Monthly Archives: October 2014

Time Flies

Did you know that there are approximately 10,568 different sayings about time??? OK, so maybe I don’t actually know the true number of sayings, but doesn’t it seem like there could be that many?? Regardless of the actual number, one of my personal favorite sayings comes from the one and only Ferris Bueller. In the movie Ferris Bueller’s Day Off, Ferris very accurately states that “Life moves pretty fast. If you don’t stop and look around once in awhile, you could miss it.” So true Ferris, so true. For the DPT class of 2016, life is indeed moving pretty fast. We’re two-thirds of the way through our orthopedic module, we’re starting to conclude our research projects, and we’ll be in the clinic in two months time!!

One of our professors recently pointed out to us that, just as Ferris says, sometimes we forget to “stop and look around.” And how true that is! I think that we’ve gotten so busy recently that we’ve forgotten how amazing it is that, in a relatively short timespan, we’ve come from knowing little to nothing about how to treat musculoskeletal impairments to feeling pretty confident in how to evaluate and treat someone with back pain or leg pain (arm and shoulder pain still to come!).

It’s pretty crazy to think about how fast this year has gone and equally crazy to think about all that we’ve learned in our first year! I’m sure it will only move faster as we continue on into the curriculum but a big thanks to Ferris and to our professors for reminding us to stop and take a moment to be proud of the PT’s that we’re becoming!

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Every clinical rotation is unique in it’s own way. That statement is true for each clinical, whether viewed from an individual perspective looking at each personal clinical experience or viewing experiences between individuals; there are simply no experiences that are exactly alike. Personally speaking, this internship is proving to be the most challenging clinical rotation yet. I love my patients, my co-workers, and the amount of equipment and resources available at the clinic that I am currently practicing. Like most clinical experiences, while the pros are many, so are the cons. Time… or rather, lack of time is the greatest con. I don’t care for the hour commute to the clinic and the hour commute home, I struggle with the expectations of 100 percent productivity (meaning that 100 percent of your workday you are scheduled with a patient and are not allotted any time away from patient care to document), and the software used for EMR and my work computer in general does not get along with me! Between the computer freezing throughout the day (every day) and the less than user friendly software for EMR, having what seems like a million tabs, dropdown boxes, and folders, I am challenged not to audibly yell my frustrations at the computer while at the clinic!

 

This is my average workday:

   
5:00-6:00am Wake up and get ready to go to the clinic
6:00-7:00am Commute to the clinic
7:00-8:00am Proof-read and enter any documentation not entered from previous day or that I took home to complete (without any identifying information & abiding by the laws of HIPPA)
8:00-8:45am Treat, re-evaluate, or discharge patient #1
8:45-9:30am Treat, re-evaluate, or discharge patient #2
9:30-10:15am Treat, re-evaluate, or discharge patient #3
10:15-11:15 am Perform initial evaluation on new patient; patient #4
11:15am-12:00pm Treat, re-evaluate, or discharge patient #5
12:00-1:00pm If there is not an In-Service Presentation, Rehab Staff Meeting, or PT Staff Meeting, then eat lunch while working on documentation
1:00-1:45pm Treat, re-evaluate, or discharge patient #6
1:45-2:30pm Treat, re-evaluate, or discharge patient #7
2:30-3:30pm Perform initial evaluation on new patient; patient #8
3:30-4:15pm Treat, re-evaluate, or discharge patient #9
4:15-5:00pm Treat, re-evaluate, or discharge patient #10
5:00-7:30pm Edit and try to complete documentation
7:30-8:30pm Commute home from the clinic
8:30-10:00pm Eat dinner, shower, un-pack and repack lunch, etc.
10:00-11:30pm Work on any homework due, check and respond to e-mails, complete any documentation and edit any documentation not finished at the clinic, look over the POC of patients being seen the next day
11:30pm-5:00am Sleep

 

