When Your Patient Yells at You

Today was a first.  I had a patient lose it on me…

My patient had been consistently coming in 10 minutes late.  Every time she would come in late I would discuss with her how it then limited the time I could spend with her because I had patients after her.  She would acknowledge what I said and then she would continue to show up 10 minutes late.  It was especially frustrating because she’s a Medicare patient and you can only charge for time spent 1 on 1 with the PT.  If I had a patient coming in 20 minutes after her, and she was showing up 10 minutes late, that left 20 minutes for me to work with her…and then start the next patient late by 5 minutes (so now I’m late) so I can at least bill 2 units of therapy with my late patient. Of course, I’m not going to explain that to her.

It eventually got to the point where we would joke about how she’s late to everything.  Other patients would pipe in on the conversation and we would all have a big laugh.  While it was frustrating to have her show up late, at least we were getting a laugh.  And my patient started showing up earlier and earlier…to the point that she showed up 1.5 minutes early the other day.

And then she reverted back to her old ways today.  So when she walked through the door I did my usual, “____, you’re 10 minutes late again!  That means I get 10 minutes less with you!”  She seemed fine, but a minute later when I was bringing her back she snapped at me, saying “you know, you really don’t need to shout that out so everyone can hear….”  She continued to rant.

Meanwhile, in my brain, panic ensued.  You see, I’m frequently getting told by my co-worker how I’m too nice.  I tend to make exceptions for people or try to inform them how they are usually late…by sorta joking about it versus getting straight to the point and telling them how my time is valuable and they are wasting it.  I try pretty damn hard to make sure my patient’s are happy, even if it sacrifices my time.

So now I have a patient yelling at me.  I didn’t respond much other than to say to get up on the table.  In a way, I could understand her point and so I felt a little sorry for that.  At the same time though, what was said was not too far out of the ordinary from our usual interactions.  So I calmly apologized and explained how it was my understanding that we usually interact in that way and that it is normally well-received.  She agreed but said I sounded more serious today.  She then went on another rant about something her husband expected her to get done that she didn’t and how she’s not prepared for their vacation this Friday.  And that’s when I realized it probably wasn’t exactly about me.  While I might have pushed her over the edge, it seemed as though she had been standing on it for quite some time prior to the PT session today.

“Well, _____, it seems like you have a lot going on and that you’re having a day…and that’s okay.  We’re all allowed to have those kinda days every now and then.”

I let it go.  I can’t let one negative experience bring me down.  If I had done that, I would have completely ignored the two very positive things that happened with the patients immediately after that one.  My patient with a knee injury from years ago actually finished a run with no pain or instability after….something he hasn’t been able to do since before his injury! And I had another patient, who normally sees my co-worker, specifically  state that she would like to continue to work with me because she thinks I’m better (not that I’m in a competition with my co-workers but it boosted my confidence).

I’ve learned some things today.  I see where I have room to grow.  One day at a time!

Red Pants, Blue Heels

With the start of this week being more stressful than usual, I figured I would go out and dance off some of my frustrations.  So I threw on a pair of my dancing pants and a brand new pair of blue Remix shoes and I hit the dance floor.  I hit it hard, my friends.

I’ve always been the type to worry in advance about things, which often makes me sit around doing nothing and just wait until whatever thing that is stressing me out finally comes about.  I’m not doing that anymore.  I don’t want to one day look back on my life and think, “if I would have just gone out and done the things I wanted to do…” So despite being tired, I forced myself out to dance.

There’s absolutely no greater feeling that going out and dancing when you’ve been stressed out.  It’s impossible to be unhappy.  And it’s a chance for me to let me alter ego out.  By that, I mean that I get to be a whole new person when I’m out on the dance floor.  When I’m dancing, I feel like a badass.  It’s a definite boost to my confidence after feeling less than stellar in the clinic.

Moral of the story: don’t make physical therapy your world.  I want to be a great PT, but I’m not going to let that get in the way of me living it up.  Besides, a happier, healthier PT is a happier, healthier patient! 🙂

 

I Had a “Peds Day”

When I first started my job, a whopping 2 months ago, I had a few bad cases of the Mondays.  I would wake up Monday morning feeling completely stressed out and unhappy.  I don’t really blame myself.  How is starting a new job NOT stressful?  Eventually I got over my Monday blues, which I attributed to me finally getting the hang of things.

