Friday, April 26, 2013

Acute Care: Preparing Students for Direct Access (Part 3)

Continued from Acute Care: Preparing Students for Direct Access (Part 2)

Case #3

While POD#2 for a total knee replacement is still just a tad early for considering a DVT/PE, NEVER rule it out. In fact, there was suspicion in 2010 regarding the Wells Criteria in that the application of the criteria was not as predictive for inpatient populations. Why? Well, they aren't as ambulatory or normally functioning as outpatient populations would comparatively be. The tell-tale-signs in this case was the elevated heart rate & elevated respiratory rate. Whenever the lungs are slacking, the heart must work harder to push more oxygenated blood around the body. Similarly, whenever the heart is slacking, the lungs must work harder to better enrich the circulatory system with hopeful oxygen to get around. This combined with the swelling in the knee and difficulty with exertion would prime the mind to suspect a cardiopulmonary factor. Interestingly enough, the subsequent Doppler demonstrated the DVT while the CT did not show PE's.

This is where I jump on my soap box regarding too much reliance on diagnostic imaging. In the end, ANY imaging analysis is only as good as three factors: (1) the technology (resolution, focus, contrast, etc); (2) the view of the image (angle, perspective, etc); and, (3) the viewer of the image itself (human error). I tell nearly all my patients who are fixated on imaging that, in the end, it is no different than photography: if I were to hide my hand behind a book, the image would tell you my hand is a book. Diagnostic imaging should help our physical examinations, not determine them. Ultimately, the patient is the rule - not the picture.

Case #4
This is one of my very favorite acute care cases (in fact, I once again came across this same set of symptoms just recently). When dealing with exertional limitations in the absence of suspicious vital signs, IMMEDIATELY back up to your basics: anatomy, physiology, fake. Now, let me first say that the bridge between the "physiology" and "fake" category are the complex links of biopsychosocial factors.

So let's work through it. Anatomy: Is there anything wrong with this patient's anatomy? Other than the hip surgery, not at all. He is as healthy as a horse with no truly interesting medical history. We could request imaging, but, imaging of what? Besides, using imaging as a knee-jerk-response to problems is bad practice (see above soap box).

Okay, so now, we must shift our thinking to consider physiological factors. What are physiological factors of exertion? Heart, lungs, neuromuscular control, musculoskeletal integrity. Was he physically weak? Did he lose control? No and no. So lets investigate the heart and lungs. First line of defense: bust out that stethoscope!

If you performed auscultation of the heart, what you would have heard was a distinct and blatant S3 heart sound - indicative of early heart failure - one of the first classic signs, in fact. To make for a sanity check, you could have had the patient perform inspiratory and expiratory holds to make sure you weren't hearing a physiological split-S2. This patient eventually was found to be in acute renal failure. The sudden exertional fatigue was heart failure kicking in after the exercise was complete which is why the delay was present, free from any type of orthostatic hypotensive event. Fortunately, the PT in this case was able to catch this event early enough that a quick round of diuretics prevented anything permanent or serious from occurring.

Case #5
The safest thing to do when dealing with dizziness, vertigo, falls, etc. is to screen out that VBI component. Now, some individuals don't have the spinal range of motion to "officially" assess the situation. Nevertheless, you can always get creative. In the end, VBI is the inability to sufficiently circulate superiorly - so - just challenge that physiology and you will unveil at least something. For this patient, VBI screening was actually doable and positive; with reproduction of symptoms and even a scary moment of slight non-responsiveness, I decided just to do a few quick tests to discern vestibular components: nothing. An MRA was performed confirming the suspicion of VBI. While the VBI screening test isn't the most reliable test in the world, it is still one of the only tools we have in this area. What should probably speak louder than the VBI screen itself is the patient's history, age, and posture.


6. Physical Therapy Re-Evaluation: Intensive Care Unit - To Move or Not To Move
My observations have served to say that there exists a definite cultural stigma in the healthcare industry surrounding the ICU - "the unit." - as if patients are so fragile that simply touching, breathing on, or looking at them would cause something to go terribly wrong. Behind the scenes of Therapydia's PT TV Episode 12,  we brought this up and universally agreed that the attitude should NOT be of "what might go wrong if the patient gets mobilized out of bed". The attitude that would better serve the patient would be "give me a reason why I shouldn't get the patient up" - and - "what might go wrong if the patient DOESN'T get mobilized out of bed."

