If I Had a Career Rewind

Recently I have been peeking at the DPT student facebook page and it brought back some memories of my early days in the profession.  Some memories I look back fondly on and others I cringe thinking about and want to grab the old me by the neck and shake some sense into him.  Looking back there are some key things I wish I had known or did differently.

Be okay with being a novice

I had a period after graduation where I felt PT school had prepared me to be a rockstar clinician.  I had a great education but no education can compare to the education our patients give us in clinic.  I practiced in a stage of unconscious incompetence for a while back then and definitely had my successes along with my share of taking credit for natural history and regression to the mean.  Of course I also had my failures (and still do).  PT school prepares you to be a safe clinician and not much more.  Just doing this is a monumental task that we need to be thankful to our educators for their work.  Becoming a great clinician is a skill that is developed with each patient encounter where you apply a framework of thinking, communicating, and reasoning that gives you an ability to determine if you are affecting change or not.

Learn how to think

Clinical reasoning is another skill that is very difficult to learn from a text book.   I remain convinced that each student should be required to read, “Thinking, Fast and Slow” by Daniel Kahneman to learn how humans are prone to error in thinking and it permeates everything we do in clinic and in life for that matter.  Being aware of cognitive bias and errors we are prone to make is important to help learn and grow in the clinical world.  Learn about metacognition and begin to think about your thinking.  The clinic is not black and white and you will need to have the ability to think and reason your way through the gray.  A great reasoning framework can allow you to take any technique regardless of what camp it came from and validate it within the N=1 patient encounter you have in front of you.

Be a critical consumer of research

Evidence-based practice has been a great movement in the PT world as it moved us away from strict reliance on dogmatic guru-driven practice patterns.  We do though need to realize there simply will never be enough research to perfectly explain all of the clinical phenomena we see daily. We all need to be aware of clinical and personal equipoise and the effects these factors have on research.  If anyone has a vested interest or belief in an intervention then we need to be skeptical of their research results.  Lastly be able to recognize strengths and weaknesses of research and never take the conclusions in an abstract at face value.

Stop getting excited about short-term changes

It is great to get short-term changes but it is meaningless unless you are able to train and maintain the change.  Read this post if you want to hear my thoughts on that.  Needles can do this, manips can do this, mobs can do this, relaxation can do this, meditation can do this, or anything that can trick the nervous system has the ability to do this.  Any new shiny tool has the capability of producing short-term changes as well so do not get seduced by treatments full of woo.

Understand pain science

It simply is not optional unless you treat patients who do not see you for pain.  If we truly have our patient’s best interests in mind we need to have a modern understanding of pain.  Pain science does not give you an out to not perform a great physical examination and consider the tissues. We cannot become too brain-bound and forget the peripheral nervous system that is constantly sampling the internal and external environment.  It is not a tissue OR pain issue.  It is both to varying degrees.

Stop guru worship and tribe mentality

Let’s not hate the gurus here but we also must realize they are not perfect and just because the guru PT says it is so does not mean it is the truth.  Being able to take on the information of a guru and critically analyze and apply it is key.  Do not camp out anywhere.  Visit various camps, learn from those in each camp, and then seek the next learning opportunity.  You only limit yourself and your ability to help patients when you camp out in one way of looking at your patients.

Stay humble

Any clinician who tells me they get amazing results with all their patients is lying.  Even the best fail.  Louw, Flynn, Gifford, Paris, Grimsby, and (insert big name here) have all failed and will still have failures.  They are human beings and are not perfect.  They are humbled by patients just like we are.  We should never be making it about us.  Without our patients we do not exist.  Make it about them and shelf your ego.  It never was about you and it never should be.

What would you do differently if you had a rewind?

Mark Kargela

Mark has been practicing physical therapy since 2003. He spent the his career pursuing expertise in manual therapy treatments. When he recognized that manual therapy had limited success in chronic pain he began intense study of pain neuroscience and advanced training. He practices in Glendale, Arizona where he is a Clinical Assistant Professor and runs Midwestern University's Physical Therapy Institute. He also teaches nationally for Modern Pain Care and lectures across the country on spine care and persistent pain.