August 8 – National Happiness Happens Day! (Can Happiness Help People Heal?)

August 8 – National Happiness Happens Day! (Can Happiness Help People Heal?)

August 8th – National Happiness Happens Day.

…which got me to thinking about the impact of happiness on healing.  As a clinician, I’ve anecdotally seen the correlation between a positive attitude and better injury recovery.  Conversely, those who do not believe they will heal well, or who are dealing with many life stressors, do not seem to as recover well or seem to experience more chronic pain.  So, on National Happiness Happens Day, I decided to perform a quick search to see if science supports the premise that happier people heal better.

Although I only performed a quick internet survey, the evidence appears to be overwhelming.  A positive attitude helps people cope better with stress and trauma, improves the immune system effect, and lowers pain levels.  On the other hand, stress releases hormones which impede immune system function.

So, today, on National Happiness Happens Day, take a few moments to celebrate the good in your life, listen to some happy music, spend extra time with a loved one, watch a YouTube clip of a late night TV comedian.  Seeking moments of happiness will now only create a positive impact on those around you, but will likely have a positive impact on your health.

Wishing you happiness and good health,

Marji

 

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

20130729-123704.jpg

Reflections On Being An Angel

Reflections On Being An Angel

Last week, a patient told me I was his angel.

Being caught up in the normal busyness of everyday life, I haven’t had a chance to reflect on the meaning of his statement until now. Did I do anything special or miraculous to deserve the title? Nope. I just did my job – hopefully in a caring, compassionate and respectful manner. So why was this glorified designation bestowed upon me?

This intelligent, energetic man had his life unexpectedly turned upside down after waking one morning with red streaks heading up his arm. During a home project several days earlier, he had jabbed and cut his thumb with a screwdriver. Having been a pharmacist, this gentleman knew all the right things to do. But that didn’t stop the infection from coming. He’d just been to surgery to have the wound cleaned and then his surgeon referred him to me.

When he arrived, my patient told me that he was anxious; that his wound didn’t look good; he didn’t like the color; it was healing too slowly; it didn’t feel right. During our first session, I cleaned and redressed this gentleman’s wound, I reassured him that the wound looked healthy and not infected, I guided him in exercises to prevent stiffness, and I learned that he had a granddaughter graduating from 6th grade that afternoon.

When he returned for his second visit, this patient of mine brought his wife. The wife was excited to tell me that her husband had come home a different man after that first visit. Much of the worry about his injury was gone.

At his third visit, the gentleman was pleased to tell me that he felt 80% better than at his first visit. He also told me that he had sung my praises during a visit to his internist that morning. Although he was exuberant in his thanks, did I believe that I had done do anything angelic yet? Still, no. Just putting in a good day’s work.

All I did, in addition to providing wound care and range of motion exercises, was listen, give reassurance and hold out the hope that there would be a full recovery. Yet, I’m told more and more often by my patients that health care professionals are too busy to answer questions or to provide comfort. This isn’t surprising as reimbursement for medical services is being cut and caseloads are increasing.

Another common phrase we hear in the clinic – “Why didn’t anyone tell me these things before?” It is often left to the therapist to provide injury information and recovery education. With our health care system, physicians are just too busy. It is a good thing that we, as therapists, still have the time to develop a therapeutic relationship and be a safety net….as long as we are getting referrals. But where are the angels for those who aren’t referred due to lack of insurance or who have a high deductible; who have busy schedules and are unable to attend; or who have doctors who decide to wait, sometimes for a month or two or even longer, until a problem is large enough to warrant referral?

Our profession recently celebrated Hand Therapy Week. It was a good time to reflect on the qualities that we have that enable us to treat upper extremity injuries with skill. But we must never forget that it is the personal relationships that we develop with our clients that give us the ability to change lives.

Would my patient’s wounds have healed if he had never set foot in my clinic? Absolutely. But, it would have been a longer, more stressful, lonely journey for him. And I guarantee that he would not have enjoyed his granddaughter’s graduation as much as he did if, during the ceremony, he was as worried about his hand as he had been when he first arrived at our clinic.

So, I will try to remember, in spite of all the administrative stressors, why I became an occupational therapist in the first place. I will appreciate the hugs my patient gives me after every treatment session. And I will accept this man’s role as his angel with honor.

Best wishes, Marji

mHealth – Using Mobile Devices to Improve Healthcare

What an amazing time we are living in! With an internet search and the click of a button, we have more access than ever before to even the most obscure information. With the current rapid changes in technology, we are seeing a trend towards people seeking answers to their healthcare questions online as well as through mobile devices. These emerging tools are allowing us to take charge of our healthcare in ways never before possible.

In fact, I just came across a new term that I think we will be hearing much of in the near future: mHealth. mHealth was defined by a National Institutes of Health Consensus group as the use of mobile and wireless devices to improve health outcomes, healthcare services and health research.

My goal, as an Occupational Therapist and a Certified Hand Therapist, is to provide you with reliable and helpful tips that will ease your recovery from a hand or upper extremity injury. Social Media is making this much easier than ever before. Here is how I will attempt to organize my information using mHealth:

  • Through this weekly blog (handtherapy.wordpress.com)
  • Through daily Tweets @handhajic. As a loose guideline, the tweets will be organized as follows ( but I’m sure we will throw in some random, off topic tweets as well!):
    • Medical Monday – information relating to specific hand injuries
    • Open Topic Tuesday -answers to questions generated by our followers
    • Workday Wednesday – ergonomic suggestions to help make your work activities more comfortable and less stressful
    • Therapy Thursday – tips, tricks, and advice from the clinic
    • Fun Fact Friday – interesting facts about our hands and arms; or just fun facts in general!
    • Weekend Warriors – tips to help you protect your hands from sports, gardening, home projects and leisure activities
  • Through our Facebook page – another way for you to keep in touch with the clinic. I will post my own commentary; provide injury and recovery information; give you behind-the-scenes glimpses into an active, outpatient occupational therapy clinic specializing in upper extremity rehab;; and throw in some general information about the profession of occupational therapy. Look for our logo and “Like” us at the Hand Therapy & Occupational Fitness Center.
  • HandHealthResources.com – our website is currently in the process of being updated for content and ease of use. However, it is still full of information on upper extremity injuries, recovery/therapy, ergonomics and prevention tips. Feel free to browse.

What will make this endeavor successful are the questions and feedback that will come from our followers. Please don’t be shy. My clinical experience leads me to believe that the healing process is fostered with a sense of community as people relate their experiences, frustrations and triumphs with each other as they travel on the road to recovery. So, share your journey. Ask your questions. Seek and/or provide support.

And, as always, let’s put some caring back into healthcare! Marji