It’s easy to make perfect decisions with perfect information. Medicine asks you to make perfect decisions with imperfect information.
Siddhartha Mukherjee, The Laws of Medicine
I thought I was supposed to know the problem and the solution on day one. I thought the patient and the exam provided perfect information and when they did not get better, then the issue was my decision sucked.
Reality is more messy. First there are the patient exerciences:
Knee pain for 10 years?
Or back pain but right now there is no pain but in the morning it is unbearable?
Or foot pain but only after a 20 mile run?
Or whole body pain and you have seen 20 providers without improvement?
Nothing helps, physical therapy won’t either, but you have to do this before surgery?
None of these presentations were in the inclusion criteria for the last study I read. The textbooks did not have a section for 4 different problems and how to treat it in 15 minutes before the next patient comes in.
Second, we have the practitioner:
What do I do when I get stuck and the patient still needs help?
Why do I make the decisions I make and why does it work sometimes and why do some people respond? What about those that don’t?
I am catching prognosis indicators or real treatment effect modifiers?
Why does the research seem to not really help in individual situations and what does that mean for evidence based practice?
When discussing cases with other providers, it was difficult to describe the patient in a way that allowed for useful information to be provided. There was not a pathway besides a continuing education course to learn new information, but none of this was actually specific to my development.
What is Physical Therapy?
From first days in the clinic, wearing dress shoes, slacks and button-up shirt, I knew my decisions mattered. There were triumphs when I nailed the diagnosis and made rapid improvement in a patient’s symptoms. It was intoxicating.
But the misses, the patients I failed, felt like a bad hangover. Combining this with a clinic focused on billing and a schedule focused on patient numbers without considering the patient results, made for a hangover that seemed to last months.
I kept thinking, I got a doctorate for this?
My initial attempt to answer – what is physical therapy – led me to a crisis in professional identity and almost out of the profession because of how much I hated the stuff surrounding clinical care (productivity quotas and billing strategies to maximize reimbursement).
I decided what physical therapy was for me. I realized that physical therapy and who I could be as a physical therapist were not written in stone, which led me to start a business where the team were expected to be idealists.
This led to more questions:
Who is a physical therapist?
Who should be on a physical therapy team?
Are there ways to maximize the physical therapy experience for the patient and provider?
What is the true long term goal of a physical therapist?
How can a physical therapist interact within a team?
How can a business support the development of a therapist without losing the ability to collaborate?
How can a specialist be created?
How can the natural constraints of physical therapy practice become an advantage?
What are the most important factors for an outcome? Is it a treatment method? Is it a diagnostic thought process?
What are the feedback tools that matter to the individual and the team?
Our team meets twice a week.
In the SPC PT Learning Sessions, we review cases seen by the team, practice exams, palpation, diagnosis, prognosis, treatment, and planning. Our goal is to standardize our practice to improve our team collaboration and shared vision. We also dive into clinical breakthroughs and strategies that are working. The team also acts as a feedback machine on thinking errors, treatment mistakes, and process integration. Each of our therapists is expected to become an expert and resource in either the spine, upper extremity, or lower extremity. Progress with difficult presentations are shared, dissected, and built into a new process that the team can follow.
In the SPC Patient Management Sessions, we spend time updating plans with patients, scheduling, and analyzing our results as a team. During these sessions, we will also schedule co-treats for cases that are not getting better or put them as a priority discussion for the PT learning meeting.
All of these meetings combined with our clinical practice constantly updates our SPC Solution Shop Methodology.
Clinical Concepts Updates
These concepts are our team’s questions, search for answers, dissatisfaction with the status quo, mental models, mental pumps, and ideas that make us still excited to be physical therapists.
We hope to influence physical therapists into a new way of approaching and thinking about practice.
The Laws of Medicine by Mukherjee is a great perspective on the developing medical provider, but we want a physical therapy perspective.
This is ours.