Every hospital has a doctor who doesn’t order occupational therapy.
They may order PT and be completely content with the fact that the patient can walk 200 feet. They may even discharge the patient without even thinking about how OT can help.
Most doctors don’t know the difference between occupational and physical therapy, and in this article I’ll explain an easy way to help them understand it better.
Why doctors don’t order OT?
Most doctors don’t order OT, because they think that OT mainly focuses on activities of daily living. Doctors may think that physical therapy’s endurance and gait training tend to be more beneficial than simple ADLs.
Doctors may also not order OT for the following reasons.
- They had a bad experience with OT
- They don’t understand the difference between PT and OT
- They want to speed up the discharge process
One reason doctors don’t order OT is because they don’t see how OT makes a difference or they think OT only works on ADLs. The doctor may think that their patient is too high level to do these simple every day activities.
Doctors may also not order OT, because they need to quickly see if a patient is safe to go home. Instead, they may have PT do a quick gait assessment, to see if the patient is safe to leave the facility.
Why OT is so important
Occupational therapy is the only spending category where additional spending [had] a statistically significant association with lower readmission rates
National Library of Medicine
There’s one questions that will help doctor think differently about OT. Before I answer that, let’s look at why OT is so important.
It’s difficult to define OT in one sentence or a paragraph. AOTA has an entire page that includes the definition of OT here. In summary, when OT does an evaluation or assessment, they look at everything.
OT doesn’t just focus on a physical aspect of a patient’s condition like physical therapy. OT focuses on the physical aspect and everything else.
There’s actually a really great research article called Higher Hospital Spending on Occupational Therapy Is Associated With Lower Readmission Rates.
The authors found that “occupational therapy is the only spending category where additional spending [had] a statistically significant association with lower readmission rates for…” pneumonia, acute myocardial infarctions, and heart failure.
It’s interesting to note that this article was not published by OTs. These were independent researchers who found that hospital readmission rates could be lowered by spending more money on OT services.
To me, that’s a clear indicator to why OT is so important.
One question to help doctors think differently about OT
Okay here’s the golden question that will help doctors think differently about OT.
I like asking questions, because it helps people learn. It’s the socratic method, and doctors love Socrates. But you have to be skillful when presenting it, because you don’t want to offend someone.
Here is the question.
What does a PT do that an OT can’t do?
Think about it for a second.
Most doctors will say PT’s work on gait, strengthening, and endurance while OTs work on ADLs. That’s a common misconception.
Your answer:
An OT can do just about everything a PT can do plus a whole lot more.
You might say OT doesn’t do ambulation. Almost every OT activity includes ambulation. It’s also included in OT’s practice framework.
PT and OT aren’t that different in their approach.
While PT may primarily focus on the biomechanical approach, OT does that, but OT also assesses cognition, fine motor/gross motor, sensory motor, low vision, neurodevelopment, functional mobility, wheelchair mobility, and ambulation.
In addition, OT helps patients become independent with their daily activities and more complex activities such as driving, cooking, cleaning, shopping and much more.
You might say OTs are the best therapy discipline to determine discharge because OTs look at the big picture.
They don’t just assess ambulation, they make sure a patient can walk their normal household distances. They don’t just assess transfers. They see if a patient can get on and off those low seats that present greater risk of injury.
How OT can be more beneficial than PT
One way doctors can be better about determining discharge is by focusing on met levels.
The highest metabolic activity in the home isn’t walking; it’s usually showering. And OTs can determine if a patient has the functional ability and MET levels to perform this activity before they go home.
Did you know about 40% of patients in the hospital have a cognitive impairment (see article). I see this everyday at the hospital I work at, and I’m often the only one who catches it.
Doctors are great at diagnosing and assessing, but they don’t always have the time to do a thorough assessment. OT or ST can do a quick cognitive assessment and report any deficits in their report.
For example, a patient with a stroke or MVA without any noticeable deficits may have a significant cognitive impairment that goes undetected by the doctor, nurse, or physical therapist.
This is a huge problem for discharge and can lead to fatalities if not caught during admission.
To sum it up, ordering OT, instead of PT alone, can have a significant impact on a patient’s recovery and can lead to better discharge outcomes.
What do Occupational Therapists do?
OTs may assess or treat the following conditions.
- Cognition, memory, language, executive functioning
- Functional mobility, ambulation, transfers, wheelchair mobility
- Vision
- Management of feeding
- Driver rehab
- Community integration
- Social participation
- Fine/gross motor
- Splinting, orthotics, prosthetics
- Upper and lower extremity strengthening
- Depression, pain
- ADLs
- IADLs
Heres the full list.
How OT can help after discharge
After a patient discharges, they may have practiced their daily activities in a hospital or rehab, but now they need home health OT to transfer those skills in the real world.
An OT can problem solve and find adaptive equipment or compensatory techniques to help patients do their daily activities at home.
Patients may even need a driver rehab specialist OT to see if they are cognitively fit to drive.
OT is not just needed in the hospital setting, but along the entire path to recovery.
Conclusion
OT is not just making sure a patient can brush their teeth or put on socks. OT is looking at the big picture.
The next time a doctor thinks about ordering PT only, they should consider the disservice they are providing by not ordering OT. While PT is great for assessing gait, ambulation distance, or stairs. OT does this and so much more in a more functional way.
Feel free to share this with any doctor who doesn’t order OT, but be sure to do it with kindness.
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David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.
