Transitions

It has been over a year since I have been able to tend to this blog and I am finally able to get back into it! things have been taking off for me like crazy. Little recap for you all:

• got married in a small, steampunk ceremony
• got appointed Clinical Liaison of the Balance and Falls SIG for AGPT
• became Eastern Regional Coordinator for the State Advocate program for AGPT 
• was elected secretary for the Gerontological Society of America's Emerging Scholars and Professionals Organization 
• presented at APTA Combined Sections Meeting in New Orleans, Louisiana 
• became a GeriEDGE task force member
• got tired of a 3-4 hours round trip commute (hooray Chicago traffic) 
• transitioned from inpatient rehabilitation to the home health setting 
• now work for 2 online continuing education groups  

All good things really, but a lot of change and a lot of time consuming projects!

Now, onto business! I am stepping back in to work focus on this blog and we have some great content coming out in the next few months! We will be talking about the pros and cons of social media use as health care providers, the importance of self-care, and weather or not to change your last name when you get married (which is a pain for those that are already licensed!). Its going to be a fun ride for the rest of the year and we look forward to causing quite a stir along the way!

Intimidation Shaming: How It Can Ruin Professional and Mentoring Opportunities

Intimidating. This word has a negative connotation in our language, and rightly so, because it's definition is "to scare someone into doing what one wants." Its Latin root, intimidare, literally translates as "to frighten." However, I am surprised how many people use this description, this action, this negative connotation improperly.

Recently this one word has kept popping up in my life and I can no longer ignore it. I have heard it before and I am sure I will continue to hear it throughout my life. Intimidating. I have not only been called intimidating, but I have also been told that I am not easily intimidated by others. I honestly started hearing this word so often in so many different contexts that I decided to do some investigatory work and figure out what the buzz is about this word! Here goes:

To intimidate is an action. In the present tense. However, being in the present tense means that the person who is performing the action is actively doing something to scare you into performing a task or action. 

On the converse...

Being intimidated by someone is entirely different. I once had a professor in undergrad who everyone feared. She was a short Icelandic woman who took nonsense from no one and worked hard every day of her life to get to where she wanted to be. Was she intense? Yes! Was she intimidating? No! She offered extra office hours to review test questions and tough materials. She went out of her way to allow me to contract my capstone through the Honors Program, which meant I had to develop a research question, which took hours out of her week to mentor me and supervise me through it. She pushed me hard and didn't take no as an answer, but she never intimidated me into anything. However, my classmates didn't feel the same way. Because of her no-nonsense attitude, my classmates feared her. 

Courtesy of  Pinterest

But, herein lies the difference. My professor never did anything malicious to anyone to get them to do anything. She wanted us to succeed, but she never attempted to scare us into anything we didn't want to do. It wasn't that she was intimidating (active), but instead people were intimidated by her (passive). These are two very different events and by accepting this fact, we have the opportunity to not only affect our thinking, but also our interactions with others. I call this "Intimidation Shaming." It's when you project your inadequate feelings to make other seem more menacing instead of owning up to your own short comings. 

Now, I know that some people might argue that the intent of the interaction is obsolete, but there are several philosophers that would disagree with you greatly. Intent is everything, and in the absence of malicious intent, the word "intimidating" is what is truly obsolete in this instance. 

I invite you to ask yourself these questions the next time you come across someone who is "intimidating": Is this person actively doing something to making be feel inferior? What proof do I have? Is this a perception that I have on them based on my reception of our interactions grounded in malice? Why do I think this person is intimidating? 

Instead of pulling out and playing the victim card, try to investigate the situation a little more clearly. Take ownership of the situation. How do you feel about this person so that you are perceiving them this way? Did they do something to you or did they do something you didn't like? Are you envious of them in a way that would make you resent them? Are they pushing you too hard to perform? 

If you find that a person is intimidating you because they are highly successful, doesn't it make more sense to seek those individuals out to mentor you so you can learn from their success rather than demonizing it? How much stronger could we be as a field if we stop fearing and start pining for answers to these questions? 

