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It’s how winning is done!

“…distress among clinicians had been understood primarily through psychological concepts such as stress and burnout, which, although relevant, were not sufficient.”

Part of the reason that burnout is not purely psychological is because this model dictates that the person doesn’t have the tolerance for the mental aspect of the game that is being played.

My game of choice is physical therapy.  Burnout is happening in this profession and it still baffles me at times, but I am starting to have a more thorough understanding of it as I apply research from other sectors to our profession.  For instance, there are therapists that pride themselves on treating multiple patients per hour.  Some therapists are able to handle the load of multiple patients, but once they understand the purpose of treating multiple patients at once, said therapist may no longer feel proud of doing this.  Some clinics need to treat multiple patients per hour to keep the doors open, which is noble for the therapist to feel like he/she is greatly helping the clinic, whereas others are doing it only to fatten a pocketbook.

“shortages of resources, such as shortages of time and staff, led to dispiritedness, a lack of respect, and an absence of recognition for both patients and staff, all of which severely diminished the ability of staff to provide high-quality care.”

In healthcare, it’s all about how much work can be done in a specific time period.  This is measured by patients seen/hour or units billed/hour or dollars made/day.  We are always being asked to do more with less.  Guess what? Us and almost every other industry out there.  This is not just healthcare, but in a limited scope its what we focus on here.  Because of this, some may feel unappreciated and believe that the big bosses (administration) don’t see our struggles.  We can either play the victim or we can take action.

I don’t know if I agree with the last part of the statement “diminished the ability” etc.  The ability has not changed.  The skills have not changed.  The personal drive should not have changed.  I have worked in environments where morale was down because of this exact scenario and still never understood it.

We make choices everyday.  We made a choice when entering this profession that we would place the patient’s needs above all else.  I made that choice.  I have to live with that choice and can’t allow other outside influences to impede the decision that I made.

I think that more in the healthcare profession need to go back and examine their personal mission. Mine is short and sweet.

“The consequences of moral distress for nurses and other health care providers include feelings of anger, frustration, guilt, and powerlessness.”

I’ve seen this firsthand.  People stop caring.  It’s sad to walk around in an environment where the employees don’t feel heard.  If things in an specific environment always remain the same, then where is the impetus for change? Are you a flea?

“…moral distress can also occur when clinicians internalize external constraints to such a point that their own moral values begin to shift, causing them to disengage morally, compromise their integrity, and possibly engage in harmful practice.”

I have had conversations with those that enforce the rules (read that as members of the department of justice) and there was something said that has stuck with me all these years. To paraphrase: people don’t start out with the intention to deceive, but they may slightly overbill every once in a while.  If they don’t get caught, then there is no external pressure not to do it and then other vices take over such as greed.

Understand the why behind actions and it is easier to understand the actions.

“…moral resilience, which can be understood as ‘the capacity of an individual to sustain or restore [his or her] integrity in response to moral complexity, confusion, distress, or setbacks.'”

Some people are just stronger.  That’s not wrong to say.  It holds true in many aspects of life.  I am a bigger guy, so I am in the bottom half of runners.  I’m just not a strong runner.  I have seen people get shot.  I’ve had friends killed.  I’ve had family in prison.  I’ve seen bad stuff.  I have a stronger resilience to bad stuff than others and I don’t tend to panic quickly.  I know…I know… “I have a high pain tolerance.”  I hear it all the time from patients, but I believe that my moral compass is on point because of my experiences.  I don’t believe that there are many in healthcare with my experiences.

Question of the day:

Do you have moral resilience?  This means can you stand up for what you believe in or are you going to get knocked down and not have the ability to stand up for yourself again?

 

Excerpts take from:

Rodney PA. WHat We Know About Moral Distress: Looking over three decades of research and exploring ways to move the concept forward. AJN. 2017;117(2):S7-S10.

 

 

Moral Distress and Moral Resilience

“At the individual level moral distress may cause burnout, lack of empathy, and job dissatisfaction, while at the organizational level it may lead to reduced quality of care, increased staff turnover, and poor patient outcomes.”

Moral distress is essentially knowing the right action to take, but being unable to take that action due to external conflicts.  For instance, in therapy we may believe that a patient only requires one visit per week, but the corporation may place pressure on the therapist to see the patient more often during the week.  Again, this decision may be due to corporate pressures to make more $$$.  If you are the therapist, you are now in the middle of doing the right thing by the patient (at least what the therapist believes to be the right thing) and doing the right thing by the company.

You can see a quick link here speaking to some of the pressures felt by staff PT’s to keep patients longer than “needed”, in the therapist opinion.

