Not Your Job Counsellor: On Being an Occupational Therapist in an Acute Hospital


Author's note

It's probably not too much of a stretch to say that this is one of the most misunderstood occupations (sorry, couldn't resist the pun) in the world, in no small part attributed to its own misleading name. 

To clarify, occupational therapy is in no way related to work or job counseling. Instead, the word occupational relates to whatever occupies your time.

Hence, it is the intention of this article to first establish a context for this occupation, before going into its nuances.

So what is Occupational Therapy?

In a nutshell, occupational therapy seeks to help people lead full and independent lives, with an emphasis on the latter.

To give it more context, consider the following two quotes:

‘If you give a man a fish, you feed him for a day. If you teach a man to fish, you feed him for life’

‘Doctors ask, what is the matter with you? Occupational therapists ask, what matters to you?

Comparing doctors and occupational therapists

With these two quotes, let's consider the example of a patient who had suffered from stroke and is now half paralyzed. Doctors will be concerned with things like blood pressure, neurological functions and how to reduce the risk of relapse. Occupational therapists however, are concerned if the patient is able to perform his daily occupations which may include things like feeding himself (literally), dressing or moving around. There is also a focus on the environment: is it wheelchair friendly? Are things accessible to the patient or is an adjustment of furniture necessary?

Comparing physiotherapists and occupational therapists

How about physiotherapists? Their focuses are mobility, muscle conditioning and strengthening, which leads to exercises to be one of the key means of reaching the goal.*

For an occupational therapist, the focus is on enabling occupational performance, which can include both rehabilitation and the use of compensatory methods. The occupational therapist would be the one to train patients to use one handed dressing methods; assistive aids such as a button hook to dress themselves, or rehabilitate the patients to improve their strength and dexterity such that they are able to regain independence in doing daily tasks themselves.

* To be fair, this is a highly simplified concept of physiotherapy, but since this article is about its counterpart, this concept will suffice for comparison's sake.

Fitting them all together

Let's go back to our stroke patient.

Before discharge, a doctor will check that the patient is medically fit and requires no further hospitalisation.

A physiotherapist will teach the patient exercises to do at home so that the patient will continue to improve in his strength and mobility.

An occupational therapist will assess the patient's ability to manage daily tasks, and if he is unable to, the therapist will teach his caregivers in order to fulfil that role (e.g. how to carry the patient properly or how to bathe and dress the patient). If necessary, the therapist will do a home visit to suggest modifications to allow for better accessibility and safety.

Together, in their own ways, these healthcare professionals come up with a holistic treatment plan to help patients on their road to recovery.

On being an occupational therapist

Studying occupational therapy at Nanyang Polytechnic

Occupational therapy is offered as a three-year diploma course at Nanyang Polytechnic. It is however, an A-Level entry course which means one needs to complete their A-Level instead of their O-Level to qualify. After the diploma, there's two paths of advancement. Some choose to head overseas for a one-year degree conversion course, while others take up a one-year local degree conversion course offered by the Singapore Institute of Technology in conjunction with Trinity College Dublin. At this point of writing, there's no local degree programs for occupational therapy.

The many possible working environments

Occupational therapists can choose to work in a variety of environments, from the acute hospital* to the community hospitals or voluntary welfare organizations, and across different specialisations. Some work in pediatrics, others in geriatrics; some in stroke rehabilitation, others in orthopedic rehabilitation, yet others in mental health institutions. As can be seen, there are many different potential areas for specialisation.

In acute hospitals, there would be a greater opportunity to be exposed to a different variety of diagnosis and patient caseloads. New staff are regularly rotated to experience and learn in different areas of specialisation. This builds up one's general knowledge before deciding on an area of specialisation.

* From Wikipedia: Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. In medical terms, care for acute health conditions is the opposite from chronic care, or longer term care. The current six acute hospitals in Singapore are SGH, NUH, CGH, TTSH, KTPH & AH.

Community care is subacute (between acute and chronic) care, and patients at community hospitals are generally medically stable. The main aim at community hospitals is often rehabilitation to improve patients' function for home.

