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March 1, 2012

Part of the Problem With Our Health Care System

When I walked into the room, I was immediately struck that I had seen this patient before. In fact, it turned out I had seen him just two weeks ago and he was back in the hospital. So, following protocol, I examined him as I have been taught to do.

Just before I assisted him to standing, his daughter said she had a question, "This is too much. Why are you doing this to him?" The doctor wanted me to evaluate the patient for strength and function before he could send him home. "But why?" she asked, pointing out that he already had a rolling walker and that was feeling better and would be going home soon. We want to make sure that once patients are medically stable, they have not lost functional ability and strength. If they have, they may need to get rehab.

"But he's already getting rehabilitation across the street at the out-patient facility for a knee replacement surgery that he had in November." This hospitalization was a different incident, he may need a higher level of care. "But clearly he is feeling better and is just fine. So why does physical therapy need to examine him?" She is clearly annoyed. We are trying to make sure that he has remained strong through this hospitalization and that he hasn't lost any function. If family does not want him to receive therapy, then they need to speak to his doctor and tell him not to order physical therapy.

I got the name of the doctor off of the consult form. She wasn't interested in seeing it. At this point, I'm confused about why she is angry. "He came into the hospital because he was sick. I don't see how physical therapy is helping to make him better. He doesn't need it, he can already walk." But we don't know that. "You can see that he's fine!" I'm at a loss for how to respond, and so I respond incorrectly: An order was put in for physical therapy by the doctor. I'm just here to do my job." This was followed by a diatribe about abuse of the patient's insurance.

Now, I'm a sentient being, and I see her point. Oftentimes, there is a system in place, especially in the health care system, and especially in a hospital system, that forces hospital staff to follow certain protocols. These protocols are set up for the benefit of the patient, but they are not always appropriate for every patient. Someone higher up in the system than myself (unfortunately) has the authority to say "no" to a protocol and relieve the 8-10 people further down the chain from having to take action. That person is often the doctor. Doctors are human. They want to be thorough in caring for their patients, not only for the good of the patient, but to prevent something from going wrong, God forbid. Following my examination, the ball gets passed to social workers, home health agencies, durable medical equipment vendors, nursing staff and so on.

So it is tough for a person in my position to flaunt the system and decide when a patient is not appropriate to evaluate. I can evaluate a patient and THEN decide that they are inappropriate for therapy. Or I can consult with a physician when I believe a patient has been over or under-prescribed physical therapy, engendering a re-evaluation (which is more expensive than a treatment - spending money to save money). So what am I to do? I entered physical therapy in order to help people. But what I have joined is a system of bloat, a health care system that is cumbersome, expensive, and somewhat broken. And now it appears, I have become part of the problem.

Posted by linda at March 1, 2012 6:04 AM

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