disappointing physical therapist shadowing

[BASuperman]

I spent two days volunteering for a physical therapist. I was practically an aide, and she let me do a whole lot in terms of getting to be involved.

The problem was how her treatments were. EVERY SINGLE PATIENT HAD THE SAME TREATMENT PLAN. Plus or minus one discrepency for maybe 1 or 2 patients. It didnt matter if it was back, ACL, shoulder, neck, they all were the same.

By the time I got the hang of it, I could practically do everything the PT did minus the manual therapy. 3 years of school to give patients generic treatments? Is this normal? I mean she hardly had to do anything, is this how physical therapy is?

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[Fiveoboy11]

I have witnessed similar circumstances as described above although not to that extreme, so I think it would be uncommon to see care that poor. Physical therapists are trained to provide individualized treatment plans based upon the patient. There is a wide range of physical therapist competence levels, but from what you describe, that definitely goes too far. State board involvement would be appropriate for this PT in my opinion.

 

[TheOx777]

It frustrates me to here this so all I can do is SMH!

By the way this person, in no way, is an indication of the entire profession! I know this to be an incontrovertible fact, and I am just about to get started as a Rehab Science student!

 

[Shelby029]

I've shadowed at three different places now. One place I shadowed completely made me question the field I was going into. From what I can tell there are good therapist that really think about the treatments for each patient and "bad" (not sure this is the right word) therapist that do the minimum. It is like that in any field you work in. Some co-workers you'll love working with others not so much.

 

[jesspt]

I spent two days volunteering for a physical therapist. I was practically an aide, and she let me do a whole lot in terms of getting to be involved.

The problem was how her treatments were. EVERY SINGLE PATIENT HAD THE SAME TREATMENT PLAN. Plus or minus one discrepency for maybe 1 or 2 patients. It didnt matter if it was back, ACL, shoulder, neck, they all were the same.

By the time I got the hang of it, I could practically do everything the PT did minus the manual therapy. 3 years of school to give patients generic treatments? Is this normal? I mean she hardly had to do anything, is this how physical therapy is?

I have suggested this previously on this forum. I'd look for a board certified clinical specialist in your area and try to shadow them. I would bet your experience will be entirely different.

http://apps.apta.org/custom/wsabpts...ry of Certified Specialists&navID=10737423513

 

[Akiramay]

I can see how there are some PT's out there who practice like this, but this is NOT the norm and not the way you should be treating patients. If you go to my clinical experience blog thread in these forums, you can see how vastly different the many treatments were that I did. Just think, if you have someone post-ACL reconstruction, why in the world would you be performing scapular retraction as you might have someone with back pain do?

 

[markelmarcel]

Definitely not the norm. I also had a "bad" shadowing experience, so I made sure to get a few other places in and they were all great!

 

[truthseeker]

Question: What do you call the person who finishes last in their medical school class?

Answer: Doctor.


the same is true in any profession, including PT. There are good ones and bad ones. Some think, some don't. Unfortunately there are plenty of the latter in any profession. Most are the former. Keep looking, you will find someone who is more representative of the profession.

 

[SCG1]

I have a friend who owns an in-home health care company and is looking for good PT's. Do you know how to get in contact with them?

 

[Drogo]

I was fortunate in that the first PT I ever shadowed is an awesome PT (outpatient private), his individualized treatment plans and thorough explanations of what he was exactly doing was very interesting. When he told me how some PT's get stuck in certain methods and become narrowminded, it told me you're going to find great PT's and well, less passionate ones here or there.

Was this outpatient or inpatient work?

 

[jellybean2020]

Just wanted to add my own experience:

Been volunteering at a skilled nursing facility where patients do exercises from their wheelchairs (no 'tables' or similar equipment). Most patients have the same needs so they all get leg extensions, leg adductor ball, leg abduction with a theraband, then get taken for a walk. PT's and PTA's are doing the same things with little delegation. Little to no 'work with hands' or 'manual mobilization' is being performed, pretty much 100% exercises (either because it's not done in SNF setting or because it's just this place)


I"m not sure whether this type of experience is representative of the setting or profession at all, but I do have to say it's a bit disheartening to see. Anyone with input?

 

[Sheldon]

Jellybean,


I worked in a SNF for 2.5 years after graduation. After 2.5 years, I had to leave b/c, as you described it, every other PT did the same treatments for each patient regardless of medical diagnosis or PT diagnosis; 5-6 days of seated ther ex, Nustep, maybe some walking. It was disgusting and it happens in all practice settings. I made it a point to treat each patient as an individual and develop each plan of care accordingly. I did not allow the PTAs to do the same treatments each time.
When you are a practicing therapist, do as trained in school and become a life-long learner. Treat each patient as an individual regardless of what your peers are doing around you; even if your peers give you crap for it. Your patients will appreciate your attention to their needs.

