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Re: Why don't most PT's give a ****?
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Re: Why don't most PT's give a ****? - July 5, 2002 5:58:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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Gilbert,
You have a point that some of the most prolific human discoveries were borne from artistic-leaning qualitative reseachers. Einstien comes to mind. These types of discoveres, while valuable, are few and far between and you're using the exception to prove the rule. Regardless, the FIRST rule of research is to apply the method most appropriate to the research question and the state of the current-evidence-base --- NOT to choose a philosophical camp and operate from within that research comfort zone only.
There is much more to art-based qualitative research most people recognize. Qualitative, art-based research DOES have a defined method to it be it ethnographic, phenomenological, or grounded theory in nature. If you'd like some references for that, being that I've spent the past 4 years neck-deep in a qualitative-methods based Ph.D., I'd be happy to supply you.
Respectfully,
Andrew M. Ball, PT, MS, MBA
Ph.D. Candidate
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Re: Why don't most PT's give a ****? - July 5, 2002 7:10:00 AM
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Diane
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From: Vancouver, B.C., Canada
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Bcat: stop trying to pull that ridiculous fear-mongering cult c**p on this BB, oh son of Quackwatch. Forget it. Even the least scientific among us have some immunity to that. Let's see... if I had to choose...
1... between a friendly, egalitarian on line community for PTs under the auspices of, but not run directly by...a very bright PT who synthesized a huge bunch of science material for all clinicians to use as food for thought
2... and this BB which remains dominated by your BS posts, let me think... which one would I pick? OH! The first one! Duh...
By the way, have you changed your name? (Ann?) Thought I recognized your style over there on NOI.
Drew, I will never post anything on here to do with anything real as long as this malicious freak is allowed full rein to come and go as he pleases, to ruin this board, and others.
Diane
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Re: Why don't most PT's give a ****? - July 5, 2002 7:23:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
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From: Chapel Hill
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Diane,
I am not the moderator of the Open forum and have no more control over it than you. I suggest, however, that you forward your complaint directly to the webmasters (David and Randy) at webmaster@rehabedge.com
Drew
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Re: Why don't most PT's give a ****? - July 5, 2002 7:44:00 AM
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mcap
Posts: 652
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Group:
I think we have gotten off topic a bit here!!
Most PTs don't bother with research and bulletin boards and other such endeavors for a variety of reasons.
1. Many PTs got into the profession for a job, not a career. They liked the limited hours and flexible environments offered. And...as a result...they are not likely to become the ones to push things forward.
2. There is a lack of scientific discipline among PTs. It is an interesting career choice because you are exposed to so much science in your preparation. Those who sit through years of biology, physics, chem, etc. and are REALLY scientifically oriented will probably switch to those areas or pursue something else. Those who continue in PT are more motivated by their desire to interact with people, their love of sports/athletics, or some other reason. Unfortunately the scientific method goes out the window at times.
3. Schools DO NOT enforce scientific discipline. When asking a local DPT student "what happened to evidence based practice?" The reply I got was "yeah...one of our professors is trying to get us involved with that." So don't think the DPT is going to raise the bar. Evidence based education is sorely lacking.....DPT or not.
4. EBP is sorely lacking among physicians as well. Don't think we are the only ones. A recent times article stated that not only to MDs not practice EBP, they don't have the tools to evaluate, read and use the research even if they tried.
5. Our profession is dominated in some ways by the old guard. There are many great researchers out there but there are also many educators who don't seem to even pick up a journal.
6. There is an epidemic of both clinicians and educators getting locked into paradigms. They think they are evidence based because they consider and read related studies. But the true intellectual will take a step back and ask "is this orientation valid in the first place." My main complaint with the NOI group is that no one bothers with this question.
7. There is dissention and some heated posts and yes....even personal attacks on soo many BBs. Take a look. Many times it gets downright nasty. As I have said before.......I think we should all have a thick skin. Yes.....personal attacks aren't good but who hasn't been on the phone with a doctor that thinks PTs require a high school diploma and weekend course to do what they do. I often find that interesting debates are stiffled by personal sensitivities.
8. And....finally.......there are the extrinsic factors that I keep harping upon. The low pay and status are not likely to encourage extra efforts.
So...why don't PTs seem to care? The answer is more complex and difficult than any us care to acknowledge. As for PTs being lazy or not good people.....I would disagree. They work a physical job, to help people, often in difficult situations for not enough money. They are some of the better people in our society so let's open our minds a bit. In an era when corporate CEOs are dishonest in ways that affect millions of people in their 401s simply all for personal gain........the PT deserves some credit.
mcap
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Re: Why don't most PT's give a ****? - July 6, 2002 4:01:00 AM
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gilbertthomson
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From: Elka Park, NY USA
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Excellent summary of the problem mcap. I agree with all of the points you made (1-8)
Now, what do you suggest we do about it?
