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#vitalsarevital

Not too many topics burn my britches, but this is one of them.

If your medical profession is skipping out on the basics, what else is being missed because it takes up too much time or is an inconvenience.

High blood pressure

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Burnout

“The interest of this project is assessing the prevalence of BOS (Burnout Syndrome) among physiotherapists who work in the Estremadura region (Spain)”

 

I can already hear the arguments from other PT’s, “Why are you reading research from Spain?” and the answer is because we don’t have enough research from America.  We will have to try to extrapolate some of the information from this article to see if it applies to our work environment.  In the end, people are people and no one article will apply to everyone, but maybe some bits of knowledge can come out of this article to help many.

 

Let’s start with burnout.  It exists in healthcare and this sector has one of the highest rates of burnout among sectors (think like education, healthcare, transportation, law enforcement etc).

 

From the other research articles that I am reading, burnout is characterized by emotional exhaustion, depersonalization, and low professional (sense of) accomplishment.

 

“LPA (low professional accomplishment) is clearly higher in the case of split shift working day as well as in private practice”

 

A split shift, in this study is defined as just that, a shift that is non-consecutive. For instance, there was one job that I was interested in that would take a two-hour lunch in order for the people working there to go to the gym next door.  As much as I was in favor of it, it would have meant another hour away from my family…so I politely turned it down.

 

Private practice is private practice.  We have this here in the states.  Private practice is traditionally seen as a capitalistic venture, in which the owners are trying to make as much money as possible.

 

“…more than 40 hours of direct attention (patient contact) is linked to higher scores in EE (emotional exhaustion), and that more than 20 patients treated per day is associated with higher scored in both EE and Dp (depersonalization)”

 

Are you surprised?

 

We treat sick people day in and day out.  We treat people in pain day in and day out.  We are constantly taking the burden of others in trying to help these folks.  It can be exhausting.  The other option that could happen when a person becomes emotionally exhausted is to just “shut it down” and then depersonalize work and simply “go through the motions.”

 

Is this what you want in a health care provider?

Be on the lookout when you go to therapy to see if the therapist is seeing one patient at a time or more than one patient at a time because it can start to give you insight into the PT’s mindset.

“Physiotherapists included in our study had a moderate level of BOS (burnout syndrome) in its three dimensions: EE (emotional exhaustion), Dp (depersonalization) and LPA (low professional accomplishment).”

Although I don’t believe that I fit into this category, it is becoming more obvious from talking to other PT’s in the profession that this is a major problem that will have to be addressed in the not-so-distant future.  Think about it! The population is becoming older, we have a shortage of PT’s and there will be a higher demand for our services.  There are only so many of us to go around and if the PT works for a company that values $$$ over quality, then the PT’s will be asked to see more and more patients per day.  This appears to be leading the charge for burnout, based on the conversations that I have with other PT’s.

 

I did an informal survey on FB to determine the primary cause of burnout among the professionals and the primary answer was productivity demands.  For those of you that aren’t in healthcare, this means how many patients are you billing per hour.  WE DON’T MAKE WIDGETS!!!! We can’t treat people like WIDGETS!  It makes sense that some PT’s are getting their ethical buttons pushed and start to depersonalize.  One PT that I spoke to literally said that he was exhausted from TREATING PATIENTS!

 

Are you kidding me?!

 

It’s only getting worse out there.  As a patient you need to know what’s happening in the profession and choose a PT that is giving you undivided attention when you are in the clinic (THAT’S WHAT YOU ARE PAYING FOR!) and as a PT, you have a choice to work in a place that is asking more from you than you can deliver or you can leave and find something different.

 

“…the age of physiotherapists does not seem to have any influence in the syndrome. However, there is an adjustment period, at the beginning of the physiotherapist’s professional development, where they are especially vulnerable to the development of BOS (burnout syndrome).”

 

Old and young alike feel stress.  We all have ethical buttons.  Some that have swam the waters of this profession for years have learned to live with it, but those coming out are facing challenges that are considered taboo to speak of in school.  It’s only due to social media that these topics are becoming more mainstream for students to learn about.