When employees feel this pressure, they start to believe that the initial reason for getting into healthcare, “to help people”, becomes trumped by the need to make more money for the company.  This difference of personal moral code and corporate code has been shown to lead to moral conflict.

Can you see how this could lead to staff turnover? Of course, when the therapist’s personal mission is not in alignment with corporate mission, it may cause the therapist to find a new job that best matches personal mission.  It has been said that Millenials are very concerned about a corporate mission matching a personal mission.

One can logically make the jump from a lack of empathy (not listening or understanding the patient’s position) and job dissatisfaction to worsening clinical outcomes.  All of this makes sense to me.

“Generally, resilience refers to ‘the ability to recover or healthfully adapt to challenges, stress, adversity, or trauma'”

I love using this when talking to patients about tissue ability to absorb force and unexpected events.  When talking about moral issues, it has to do with a person or therapist’s ability to absorb stress without significant setbacks in emotional or physical well-being.

The article went on to create recommendations for addressing moral distress and moral resilience.

“Institution leaders need to value and create a culture of ethical practice and commit resources to support individuals in cultivating moral resilience”

Many statements can sound great, but creating a culture of ethical practice may be near impossible in all practices.  From the top there is a culture that leaks downwards onto the worker bees.  This company will assume the “culture” of the owner, if not in whole, at least an iteration of the owner.  This is where I believe that having a thorough understanding of one’s own personal mission is vital because otherwise one may assume another’s mission and waste years or decades on a mission that one doesn’t own.

“Encourage accreditation bodies to mandate that curricula for all health care professions include content addressing ethics, moral distress, and moral resilience”

I fully disagree!  Whaaat?!

I don’t think that the curricula should include ethical content, but ethics has to be embedded within all of the curricula. Here’s my rendition of an ideal program set-up.  The ideas on the periphery can always change, but they must center around creating an ethical professional.

ethical curriculum

The ethical issues that are noted across the lifespan will differ and the ethical issues noted in business are a completely different animal.  Because of this, it is important that topics are brought to the students attention so that they have some background from which to make a decision.

I also don’t think that this should be taught by the professors at the universities.  In terms of treating in the trenches, most of academia that I come in contact with haven’t practiced full time in a clinic in a long time or ever.  Because of that, there is a lack of “street cred”.  It’s hard to discuss and own a topic if there is no experience in the topic.

We had a teacher in PT school that would always say refer to Reese and Bandy (authors of a book), whenever we brought a question.  At first, I thought that she wanted us to obtain the answers for ourselves, but over time I learned that the professors (plural) teaching that class 1. didn’t know what was in the book and 2. couldn’t rationalize the ideas that were in the book.  They had me refer to a different teacher altogether in order to have him explain the concepts in the book that were contradictory.

Ethics has to be taught from experience…in my opinion.

Excerpts from:

Rushton CH, Schoonover-Shoffner K, Kennedy SM. Executive Summary: Transforming Moral Distress into Moral Resilience in Nursing. AJN. 2017;117(2):52-56.

Moral Distress

“Unfortunately, information about moral distress and its consequences is often inadequate in healthcare provider education.”

This topic of moral distress was never spoken of in our physical therapy program, but I am unsure if this has changed with time.  Moral distress occurs when someone knows the morally right thing to do for that person, but the individual feels like they are unable to do the right thing for one of many reasons.

These are topics that are not addressed well enough in PT school.  If a person doesn’t have strong moral resolve, then the person may work to appease the reason that he/she feels constrained instead of fulfilling his/her own moral code.

 

“Moral distress as ‘psychological response to morally challenging situations such as those of moral constraint or moral conflict or both’…experience moral distress and burnout in situations such as patients receiving non-beneficial treatment, patient suffering, care not consistent with patients’ preferences, lack of administrative support, perceived powerlessness, and competing obligations.”

For those that are new grads reading this…WELCOME TO THE WORLD OF HEALTH CARE!

Burnout is a topic that has apparently been taboo to talk about in previous years or there hasn’t been a platform in which healthcare practitioners felt comfortable releasing their thoughts.  I can’t remember in my career, albeit only 11 years, in which burnout has been such a large topic as it has been in recent months.

Moral conflict can happen from providing care that is not beneficial.  WHY IN THE WORLD WOULD ANYONE EVER GIVE THIS TYPE OF CARE?!

Enter Shane McMahon

Unfortunately, there have been many therapists that I have spoken to across the country that are performing treatments that they do not personally believe to help the patient, but are trying to stay out of trouble with higher-ups in the company that they are employed.

 

If you are a patient reading this, close your eyes for this and skip to the next paragraph…Companies are trying to get their hands in your pockets.  (YOU WEREN’T SUPPOSED TO READ THAT!)

