Don't Measure Your Self-Worth Against Your Patient’s Outcomes
Estimated Reading Time: 4 minutes
By nature, we as physical therapists (PT) are focused on outcomes. We tend to be a group of achievers who have spent the better part of 10 years constantly trying to be the best in school.
We strive to make the highest grades in undergrad to get into physical therapy school, then we must make consistently good grades to graduate, so it's not hard to imagine how this environment fosters a group of people who weigh our self-worth on what we see as our "grade."
In physical therapy school, we focus significantly on outcome measures. Insurance companies want them, research studies require them, and it's an objective way to show progress. This can seem a lot like a grade in the professional world.
Not to mention, we also grade ourselves based on our patient's views of their success. Did they think they were better? Did they think what they paid for was worth it?
Most therapists who have been in practice for a few years can probably tell you the first significant failure they had as a therapist. They could also probably tell you about several patients they currently have who they feel they aren't having success with. If you asked those same therapists who the first person they made better was, they probably wouldn't be able to tell you.
We all tend to remember the bad much more vividly than we do the good. We remember the 1 complaint and forget the 10 compliments that came before it. A good therapist cares so deeply about getting their patient better, that they may at times take it personally when their patients aren't improving. When you pour so much of yourself into treatment, you can't help but feel this way.
Our profession requires deep thinking and empathy to do our job well, so how do we turn this off? How do we as professionals not let ourselves be overridden by the people we couldn't help? Instead of losing sleep over the lack of progress of our patients, we should strive to keep a positive attitude and look at the situation objectively, not emotionally. But how do we do that?
First, we need to consider our treatment plan.
Every visit should be an ongoing assessment. Is the patient responding to the treatment as you predicted? Two patients with the same demographics and diagnoses may need totally different treatment plans. Often, when progress is not being made there is 1 small component that we've missed.
Remember, even though it may seem tedious to test multiple joints, upper-motor neuron signs, and use multiple special tests, this makes it less likely to miss something. Look at each patient with a discerning eye at every visit. Let every exercise be an evaluation. You may notice something in their movement pattern that will key you in to an impairment you did not realize was there.
The next thing to ask yourself when you feel like you've hit a wall is are you using the tools at your disposal.
These tools aren't always physical things that you have in the clinic. The tools also may be other clinicians around you. Sometimes a fresh set of eyes can see something we've missed. Another therapist may have had an experience with a patient that would shine a light on your patient. Also, remember that sometimes a patient may just not connect with certain personality types.
As competitive as we all are, it can be hard to admit that we may not be the best person to see a particular patient. They may respond better to a different person, simply because of who they are. It is never a negative reflection on you. Each of us have different strengths, and those strengths help us to make connections with people and affect the way the patient buys into what we are giving them.
Buy in is incredibly important to the patient.
It does not matter what you do for them, if they don't believe what you are doing will help them, it won't. It is important to set clear expectations with the patient early on to let them know what they can expect from treatment. If they have factors that may make the course of their treatment different than the average, tell them. In your initial evaluation, give the patient an idea of what the treatments will be like, and most importantly, why. The average person may not understand why we would be doing hip strengthening for an ankle sprain. To them, the treatment may seem misplaced and they can easily become discouraged.
If the patient's attitude about therapy is positive, it is more likely your results will be too.
Lastly, there is one resounding truth that we all have to accept: physical therapy cannot help everyone in every circumstance. If it could, there would be no other treatments.
I can specifically remember the first time someone told me this. I was in my first year of practice and a patient was taken away from me by their physician and sent to their in-house therapist. I was devastated. I felt like I had failed my patient, failed my employer, and in that one moment, felt all of my confidence slip away.
A senior therapist pulled me aside and let me in on this truth. We have to remember that there are circumstances out of our control. We can do everything right, we can try every tool and resource at our disposal, and the patient simply may not respond. There are a variety of things to keep in mind that research tells us can negatively affect treatment. What is the time between onset of symptoms and beginning therapy? Is there secondary gain at play? Are there lifestyle factors negatively impacting treatment? Is the patient compliant with their program? Is the impairment we are treating simply beyond what therapy can help? Any of these factors can affect your treatment, regardless of what wonderful treatment you provide.
In life, not just in therapy, we must keep our focus on our successes and use our failures to learn and grow. Every patient who we feel we have failed carries a lesson. Taking those lessons and using them as opportunities are what make an excellent therapist.
Michelle Jones Landry, PT, DPT, is currently practicing at Melanie Massey Physical Therapy in West Monroe, Louisiana. You can find Michelle on Facebook or Instagram at: @michellelandry12.