For years, healthcare has been looking for the “silver bullet”, or the perfect way to make the most money possible with the least services possible. We could debate about this for days, but let’s call it what it is, healthcare is a business just like any other business. The issue with this is that the subjects that are at risk are people, including our friends, family, and, at one time or another, providers themselves.
We could take this in so many directions with different aspects of healthcare, but recently there has been a push for automation of therapy services, including Physical and Occupational Therapy. These automation services include web or app based programs that have been presented and advertised as a way to minimize the need for therapy.
At first glance this software is interesting to many people and organizations, especially with the dynamic nature of healthcare payments. The software has pictures and videos of exercises that a patient can follow on their own in the comfort of their own home. Additionally, emails are sent to “check in” on the patients and provide additional information, including education about various complications such as blood clots, infection, benefits of exercise, and more. This type program has been increasingly used as a discharge option for those undergoing orthopedic surgeries, such as total knee or total hip replacements.
After the first glance is where things get a bit dicey. Let’s use a hypothetical:
Patient, Mike, 62 year-old who has been very active throughout his life and is having progressively worsening hip pain impacting his lifestyle to the point of being interested in getting a hip replacement. Mike is relatively healthy, just on a low dose blood pressure medication. Additionally, Mike has no history of allergies.
Mike goes in for his preoperative appointment and gets told that he will be in the hospital for 2-3 days, but likely 2 if everything goes well and then discharged home. He will be discharged home with all of the necessary devices, medications, and have all of the information needed to seek help when needed. Mike is on “Cloud 9” and will be back to life as he knew it in no time!
The surgery day comes and goes exceptionally well! On day 2 he goes home, but now is on a few new medications, including stool softener, blood thinner, and a pain medication (or 2).
Here is this issue in actual practice, Mike was just discharged with 10+ pages of information, some in layman’s terms, some in medical terms, a minimum of 2, but likely more, new medications, assistive devices that he has never used, except at the hospital, and a new app that will guide him through his exercises (also referred to as his “physical therapy”). The issue is that when working with people and their health, there is no replacement for hands-on treatment. Mike is the perfect candidate for this conservative style treatment; however, there is no monitoring of vital signs to ensure that he tolerates the new medications properly and that his heart and lungs are working the way they should after anesthesia and an invasive operation. There is no in-home visits to ensure that the devices are working properly and positioned appropriately, and, even more importantly, used properly!
Physical Therapy is not just performing exercises. As a matter of fact, in-home therapy services, including Physical, Occupational, and Speech Therapy, focus on a number of areas before starting exercises. In-home therapy services include the full assessment of the patient’s living situation, support systems, and functional ability. In the case of Mike, his care should be started day one after his discharge to ensure proper discharge from the hospital, including having the appropriate medications on hand and devices to keep him safe. All visits should start with a baseline vital sign assessment, incision assessment, and general overview of his well-being. Therapy does not have to be 3, 4, or 5 times per week for everyone, but managed on a case by case basis to ensure safety, compliance, and proper progression. The therapist will ensure proper performance of exercises to reduce the risk for muscle shortening and compensation, so that the impacted muscles/joints do not get neglected. Additionally, the therapist will communicate any identified issues as they are found to prevent rehospitalization/readmission.
Technology is fantastic, when it works! But there is no substitution for human interaction and in-person assessment. Programs like those mentioned should be used as a compliment to true services. But to use them as a replacement, dilutes a profession and clouds the ultimate goal, and the patient is the only one that misses out.
Mission statements in healthcare are largely about the patient; however, when the “rubber meets the road”, it is interesting to see the way healthcare is truly practiced. There is definitely a need for technological advancements in healthcare, especially in therapy. But that should be to increase accessibility, improve inefficiencies, and improve outcomes. To replace a profession with a preprogrammed, automated (not customized) system, is ultimately prioritizing profit over patient care and unnecessarily increasing risk and liability.
Find quality providers in the area, develop a relationship and trust them! They may not be in the same health system, they may even be a competitor in some way, shape, or form. When we develop a strong network of providers that put the patients first, ultimately, the patients win, the providers win, and the community wins!
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