By asking yourself these questions, you might learn something new about yourself that you can carry into future interactions with friends, co-workers, or even mentors. Last but not least, a mantra for you to repeat in your head if you ever find yourself at the center of this intimidation shaming: "If I was truly intimidating you, you would know." 

Connect the Ages!

In November 2016, I had the unique opportunity to participate in a media campaign as part of Connect the Ages, a grassroots organization dedicated to connecting young people to careers in aging. Connect the Ages was founded by Amanda Cavaleri, who has dedicated her life to fighting isolation among older adults, vowing to connect generations, thus forming lasting bonds which help to enrich the lives of both older adults and their younger counter parts.

She has launched her first video of a series which highlights not only the rewards of careers related to the aging population, but also the benefits that these can provide to society as a whole. By getting students invested in our rapidly aging population at the earliest of ages, we can create a world in which stereotypes, disproportionate healthcare services, and social isolation cease to exist.

You can find Amanda's Tedx Talk here. It is quite inspiring to hear her ideas on how to combat ageist views within a "youth-obsessed" society.

More videos to come! Get involved, get together, and connect the ages! 

LinkedIn: https://www.linkedin.com/company-beta/11066579 

Facebook: https://www.facebook.com/CONNECTTHEAGES/  

Instagram: https://www.instagram.com/connecttheages/  

Twitter: https://twitter.com/connecttheages  

Website: https://www.connecttheages.com/ 

Ethical Discussion: Public Displays of Medical Conditions and Your Responsibility in Addressing Them

I was at a Hibachi Grill with my fiancé's family when I noticed something different. It wasn't enough for anyone else to notice, it seemed, just enough to peak my interest. As many of you know who have been to these establishments, the chefs cook on a hot grill in front of your dinner party and commonly interact with the dinner-goers. They squirt water or sake in your mouth, have you catch hot food off of the spatula, etc, etc. But in this instance, a man across the room at a different table wasn't interacting quite like everyone else. While everyone at his table was laughing and interacting with the chef, this man was stoic without reaction. He blinked quite sparsely. He didn't react with any sort of emotion, nor reacted with the members of his party. His chewing was mechanical in nature with food spilling out occasionally. He neither looked engaged nor particularly disengaged, he just simply was existing at the dinner table, quite possibly without any knowledge of his surroundings.

Then it happened. The chef began challenging people at the table to catch remnants of the food he had cooked out of the air with a toss from his tools. Everyone was laughing an enjoying himself and then it came time for the man to participate in this feat. First toss. He didn't react. Everyone laughed and jeered. Second toss. He didn't even blink this time. His party continued to tease him. Third toss hit him square between the eyes. No reaction. The man continued to chew and spill his food. And the chef moved on. At the end of the meal as they filed out, the man demonstrate difficulty initiating movement from sitting to standing, was unable to don his coat without help, and shuffled out of the restaurant with his family, festinating at the beginning of his attempt to leave.

This was quite possibly one of the most cringe worthy-experiences I have experienced in a social context. This man obviously had something wrong with him. Without objective measures, my highest suspicion was possible Parkinson's Disease. This event made me ponder. What is our responsibility in this matter? Do we educate? Do we intervene? Do we engage at all?

Now, I would hope that if this man's family was aware of his condition, they wouldn't have laughed and jeered in the manner that they did at his inability to catch the food from the air. I'd like to think that they would have either educated the chef, asked him to stop, or maybe even avoided the situation all together. But maybe not. Maybe they were aware of his diagnosis and were determined to live a normal life, despite the symptoms and the stigma. Maybe this was a discussion that hasn't occurred yet, and without a consent to treat provided by the patient (and I consider education a treatment), I am outside of my legal boundaries to act otherwise.

With the opportunity that the intervening physical therapist could be hailed as a hero, that same person has as equal an opportunity to be hailed a villain.