Most people reading this extensive list, which makes up my typical day, can see where things can be more than a little overwhelming! However, as the old saying by Theodore Roosevelt goes, “Nothing in the world is worth having or worth doing unless it means effort, pain, difficulty… “ For me, personally, the toughest aspect is performing documentation while working with my patients. Simply working “one-on-one” with a patient can prove challenging to a student. This becomes more challenging in many clinical settings like the one I am at, in which OT, PT, SLP, and cardiac rehab clinicians (and each of their patients) are all working in the same rehabilitation gym. Add over-head music thumping loudly through the speaker system along with the need to multi-task in order perform as much documentation (while exanimating, evaluating, or treating the patient) as possible and one can envision the difficulty a clinician might experience, especially an inexperienced, student clinician! Unfortunately, this is becoming more and more the normal expectation of clinicians in many settings. In a conversation with another clinician, I was told that in some settings within the state of NC, clinicians are now expected to clock out if their patient’s cancel or do not show within a certain period of time of their appointment and clock back in when their next patient arrives. In our clinic, if we have a patient cancel or not show for the scheduled appointment, we may assist the PTs in the acute portion of the hospital if they have a high number of patients on their caseload.

I find some peace and reassurance in the fact that I very much enjoy working with each of my patients. I am also reassured by hanging on the words of a friend, who has been a nurse practitioner for 20 years. Just this past month, my friend shard with me that like job responsibilities in other fields, her job duties as a clinician have never been as demanding as they are now due to the extensive documentation expected in conjunction with the lack of time provided to complete it. My friend shared with me that it is her belief that such expectations of clinicians is sure to change for the better in the near future; that is what I hope as well. I love the field of PT, I love my patients, and I love all the advances in technology bringing hope to those with impairments. It is these aspects that I want to see clinicians have the time to focus on; not becoming overwhelmed by the expectations of productivity or buried under the demands of documentation.

While we are on this 6-month adventure, there is some reprieve from overwhelming expectations and demanding documentation. One aspect that is different with this internship than from previous clinical rotations is the fact that, during this final internship, we are provided with 5 days that can be taken off for any reason. This is something that I not only appreciate being able to utilize, but something I feel is essential. Like the majority of full time jobs, in which employees are provided time off for rejuvenation, time to spend with family and friends, or time to attend doctor/dentist appointments, these same privileges hold true for us as interns. As students we may need this time even more than we will as full-time employees, for we have course work to complete along with our clinical experience as well as an additional research course we are taking (that requires much time and focus) during this clinical rotation. I just used two of my five allotted days off to enjoy a long weekend in NY to rejuvenate and celebrate the 20-year anniversary of my high school reunion! It’s back to the clinic tomorrow and I feel refreshed and ready to take on the remaining seven weeks of this clinical rotation known at Elon as DPT 805!

Elon DPT Class of 2016 …aka a room full of Sherlocks

It’s hard to believe, but we’re officially a third of the way done with our orthopedic module! The spine has been conquered, and now we’re focusing in on the legs. As we’ve been discussing these oh-so-important structures that get us from point A to point B, I’m becoming more and more aware that treating a patient who presents with an orthopedic condition is like pretending I’m Sherlock Holmes reincarnated as a PT (pardon the comparison but it’s true!). From the moment we lay eyes on the patient and begin to observe their gait and posture to the moment we prescribe them with a home exercise program, we have to take a whole bunch of information and try our best to piece it all together. Sometimes, figuring out a patient’s impairment(s) is easy, and the pieces of the puzzle seem to fit together very neatly. Unfortunately, most of the time it feels a bit like trying to find a needle in a haystack.

So my dear Watson, how do we make this process easier on ourselves? Well first of all we practice! While there certainly are some cases that are just flat out difficult, there are some patterns to look for in many orthopedic conditions. For instance, if I were to suspect that my patient might have arthritis in his or her hip, I would expect him or her to complain of hip tightness/stiffness in the morning, among other things. To further aid our cause, we also seek out the professional wisdom of our professors, and we find out what the current research has to say. While PT certainly isn’t “elementary,” we’re getting a better grasp on our sleuthing skills and learning how to make the puzzle pieces fit!