“Poor work environments…associated with a higher frequency of nurse-reported healthcare-associated infections. Persistent moral distress can progress to burnout, which is also associated with increased incidence of hospital-acquired infections.”

So…who do you want treating you? Do you want to be treated in an environment that increases your likelihood of developing an infection?

If not…pay attention to your surroundings.  Are your healthcare professionals happy, energized, empowered and fulfilled?  If so, you are probably in a good spot.

“Nurse leaders provided insights on risk factors that increase the possibility of moral distress. System-level factors such as work environment, lack of strong ethics resources, and heavy workloads prevailed.”

If you are practicing in healthcare, does this sound familiar.  A lack of ethical resources and heavy workloads describes most institutions in which I have worked and hear from others in the field of PT.  At no time should money trump patient care, but it happens all too frequently.

I get it…I am trying to run a business.  I have heard the phrases that we need to keep the lights on.  We need to make sure that we are making a small profit.  I get it, but at no point in time should we allow greed to take precedence over patient care.

Seek it out

Understand it

Pay attention to workplace climate

Promote receptive environment and engagement

Open opportunity for dialogue

Reflect, Evaluate, Revise

Transform Environment

Link to article

Thanks for taking the time to read this synopsis.  It would mean a lot to me if you would share this for others to see the state of healthcare in today’s environment.

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

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.

What’s it mean to be a PT part I

 

 

As professionals, we are all supposed to practice in accordance with the core values and within the Code of Ethics.  Having conversations with PT’s all over the country regarding unethical situations makes me think that some in the profession could use a refresher.  Especially those (me included) that may not have been paying close attention to this information while in school.

Principle #1: Physical therapists shall respect the inherent dignity and rights of all individuals.

It’s unfortunate that there are people that make bad decisions in life.  There are cases of PT’s acting inappropriate with patients. Here’s a recent article regarding a PT that was found to act inappropriately by his state board.

Moral of the story: patients have inherent rights as people.  Although we are in a position of trust, we must never do anything to compromise that trust that patients place in us.  Patients are coming to us at a vulnerable time in his/her life and we must acknowledge that.

  1. Physical therapists shall act in a respectful manner toward each person regardless of age, gender, race, nationality, religion, ethnicity, social or economic status, sexual orientation, health condition, or disability.
    1. It’s been published that some students receive lower grades during a clinical correlating with race.
    2. PT students may not feel comfortable treating the older patient with the same principles as the younger patient per this
    3. Another study speaks to the disparities among races for receiving medical care for knee

 

I guess that I have been naïve all of these years.  As a minority that comes from a blue-collar family, I never paid attention to this and have not seen it personally.  We have to take into account our  implicit bias at all times.  For instance, I recently attended a health fair at the local Spanish Community Center and the people were so surprised that a Mexican from “the neighborhood” was able to earn the title of Doctor.  This type of bias affects every generation that gets infected with this negative thinking.

  1. Physical therapists shall recognize their personal biases and shall not discriminate against others in physical therapist practice, consultation, education, research, and administration.
    1. I thought that a lot of these principles were common sense and part of being a good person, but apparently there are a lot of people who have these biases in healthcare.

 

 

THIS IS THE FIRST IN A SERIES OF POSTS THAT I WILL BE DOING ON THE CODE OF ETHICS AND CORE VALUES.  FOR SO LONG, I’VE ATTEMPTED TO LIVE THESE CORE VALUES OF OUR PROFESSION, BUT THEN I HAVE COME TO REALIZE THAT SO MANY OF MY STUDENTS COULDN’T RECITE THEM.  TO ME THIS MEANS THAT THEY HAVEN’T BEEN INTERNALIZED.  AS PROFESSIONALS, WE NEED TO ACT LIKE PROFESSIONALS AND AT LEAST BE AWARE OF OUR CORE VALUES AND CODE OF CONDUCT.

Right hook

If you’ve never heard the saying that one works for decades in order to become an overnight success, then you’ve heard it here first.

I’ve been in PT for 10 years and am now getting mentioned in conversations with people that I’ve looked up to for years. At one point, someone was shocked that another student didn’t know who I was. I find it comical.

As the son of a laborer, especially one that worked in the sewer systems, I have always had a strong work ethic. For 10 years I’ve kept my head down, avoided causing any waves and just worked. I worked through a divorce. I worked through a fainting episode. I worked through a cardiac issue. I worked. It’s what I’ve always known. I guess I’m just too dense to know any different.

