I am just c/ping the first part of this newsletter I was forwarded from “Cookie Gimp”. I thought it was interesting, period, about Medicare stopping payment on preventable issues such as bed sores (ie anything occurring after patient gets into hospital that was not pre-existing)….since they have a valid point there….at least it seems to me…the question is how hospitals are going to step up and and deal with these issues now that they have a much greater financial incentive to prevent these problems.

Also interesting for this man to point out that nursing homes are typically much worse than hospitals about such things.

From: SteveGoldADA@cs.com
To: stevegoldada@stevegoldada.com
Sent: Mon 6/10/08 10:39 AM
Subject: Fwd: Stop Paying Nursing Homes That Injure Elderly and Disabled People

Stop Paying Nursing Homes That Injure Elderly and Disabled People.
Information Bulletin #264 (10/08)

On October 1, 2008 Medicare announced that it would stop paying hospitals
for injuring patients. The Centers for Medicare and Medicaid Services
listed 10 “reasonably preventable” conditions for which it would no longer
pay hospitals.

These “preventable” conditions included injuries from patients who fell
in the hospital, catheter-associated infections, stage 3 and 4 pressure
ulcers (aka bed sores).

Why has CMS not addressed “reasonably preventable” conditions and injuries
that nursing homes cause elderly and disabled persons? Why has CMS not
instructed States to stop Medicaid payments to those nursing homes that
cause specific injuries? Why is this standard applied only to hospitals?

Picture taken before going to April's wedding on Saturday night (April is now a full-fledged therapist, she was an OT student in class ahead of me).

Augh! Sundays overwhelm me! A whole new week to be scared! I'm about to start Week 3 of 12 of my phys dys rotation…I dread each and every day and the new challenges. Ugh. I just want to go to sleep and never have to wake up so I don't have to be scared!! Can I just sleep through the next 9 weeks please? Or maybe the next 3 months and 9 weeks so that I can get through all this fieldwork as a frightened student? Every time I see a kid  I just want to grab him and be like PLEASE LET ME WORK WITH YOU! NOT ALL THESE ADULTS! THESE FRIGHTENING ADULTS! PLEASE, KID!

Ok that was my melodramatic moment of the day, moving on.

I need to take some deep breaths and remind myself of the attitude readjustment I'm trying to have!! Trying to not be so hard on myself and to not be so scared and to just go with the flow!
Friday I did a treatment session with my supervisor and the Level I OT student watching me, it was a pretty basic session of just getting up and moving and doing ADLs (activities of daily life) like brushing teeth/grooming, working on standing endurance and bed mobility and all of that, with a woman who is deconditioned, but still…ugh. It's hard having someone judge your every move. I want the criticism, I accept and learn from the criticism, but that doesn't make it enjoyable! I have to remember that with each day, I gain new experience and knowledge, and that pretty soon, it won't be so scary. SO REMEMBER THAT KAREN! lol

I do have a lot to share and catch up on from an OT/blogging perspective, some neat stuff I've read on other OT blogs, getting to go to OT student April's wedding, my friend Doug coming back from England, some funny things patients have said, hearing stories about other OT student fieldworks…even some thoughts on some of the special needs remodeling that Extreme Makeover does on houses……. I'm also behind on e-mails and Facebook messages, but when I get this overwhelmed I don't feel like doing any of it! I think I'm going to go shower and breath deep and come back to try and deal with a few of these things!!! And I'm going to go see an attitude chiropractor to adjust me! Ha ha ha I crack me up! Like a chiropractor! Ha ha ha! That was funny too! Ha ha ha ha! Ok I'll stop now.

Ok…So…my goals for this week…which are repeats because they take time and effort and practice…..is….to be calm and confident. To speak slowly, clearly, and loudly. To not be so hard on myself. To try and ENJOY the experience instead of dreading it!!

On Gray's Anatomy tonight they were discussing a man who says he has lived with a pain level of 8 (on a scale from 1 to 10, 10 being screaming excruciating pain), for years. One of the doctors scoffed and said, he's a wimp. His eight is my three.

This is EXACTLY something I've been pondering the last few weeks in acute care, as we have to ask all our ortho patients (knee, hip replacements) their pain level. Two ladies with the exact same surgery on the same day may have two very different answers. People with low pain tolerance who complain of high levels of pain – like a 7 – always seem to be seen with at least a slight level of disdain. I've noticed in general, people brag about high pain tolerances, as if it's an amazing talent. Or calling people wimps like in the TV show – “His eight is my three”.

I guess I'm sensitive to the pain issue because I personally have a low pain tolerance and I get tired of people treating me like I'm just a baby. It's not a choice – nobody WANTS to feel pain acutely. My personal theory is that it is somewhat related to sensory systems – just like some people have sensory processing disorder and/or are hyper or hyposensitive to senses – pain is one of those senses where some people feel it more acutely than others. It's not a choice. It's congenital.

I'm not dealing with the issues surrounding painkiller addicts or anything here – I know some people complain of horrible pain just for painkillers – but in GENERAL – LEGITIMATELY – I think people's perceived level of pain needs to be respected. Who cares if their eight is your three? They have a differently wired nervous system.

…said the “pleasantly confused” woman in a wavering voice, lying supine in bed and a mod assist just to get sitting EOB (edge of bed). Us therapists were like “Awwww!!!”

