Making assumptions

August 28, 2008 at 11:30 pm 6 comments

One thing I’ve learned in the last year as being a practitioner is to never make assumptions about anything.  This lesson was really reinforced today.

I had a patient who had amputations below both of his knees, as well as on one of his hands, leaving only one finger on one of his hands.  On top of this, he was blind.

Reading this information in the chart led me to automatically assume that this patient would be a cripple, dependent with all of his activities of daily living, unable to transfer, and unable to care for himself.

Was I ever wrong!

He lived in an assisted living facility, where he was extremely comfortable with his environment and he knew where everything was.  In the room at the hospital, we only had to give him verbal cues as to where certain items were.  Not only did he manage to don his prosthetic independently, he was also able to complete a wheelchair transfer completely by himself!

Once familiar with his surroundings, he was found to have no occupational therapy needs in the acute care setting.

In the past, I’ve made bad assumptions on lesser details. For example, if there is someone visiting in the room, I always ask, “how are you connected with the patient?” because I once made the mistake of assuming that a female friend of a female patient was a sibling instead ofa significant other.  I’ve also mistaken visitors to be grandparents when they were really siblings (making them look older).   But these are small assumptions that we make that don’t have an overall effect on patient care.

It is important to go into a patient’s room with an open mind and not assume that a patient performs at a low (or high) level just based on the chart review.  The book often does not match the cover.


Entry filed under: occupational therapy.

Can a family be too involved? Quote of the day

6 Comments Add your own

  • 1. Angela  |  June 1, 2009 at 1:19 pm

    I’ve learnt never to assume anything when I read a chart concerning a patient. Sometimes the patient who sounds like a cripple turns out to be high functioning and vice versa. I too have made the mistake of addressing someone as Mrs So and So when she was the patient’s daughter. Thankfully, they have all been very gracious and never seemed to mind my foot-in-the mouth disease.

  • 2. WildKat  |  August 31, 2010 at 7:04 am

    You are right about assumptions! Just last week I visited a new Dr. to get some prescriptions written and he stopped dead at the door, sheepishly came into the room and asked my name. He had assumed he was in the wrong room because he read that I’ve been blind since birth, have parts of my brain missing, had CP since birth and became a quadriplegic in 2004. He assumed I wouldn’t even be able to communicate and would be there with my “carer”.

    He actually said a few times “but your intelligent”. People assume a lot about me all the time, and 99.99% of the time they are totally wrong! The Dr. I had after my sci even tried to have papers signed saying I was incompetent so she could put me in a nursing home instead of letting me find an accessible apt. and move into it on my own again. Of course every psychologist, psychiatrist, PT and OT she sent at me refused to go along with her! I wish that for once people wouldn’t “assume” at all, but have an open mind and learn instead.

    • 3. Jill  |  October 2, 2010 at 8:25 am

      I find your story to be fascinating! If you don’t mind me asking, do you use any adaptive equipment in your daily life? Do you have assistance when you are typing into the computer? I would love to hear more about your story. I am a COTA and a graduate student in a master’s OT program. Thanks!

      • 4. WildKat  |  November 4, 2011 at 11:16 pm

        Sorry I’m just noticing your reply to my comment now. I’ve been basically imprisoned in bed at a rehab facility for over 150 days now (plus the 38 day hospital stay). All because the OT and management won’t allow me to have the power wheelchair I now need because the OT “doesn’t have the expertise” and says it is “too dangerous” to allow me to use any wheelchair or my guide/service dog. The 29 yrs of experience of being blind (my entire life), the 11 yrs of working with and training guide/service dogs and the 7 yrs of using both manual and power wheelchairs with guide/service dogs are not even taken into consideration. They are trying to put me in a nursing home or back into the community with 29 hrs a day of homecare (the extra hrs are for a second person) with a wheelchair that I am unable to move on my own for someone else to have to even push me around my apt. I will have to retire my guide/service dog, step down from the head of my company and rely on another person for everything just because they are not even giving the same chance as everyone else to show them what I am capable of.

        To answer your question, I do use some adaptive equipment. I use a MacBook Air (all of Apple’s products have VoiceOver which is a text to speech program). I had learned to touch type back in jr. high, but had to re-learn to type after my SCI because I can’t feel my fingers anymore. I use a velcro strap to hold utensils for eating, and I generally use cups and mugs that are easier to hold (with handles that I can put my hand through). I use all of the ‘normal’ things (bath benches, my wheelchair etc.) that you would expect with a spinal cord injury and also have a guide/service dog (he does both guide dog work and service dog work). To be honest I try my best not to use a lot of adaptive equipment because it means I have to travel with more. I have to spend a lot of time traveling, in airports and planes and hotels with my job so I usually just pack food and other things for my dog, the velcro straps (and another that’s on my toothbrush), my laptop and any other essential clothing and supplies. If I spent more time at home I would probably use more equipment, but I don’t want to start to rely on things when I don’t absolutely need them.

        I’ve linked my blog to my name on the comment so feel free to browse through it and if you have any other questions I would be more than happy to answer them.

  • 5. Lennisa Shabazz  |  November 5, 2010 at 12:26 pm

    I want to start by saying as professionals; I am not at all thrilled to see reference to the patient as “cripple” by assumption. I know many others that also agree with me on this. I think we need to be more respectful than that. You assumed the patient to be completely dependent on others, or not able to complete tasks independently. I just feel that within this profession we need to be disability advocates and promote correct terms. We of all health care professionals should be judgment free individuals because our primary role is to focus on the client’s abilities rather than their disabilities.

    However, I also have found myself in similar situations. It is easy to read a chart and feel that the medical history will accurately depict the client. Having done this myself I feel that I have been prepared for the worst and when the patient has performed better than expected I question them: “what do you do to maintain this level of functioning?” Often times I am glad to hear that their previous therapeutic encounters have been successful and their current level of function is the result of it. I think it is ok to assume because then it does in fact prepare you to deal with the most difficult situation. Maybe get the help you think you may need or say a prayer. But on the other hand no two individuals deal with the same illness the same so I think we need to be more open and not to generalize a patient’s ability based on their reported medical history.

    Thanks for sharing your experience because it does happen often.

  • 6. R McCoy  |  April 27, 2012 at 5:40 pm

    I am an OT student and have whilst on a Fieldwork placement I have often been unsure on how to address a client’s family members/partners as I was unsure of their relation to the client. I do agree that it is easy to make assumptions based on information in referrals and when you make a home-visit or visit the patient in the ward it can be completely different to what you initially thought! Thanks this has been really helpful!


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