ninevirtues: (bike)
Earlier this month, I quietly reached five years of practice. Somewhere in there, I lost that "I can't believe I'm really a physical therapist. I made it!" feeling, and reality set in: I get up, I get ready, I go to work just like anyone else.

I finally came to terms with myself: No, I am not perfect. I have a body and brain that make some things easy and other things difficult, and that is true for all clinicians. Some patients are emotionally easy-- they're smart, organized, and diligent. Others are a trial: they're whiny, disorganized, anxious, or rude; they don't do their homework; or they just don't try. But I will treat them all. Some have a diagnosis I've seen a million times (like a knee replacement), and others have something I've seen maybe once-- time to think!

No, I do not know everything, and no, I cannot fix everyone. (That's why it's called practice.)

Yes, I will get up every day and do my best. There is always something, somewhere, I can improve.
Yes, I will keep learning as much technical, professional information as I can along the way.
Yes, I will recognize that I have prejudices, issues, and weaknesses, and I will do my best to compensate for them.
Yes, I will seek wisdom, and by that I mean, understanding people and how they work.

That said.... I now know this:

- I must figure out the criteria for success in each workplace, and meet that. In other words, don't go fighting the last war.

- I will put just as much effort into your rehab as you do. Doing otherwise leads to frustration.

- I am my own instrument, and I need ongoing sustaining engineering (enough sleep, consistent strength training, down time, good diet) and development engineering (learning new skills and acquiring wisdom) to work well.

- Employers want you to treat the patient more than they really need (extra visits or, for inpatient rehab, more treatment time.) Don't fall for that. Insurers want you to treat the patient less than they really need, and I shouldn't let that fly either.
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A bit of catchup: So far the job is going well; the facility is nice and well run and the people are friendly and organized and already are making comments that they want to renew the contract. All good.

Also good: A super-nice gym is right down the street. It's clean, has a pool, well equipped, very nice. I go right after work. That's good cause-- it's skilled nursing. Caseload will be "four little old ladies who wobble slightly and need oxygen, followed by a super-heavy person with a bad stroke who can't sit up by herself and needs to learn to do that, and a very large man with poor balance and a recent below-knee amputation who needs to learn to walk with a walker." Yeah, that would be my job.

In short: My shoulders, hips, back and knees will love them some core strength. And, while I used to lift with machines, or with dumbbells that isolated a single body part, current thinking is whole-body exercises that make you use your core to stabilize, then your extremity (arm or leg) to move a weight. The result is a body that moves well, rather than parts that are strong in isolation.

So, today I did:

3x15 pushups with a 5 second plank hold (okay, there were some breaks in there)
3x15 assisted pullups
2x10 lunges with bicep curls (10lb and 12.5 lb, boy, I need to work on that)
2x25 kettlebell swings with a 20lb kettlebell
2x15 seconds lateral holds (squat, hold a cable machine and 15lbs sideways, isometric)
2x15 Kroc rows (this is a bent over row with a lot of scapular retraction in it)
2x10 each side, side planks with external rotation
3x15 ball pikes and 2x15 can openers (hands in plank position, shins on ball, bring knees to chest).
2x15 shoulder extension on the cable machine, done in an isometric squat.

As I chose a cable tower and reset the cable stack from 75lbs to 7.5 lbs for the last exercise, the man using the next stack over (tricep pressdowns, 47.5 lbs, guy looks and sounds blue-collar) said, "Oh good. If you'd lifted that previous stack,  I would have had to make mine heavier."

I gave him a half-smile and said nothing. The comment made me see red, for a minute, in that flashback-to-pretty-good-for-a-girl kind of way. I finished my set, briefly considered going back, setting the stack to the heaviest weight I could manage, and doing something like walkbacks (very do-able with an impressively heavy weight). Let him try to tricep-press _that_.


For a moment, I grasped and held the idea that I didn't need to let a random comment, delivered by a person I don't know whose worldview I don't share, get to me. I could just let it go.

Then I went back to the dumbbell stack, picked up a pair of 22.5s, and did farmer's carries. And, with that, I finished my workout and went home.
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Some excellent commentary from the regional manager, a speech-language pathologist, on treating a mentally ill person:

"People who are mentally ill have a way of 'spearing you'-- they seem able to find your weak spots and make very hurtful comments about them. You need to remember that, when they do that, it's their illness talking--- it's not them-- don't take it personally. For that matter, anybody can go in a mentally ill patient's room, say, "Okay, let's do physical therapy," and when the patient says, "NO! EFF YOU," turn around and leave. It doesn't take skill to do that. Anybody with a minimum amount of training can get them out of bed and walk them around; nursing assistants do that routinely. What makes it a skilled service is your ability to persuade this difficult patient to work with you and perform a physical therapy session that they would not otherwise do.

She probably won't do things for the sake of doing them; you won't be able to say, "Okay, let's go from sit to stand five times to practice it." She won't care. You will need to find a way to do things she already wants to do, like go down to the kitchen for coffee, or go outside, or pack her bag, and get physical therapy out of it. She may not ever realize you're the physical therapist, and that's fine. She may think you're the coffee girl. But in the meantime, she gets better.
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I have about nine hours of compassion and empathy in me per day.

