A few months ago a reader posed a question on what to do if you’re not getting what you need out of Therapy. It has been wonderful for me to get in touch with so many aspiring walkers since I wrote 152. 10 Tips for Learning How to Walk Again. I think this person was troubled bc sessions seemed to be 80% chatting, 20% exercise. So I wrote back via email and have edited it slightly for public consumption bc I think it’s useful information. I’ve also written on 127. How to Enjoy the Rehab Process, which might be of interest, although I’ve begun to think that my experience may not have been representative as I’ve had a disproportionately high number of excellent PTs. Also, my POV has developed as I’ve started paying for more things out of pocket. When my insurance paid for everything I accepted my Therapists without a thought (it helped that they were fabulous). Now that I’m largely financially responsible and have more experience I have developed my own selection process and have become choosier. Like I said a couple weeks ago, I don’t have the time or money for anything less than fantastic.
This is what I wrote: …I’m not sure how healthcare works in your country, but when I was that early in the rehab process I went where insurance sent me, and also bc I knew we’d have to be there 3x week I went to a place close to home. I am assuming you will not be able to pick up and leave clinics without extreme deliberation, so I would say the best tactic would be NOT to burn any bridges but to try and turn the situation around.
It could be that the PT is a good practitioner, but just a chatty person. If the PT is not a good practitioner, that’s another issue, but there is a way to find out: At every hospital I’ve been to there has always been a very clear goal-setting process and periodic evaluations. A critical question I asked before signing up for Vision Therapy was: How often and in what manner do you measure progress? I have always been guided by the specific tests and tools they have been trained to use (that’s not my area of expertise) but the main thing was for me to signal that I have specific goals and I wanted to make sure there was an evaluation process.
My family really helped with this. At my last inpatient hospital they had a weekly “family conference” where Therapists from all disciplines, my doctors, a nurse, and social worker all gathered with my parents and me (my siblings were on the phone) to go through my progress. My first outpatient hospital did not have this practice but my father insisted that such a meeting take place (and it did). I cannot overemphasize the importance of family and loved-ones’ advocacy. The fact that my room was always full of cards, flowers, and people – and that even now as an outpatient and in my post-Rehab life my parents (mostly dad) hover nearby the session (Daddy pretends to read a book) is an unspoken indicator to the entire staff that people are invested in the quality of my care, so it had better be top notch. My Mommy is the nicest, sweetest person ever – but the staff could just tell by the way she attended to me that she had the highest standards for my care and fully expected everyone to meet them.
Call a meeting if you have to, but the first goal should be to set some measurable goals and inquire as to the plan of care for how to reach them. If they give you a timeline, that’s great – but don’t stress out over it. The timeline would only be good in terms of making sure the staff has a big-picture goal orientation. I was so horrified when I did not walk by the date someone mentioned to me. Granted, no one knew at that point that the damage was as severe as it is, and the person who gave me the timeline was not my regular Therapist, but the point is that I walked when I was ready – no need to stress out about it beforehand. If it becomes apparent that the PT’s skill level is not allowing the patient to progress I would escalate the matter to the head of the department and ask for a change if necessary (just choose your words carefully and keep things cordial as you’ll likely still have some level of interaction). At this point you would have some documentation on goals, evaluations, and lack of progress – and documentation is always key in managing performance issues. At work you always want to set expectations, provide a framework for achievement, and if the person is unable to produce results it’s not bc they did not have the chance. I approach Therapy the same way, but thankfully I haven’t had to manage anyone out of my PT life. There was only one practitioner who wan’t quite what we were hoping for. I was still barely lucid so I didn’t really care, but Mommy was ready to take decisive action ASAP. That wasn’t necessary since he was gone within a week, anyway.
In general, you have to learn to manage your Rehab life or if you’re the caregiver, do it for someone else. Yes, this is your Therapists’ livelihood but it is impacting your life. Unfortunately you will not have boundless resources to invest in this process so you have to learn how to play the hand you’re dealt and do some maneuvering to position yourself as well as you can. Again – it’s your life – so even though it’s a lot of effort, it’s worth it.