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Old 22-06-2012, 01:10 PM   #1
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Default Day Dreaming: If not this, what?

With idle time and a scotch in hand, I was thinking last night about how I recenly told my father that I am still not certain I know what I want to do when I "grow up". I thought about how I want to take flight more often than stay and fight a losing battle (ANdy, Barrett). This morning, other thoughts have been posted to board in the same vein (Patrick, Ian).

If you had the financial resources, would you do something else? If not this, what would it be? Would you seek satisfaction in your new line of employ that is similar to what you seek from your current career, or would you necessarily need to change what you want from your employment altogether?

Am I the only one who wants to think of something else, but keeps coming back to the same place where I began?

Respectfully,
Keith
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Old 22-06-2012, 01:53 PM   #2
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Keith,

The first thing that comes to mind is this: When I leave a facility (and I've left 17 in the past four years), the thing that bothers me most, really, the only thing that bothers me, is the fact that I must leave my patients in the "care" of others; others who haven't read a thing in years and haven't any real sense of what they're doing or what/who they're doing it to.

Notice I'm not concerned about any of them reading this.
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Old 22-06-2012, 02:22 PM   #3
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With idle time and a scotch in hand, I was thinking last night about how I recenly told my father that I am still not certain I know what I want to do when I "grow up". I thought about how I want to take flight more often than stay and fight a losing battle (ANdy, Barrett). This morning, other thoughts have been posted to board in the same vein (Patrick, Ian).

If you had the financial resources, would you do something else? If not this, what would it be? Would you seek satisfaction in your new line of employ that is similar to what you seek from your current career, or would you necessarily need to change what you want from your employment altogether?

Am I the only one who wants to think of something else, but keeps coming back to the same place where I began?

Respectfully,
Keith
Ohh...these are questions I have asked myself many many times over the past few years. I've some insights:

1) If not Physiotherapy what else? Pretty much all of the medical disciplines are wrought with the same silliness, uncertainty and ever changing landscapes.

2) What about a career in the financial industry? To me...too structured with virtually no room for scientific inquiry (something I find fasinating). Plus...you think we have ethical dilemma's? Imagine associating with out and out crooks on a daily basis...at least in our profession the robbery is more out of ingorance than anything else (I'm not sure that's better)

3) How about something really straight forward like a farmer, or a contractor? Again, this lacks scientific inquiry and to me would become pretty mundane after a while.

To me, the Physiotherapy profession has the ability to grow into something great. I see some of my colleagues who have opened private practices who are doing things the right way and I have hope that we will see more of this...eventually.

Admittedly I have spent most of the past 4 years trying to get up to speed and have done very little to effect real change in our profession (like Diane being instrumental in developing the Pain division here in Canada for example). However, my plan is that once I have a little more time and energy (young family seems to take most of it), and once I feel more confident in what I have learned (I'm edging closer)...I intend to become more vocal and involved. I think I'll start with the Universities here in Canada. I have nothing to lose by poking that hornet's nest.

To me...that's exciting.
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Old 22-06-2012, 03:02 PM   #4
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Retrospectively, it was clear the path that I had to take. Obvious even.
Prognosticating, I am the small white ball bouncing and rolling on the spinning ribbed wheel calling for safety in black 4.
And it feels like the wheel is tilted.
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Old 22-06-2012, 03:45 PM   #5
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Keith,
Somebody probably has to test recliner chairs and quality control Scotch for a living. You could do both jobs at once.
Kind thoughts,
Steve
ps And yes For all its frustrations what I am doing is what I want to do. And I may well see the next 23 years out and never reach the promised land. I can't help but trickle through the lyrics of Talking Heads - Once in a lifetime.
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Old 22-06-2012, 04:21 PM   #6
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Every path has two sides.
I dined last night with some shirt-tail relatives, one of whom is a business lawyer in Montana, who told me that he sticks to business law because its culture is non-confrontational, and that suits him way better than criminal law, which is all about generating a dog fight on behalf of the client who may or may not be a scuzzball but is still entitled by law and order to have an advocate. He said, I'm not interested in fighting. I like business law because mostly the two parties want to come to agreement and they simply need help finding a way to arrive to it.

I think I'm a weird version of both confrontation and confrontation avoidance. I want world peace and harmony, perfection in PT, deep pain relief and happiness for all patients for all time, all that, but it better be on my terms, and I'll fight like a dog to get that.
I ended up in human primate social grooming because I chose it, instinctively, because it "felt" right to me - I think my critter brain chose it, because I was only 16, and clearly my rational brain hadn't grown all the way in yet. It had grown in enough, however, to know what it didn't want (shift work, children), and that it wanted to go to university, but that was about it - it wanted the "new", and (at the time) exotic. And PT still is new and exotic, 40 years later!
My rational brain subsequently adapted to its lot in life, weathering a few escapades along the way, try-outs in other walks of life, but it always returned to this one. It mostly sits back and tries to just figure stuff out. This should all be enough to keep it busy until it's ready to shut itself off for good.
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Old 22-06-2012, 04:43 PM   #7
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Todd Hargrove posted this on FB. Timely.
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Old 22-06-2012, 05:39 PM   #8
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It might be different for me because I chose to do this aged 30. Having done an engineering degree and worked hard in a steelworks on a coke oven for seven years I finally thought as I watched a physio work "That guy has a great job. He helps people, they respect him, they listen to him and he drives a cool car". I got a front row seat watching the guy do his thing three times a week for 18 months as I had been crushed and sheared in an industrial accident. My employer trashed so many people it made financial sense to employ a full time PT and gym on site! Lucky me.
Whilst retraining as a PT I worked sorting mail on nights, making aluminium frames for caravan windows, climbing into tanks to suck effluent out and taking bets over the telephone. Seven years of coke ovens, casting floors and rolling mills made all that seem quite nice. And you know what sometimes the grass really is greener.
Kind thoughts,
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Old 22-06-2012, 06:00 PM   #9
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Neuroscience is lookind exciting, though I'd miss the clinical aspects.

