The following is a cross-posting of Dustin’s original post: http://www.dustinjonespt.com/blog/dear-future-physician
It is posted here on AMSA On Call with Dustin’s permission.
I was recently asked by Dr. Mark Cucuzzella to provide his medical students with some insight from my experience as a PT working with the elderly. The following is my response…
Dear Future Physicians:
I am writing you to offer some observations that I hope to be helpful for you in caring for people. I am a physical therapist (PT) who works with adults who are homebound. PT’s help people be as mobile, functional, and independent as they can be. There are many factors that can limit patients’ abilities, and it is our job (along with yours) to figure these out and provide ways to optimize their abilities and their participation in meaningful life activities.This is not an easy task, especially from the medical standpoint. I have seen what your life is like second hand. My wife is an Emergency Medicine Physician. I have been alongside her at every step of her career. I recognize that being a physician is very challenging. People aren’t getting any healthier, Dr. Google “knows” more than you do, and patient gratitude can seem like something of the distant past.
Yet, I want you to know that your work still matters. As a PT, I often interact with patients right after physician visits. This is a unique perspective as I get to see how interventions, bedside manner, and education impact patients. Now I’ve only been practicing since 2011, but I can confidently say that physicians still have a tremendous amount of influence in patients’ lives.
I know it sounds crazy given your experiences in the hospital/clinic, but some, if not most, patients really do trust you! Nearly every day, I make recommendations to my patients, and by far the most common response is, “Well, my doctor said…”. Physicians are able to influence patients exponentially more than most other healthcare providers. I know there are exceptions to this and differences among generations. Yet, I don’t want you to lose sight of your power.
Your responsibility (and mine) is to: 1) assess patients, 2) identify dysfunction/disease, and 3) negotiate an action plan for ongoing care. The third role is often the toughest one for all types of clinicians. How do we develop an action plan that is simple, understandable, effective, and empowering?I feel this is a big reason why figures such as Dr. Oz, Mark Sisson, Robb Wolf, etc., are building such massive audiences. Regardless of what you think about their health philosophy, these public figures are providing something that people are seeking. You, Future Physician, can do the same.Physicians often have to give the “bad news” – diagnoses with Diabetes, Lung Cancer, or Osteoarthritis. However, with the bad news can come good news. With almost any condition, patients can and should be empowered to take charge and be proactive about their situation.I will go through a couple scenarios that PT’s often encounter when patients are not empowered, with a discussion and recommendations after each.
“I can’t do that because I was told 23 years ago that I had _________ (insert any degenerative condition).” -Frank
People need to hear how their body works and how it can recover in a clear and concise manner. Frank’s statement is very common to PT’s as many of our patient’s have been given a diagnosis through imaging that was perceived as a death sentence. And there lies the problem, Frank’s perception of his back may be more debilitating than his back itself. Based on interactions with Frank, one could be led to assume Frank does not believe that:
Frank’s response screams “Thought-Virus”. The “Thought-Virus/es” that’s infiltrated Frank’s mind will more than likely limit his potential to recover.
People’s beliefs or ideas have a tangible impact on the human experience. This is being demonstrated in current pain research as peoples’ pain levels and physical performance have improved through neurophysiology education. Our thoughts and beliefs matter and shape our experience!
“Pain is the vehicle that brings most people to the clinic. We need to give meaning to the individual’s meaning about their pain that they have already created, bringing their thinking into alignment with what we really know about pain. We must convey the right messages from the start to reduce the risk of chronicity.” -Dr. Erson Religioso III, DPT, FAAOMPT
“I’ve fallen 3 times in the past week. I’m just losing it.” -Betty
Aging is inevitable. Yet, each individual can have great influence in how he or she ages. Osteoporosis, sarcopenia, frailty syndrome, and frequent falls, may be minimized with prevention. Yet, patients must believe that they can and know how to age gracefully.
I believe the healthcare system has done a great job in emphasizing active lifestyles to minimize the effects of aging. Millions of people exercise regularly in some way shape or another. Yet, many people:
Quality before quantity should be our aim. There are definitely exceptions to this. For the most part, people need to move well before they move often. As movement quality increases, movement quantity (and load) should increase. Here’s what physicians can do to encourage their patients to age gracefully:
In conclusion, thank you, Future Physician, for what you do. You have invested a tremendous amount into your career and other people’s lives. I hope you don’t lose sight of the tremendous influence you have on your patients or of the importance of interprofessional teams to support your patients’ health.
*My fellow clinicians, feel free to add anything you think would be helpful to the comments section. Specifically, I would love to hear from any physicians on how PT’s can work more effectively with our physician counterparts.