Outpatient Physical Therapy and Psychiatric Help
OK, so I just want to start by saying I LOVE MARQUETTE PT AND ALL MY TEACHERS. Just as a clarification.
While I was working in an outpatient practice I realized that it was not easy to handle situations where patients needed possible psychology/psychiatric consults. In hospitals and skilled nursing facilities recommending someone for a psych consult seems like nothing more than a quick word and a little paper work. However, in outpatient therapy it is mostly only "appropriate" to discuss information with a patient's doctor only as it pertains to their direct care during PT treatment. Unfortunately in outpatient you must discuss the possibility of a patient seeking out psychiatric help with the patient or patient's guardian only, otherwise you risk violating the patient's confidentiality right. This can be very problematic and cumbersome as most patients will deny that they need any type of outside help or acknowlege they never actually seek help even if you supply them with a million facilities.
This summer I saw a 13-year-old patient who had very obvious signs of self mutilation in the form of cutting. She had some marks that appeared at least a year old and others that appeared to be inflicted that morning. When the patient was asked what happened, she replied that she did not know. Later, the mother was asked if she was aware of the marks; she replied that she was aware and that the she was "seeing someone." Now, for some of those marks to be as fresh as they were, either someone was in denial or the patient may not have been adhering to her treatment. At this point, however, the only thing we could do is offer our assistance and express that we were willing to help.
Now obviously cutting is very serious and life threatening, so as health care professionals we almost have an obligation to get involved, however, we are not trained in that area of expertise, so shouldn't it be our place to be involved in an outpatient setting too?