If they ever come around to allowing MD's to do a residency in Pain Medicine, I'd jump on the med-school bandwagon for sure. I am still unsure, as starting in a profession that has very interesting, fullfilling potential (intense patient contact) but that is so rotten at its foundation is a hard pill to swallow.

I have never doubted that working with patients was the right choice and I've done just that for 5 years now.
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Old 22-06-2012, 06:40 PM   #10
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New blogpost on the interoception of empathy.
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Old 22-06-2012, 06:57 PM   #11
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I have had to come to terms with why I am earning money at all.
I finally realized that my motivation is not money, though I do appreciate what it allows me to do. I am enchanted with my human. I find that learning ways to interface with my body, to learn about this most excellent action figure that I inhabit, how it reacts, how it moves, how to help it improve, how the mind works and how all this involves me with the world outside. Being a manual therapist is just an expression of excitement, AND I get paid for it! Each time I discover something new I enjoy my world better. I learn how to translate it from experience into words and share it with other people who need help. THere is a spectrum of interest from the people I see in my office that runs from "fix me" to "holy crap, you're a genius! Can you teach me more?"
I am learning to care less and less who walks in. In the end the relationship that is growing between consciousness and my human is worth the bumps. As they say, it is all about the journey for me.
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Old 23-06-2012, 12:48 AM   #12
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If you had the financial resources, would you do something else? If not this, what would it be? Would you seek satisfaction in your new line of employ that is similar to what you seek from your current career, or would you necessarily need to change what you want from your employment altogether?
The bold part is the question I find most interesting.

What I think I'm experiencing since my 'neuroscience awakening' is the death of 2 aspects of my previous work that formed a large part of my job satisfaction. The first is the biomechanical/diagnostic puzzle. The second is the good feeling I got from solving the puzzle and "fixing" someone. I think my ego enjoyed being an operator, and I can admit that I miss the puzzle and that feeling of working out the problem and "knowing" that I "fixed" someone. (On the flipside, my ego took a good self imposed beating when I couldn't fix someone)

That ego inflating feeling, as I suspect it should be, is gone for me now for as long as I work as a physio. If I was to change careers, for the sake of chasing that feeling, I guess I'd become a fireman or rescue worker where I could problem solve and get an ego boost from helping people. But like proud suggested, I think I'd begrudge the lack of scientific thought.

I don't want to stop being a physio. I think the challenge for me is to learn to enjoy the process of not problem solving but rather interacting, and to not to judge myself too harshly by treatment outcomes.

Wimbledon starts next week. I've always liked the quote that is written above the door that leads onto centre court- but its only this year i've considered its relevance to my work as a physio. It says:
Quote:
If you can meet with Triumph and Disaster, And treat those two impostors just the same
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Old 23-06-2012, 12:51 AM   #13
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In the early 90s I wrote a column that began, "I want to mow lawns for a living."

It was in a popular weekly everybody seemed to read and I had about 20 PTs come up to me at a convention the following month who mentioned it immediately. They had all said this, and most wish they'd written it.

Believe me, it wrote itself.
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Old 23-06-2012, 01:22 AM   #14
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The bold part is the question I find most interesting.

What I think I'm experiencing since my 'neuroscience awakening' is the death of 2 aspects of my previous work that formed a large part of my job satisfaction. The first is the biomechanical/diagnostic puzzle. The second is the good feeling I got from solving the puzzle and "fixing" someone.
There are better, more intricate puzzles to solve now. Plus, you can still enjoy a good feeling from helping someone, even as you leave the locus of control with them.

Quote:
I think my ego enjoyed being an operator, and I can admit that I miss the puzzle and that feeling of working out the problem and "knowing" that I "fixed" someone. (On the flipside, my ego took a good self imposed beating when I couldn't fix someone)
All egos enjoy "operating". That's probably a definition of an ego in lots of lines of work.

Quote:
I don't want to stop being a physio. I think the challenge for me is to learn to enjoy the process of not problem solving but rather interacting, and to not to judge myself too harshly by treatment outcomes.
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Old 23-06-2012, 02:20 AM   #15
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Quote:
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Keith,

The first thing that comes to mind is this: When I leave a facility (and I've left 17 in the past four years), the thing that bothers me most, really, the only thing that bothers me, is the fact that I must leave my patients in the "care" of others; others who haven't read a thing in years and haven't any real sense of what they're doing or what/who they're doing it to.

Notice I'm not concerned about any of them reading this.
I too find the same sense of things now that I am in the home care setting, serving only as a bridge to outpatient care.

I never thought about my frustrations in the context of what simply "bothers" me...food for thought as it probably all boils down one, yet to be understood, idea.

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Keith
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Old 23-06-2012, 02:38 AM   #16
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1) If not Physiotherapy what else? Pretty much all of the medical disciplines are wrought with the same silliness, uncertainty and ever changing landscapes.
Agreed...there is nothing in the field of medicine that I find more appealing than physical therapy. Docs make more, but at too high a cost. Chiro is out. NPs make some good coin, but despite legal autonomy are often just glorified Physican Assistants; I prefer autonomy. I dislike sputum, so respiratory and speech therapies are out.

I love that I can do what I do (now) on my terms...very few people can be so fortunate.

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2) What about a career in the financial industry? To me...too structured with virtually no room for scientific inquiry (something I find fasinating). Plus...you think we have ethical dilemma's? Imagine associating with out and out crooks on a daily basis...at least in our profession the robbery is more out of ingorance than anything else (I'm not sure that's better)
I am somehow indoctrinated with this belief that what I do should have some benefit to society as a whole and should be noble in some way. Ridiculous, and something I need to get over, but it is a part of me nonetheless. There is so much wrong with the world, I cannot help to try to do something to make the world a better place besides separating my paper from plastic. Financials are out for me too.

