Mediocracy

I have noticed a trend toward the mediocre. This is not new, but lately it is really starting to annoy me.  Maybe because it seems that the bar has been lowered, and what I consider to be sub-standard, not even passable, is viewed by the world at large as mediocre.

I consider myself to be a mediocre Home Health Physical Therapist.  I know what it is like to be REALLY good at something.  I understand the passion and drive for continual improvement, the attitude that if I don't have an answer, I will find it - because I want to know everything I can about a subject.  I understand the desire to be the BEST, or at least the BEST I CAN BE.  I don't have that with home health. Frankly - I show up at my patient's house, assess where they are at that given moment, what we need to do to steer them toward one or more of the goals we laid out in the eval, work with them: educating, pushing, cheering them towards that goal, document the day's work, and walk out.  The skills I use are the ones I learned in PT school.  Not the hours of continuing ed and research I have worked at in the past 17 years.  When I take continuing ed now, it is how to document, or how to keep up with Medicare guidelines, not anything to do with improving my skills as a therapist.  Sadly - this is interpreted by patients, employers and peers as "good" physical therapy.  And it is not "bad," I am way too ethical to spend my time and Medicare money not providing reasonable and necessary care.  I just know, for me, this is as lazy as I get. My job requires a strong back and a license.  Any physical therapist can do what I do, but apparently many do not.  It appears that if you are friendly, the patients will like you, if you get them to move at all, they will improve, or at least not decline, and patients (and families) do not have a point of reference for interpreting whether the care they get is quality or not.

It is not just PT, or medicine, for that matter.  Everywhere I look, I see people going through the motions of their day, without really putting any thought into what they are doing, or if it is producing the desired effect - sometimes I wonder if people remember what their goals are with each activity.  But as patients, or consumers in any industry, we remember the goals.  We have a vested interest in the outcomes, much more than the professionals providing the service. So how to make sure that the care we receive is quality? That the goals being addressed are specific to our needs? That the care is really focused on the goal?

ASK QUESTIONS !

The provider may get a little annoyed - he/she will probably feel like they are being personally questioned, which they are.  But if they thinking about the process, and answer will be available, and if they are not thinking about the process, you may jump start a dormant part of their brain that will improve the quality of service.  As a caretaker, hang out during the session, observe (don't interfere) and prepare specific questions and observations for discussing with the provider after each session.  Is the therapist doing the same exercises over and over each session?  Are they the same exercises your mom does as a home program?  If you can do them with her, or if she can do them on her own - do we need to use valuable treatment time doing them again?

This principal of observation and discussion can be applied in almost any scenario, PT is just the one I know.

So there is my rant - demand Mediocrity - it will be such an improvement over the norm.