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PTA Blog Talk

Reining Me In - Part 2

Published October 7, 2009 2:37 PM by Jason Marketti
When I was doing wound care I put together most of the protocols that we would use in the department as well as stocked the equipment that was necessary to treat almost any kind of wound.  I met with the appropriate nursing staff so we would all be on the same page in the treatment of wounds.  I took several courses in wound care education and then it happened. 

I was excited one day that a patient had a wound we could treat, and I suggested to the MD that he should let us.  When the PT found out that I was the one who spoke with the MD, it was not a good day for me. 

I was told plainly to allow the PTs to make the suggestions in the future and my role was not in treatment implementation but to carry out the treatment that was designed by the PT. 

But, but, but...I am the one who put all the work in the wound care program and I can't even help try to implement it?  "NO!" was very clearly told to me.

I now understand why the PT pulled me aside and let me know who has the responsibility for the patient and why they wanted to be the one to determine whether the patient is appropriate for therapy or not.  At the time I did not.  But even today I tend to open my mouth a little wider than I should, and when that happens I fully expect the PT to be there to let me know who is in charge. 

A PT once described to me in terms I could understand about correcting and guiding the PT/PTA relationship.  The PT described it as a parent/child relationship.  The parent will need to guide and direct the child until there is enough confidence to allow the child to go further and further from home, but both should know when they have gone too far with freedom given and freedom taken.

So my question is how much freedom is given to the PTAs in your facility?


I recommend going to Home Health, so much easier on your body and way less headaches and you should make more money.  I think its the perfect job for experienced PTA's.  If you take the driving its great.

Patrick Todd, HH - LPTA December 1, 2009 9:22 PM
Federal Way WA

I too have been told that I have gone too far at times. So I understand your questions. I think it is a trust issue between the PT/PTA. If you are the one seeing the patient or you pick up on something before the PT does I do feel it is your place to approach the PT and  MD if you have that type of relationship with your ideas. The PT's I have generally worked with appreciate the extra eyes because they are busy. Even if you make the recomendation for an intervention the PT still has the job to evaluate and set the POC before anything can proceed. It comes down to team work.

Jackie , PTA,MS November 3, 2009 6:44 PM
Lubbock TX

Jason, after reading many of your posts, I think you need a new job. Suggesting that a treatment is available to an MD is NOT the same as initiating a treatment without consulting the supervising PT. There is also a difference between program implementation and treatment implementation.

Carla's idea that perhaps the PT themselves are not comfortable with wound care sounds very likely, however I can't imagine that you got to this point without the PT having some knowledge of the plan to implement a wound care program.

In this case, I don't think you were out of line at all.

Dean Metz October 8, 2009 11:15 AM

I am in a long-term care facility...The PT staffing in this area is limited. A PTA has to prove quickly that he/she is capable of carring out a POC and able to follow instructions, even over the phone. There is a PT in my building once a week and he fully trusts my judgment in patient care. He lays out a POC for me to follow and if I have any questions or concerns I address them. He, my PT, knows that if I am having trouble he will hear from me. Otherwise, he trusts my judgment.

In your case, with the wound, if I am comfortable treating such a patient, my PT would be more than happy to take that referral and would not be offended that I spoke to the doctor. The PT world here isn't as involved in wound care as I would like to be. I LOVE Wounds and would be "tickled pink" to get to treat them on a daily basis. However, there is a nurse that does it here and she does an excellent job. From my experience...lots of PTs don't treat wounds because they are not comfortable with them. Therefore they do not want to oversee the care of that wound. Your PT may feel this way, and if so would explain the reasoning for such a response.

I commend you for wanting to expand your skills, and hope that in the future you have that opprotunity.

Carla, PTA October 7, 2009 1:55 PM

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About this Blog

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