A Good Week & Thoughts on Healthcare Trends

A Good Week & Thoughts on Healthcare Trends

The last several weeks have been really good weeks- those types of weeks where you just feel really good about your career choice; those types of weeks where you feel as if you are making a difference in people’s lives. The reason? We had several former clients stop by the clinic to say thanks and to let us know how they were doing. One brought us a bouquet of gorgeous Dahlias. He has one of the largest collections of Dahlias around. He continues to treat us with these beautiful flowers even 3 years after he graduated from hand therapy because of the positive impact we had on his life during a difficult time.

And this case is not unusual. Some common refrains that we hear from our clients are: you provide me with the knowledge I need to recover from my injury; I don’t feel as worried or frightened about the injury and my recovery because I now have that knowledge; and I wish I had known this information earlier.
Unfortunately, as healthcare changes, I see a trend towards fewer referrals, towards fewer people receiving the benefit of our experience. We are having to fight harder to receive authorization for fewer visits with less reimbursement. In spite of my good weeks, now I am the one feeling worried and frightened ….about the future of my profession as an occupational therapist and a certified hand therapist.
A few examples of this trend: (please note that these examples are based on situations with physicians who do not regularly refer to our clinic) Last week I worked with a client who returned to the clinic to be treated for a right carpal tunnel release about 6 months after being seen for her left. She felt she had progressed very well with the previous therapy, returned to work almost immediately post surgery, and was quite pleased with her end result. She assumed her physician would refer her once again for therapy for this recent surgery on her dominant hand. The physician did not. At her second follow-up visit with the physician, surprised that therapy was once again not mentioned, she requested it. Her physician reluctantly wrote a prescription “but for only a few visits”. She was glad to have these few and upon completion, she requested a few more feeling that she had just a bit more work to do with us. Based on early return to work with residual swelling, scar thickness, limited grip and pinch strength, and a moderate pain level with typing, our progress note to the doctor also reflected that a few more visits would be beneficial. However, her physician told her that she should be grateful for what she got as this particular physician only refers 1% of patients to therapy. 1%!
I think I recall coming across a statistic a while back that most hand surgeons refer about 10% of their caseload to therapy services. (I have not been able to find this source again. I would love to have this confirmed if anyone out there has information). So what is happening with the other 9% of the patients that are not being referred? Are they receiving sub-optimal results? Taking longer to recover? Staying out of work longer? Just getting by? Finding information on the Internet instead of through qualified personnel? Having multiple questions that go unanswered? Putting energy into worries that can be resolved with education?
I once had another physician ask one of my clients who had requested therapy, “Why? Do you need someone to hold your hand?” Is that how scar management, retrograde massage, joint mobilization, manual therapy, range of motion is viewed? As hand holding
And, if people are being seen by physicians who seem as callous as in these two examples, I don’t think that a session or two of our “hand holding” is out of order. Why does medicine need to be so cold and unsympathetic? And why do some physicians believe that it is more effective that way?
And for those physicians who believe in our services, even they are being impacted and discouraged by the hounding of insurance adjusters, multiple phone calls received, and the increased need to prove medical necessity (often to ridiculous degrees). It is becoming easier for even them to not take out the prescription pad.
Dr. Roy Meals referenced a study in his newsletter that he believed every hand therapist should be aware/wary of. This study “proved” that wrist fracture recovery was better without the “coddling” of physical or occupational therapists. Of course, the control group (those who did not attend therapy) were seen for frequent follow up visits with a physician who spent 10 minutes each appointment providing them with exercise instruction. Unfortunately, all of the physicians who refer to me do not have that luxury anymore. They count on us to provide eduction and home program instruction. But, if insurances can use this study to deny treatment, do you think they will make that distinction? I sure don’t.
So, what can we do to offset what seems to be an increasing disbelief and disrespect of our services? I personally don’t know what the answers are. Maybe insurance companies (who i believe to be the driving force behind this ennui) are just too big to fight. But in the meantime, I will carry-on at a grassroots level by trying to promote my profession, by returning those annoying calls to adjusters, by answering questions and providing education, by suggesting that my clients tell any and all about the value if services that they receive from us. I will support our local and national organizations who can fight at a political level. And I will hope for the best because I want to continue to have these good weeks.
Best, Marji

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Repetitive Strain Injury -A Computer User’s Guide

Years ago, I had the good fortune to attend a conference at which Dr. Emil Pascarelli spoke. Considered to be one of the world’s leading authorities on repetitive strain injuries, Dr. Pascarelli is as good a writer as he is a speaker. His book, Repetitive Strain Injury – A Computer User’s Guide, is highly recommended for anyone who works on a computer or at a desk. His first book, published in 1995, is an easy-to-read and concise summary of his approach to repetitive strain injuries (RSIs). It was one of the first written about RSIs, and it continues to be one of the best.

Dr. Pascarelli began his study of RSIs not with computer users but with musicians who experienced upper body pain after intense practices and stressful performances. His successful approach was to treat the musician comprehensively by improving a combination of playing technique, positioning, posture and general physical conditioning. Similar problems – improper typing style, poor computer and work ergonomics, an ill-fitting workstation and equipment, a lack of postural awareness, and poor physical conditioning – were observed and addressed when computer users began seeking treatment at his clinic.

Deborah Quilter co-authored Repetitive Strain Injury – The Computer User’s Guide. Ms. Quilter is a journalist and an RSI sufferer who developed painful symptoms so severely that she was in danger of not being able to perform her job. After seeking treatment from Dr. Pascarelli and beginning the slow journey to recovery, Pascarelli and Quilter joined forces to write this guide as a resource to help those already dealing with RSI and to prevent others from developing it.

Between Dr. Pascarelli and Ms. Quilter, thousands of people suffering from RSIs have been observed, treated, and interviewed to provide the common-sense recovery and prevention information outlined in their Seven-Point Program. Their seven-points include the necessity to find a physician who can diagnose and treat the injury appropriately, to develop appropriate pain management techniques, to perform preventive stretching and strengthening exercises, to develop postural awareness, to acquire proper workstation positioning and equipment, to pace activity, and to have patience during the recovery of these slow-healing injuries.

The authors take the reader through all the steps of the RSI process beginning with a risk assessment, symptoms checklist, and discussion of common examination and treatment procedures. They then outline treatment options, give advice on performing daily activities in less physically demanding ways, provide vision care and exercise guidelines, and discuss the emotional aspects of living with an RSI. Lastly, Dr. Pascarelli and Ms. Quilter outline prevention techniques through ergonomics, workstation set-up, and typing retraining.

Although the authors provide brief descriptions of a variety of injuries, this is not a medical text. Rather, it is a comprehensive, practical approach to a complex problem written in an easy format with quotes and drawings that enhance the information provided. Repetitive Strain Injuries – The Computer User’s Guide is a necessity for anyone who is trying to avoid injury or who is looking for more than a temporary, quick fix of medication or cortisone to alleviate their computer-related pain. It is a must-read for those with chronic pain who are willing to take charge of their own recovery rather than relying on the unreliable and possible ineffective medical and insurance systems for answers.

Repetitive Strain Injuries – A Computer User’s Guide is available at Amazon.com.