You are sitting in a room with some colleagues or friends, having a nice relaxing discussion about work, or politics, or college football. Before you know it, some innocuous disagreement in principle or practice has evolved into a knock-down, drag-out heated debate. The room's net blood pressure rises. What happens from there is, more often than not, highly unproductive.
As long as we all have opinions, we will always run the risk of disagreement. If you live on planet earth and interact with others, you will at some time or another be faced with a similar scenario. However, moments like these can provide us with a great opportunity for learning and growth. They can provide us with the potential for open dialogue and depth of understanding.
If you can check your ego at the door.
When we find ourselves knee-deep in disagreement, how can we turn it into an opportunity for discussion and dialogue instead of diatribe and derision?
The 83rd Texas legislature is now in session, and with it comes the latest effort to improve patient access to physical therapy.
As it stands right now in the state of Texas, patients cannot receive treatment by a physical therapist without a referral from a physician, dentist, chiropractor, podiatrist, physician assistant, or advanced nurse practitioner. Contrary to popular belief, this is not an insurance issue - this is the law. Physical therapists are one of the few (if not only) health care providers in the state of Texas that require a referral for treatment. Texas patients can see a chiropractor, massage therapist, acupuncturist, rolfer, and even a personal trainer without a referral, yet cannot do the same with a physical therapist.
How does that affect patients? It serves as an arbitrary, unnecessary and costly access barrier - plain and simple. The current restrictions are not based on evidence; however, they increase wait times and cost to patients.
It is time to remove arbitrary barriers for patient access. This would be accomplished this session with HB 1039 and SB 402.
Two concepts that are often thought to exist in separate training worlds are endurance and power. Traditional coaching philosophy would have you train them in vastly different ways.
The typical example is the difference between marathoners and sprinters. This leads to a common debate - can a sprinter become a marathoner? Or vice versa?
Are endurance and power really as different as we might think?
Endurance and power have a common thread. What brings them together in real life? Mitochondria.
The world of sport is filled with more assumptions than we care to consider. And we all know that when you build a house on the quicksand of faulty assumptions, the second and third stories topple over pretty easily.
So it goes with "performance-enhancing" drugs. The Lance Armstrong saga has reminded us yet again that the culture of sports continues to need to believe - deeply - that high level athletic performances require doping. Our sporting culture assumes that human performance is at a crossroads, that stellar world-record performances require something illicit.
But with that said, I would suggest that it is the belief systems in sports - not the drugs - that are the bane of our athletic existence.
What defines clinical excellence? In his book "Outliers", Malcolm Gladwell writes about the "10,000 Hour Rule". Based on his research and observations, he claims that the key to success in any field is a matter of attaining 10,000 hours of practice.
After four days of interacting with many physical therapists, physical therapist assistants, educators, and students in San Diego, it became readily apparent to me that Malcolm Gladwell was describing clinical excellence in the physical therapy profession. Very well, as a matter of fact.
Clinical excellence is not a degree program. It is time in the clinic - assessing, treating, observing.
So what does 10,000 hours look like in physical therapy? And why should the physical therapy profession care?
The past week had me out in San Diego for the American Physical Therapy Association's Combined Sections Meeting (CSM). It looked like a pretty good conference program, and hey, you can't beat the weather in San Diego, right?
As it turns out, San Diego was overcast the majority of the time I was there. When it was all said and done, I really can't say that I was that impressed with the programming. More on that later.
But there was a huge redeeming feature to those days in San Diego. It turned out to be a "meeting of the minds" of sorts - brought to us by social media.
During my 25 years of clinical practice, I have seen my share of patients tagged with the "complex" label. Many of the patients that I see in the clinic come to me after having failed other treatments. Colleagues will refer patients for case review or for second opinion. I truly enjoy the process of problem solving and being the clinician charged with the task of finding the essence of the patient's problem.
Sometimes, complex patients are truly complex. They may have co-morbidities or confounding variables. It may be a challenge to sift through their history. They may present with confusing signs and symptoms.
But more often than not, complex patients aren't so complex. They are complex in our minds as we become victims of our own poor clinical reasoning processes.
Up to 60% of runners will sustain an injury within any given year. Poor running mechanics, in conjunction with poor, ineffective and outdated training methods, can pose a significant injury risk. "RunSmart" was written to address these issues in the running community.
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the third edition and fourth editions of "Clinical Orthopaedic Rehabilitation: A Team Approach" by Charles Giangarra, MD and Robert C. Manske, PT.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.
Top 5 finalist in three categories: "Best Overall Blog", "Best PT Blog" and "Best Advocacy Blog".
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