I see it as common sense: You should do what the therapist tells you. I mean, when doctors give them medicine to take, there is no hesitation most times. But, if I give them three exercise to do at home twice a day, they come back complaining that they feel the same or worse-which makes me feel like I did something wrong. With further investigation, I find that they didn't do them, or that they are doing something totally different than the pictures show because "it was more comfortable at first."

I know some will discharge patients who aren't adhering to the therapist instructions, but what's the time limit on that? And how do people avoid getting discouraged?

So far most of my patient's diagnoses have been pretty basic but I have had a few complex/interesting diagnoses also. I realized that though it feels good to practice on my own, the most important thing is to know when you need help. Granted you don't want to seem like you don't know what you are doing in front of the patient, but it is better than doing or saying something incorrect. Heck, the therapists at my site frequently ask one another for assistance when they are stumped, so why should I be afraid to ask for help when I need it?

Even though half of me hates asking for help, I learned young that if you never ask, you'll never know. I assumed that it would more or less only apply to school-related activities, but this has quickly made me notice that it applies throughout life, especially in a field that is constantly evolving.

On the flip side, today I had a patient "stand me up." The last time I saw the patient he said that he was feeling better than before and wanted to stop therapy even though he still had some pain. Now this was someone who after 2 weeks had maybe done 1 day of his home exercise program that consisted of about 3 exercises... Needless to say I didn't feel that this patient was appropriate to discharge and continue therapy on his own. After expressing this, I assumed that the patient would choose to continue therapy as most others do when you make a recommendation...but of course he didn't show up.

Part of me wants to be stubborn and say FINE if you don't want to help yourself then how can I help you, but the other part of me just wants what is BEST for his physical needs and somehow spend all of my time trying to get him to comply. I tried a stern, but caring approach...obviously it did not work with him. It's like a rollercoaster ride! :D

In the one day that I was gone, the majority of the patients who came realized that I was not there and asked where I had been. This included patients that were not my CI's or mine.  I was so surprised that they had even noticed that I was gone! It was so cute because some were concerned that I was not coming back. I felt so loved!!!

This really made me realize that even when you are working somewhere where the patients are not totally dependent on you, you still significantly impact their lives even when you feel as though you are not doing much. Life lesson: Always make sure you are making a good impact on a person's life because even the slightest negativity can affect a patient just like the slightest positivity can.

One of the major things that came up was treating patients with mental and emotional challenges. For some reason, we foolishly assumed that we would not see patients with these challenges just because we were in a different setting. I say "foolishly" because we clearly know that a large amount of the population face these challenges at some point in their lives (depression being perhaps the most common), yet we still assumed we wouldn't see it.

So often we hear that outpatient facilities have more cookie-cutter type practices. However, during the short two weeks that I have been at my site, I realized that you can't be "cookie cutter" no matter the setting because each patient has different needs. Even if you have two middle-aged construction workers with L knee pain, there are so many other components that must be accounted for when you are treating them, especially their mental state and how they perceive pain.

What works for one patient might not work for others and how WE think patients should react to pain is honestly of little importance, because pain is perceived by everyone differently. I think it is so critical for everyone to remember that. Even if a patient has anxiety, is depressed, etc., how they perceive pain is how they perceive it, and though it may be frustrating, we have to find ways to do what is best for them.

I have found that these patients in particular have an extreme amount of lower extremity weakness. Most can barely perform a single leg stance for more than 3s or a single leg demi-squat-no matter the age, activity level, or physical build! It is amazing how something so simple as a single leg stance, which is needed every day to walk and perform many functional activities, can be so easily overlooked (especially when you have the big strong men who squat hundreds of pounds, but can't balance on one leg to save their life).

I think everyone should take time out of their day to practice the single leg stances and squats, and see if they notice a difference in their bodies. I know I have!

Everything about this clinical has, for the most part, been different. A lot more individual exercise plans are done versus group exercise, the patients are all relatively independent with their exercise plans, and best of all I get to work with more biophysical technologies!!!

The only down side is the LONG hours. Since the clinic is open 7 a.m. - 7 p.m., there are some days that my CI (and thus me) is scheduled for 11 hours. This will definitely be something that I will have to get used to, but I know that it will all work out.  

