In my practice I have seen many OT’s getting trapped in the wrong goal setting and that most of the time, the goal setting is based on what they intend to do. Sometimes, goal setting is very theoretical that it is impossible to be achieved by the patient because the client centeredness of goal setting has disappeared. Most OTs are afraid of breaking old habits and it is quite difficult for my thoughts and ideas to be put across. Problems in breaking the habit of old goal setting may be due to the following:
- Most OT’s are not using any framework – although frameworks are taught at the universities, it is sometimes difficult to actually use it in practice and in my experience, few to none uses framework in their practice.
- No unified understanding of the domain of concern of the profession – Most OT’s are specialised in the detailed treatment approaches and because of this, I feel that the basic domain of concern of the profession has been forgotten and it does affect an OT’s ability to promote oneself. In effect, OT’s are sometimes considered – equipment provider, commode provider, tea making profession, and many more that is really degrading and insulting professionally.
- Goals are limited to a person’s ability and disabilities rather than, ‘occupational concerns’ of both the client and their family. – most of us are hooked on making goals only relevant to the client because the client is ‘our’ patient. We are forgetting that the client is an ecological entity and he is attached to a bigger unit e.g. his family. Any Occupational changes in him will have an effect on his social circles like his family, friends, work. The client is a part of a whole so, it should not just be the client’s goals that an OT should be considering but also the concerns of the social group he is a part of. The client, as an individual, is not only the OT’s ‘client’. His Social group also becomes and OT’s client so intervention and goals for the group also matters significantly.
- No use of Uniform Terminology -
- Unconscious method of clinical reasoning - Clinical reasoning is suppose to be easy and simple if everybody knows the formula. To my observation, clinical reasoning is mostly relied on experience and on what is available within the arena of practice but if you take one practitioner to another arena, it will be difficult for the practitioner. And, a more major barrier to unified clinical reasoning is the fact the most of the junior’s clinical reasoning is only as good as what their supervisors have instructed them to do.
- People are afraid to do something different than others – this explains why we OT’s persists on using disability scales even if we know that they are not measuring what we are doing. We tend to duplicate what other trust’s assessment forms. Unless OT, as a critical mass agree that something different needs to happen, we will always be in a loop of status quo.
- OT service is Free – Though not totally bad on its own, having the cost of the OT department subsidised by the NHS puts a lot of people complacent about the service provision and development. People ( I emphasise that not everybody!!!!) are happy of status quo or just happy to meet targets like KSF. Some reason out ‘work hard or less, at the end of the month, you get the same amount of compensation/salary’. So, in the end, why bother changing.
