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.