Time to break out the old ortho and test and measures notes to brush up!

Nonetheless, I will be so happy when finals are done. No more late nights, all nighters, and need for vitamin overload for three whole months! Luckily I get to start my clinical ASAP while everything is fresh in my head.

This has been a pretty difficult year; however, I must say I will kind of miss it. No more adventures and jokes about red hair and Canada, jokes about the limbic system, random songs about the professors, baby stories, movie nights, gross pictures or stories about THE neighbors for an entire summer. L

I just want to thank all of my professors for at least attempting to make this an enjoyable semester even when the material wasn't! THANK YOU!!!

As soon as finals are over I will be starting my second internship. I am expecting this one to be very different from my previous experience considering this one will be an outpatient orthopedic setting. None the less I am still very excited for it. Hopefully my CI will be as great as my previous one!!!

In our program we have an entire 16-week course dedicated to wound care that is very detailed and even includes the opportunity to see patients in the hospital and have some patients come to labs. We learn multiple ways to change dressings along with multiple treatments for a wide array of wounds.

On the contrary, according to a nurse in our class, the only thing they learn is the wet-to-dry technique. So why do facilities choose to allow them to handle the wound care if they are less trained and receive less reimbursement?

In addition to this, I am curious as to what state dependent restrictions are placed on PTs and what each state's practice act is like-it's one thing to read about it, but it is another to understand how it affects the practicing PT.

Another important factor is income compared to the cost of living. I know a lot of PT students are wondering the same thing and was wondering if there were any PTs out there that would be able to help and offer some resources.

Working in the hospital, I have found that there are few things that tend to work, but you have to know the patient's personality a little:

1)  Challenge them-some people feel compelled to achieve goals when they are challenged to complete them. It's sort of like when you were little and you tell your sibling, "bet you can't do this."

2) Get their family involved-some people just need the extra motivation to come from a loved one.

3) Guilt-this sounds kind of bad, but patients need to know the bad things that will happen if they don't comply with therapy. Also sometimes it‘s good to tell them that this is what their family wants (if it actually is) to play on the "disappointment factor." 

Sometimes as an aide it is especially difficult to convince patients to do their exercises with you, but these have worked for me in the past.

I know a lot of students are going through the same thing, but there are also lots of practicing PTs going through it too. Is there no solution to paying off loans 30 years later? Upon doing some research I have found that some places are actually offering students scholarships under the condition that they work for them for a certain amount of time; others offer loan repayment programs for their employees.

Part of me is really drawn to this; however, I'm concerned about entering a contracted agreement and possibly not liking the facility or specialty that I initially enter. Has anyone done this before and if so can you please share your experience?

In addition to the disparities, listening to some health care providers I occasionally hear disheartening remarks about their patients-whether it's a discussion about the crabby old man, etc.-but how many of us think to ask why he is crabby? Sometimes we get so caught up in our own lives that we forget to think about the situation the patient is in. They are the ones who are sick, in the hospital, injured, etc. I too have been guilty of it, and had to turn and "check" myself.

Sometimes thinking about all of the negativities that surround the health care system, I question my ability to uphold the poor standards that it maintains. Then I realize that maybe I'm here so that I can change it, because I shouldn't uphold poor standards! None of us should.

It was kind of funny actually, because when I was in Florida this week, one of the rental car associates was engaging in conversation with me as he loaded my luggage in the car and asked what I did, etc. He of course made the automatic association of PT and massages, stating that he needed one for his painful back.  Without thinking for a second I laughed and replied, "Or I can teach you proper lifting mechanics for handling baggage so you avoid the pain." He laughed and replied, "Can you? Because that's when it hurts." I thought it was so funny for some reason. Nonetheless, I proceeded to teach him the proper way to lift the luggage into the cars. It's interesting how people can know the source of their pain, yet they automatically assume that the cure is a massage.

More education to the public as to what PTs do and how basic home remedies such as hot and cold packs, massages and stretching work and help could definitely benefit the public because I see a lot of people who have misconceptions as to what we do and when they should use these items (and most of the times it's when they shouldn't be).  I love to use every moment as a teaching moment and recommend other students do so also. It can be scary at first, but people truly do value your opinion, even if they don't take the advice right away.