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The Essence of Effective Physical Therapy
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The Essence of Effective Physical Therapy - May 23, 2000 12:36:00 PM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
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I’ve recently been asked by several university professors, practicing clinicians, and students alike, what I believe to be the single most important thing that should be taught to students, and what I believe to be the cornerstone of effective delivery of physical therapy services. I’ve adapted much of the following from the words and philosophies of the well-known lawyer, Gerry Spence. His argument for how to be an effective lawyer transcends the courtroom. It is as true in his profession, as it is in ours.
To truly be an effective clinician, one must prepare oneself by understanding the evidence-base for one’s area of practice.
The operative word is PREPARATION.
This is where the true art, the true magic of physical therapy begins. Yet therapists, novice and experienced seem disappointed when I tell them this. They yearn for an easy formula that will permit them to bypass all the stodgy, dreary stuff called WORK. I wish that I could explain to them that true preparation (e.g. MEDLINE searches and analysis) is not work. It is part of the joy of creating, part of the joy of being effective. “Preparation is wading into life, rolling in it, embracing it, living it.” I doubt that you could have gotten Rob Thomas, or Eddie Vedder, or even Mozart to ever admit that they ever worked a day of their lives. Each of their lives, every breath they take, the entirety of their being, and all of their music, is the product of intense preparation – preparation that consumes (or consumed) them every day of their lives.
There is a lesson to be learned here. It’s better to be a regular person who has eloquently prepared themselves than a person with an extraordinarily high IQ who hasn’t been bright enough to prepare (e.g. therapists who feverishly defend the “skilled techniques” of craniosacral therapy or strain-counterstrain).
Clinical effectiveness, clinical genius, is not the by-product of a fortunate arrangement of the therapist’s brain cells. It is not the over-the-top touchy-feely attention to the patient’s psyche, year of experience, nor certification in the latest fad technique on the continuing education circut.
Genius is energy, directed energy.
Genius is preparation.
Drew
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Andrew M. Ball, MS, PT, MBA
PhD Candidate
[This message has been edited by Andrew M. Ball, MS, PT (edited May 23, 2000).]
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Re: The Essence of Effective Physical Therapy - May 23, 2000 1:23:00 PM
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Dana D
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Joined: September 18, 1999
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I believe there are two things which are key in building a foundation of a physical therapist. One is to be provided with a solid anatomy/orthopedic basis... to know the muscles, the nerves, their functions, the kinesiology of the joints, the inter-relation of each....... A solid orthopedic basis is key in any area of PT.
Agreeing with Drew:
The second, is to have the ability to seek out information... to use your resources wisely... whether it is books, other literature, other therapists, continuing education...... Being an excellent therapist entails having the ability to know where your weaknesses are, and actively pursuing information/knowing where to go... to build your knowlege base.
As you stated Drew... many artists devote their life to their career, their career is their passion.... as your examples of Rob Thomas and Mozart... making them phenominal at what they do... But unfortunately, not everyone's careers are their passion...someones passion may be a hobby, rather than a career... not everyone will devote "after work hours" to better themselves as a professional. I've met many who do, yet others who look at PT as a 9-5 job, "that's it, no discussion post work hours... won't do anything related to PT unless I'll be getting paid for it..etc. etc."...... I guess the intensity and extent of dedication to one's career is entirely individual... related to personality type, lifestyle, point in one's life/career etc...
[This message has been edited by Dana D (edited May 23, 2000).]
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Re: The Essence of Effective Physical Therapy - May 24, 2000 7:55:00 AM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
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When I taught for Paris in the 70s he would schedule courses without regard to holidays. I taught courses that extended through both Thanksgiving and Easter, and they both had waiting lists of attendees.
Now if I offer a workshop in the summer, I'm told by supervisors that their staff "hates to give up a weekend this time of year."
While teaching in Florida recently a PT showed up over an hour late both days because, she said, "I'm not a morning person." My classes are full of people who have not read a journal in years, won't answer a question out loud no matter how gently it is asked, and who actually think that everyone's opinion is equally valid, no matter how crazy it might be. They avoid intellectual conflict at all costs and offer nothing new from their own experience or reading.
I've watched the profession evolve in this direction since '74, and I see no evidence that it is slowing down.