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Re: Why don't most PT's give a ****? - July 6, 2002 7:16:00 AM
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mcap
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Gilbert:
That's the hard part!!!
1. I don't think there is much we can do to prevent people going into PT for just a job instead of a profession. Schools can talk all they want about screening for dedication, but most of them are just looking to keep the classes full at this point.
2. You can do something about the scientific rigour in PT. It has to start in the programs!!!!! It must be drilled into them by professors!!!! All the time!!!! This is critical!!!
-In the future, the patients will be doing their own research. Wouldn't it be nice if they could count on their PTs to spend time with them, discuss the related research and the newest issues/treatments. Why shouldn't the public come to regard PTs as even MORE evidence based than MDs or other practicioners? This involves a good awareness of medical treatment as well as PT treatment.
3. This is unlikely to happen until their is a displacement of the clinical hierarchy of the profession. While we debate EBP and newer treatments, people continue in the continuing education circuit getting rich by perveying aboslute garbage. Therapists spend years perfecting techniques that were used 10, 20 and yes....even 50 years ago. New grads must be educated consumers of continuing education and they must not be so influenced by the more experienced PTs who are likely to lead them to "the dark side." [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
4. There must be an embrace of technology by PTs. This must start in the classroom!!!!!
a. PTs should know powerpoint, web design, etc. These are important marketing tools. Instead of wasting soo much time hoping physicians will grace your clinic with the few odd patients......we need to take our cases directly to the public. They are ready for the information!!! They need to know what we know so that our public perception can change.
b. PTs need to integrate more technology into the clinic. If shockwave therapy is being used,,,,,could we possibly get more out of our ultrasound units? Can we change them. If a shoulder patient has poor scapular mechanics, can we use a clincal EMG for evaluation. These are just a couple of examples.
-nothing will ever take the place of a good history and physical exam....but really we do need to move forward.
5. Hopefully as this changes, the extrinsic factors will change as well. However, it would help if our professional association and our faculty members were a bit more concerned about the plight of the average PT in the clinic. When salaries don't improve during the largest economic expansion in history (not sure if the advance survey accounted for inflation - if it didn't...then salaries went DOWN in real terms).....we have a HUGE problem. Why doesn't anyone talk about it. In fact...it almost seems taboo to talk about compensation among PTs and on this board. Somehow we are not supposed to be concerned about it. In other words...we have to hold to a higher standard than EVERYONE else. It's ridiculous and its a topic that should be out there.....all of the time.
These are just a few ideas I have. If I ever get a faculty position, perhaps I can help begin the long process. I think PT has a good opportunity now. But I am not confident that we have the personel to take advantage.
mcap
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Re: Why don't most PT's give a ****? - July 8, 2002 2:14:00 AM
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Mark Hirsch
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From: USA
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Hello All,
finally this is getting to a discussion that addresses the problems on this BB.
So Bobcat, who are you?
Mark
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Re: Why don't most PT's give a ****? - July 12, 2002 3:34:00 AM
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Sebastian Asselbergs
Posts: 1205
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From: Barrie, Canada
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Interesting subject. A small but significant part in promoting PT excellence is by doing what we are all doing here, by interacting and challenging colleagues at work - the place where most effect can be obtained. I feel that the setting of standards, the requirements at schools, the attitude of profs and CIs, are all important, but as was mentioned before, after starting a career, in the beginning all one does is work and let the study sink in with the practice. I did not read more than ONE journal for at least three years (came with membership in the association) - then started to develop a curiosity. Having colleagues was a great stimulus - justifying what I did was a main drive to study.
I really believe that PTs need to challenge eachother at every opportunity - the greatest opportunity is at work...
.02 Euros worth.
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Re: Why don't most PT's give a ****? - July 12, 2002 5:13:00 AM
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Sebastian Asselbergs
Posts: 1205
Joined: September 29, 1999
From: Barrie, Canada
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Interesting subject. A small but significant part in promoting PT excellence is by doing what we are all doing here, by interacting and challenging colleagues at work - the place where most effect can be obtained. I feel that the setting of standards, the requirements at schools, the attitude of profs and CIs, are all important, but as was mentioned before, after starting a career, in the beginning all one does is work and let the study sink in with the practice. I did not read more than ONE journal for at least three years (came with membership in the association) - then started to develop a curiosity. Having colleagues was a great stimulus - justifying what I did was a main drive to study.