I must say, lately I’ve been feeling a relapse of the stress and Monday blues.  I’ve gotten a little annoyed by the fact that my hour lunch is really only a half hour since they book patients a half hour before my actual lunch and we are expected to see patients for an hour.  That’s been a problem for me because I only have 30 minutes to eat AND try to catch up on all my morning documentation.

My other issue is that I was supposed to see my last patients at 4:30 which would give me 30 minutes after the last patient leaves for paid documentation time.  Well somebody has been booking me for the 5 pm slot, which means I have no time for documentation at the end of the day.  Obviously, I need to document, so I’m staying late to get I done.  Now, I don’t know who started booking me at this time, but that wasn’t the original plan.  All the other therapists have 30 min of documentation time at the end of the day.

I’ve managed to fix the problem by having the front desk block the slot before my lunch so that now I at least get a whole hour to eat.  This whole inhaling my food thing hasn’t been working, and I’m sure it’s not healthy.  I’ve decided to keep my 5 pm slot open for patients since they seem to be consistently filling it.  And I’d much rather have a whole hour of lunch then 30 min of documentation time at the end of the day.  I HATE having morning paperwork to do at the end of the day vs just having to complete everything from the afternoon by staying a few minutes late.

All in all though, today was just one of those rough days.  I felt on the verge of tears at one point but kept myself together because I only had 30 minutes to eat and finish all my morning paperwork.  Not only that, but I had to see 3 evals today (all Medicare) which meant that I would DEFINITELY be having to do A LOT of documentation after hours.

I call these days “Peds Days”.  It’s in these moments that I start really considering pediatrics…  Like really seriously.  Like, as in I started checking Craigslist today and ALMOST sent out a resume to potential employer.  But I didn’t.  I think pediatrics might be what I go to when I get stressed out and feel inadequate in the world of outpatient ortho.  I put a crazy amount of pressure on myself to do well and I take it very hard when I don’t feel like I’m living up to the crazy high expectations I place on myself.

I don’t know if pediatrics is right for me but I definitely think I could be in a better outpatient ortho clinic.  Is it the worst?  No way.  But it has a lot of flaws and things I’d rather not have to deal with for the rest of my career.  At this point, though, it’s about gaining experience.  So I’m hanging in there and hoping I’ll take some of the pressure off of myself as I get a better handle on where I’m at and what I’m doing.

Ultimately, I just know the dream job is out there for me and that this is a stepping stone to whatever that might be!  One day at a time… 🙂

The Patient with Panic Attacks

I had an initial evaluation yesterday for an older lady with back pain.  She was very pleasant, extremely silly, and very honest (and by that I mean she told me she had been to PT before but that she just stopped going because she was a bad patient).  I could tell that she was going to be fun to work with…well, if she continued showing up for PT.

After getting everything I needed during my eval, we started doing exercises.  She started off with some exercises on her side and then we moved to some exercises on her back.  She started feeling dizzy pretty soon after rolling over.  She asked to sit up, took a few deep breaths, and with her eyes closed said, “I just don’t think I’m going to be able to do this.”  She was very concerned about her heart (has a-fib), but walks everyday, and everything we had done was not any more challenging than walking.  She attributed the dizziness to the a-fib.  She didn’t want to do anymore because she was afraid of pushing herself too hard and having a heart attack.

We talked a bit about how the activity was not any more strenuous than walking and that if she had the okay from her doctor to walk, what we were doing should be okay as well.  I asked if she had any issues with her inner ear and explained how her dizziness immediately followed her rolling from her side back onto her back.  She said that she does have inner ear issues and agreed that it made more sense that that was likely the reason for the dizziness.  To ease her mind, I made a call to her cardiologist to see if there were any other issues or restrictions I should be aware of.  There were not.

