Catherine, a reader, recently commented: “I know this question has nothing to do with this article, but here goes. I currently work at an acute care hospital and the hospital primarily treats elderly; gastric bypass; hip and knees; and geri psychology. We are having limited success in getting referrals for OT from the doctors. Suggestions?”

What a great puzzle to solve — and an opportunity to actively shape your practice. I really hope we’ll hear from other readers who have ideas. In the meantime, here are some of my thoughts:

I have never left a professional position the way I found it. By actively shaping my roles, I have met a wider range of clinical goals and my own need to experiment with new ideas. We are experts at modifying and personalizing things; why not do so with our roles and practices to benefit our clients and ourselves?

For example, in my first job, prior OTs had focused on sensory integration. I continued doing SI, but I added cooking and crafts groups because I saw our kids had a need for more social skills with peers, and they were super-motivated by making things that they could eat or take home. In a youth residential treatment program, I provided the traditional school-based sessions, then added a lunchtime club to teach and practice good manners and nutrition. As an educator, I initiated problem-based learning courses.

With some imagination and planning you can expand your role to best utilize your full capabilities and interests. Start by adding some new twists to therapy sessions. Soup them up by enriching and personalizing the environment and tasks. It could mean having your session in the kitchen, preparing a snack rather than staying in the clinic or gym and doing rote exercises. Put a couple of clients together and create a game that elicits mutual interaction and the skills practice they need. Have your clients make crafts they can give to someone special or use to brighten their rooms. Once you see some enthusiasm, ask your clients to talk about their experience with their physicians, nurses and families.

Bring your work into spaces where other team members can see it. People notice when clients are smiling and laughing in your sessions; it shows the power of OT to engage, motivate and instill hope. Explain how making those cookies or that flowerpot addressed your clients’ treatment goals.

I propose we take more control of our caseloads and the focus of our work by routinely reaching out to teammates, referral sources, families and clients. Attend meetings and gatherings with your teammates as often as possible, and talk up what you’re doing and would like to do. As a culture, we OTs and OTAs tend to view our magic as self-evident. Well, it’s not! What you do is truly transformative and essential, but like the air we breathe, most people cannot see the magic in performing everyday actions unless it’s pointed out.

We tend to avoid calling attention to ourselves, or asking for what we need. While humility is a virtue, in this case it can cost people the opportunity to have the full-on OT services they desperately need.

Bottom line:

  • Lead and influence by example: Do OT with obvious occupational focus.
  • Talk up your clients’ accomplishments.
  • Ask for what you need. If you want referrals for patients who need to improve IADLs, say so. If you need an electric skillet or foodstuffs or small crafts kits, order them as essential tools of your profession.