Beliefs, capacity, and best interests
November 24, 2023
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Two recent judgements from the Court of Protection have concerned the conflict between a person’s
This site is unashamedly evangelical about rehabilitation, its importance to patients and their families, its never-ending fascination, and its intellectual, philosophical, ethical, and emotional challenges. It is a personal website, expressing a personal view of rehabilitation. The view is based on over 40 years of experience, research, writing and, most of all, thinking. It is, I hope, based on evidence; it is, I hope, not afraid to challenge orthodox beliefs where they need challenging; and it is, I hope, interesting.
Quick links
The five purple buttons below jump to parts of this home page. The five green buttons jumps to section pages. The star page button takes you to a recently added or changed page, a popular page, or a page I think you might find interesting.
Overview of Rehabilitation Matters
This site is for everyone curious about or interested in rehabilitation, from experts to people knowing nothing, from rehabilitation professionals through other healthcare workers to politicians, patients, and the public, from those who pay to those who provide, and especially it is for people who are curious about rehabilitation.
This site is interested in all types of healthcare rehabilitation regardless of age, setting, or condition. My interest is in neurology, but the content considers all conditions, including psychiatry, learning disability, and drug and alcohol rehabilitation,
So, as the strapline says, this site is all about rehabilitation and about all rehabilitation.
I do not know of other sites centred on rehabilitation. Academic journals such as Clinical Rehabilitation (which I edited) and Archives of Physical Medicine and Rehabilitation publish short articles about specific topics. Sites such as the British Society of Physical and Rehabilitation Medicine or the Society for Research in Rehabilitation have a particular focus (medical aspects or research). Textbooks such as the Oxford Handbook of Rehabilitation Medicine rarely discuss the process of rehabilitation, mainly having chapters on speecific topics.
The content will inevitably reflect my philosophy and approach. I have recently written about this. I believe rehabilitation must be centred on the person, always consider longer-term social goals, and that rehabilitation professionals need to develop wisdom, which is the best way to respond to the many uncertainties and complexities associated with many of our patients. We must remain humane and remember that patients are people, just like us.
It is essential that everyone contemplates the philosophical, legal, and ethical challenges associated with rehabilitation. For example, what are the distinctions between disease, disability, sickness, and illness or, of equal importance, what is rehabilitation. Ethical issues arise daily, for example when considering people with prolonged disorders of consciousness or functional disorders. I will refer to a book I have just bought, The Routledge Companion to the Philosophy of Medicine.
Who should read it and why?
Almost everyone asks, “What is rehabilitation?” This site should answer the question for anyone asking, from relatives of family members offered rehabilitation through politicians and managers to healthcare professionals. Strange though it may seem, I think this might benefit rehabilitation professionals because many have a limited understanding of rehabilitation compared to their professional expertise.
Professionals involved in rehabilitation should find much of interest. I challenge common assumptions, explain complex concepts, and offer facts and arguments they may use when promoting rehabilitation. I am particularly interested in education and training; a substantial proportion of the content considers how people can gain expertise and show they are experts. I have drawn upon my involvement in writing the medical rehabilitation curriculum. This should interest students and anyone training in rehabilitation.
Healthcare professionals, including all managers, should read to gain insight into rehabilitation. It is needed throughout the healthcare system, and well over half of all patients would benefit from it. The site has information on the role of nursing homes in rehabilitation. Social Service professionals will also find much of interest, as social care is indistinguishable from rehabilitation.
Patients and their family and friends will, I hope, find this site gives them helpful information. I hope most of it can be understood and that I avoid jargon. Some pages are written primarily for patients, and patients (one so far) have contributed material – more is welcome; use the contact button at the bottom.
Who writes and curates the site?
The content is mainly written by me, Derick Wade. I also welcome contributions from other people, which I will edit with the author’s agreement to ensure its readability. I have been a doctor interested in rehabilitation since 1980, when I started researching stroke rehabilitation at the Frenchay Stroke Unit, Bristol, UK. I have experience in almost all aspects of rehabilitation: clinical work with patients, managing services, advising on local and national policies, research, education and training, and occasional recipient of rehabilitation; I edited a journal on rehabilitation, Clinical Rehabilitation, from 1994 – 2021. I currently work at a specialist care home in Gloucester, give second opinions on patients around the UK, teach, research, and write.
