PTA Blog Talk : Ethics & Legal Issues

Immigration and PT

Jason Marketti — Wed, 18 Nov 2009 12:45:00 GMT

I spoke with Emily Lopez Neumann, an an immigration attorney at Reddy & Neumann, P.C., Houston, TX, about the immigration process for PTs recently. What follows is a Q&A of our discussion. Question: Are you seeing a change in the way immigration...(read more)

Controversial Pain Therapies

Jason Marketti — Wed, 04 Nov 2009 14:39:00 GMT

The debate continues for America on whether to legalize this. Pros and cons have been heard on both sides and still it is unsolved for the majority of us. Let's take a look at other "controversial" pain therapies. Craniosacral Therapy (CST). Some have...(read more)

Therapy Menu

Jason Marketti — Wed, 28 Oct 2009 12:48:00 GMT

Like buying fine foods by number we should offer a therapy menu for those who are undecided what will take care of their aches and pains. It would look something like this: JASON'S THERAPY #1 Massage...........................$XX.00 (For first 15 minutes....(read more)

Participation in an NIH Study

Jason Marketti — Wed, 14 Oct 2009 12:48:00 GMT

I was recently at the National Institute of Health. My family and I are involved in a study there. Since I had not flown in an airplane since pre-9/11 it was quite an experience for me. The police and armed guards were initially intimidating and security...(read more)

A Political

Jason Marketti — Wed, 19 Aug 2009 20:46:00 GMT

I try to stay out of politics, but with all the talk of health care reform I need to speak. As a father of two children who have disabilities I have incurred a large debt even though I have health insurance. The system does not work for families like...(read more)

Litigation

Jason Marketti — Wed, 17 Jun 2009 21:02:00 GMT

I have never been hauled into court over what I have or have not done. No jury has appraised me for what I look like and no attorney has battered me on the stand. I recently read Gloria Allred's book "Fight Back and Win." I think if she took on the health...(read more)

Progression

Jason Marketti — Wed, 29 Apr 2009 15:08:00 GMT

Therapy treatments should show progression, and insurance companies will approve treatments as long as the patient will progress. This is probably why few PTs are in hospice care. But what about PD and dementia-related diseases that are slowly progressive...(read more)

Michael Phelps

Jason Marketti — Mon, 09 Feb 2009 16:51:00 GMT

I thought I would comment on this man. I am not a sports fan, nor did I watch the Olympics. In fact I did not even watch the Superbowl this year.

So, back to Phelps. He has a charity foundation to promote water safety and advocate swimming for children, he wrote two books, won 14 career Olympic gold medals, and has set numerous world records. He voluntarily signed up for Project Believe to be tested for doping and passed 9 times.

He has an impressive history in the sport of swimming and all of this is easily found on Wikipedia. He has also been picked up for DUI and most recently a picture of him with a bong.

So we have to weigh whether his accomplishments far out way his mistakes. Also, he is 23 years old. Young people will make mistakes and I don't think we should destroy them for those mistakes.

He could claim his ADHD was uncontrolled and he acted impulsively during the troubled times, but he didn't. He manned-up and is taking his punishment. Good for him.

Imagine if pictures of me were published back in my hey-day. Either I would be laughed at because of the way I was dressed or criticized for what I was doing.

Great people have been penalized for making mistakes. Presidents, kings, and military hero's have all made mistakes (some have tried to cover them up), and yet we realize later they were great people under a greater amount of pressure because of their accomplishments.

The power to forgive is greater than the power to penalize.

Money Makers

Jason Marketti — Tue, 03 Feb 2009 16:52:00 GMT

I have thought of a new way to supplement my income. I am going to sell space on the back of my name badge.

What!?!

You see, we have lanyards that we use for our name badges and often times my name badge gets turned around and my name is not shown, so if I rent out that free space to companies that represent health care, our patients will see this and want to buy those products. I will be a walking billboard in the facility.

It sounds crazy, but it may not be so different when you look at the tissue boxes at the MD's office or the pens, magnets and samples given out by reps who want us to recommend their products.

