By Debora A. Davidson, PhD, OTR/L
I have always been fortunate to practice OT among an amazing community of clinical role models with whom I have shared stories about our ways of practicing. I recognize the enormous effect these stories have had on my development as a therapist. I was and am part of a wonderful community.
The oral tradition has taught me there are many ways to influence people’s occupational lives. I’ve learned that OTs can develop their own best strategies and avoid mistakes based on stories shared by peers.
Here is one of my best stories. I am sharing it to illustrate the power of clinical story-telling. I have left out or changed critical details to protect my patient’s confidentiality, but it’s quite true. I’ve used this story in my classes to springboard discussion among my OT students about safety in the workplace. I’ve also relayed it to experienced OT pals to generate a laugh.
It was 31 years ago. I was a young OT, newly hired onto the child psych unit of a large teaching hospital. I had worked with lots of kids in community settings. I felt quite confident in my skills and was eager to prove myself.
My patient, a young adolescent boy who was about my size, seemed fatigued and depressed. Those traits were not uncommon for kids in our unit. I decided that what he needed was mildly aerobic activity. I decided we’d play badminton in the gym. My colleagues raised their eyebrows when I announced my plan, but I was not worried. I knew this kid, and we had a solid therapeutic alliance. Off we went. I was well aware that what brought this patient into our care was his assaults on younger children. However, these behaviors seemed pretty remote in our antiseptic unit, and he was sleepy with medication.
Once in the hospital’s gym, the patient helped me to set up the net, and we played a rousing game. His face became rosy with exertion and he began to smile. About halfway through our second set, he suddenly darted into the walk-in storage closet where we stored equipment. He closed the door, just as I realized with a sinking heart, my keys were on a shelf in that room. I called in to him through the door, “Hey, are you OK?”
“I just need a little time to myself,” he said. Soon he emerged with a bow and arrow, all loaded and ready to use. He pointed the arrow at my chest, saying, “Just lay down and you won’t get hurt.” This was not the therapeutic session I had envisioned, for sure. Who knew that there were bows and arrows in our hospital’s closet? Happily, I was able to remain calm and talk my patient through this moment of mutual bad judgment and then walk him back to our locked unit. Afterward, I found myself shaking uncontrollably.
This is where I ask my students what things I should have done differently. They always come up with at least a dozen ideas. If my listeners are experienced colleagues, we just laugh and shake our heads at my young, clueless self. It’s always fun to watch my audience’s expressions as the tale unfolds, and it’s a memorable way to make some important points about professional judgment and safety.
The oral tradition is an effective way of transmitting clinical reasoning, as long as we take care to always protect patients’ and colleagues’ dignity and confidentiality. Do you connect with colleagues and students through iconic clinical anecdotes? What have they taught you? Tell me a story!