“The physicians are the natural attorneys of the poor,” said Rudolf Virchow, a German physician-anthropologist, in 1848. It was this framework for public health that motivated me in those early, molecule-based years of medical school.
Ultimately, I thought my career would be more about empowerment than medications, with more attention given to social pathologies than cellular ones. And, like Virchow, my vision was a doctorcentric one. Since starting residency, however, it’s become clear that client advocacy is far more complicated than I’d imagined. It is a team project. And occupational therapists (OTs) are perhaps most concretely situated to empower our clients in functional ways.
Admittedly, I struggled in my early career to understand the purpose of occupational therapy. During my first year as an internal medicine and pediatrics resident, I asked my superiors what the field was all about, and the answers were vague. “Just like physical therapy takes care of the lower extremities,” a case manager told me, “OT manages the upper extremities.” “Occupational therapy helps people do their jobs,” a senior resident informed me.
These were unsatisfying answers. And what would they mean for pediatric patients who were jobless?
So I asked some of the OTs I’d come across at The Johns Hopkins Children’s Center.
Megan Hauer, a pediatric OT who works with kids of all ages, told me that ultimately, her role is to both motivate and educate children with “new strategies, skills and techniques on how to participate in play, school, community and family-related activities.”
“Physical therapists will teach you to walk. OTs will teach you to dance,” she said.
This is relevant even for infants. She described a client who had been admitted to the neonatal intensive care unit after birth with an omphalocele, a defect in the abdominal wall that causes some organs to remain outside the abdominal cavity. This places significant limitations on the baby’s ability to be held, fed and positioned by his family. Even as a pediatric resident, I’ve been fearful and clumsy with such children. But Megan’s team helped the child’s family develop skills to take him out of the crib and even place him onto mats on the floor to play.
“Mom became empowered to feel confident interacting and playing with her son in ways she may have never expected while in the hospital,” she told me.
Tess Lichtenstein, a psychiatric OT, told me about a client with depression who was struggling with her activities of daily living, oftentimes an indicator that it is not safe for the individual to remain at home. However, by breaking down the tasks like budgeting and bill-paying into individual steps, and identifying where depression and anxiety interfered, small strategies were implemented with huge results. Her client was able “to stay living in her home and have enough money at the end of the month to pay for her prescriptions.”
Empowering our clients to engage fully in society is the very thing I felt would be my job as a primary care physician. But we’ve come a long way from Virchow’s day, and the role of the advocate is now shared by several types of practitioners. Working with OTs has helped me see how this can be done on the ground. As physicians, we should honor OTs as vital partners in the project of client and community empowerment.