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Conflicting Provider Advice
248 Plays11 days ago
Josh and Tristany talk about what happens when you get conflicting advice.
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Transcript
Introduction to Hosts and Hand Therapy Academy
00:00:06
mmateri
Hi, I'm Josh McDonald.
00:00:08
Tristany
And I'm Tristany Barry, and this is Hand Therapy Academy.
Ask an Old Therapist: Questions and Answers
00:00:12
mmateri
So Tristany is joining us today in our section about ask an old therapist. um She is going to have a couple of these where we're going to talk like we did with Shannon last time with Miranda. She's going to ask some questions. So today she's got a question for me. She's one of our younger therapists. So she's going to ask a question. We're going to kind of chat about it for a little bit. So Tristany, what's our first question?
Navigating Conflicting Instructions in Patient Care
00:00:34
Tristany
Well, I was going to ask, um how do you navigate working with other healthcare professionals that kind of can give different instructions to the patient in regard to their care?
00:00:48
mmateri
So that's that's a tough one. Patients desperately want to get all these things right and they want to make sure they get the details specific. Some of our patients don't really care and they go off off plan with things. But for those that are really trying to navigate all of this, a lot of times worth a second or maybe third person that tells them what to do for their plan of care And sometimes it's conflicting information. Honestly, there's so many of us involved. It's kind of remarkable when it does all line up um as long as the doctor didn't just say do what the therapist does. So when they give something specific and we think maybe that's not fantastic, things don't always line up. Do you have like a specific example of something like some realm of therapy that is that's a specific example?
00:01:33
Tristany
Yeah, so wound care specifically, I feel like we get a lot of conflicting information about what to perform for dressings and how to clean the wound and the patient can get a little bit confused.
00:01:47
mmateri
Yeah, so it's we have some providers that like have stock in zero form or something where they feel like every wound in any status for excessive amounts of time needs to have zero form on it. And we know from time spent with patients and up-to-date research and stuff that that keeps the wound bed wet for too long, humid for too long.
00:02:11
mmateri
and can allow bacteria to breed underneath. Zeroform has a limited usage and so we should be progressing and at no point should we be doing the same wound care treatment for more than about two weeks. And if we are, that wound is stalled and we need to do something else to advance it. So we try as best we can with wound care to educate patients on why what the rationale is behind a given product and why we would want to use that for a while and why it's time to move on from that.
00:02:37
mmateri
Sometimes those patients come in and say, well, the doctor told me to do this. And they think that runs for the duration of the time that they're in our care. And we say, well, that was for a time. And then we change. Like the precautions for flexor tendon, they advance and change. So do wound care dressings. And so sometimes we say, well, that was for a time, but now we're on something new. Sometimes they'll come from the burn unit right to our clinic after a follow-up visit. And they'll say, well, they told me to put a big old piece of zero form on this small two centimeter wound. And we're like, okay, well, let's talk about what that looks like. And so we try to not contradict the the medical professional that gave them that information, but also educate and say, well, here's why we would kind of debt diplomatically and tactically, like this is what we kind of want to do instead. So it's tough to not directly contradict, but still like give them the rationale as to why we want to do this instead.
Communication Challenges with Doctors on Splint Use
00:03:33
Tristany
Sure, and what about splinting?
00:03:34
mmateri
Bye.
00:03:35
Tristany
Discharging a splint or continuing to wear a splint, how do we kind of navigate that?
00:03:42
mmateri
Yeah, we we try to encourage, so let's assume that in this case, the doctor wanted to discharge it too soon, like sooner than we mean maybe would with a protocol. um If I can tell that patient, well, let's reach out to the doctor. Let me see if there's something like, oh, this really wasn't as big a fracture as we thought it was, and it's healed already or or something like that. If they want them to wear it longer, then I need to make sure I'm finding out if it was not healed all the way, like, oh, it's six weeks. They say, nope, eight more weeks.
