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The Reflective Practitioner

Factual Strand

It was only my second time performing a tremor evaluation during my outpatient

therapy rotation and I was full of nerves. I reviewed the client’s medical history, took a

deep breath and went into the waiting room to find my client. There he was. A fragile 85-

year-old man with scabs on his face, greasy hair, and dirty fingernails. As he greeted me

with a smile he asked if he could take a moment to use the restroom. I kindly agreed and

quickly turned my future occupational therapist lens on. During my analysis of

occupational performance I had a plethora of moments that made me raise my eyebrows.

He displayed abnormal gait, improper use of his walker, and required assistance to get in

and out of the restroom. Additionally, he took 15 minutes to use the bathroom and when

he finished his pants were soiled. Upon performing an occupational profile, I was

shocked to learn that he had not bathed for 8 weeks, he lived alone, he fell frequently, and

had no social support.

I quickly realized that while he did demonstrate minor essential tremors in both

hands, there was a much more concerning problem that I could not ignore. After

confiding with my clinical instructor she encouraged me to trust my gut and use my

clinical reasoning. I made an executive decision to change the plan and I performed an

impromptu ADL evaluation. I learned through both observation and the interview process

that he was in danger. He ended up sharing that his sole reason for coming was because

he desperately needed assistance because he couldn’t do it on his own anymore and he

was afraid for his life. I had to stop myself from crying. Even though evaluations are

limited to 60 minutes, I opted to skip lunch and work with him longer until I felt

confident with his plan of care. With guidance and encouragement from my CI and other

therapists, I ended up contacting social work and forwarding both his PCP and

neurologist in on the evaluation. I also wrote the most detailed SOAP note I have ever

written. I will remember that moment forever because it tested my character and the type

of therapist I want to be. I could have easily seen him only for what his PCP requested-

adaptive equipment for essential tremors, but that felt immoral.

Interestingly, when I consulted with another therapist in a different department for

advice on how to handle similar cases he told me I will never make it if I continue

practice with so much empathy because I will become mentally drained. I went home and

thought about that for weeks. I am still thinking about it now.

Retrospective Strand

Retrospectively, I felt a deep sense of sadness and anger because from my

perspective it was very clear that he was no longer functioning at his prior level of

function and was experiencing elderly self-neglect. Yet, his notes did not indicate concern

at any point from multiple healthcare providers. Knowing that his PCP had seen him only

a few weeks prior I could not understand how that was possible. I felt like the system

had failed him and ignored his cries for help. Simultaneously, I had a breakthrough

because it was the first time I felt like I was capable of making intuitive, client-centered

decisions. This feeling was solidified when my CI encouraged me to trust myself. After
spending months reflecting on the situation I realized that the advice that the other

therapist gave me was also sound, albeit slightly cynical. I need to establish boundaries

when it comes to immersing myself in my patients’ lives.

Substratum Strand

I recognized that I can be too harsh and critical of other healthcare disciplines. I need to

humble myself and remember that not every healthcare practice views a person

holistically, and that is not necessarily a bad thing. I also need to get rid of my

preconceived notions that doctors view patients as just another number. Each practitioner

has experienced different lived experiences, and these experiences influence their

practices. Additionally, theory greatly influences practice. The Biomedical model looks

different from the PEO model. Beauty is created when you can combine the two. Hence,

why it is so valuable to give every person a seat at the table and approach situations

without prejudice.

Connective Strand

Overall, this experience taught me that I need to have confidence in the practitioner that

I am becoming while remaining humble. While my intentions are pure I need to ensure

that I create a work-life balance. This means knowing how to separate my emotions from

my patients’ emotions. I have also learned that your gut feeling 9/10 times is right. I

should never feel ashamed for doing the right thing, even if that means working through

my lunch hour every once in a blue moon. I need to become comfortable with honoring
that. Lastly, I have learned that it is okay to rely on other members of your team for

guidance. I am not an expert in all things, and I never will be. I need to utilize my

resources wisely. In the future I plan on doing the following:

A) Getting to know other members of the healthcare team and each of their duties. I

can do this by scheduling one-on-one meetings and reading through each

department’s mission statement.

B) Continuing to seek guidance from other practitioners during ethical dilemmas.

C) Gaining confidence in my ability to make sound, client-centered decisions. I can

do this by enrolling in continuing education programs and getting a mentor.

D) Learning how to establish a work-life balance. I can do this by setting strict

scheduling guidelines that I must follow.

E) Handling my emotions by seeking out professional help from a therapist to ensure

that I am able to keep my mental health a top priority and to avoid burnout. I also

will create a regular self-care routine.