As paranoid thoughts
begin to fill barren grocery shelves, it is safe to say that 2020 has been off
to a rough start. Sports seasons canceled, universities shutting down,
countries closing their borders. But the ultimate stinger, in my opinion, was
the death of Kobe Bryant. The coronavirus has spread like wildfire, quite
literally. It has been a combination of unfortunate timing and lack of preparation.
At the onset of COVID-19 in the United States, many people had spring break
trips planned and refused to abandon them even when the severity of the
pandemic started to break news. Many universities began to cancel study abroad
trips at this time, but nothing was done at the federal or state level to
restrict travel and large gatherings. A recent video went viral showing college
students refusing to cancel their trip to the beach in response to COVID-19,
citing reasons such as “just trying to have a good time” and “whatever happens,
happens”. These outliers are what I like to call “COVID-iots”. Statistically
speaking, we are the age group that is least affected by this. But the majority
of us do not sympathize with them. We are not the problem, we are the solution.
Now more than ever, there’s an astronomical need for healthcare professionals.
Millennials are now just entering the workforce. That means we are the next
generation of healthcare workers. From my PT class alone, I see 61 other
individuals who are more motivated than ever to offer their contribution to the
world. We all joke with each other about this grueling situation that we are
facing together but when it comes down to it, we all handle it with the utmost
seriousness. All of us are being vigilant about social distancing in an effort
to flatten the curve, for the sake of our patients, our friends and our loved
I see light at the end
of this tunnel. This extended period of social distancing can get boring, but
also hosts the potential for individuals to pick up some healthy habits. As we
shift into spring, take advantage on the rare occasions that the Pittsburgh sun
uncovers underneath its infinite clouds. Vitamin D is essential if we want to
stay sane. Personally, I have been trying to stay active by running or biking alone
outside, catching up on much needed sleep, and taking care of myself (I’ve
discovered a newfound passion for flossing). Use this free time for self care.
Put your mask on first before helping others. Facetime with loved ones who you
cannot visit. After all, social distancing does not equal solitary confinement.
Partake in some social media challenges, make tik toks. No one will judge based
on your screen time.
Never in my lifetime did
I expect to experience a pandemic. Hospitals are ground zero. Antarctica is now
arguably the safest place in the world. Nearly every aspect of our lives has
been altered because of a stupid microorganism. But I know all of these
protocols are implemented for the greater good. As citizens of the world, we
have a duty to our neighbors to be responsible in the coming weeks in who we
interact with. Healthcare workers, thank you for your bravery. Sacrificing your
health for the benefit of others is the ultimate display of altruism.
In conclusion, stay away
from others. Wash your hands. Cover your mouth. Stop buying all that toilet
paper. Don’t be a COVID-iot. Thanks for attending my TED talk.
P.S.: Please stop
calling it the “Chinese virus”. Viruses do not have an ethnicity.
P.S.S.: With spring
comes seasonal allergies. Do not be alarmed just because someone sneezes.
Where Research Can Make an Impact in Patient Care – A Case Study
As we continue reviewing journal
articles and learning about research methods through our Evidence Based
Practice curriculum, I am sure plenty of my fellow students are left wondering,
“What current research is being done, what are the implications, and is any of
it more interesting than comparing the effect of receiving physical therapy vs.
not?” I have been a research assistant in the Ferguson Laboratory through the
department of Orthopedic Surgery for just over a year now and would like to
share my insights from the Head and Neck Cancer project I have been working on.
Over at the Otolaryngology clinic in
the Eye and Ear Institute, every Thursday there is a survivorship clinic during
which head and neck cancer survivors are seen for their annual visits (including
physical therapy, swallowing, and dental screens) and can participate in
research studies if they so choose. One of those being the project I am working
on, which is a study that aims to understand the relationship between Neck
Disability Index, patient reported scores related to beliefs about pain and
pain recovery (FABQ and TSK), and objective measurements of function (ROM
scores). At the end of the day we are observing and understanding neck function
in this population, however, when these patients are seen by the physical
therapist there are plenty more things to consider. Shoulder function is
observed and tested (scored via PENN-ASES/DASH) as well as eating and swallowing
(EAT-10); deconditioning, lymphedema, trismus, and radiation fibrosis are all
Cancer is a disease that affects the whole person, and frankly its quite silly that the NDI is the driving score to determine whether a patient needs physical therapy or not. As well, it does not make sense to use it as a measure of recovery since in my experience I have seen both very good and very bad ROM for a range of NDI scores from low to high. Ultimately, this is a very complex patient population with many factors that affect decision making, however, we as students and practicing physical therapists can do more to advance the profession through research. Some of my lessons and observations thus far: quality of life is as good a score as any other to understand patient outcomes, we can look at specific NDI items instead of using the survey in its whole, as well the NDI could just not be specific enough to capture the problem for this population, and that some patients tolerate losses of ROM in certain directions better than others.
