Frustrating, Unsettling Day of Volunteering--Making Me Have Some Doubts

[Chevy Chase Fan]

Well, I have around 25 hours of volunteering done now, and I have to say, today was not a good day. The lack of enthusiasm the therapists seem to have for my presence aside, what's really bothering me right now is three things:

1) One of the things that turned me onto PT initially was the problem-solving aspect of it ("given this guy's limitations, how do we get him up and running again?") But from what I've seen thus far, the overall approach of physical therapy feels very generic (e.g. "if he's weak here, have him do 3 sets of 20 of these exercises.") It seems like there's not much of a creative, problem-solving aspect to it at all, with most therapists just following a standard template from patient to patient.

2) For all the money and schooling that a DPT requires, the actual practice doesn't appear all that scientific. I mean, just today I saw a rehab tech conducting a therapy session with a patient instead of an actual therapist. The therapist just sat on his computer doing something else while the rehab tech did all the work, checking in from time to time but never really getting more involved than that.

3) An overall sense of apathy a lot of therapists seem to have for their job. I see some therapists all the time glancing around the room with a look of boredom and irritation on their faces while their patients struggle to do an exercise. Often times they're so detached from the situation that they aren't even sure how many reps he/she did, and just shrug it off like its not a big deal. This bothers me because 1) it makes me wonder if I'm going to be the same way 5 years out of school, and 2) it makes me question how legitimate physical therapy as a field is if a therapist can be so casual with their treatment plans without any real repercussions


Anyway, I know I'm still just a pup with my measly 25 hours of observation, but nonetheless, these are legitimate concerns of mine. So please, I invite you all to respond to my points, b/c I'd love to get a little motivation to pursue this profession back.

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[dny22]

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[artizzle]

I enjoyed the volunteer hours that I did, but I was in a pediatric hospital setting. My other hours were working as an aide, so I can't really complain when I'm getting paid. But, as dny22 said, the PT field is moving (slowly) towards evidenced-based practice and the clinic/hospital/area can have a huge influence on where a PT stands on this issue. For instance, if you have an outpatient clinic owned by a PT who got the tDPT or just keeps up with recent literature, that clinic will use more evidence-based treatments. Even with transition towards the DPT, there still will be PTs and clinics that use ultrasound and electrical stimulation on (nearly) every patient.

Schools generally require about 30 or 40 hours from one site, for it to be used as volunteer hours. Finish up as much as you think you can, then go find another clinic or even better, another setting such as inpatient, neuro, SNF, or whatever you can get your hands on. And before you jump into an internship, check out the facility to see what's their PT philosophy and approach. Both you and the volunteer site are helping each other out, so you both should benefit and enjoy working together.

 

[atstudent]

Well, I have around 25 hours of volunteering done now, and I have to say, today was not a good day. The lack of enthusiasm the therapists seem to have for my presence aside, what's really bothering me right now is three things:

1) One of the things that turned me onto PT initially was the problem-solving aspect of it ("given this guy's limitations, how do we get him up and running again?") But from what I've seen thus far, the overall approach of physical therapy feels very generic (e.g. "if he's weak here, have him do 3 sets of 20 of these exercises.") It seems like there's not much of a creative, problem-solving aspect to it at all, with most therapists just following a standard template from patient to patient.

Well I've worked in 5 different PT clinics (4 in the same company) and in numerous athletic training facilities with many different clinicians of various credentials. A lot of it is the same-- things seem very generic to me as well. 3 sets of 10. 3 sets of 20. Ultrasound, estim, heat pack, etc. For my rehabilitation of sports injuries class this semester, we had to write out multiple rehab projects. I wrote roughly 75 pages of rehabs (6 injuries) and not once did I do 3x10. It absolutely drives me nuts! I am also not a big proponent of modalities-- will use them on occasion but many clinicians seem to rely on them. Another thing that drives me nuts.

Rehab needs to be creative and fun. If it's not, you're not going to have people putting in the effort into it. And you're going to become bored with it as well.