There was a recent article floating around on the DPT student Facebook page about a PT who was on a flight and was able to identify and treat a case of BPPV in a flight attendant on the flight. She was hailed as a hero, but she had a very unique set of circumstance in this situation. First, a medical doctor was present on her flight and was able to assist the PT in clearing the patient of any cardiovascular or neurological conditions. This gives her extra credibility in the eyes of the public who aren't familiar with the services that direct access PT can provide. Second, this PT has extensive training in management of balance and vestibular disorders and was comfortable intervening. Without this training, injury could result to the patient, thus making a bad relationship worse. Third, the individual who was experiencing the condition was able to be educated on her care, and provided a verbal consent to the treatment provided.

Image courtesy of:
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This was a near perfect situation and leads to little discussion on the pros and cons. However, if even one of these components is less than perfect, it's a recipe for a hefty lawsuit where even the best intentions can get you into trouble. If you are intervening to inform a patient that they might have Parkinson's, you are breaking several rules. First of all, that person never consented to your treatment, and education is an intervention. Second of all, as a PT, while we can screen for conditions such as Parkinson's Disease, CVA, and other impairments, we technically don't diagnose them. This makes your actions an automatic violation of scope of practice, demonizing our field as overzealous and giving the AMA more fuel to use against us in our campaign for full and unrequited direct access. Lastly, while Good Samaritan laws exist in many states, these truly are reserved for emergent situations. And even then, you need to ask the individual if they desire your assistance, and if the answer is no, your hands are tied at that moment. Good Samaritan laws vary from state to state, and people are still able to sue around them.

This is an important issue to discuss, revisit, and continue to digest in our field. As our field shifts, our role in the eye of the public will as well. When people ask for an individual with medical training to assist in an emergency, not even their 6th choice is that of a physical therapist, despite our extensive training in school. My fiancé is also a DPT and didn't even realize the situation until I pointed it out to him. I attribute this to our differences in training. I work in inpatient rehabilitation and am used to identifying medical emergencies and symptoms of diseases that might be developing in people who are already medically delicate. He works in the outpatient manual therapy setting and isn't as attune to treating every change and behavior as a potential crisis. This is similar to an endocrinologist treating patient for a heart attack. They don't have the skills necessarily and neither will we at times.

Our experiences lead to our actions and will continue to build the public's opinion about us, so let us work towards building a positive interaction by being mindful of our actions and the perceptions that others have of us.

Head First: What I Learned from Jumping In as a New Grad DPT

When I was a student in PT school, I wasn't comfortable jumping in first. I was never the student to volunteer first. I never wanted to be the "patient" in the class demonstration. I never wanted to answer questions that the teacher posed first. Since I have graduated, many of these things have changed, but some have not.

I am still a shy person. By no means have I transitioned from being an introvert to an extrovert. I still enjoy my quiet nights at home to recharge. I like reading by myself. Large crowds of people continue to make me nervous. But my harnessing my ability to control my anxiety in those uncomfortable situations, and learning to take control in those uncomfortable moments for me, I have been able to grow and expand into several realms of the PT world that I never thought I could access before. In my short 8 months as a licensed physical therapist (and 3 years of immersing myself in PT culture as an SPT), I have had many experiences that I previously didn't think that I was capable of.

Below is a list of ideas to help you get more involved in our physical therapy profession based on the successes that I have had thus far.

