Do we have to write goals?
You may not be aware of this, but if you see someone for therapy, the therapist has to write goals for your rehab. Sounds necessary and reasonable.
If I’m seeing someone for personal training, I’m absolutely asking what your goals are, because that will shape what kind of routine we establish. If you want to gain muscle, that routine will look different than the goal for walking endurance.
There is this new narrative quietly floating on social media from therapists. “Do we really need to write goals?” Someone said the quiet part out loud, and a larger chorus agreed, “We hate writing goals!”
That sounds sacrilegious. Medicare and insurances require this, and if someone refuses they would likely lose their job.
The admission
In 29 years, I’ve largely not looked at the goals that were written. Initially it was because we were seeing 2-4 patients per hour, and I had to gather info on the fly. The goals were obvious; decrease pain, improve strength, range of motion, quality of walking, posture, etc.
The ugly
Insurance companies like to look at goals as a way to deny claims. They are not happy for you when you feel better, they just want to see expenditures drop. If they see you’ve met some goals, it’s just another excuse to deny a claim.
Like the pain scale, let’s not nickel and dime your symptoms or goals. You only want to gain 20 degrees of range of motion out of 180? Improve one muscle grade? No, if you want to get better, we need to work much harder and have loftier goals.
The other side of the coin
In fairness, there are people who want to be seen by therapy forever, as some sort of social personal training sessions. Goals can be a good way of putting limits on these nefarious numbered cases. “I can’t seem to motivate myself to do the exercises…” is not an excuse to have therapy forever.
The best case
The best case of goal making and delivering that I ever saw was by a pediatric therapist I met 25 years ago.
She was teaching a course at a Shriners type facility, with about 30 therapists present. The presenter was a titan in the field. Her singular focus was, “what is the goal for this session?”
At the time, this sounded pretty bold. If we are seeing a kid with cerebral palsy, we generally think in terms of months or years, not hours.
This presenter had a goal for one session. She asked the facility to arrange one child to be seen by her, at random. No prior knowledge.
The mother stated that her main goal was for her daughter to walk without her walker. So the presenter has the young girl stand at some toy stations and play for about 45 minutes. The entire time the girl was playing, the therapist was on the floor behind her, applying over pressure to her joints, giving proprioceptive feedback, and postural awareness.
There was some balancing in staggered stances, reaching for toys, etc. (There was no stretching).
At the end of the session, the therapist had the child walk to her mother 10 feet away without a walker.
The place erupted in gasps, and then cheers, and a few tears. Best deliverance on goals I have ever seen.
That lesson really stuck with me over the years. What is our singular focus for today?