One of the aspects of physical therapy school that I was most excited about was the clinical education experience. While the didactic curriculum is pertinent and provides a working framework, the clinical experience is where we get to implement what we are learning in class and practice honing the skills that we will be using for the rest of our career. One of the unique assets of the University of Pittsburgh’s Doctor of Physical Therapy Program, and one of the factors that helped me decide to attend the program, is that “the curriculum is designed to emphasize early and intensive integration of [our] students into the clinical environment throughout their educational program.” Unlike most programs, the University of Pittsburgh gets us in the clinic part-time starting in our second semester of the program after just a quick summer term covering three basic science classes and a week of preparatory “Boot Camp.”
The first day of my first clinical
experience was a whirlwind. My CI was the only therapist at the site and was
running between patients, trying to keep up with documentation while also
attempting to orient me to the clinic. Everything was new and intimidating,
especially because I had no previous experience as a rehab aide. I figured I
would spend most of that first day shadowing and observing my CI, trying to get
a feel for how the clinic is run and what a typical treatment session would
look like. However, as the weeks went on, I found myself struggling to find
ways to integrate myself into the clinical experience. The inevitable
consequence of early integration into a clinical setting led me to be plagued
by thoughts such “I don’t know enough,” “I am incompetent,” “I don’t want to make
a mistake,” and “I don’t want to be a burden.” I felt lost and was constantly
looking for ways to be helpful despite what I felt was a lack of knowledge and
adequacy. As we began covering more material in our classes, it became a bit
easier to try and incorporate information from class into the clinical setting,
but I still struggled to find the balance between wanting to practice my skills
and not wanting to make a mistake or get in my CI’s way.
Another aspect of clinical practice
that our classes did not prepare us for was working with patients who presented
with actual deficits and impairments; this is something that just could not be
simulated in our lab time during class. There is no predicting who will walk
through the doors of the clinic and what they will bring to the table. Trying
to figure out how to interact and connect with the patients and do what is best
for them given their presentation, symptoms, and therapeutic tolerance also
proved to be a great challenge initially. I quickly realized that I had a lot
of patient management skills to develop, such as learning how to communicate
with patients in terms that they could understand and ensuring their safety
while performing their exercises.
Now that I am in my second clinical
rotation, the feelings of uncertainty and helplessness have diminished. While
there are still moments when I feel as though I lack the appropriate knowledge
and skillset to be of any help, I remind myself that I am, after all, a first-year
student, and that the expertise will come with experience, practice, and
I would like to leave the future first year students with a
few pieces of advice for when they go out into their first clinical rotation.
First, do not feel as though you are a burden. You are in the clinic to learn,
grow, and hone your skills, so take control and maximize on the learning
opportunity you have been given. Second, do not be afraid to make mistakes. Making
mistakes is part of the process; just be sure to take the opportunity to
reflect on them and use them as a learning experience. Third, do not
underestimate the importance of building rapport and trust with patients. Even
if you are unable to practice any physical skills with them or are not sure how
to engage yourself with their treatment given their unfamiliar or complex
condition, something as little as taking the time to get to know the patient is
an important aspect of providing quality care. In addition, there is so much
that a patient can teach you about what it is like living with their condition
and how it impacts their day-to-day life; the opportunity to converse with
patients about their experiences is eye-opening and a privilege that not every
career affords. Lastly, be patient with yourself! Never forget that every
expert was once a beginner. Fighting feelings of incompetence is not uncommon
and representing one of the best programs in the country can feel overwhelming
at times, but trust that with a little bit of hard work and practice, you too
will become a competent clinician.
