Toni Talks about PT Today : Student Issues and News

Workaholic or Hard Worker?

Toni Patt — Wed, 26 Aug 2009 21:40:00 GMT

Anyone in the profession of physical therapy knows there are several areas of contention surrounding the move to the DPT. Some I think are valid points. Others, I don't see the problem. One irks me to no end. I don't understand why a new grad DPT is able...(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)

Are We Ready for Direct Access?

Toni Patt — Wed, 10 Dec 2008 14:09:00 GMT

This semester I'm taking a class addressing differential diagnoses. Its purpose is to prepare me to screen patients for medical problems prior to initiating therapy. Each chapter covers a different system and reviews the signs and symptoms of medical conditions that might mimic physical therapy diagnoses. The purpose of the class is to prepare me to practice in a direct access environment. Though the class has barely begun, it's been an eye-opening experience.

Before starting this class I would have told you I know this stuff. I would have said since I work so much in acute care, I'll recognize the difference. I would have been wrong. We've barely covered the patient interview, and I've found myself inadequate. Who knew to ask such questions? Working in acute care has spoiled me. I always have a current H&P to work with. The medical conditions, PMHx, home meds, etc. are written down for me. Until recently I didn't realize what was involved in getting that information. Any PT will agree that getting useful information from patients is difficult at times. It would be next to impossible to get this kind of information if you didn't know the questions to ask and what to ask in follow-up.

Even though there is a lot of information I don't think it will be difficult to learn. As I get into the readings I'm seeing some logic in the process. By the time I finish I should have no problem knowing how to obtain the information and what to do with it. I have an excuse for my lack of knowledge. This wasn't taught when I went to school back in the day. I've yet to see a CE course covering the material. Until this class I hadn't had an opportunity to learn. DPTs are exposed to this during the education process. The patient interview process won't be a problem for them. What about everyone else?

My understanding is that as we move closer to everyone being a DPT, those of us who aren't will be grandfathered along enabling us to keep practicing. I don't think additional education of that nature will be required. If I'm correct, therapists who aren't DPTs will be able to practice as one. In a profession that is pushing for direct access across the board that scares me. It's all fine and good to say existing PTs can continue to practice. The problem I see is allowing those same therapists to work in a direct access setting without requiring them to have the same education. I'm not talking about therapeutic skill. I'm talking about knowledge and liability.

My understanding is that no restrictions will be placed on the grandfathered therapists. I speak from experience when I say in this area there will be a knowledge gap. My textbook is filled with case studies illustrating instances when a PT did and didn't pick up on an alternative diagnosis. I have no reference point to say how rare such instances are. All it would take is one major mistake and someone's career would be over. I wonder if the APTA has thought of this.

I don't want to get into the "everyone needs to be a DPT" debate. I now think someone practicing in a direct access setting should be a DPT. Maybe the PT world is debating the wrong subject. I know many PTs with strong opinions about the DPT, but no one who has any opinion about direct access. I can make a strong argument either way using exactly the same information. Among my friends the general consensus is it won't happen anytime soon because insurances and physicians will resist. That may be true. But if it were to happen in 10 years the majority of us would still be practicing and no more prepared than we are now. There are a lot of therapists in my age group this will affect. Are we going to be prohibited from practicing in those settings because we lack the knowledge deemed necessary to do so? If there is a sudden rush for transitional DPTs, the schools will be overwhelmed. The process takes between 1 to 3 years. It might be a solution for some but it won't be timely.

I have no idea what the answer to this might be. Maybe I'm creating a problem where none exists. I might be reading more into this than is actually there. I'm basing my comments on myself and I went to school a long time ago. The curriculum has changed so much it might not be a problem for more recent graduates. We live in a sue-happy society. I can easily imagine a PT being sued over less. As soon as I started reading the first chapter I started thinking about this.

We Need to Work Together

Toni Patt — Tue, 22 Jul 2008 13:09:00 GMT

In the latest issue of PT Magazine, Sharon Dunn, PT, PhD, OCS, talks about the need for PTs to work together no matter what degree they have. Throughout her article, Ms. Dunn provides examples of difficulties she believes PTs are running into as the three degree levels merge into one profession. Her intentions were good. But for some reason Ms. Dunn used her article to defend DPTs and tell the rest of us how we need to change. She relies on generalizations based on things she has heard rather than research to make her points. After reading the article I was offended. Why does all the responsibility to make things work fall on the rest of us?

