Tag: physiotherapy

One school’s take on educating the future

One school’s take on educating the future.

 

This was a refreshing article regarding the creation of a progression to a doctoring program for a school in Australia. Although this school is a world away from my practice, they face the same situations that we do here in the states. I was impressed with the thoroughness of the article’s message and am excited to see the students that graduate from a program like the one described. I would love to see this type of program offered in the states, as I personally don’t feel that this type of education is being offered. At least I haven’t seen many students that possess these traits in my clinic yet. Those that do, I am uncertain if they were learned in school or through inherent characteristics.

 

  1. “Chronic disease management requires holistic, patient-centered care, with collaborating and respectful teams of interdisciplinary providers (physicians, nurses, pharmacists, and allied health workers).”

 

I see where the authors are going with this, in that they are creating the lead in for the rest of the article. On a side note…I can remember in 6th grade reading/composition learning how to make a house in order to get a point across. You had to start with the roof, which is the overall theme and then build the house down from the roof by adding in the thesis and supporting points. Mrs. Hart..I didn’t forget. With that in mind…that analogy doesn’t apply to this type of writing, as I simply brainstorm and just try to keep up with my thoughts on paper.

 

Back to it. We should be collaborating for all patients, not just chronic illness based patients. All patients should expect the same high level of care, which involves calling other professionals with results if need be. I see way to often the lack of communication when working with patients in the clinic. Luckily, no one has suffered greatly from the lack of communication, but luck shouldn’t be my basis of success.

 

  1. “health care ‘now requires large enterprises, teams of clinicians, high-risk technologies, and knowledge that outstrips any one person’s abilities’”

 

I beg your pardon?! I am very capable mind you…just kidding. No one person can know all of all things. It is important for a PT, or any one for that matter, to know his/her weaknesses and place him/herself in a position to leverage strengths, while hiding weaknesses. For instance, I am very good at orthopedics, which means that if I work in a clinic that sees more than just orthopedic patients (which I currently do), then I have to partner my skills with those of someone that is very good at everything else. Luckily, I have. If I were to ever leave to open up my own practice, I would have to either 1. Work on my weaknesses (I’ve never been a fan of that) or 2. Be so good at treating orthopedic conditions that I can refer those patients that encompass my weakness to a colleague or a friend at another clinic. WHAAA?! Turn away patients…sacrilegious! I wouldn’t want my mother to see me if she had Dandy Walker syndrome…it’s not my specialty.

 

  1. “The Centers for Medicare & Medicaid Services recently implemented bundled payments for hip and knee replacements…the hospital that performs the surgery will be accountable for the costs and quality of related care for the episode of care…The payment structure incentivizes better coordinated care”

 

SIGN ME UP! Accountability paired with incentives to improve patient outcomes. This is a great thing. Some people are scared of this bundled payment thing, as they talk only about loss of profits. I only see rewards for fixing patients quicker, with fewer complications, leading to increased pay.

 

EVERYONE NEEDS TO WAKE UP THOUGH! This is happening. You need to do a better job of choosing your provider. If you ask a friend and learn that the friend got crappy care from their provider…don’t go there! Even if others (namely health care professionals) are trying to push you in that direction, make more informed decisions. Get a second opinion before going there.

 

  1. “The curricula need to engage students to develop the necessary attributes, knowledge and skills in health leadership, policy, advocacy, and research…physical therapy curricula need to be forward thinking and innovative.”

 

AWESOME SAUCE! Now…I’ll believe it when I see it. I totally agree that PT’s need to be better trained when coming out of a Doctorate program, but unfortunately tradition appears to be taught more so than forward thinking…or thinking in general. We have come past the recognition and regurgitation aspect of therapy. We need to do a better job of teaching how to think.

 

The rest of the article went deeper into the curriculum for the program. I highly recommend any and all teachers of health care to read this article. It touched on some very important points and I look forward to practicing alongside those that graduate from a program like the one described in the article.

 

Quotes taken from:

 

Dean CM, Duncan PW. Preparing the Next Generation of Physical Therapists for Transformative Practice and Population Management: Example From Macquarie University. Phys Ther. 2016; 96:272-274

If it hurts it must be bad, or good, or whatever. Vincent Gutierrez, PT, cert. MDT

Louw A, Puentedura EJ, Zimney K, Schmidt S. Know Pain, Know Gain? A perspective on Pain Neuroscience Education in Physical Therapy. J Orthop Sports Phys Ther. 2016;46(3):131-134.

