Be the change

“Be the change you want to see in the world”

Mahatma Gandhi

This quote gets thrown around, but how often do we stop to analyze it?

What is the change that I want to see?

1. I want all PTs to have easier access to research.

2. I want the public to be more aware of the difference between good PT and bad PT services.

3. I want the public to know that a. PTs exist b. how PT is covered by insurance related to out of pocket costs c. and how PTs can help with physical issues.

4. I want PTs and students to be humbled and ask for help when needed and offer help when able.

Hello 2018, I got some lofty wants.

How have I started to accomplish these goals

1. Writing a blog and putting out videos describing the research that I am reading on a daily basis.

2. Giving community lectures educating the public regarding what to expect from a physical therapist. Educating the public on the core values and how some practices may demonstrate the practices. Unfortunately, I also highlight how some may not practice according to our profession’s core values.

I also started posting reviews of some of the neighboring clinics on social media when these clinics aren’t practicing in an ethical fashion.

3. Again, the blog and community lectures serve to educate the public of our existence and during these lectures I typically explain Medicare Part B regulations and coverages so that the potential patient can feel more comfortable about their responsibility financially.

4. To help others in areas of my strengths I do one-one conversations on FB, via telephone and in person. I readily ask for help when I am stuck and believe that I have a team of Avengers that I can reach out to at all times of the day.

How will you be the change in 2018?

Functional Therapy and Rehabilitation

903 N 129th Infantry Drive

Joliet, IL

815-210-4969

“No one owes you anything”

This quote is from an excerpt of a conversation with Amelia Boone from “Tools for Titans”.

Growing up with 5 brothers and a sister, I learned that I wasn’t owed anything and that I had to work to get anything. My brothers were great baseball players and my sister had a mean tennis serve. I wasn’t built to be an athlete. At least that’s what I told myself.

In my neighborhood, college wasn’t an expectation or even an option unless one was a master of sport. Our area wasn’t known for producing scholars.

This would be my path. My parents sacrificed in order to send me to a private high school, where it would be hard to fit in because my upbringing wasn’t the “Leave it to Beaver” type. I had more in common with JJ Walker than Wally Cleaver.

I was descent at sports, but I knew I couldn’t play. I saw sports as a gateway to failure. I saw too often how excelling at something could lead one down a broken road. I chose not to play.

I instead joined the honors group at Providence. It was a small group of about 30 of us. One of the coaches said we weren’t “that smart, just knew how to cheat better”. He was partly correct, we knew how to cooperate to win.

What’s all this have to do with physical therapy?

In the end no one owes you anything. Having finished PT school, it was time to rest on my laurels and collect a paycheck. It was time to treat every patient that walked through my door the same as anyone before him/her. It was time to take the easy road…because I earned it.

Anyone who knows me, knows that I am blowing smoke.

I still follow this saying that I’m owed nothing and bust my tail to continue to learn and produce. I treat each patient as a new patient, even if it’s a presentation I’ve seen hundreds of times before, because it’s possible that there will be something with this presentation that will help me with the next hundred.

I never get to “cash it in” because I haven’t made it yet.

I have a pattern in life and it’s very apparent. My mom brought it to my attention about 15 years ago. The pattern is that once I’ve climbed the mountain and made it to the top…I pivot. The juice is always worth the squeeze, even when there is no juice.

There’s always something to learn, something to accomplish and another mountain to climb. I only wish that everyone could live a live never feeling like they were owed anything.

Salute!

Hey! If you enjoyed this post, so may your friends…SHARE IT!

Thanks.

The underdog story

The Underdog Story

How many of you stood in line to collect government cheese? That used to be a joke I would hear from those that were part of the “have” culture, but being raised in the “have not” culture made the line for government cheese a reality. The cheese was a brick of cheddar cheese.  Picture the industrial size that you would buy from Sam’s club or Costco, but it wasn’t near as good.  We had to use the old wire cutter in order to slice it.  We would race home and start cutting the cheese (not like that) with the wire cutter and the kids in the neighborhood would be full.  I never told my dad this story because he would’ve been upset with us taking handouts.

That’s were I grew up.  Our playground was a parking lot.  Our games of choice were whiffle ball and if you hit the taped up ball over the roof of the corner tavern, it was a home run.  We played tag in a blocks radius, which takes me to my next story.

