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PT and the Greater Good

Healthcare 'Silos'

Published November 20, 2012 11:59 AM by Dean Metz

I've heard more frequently the term "silos" to describe a disjointed way of delivering care to patients. It's often used for multidisciplinary teams where each discipline has its own task and never overlaps, except in the increasingly rare MDT meeting. Nursing, medicine, OT, speech and PT each has their own function. If you've ever heard, "That's nursing's job!" or something to that effect, you've probably been working in an environment of silos.

I can imagine some people saying, "What's wrong with that? I didn't become a PT so that I could do nursing tasks!" We do have to work within the scope of our practice acts, but why do we take a pharmacology module if we're never going to apply that knowledge? Silos also ignore the idea of patient-centered care. In silos, care is provided based on a limited remit or a specific algorithm, not a comprehensive holistic approach.

I remember working with a patient in the UK who had started falling over. The doctor asked me to visit him to issue a walker and perhaps a home program. The nurse hadn't visited him yet when I arrived. I performed a lying and standing BP reading on him and discovered a massive postural drop. I did a medication review and learned he had been placed on a new dose of his BP medications 14 days prior (he had started falling more than 13 days ago). He didn't need a walker; he needed to have his meds reviewed and altered.

There are some who would say it wasn't the job of the PT to investigate these things. Maybe the nurse could have or should have done that investigation. The point is that it needed to be done. I say it's imperative we do all the things that can get patients well as quickly as possible. These are the things that will prove our ability to function autonomously, be appreciated for our extensive skill sets and demonstrate value for money.

It's curious to me that the term silo has been coined for this phenomenon. Silos on farms can be dangerous and deadly places. They could be dangerous to our patients and profession as well.

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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