I always tell new grads and students how lucky they are. You have access to a ton of great information from social media, instantly!
You also get to learn from our mistakes, which is a huge part of experience. Jesse Awenus suggested that I post about 5 mistakes that I was able to learn from. Some of them are flat out mistakes, some are cases I learned from. By no means are these my top 5, but these are ones that are memorable.
1) Trying too much for too long
- We all want to make patients better, but experience and plenty of failed cases told me when enough was enough
- like many clinicians, I would often try with certain patients 2-3 times/week for 6-8 weeks with little to no change in the way a patient feels
- even slow responders like frozen shoulders should see a change within that time frame!
- Frank Ward, a MDT Diplomat who I mentored over the past year told me research that was done sometime in the 80s (not able to find citation) that cases that took longer than 6 visits ended up being very difficult
- when I thought about this compared to current MDT research - 87% are rapidly responding across an entire caseload and not just acute, it made sense
- you should make MAJOR changes within 1-2 visits, if not, change things up, within 6 visits, if you have not made a huge breakthrough AND the patient is compliant, refer out and have a plan B for the patient
- my plan B are other providers that I trust, usually smaller practices where I know they will get the same quality care and attention
- I normally tell patients, if there are NO changes in 4-6 visits, I will refer out, but lately, I want to see major changes in 2 visits
- a least 3 evals in the past week, I have referred out, or sent them back to their referring neurologist because there were zero changes in 2 visits
- another case was worse after just this week was worse after 3 visits, so I referred her to a neurologist for her HA
- moral of this story: Trust your gut and know when to call it quits
2) Everyone deserves a fair shot
- I will never forget one of the meanest, crankiest, impatient TMD patients ever
- she was short tempered, and rude, starting off with rubbing my former secretary on the phone call, proceeded to upset my intern, and also my other PT
- after a few short visits, we all started being very short with her as well
- she would sign in, we would call her back, I'd basically tell her that heat was waiting for her on the table, I would run and do SOAPs
- I would DREAD going back to the table, pretty much ask a VAS, do a few measurements, treat her and send her on her way
- this was about 13 years ago, so this probably went on for 4-5 weeks at 2-3 times/week, possibly longer
- one day, she says something like, "Maybe I'd feel better if you people showed me a bit of compassion, I am in serious pain!"
- that made me feel like a real a-hole... and this was before Explain Pain... so I actually made sure to go out of my way to be extra special nice to her (staff was directed to as well)
- she eventually turned around to our sugary approach and started responding, started smiling at each visit, and although she did not get more than 50% better (phantom tooth pain after all teeth extracted except 2), she was grateful for our services and any improvement she could get
- moral of this story: Kill em with kindness!
3) Acting Like The Case is Simple
- again, this was very early in my career
- I saw an older gentleman with shoulder pain, and a separate time for lumbar pain
- both cases resolved well (back then, that probably meant 20-30 visits!)
- he then came back with a referral from his neurologist for headaches that were constant and unremitting
- he had objective findings consistent with cervicogenic HA - loss of upper cervical mobility, tenderness in the occiput, general loss of cervical mobility
- anything I tried at that time, which was probably a lot of joint mobilization and suboccipital release - I was only 1 year out, did not help
- I was dumbfounded because he responded so well to PT with his other conditions
- He thanked me for trying, and I never forgot that because he was so genuine about his gratitude
- several years later, I just finished up getting certified by Dr. Rocabado, and felt like I could handle any cervicogenic HA
- the patient came back, with the same complaint of headaches, and I basically stated I just learned a whole new form of assessment and treatment, so you'll surely get some relief
- light tissue work, postural correction, MDT, subcranial shear distractions, after 3 weeks, still no change
- each time he reported no change, I felt terrible, because he was such a nice older guy, and each visit, he thanked me for trying
- on his last visit, I asked him how he was feeling and he broke down crying saying, "I just miss my wife so much! She passed away shortly before I started getting these headaches. I miss her every day."
- I knew then that I could not help him with my skill set, and referred him back to his neurologist
- I didn't think I'd see him again, but I did see him a few years later, for his opposite shoulder, which responded well to PT, he still had his HA, and thanked me for asking
- moral of the story: Absolute certainty of case simplicity will have you eating your words
4) Cranking on slow responders
- a true slow responder, like a frozen shoulder will NOT improve ROM quickly
- they act like a patient coming out of a cast for 6-8 weeks, stiff in all directions
- assuming I could somehow break up scar tissue and deform the fascia and joint capsule with superhuman strength, I would crank on patients and nicely tell them to suck it up
- I now liken tissue deformation to muscle hypertrophy... it will happen gradually over time given the right stimulus and conditions, just not rapidly
- you will have more compliant patients if you do light soft tissue work, plus joint mobilizations, then have them move regularly and often in mid ranges
- moral of the story: Slow and steady wins the race
5) Good PT/Bad PT
- this is not a case from over 1 decade ago, but just 6 months ago!
- as you know, I am hard on my patients, and it gets results, but this is when I got schooled by Southern Hospitality by the aforementioned Frank Ward
- moral of this story: Everyone has something that motivates them, and it's usually not someone being a hard ass
Keeping it Eclectic...