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3) How about something really straight forward like a farmer, or a contractor? Again, this lacks scientific inquiry and to me would become pretty mundane after a while.
Again, we are like minded...although I wonder if I could do a more "mundane" job during the day if my evenings were more intellectually stimulating than they are now (parenthood is great, but examining blueberries in baby feces does not qualify as scientific inquiry). Perhaps computer programming or repair (if I owned the shop) would be nice from a problem solving perspective, but would get boring after a while (kinda like the urgent care doc that sees the same cold symptoms ALL day long).

Quote:
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To me, the Physiotherapy profession has the ability to grow into something great. I see some of my colleagues who have opened private practices who are doing things the right way and I have hope that we will see more of this...eventually.

However, my plan is that once I have a little more time and energy (young family seems to take most of it), and once I feel more confident in what I have learned (I'm edging closer)...I intend to become more vocal and involved. I think I'll start with the Universities here in Canada. I have nothing to lose by poking that hornet's nest.
I, for one, am not certain how much I care to hornet's nest...

<shame: not advancing the profession, not so noble after all>Is it wrong that as an eventual private practice owner, that I have no interest in pointing my colleagues to the path of righteousness, let alone walk along holding their hand? Is it wrong that I see my increasing understanding of pain neuroscience (and my emphasis on serving as an interactor) as the thing that might set me apart from my future competition?</shame>

Respectfully,
Keith
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Old 23-06-2012, 02:49 AM   #17
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I ended up in human primate social grooming because I chose it, instinctively, because it "felt" right to me - I think my critter brain chose it, because I was only 16, and clearly my rational brain hadn't grown all the way in yet.
Meanwhile, at 17, my critter brain hadn't thought ahead far enough: I wanted to work with kids, in schools, for 6 hours a day. It turns out that I only had a finite amount of patience for children, so I devote what little bit I have to my own children now. So working with adults created Keith 2.0, this Keith last year is Ver. 2.1...still with adults, still with the same "shell", but what how things work on the inside is completely different.

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My rational brain subsequently adapted to its lot in life, weathering a few escapades along the way, try-outs in other walks of life, but it always returned to this one. It mostly sits back and tries to just figure stuff out. This should all be enough to keep it busy until it's ready to shut itself off for good.
I too hope to busy with this line of thought for many years to come...there are just some days that I cannot help but wish that it felt more "recreational" and that my rational mind did not feel so guilty about watching a re-run of the Big Bang Theory instead of reading another chapter in another book that I have genuine interest in.

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Keith
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Old 23-06-2012, 02:54 AM   #18
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It might be different for me because I chose to do this aged 30. Having done an engineering degree and worked hard in a steelworks on a coke oven for seven years I finally thought as I watched a physio work "That guy has a great job. He helps people, they respect him, they listen to him and he drives a cool car". I got a front row seat watching the guy do his thing three times a week for 18 months as I had been crushed and sheared in an industrial accident. My employer trashed so many people it made financial sense to employ a full time PT and gym on site! Lucky me.
Whilst retraining as a PT I worked sorting mail on nights, making aluminium frames for caravan windows, climbing into tanks to suck effluent out and taking bets over the telephone. Seven years of coke ovens, casting floors and rolling mills made all that seem quite nice. And you know what sometimes the grass really is greener.
Kind thoughts,
Steve
Thanks for sharing, Steve...hope you are driving a cool car too!

I suppose that part of my initial posting was to your point: Yes I get frustrated when there are grubs are in my yard, but...the grass is watered daily, get fertilized often and is the greenest in the neighborhood. There are times though, that I still only see the grubs.

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Old 23-06-2012, 03:09 AM   #19
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I don't want to stop being a physio. I think the challenge for me is to learn to enjoy the process of not problem solving but rather interacting, and to not to judge myself too harshly by treatment outcomes.
On the flip side of the same coin, when I moved over to "ortho" after working peds for 8 years, I felt as though I was less of a PT because I had no background in Maitland, Mulligan, Paris, Greenman, etc...and I could not afford all the trips and courses to learn, and my palpation skills are historically poor as I struggle to "feel" what others "feel". To compensate, I threw all of my CEUs into movement based MDT, PRI, and had started delving into Sahrmann when I found SS.

My own "neuroscience awakening" was empowering; it killed my feeling of inadequacy related to some of my peers and their own HVTM skills. What remains though is a feeling that I am part a culture that is moving away from what I understand to have value, and the farther it moves over time, the less use it may have for me.

But a philosophy professor on the other hand...

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Old 23-06-2012, 03:10 AM   #20
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In the early 90s I wrote a column that began, "I want to mow lawns for a living."
Dog walking came to mind for me.

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Old 23-06-2012, 03:25 AM   #21
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"there are just some days that I cannot help but wish that it felt more "recreational" and that my rational mind did not feel so guilty about watching a re-run of the Big Bang Theory instead of reading another chapter in another book that I have genuine interest in."
Big Bang is great on lots of levels - I don't miss very many episodes. It's one of the only shows on TV that I don't mind watching episodes over and over again. (The brain needs comic relief and a sense of repetitive security.)
Graded exposure goes for all those book chapters too. So put aside guilt - enjoy.
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Old 23-06-2012, 09:04 AM   #22
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Neuroscience is lookind exciting, though I'd miss the clinical aspects.

If they ever come around to allowing MD's to do a residency in Pain Medicine, I'd jump on the med-school bandwagon for sure. I am still unsure, as starting in a profession that has very interesting, fullfilling potential (intense patient contact) but that is so rotten at its foundation is a hard pill to swallow.

I have never doubted that working with patients was the right choice and I've done just that for 5 years now.
Considering you're in the US, I probably have to emphasize that the role of PTs here is a lot different than it is over there (re: autonomy).
With more autonomy, I think working in PT could be a great "thing".

