Re: Stopping PT's From Referring to OT for UE issues

[Guest guest]

Hi Ron,

I really hate it when things like this happen between therapists.

But the main point is who is the best person to treat the problem?

Maybe the PT does not have that skill set?

Does this patient need a hand therapist?

If so the patient could go to an outpatient hand therapy clinic for an

assessment. But probably not while on home health.

Also you refer to the fact that this is an ongoing issue, if it were me

I would request a meeting with the manager and the therapists to discuss

this issue. If the PT is not skilled with hands and UE's then it would

be appropriate to defer it to someone who can treat this patient

competently.

Wade , PT

OR

>

> Today, a PT told a home health patient that OT should order a splint for

> the patient's hand. I've previously discussed the issue of PT's NOT

> treating the UE and deferring to OT.

>

> I want feedback from PT's on how best to stop the practice of PT's NOT

> treating patient's UE and deferring the treatment ot OT.

>

> Thanks,

>

> Ron Carson MHS, OT

> HOPE Therapy Services, LLC

>

>

[Guest guest]

Thanks Wade:

In my opinion, the entire skill set between OT and PT is really messed

up. Granted that specific therapists are better in some areas, my issue

is that generally speaking, the OT and PT division of expertise is

flawed. I've been a therapist almost 15 years and the old UE/LE thing

has always been the predominate practice pattern, but I think it's truly

a silly and artificial division that does not serve patients well.

Just out of curiosity, isn't a hand splint part of basic PT training?

Also, I agree that ANY therapist can defer to a better skilled

therapist, but as I stated, my concern is not about individual

therapists as much as the professions as a whole.

In this specific case, the PT has no knowledge of my splinting skills,

but according to the patient's wife, the PT referred the situation to

me. I think an obvious explanation for whey this PT is referring to me

is simply because I'm an OT. There is a mind-set between both OT and

PT's that OT's automatically treat UE/hands. And it's this type of

thinking that is flawed, at least in my opinion.

As an FYI, I've spoken to my clinical manager about role delineations of

PT and OT and we are scheduled for a meeting. I don't anticipate the

meeting will go well, but who knows, right?

Thanks,

Ron

> Hi Ron,

> I really hate it when things like this happen between therapists.

> But the main point is who is the best person to treat the problem?

> Maybe the PT does not have that skill set?

> Does this patient need a hand therapist?

> If so the patient could go to an outpatient hand therapy clinic for an

> assessment. But probably not while on home health.

>

> Also you refer to the fact that this is an ongoing issue, if it were me

> I would request a meeting with the manager and the therapists to discuss

> this issue. If the PT is not skilled with hands and UE's then it would

> be appropriate to defer it to someone who can treat this patient

> competently.

>

> Wade , PT

> OR

>

>

> >

> > Today, a PT told a home health patient that OT should order a splint for

> > the patient's hand. I've previously discussed the issue of PT's NOT

> > treating the UE and deferring to OT.

> >

> > I want feedback from PT's on how best to stop the practice of PT's NOT

> > treating patient's UE and deferring the treatment ot OT.

> >

> > Thanks,

> >

> > Ron Carson MHS, OT

> > HOPE Therapy Services, LLC

> >

> >

>

>

[Guest guest]

Hi Ron,

I agree with you about these arbitrary divisions, there are PT's who are

certified hand therapists. You are correct, in my training we were

taught how to make several types of hand splints but I would not dare to

make one now. I usually find the best person for the job, and refer

appropriately. I have specific therapists I refer patients to for hand

therapy as well as things like coccygeal mobilizations.

I'm not sure how to approach the meeting and hopefully some others can

give some good advice on that. I would try to keep the focus away from

PT and OT divisions and focus on skill sets. When I did home health

years ago there was an OT who absolutely did not do any UE's. I got the

shoulder rehab patients not the OT. This was simply because she knew

her limitations and did not feel competent in that area.

But your case may very well be different.

Good luck,

Wade

> Thanks Wade:

>

> In my opinion, the entire skill set between OT and PT is really messed

> up. Granted that specific therapists are better in some areas, my issue

> is that generally speaking, the OT and PT division of expertise is

> flawed. I've been a therapist almost 15 years and the old UE/LE thing

> has always been the predominate practice pattern, but I think it's truly

> a silly and artificial division that does not serve patients well.

>

> Just out of curiosity, isn't a hand splint part of basic PT training?

