Tag: ethics

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

 

Cover your ears

Cover your ears

 

“Scurlock-Evans et al reference studies indicating that while 69% of physical therapists (PTs) claim to read relevant research only 26% critically appraise it.”

 

This is disheartening. Tradition trumps evidence in certain cases and without actually reading and attempting to understand the evidence, we will continue to treat using a little bit of evidence and a whole lot of tradition. We are a doctoring profession. I went back to school to get this piece of paper that says doctor. I am also clinical faculty at GSU and have worked as a clinical instructor in both private and non-for-profit practices. I have seen first-hand that some (more than 90%) of students don’t have the passion, will, time, or knowledge to actually read anything more than is handed to them in PowerPoint. I have actually had students get upset when I give them reading assignments to do. Once students graduates, they enter the real world of the profession. If you didn’t have the time to read and take your studying seriously when all you had to worry about was the 40 hours of school, how is the switch going to flip and all of a sudden one will begin studying when leisure time is taken up by other priorities? We have to represent our profession…if for nothing else than for our patients and personal pride. Our profession is supposed to live by these core values, but unfortunately those that display all of them are highlighted instead of the norm. One person that is highlighted, for good reason is the founder of PT Haven. I had the pleasure of meeting Efosa before he graduated and he had his priorities in order then and has lived up to the standards that he set for himself during our conversation. This is but one of many PT’s that practice all aspects of the core values of our profession. I say many, but know that I can’t say all.

 

Back to the point, if we aren’t able to critically read the research, then we can’t confidently apply the research. So much for EBP or “evidence informed practice”.

 

“It has been estimated to take an average of 17 years for research evidence to fully integrate into clinical practice”

 

Are you F’N kidding me?! I know this to be true. I wish I had a thousand dollars every time that I heard a student say that they were told that the information learned was taught because it would be on the boards! I’d be retired by now. There is so much information that is outdated, but students continue to learn it because they will be tested on it. At this point, I can’t state that schools are attempting to produce clinicians, but instead are producing students that can pass a test. We are a doctoring profession. The damn well better be able to pass a test or they shouldn’t be treating patients!!! With that said, it is the school’s responsibility to ensure that not only can the student pass a test, but also be able to treat a patient with confidence and critical thought. This is where I believe that the school’s are failing the students. Should the student end up in a clinical rotation that doesn’t practice the core values of the profession, then the student will learn in a “trial by fire” by being thrown into treating patients although they are fully unaware of the mistakes that they may be making in the process. They aren’t prepared for this type of training. I have taken students for about 10 years and in 10 years I have had 2 students that I could say that I had nothing left to teach by the end of the clinical. I felt like Mr. Miyagi watching the crane kick by the final weeks. As you can see though, this isn’t the norm. Part of this is that school’s haven’t fully integrated the evidence to teach the students. I get it. I hear it from professors… “there is only so much time during the day”. I don’t know where the blame for a lack of preparedness comes into play. It could be the governing body of PT programs for not changing the required learning prior to taking the PT boards, it could be the universities for not embracing clinical practice but instead teaching from books that are at least 5 years outdated (don’t get me wrong, the students need to know the basics from the books, but this is the students responsibility due to the lack of time), it could be the lack of quality clinical rotation sites from which to learn from those therapists that not only practice using best/current evidence but also utilize the core values on a daily basis and finally it is the students fault for not taking more ownership over his/her education. There is a lot of blame to go around, but in the end it is the patient that suffers from this cycle of inefficiencies surrounding learning.

 

Schuppe V. Viewpoints: Exploring the knowledge-to-practice gap. PT in Motion. March 2017:6.