My research interests and output can be seen on Google Scholar. I write on three Twitter accounts: @derickwaderehab, @rehabil31319128 (rehabilitation matters account), and @ClinicalRehab (I tweet on behalf of Clinical Rehabilitation).
Although I write most content, I often draw on work published by others, questions asked of me, or other events of work that spark my interest. For example, a blog post on “Multidisciplinary, interdisciplinary, or transdisciplinary?” was my response to an email, and another on “A model of patient-centred rehabilitation” was my interpretation of an article I read.
There is no commercial interest. For more information see About and Purpose pages.
What is new or changed? November 12th to 24th, 2023.
Over the last two weeks, I have returned to the syllabus and written a significant post. I have added two new competencies. The first was on spasticity management; the second was on rehabilitation for people with sexual dysfunction. They were published in close succession, and the differential in interest has struck me. The page on spasticity has been visited many times, the page on sexual dysfunction scarcely at all. I thought that the one on sexual dysfunction was more interesting; I learned more writing it. I also guess that there is less material available on sexual dysfunction.
One explanation might be an embarrassment and a feeling that sexual dysfunction is a luxury add-on’ that people do not need to bother about. Alternatively, people may find the topic too challenging. Third, people often think and say that another profession or service should be responsible. The page provided research data to show that such attitudes are common. The page also shows why sexual rehabilitation must be fully integrated with the rest of the team’s work, not outsourced.
Spasticity, in contrast, is considered a proper medical problem with specific solutions; my page tries to dispel this.
The common feature across both competencies is the requirement to think well beyond the impairment, focusing on the long-term and social consequences and a broader range of factors that impact muscle tone and sexual function.
The post arises from two recent cases heard in the Court of Protection. One case considers how much a person’s beliefs about treatment should determine the eventual decision. Specifically, did the person’s Pentecostal belief in continuing medical treatment until a natural death occurred trump all other considerations? The other case concerned the relationship between a firm belief, which meant that all other evidence and factors that most people would consider could be used as evidence of a lack of mental capacity and an impairment of the function of the mind.
Quick links
Your input is welcome.
My goal is to improve rehabilitation in two ways. First, I wish to increase the knowledge and understanding of rehabilitation among healthcare professionals and the general public. Second, within the UK, I would like to see a national multi-professional rehabilitation society like the American Congress of Rehabilitation Medicine that would advocate for rehabilitation independently of any profession and develop multi-professional rehabilitation standards and, possibly, qualifications.
You may help in several ways.
Patient experience can educate professionals, other patients, and the public. I want a variety of patient reports to illustrate how we can do better, either by reporting on our successes or our failure. Usually, one learns more from failures, provided they are analysed constructively. We have one report at present.
I am also interested in professionals’ reports of their experience, particularly what they consider their unique contribution to the team’s expertise. I have a category of posts, “What do we add”. So far, I only have my report on what doctors add and a report from a speech and language therapist. More would be welcome.
You may also:
Blog posts
There are (September 18th, 2023) 68 published posts covering various topics. The page devoted to blog posts gives the categories used, and there is a separate page for each category where you can see all posts in a category. The most recent six posts are given at the bottom of this page. I have recently (September 17th) culled 20 old, low-quality posts.
Six latest blog posts
Personal factors in rehabilitation
October 21, 2023
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The World Health Organisation’s International Classification of Impairment, Disability and Handicap, published in 1980, was
Healthcare theory
October 16, 2023
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What theory underlies the delivery of healthcare? The design of hospitals, services, policies, and almost
The medical model
September 23, 2023
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The biopsychosocial model of illness was born in 1977, with a reasonably well-documented gestation. Its
Speech and language therapist – 1
September 5, 2023
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What is the unique contribution of a speech and language therapist to the rehabilitation team’s
Doctors in rehabilitation – 1
August 31, 2023
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“But what do doctors do in rehabilitation? “I have been asked this question since I