> Also, I agree that ANY therapist can defer to a better skilled

> therapist, but as I stated, my concern is not about individual

> therapists as much as the professions as a whole.

>

> In this specific case, the PT has no knowledge of my splinting skills,

> but according to the patient's wife, the PT referred the situation to

> me. I think an obvious explanation for whey this PT is referring to me

> is simply because I'm an OT. There is a mind-set between both OT and

> PT's that OT's automatically treat UE/hands. And it's this type of

> thinking that is flawed, at least in my opinion.

>

> As an FYI, I've spoken to my clinical manager about role delineations of

> PT and OT and we are scheduled for a meeting. I don't anticipate the

> meeting will go well, but who knows, right?

>

> Thanks,

>

> Ron

>

>

>> Hi Ron,

>> I really hate it when things like this happen between therapists.

>> But the main point is who is the best person to treat the problem?

>> Maybe the PT does not have that skill set?

>> Does this patient need a hand therapist?

>> If so the patient could go to an outpatient hand therapy clinic for an

>> assessment. But probably not while on home health.

>>

>> Also you refer to the fact that this is an ongoing issue, if it were me

>> I would request a meeting with the manager and the therapists to discuss

>> this issue. If the PT is not skilled with hands and UE's then it would

>> be appropriate to defer it to someone who can treat this patient

>> competently.

>>

>> Wade , PT

>> OR

>>

>>

>> >

>> > Today, a PT told a home health patient that OT should order a splint for

>> > the patient's hand. I've previously discussed the issue of PT's NOT

>> > treating the UE and deferring to OT.

>> >

>> > I want feedback from PT's on how best to stop the practice of PT's NOT

>> > treating patient's UE and deferring the treatment ot OT.

>> >

>> > Thanks,

>> >

>> > Ron Carson MHS, OT

>> > HOPE Therapy Services, LLC

>> >

>> >

>>

>>

[Guest guest]

Hey Wade:

It seems to me that where OT and PT work together, or even where they

don't, there MUST be clear delineations between what OT and PT can and

will do. OT and PT are different professions and despite the watering

down of OT and the expansion of PT, we still remain different. And it's

these differences that I'm trying to understand and hammer out.

Without question, there our professions have a large area of overlap,

but I think what's missing is a clear-cut boundary between what is OT

and what is PT. I don't know for sure, but I imagine searching for such

a boundary is how the the UE/LE division occurred. But, despite this

being the predominate pattern for many, many years, I think it a poor

separation of the professions.

Ron

> Hi Ron,

> I agree with you about these arbitrary divisions, there are PT's who are

> certified hand therapists. You are correct, in my training we were

> taught how to make several types of hand splints but I would not dare to

> make one now. I usually find the best person for the job, and refer

> appropriately. I have specific therapists I refer patients to for hand

> therapy as well as things like coccygeal mobilizations.

>

> I'm not sure how to approach the meeting and hopefully some others can

> give some good advice on that. I would try to keep the focus away from

> PT and OT divisions and focus on skill sets. When I did home health

> years ago there was an OT who absolutely did not do any UE's. I got the

> shoulder rehab patients not the OT. This was simply because she knew

> her limitations and did not feel competent in that area.

>

> But your case may very well be different.

>

> Good luck,

> Wade

[Guest guest]

Hi Ron,

Appreciate your concerns but let me throw out that you have the chance to

educate a lot of PT's and OT's by putting a post on this list of some of

things I found missing from your discussion such as:

How would you handle the situation?

What do you find as a boundary between the professions and when/how should

it be used?

I think we would appreciate seeing what your experience has been and what

you think.

For my part, I agree with Wade in that what needs to be focused on is who

has the skill set to treat the problems presented. Most often the only way

to effectively determine who is best to treat and to avoid the problem you

are having is to have good management. Home health is not a field, in my

experience, where management has a strong presence. Therapists are more

often on their own to make all decisions. Management needs to be the ones

making the decisions about therapists skills sets, referrals, boundaries,

education and when good management exists, the problem that you cite, will

not occur (or if it does it will be handled through education from

management in an appropriate way). Without strong effective management, we

all can slip into bad habits and other bad behaviors and forget the ultimate

goal is to pair the therapist with the skill set with the patient in order

to get to the patient the most effective and competent treatment.

If your management is not effective, then it may fall on you to take the

lead in this situation and present your case to educate or just simply

remind the other therapists what is appropriate in these situations - maybe

even an education sheet to hand out. Again, the ultimate message would

still be what is best for your clients.