Keeping the customer/patient happy

 

“…owners and managers an no longer rely solely on the relationships they have built with referral sources to grow their practices”

 

Look at the drug companies…they know how to peddle their wares. Once it became mainstream to advertise directly to the consumer we have what is now known as the “opioid epidemic”. If we can advertise directly to the consumer, and give the consumer what they want…business will boom. We have to know what the consumer wants first though. Don’t try to sell them what we have, know what they want and then create the product. We know that patient’s primarily want education first. Give them a taste of the education during a seminar and then tell them that they have to schedule an appointment in order to get the rest of the information. It’s funny. I remember working for Bill Curtis at PT and Spine and he would refer to the magic treatment. In that patients are looking for that magic so that way they can take control of their own issues. If one is the owner, we want to give the patient the magic…but not on the first day. If we got paid for outcomes and not for the patient coming to the clinic, there would be more incentive to help fix the patient at the initial visit and not carry it on for the national average of 8-16 visits for the average orthopedic issue.  

 

“Even five years ago physicians largely dictated our referral patterns…hospital-based clinics and physician-owned practices are aggressively attempting to keep their patients “in-house”.  

 

Everyone in business wants money. THEY WANT YOUR MONEY! There is incentive to keep you going to the same company for every service performed. If you need an MRI, X-ray, PT, sports physical, etc it is very convenient if it is all under one roof. Now, who is making the money? I’m going to make it easy. If your mechanic finishes looking at your car and then says that you need $10,000 dollars worth of work, but he can do it all at once, what are you going to say? What if I say that you need $20,000 worth of work? How high do I have to take that number before you realize that it may not be legitimate needs to continue? The doctors/hospitals that own all of the above “services” may be doing the same thing, but you never see the costs because the insurance “covers” the cost.

 

“We are aware that patients can choose to receive therapy wherever they would like…”

 

Are the patients aware of this? If you go to the doctor and get a referral for therapy (it’s like a referral to any other practitioner), but the referral has the name of a specific clinic on it, does the patient realize that they can still go anywhere? IF YOU ARE A PATIENT AND ARE READING THIS…YOU CAN GO TO ANY THERAPIST THAT YOU WANT TO GO TO! Not all PT’s have the same training or even the same specialty. If you don’t see progress with your therapist after 6 visits, and you are given the words “it just takes time”, find a new therapist. Some things do take time, but hear it from 2-3 different therapists before you actually believe it.  

 

“We are not here to ‘fix’ a patient; we are here to partner with them in their rehab”

 

This is huge. I don’t fix you…I help you fix yourself. I play the role of cheerleader, teacher, listener, advisor, but at no point am I the “fixer”. When I see you for 2 hours per week, there are so many hours throughout the week in which you have to help keep yourself fixed by what you learn in the clinic.  

 

I realize that I can come across as negative with regards to the business of healthcare and unfortunately it is more of a realistic view than either pessimistic or optimistic. I have had discussions with those that audit clinics, researched the Department of Justice website for healthcare fraud, shadowed/worked/observed in unethical clinics and have heard patient stories from their times in other clinics. My view is personal, but real. When I say get a second or third opinion, it’s because you may have to go through that many different clinics before you find one that has your intentions at the forefront.  

 

Excerpts taken from: Stamp K. Happy Customers: How to create a positive patient experience. IMPACT. July 2016:31-32.

 

 