 

“…physiotherapists who work split shifts and more than 38.5 hours per week are those who present the highest level of BOS (burnout).”

 

I don’t know any PT’s, minus those that don’t choose to work full-time, that are consistently putting in less than 39 hours per week.  I am personally putting in a ton of hours per week of direct patient care and indirect care through notes, blogging and doing videos.

 

“Burnout syndrome reaches its highest levels in those who dedicate more than 40 hours per week of direct attention to patients…”

 

Should we even bring up student loan debt?

 

If you want a comfortable/stable life, then you will work more than 40 hours per week.  Otherwise, you will pay your student loans off over decades.  That ball and chain will always be there.  Click  here to learn more about the ball and chain.

 

I personally receive income from three different companies, which I wished that I did sooner instead of waiting almost 10 years to work multiple jobs.  On the flip side though, had I done this sooner, then I may have experienced burnout and not be in the position that I am in today.

 

“…more than 20 patients per day have the highest levels of EE (emotional exhaustion), Dp (depersonalization) and BOS (burnout)”

 

PTs: Does this fit the description of the person and therapist that you want to be? If so, go forth and treat 2+ patients per hour.  Just know that you are making that decision and there is no sympathy for you in the end.

 

Patients: Does this describe the person that you want treating you? Emotionally exhausted, depersonalized and burnt out? If not, look around.  How many patients are there per therapists.

 

YOU ARE NOT A WIDGET!

 

Excerpts from:

Gonzalez-Sanchez B, Lopez-Arza MVG, Montanero-Fernandez J et al. Burnout syndrome prevalence in physiotherapists. Rev Assoc Med Bras. 2017;63(4):361-365

Police ride along for the day

The Joliet Police Department was gracious enough to allow me to do a ride along. I had an eventful night and learned about adrenaline and the following adrenaline dump. I was so exhausted and only did half a shift.

If you get the chance to go on a ride along to see how well they work together and how well they patrol the area, you should take the opportunity to see the city from a different perspective.

Raise your game!

A recent conversation inspired this video.

We, as professionals, need to lose the mindset of technician and up our mindset to Doctor. This means no more 3x/week for 4-6 weeks. This means no more 4 units plus one modality per visit. This means no more selling patients on gym memberships or buying products from Amazon or the front desk.

Up your game to the Doctor level that we are at. Be a consultant. Figure out what is right for the patient, and sometimes this means that it isn’t PT.

Don’t cower to productivity demands or the “we need to keep the lights on” argument. You are a Doctor…act like one and keep your patient’s needs first.

You got a choice: right or not so right

As a father and husband, the topic of ethics and morals has a deeper meaning for me.  I need to make choices that will allow me to sleep at night.  I can’t afford to be passive in my profession because I have multiple sets of eyes watching my every move.  The best way to influence the future is through decisions that I am making today.  My wife may not like that I am posting this picture, but it’s done with love so that should override all.

Enjoy today’s article.

Moral Distress is knowing the right thing to do but being unable to do them because of internal and external constraints.

Flood gates are opening now. This profession is full of good people that want to do what is right, but are torn between collecting a paycheck or doing what is right for the patients.  This is a huge deal!  I hear from therapists all over the country that after long conversations just shrug their shoulders and say, “what can you do?”

 

What you can do is stand up for what is right.  In print, it doesn’t come across as well, but either stand up for what you believe in or bend over and take it.  If you chose to bend over, just know that you have a choice! You are not forced to make the decisions that you are making! There are other places that offer a paycheck!

 

I walked out on a job at lunch, albeit not the most professional thing to do but the right thing for me, because I could never wrap myself around to performing the acts that the corporation wanted me to perform.

 

The meek shall inherit the land…don’t take this literally.  Stand up for what is right for the patients! Stand up for what is right for the patients! Stand up for what is right for the patients!

 

The profession of physical therapy has the potential to be a great career choice, but unfortunately so many are experiencing burnout, helplessness, and exhaustion because of this moral distress.   Can we stop doing this to ourselves?