1. Join a section with the APTA. I have been a member of the geriatrics, neurology, and research sections of the APTA since becoming a student member at the start of my DPT schooling. It has connected me to professionals within the fields that I am interested in, and has also lead to opportunities to serve and volunteer within those groups. Being a student section member also allows you to explore that realm of physical therapy, assisting you in researching not only the opportunities in that field, but also the general vibe and feel of the group. Neuro feels much different from geriatrics, which are both entirely different than research. I was an ortho section member for a year during my orthopedic semester for PT school to get access to the resources, but decided I wasn't interested and did not re-join the following year. 
2. Volunteer for committees. Many of the connections I have made have been through experiences I have had on committees as a student and now young professional. Many of the sections have committees or SIGs (special interest groups) that you can sign up for/serve on, even as a student or new graduate. Most groups really like having the fresh perspective. It is also an opportunity of you to work had and impress people within the field who you otherwise might not have met. Through working on the Academy of Neurologic Physical Therapy awards committee, I have been able to meet several individuals who have very unique experiences and opinions outside of my own, which has allowed me to grow as a newbie. 
3. Join groups outside of the APTA. One of the connections that I gained, which has helped to solidify my involvement in the Academy of Geriatric Physical Therapy, actually started through a different group. I currently serve as the clinical liaison for the Balance and Falls SIG of the AGPT, which is a recent development thanks to a contact that I met through volunteering with the Health Sciences Section welcome crew through the Gerontological Society of America. I met Mariana, the chair of the SIG, as I was sending out a welcome email for GSA's HS section. I noted that she was a familiar name based off of the materials I regularly receive from the AGPT and met her not at an APTA conference, but at the GSA Annual Scientific Meeting in New Orleans this past November. We connected at GSA, and she inquired if I was interested in joining the Balance and Falls SIG leadership board as the clinical liaison (as a new grad... Which is so cool) and I accepted. Having a person in my professional circle that is even more motivated than I am (she is only 4 years out and could easily be mistaken as a 10 year seasoned professional) has helped to push me and keeps me moving forward and avoiding burn out. 
   
4. Apply for it... Even if you aren't/don't think you are qualified. Sometimes you just need to lay it all out on the line. My personal example comes from the time I applied as chair of the GeriEDGE committee on research and practice. Was I qualified? No! But they sent out several emails to the AGPT members asking for applications, extending the deadline more than once, so I figured I would give it a shot. Obviously there are many people out there who are way more qualified and experienced than a new student, but I applied and got a response within a week. They explained that while they were looking for someone with more experience, they would be happy to welcome me to the group, and thus, I was in. 
5. Shake things up! As the co-chair in Illinois for the AGPT state advocate program, my first line of action was to establish a Facebook group for communications among AGPT members within our state. What seemed like a simple task resulted in a two month long discussion including a formal proposal within the AGPT board of directors. While my ingenious idea to start easy in this new role soon snowballed into a branding, licencing, and image discussion, my name is now out there among the higher-ups. 
6. It's not what you know, it's who you know. Through my involvement in the APTA and GSA, I have been able to rub elbows with many of the giants in the fields I am interested in. I am on a first name basis with Tim Kauffman. I had tea with Desmond O'Neill at a luncheon. I am also on the radar of several giants within the social media realm from my work with the Balance and Falls SIG. Being involved means staying involved, because these connections lead to not only further opportunities, but also accountability to stay involved.

So take a chance! Volunteer. Sign up. Raise your hand. You might just find a new niche and meet some cool new friends. If you are not currently a member, I recommend joining the American Physical Therapy Association. Once a member, you can join the many sections the group has to offer. Each section has special interest groups, or SIGs that can help you further focus your efforts as a physical therapist.

A Survival Guide for the Introvert for CSM: Tips for Surviving and Thriving at Large Conferences

As I have mentioned in a few previous posts, I am an introvert. My coworkers, classmates, and acquaintances might disagree, but my family and friends know that I really, truly, and passionately am an introvert at my core. I would like to share a little about how I survive large events as an introvert so that I might be able to give the tools to fellow introverts in order to not miss out on the awesome opportunities that CSM and other conferences can provide to us as physical therapists.

First, let me start by emphasizing that I think that the terms introvert and extrovert get mixed up a lot, as they are not descriptions based on how you act, but descriptions based on how you recharge and like to spend your "me time." I love nothing more than a fresh cup of coffee and a new book in a quiet space. I will always opt to stay home and watch a movie rather than going out to see one at the theater. I avoid eating out on weekend nights due to the busy surrounding tables, noise, and often long wait to be seated. I minimize my interactions with others to strictly digital mediums as I am able to on my days off in order to be ready to face another week at work, where I work with...you guessed it! People.