Evidence Based Medicine

“Evidence  based”  practice  or  medicine  appears  to  be  the  phrase  of  the   current  generation  of  health  care  professionals.    A  general  search  utilizing  Ovidsp   resulted  in  over  200  journal  articles  with  the  phrase  “evidence  base”  in  the  title.     Although  the  basis  of  evidence  based  medicine  was  first  established  in  the  1970’s,   the  evidence  has  grown  exponentially  in  the  previous  twenty  years1,2.    Evidence   based  medicine  is  the  “use  of  current  best  evidence  in  making  decisions  about  the   care  of  individual  patients3.”       As  professionals,  but  more  specifically  as  APTA  members,  we  can  agree  that   the  utilization  of  evidence  is  important  for  our  profession4.    There  are  a  plethora  of   articles  establishing  evidence  for  various  types  of  medicine,  but  it  is  important  to   understand  that  evidence  based  practice  also  presents  with  limitations.    For   example,  Jette  et  al4  reports  that  physical  therapists  have  a  positive  attitude  towards   evidence  based  practice.    A  limitation  of  this  study  is  that  the  survey  was  issued  only   to  APTA  members.    It  may  be  argued  that  those  that  have  joined  their  respective   professional  organization  are  more  proactive  than  those  that  have  not  joined.    This   study  surveyed  motivated  therapists,  which  may  have  led  to  the  positive  attitude   regarding  evidence.    Another  limitation  related  to  positive  results  is  “publication   bias”,  which  indicates  that  research  with  negative  results  is  less  likely  to  be   published1.    Because  not  all  research  is  published,  specifically  negative  research,  the   audience  (physical  therapists)  is  inundated  with  positive  outcomes,  which  may  bias   the  reader  that  the  intervention  is  statistically  effective  in  treating  patients.       It  has  been  established  that  randomized  controlled  trials  (RCT)  are  the  gold   standard  for  providing  the  best  evidence  for  interventions5.    It  is  the  physical   therapist  responsibility  to  thoroughly  assess  the  RCT  in  order  to  determine  if  it  is   applicable  to  the  population  treated  clinically2.    Maher  et  al1  concluded  that   individual’s  ability  to  critically  assess  an  article  is  a  limitation,  as  not  all  therapists   critique  an  article’s  validity  to  the  population  treated.    Another  limitation  to   evidence  based  practice  noted  by  Maher  et  al1  is  FUTON  bias  (full  text  on  the  net),   which  means  that  therapists  are  more  likely  to  quote  and  utilize  only  the  articles   which  are  available  in  full  text.    I  am  guilty  of  this  bias,  as  I  do  not  find  that  utilizing   an  abstract  is  valid  for  patient  care  if  I  cannot  assess  the  methodology  of  the  study.       Additionally,  conflicts  of  interest  serve  as  a  limitation  to  evidence  based   practice6.  Croft  et  al6  states  that  professional  groups  that  have  an  interest  may   promote  a  specific  intervention.    Because  of  this  financial  conflict  of  interest  the  use   of  evidence-­‐based  practice  may  be  used  as  a  marketing  tool  for  individual   professions.       To  answer  the  question:  Do  I  think  that  evidence-­‐based  practice  will  require   a  change  in  the  profession?  Based  on  Jette  et  al4,  I  do  not  believe  a  change  is   required.    Time  will  eventually  dispense  of  the  therapists  that  are  uncomfortable   with  research,  lack  the  database  knowledge,  or  are  unable  to  critically  appraise   research.    According  to  the  article,  younger  therapists  are  more  inclined  to  be   researched  based  practitioners,  as  they  are  more  confident  and  able  to  critically   appraise  the  research  out  of  school.    Based  on  Vision  2020,  it  is  hard  to  believe  that  a   change  needs  to  take  place  in  order  for  our  profession  to  become  more  research   based.

 

References:

1. Maher  CG,  Sherrington  C,  Elkins  M,  et  al.  Challenges  for  Evidence-­‐Based   Physical  Therapy:  Accessing  and  Interpreting  High-­‐Quality  Evidence  on   Therapy.  Phys  Ther.  2004;84(7):644-­‐654.

2. Vaccaro  AR,  Fisher  CG.  Evidence  and  Impact:  Should  these  articles  Change   the  Practice  of  Spine  Care?  An  Evidence  Based  Medicine  Process  [Published   Ahead  of  Print].  DOI:  10.1097/BRS.0b013e3181d4ea37.  Accessed  on  January   25,  2012.

3. Sackett  DL,  Rosenberg  WMC,  Muir  Gray  JA,  et  al.  Evidence-­‐based  medicine:   what  it  is  and  what  it  isn’t.  MBJ.  1996;312:71-­‐72.