Though I do find myself occasionally glossing through the available courses in neuroscience. Oh well...
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Old 23-06-2012, 10:30 AM   #23
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I found Patrick's answer with reference to problem solving interesting. It resonated as I would describe myself as an inveterate problem solver. However while the puzzle around patients would, like Patrick, give me a buzz I maybe found more fascination in the bigger professional puzzle.

I continue to find that like Diane mentions above patients and their problems are a puzzle albeit in a very different way. But it is this very approach which has begun to trouble me and has led me to wonder do I best serve my patients by having such an approach whether founded in an interactor or operator mode. I continue to wonder if my patients actually want or at least expect a more passive role and to be acted upon and that my colleagues who may be less considered in their approach are actually more successful because they meet those other social needs or expectations in the pavane of treatment.


Yet like Patrick I am finding the dissonance so severe I would seriously consider a move - where to? I have no idea for now.

I realise that I have a mountain to climb in terms of knowledge and skill and what was a career in physiotherapy has threatened to become and entire lifestyle. This does not fill me with delight but rather disquiet for that gap in my knowledge troubles me as I watch another patient who does not find relief from their pain or release to a more fulfilling life and had they met someone more able at this juncture they would have had less of their time wasted. I find I am increasingly worried by the thought, in the sense that a dog "worries" sheep that I am not good at this but rather am competent. I find that dissatisfying, very.

I wonder if Patrick knows the provenance of the writing over the gates of centre court?

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Old 23-06-2012, 11:45 AM   #24
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If a PT thinks they are supposed to be the one to solve the problems people bring, well... in one way, they're right. That's exactly the role we're supposed to be filling. Solving problems is a good fit for an operator. But then you start to learn all about how the brain works, and you go whoa.. no way is what I think I'm doing, doing anything, really. Then dissonance hits. Then you disintegrate ("die").

There is this feeling of chaos and worthlessness for awhile, wondering what you're doing, feeling like a poser, wondering if you should change careers, etc. (Sometimes it's worth going out and trying a few other careers on, just to see. But something about PT will usually pull you back.)

Anyway... eventually your brain puts itself back together, re-integrates, and you realize that your thinking changed: that's all that happened; on the outside, you're still doing the same stuff, being a person that people having a problem hire to solve problems, only now you realize that the solving of patient problems comes out of the relationship, and out of the patient, and all you are is a catalyst. A catalyst is something in a chemical reaction that helps facilitate a transition or transformation, but precipitates completely out, leaves nothing of itself behind.

I can't stand being a person a system hires to solves its problems. So I have not done that for a long time, in any unconscious way. I've done it, yes, in the last three years, but on my own (very conscious) terms (hours, freedom to work how I want, etc..) And it turned out fine. And I even was paid top of the scale. Now I'm nearly relaunched. I have my own practice again, and things have really picked up this month. Haven't just paid the rent, I actually paid myself too.

It's not so bad, realizing you are mostly just a catalyst. There is more freedom to fail (and sometimes we do), but there's a lot more success, overall, because although you know the locus of control is not with you (it's explicitly with the patient where it properly belongs), there is a lot more freedom, a lot less rigidity within the encounter, less stress. Less stress makes for more chance that optimal interoceptive relationship will develop between oneself and whatever patient arrives at one's door. Optimal interoceptive relationship usually means improvements the patient can note, immediately. I don't have to be some kind of genius. The pressure is off. All I have to do is be willing to handle body parts, nervous systems embedded therein, and listen, reflect to the people embedded therein, and track them on as many levels as my own brain can manage. And, I've got to say, over time, it has improved its ability to do that, all by itself pretty much. All I had to do was be willing to let that capacity develop, figure out how to keep my operator mind entertained/engaged with something relatively innocuous/inconsequential meanwhile, so it a) wouldn't hurt anyone, and b) still could feel it had a job to "do" and not become too bored.

So, I feel that over time, the biggest problem that I was able to solve, in terms of "PT, to be,.. or not to be", was my own inner problem, and the solution was to simply "be", but deliberately, not passively; gradually let my interactor self take over more and more from the operator self, allow the operator self to "do" less and less.

It's going to be different for each person. And maybe some will feel so frustrated they'll bail and go off to learn how to fight fires or climb mountains or race horses, or whatever gives them whatever they need that they can't find in PT to keep going. But most will figure out that there is really not much else out there more worth spending one's life growing into.
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Old 23-06-2012, 01:33 PM   #25
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I realise that I have a mountain to climb in terms of knowledge and skill and what was a career in physiotherapy has threatened to become and entire lifestyle. This does not fill me with delight but rather disquiet for that gap in my knowledge troubles me as I watch another patient who does not find relief from their pain or release to a more fulfilling life and had they met someone more able at this juncture they would have had less of their time wasted. I find I am increasingly worried by the thought, in the sense that a dog "worries" sheep that I am not good at this but rather am competent. I find that dissatisfying, very.
This resonates with me...

Something that bothers me is that it seems that the more you know in most fields, the better you will necessarily be. There is usually a (practical) reward for one's efforts of academic pursuit.

The logic would be that the more courses I take and the more certifications that I have, the better I should be. Understanding what information we currently have available to us (and my limited reading of the available information), I understand that this is not how it "works". I "may" be a better therapist if I were FAAOMPT, but not necessarily so...and what would likely make me a better clinician would not be the hands on skills as much as the confidence and stories gained from such an experience. Then...if that is the case, it renders the acquisition of those skills unnecessary, but potentially fruitful for unintended reasons?

I wanted to solve the puzzle too...the patient's puzzle. My neuroscience awakening has brought me to the conclusion that the puzzle is my own.

So what do we do to get better? Practice, practice, practice...but that is a terrible answer for the patient. Does each patient then become the guinea pig as we try to mold ourselves in such a way that is optimal for therapeutic relationships? Would they be better off with a clinician with less understanding, but a more convincing hubris than I can muster?

On the flip side of that coin...isn't that the patient's expectation of the medical field? They expect to go the hospital and see an intern. They expect that a new grad is not going to have the knowledge of an elder statesman, but at what point do the expectations shift on that clinician from novice to expert? In our field, what would qualify someone as an "expert"? Is it as simple as earning more gray in my beard? Sometimes I think so...