That said, here is the case of a male in his late 60's with a long history of COPD, A-Fib, chronic kidney disease, and valvular insufficiency. This is a great time to point out to my #DPTstudents that this trifecta almost always exists in some form (whether detectable by modern medicine or not): HEART + LUNGS + KIDNEYS (much like ears/nose/throat) - when one chain in this trifecta is broken or bent, the entire chain will become affected and will weaken. This unfortunate man was admitted to the ICU for a COPD exacerbation and had very little inspiratory reserve left to fight with. The RCP placed the patient on 10 L of oxygen with an oxymizer and was very nervous about the possibility of a physical therapist causing the patient to exert and desaturate any further than he already had. He was hanging on at this supplemental flow rate in the high 80's and low 90's in percent saturation of oxygen.

So! Do you move this patient? Will you get this patient out of bed? Is the risk worth it? What if this patient desaturates into the 70's??? What would your discussion with the RCP and the RN look like?

7. Physical Therapy Evaluation: Intensive Care Unit - Ventilated Trauma Patient
A 20 year old male suffered a terrible motorcycle accident and was fortunate enough only to sustain minor rib fractures and some minor trauma to the left shoulder (no fractures) from an orthopedic standpoint. Curiously, the patient was found in respiratory distress at the scene, and as a result, ended up ventilated with a tracheotomy. When you arrive at the room, the patient is awake, alert, following commands, and purposefully moving his extremities to reposition himself in bed. However, the RN is nervous about mobilizing the patient further than a dangle - sitting at the edge of the bed.

Do you still want to move this patient? What questions do you have for the nurse and yourself before you get inside the room? What would your discussion with the RN look like?

8. Physical Therapy Evaluation: Short Stay/Observation - Acute Low Back Pain
An electrician in his late 40's presents to the emergency department with acute low back pain and inability to ambulate without excruciating pain. He receives all the usual tests and measures with an MRI displaying a greater than 5 millimeter central disc protrusion (slightly left of midline, less than 10mm). The internist is convinced this patient will need a diskectomy and consults a spine surgeon. The nurse reiterates that the patient will likely need surgery and requests that the physical therapy evaluation be held off.

What would your discussion with the RN look like? Do you still want to treat the patient? If so, what would your treatment approach look like? Is the prognosis good? bad? ugly? indeterminante?

9. Physical Therapy Evaluation: Trauma - ATV Crash
A 40 year old male was driving an ATV and suffered a crash. He was admitted with a clean fracture of the left humerus, just distal to the surgical neck. Outside of some minor rib fractures, he was given clearance by the internist and orthopedist for home return pending a physical therapy evaluation. The fracture was deemed as reducible and thus not requiring open reduction; the orthopedist had the arm splinted citing that the majority of cases involving these types of clean fractures will heal without the need for surgery.

All systems checked out within normal limits except for the fact that the patient kept complaining that his arm felt like it was in two separate pieces. He's rather frightened about returning home tomorrow morning and is seeking your advice regarding these sensations. Also, functionally, he qualifies for home return with spouse.

What do you wish to further investigate? Do you suspect the splinting has failed? Or, is this just sensory noise from the trauma and inflammation? Should you recommend this patient to be sent home?

The results of these cases and more cases to come on Part 4 of Acute Care: Preparing Students for Direct Access!

Monday, April 22, 2013

Acute Care: Preparing Students for Direct Access (Part 2)

Case #1: Vertigo... or something more?
With vertigo, what do we typically run to? All your BPPV tools, right? If you ran through all these tests, performed the head thrust, oculomotor assessments, screened out for VBI... all these tests would have given the same result: nystagmus that lasted for minutes at a time, with and without torsional components. And, sure, the patient was complaining of vertigo the entire time as well. What should catch the clinician's eye immediately was the picture I posted in Part 1: Horner's syndrome.

While we're not tapeworms and therefore have given norms for amounts of asymmetry, the clinical eye should widen a bit when a history of CVA is combined with a fall plus vertigo. Now while the patient's Horner's syndrome was not as pronounced as the picture posted, it was definitely present enough for the nurse, the wife, and myself to raise suspicion. Coordination, as would be suspected, was absolutely terrible. Strength was bilaterally strong. Stance, balance, and attempts at ambulation were nothing short of terrifying - the patient simply did not have control over his movements. Did he go home? NO WAY. In fact, I held discharge and insisted on another MRI. In the end, this patient went to the acute rehab unit for several weeks.
Diagnosis: PICA syndrome. What was neat (for me) about this case was that I called out a posterior cerebellar stroke prior to seeing any imaging. What was a bit ironic is that the repeat MRI was practically identical to the admitting MRI. In fact, later in the day (after my evaluation) when the MRI became available, I pointed out the area in question to the nurse who was then quite convinced of my assessment. Oh, yes! Most importantly, the patient even said that all this felt like a stroke - just a "different" type of stroke. Lessons: listen to your patient, always make your own calls, if it smells/feels/looks/acts like a duck - it IS!