So along that line, I know I would appreciate your insight on what you think

should have happened in your scenario and in general.

Thanks

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

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From: PTManager [mailto:PTManager ] On Behalf

Of Ron

Sent: Wednesday, January 05, 2011 6:55 AM

To: PTManager

Subject: Re: Stopping PT's From Referring to OT for UE issues

Hey Wade:

It seems to me that where OT and PT work together, or even where they

don't, there MUST be clear delineations between what OT and PT can and

will do. OT and PT are different professions and despite the watering

down of OT and the expansion of PT, we still remain different. And it's

these differences that I'm trying to understand and hammer out.

Without question, there our professions have a large area of overlap,

but I think what's missing is a clear-cut boundary between what is OT

and what is PT. I don't know for sure, but I imagine searching for such

a boundary is how the the UE/LE division occurred. But, despite this

being the predominate pattern for many, many years, I think it a poor

separation of the professions.

Ron

> Hi Ron,

> I agree with you about these arbitrary divisions, there are PT's who are

> certified hand therapists. You are correct, in my training we were

> taught how to make several types of hand splints but I would not dare to

> make one now. I usually find the best person for the job, and refer

> appropriately. I have specific therapists I refer patients to for hand

> therapy as well as things like coccygeal mobilizations.

>

> I'm not sure how to approach the meeting and hopefully some others can

> give some good advice on that. I would try to keep the focus away from

> PT and OT divisions and focus on skill sets. When I did home health

> years ago there was an OT who absolutely did not do any UE's. I got the

> shoulder rehab patients not the OT. This was simply because she knew

> her limitations and did not feel competent in that area.

>

> But your case may very well be different.

>

> Good luck,

> Wade

[Guest guest]

Hi Ron,

I'm surprised no one else has jumped in this discussion.

You know about 15 years ago a PT where I worked reported an OT to the

board for doing " Gait training " with a patient.

I'm not sure if that is in the OT practice act or not, but that is

ridiculous, if an OT is going to have a patient walk to wherever for

doing ADL's don't we want the OT to make sure the patient is observing

good gait technique.

That disgruntled PT left and I was the replacement coming in there. All

of that happened before I arrived and the OT in question was absolutely

top notch, she was a very dedicated acute care rehab therapist and was

NDT certified. We worked together as a team and I learned a lot of

great gait training techniques from her when we worked with neuro

patients. The PT who reported her I think felt threatened because she

was not very skilled at her job and probably needed to be in a different

profession.

So I can't argue with you about much of what you say. But maybe not

focus so much on some arbitrary delineation and instead see who on the

team can offer which skills. Sadly I think the whole team approach is

long since gone and therapists don't communicate as well with each other.

As I said previously I worked with OT's who did not want have anything

to do with shoulders or hands, I also worked with OT's who knew more

than me in gait training techniques, as well as some who hated w/c evals

and some who loved them.

I have found good communication is important and trying to work together

as a team helps.

Wade , PT

OR

>

> Hey Wade:

>

> It seems to me that where OT and PT work together, or even where they

> don't, there MUST be clear delineations between what OT and PT can and

> will do. OT and PT are different professions and despite the watering

> down of OT and the expansion of PT, we still remain different. And it's

> these differences that I'm trying to understand and hammer out.

>

> Without question, there our professions have a large area of overlap,

> but I think what's missing is a clear-cut boundary between what is OT

> and what is PT. I don't know for sure, but I imagine searching for such

> a boundary is how the the UE/LE division occurred. But, despite this

> being the predominate pattern for many, many years, I think it a poor

> separation of the professions.

>

> Ron

>

>

> > Hi Ron,

> > I agree with you about these arbitrary divisions, there are PT's who are

> > certified hand therapists. You are correct, in my training we were

> > taught how to make several types of hand splints but I would not dare to

> > make one now. I usually find the best person for the job, and refer

> > appropriately. I have specific therapists I refer patients to for hand

> > therapy as well as things like coccygeal mobilizations.

> >

> > I'm not sure how to approach the meeting and hopefully some others can

> > give some good advice on that. I would try to keep the focus away from

> > PT and OT divisions and focus on skill sets. When I did home health

> > years ago there was an OT who absolutely did not do any UE's. I got the

> > shoulder rehab patients not the OT. This was simply because she knew

> > her limitations and did not feel competent in that area.

> >

> > But your case may very well be different.