If I work in a wound care clinic and Stryker or 3M wants to advertise their products, I can sell my name badge space to them for a fee with the stipulation that I will wear the name badge flipped to their product logo when I am at lunch or doing non-patient related tasks.

Branding is not something new. All I propose it to exploit it a bit. Maybe I could get a free shirt out of it and a couple of free pens to take home to my children.

We often recommend products, places to purchase equipment and the equipment itself. Patients trust us to do this. And if we trust the companies that we are telling patients to go to, we are advertising for them without a kick back. (Maybe kickback is not the best legal term to use, but oh well, I call it as I see it.)

This will be a win-win situation for everyone. Companies will be able to have their product brand visible to patients up close, we will be paid to wear (and represent) their brand, and the patient will be treated in the most professional manner with maybe a small marketing spiel from us. But that will cost extra.

Health Care Unions

Jason Marketti — Fri, 30 Jan 2009 14:55:00 GMT

I got to thinking, what if therapy was part of a union which would help us keep patient-to-therapist ratios to a limit, allow us 40 hours a work week no matter if the case load is there or not, and limit our productivity standard to 80 percent with a stipulation that we will receive a bonus if we exceed it?

I called up my Uncle Jim who is the former President of the CWA Local 1032. The first thing he said was to get a professional union organizer.

So after I contact a local union (or one that represent those in health care) I will need 30 percent of the employees to sign union authorization cards or a petition to begin a union. Then after we vote for a union, negotiations can begin.

There are those out there who are adamantly opposed to unions and would refuse to join one stating that, "Unions only want our money," and/or "I won't join a nursing union," etc.

Listen, therapists are the big money makers in facilities; every other department costs a facility money. We should be the ones setting the standards of care and what is best for the patient-not facilities, and certainly not the government. We can sit on the sidelines and allow our care to be dictated to us or be proactive and set our own standards of where we want health care to go.

Policies are set in a union so the majority will benefit, just like where we work now. We don't always agree on the policies, yet we follow them. With a union, if we don't like the officers, we can vote them out. In a facility, we cannot vote out the CEO. We can even have a vote to get rid of the union if they are not representing us appropriately.

Yes, there are dues to belong to a union. And therapists may not want to pay those dues, yet will spend $5.00 on a cup of coffee a day. So we will pay money to a corporation for self indulgence, but will not pay dues that will benefit patients and therapists in their working environment. Someone explain this to me.

In the private sector, the Service Employee International Union (SEIU) is the largest health care union. These are the people to talk to. Or, find the largest and most powerful local union who is willing to organize employees in health care.

Reading My Documentation

Jason Marketti — Tue, 23 Dec 2008 20:43:00 GMT

Before computors I wrote all my notes out in long hand and could scrible the "n's" and "m's" or add a dot above the word if I wasnt sure the word had and i or an e.

There was no spell check with red underlnes or grren wavy lines if the sentances didn't make sence. Oh the good old days when mis-spelings were not noticed as easily.

We are getting a new computor at my work. It will contain all the billing, documentation and time in/out for us. The documntation scares me. I am not the best speller nor am I the most eloquant when it comes to therapy phrases to denote progress. I hope it will have spelll check on it, although some of the medical words we use come up as wrong.

And what do I do if I see another co-worker continueously mispell a word? Should I subtley buy a dictionary or pretend the word is correct? And what will happen if a not needs to be sent to the doctor? Do I write it or let the worst spellar do it and really make our department shine?

Some places will use a simple check the box method for progresses notes with limited room for actual writting. This is good but may lack the full extent of a pateints progress. And if we write too much it may set us up for a denial or a lawsuit.

I have also seen too little documentation where I had no clue what the patient did or how they had progressed. Is there a happy medium with documenttion?

P.S. how many mistakes were in this post?

Chairs, Stairs and Ramps: Part II

Jason Marketti — Wed, 19 Nov 2008 02:59:00 GMT

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?

PT’s Time

Jason Marketti — Mon, 20 Oct 2008 19:25:00 GMT

Recently I had a list of what I thought were difficult patients. One particular patient was actively vomiting in the morning. I spoke with the nurse who stated she needed to call the MD to get something for the patient because of this.

