5 Early Lessons of an Orthopedic Resident in a Private-Practice Clinic

Truthfully, I have been meaning to update this since August. I had grand plans of weekly blogs detailing my life in the clinic and what it is like to be an orthopedic resident in a private practice physical therapy clinic in Chicago. I would regale you with tales of triumph and lessons of failure as I fumbled my way through patients.

Alas, here I am, six months later with loads of failure and some triumph under my belt. I have held on to a few lessons that continue to influence me as a novice clinician trying to eschew the inefficient habits that seem to build quickly while practicing.

Without further ado…

  1. No matter the patient load, preparation can be a life-saver on a busy day: In the beginning, I found myself making little notes about each patient and what I wanted to accomplish in their session. The journal was a slim Moleskin I would keep on my desk so I would look trendy.  The Moleskin was quickly replaced by exhaustion and subsequent improvisation. Much to my chagrin, I was not good enough to “wing it.” I am back to using a simple preparation sheet noting each patient’s subjective signs, objective signs and what I have done that has been successful. I am sure you might be thinking, “Congratulations, you wrote a S.O.A.P note,” but this is much shorter and easier to read. This also helps tremendously with documentation.
  2. Do no more than two manual treatments (or whatever it is you like to do) each session: I love manual therapy. It is what led me to become a therapist in the first place, but my mentors quickly pointed out that I was throwing every single technique at an impairment. I became afraid that one or two would not do it, and so surely three or five or seventeen would be better. This was clearly not the case. It is hard to stay reigned in when I see great results, but more is not more in the case of any treatment.
  3. Reassess, reassess, reassess: This should probably be number one, but it came up third in my head, so here we are. What am I doing as a clinician if I am not reassessing with the patient after each treatment? And I mean each treatment. If it is feasible for the patient to move, I have them perform their reassessment sign. This goes a long way to sticking with tip number 2.
  4. Stop talking and start paying attention to what you are doing: I love to talk. It is why I was good at sales and probably the main reason I am writing this blog post. Being a therapist or a health professional who spends thirty-plus minutes with patients is hard if you are not sociable. I enjoy the bond I share with my patients as we flow from how they are feeling to the shrimp that is on sale at the market. This limits my ability, however, to stay aware of my hands and what I am feeling as a manual therapist, and if the patient is exercising, it draws my attention away from the inevitable compensations that pop up with therapeutic exercise. I have to tell myself it is acceptable to listen to the patient as I work, but stay engaged in the session as a therapist.
  5. Check your biases: I am always right. Most of the time. Some of time. Maybe once or twice. I pride myself in being an evidence-based practitioner; meaning I read one article, extract the quotes I like, and toss around phrases to support my beliefs so I seem well-read and current. My mentor likes to challenge me on this, and while it is difficult to admit, I am happy she does not let me fly into treatment with JOSPT articles clutched in my hand ready to finally solve my patient’s long battle with whatever impairment has brought him here. Evidence is important, but evidence-based practice is three things:  the best available research and why it may work, clinical experience and expertise and patient values and preferences. 

I realize that none of this is ground breaking, but as I continue to grow, I hope these are second-nature to me as a therapist. It is tough to be new and want to save the world through mobilizations and movement, but keeping these lessons in mind is my best bet to give the patient what they deserve.