A typical day for an in-patient occupational therapist in an acute hospital

As an occupational therapist working in an acute hospital, it's a five-day week with regular office hours, with starting times ranging between 8-9am. Some centres require therapists to work on weekends. In the mornings you'd check for status updates from the medical team for patients under your care, to make sure they are well enough to be seen for therapy. Mornings are also for administrative duties, as it is sometimes too early to see patients (who might be having breakfast). Department or unit tutorials, or meetings can also take place in the mornings.

Lunchtime is typically a one hour affair with little fanfare. Most therapists only have time to grab a quick bite within the hospital before you have to go back to seeing your patients. As with any other professions, sometimes work creeps in during lunch hour, with meetings, talks, or administrative work to finish up.

After lunch, it's back to seeing patients again until it's time to knock off. Typically, an occupational therapist sees up to twelve patients a day, on average spending 15-30 minutes with each patient. For complex cases where the patient can benefit from more rehabilitation or if patient's family require caregiver training, consultation times can take 45 minutes to an hour.

Beyond patient care, you can also participate in other activities such as joining work groups for patient advocacy, engaging in various projects and planning for events, research work, quality improvement projects, and workplace safety projects. There are many opportunities to develop and grow outside of clinical areas and to develop other skills such as project or people management skills.

Traits of a good occupational therapist

First and foremost, it's a healthcare profession which means it is no understatement to say that the desire to care and make a difference is a non-negotiable. It can be very heartening to see your patients get better under your care, recovering and being able to go back to enjoying their lives. You are directly making an impact and a difference to the lives of others.

Since occupational therapy is a job that requires interaction with patients, family members and other health professionals, it would help greatly if you enjoy interacting with people. Good communication skills are also important as you will need to articulate your thoughts and treatment plans clearly to patients, your peers and other healthcare professionals. Being a good team player is crucial to developing good working relations with the team of doctors, nurses, physiotherapists that you often work closely with.

It would benefit an occupational therapist greatly if he is a creative problem solver because every patient's situation is different and he may need to think out of the box to come up with creative solutions to help the patient. Furthermore, since occupational therapy is about others leading full and independent lives, it helps that the therapist himself leads such a life as his experiences and skills can lead to creative therapy methods. For example, art and crafts can be used to help patients work on hand functions, while cooking helps patients train cognition, planning and sequencing.

Go in with two open eyes and reap the benefits

Even if you have what it takes to be an occupational therapist, it's still important to go in with open eyes, and maybe you'd gain more than what you expect.

For starters, it's challenging.

It's challenging because you'd be working with many different medical conditions with different potential outcomes or prognosis, since occupational therapy covers a wide scope in its definition. It's challenging because you'd be working with many different patients with their different personalities and their own social issues or needs, and their caregivers or the lack thereof. It's also not unfair to say that many of the medical conditions are suffered by those who struggle with making ends meet, which may make many textbook therapies unsuitable.

Also, you must remember that you are in a people-profession, and that means that the usual challenges of working with people applies here, if not more because these are people with medical conditions and they won't be in the best of moods—both them and their demanding caregivers. Work politics are inevitable too since you are still working with humans, but it's not as bad as other professions, since it's still an industry with caring people!

Because of the nature of acute hospitals, sometimes you might not be able to complete your treatment or fully prepare the patient and his caregivers before discharge.

You may also need to manage patients' waste discharges when you bring them to bathe or use the toilet. And no, you cannot just involve the poor nurses to do your job.

However, because of all these experiences, you can learn a lot and it would definitely come in useful in your daily life, especially when interacting with the elderly in your own circles. Also, as a by product of your daily experiences with patients, it's not hard to be thankful for health and independent living.

Choosing occupational therapy

The healthcare industry is a wonderful one which allows professionals to make a huge positive impact on the lives of others. Occupational therapy is a little different from the others in that it's scope is really extensive, since it concerns itself with pretty much any activity a patient might want to engage in life. Because of this, it allows for creative methods of therapy compared to following set rules. It's arguably also more holistic since it looks at getting the patient back to activities that make life interesting.

Concluding thoughts

Occupational therapy is often misunderstood but its importance in healthcare today is paramount, especially with the greying population of Singapore and many developed nations. It has its challenges, but it also has its wide scope of work which may appeal to the individual who seeks to make as much of a difference as he can. If being creative in helping others suits you, and the work and challenges here excite you, this might just be your calling.