4. Jette  DU,  Bacon  K,  Batty  C,  et  al.  Evidence-­‐Based  Practice:  Beliefs,  Attitudes,   Knowledge,  Behaviors  of  Physical  Therapists.    Phys  Ther.  2003;83(9):786-­‐ 805.

5. National  Health  and  Medical  Research  Council.  How  to  Use  the  Evidence:   Assessment  and  Application  of  Scientific  Evidence.  Canberra,  Australia  Capital   Territory,  Australia:  Biotext;2000.

6. Croft  P,  Malmivaara  A,  Van  Tulder  M.  The  Pros  and  Cons  of  Evidence-­‐Based   Medicine.  Spine.  2011;36(17);1121-­‐1125.

Why be a mentor?

I have some passions in the profession of physical therapy and the first is to provide the best care to my patients.  The second is to create therapists that will provide the best care to patients, as they indirectly represent me.  I do my best to ensure that PT students that go through me develop the reasoning ability to understand ethical and unethical environments that will challenge their ability to provide that best care to patients.  This profession is very much driven by the almighty dollar and I understand why some students make specific decisions as to which job to take, but as long as that student has weighted the “pro’s” and “cons” of taking a job, I know that I did what was right in teaching my students.  Some students unfortunately never develop that ability to reason past the $$$.  

 

The Oxford dictionary defines mentor as “an experienced and trusted advisor” and “an experienced person in a company, college, or school who trains and counsels new employees or students.” 1 There are published studies that oppose this definition, which will be discussed in detail further in the paper. Other professionals have specific definitions of mentor as follows: “ Mentor is an individual with noted experience and position within the Military Nurse Corps who possesses a genuine interest in guiding the professional and personal development of a less experienced Nurse Corps officer.”2 As a physical therapist, mentoring is a topic of importance for the author.   I started my career as a teacher of biology, secondary education, with the intent to mold current students into future leaders. Because of circumstances, that dream was never to become a reality and I chose a different career path. My first year of clinical practice, I was asked by GSU to be a clinical instructor because of personal characteristics. Holmes3 states that novice clinicians placed in a mentoring role may have difficulty with individual personal development. My boss/mentor at the time believed that I possessed the qualities to overcome this added adversity and after serving as a clinical instructor for the first student, I found that my initial dream could become a reality in this new field. The stresses of mentoring during the initial years

Christiansen et al5 notes that there are two processes for mentor selection: assignment by an institution or selection by the protégé. Others disagree with this statement, in that preceptors are assigned, but mentors are chosen8. It is advised to choose a team of mentors in order to advise on multiple issues, with each mentor having a specialty6. In the end, one should choose a mentor “who exemplifies traits and skills that you want to adopt”6.

As a mentor, it is rewarding to observe students and clinicians that choose me as a mentor when these individuals apply the information garnered from the relationship in order to treat a patient whom previously the clinician would not have the knowledge or experience to treat. This is consistent with Wainwright et al4, in which the following is stated: 1. clinical decision-making is advanced through clinical education, 2. positive mentoring enhances clinical practice skills, 3. Experienced clinicians inevitably become mentors to novice clinicians. Christiansen et al5 and Holmes et al3 also relate mentoring to the advancement of clinical skills.

Attributes and roles of a mentor are widely published in the research as demonstrated in the following table:

Characteristics Roles
Experienced4,8 Coach6,10
Content knowledge5,6 Advisor1,6,9
Communication skills5,8,9 Counselor1,6,10
Personal integrity5,6 Confidant6
Self-reflection5  
Systems-based learning5  
Willingness to teach5  
Intellectual humility5  
Internal locus of control5  
Empathy8  
Caring8  
Unbiased6,9  
Committed6  
Maintains confidentiality6  
Patience6  

 

As stated previously, a mentor is an advisor…who counsels new employees or students1. Christiansen et al5 states, “Mentoring is not supervising, advising, career counseling, shadowing or coaching. Mentoring is workplace learning and must occur within that environment.” Although the previous statement relays that a mentor must work in the same environment as the mentee, Liu and Ansbacher6 state that long-distance mentoring can be successful through e-mail, phone conferencing or meeting at annual conferences. Based on the aforementioned articles, the act of mentoring appears subjective in nature, as varying authors have different opinions on both the definition and act of mentoring.