> >

> > Good luck,

> > Wade

>

>

[Guest guest]

Jumping in here... Recommend you take the perspective of why you are

doing something so you can charge appropriately. This happens frequently

in both professions. The gait work that OT might be doing, could be part

of their ADL work in the kitchen or balance work might occur when they

are dressing. PT might focus on a motor control issue with gait

training, or with correct use of gait equipment. So, is it an ADL

charge? neuromotor reed? Gait training? Depends on the focus of the

treatment. I'm not sure why you are feeling you need to have a cut and

dried, black and white line here Ron. It's all gray... I think you will

be more successful if you approach it from that angle, than if you try

to come up with a list of OT does this only and PT does this only.

People have different skill sets within each discipline, but also have a

different end goal in mind for their pt and that is what really matters.

Sara Ehlert, PT

North Valley Hospital Outpt Dept

Columbia Falls, MT

From: PTManager [mailto:PTManager ] On

Behalf Of Wade

Sent: Wednesday, January 05, 2011 1:05 PM

To: PTManager

Subject: Re: Stopping PT's From Referring to OT for UE

issues

Hi Ron,

I'm surprised no one else has jumped in this discussion.

You know about 15 years ago a PT where I worked reported an OT to the

board for doing " Gait training " with a patient.

I'm not sure if that is in the OT practice act or not, but that is

ridiculous, if an OT is going to have a patient walk to wherever for

doing ADL's don't we want the OT to make sure the patient is observing

good gait technique.

That disgruntled PT left and I was the replacement coming in there. All

of that happened before I arrived and the OT in question was absolutely

top notch, she was a very dedicated acute care rehab therapist and was

NDT certified. We worked together as a team and I learned a lot of

great gait training techniques from her when we worked with neuro

patients. The PT who reported her I think felt threatened because she

was not very skilled at her job and probably needed to be in a different

profession.

So I can't argue with you about much of what you say. But maybe not

focus so much on some arbitrary delineation and instead see who on the

team can offer which skills. Sadly I think the whole team approach is

long since gone and therapists don't communicate as well with each

other.

As I said previously I worked with OT's who did not want have anything

to do with shoulders or hands, I also worked with OT's who knew more

than me in gait training techniques, as well as some who hated w/c evals

and some who loved them.

I have found good communication is important and trying to work together

as a team helps.

Wade , PT

OR

>

> Hey Wade:

>

> It seems to me that where OT and PT work together, or even where they

> don't, there MUST be clear delineations between what OT and PT can and

> will do. OT and PT are different professions and despite the watering

> down of OT and the expansion of PT, we still remain different. And

it's

> these differences that I'm trying to understand and hammer out.

>

> Without question, there our professions have a large area of overlap,

> but I think what's missing is a clear-cut boundary between what is OT

> and what is PT. I don't know for sure, but I imagine searching for

such

> a boundary is how the the UE/LE division occurred. But, despite this

> being the predominate pattern for many, many years, I think it a poor

> separation of the professions.

>

> Ron

>

>

> > Hi Ron,

> > I agree with you about these arbitrary divisions, there are PT's who

are

> > certified hand therapists. You are correct, in my training we were

> > taught how to make several types of hand splints but I would not

dare to

> > make one now. I usually find the best person for the job, and refer

> > appropriately. I have specific therapists I refer patients to for

hand

> > therapy as well as things like coccygeal mobilizations.

> >

> > I'm not sure how to approach the meeting and hopefully some others

can

> > give some good advice on that. I would try to keep the focus away

from

> > PT and OT divisions and focus on skill sets. When I did home health

> > years ago there was an OT who absolutely did not do any UE's. I got

the

> > shoulder rehab patients not the OT. This was simply because she knew

> > her limitations and did not feel competent in that area.

> >

> > But your case may very well be different.

> >

> > Good luck,

> > Wade

>

>

[Guest guest]

Hey Tom:

I handled the situation by texting (which is how most therapists

communicate) that if she thought the patient needed a hand splint to

please order it.

Regarding boundaries, I feel that OT is best prepared to address

self-care and productivity. PT is best prepared to address body

dysfunction. There is obvious overlap in these areas but at the end of

the continuum, this is how I view the OT / PT split.

I FULLY understand that therapist must deliver what is best for the

patient, but in all honesty, as an OT I must also be concerned with a

broader concern of what's best for my profession. My primary concern

at the moment is addressing the OT / PT split without regard to a

specific patient. In other words, I'm trying to define general

guidelines for OT / PT treatment areas.