 

[Chevy Chase Fan]

Rehab needs to be creative and fun. If it's not, you're not going to have people putting in the effort into it. And you're going to become bored with it as well.

This is EXACTLY it! The main reason I think a lot of the therapists I see are so unenthusiastic about their jobs is because they're tired of doing the same stuff everyday. I guess I'm just not sure if that's because they're lazy and don't seek out new modalities, or because there's just not much else out there in the rehabilitation field. Least you guys are giving me some hope that there is.

 

[artizzle]

Well I've worked in 5 different PT clinics (4 in the same company) and in numerous athletic training facilities with many different clinicians of various credentials. A lot of it is the same-- things seem very generic to me as well. 3 sets of 10. 3 sets of 20. Ultrasound, estim, heat pack, etc. For my rehabilitation of sports injuries class this semester, we had to write out multiple rehab projects. I wrote roughly 75 pages of rehabs (6 injuries) and not once did I do 3x10. It absolutely drives me nuts! I am also not a big proponent of modalities-- will use them on occasion but many clinicians seem to rely on them. Another thing that drives me nuts.

Rehab needs to be creative and fun. If it's not, you're not going to have people putting in the effort into it. And you're going to become bored with it as well.

I'm not a PT, but I'm pretty sure rehab just needs to work. In school when you're doing projects, being creative is fun and a great way to think outside of the box, but in the end it just has to work (and ideally there will be evidence that supports its use.) Don't get me wrong though, it will definitely help if it's fun.

 

[MinnDasota]

Unfortunately, sounds like you guys are in the wrong clinics. There are much better clinics out there and I hope you guys find them.

Hopefully, when you guys graduate, you guys don't fall into redundancy and boredom as stated. As young clinicians, we have to change this!

 

[atstudent]

I'm not a PT, but I'm pretty sure rehab just needs to work. In school when you're doing projects, being creative is fun and a great way to think outside of the box, but in the end it just has to work (and ideally there will be evidence that supports its use.) Don't get me wrong though, it will definitely help if it's fun.

You do realize there is no research indicating 3x10 does anything, right? But it is simple and easy. "Hey, do 3 sets of 10." Creativity is one thing athletic trainers may have over the PT counterparts... we have facilities that allow us to do more. I worked with our gymnastics team last fall.. the athletic trainer there did all kinds of things inside of the gym. On the floor, in the mats, the trampoline, etc.

Let me put it another way... rehab has to be fun, creative, and FUNCTIONAL. Laying on a treatment table doing exercises is not functional or fun.

 

[Chevy Chase Fan]

Of the 100+ volunteer hours I've done, I've enjoyed very little of it. I'm sure I will enjoy being an actual PT much more.

That's good, but what makes you think so?

I'm imagining myself doing a lot of the stuff I see the therapists do, and I find myself 1) very bored with it, and 2) unconvinced that I'm actually making a tremendous difference in this person's quality of life.

 

[MinnDasota]

Let me put it another way... rehab has to be fun, creative, and FUNCTIONAL. Laying on a treatment table doing exercises is not functional or fun.

I agree with this part of your post. However, sometimes, you can't do functional training until you've isolated deficiencies.

 

[Chevy Chase Fan]

Unfortunately, sounds like you guys are in the wrong clinics. There are much better clinics out there and I hope you guys find them.

Hopefully, when you guys graduate, you guys don't fall into redundancy and boredom as stated. As young clinicians, we have to change this!

what do you find different at "better" clinics?

 

[atstudent]

MinnDasota, definitely agree with you. But I feel like too often we do the same thing over and over again late into rehab as well. I think PT is much the same though it is also quite a bit different from doing rehab with athletes. I feel like many of the clinicians I've worked with (both in the PT world and athletic world) have fallen into the same trap of doing too much that is NOT what functional. For example.. had a few patients this spring who had hamstring strains. Every single exercise was done on the table 3x10 with little progression. Oh, and let's not forget 5 minutes of ultrasound for EVERY patient EVERYDAY.