00:04:10
mmateri
Was this an unstable fracture? Is there some problem with this? Is there some complication? Sometimes it's a it's lost in translation with the patient and sometimes that healthcare care provider before the doctor, the PA, was giving the same kind of information we were But it's not communicated to us in in the telephone game. We had a patient just this last week that came in and said, no, I'm something like six weeks out and they want eight more weeks of splintware. And I contacted a doctor who works with that doctor and found out, no, they want them to be done. Like.
00:04:44
mmateri
they said we now don't use it anymore so there was some gap in this communication so if they really want them to wear it maybe we find out why maybe we educate the doctor and say like hey we're normally cool with moving on with this what do you think. It depends on like why the discrepancy.
00:05:03
Tristany
Sure. And how do you maintain that close relationship with the doctors to be able to kind of reach out and say, hey, whats this is kind of our update and change in changing status.
Building Relationships with Doctors for Better Communication
00:05:14
mmateri
That's something that comes, that's that's a relationship established long before that moment. Like the first time I reach out to a doctor, I'd rather it not be something of this kind of point of contention. I want to go visit doctor's offices and say hi to them and get their phone numbers. A lot of times I'm going to patient visits with the doctor so I can establish a connection and say, hey, can I have your phone number?
00:05:35
mmateri
Promise I won't give it to patients. But if I can have your phone number so I can ask you these questions on the fly, if the MA enters the script wrong and I can see something's not right. So I established that relationship early and that gives me a much more open dialogue. And we have a lot of providers now that say,
00:05:51
mmateri
Just do what the therapist says. Do what Josh and Tristan say, because they know what they're doing. if If there's any question, run with it. Because they don't always know the therapy protocol. They're great surgeons, but they don't know what our advancement would be. So they kind of defer to us once we establish that strong relationship.
00:06:08
Tristany
Sure. That's super helpful. Thank you.
00:06:12
mmateri
Yeah.
Balancing Treatment Conflicts and Educating Patients
00:06:13
mmateri
And it's helpful when we're, like if you have a true like conflict with, like we have patients that come from our local burn unit and they'll be getting a specific suggestion on um compression garment wear or ah something to help with scar management or wound care stuff. And we see that as counterproductive, right? Like they're using a treatment method for a wound or scar that is gonna hold them back or keep that wound from closing or whatever it is.
00:06:41
mmateri
We work with that patient to not undermine the other provider, but at the same time try to establish a trust and say like this is the why. This is why we want to do this and this product serves this purpose for this length of time.
00:06:54
mmateri
but now you're in this new stage. And sometimes there is a conflict and they have to, the the patient has to decide and we'll say, this is what we would recommend doing. They recommended something different. If you want to go with what they recommended, that's okay. We'll work within that construct and do the best we can to get you as far along as possible. So sometimes we let, if there's if there's an irreconcilable difference, we say, you pick, you do what you feel like is best for your wound and we'll work within that construct as best we can.
Empowering Patients in Their Care Decisions
00:07:25
Tristany
Sure. I love that.
00:07:26
Tristany
Giving our patients its autonomy. I like it.
00:07:26
mmateri
Yeah.
00:07:30
mmateri
yeah Yeah. And letting them be in charge of their care, which so often they aren't allowed to do. We're all just telling them what to do. And we say, you know what? If you feel like this is best, honestly, you're an adult. You're going to do whatever you want to do anyway as a patient. So you know we'll educate you and say maybe what i I like to do is different. But if you're going to do that, all right, we'll work with that and do the best we can. And so that when it takes longer to close or we'll deal with those repercussions or are those those dominoes down the road as needed, but giving them that autonomy is helpful.
00:08:00
Tristany
Sure.
00:08:02
mmateri
Yeah.
Closing Remarks and Contact Information
00:08:03
mmateri
All right. Well, that's our first one of these. We're going to do a couple more of them, but thanks for tuning in. If you have any questions, reach out to us on our email info at handtherapyacademy.com or on our social media sites, um just Hand Therapy Academy.