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Raising the Bar in Rehab

According to Plan?

Published November 10, 2011 12:26 PM by Lisa Mueller

I am a planner, an organizer, a 10-steps-ahead thinker. Many times during an initial evaluation I will explain to my patient things to expect in treatment, starting the first day all the way up to discharge. You can hear me say things like, "I know this is hard to understand now, but in three or four weeks we are going to start working on something..." I do this for a number of reasons - first, to maintain clear communication with my patients, and second, to remind myself of my plan and what I need to do to accomplish it.

So what happens when my brilliant plans are disrupted? Well, I've learned to adjust. And that's been a hard thing to learn.

There are times when I have everything planned out, and then my patient will be discharged from the hospital early - leaving me without the final opportunity to review an exercise program or teach a family member proper transfer skills. I had plenty of opportunities before the patient was discharged, but I incorrectly thought I would have more time.

I think this happens a lot to physical therapists in any setting. Like the outpatient PT working with a patient who suddenly must travel for work, and you miss the opportunity to review techniques to manage their symptoms. Or the PT who spends hours helping a patient train with an AFO, and then learns the patient's insurance will not cover the costs of the equipment. Or the PT working with a patient who then receives a call from her child's school, and both must postpone progress until the next appointment a week later. Sometimes our treatments are not as effective as we plan them to be, and what we had planned to accomplish in four sessions will end up taking eight.

I have many things planned for myself, both personally and professionally. I have five-year plans, to-do lists for Christmas shopping and my grocery list neatly organized in my office. While I don't enjoy calling myself "rigid," I find a lot of comfort in my plans and am often surprised when things don't work out the way I envisioned.

But more often than not, what was meant to be will be. Perhaps the patient needed a week away from therapy appointments. Maybe the patient without the AFO will regain the ability to dorsiflex. A missed family teaching opportunity may empower the patient to teach his family members and create more unity than they previously had. Those solutions can be just as effective as my micro-planning, and are a part of this profession I have enjoyed seeing.

Things tend to work out one way or the other. What kind of a therapist are you? Do you plan every minute out? Or are you more flexible in your approach?


I used to plan every minute.  My husband mellowed me a bit.  Then each child has whittled a bit more.  I still love my lists, but I'm okay with moving an item to the next day, or deleting one altogether.  Now, the lists may be more of a comfort measure.  I'm not sure whether it is age or all I have on my plate, but my memory isn't what it used to be.  I hate disappointing people by dropping the ball, so the lists are my compensatory technique.  I've gone from, "If it is written down it IS going to happen" to "If it isn't written down, it didn't happen"!

Janey Goude November 11, 2011 1:30 AM

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