So, for nine hours a day, I can be endlessly empathetic about you and your issues and your FUBARed schooglesplatz.
After 6 PM, though? I'm on my own time. You and your schnooglesplatz can wait until tomorrow.
ninevirtues: (Reflex hammer)
I had seven evals scheduled today, six of which actually happened.

For reference: I see fifteen patients per day. So, almost half of my day was new appointments (in which I have to meet and connect with the person, convince them that I know how to help them and they should follow my advice, figure out what is wrong with them, and write up a treatment plan and a record of the initial appointment with patient history, exam findings, and assessment).

I've taken to timing my notes, actually. When it's time to document, I bogart a timer from the therapy gym, and I give myself two minutes for a daily note and eight minutes for an evaluation, discharge or progress report. This keeps me from dragging my feet on the documentation pile.

Result: When I left today, I had finished all seven evals and all my daily notes and I had discharged three random other people who were done with treatment.

1) Remind me never to complain about a day with five evals in it again.
2) I'm getting better at this.
3) If you make ANYTHING a race I'm more motivated.
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Patient is a chatty lawyer.

Patient says, "It doesn't matter what you do, if you work with people, you are in sales. A lot of people don't get that. I know a lot of very bright attorneys who don't know how to market or present themselves."
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This quote should be required reading if you work with hurt or sick people!

A wretched soul, bruised with adversity,
We bid be quiet when we hear it cry;
But were we burdened with like weight of pain,
As much or more we should ourselves complain.

—William Shakespeare

The pants

Apr. 5th, 2009 10:34 pm
ninevirtues: (Default)

Problem: I need work clothes.

Solution: Lightning raid on Nordstrom Rack. Seriously, not interested in spending lots of time there. But pants, I need pants.

Find rack of pants. Pick out gray striped ones, my size, well made, nice fabric. Label says dry clean but... do 55% cotton 40% elasthane 5% spandex pants really need the five star treatment? No, they can go in the washer, thanks.

Tag: $149. Yikes. Marked down to $120, then $59, now has a tempting tag saying "50% off last marked price."
Okay, does that mean they are now $59 or now $29.50?

$29.50.  And they fit nicely. Thank you, I have scored.

The pants fit. I buy them; they're sitting in my pile-o-mending to be hemmed. But really now, a $150 pair of pants gets treated nicely, sent to the dry cleaner, worn on special occasions. A $30 pair of pants gets the Darwin treatment: thrown in the washer, worn to work, I demonstrate exercises in them, I try not to stain them while eating lunch. If they survive all that, they are allowed to continue their existence in my house.

Same pants, two different outcomes based on the price paid for them. The pants didn't change; my view of them did. Hmm.

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it's the Able People Foundation, which advocates for people with disabilities, and the Foundation is holding a no-cost four-wheeled-walker giveaway.

Background (I've said it before, but in case you forgot...) Medicare will pay for walkers that are not very useful. Medicare walkers are free, but don't have a basket or a seat--- and since you need both hands on the walker to use it, that makes it pretty useless if you want to, you know, use your hands to carry something with you.

That made four-wheeled walkers a status symbol at the adult day healthcare facility; and that's what makes this foundation's giveaway super cool.

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Voodoo medicine man has the right questions, phrased in trademark blunt language:

Here are the good questions he's asking, if you don't want to jump to the link, and now that I've read his article I'm asking them too:

1) Are all aspects of health care a right or a privilege?

2) Just because someone goes to the gynecologist and asks him to help her have octuplets, doesn't mean he ought to do it. That lady can't take care of the kids she has now (some of whom have serious disabilities and who will be on lifetime social security). What is the doctor's responsibility here? (Just because you can implant someone with eight embryos, doesn't mean you should. Where ought the doctor to draw the line?)

3) How much of the bill (reportedly 1.7 million dollars for the first year) for the octuplets should taxpayers pay?

ninevirtues: (Default)
Here ya go, five modest proposals... comments?

1) Drug companies should stop advertising drugs and/or giving money to support groups or advocacy groups. Yeah, I mean like the ones for irritable bowel syndrome or fibromyalgia and other newly-minted ailments. We're all suggestible; how many of you have read about a disease and walked away convinced you had it? Yeah, that's what's going on here. Stop the advertising madness and we'll all be healthier.

2) We should stop prolonging life for the very old (or the terminally ill, or those in a vegetative state) when they have no quality of life. Someone has to sternly say that the end of a life is THE END. 90% of Medicare dollars are spent in the last year or so of life. Do not keep people alive when it would be much kinder to let them go in peace.

3) Emphasize prevention for chronic illnesses. I mean, spend some money on publicity so that every American knows how to eat right, how to get enough exercise, and what happens if you don't. (See above about not advertising newly-minted illnesses.) Make it easy, make it cheap to be fit: This could include: More money for bike paths, subsidizing vegetables so they are cheap cheap cheap to buy, redesigning cities so you can walk to a livable downtown. (This is one thing that Kaiser does right: They emphasize prevention.)

