OT by PT

Addressing the problem of professional crossover.

One of the downsides to having a profession with such a broad scope of practice is that there is overlap with other professionals. We share functional mobility and UE rehab w/ PT; feeding, swallowing and cognition w/ SLP; pursuit of leisure activities w/ rec therapy. But ADLs are our bread and butter, and I think that when there is an overstep into that territory that it strikes especially hard.

One PT coworker bragged that she does ADLs all the time, and just bills for functional standing activity. Another PT coworker had a penchant for instructing people who'd had shoulder surgeries on hemi-dressing, also was fond of giving UE fine motor and self ROM exercises to individuals post-stroke. One of the more blatant violations was when a PT walked into the OT office to get a sock aid and spent the next 15-30 minutes billing for ADL retraining for teaching a client LE dressing.

I know my response to these issues was not effective, since usually I was just dumbstruck. The most action I took was discussing the action w/ my OT coworkers. Another OT called a meeting to discuss this, but I don't know what came of it. I think what made it harder to address is that these scope of practice infractions were all perpetrated by practitioners who were holistic in their practice, easy to cotreat with, and my friends. I don't want to jeopardize those relationships, but I don't want my professional identity to get gobbled up by an overzealous therapist either.

I'm not trying to pick on my PT buds either. I have done stair climbing in acute care when evaluating a pt. and didn't have time to wait for PT and wanted to have a definitive answer when asked if they were safe to return home. Obviously, my understanding of gait and stair climbing is not that of a PT- I use phrases like "wobbly" instead of, I don't know, 'poorly-sequenced toe strike.'

I did get a good response from a PT coworker the other day. She had called me to ask about giving a sock aid to a person post-spinal surgery who was scheduled for discharge in a few hours. As we talked about the case, it became clear that this pt. was going to have significant problems dressing since she had spinal precautions and had never been instructed in AE use. We concurred that this pt's issues extended beyond a simple sock aid handover and that even though it would mean another evaluation at the end of the day, it was the appropriate thing for this pt. Turned out that the order had been written for both OT and PT, but the OT orders never came down the chute. (Metaphorically speaking... our chute is a computer system) So that was a good moment since she realized that there was a greater problem than she could quickly address w/i her scope and did alert an OT and pass it along.

Anyone have an idea on how to address this issue w/ coworkers? It's more than just smacking someone's hands back when they try to help a pt put on their socks, it's feels like a disregard for my expertise. I'm sure that we've all had this experience 10 times over, so if anyone has a good way to handle it, please let me know.