Dr. Rehab
Los Angeles, CA
Female, 31
I'm a practicing PT with a Doctorate for the past 4 years now. Although it may not seem like a long time, I have gained extensive knowledge and experience in various PT settings. I've worked anywhere from outpatient therapy, home health, aquatic therapy, inpatient rehab, and private clients. I now also instruct on an online prep course for graduates seeking to pass their National Board Examination. PT is a very rewarding job, but can also SUCK, which explains my quest to find the ideal situation
Hmmm, I'm not sure if I'd consider PT a lucrative industry. It's no secret that I think insurance companies are making things difficult for our profession, so our salaries reflect that struggle. PT is also a pretty physical job where getting burned out early is not uncommon. In my earlier post regarding PT emerging as one of the best paying jobs of the future, I think it would be more appropriate if it was about job security. While in school, there seemed to be a general consensus that we weren't doing this job 'for the money', as they say. My student loans from getting my Doctorate were also astronomical. So I guess from my viewpoint, it's not quite lucrative. But I'm sure there are others out there who would disagree. Therefore, I do think most people go into PT because they're passionate about it. Most say they chose PT so they don't have to have a desk job in a cubicle, like being physically active, like working with people, and genuinely want to make a difference in other people's lives. It can, at times, get physically tiring and repetitive. But if you have a passion for PT, it'll all be worth it in the end!
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I'm not going to lie. When a patient doesn't show their commitment to their rehab, it's tough to stay motivated and positive myself. It can be very easy to get in a rut and start thinking, "well if they don't care, why should I?" But this is really the time to just suck it up and help that patient no matter what. If a patient shows they are trying, then I will try 100x harder to make sure they get the best care possible. But I definitely come across those that truly don't care or get the point of what we are doing. Again, it's a struggle that many therapists face and those frustrations are just part of the job. It's hard to please everyone and we can't fix everything or everyone. At the end of the day, if I can say I did my best, then I did my job well and be proud of it.
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Yes, with any patient we must discharge them when they've reached their max rehab potential, achieved their attainable functional goals, or if they plateau. It gets a bit tricky when the don't make progress because they don't follow the prescribed regimen or do their HEP. In this case, it would be best to have open and honest communication about the importance of following the treatment plan. As I mentioned before, half of PT is patient education and teaching them how to take care of their own health and wellness. It's also important for the PT to try and understand why the patient is not following the prescribed regimen, and if modifications need to be made so they will be more successful. Earlier, I griped about the direction Insurance billing and reimbursement is going. They will most likely run out of benefits before anything else. Of course, you can then become a cash paying patient and are free to come as often you like. This happens often for those who like to come in for maintenance, which insurance does not cover. There are a select few who have the holy grail of unlimited benefits. If this is the case and they don't continue to show measurable improvements, I will have a discussion with them about a discharge to a HEP. I make it a point that I'm not abandoning them as they can contact me at any time with questions or concerns. They can always come back to therapy if a flare up occurs or a new injury happens. It is a bit like breaking up since we often develop close relationships through all the time spent together. But as long as you remain honest and open, people often are ok with this. Nothing that a pint of Haagen Daz can't fix.
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This is one area that I don't have a ton of experience in. Where I'm located, most veterans go to the veterans hospital for their treatment. I initially had an interest in working with amputees and being a part of helping them learn to walk again. I haven't quite had the chance to check out that part of PT yet. I would think that most veterans have tons of motivation to improve with strong work ethics and determination. However, there is the psychological aspect (i.e. PTSD) that I'm not particularly experienced in that I'd imagine would cause some difficulties. But it sounds like a challenging and interesting scene to pursue next.
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The short answer is No. However, I've been told stories of patient's given a certain prognosis by their Physician and beating all odds. It seems a much more common story with spinal cord injury patients or those with progressive disorders like Multiple Sclerosis or Parkinson's Disease. From my experience, I've only had those select few patients who I initially thought wouldn't achieve a higher functional level than they actually did. And this largely had to do with their attitude about their injury, their motivation and level of commitment. I've had some who had initially didn't seem to care much about their rehab, but turned things around dramatically by the end of our time together. I'd like to think it was all because of my PT skills and awesome personality, but credit should always be given to the one actually taking part in improving their physical health. As I've mentioned before in previous posts, the mind is a powerful thing and the human will is undeniable. Even a little hope can change things around for the better and that is what I try to encourage with all of my patients.
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The saying, "your mind is a powerful thing" wasn't created out of thin air. I most definitely see a HUGE difference in someone's rehab potential based on their attitude. You also have to consider other factors when dealing with those that have poor or negative attitudes. They may be depressed, having a rough time at work, or anything else that can cause lack of motivation or enthusiasm for their treatment. As a result, they tend not to be 100% committed to their rehab program and will not see the same benefits as someone with a positive outlook. I was inspired by this year's first double amputee Olympic runner, Oscar Pistorius. I would often see quotes or sayings such as 'your only disability in life is a bad attitude' or 'you can't live a positive life with a negative mind' when stories about him came on tv. His life and journey to the olympics was probably a huge motivator for anyone who was on the road to recovery from an injury, surgery, etc. It also reminded me of a time when I met a patient with Parkinsons Disease. He mentioned he had been diagnosed for over 15 years but was doing very well. I asked what his secret was, and he replied, "I'm always happy".
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Sorry for the late response, I totally forgot to answer this! Typically a day is filled like this: see patients every 30min, document their progress, more paperwork, on the phone with insurance provider. The bulk of the day is patient care and documentation. The phone calls and other paperwork is interspersed throughout the day. A patient usually stays for about 1 hour. At the clinic I worked at, I would see the patient for 30 min, and then hand them off to an aide for the rest of the time while I worked with the next patient. If it was the patient's first visit (evaluation day), then I'm with them for the entire hour. So you are really on your feet and staying active pretty much all day long. I'm rarely sitting as I tend to document while with the patient. But I will still try to steal a few minutes to finish up documenting their visit once they leave. In the end, it can be pretty tiring and I can understand how some people get burnt out doing this day in and day out.
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