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New grad blues
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New grad blues - December 28, 2006 3:00:00 PM
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ysumpt2006
Posts: 113
Joined: March 31, 2005
From: Youngstown, Ohio
Status: offline
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How did y'all make the transition from student to PT? There are so many things that I feel I don't know.
I also feel "bad" asking for help--I'm a professional--I almost feel like I should know all of the answers.
I am still taken aback by SI Joint pain and pelvic obliquities, etc. My back pain patients (though I thought I knew a lot about the back--my research project was in that area) throw me for loops all of the time.
I just don't want to get into a rut of doing the same thing.
I also think I'm hitting the wall (similar to a rookie football player) as this is the first time in almost 6 years that I havent' been in school--my body must have been used to the "winter break"
Just times when I feel like I know nothing.
_____________________________
Ken Shearer, PT
Certified Strength and Conditioning Specialist
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Re: New grad blues - December 28, 2006 3:23:00 PM
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PTupdate.com
Posts: 1433
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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Guess what Ken? You DON"T know anything...at least much! I've been practicing 16 years, read more than anybody I know, and feel I am just touching the tip of the iceberg. The good thing is that you feel that way, and therefore will continue to grow. Many graduate and feel they know all there is to know, never learn anything more, practice like crap, and wonder why they aren't busy. So, keep learning, making mistakes (but don't kill anybody), try new things, drop old things, and find what works for YOU. Read through these threads everyday, read through the NOIgroup.com threads, and you will be ahead of most.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: New grad blues - December 28, 2006 3:32:00 PM
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jma
Posts: 2312
Joined: August 24, 2000
From: NY
Status: offline
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Your absolutely right!! The transition from student to PT first took place when you were on your affils, practicing hands on in the field. I felt that way at first. Hooking up with those with experience and know how, helped me focus my thoughts and ideas and put them to practice.
Six years is a long time and it takes a little while to get out of school mode. You may not go to school anymore but you will still continue to learn from experience and through continuing ed and talking to others who have been down the same road you are driving on now.
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Re: New grad blues - December 28, 2006 5:53:00 PM
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ianwvu
Posts: 64
Joined: June 11, 2004
From: Glendale, AZ
Status: offline
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I felt the same way. It was really frustrating for me to think "this patient could get better a lot faster if they were with an experienced PT". I didn't like that so much. Hopefully you can find a mentor to ask questions, and bounce Idea's off of. Try your best to help the patient, and if you get stuck, ask a more experienced PT what they would do, then try that. Its a learning process, but It will get better.
The best you can do for now, is simplify your treatments. You have trouble with low backs? Figure out a few safe ROM or stability exercises, teach them to the patient, and go from there. A good number of LBP patients will get better with basic strengthening and ROM exercises. When you get stuck with patients that don't respond to the simple stuff, then its time to research, ask questions, and come to places like this. It will get better.
The only thing that really got me by initially was my personality. I could connect with patients better than the average PT. This helps a lot. The patients trust you, and enjoy their time with you. This will at least buy you some time to figure out what their problem is, if you aren't nailing it down after the first few treatments. Hope this helps.
Ian
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Re: New grad blues - December 28, 2006 6:20:00 PM
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ysumpt2006
Posts: 113
Joined: March 31, 2005
From: Youngstown, Ohio
Status: offline
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Treatments are easy for me, it's the differentially dx'ing of the many causes of low back pain. Treating them is basically the same, but it is just figuring out what is what. At most of my clinical rotation sites, I rarely saw an SI problem, now, the people I'm bouncing things off of are shooting there first with the advice they give. Same goes for neural tension issues.
When I get stuck, I take it too personally.
As for the patient interaction? I take the time with my patients (perhaps too much time?) to let them know that I am doing all that I can to make them better.
_____________________________
Ken Shearer, PT
Certified Strength and Conditioning Specialist
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Re: New grad blues - December 28, 2006 7:20:00 PM
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ianwvu
Posts: 64
Joined: June 11, 2004
From: Glendale, AZ
Status: offline
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Well, I have mixed feelings personally about the differential dx when dealing with LBP. Yes there are cardinal signs when dealing with certain patients and dx's, but for the most part, not many clinicians can diagnose with certainty what is causing someones low back pain. Ask Don Tigney what causes LBP, and he says 90% of LBP could be stemming from the SIJ. Ask Mckenzie, he will say disk, ask Paris, he will say Facet,ask a pain management pro and they will say its mental, and the next person you ask will say its all myofascial. Who's right? That SI muscle energy technique you just did may just have released a trapped facet capsule in the lumbar spine (result= patient feels better). That P/A grade I to the lumbar spine to increase extension, may have convinced the patient you are doing something to them that will help, regardless of it actually does anything mechanically, and it still works. Lumbar stabilization exercises may be "stabilizing the spine", or just from the contraction pull of the multifidi and their attachments during the activity, you may have just mobilized the spine indirectly (result= patient feels better).
I'm not saying don't bother with really trying to figure things out, just don't over think it.
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Re: New grad blues - December 29, 2006 2:33:00 AM
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Shill
Posts: 1056
Joined: February 13, 2003
From: Madison WI USA
Status: offline
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Ken,
The SI joint rotations, upslips, and all of that garbage used to throw me, but now I have dismissed it as utter nonsense. It really helps to not learn this stuff, as it clutters the mind with, as I mentioned, utter nonsense. Some people can think in the 4 dimensions necessary to visualize and conceptualize the utter nonsense that is SI joint malalignment treatment and evaluation. My brain does not allow me to do that. However, I am validated by the preponderance of evidence against needing to. So, dont worry about not getting that stuff, just grasp onto the more concrete aspects of our field.