33% of nurses will consider leaving their profession because of moral distress

I’ve already read about PT’s leaving the profession and spoke with PT’s that left because of this issue.  I don’t feel bad for them.  They stood up and walked out.  That was right for them.  I feel sorry for the people that don’t have the ability or internal strength to make that decision, but instead struggle in silence.

“When students encounter microethical dilemmas, the risk for moral distress is present because they are confronted with making a decision between two choices: speak up and advocate for quality patient care or remain quiet and permit the substandard practice to occur.”

I left this in as a quote because it goes well beyond schooling. If you are a member of the public and reading this…I apologize for what I will say.  If you are in healthcare, you already know this.  Shady stuff is happening in healthcare.  People are asked to do things that aren’t ethical.

example 1

example 2

example 3

I got tired of copying and pasting, but I could do this all day

Those choices never go away.  If anything, the chasm between the choices grows with each decision made.  For instance, standing up for one thing, in my opinion, will allow you to find your voice and draw your line in the sand.  It will be easier to draw that line and that line will become deeper each time it is drawn.  You learn more about yourself from standing up, which makes your ethical radar stronger over time.  It will become more apparent when your ethical button gets pushed and again you will have to make a decision.  Long story short, it never gets easier.

Top two reasons for having ethical dilemmas among nursing students was 1. I wasn’t in charge and 2. I didn’t have enough information

Unless you are the founder or an executive, I got news for you   YOU AIN’T IN CHARGE! This feeling of being subordinate never goes away until you reach the top of the mountain and there is only so much room at the top.

I get that some people don’t want to make decisions because they feel that they don’t have enough information, but there is a solution to that…go get the information needed in order to make a decision.

It’s not hard people…it takes a little more work.  As a PT, we spend hundreds of thousands of dollars to enter this profession.  We study for 7 years to become doctors.  No one is afraid of work.  We may be afraid of learning the information because then it will force us to make a decision that makes us uncomfortable.

It’s my opinion, based on multiple conversations with other professionals, that there are a lot of PT’s that are comfortable.  Unfortunately, those that are comfortable also have a lot to complain about.

Thanks for reading.  I appreciate that you took time out of your day to read my rants and hear my thoughts.

 

Excerpts for this blog were taken from:

Krautsched L, DeMeester DA, Orton V et al. Moral distress and Associated Factors Among Baccalaureate Nursing Students: A Multisite Descriptive Study. Nursing Education Perspectives. 2017;38(6):313-319.

Monk and the Merchant: a personal perspective

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Part 2 of the Monk and the Merchant.

five “Take responsibility for problems that are the result of your own bad decisions. Don’t displace the blame”

 

I’ve taken accountability for my actions for as long as I can remember.  Growing up, my dad was a huge influence on me.  There were many sayings that he would consistently use and I’ll list them here to give you an idea what growing up in a household with my dad was like:

  1. If it was after 6 AM and I wasn’t awake, this phrase would always come out “You’ve already slept away half of the morning…Are you planning on sleeping your life away?”
  2. “Either get busy living or get busy dying”
  3. “We send you to school, buy you books and THIS is what we get?!”
  4. “I just don’t understand…and I don’t think I ever will”

Mind you, I started hearing these phrases at an age of 5, probably sooner, but that is the earliest recollection of these phrases.

 

I haven’t always made good decisions.  When I was 13 I was caught shoplifting.  I was a chronic shoplifter and I kept it hidden from everyone.  I would steal for no other reason than the thrill of the challenge.  It didn’t matter what I would steal, as I would typically throw it away or give it away later.  Mind you, these were bad decisions and I don’t condone it.  I was making mistakes and it took getting caught to actually see the error of my ways.  I was actually proud of myself for getting away with it for so many years prior to getting caught.  My mother couldn’t understand and we had a long discussion about this.  She tried to understand the motivation.  My dad on the other hand didn’t even try to understand.

