I’ve finally figured it out, I’ve boiled it down to the simplest of terms: I dislike unsupported claims. From this simple seed, stems so many urges to engage in discussion, debate, conversation and reflection.
I could not figure out why listening to biomedical model explanations bothered me so much. I could not figure out why those using nocebic analogies drove me crazy. I did not know the reason that I loathed unsubstantiated predictions of the future (“You will need a knee replacement.” “You will have pain forever” etc). It comes down to the claim.
Maybe you could say I just enjoy truth, but truth is a complex part of this whole thing (personal truths, facts, outcomes, etc). To explain this best, allow me to use some math: Continue reading
I was recently at a company-wide meeting with all the PTs and as I looked around I got thinking…
An entire room of people who think differently, have different algorithms and thought processes, and are all going to be treating people who are seeking one thing: Physical Therapy.
It was a very crazy thought. How can this ALL be Physical Therapy? Certified Manual Trigger Point Therapists, Certified Mechanical Diagnostic Therapists, Certified Othopedic Manual Therapists. At first it is a bothersome idea, as in, they can’t all represent PT, or the PT that I envision. But perhaps that is short sighted. Isn’t that one of our greatest assets? Isn’t that a selling point right there? We are extremely varied in our approach… there is a therapist for every patient. There’s a PT for every pt.
We, in PT, are evidenced-based and research driven. We look for the Continue reading
Image Credit: NASA
It is the space between the notes that make the music. A wash of sound and pitch and tone does not stir emotion or evoke dance and tears. It is the time taken, and placed, between to the vibrations that add meaning.
It is the silence and expanse of nature and wilderness that allows the existence of city life. It must be there, a place to go to, or the mind cannot breathe.
When looking at the earth from space, we do not assume the only activity or important part is the part that is lit up. The darkened areas are alive as well. This is also the case with fMRI. Yes one part is lit up, but this says nothing about the importance of the less active or “silent” areas. They too are playing an important role.
And so it goes for any meaningful interaction, and in particular, care-based interaction. Silence is the time when the ideas can settle, when concepts can take root, when importance is emphasized.
We all know that a good history can yield some superb differential diagnosis choices. This can only happen in environmentally appropriate silence. We already know what we know. Therefore we can keep quiet about it. We don’t know what the patient knows… so we must listen.
Silence has a time component. Perhaps that’s why it’s so hard to come by…
Give silence a chance.
We all know there is a 4th Pillar in clinical practice… in addition to the 3 Pillars emphasized by Sackett et al in 1996. We manage this pillar every day and it strongly influences the decisions we make when treating and advising your patients. What is it? 3rd Party Payer Demands. Continue reading
Buh-BAM! I really like the MoveForwardPT.com campaign for National PT Month on the 7 Myths About Physical Therapy. Nice work APTA! We do combat many-a-stereotype out there in the field, so this is a nice push.
Let’s look at Myth #2: Physical Therapy is Painful. This one really stands out to me. There are others who write about this more (Diane Jacobs, KeithP, Jason Silvernail, Harrison Vaughan, Barret Dorko, … and others, I don’t intend to leave anyone out) about how adding pain to the treatment equation is detrimental to patient experience and outcomes. But does everyone hold this patient centered view? Continue reading
There is quite the debate these days about how manual therapy works and particularly what types are best or get different/better results or is it all just placebo. Here is a case, n=1.
I’m evaluating a patient with upper back pain, medial to the scapular border and lateral to the spine, around T5-ish. We all know where this spot is, right? The complaints are approximately 8 months in duration, 5/10 pain secondary to increased breast tissue (20 lbs) during pregnancy and post-partum time periods, per the patient. Continue reading
The topic of one-on-one care vs a double-booked/overlapping/>1 care model is one of great emotion and opinion in the physical therapy community.
So, I am a huge fan of the one-on-one treatment model and it really seems to suit me. Bias warning, I am drawn to this style of care. This model is not pushed or addressed in school other than to say that most out-patient ortho clinics are >1 treatment model providers. My experience has been as follows: I was a PT Tech in a clinic for two years that saw 3 pt/hour/PT and I have interned in a clinic with one-on-one care and am currently in a clinic that does 2-3 pt/hour/PT. I recently posted on Twitter about not feeling I could ask as much from my patients in a >1 care model, since I was wasn’t giving them as much of myself. I felt (and still feel) that if a patient comes in and I give them divided care, and not my full attention, that I could only expect the same in return from them.
I got some responses that were quite positive for the >1 model of treatment and it got me thinking about some of the pros and cons. First off, I was happy to get the insights since I may be in a situation in the future (actually, as I am now in this internship) where I am practicing under the double-book model. Also with future health care regulations and changes, a double-book model may be the only way to operate and I want to be able to think positively about it. So let’s take a look… Continue reading
When evaluating and interacting with patients there will inevitably come the part where they ask “So, what’s wrong with me?” or “What’s my problem?” It is our job, no, our duty to educate the patient and inform and discuss with them their condition and prognosis to the best of our knowledge. Continue reading
The ‘Therapeutic Alliance (TA) is a term that basically describes an enhanced patient-PT interaction with patient centered care as the driver. Empathy, compassion and a safe positive atmosphere all fall into this realm as well. (The term is more associated with psychotherapy as far as I can tell). Continue reading