 

[artizzle]

There is research supporting that doing 10 repetitions, depending on the load, works hypertrophy or muscular endurance. Also, doing multiple sets has been shown to be more effective than single set training. Now, that doesn't mean the PT who says "do 3 sets of 10" knows exactly why to do that many sets or repetitions, but that's what they tell the patient to do. The PT must have heard it somewhere and started using it and saw some positive anecdotal results, which is exactly what the drive towards evidence-based practice is trying to change.

This is getting severely off topic and is not the point that I wanted to make earlier which is for Chevy Chase Fan to find a different clinic or setting. If you go into an interview with bad experiences during your volunteer hours, the committee will sense it. Even worse, if you get into PT school and have only had bad experiences, how do you know you will actually like it when you become a PT? Just get as much exposure as possible and make an informed decision then.

 

[MinnDasota]

what do you find different at "better" clinics?

Chevy, there are many clinics out there that see that every pt is different. Just because someone has a hamstring strain doesn't mean the cause is the same and thus, must be treated accordingly. The better clinics (or better yet, clinicians) spend time educating their pts why the injury happens and why certain modalities and exercises will be beneficial. They should (time permitting) also spend time educating their aides so they can better help with these patients (and to get them excited about PT school!) .

 

[johncronejr]

I just finishes up my first observation, and I did see some of the same things. Here is my take on it regarding the sets of exercises versus doing creative and functional exercises. Most of the patients I observed were either elderly with little strength, or patients who were in overall poor condition in addition to injuries. The repetitive exercises work great for these people because they need strength first and foremost. Given their level of de-conditioning it is not likely that we can set them up for a rousing game of hopscotch or Wii bowling just yet.

Another factor that I see impacting this is the availability of space. I have been a national level powerlifter and have always been intrigued by creative ways to get stronger ie flipping tires, dragging sleds, etc... But the biggest hassle at times has been where to do it. Imagine a clinic that had 5 therapist and they all want to do something creative and functional for every patient. Think of how much space that would require.

I started my pre-PT training with the notion that I was going to work predominantly with more athletic people. I now know that is not likely to pan out given the location I want to live in. I am going to need to be able to see a wide range of patients, especially if I desire to own my own clinic. I hope to be able to be as creative as possible, but realize that for many patients the tried and true more boring methods will be the best route. For the poster saying that "there is no evidence suggesting that 3x10 works"....do you actually believe that all the PT's now practicing have just been wrong? That all of those patients have continued digressing? Powerlifters and Olympic lifters from the dawn of the sport have used many variations of the boring set/rep scheme with great success for building muscle. Are there more fun ways to get an extra functional edge? Absolutely, but that is not for every person at any given time, nor is it always the most feasible/cost effective method.

 

[atstudent]

I started my pre-PT training with the notion that I was going to work predominantly with more athletic people. I now know that is not likely to pan out given the location I want to live in. I am going to need to be able to see a wide range of patients, especially if I desire to own my own clinic. I hope to be able to be as creative as possible, but realize that for many patients the tried and true more boring methods will be the best route. For the poster saying that "there is no evidence suggesting that 3x10 works"....do you actually believe that all the PT's now practicing have just been wrong? That all of those patients have continued digressing? Powerlifters and Olympic lifters from the dawn of the sport have used many variations of the boring set/rep scheme with great success for building muscle. Are there more fun ways to get an extra functional edge? Absolutely, but that is not for every person at any given time, nor is it always the most feasible/cost effective method.

What I said (or at least what I meant maybe?) is that there is nothing to prove 3x10 is the only way to make improvements. It puts me to sleep and I know from experience that patients get bored with it being that simple. How do I know? Because when doing it, we both forget how many it's been because we don't pay close enough attention because it's that simple. If you want to work endurance, you could do as few as 8 or as many as 20+! Why do we always choose 10? Because it is simple. But simple also makes it BORING. I'm sure I'm not going to sell anybody on this point because you all seem pretty stuck in your ways. Whatever floats your boat.