“You know, I’m always very worried about my heart.  I have panic attacks…” she said.  I wouldn’t wish panic attacks on anybody.  They are awful.  And if you’re familiar with my  other blog, The Life of a DPT Student, you know that I struggled with them at one point.   I had always told myself that if I could use my experiences with them to help at least one person, that horrible time in my life would be worth it.  And this moment was yet another one of those many moments that made me appreciative of the tough days I went through.

“Well, I know exactly how you feel” I said. “I’ve had panic attacks before.  They are really, really awful, aren’t they?!”

The patient perked up a little.  “Yea! They are!” she laughed, as if we were bonding over some shared hobby or favorite TV show. ” And you know what? People who haven’t had them before have absolutely no idea what they are like!!!”

I agreed with her.  And to be honest, having 3+ years between me and my last panic attack has almost made even me forget just how evil they are.

“The doctor gave me Xanax.  I had to take one because I was afraid I was going to have a panic attack while I was here” she said, sounding a little upset.  I was instantly taken back to the white coat ceremony for my program where I had to take a Xanax because I didn’t want to ruin such an exciting moment by panicking.

I told her that I had been given Xanax, too, and that I had to take it when I was afraid that I was going to have panic attacks. I told her that I knew what it was like to be afraid to go places for fear that a panic attack would strike.  I told her that I knew how bad the feeling was when you could feel one coming on and how I would cry on the phone to my mom before going into tests because I was afraid I would panic and have to leave.  She said that when she started feeling dizzy on the table, she was afraid one was going to come on.  I told her that she should never feel like she can’t speak up and say if she feels a panic attack coming on and that she will not at all be judged if she has to call it quits because of it.

And my patient left feeling pretty happy.  And I left feeling pretty fortunate to have been able to actually relate to her.  I know I wouldn’t have understood had I not had panic attacks before.  And while I wouldn’t say it is a time in my life I would want to relive, I can say that it’s a time in my life that has taught me so many valuable lessons and that has enabled me the opportunity to help people in ways I didn’t expect myself to do! The Life of a DPT Student would not have been created without them….this blog would not have been created without them…I wouldn’t have been able to relate to that patient without them.  And I have a feeling there are a lot more opportunities ahead of me that just wouldn’t be had I not had those “darker days”.

Oooh if my past self could just see the good things on the other side! 🙂

 

 

 

When Life Gives You a Farsi Speaking Patient….Learn Farsi

I did 3 years of Spanish in high school.  Three years!  Yet I can’t really speak much of any of it.  My last clinical rotation involved a lot of me trying to recover any bit of Spanish my brain had retained.  I found that even though I did not know much, my patients really appreciated the effort…or at, at the very least, enjoyed laughing at me. In an interesting turn of events, I have not had a single Spanish speaking patient yet! But I’ve had two Farsi speaking patients….and that has been a challenge.

Both of my Farsi speaking patients know English.  One knows it more than the other and so I can say just about anything to her and she understands.  The other patient struggles quite a bit and usually responds with “Yes” when I ask when she feels pain.  It makes treating her quite difficult.  So I took it upon myself to learn as much Farsi as I can from my patients so that I can communicate with them better and so that if another Farsi speaking patient comes in, I’ll be ready.

So far I can count to 30, say # times, # seconds, ___ times with the ____ leg, say up/down, say hello/goodbye/pain, say ankle/knee/hip/back.  I’ve learned so much in such a short amount of time and my patients absolutely love that I’m trying.

As physical therapists, we have a lot that we can teach patients….but we also have A LOT of patients that have quite a bit that THEY can teach US.  Take the time to get to know your patients beyond their injuries and you’ll not only gain their trust, but you’ll learn so many new things!

“So…how long have you been doing this?”

This question….you just HAVE to love this question when you are a new grad.

Of course, I’m joking.   I’ve gotten this question quite a few times now, no thanks to me looking younger than I am.  In fact, today I had a patient joking about having a teenager working on him.  And that’s when he asked me how long I’ve been doing this.  It didn’t make things any easier when he followed it up with, “you said 3 years the other day, right?” Ummm…wrong.  Not even 3 months.  Oooof.

I’ve managed to find a way to answer this question pretty well and, fortunately, I’m able to use my very short time in my per diem position to my advantage.