Dont worry about asking for help, that is what growing as a clinician is all about. Someone you ask will tell you in a way that makes it easy, whereas others will confuse you further.
Patience young jedi.
Steve
_____________________________
Steve Hill PT
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Re: New grad blues - December 29, 2006 3:50:00 AM
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JSPT
Posts: 271
Joined: April 19, 2005
From: Michigan
Status: offline
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My advice is to check your ego at the door and be a sponge. I have learned a lot reading this site, keeping up on journals, etc.
I have learned the most from other clinicians. I think it takes a confident (and smart) person to consult a colleague, and I have no idea why this doesn't happen more often in our profession. Think about it; there is much more art than science in our field (treatment-wise), so why should you feel confident at this point in your career?
I have been out about 3 years now. I learned more in my 1st year out than in 6 years of school. I learned more my 2nd year out than my first year.
I feel confident with 90% of the stuff I see now, but I know there is a ton out there that I don't even know I don't know. Maintaing a healthy respect for that will take your far.
In sum, you're far from alone, and your long-term prospects are better than most because you're thinking about these things now.
I also felt a bit burned out after a year. The single thing that has made the biggest difference in that is to change the time frame of my goals. Instead of getting better at knee evaluations in a month, I may spend the next 6 months reasearching and experimenting with treatment and eval techniques.
_____________________________
JS
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Re: New grad blues - December 29, 2006 5:01:00 AM
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SJBird55
Posts: 2292
Joined: May 10, 2004
From: Michigan
Status: offline
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If you have read the literature by Jansen on "expert" clinicians, a particular behavioral component that was common among the "experts" was to seek advice or bring in a co-worker for an impression or ideas as needed. This commonality of "experts" wasn't limited to those with lesser years of experience - it was a commonality that was there for those that were found to be "experts" via their outcomes.
I don't believe we always know exactly what is occuring with patients. Be familiar with the various clinical prediction rules; be familiar or know where to find the specificity and sensitivity of diagnostic tests when making diagnostic decisions.
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Re: New grad blues - December 29, 2006 6:24:00 AM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
Status: offline
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Ken,
I agree with the above....just the fact that you feel you know nothing means you are a conscientious practitioner and your head is in the right place. I also think that it is imperative as a new grad to find a mentor or mentors. The more professionals you are exposed to, the more you can start to assimilate different techniques and ideas that work for you. I also encourage you to read journals and participate here and at other sites, like evidenceinmotion.com. The APTA has some good correspondence courses on current best practice for different patients.
Differential diagnosis is a skill that is learned over time. You have to have exposure to a certain number of patients before you can begin to make constructs in your mind of what a disc problems presents like, what a neural tension problem presents like, etc. Once you make these constructs, it is much easier to form a mental algorithm to follow a step-by-step logical process of ruling in and ruling out possibilities. This is especially true with spinal pain. It might help to take a course that teaches you to think this way....I liked Angelo DiMaggio's course for its coverage of how to talk to patients, how to think about back pain, and how to constantly re-evaluate the patient. Basically, each visit, you should observe or test something that is aberrant, do a treatment, and then immediately retest. Expect to have immediate change with your treatments. Don't wait 6 visits to see if the patient has improved.
I felt the same way you did after graduating, but I was eager to ask questions and learn. Do not let your pride get in the way of giving your patients the best possible care. I have been practicing for almost 5 years now and I feel very confident with most patients now. That doesn't mean I don't have days where I still feel that I know nothing.....I just accept that and continue to learn. I still consult colleagues too. For example, I'm not an expert in fabricating orthotics and I have a patient who is a runner (training for a marathon). I've gotten her about 60% towards her goals, but needed some expert help in the orthotics, so I called in my supervisor. Now she's 80% better. There's nothing wrong with asking for help or another opinion on a patient. I did that a lot my first two years out of school...ususally the other therapists would just reinforce that I was on the right track, which helped build my confidence.
Good luck! If you need any more advice on specific differential diagnoses, post them here...we will lend our collective knowledge to the process.
Sarah
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Re: New grad blues - December 29, 2006 8:20:00 AM
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ysumpt2006
Posts: 113
Joined: March 31, 2005
From: Youngstown, Ohio
Status: offline
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Thanks all. I have to clarify something. I am one to ask questions and have done so many times during the past 3 mos (my current tenure). It just makes it hard when I ask the other clinicians in the bunch and get 3 different opinions (everyone treats differently, I guess).
I am all about learning, but some of the new stuff I have done in this clinic (new to other clinicians) is sometimes looked upon as "rogue" treatment because it isn't something they have tried.
I know my limits, but I sell myself short many times, also.
I realize there will always be times when I will be "clueless", but I have to realize that is a challenge to my skill at that time, not me personally or professionally as a whole.
I am a firm believer that complacency breeds contempt and I must be challenged quite often. That is why I took this position knowing that I would see a huge variety of diagnoses and not just TKA's or THA's of another clinic I was considering.
Thanks all
Glad to know I'm not alone
_____________________________
Ken Shearer, PT
Certified Strength and Conditioning Specialist
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