At the end of the day, until I can convince my PT-educated wife that the brain matters and I can help my father understand that his back doesn't hurt (but rather he has a pain at his low back) I wonder how successful I am with my patients. Which actually steers me to Drowning in Shallow Water...

Earlier, Barrett made me think about what bothers me the most...perhaps the answer is my own lack of confidence. Perhaps it is knowing that I can never know enough about neuroscience. Perhaps it is wondering if that knowledge gap that ANdy references above will always be too wide for me to be confident enough to sell myself and my services to the patients for I provide care.

But dog walking...nah...who am I kidding?

Respectfully,
Keith
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Old 23-06-2012, 02:48 PM   #26
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Well, I can say that oddly, I find I enjoy Physiotherapy much more now that I'm dead (or at least on my way). I rather enjoy the mystery for whatever reason. I look forward to advances in our understanding and applying it to what I do fully recognizing that we may never come close to understanding it all. But I'm sure we know more today than we did even 10 years ago.

I enjoy being contrarian and engaging PT's who drink excessive Kool aid...they either feel the need to punch me, or they appreciate my dedication. Whatever.

Like I said, I am hopeful that science will become the "norm" in Physiotherapy, and guruism will fade away to where it should be...the toilet.

I'm hoping to be part of the flushing process, so I suppose I have a second career as...a plumber.

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Old 23-06-2012, 04:24 PM   #27
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Something I saw in a tweet by Larry Benz. About a PT leaving PT to go off to be a priest.

I guess, in one way, that could be considered the ultimate operator model.
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Old 23-06-2012, 04:29 PM   #28
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Her: What would you do different for her?
Me: I would help her understand where her pain is coming from.
Her: And where is it coming from?
Me: I understand that there is not some specific tissue “giving” her pain, but I get sickened by the fact that wherever she goes, they will be very certain that there is. Where do you think it is coming from?
Her: Well, her ligaments are loose, so her SI could be out, or the weight in her front is throwing her posture out of whack. I suppose you would just tell her it is coming from her brain, right?
Me: Why do you say it that way?
Her: Because, it seems to be your go-to answer lately.
Me: Are you arguing that I have a fundamental misunderstanding of how pain manifests itself? Is your argument that you can have pain without the brain?
Keith, you are a braver man than I to go down this path!

I find it tremendously difficult to 'sell' neuroscience to my family or close friends. I don't know what that means.
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Old 23-06-2012, 04:37 PM   #29
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What a great thread.

The ability to "go down that path" will lie in our ability to tell a story. That, according to my latest reading, has proven to be far more powerful than any other form of persuasion (read teaching) ever known.

Ironically, this is because our brain is the way it is.
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Old 23-06-2012, 04:44 PM   #30
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HI ANdy!


Quote:
I wonder if Patrick knows the provenance of the writing over the gates of centre court?
As a track coach, I've used the last four lines of Kipling's "If" in the past;

If you can fill the unforgiving minute
With sixty seconds' worth of distance run,
Yours is the Earth and everything that's in it,
And - which is more - you'll be a Man, my son!


.
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Old 23-06-2012, 04:54 PM   #31
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I find it tremendously difficult to 'sell' neuroscience to my family or close friends. I don't know what that means.
Is it the context of "authority" that we do not have among family? I hope not, but the context is important, I think.

My wife sees me grapple with the dissonance, which I think raises doubt in her as well...I can only imagine the same would hold true for my patients (which is why I keep my i-life unsearchable from my real life). My father, on the other hand, is just stuck...after all, he has had a bad disc since he was 27 and there is no convincing him otherwise (not yet, anyway).

He (my father) makes me realize that the story must be good/appropriate/on point...but he needs an "ah-ha" moment, something that would almost force him to step away from his old thoughts for only a moment to see what is possible. I suspect that Barrett's approach to education (letting the patient "feel" something without preparation and to find a story to accompany what the patient begins to perceive interoceptively*) has better rate of success than what I am capable of...but that takes some cojones and confidence that I lack...to do "nothing", when patients expect something (and they expect that something to be magical).

Hopefully, with greater understanding...

Respectfully,
Keith

*-if I am mistaken, please correct me.
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Old 23-06-2012, 05:04 PM   #32
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Keith, You're correct. A story shows up - which isn't exactly "nothing" in the usual sense. In fact it's everything to most. Maybe ineffective therapists are just really bad storytellers. Of course, many just make up stories of successs that they themselves believe to be true.

It's complicated.

In my book I said, in effect, "The patient has to somehow tell the story of their own recovery." Of course, back then I didn't actually know what I was talking about. Not consciously anyway. Perhaps that was best.

Magic plays a role for sure, but what I do is "magic-like" and not actually "magical." Think of the difference between "child-like" and "childish" and maybe you'll get what I'm driving at.
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Old 23-06-2012, 05:21 PM   #33
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Maybe ineffective therapists are just really bad storytellers. Of course, many just make up stories of successs that they themselves believe to be true.
I appreciate your careful choice of words here when characterizing a therapist as effective, or not. It removes the distinction between educated/not, right/wrong, etc.

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In my book I said, in effect, "The patient has to somehow tell the story of their own recovery."
Thank you, this more succinctly expresses what my words may not have.

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Keith, You're correct. A story shows up - which isn't exactly "nothing" in the usual sense. In fact it's everything to most...
I understand, and I hope I did not type something that implied you do "nothing" in the conventional sense, but more in the sense that you have used the term "nothing" in your writing (i.e. extremely minimal exteroceptive input, allowing for the patient to express that which is instinctive with an appreciation for the interoceptive).