I really believe that PTs need to challenge eachother at every opportunity - the greatest opportunity is at work...
.02 Euros worth.
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Re: Why don't most PT's give a ****? - July 13, 2002 11:09:00 AM
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Diane
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From: Vancouver, B.C., Canada
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Revisiting this thread is a bit discombobulating...it's like visiting Flanders 40 years later and seeing the corpses are gone, the blood has disappeared, and the shell holes are covered in poppies and green grass (..and crosses, row on row...).
It seems a bit strange to read one's own posts after the opposing ones have been totally hosed away; only one side got recorded.
I do want to thank the webmasters however, for attending with mop and pail, shovel and bucket, removing the spew, hairballs, truly pernicious postings and generally cleaning up the site.
Diane
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Re: Why don't most PT's give a ****? - July 15, 2002 4:32:00 AM
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PTupdate.com
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Perhaps as mcap indicates, there is most likely no way to change the type of person entering PT looking for a job, not a career or profession. However, would the type of person who enters into an academic program that has an extremely rigid scientific base bring in the right persons? Those that are good in the clinic may not always be the ones that are geared towards research and development. I believe there are two types of people, and we have all seen them in our education throughout the years..those that love to do research and that are not really good at communicating and working with people, and those that are great with people, yet hate the "lab". It is hard to find someone with high quality attributes of both traits.
Maybe there needs to be two sides to our profession. Those like Kevin Wilk, Jay Irrgang, etc. that provide an excellent source of research, and the other group that just wants to treat patients. However, the group that just wants to treat patients needs to read the stuff that the other group is putting out!!!! They don't however!
Duffy [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: Why don't most PT's give a ****? - July 22, 2002 8:00:00 PM
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MtnPT
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I'm new and jumping into this discussion late, but I figure I'd add my thoughts. I have a BS in PT. I've thought of getting my Masters or Doctorate, but got caught up in the job and a) didn't have the time b) didn't have the money c) it wouldn't have made an impact on my job ie: pay raise, promotion etc. I've worked with many DPTs and MSPTs and frankly, I'm wasn't impressed. They're egos were huge, but they didn't have a lot to back it up. I love my job. I have great results with my patients and have a lot of respect by my peers and the doctors I work with. The lack of initials behind my name doesn't mean I'm any less of a PT or less motivated than anyone else. I'm an ex-NYer and I prefer straight up, concise responses. There's a lot of fluff on this thread which is a turn off and I know a lot of people turn the other way when people rant and blow. It is a free country say what you want, but don't be surprised that people turn you off and don't want to deal with you. I'm glad I stumbled upon this site. I look forward to continuing to improve myself as a therapist in both the scientific and artistic aspects of the field. To deny the artistic aspect is to deny the human aspect- dealing with people positively, especially hurt/injured people, is an artform at the very least.
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Re: Why don't most PT's give a ****? - July 23, 2002 2:55:00 AM
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Andrew M. Ball MS MBA PT
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From: Chapel Hill
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What does it mean, in your opinion, to "back it up?"
Drew
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Re: Why don't most PT's give a ****? - July 23, 2002 6:24:00 AM
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Barrett
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Drew,
Good question. It's not been my impression that people with graduate degrees lord that over those of us without them. I admire the courage and commitment it takes to stay in the academic world as a student though I don't seem to have this myself. It would be nice for them if the monetary returns for that were easier to see and the real effects of education in the clinic might escape our notice until we realize what we think we're doing isn't actually possible. This type of revelation is normally a function of research and postgraduate education, in my experience, and I welcome that.
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Re: Why don't most PT's give a ****? - July 23, 2002 7:17:00 AM
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Andrew M. Ball MS MBA PT
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From: Chapel Hill
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Agreed. Mostly anyway.
I'm just a little confused as to what the phrase "back it up in the clinic," really means to the experienced non-DPT physical therapist. Does it mean differential diagnosis (including medical diagnosis beyond the "red-flag" stuff that most PT's claim to understand)? Does it mean understanding radiographic imaging? Does it mean a better understanding of basic science neurology? Does it mean better evidence-based skills? Or are these skill waived as unimportant to PT practice by the experienced PT because they were not part of the experienced PT's education, and as such, they have no way to assess the value and worth of a DPT with these skills?
DPT's certainly have these basic primary care practitioning skills over those of us who graduated 5 years ago or more. There is no question. So what does, "back it up in the clinic" mean? What criteria are non-DPT's using to assess DPT's?