On the first day of neuromuscular PT 3, we watched a video where Selma Blair told her story of being diagnosed with multiple sclerosis. She mentioned how she was having symptoms of MS for months – weakness, falls, pain. She brought this up to her physicians, even asking for MRIs to be taken, but time after time they dismissed her claims. At one of her appointments, Selma unfortunately fell in front of her physician, and this is what it took for them to take her complaints seriously
Sadly, this is a story that many women know all too well, even me. Physicians often struggle to judge the seriousness of a woman’s pain, which can lead to fatal consequences. A study in The New England Journal of Medicine found that women are seven times more likely than men to be misdiagnosed and discharged from the emergency room while having a heart attack. Everyone is taught that left-sided chest and arm pain could mean a heart attack, however, women’s symptoms can differ vastly. Some women can experience an increase in fatigue, neck and jaw pain, and shortness of breath when having a heart attack. Many people do not immediately pick up on these female heart attack symptoms because our studies of medicine have predominately been based around male physiology. Research has recently become more diverse, including subjects of all races and genders, but for the majority of the past century that has not been the case.
Chronic pain is another area where the current U.S.
medical system is failing women. 70% of people with chronic pain are women. Musculoskeletal
pathologies such as fibromyalgia and complex regional pain syndromes are often
seen as “made up” diagnoses, likely because the people suffering from them are
mostly women. Stereotypes surrounding chronic pain diagnoses often lead to
women experiencing pain more often and longer than men. Physical therapists can
directly intervene here by listening to and advocating for our patients with
Women are not the only group who experiences disparities in pain management. According to the National Institute of Health, PCP’s are more likely to underestimate pain intensity in African American patients. African Americans are also less likely to receive pain medication than white people. The NIH reports that opioids are more often prescribed to those in a higher socioeconomic status, although low income patients are more likely to report having pain. Reasoning behind these statistics can be due to access to care (geographically and financially) as well as implicit biases.
To progress ourselves as a profession, physical
therapists must be aware of our own implicit biases and educate ourselves on
how to eliminate them. We need to listen to our patients and take their
complaints seriously. One of the books on my reading wish list is Doing
Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed,
Misdiagnosed, and Sick by Maya Dusenbery. In this novel, Dusenbery talks to
physicians, researchers, and women to provide an account of what it’s like to
seek medical help as a woman. From the brief excerpt I read, I believe that
this book would be a valuable read to every student and practitioner in the
health professions. Women deserve to have their pain seen as a priority. I hope
someday we will get to the point where we don’t have another Selma Blair story.
and Inclusion, which are the real grounds for creativity, must remain at the
center of what we do” – Marco Bizzarri
For this Monday Memo, I was inspired by Dr.
Gregory Hicks, Chair of the University of Delaware Physical Therapy Department. On October 15th, 2019, Dr. Hicks
visited the University of Pittsburgh to give the 2019 Endowed Scully Lecture
entitled “Who Do We Want to Be? Responsible Stewardship of our
Profession”. Dr. Hicks spoke of the
diversity of the Physical Therapy profession… or should I begin by noting, a current
and persistent lack-thereof diversity in both practicing physical therapists
and the present student body. To premise,
I am writing this as a Caucasian Female, the most prevalent statistic according
to the APTA member demographics profile.
To some readers, this may be viewed as a “taboo” subject but increasing
the diversity of the PT student body and workforce plays an integral role in
the future direction of our profession, and our patient outcomes alike. The intention of this Memo is to educate
about the underlying issues regarding a lack of diversity and pose suggestions
for what we, as students, can do!
First, we’ll begin with some statistics. According to the WebPT Industry Survey of
2019, 79.4% of PTs are White, 4% are Hispanic or Latino, 2.2% are Black or
African American, 5.7% are Asian, 0.7% are American Indian or Native Alaskan,
0.4% are Native Hawaiian or Pacific Islander, 1.6% are “Other”, and the
remaining 6% preferred not to report their race or ethnicity. From this statistic alone, it is clear to see
that there is an apparent lack of diversity across the Physical Therapy
profession. Based off of APTA Membership
in 2015, only 15.5% of members reported being of a minority race or ethnicity,
whereas at that time, the US population of minority races and ethnicities was
33%. Regarding diversity in PT academics,
the disparities are also clear. According
to the American Counsel of Academic Physical Therapy, the following populations
are currently underrepresented in PT programs as compared to the US population:
Hispanic/Latino, African American/Black, American Indian/Alaskan Native, and
Hawaiian/Pacific Islander. From this
information, it is clear to see that there is an apparent lack of diversity in
both the current PT workforce, and within the student-body.
