Occupational Therapy at the First Visit: A Case for Joint Consultation in Hand Care.

For many common hand conditions, such as carpal tunnel syndrome, trigger finger, and thumb base arthritis, both surgery and nonsurgical care can lead to good outcomes. The best choice depends on the patient's occupations and goals, so the patient should help make it. This is what shared decision-making, choosing together after weighing the options, is meant to do. In practice, though, patients often meet an occupational therapist only after deciding on surgery, so the nonsurgical option gets little attention when the choice is made. We argue that the occupational therapist belongs at the first visit, when the decision is made. Drawing on a model used for one year in two West Bank clinics, in which a surgeon and an occupational therapist see the patient together and present the options side by side, we show how the therapist's presence makes shared decision-making concrete and supports continuity where access is limited.What This Article Adds: This article makes the case for including the occupational therapist in the first surgical consultation for common hand conditions, so that the surgical and nonsurgical options are weighed together, with the patient, at the moment the decision is made.