Published November 18, 2008 9:59 PM by Jason Marketti
A couple of weeks ago I wrote about a PT not writing a gait goal for a patient and me walking with them. 

Apparently this was done to thwart the insurance company. Insurance companies are notorious for looking at gait goals and discharging a patient when the goal is met. The PT figured that if the patient didn't have a gait goal we could see the patient longer and work on static balance and leg strengthening. 

My only question is whether this approach was beneficial for the patient. 

And speaking of being beneficial with regard to patient care, I was told I overstepped my PTA role when I discussed with social services about discharging a patient. I am not allowed to discuss such planning with other departments even though the PT had already discussed it with me. 

As a background, the social service person and I had worked together in a previous job and I often sat in her office to discuss the current patients and needs that the patients will require at discharge. She trusted me, and thus trusted the department in our collective decision making. 

So now I am told I cannot do that anymore. Was this because the PT felt threatened? 

My thoughts on it are this: If I am told by the PT that a patient is going to be discharged, I want to be assured that the patient is going to get all the equipment necessary prior to going home. Maybe the PT will do that on top of evaluations, supervision duties, meetings and, of course, 500-plus minutes of patient care. 

It is strange how different PTs react to me. Another PT at the facility encouraged me to take the reigns because he was too busy to adequately make those decisions and I was the one who saw the patients most of the time.  You would think if a PTA is the primary person seeing a patient they would know when it is time for discharge. 

This situation reminds me of a saying in the nursing field: Do you want to talk to the doctor in charge or the nurse who knows what's going on?

5 comments

Please send me a PT who does evals, d/c, meetings, and 500 minutes

of patient treatments. heheheh I didn't know they existed anymore.

If the PT has 500 minutes of treatments with all the other meetings and tasks, how do you find time to confront each other with anything?

Send that PT here Please. I will work for them for sure. :)

Donald meadows December 1, 2008 10:02 PM
robertsdale AL

I might retract that confrontation is wrong.  Some people need to be told they do not know everything.  Some people need to be told they did something wrong.  And some PT's don't need to be doing therapy just as some PTA's shouldn't because they are unsafe and incompetent.  

Just search your local PT board of licenseing and you can search which PT/PTA's have violated codes.  If they were not confronted with wrong doing they would still be practicing.

If we mince words will our message still come across as we intended?  Open frank discussions are necessary to understand others.  If the PT is not comfortable with telling the PTA what they want done, the PT has no right for complaints.  The same for the PTA, if they are not sure what to do they need to ask.  

The PTA should be direct as possible so there is no error in the PT's direction with patient care.  Disagreements in the course of care will come up and communication will be strained but this is part of putting people together who have different beliefs, values, morals, etc.  

PT's will always say they have the ultimate responsibility of patient care - and they are correct.  However, if they fail to listen to their "advisors" (PTA's) they are doing a disservice to the patient.  

Karen November 30, 2008 11:33 AM

"Confronting the PT on any issue can be wrong, most people do not like confrontation..."

I agree.  Confrontation is rarely a good idea.  Opening up lines of communication, on the other hand, is almost always a good idea, "placing a respectful question before her is not inappropriate..."  The key is in the approach.  

Granted, you won't always meet with success.  But if you go into a situation with sincere respect for the other person and the single desire to improve patient care, you will have done your part to improve communication.  

You can't control the other person's response.  It is easy to dismiss an action because we feel it won't bring about the desired outcome.  But you should never let your assumption--of what someone else's response will be--keep you from doing your part.  

People are full of surprises.  Sometimes they will surprise you immediately, responding directly opposite of what you expected.  Sometimes your words will appear to fall on deaf ears, only to have the person return later with a delayed response to what you have said.

Ultimately, another person's reaction (or, if all goes well, the person's response) is not what is most important.  You taking action is what matters--doing your part to improve the situation.  Then you can rest your head--and your mind--at the end of the day, knowing you have done all that was in your power to do.

anonymous November 30, 2008 2:08 AM

Jason,

reading comments like this is interesting.  Most PTA's do know their patients and their patients needs prior to D/C.  Some PT's do have control issues like anonymous suggested.

Confronting the PT on any issue can be wrong, most people do not like confrontation nor do they want to know what they are doing wrong.  If the PT is open enough to realize mistakes happen and understand they and the PTA cannot know everything about patients then open communication is possible.  

Some PT's will play supreme ruler and micro manage PTA's treatments.  IF they do they do not need a PTA.  And if the PTA allows the PT to micromanage then it is their own fault.  

If PTA's are smothered and not allowed to speak with other patient care services this puts a damper on communication.  What if the PT fails to act on an issue the PTA brought up - whose at fault?  The PT will deny fault and the PTA will say they told the PT.  

Each one is licensed, each one has a responsiblity with patient care.  If the PT doesn't act for the benefit of the patient, the PTA has to.  A good PT will see this and recognize a good PTA.  The PTA has an open responsibility to directly communicate actions to the PT as well.  The PTA is under the PT's license and must act accordingly.  

If all else fails quit.  There are enough positions out there for both PT's and PTA's.  

Karen November 29, 2008 7:10 PM

People come in all shapes, sizes, and quirks. I don't know you or the therapists you speak of, so none of this is personal.  Just throwing out some options.  Scenarios for why the therapist doesn't trust you:

Option One:  The therapist had a bad experience with a PTA who inaccurately coveyed information and made a mess of things.  She's projecting that experience onto you.

Option Two:  The therapist doesn't trust you because of something personal.  You did something that made her wary.  You could argue that it is her responsibility to confront you with this.  She could argue that you should know.  If this is true, understand that this man/woman communication gap goes back to the beginning of time.  Woman thinks man should know what he did wrong.  Man is clueless.  Any one who is married, or who has dated for any length of time, understands this conflict.  Just because you are at work doesn't change this dynamic.  

Option Three:  The therapist has deep seated control issues...you don't want to go there.  Just smile and run--don't walk,run--to your next patient.

In any scenario, you going to the PT and placing a respectful question before her is not inappropriate, "It appears you don't feel comfortable with me speaking to the social worker about discharge plans after you have discussed them with me.  Is there something I have done to cause you to have these reservations?"  Whatever her answer, your ultimate response is, "I want to work together with the patient's best interest in mind, so I want to make sure I'm clear on how you'd like this handled.  In the future, you'd like me to......"

This response affirms your respect for her (at least for her position).  When you follow through with the parameters she sets out, over time you will gain her trust.  Some people just need baby steps.  We never know where someone else is coming from.

anonymous November 28, 2008 11:39 PM

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    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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