No matter where I am, I hear the old school/new school discussion. In simplest terms, it's a comparison of how we did something years ago compared with how we do it now. In more unkind terms, it can become a condemnation of those who went to school back in the day or new graduates. It came home to me how different the thinking is last Friday. I ...

Anyone who reads my blog with regularity knows the last year has been a struggle for me. I lost my beloved job. I was fired for being ethical. I encountered more than my share of unethical and self-serving people. During all of that, I hung on and kept going to work. Every so often I made a difference to someone, which kept me going. For the ...

I'm a peer reviewer for the Texas continuing education program. I review submissions for neuro, geriatric, acute and general so I get to see a lot what is being proposed for continuing education. Texas has a specific form that must be completed for each course submitted for review. It includes speaker qualifications, specific goals, a statement of ...

Last week I questioned what the definition of skilled therapy was. I had worked with several patients the previous weekend whose only deficit was the need for supervision. I've realized I wasn't clear in describing those patients. All of them had been on caseload for a while. Previous safety issues, such as Berg and Tinetti scores, had been ...

I've been noticing a disturbing trend lately. More and more facilities are considering the need for supervision as a need for skilled therapy. Back in the day, patients referred to SNFs and outpatient had an obvious need. They had trouble walking. They couldn't transfer. They'd recently undergone total joint replacement. The knowledge and skill of ...

Someone was fired last week. The rumor is going around that she was fired because she didn't smile. I don't know if that's true or not but in Texas it is legal. Here an employer can fire an employee for any reason, even if they make it up. Nor do they have to prove it's true. There are no laws preventing it. Maybe the woman smiled. Maybe she ...

Now that I'm home from CSM, I've had an opportunity to process all of the information. Most of the presentations were excellent. Those that weren't purely theoretical had a common theme. We have to maximize what we do because we're spending less and less time with patients. We have less time to spend because there isn't money to pay for our ...

Reading Jason Marketti's blog last week reminded me of a discussion we're having here in Texas. It's called RC-3 and is an amendment to the Texas Physical Therapy Practice Act. It proposes unlicensed individuals such as athletic trainers and massage therapists be used as PT extenders. These extenders are to provide care as directed by the physical ...

Last week, I wrote about my experiences teaching my first CEU course. I mentioned how much work it was but didn't go into details. It took me nearly four months to finish, including two months of working at least an hour or two every night. Now I'm going back and revising the content. I'm beginning to think that is an ongoing process. In the ...

Today was one of those days. There is a full moon. Healthcare workers often joke about the effects of the full moon on their patients. I believe there is something to that, which means my patients gets more of a workout than usual. I am used to brain-injured people being difficult, making inappropriate statements and being confused. I shrug it off ...