spreading to the bone in the proximity of the ear), something that can usually be avoided by treating ear infections when needed. The nurse practitioner examined Zen’s ears and decided each time whether to give an antibiotic or not. When I arrived there for clinics, the nurse arranged for me to see patients that she felt needed further assessment by an ear specialist, and I would decide on the next mode of treatment. In the case of Zen, insertion of small tubes (known as grommets in some countries) into the eardrums was needed. I arranged for this to be done in the closest city that could do this procedure. Thank goodness for the nurse who was working in this community, contributing in a meaningful way to the care of Zen, avoiding untoward medical complications, and initiating the definitive treatment.
At every stage in my career, whether it is in the hospital setting, or outpatient setting, I have worked closely with nurses. Another example would be a family practice clinic where I worked for a few years. The nurse was the first contact, and did the initial screening and questioning of the patient. She also did part of the basic examination needed for any assessment including the measurement of the pulse, blood pressure, and body temperature. The nurse would give the injections and draw blood for investigations. She would accompany me and help out with some examinations and treatment that were carried out in the examination room. The nurse was a team member every step of the way.
2.8 Occupational therapy
An occupational therapist works closely with physicians and other health-care providers in creating rehabilitation plans for patients, amongst other things. The patients could be in the hospital after a stroke or recuperating at home following a motor vehicle accident. It’s an exciting field that people generally know little about.
The training overlaps with medicine in much of what is learned and trained, and there is a strong collaboration with doctors and other health-care providers on many levels. While many occupational therapists work in a hospital, or other health-care facility, they could certainly work independently in an office environment, the function being somewhat similar to any other medical office.
2.9 Optometry
Optometrists also have a doctor designation in many parts of the world. They usually practice independently in an office setting, or they may be closely affiliated to medical doctors — particularly ophthalmologists working in a medical office, or in the hospital.
A while back I personally consulted with an ophthalmologist, the basic eye assessment and examination being performed by an optometrist. I have also seen cross referrals between the two specialties. An ophthalmologist might choose to ask an optometrist to do the initial evaluation of patients before medical treatment is considered, as was the case in my experience. In turn, the optometrist can refer patients to the ophthalmologist for more complex examinations or treatment.
There are limitations with what optometrists can do with many eye disorders. Optometrists do not perform surgery and have limitations in regards to prescribing medication. They do, however, take care of eyes with appropriate examinations, diagnose pathology, and prescribe glasses and contact lenses.
Obviously, as with any of the health-care disciplines, regulations and boundaries of what the scope of practice of optometrists can entail changes from one country, state, or province to the next. Certainly the running of the office has a lot in common with any other medical-related office, but like their ophthalmologist colleagues, the equipment and initial financial outlay far exceeds what most health-care professionals have to spend to get things up and running.
Note that an optometrist is not the same as an optician, although in some countries there is some overlap between these two professions. Opticians deal more with fitting of lenses, and have a wealth of knowledge and information as to the best options for a person’s glasses or contact lens prescription.
2.10 Osteopathy
While attending a course on the temporal bone at the House Ear Institute in Los Angeles many years ago, I first came across osteopathic doctors in my professional career. The temporal bone is part of the inner portion of the ear, and the surgery can be quite complex and difficult. It is not always something that can be fully mastered during surgical residency, and it often requires further training.
Osteopathic doctors practice just like medical doctors; for example, they prescribe medicine, do further specialty training, perform surgeries, and take care of patients in a hospital. Their training and practice is somewhat different in that they concentrate on the muscular-skeletal aspect of the body and perform procedures such as spinal manipulations — something that medical doctors do not usually do.
An office for osteopathic doctors would, for the most part, seem exactly the same as medical doctors and patients might never be able to tell the difference in how the two professions function.
2.11 Physiotherapy
Physiotherapy is well known to most people, especially those of us who have had some sort of sports-related injury. These health-care professionals are involved with the muscular-skeletal system — maintenance, diagnosis, and treatment. They can work in a solo or physiotherapy group environment, together with a multi-specialty office, or work full time in a hospital-type environment.
The set up of a physiotherapy office can be quite costly as there are usually expensive purchases needed; for example, some offices provide fitness equipment in a gymnasium setup and maybe even a swimming pool or steam bath.
2.12 Podiatry
It is often very difficult to tell the difference between a podiatrist and medical doctors who specialize in disorders of the foot. Podiatric physicians undergo training similar to medical doctors, but their schooling is more focused on feet. They perform many procedures on nails, toes, and feet including some surgical procedures, which are performed by surgeons as well, particularly orthopedic surgeons.
Podiatrists usually practice in an office setting, most procedures are performed on out-patients. The set up and running of a podiatric office would be indistinguishable from a medical office.
2.13 Psychology
Psychology is a field that people usually know something about, with little explanation needed. What is less well known is that there are many different types of psychologists, besides the clinical psychologist. Industrial, educational, developmental, sports, and forensic psychologists are a few examples of the different types of professionals in this field.
A psychologist’s office is certainly simpler to get set up as clinical procedures are not relevant here, but all the same basic principles for office set-up apply.
2.14 Respiratory therapy
Respiratory therapists are integral team members in many hospital settings, and they might also work in selected outpatient facilities independently. They can work on hospital wards, in emergency and operating rooms, or in intensive care units — or more commonly a combination of any of these. They can do specialized diagnostic procedures, administer oxygen, and intubate patients, to name a few of the responsibilities.
A respiratory therapist can certainly work exclusively in the outpatient setting, if this is the choice of the individual. Practice scope could include pulmonary function testing, sleep apnea management, and distribution of other respiratory assistance devices. I personally refer patients for some basic investigations to respiratory therapists.
2.15 Speech-language pathology
Speech-language pathologists are otherwise known as “speech therapists.” These health-care providers specialize in speech disorders, voice care, and even swallowing problems. The type of conditions and people they take care of include speech delay, stuttering, singers with poor voice technique, and stroke patients with speech and swallowing issues.
These professionals have a choice as to how they wish to practice.