Quote:
Originally Posted by Barrett Dorko View Post
...Magic plays a role for sure, but what I do is "magic-like" and not actually "magical." Think of the difference between "child-like" and "childish" and maybe you'll get what I'm driving at.
The reference to "magical" was more in relation to the patient's belief that somehow we (as manual practitioners) wield a power that can eradicate them of their pain by the touch/thrust of our hand.

I also appreciate your avoidance of using the term magical, which seems to point back to your "Re-Enchantment" essay where you said , "...there is no deception. All questions are answered, nothing hidden from view goes unexplained..."

Thanks for your responses/input.

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Old 23-06-2012, 06:27 PM   #34
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Keith, check out this (thinking of your dad and his "disc"): Seeing It Helps: Movement-related Back Pain is Reduced by Visualization of the Back During Movement. (Hat tip @PacificDPTweet)

Rig up mirrors and let your patients "fix" their own backs.
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Old 23-06-2012, 06:36 PM   #35
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Much food for thought here as usual Keith.
Yesterday a Dr at work gave me a spare ticket to go and see the Dali Lama doing a 'gig' up in Dundee!
An unexpected gift and opportunity to hear the man in person . You can watch how the chair he was sitting on was created http://www.youtube.com/watch?v=dgGjGUQIL44
Imagine having the idea and skill to carry out this work? (I can as my brother makes libraries and furniture for rich people).
When you have fairly predictable materials, with the potential for creativity the work can be highly satisfying --probably the best type of work available I would guess http://www.amazon.co.uk/The-Case-Wor.../dp/0670918741
I would assume that if the physical materials didn't react in this predicable way than the work would be more difficult and a lot more frustrating . Living biological materials don't act like wood very often and people certainly don't, so to work with people requires a different mindset perhaps.
The Dali Lamas talk was largely about the need to develop the 'heart' as well as the 'brain' - compassion and empathic communication being the essence of it . At one level modern health care needs a massive injection of this --to put the person at the heart of it all as the pendulum has swung too far towards techno medicine and eminent based hierarchies (see Bas rant!).
As to your question, I wouldn't recommend a career in any institution to my children --health/education or government.I would encourage them initially to be part of the less secure worlds - the arts/humanities/design and creative industries, where people on the whole are far more open minded and there is potential for individuality being valued not stifled -see ken robinson talk.
As far as I am concerned I am not sure if had sufficient resources I would carry on doing any form of health care work ..there are plenty of better options to keep me occupied without any concerns.
Being realistic however movement is the essence of life and physiotherapy has unrealised potential given the issues that plague modern health care settings .
I think it will always remain a fairly frustrating career path as so few people think , reflect or see other ways of understanding people other than in 'woo' terminology or the opposite spectrum of structural biomechanics.
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Old 23-06-2012, 07:01 PM   #36
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but that takes some cojones and confidence that I lack...to do "nothing", when patients expect something (and they expect that something to be magical).
Quote:
The reference to "magical" was more in relation to the patient's belief that somehow we (as manual practitioners) wield a power that can eradicate them of their pain by the touch/thrust of our hand.
I feel the same way when it comes to having the courage to do "nothing".

I think this is derived from my concern to not be one of those Therapists who "do nothing" in the sense that their treatment involves nothing more than ultrasound, heat packs and interferential. I worry that if I sit there for 30 min with my hands barely doing anything, and nothing happens, the client walk out thinking "what a waste of time that was... He's no better than the last guy I saw who just put me on stim and heat... I'm going to go find someone who actually do something for me".

Very often lately, I've used education, DNM and my own version of simple contact for 90% of a treatment session... Then at the very end, I get hesitant and finish up the session with some mobs/manips or some other treatment that I know the client will "feel".

I have this notion, from where it came I'm not sure, that when treatment is ineffective clients would prefer to feel that they've had something done to them rather than feel that they've had nothing done to them.

As long as I'm fearful of poor outcomes, I think I'm going to battle with this.
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Old 23-06-2012, 07:19 PM   #37
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Hi Patrick!

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That ego inflating feeling, as I suspect it should be, is gone for me now for as long as I work as a physio. If I was to change careers, for the sake of chasing that feeling.
I can empathize with this situation. I've been a track coach for the past thirty-seven years. I've always questioned why coaches train athletes the way they do, and I've always felt I was ahead of what many of my colleagues were doing, if for no other reason than I questioned everything that I had been doing. My biggest transformation came after attending the locomotion laboratories, first at Harvard and then at Rice. over ten years ago.

These experiences really inidcated to me that, for the first twenty-five years of my coaching career, I was basically guessing and making things up, and yet I was doing good job of that.

For a while, I had a speed and performancement enhancement business called Faster than Gravity. The money was in landing whole soccer clubs for performance training, and that went on for a while. But as I got further into the science of human locomotion, the more I took Occam's Razor to a lot of the "stuff" that I was doing that really didn't make much sense relative to what things changes mechanically as kids ran faster.

But that "stuff" was what made other folks think I really knew what I was talking about. It's not trendy to tell athletes there are basically just three things that I can do for them: get them in shape, get them stronger, and give them individualized bouts of high speed running.

So, by dumping all the toys that everyone else was using--the parachutes, the surgical tubing, the resistance sleds, high speed treadmills, the time filling but useless drills, etc. I was was actually "dumping" the business.

Whatever profits I made went to purchasing assessment and evaluation equipment, the things nobody else at the time was considering, but the things that weren't what coaches and athletes felt it was worth paying for.

The more I learned from those studying human locomotion, the more I began to consider what I now refer to as "big picture" mechancis and the training that seemed most in line with the direction the research was taking me.

But that made me a dead man as an independent speed trainer.

And this seems also to have been the plight of many of those on this site: the more they've learned about pain, the less of the "conventional/mesodermal stuff they end up doing to the point scrapping it as a flawed model, but that stuff it what "sells" employers and well as patients, and without it a PT can quickly become dead to employers and colleagues.

My "salvation" has been as a high school coach with kids I see long enough for them to buy into what I'm doing. It's far easier for me, because kids come out basically to have fun and to feel good about themselves in the process, and what I offer, and the way I offer that, allows those things to happen.