One thing that I am realizing after all these years is that I gained a lot of knowledge by working with patients, working in study groups and working at night by reading journals. I worked hard and now I’m starting to speak out more from behind the computer.

I have a lot of passions for this profession, but this profession is just that…a profession. At some point I will leave it and move on, but while I’m here, I want to have an IMPACT.

Jim Rohn said “If you let your learning lead to knowledge, you become a fool. If you let your learning lead to action, you become wealthy.”

I’m starting to take action. For those that follow my blog, keep your eyes and ears opened because I am creating a CEU that will encompass our profession, but I believe that it will transcend our profession.

I am not doing this for the money. I am sick of hearing the negatives of our profession. I chose to look at these negatives systematically to try to determine how I can help. I think I know how to create waves and make an IMPACT.

see you soon…hopefully in a class near you.

Marathon or sprint

“Customers and employees come and go. Supporters are with you for the long haul.”

Blake Mycoskie, Founder of TOMS shoes

I recently took over as a manager in an outpatient physical therapy clinic. I would love to say that I came in and that business is booming, but it’s not so…yet. I’m busting my tail and those patients that have come into the clinic are no longer just patients. They are supporters. Heck, they might as well be a giant billboard walking around town. I’m getting new patients coming in and their doctors are telling them that they are hearing great things about me and the clinic! This is exciting. It takes a small event to create a ripple in the ocean. That one patient telling the prospective patient about me and the clinic is the rippling effect that I need.

Not everyone needs PT. It’s a shock to hear that coming from a PT! I’m telling you that you may not need my services, which in turn means that you won’t spend your hard earned money on my services. Financially, this statement hurts, but I learned from a wise business man that service to the people is the most important part in business. I had the opportunity to hear his story and ask questions about his journey. This man has a following, with me included in that line. He built a career on serving his customers and creating supporters.

This guy is one that I will attempt to emulate in the coming years. Doing good deeds can’t hurt anyone. When I go back and review these blog posts next year, I’ll give an update on my attempt to emulate the best businessman that I had the opportunity to chat with this year.

Thanks for reading.

Not knowing versus not learning

“Ignorance: a limited understanding of all the relevant physical laws and conditions that apply to any given problem or circumstance”

I don’t think that this is much of a problem in the physical therapy profession for the basic concepts of the profession.  The issue of ignorance comes into play when we start discussing current evidence.  A new graduate’s primary responsibility is to pass the boards ( a national test in order to determine basic competency in order to practice as a PT).  Unfortunately, the boards are based off the books used during the physical therapy program and the books are based from research that is at least 5 years old or older.  This means that the students are being tested on material that is greater than 5 years old.  Current published research may not make its way into an educational programs curriculum due to time constraints.  In this fashion, the students may be ignorant to current research or niche research.

“Ineptitude: meaning that knowledge exists, but an individual or group fails to apply that knowledge correctly in a particular circumstance. “

This is common.  We know that therapists are not staying current with published research.  Time and access are two barriers to staying up to date on the research.  Just a quick example.  I dedicate 10 minutes per day to reading.  Even 10 minutes per day is hard to fit in with all the other hats that I must wear such as: business partner (http://www.goodliferehab.com/) , father, husband, running a separate Facebook page that interviews influencers and performing community lectures.  There is only so much time in the day and I can understand how some therapists will have a difficult time fitting learning into their day.  Barriers to obtaining current research can be the cost of a subscription to get the journal articles.  For instance, I pay over $1,000/year just to have access to research.  This is a big chunk of money when you consider all the other life activities that aren’t free.  Pair this with the fact that the “average” salary for PT is 80,000 ish and that students have well over $100,000 in debt.

, that $1,000/year over the lifetime of a career becomes expensive!

“For instance, through numerous scientific breakthroughs, there has been a repudiation of ‘folk’ treatments in our profession-such as hot packs or ultrasound for heat therapy-in favor of treatments based on scientific evidence.”

Going to PT should not resemble going to a spa! If you are going to PT and getting electrodes placed on you…getting hot packs placed on you…getting rubbed with gel while someone is moving a wand on your skin…or getting a rubdown…THAT IS NOT PHYSICAL THERAPY! On the flip side, PT should not resemble personal training! Going to your therapist and getting a list of exercises for you to perform independently while your therapist is chatting with others…IS NOT PHYSICAL THERAPY! The closes profession that I can equate therapy to is that of a teacher-student (and not always is the therapist the teacher!).  This healthcare relationship should be a personal relationship that takes place in a private setting allowing for open communication between the therapist and patient.  The patient should walk out of each session with more knowledge than they walked in with. The patient should understand why interventions are performed…or better yet why some aren’t performed.  We need to get away from the tradition of PT and move towards what the evidence tells us.