I shudder to think that non-DPT's want DPT's to "back it up" with technical skill in physical therapy procedures that have no evidence-based clinical worth in the first place. Why should a DPT bother becoming technically skilled in craniosacral therapy or strain-counterstrain when there is no justification for their use, and experienced clinicians who use them (or worse yet charge patients for their quackery), should be ashamed of themselves? I'm not saying that everyone who attacks DPT's as not being able to "back it up" is a worthless clinical abomination to the profession who's opinion the APTA doesn't (and shouldn't) value anyhow, but as the phrase gains increasing popularity among rank-and-file clinicians who have made the decision not to spend the $5000 in completion of the above three or so courses and complete their t-DPT, there is a need to define objectively what non-DPT's using the "can't back it up" defense really mean.
Isn't is possible that the phrase, therefore, is more of a reflection upon the unscientific/artistic leaning philosophies of the anti-APTA vision 2020 clinician than a fair and accurate assessment of DPT education? I suspect that it might be.
Personally, I have been disappointed that 1/3rd of DPT education is spent being trained and corrupted in the clinic by non-evidence based, unscientific, non-visionary clinical instructors who don't understand the DPT vision, have never read APTA's 2020 vision, and serve by action or omission, to stifle the DPT student from reaching his or her fullest potential because they are incompetent in training the DPT with regard to the above primary care practitioning skills. I think of myself as a pretty good CI. I'm APTA credentialed and have been nominated for several awards, but although I have more than most PT's, I don't have all of the current entry-level skills necessary to be an effective CI for a DPT.
How does one rectify the problem? Pursue a t-DPT and patch the holes in your entry-level knowledge --- and that is exactly what I intend to do upon completion of my Ph.D. this Thursday. Otherwise, regardless of our definition, we have no one to blame but OURSELVES when DPT's don't perform to our expectations, or fail to lead the profession into the new millennium.
But I digress, what do non DPT's mean when they say that DPT's "can't back it up in the clinic????"
Andrew M. Ball, PT, MS, MBA
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Re: Why don't most PT's give a ****? - July 24, 2002 1:40:00 AM
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Mark Hirsch
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From: USA
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Hi Drew,
Interesting topic. I think one answer may be that it's a sociological/professional culture issue and it has to do with stereotypes, which are hard to break down in any profession. Think how long it took, and is still taking, to break down racial and gender based stereotypes in this country. What evidence is there this really exists in the profession as a whole?
The clinical "skills oriented" physiotherapists (if they can even be identified) versus the graduate and postgraduate trained physiotherapists. I think that's a stereotype right there -- clinical "skills oriented" PT's should not be well versed in theory? That's strange.
It's pretty sad to me that that kind of cro-magnon territorial thinking is threatening to fractionate the profession -- or has it already? In my view, physiotherapy is already fairly fractionated from the rest of the scientific community - we need more unity and harmony within the ranks and also between professional groups -- but that is all too theoretical with so many "camps" and techniques already in existance in modern day physiotherapy.
Cheers, anyway. Mark
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Re: Why don't most PT's give a ****? - July 24, 2002 3:36:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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Mark,
I don't think all is lost, and I don't think that the growing fissure is beyond repair. This very topic was a major focus of my Ph.D. dissertation, and I think I have a few ideas. I will be defending on July 25th and will present to APTA leadership in August. Hopefully, an article is forthcoming as well.
I hope the end result to be an increase in membership saturation in the APTA from 35% to 80% within 3 years --- clinical artist and clinical scientist alike feeling represented.
More details upon publication . . .
Drew
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Re: Why don't most PT's give a ****? - July 24, 2002 5:57:00 AM
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Mark Hirsch
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From: USA
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Drew,
I did not know that non physiotherapists could join the APTA.
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Re: Why don't most PT's give a ****? - July 24, 2002 7:48:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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Until recently, non-physical-therapists could not join the APTA. There is now an associate status. I'm not sure what the criteria is, but I belive that it's someone working on a physical therapy education program who does not have a PT degree. If you like, I'd be happy to check.
As for clinical artisit and clinical scientist comment, I was referring to physical therapy clinicians who THINK of themselves as either artists or scientists.
Drew
[This message has been edited by Andrew M. Ball MS MBA PT (edited July 24, 2002).]
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Re: Why don't most PT's give a ****? - July 25, 2002 2:28:00 AM
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Mark Hirsch
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From: USA
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Drew,
yes please check for me but only if you have time, It's not that pressing. Would be very suprised if neuroscientists can join the APTA. Mark
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