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Raising the Bar in Rehab

Ignorance is Bliss

Published July 9, 2009 8:21 AM by Lisa West
I was working in the outpatient clinic last week and had an evaluation for a 43-year old woman for "Left Shoulder".  I had no information other than those two words, which isn't terribly uncommon for the setting I am in. (This is a whole different discussion, about medical records and patient care- we'll save that for a different day.) 

The woman walks in, very pleasant and cooperative.  I asked all the related social questions regarding living situation/job/hobbies and then started to ask her about her left shoulder.  She had three recent incisions on the superior aspect of her shoulder, resembling an arthroscopic procedure. 

"What kind of procedure did you have on your left shoulder?"

"I don't know."

This woman literally had no idea what she had done to her shoulder.  She recited words like ‘dislocation' and ‘bony spurs', but truthfully didn't know.  She was actively moving her arm around, was motivated to make progress with PT, but couldn't tell me anything else.   I spent the remainder of the evaluation time trying to get in contact with her physician, who reported she had a rotator cuff repair.

Obviously, my patient wasn't following post-op precautions or protecting her healing shoulder in any fashion.   Who's to blame?  Did the surgeon not emphasize the generic post-op protocol followed by most surgeons?  Was the patient absent minded?  I can't even begin to imagine the amount of damage done to those healing tissues; but what frustrates me more is the lack of accountability some of our patients have.  If you cannot tell me what procedure you had done, how will I know you are compliant with a HEP?  With work limitations?

Have you seen this before as a therapist?  What did you do? 

2 comments

What you are experiencing is nothing new.  I have been a therapist for 24 years.  You did the right thing of course by contacting the physicians office, even request a copy of the op report.  If, under the new health care reform, physicians, or for that matter, all providers, including PTs will be held accountable and reimbursement tied to outcomes, what outcome potential exists with this patient.  Sorry for the divergence.  Patients don't always know what is going on, most are just going with the flow.  What you did was right, so, if you use this opportunity to educate your patient, you hopefully will have a patient for life.  They will remember how you explained everything, possibly even in more detail than her surgeon, and will return the next time she needs a PT.  Unless her surgeon owns a POPTS, but let's not get on that train.

Carl, Physical Therapy - Owner July 15, 2009 8:53 AM
VA

What you are experiencing is nothing new.  I have been a therapist for 24 years.  You did the right thing of course by contacting the physicians office, even request a copy of the op report.  If, under the new health care reform, physicians, or for that matter, all providers, including PTs will be held accountable and reimbursement tied to outcomes, what outcome potential exists with this patient.  Sorry for the divergence.  Patients don't always know what is going on, most are just going with the flow.  What you did was right, so, if you use this opportunity to educate your patient, you hopefully will have a patient for life.  They will remember how you explained everything, possibly even in more detail than her surgeon, and will return the next time she needs a PT.  Unless her surgeon owns a POPTS, but let's not get on that train.

Carl, Physical Therapy - Owner July 15, 2009 8:53 AM
VA

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