 

Let me paint you a picture.  My dad is a Vietnam Veteran.  He was a Medic for the 101st Airborne (Screaming Eagles).  He was a light sleeper and would wake up every night at 1 AM to do a check throughout the house.  He would wake up between 3:00 AM and 3:30 AM every day, even on weekends.  When I got home from getting caught shoplifting, my mom woke up my dad to inform him of what happened.  He pulled me into the room and had a short conversation with me.  There was no punishment.  He simply said, “Son, I’m disappointed in you”

 

You have to understand my background.  I am the youngest of seven and the one that was supposed to stay out of trouble.  Those words that my dad, my Superman, said to me that night completely changed my life.  I have never done anything and would never do anything to make my dad feel disappointed in me again.

 

I had to pay back a $2,000 fine to the place that I was caught and have been straight-laced since.

Principle six “See challenges as stepping stones, not as obstacles”

Joliet Junior College is the oldest community college. One of the few classes throughout my academic career that was my bane was Chemistry 101 with Dr. Matthews at JJC.  I dropped this class twice, although the second time was because someone stole my lab work for the semester and I wasn’t able to complete all of the work on time.  I was working 2 jobs (Sam’s club from 3-9 PM and Eagle [no longer exists] from 10PM to 6AM).  Because of all the hours that I was putting in, I chose to take one semester of just chemistry with Dr. Matthews and made it through with an “A”. Knowing that I could tolerate discomfort made the rest of undergraduate “easy”.

Principle seven, “Be meek before God, but Bold before men.”

Getting back to some of the prayer conversations that I had with God (I highly recommend the series  of books regarding conversations with God), I was humbled before God when making my decision for a career. In this career, I have had to stand my ground many times.  As someone that cares deeply about the profession of physical therapy, I stood my ground many times and lost multiple jobs because I wouldn’t sacrifice my morals.

Principle eight, “Live debt free and below your means”

Hello Dave Ramsey! This is where the Ramsey influence comes into play.  I actually purchased this book at EntreLeadeship One Day.

 

You know that saying, If I knew then what I know now then there would be so many changes in life.  Like many, I am coming out with student loans and made some poor financial decisions over the years.  I am now digging out of the hole of debt.  Luckily, we have a big shovel to start digging out of the mess.

If you are in debt, this is a great plan to start following.  I paid off more debt in the previous year than I did in the 5 prior.

 

Principle nine, “Always keep to your budget”

This is something that is very difficult and takes practice.  It takes time to understand fixed and variable expenses.  Trying to cut fixed expenses is hard, but there are companies out there that work to reduce fixed expenses such as Bill Shark.  This company reduced our internet and phone bill.

Variable expenses such as going out have been greatly reduced as my family is attempting to get out of debt.  I’ve been out of school for 10 years and still have student loan debt around my neck.  We are planning on getting out of debt in the next two years, all except the mortgage for now.

 

Principle ten, “Loaning money destroys relationships”

I’ve never borrowed more than $20 dollars from friends or family because the guilt of being in debt to them changes the relationship.  I don’t think that it affects everyone the same way.  My brother has owed me $100 dollars for years and it’s just never going to be paid back.  I realize that, and it was the best $100 dollar lesson I could’ve learned.

Principle eleven, “set aside the first ten percent to honor God”

I have been much better at this over the years, but am no where near tithing.  Honoring God doesn’t mean that I have to give to the church.  I now donate to so many of the local charities and purchase gifts for kids in need during Christmas.  This was the first year that I did the kid’s gifts, but it felt great.  The thought that a kid wouldn’t have a gift to open is heartbreaking.  Pairing that with the fact that the only gifts that this particular kid wanted was winter clothes, jackets and boots made me sad.  Knowing that there are kids in this country that don’t have the basic necessities is heartbreaking.

I realized that giving to others is selfish in that the way that I feel after giving hasn’t been recreated by anything else I’ve done.

 

Principle twelve, “Understand the power of partnership”

The ship that won’t sail is a partnership. Understanding the power of partnership is important.  This principle goes beyond business.  A marriage is a partnership in which both individuals work to make the unit stronger over time.  I am still curious as to the power of the business partnership because one person always has more leverage than the other.  This leverage can be dangerous to the partnership because it can always be held over the other’s head.  If there is a 50/50 partnership, which includes 50/50 work ethic, I may be convinced otherwise.  I just haven’t seen it yet.

 

Thanks for reading and I hope you get something from the links provided in the article.