You guys don't have that luxury. People come to you to resolve their pain issues, and the "feel good" of your career is on a literal level. They want to stop physically hurting. In your situation, things like getting patients to learn self correction simply smacks of seeming to simple to be true or good or worth paying for.

Getting kids "tired" in m line of work seems to be what folks value, even though, as I always tell them, any fool can get another fool tired.

For you guys, unless a patient is massagesd, thumbed, adjusted or whatever suggests things the therapist is doing pnysically, patients assume they are simply not getting effective therapy.

And then there's what many of you probably must confront at some point. If you know from the research you've poured over and analyzed that the best course of treatment really is "simple" relative to what conventional PT's are still doing with a confidence steeped in either arrogance or complacency, how do I justify this as a career choice?

I think I come to SomaSimple every day just to see how you guys continue to deal with that. Your insights are compelling reading for someone on the outside of PT who neverthless grasps things from your perspective.
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Old 23-06-2012, 11:41 PM   #38
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Is it the context of "authority" that we do not have among family? I hope not, but the context is important, I think.
I don't know that is necessarily equates to authority vs. knowledged expert. I am historically poor at being able to help my wife with her aches and pains. My theory is that she's seen me be a dumbass more than any other person on earth. We also went through PT school together and so she knows the foundations of our education and is less inclined to categorically reject entire amounts of it. Despite this she very frequently has her friends call me when they have issues (and my wife is a PT too). So, it's not that she doubts me, categorically.

I used to have a similar trouble with helping my dad. Then a few years ago I picked up on something with him that turned out to be a genetic neurologic disorder and had he continued down the path he was on (wanted a TKA and orthopods more than willing to make the cut) it would have been catastrophic for his functional abilities. Since then, he takes me serious. Sticking with my theory, he and my mom have also seen me at my dumbass-iest in large sample sizes. But, I must have broke that mold with a perceived "moment of expertise".

In regards to choosing a profession, I would still be a PT if I hit the lottery tomorrow. I would definitely feel more inclined to do things more and more on my terms, but I thoroughly enjoy, if not the work itself, the way in which it challenges my creativity, my entrepreneurial spirit, and my sense of curiosity. Of course I wish that the path were entirely greased. But as Tom Hanks as Jimmy Dugan in "A League of Their Own" so eloquently puts it: "If it were easy everyone would do it. The hard is what makes it great." I try to keep this in mind, but I often fail.
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Old 24-06-2012, 03:10 PM   #39
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I feel the same way when it comes to having the courage to do "nothing"...

Very often lately, I've used education, DNM and my own version of simple contact for 90% of a treatment session... Then at the very end, I get hesitant and finish up the session with some mobs/manips or some other treatment that I know the client will "feel".

I have this notion, from where it came I'm not sure, that when treatment is ineffective clients would prefer to feel that they've had something done to them rather than feel that they've had nothing done to them.
I understand where you are coming from here, but it seems that such an approach is very defensible so long as it fits your explanatory model (which I am certain that it does).

I am sure this approach doesn't keep you from sleeping well at night.

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Old 24-06-2012, 03:26 PM   #40
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I understand where you are coming from here, but it seems that such an approach is very defensible so long as it fits your explanatory model (which I am certain that it does).

I am sure this approach doesn't keep you from sleeping well at night.

Respectfully,
Keith
It leaves me feeling like like I am being less than honest with clients, generally my sleep is troubled!

ANdy
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Old 24-06-2012, 03:47 PM   #41
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It leaves me feeling like like I am being less than honest with clients, generally my sleep is troubled!

ANdy
It would leave me troubled as well if I were being less than honest with my patients, but I suspect (after some conversation with Patrick in person, reading his patient handout, and reading his postings here) that he is likely providing the patient with hands-on treatment in a context where he is letting the patient know that he is simply providing the nervous system with yet another (albeit exteroceptive) novel stimulus only...no bells, no whistles, no story of a magical mesodermal correction of any kind. Perhaps I am mistaken...

It may not be necessary, but does not strike me as unjustifiable either.

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Old 24-06-2012, 04:28 PM   #42
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What a thread!
Steve, my PT career started late as well at 31 - after teaching, bookkeeping, writing correspondence and army - and maybe because of that, being dead has really provided me with a new energy and enthousiasm for this work. And quite some despair for my profession.
However, in my small world I find the daily challenges with the patients still exciting: their histories and the assessments all leading up to this.
The plan.
Tailored to that oh-so unique person in front of me. For whom I need to find just the right verbal stuff to match. The hands-on is not so different - but that other? wow.
I will be doing this as long as I keep having such an exciting time.

I could NOT do this work while working for someone else: I would not last and they would not allow me to be me.

(Unless of course, one of you guys is starting a clinic in Barrie and want to pay a moderate but steady salary....?)
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Old 24-06-2012, 05:20 PM   #43
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I have been thinking about this still through most of the weekend...what to do if not therapy?

All I can come up with is photography and dog-wallking, neither of which would pay the bills. Both would, however, afford me the time to pursue more "academic interests", but they offer little contribution to society as a whole either. I suppose that would probably acount for the low wage.

Mowing grass is out (sorry, Barrett)...I am allergic.

In the end...there are days that I am frustrated with colleagues and days that I am tired of all the bureaucracy, mandates and regulations that go with the job, but all it takes is working with one (certainly not every) patient to remind me that there is nothing else that I would rather do.

Additionally...it is on those days that I have been most frustrated and fatigued that I find perspective here. I do not know where I would be today if not for the readings and interactions on this board. I cannot express enough gratitude to Bernard and all of the active members in this community for making that possible.

Merci.