I was always the heavy one.  I can remember going to Sears as a kid and heading straight to the Husky section.  That’s right…we had a section named just for us big kids.  Men’s, women’s, kid’s…husky.  Yeah, that wouldn’t fly today.

Being the “big kid”, I was always “it” when playing tag.  I wasn’t as fast as my more athletic brothers and would only be able to tag them if they let me.

One day while playing tag, I was chasing my brother and out of nowhere a car hit me and ran me over.  It could have been the end of me.  I should have been up in the clouds playing a harp.  Luckily, I was the big kid and my doctor reminded me of this when I was finally taken to the doctor after the accident.

He said (in a Chinese voice): “If you weren’t so fat, you could have been seriously hurt”

Looking back now, it’s a funny story, but it wasn’t then.

When my dad got home he only had one phrase for me; “did you learn anything”.  Mind you I’m 5 at the time! My dad is a Vietnam Veteran.  Tough to the core, but a heart of gold.  Whatever didn’t kill us would make us stronger and there had to be a learning lesson in there somewhere.

Needless to say, I had to overcome a lot of challenges growing up in an area where the anticipated outcomes were jail or cemetery.

This is what makes the story so great.  I overcame! I believe that anyone can overcome with the right mind set.

To other PT’s the title of doctor is one that can be spoken of only quietly in dark corners.  I am proud of it.  I am more so proud to have been named among the greats this year.  Updoc media named me among the top 40 influential physical therapists of 2017.

I’ve come a long way from the husky kid collecting government cheese.

Thanks to the guys at Updoc and thanks for reading.

https://updocmedia.com/2017-top-40-influencers/

A quick story

“Twenty years from now you will be more disappointed by the things you didn’t do than by the ones you did do…Explore. Dream. Discover” Mark Twain
Where do I start? I come from very humble beginnings. We were a family of 5 growing up on the East side of Joliet. I have 3 brothers and one sister. This changes over time so follow closely. Growing up on the East side wasn’t easy. Access to drugs was though. I smoked my first joint before some kids learned to read, although I learned to read before smoking the joint. My dad used to make me sit down with the Joliet Herald News and read the comics to him. This was from the age of 3 onward. Anytime I would ask him a question, one that readily comes to mind is “why is Australia called the land down under?” He would tell me to look it up. I WAS FIVE! This was before the days of Google. We actually had to go to someone’s house (Terri Graves) of someone that had the old set of encyclopedia Brittanica. I learned the answer from somewhere in that stack. My dad would always say that he was doing it to make me learn, but I don’t think he actually knew the answer and was taking the easy way out. If you knew my dad, he’s never at a loss for saying what’s on his mind. 
I smoked my first joint at 5. Before I got hit by a car on Clay street, which is another good story that I will get to. Marijuana was so easy to come by on the East side. Hell, we were growing it in the backyard. (When I say we, I mostly mean my brothers). I am the youngest of the bunch…the runt of the litter you could say. Wasn’t planned, but i’ve come to accept that over time. Drugs were commonplace, and access to guns was even less restricted. At one point growing up there were guns in almost every room, but that because of a Hatfield-McCoy quarrel that my family had with one of the gangs on the East side in the 1990’s. 
How does a kid from that environment go on to become a Doctor of Physical Therapy? How does one get out of that mindset of drugs, gangs, teenage pregnancy, and high school dropout to go on to study under some of the best minds regarding back pain and dizziness that our country has to offer? Why would that same kid go “straight edge” for over 20 years?
Finally, why would that kid ever want to come back to the streets and city that started it all?
Come see me for any of your aches and pains, dizziness or just to learn the rest of the story. I’m at FTR on Essington. Maybe we could swap stories. 
Dr. Vince Gutierrez, PT, cert. MDT
903 Infantry Drive