Thanks,

Ron

> Hi Ron,

>

> Appreciate your concerns but let me throw out that you have the chance to

> educate a lot of PT's and OT's by putting a post on this list of some of

> things I found missing from your discussion such as:

>

> How would you handle the situation?

>

> What do you find as a boundary between the professions and when/how should

> it be used?

>

> I think we would appreciate seeing what your experience has been and what

> you think.

>

> For my part, I agree with Wade in that what needs to be focused on is who

> has the skill set to treat the problems presented. Most often the only way

> to effectively determine who is best to treat and to avoid the problem you

> are having is to have good management. Home health is not a field, in my

> experience, where management has a strong presence. Therapists are more

> often on their own to make all decisions. Management needs to be the ones

> making the decisions about therapists skills sets, referrals, boundaries,

> education and when good management exists, the problem that you cite, will

> not occur (or if it does it will be handled through education from

> management in an appropriate way). Without strong effective management, we

> all can slip into bad habits and other bad behaviors and forget the ultimate

> goal is to pair the therapist with the skill set with the patient in order

> to get to the patient the most effective and competent treatment.

>

> If your management is not effective, then it may fall on you to take the

> lead in this situation and present your case to educate or just simply

> remind the other therapists what is appropriate in these situations - maybe

> even an education sheet to hand out. Again, the ultimate message would

> still be what is best for your clients.

>

> So along that line, I know I would appreciate your insight on what you think

> should have happened in your scenario and in general.

>

> Thanks

>

> Tom Howell, P.T., M.P.T.

>

> Howell Physical Therapy

>

> Eagle, ID

>

> thowell@... <mailto:thowell%40fiberpipe.net>

[Guest guest]

I have to say my peace. I have been an OTR for over 20 years and while I do

believe that OTs generally have more training and skill in splinting (probably

because PT abdicated this to OT somewhere along the the line)the problem lies

with the OT profession itself. While PT is very clear in its role and scope of

practice OT is all over the map. OT's role is human occupation and its effect

on quality of life. This is a difficult concept for many OTs to grasp so they

instead practice like upper extremity PTs. This is a disservice the patient

because the patient is getting duplication of services as opposed to a

professional who is going to evaluate the rich complexity of his/her

occupational engagement and how that has been limited by disability hence

presribing alternative or complentary occupations to improve his/her quality of

life. This is the scope of OT and is completely different than that of PT. So,

PTs have the right to question this type of practice. Now, I'm done.

Amory, MS, OTR/L

Network Director of Rehab Services

St. Luke's Hospital and Health Network

>

> Today, a PT told a home health patient that OT should order a splint for

> the patient's hand. I've previously discussed the issue of PT's NOT

> treating the UE and deferring to OT.

>

> I want feedback from PT's on how best to stop the practice of PT's NOT

> treating patient's UE and deferring the treatment ot OT.

>

> Thanks,

>

> Ron Carson MHS, OT

> HOPE Therapy Services, LLC

>

[Guest guest]

, I appreciate your input, but I'm not sure what you mean by,

" " PTs have the right to question this type of practice " . To what type of

practice are you referring?

Thanks,

Ron Carson, OT

> I have to say my peace. I have been an OTR for over 20 years and while I

> do believe that OTs generally have more training and skill in splinting

> (probably because PT abdicated this to OT somewhere along the the

> line)the problem lies with the OT profession itself. While PT is very

> clear in its role and scope of practice OT is all over the map. OT's

> role is human occupation and its effect on quality of life. This is a

> difficult concept for many OTs to grasp so they instead practice like

> upper extremity PTs. This is a disservice the patient because the

> patient is getting duplication of services as opposed to a professional

> who is going to evaluate the rich complexity of his/her occupational

> engagement and how that has been limited by disability hence presribing

> alternative or complentary occupations to improve his/her quality of

> life. This is the scope of OT and is completely different than that of

> PT. So, PTs have the right to question this type of practice. Now, I'm done.

> Amory, MS, OTR/L

> Network Director of Rehab Services

> St. Luke's Hospital and Health Network

>

>

> >

> > Today, a PT told a home health patient that OT should order a splint for

> > the patient's hand. I've previously discussed the issue of PT's NOT

> > treating the UE and deferring to OT.

> >

> > I want feedback from PT's on how best to stop the practice of PT's NOT

> > treating patient's UE and deferring the treatment ot OT.

> >

> > Thanks,

> >

> > Ron Carson MHS, OT

> > HOPE Therapy Services, LLC

> >

>

>