Mood wise I'm actually doing a little better, but I'm also kind of stressed out…I know it's only the second week but I FEEL SOOOO STUPID! SO STUPID! SO STUPID! Did I mention I FEEL STUPID?! REALLY STUPID? I get intimidated easily, and I'm insecure, and I am so freaked out about the idea of someone falling or getting hurt because of me…and then I just don't have much experience at all in phys dys. All this physical stuff of actually putting hands on patients and moving limbs, transferring from one place to another, walking etc….I'm like…um…where do my hands go….what do I do…oh….and then my supervisor does something so simple and easy and I'm like I SUCK!!!!

And we have a Level I fieldwork student (a two-weeker) watching as well because census is so low that the PRN COTA didn't come in (and/or she goes home early because of a baby), so I feel extra inept because he is pretty confident/secure already, watching me fumble around. Not that he is judging me, I'm just projecting my insecurity.

One of my goals for this week is to speak louder and clearer…..people, not just patients, have trouble understanding me. And I need to successfully complete an eval by myself. I have kinda done a stroke one and a deconditioning one but in both cases my supervisor had to jump in a lot.

I think I am being too hard on myself, it's only Week 2, but I just feel so inept. I kind of dread work because I feel I am constantly showing incompetence. This afternoon I got to see a pediatric speech session with a little girl with velocardiofacial syndrome – very cool – we played CandyLand and did B, D, and T articulations, and I was like right at home…pediatric speech and OT have so much overlap and I was like…oh man….it feels good to not be scared.

I'm trying to keep a good attitude – and just need to swallow fear – and realize it's not that hard or scary – just a matter of getting used to adults with physical issues. It's not rocket science. Ok. That's my goal for tommorow. To be less intimidated and just TACKLE the day. To speak louder and clearer. To just do my best.

1) Friday afternoon I went to a health networking event at my undergrad Rhodes College- they asked alumni doctors, pharmacists, dentists, PTs, OTs, etc to come and serve on the panel and then invited current students to come ask questions. It was 1.5 hours long and I spoke to four students total, two who were very serious about rehab and two who hadn't really heard about OT before but were intrigued when I explained all the possibilities – from babies to old people, etc. We discussed internships, scheduling, majors, volunteer/observation hours, pros/cons, etc. They were all really smart girls wanting to do majors like physics or pre-med. Anyway I think it went well.

2) One of the speech therapists brought up an interesting point, about how some of the doctors come in in pal-mode, “Hey how are you doing, ::checks patient very briefly:: yeah great to see you we're going to get you out of here okay goodbye!” while others come in “Hello. Here's what is going on. X, Y, Z, and here is what we will do about it. Bye.” And that most of the patients seem to relate better to the jokey-schmoozey doctor who gives them no information, rather than the straight-forward doc. It doesn't seem like many of the doctors I've encountered have a good combination of warmth AND straight-forwardness. One or the other.

3) Census is really low…as in, inpatient, there were only SEVEN patients today…yet an OT, a COTA, a Level II student, and a Level I student. I think the rest of the week will be very slow as well.

4) Today I did two evaluations with quite a bit of assistance. The first one was a stroke and I have only seen one stroke eval so far and it was a very minor one. So my supervisor had to show me a lot of the stuff to do because I've primarily seen ortho evaluations which are much more straightforward. The second one was a very deconditioned woman with a lot of problems and depression and again I needed a lot of help. It was somewhat nerve-wracking/scary to do these evaluations, but really they were pretty straight-forward. I just need more experience. This week- well at least Weds, Thurs, Fri – I think I'm primarily the one seeing the patients and just getting help from my supervisor, versus observing. I guess considering it's only my second week I shouldn't feel disheartened – I'm pretty much writing up a lot of notes/evals etc by myself and navigating the computer system well and getting a feel for hospital layout and procedures – but I just want to like, know exactly what to do and when, and I'm not there yet.

5) I went to traffic court this afternoon…for my 10-over speeding ticket I had to pay 61 dollars but it won't go on my record so my insurance won't go up. Yay on insurance, boo on the cost. What a bummer. Oh well.

Ummmm……it's almost 11pm…I've been so tired…I want to go to bed now…even though I'm way behind on e-mail and feel like I've neglected a lot of my friends….but I need to be on my game tomorrow….tomorrow I don't know if we'll have any evaluations, but I know I have to be ready to treat the patient with the stroke, and the patient with depression and deconditioning, plus a few others I'm sure.

I have so much I want to write about! But I'm so tired! I need to shower and go to bed! Like now! I was up from like 3 to 4am last night with a bad headache and stuff so guess I am extra tired.

Today I followed speech therapy all morning – got to try thickened water – whoah – and watch bedside evals including one lady who probably needed a psych consult more than a swallowing study. Also followed physical therapy all afternoon, in the ICU – a lot of passive range of motion.

Tomorrow morning I do some evals by myself (although with 100% supervision), augh scary!

I have somewhat of a list of things I want to write about from last few days. Just not tonight.

Good night!!!

Planting my “growth” plant in a hanging planter but needed a manly man to get rid of spiderwebs where my landlord keeps the dirt; finally got a filter for my tap water and Mr Manly Man is also helping me take off my faucet aerator. I've been to the gas station, Lowe's, Costco, cleaned my house, etc. Meeting up with a friend soon for a little while; still lots to do – some blog catchup, but also prepare for this week fieldwork wise – I'll be basically seeing patients from now on instead of just observing – although with about 100% supervision this week – scary!! Especially because I like to joke around and I think –  or okay, know – that is not my supervisor's style – with patients. I mean clients. I mean consumers. What do I mean?! LOL

Anyway..more later