Joliet, I’ll

60435

QUITTER

QUITTER
“A recent survey revealed that 84% of employees plan to look for a new job this year ”
I actually think that this number may be higher in the physical therapy field. There are many people dissatisfied with the corporate structure of physical therapy, and I am among that group. I think that every year since 2010 I have reassessed my job outlook and searched for other opportunities.
“a US department of labor study revealed that the median tenure for the 55 to 64-year-old category is 10 years. For the 25 to 34-year-old category, the average tenure is only 3.1 years. ”
This one is interesting. There are multiple classmates of mine that worked 3 to 5 jobs within their first 3 to 5 years in the physical therapy profession. I have been out of school for about 10 years now and I I am on my second job. I have had multiple side hustles along the way, but I am still on my second primary job.
“The golden watch has become the other end of the golden handcuffs. ”
I recently received the silver watch. I’ve been at the hospital that I work for for five years and after five years one receives a Watch. I don’t consider the watch a handcuff, but it is a life ring from my perspective. There are many people that have been at this hospital for well over 20 years. Many people realize the problems within the institution, but few people want to change the institution. As much as I’ve tried to change the institution, I realize my power only go so far and that I will need to leave in order to create that change.
“There is a wiser way to get to your dream job, and it begins by keeping your day job. ”
In PT, I have a dream. Not that major dream from Dr. Martin Luther King, but a dream nonetheless. My dream is to see all patients receive quality care. There are many corporations that provide crap care to patients. I hear it from the patients every day. I recently had a patient who underwent 53 visits of physical therapy for her back pain. After two visits his pain was completely abolished and he rated himself as 100% functional. On the one he read it himself as 60% functional. This is a problem. Corporations should not be allowed to milk the patients. The reason why this continues to happen is because patients are under educated with regards to health care in the business of healthcare. If they knew that we get paid based off of how long they kept us they would start seeing themselves more as a $. Healthcare is a unique business because the patients place their trust in us to be altruistic. Unfortunately, the almighty dollar sign can override altruistic tendencies. 
“When you keep your day job, all opportunities become surplus propositions rather than deficit remedies. You only have to take the ones that suit your dream best. ”
I value educating people. I spend much time reading outside of work and I want to share that knowledge. If I would’ve quit my job in order to go teach at a university or community college, I would actually take a pay cut from what I’m doing today. This is why I do so much on the side so that way I don’t risk losing the pay that I currently have. If I want to quit my day job at the hospital, I would be very stressed for money and would have to take every opportunity that came my way. There are some things in the physical therapy field that I realize I don’t really enjoy doing. I love teaching students that are passionate, but I hate teaching students that are just there to check off a box, which is one of the reasons why I don’t see myself going into education long-term. I struggle to work with students who don’t share the same passion that I have for the profession. Students are spending 90,000 upwards to $200,000 in order to enter this profession, and it kills me to think that there are some students that are just checking off boxes and going with the flow. This is why I am very picky as to which schools I take students from. Some schools have better reputations than others for the quality of students that come out of the school.
“Dreams tend to challenge the status quo… At the heart of a dream is change”
Because my goal is to ensure that the most amount of people receive quality care, I realize that I have to leave the job that I’m at. I’ve been working on my side hustle now for years. This started with educating myself to become a better clinician. I finally feel confident enough in my clinical abilities and my leadership abilities to be able to step away from my job in order to create my dream.
“I’ve met hundreds of people who tell me they’ve never written their books because they are too busy. ”
Count how many times you hear ‘busy’ as the response when asking someone how things are going? How many of us would say ‘productive’? Is life truly busy or unorganized to an extent that it feels ‘busy’ and rushed? I stopped saying busy. I take at least 45 minutes to watch tv with my family per day. This is usually “Curious George”, but still unproductive time. I recently went to EntreLeadership 1 Day and the talk by Christy Wright was AWESOME. It had to do with prioritizing your top 5 priorities. I no longer feel that George is wasted time because it meets a priority of spending time with the family. I have more time now that I have prioritized my days. 
“You don’t ask the bottom less, ‘what do I want to do with my life?’ but instead, “what have I done in my life that I loved doing? ”
I have always been against bullying. I have always been the helper. I didn’t realize it at the age of 5, but that’s my earliest memory. There was a group of bullies that pushed a girl. I went berserk. Think of the movie A Christmas Story. It was kind of like that. They got me back later, but it was all three of them together to get me back. My point is that I stick up for people that are being bullied. The problem is that some people are naive or ignorant and don’t realize that they are being bullied. When I say “ignorant”, I literally mean that they don’t have the knowledge to know that they are being bullied. There are very few reasons that I can think to keep a patient in the clinic for over an hour and fewer still to keep them for more than 6-12 visits. Obviously there are some patients that will need more, but in an orthopedic setting we don’t tend to see that.
“A hinge moment occurs when you are planning to do something standard and normal, something you’ve done many times before… And then seemingly out of nowhere, something, a small detail usually, hinges you in a different direction.”