 

[jellybean2020]

Jellybean,


I worked in a SNF for 2.5 years after graduation. After 2.5 years, I had to leave b/c, as you described it, every other PT did the same treatments for each patient regardless of medical diagnosis or PT diagnosis; 5-6 days of seated ther ex, Nustep, maybe some walking. It was disgusting and it happens in all practice settings. I made it a point to treat each patient as an individual and develop each plan of care accordingly. I did not allow the PTAs to do the same treatments each time.
When you are a practicing therapist, do as trained in school and become a life-long learner. Treat each patient as an individual regardless of what your peers are doing around you; even if your peers give you crap for it. Your patients will appreciate your attention to their needs.

So basically SNF's are a black mark on the profession in terms of quality of care?

 

[Sheldon]

I would not say SNFs are a black mark on the profession in terms of quality of care, but rather individual therapists (regardless of degree, BS, MS, DPT) who only want a paycheck and do not attempt to individualize care. I've seen these therapists in SNFs, in-patient, out-patient, you name it. There are good apples and bad apples, to use that cliche (but it's true). These are only my experiences though. Wherever you decide you work, treat each patient as an individual and continue your education through residency and fellowship.

 

[TheOx777]

I would not say SNFs are a black mark on the profession in terms of quality of care, but rather individual therapists (regardless of degree, BS, MS, DPT) who only want a paycheck and do not attempt to individualize care. I've seen these therapists in SNFs, in-patient, out-patient, you name it. There are good apples and bad apples, to use that cliche (but it's true). These are only my experiences though. Wherever you decide you work, treat each patient as an individual and continue your education through residency and fellowship.

So how do we hold each other accountable? If you see someone who is clearly not practicing the way they should and patient care is seemingly compromised, where does a fellow clinician say "enough is enough?!"

 

[jellybean2020]

So how do we hold each other accountable? If you see someone who is clearly not practicing the way they should and patient care is seemingly compromised, where does a fellow clinician say "enough is enough?!"

Who knows. Even if SNF's are not a black mark at least they make it really easy for practitioners to be lazy and practice at low standards. In fact I am willing to bet that none of the PT's where I am volunteering have picked up a single journal article in years.

I think it might be because your patients are all 70+ years old and generally do not question the PT or challenge the PT to give more than the minimum. The elderly patients I've talked to at the facility care more about the quality of their daily lunch and how friendly the staff is than the quality of care they're given by their PT's. Plus most of the oldest patients don't know any better. I think you could put potted plants on their heads and tell them it's for their rehabilitation and they would follow along.

As far as my situation, I still am going ahead in my application to PT schools, albeit with new-found caution and doubt about the profession. Maybe I just need to volunteer at a better place. Somebody say something to cheer me up because everytime I got there for my observation hours I leave really bummed out.

 

[TheOx777]

Who knows. Even if SNF's are not a black mark at least they make it really easy for practitioners to be lazy and practice at low standards. In fact I am willing to bet that none of the PT's where I am volunteering have picked up a single journal article in years.

I think it might be because your patients are all 70+ years old and generally do not question the PT or challenge the PT to give more than the minimum. The elderly patients I've talked to at the facility care more about the quality of their daily lunch and how friendly the staff is than the quality of care they're given by their PT's. Plus most of the oldest patients don't know any better. I think you could put potted plants on their heads and tell them it's for their rehabilitation and they would follow along.

As far as my situation, I still am going ahead in my application to PT schools, albeit with new-found caution and doubt about the profession. Maybe I just need to volunteer at a better place. Somebody say something to cheer me up because everytime I got there for my observation hours I leave really bummed out.

JellyBean,

I agree that the nature of the patient population certainly dictates how a treatment plan is formulated. Patients at that age tend to have numerous comorbidities that make even the most rudimentary treatment plans a challenge. My question to the other poster relates to the fact that there will always be those clinicians who get into a "lull" and are not interested in individualizing treatment plans for each and every patient. That fact is ture across the board for what I am told. Have you not done volunteer work in any other setting? Places like outpatient ortho groups, sports medicine clinics, inpatient neuro-rehab facilities, hand therapists, etc offer a much different viewpoint on the profession. On another note, what specific doubts/questions do you have as it relates to the profession?

