Toni Talks about PT Today : Education

My NDT Course Wasn’t What I Expected

Toni Patt — Wed, 18 Nov 2009 13:02:00 GMT

Last weekend I finally got the chance to attend an NDT course. Even though some of the material was basic, it pulled things together for me. For the first time I feel like I might have a chance at passing the NCS exam in a year or two. Listening to the...(read more)

Deciding When to Move On

Toni Patt — Wed, 02 Sep 2009 16:59:00 GMT

How do you know when it's time to start looking for another job, or in my case, another assignment? For the last two weeks I've been asking myself that question. I've experienced some things over the last few weeks that have made me start to wonder if...(read more)

A Matter of Perspective

Toni Patt — Wed, 19 Aug 2009 20:31:00 GMT

I went to a CEU course last week about motor control. One of the key points of the presentation was the influence of perception on movement. For example, a patient will move in response to the perceived environment. Therefore, if the patient perceives...(read more)

How to Handle Incorrect Information

Toni Patt — Wed, 12 Aug 2009 15:23:00 GMT

I found myself in an awkward situation a few days ago. I had just finished an evaluation in the stroke unit. The OT was preparing to work with the patient, so I gave her a summary of what I had already done so she could be more efficient. I mentioned...(read more)

What is the Value of a GCS?

Toni Patt — Wed, 22 Jul 2009 13:17:00 GMT

Somehow this week during all the normal chaos of life I managed a major accomplishment. I completed and mailed my registration to sit for the GCS exam next year. I'm very proud of myself. Completing the application isn't very difficulty. Making the commitment...(read more)

The Problem with Continuing Education

Toni Patt — Wed, 01 Jul 2009 13:21:00 GMT

I'm a continuing education junkie. I love going to courses. Home study courses aren't bad either. I've had to cut down and limit myself lately because things have gotten so expensive. I will no longer travel for a course, unless it's NDT next year. I've...(read more)

This Was a Learning Experience

Toni Patt — Wed, 13 May 2009 12:22:00 GMT

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...(read more)

It’s Time to Read the Literature

Toni Patt — Wed, 29 Apr 2009 14:53:00 GMT

Last week I had a unique assignment. I was to read an article, present it where I work and report back on the response. Specifically, I was to address whether anyone could follow my presentation and knew the statistics. It didn't surprise me when no one...(read more)

A CEU Course Got Me Thinking

Toni Patt — Wed, 22 Apr 2009 13:41:00 GMT

Saturday I went to a CEU course on neuroanatomy. That isn't something that lends itself to a full day of lecture but I made it through. The last hour or so is a blur. My brain stopped processing before the class finished. The instructor included treatment...(read more)

Computers Are a Part of PT

Toni Patt — Thu, 02 Apr 2009 11:43:00 GMT

My computer was down for a few days. Three calls to the manufacturer later and I'm back up and running. Being computer-less was an eye-opening experience. It made me realize how much I've come to depend on mine. I had to stop and think about how to do...(read more)

PTS SHOULD BE ABLE TO ORDER XRAYS

Toni Patt — Thu, 12 Feb 2009 15:07:00 GMT

This semester my class is Radiologic Imaging. It's an overview of the various radiological studies a PT might encounter, how the study is produced and what each study shows. Each week we have two discussions. One concerns how the study being covered benefits PTs. The second concerns giving PTs the ability to order some radiologic studies for neuromuscular problems. This hadn't occurred to me until this class. It makes sense. We work with the neuromuscular system. It would improve our ability to provide treatment and decrease the expense and waiting time compared to the current system of sending the patient back to the physician for one. The ability would also allow us to determine more quickly if a patient has a musculoskeletal problem we can address or a medical one a physician should address.