 

  1. “Pain is a normal human experience and essential to survival”

This portion is rarely spoken of in PT school and we spend our time in school learning how to shut down the pain, either in an ideal way of dealing with a mechanical problem or in a way in which we “trick” the brain of not seeing the pain for a short period of time. When working with patients, I often describe the gate control theory as the “Three Stooges” way of treating pain. For instance, if you have a headache and I hit your foot with a hammer, what happened to your headache. I stole the example from my dad, because this is how he would always respond if I told him my arm was sore after baseball practice. This was way back in the 1980’s and he was a laborer by trade. The gate control theory makes sense to most people, but we can also see the example and understand that it is probably not the best way to fix a problem, as we end up with a broken foot from the hammer.

 

  1. “The pain neuromatrix explained our knowledge and understanding of the functional and structural changes in the brains of people suffering from chronic pain”

To simplify, we have pain because our brains tell us that something is painful. This could be due to past experiences, actual painful stimuli eliciting Nociception, super excited nerves , so on and so forth.

 

  1. “biomedical models may induce fear and anxiety, which may further fuel fear avoidance and pain catastrophization”

It is very common for a patient to come into the clinic and say that he/she is avoiding a particular activity because of a history of a herniated disc. There is research that shows that a herniated disc can become “unherniated” (for a lack of a more layman’s term) over the course of 6 months. The patients are never educated regarding this point. Once a herniation, always a herniation is just not true. This biomedical or pathoanatomical (patho=bad and anatomical = body parts) model of health care is outdated and simply is not as useful to use with the general public because research demonstrates that the patient may become “sick listed” and from there stop participating in previously enjoyable activities.

 

  1. “a plethora of papers have been dedicated to a mere 20-millisecond delay of abdominal muscle contraction, yet despite the enormous amount of time, money and energy spent on this science, clinically it has yet to provide results superior to those of any other form of exercise for low back pain”

Doing the vacuum pose while lying down is no better than doing a general squat or learning how to utilize your diaphragm during breathing mechanics. As the layperson, there are many people that want to take your money in the health care industry. (I hate to say it like this, but healthcare is a huge business and the public needs to see it as so.) When the new fad comes out to solve back pain, don’t buy into the infomercial and as a matter of fact, turn off the t.v. and go get a book from the local library. You will spend hundreds of dollars less than what is proposed on the infomercial and be better off after having read the book. Nothing beats knowledge and the smarter you are at taking care of yourself, the better armed you are when you actually get in front of a health care practitioner. Remember, it is a business and we all want your money if you will give it to us. A better use of your time is to come educated so that I don’t have to teach you the basics of posture for 30 minutes, but can instead can teach you how to perform more high level movement patterns instead of sitting properly to reduce your pain. Oh wait, pain is normal. I’d lose my job if I sold this to all of my patients, but instead the patients need to be educated between hurt and harm.

 

  1. “In all health care education, be it smoking cessation, weight loss, or breaking addiction, the ultimate goal is behavior change.”

Speaking as a physical therapist, I can’t stress to the patients enough how the therapy experience is a team. Smart people call it therapeutic alliance, but I’ll settle for team. My part is to educate the patient and attempt to solve the puzzle of the patient’s pain, but it is the patient’s job to take the information that they have gained during the session and go home and apply it to their daily lives. For a patient to do nothing at home, AKA make no changes in behavior, and come to the following session thinking that the pain will go away is similar to :

 

https://spencergarnold.files.wordpress.com/2013/01/snatch-miracle.jpg

 

Patients may come hoping for a miracle, but it is not to be. The patient and therapist have to work together to attempt to solve the pain problem. If one side of the team is not doing their part, then the PT has to be willing to discharge the patient or the patient has to be willing to fire the PT.

 

  1. “…when PNE (Pain Nueroscience Education [pain is a normal human response]) is paired combined with either exercise or manual therapy, it is far superior in reducing pain compared to education alone”

From this I take that teaching the patient and then moving the patient is better than just teaching the patient. We can all agree that low level exercise is good for people. If we don’t agree with this, then we are saying that it is safer long term to live like a slug then to get up and walk around the living room. It just isn’t so. People will refuse to get up and walk around the living room when they start experiencing low back tightness, leg fatigue, or the dreaded “Fran cough” (look it up and btw I am an advocate professionally speaking). We as a society have to start moving more and learn about how our body is supposed to work. This can not be done from infomercials that have pictures of pulsating backs or frowning stomach fat.

And this is my two cents for the night.
If you are in need of physical therapy or would like to sign up for a complementary discovery session (a conversation to determine if therapy is right for you), contact me. 

Functional Therapy and Rehabilitation 

(Now part of the Goodlife family)

903 N 129th Infantry Dr. 

Joliet Il 60435

815-483-2440