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Tuesday, February 7, 2012

The "Top 11" Mistakes Physical Therapists Make... In my opinion...

I will probably ruffle some feathers with this blog- but that is my exact intent...  You may agree with some and you may disagree with some.  Please feel free to open up a discussion with me, that's the point.

I'm taking a page from the book by Jon Goodman of the Personal Training Development Center who recently finished the Free E-Book Titled "101 Personal Trainer Mistakes-- and the solutions to each".

I have been cruising around the web reading blogs, articles, websites, face book pages and everything else possible and I have noticed one common trend.  I am seeing the Fitness world really pushing hard to "better themselves" and learn from each other.  By learning from each others mistakes (and our own) we will only become better at what we do.  I came up with the idea to list what I think the 11 most common mistakes Physical Therapist's make on a daily basis and how to resolve them.  Here we go from 11 to 1!

11.  Inconsistent Re-Evaluations...
   Re-evaluations every 30 days or 10-12 visits is essential to developing proper Physical Therapy routines for patients.  If we are doing a good job, the patient should be progressing consistently and we need to see where their "new baselines are.  In all actuality, we should be reassessing every visit the person comes in for.  Everything manual technique, every movement should be used as a way to evaluate and determine progress.

10. No reasoning for developing certain exercises in a patients program...
   When I have students I tell them one simple thing:  I do not care what exactly you do with your patient (to a certain extent) but have a REASON for what you are doing.  Physical Therapy is NOT cookbook so create a program for the patient sitting in front of you!

9. Have the blinders on to other professions...
   I believe in chiropractic care, I believe in accupuncture, I believe in strength and conditioning, I believe in anything that works.  PT's have a tendency sometimes to only believe in what they do.  If you do not have a Strength and Conditioning background, don't pretend to be a strength coach.  Working together with other professions will only make you better as a practitioner and it will only help your patients get better faster and more effectively!

8. PT's tend to call themselves "Mulligan" Therapists, "Mckenzie" Therapists, "Maitland", etc...  Using tools and not the Tool box...
   This bothers me a a lot.  Be your OWN therapist.  Yes we must learn from others but there are pros and cons to each tool we use.  A GREAT therapist knows how to use the tools to work with each specific patient.  A GREAT therapist also never stops learning and never stops putting another tool into their box.

7. Utilization of Modalities for time killers or because it can be billed for...
  Do I even need to explain this one.  If you know me; you know I hate utilizing modalities such as E-Stim and Ultrasound.  If I need to explain this one to you then you probably fall into a lot of these categories i'm discussing.  There is a time and place for Electrical Stim but US; i'll battle anyone on this. Steel cage death match anyone?

6. A lack of understanding on how to market and build relationships...
   This baffles me?  PT's build relationships with patients everyday but for some reason have a hard time talking to physicians or other health care providers.  Have confidence in your knowledge and your skills.  Chances are they will respect you more if you have confidence and can be clear and concise.

5. Not having the "cojones" to either question a possible improper diagnosis or make their own diagnosis...
   If you think something wasn diagnosed wrong- make sure you approach the appropriate person.  Be ready to back your belief with solid data, but if you feel strongly, do not hold back.  But make sure you are respectful.  PT's (in most states) are allowed direct access and that means we are an entry point into the healthcare system.  Making a proper diagnosis from the start, needless to say, is fairly important.  Now the fun part begins-  you have made the diagnosis, but now you get to figure out WHY!

4. Are just content with being "good" and not "great"...
   Do something great, be something great and don't settle for just good.  Constantly learn, absorb, be mentored, mentor and teach others.  This will set you apart from the pack.  If you want to "just be good", you will never get ahead and you are not doing right by your patients.  Strive to be the best and nothing less.

3. Not listening to the Patient sitting right in front of you...
   The history is the single most important part of patient care.  Take a proper history, listen to patient and you will gather more information than you could ever imagine.  The history will lead your evaluation and will set you up for success.  Patients also crave this.  So give them what they want!

2. Not educating patients on the "why"...
  This really can be 1B.  Just giving someone an exercise is not good enough...  Just doing a mobilization is not good enough...  Just doing post-op rehab is not good enough...  You need to give the why component to the patient.  Explaining why someone is not allowed to do X after a Cuff Repair or why open chain knee extension is the Single. Worst. Exercise. Ever.  Just telling someone is not enough; you must educate them on the why.  If you do this simple task, they will trust you more, listen to you more and get better faster.  Isn't that what we want?

And #1....  Drum Roll please..........

1.  Go straight to the site of pain...  To take a phrase from a friend and colleague, Perry Nickelston: "Stop Chasing Pain"!...
   Man has he this nailed on the head.  Simply speaking just because someone has knee pain, doesn't mean the problem is coming from the knee.  By understanding human movement and how the body functions you can pick out and find the Non-Painful Movement Dysfunction that's causing the Painful Dysfunction.  It's as simple as that.  Systematically assess human movement and assess the patient- I promise you will find things that will blow you away and will blow your patient away.  In other words:  Treat the Problem and not the symptoms.  You also must be able to explain to the patient why a sprained ankle 3 months ago is the reason for their neck pain.  You have to get it first before the patient gets it.  If you can answer this question, then you are on the right path.  "Why would a rigid great toe with decreased extension on the lead leg of a pitcher lead to medial elbow pain in the throwing arm?"

6 comments:

  1. Bravo!! So many good points here it is hard to pick out which one I want to comment on. I challenge all of my students that they should be able to explain EVERY stretch/exercise/balance exercise, etc. to the patient and what it is doing for them. You would be surprised how many say "I just give them it because that's what I did in my last clinical." UGH! I am printing this for my coworkers!

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  2. Thank you! I'd love to talk more. Please send me an email: gameonpt@gmail.com

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  3. Great post, mind if I link back on my blog? Most of the things you are ranting about frustrate me daily. I believe in the toolbox, but respectfully say who came up with the technique/assessment. Just a comment about 11) Re-evaluations should be performed EACH visit, as each visit is an evaluation for function/strength/movement quality pre and post treatment. Glad to have you blogging! Love a good rant.

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  4. Excellent post. Thanks for taking the time to write.

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  5. Good post! I agree with all your points above. I also like to educate my students, and my patients, that I "treat the patients, not tests". Tests are important for other healthcare fields but not necessarily ours. Keep up good work!

    Harrison

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  6. A physical therapist should talk with the patients with good manners and politely. A physical therapist should also avoid from such mistakes.
    physiotherapist bergen county , physical therapy bergen county

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