I think sometimes the hardest thing to do in rehab is to remember that not every patient is going to react the same. 3x10 may work for some. Others you have to mix in 3x5 or 3x15 or 5x5, etc. Yes, some patients may need to build muscle strength rather than muscle endurance. It seems to me 95% of rehab clinicians only do muscle endurance. We get set in our ways and that only hurts our patients. Sure, there are times that we won't have a choice on the selection of rehab depending on the injury. You obviously can't be doing plyometrics with an 75 year old lady who just had a total knee replacement.

If you do the same thing over and over, you'll get the same results over and over.

 

[Chevy Chase Fan]

Yeah, having cool PTs to work with makes the experience so much better. There's about two nice ones where I'm at. Most just pretend I'm invisible or act like they don't know why I'm standing there watching them. Some are just infuriating to be around b/c I'll stand in plain site watching them work with a patient, and when they need some menial task done, like getting a towel or a dumbbell or something like that, they'll just walk right past me and do it themselves instead of--heaven forbid--getting me involved. Its downright offensive to me. Yes, offensive. I don't get paid, I'm there on my own volition, I'm a college graduate, and you can't let me grab a 2.5lb dumbbell for you or get new pillowcases for a bed? Its more maddening than you can possibly imagine.

Man today sucked ass. I'm gonna volunteer at a different hospital soon.

 

[dny22]

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[jess818]

i volunteered for some time and also worked as a rehab tech (VERY BRIEFLY). volunteering was boring at times because there is little i was allowed to do as a volunteer. the PT aide tried to involved me in as many activities but it mostly involved me sitting around and watching repetitions-especially when i observed sub-acute patients. out-patient was definately more exciting. it really does depend on the therapists abd settiing. all of the therapists i observed while volunteering activley tried to involve me and were up-beat and personable.

when i worked as a rehab tech, i only worked with PTAs and OTAs-i don't think i ever even saw the PT or OT. it was awful. the PTAs would read newspapers while having the patients perform 3X10 reps. they would also tell me "there is a lot of $ in PT, but we're just too lazy to get there". i quit within a week. as bad of an experience as it was, it has shown me how NOT to behave as a therapist.

i have also gone to PT tx for my dad and boyfriend. some of therapists were great and others not so much. the one didn't even introduce herself to my boyfriend or i-we had no idea what her name was until the receptionist yelled out to her about a phone call she had waiting.

all in all, it really just depends on the facility and the people working there. when i was a volunteer, one of the OTs told me that before i take a job, i should try to shadow for a day and get to know the other therapists who work there. he said your fellow therapists and the management can make or break your satisfaction.

i personally hope to be more evidence based, creative, and positive as a practitioner and fortunately all of the people who post on these boards seem to want to be as well .

 

[lee9786]

Sounds a whole lot like my volunteer experiences unfortunately. The one outpatient clinic only had one therapist out of five that seemed interested at all in showing me how things were done. I felt like my presence was a huge inconvenience as I tried to stay out of the therapists' way and observe from a distance. I felt uncomfortable asking questions because I didn't want to distract them from their job. I was told by the front office I should be more proactive and ask PTs if I could sit in on their evaluation. I was hoping they would have asked if I would have liked to. Anyways I did so and one of the PTs allowed me to observe, but it was made clear I should not talk but only observe.

One day it was relatively busy and I attempted to take the initiative of putting a hotpack on someone's back. I was asked into the front office and was told I was not qualified to do so and that I should only do what I'm told. Meanwhile the PT aide that I was helping wouldn't even say hi to me or shake my hand when we first met let alone give me insight on the rehab world. She walked around miserable all day and I think pretty much hated me. I really don't know why because I gave her no reason besides being there to feel that way. Now this is only a reflection on her and not therapy, but this person was somehow more qualified than me to put a hotpack on someones back.