“Mentoring requires dedication to the process, which includes substantial investments of time, energy, and resources-physical, emotional and intellectual.”3

As a clinical instructor and mentor to other Mechanical Diagnosis and Therapy (MDT) trained therapists, this statement is accurate. When I was a new professional (< 5 years of experience), I was consistently studying the concepts of MDT, hierarchy of knowledge principles and coursework for clinical instructors. This studying was not without cost. I sacrificed time from family, friends and life experiences in order to work towards that initial dream. Being a mentor also poses a challenge of finding a mentor4. The mentors that I chose are from around the country, and I am only able to meet with them at large spine conferences. As a clinical instructor, I am aware of the bias that is inherent when a relationship is created and established with a mentee and try not to provide preferential treatment for my students7.

The American Physical Therapy Association (APTA) does not define a mentor, but establishes the roles for the mentor and protégé as follows11:

MENTOR

  1. Acclimate the early-career protégé into the culture and the value of PT12
  2. Help the ECP understand the core values of PT and the role of each PT and PTA to support the practice mission of PT
  3. Be open to working as a mentor
  4. Create a collegial atmosphere that provides responsiveness and respect for the ECP
  5. Seek training and education to further skills in mentoring

PROTÉGÉ

  1. Identify knowledge and skill gaps
  2. Establish career goals for life-long learning, both short and long term.
  3. Identify specific experiential opportunities
  4. Identify potential mentors, both junior and senior, who have compatible interests.

During the literature review for this paper, there was only one article that formalized a mentor program. Burritt et al13 studied the outcomes of removing experienced nurses from clinical practice in order to work as a mentor for novice nurses. “The prevalence of stage 2 or greater nosocomial pressure ulcers improved by 38%, which was significantly lower in the post implementation phase. A 47% reduction in the number of adverse events that comprise the composite measure of failure to rescue was also noted to be significant.” Tactics such as this may also influence retention rates of nurses8.

CONCLUSION

To conclude, Holmes et al3 sums it up in a concise statement, “Rejoice in the successes of your mentee, these triumphs can only enhance your own standing.” The author personally chooses to be a mentor for those with less experience, in order to assist those with the characteristics needed to become a successful mentor. My dream of creating future leaders is now reality as my protégés are now becoming mentors.

Bibliography

  1. Mentor. In Oxford dictionary online. Retrieved from http://www.oxforddictionaries.com/us/definition/american_english/mentor.
  2. Blankenbaker SE. Mentor Training in a Military Nurse Corps. Journal for Nurses in Staff Development. 2005;21(3):120-125.
  3. Holmes DR, Hodgson PK, Simari RD, Nishimura RA. Mentoring: Making the Transition from Mentee to Mentor. Circulation. 2010;121:336-34.
  4. Wainwright SF, Shehpard F, Harman LB, Stephens J. Factors That Influence the Clinical Decidion Making of Novice and Experienced Physical Therapists. PTJ. 2011;91:87-101.
  5. Christensen N, Gerber P, Jensen G, et al. (2014). American Board of Physical Therapy Residency and Fellowship Education: Mentoring Resource Manual. Accessed from: www.abptrfe.org
  6. Liu JR, Ansbacher R. Assembling the Optimal Mentor Team. Obstetrical and Gynecological Survey. 2008;63(4)

7.Coulson CC, Kunselman AR, Cain J, Legro RS. Graduate Education: The Mentor Effect in Student Evaluation. Obstet Gynecol. 2000;95:619-622.

