Oil painting depicting Claude Bernard, the father of modern physiology. (Image Courtesy of Iconographic Collections Keywords: Léon-Augustin Lhermitte; Vivisection; Physiology)
To my student followers struggling with fundamental science coursework: Remember that you are entering a healthcare profession and potentially earning a doctoral degree. A thorough understanding of the fundamental sciences, especially physiology, is necessary for anyone awarded a doctoral degree in the health sciences. This is true for the doctor of medicine degree and it is true for the doctor of physical therapy degree. The performance of our various biological systems dictates physical function and movement. Additionally, a thorough understanding of these systems will allow you to understand the basis for the symptoms and functional limitations present in many of the patient populations physical therapists work within the clinic. Lastly, understanding physiological systems allow physical therapists to prescribe exercise and other interventions appropriately for a patient. So while some of the information learned may seem irrelevant and overly detailed, there is a good reason for it. You may be surprised how many things we do as therapists traces back to a thorough understanding of physiology and other fundamental sciences.
Physiology specifically is also probably the area where most physical therapy students and practicing physical therapists struggle. (I’ve taught both for a few years now.) It’s harder to study/practice and appreciate physiology because you can’t actually “see” many of the things you’re studying, unlike in other areas of the curriculum. But when you start practicing and treating patients with conditions, you’re going to really appreciate the amount of time you spent studying physiology. This is especially true if you work in settings outside of outpatient orthopedics, although physiological principles are very relevant there as well.
As an aside, I’ll also add that a thorough knowledge of physiology will also help with discerning whether and which, continuing education and post-professional training are worth pursuing. There are many approaches to care within our profession which make claims that violate basic concepts of physiology and other accepted sciences. These courses and narratives have perpetuated and promulgated likely in large part due to a lack of understanding (or forgetting) of central tenets from human physiology.
Long story short remembering physiology helps improve your bogus detector. This is important both for you as a clinician and for your patient, who will also be exposed to many of these bogus narratives. So embrace this challenge, like all others in life. You’re going to do fine. No student is ever accepted into any clinical program if the faculty didn’t think they would be successful. And you’re going to be better for having gone through it, like all others challenges in life!
This view might not be too popular among some but it is something that I think is worth mentioning.
I wish more people in our profession dedicated their efforts to creating content that targets the public or is public facing. As someone who oversees some of the largest groups for physical therapists (PTs) (here
) it never ceases to disappointment me by how often PTs create new accounts which basically just repackage previously created content or ideas and then share them to other PTs.
While it is important that we discuss and share information among ourselves as PTs, how many accounts do we need that share the same information and content with dissemination strategies that are really limited just to PT groups? Come on man, at least be original or at least share content beyond the confines of the same PT groups! The real battle is educating and motivating the public (and other professions) to address the many problems facing our healthcare system upstream. It is not creating another for-profit or self-serving PT mentoring group etc.
This is not to lambaste people for creating such groups, accounts or content. Instead it is a call to action to use your creative efforts to take on a larger and more pressing challenge. It also might be to your benefit, the most successful pages and personalities in our profession are those that are more public facing (KStarr
, Prehab Guys
and Rehab Science
just to name a few). From a business and marketing standpoint (in most instances) it is better if your content reaches or is more relatable to a broader audience. Think about it, there are only about ~250K PTs in the USA, while there are 325 million people in the USA (and 3.9 billion internet users worldwide). There is a rather smaller carrying capacity for marketing or sharing content just to other PTs.
To quote the Physiological Society who in 2017 made a similar call to action to scientists:
“In an era of ‘alternative facts’, it is our responsibility that the true (scientifically-evidenced) message is made public rather than allowing rampant myths to be propagated and not challenged by those with access to the wider public, who are, in the end, our target audience. We are in a privileged position whereby a lot of our research can and does have direct application pipelines and as such should reach the end-user directly from us.”
In summary, not only is this more public facing or direct to consumer approach beneficial for improving the status of our profession and potentially your own finances, it will help our patients by offering a discerning voice to the overwhelming amount of nonsense that exists. A light in a world of darkness. A compass in a chaotic healthcare system!
To all of my friends and family read below.
HB 4643 has passed out of committee and will go to the House! This is the closest IL has every been to Direct Access for Physical Therapy Services. Please call the IL reps, even if you aren’t in Illinois. The more states that have direct access, the larger chance the states that do not will move toward it.
The Illinois Chiropractic Society has stated they are against PTs having direct access, mainly since this would put us on a fair playing field. We can pretty much guarantee every Chiro in Illinois will be on the phone to their reps, so lets do the same. All the info you should need is below.
