Many of us physicians are starting off 2023 with various new resolutions, including efficiency and “doing better,” but how do we get there? Our variable training experiences may prevent us from working with health professionals around us who can make our life easier and more efficient. Occupational therapists (or OTs) are that magical unicorn you may have overlooked.
Occupational therapists are regulated health care professionals with advanced training in physical and psychological aspects of human function. They assess daily occupational activities—at home and work—using evidence-based tools and techniques and assist in finding strategies to either accommodate needs, disabilities, or limitations or find occupational fulfillment and meaningful life. In most places, occupational therapists are also trained in providing various psychotherapies, skills training, and coaching.
As a psychiatrist, I first encountered occupational therapists in my psychiatry residency training when several occupational therapists were running our outpatient therapy day programs, teaching our patients therapy skills, and how to return to their activities of daily living post-hospitalization. On the inpatient psychiatric unit, our OTs also ran various therapy groups and helped us assess safety for discharge. In child psychiatry, OTs were absolutely essential in sensory work, assessment, skill, and therapy provision, especially for neurodevelopmental conditions.
So, how can collaborating with an occupational therapist help you professionally and personally?
I heavily rely on my OT colleagues when my patients go off on mental health-related disability leave or return to work process. Outside of occupational medicine, doctors are not trained to comprehend a patient’s function and how it interacts with the cognitive and physical demands of the workplace, safety concerns, and potential modifications. Occupational therapists can assess the cognitive and physical demands of a job and evaluate a patient’s medical condition’s impairments, limitations, and potential accommodations with respect to the patient’s job demands.
As an example, if I have a patient with PTSD returning to a call center job – an occupational therapist could observe the patient at work, measure how much time the patient may need for a task, and suggest accommodations such as possibly longer call duration allowed for this worker for cognitive accommodations as well as possible noise canceling headphones as a physical accommodation. With appropriate work accommodations for this patient with PTSD, the patient is more likely to return to their occupation. Their continued employment with accommodations means housing stability, health insurance, independence, and focus on wellness rather than deficit. A simple, functional assessment and accommodation plan created by an occupational therapist for each individual patient can mean the difference between maintaining employment and housing, unemployment, loss of housing, and perpetuating the deficit model.
OT assessments assist me in making evidence-based decisions on the return to work process rather than assumptions from a standardized checklist. Having an OT involved with work and disability-related care not only shifts the focus from deficits and limitations to accommodation and ability for the patient but also saves me time in paperwork.
Certain conditions, such as ADHD and ASD, require their own mention within the skillset an OT can provide for you or your patients with these conditions across the lifespan – from childhood to transitional years and into adulthood. ADHD is an executive function disorder that affects one’s social, academic, work, personal, financial, and parenting functions. Occupational therapists can work closely with children with ADHD, teaching them a variety of routines and strategies to scaffold their function. The youth transitioning into adulthood can be further scaffolded with academic support, school accommodations, and routines and strategies to support the demands of adult functioning. In adulthood, OTs can assist in developing suitable work accommodations and household management. OTs are also quite skilled in teaching emotional regulation and social skills, role-playing work scenarios, and managing sensory issues.
Regarding physician health, most physicians are currently struggling with burnout, mental health conditions, and physical injuries related to our medical work. Most of us never once considered actually understanding what type of work environment (hospital, office, shifts, etc.) is conducive to our abilities or perpetuating our limitations, leading to burnout. Many physicians engage in repetitive movement, whether it be typing in the EMR, performing procedures, or even sitting– yet most of us have not once had an ergonomic assessment of our workstations, chairs we spend hours in, desk heights, or anything in our physical environment that could be perpetuating fatigue, physical injuries or even task completion. If your arm and wrist are hurting from a poorly fit workstation, how likely are you to finish your charting, or are you more likely to avoid, delay, or worsen a repetitive use injury?
Occupational therapists are trained to assess the job’s cognitive demands, physical demands, and ergonomic setups. Having your own ergonomic assessment when planning your workstation or requesting one from your employer can literally make a difference not only in how your body feels at the end of the day but also in how many cognitive tasks you can complete in your shift or take-home after-hours. Occupational therapists are also crucial for physician leaders as OTs can assist us with efficiency strategies, prioritizing and managing cognitive tasks, and help us explore our values and occupational fulfillment. Suppose you are considering career changes or reconnecting with what’s important to you as a person. In that case, occupational therapists can help you with that exploration in a confidential, evidence-based coaching session.
As I finish writing this article, I am also asking for an occupational therapy assessment for yet another patient. This OT assessment request will ensure that my patient can access an evidence-based functional assessment to support their work function. I am saving myself time in the long run with future workplace accommodations forms that I otherwise would spend hours on. I am also eagerly awaiting the next OT appointment for my child to aid in developing their motor skills.
Maryna Mammoliti is a psychiatrist.