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.
We might have different rooms, but we are all under the same roof
The debate of who to trust in our profession is like watching two parents disagree on how their kids should be raised. The good news is that both sides will almost always act in their child’s best interest. In the PT world, we’ve found ourselves in a place where we are stuck eating soup with a fork knowing there is so much yumminess still left in the bowl. At some point, we hope to scoop up this content with a spoon, leaving no good information behind.
I’ve been blessed enough to have had in depth exposure to great minds on both sides of the fence when it comes to comparing physical therapists in the academic and clinical settings. I can honestly say I admire the landscaping on both sides.
The Renowned Professor
The first group of intellects is what we are exposed to in school. This group includes those with PhDs, years of participation in groundbreaking research and even published books. Early in our careers, we spend countless hours consuming their content to grasp a proper introduction into the world of PT before truly getting our feet wet. This group may have had years of clinical experience as well, but usually will have been removed from consistent clinical practice to pursue even more accolades. They are the backbone of our profession; we’ll never make it through this stage of adolescence without them.
The Rockstar Clinician
The second group consists of clinicians who are out in the world carrying the profession in a different sense as they deal with the day-to-day load of patient care. Those at the forefront of this group may or may not have kept up with all of the latest research or even the most up to date textbooks, however, they are idolized by their colleagues and usually sought after for advice on complex patients even by some of the most experienced clinicians. Their approach to PT is probably different than what is taught in DPT programs, but they are getting their patients better consistently.
The Alligators of the Swamp
This last group is a very special one. They have shown the ability to not only run on the land of academia, but also swim in the marshes of patient care with the Rockstar. They value what both groups bring to the table and have found a way to master this art in a manner that an advanced practitioner can appreciate. These are individuals who have pioneered and disseminated their philosophies to the PT community as a whole. If you’re ever wondering what’s being left behind from the fork in the bowl of soup, here is where you will find it.
If you’re striving to be an alligator, you have to first respect how the Renowned Professor and Rockstar clinician are giving you landscape to explore on both sides of the fence. It’s impossible for either group to be right 100% of the time, but the level of intelligence in each provides plenty of fertilizer for you to excel. Stay grounded in why you chose this journey of becoming a master clinician and embrace the pearls you receive from each group knowing you’re leveling up with each patient contact.
Accepting the walk of shame... admitting you were wrong
Truth be told. We are all wrong at some point. Even those with a photographic memory or those described by patients to possess hands that have been “touched by an angel,” occasionally fall short. The impact of these errors come with the actions taken afterwards, not the error itself. As a new therapist, the hardest pill to swallow may be finding a way to tactfully admit fault. It happens on a daily basis. You have a patient you may have progressed too quickly, and they’ve been waiting all weekend to let you know that on Tuesday, they are still sore from their therapy session the previous Wednesday. Better yet, you’re working on balance exercises with a patient in the clinic and they fall after you turn your head for a second, ending up with a compression fracture in their thoracic spine.
Accountability is more than just a 14-letter word
How do we handle these situations? These errors can change the course of your career if not handled properly. The reason organizations implement drills is to diminish and hopefully eliminate these close calls or occurrences. After the fact, we have to hold ourselves accountable. This could be admitting to a patient that you may have advanced their program too quickly, and this response is good information for moving forward on how their body responds to exercise. Or with the patient who suffered a fall, you could let them know you may have underestimated the magnitude of their balance deficits and you should have been more attentive in the moment.
What are we afraid of?
Will be there consequences? Absolutely, but when you hold yourself accountable, you’ll never have to keep justifying why the finger is pointed in the direction away from you. The blame game becomes lame (caught that?). It’s a tough topic, but if we start our journey with a pledge of being accountable for our actions in all situations, it will create a level of clinical maturity that just can’t be taught.
How do we change it?
We take the time to become more prepared and avoid risky shortcuts. You never want to be that guy or girl that is driving a car 75 mph on a curvy road with bad brakes because you were being too lazy to get them fixed. Confront bad habits now and use those occurrences to make your story even better to read. Our peers and patients respect us more when we are consistently honest and genuine. Staying true to these principles, regardless of how much “book smarts” we possess, will keep them fans of us for life.
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