Way back 2009, I was offered a job by Mickey Shah. I turned it down. That was my hinge moment. I knew that if I had taken that job that I would be riding on the tail of Mickey my entire career. I wasn’t ready for that. I needed to take charge of my own education. I need to create my own presence. I need to create my own brand. And I have spent the last 7 to 8 years doing just that. 
“The things that you create and share will always outperform the things that stay stuck in your head or your desk or your laptop. ”
Last year was my step out into the public via a blog. I had 5,000+ views last year and already increased that by over 50% for the year, this year. Had I not done anything, the ideas would’ve taken me no where. I’ve met and conversed with many people this year and I believe it’s because of the writings. 
“You have the perfect amount of time each day for the things that matter most. The key is spending time on those things.”
Improving my role as husband and father

Improving my skills as a PT

Improving my teaching of PT to students and other professionals

Exercise

These are my priorities. The order changes as the seasons change. Some times I may have to devote more energy to teaching compared to learning. Some times I need to exercise because the other aspects have become too overwhelming. The average American watches 4.3 hours of tv per day. I may watch one hour of either news or a show my wife wants to watch. I find that in order to accomplish my 4 priorities, that there just is t enough time to know who married who or who got voted off the (insert modern reality tv show). 
“When enough people ask when you’re quitting, you start to feel dumb for staying. ”
This has started happening to me in the last year. I keep hearing “you don’t belong here…you think differently…you’re work ethic is different from everyone else”. Why have I stayed? The incentive to leave wasn’t greater than the safety of staying. The incentive just grew by leaps and bounds. My wife and I have a daughter with special needs. I don’t know what her future holds, but I have a responsibility to give her every opportunity to succeed. People say that money is t everything, but few people can prosper on social insecurity alone. Since her birth, I have driven the pedal down and pushed forward and harder than I have ever done in the past. My family is my inspiration to work harder now. I’ve always taken pride in being good at my job, but now I want the prestige and rewards that come with hustle and work. I’ve been grossly underpaid and have settled because of job safety for a long time, but that is rapidly ending. It’s time to leave the cave, kill something and drag it home, as Dave Ramsey would say. 
“Bad employees make horrible dreamers. You can’t loaf on your day job all week and then expect to magically throw the switch on the weekend and hustle on your dream. ”
I’ve always lived by a phrase “all hustle, no talent”. Obviously, I overstate the talent part, but I want to be known for work ethic. It’s one of the few things that I can control. In 2003 I was voted as employee of the year at Sam’s club and quit soon thereafter. The worst thing that can happen for me is to have no where to move up towards. I need a goal and an ability to continue to rise. I have no where left to transition to st my current place of employment and my boss is aware that I am leaving. I need to do bigger things next year than I did this year. I can say without a doubt that this has held true year to year. 
“The first thing you need is a passion. Like Malcolm Gladwell’s unquenchable curiosity to explore the unexpected relationships between things, you need a passion that will drive you forward.”
I’ve thought a lot about this through self reflection. What drives a person? Anger is a strong force and has driven me for a long time and continues to drive me. There was an interview with Lewis Howes (from The School of Greatness Podcast) on The Art of Manliness Podcast and he discusses how he was driven by anger for a long time. The problem with being driven by anger is that one is never fully satisfied because there is never enough positive to drown out the negative. I continue to be driven more by anger than by happiness. I see an injustice and I want to work to fix it. I see people being taken for a ride and I want to stop it. In PT, I see patients getting garbage care (if I could even honor it by calling it care) and I want to stop it. For every patient that receives garbage care (this means that the therapist is not providing treatment, but instead delegating treatment to someone unqualified, this means that the therapist is doing more harm with their words than good with their interventions, this means that a therapist is not empowering the patient to take charge of their health, this means a lot of things), I want to stop it because it gives my profession, and therefore me a negative reputation. 
“It’s not that difficult to be trans parent to a group of 10 readers. You realize that if you say something they don’t like and they all stop supporting your dream, you can always start over.”
This is something that I have struggled with over the last year. The movementthinker blog is finally starting to get readers, and the last thing that I wanted to do was to alienate any of the readers. Now, I don’t care as much about alienating readers as much as I care about me being me. If I lose readers, so be it. This is not meant to make me any money, but instead is an avenue to allow me to vent my thoughts. 
“It ultimately worked because I hustled… To push harder than the other person. To dream further. To work longer and faster… I don’t think any of the information in this book works without applying hustle to it. That’s the key. ”
This is the mantra to success. Some people are born into wealth and success. With that said, they have the blueprint from their fathers and forefathers for success. They have the shortcuts branded into them so that they don’t have to go through the heartaches of life. For instance, I started my career already 100K behind. I had to take jobs that paid the bills because I had a lot of bills to pay. My child won’t have to work for money the same way that I did, but they will have the privilege of learning from my mistakes and obtaining advices learned the hard way. I want my children to work and be successful, but I want them to be able to keep the money they earn instead of giving it away to lenders or poor investments. 
This is why I hustle. 
“Hustle is not hard.”
“Take it easy” is a phrase that gets said instead of goodbye. It kills me! I don’t want to take it easy. It took a lot of work to get to where I’m at in life, but that is the work that in used to doing on a daily basis. For me to take it easy is stressful. I have trouble not accounting for my time. I hear from colleagues that they wish that they could read as much as I do or invest as much time into the profession as I do, and I think BullShit! Everything we do is a choice. Hopefully, we have a list of priorities and are scheduling our day in order to maximize these priorities and minimize distractions. I’m okay if some therapists don’t prioritize their career or profession over other priorities such as family or religion, but to state that they wish there was more time is a fallacy. We all work with the same 24, but may work the hours differently. 
“I want the peace in knowing that it wasn’t for lack of hustle that I missed a target for my dream.”
When I was competing in powerlifting, I lived by the phrase ‘No regrets!’ I walked out of the gym on a daily basis knowing that I did my programming as best as possible to compete and place in the top 3. I’ve never been the strongest or the best at any one lift, but I worked my tail off. That work ethic carries over to everything that I do. If I were a street sweeper, which I’ve been, then I work hard to make sure I am among the best sweepers. That hustle comes from somewhere, but I don’t know where that hustle originated. 

