Think Differently About How You Prescribe

What happens when you run out of choices of treatment for a patient? Do you change goals or continue to pursue therapy? This is a question that Atul Gawande contemplates in his book Being Mortal, and should be something that we consider as health care professionals. Throughout our training we are embedded in a system that has a big focus on "fixing" the problem. However, there will be problems that we come across that are UNFIXABLE. What will you do, and how do you react?

Treatment goals

By starting a conversation with your patient you can begin to understand their personal health care goals and tailor your practice to meet their individual needs. Questions should aim at discussing what your patient finds valuable. Once you have identified your patient’s goals, TOGETHER you can begin to move forward to think about how you might accomplish them. Without these conversations you can not have a clear understanding of your patient’s perspective and values.

External factors

It is important to realize that, in some cases, optimizing participation will NOT require treatment to the patient. Other factors are at play in a person’s participation

in their own care that are outside of body function. We can instead

start to think of external factors such as environmental support and personal relationships that may be help to optimize individual participation. Likely, tackling these barriers will take a diverse team of professionals to best meet the unique needs of your patient

Optimize Participation

Participation is the execution of an activity in a life situation that is tied to the treatment goals articulated by your patient. For individuals that have some type of functional impairment (e.g. physical, cognitive) it is through the interaction of their impairment and external factors (e.g. environment) that a disability emerges. In other words, a disability is not and cannot be housed within a human being. It is only through other external factors that functional impairment poses a problem.

So, when you come across an unfixable body function, don’t lose hope! There are ways in which valuable life participation WILL take place, and it is through the modification of these external factors. Through inter-disciplinary work we can begin to untangle the complexity of participation restrictions and optimize health for ALL of our patients.

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Erica Twardzik is a PhD student in the School of Public Health and the School of Kinesiology. When she is not in the lab she enjoys playing board games and riding her bike.

Annemarie Gebhard is a senior in the School of Nursing working on her BSN. She hopes to work in pediatrics when she graduates! When she's not at clinical, she's trying all the best coffee in Ann Arbor or exploring parks with the kids she nannies.

Tommy Vu is a first year dental student in the School of Dentistry. When he is not studying or working on his hand skills, he looks for different places to go and new things to do on the weekends. You might find him running to Welcome Wednesdays for his weekly bagel between classes or playing euchre on his lunch break.