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Journey of a DPT Student

A Hands-On Profession

Published December 23, 2013 4:08 PM by Lauren Rosso

When I take a step back and think about the concept of "personal space," I realize that it doesn't exist in the PT world. Three years ago, if I had to poke around a stranger's greater trochanter or get up close and personal for a transfer, I would have heard that natural alarm in my head saying "you're way too close to this person right now... and it's awkward." I'm amazed at how desensitized I've become. That being said, recognizing this type of physically based interaction also makes me realize that for patients, it may be something completely foreign.

There's no getting around the fact that PT has to be hands-on. I remember reading an article about expert vs. novice clinicians, and one of the major differences was that experts had a lot more "hands-on" time. It's important. For a patient, I can imagine that the 10 minutes you have between first introduction to the therapist and the start of the physical exam is surely not enough time to feel comfortable with a complete stranger trying to find your PSIS. I've made an effort lately to say a sentence or two about the way PT works, why and when I'll be putting my hands on the patient, and what I'm looking for. It seems to help, but I'm sure it's still slightly alarming for some patients.

Inevitably, there are going to be people who just don't feel comfortable with the invasion of personal space. In that case, I'm not sure what to do. I think hands-on skills and interactions are an invaluable piece of what we do, so I've taken the approach that it's my responsibility to make people comfortable and knowledgeable about what to expect during their physical therapy course.

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Great post on a great topic. As a male in the profession I think this can be a particularly sensitive subject. In my experience, although limited as a 3rd year student, there is more "awkwardness or apprehension" from female patients working with male therapists vs. female therapists working with male patients. I understand this could be my own bias and/or me projecting my own discomfort onto the pt. therapist interaction. Two things that I realized over my final clinical rotation on this subject: 1) Your confidence can make them feel more comfortable. So be confident. Remember you ar doing something totally appropriate and beneficial for the patient. and 2) communication is key! Explaining what you are going to do and why you are doing it, can go a long way to ease the situation for all parties involved.

Justin L March 26, 2014 12:34 PM

This is a great blog post of how I felt when beginning our program versus now. I'm still a first year, but at the end of our third semester it's not as awkward to palpate someone's ASIS or illiopsoas than as a few weeks after classes began in the summer and palpating a personal place with someone you barely know- all while watching their "facial expressions" (i.e. making awkward eye contact). As students, we are so used to palpating and touching one another so much that it is not a big deal to us anymore. Your post is an important reminder that although we are comfortable with it, our patient is not always comfortable. One of our jobs as physical therapists is to make the patient as comfortable as possible. Therefore, we always need to remember to warn the patient beforehand, introduce ourselves, and ensure the patient feels as comfortable as possible. This was a good reminder before I go on my first clinical in a few weeks, and something everyone in this profession needs to do.

Mary, SPT March 10, 2014 1:29 PM
Greenville NC

As a first year DPT student about to go out on my first clinical I've been thinking about this topic a lot lately. So far our patient interactions have been limited so I feel far from desensitized about personal space. We've been told it's not awkward with patients because they understand there's a reason behind the interaction. While that's true, I feel like my lack of experience will show and make matters worse when I am so caught up in what I need to do and forget about making them comfortable. I think I'll use your approach of taking the time to explain how PT works and why I'm being "hands-on". I imagine this will also help me get my thoughts straight while I'm still learning and building good habits. It's great to read the perspective of someone who's had the experiences that are in my near future. Thanks for sharing!

Liz Windsor, , SPT ECU March 9, 2014 9:03 PM
Greenville NC

What a great post!  As a 3rd year DPT student I completely agree about the desensitization of personal space.  To your point on making sure to communicate with them on what you are about to do and why, is something I still need to work on.  There are many times where I will follow my brains thoughts and go straight to what I want to do.  I won't even realize I made them uncomfortable until I see their face or my CI reminds me of the need to preface the assessment with what I am about to do.  Most patients do not mind and recognize we are well trained and we are only encroaching their space for more answers or better results.  However, it is still a good idea to go ahead and state your purpose for each patient so you don't run into an uncomfortable situation.

Nathan W March 2, 2014 2:18 PM
Greenville NC

Dean- thanks for the ever-positive feedback!

Lauren Rosso December 29, 2013 7:39 PM
Pittsburgh PA

I think that as you continue to build your skills and, importantly, your confidence, patients will pick up on that and be more at ease more readily with physical contact. That you take the time to provide and explanation is brilliant and I'm sure very welcomed by your patients. You'll get there!

Dean Metz December 24, 2013 5:22 AM

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