Notes from Dr Oz Interviewed by Rosie O'Donnell About What Makes Doctors Be Good to Patients and Not

I've ALWAYS thought it was interesting that I'd co-created, with the help of Dr Young, what Lumigrate launched with in 2009 as the Lumigrate YOU Model, while Dr. Oz was creating his now famous/bestselling "YOU the Owner's Manual".  Here's an esteemed heart surgeon on the east coast of the US and an occupational therapist in the middle in Grand Junction, Colorado having the same experiences with patients and coming up with similar routes to teach them to become proactive patients.  

I just think we're all connected at some level that has lead us to go the directions we have with our careers and lives, and the power of the Internet and television and all the other things combined will be able to create the health care reform from the people/consumers out to the providers.  Again, the You model: 

I went a little further with my patients when working with them on the 'occupation of health care'.  As Dr Oz says here, I also suggested they write things down or type them up and print before going to an appointment, which, as Oz says, shows the doctor you're taking this seriously. What he didn't say, though, is this strategy also allows for more to get done in your time with the provider, as they typically can read faster than you can verbalize something. I viewed myself as an occupational therapist as being a 'specialist' with patients referred to me in working with them to learn the 'occupation of health care', so I provided them with a complimentary notebook and taught them how to organize their notes and records, ask for copies of their labs and diagnostics and important medical appointments, prescription information, etc.  Depending on the complexity of a person's health issues and their individual style/needs, the system often was modified.  I have been in the process of re-doing my records where I archive the things I don't refer to as often in groupings and then have what I most frequently need to show providers with me in a smaller folio, with what would be needed in a medical emergency or more complicated conversation in another box.  (I'll never forget at the age of 25 when I accompanied my future husband to the hospital where he'd had eight surgeries for shunts for hydrocephalus and the interns asked for his records to be sent down and there were SEVEN binders which were 3" each!)

I didn't previously suggest the tape recording of conversations with my patients because I thought that I would then be viewed by the providers in my community as threatening, but I like the reasons he gives for it, and the way to approach it.  So, since he's said it, I'll agree with it.  

I had a recorder from the time I started going back to college to become an OT, after finally finding out at age 30 that I had many significant visual/perceptual "brain based" learning disabilities.  I also had learned when I was 27 that I had a particularly good memory for things I'd heard; that came out of my doing extra credit to get an A in a fairly easy "Into to Psychology" class.  The teacher was getting a PhD and was studying the effects of cameras in the courtroom and I took the test that I'd be giving the subjects so that I knew the whole process they were going through and he called me right after I got home that night and said "You just got these all right -- you should be acing my class, something's not making sense with your learning."  Learning what my strengths with auditory and weaknesses for visual were allowed me to then plug back into college and finally be successful at it.  It took me eighteen years from the time I started to the time I earned my B.S. in O.T. I was 36. 

Since I'd recorded and reviewed information I was learning for those last years of college, I'd always wanted to record medical appointments but didn't because, again, I thought it would make the providers defensive.  I'd write notes in the the appointment and then write more detail as soon as I could afterwards. In retrospect, there were a couple of turns in my medical treatment where I was verbalizing to my primary care doctor what a radiologist had said when he did a test, since the report didn't include what had been said. Since I have a good auditory memory, that was something I was able to do which facilitated my care, but the average person might not have 'made that mental note'.  

(Although, in that case, the radiologist was wrong and the PCP went along with it saying 'he was that sure of that?... well, okay'. And had I done more fact-checking on that, I likely wouldn't have gone through a whole other saga of expensive testing that was unnecessary. That was in the year before I started Lumigrate, I was literally working with people on this subject of being an effective consumer and seeing how, even as much as I knew, my providers were still bungling me here and there, and I thought we just needed to have a website to educate more people about this! )  

I'm glad millions are following Dr. Oz now and hopefully we can all feel comfortable pulling out a recording device! If my old PressMan were still working, I'd be able to record what's on TV and listen to it, slowing it down so I can type as fast as the speaker speaks, too.  That might be a little tip to add in here as well. I'm happy to do a few of these that I catch and you get to read them, but that way you could be essentially doing this for the topics you might hear in podcast/radio or watch, so that you have it typed up.  There's actually a shortage of people meeting the demand for all the professionals out there wanting to have things they verbalize transcribed!  

