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Who Should Lead the Rehab Team?
By Judith Phillips Otto  Should the rehabilitation team leader
be a physiatrist? Other physician specialist?
Prosthetist/orthotist? Nurse? Some healthcare professionals give
their opinions and
reasons for their choice.
Although other specialists may be called in as needed on a
case-by-case basis, the core team remains
physician-prosthetist-therapist, according to Joan Edelstein, MA,
PT, FISPO, a senior research scientist in New York University's
Department of Prosthetics & Orthotics from 1961 through the
program's close in 1991. Sometimes, the physical therapist may not
be needed, she notes, but the physician and prosthetist are always
key members of the team.
Edelstein explains, "If we are discussing somebody who is
getting a prosthesis for the first time, legally a physician must
prescribe the prosthesis so that payment can be made; the
prosthetist makes the prosthesis; and the therapist trains the
patient in its use. Now, if we are talking about somebody who has
worn a prosthesis for several years and knows how to use it and
simply wants to replace a prosthesis that is worn or does not fit
anymore, then the responsibility of the physical therapist is
considerably less, because the patient already knows how to use the
prosthesis. If he's going to be learning new skills--maybe he wants
to engage in sports, for example--then, again, the therapist can be
very helpful. So it depends on the particular patient."
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Joan Edelstein, MA, PT, FISPO |
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A team leader is a necessity, agrees Edelstein. A
leader is required "simply for orderliness, but also for
administration and for ultimate responsibility, which is financial
responsibility--and that person is the physician. While the de
facto leader may indeed be the prosthetist, and in rare instances,
the therapist, the de jure leader is always the physician."
In the past, the physiatrist would serve as the team leader,
tying the whole team together, explains Kevin Carroll, MS, CP,
FAAOP, vice president of prosthetics for Hanger Prosthetics &
Orthotics Inc, headquartered in Bethesda, Maryland. However,
depending on the location, it's not always possible to have a
physiatrist as leader--since not every town has a physiatrist.
Often someone else has to take the role of team leader, whether
it's a physical therapist, prosthetist or orthotist, occupational
therapist, or physician. He points out that the ultimate team
leader is, of course, the patient.
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Kevin Carroll, MS, CP, FAAOP |
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"Today, fortunately, we're dealing with an
educated consumer; however there are still a lot of people out
there who are unable to manage on their own as that team leader,"
Carroll says. "They've just gone through an amputation, and often
they don't have the push' within them. However, if the patient is
the team leader and they're a sharp individual, they get a lot of
things done."
Carroll continues, "Often, we forget about the primary care
physician, yet he or she is the one who has all the history of that
particular individual from Day One. In the most rural areas across
the United States, you always have the primary care physician who
can step up to the plate as team leader."
Diverse Background Needed
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Colm Roe, LPTA |
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"Although it will vary from case to case, team
leadership should definitely be in the hands of somebody who has a
diverse background," says Colm Roe, LPTA, physical therapist
assistant, who is currently a case manager at a central Florida
hospital and rehabilitation center. "There are moves under way
right now within my organization to have, for example, physical
therapists co-train and be qualified as nurses. Ideally, we would
have somebody with an eclectic and multifaceted background--whether
it is a social worker and a nurse, or a physical therapist and a
prosthetist--who could be seen as a leader and respected as a
leader by all of the team."
Leader Like a Movie Director
A unique view of team leadership is presented by Harry Webster,
MD, chief, Division of Pediatric Rehabilitation Medicine, Tufts-New
England Medical Center Hospital, Boston, Massachusetts, and
assistant professor of rehabilitation medicine and pediatrics at
the Tufts University School of Medicine. "The ideal person is
normally an RN," says Webster. "But they are extremely
expensive--almost more expensive than doctors, because of their
contracts. The role of coordination and running' is different than
the actual provision of service," Webster cautions.
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Mildred Hake, transfemoral amputee, is assisted by Kevin Carroll, CP, and Eddie Traylor, MEd., physical therapist. |
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He likens the rehab team's work to making a movie:
"The director of a film doesn't really show up in the film--it's
the actors. And we are the actors, who provide service and
recommendations at the professional level. We're the people who are
onstage with the patient. But the director should be the person
most skilled in moving the actors around and getting the stage set,
etc. And just as the director of the film knows everything from
stage crew, lighting, dealing with difficult actor
personalities--he is not trained in any of those areas," Webster
explains, "the rehab team leader is someone who has that sort of
systems view' of things and has interpersonal skills and enough
technical skills to match the patient to the necessary specialist.
If I had a large grant to set up a clinic, and I could hire anybody
I wanted for that leadership role, I would probably look for a PA
[physician assistant] or a RN with some administrative experience
to take on that role."
As an example, Webster is also the medical director at a skilled
nursing facility with a $5 million annual budget. However, the
administrator--the coordinator--is an RN, "so she can understand
what I need and why, and how to get it physically done. I admire
those people who respect what we do, but have other skills to bring
into the mix."
Webster concludes, "Really, the credentials could be quite
varied, but probably the worst person to coordinate and run the
clinic would be the physician!" Judith Philipps Otto is a freelance writer who has also assisted with marketing and public relations for various clients within the O&P industry. A graduate of the University of Missouri School of Journalism, she has been a newspaper writer and editor and 
Table Of Contents - April 2004
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