I started practicing 3.5 years ago.  I know very short period of time for you veterans out there but I feel this period of time is perfect between being a hungry student and a set-in-my-own-ways physical therapist.  Plus, 5 years and seems so far away. 

I would like to reflect back over this time and share a few take away notes from my personal experience. There are probably hundreds of notions worth considering on but to celebrate 3.5 years, here are 3.5 reflections.  Enjoy and if you get a chance, let me know your thoughts and experiences so we can all learn from each other!

#1 Touch

Personal Touch.  As I mature as an individual and more picky with my choices in life, I know that I like the personal touch that seems to be leaving any industry due to technology and cut-backs.  This is no different from picking your healthcare provider, especially someone you will see multiple times a week for possibly many months as in our field.  Being able to provide an exceptional service that goes above what someone expects separates you as a clinician.  This can be something as simple as not interrupting the subjective history during initial examination (as it has been shown that physicians interrupt every 14 seconds), or taking the time out to simply educate your patient with something other than your office’s ‘handout’, or just calling the patient the day after initial evaluation to check in on them.  I’m sure you have more to share but you get the point.  Give in abundance. 

Physical Touch.  My wife tells me that no one can ever take away your education.  I agree and think the same in terms of manual, physical skills.  This is what we do day to day in not only assessing during an exam but more importantly treating.  This is an expertise and trade that only a few possess.  As much as the research dethrones the palpatory, physical exam; just you can’t go without it.  Sometimes it can be just as diagnostic as more expensive imaging.  Keep our profession fresh!

#2 Treatment vs Diagnosis

If you have read this blog in the past, you have probably seen multiple posts about sensitivity/specificity, etc values during several clinical, “special tests”.  Not so special actually if you look at the numbers.  I am still highly intrigued and interested in ‘diagnosing’ and knowing the probability that a certain pathoanatomical structure is of fault but honestly, I am starting to get more away from it.  Maybe its because the more I look into it, the more I find inconsistent and various interpretations that makes it frustrating; but probably more in that patients just want to get better.  We learned more diagnosis and exam in school, but not treatment so I guess everyone is on the same page here. Patients come to you to get better, lets continue to be good at this part of our field and not spending all our time with a “physical therapy diagnosis” (what is this really?).

#3 Nutrition

During one of my oral exams in PT school, I was asked by a professor if I should provide nutritional advice for a home health patient if you were seeing them for a wound.  I commented yes and spoke about importance of protein, etc (I don’t exactly remember my answer but you get the jist).  Well, I was “wrong” and told that this is not my specialty and ask for nutritionist consult.  Wow, do I not follow these guidelines now.  As an adjust healthcare provider with multiple backgrounds in exercise and nutrition from undergrad studies, patients can certainly benefit from my knowledge.  Who has the money anyway to go to a nutritionist?  Maybe it is because I work in a rural, social and economic deprived area without healthy choices to eat but you would be amazed at what patients think is healthy, or simply do not know.  Continue to educate about nutrition, it will pay off.

#3.5 EBP

You have probably read in the past that I am a component of evidenced-informed medicine, not necessarily evidenced-based medicine.  This meaning you are aware of what the literature says, but not necessarily follow it to a T. If you practice the latter, well, you probably will not work or get a paycheck because you will be hardly able to do anything “correct”!  The reason I put this as 3.5 is that you should strive for 50% evidence in your practice daily.  I do mention everyday EBP such as “combination of manual plus exercise yields best results, etc.” but also incorporate my own experiences as well as patient’s status in front of me. Students always ask if what I am doing is EBP and I don’t always have an answer.  Sometimes it just works and for now, you have to go with what you got.  

Hope everyone has a happy and healthy New Years! See you in 2012!

Harrison

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8 comments

  1. Great post as always. On the nutrition bit though, I have to say “proceed with caution” especially when in the “role of PT”. Each state has their own practice act and some are much more strict about nutritional advice than others. It is often safer to give nutritional advice coming as a “personal trainer” since there is almost no regulation of that “fitness industry” (I do enjoy these quotation marks “apparently”).
    What’s worse about referring out however is I tend to disagree with the majority of advice given by those considered the experts such as RDs who follow the government regulations more often than not. A low-fat, high carb diet can be one of the biggest mistakes a patient in any stage of recovery or pre-hab can make. This nutrition issue is a huge one that should be cleared up (why doesn’t the APTA have it’s own nutrition section or special interest group at least?). This is a small but crucial part of the huge issue going on in America and worldwide and we should be the ones to help improve nutrition but we must tread lightly.

    1. Bo,
      Thanks for commenting and again reading the blog. You do make a very good points about nutrition and especially about practice act. Honestly, I do seem to sway from policies if I feel it is best for the patient. I know this argument will not hold up if I was put to it.

      To back me up on the other hand is how the government is trying to get all clinicians to report on quality measures through PQRI. I am not sure if you use it in New York but we voluntarily do it (it will be a penalty if not in 2015 I believe) for our Medicare patients. One of the measures is taking height/weight for BMI and then make a follow-up plan for weight reduction. So, in order to do this, nutrition is definitely a top priority.
      Hv

      1. Don’t get me wrong, I completely believe that nutrition is one of the single most important factors to facilitate health including recovery. At this point in my PT career I easily do more reading on nutrition than I do on actual clinical practice and am trying to figure out the best way to establish an independent business model within the NY practice act to allow me to reach the greatest number of individuals. Sleep seems to be another HUGE component that often gets overlooked. I am working with Reverie (reverie.com) to begin to spread the word about individualized sleep needs – shameless plug: if you or anyone you know is in the market for a new bed and willing to INVEST in their REST, I am happy to share what Reverie has to offer along with all I have learned about sleep in general.

      2. Yes nutrition and sleep are huge! I cannot believe how many people have trouble sleeping at night, not just due to pain. I will have to check out Reverie’s site. Anything to help people is great. Do you have any particular products that you normally recommend or mainly education (i.e. take TV out of bedroom, don’t look at finances a few hrs before going to bed, etc)

        P.S. I am responding through my email and not on WordPress site so hope it works.

    1. @ Bo again,
      Thanks for the website about Sackett’s EBM model. I haven’t been to this site but have seen similar depictions. Good place to send my students.

  2. Harrison,
    Like your site. plan to follow. I am PT in Laguna Hills, Ca (24.5) and dabbling in the blog scene: http://bauerphysicaltherapy.wordpress.com
    About nutrition. I provide information that addresses my clients wellness, as I do not believe, nor see, the medical doctors providing this information. I refer to Dieticians that I have established relations with in the community that address more specific medical based diet and nutrition services. I prefer the route over the “nutritionist’ based on professional background.
    thanks for your quality material.
    Randy Bauer

    1. Randy,
      Thanks for the comments. I agree with your statements. I work in a very rural region where we do not even have dietitians! (except maybe the community hospital). Only one nutritionist that I know of too. Sometimes you gotta take the bull by the horns since these individuals do not have the resources.

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