Istributive Justice in Physical Therapy
Mary Smith is a physical therapist at a busy, outpatient orthopedic clinic. She is examining her case load for the day and notes that she has been overbooked with patients from 9-10 am. The rest of her day has no breaks with several treatment times lapping across each other. She looks at the patient list and the diagnosis and then further investigates what type of payer each patient has.
During this time slot she has an athletic screening for a star athlete from the local college. The students treatment is part of a contract that her clinic has with the college. There is no health plan payment involved. She enjoys this type of work and hopes that this will help her land a job with a professional team in the future. The athlete is scheduled between college classes and he needs to be done on time.
Another patient is an 85 year old woman who had total knee surgery four days ago. This will be the patients first post-operative visit. Mary knows these are lengthy visits. Pain is a large factor for patients like this. The payer source is Medicare Part B. She needs to be judicious with services provided as Part B does have caps. The patient will be taking a Medivan for treatment and will be alone. The Medivan runs on a strict schedule.
The third patient is a child with cerebral palsy. This child comes in twice a week for therapy with Mary. Mary is exhausted by these services and she is beginning to resent seeing the child and her demanding mother. The payer source is Medicaid. Mary has been told that the Medicaid payment does not even cover the cost for 10 minutes of therapy yet the child has orders that take 45 minutes to an hour.
At the same time Mary has been contacted that a patient is being sent directly over from the orthopedists office for immediate acute care for a torn rotator cuff of the shoulder. The physician has ordered physical therapy to commence as soon as the patient appears. The office receptionist has accepted the appointment and told Mary that the patient is on his way.
Mary comes to you, her supervisor with suggestions of who should be cancelled for the day. What do you think? How does justice weigh on your mind?