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Monday, September 22, 2014

My Own Co-Workers Don't Know What the Heck My Certification Does

I  frankly have  seldom been more aggravated.

Now, see, I have a certain certification, one that requires  a certain number of qualifications.  EVERYONE has to pass a test, a fairly demonic test that requires, frankly, a significant level of academic talent and a lot of self-study.  You must also have a four-year degree, or a two-year degree and a certain amount of on-the-job experience, or a high school diploma and six years of on-the-job experience.  I fall into the last category.

When we first thought we needed someone with this certification, I was willing and I was chosen because A) Snotty as it sounds, everyone knew perfectly darn well I was the only one sufficiently academically inclined to pull it off, and B) I had the years of experience necessary.

But as time has gone on, even though I am not often called on for anything seriously related to that certification (we were never seriously in the running for the business it was originally intended for and my possession of the certification is now mostly for bragging rights), occasionally I notice that to this minute, nobody really knows what the heck I am supposed to be able to do with it.

My boss's boss has asked me no less than three separate times what my certification is.

A few weeks ago, I was asked to travel to SmallTown to (as close as I can from memory) "assess item X for whether it is cost-effective to repair or replace."

I got out there and, knowing NOTHING about the patient, saw fairly quickly that the item was serviceable, though, after 17 years of use, it had flaws.  Two major parts were shot, despite overall good care having clearly been given to the item.  A couple of braces had suffered major wear, though in my opinion they were not likely to fail and presented no safety issues.  And the patient clearly DID NOT want to replace the item.  He liked it and wanted it repaired, if possible.

So I called the manufacturer.  They told me MOST parts were no longer available for that item, and that without the serial number (which was totally obliterated, nor was the original paperwork available) it would not be possible to look up the specs for the item--which was semi-custom--as originally ordered.  This last was important information, because as a semi-custom item, my options were LIMITED.

I could eyeball it (I didn't have a protractor, and it would have been of limited utility if I did) and try to guesstimate a certain angle, and take a couple of other critical measurements.  This would have been silly.  That information was 17 years old, and just because the patient liked it didn't mean that mindlessly repeating it was a hot idea.  He may have changed.  His pathology may have changed.  His pathology might have been likely to change. Remember: I had not been told a THING about the patient--and when you're talking about a patient's pathology, you sure as snail snot don't want the patient to be your only source of information.  They've been known to lie, or just not know what the heck's going on, or to indulge in wishful thinking.

I could have tried to measure the PATIENT, which in this case would have meant getting an accurate weight (With what? Did they think I kept a scale in the van?), height, hip width, distance from the floor to the popliteal crease, distance from the popliteal crease to the rearmost adipose tissue, distance from the seat to the armpit, and, most critically, RANGE OF MOTION, which is critical if PELVIC TILT might be an issue.  RANGE OF MOTION is typically determined by a physical therapist, on a raised mat (you have to be able to measure some things in a seated position, too, which means the patient needs to be able to sit with his feet flat on the floor), and involves, among other things, the use of a goniometer, which is a device for measuring the angle formed by joints.

I could have decided, all by myself, that the patient didn't actually need a semi-custom item and just gone with a lightweight item X with a few bells and whistles.  Yeah.  Right.  I'm the doctor. Not.

At NO POINT would I, by myself, have been able to make the determination whether or not a
new item x was even medically necessary!

Well, since (I THOUGHT!) I had been asked just to see if the item was worth fixing or needed to be replaced, and since I do not have a goniometer, and since I sure as **** didn't have a raised mat, and since I thought it was stupid to guess at measurements on 17-year-old equipment, and since the man wanted to remain with his current item x anyway, I just determined that the needed parts were available, had a quote faxed over, and noted that if the cost of the parts exceeded half the cost of a new item x, then and only then would I recommend replacing the item.

I never in a million years thought my task was supposed to extend to getting all the information necessary to getting the man a new item X.  I mean, ****, I didn't have all the equipment for a mat evaluation, and ordinarily a person with my certification is not expected to do them, though I suppose I could stumble through it.

MY FREAKIN' MISTAKE!  A couple of weeks later, the boss informed me and the warehouse guy that we were responsible for getting a quote on a new item X.

Turns out there are like fifteen bajillion options available on the thing.  Most were at no extra charge, but some--including some potentially critical ones--cost money.  And the manufacturer, understandably, needed some specifics before giving us a quote.  But dadgummit, I could only guess at those specifics!  Even measuring the old item X directly would have been an approximation of some things at best, and if it didn't turn out right, the patient might very well end up rejecting a potentially three-thousand-dollar item.  Still, I could have measured the old item if they wanted me to, if I'd known they were willing to do such a thing.  I certainly couldn't have gotten all the necessary measurements of the patient, unless I made certain assumptions (no pelvic tilt!  Full range of motion!) which isn't the hottest idea in the world when you're dealing with complex rehabilitative equipment.

And the place that was apparently using us as a subcontractor wanted us to provide a quote.


And so I was getting some fairly snotty things said to me about my failure to get the relevant information.  I protested that I'd been sent to see whether the item was worth fixing, not to measure the patient for a new one, only to be told, in a roundabout way, that if measuring the patient for a new item might have been necessary to making the decision, I should have done so.

Maybe I should have.  I know this: I'm asking for a goniometer.  I haven't needed one for the two-and-a-half years I've had this certification, and I may not need one for the next ten, and I sure as snail snot wonder what the heck people who didn't even know I'd need a goniometer to do the job are doing criticizing me for the way I did it, but I'm asking for one.  And the next time I'm asked to do ANYTHING resembling this, I will ask for a detailed list of information that I'm expected to bring back.  And if a mat evaluation is needed, they can by golly expect me to ask for an appropriate surface.

The capper: it occurred to me to look up the contractor that we were working for, and when I did, I found this:

All services are provided after a thorough patient evaluation by a qualified rehab technician.

Really?  I am a "qualified rehab technician"?  Well, that's pretty generic, and I suppose for some things, I am.

A "thorough patient evaluation"?  They sent me out there without any clue as to the patient's medical history and pathology, and without giving me a **** clue that I was supposed to come back with a detailed assessment of his physical capabilities.  I just thought I was looking at a **** item X.

Just remember that, the next time some company is bragging to you about how they do things.  What they mean and what you are hearing may be two different things.

In the meantime, like I say, if I wind up with such instructions again, you can bet your bottom dollar I will know IN DETAIL what they want before I go out there.  They think I'm supposed to do what in almost every circumstance imaginable the law requires a physical therapist to do (I'm serious: if you're dealing with Medicare or Medicaid, or most insurances following their practices, the law says you must have a physical therapist operating under a doctor's supervision--or the doctor himself--conduct that part of the process.  You ordinarily only escape if you're doing the private-pay thing.)

Not that I anticipate being there much longer anyway.  After a certain major issue in life is settled, I'm going to try to be ready to move on early next year anyway.

And lastly...AFTER the snotty comments, people found out that the manufacturer is in hot water with the feds and CANNOT SELL THE ITEM WITHOUT A PHYSICAL THERAPIST CONDUCTING AN EXAM.  PERIOD. Or so I understand the situation.


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