I want to reiterate some advice I learned along the way from course instructors and my own mistakes.
- this stemmed from an online telehealth session with a colleague from NYC and one of his patients
- she is doing much better but has plateaued and recently flared up with some unusual complaints suggesting occipital nerve irritation
- the point was that this colleague does "not give up on anyone"
- I asked if he felt he could help 100% of the patients get 100% better
- I told him what older MDT research stated about signfiicant changes in first 2 visits, and you're unlikely to make significant and/or rapid changes after 6
- he's been at it for months (we've all done this), but also she is a chronic pain patient from a whiplash injury
- recent research by Jull, et al has shown even the best evidenced based approaches do no better than the control group with this particular subset of patients
2) Referring out is not giving up, it's another way to help the patient
- the patients should be assured that if you cannot help them, or they plateau along the way, that you have a plan B
- I keep a short list of specialists I would refer out to for a second opinion or alternative treatments
- physiatrist who does TrP injections
- my thought is either they have an actual disease process that needs to be looked into, or they need an alternative input to their CNS to change the output of pain or motor control that you cannot provide
- after a few sessions of these alternative treatments, the goal should be to follow up with you again, maybe your treatments/HEP will stick then
- I also have to say most PTs say "Please refer to me" but think they can do it all so do not refer back
- a great way to build relationships with referral sources is to have it work both ways
3) Know your limitations
- As a profession, we should be at the primary care forefront for all kinds of neuromusculoskeletal conditions
- we are better prepped to Explain Pain, Assessment movement, make rapid changes, and educate on self treatment than most others offering passive treatments only
- how this differs from point 1, is that you should know your limitations/weaknesses as a clinician
- my list would be
- vestibular treatment (always had someone in the office to refer out to until recently, this will have to change now)
- the 4x4 matrix of corrective exercise - haven't taken FMS or SFMA 2, so I just make them up, but it helps to hear ones that work great and from the horse's mouth
- my impatience for noncompliant patients
- scapular stability exercises - hey, I learn from Cressey, Weingroff, and Reinold too!
- I am not great with names (why the patient is there and their movement, yes... names... not so much)
4) Go home and be yourself
- as a novice clinician, I used to obsess over patients I was not helping, and sometimes lose sleep over it
- I would then see that patient's name on my schedule and get that sinking feeling in my stomach
- Greg Johnson of The IPA said he learned from Maggie Knott (PNF fame) to go from patient to patient and forget the last
- he then passed that onto us, try your best and move on
- if you've educated them, tried your best treatments that work on all similar cases, the patient is compliant, you have done your best
- go home, have your favorite drink, listen to your favorite music and spend time with your loved ones and be fresh for the next day
5) Work on your patient interactions
- a colleague, Mark Strickland, told me he would tell his employees, "Be interested, not interesting"
- we all love to talk about ourselves, which is why "I" is the most commonly stated word
- the patient is there for you to listen to them, if they ask about you, or you eventually have a rapport and they know all about you and your family, that's different obviously
- I'm not great with names, but here is a tip I learned from my buddy Jesse Awenus
- write down your patient's name, kids names, where they go to school, what sports they play etc, so you can engage your patients better
- read Therapeutic Neuroscience Education to realize why you have to soften your words and make your interactions very positive for those in pain - seriously, how many times do I have to recommend this text?
Any advice you had or lessons learned over the years? Share in the comments below! Have a great weekend and forget you're a clinician for once!
Keeping it Eclectic....