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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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

We’re Back! And Social Media Can Make us Stronger!

After a several year hiatus as a new business owner establishing a thriving clinical practice, I am now ready to make my online presence known once again!  

In the clinic, we have an open gym forum that allows those recuperating from their hand and upper extremity injuries the opportunity to share their experiences with others who are on the same life journey.  This community experience has many positive effects.  Last week, we took an informal survey of our clients.  The request for using technology as a means of assisting in both the physical and emotional aspects of injury recovery was overwhelmingly positive.  

As I am personally not technologically savvy, I have found a team of family and friends willing to take this journey with me.  So, a big welcome to Steve, Annette, Kevin and Jon who will be my Social Media Support Team.  

  • We will begin by using Facebook, Twitter, and Blogs to provide tips, tidbits and information to help make injury recovery smoother and less overwhelming.  
  • Our website, HandHealthResources is cosmetically outdated but still filled with lots of great information.  We have just started the process of updating and reorganizing.  More information on that coming soon!  
  • And, with all of the opportunities that portable technology offers, we are hoping to have some interesting and helpful SmartPhone and Tablet applications farther down the line.

I believe that the community aspect to injury recovery and wellness promotion is going to become a critical component of care as our healthcare delivery system changes.  We are already noticing a trend towards higher deductibles, fewer appointments authorized or covered, and more difficulties in obtaining reimbursement for care provided.  Social Media may allow us new ways to offer the support of a caring community that is currently in danger of disappearing.  So, let us know what you think!  Share your own stories, triumphs and advice for recovery.  Let’s put the caring back in to healthcare!