One example she brings up is that PTs and DPTs were raised in different environments. I, and others in my age group, grew up using talking to convene information. You said what you needed to say. DPTs on the other hand grew up in the information age where everything is immediate. According to Ms. Dunn this results in communication problems because DPTs will tune out PTs if they take too long to get the point across. She refers to this as expecting information now. I refer to this as being rude. Common courtesy is to listen to someone while he or she is speaking. Tuning someone out because they are taking too long is rude. I don't care when you grew up.

She also brings up what she refers to as a difference in work ethic. DPTs, she believes, have found the balance of work and leisure. The rest of us are workaholics who become burned out, used up and bitter. Ms. Dunn failed to consider that work environment and the pressures of providing health care are responsible for being overworked. Fewer people are asked to do more. For those of us with a work ethic that means occasionally we take the extra patient or stay late a few minutes to get everything done. Where is the value of leaving on time if things are being left undone or incomplete? The patients that the DPTs are missing because they've gone home are falling to the rest of us to treat. Yeah, that makes me overworked.

She does address what she refers to as the "unteachable" attitudes of DPTs. Instead of telling them to get over themselves and recognize experienced PTs as a valuable resource, the rest of us are scolded. We are not doing enough to make the DPTs want to listen to us. PTs are instructed to take a DPT to a legislative session. When do I have the time? I'm overworked. We're instructed to incorporate evidence into our practices. I thought we were doing that. We're also instructed to become more comfortable with technology. Since you can't function in today's world without using technology I'm not sure what she means. Nonetheless these things will make DPTs more willing to listen to us. I have a suggestion. When they are students, tell them they will fail if they don't listen to their CIs.

I don't think her proposals are going to help us work together any better. For that to happen, each degree level needs to respect the others. We need to recognize that each group has something to offer and be willing to learn from each other. I'm not going to think much of someone who doesn't listen to me and thinks I don't know anything. Just like a DPT isn't going to listen to someone who thinks he knows it all but doesn't. I work with someone like that. No one listens to him. Eventually we'll get it worked out. In the mean time, I think a little flexibility and respect will go a long way.

Therapy is an Automatic Response

Toni Patt — Tue, 20 May 2008 14:43:00 GMT

I was sitting with a group of friends this weekend during a lull in the horse show. Everyone was complaining about being sore. Listening made me realize two things. First, people don't adequately stretch on a regular basis. Second, I was the only one it occurred to do something about the situation. I'm a PT. I immediately started developing plans of care and interventions while everyone else was still complaining.

That's the nature of being a PT. We see someone with a problem and we want to fix it. PT school teaches what signs and symptoms to look for when making a diagnosis and treatment plan. I look at people and can tell something is wrong. I don't think I'm alone in this ability. Therapists are able to look at people and determine something is wrong. The only question to me is which came first? Was it the desire to help people that made us therapists? Or did becoming therapists improve our abilities to notice dysfunctions? This is similar to the chicken or the egg question. We need to have one to be able to do the other.

The nature of being a therapist is to help individuals. To do our job we rely on both subjective and objective information. I look at someone with a neuromuscular problem and a treatment plan pops into my head. I can't help it. That's the way my brain works. I have to hold myself back when I see someone using an assistive device incorrectly. I just want to go over there and teach whomever the correct pattern. I bet I'm not the only one.

PT school teaches us what to look for to make a diagnosis. It refines a skill we already possess. It gives us the vocabulary to describe what we see. For most therapists, providing therapy is a drive. We can't not do it. Thus we find ourselves in PT school learning the skills to do what we want to do. Then we go to the clinics and practice what we've learned.

I gave my sore friends mini-massages this weekend. Putting my hands on someone to provide treatment is second nature to me. It's what I do. It's almost an automatic response. The only difference this time was my patients weren't elderly or confused. I think all PTs have this response. It's what we do, so we do it. It's why we became PTs.

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.