  1. Martin CA. Across the Generations: It takes a village to raise a nurse. Nursing Critical Care. 2007;2(3):45-49.
  2. Ansbacher R. A Guest Editorial: The Mentor-Mentee Relationship. Obstetrical and Gynecological Survey. 2003;58(8):505-506.
  3. Hurst SM, Kplin-Baucum S. Innovative Solution Mentor Program: Evaluation, Change and Challenges. Dimens Crit Care Nurs. 2005;24(6):273-274.
  4. American Physical Therapy Association. (2012). Best Practice for Mentoring Early-Career Proteges: HOD P06-12-16-05. Retrieved from: http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Professional_Development/BestPracticesMentoringEarlyCareerProteges.pdf.
  5. Gardner EA, Schmidt CK. Implementing a Leadership Course and Mentor Model for Students in the National Student Nurses’ Association. Nurse Educator. 2007;32(4):178-182.
  6. Burritt J, Wallace P, Steckel C, Hunter A. Achieving Quality and Fiscal Outcomes in Patient Care: The Clinical Mentor Care Delivery Model. JONA. 207;37(12):558-563.

Not all are altruistic

Not all are altruistic

 

I want to congratulate this student for getting published before graduation. This is a great feat and kudos to you. Now the student makes great points, but I doubt that this student is at the bottom of his class. Not all can be amazing students. Someone has to be the student that brings the average down. Nothing wrong with that, but unfortunately, anyone lower than the highest-grade earner will be that student. Someone wrote this article on the “awesome-side” of the bell curve. I retort using the “not so awesome side” of the bell curve examples.

 

  1. “There is a way to meet these goals (increased productivity demands), a simple and safe way that bypasses the “high-risk, high-reward” decisions that practice owners face when on the brink of future growth of their company: Add a student into your clinic”

 

This is coming from a student!? Look, I love taking students. I am a credentialed clinical instructor (this means that I have taken a course to learn how to work with students). I completely disagree with the above statement. From a business perspective, we should not be using students as free labor in order to pad our profits. These students are paying for the right to be in the clinic. Our primary objective as clinical instructors is to produce the best therapists that our ability allows. If I treat a student as a therapist, then I am doing the student a disservice by asking them to do the work that I usually do, and then going off to do more work in order to increase the companies bottom dollar. There has to be a line drawn in the sand regarding business ethics.

 

  1. “I have experienced good clinics, bad clinics, and great clinics; and I have noticed certain characteristics that tend to separate one from another”

 

I’m sorry, but as a student, the sample size is very small. To say that one has seen great clinics is a far reach since, in my opinion, they are few and far between. It is rare to be in a clinic in which the bottom dollar is secondary to patient outcomes. This will be changing in the future, but not anytime soon. For additional information, please see: http://www.mechanicalcareforum.com/podcast/97)

 

  1. “…students can be your safe haven for boosting morale”

 

I haven’t seen this as much in my career. There are those “go getters”, but this is just as rare as finding a “great clinic”. When looking at the bell curve of PT classes, there are only so few on the awesome side of the bell curve. Mostly, students coming out of PT school are average in my experience. Every once in a while, we get the student that has the potential to change the profession, but again…few and far between.

 

  1. “…having a student in their second or third year of physical therapy school who can take half or one-fourth of your caseload can save you time to work on documentation while maintaining clinic productivity standards”

 

This is where the shit hits the fan. Most students coming out of school have not mastered biomechanics. If a student can’t step in and do my job, including my clinical rationale, then I should not be using this student to bolster “my productivity” because the student will not be giving “my quality”. Some therapists come out of school and after 3 years are no more than overpaid personal trainers. Again, this doesn’t apply to all, but to believe that a PT student can come out of school and do my job with my experience leads me to believe that I am overpaid. In 8 years of practice and having well over 50 students, I have only had two that could possibly take my job. Again, these two were rock stars. They have the potential to change the profession. All other students needed to be built into clinicians. This does the opposite of improving my productivity because I am now spending time that would have been spent on paperwork in order to teach the future of our profession. I have had very few failures, but also very few rock stars. The rest start as average and become clinicians as the weeks progress.

