Back in May 2014, I wrote a blog in response to having encountered young colleagues who were burning out because they had been systematically prevented from providing essential, scope of practice OT functions at their jobs. They had been forced to narrow their services in order to meet ever-increasing productivity standards. I exhorted readers to “rock the boat and save your own life” by taking real steps to practice authentic, occupationally relevant OT, despite bureaucratic and cultural pressures to provide cookie-cutter, reduced services. The response to my call to action was strongly positive, and I was pleased to know that my concern for our clients’ and our collective wellbeing was not unique.
Last fall, I was made aware of a larger movement afoot, or at least a growing awareness that we need to provide practitioners with support and means to push back. In October 2014, AOTA, in coordination with the American Physical Therapy Association (APTA) and the American Speech-Language-Hearing Association (ASHA) published a “Consensus Statement on Clinical Judgment in Health Care Settings.” This official document reflects awareness at the upper levels that practitioners often work in contexts that stifle them professionally, and may even strive to force unethical practice.
“Decisions regarding patient/client care should be made by clinicians in accordance with their clinical judgment.”
“Respect for the therapist’s clinical judgment and expertise is critical to achieving optimum patient/client care. Overriding or ignoring clinical judgment through administrative mandates, employer pressure to meet quotas, or inappropriate productivity standards may be a violation of payer rules, may be in conflict with state licensure laws, and may even constitute fraud.”
The document also outlines practitioners’ responsibility to know and abide by payers’ rules and regulations, and to provide and clearly document skilled service delivery. It supports the right and necessity of therapists to be paid and scheduled reasonably for documentation, team interaction, and professional education.
These are powerful words, and they give me hope that our national associations recognize the tremendous pressure that therapists work under, pressures that can distort our practice and – over time – our ability to reason effectively and to perform ethically. They ask practitioners to “take action if there is a problem” and list ways to do so. The question is, will we use this leverage to effect needed improvements in our own, everyday practices and work environments?
As in the past, I encourage you not to settle for a pale, factory-like, boring, constrictive model of practice. If my saying this makes you angry, perhaps that is because your own practice is rich and exciting and you’re annoyed by my tone. If that’s the case, I celebrate your success! However, if it causes you discomfort because it hits close to home, take heart, you are clearly not alone. Gather your courage, step back from the action long enough to assess your situation and look for some allies to help you generate positive change. Based on the blended authorship of the consensus statement, it seems safe to consider that you may find significant support outside of OT, as well as within it.
If you recognize that you are being coerced into doing things that are inappropriate, stop doing them and let your supervisor know why. If they have been forcing your practice, they most likely have no idea of what they have been missing out on; it’s time to tell them how your therapy could be most effective, and for whom, while still fulfilling the rules. Contact your state association or the AOTA Practice Division for guidance and support. Start talking with your colleagues about ways to bring your program’s services forward, such that your wonderful clinical reasoning abilities are fully engaged.
Rock the boat and save your own life!
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