“Well, I have been here since January.  Prior to working here I had been doing per diem at another clinic”.  Now, usually the conversation ends there without the patient asking me how long I’ve actually been a PT.  If a patient asks about that, I respond with that I graduated in August (and not that I started working in December)…but I don’t stop there.  This is the time to flaunt that DPT and all the hard work that got you here.  Plus,  a lot of patients don’t really know what it takes to become a PT, so after you explain all that was involved, they aren’t as fixated on you only graduating in August.

“I graduated in August from ________ where I completed 3 years of physical therapy school to get my Doctorate of Physical therapy (cue the…”wow…3 years?! ” or “oh, it’s a doctorate?!”…bonus points!!!).  While in the program I completed clinical rotations where I went out to various PT clinics/sites where I got to practice my skills and learn from practicing physical therapists.  These rotations varied in length between 6-12 weeks and included a variety of settings.  I did one rotation in the hospital,one  in pediatrics and about 7 months of outpatient ortho at 3 different sites so I was very fortunate to get a lot of experience in the setting I wanted to be in.”

And I have not had any issues with this response.  The key is to speak confidently.  If the patient can tell you are a nervous, that will be make them nervous about working with you.  Just own the fact that you are a badass without sounding like you are defending yourself.  You are qualified to work with this person, now prove it!

New Grad Life Lesson #1: You Can’t Make Everyone Happy

I’m so thankful I’m learning this one early.  I was a bit bummed a couple of weeks ago when a patient of mine switched to another therapist’s schedule (one that was also treating his wife).  He was a tricky patient to work with mainly because I believe he has other factors at play (previous history of TBIs (yes, plural) and some depression).  He was difficult to work with because I felt like I had to hold his hand through every exercise and he wasn’t doing anything at home.  He kept saying “I just want to get better” but then never did anything I told him to do.  So, while I was disappointed that I wasn’t able to do more for him and that he thought someone else could do better, I was a little relieved to see him go.  Still, striving for perfection can really bring  a person down and I’m learning that you just can’t make everyone better…or happy.

The two other therapists I work with had some similar things happen this week.  One had recently called one of her patients who had cancelled her last two visits only to hear that she had gone to another clinic.  The therapist was really bummed about it and I think she’s still trying to get over it.  The other therapist had a patient ask to be switched to somebody else’s schedule because they didn’t feel like she spent very much time with them.

I don’t want patients to be unhappy or the other therapists to be upset, but it was nice to see that it wasn’t JUST me.  I’ve learned in my clinical rotations that there is more than one way to treat a patient.  Each CI had a different approach.  Was one better than the other? I don’t know, but the patients were getting better.  So when a patient switches off of your schedule, maybe it’s just that your particular approach isn’t for them.  It doesn’t make you any less intelligent.  It doesn’t mean you are a bad therapist.  But maybe the way that you like to go about treating X, Y, and Z isn’t the most compatible with the patient.  Just let that patient go and focus on all the other patients who you’ve made great changes with! 🙂

The Last Two Weeks

I’ve been getting more and more comfortable with where I’m at.  The therapist that didn’t exactly seem all that inviting has really opened up and we talk quite a bit.  We even went to this skills lab thing where we were partners to practice techniques on.  I think the potential is there to be friends.  The other therapist who started a week before me is allllll over the place.  To be honest, I wouldn’t be surprised if she got fired in the next few months.  She’s always trying to do a million things at once while treating her patients…and by that, I mean she’s trying to do a million things that are completely unrelated to PT while she’s treating her patients.  For example, she’ll be telling me about something that happened over the weekend, while looking up how to get a license at the DMV, and completely ignoring the fact that one of her patients is waiting for their HEP or for her to take them through the next exercise.  Our clinic director has gotten on her a number of times which has led to the therapist ranting about how she doesn’t know why the clinic director keeps getting on her case….while the clinic director is still in the building!  So I just do my best to change the subject, which is awkward!

The clinic director, for the most part, leaves me alone.  I’ll get updated on things I haven’t learned yet but I haven’t been told anything negative about how I’m performing.  We are super over-staffed right now so that has given me the chance to get the hang of things without feeling super overwhelmed.

