Tuesday, April 14, 2015

Experiences: By Cinema

Very grateful to Cinema for sharing his insights as a clinician. Cinema has been an inspiration to me with his blog and twitter presents. Please take the chance to read some of his blog posts/interviews. He is an advocate to PTs and PT students alike. _________________________________________________________________________________________
  • Bio:
I graduated less than a decade ago from University of Saint Augustine FL. Back then our classrooms were basically mobile homes that looked like classrooms on the inside. Rainy days felt like scenes out of “Jurassic Park” - noisy downpours on our double-wides amidst lush vegetation while I peered out the window expecting a velociraptor or two… Since graduation I’ve been lucky enough to work with fantastic PT’s while adding to my out-of-the-box knowledge & skills. I love learning from other PT’s who walked the paths before me, as well as getting a better understanding of my philosophy of treatment and approach to our incredible profession. Connect with me on twitter (@Cinema_Air); also check out my blog CinemaSays.wordpress.com for interviews, opinion pieces, & more.
  • How was the transition/learning curve coming out of school and starting your first job?
At first, the learning curve wasn’t so steep...until I realized I wasn’t sure if patients were getting better on their own or if I was adding any benefit. Some patients were improving, but others weren’t. Textbook cases suddenly became less & less textbook. I wondered about the modalities I was using - “was this ultrasound actually doing anything?” The answer came to me one day when - after using applying US for about 8-10 min - the patient said he felt better. Then I went to turn off the machine and… I NEVER TURNED IT ON! I got more curious, so I decided to use US for some TKA (Total Knee Arthroscopy) cases and skip it with other TKA cases. I didn’t notice difference; both progressed just as well. The 3 things we did consistently was Manual Therapy, Therapeutic Exercises, and Ice. That’s when it hit the fan - I started taking as many continuing education courses as possible; and my learning curve steepened very quickly.

While I was ready for most situations I faced in the clinic as soon as I graduated, I’m better today than I was before; and I hope I’m better tomorrow than I am today. I was also fortunate to work for & with someone I really admired. Do what I did - work for someone you really admire. And, make yourself indispensable.

    • What is your work load like and what is typical day is like for you?
      I worked previously at an outpatient clinic where I attempted to juggle 3-4 patients per hour. While many patients seemed to progress, it didn’t provide enough time for me to slow down & reflect on individual patient cases. There wasn’t enough time allocated to analysis and reflection.

      Today I see 1 patient per hour; adding up to about 8-10 patients per day. We tend to share patients between 2 physical therapists - I like this set-up because I can bounce ideas off the other therapist and get their input on what I’m thinking since both of us have direct contact/experience with that particular patient. I really enjoy the mix of chronic pain and neurological cases we see. The environment at our clinic is geared toward progression as clinicians - something I was looking for and am glad I found. About once a week (or more) we chat about patient cases over lunch meetings and exchange ideas on treatment approaches or management of patients.

      What do you wish you would have known/been prepared for after graduating?

      I wish I had a better grasp of Strength & Conditioning. My opinion is that PT school does not adequately prepare you for real-world strength & conditioning applications. I would strongly encourage you to dig into this after graduation - take as many continuing education courses as you can handle. Additionally, I don’t believe I had enough neuro exposure thru my clinicals. Retrospectively, I should have signed up for a pure neurological setting in one of my clinicals. Every orthopedic case you will see in the clinic has a neurological component - I wish I learned that sooner. It would be to your benefit to explore as many paradigms of treatment as possible until you find the one(s) that yield the best results for your patients.

      As mentioned earlier, in a prior location I worked at a stereotypical outpatient clinic where I juggled 3-4 patient per hour. ONe big benefit of that experience was I gained significant exposure to the business facet of running a clinic. Managing a clinic requires a stronger and broader skill-set than I had imagined - I knew it would be challenging, but didn’t grasp just how challenging it can be for an owner-operator. I wish I had a strong understanding of the business aspects of Physical Therapy, but unfortunately PT school didn’t prepare me for this, and I didn’t take the time to learn it on my own prior to graduation.

      • Additional Thoughts
      1. I really don’t know that much - there’s always more to explore. I think we think we know more than we really know. Believing that I know everything - on any subject/topic - immediately closes the opportunity to step into the sunshine of something I could love/enjoy more than I can imagine to day. Connecting the knowledge I accumulate can open avenues of thought and perspective that can surprise me - and they have! Rather than believing or pretending that I know all there is to know about a particular subject or topic, I find it much more interesting when I’m given new perspective on generally accepted ideas/truths. Read broadly, connect the dots for yourself, and stop pretending you’re smarter than the person next to you. Choose Intellectual Promiscuity over Intellectual Vanity.

      2. The occasional lone wolf may outperform, but a collaborative effort elevates the tide that lifts everyone. Contribute to the larger ecosystem that you’re engaged with. Engagement today is significantly more viral than ever before; why not use this virality for the greater good? What you (Dalin) are doing by sharing these quick interviews is a benefit for all readers. I’ve learned quite a bit from some of the individuals you’ve interviewed before me. I’ve even extended “collaboration” into the workplace by viewing myself as “working with”, not “working for” somebody. Start by collaborating locally while gradually growing your sphere of positive influence. And, collaborate with your colleagues across the country via the APTA to create the change you want to see. A rising tide lifts all boats.

      3.The proof is in the pudding - in our case, the pudding is the patient. Our process should be based on how our patients respond to our care & interactions. Does it consistently improve your outcomes? If so, then it might be worth pursuing. This is the guiding star for my clinical progress, and I use it as a ruthless filter. This also comes with the added benefits of preventing me from getting too attached to the latest professional & academic zeitgeists. Physio fads, academic themes...all these come & go; but my North Star remains Consistent Patient Outcomes. You’ll never be 100% consistent, but it’s definitely worth the effort.

      4. Finally, find a mentor. There’s significant value in seeking and being mentored by someone of experience that you truly admire and with whom you have shared goals/visions. One mentor will (very) rarely fill your needs in more than 1 or 2 of your interests. Find different mentors for your different interests. Leverage their experience, proficiencies, and skills to fast-forward your progress. Then, become a mentor yourself. As a mentor, you realize how much you really don't know! (back to point #1)
      Special thanks to Cinema for his willingness to share his insights. For more information about Cinema find him on twitter @Cinema_Air or on his blog at CinemaSays.wordpress.com.

      Click HERE to read about other PT's experiences.


      1. Should we be teaching students US anymore? I go to USA and my professors, except the modalities professor, NEVER use it. They say it's a waste of time. Is there any evidence that it does anything? I feel manual therapy, NM re-ed, therex, and patient education should be able to treat most of our patients.

        1. Hi Kevin, I do not use US. As you read, I have read I have used it in the past, but did not see meaningful changes with the use of US. Diagnostic US could be introduced. I think E-Stim also has it's place, but I haven't used one in a few years. No reason to lump all modalities into one throw-away back, but I believe they can be "re-purposed" to play new & different roles. With that said, yes, MT, NMR, Pt Ed, and Ther Ex is a powerful combination.

      2. Thank you for taking the time to share your thoughts Cinema! As a SPT at USA Austin, I find any information about the field an opportunity to learn, discuss and continually refine our practice. It was interesting to hear about you US experience and stance on strength and conditioning. Again, thanks for taking the time to share!

        1. Thanks! Glad you got something out of it.