Critical Thinking

Fellowship Journey: Part 1

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When I began my Fellowship journey in January 2012, I decided to enroll with Sports Medicine of Atlanta.   I decided this was the right program for me for several reasons.

  • It had a large focus on “introspection“.   To me, this meant a lot.  Introspection is simply a self-reflection over my thoughts and feelings of particular situation.   This program offered tools which allowed me to look at how I was thinking with each patient interaction.  It reinforced the cognitive and metacognitive aspects of clinical reasoning.
  • It was small enough that I could have direct interactions with the faculty on a regular basis.   I was not looking to attend a bunch of classes or learn a bunch or “tricks”.  I was looking for a program that could garner a significant amount of 1:1 interaction to challenge my reasoning for everything I was doing.
  • The outcomes identified for my completion of fellowship were individually tailored to meld with my professional development plan.  I had goals of not only becoming a better clinician (which was a large focus of fellowship) but an educator as well.  Through mentorship, I was able to develop better educational courses and tools in addition to becoming a better manual therapist.

During the application process, there were several essays that I was asked to complete.  Below I have pasted “My Reason for Being” (***Note this essay was written over 2 years ago during my application for fellowship).   What is your professional reason for being?

My Reason for Being

By: Joseph Brence, DPT

As a young Physical Therapist, I can say that I am truly proud of what I do.  Maybe this is because I have molded a career path in which I not only have attempted to treat patients, but also have attempted to understand why my treatments are effective.  I have seen the rut that many clinicians get in, and have been determined to develop ways to better our profession and assist in forward thinking.

Growing up in a rural town, I was taught to work hard and appreciate the results one gets from fine work.  I always had a business mindset and would look for ways which I could self-provide.  At the age of 14, I negotiated a deal with a bus contractor, that I would clean his buses better than anyone else for $5 per hour. I won the bid.  A year later, this contractor hired me to work on his farm, which I did for several years.  I decided my new found laborious skills could be used elsewhere, and took on an additional role in an ice factory, as an assembly line worker in a -10°F freezer.  These opportunities led me to gain appreciation of manual laborers and the physical toll these professions have on the mind and body (my boss at the ice factory only had 2 fingers on one of his hands; the other three were lost in machinery).

Today, I operate an outpatient Physical Therapy clinic in an urban atmosphere that treats a large workers compensation base.  Despite many physicians and nurse case managers looking at these clients with skepticism, I believe every complaint my patients have.  This is my job.  My job is to help them get better.   My job is to eliminate their pain.

Pain is a fascinating thing to me.  The majority of the clients that present to me (as well as other outpatient therapists) have a primary complaint of pain.  The majority of clients who present to any outpatient physical therapist present in pain.  I differ from most therapists in the fact that I suspect that many simply don’t understand, the most common thing they say, they treat.  I have worked with “joint-heads, muscle-heads, fascia-heads, and disk-heads (thanks Dr. Jason Silvernail for this terminology)” and have found that many clinicians erroneously blame a certain tissue for a patient’s pain.  They ignore that pain is a complex output from the brain which can be modulated due to past experiences, the context in which the injury occurred, etc.  Tissues do not cause pain.  Pain occurs because the brain determines there is a threat or the potential for a threat to tissue, and pain is a means communication to protect it.   

My professional reason for being is to help treat individuals in pain and to help other professionals better understand how pain occurs.  Since a young teenager, I have always worked hard in an attempt to make a difference.  As a professional, I not only believe that I have the obligation to help my patients, but any individual who experiences or interacts with pain.   

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