I underlined and italicized and bolded the part that I think is the most 'enlightening' part of this interview, where he talks about doctors becoming "technicians" instead of "healers" over time, as there were more tests and scientifically-based 'objective' things to go by with medicine.  This is something that came very into view for me in December when I attended a training about the new law in Colorado that went into effect on January 1 related to school attendees who get brain injuries at school/events; The Jake Snakenberg Law. Physicians or related providers have to determine within 24-72 hours if they're okay to go back to playing or harder thinking tasks and they have to 'take into account' a lot of things, which is not what they're been bred to do for the last generations of doctors, like Dr Oz said here.  Occupational therapists have been totally left out of the whole process, and in my case, I'm really good at the type of clinical reasoning and interviewing/detective work they're needing done.  And there are many other states doing similar laws; there will be a show on this weekend on CNN I believe related to professional football players and the results of 'repetitive brain injury' as I call it.  (Like repetitive motion injury of the extremities, carpal tunnel, etc.  Why not just call it what it is with brains the way we do arms!)

And Dr Oz was right on with his year of CT scans, because my husband's daughter was three in 1975 and she had answered the phone when his doctor from the University of Minnesota had called after they'd had him be one of the first people they used their new CT machine on. They'd been baffled by him since before he was in Vietnam and was a father, he'd married his high school sweetheart.  He'd had a significant 'concussion' in junior high PE class, which was ironic as he never was hurt playing hockey and was thought to be 'the next Gordie Howe, per the Minnesota Star newspaper who covered him about the same time as the brain injury. They'd paired the coordinated smaller boy with a large uncoordinated boy for a wheelbarrow race, thinking that would allow the boy to have a success and if you think about the physics of that, you can see how his head got bashed into the floor with such force (and no helmet, naturally).   

I can see why OTs were not included in the process that has been laid out for injured students because doctors aren't the only ones who have, overall, been turned into 'technicians' and not 'healers'.   OTs have been turned into different providers as well, due to the money/insurance changes as well. I've been hired to the an OT in many sub-acute rehab facilities where they expect the OTs to be giving showers every morning before the residents have breakfast! I did that for about one week as a new graduate and said 'this is ridiculous' -- and they were literally finding it to be a way to bill for OT time while taking a few showers off the bath aid's list.  That's fraudulent.  IF someone is going to be returning to showering, then towards the end of their time with rehab you work on goals for them to do that with increased safety and independence, and you'll find it's much better for them to not be doing it when they're still asleep or their pain medications haven't kicked in or they've not had breakfast yet! And sadly, my colleagues were going along with the management that wanted these things to happen this way.  Even worse, one well-known provider of acute rehab services had me quadruple billing; my aid was not in eyeshot, she was in another wing sometimes, also working with TWO people in adjoining rooms with their showers!  I went home after my first day and looked a few things up to be sure I was right to suspect they were breaking some laws, and went back the next day and said 'go over this billing with me again because it appears to me this is illegal to do' and I was right, they were doing it.  Needless to say, I didn't work for them after that. But again, a whole army of well-paid and benefitted therapists and aids were going along with it.  

If that's what it takes to keep operations in business, that's really saying something about the way Medicare reimburses.  They should make it so businesses can be slightly profitable without killing their employees working exhausting schedules or having them commit crimes in the process.  And we all should be standing up on this and letting those who can make changes know about it.  I liked that Rosie pointed out that nobody should be having to work themselves to exhaustion to get a job done; I was disappointed to see that Dr Oz thinks you need to get doctors used to being exhausted and doing surgery.  I hope that there are many changes ahead for the way we do business in this country.  

When OTs were 'invented' after World War I/one, they were nurses aids who thought psychologically, and the first formal OT programs taught OTs, which were all women, to use woodworking and various 'manly' leisure hobbies as well as pure WORK -- gardening, painting, building things -- to get people's bodies better.  "Engage the mind and the body will follow" is the 'motto' for occupational therapy historically.

The example I use is to compare painting a wall to doing dumbell curls -- it's a lot more FUN and engaging to paint the wall and the body gets the same movement.  When someone's been through something rough that has affected their mind and spirit and potentially their body as well, doing therapeutic activities was a huge part of OT. That's what I'd hoped to do when I learned about OT in 1982 and took "Introduction to OT", and by the time I graduated in 1996 it was a WHOLE different world of medicine! To some extent, the teachers in academia hadn't kept up with what we needed to know in the world of work and they taught the historical stuff, but at this point in my career I've learned what you need to know after graduation and am appreciative of the formal education.  

However, this leaves consumers/patients who have new grads in the hands of people who are on that learning curve and that's scary to me.  It was scary to me as an OT on that curve working with people, and I didn't have a true "mentor" step up to the plate until Petie the OT, who now writes in the forums about various things, until I was in my FIFTH year as an OT. There were 'supervisors' and 'trainers' and 'managers' or people whose job descriptions, at least, said they were supposed to be those things, but not one of them initiated being a 'mentor'.  That's something that the elder needs to initiate, as those who are in the beta position aren't going to ask for it.  So, MENTORING is very important; last week was National Mentor Week or something like that and I think it's important to recognize the need for mentors/teachers and encourage people to look at what they might be able to do to facilitate someone's growth.    

