Take it away, Aaron!
Discharge Does NOT Mean Done!
Today is the last day, discharge day, A.K.A. D-Day. The patient you’ve been treating 2x/week for the past 4 weeks has made dramatic improvements. Their Oswestry decreased a whopping 90% and their satisfaction scores are through the roof. You’ve built a solid rapport. The patient has spent more time, and shared more personal stories with you than any other healthcare provider. Stories that include their fears, wants, needs, goals, and loads of personal anecdote unrelated to their low back pain. They trust you. You’ve successfully guided them through rehab. So, what happens next?
Discharge does NOT mean done.
While writing this post I googled “D-Day”, mainly to go down a rabbit hole of WWII history to procrastinate actually writing. And also to answer the question in the picture above. Instead, I learned the definition of D-Day fits beautifully with the theme of this post. The definition reads, “The day on which an important operation is to begin or a change to take effect.” Is that consistent with what typically happens on D-Day in the clinic? Is it an end, or just the beginning?
I think most of us would agree our roles as physical therapists expand beyond resolving a patient’s complaint of pain. While pain is often their initial reason for seeking our care, their desires frequently involve more than pain relief. Our goals as physical therapists should as well. Physical inactivity is the common denominator of many leading causes of death in the United States. Which healthcare profession is better suited to address this major population health concern than physical therapists? Who else spends an hour or more each week encouraging and improving movement? We are uniquely positioned to effectively address it. But, it seems a bit unfair to expect significant and sustained lifestyle change in a typical plan of care duration. Insurance also isn’t likely to pay for more visits.
What can we do?
We need what everybody needs, time. Sustainable change is gradual. Lasting change takes time. How can we get it? How can we continue contact with patients to help them accomplish more of their goals and have a greater impact on their overall health? One common model is clinic membership programs for patients who have completed their current plan of care, but desire more. This is similar to commercial gym memberships, but offer the benefit of having the physical therapist you just spent the past few weeks with guide your progress. The physical therapist you trust, who knows your health history, goals, preferences, strengths, and areas needing improvement. This model is also similar to commercial gyms in the sense that, if every member actually used their membership, we would be screwed. The resources needed to sustain that model through large scale growth while prioritizing success of each person seem unrealistic.
Is there a better solution?
An ideal model would be low cost and maintenance, encourage success of all members, and have large scalability. In the world of social media and quickly approaching virtual reality, connecting is easier than ever. I’m motivated everyday as a physical therapist by connecting with other like-minded physical therapists on Twitter, Facebook, and other social media outlets. Could there be similar outlets for patients? What if there were online communities filled with like-minded individuals motivating each other to continue on their own path towards health and wellness with varying amounts of guidance from the physical therapist they know and trust? What if we offered these options on D-Day? Better yet, why don’t we?
I’d like to give a quick shout out to the many who have inspired this spur-of-the moment 2AM musing. Namely Greg Todd (@GregToddPT), who introduced me to this model and uses it daily to successfully change the world for the better. There are also countless others within the physical therapy profession who inspire me to think bigger and get better. Shout out to you all.
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