“Hustle fills you up. Burn out empties you. Hustle renews your energy. Burn out drains it. Hustle impacts every other aspect of your life in a positive way as you learn to prioritize the things that matter. Burn out impacts every other aspect of your life in a negative way and your dream becomes the only thing that matters.”
Acuff J. Quitter: CLOSING THE GAP BETWEEN YOUR DAY JOB & YOUR DREAM JOB. Brentwood, TN: Lampo Licensing,LLC. 2011.

Why we do what we do

I’ve been writing blogs now for about a year.  Soon will be the 100th blog post.  I don’t make anything for this.  I don’t get any recognition for this.  Big picture, there is no incentive for me to do this blog. So why do it?

I owe it to the profession that has given me the capabilities to treat patients, make a living, and pay my bills.  My job is not that hard.  I don’t have to dig ditches (what my dad did for a living working in water and sewer), I don’t have to drive a forklift (which is what I did prior to going into PT school), I don’t have to teach kids in high school (which is what I initially intended to do).  This job of a Doctor of PT is not that bad.

Looking at it realistically, writing this blog actually makes me a worse clinician.  I spend a lot of time reading.  Instead of spending 30-40 minutes typing a blog weekly, I could be reading to enhance my own knowledge of the profession.  I could be reading to improve my skills.  I could be spending extra time with my family.  There are a lot of things that I could be doing instead of writing the blog.  This isn’t a rant, but why do I do it?

I have students that come through me as a clinical instructor.  It is my responsibility to pass off the knowledge that I obtained over my years in the profession.  It is my responsibility to coach up others around me and those in the profession that may not have the want to actually do the research themselves.  There is a saying on a t-shirt that I read in a Crossfit arena that says something to the effect: the only knowledge wasted is the knowledge not shared.  This really hit home for me.  I spent a lot of time acquiring knowledge through reading books, research articles, spending time in the gym, watching youtube videos and so on and so forth.  I have a lot of hours put into increasing my knowledge and now that I think of it…it would all be for a waste if I don’t attempt to share it.

I owe a big thank you to Dr. Ben Fung for inspiring this blog.  I owe a thank you toDr. Mickey Shah  for his years of mentorship through my growing process.

