Following my summer semester, I was fortunate enough to embark on my first clinical rotation. I was placed at Drayer Physical Therapy Institute’s Hummelstown clinic in Central PA (right outside of Harrisburg). I was only in the clinic for two weeks but I couldn’t believe the skills I learned and all the things I got to do while I was there. I also got to stay with my cousin, his wife, and their two kids who I usually only get to see on holidays, so that was pretty awesome. It was fulfilling to be able to apply what I have learned in school and also to learn new things I had no experience with! My clinical instructor, Lauren Houser, was amazing and helped me a lot with all the questions I had while I was there. I was very thankful she invested her time and effort to make sure I got the most out of my experience instead of just tagging along for two weeks. With that being said, here are 5 of the most important things I learned in Hummelstown!
- Walk alongside your patient and don’t be a healer
- All too often, healthcare professionals act as all-knowing beings who can “fix” any patient who walks through the door with a surgery, intervention, tool, pill, or modality. No matter what Aunt Linda says on Facebook, the Fascia Blaster or any other instrument won’t cure all your musculoskeletal conditions that have an underlying cause of “fascial adhesions.” Having a “one size fits most” approach as a clinician isn’t just irresponsible, it’s inefficient. I say this because the same patients that get treatments or surgeries thrown at them often return to the medical system with the same ailment. i.e. Patients with a spinal fusion with recurrent low back pain. Aim small, miss small. Physical therapists need to educate patients and help them to become self-efficient and own their pain. When we do this, we empower patients and build better therapeutic alliances.
- As a respected healthcare provider, words matter
- When patients hear things from a knowledgeable professional, it sticks in their minds. This man or woman in a white coat is telling me how broken my body is, so it must be true. “Man, your hips are pretty weak!” “You have some severe degeneration in your back, both in your vertebrae and your discs.” “You have arthritis all through your bones and joints.” These thought viruses, as they have been coined, have a real impact on people’s lives and what they think they can do. If your primary care physician says the cartilage in your knees is degraded and your bones are practically grinding together, the chances of you going out for a jog or playing a recreational sport are slim to none. We know from the research that general exercise is great for patients with osteoarthritis but they are scared to death of movement because their doctor said how frail and broken they are. The human body is robust and your discs aren’t going to shoot out of your back if you bend forward. Trust in your body’s tissues. Healthcare professionals must do a better job of telling patients what is right with them (instead of wrong) and being mindful of the language they use when explaining any deficits.
- Patients want someone who will listen to them
- Look, listen, speak, and then touch. All too often, healthcare providers (PTs included) want to cut to the chase and start gathering subjective information as soon as the patient walks in from the waiting area. It is important to take your eyes off the computer screen and actually listen to what the patient is saying. Documentation can wait until the patient is doing their exercises or during lunch. In addition, it is imperative to let patients talk and not to cut them off when you hear something that puzzles you or confirms the plan of care is working. If a patient’s pain or dysfunction is so bad they are seeking the care of a healthcare professional, they want these four aforementioned things to happen. They want the clinician to look at them, they want to be listened to, they want you to ask more questions about their pain or dysfunction and how it affects their life, and they want to be touched where it hurts. Physical therapists are in a unique position because we see patients multiple times each week! Considering this, we can build relationships with patients you just don’t see from other providers. Patients need to feel safe sharing things with us and be open about their pain, dysfunction, or post-surgical process.
- Embrace challenges and new information
- When I walked into Drayer for the first time, I had just finished my last competency of my first year that previous Friday. I was hooking up TENS on my lab partner and had never put my hands on a “real” patient. I had been in contact with Lauren, my clinical instructor, in the month leading up to my clinical so she knew what I had learned already but I wasn’t expecting to be thrown into the fire on that first day. Looking back, I can’t imagine it any other way. Within the first hour on the first day, Lauren asked if I could do some soft tissue work with a patient. I wasn’t really expecting to do much on the first day but once I got over the initial rush of nerves I was ready to go. When I got my hands on the patient, I said to myself, “Hey, stop being nervous, you know how to do this!” Also on the first day, I was asked to get a subjective from a patient and run them through their exercise program. I had never dealt with “real” patients before this but I just asked how they were feeling that day, what their pain has been like at home, if it’s affecting their activities and if so, which ones, and if their pain was affecting sleep. I don’t know where this came from considering I had never done it before but it did because I was prepared and confident in my abilities! I ran the patient through their exercise program and wrote up the rest of the note (subjective, objective, assessment, and plan). During the summer, my SOAP notes were constantly critiqued by my professor but Lauren thought it was great and told me to make it a good habit to write good notes as such. I am so thankful Lauren challenged me and made me step out of my comfort zone because I learned a lot more from doing than reading from a PowerPoint slide.
- Don’t be afraid of the unknown
- During our first year, we didn’t really learn any manual skills or therapeutic exercises outside of some shoulder range of motion exercises. I had never stretched a patient, performed a mobilization or nerve glide, or done rhythmic stabilization. Lauren blocked time out of her schedule on my second day in order to teach me some manual techniques I would use to treat patients. We went through mobilizations, stretches, Mulligan mobilization with movement, and nerve glides of the upper and lower extremities as well as the spine. This was all brand new information for me as I was a Biology major in undergrad. I was too busy researching the anabolic effects of carbohydrates and essential amino acids in mice to worry about stretches of the shoulder and hip. *eye roll* Because I was taught these manual interventions, I was able to greet a patient from the waiting area, take them through their entire treatment, and then write up the note. Lauren also taught me a few common exercise progressions and what types of patients we would prescribe them to. When you surround yourself with new information and actively learn, that’s where the magic happens. It was refreshing to immerse myself in things I had no idea how to do but had heard about. ALWAYS make sure you are being challenged!
Aaron Burger | Physical Therapy 
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