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Toni Talks about PT Today

This Was a Learning Experience

Published May 13, 2009 8:22 AM by Toni Patt
Recently I had the opportunity to work with a different PTA on the rehab unit. She'd worked there off and on over the years and more recently has been filling in as needed. For some reason I hadn't met her previously. I'm sorry to say I wish I would have missed this opportunity as well. Before I go further, I must say I'm not picking on PTAs. Over the years I've worked with many wonderful ones. This woman was the exception. I mention her because I learned from her mistakes.

I knew there would be a problem almost immediately. She tried to rearrange her schedule with an abundance of orthopedic patients. It wasn't that she wanted to change the patients. It was that she came in after many of us had already started our day. Making changes would have been difficult for us. She was scheduled to fill in one day. When you fill in, you take what you're assigned. Later she tried to help me transfer a patient. He was a larger man with a dense hemiplegia. I'd been working with him for a few days and had a transfer technique that worked. As soon as she came into the room she wanted to do everything differently. I don't mind someone making suggestions. I do mind someone coming in and telling me how things should be done without asking me why I was doing them differently.

By lunch I'd decided to stay out of her way. She obviously had her own way of doing things that worked for her. She'd made it clear earlier she wasn't going to change. Then she brought up evidence-based practice. She was tired of hearing about it. She missed the days when you could do whatever you wanted. She didn't think she should have to do anything different. She'd been doing the same things for years and had good results. I can't even describe all the things that went through my head.

This woman is an example of one of the challenges facing PT as it moves toward 2020. She is stuck in the "old way" and is refusing to move forward. The DPT can be debated on end. Having treatment interventions supported by research makes sense. Medicine has been using evidence for years. Having evidence to support what we do is a necessary part of practice. With evidence we can defend interventions to third party payers, to other health care professionals and support our requests that patients receive continued therapy or defend why someone is ready for discharge.

After listening to her I realized how difficult it's going to be to move our profession forward. She couldn't even tell me what she meant when she said evidence. I can't imagine her doing a literature source for answers. In her world she has no reason to do things different. She believes her treatments have been successful. She is one person. Now multiply that by the number of PTs and PTAs out there who feel the same way. All the education in the world won't do a thing if those therapists don't buy into the vision of what we want to be. I'm beginning to think that Vision 2020 is going to be Vision 2030 because the only way those individuals will change is when they retire.

As I said, her presence was a learning experience for me. I saw firsthand what we're facing if we want direct access, autonomy and the like.  Now I have a better understanding of how someone on the other side of the issue sees things. I also understand why someone might think Vision 2020 isn't that important. Whenever she's back I'm going to talk to her. I won't try to change her mind. Instead I'll try to explain my thoughts and hope for understanding.

2 comments

It is amazing how the profession has changed and if one does not keep up with evidence then they will be left behind.  

We are fortunate that we have good research available for us to access.  It is sad to see and hear that others could care less about moving on, they are not seeing a larger picture of where the profession will be.  

Hopefully there will be a place for them.  Toni, right on, go talk to her, educate her for all of us.  

Jason Marketti May 13, 2009 10:26 PM

Toni,

I feel for ya!  I am currently dealing with a similar situation only...my counterpart involves a physician.  

To lay the ground work...I had seen a patient from this physician about 3 months ago.  She originally came to me because she had developed numbness in the toe...saw the MD, but by the time she came to me, it was resolved.  During the eval, she does report a more than 15 year history of back pain after a coccyx fracture years ago.  She'd been "living" with it and it didin't really seem to affect her function, but she was willing for us to take a stab at it to see what we could come up with.  Long story short, I could never replicate the symptoms through the spine, but several SIJ tests were positive. After 6 visits, we could not relive her symptoms, but she could complete all her exercises without worsening. At this point, I sent her back to the physician.  A day or two later, I had a hysterical call from the physican's office manager (who happens to be his wife) freaking out that I didn't do electrical stimulation on this pateint.  After a long drawn out conversation (I won't even get into the details about how off her rocker this woman was), she stated thay THEY were the doctor and that they make the decision and would send her for further testing (fine by me...that was my whole point of sending her to the doctor).  

Fast forward to yesterday. I saw a patient from the same physician who is one week s/p MVA with a remote history of cervical fusion with constant neck pain and intermittend UE pain.  At this point, all cervical motions increase symptoms, but do not remain worse...yet she's very uncomfortable and in siginicant pain.  It obvious she's still in a chemical pain state.  She also smokes and is seeking litigation.  The physician's orders state "PT for modalities and HEP"...OK, knowing what happened with the last patient, I at least checked on my plan of care that modalities/physical agents would be used "prn."  In the back of my mind, I really just intended to have the patient continue the hot/cold at home.  Yet, I never mentioned e-stim or US and just left it at that.  Really, I was just trying to avoid having that conversation with the Dr.'s wife about the lack of evidence...yet, I was perfectly willing to complete the modalities IF the patient cannot complete the needed exercises or procedures.  Well, I got that phone call again...she didn't even want to talk to me this time...fine...talked to my supervisor who went around with the whole lack of evidence with modalities.

At this point, I don't know if they are mad because I was at least willing to consider modalities or that I didn't do them with the first patient who really wasn't bothered by their pain in the first place.  

The point is...this is family doctor who probably doesn't know the first thing about PT. So here I am with my DPT, 9 years of experience, a certificate in mechanical diagnosis and therapy. I read the literature weekly...spine, journal of MDT, Archieves of physician Medicine and Rehab, PT, etc.

I question when the last time was that this physician picked up a PT related journal...if ever...yet HE gets to make the decision about PT treatment? C'mon!

Christie ,,, Physical Therapist May 13, 2009 6:13 PM
Streamwood IL

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