Become Your Patient’s Favorite Teacher
It’s always interesting how life comes full circle. One of my favorite teachers growing up was my kindergarten teacher, Mrs. Griswold. She had a knack for controlling her classroom and connecting with her students. Fast-forward more than 25 years later and being in a new city over 100 miles away, I ran into her granddaughter at my new place of employment who is now my coworker. I found myself filled with euphoria just hearing her last name. I was unaware of the effect she left on my life, but in retrospect, my love for school started with her.
“A good teacher can inspire hope, ignite the imagination, and instill a love of learning.”- Brad Henry
As said before, it’s easy to assume the best teachers are always the smartest or most accomplished, but there is something to be said about developing a connection with your students. Oddly enough, as a teacher, you may not even know the connection exists. Sometimes your explanation of concepts and ability to tap into different learning styles leaves an imprint that can never be erased. Mrs. Griswold didn’t teach me long-winded algebra equations or quantum physics, but she sparked a fuse for my desire to learn. If asked, my mom will tell you that I was never the kid that needed to be coerced into going to school or reminded to do my homework. She may even add that I didn’t need to be prompted to do my chores, but that may be a bit of a stretch. We’re all perfect. Right? It was worth a try.
Don’t Ruin Their Movie
I love when a patient tells me how great their previous course of physical therapy may have been and how much they adored their physical therapist (PT). I make it a point to ask what made them switch to a new PT and what did they enjoy about their experience with that particular therapist. You will often find that the therapist was able to get the patient to “buy-in” to their approach to treating their condition in one way or another. You may also realize what the patient recollects about the experience wasn’t necessarily the most up-to-date treatment approach or even anything remotely close to evidenced based practice.
Here lies, your defining moment.
Do you dig up the roots and chop down the tree from the seed their favorite therapist has planted, or do you insightfully find another way to shed light on it? On paper, the latter seems very near common sense. In the real world, however, we may find this encounter to be draining and cumbersome causing us to go out of our way to convince the patient they were not receiving best practice. I personally, find it harder to point out the good in what could have been a less favorable way of delivering care. It is way easier to just create a new slate and just hit them with the facts! In reflecting on these situations, is it worth ruining fond memories for that person? If my 2nd grade teacher had gone out of her way to persuade me that Mrs. Griswold was a horrible person and was mediocre at best as a teacher, my tree would have succumbed as well. We as a profession, promote independence and accountability in healthcare. If your patient is on the path to “pursuit of healthiness”, don’t be the nail that flattens their tire.
Your gluteus maximus is innervated by the inferior gluteal nerve.
We get it. You’ve studied and have worked hard to become a specialist. Don’t fail your patients by not meeting them where they’re at, irrespective of their level of education. If your patient only understands 25% of what you explained to them, how much of that is converted to “buy-in”? I’m sure anyone who has worked in pediatric healthcare will agree that how you educate a child can be the polar opposite of teaching an adult, even when you have to inform both simultaneously. Of course, in that setting, it seems more obvious, but when you have a patient with a graduate level degree or a 10th grade education and/or may be at risk of losing their job because they can no longer perform it, it’s not so simple. Consider the person in front of you as a whole, not just an assigned diagnosis. In doing so, you may create a relationship that inspires them to see the light at the end of the tunnel, hopefully before the batteries in your flashlight loses power.
New Year… New Me
Or is it? Personally, I love this time of year. I know people get tired of hearing everyone’s New Year’s resolutions that will most likely fail, but what other time of the year can you get so many people to even consider making themselves better at the same time? There are some things that you must consider moving forward and now is the best time to reflect. It’s not so much about setting up a resolution, it’s more about reflecting on which systems did not work well for you over the past year and which made you more refined. What skills did you acquire? Did you implement them? Are you proficient at them? What diagnoses did you see for the first time? What did you learn from that experience? Did you fail at anything? If so, how can we ensure the same mistakes don’t happen again?
"Let go of the past, but keep the lessons it taught you." — Chiari Gizzi, Fearless Soul
Some say you should leave the past in the past, but if you don’t look at where you’ve come from, you might miss out on how far you have made it. Tread lightly and be careful not to stare, you may get enticed into making the same mistake twice. As you’re driving in the opposite direction of who you were at the beginning of last year, you may fail to appreciate that you have transitioned from steering your sedan over a bumpy, dirt road to now smooth sailing on an open road with very little traffic. Of course, there were times where you may have lost control of the wheel a little or made wrong turns, but you’re here. Take a moment to give yourself credit for your growth. It’s easy to overlook how much you’ve blossomed if you let your failures overshadow your gains.
We are not taking a stroll on the beach here. We are learning to adjust to weather changes that are both anticipated and fickle. Some days will be sunny with a 50% chance of showers, while others are nothing but heavy rain with a 0% chance of sunburn. Either way, our goal is to always perform at a high level. I mentioned earlier about reflecting on which systems did not work well over the past year. This concept of "systems" isn’t new at all.
“Goals are about the results you want to achieve, and systems are about the processes that lead to those results”— James Clear, Atomic Habits.
In fact, you may already have a few in place such as preparing your work clothes the night before, so you’re not surprised by a shortage of clean laundry or even food prepping to take the decision making out of your morning routine. In both circumstances, you had a goal that was able to be attained by establishing systems that increased your probability of becoming successful. These same habits can certainly be translated into your day-to-day pursuit of professional goals.
So where does this leave us today on our excursion of becoming The Rockstar clinician for most and The Alligator of the Swamp for a chosen few? It places us in a position of strength and gratitude as we take the time to balance our checkbooks, as my grandmother would say. Reflect on situations over this past year with the intentions of seeing how each one made you a little better as a person and clinician. Did you express empathy in times of need, like when a patient has lost a family member while under your care? Did you empower those that may have felt helpless before seeing you? Did you teach or learn from a colleague when given the opportunity? Did you Shut Up and Listen to your patients when they felt like they weren’t improving? Did you admit when you were wrong or weren’t the solution to your patients’ problems? Sometimes it’s not a clear cut yes or no. The growth comes from acknowledging these efforts and allowing yourself to mature as a clinician from them. Let’s start the year with a challenge of embracing these experiences collectively, personal and professional, to help strengthen our footing as we push forward into this new year.
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.
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.