 

  1. “Another benefit of having a student is that they can keep you up to date with the latest evidence”

 

Again, this is another fallacy. There are clinicians out there that don’t know how to research. I believe that Jensen (many will cite this article about PT’s that don’t research) states it clearly that the longer you are out of school, the less likely you are to perform research. That doesn’t mean that the newer grads coming out of school are much better at interpreting research beyond an abstract. I have encountered many abstract readers, but few students that can break down the article to actually tell me if it will affect my clinical outcomes. As you can see though, I also am spending time making myself better by reading the “latest evidence”.

 

  1. “What better way to create a legacy than to help students practice with the same methods that helped you prosper?”

 

It took the author many pages of writing to get to the heart of why many of us take students. I am looking to create amazing clinicians that feel confident in their abilities. My goal is that for any student that goes through me to become a Doctor…Doctor…Doctor of Physical Therapy, will earn that title. If a student has me as a CI, it will be a rough clinical, but I guarantee that the student will be much better off for it. This is why I do what I do!

 

Quotes taken from:

 

Sinacore A. SIMPLIFY! How adding a student can amplify growth. IMPACT. April 2016:40-46.

HEALTH CARE BUSINESS

HEALTH CARE BUSINESS

 

  1. “As an industry, we have a tremendous responsibility to offer our consumers information, tools and, of course, quality treatment”

 

Having sat and conversed with PT’s with other companies recently, I think that this sentence is a bunch of fluff. Don’t get me wrong, it sounds great, but it doesn’t happen too frequently. As a profession, we are hounded with productivity requirements and profit and loss statements. We got into this profession to help people, not to make mega corporations a mega-profit. Unfortunately, to the company, you are just a number. The bigger the number (see $$$) the better your number. If you have a therapist that treats you one-on-one, then you are among the few. This profession is being taken over by the “wallymarts” of physical therapy. Focused more on price than quality. For instance, if your sessions followed this game plan: warm up, stretch, manual therapy, and rehab tech or aide (see high school graduate) takes you through some exercises and then applies a hot pack with some electrodes or an ultrasound, then you are among the majority. It is harder and harder for a private (one owner, not publicly traded, not 100’s of clinics) practice owner to make it because everyone sees “wallymarts” and prefers convenience over individualized care. I am blessed because I still work for a company that allows me to treat one patient at a time. I don’t have to worry about productivity, as long as I am seeing one patient per hour that I am in the clinic. This is easy…but two every hour…this is very stressful. You should look up the term burnout. If you want to be a therapist, at least understand the world that you are entering.

 

  1. “Payers are pushing for new payment mechanisms: pay for performance (evidence-based medicine), higher deductibles and coinsurances, and assistance in managing spending. Relying only on insurance payments is a thing of the past”

 

Customers…patients…need to understand the nature of healthcare. For instance, if I could help you in 3-5 visits and you have to pay 70 dollars per visit out of pocket, your total would be 350 dollars. Now if you have to pay a 40-50 dollar copay and I decide to keep you in the clinic because the insurance is reimbursing more than I am getting from you, then I would keep you for 12 visits (average for back pain). In the end, I would make 480 dollars from you. You would have paid an extra $130 to be seen for more visits that you would have needed from someone that runs a cash based business and doesn’t take your insurance. Seek out good, quality care. Take care of your wallet, because there are some of us that will pick your pocket, shake your hand, and give you a t-shirt to advertise our clinics.

 

Quotes taken from:

 

Ziccarelli C. A Shifting Landscae: Growing your business in changing times. IMPACT. April 2016: 29-30.