STEP 1: Shut up and listen
STEP 2: Embrace your mistakes STEP 3: Be consistent STEP 4: Stay Humble STEP 5: Never forget your purpose Only swing at fastballs, ignore the change-ups In baseball and softball, when you’re up to bat, you have the option of deciding whether to swing at a pitch you consider favorable and ignoring those you don’t. In our role as healthcare practitioners, we can’t just sit back and cherry pick who walks through our door in need of our expertise. With that being said, if we are thrown a curve-ball that is more difficult to handle, we owe it to our profession to deliver. This curve-ball can be in the form of a personality type, gender, age or even a difficult diagnosis that may make us feel uneasy. His name was Marcus Everyone has a story that altered the course of their career in one direction or another. Mine started with a 10-year-old we will call “Marcus”. He had suffered from chronic seizures as a toddler and required brain surgery involving removal of his frontal lobe as a treatment. I had only been a PT for a year or so and this was his first time receiving physical therapy because he had never been covered by insurance. His mom was distraught, overwhelmed and somehow full of excitement at this new opportunity for him. He was developmentally delayed. He was unable to verbally communicate or stand/walk on his own and was confined to a wheelchair. My 10-year-old mentor He and I spent 8 months together. In that time period, I truly believe he taught me more than I could ever teach him. I learned what it meant to fight for your patients and appreciate the concept of serving a cause that was bigger than myself. Without intentions of being contemptuous, I had colleagues tell me writing letters of medical necessity were fruitless and a waste of time, but I wrote them anyways. We were able to get Marcus a stander and a gait trainer. Seeing the tears of joy on his mom’s face after watching him walk for the first time still gives me chills. As our time together came to a conclusion, I was gifted with 3 pairs of socks, all being themed of different superheroes. I was only a year out of school and was considered a superhero to Marcus and his family. Little did they know, he was actually mine. You don’t have to be an expert to care I didn’t have advanced training, or a skill set that set me apart from the crowd. I did, however, have questions that I felt needed to be answered. My passion for finding answers outweighed my fear of imposter syndrome and being inadequate. I knew that with some effort of seeking guidance and resources, I could help this family in one way or another. There will be plenty of challenging circumstances and people we will encounter throughout our career. We can’t let the day to day nuisances of productivity or keeping up with notes discourage us from embracing these challenges. I wear my superhero and crazy socks daily as my reminder--you may have to find your own.
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STEP 1: Shut up and listen
STEP 2: Embrace your mistakes STEP 3: Be consistent STEP 4: Stay Humble The good ole taste of humble pie never gets old. I remember graduating from physical therapy school with my Doctorate of Physical Therapy degree. I was ready to change the world and the people in it. I started my first job and all of my patients were reportedly getting better. I had it all figured out… or at least I thought I did. It was like the feeling of mastering your grandmother’s lasagna recipe that you devoured as a kid. It wasn’t until my first weekend at one of the residency classes I was “enlightened” with this delicacy we call, humble pie. At this point in my career, I had only been practicing for 2-3 months. In retrospect, I believe my sense of confidence may have stemmed from being protected from difficult cases by my boss who had been a PT for 10 years. This residency module in particular was focused on the lumbar spine and was taught by the residency director who was a PT with 25 years of experience. I sat there with my notepad blown away by her insight to treatment of an area I had very well oversimplified. She posed questions of clinical reasoning and foundational knowledge I couldn’t seem to google search quickly enough and yet still mentioned feelings of uncertainty herself. I felt ashamed to have taken my profession for granted. I had no fancy silverware or elaborate table setup, but that was my first serving of this eminent dessert as a physical therapist. What do you mean, you don’t know? Myth: admitting you don’t know something is a sign of weakness. We are trained in academia to always have an answer. Whether a short answer or multiple choice, no question could go unanswered. We are all too familiar with the term “take an educated guess”. What impact does this have on our patients who are relying on us to lead them through their times of helplessness? I’ll never forget hearing Ann Porter Hoke flat out say the words, “that’s a good question, I don’t know.” This is a woman who was trained by the “father of orthopedic medicine” himself, James Cyriax. I was baffled!! My sense of disbelief was not in that she did not know the answer, but in that she had the audacity to admit it. I may not be the smartest fellow in the room, but I was starting to connect the dots. In the two instances provided thus far, I had the utmost admiration for both therapists and there was a lesson I learned. There