It’s the question I am asked time and again by family, friends and prospective students. To be honest, there isn’t one answer to this question. It depends on you as a person and what your interests and experiences are and of course the placement you are provided by your university. Of course, because occupational therapy students are still learning there is a limit to what duties they can carry out, but the more interest, understanding, and professionalism showed the more opportunities arise. There are many different clinical realities for occupational therapy because it is such a versatile and widespread vocation. As I have just completed my second-year placement I’ve decided to write a little bit about what that was like and what I learned from it.
Where was your placement based?
For this placement, I was working in an outpatient setting seeing people with Chronic Fatigue Syndrome or Myalgic Encephalomyelitis [CFS/ME]. It was quite a controversial placement in the fact it was labeled as mental health by my university but in fact was very focused on science and physiological symptoms – an ongoing issue in the diagnosis and treatment of CFS/ME.
CFS/ME is a diagnosis given by elimination of other possible and contributing conditions that present with the same symptoms. Health professionals are still unsure what causes CFS/ME and further research needs to be conducted, however, it can be diagnosed using the Fukuda criteria based on the presence of four or more characteristic symptoms including post-exertional malaise, chronic fatigue, generalised widespread pain and autonomic symptoms. All of which you can read more about here.
The service I worked alongside covered all aspects of CFS/ME from assessing symptoms and diagnosis through education and rehabilitation to planning for setbacks and discharge. The multidisciplinary team included nurses, dieticians, physiotherapists and occupational therapists to offer all aspects of care detailed in the BACME and NICE guidelines.
What sort of thing did you do?
In the team occupational therapists triaged people referred to the service through a thorough clinical evaluation that takes full physical, mental and social history alongside the history of symptoms. If the criteria were met the therapists would then give a diagnosis of CFS/ME, however more complicated cases were taken back to the weekly meeting to be discussed with the wider MDT.
The service provided individual or group educational and rehabilitation focussed sessions for people to make sense of their condition and work towards the management of symptoms and recovery. This included information on pacing and grading, stress and quality rest, employment and diet amongst other areas with a view to meeting the individual’s goals and improving their quality of life.
What did you learn?
This is the first placement I have been on where occupational therapists were diagnosing people and I am aware this is a rarity which made it an extremely valuable learning opportunity for me. Alongside continuing to improve my core occupational therapy skills and meet my learning outcomes I was given the opportunity to discuss the impact and controversy of high profile research papers on the patient community and services provided and why evidence-based practice is essential.
Throughout the placement I increased my knowledge of the regulatory and immune systems, and how these impact on brain function as well as one another. I also did a lot of reading on common co-morbidities such as functional neurological disorder, hypothyroidism, fibromyalgia, inflammatory diseases and autoimmune conditions which helped to improve my clinical reasoning and reflect on my current practice.
I was introduced to more standardised assessments and outcome measures that are used across a variety of settings as well as condition-specific models and assessments.
Where can I find out more?
If you want to find out more about CFS/ME then the ME Association is a good place to start. It offers information, support, and advice as well as details of regular support groups across the country.
For more information on managing the condition and first-hand accounts of how CFS/ME can affect people I would recommend the following books, blogs, and documentaries: