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srcase -> Re: New grad blues (December 29, 2006 6:24:00 AM)
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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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