 

[amaprez]

.

 

[Sheldon]

I made the mistake of accepting a position in a setting where I did not have any mentorship (my fault), and where the other practicing clinicians who were bachelor or master's trained did not accept the DPT degree. No matter what setting you practice in, chances are you will meet a certain level of this resistance.
My advice: 1) Choose a setting where there are other DPTs. 2) Choose a setting where there is experienced PTs willing to mentor despite a difference in initials behind the name. 3) Pursue credentialed clinical after you have been practicing a year, and be the change-agent. 4) Continue your education through certification, residency, fellowship.
Ultimately, we cannot tell others how to practice. Lead by example and surround yourself with like-minded individuals. Those who refuse to change will become extinct: see Vision 2020.

 

[Fiveoboy11]

If it was up to me, any clinician providing this type of care would have their license permanently revoked. Nobody should never observe this person or at that clinic ever again.

The majority of clinician's I've seen make an effort to help the patient based upon what they know. The ones as described above probably do so because they don't feel it is worth the extra effort in terms of relative benefit, are too lazy, or have their own MSK problems that prohibit a good level of care.

It hasn't taken me long in my experiences working in SNF's to get the reputation as relentless. I've always done everything I could for patient's to improve whatever issues they have, to the point of sacrificing my own body. So, there is a continuum. On one end the slacker PT's, and the other the "all go big nutts harry stamper" PT's. But it has been worth it.

 

[jellybean2020]

If it was up to me, any clinician providing this type of care would have their license permanently revoked. Nobody should never observe this person or at that clinic ever again.

The majority of clinician's I've seen make an effort to help the patient based upon what they know. The ones as described above probably do so because they don't feel it is worth the extra effort in terms of relative benefit, are too lazy, or have their own MSK problems that prohibit a good level of care.

It hasn't taken me long in my experiences working in SNF's to get the reputation as relentless. I've always done everything I could for patient's to improve whatever issues they have, to the point of sacrificing my own body. So, there is a continuum. On one end the slacker PT's, and the other the "all go big nutts harry stamper" PT's. But it has been worth it.

I"m not sure what that term means but it sounds dirty Sounds like you should let me shadow you lol

 

[lanxandreads]

How would I go about shadowing and/or volunteer with a PT? Do I have to be committed to a school to do so?
I have an interest in several healthcare fields and I would like to be as informed as possible about what to expect in each one, especially Physical Therapy.

Thanks!

 

[okramango]

How would I go about shadowing and/or volunteer with a PT? Do I have to be committed to a school to do so?
I have an interest in several healthcare fields and I would like to be as informed as possible about what to expect in each one, especially Physical Therapy.

Thanks!

You can shadow a PT before being in PT school. This thread might help you:
http://forums.studentdoctor.net/showthread.php?t=791258

If you do a search, you'll find a few other threads on this topic as well.

 

[kcrat21]

On one end the slacker PT's, and the other the "all go big nutts harry stamper" PT's.

Off topic: Love your quote, I think that horribly awful movie is in my Top 10 all-time.

 

[Danae00]

Just wanted to add my own experience:

Been volunteering at a skilled nursing facility where patients do exercises from their wheelchairs (no 'tables' or similar equipment). Most patients have the same needs so they all get leg extensions, leg adductor ball, leg abduction with a theraband, then get taken for a walk. PT's and PTA's are doing the same things with little delegation. Little to no 'work with hands' or 'manual mobilization' is being performed, pretty much 100% exercises (either because it's not done in SNF setting or because it's just this place)


I"m not sure whether this type of experience is representative of the setting or profession at all, but I do have to say it's a bit disheartening to see. Anyone with input?

Just out of curiosity, what was the PT to patient ratio? This can have a huge impact on patient care, as a single PT can only spend so much time with each patient assessing and treating. I known some care facilities there many only be 1 full time PT for 75+ patients. Group exercise programs are often the main form of "treatment" because that's all you have time for.

Also, what were the goals of the PT program? If the it is to just maintain current levels of mobility then a general exercise program that can be applied to the majority of patients may be appropriate. Often when working with geriatric populations who are already at their current baseline the goal is not trying to "fix" them. We are just trying to keep them as independent as they are now. This is still an admirable goal. This does not mean the PTs are not doing their job. As long as the PT is still screening patients for red flags and is modifying programs as needed due to a patient's particular health history then I don't think we should judge too much without actually being there.

 

[lanxandreads]

Cool, thanks for pointing me in the right direction!