I decided to move on after this experience. I figured possibly a hospital setting would be a good place to get another perspective. Starting out in acute care, I found I was following PTAs for the first three weeks. All but one PT generally seemed apathetic toward me. I followed the PTAs around and they stated I was crazy for pursuing this DPT. They claimed they could do everything the PT could or even better. After realizing there was no intention it seemed to eventually have me follow a PT around, I took the initiative and asked if I could do so. After all I do need two letters of recommendation and at the time it didn't look like I was going to get a chance to get them. All they knew about me as that I was interested in PT and some of the schools I was looking to apply to.

I did end up following the PTs around. One PT in particular was extremely helpful and I commend him for his effort. He explained how the world of PT works a little. He allowed me to review MRI data and imaging. When I would observe his evaluation, he would be talking to both the patient as well as me educating us both. When we did wound care he described what he was doing, why he was doing it, and encouraged questions. I learned more from him in one day then I learned in two months with the other therapists.

I still to this day do not know why current PTs would not want to embrace a highly motivated potential PT during a work-force shortage. Out of all the therapists I encountered, I feel confident with asking one to write me a recommendation letter. I still have more voluteer days ahead of me so who knows. It makes me doubt my decision to pursue this profession. I've definitely considered pursuing a PTA degree which could open up a door to a career as a PA. After all if PTAs can do everything a PT can besides the evaluations, discharges, and paperwork then maybe it's not such a bad idea. It sure seems to make more sense financially. Who knows.

I'll add I attempted to volunteer with one of the PTs at the outpatient clinic to help out in the skilled nursing facility on weekends. It never ended up happening. I do understand that it is an inconvenience, but I would like to actually help and not just be standing around. I'd like to get a job working as an aide somewhere, but nowhere in my area is hiring. Very discouraging, but I try to remain positive.

 

[AspiringDPT]

I have over 1000 hours of paid and unpaid PT experience. I've encountered therapists who are both very creative and innovative and some that take a more structured approach. I agree it can be frustrating when you have a passion for something and you see someone else with that opportunity just going through the motions. Perhaps you should aspire to be the change you want to see in the field.

 

[PTSuccess]

It's unfortunate that many of you seem to have had bad experiences. I personally have had some great experiences and some really awful ones. When I did volunteer work at a hospital, I enjoyed maybe 25% of it. The first clinic I worked as an aide was the best experience I have had thus far, the patients and therapists were amazing. Another clinic I worked as an aide at was the most uncomfortable place I have ever worked at because the therapists there always made me feel like I was in the way, never actually engaging me in the activities patients were performing. And the clinic I currently work at is GREAT! The therapist is very knowledgable and never makes you feel like you are stupid, he actually takes the time to teach his aides information, which to me is very beneficial since I am still in school. I am able to apply what I have learned in school to the information he teaches us.

As I said, it's unfortunate that one bad experience can possibly change your mind about your future profession. But as you can see I have had both good and bad, and I still want to go into PT. Nothing can change my mind about what I have invested so much time into. I think one thing we can take away from the bad experiences we have all had at one point or another is how NOT to be once we become PT's. It's a great career, and I think it's worth all the effort we have all put into it, but it truly comes down to what you make of it!

 

[trichic]

I understand completely. Last summer I shadowed at a clinic where the PTs would hand out the same pre-printed exercise sheets to every client. The office person spent all day making copies of the exercise sheets. I didn't realize it at the time, but the clinic was owned by an MD and they only worked with patients from his orthopedic practice. Not sure if this was why cold packs, ultrasound, and e-stim were so popular. I am looking forward to shadowing at a PT owned clinic this summer and hoping for a more positive PT experience. I am optimistic about the future of the profession when I read how many people on this forum are frustrated by the "same old thing" they've seen with their volunteering/shadowing. Eventually those PTs will retire and more people will see the evidence based practice and have more respective for physical therapy as a whole. It's sad when my own mother won't even go to her physical therapy appointments because "I'm not going there three times a week. I can ice my own shoulder."