On honesty and addiction

I love “the Dude." It is worth remembering that as a culture we support, nurture, and celebrate substance use and abuse as often as we condemn and punish it. So one must remember that the voices telling a person to use are at least as loud, and as many as those telling one to stop.

Abuse and addiction represent part of a continuum of human behavior. Health care professionals get to see it, feel it, treat it, ignore it and smell it every day. It’s an area where we see success, sadness, and our own frailty. Clients with substance abuse problems frustrate caregivers because they manipulate their care and their caregivers. This creates anger, mistrust and frustration, which in turn results in escalating behaviors to get more medications and attention. This video shows a dysfunctional dance that plays out daily in hospitals and clinics. (Notice the behaviors and prejudices of the caregiver are as predictable as those of the patient. Remember, it takes two to Tango and this isn’t a dance you want to learn.)




To work well with addicts one must understand that recovery is incredibly hard work, and most of it is done by the patient. This video is from “The Wire” but the actor is in recovery and the monologue speaks to his experience.




Our job as caregivers is not to “stop abuse” but rather to "support recovery". There is actually evidenced based data that shows that supportive coaching and Motivational Interviewing (MI) helps clients with addiction and other chronic conditions. Listening often helps more than talking and questions can lead to more answers than ultimatums or directives. Every patient knows their disease in ways we cannot, and in the case of substance abuse and addiction a client has to want help before you can give it.

Sepsis-what they ought to tell you

Physical therapists get trained in how disease and disease treatment is supposed to work. There is no exhaustive study of how things go wrong, then novice therapists get into the work place and they get consulted on every medical muck-up, missed diagnosis or just tough case.

Sepsis is the unhappy outcome of many diseases, disasters, hospital stays and just bad luck. While a physical therapist can get away without knowing all the biochemistry behind this process; they should know and recognize the clinical signs and symptoms.

This is a video of how things go bad, it was made by the medical and nursing geniuses I work with.



So if you you couldn't get it all from the first video, this guy really breaks it down well to the molecules; if not the atoms.



So now that you're an expert, what should a physical therapist do if based on the signs and symptoms you observe the patient is at risk for sepsis? Run and tell a doctor or a nurse.

How hospital's work, or not

“Patient’s don’t come into hospitals to be doctored they come to be nursed.”

Ofelia Long RN

I know in Grey’s Anatomy and House MD doctors do all kinds of real work and hand holding, but in real hospitals it doesn’t quite work that way. Doctors work pens, paper and laptops; nurses, respiratory therapists, physical therapists, social workers, nursing assistant, echo-technicians, phlebotomists, EKG technicians and dieticians work patients.

Actually surgeons are completely hands on, but most physicians act more like conductors with a huge symphony of allied health providers, technologies and drugs. They have the task of directing and coordinating all of these people, tools and medications, that’s why they don’t spend hours at the bedside sharing with their patients. Nurses really own the bedside care: if a patient doesn’t need a nurse to put in lines, monitor vitals and give medications, then the patient can go home with a pamphlet and a box of pills. Physical therapists play a hugely important role, most people don’t want to stay in the hospital a second more than necessary and you have to move, to move on.

So Dr. Phil and Dr. Oz won’t stop by to chat with the patient, but there will be a steady stream of nurses, technicians and allied caregivers. Illness, surgery and hospitalization create trauma, our bodies forget how to function properly, so a constant stream of technical experts come to the bedside to help with breathing, eating, going to the bathroom and finally, getting home. Getting well is hard work and the patient must do most of it. So once a patient has relearned how to breathe without a machine, how to eat solid food, and how to walk on crutches, they rush home and flip on General Hospital.

The Waiting Room

This is a video trailer of a movie about the patient's I work with at Highland Hospital in Oakland California. There is a short clip of a client and I.