Critical Thinking

Passion and Purpose

I recently spent 2 weeks in a marathon course with 31 second year physical therapy students. As part of the course, we brought in real, live patients, and the students had the opportunity to evaluate and treat them over two visits. This was the first time that these students had the opportunity to try out their new skills on real patients. It was amazing to watch these students, who had been sleeping through my lectures, come alive. They were full of passion and excitement over their ability to connect with and help their patients.

Watching these students reminded me of how I felt when I first started my career as a PT. It also reminded me that it is so easy to lose that passion and excitement. I could picture the stagnant PTs I have worked with over the years who, in the words of ZdoggMD (star and creator of classic videos such as A Hazombierd Docs Life, Hemorrhoids Rap, Diarrhea: The Musical and Manhood in The Mirror) had become disconnected burned out Zombies with a goniometer.

I am not sure exactly what causes this burn out. Perhaps it is things like the 8 minute rule, G codes, functional goals, plan of care, defensible documentation, practice act limitations, KX modifiers, Form C-4, C-4.2, C-5, high co-pays, productivity standards etc… which make us forget why we became PTs.

I have two (related) questions for you.

1)How do you keep yourself from becoming a thoughtless zombie physical therapist?

2) How do I help my students avoid becoming thoughtless zombie physical therapists?

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Categories: Critical Thinking, Education

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7 replies »

  1. 1) I got out of the outpatient world…not permanently, but to recharge and re-assess. Locally, in the home care setting, 7 patients per day is considered overtime. 30-45 minutes with each patient individually is the standard. The therapist is afforded the opportunity to provide genuine care as they see fit. While there is little special testing and diagnostic/direct access care to be provided, the opportunity for genuine and thoughtful patient interaction is something I cherish.

    2) As far as the student’s are concerned…the same kid that might sleep through a lecture on one topic might be excited about another, no? My goal as a CI (starting again next week) is not to kill the enthusiasm the student might have coming from their academic institution while still challenging them. I aim to get them to think differently about how they might consider caring for a patient without creating dissonance. Most importantly, I reinforce the importance of creating a therapeutic alliance with each patient; I know that I am likely the only CI they will have that has an opportunity to stress this most important aspect of their role as a physical therapist. Hopefully, a focus on each patient – and spending time with them – will keep the zombie at bay. If not, he/she will have another 3 affiliations to learn how cool it is to hear that cavitation with a HVTM, how to use a tool to scrap a patient’s skin, or how to stay “busy” managing a caseload at an outpatient clinic.

  2. 1) I think pushing residencies and fellowships play an important role her. Reading the new research, learning and researching new treatment models/techniques, and then implementing them directly into clinical practice and seeing the positive outcomes is very exciting. Similar to what Keith said I think it’s important to mix up the type of patients you see, whether in the same setting or switching settings. And don’t see a lot of post ops, those are boring and they suck.

    2) As far as this, as a CI the main way is to challenge the students, make them think outside the box, and make them see the results which should excite them. Classroom was always kind of boring for me in some aspects, however I couldn’t wait to get out in the clinic and actually use what had been getting delivered to us in the classroom for a while. I try to deliver research articles/education that I know they aren’t getting in school (i.e. graded motor imagery, chronic pain/success stories of chronic pain, and out of the clinic demonstrates such as ergonomic assessments.) Today my student was excited over us using a mirror for mirror therapy for the first time, that was pretty cool.

  3. Regarding my answer to 1), post ops are boring in the sense that they cannot handle much, however these are some of the best patients to educate as they most likely have been in pain for quite some time even before having surgery. Providing education to these patients bout the pain process is quite enjoyable. Sorry for any confusion, thank you Keith for asking me about that.

  4. I work in the Netherlands, without contracts of health-insurance companies. Because of that untill now, I can focus on my patient instead of how I write all things down. Of course I write things down, but only in a for me functional way, to remeber my clinical reasoning by this particulair patient and where we are in the proces and progress. Furtherone I only do therapy that is provocative related. Only when the patient feels that the therapy targets his problem, I feel I get succes. There by I am looking for THE single home exercise in the right dose. Hands – off therapy on a regular dialy base (6 to 8 times a day for 1 minute) gives a lot of succes on patients that were not succesfull by following former passive therapies. To make a difference by so called difficult chronic patients in 5 to 6 sessions to continue then the therapy (if still necessary) gives me a daily boost. I must say I took me a few years of experience and studying to get there. The McKenzie system helped me there at most..

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