I found the PT and was updating her on the patients condition and my conversation with the nurse.

The PT's response, "I don't have time for this Jason".

My first inclination was to remind the PT that it was HER patient that SHE evaluated and she better make the time to listen to what was transpiring with the patient. But, I played it cool and suggested that I would check back with the patient later in the day.

Well, the PT decided to see the patient after all. Cool, I went home early to play with my children that day.

I suspect it was inexperience that caused the PT to respond that way. I remember I hated to hear bad news about the patients I saw and became upset if they did not progress. The PT probably felt overworked and didn't want added stress as well. Well, maybe. I also think the PT wanted that patient in a higher RUG category and realized the only way to do it was to see the patient herself. She knows I will not get the minutes if a patient is actively vomiting and ill. How she was able to is still a wonder to me.

I also question the PT's ability to work effectively with PTA's. If she does not take the time to listen to what is going on how can she keep adequately appraised on the patients situation. If I choose not to discuss a patients condition I will be questioned about why I did not tell her and then when I tell her she says she does not have time to hear it.

I am thoroughly confused about this PT, no DPT.

Trying to Understand

Jason Marketti — Tue, 30 Sep 2008 21:06:00 GMT

In my search for information I come across many sites that provide valuable references for me.

One search led me to a biography site (www.whonamedit.com) that I devoured rapidly and I enjoy going back frequently to keep updated on the information as new entries are provided. And since I read frequently about many subjects I figured I was pretty smart until I read about BIID or Body Integrity Identity Disorder. There are many Internet sites about this disorder that are available and even Wikipedia provides a fairly accurate article on BIID.

There are some things we may never understand when it comes to humanity. Even the sessions involved in patient care can come into question daily while we are treating or trying to treat certain patients. For instance, if a patient requests hot packs, ultrasound, TENS and massage for a treatment but declines any participation with exercises, should I provide the "feel good" stuff and ask them to come back three times a week for two weeks? Or advise them that I am not a spa and send them on their way to another therapy place that will provide them with what they want?

I chose the latter and was reprimanded. Was it right? I don't know; at the time I was busy and frustrated that people thought they could dictate their care. It's not that I knew what was best for them; I just didn't want to see the patients treat our profession that way.

People do things that I just don't fully understand. In fact, I do strange things that even I don't understand. I drink from the same cup at every meal, I have my own fork that I use and no one is allowed to touch it, I even mix my peas and corn on my plate.

For the most part I try to fully realize what the patients and family members are going through during their difficult times. It is too easy to ignore subtle signs of irritation and frustration during family meetings or brush off remarks the patient makes about their care.

With the patients I see I employ compassion in the care provided, empathy when discussing the patients situation, and a broad understanding of their situation so I can provide the best treatment possible for every patient (except the one that walked out and thought I was a spa technician).

Elections

Jason Marketti — Tue, 09 Sep 2008 23:29:00 GMT

The focus is always on two folks running for president. It seems the independent people that are running never get the press coverage that they deserve. If you look, there are quite a few people that are trying to get into the White House.

After looking at the candidates and trying to decipher where they stand on subjects important to me I am finding great things in each one. It is hard to decide on just one person to lead the country. I think there are too many issues that need to be taken care of for one person.

If things go wrong, that one person is who we all blame for the world's woes. And if everything is good, we praise their leadership ability. Kind of like what we do to our rehab directors.

But to give credit to those who run for presidency it takes temerity to put yourself out there for the world to pick you apart and find every fault of yours and exploit it. I sure wouldn't want to run for office.

One big issue for health providers is who is going to pay us for the services we provide? If insurance is constantly cutting costs and the price of durable medical equipment continues to rise, who will take care of the patients?

The best time I had was right before I got into PTA school. I volunteered for several years in a pool program for handicapped children. There were no time limits and no worry about payor source. It was great. And I didn't have to call a doctor to get approval to "treat" the person. I just did what seemed right and learned techniques from others that were there.

For now I will keep my eyes open to all candidates and listen to their issues and try to understand where they want to lead our country. I am undecided at this point.