As wonderful as it sounds I have concerns. One is that we'll become dependent on radiological studies and lose our ability to diagnosis. Currently we develop a POC based on patient history and objective examination. X-rays and what not are used to confirm what we already suspect, not diagnosis what is going on. It would be easy to become lazy and send everyone for a study instead of performing a thorough evaluation. The problem with that is not everything on a study is painful and not everything painful shows up on a study. Back in my OP days it wasn't uncommon to have a patient who symptoms didn't match the MRI. I could still treat that patient. I wouldn't be too successful with that patient if I only looked at the MRI. What if a large OP clinic decided to buy its own machine? Would every patient automatically get an X-ray?

I'm not saying this is a bad idea. I think it could be a good idea. I just think it needs to be more thoroughly thought out. Everyone in class believes additional education, possibly certification should be a requirement. A DPT isn't enough. Radiology is covered but not in enough detail. By making it certificate based all PTs could have the privilege if they were willing to take the classes. Trust me, it would be more than an 8 hour course. There is more to ordering a study then ordering an X-ray. In order to order the right study I need to know which one is best for what I want to see. I can order all the studies I want. If I order the wrong thing I won't see what I'm looking for. I known many patients who've had multiple studies because the physician couldn't find what was wrong. If that happens to physicians I can imagine what would happen if I tried to order something without proper knowledge.

I also think specific parameters would need to be defined of what a PT can and can't order. There is no good reason for a PT to order a CT of the abdomen. That pt. needs to be referred back to the physician for medical management. The same is true of angiograms, MRAs and nuclear medicine. Those are beyond our scope of practice. If a patient needs one, that patient should be under a physician's care. I can make a pretty good argument against MRIs and CTs of the brain because, again, that patient should probably be under a physician's care. However, if I'm working in a SNF and my elderly patient is deteriorating I want to be able to order a study. Increased confusion can result from an untreated UTI or a slow ICH. A UTI can be treated with antibiotics. An ICH requires hospitalization.

I disagree with my class on one thing. I think the privilege should include PTs who practice in hospitals. Very few of my classmates agree with me. They say the physicians will have already ordered everything. I say we should because we spend a lot of time with our patients. Frequently we notice status and cognitive changes first. Or, we have a patient who just can't walk even though there is no diagnosis explaining why that is happening. Does it matter who orders the study if the end result benefits the patient? I think hospitals might be our easiest target because most reimbursement is DRG based. The hospital only gets so much money no matter what the actual costs are.

We're a long way from being able to do this. Many states lack direct access. Texas is one of them. That seems minor compared to ordering radiologic studies. I'm not sure why we absolutely have to have one to get the other. Ordering a study would change my scope of practice less than having direct access. A radiologist would read anything I order. Insurance companies probably see that differently. It's hard enough to get them to fairly reimburse now. Getting them to pay for something new will be an uphill battle. Either way we're not there yet.

Should I Go To Dallas?

Toni Patt — Tue, 27 Jan 2009 19:51:00 GMT

Which is better? Is it better to earns CEUs doing home study, or is it better to attend courses? I've been having this debate with myself. Like almost everyone else, I have a continuing education budget. In previous years, I've fulfilled my requirement with home study courses. Now there is a course coming to Dallas in March I would like to take. Doing that would deplete my budget but this is something that doesn't lend itself to the home study format. Taking it would also mean no more courses for the rest of the year. I'm a CEU junkie. I like taking courses. I don't know if I can go an entire year without taking anything else.

Both methods have advantages and disadvantages. Home study courses are usually less expensive and can be done at one's leisure. Most of them are only worth an hour or two, so more courses are required. There is no opportunity for interaction with the author. Going to a course provides the opportunity to ask questions and practice techniques. Most courses are at least six hours, which means fewer courses are needed to make the requirement. Normally it's not much of a debate for me. I can manage a one-day course if it's in Houston. The problem is this is a multi-day course in Dallas.

So now I'm asking myself is it worth a road trip? As big as Houston is, very few courses actually come here. I'm lucky if there is one course a year that I would actually like to attend in Houston. Now there is an NDT course, which to me is a must for treating neuro patients, and it's in Dallas. There will be other courses if I pass on this one. There may even be something better later in the year. But I have no way of knowing because it's only January and many providers haven't posted complete schedules.