I am most likely getting two reactions right now from two different kinds of folks. The introverts thinking, "That is so me... How do you survive a large conference if you can't handle crowds?" and the extroverts exclaiming, "That is so not me... How do you survive a large conference if you can't handle crowds?" In this blog post, I will explore a few of the survival habits I have at conferences, such as the upcoming CSM, so that you introverts can take good care of yourself and you extroverts can take better care of the introverts you love.

So here they are: my top 6 techniques for not only surviving but thriving at conferences in order to maximize you time spent there, but also maximizing how you take care of yourself once you are there.

1. Take scheduled breaks. When you register for a conference, they usually have a sequence of events and have you sign up for sessions. When I do this, I build in purposeful breaks throughout my day, and I take them whether I think I need them or not. This keeps me moving forward and able to participate in things that I need to attend later in the day. I also consider meals to be breaks. I plan out ahead of time where I will eat so I have a game plan of what I am eating and how to get there so I feel a little more control in this crazy short time in my life. It also helps fuel my self talk such as "You can do this... Only 30 more minutes until lunch and then you can chill." 
2. Take unscheduled breaks as your body tells you that you need them. Sometimes your body may be telling you that you need your space at an inopportune time. Since conferences typically derail your normal biological clock (sleeping at weird times, eating different foods, not following your normal workout routine), the introvert in you can also be disrupted by those innate changes. When I attend a conference, I always label which sessions I MUST go to, which I WANT to go to, and which are OKAY TO MISS in the event I need to disappear.  By pre-labeling my sessions as such, I don't feel guilty when I need to find a quiet corner to think or go back to my room to take a nap, as I already pre-filtered them as a non-essential. 
3. Be unashamed of your need for space. I used to apologize for needing rest and sneaking away. I used to make up excuses for bouncing out of events early, and now I am able to be more honest with people about my actions. I have found that people react just fine when I respond to their questions with, "Large crowds wear me out so I went to take a nap to recharge." Normally they reply with a "Man I wish I took a nap! I am so tired!" You might just be the trend-setter that leads to scheduled naps among your squad at these shin-digs. I know I have instigated a couple already. 
4. Stick to your normal habits as much as possible. Like I mentioned in bullet point 2, conferences throw your normal internal clock for a complete loop. Stick to your habits as they have gotten you to this point so far. If you go to bed at 9pm, then go to bed at 9pm during the conference, regardless of what is planned at that time. If you normally have a protein shake every morning, then bring your ingredients (as travel restrictions allow) to continue that ritual. I have a friend who is an ultra-marathon runner and she will get up early to get her run in before the start of the activities to keep herself moving and firing like normal. I also only room with people who I know have the same habits as me (need for quiet, early riser, early to bed, etc) in order to ensure I can stay at my best for this event. If I can't find a comparable roommate, I eat the cost and pay for a room for myself. It is more expensive, but I am paying to be able to participate more fully in this already expensive experience. 
5. Know that by taking care of yourself, you are allowing yourself to participate more fully in the conference events. Your need to go take a nap mid-day is not a sign laziness, you are simply recharging so you are able to attend a later, more important event. I used to feel really guilty breaking away form my group to take some personal time, but now I know that doing so allows me to interact with them on a more quality level, since I am not a walking zombie as the day carries on. 
6. Hang out with someone who will look out for your introvert self. Often times, my friends and coworkers start to notice that my energy is draining before I do. As I always have an internal dialog running, I don't always notice when I become less talkative... But those around me do. The people you surround yourself with can point out to you when you need a breaks sometimes before you even realize it, and they can help you regulate yourself before you spiral towards the safety of your inner (very cozy!) turtle shell. This tip is particularly important to me. When my now-fiancée and I went to Disneyland, he was able to point out when I needed a break (usually I stopped talking for a bit and then got cranky because I was tired/hungry/whatever), and then we took a break together to just sit on a bench, drink some water, and eat a churro. It led to a more quality experience for both of us, as the whole point of the visit was to spend quality time together anyway. 