4) You should know how much a given medical treatment will cost you, personally, when the doctor suggests it for you. Or the physical therapist, actually. I mean the REAL cost to you, after the insurance company pays its share. So, for example, when the doctor says, "We could test you for X," and X is a remote possibility: You know exactly how much it will cost to satisfy your curiosity about that.

(For example, when you have low back pain, you can get an MRI for it. And, after age 30 or so, most of us have some joint degeneration or something that will appear on an MRI-- even though not all of us have back pain. However... no matter what's on the MRI, the doc will probably send you to physical therapy, because hey-- we're cheap and effective. Only in a very specific set of circumstances should you have surgery... and an MRI so the surgeon knows what he's dealing with before he cuts you.

5) Fix emergency rooms so that people with non-emergent complaints are routed to urgent care after being screened. Then find the 20% of remaining ER users who consume 80% of the ER resources. Assign them caseworkers and deal with their issues individually.
ninevirtues: (Reflex hammer)

I guess I am learning how to deal with people. Here are the six rules for dealing with patients I have found true so far:

1)       There are two kinds of people in the world: Those who enter a room and say, “Here I am!” and those who enter and say, “There you are!” The second ones are more popular. Do that. (From random email)

2)       Never miss an opportunity to praise or compliment the patient for doing something right. (from _Love Your Patients_)

3)       Preface your opinions and instructions with “I”. As in “I think your range of motion will improve quickly with these exercises.” It shows you are personally interested in the patient. (Again, _Love Your Patients_)

4)       Replace “No, that’s wrong,” with “Let me show you a way to do that that’s better for you.” (From former CI)

5)       Deal with the emotions first, THEN deal with the injury. (From experienced tech support engineer)

6)       Say “I’m sorry” when you can. As in “I’m sorry you had to go through that.” (Love Your Patients again)

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It's laundry time. More specifically, it's White Load Time, since I now wear a lab coat 5 days a week.

Here's the Law of Laundry: All pens, tape measures, goniometers, and patient lists must LEAVE my lab coat before I wash it! (The pen that went through the white load two weeks ago, and mysteriously failed to scribble black ink all over my white coats, was a warning shot across my bow. I'm not really sure where my bow is, anatomically, but that was definitely a warning shot across it.)

The Scene: Out I go, sheets, white socks, T-shirts and lab coats in hand, heading for the complex's laundry room. Johnathan, the Korean toddler next door, decides I'm interesting and follows me to investigate. About the time I find a pen in my lab coat pocket (WARNING! WARNING! Danger, Will Robinson!) he decides he wants to help.

I can oblige; I give him a lab coat I already know is empty and tell him to search its pockets while I sweep the other three clean of ticking laundry bombs like uncapped black pens.

When he's done, I amuse his mother by inviting him to put on the lab coat and model it for her. It wraps around him twice and barely avoids sweeping the puddles on the back deck; he is, after all, only three. "Look out for med school, 2033!" I grin at her. She smiles.

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9:30 AM, over the PA: "Will the janitor please come to nursing station 1. Janitor to nursing station 1."

9:52 AM, over the PA: "Will the janitor please come to nursing station 1. Janitor to nursing station 1."

10:30 AM, over the PA: "Will the janitor please come to nursing station 3. Janitor to nursing station 3."

10:45 AM, over the PA: "Will the janitor please come to the front lobby."

11:03 AM, over the PA: "Will the janitor please come to the front lobby with a mop."

ninevirtues: (Default)

Ooo Eeee Oooo Aaaaa Aaaa
Ting...Tang... Walla walla bing bang!

........and bonus points if you get the reference. 

It was a good day at work.

ninevirtues: (Default)

My 4:30 patient is not here, probably won't show, leaving me with thirty blissful minutes to catch up on my docs in an otherwise full day.

Fabulous. Thanks patient. That was very nice of you. Just this once. 

Bye, all......

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Everybody, and especially [info]sirst, check out the Cossack dudes doing synchronized things with their knees that are currently considered highly inadvisable:

(Seriously, the duckwalking? It's a special test for readiness to return to sport. and we make people WALK, not BOUNCE. Other than that... after watching this, you can see why Russians dominated figure skating, gymnastics, and ballet for years. Yikes!)

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I really, really need to know how to say the following phrases in... let's see... Vietnamese, Cantonese, and Tagalog:

Good job!
Very nice to meet you!

Don't let me push/don't let me pull
Do it like this/Don't do it like this

Sit up, please.
Do as much as you can by yourself. 
Stand up, please.
Push from the bed when you get up.
Back up until you feel the chair/bed with your knees.

Do you need to rest?
Do you want to go to the toilet?

(once on the toilet) If you fall, they blame ME. Don't get up by yourself! Ring the bell and let me help you. (I need to pair these phrases with a significant look and a general air of being a petty martinet with a gait belt. Sigh...)

Bend your knees and scoot yourself up in the bed, please
Roll to the right/Roll to the left


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April 2016



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