I don't need to be worrying about this. I have plenty of education coming my way through school. For a small fee I can get a class approved as a CEU and get credit. My problem is I want to learn more NDT. I want to take this course. The debate would be much less if the location was Houston. I eliminate much of the cost by not having to travel. This happened to me a few years ago when the APTA came to San Antonio. I wanted to go, but couldn't afford it. Retrospectively that was a mistake. I should have sucked it up and gone. Now I'm waiting for the APTA to choose another Texas city. I don't want to make that mistake again.

I'll eventually make a decision. The course isn't scheduled until the end of March so I have some time to make up my mind. I'm going to call the company offering the NDT course to see if there are any other Texas dates in the future. I'm also going to do a cost/benefit analysis for the total cost. Maybe I'll be lucky and get a tax refund large enough to help cover the cost. I was going to buy a saddle if I got a refund. This might be better use of any money.

Osteoporosis

Toni Patt — Tue, 24 Jun 2008 14:59:00 GMT

This semester my class is about woman's health from midlife to beyond. We're studying disease processes that typically affect older women. Last week the topic was osteoporosis. I thought that would be pretty basic. It's caused by loss of bone mass. It's treated with weight-bearing exercises. I've never had a patient with that as a sole diagnosis so I thought there wouldn't be much to it. I was wrong.

My eyes were opened. I was surprised at how little I actually knew. At the same time, I found myself making connections between things I knew but never saw as significant. I always associated osteoporosis with compression fractures. It never occurred to me that other bones such as hips and wrists are also involved. I had the misconception that osteoporosis is responsible for broken bones. I learned that falls break bones. You can have osteoporosis for years and never break a bone. Falling will break a bone whether or not the person is osteoporotic. I was right about compression fractures, but wrong that there is no treatment therapy can offer.

I had to stop and think. Fractured hips are one of the most devastating problems an older person can face. Billions are spent annually on treatment alone. Falls are one of the top five causes of death in the elderly. PTs can do something about this. We can teach fall prevention. Reducing the number of falls will reduce the number of fractures. Prevention of one fall keeps one elderly person home longer. Extension and back strengthening exercises have been shown to reduce a thoracic kyphosis. A kyphosis impairs breathing mechanics. Inadequate lung expansion has many nasty side effects.

There are other things we can do. We can include resistance exercises in treatment programs. We can encourage women to become more active. We can promote weight-bearing exercises such as walking. We can educate women on improving their diets and taking calcium. We can encourage those taking antiresorptive agents to be complaint. These drugs work, but take time.

I'm rethinking how I will approach older women patients. I'm going to add some bone strength education and include weight bearing and/or resistive exercises when I can. I'm also looking at myself. Fortunately I'm already doing the right stuff like taking a calcium supplement. I get weight-bearing and resistive exercise when I ride. I'm in the sun a lot so I'm getting plenty of vitamin D.

I'm sharing this with as many PTs as I can. I think others have the same misconceptions I had. I wouldn't have learned differently without this class. I'm sharing in my blog because many of us treat older women. This is something we need to think about when planning treatments and providing education. I have one last thought. While women are predominately the ones who have this, it isn't exclusively a disease of women. Men can benefit from education, too.

A Disturbing Trend

Toni Patt — Wed, 14 May 2008 13:21:00 GMT

The old ladies of therapy have been talking again. This time we were discussing a trend we've noticed. We're concerned because what we've seen doesn't bode well for the future of our profession. None of us are excited with the new graduates we've been coming across. They don't impress us. They don't have the same commitment to the profession as those of our generation. They lack skills. Each of us old ladies had an experience of leading a new graduate by the hand through something because the grad didn't know what to do. These are the up and coming therapists who are supposed to lead us toward Vision 2020 and beyond. I expect better.

