Just call me "the all-knowing, all-seeing Trash Heap!"

From Fraggle Rock?! Anyone? Anyone? Beuller...Beuller...

Sorry Midge, you've already heard this one...

I had a case conference meeting early this morning, with a consultant (doctor) who I have enjoyed "working with" since my arrival. I say "working with" because I only ever see him in case conference-- almost all of the patients at the day hospital are seen by SHO's (Senior House Officers - basically residents), and the cases are then reviewed by the consultants once a week. Or perhaps a bit more often if the SHO's consult with the consultant before case conference comes up. Anywho, the physio and I brought a case up this morning for a lady who had been declining functionally, with a previous medical history of stroke. She has shown some improvement in two weeks with two physio appointments, but the physios are only part time at the day hospital. They cannot see patients on a daily basis, and are able to only take on so many to be seen once a week for 4-6 weeks. This lady, it was felt by myself and the physio, had much to gain if she were willing to participate in a 6-week inpatient rehab program, which she did say she'd be happy to do.

The consultant's first retort was, well, why can't you see her more frequently here? Evidently in the past, the day hospital did function in a rehab sort of sense, and there was enough therapy staffing for patients to be seen on a daily basis. The trouble is, now there's not, and the consultant couldn't seem to wrap his head around the fact that the physios are struggling to keep up with patients for balance class and new referrals. In theory, it's ok that we aren't able to offer rehab through the day hospital because there are other hospital services to whom we can refer where they can get rehab. He gave up on arguing about what services the physios should be providing at the day hospital, and next wanted to know why we wanted to "bin" this poor lady by putting her in Intermediate Care (inpatient rehab), what has she done to deserve it. When you bin something over here, you're putting it in the garbage can. I cannot even begin to explain how offended I was that he was calling inpatient rehab services a bin. I have had most of my OT work experience in such a bin, I have helped many a patient regain functional independence in such a bin, and as with any medical agenda, if the patient didn't want to go to rehab and did themselves consider it to be a bin, they always have the right to refuse. If inpatient rehab is garbage, then I will happily self-profess myself to be a garbage-man. Er, woman.

Being a professional, I did not make a sweeping exit as I yelled back at the consultant "Bin this!!!" with accompanying obscene gesture.

Our only recourse is to refer this lady to a more short term therapy in the home, and tell that therapist we had wanted rehab for her, and hopefully that therapist will then make the rehab referral after their two-week time frame for working with the patient expires.

"The Trash Heap has spoken! Nyeah!"