So, why is
diversifying the profession so important?
According to Cohen et al, it is argued that achieving greater diversity
will lead to a more culturally competent workforce, improve access to
high-quality care for the medically underserved/underrepresented, increase the
scope and depth of the United States’ health-related research agenda, and diversify
the population of medically trained executives and policymakers taking on leadership
positions in the health care system in future years. One frequently cited consequence of
inadequate minority representation within the healthcare professions is reduced
utilization of preventative care and increased utilization of emergency
services. Increasing utilization of
preventative services is particularly important for our profession, as upwards
of 90% of patients with musculoskeletal injuries choose NOT to seek formal care
from a physical therapist. It is important to note that it is widely accepted
that health care outcomes are improved, especially for minority patients, when
the healthcare providers and staff in a hospital or clinic resemble the patient
populations they seek to serve. To add to this, in 2013, Yeowell conducted a
qualitative research study investigating physical therapists’ perceptions,
views, and experiences of ethnic diversity in relation to the profession. Yeowell,
too, argues that it is important for the workforce to reflect the patient
population it serves, so they are better equipped to understand and respond to individual
patient’s needs. This is NOT to say that
a therapist with a differing background from a patient is incompetent and
unable to treat them effectively. According
to Dave Kietrys, PT, PhD, “We live in a
diverse world, and our clients and patients come from diverse communities. We should be mirroring that. We also should
be welcoming people from all backgrounds into our profession. The greater our
diversity, the deeper and richer our understanding will be of the needs of a
varied population. We’ll naturally be more sensitive to underrepresented
communities—what they’re going through and how they might have been
marginalized, stigmatized, or treated with bias.”
There are many speculations to why a lack-of
diversity is persistent in the field of PT, such as the astronomical cost of
higher education, implicit biases of interviewers/directors, lack-of exposure
to the Physical Therapy profession, and several other potential reasons. As a physical therapy student, it may seem like
we do not have control over this aspect of our future profession at this point
in our careers. Luckily, the APTA does have some suggestions of what can be
done to aid this pertinent issue while we are still students!
to our chapter delegates! Discussing these pertinent issues while we are still
students gives us an opportunity to become “responsible for the stewardship” of
our future profession!
to faculty and staff in the program that you are attending. Determine if there are any programs/policies
that are currently enacted, or work diligently to establish a program to
support future students. For example, at
the University of Delaware, there is a mentorship program in place for minority
undergraduate students interested in the field of Physical Therapy. Qualifying students have the opportunity to
take classes alongside of PT students, meet with advisors directly in the
program, and receive access to study resources.
This assures that these students are receiving support to function
academically at their highest potential and remain solid, competitive
candidates for Physical Therapy school programs nation-wide.
Educate children in
underrepresented minority, gender, and socioeconomic groups about what physical
therapy is and how they can be part of our profession. A program that was enacted
once within Pitt Physical Therapy with this goal in mind was referred to as the
“Homestead Community Sports Medicine Exposure”.
Pitt PT students met with athletes from the Homestead area of Pittsburgh
and showed them various exercises, as well as educated them about the field of physical
therapy! These are the fun, rewarding
experiences that students will remember when they are choosing a career
path. This shows that having physical therapy
exposure is not limited to patients walking into your clinic alone. Exposure to the profession
was identified as a more influential factor in career choice among minority
students compared to white non-Hispanic students. However, Caucasian students
are five times more likely to have had direct (being a patient) or indirect (family
member/friend being a PT or being seen by a PT) personal experience with a
physical therapist than their minority counterparts.
am hopeful that, as time progresses, diversity in the field of Physical Therapy
will increase. The future of our
profession, student-body, and patients are counting on us to do so.
A special Thank You to Dr. Gregory Hicks for bringing this pertinent information to the University of Pittsburgh.