Back in the Lab Again

Toni Patt — Wed, 27 Feb 2008 21:28:00 GMT

I spent last weekend in Dallas. I had to go there for a lab for my online class. Three one day labs are required. This was the first. It was also my first venture into onsite graduate education. My first class was 100 percent online. All the lectures were downloaded. I completed assignments and submitted them electronically. I never met anyone fact to face. Even though I was doing school work it didn't feel like school. Working at my computer with my parrot on my shoulder just doesn't feel like school. Being in the classroom and sitting at a desk felt like school.

The most exciting part of the agenda was a visit to the anatomy lab. Since this is a cardiology course we looked at hearts and related structures. The first thing I realized when I looked at those things was how much I've forgotten. The second thing I realized was how much I've learned since I took gross anatomy. I learned more from that hour in the anatomy lab than I would have gotten from hours of lecture and textbooks. There's nothing like seeing to understand. When I looked this time I knew what I was looking at.

My memories of gross anatomy are of struggling to identify structures while memorizing origins, insertions and actions. I might have looked at something else but I wouldn't have remembered it. My entire focus was on learning the anatomy and passing tests. I didn't have time for added significance. This time I knew the anatomy. Instead of focusing on what I considered why and how. I know the aorta carries oxygenated blood. I'd forgotten how large it is. I know what a AAA is. Now I know where it occurs. I had the opportunity to feel calcification in an artery. Now I know the mechanism by which it causes problems.

This got me to thinking. What would happen if I were able to retake PT school? Would I learn all kinds of new things that I missed the first time? I know I would ask different questions. I wonder how much I missed as I struggled to put a whole lot of information into my head in a seemingly short time. Would I be a different therapist now? I'm certainly a better student. Of course one class a semester is a little different than a full course load. Back then I dreaded exams. Now I look forward to them to as a chance to use my mind.

At lunch the four of us sat around talking about school. We all felt the same way. We are in school now because we want the knowledge. We want to do the work. We're all about the same age so that might slant our opinions. That doesn't mean it isn't something to think about. I work with two therapists who have about 4 years experience each. Both have master's degrees. One is adamant about never returning to school. The other expects to in a few years. Compare that to people almost 20 years older having a similar conversation at lunch. It makes me wonder.

Right now I'm enjoying myself. I'm working on a certification in geriatrics which only requires 4 classes almost all of which are 100 percent online. I might feel differently if I was looking at a 30+ hour curriculum or actually had to go to school. I've also been out of school more years than I want to admit. That might make a difference. Right now I'm learning things I can use immediately. That's what is important.

*** Anyone interested in the geriatric certification should go to http://www.twu.edu/. Go to the school of PT and follow the prompts.

Would you look at this Website!

Toni Patt — Wed, 21 Nov 2007 13:04:00 GMT

This fall I returned to school. As a result I've been spending a good amount of time online. This has led to many discoveries. One of those is the APTA webpage, http://www.apta.org/. I knew the page existed. I'd been there a few times. I didn't know all that it had to offer. To complete my homework I had to do research. Doing research forces me to explore the web to find what I needed. In the process I learned what I've been missing from the APTA.

I'm an APTA member. I have been for several years. I'm not writing this to encourage anyone to join. As a member I had access to members only areas some of which were the most helpful. From the perspective of being a student my favorite site is Open Door, the research part of the APTA. From that page I was able to access various databases including CINHAL and ProQuest. Both are oriented toward healthcare journals. For no charge I could search either one as long as I wanted. I could print articles. The only limit was how many words I could think of to use as my topics. I was also able to search previous issues of the "PT Journal". Homework was so much easier after my discovery.

From the perspective of being a PT the home page was the best. From there I could learn about future events. I could use links to other sites to learn about specific topics such as Medicare. There is information about documentation and Risk Management. Each section has its own page. I can go to the Practice Act or find CEU courses. These are things that are meaningful on a day to day basis. If I want to know something I still have to look. Now I know where to look. I feel like I've become more involved with my profession

As long as I've been a therapist I've heard debate concerning APTA membership. I chose to join. I also belong to two sections. To me the membership is worth the cost. My course is nearly over. It has taught me what it set out to do. It has also taught me what else is out there. There are more courses in my future. I've added this web site to my bag of tricks to help get through them. I've also decided I need to check often to see what is going on and what is new. My goal is to be a better therapist. This is going to help.