The Geriatric Expert: Life Long Learners
I always have felt that continuing to learn is one of the most important things anyone can do, but I find in the area of physical therapy and geriatrics, it is essential. I had just finished in the clinic and went off to George Washington University to give the graduating DPT class my final lecture. One portion of the lecture defined an expert from a novice. It came from an article titled "The expert versus the novice clinician" published many years ago in
ADVANCE for PTs by Salzman in January of 1998. It described character traits of an expert clinician. For example it described the "tingle" you get when you know something to be true based on some fact and some years of experience. The example given in the article was when a seasoned therapist knows that a patient with TKA has a DVT and makes an appropriate referral
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As I went over this information, I stopped to reflect on my earlier experience in the clinic that day. I was working with a therapist who feels she is an expert; which can be a good thing when limits and mutual respect are present. In her case, it is not. She feels she stands as an expert on an island all by herself and I explained this to my students. I also explained how this type of attitude is death for our profession. I then relayed what had happened that day because of this therapist's attitude which impeded patient care.
I had seen an 84-year-old woman with back pain. I felt a major contributor to this pain was an SI (sacroiliac) involvement. I mobilized her and showed her how to do self mobilizations for this. She came in with a pain of 8 and left with a pain of 4 on a 0-10 pain scale. I had to leave the rest of the week to teach and gave her to my fellow therapist.
On the next visit my patient relayed her improvement and her love of the self correction technique to this therapist. The therapist immediately stopped the exercise because she felt it was not good. My patient came in one more time that week and was put on a stabilization program. When I finally saw the patient the pain had increased to a 6 and she was wondering why she had to stop the exercise that was helping. When I approached the therapist, I was told she had extensive training in treatment of the SI and did not believe in self correction and refused to discuss it. Needless to say, I left it at that. The patient now refuses to see this therapist when I am gone and my hope is this therapist might question why, which I doubt will happen.
I told my class that the reverse situation had also happened to me. With this same therapist, several months ago I treated a younger patient (65 years old) and what the other therapist had done after my treatment really helped. I was excited to ask the therapist what she had done and I enjoyed using her ideas to help heal this patient in subsequent visits.
Being an expert is not being a know-it-all or a zealot. We need to get over ourselves. Who is teaching therapists to have this kind of attitude? I told my class if I ever become this myopic and self centered to just take me down a notch. We can all learn from each other. But how do you teach that and how do we get therapists that already have that air about them to come down to earth?
We need good geriatric experts because of sheer impending numbers alone. Any ideas on how to make this happen would be great. Thank you. Let me learn from you.
Carole Lewis DPT, PT, GTC, GCS , PhD, FAPTA