“However, despite the excellent EBP (current evidence) resources now available, ineptitude remains a major 21st century challenge in medical and rehabilitation care”

I have a dare for all of you reading this.  When you go see your next healthcare practitioner I want you to ask a simple question: “How much education do you get every 2 years?” In PT, we are required to get a minimal amount of continuing education to maintain our license.  DO YOU WANT TO BE TREATED BY SOMEONE THAT IS ONLY GETTING THE MINIMAL AMOUNT OF EDUCATION OR SOMEONE THAT IS DEVOTING TIME TO FURTHER THEIR KNOWLEDGE OUTSIDE OF THE MINIMAL STANDARDS FROM EACH STATE!

“…3 types of influence that have been shown to relate to the rate of spread of an innovation: (1) perceptions of the innovation, (2) characteristics of those who adopt the innovation or fail to do so, and (3) contextual factors”

The following will discuss how these all relate.

“First, the perceived benefit of the proposed innovation relative to its cost is the most powerful influence.”

For instance, a hot pack may not give much benefit, but it is cheap and relatively safe.  You will see this frequently in a PT clinic that sees a high volume of patients because of its relative ease of use and safety…assuming the therapist is asking you how you’re doing and checking a few things before, during and after.

Cold laser treatment is slower to take off in our profession because it is an out of pocket intervention…which means that your insurance company won’t pay for it regardless of whether it works.  This intervention is slower to be used in the clinic because it may be cost prohibitive for some patients.

“Second, rapidity of change is directly related to how compatible the innovation is to values, beliefs, and history.”

There are some “treatments” that become popular during years of summer Olympics.  In 2012, a specific brand of tape was seen on many of the “big name” volleyball players.  The thought was that it “kept things more supported”.  There is no research that conclusively states anything near this type of statement…but there is a lot of research that says the opposite.  We still see it used in clinics today…which is okay, if the rationale for using it is what is intended from our current knowledge base.  For instance, we know that it reduces pain and allows for increased ROM…sometimes.  If the patients are educated in this regard and not that it “keeps things in place” …go for it.  It seems like 2016 was the year of the octopus.  If you looked at one of the “world’s most famous swimmers”, it looked like he wrestled with an octopus underwater.  This technique has been around for centuries.  Some therapists are starting to do it because patients are asking for it.

“Third, the complexity of an innovation affects the rate of its adoption, and, as expected, simple innovations spread faster than complicated ones.”

Ultrasound, electrical stimulation, and traction are all very easy to perform…since the machine does most, if not all, of the work.  These were quickly adopted into our profession and are hard to convince some clinicians to stop using…regardless of what the evidence states.

More complicated interventions such as “critical thinking” are harder to adopt.  For instance, when assessing a patient with back pain or vestibular issues, there is a plethora of research showing that if we can classify it that we have a better outcome.  Classifying the problem requires (1) knowledge, (2) assessment, (3) application, which is a lot harder than just pushing a button on a machine.

Some of the personality types are as follows: 1. Innovators, 2. Early adopters, 3. Early majority 4. Late majority, 5. Laggards

A lot of these are self-explanatory, but it trends from those that jump onto something quickly to those that just hate change.

“Organizations that foster social exchange among its members are likely to see faster adoption of innovations as compared with institutions and organizations that foster habits of isolation and tradition.”

Essentially, workplaces that allow for communication will allow for change faster than workplaces that keep everyone separate.  This has to do with changing a culture.  A business that has a fluid culture (one that is easily adjusted), is more apt to change than one that has a strict culture.

“Publishing our work in journals is essential-but publication of research is not, by itself, sufficient if our goal is to change clinical practice. People follow the lead of other people they know and trust when they decide whether to take up an innovation and change the way they practice!”

This is huge! Any profession is a small world and PT is no different.  To push the profession forward, we must depend on more than just published research.  There are many influencers in our sphere such as Dr. Ben Fung, Dr. Jarod Hall, the team from PT on ICE, the team from Evidence in Motion, Dr. Richard Severin, and myself (I’m always trying to sneak my way into this group of titans).  By seeing others lead the way, it is much easier to follow.  Only the innovators and early adopters will feel comfortable at the front of the pack.

As a patient and therapist, you may want to assess your therapists/mentor and determine which of the 5 personality types he/she has.

 

Thanks for reading.  Please leave a comment on my FB page letting me know what you think.

EXCERPTS TAKEN FROM:

Jette AM. Editorial: Overcoming Ignorance and Ineptitude in 21st Century Rehabilitation. Phys Ther. 2017;97:497-498.

 

link to abstract