is humility in admitting you don’t know something to those who have placed you on a pedestal and it’s even more courageous to display this type of wisdom consistently. Not really into pies? Too bad!!! The moment you accept you will not be perfect all of the time is the moment you will begin your growth as a person and a clinician. This journey of perfection does not exist. What works today will somehow be discredited 10 or 15 years from now and we will all have to admit that we could have been better. This does not negate our intentions nor our efforts in making a change. The humble clinician will never develop shoulder pain from a repetitive injury such as patting themselves on the back or reaching up to stroke their ego. They will instead appreciate changes that are for the good and take on this challenge we call lifelong learning. These are the clinicians that empower students and new grads that are up and coming to take the profession by the horns and help lead the way. Keep grandma proud knowing that she can trust her closely held list of recipes with you as she begins to relinquish her time in the kitchen to enjoy the harvest of the seeds she faithfully planted. STEP 1: SHUT UP AND LISTEN
STEP 2: EMBRACE YOUR MISTAKES STEP 3: BE CONSISTENT As a child growing up, I would receive a homemade red velvet cake from a friend of the family each year. It was amazing! I never filled out a survey or application, but it was as if she had my taste buds in mind while dialing up this recipe. When I went off to college, my close friends would go to our local supermarket and buy me the same cake because they knew how much I cherished this dessert. Sadly, the pastry chef from our local supermarket didn’t reach out to the one I grew up with. The level of disappointment was profound. No matter how many bakeries I tested, finding a match that was consistent with my childhood pastry chef was a mystery that has yet to be solved. Foundation of trust Step 2 invited great feedback from one of our peers who pointed out this concept of creating a groundwork of bedrock in which our patients and colleagues can rely. She added that this is done by owning and acknowledging our mistakes on a daily basis. As another colleague pointed out, if you begin to create even minor inconsistencies in this foundation, it could easily lead to a case like the Millennium Tower in San Francisco that has sunk 18 inches and tilted 14 inches since being built in 2008. Imagine all of the bad habits and behaviors that you could have developed after graduating 10 years ago or even three years ago that could be detrimental to your workplace environment and patients. The further out from graduation you are, the harder it is to rectify this Leaning Tower of Pisa you have allowed to develop. The walk of shame is actually a good thing We all encounter off days and personal challenges sporadically that may interfere with our normal ebb and flow. However, in the midst of this whirlwind, your colleagues and patients need to be able to depend on you to hold yourself accountable regularly. You then in turn provide them the privilege of knowing they can expect you to give your all daily. The legitimacy gained from this interaction allows them to feel substantiated in their decision to trust you and will keep them coming back. You don’t have to be the best at what you do, but you must act with their best interest in mind. Sorry. No exceptions. Clean your mirrors and filter your water!! That reflection of what you see every day has everything to do with how others see you. Why not start with making sure your perception of yourself isn’t based on a cloudy mirror. We sometimes don’t realize how much we as humans value consistency. I find this step to be one of the most vital of the group thus far as it applies to every realm of who you are as a clinician. Are you the type to greet everyone with a smile and kind words when entering a room? Are you that person that shows up on time and ready to work each day? Do you go into a treatment session with a plan that is optimal for the patient or what’s more convenient for you that day? If you begin to second guess yourself when posed with these questions, regroup and redirect your energy into being predictable for the right reasons. In a world where our patients come to us with more chaos than we can fathom, let us be the slice of red velvet cake that is whipped up as their own personal recipe, unswerving with each bite. STEP 1: SHUT UP AND LISTEN
STEP 2: EMBRACE YOUR MISTAKES Sometimes when we become good at a skill, we forget the countless hours of dedication it may have taken to acquire it. It’s probably safe to say, no one sets out to have a knack for being wrong. Mistakes are ultimately inevitable and are critical in this process we call professional development. The pearl lies not in being wrong, but in our ability to turn these errors in judgement into lessons that shape our careers. No shoulder left behind You look at your schedule today and see a 30-year-old female patient with left shoulder pain. She has been seeing one of the more experienced PTs at your clinic regularly for about 6 weeks with success. She denies having any pain over the past 3 weeks and is feeling much better. She really feels like this physical therapy thing is working and is very motivated to get back into her normal workout routine again. You’re excited for her as well and decide to get “creative” with her treatment by adding some shoulder exercises you saw on Instagram from a PT that is heavily followed. She shows up at her next appointment with her primary PT and you overhear her explaining that she now has pain in both shoulders that has interrupted her sleep. Chess not checkers What’s your next move? This situation can play out in several different ways. You could: 1) Run like the wind and treat it like a bad date you want to forget, hoping the primary PT never brings it up again. You fear this route will lead to your coworker never trusting you with a patient of theirs again. 