 

If any of you have a topic that you would like to see covered on this blog in the future, please send me the topic and I will do the work of reading and writing about the research.

Thanks for reading.

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.

Mission Statement

My personal mission statement is as follows: As a professional, I will provide a thorough assessment of your clinical presentation and symptoms in order to determine both the provocative and relieving positions and movements. The assessment process and ensuing treatment will be based on current and relevant evidence. Furthermore, I will educate the patients regarding their symptoms and their likelihood of improving with either skilled therapy, an independent exercise program, spontaneous recovery or if the patient should be referred to a separate specialist to possibly provide a more rapid resolution of symptoms. Respecting the patient’s limited resources is important and I will provide an accurate overview of the prognosis within 7 visits, again based on current research. My goal is to empower the patient in order to take charge of both the symptomatic resolution and return to full function with as little dependence on the therapist as possible. Personally, I strive to be an example for family and friends. My goal is to demonstrate that success is not a byproduct of situations, but a series of choices and actions. I will mentor those, in any way possible, that are having difficulty with the choices and actions for success. I will continue to honor my family’s “blue-collar” roots by working to excel at my chosen career and life situations.   I choose to be a leader of example, and not words, all the while reducing negativity in my life.

I began working towards the professional aspect of the mission statement while still in physical therapy school. By choosing an internship that emphasized patient care and empowering the patient, instead of the internship that was either closest to home or where I knew that I would have the easiest road to graduation, I took the first step towards learning how to utilize the evidence to teach patients how to reduce their symptoms. I continued this process by completing Mechanical Diagnosis and Therapy courses A-D and passing the credentialing exam. I will continue to pursue my clinical education through CEU’s on MDT and my goal is to obtain the status of Diplomat of MDT. Returning back to school for the t-DPT was a major decision for me, as resources (i.e. time and money) are limited. My choice was between saving money for the Dip MDT course (about 15,000 dollars) and continuing on with the Fellowship of American Academy of Orthopedic Manual Physical Therapists (FAAOMPT) (about 5,000 dollars), as these courses are paired through the MDT curriculum or returning to school to work towards a Doctorate of Physical Therapy degree. I initially planned on saving for the Dip MDT and FAAOMPT, but life changes forced me to re-evaluate my situation. The decision then changed to return for the tDPT, as my employer paid for a portion of the DPT program. My goal for applying to and finishing the Dip MDT and FAAOMPT is 10 years. This is how long I anticipate that it will take to finish paying student loans and save for both programs, based on the current rate of payment.

I don’t know if I will ever accomplish what I set forth in the mission statement, but I do know that it will be a forever struggle to maintain this standard that I set for myself.

 

 

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.

Brother my Brother

Today’s blog is very different from any of those written before. This is an insight into my life, into my thought process, into my experiences, into those things that made me who I am. I started this blog to teach people about healthcare, but there is so many more things that people can learn from my experiences. I dictate today’s blog on my way to the cemetery. It’s a little bit more emotional than anything that I would typically write. 
 Life is precious. My brother is a fucking idiot, in 2008 he overdosed. He never really saw anything outside of Joliet Illinois. I want to live until I die. There is too much to see and too much to live for in this life. After eight years, I still think of everything that he missed out on. He missed out on having a family. My family is the greatest thing that ever happened to me. I would be my fathers son, I would be content to stay at home and work hard and live my life in that fashion. My wife loves to travel and loves try new things. If it wasn’t for her I would’ve never traveled to Europe, I may have never made to Alaska. If it wasn’t for my daughter, I wouldn’t slow down and slide down the big slide. I probably wouldn’t go to another waterpark, I probably wouldn’t climb in the tunnels at Odyssey fun world. My brother missed out on a lot, when I go visit cemetery it just my heart.. Life is precious. For those going through difficult times, Know that life is precious. There are people that love you and people that will miss you if you’re gone. I miss my brother frequently. Life goes on, and life will go on without you. I hate to say that because it sounds harsh but it will. I am happy, and unfortunately he’s not here to see that. 

At what age does dreams die? I don’t know that answer. At what age do we throw in the towel? At what age do we give up? I don’t know what was going through my brothers head those last days And it kills me eight years later. 
In memory of Michael Anderson. I miss you brother