Stroke (cerebro vascular accident, CVA) patients often need a lot of rehabilitation even when they as discharged from the hospital. The goals of rehabilitation are to help survivors become as independent as possible and to attain the best possible quality of life (National institutes of health, 2014). When there is no one at home they need to go to a rehabilitation facility to help them to regain function and become as independent as possible. Even though rehabilitation does not “cure” the effects of stroke in that it does not reverse brain damage, rehabilitation can substantially help people achieve the best possible long-term outcome (National institutes of health, 2014). Here are 2 cases that I was faced with regarding rehabilitation placement at a facility.
Case 1: Mrs. E is a 66 year old patient who had a CVA and now presents with flaccidity of the Left upper limb and lower limb. Her lungs have secretions due to immobility. Her functional ability is rolling to the affected side. She still needs assistance with other activities.
Case 2: Mrs. V is a 56 year old patient who had a CVA and now presents with increased tone in the right upper limb and lower limb. Her functional ability is transferring from the bed to the wheel chair with minimal assistance.
Both of these two ladies still needs a lot of rehabilitation post CVA. The patients were both in hospital and were awaiting placement at Aquarius intermediate care. A week went by and both of these patients were still awaiting placement. The patients stay in hospital and receive physiotherapy until they are accepted for the placement.
Case 3: Mrs. M is a 37 year old patient who was admitted to the emergency unit in the hospital after the above ladies. The 37 year old patient then needed to be moved into a Neurology ward as this patient also had a CVA. They then decided to send Mrs. V home to await placement at home so that they can move the new patient in.
Furthermore, Case 1 and 3 are now receiving physiotherapy daily with each session being about 30 minutes long whereas Case 2 is at home receiving no physiotherapy or any kind of rehab. The patient can be sent home with exercises, but there is no way of knowing if she does it correctly or even do them at all.
My question after this experience was, how do we decide who goes home and who gets to benefit from physiotherapy rehab? I thought that it was very unfair to send the one patient home to await placement so that another new patient can move in. Case 1 and 2 both had 1 person that would have been able to assist them at home, but the thing is in hospital they received more intense rehab and treatment and they both still needed it. I feel like the Doctors have a difficult job to make these kinds of decisions.
Furthermore, one of the rights a patient has is continuity of care. It states “No one shall be abandoned by a healthcare professional worker or a health facility which initially took responsibility for one’s health “(Nevhutalu, 2016). One can then argue why did Mrs V got discharged and not Mrs E? Both of them still needed a lot of assistance and rehab while waiting for the placement. The other question that arises with this situation is, should Mrs M (the new CVA patient) then wait in the emergency unit for placement in a ward were the neurology Drs. can’t go to her immediately and see her? Isn’t that violation of her access to health care? Access to health care means that everyone has the right of access to healthcare services that include:
- receiving timely emergency care at any healthcare facility
- treatment and rehabilitation (Nevhutalu, 2016).
These types of situations as above arise due to scarce resources.
Moreover, hospitals and rehab facilities have policies which can provide guidance for clinicians who are faced with resource allocation decisions (McKneally, et al., 1997).These policies form a baseline and help the organisations to prioritize. McKneally., et al (1997) suggested the following guidelines that may prove to help in practice if there is scarce resources:
- “Choose interventions known to be beneficial
- Minimize the use of marginally beneficial tests or marginally beneficial interventions
- Seek the tests or treatments that will accomplish the diagnostic or therapeutic goal for the least cost.
- Advocate for one’s own patients but avoid manipulating the system to gain unfair advantage to them.
- Resolve conflicting claims for scarce resources justly, on the basis of morally relevant criteria such as need and benefit using fair and publicly defensible procedures
- Inform patients of the impact of cost constraints on care, but do so in a sensitive way.
- Blaming administrative or governmental systems during discussions with the patient at the point of treatment should be avoided
- Seek resolution of unacceptable shortages” (McKneally, et al., 1997).
To conclude we can say that there is a lot of situations where we experience scarce resources as physiotherapy students, but if we follow ethical procedures, policies and guidelines we can provide the best care we can for our patients.
References:
McKneally. M, Dickens. B, Meslin. E, Singer. P, (1997). Bioethics for clinicians: Resource allocation. Canadian Medical Association Journal, 157 (2): 163
Nevhutalu, H. K. (2016). Patients’ rights in South Africa’s public health system. 84-114 159-174.
National institutes of health. (2014). Post-stroke Rehabilitation. Retrieved 5th June, 2019, from
https://www.stroke.nih.gov/materials/rehabilitation.htm
2 thoughts on “How do we decide who gets to benefit from physiotherapy rehabilitation? (Resource allocation)”
Hi Agatha. Thank you for sharing your piece and stating what stood out for you in your experience at the hospital. Sometimes it can get upsetting for you as the physiotherapist when you want to help patient’s improve but on the other hand, doctors have other desires and wants for that patient. Often we see that patients do not always equal treatment and some get “better” treatment than the next.
I like that your writing piece gave different patient case studies which indicates that is an evident problem that occurs in the hospitals. I also like that you asked questions in between your writing which makes the reader aware of what you are thinking and what the major problems are that stand out for you. The writing piece also made me aware of ethical procedures and policies that can be followed to make sure our patients get the best treatment.
I think to make your piece a bit stronger, you can add a short introduction of what your writing piece is about or a summary of what you have experienced so it is easier to follow from the beginning. After the case studies, you could also add a summary based on those 3 patients and state what is happening where the two patients are awaiting placement and getting treatment vs the one who is awaiting placement but got sent home.
With regards to your argument, you can check this link out https://www.fhr.org.za/files/7215/1247/1732/Health.pdf – it speaks about the socio-economic rights in South Africa in the healthcare system
Grammar:
Line 3 – Groote*
Paragraph 4 line 5 – where*
Other than that, good job! all the best for your final piece
Erin
Thank you Agatha for this piece. I enjoyed reading it. It made me think this is a difficult decision that doctors have to make everyday.
Content: It is good. You used a topic discussed in ethics and was able to link it up with a clinical experience. I liked how you used three cases to make your point. Which made your piece stronger. Maybe in paragraph 5 you can add how this experience made you feel and what you think about the decision they made. Or why was case specifically important to talk about for you.This is a topic that comes up every time. In South Africa we know there are scarce resources. But how is the decision made of who gets of these resources and who don’t. I understand why they sent the second case home and not the first case because she was more functional compared to the first one. As physiotherapists we get personal with our patients and hear their stories and feel sorry for them. We went them to recieve the best treatment and let them be functional again. However doctors base their decision on the medical state. What stood out in your piece for me was the guidelines that can be used to make a decision on who get the benefit of the resources. It was interesting for me. I also liked how you asked the questions in your piece, as it made me also think. However as students luckily we not in that position yet to make that difficult decisions.
Writing style: In the first paragraph it should be “Groote” instead of “Grotte”. In the fourth paragraph it should be “where” instead of “were”. Other then that the punctuation, grammar and spelling is fine. Maybe you can add an introduction to introduce your piece. As it begins with a case and I was not sure where it was going. Maybe in your introduction you can talk about the scarce resources in the south African healthcare system and why is it like that. You have a good conclusion that sums everything up.
References: You have good references to back up your argument. But two looks little maybe you can add a another one. Maybe in your introduction linking up to what I mentioned up above.
Information literacy: I liked the two pictures you added. It is funny and links up to what your piece is about. Don’t forgot to add the links of where you got it from.