2) Point the finger by explaining how the patient may have done something outside of her PT session that contributed to her symptoms because you “stuck with the script”. 3) Accept responsibility by meeting with the primary PT privately and letting them know your thought process for progressing the patient in the manner you did. If this experienced PT is indeed a Rockstar Clinician , they will turn this into a coachable moment that will forever stick with you. Don’t get caught up in defensive driving We sometimes fall victim to getting bogged down in the art of rebuttal so much that we begin to convince ourselves user error is impossible or only applies to those that are careless. In doing so, we miss the opportunity to learn from our utmost resource, the patient. Here’s where Step 1: Shut up and Listen is intended to set the groundwork. If our patient follows up and is feeling worse, be empathetic and acknowledge their vulnerability in coming back to you. Then make a genuine effort to dig deeper to determine a viable plan for moving forward for the both of you. There are opportunities for this every day of your career, but if you’re the type to wear sunglasses at night you’ll surely miss them. STEP 1: SHUT UP AND LISTEN
If we don’t listen… google search will! Could you imagine a time where a patient could just type in their symptoms into an app that in turn gives them a diagnosis and an entire exercise program to follow without ever having seen a healthcare practitioner? In a time where our use of technology grows professionally and socially, we have to stay committed to what drives our efforts of research and desire for clinical expertise. That is being engaged and listening to our patients. The first date is great… but the second date may be more important. Structurally, we typically only set aside one point in time where we truly listen to our patients. We enter our evaluation, fully grounded in this concept of motivational interviewing in which we are empowering our patients, tactfully guiding them towards an internal locus of control over their situation. Before you know it, we’ve reached our 10th visit and it’s time for a progress note. We’ve updated a few exercises here and there, but we haven’t revisited their original reason for coming to therapy in the first place. Where did we go wrong? We fell victim to becoming too comfortable with the relationship and unfortunately taking their time for granted. The world of speed dating In the midst of our day to day caseloads, it may seem cumbersome to have a patient that won’t stop rambling. It’s their fault, they should know you have notes to write, another patient that is also requiring your attention and a few text messages you need to respond to from an hour ago. It’s like speed dating with two people simultaneously and you’re trying to listen to them both tell you their life story. You may take pride in finishing the day with your notes done, feeling efficient and like you’ve mastered the art of multi-tasking, but at what expense. Use cruise control with caution. It’s so much easier to take your foot off the pedal knowing all you need to do is control the steering wheel. You write up a great eval note from the first visit but fail to refer back to it. You go on auto pilot because you have already decided what is needed to get this person better based on their initial presentation. After a few visits with you, they’re doing much better, only having 1/10 pain and being consistent with their exercises. Their only problem now is being able to pick up their newborn grandchild. This was their initial problem described to you at the first visit, but we became sidetracked and only focused on the numeric pain rating scale as an outcome. We haven’t asked how their grandchild is doing or determined if they have obtained their goal of holding them in their arms. It may be minute in the grand scheme of medical diagnoses but remembering something this simple can go a long way. With preparation comes less effort. Give yourself time to chart review. Take notes. Go into each session as if it’s the last time you may get a chance to make a life better. There are a good number of people who will only seek our help when they are desperate, let’s surpass their level of vulnerability with preparedness. Being present, listening to them each visit and allowing their concerns to direct our care will ultimately prove most effective. Taking the time to hear them out can be useful if we are asking the right questions at not just the evaluation, but also during follow up visits. Appreciate their learning style and try your best to tailor to it. Understand your wealth of knowledge may only be useful to those that find value in it as it relates to their circumstances. |
Author: YFF
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