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  • How Can This Be a Safe Discharge?

    This morning I was working on discharge planning with one of our case managers. A doctor was ready to discharge a patient and she had asked me for recommendations. I immediately said SNF. He wasn't able to safely transfer out of bed. I had yet to see him walk due to complaints of back pain. And he lacks insight into his limitations. The case ...
    Posted to Toni Talks about PT Today (Weblog) on July 30, 2014
  • We're Not Going to Pay for That Brace

    A few weeks ago, a woman was admitted to our facility with a knee injury. She appeared to have ligamentous damage on top of arthritic deformities. She came to us for medical management and antibiotics prior to surgery. Before she was admitted, her orthopedist ordered a KAFO for the involved leg. I'm not a big believer in KAFOs. In my experience ...
    Posted to Toni Talks about PT Today (Weblog) on July 15, 2014
  • She Loves Her Job

    I always enjoy talking to the therapists who come to my course. Last week I met a PT I'll call Dottie. I don't want to use her real name, but she reminds me of someone named Dottie. Dottie has been a therapist since back in the day. She graduated years before I even thought about PT school and is still going strong. Dottie is a home health ...
    Posted to Toni Talks about PT Today (Weblog) on May 13, 2014
  • Selection for Recognition

    Driving home from work today, I was listening to a podcast of a morning radio show. They were making fun of a man who had been given some awards because he had been contributing regularly to the organizations. Because it's a local show, I knew who they were talking about. I had to agree there was no reason other than money that the man was being ...
    Posted to Toni Talks about PT Today (Weblog) on April 29, 2014
  • ‘We're All Gonna Need Physical Therapy Soon'

    I spent last weekend at a horse show in San Antonio. Even though I had both show horses with me, there was still a lot of down time. Since everything is close quarters it's easy to overhear conversations. While I was waiting I was surprised to hear someone in the barn next to us say, ''We're all gonna need physical therapy soon.'' I wasn't ...
    Posted to Toni Talks about PT Today (Weblog) on March 25, 2014
  • ‘Passive ROM Is Not a Skilled Therapy'

    Let me clarify that statement before I go any further. I refer to performing PROM as the only treatment on patients who are sedated, minimally responsive, have significant neurological involvement and the like. I'm not referring to outpatient settings, PROM as part of an overall treatment, stretching and the like. I thought that argument was ...
    Posted to Toni Talks about PT Today (Weblog) on December 11, 2013
  • The Declining Census

    In previous posts, I've discussed staffing issues where I work. Those problems continue. So does the return of the frequent flyer. Now we have something even more troubling. Our census continues to drop. The facility is at one-tenth of its capacity. There doesn't seem to be an end in sight. As of the time I left work this afternoon, no admissions ...
    Posted to Toni Talks about PT Today (Weblog) on September 24, 2013
  • What's the Purpose of a PM & R Doctor?

    Until recently, I had never worked closely with PM & R (physical medicine & rehabilitation) physicians. When I worked at the ''evil empire,'' I dealt exclusively with neurologists. Some were good. Some weren't so good. Either way, their purpose for being involved in the patient's care was clear. There was a PM & R service. From what I ...
    Posted to Toni Talks about PT Today (Weblog) on September 10, 2013
  • Unintended Consequences of Cutting Staff

    In recent posts, fellow ADVANCE bloggers Dean and Michael have been discussing how companies cut staff as a measure to lower costs. Neither of them supports the idea. Both make valid arguments against the practice that I'm sure would fall on deaf ears. Anyone who works in patient care sees the foolishness of the practice. The facility I'm working ...
    Posted to Toni Talks about PT Today (Weblog) on September 3, 2013
  • Sometimes Even the Doctor is Wrong

    I had a good laugh this morning. A doctor was ranting and raving that an order he'd written two weeks ago still hadn't been followed. The order was for a pressure-relieving shoe for a patient with a plantar wound. The doctor was very upset. He was making threats. He demanded something be done by 7 p.m. this evening or he would do something. The ...
    Posted to Toni Talks about PT Today (Weblog) on August 6, 2013
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