Are you IN or OUT?

In n out? 😂 

Throughout my level 2 fieldwork, I found myself struggling about OT’s role in inpatient acute care vs. outpatient therapy. Simply put, 

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Inpatient: patients are admitted into a hospital bed (either brought into the ER, surgery, brought in by a family member, etc.) and stay no longer than a week with the opportunity to engage in therapy 2-3x. 

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Outpatients: after referred by their primary care provider and assessed by a physical medicine rehabilitation doctor, and if deemed appropriate, patients come 1x or 2x a week for therapy. 

It’s already the end of week 10 and I still find myself struggling between inpatient and outpatient. Furthermore, I spend my time upstairs (acute setting) on Mondays and Fridays. Hence, the things I learn on Monday, I would forget by the time Friday came around. The things that I learn on Friday may not apply by the time Monday comes around (as the patient may no longer be in the hospital). In an inpatient I don’t get to spend much time with them but we can get really intimate with self care activities  whereas in outpatient, you’re with patients over several months focusing on strengthening and protecting the muscles of the body. 

For example, I had this one patient who had generalized muscle weakness all over. He had poor endurance and difficulty getting out of bed.  Somehow the first time I get him out of bed he experienced a bowel movement (My clinical instructor explained that the effects of gravity can really influence bowel movements). I was sweating but so convinced and determined to get him to the toilet. Eventually we got there together... wasn’t a pretty journey but we got there! And after an hour of sweat and instructing the patient how to MOVE, he held my hand (after finishing his business of course) and said “thank you”. Yes, that kind of intimacy. 

In outpatient, I see patients with shoulder pain, hand deformities, and rehabilitation after surgery. I see patients once or twice a week and I get the time to sit and listen to their stories and experiences. I spend anywhere from 30 minutes to an hour instructing patients and providing assistance as needed for posture, form, or education. Over several weeks, I have the opportunity to know them and sometimes their family! Overall, my experience with veterans have been amazing (for another post entirely) but moreover I’m honored to be a part of their lives. 

I’ve learned to appreciate both settings and feel extremely blessed to have been able to experience both (most fieldwork are either inpatient, outpatient, or community settings). What are your thoughts? Do you have a setting that you prefer? Would love to hear your thoughts and feelings!