Now I'm not saying this is true of everyone who has graduated in the last few years. I've met some wonderful new and recent graduates. I've met some who have knowledge and skill beyond their experience. I've also met the opposite. I've lost count of the students who tell me they only want to do orthopedic outpatient. I can't count the times I've heard someone refuse to do something with the excuse of being the therapist. Worse, I've met several recent graduates who look down on us old gals because we do things "the old way." Does it matter how old the technique is as long as it is effective? Robin McKenzie developed his system over 40 years ago. It has proven to be effective over and over again. By that logic we should throw it out because it is an old therapy.

I'm not sure where the problem comes from. I've talked to professors. I'm taking courses. I don't' think the schools are teaching this. The attitude may be an unexpected byproduct of the learning process. I don't' think it is deliberate. Maybe the selection process inadvertently weeds in these individuals. Us old gals think it has something to do with the generation of individuals entering schools. We've noticed an attitude of expectation. Back in the day when I was in school I hoped I would find a job. I hoped I would make a decent salary. I worked as hard as I could so I could keep my scholarships to stay in school.

This last week I came across two prime examples of this behavior. One recent grad boasted how she could handle anything because she worked for 8 months rotating between several units in a hospital. I doubt that. She had trouble keeping her left neglect patient from walking in a circle right before she said that. I know that place she worked. It was good experience but nowhere near all encompassing.

The second example was a therapist who doesn't want to be a therapist. He made it a point to tell me he didn't like being a therapist. His real job was selling a medical product. So, I wanted to ask, why did you waste all that time in PT school? I would have except I had to walk away before I said something really not nice.

What concerns me is the lack of respect for the profession I see in this. Physical therapy doesn't need individuals who settle for mediocre because it is easy to accomplish. We need individuals who are pushing the envelope for every patient. If I take my horse to the vet I want a vet who not only knows what he is doing but is learning more and willing to stay with my horse as long as it takes. Horses are fragile. So are people. I want my loved one to have the best care possible which to me means someone who knows what to do, how to do it and doesn't mind if it isn't easy.

I know lots of experienced therapists who just get by. That isn't age specific. What is age specific is the apparent lack of knowledge and skills. Maybe I'm totally wrong. Maybe what we're seeing is uncertainty or fear of being wrong. As I initially said, it isn't every one. Us old gals were just talking. We're old. We could be confused. I hope we happened to pick up on the outliers rather than the trend.

Give Me What I Paid For

Toni Patt — Mon, 28 Apr 2008 12:35:00 GMT

My online class is wrapping up this week. I can't say I'm unhappy about that. The class was a big disappointment to me. This was a graduate level class. I paid regular college tuition to be in it. I spent over one hundred dollars on books. I don't think I got my money's worth. I think for what I paid, I should have gotten a lot more class. I spent half of the semester trying to figure out what I was supposed to be doing. The other half was spent getting everything done before the deadline.

I really hate it when you paid for continuing education and walk away feeling like you didn't learn anything. I pay out of pocket for all my continuing education. I don't have a big budget so every course has to count. I'm required to get CEUs to maintain my license so I might as well learn something in the process. The worst class I ever attend was a few years ago. It had good billing and was sponsored by an organization with a good reputation. I can't tell you how disappointing it was when the class consisted of the instructor reading directly from the manual I received as part of my tuition. Even worse, he got confused if he deviated from the topic.

Another thing I hate is when I feel like I know more than the instructor. This becomes a risk as more classes are taken. I've taken "advanced" classes and felt like they should have been introductory. I paid money to learn from the instructor's expertise. If someone is teaching a class, I have the expectation that he or she is knowledgeable in the topic. Now I've had some excellent instructors. One of my favorites was a pharmacology course for PTs. That woman knew her stuff. She was also a good teacher.

Lately I've been using online and home study courses. They aren't as expensive and can be done as my time permits. I've found some very good ones through the APTA. If you're a member they are reasonably priced. Reading a booklet isn't the same as asking questions. Once an instructor looked at me like an armadillo in the headlights and told me he couldn't answer my question nor would he make the effort to research the answer. Hmm, maybe self study isn't so bad. That was another unmemorable learning experience. Lucky for me university courses count for CEUs. I have a few more online courses to take so I'll be set for awhile. Who knows after that? Maybe I'll teach a course.