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As a health care professional, it seems like the ‘doctor’s orders’ are always a must. What I’ve realized is that we need to question them– why the referral? Why the consult? etc. Nowadays it seems like OT/PTs get referrals for pretty much anyone and everyone in the hospital. Young. Old. Independent people who walk around the unit and can find their way to the cafeteria. Bed bound people who are from long term care. Some aren’t even applicable, and unfortunately, it takes us time for each of them to sort out and tell them that it’s inappropriate. And there goes another 30 minutes we could have spent with a patient who actually needed our services.

The ones that OTs face the most though are the ‘cognitive and/or perceptual assessment’ referrals. The worst is when that’s all the information they provide, and they don’t even have the specific question at hand. Cognition is so broad… where does one even begin to delve into this topic? Is it because they’re confused? They can’t manage their medications and there was a question about discharge planning? Or is it because they’re functionally declining to the point where they cannot manage independently at home? It takes us a long time to have to go over the chart and figure out what the -exact- question is.

Unfortunately, most of the time, everyone just cares about that magical number. What they fail to realize is… why does it matter? The better question to ask is… what is the implication of that on function. Because at the end of the day, we focus on FUNCTION. Someone can get a crappy score on the MOCA and still be able to live independently at home because it hasn’t yet affected them functionally. The worst part is the problem of when people come to irrelevant conclusions about that MOCA score. For example… if someone gets 20/30 means they absolutely cannot drive… or that they don’t have capacity. What other professions don’t see is that cognition does not necessarily need to be formally assessed… you can assess or infer cognitive status from how someone does their activities of daily living like going to the bathroom… following commands… needing assistance to get dressed… etc. Why do we need to go through all those formal assessments which aren’t even warranted and could potentially be intrusive to the person?

Capacity. Wow. That word comes up way too often when it’s not even needed. I’m pretty sure if we questioned everyone’s capacity, that there would be a lot of people who would need placement or need assistance with that area of “capacity”. Why do we so easily jump to these conclusions? Yes, unfortunately in acute care we all feel the pressure from up above for the need to make quick decisions… but it’s because of that that we neglect the basics- the person’s right and the ethical way to treat that person. We never stop and question the things we are told to do. To do that self reflection.

I definitely think I’ve found a project for myself while I’m on this new unit- to educate the staff and hopefully be able to bring it to the attention of the doctors. If I’ve made them think twice about the area of “capacity” and “cognitive assessments” I’ll be happy. Pick your battles. And this one is one I think I want to tackle.