We received great news today as our DIRECT ACCESS BILL PASSED OUT OF COMMITTEE. Now our DIRECT ACCESS bill heads to the House floor and we need your help NOW!
Below is a template letter that we would like you to forward to your House Representative in support of House Bill 4643. The full House will be voting on House Bill 4643 on Thursday or Friday.
I am writing to ask you to vote YES on HB 4643 as amended, which would provide direct access to physical therapists for Illinois residents. This is a practice which is already occurring in 44 states, several of which are not restricted in any way.
The amendments, in summary, provide that a physical therapist may provide services to a patient without a referral from a health care professional for 10 visits or 15 business days whichever occurs first. The bill also ensures that the physical therapist notifies the patient’s treating health care professional within 5 days, ensuring that all health care professionals in the continuum of care are informed of the patient’s treatment plan.
In addition, we have reached an agreement with the dentists and the chiropractors that addressed concerns relating to the treatment of temporomandibular joint disorders and length of care.
This important legislation will provide better and faster access to physical therapy for all populations, including Medicare patients, and will help in the fight against opioid abuse in Illinois, as physical therapy is a non-prescription, non- addictive way to reduce pain.
We appreciate all stakeholders work on this bill as well as the work of legislative staff to bring HB 4643 without any objections from any stakeholders.
Please email, call and fax your legislator TODAY. You can find your Representative’s name and contact information, by entering your address at: https://www.illinoispolicy.org/maps/illinois-house/
It is important that every legislator hear our message from many constituents.
The legislation gives the public Direct Access to physical therapists in Illinois. You can access HB 4643, House Amendment 001, 002, 003 at www.ilga.gov. Click on “full text” to read amendment. A new definition labeled 1.2. Physical Therapy Services, allows direct access. There are a few protections for the public and they are reasonable.
There was a discussion recently in a Facebook group regarding frustrations with difficult patient encounters and advice on how to best manage these cases. Here below, I have provided a brief list of advice imparted onto me by mentors of mine. Hopefully this helps…..
One of the best pieces of advice a professor of mine gave me was “that you cannot control how people act, you can only control how you react”. This simple quote or credo is so incredibly true and is a great approach to life in general. People can be irrational and their actions frustrating, both of which may become magnified surrounding episodes of poor health.
Another thing to consider, which is a message I’ve adapted from an icon of mine Cael Sanderson, is that every challenge that you face is an opportunity for growth and that we should look forward to challenges; they make us better. Difficult patient encounters are opportunities to learn how to manage difficult patient encounters and it will get easier. It’s also always important to consider that the people we serve could choose elsewhere. They don’t have to be in our clinics. Even in public or federal systems, the patient can still choose to not show up. Take it as a privilege that YOU get to SERVE them and even though they may state that they don’t want to be there, they still decided to show up. Also realize, (and I’ve learned this working with many disadvantaged populations) for many people, even getting to the clinic may be more difficult than you may ever realize.
Regarding verbose patients; there are many people who come to our clinics who have never had the opportunity to speak to a healthcare provider about their problems. Some may not have the opportunity to share their frustrations with anyone who cares or has concern for them. This issue of social isolation and loneliness is a real and growing problem in our modern society. Therefore, consider it a privilege that they are comfortable enough to be verbose with you. Just taking time to listen to them can go a long way. In terms of managing verbosity, because there are time constraints to clinical practice, what I have found to be useful is to try to steer their conversation around the goals for the session or intercede with questions that may help redirect it. Always try to acknowledge what the patient has said before talking, this helps convey that you did listen to them (you really should be), which is important for building trust and rapport. This process can be difficult but it gets easier over time as well.
Regarding patients who are difficult to convince or establish buy-in for your plan of care, especially those who may believe in more liberal interpretations of physiology, be persistent and steadfast but always be respectful and considerate. Remember that few people possess the specific knowledge of human physiology to determine a falsehood from truth as it pertains to disease and 88% of US population is insufficiently healthcare literate. Given these factors, and others it is incredibly difficult to change someone’s views once they have internalized information; ie “You can’t sell meat to vegans and you can’t convince a carnivore to eat vegetables”. If their views interfere with your best judgment as a provider, consider referring them elsewhere; it’s probably best for both. We as a profession and field (healthcare) need to do a better job addressing this process of translating knowledge to our communities both at the clinic level and institutional level. But it all starts with a conversation and re-framing expectations with each individual. At the fundamental level, a clinician is an educator and motivator.
These are just some recommendations and tips. I don’t practice as much now but can recall how difficult it can be in the clinic and realize that things are rarely ideal and we all have our limits. However, if you consider some of these basic principles and perspectives, it helps make difficult situations a bit less stressful when they do occur.