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Old 24-06-2012, 10:12 PM   #44
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It would leave me troubled as well if I were being less than honest with my patients, but I suspect (after some conversation with Patrick in person, reading his patient handout, and reading his postings here) that he is likely providing the patient with hands-on treatment in a context where he is letting the patient know that he is simply providing the nervous system with yet another (albeit exteroceptive) novel stimulus only...no bells, no whistles, no story of a magical mesodermal correction of any kind. Perhaps I am mistaken...

It may not be necessary, but does not strike me as unjustifiable either.
I would point out that my disquiet is internal and is no comment on anyone else's practice least of all Patrick's who I suspect quite strongly is a vastly superior clinician to me.


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In the end...there are days that I am frustrated with colleagues and days that I am tired of all the bureaucracy, mandates and regulations that go with the job, but all it takes is working with one (certainly not every) patient to remind me that there is nothing else that I would rather do.

Additionally...it is on those days that I have been most frustrated and fatigued that I find perspective here. I do not know where I would be today if not for the readings and interactions on this board. I cannot express enough gratitude to Bernard and all of the active members in this community for making that possible.
I would echo that sentiment, one of the few areas that encourages me that my practice can find some sort of, well redemption(?), is this board and the ppl who frequent it here. It does however amplify at times very painfully how far behind the curve I am in terms of learning, knowledge and practice. It is this as much as anything else that keeps me awake at least some of the time. I detest not being good at something and for once possibly the first time in my life I do not feel that I am good at this, to overcome this is my struggle at least for now. I do wonder if I will find myself echoing Barrett's frustration twenty years from now but with much less grace.

regards

ANdy
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Old 24-06-2012, 11:14 PM   #45
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It does however amplify at times very painfully how far behind the curve I am in terms of learning, knowledge and practice. It is this as much as anything else that keeps me awake at least some of the time. I detest not being good at something and for once possibly the first time in my life I do not feel that I am good at this, to overcome this is my struggle at least for now.
Agreed...then there is still the disconnect (at least for me) between my limited (but expanding) knowledge and that knowledge which has become actionable.

I too still have a long way to go...ignorance would be blissful if I were willfully capable of such a thing; there are times I am envious of those who sleep so well at night, read so little, and still find a way to get good results in spite of themselves.

We will may not be one of those people, but at least it is a consequence of our own volition.

Respectfully,
Keith

PS: I doubt dog-walkers are kept awake at night pondering such things.
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Old 24-06-2012, 11:34 PM   #46
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We will may not be one of those people, but at least it is a consequence of our own volition.
In such terms it rings of a moral choice, and in my book a good one (if difficult).

regards

ANdy
(swimming in deep dark waters)
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Old 25-06-2012, 12:20 AM   #47
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It is a thread like this that a really love to come to SS for.
Thanks Keith for starting it.

Ken, I know I said it before but I really wish there were more teachers like you when I was in school. All the kids you influenced over the years. Your sentiments echo the same thing I come here for.

I think if any of you that post here left the PT profession it would be a tremendous loss for the patients. If you get any joy working from them whatsoever stay with it.

ANdy, I would rather have met a PT that was honest with me and couldn't help me than 1,000 of the charlatans that couldn't be bothered to pick up a book in the last decade. You don't give yourself the credit you should.
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Old 25-06-2012, 02:51 AM   #48
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When I gave up on physiotherapy (um, retired), my very good friend, also a retired PT, said: Do you think about opening up a solo clinic, just a room, somewhere? To make full use of all you have learned in recent times? (Pain physiology, Moseley, Dorko, et al)
I did think about that, but running my own cash for practice scared me off. Economics is something I avoid - I would go broke and get thrown out in a month. I hate taking money from patients....

Like others here, it was never the patients that put me off - always colleagues with their rigidity of thought and obedience to 'whatever works and passes muster.' All fiercely operative with a real belief that the more you did to a patient, the better it would be.
The usual chatter is : There is so much I want to (physically)do with them/him/her there isn't enough time to get through it all!!!

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Old 25-06-2012, 03:29 AM   #49
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keith said:

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I am somehow indoctrinated with this belief that what I do should have some benefit to society as a whole and should be noble in some way. Ridiculous, and something I need to get over, but it is a part of me nonetheless. There is so much wrong with the world, I cannot help to try to do something to make the world a better place besides separating my paper from plastic
This is not ridiculous. If you get over this feeling then perhaps that would be the time to leave the profession. I think this is awesome and please do not get over this!

I never really understood what exactly drove me towards this profession. However, as I mature and think more about what I believe in life I've realized that being a PT fits my belief system. I can't think of a better way to earn a living than performing a job that incorporates aspects of my belief system.

Specifically, helping other humans and using science to achieve this.
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Old 25-06-2012, 01:30 PM   #50
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I am somehow indoctrinated with this belief that what I do should have some benefit to society as a whole and should be noble in some way. Ridiculous, and something I need to get over, but it is a part of me nonetheless....
This is not ridiculous. If you get over this feeling then perhaps that would be the time to leave the profession. I think this is awesome and please do not get over this!
I guess the part that is ridiculous is the indoctrination aspect, that I believe(d) that there is some moral imperative to benefit society through my employment. Would a dog-walker be any less beneficial to society than I if they live peacefully, abiding by the laws of their community and volunteered in soup kitchens during the weekdays and with the Special Olympics on the weekends? The question is rheotorical, but hopefully illustrates what I meant.

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I never really understood what exactly drove me towards this profession. However, as I mature and think more about what I believe in life I've realized that being a PT fits my belief system.
One problem for me is that I do know what drove me to P.T.: a desire to work with children, earning a decent wage, having summers off and traveling. Granted, I was 17, but I am in a different place in my life now than I was then, and I wonder...have I created values for my job (helping society, scientific inquiry, etc) to help cope with the dissonance experienced when I realize that all of the reasons that led me to be a therapist are no longer applicable, or has my move towards working with adults 52 weeks a year been a consequence and result of my evolution/maturation as person? Have I created a belief system to fit my job, or vice versa?

Regardless, I am in a position that I cannot see myself doing anything else in the near future.

Respectfully,
Keith
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