Wow, that was fast! As of yesterday afternoon, I have completed my first clinical rotation and am officially 1/3 of a PT! I had the best two weeks interning for Lawrence County Physical Therapy Institute in New Castle, PA. My CI (clinical instructor) was a fellow Penn State graduate and got his doctorate from Slippery Rock. He taught me so much in so little time, so I figured I’ll share the top 10 things I learned:
1. Skilled care is EVERYTHING our profession needs to be.
I’ve interned at various outpatient PT settings across the state of Pennsylvania, and this was the first time I’ve ever worked in a 100% one-on-one clinic. LCPTI’s philosophy is skilled care; meaning they have one hour blocked out for one patient, and are providing one-on-one, hands-on care for that full hour. Instead of telling a patient to go do 15 reps on the leg press, the PT’s and PTA’s stand there and watch the patient’s every move. They do this because, 9 times out of 10 if a patient is hurting or injured and their body mechanics are not perfect so they are compensating with other muscles and joints to complete the prescribed exercises. This does absolutely nothing to heal the injured site!! With skilled care, patients are guaranteed to be doing their exercises correctly and efficiently to maximize functioning at the injury site. As I go on to my next three clinical rotations, I will take this mentality with me to ensure I am providing quality care.
2. Encouragement and empathy go a long way in helping a patient recover.
You would be surprised with how well a patient responds to a little positivity and reassurance! If the patient knows that you are on their team and want them to get better, they will be that much more motivated to do well with therapy not only for themselves, but for you.
3. Beware of “plug & chug”-ing!
Many times, a lot of the same exercises are prescribed for certain diagnoses. This is usually alright, but just be aware of the precautions for each patient’s diagnosis/surgery as well as their personal abilities. Also, don’t be afraid to get creative with an exercise! We had a patient who was a bus driver and needed to be able to turn a big steering wheel, so instead of the typical rotator cuff repair exercises, we used therabands (resistance bands) to add resistance in the motion of turning a steering wheel to mimic that action and strengthen those muscles.
4. SOAP note documentation is SO important.
For those of you reading who aren’t in/haven’t started PT school yet, SOAP stands for Subjective, Objective, Assessment, and Plan and it is the standard way that all PT’s document treatment. My CI was the best in the clinic at documentation so I was able to write a really good SOAP note by the end of my two weeks. This was something that was talked about in class, but we really didn’t get a ton of practice with so I was glad to be able to perfect this skill at LCPTI.
SOAP notes are important because they tell the other clinicians, as well as insurance companies what you did, why you did it, and how the patient responded to the treatment. The subjective portion consists of what the patient tells you when he/she comes into the clinic (i.e. pain level, how they felt after last session, what they still cannot do, and what they now can do that they couldn’t do before). The objective portion is what you did during the treatment session (i.e. 2 sets of 10 reps of external rotation using green theraband). The assessment is WHY you did what you did in objective and how it helped the patient. This is where you show that skilled care I talked about (i.e. the patient required verbal cueing to keep his elbow in during external rotation to maximize shoulder motion and avoid compensation). To me, the assessment is the most important part-it tells insurance companies that what you’re doing is working!! Finally, the plan section is what you plan to do during the next session.
5. Didactic work is, in fact, 100% relevant to clinical practice.
Anatomy lab came back to haunt me! Those origins, insertions, actions, and innervations for muscles started becoming more and more relevant in the last two weeks. Take it from me, the next time you think: “why do I need to memorize the cranial nerve pathways or the muscle innervations??” remember that this will all come full circle when you are a practicing clinician!
6. Use treatment and down time wisely.
In the clinic I interned in, you were allotted one full hour to treat patients with very little down time to document treatments. This meant that in the few minutes you’d have in between sessions while a patient is sitting with a heating pad, you need to be super efficient in documenting everything from the last patient or you’d be left to have to remember everything twelve hours later before it’s time to go home!
Additionally, be wise when treating patients. For example, if the patient has an hour-long exercise program that they did two days ago and they’re still really sore, maybe only do half of the program today and use the rest of the time to do some stretching and massage-work.
7. Goniometry is not an art.
Don’t get me wrong, while goniometry is very important, exact measurements will vary from clinician to clinician. For those of you who don’t know what goniometry is, it’s basically a protractor for your joints and it helps a PT measure the angles of motion at a patient’s joint to judge how much their range of motion is impaired. So if your patient’s note says they were able to get 110 degrees of motion last week, and you’re only getting 103 degrees, don’t get discouraged because a difference that small is not going to change your plan of care.
8. Being a PT is not for the faint of heart.
You’ll work long hours, with little down-time, and be on your feet for most of the day. But when it all comes down to it, just remember why you’re becoming or are a PT in the first place. Hopefully it’s because you have a passion to help others and that will get you through the hard days.
You’ll also work with patients who have severe chronic illnesses or disabilities and sometimes it’s easy to become discouraged. Instead, use that discouragement as fuel to provide the patient with the best care possible-remember, you are one of their greatest allies!
9. Be an active listener.
It is so common for a patient to leave out important details in their history, so it is vital to ask the right questions to fill in the blanks. For example, a lot of times people say they’re getting dizzy; it is your job to differentiate if they’re light headed (dizzy) or if the room is spinning (vertigo) because these are two totally different symptoms and lead to different diagnoses! Additionally, if you repeat back to the patient what they’re reporting as well as acknowledge that you understand and empathize with them it makes the patient much more willing to work with you to help get themselves better.
10. Work with what ya got.
I encountered many patients in the last two weeks who are in so much pain they are guarded (meaning their muscles are so tensed up because they’re afraid to move at all and induce pain). If a patient is unable to relax those muscles, there is very little you can do treatment-wise. So, utilize modalities, massage, and anything else you have available at the clinic to help relax the patient, and reassure them that if they can relax those muscles they will feel so much better. This way, when the patient comes back next time, hopefully they are relaxed enough to be able to stretch and exercise.
Another reason you may have to improvise is if the patient provides very little information during the patient interview. Oftentimes patients don’t have a medical background and really don’t know how to explain symptoms, doctors visits, etc. This can make the evaluation process more difficult so you as a PT may need to use trial and error to determine what induces pain/symptoms in order to make your diagnosis and create a plan of care.
Now for a nice relaxing three weeks off! I’m currently in Chicago visiting my dad’s side of the family and next week I head to Florida with my mom’s side! At the end of the month I start my second year and will post updates on our classes and curriculum.
Do you have some good lessons learned during your clinicals? Leave a comment below and share your experiences!
Keep on Dreaming,