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Re: The Essence of Effective Physical Therapy - May 30, 2000 6:13:00 AM
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SamCopp
Posts: 10
Joined: January 31, 2000
From: Bolivar, MO. USA
Status: offline
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Dear Andrew:
I have been working on career analysis for the last 6 mos. and agree with you that the most essential activity is preparation. I have found that there are a few more things to consider along with this to round out the picture. Career is to me more than my position and training. It includes my family life, church life, and other aspects of life-it is a broader path. With this in mind, the top pre-requisite is to know your personal life mission. It is the over-riding canvas of what makes a person tick and impels that person to a passionate approach living.
The folks who don't perform their passion at work will usually do it after hours in another area. Although this is not optimal, it is a good way to go, according to the experts. I think that this goes along with what Dana was saying. I have spent the last 10 years trying to find it by trial and error, and have just recently found a resource based on the Myers-Briggs, that has helped me. I think all PT students and PT's may benefit in taking the course to see if PT is really holds a passion for them.Education is mine, and I have linked it up with PT. I agree with Barrett in that I have found some of these same folks who are after Mediocrity in life and do not search deeper into PT issues or therapies. We should always strive to grow and be lifelong learners, and some PT/PTA's have not taken that extra look inside to see what makes it come alive for them.
Hope that this helps
Sam C
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Re: The Essence of Effective Physical Therapy - May 30, 2000 4:07:00 PM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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The question originally posed to me was what was the most important thing to be TAUGHT to a PT student. . . not the most important character traits. I agree that honesty, sincerity, empathy, courtesy, confidence, attitude/teamwork, and humor are important character traits, but I don’t think that they can be taught. Even if they could be, what educator wants (or should be asked) to waste their precious time with dishonest, insincere, uncaring, insulting, arrogant, self-centered student or mentee???? Such a student should never have been admitted to physical therapy school (or school of any other health profession) in the first place. Your point is well taken that these are traits of a good clinician, but with respect to the original question of what should be TAUGHT to PT students, your suggestions though perhaps true, doesn’t really answer the original question and are mostly besides the point of the thread.
You did however dig up a few other issues that I’d not considered:
ACTIVE LISTENING is an excellent point, but I’d suggest that someone who exhibits the character traits listed above (esp. sincerity, empathy, and courtesy) would have this skill as an innate characteristic. True, active listening skills CAN be taught, but as I’ve suggested above . . . doesn’t’ the fact that the student NEEDS to be taught how to listen actively tell us a little bit about the kind of person that the student is? Perhaps his or her very moral fiber? Should this person be encouraged to continue their studies as a therapist?
EDUCATION OF THE PATIENT is an interesting point that you brought up. I’d once again have to disagree and submit that this skill is not nearly as important as PREPARATION. Many therapists with this ability to “EDUCATE THE PATIENT” are still ill prepared to explain the TRUTH about crainosacral therapy, facilitated communication, or strain-counterstrain to their patients. Hiding behind the smoke and mirrors of patient “individual differences”, “I know what I feel”, or other pseudoscience garbage spoon fed to them at continuing education courses with no basis in evidence or fact whatsoever. If that’s not malpractice, it’s **** close. I can educate you all I want that the sky is actually green, that the Sun moves about the Earth, the world is flat, that the heart is for warming the body and the brain is for cooling it. I could come up with wonderful, technical-sounding-jargon to state my case. THAT DOES NOT MAKE MY ASSUMPTION/THEORY TRUE! The education of others (e.g. patients) begins with knowledge of the facts. Knowledge of the facts depends upon PREPARATION. Educating (and treating) patients without knowledge of the facts is one of the primary problems with this profession and is part of the reason that our profession is in decline.
TIME MANAGEMENT AND DOCUMENTATION skills are also very important. I think you’ve really hit on a great point here, and I don’t mean to minimize their importance, but time management helps PREPARE the PT for the day to come, and documentation helps the PT in PREPARING for billing procedures, or PREPARING to cover one’s butt in the event of a lawsuit.
Finally, I was asked for the SINGLE most important thing. SJ's retored with much more than one. What do others believe is the SINGLE most important skill that should be TAUGHT in physical therapy school???
Drew
SJ and I could go round, and round, and round about this. Before the two of us continue, what do others think? Are forum members thinking that patient psychology or preparedness, (as I’ve described it) is more important????
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