There have been a couple things I’m not quite fond of.  For example, our clinic just switched over to charging patient’s for therabands and that bums me out.  What was once free is now $16!! It blows my mind.  So I’ve been working really hard to find ways to modify patient’s exercises so that they can still get what they need without having to fork over money.  That being said, I’m practicing at a clinic where the average patient probably makes at least double what I make…so a $16 theraband probably isn’t the end of the world to them.  Anyway, it still bothers me.

Another thing I don’t like right now is having to see a crap ton of Medicare.  It’s not the Medicare patients I don’t like…it’s just Medicare.  Documentation for Medicare makes you want to rip your hair out.  And if you have Medicare patients overlapping on the schedule, it becomes super annoying trying to figure out how you can get 3 units of therapy out of the session.  So that has been really frustrating and the people up in the front scheduling haven’t been scheduling in a way that would make it easier for the therapists.

Let’s see…I had discharged my very first patient after only 4 visits! One of my patients switched onto another therapist’s schedule which really stressed me out that I wasn’t doing  a good enough job BUT one of her patient’s switched onto my schedule….so whatever.  Oh! I’m also learning Farsi.  I have a patient who speaks Farsi (her English isn’t the best) so I’ve been having her teach me things each time she comes in so that I can communicate with her better and so that if another Farsi speaking patient comes in, I can communicate with them! So far I can….count to 10 (working on 11-20), say right and left, say ankles, knees, hips and back, say hello, goodbye, good job, say ___ more times, say ____ seconds or ____ times and put a lot of it together to say ____ times with the right/left leg or ____ second with the right/left leg.  What’s really great about it is that I’m getting to learn something from a patient while they are learning something from me!  And the patient really appreciates the effort I’m making!

Anyway, that’s the news for now! 🙂

Who the Heck Am I?!

Wow, 2 posts in one week for me.  I’m impressed 🙂

As I wrote in my previous post, this week started off a little rough.  It did get better, though.  I had moved over to sit with the other therapists so I felt more included.  I was seeing patients for their second or third visits (and some of them had gotten A LOT better!). It went pretty well.

The problem I’m currently having right now is figuring out who I am as a physical therapist.  What do I believe in?  What do I stand for? What is my preferred way of practicing? I’m still figuring that all out and it’s a little scary.

I had had 3 clinical rotations in outpatient ortho before going to per diem at a clinic and then taking the full-time position where I’m at now.  All of these experiences have been super helpful, but they are also confusing the heck out of me.  Some therapists did STM…others were very much opposed to it.  None of the therapists on my rotations used ice and stim but my per diem position did and now they are telling me I should do that with my patients where I’m currently at.  One clinic had 1 patient every 45 minutes with no overlapping (it was the best!!!).  Everywhere else has been 1 patient every 30 with overlapping (and my per diem was switching to 1 every 20 min!!…glad I got out!). I get why  it comes down to that but I absolutely hate that set-up, especially since I know what it’s like to have complete 1 on 1 time with patients.  I can’t help but feel completely stressed out about making sure everyone is happy and feeling cared for.  And I don’t feel like I can really make sure they are doing things appropriately.  But there’s nothing I can do about that.  Ultimately, the goal is to find a clinic where patients are seen 1 on 1 without overlapping but, for now, I need to get experience under my belt.

I’m also struggling with what types of exercises I like for my patients.  In this day and age, we have access to sooo much information. It’s great but it’s overwhelming.  There are so many therapists posting their opinions on exercises and techniques that it’s really had to figure out which is the best.  Obviously, if there’s research to support it, it makes that decision making process easier, but sometimes there isn’t any research.  So what do you do?! How do you figure out the best course of action for your patients?  I’m not going to lie, there have been quite a few days where I’ve felt like hiding the content from all the PT Facebook pages and just saying “screw it…I’m just going to do things my way”.  In a way, that’s actually probably what is best but then I freak out about missing something that my patients could really benefit from.

So I’m obviously floundering around at the moment.  I know I’m eventually going to find my way and I know I’m going to come out of this a great therapist.  I care too much about my patients to give them anything less than what they deserve.  I just have to figure out myself out along the way.