When you're being used by medical companies to see patients and bill their insurance, the occupational therapist has become a technician to hand out tools to help them with their dressing, toileting, grooming and hygiene, showering/bathing, etc., which is difficult since Medicare doesn't pay for anything that goes in the bathroom, so then there's a whole problem of people who have no money to buy things not EASILY being able to get what they need.  So what does the OT do?  Some don't stay late, others do. But making phone calls isn't billable time so then it brings your productivity down and you'll get fired.  So you can work 'off the clock', which is illegal, and you can get fired for that too.  Sadly, these are the realities of what most OTs have to deal with in the United States.  

We've not been allowed for many decades, overall, to work on the cognitive aspects, the motivational aspects, which are our history.  So many don't have the skills that could be helping the doctors figure out if a person's brain is functioning like it's still healing from a brain injury or not.  

I didn't become an OT to walk into a hospital room and get the patient up AGAIN to do the same thing the PT just did with them earlier, so they can bill their insurance for another service!  If a patient told me "I already had one of you today", I'd look and it was the physical therapist.  So then I'd have to explain that it was another opportunity to get up out of bed and practice, get the body and mind moving, and they'd often decline because they were TIRED of all the hubub going on in their room and they just wanted to REST.  

But the hospital can't charge extra for REST, which truly is what some people need more than activity at that point.  But then that would be a half hour of time I couldn't bill for because they declined.  Had there been educational things or bed-based activities I could do with them which were approved of by managers, I could have done that but ..... that wasn't OTs were allowed to do in the hospital, nursing home/subacute or acute rehab settings.  So OTs get turned into extensions of PTs by 'the system' in many situations, and they never develop their skills at cognition and testing. Truly, some days the PT and I might do identical things with a patient; get them up with their walker and walk to the bathroom to use the toilet.  But Medicare doesn't allow for duplication like that, so PTs would document one way, OTs another and everyone made money. It's mind boggling how complicated it has gotten because of all the rules and stipulations and laws, and the patients are the ones that are being hurt by it.  Ironic, since it was their taxes in the first place.  And again, most therapists I worked with, OVERALL, didn't think about it, they just had a job and were paying off their student loans and supporting themselves and their families.  And that was and is a shame, and I hope it changes.  

Fortunately, I was certified before I was an occupational therapist, in Assessment of Motor and Process Skills (body/brain), so I went into being an OT differently. I'd also had a very good career doing program administration for a now-famous visibility monitoring program the National Park Service funded, so in my 20s I got to see how one really smart researcher changed how the big powerplant industry did business. I learned that rules and laws are intended to be interpreted with the reason for the law in mind, and that was very helpful to me as an OT in an industry that was being brought to it's financial knees.  

I also applied for a not-wanted fieldwork, because of it's difficulty on the PhysDis portion, at the Denver VA -- the supervisor was very good, she was just very hands off and all the responsibilities for showing you what to do went to her only occupational therapist and OT assistant.  But I wanted a Denver fieldwork, as my father was clearly having some problems with his health at age 75, and so I applied for it. The psyche fieldwork was really GREAT and very easy and everyone wanted it, so they 'paired' the fieldworks; to do one you had to do both/all your fieldworks at the VA.  

So I exited my education without getting one minute of education about Medicare, or the very complicated system for billing and documentation. That caused a lot of problems for me initially but in retrospect, I'm so glad things worked as they did; it was a true 'blessing in disguise', as military medicine has so many advantages related to how you spend time with your patients since they don't have to bill another party.  

The VA's recruiting for doctors right now on television ads, and they even use a physician saying "I get to spend more time with my patients". I had doctors on my internship at the VA in both the physical and the psychiatric teams asking me for my input about patient's cognitive abilities -- are they intelligent enough to learn how to use a prosthesis, for instance, because they're appearing to not be learning to follow the diabetic training about things. Or is this residual from the effects on the brain from surgery and medication -- what's this patient's 'baseline'. I learned to peel the onion and look at many different things and come up with what the person's baseline was, as well as current issues which might be standing in the way of their doing what they need to do to be well.  

So I agree, and am glad to see that Dr Oz thinks there will be changes coming where medical providers get to become a BLEND of technicians and healers.  I hope it applies to OTs as well, and we can get back to 'our roots' also, as the true therapists that look at how the mind/brain interacts with the physical body and leads to how a person goes through their day, occupying their time.  ~~ Mardy