By following these "rules," I feel that I am able to participate more fully in the conference experience (or any experience resulting in a crowd-level attendance). I am able to be outgoing andsocial on a more quality level, leading to meaningful interactions. Said interactions are able to occur on my terms, thus allowing me to feel more in-control of a sometimes, and mostly, out of a control situation. I hope my fellow introverts will be able to attend CSM in a more powerful and meaningful way to continue to foster your professional growth by using these pieces of advice.

Forever an introvert,

Heidi

Why I Introduce Myself as Heidi, Doctor of Physical Therapy

A really hot topic in today's field continues to be the use of "doctor" as a descriptor for those of us that hold a DPT degree. Two clearly divided camps exist between its use or non-use within our field. While I used to be in the camp that was vehement about not using it, I slowly transitioned into using it in my introductions and have seen some unexpected results. Here, I will share my experiences as I transitioned from a non-user to a user with this simple word and how it has changed my clinical practice.

At first, I was set against calling myself "doctor" as I felt that it was too confusing for most of my patients. I didn't want to be looped in with medical doctors and cause any unneeded confusion among the general public. However, as I started my clinical practice, I began to use my DPT degree more as a "get out of jail free" card when I met a barrier to providing patient care. When I met a new prosthetist that didn't take me seriously and condescendingly called me "hun" and "sweets" throughout our time together with a patient, I corrected his tone by stating that the only endearment he was allowed was "Doctor Heidi." Our relationship improved immediately. When physicians try to talk me into documenting that certain patients are safe to use a specific assertive device (when they are not), I remind them that as a Doctor of Physical Therapy I receive ample education into the fitting and appropriateness of device prescription. The disagreement comes to an end. When a patient asks me when I am going to go back to school and get my nursing degree, I explain my schooling and degree a little more in depth. Now on this last instance, I started to notice a shift in how my patients viewed physical therapy, and this is where I started to have my transformation, too.

I decided for 2 weeks to introduce myself to every new patient as a "doctor of physical therapy" to see what the difference was in our interactions. As this was obviously not an IRB approved experiment, I have no data to back up my claims other than that of the anecdotal kind. Nevertheless, what I witnessed was incredible.

The most importance difference I witnessed was the buy-in patients had in their care. Not only were they more compliant with precautions, attending sessions (patient still have a right to refuse treatment, even in the inpatient setting with a 3 hour compliance rule), as well as adhering to the home exercise program, but they were prouder to be working with me. A few of my co-workers don't hold the same credentials and while a degree does not a clinician make, it sure made one hell of a difference to my patients.

What I most feared what that patients would confused me with their attending medical doctor (I work in an inpatient rehab setting). However, before I could give my explanation of the difference between the two, patients were already asking questions. The first one usually being how many years of college it took, followed by "similar to a medical doctor" after I explained the process. I feared my patients wouldn't know the difference between an MD and a DPT, but I underestimated them. Even though I work with older adults primarily in this setting, because they are familiar with the health care system, they already had at least the scaffolding for the framework of the difference.

Another difference was the pride that was displayed by patients as they described to their families that they were being treated by a doctor of physical therapy. Occupational therapy and speech therapy soon were discarded, even though they were just as essential in these cases to the patient's progression and return to their prior level of function.

Seeing as we are not the only field that is taking on the title of "doctor" (pharmacy, dentistry, etc), it seems that patients are becoming more familiar with the idea of the title demonstrating a level of education, not necessarily a vocation.

Attitude is everything and the more pride you can instill in your patients, the more of a positive influence you can have in their care as an adjust to your clinical skills.

Now to be perfectly transparent, there are other similar aspects about our appropriation of medical culture that I do not agree with. Namely, I see the white coat ceremony as pretty useless. As a disclaimer, I don't feel that the culture of the medical doctor is one that we should strive to completely replicate or replace, but I do feel that through careful consideration and debate, there are parts of it that are helpful is progressing our field to be come competitive in this evolving healthcare environment.