Case #2: Acute Low Back Pain with Suspicious Hip Range of Motion
The event: Sign of the buttock. While not following the classical criteria, it should pique some curiosity when anything close to the sign of the buttock presents itself. I made the attending physician aware of the constellation of symptoms and signs that I found, expressing concerns that an x-ray was likely not thorough enough to uncover the physiological root cause of this patients range of complaints. An MRI was ordered. Most unfortunately, the radiologist reported that metastatic cancer had developed throughout the patient's pelvic and lumbar region, quickly spreading into the the thoracic spine. In fact, there were several small compression fractures that had developed due to the cancer. Direct access isn't just about improving the welfare of society by freeing up economic markets; for the healthcare provider, it also means keeping an eye out for the rare but tragic and sinister health events - hopefully, there are times when we can catch it early enough and save lives.

See below for two related publications:

Ok. Back to the cases!

3. Physical Therapy Treatment: Total Knee Replacement, Post-Op-Day #2 (POD #2)
A man in his early 70's is on POD#2 of his second knee replacement (on the contralateral side of the first). His first knee replacement was only a couple years ago and was met with sterling success. However, these past few days were met with frustrations of orthostatic hypotension, slightly more swelling at the knee than expected (but within acceptable norms), and a copious amount of pain at the surgical site which was far more threatening to the patient's consciousness than was his first knee replacement. On POD#2, PM treatment, the patient began having difficulty with exertion. In-room-ambulation was fairly easy at supervision with a walker POD#1 PM and POD#2 AM. Although blood pressure was stable, the patient's heart rate was significantly elevated; respiratory rate was also elevated with a slight decrease in oxygen saturation. The nurse and the telemetry technician noted that other than the elevated heart rate, the heart did not seem to be displaying any abnormal signals.

The orthopedic surgeon is now frustrated, concerned, and is asking you - the physical therapist - what do you think is going on. What do you tell him? (Please, don't say, "You're the doctor... you tell me!" That's an automatic FAIL if you rotate with me).

4. Physical Therapy Treatment: Total Hip Replacement, POD#3 AM
A very strong, former high-level-athlete is receiving his first total hip replacement. He is in his early 60's and has been demonstrating the most impressive physical feats post-op. However, he keeps coming across this strange "wall" of fatigue and exhaustion approximately 15 minutes after he completes gait training. His orthostatic vitals demonstrated within normal limits throughout his stay. However, he is becoming increasingly anxious regarding this sudden fatigue that washes over him while he rests in his bedside chair, after he completes his ambulation. In fact, one episode performed with nursing got so bad that the patient was forced to lay back down in bed. He expressed after the episode that he felt like he was going to pass out. When the nurses checked his vitals, there were all normal.

What do you want to check? Do you wish to order any diagnostics if you were the provider? What do you think is going on?

5. Physical Therapy Evaluation: Status-Post-Fall
A severely kyphotic and osteoporotic woman in her late 80's is admitted to the hospital's short stay observation unit due to a possible syncopal episode resulting in a fall. The physicians have ruled out any cardiac factors and are now suspecting a mechanical fall in the patient's bathroom. Per usual practice, a physical therapist was consulted to further evaluate the situation and rule out any neuromusculoskeletal contributive factors. The evaluation revealed nothing out of the ordinary - not even orthostatic hypotention.

However, when cervical range of motion was screened, the patient complained of some neck pain and a small amount of dizziness. Due to the woman's slightly impaired memory, she is unable to give you a definitive history of the fall. She did mention that in the past, she was treated by a physical therapist for vertigo.

What is your most acute concern at this point? How do you confirm this suspicion? What special test/imaging/diagnostic test would you order if you were the provider?

The results of these cases and more cases to come on Part 3 of Acute Care: Preparing Students for Direct Access!

Friday, April 19, 2013

Acute Care: Preparing Students for Direct Access (Part 1)

In Therapydia's PT TV Episode 12: Acute Care, Promoting Best Practice, there was some discussion about how to prepare students for unrestricted direct access. In this discussion, it was keenly identified that an acute care rotation is absolutely essential to garnish the exposure of medical complications, the diagnostic skill sets, and the mental toughness of high pressure second-by-second thinking in a truly unstable medical environment - all crucial parts of bringing the #DPTstudent to the next level.

For this blog post, I'd like to cover the conceptual basis for this as well as a couple case studies for which I will follow up with posts covering the results of each case.

A Pinnacle of Medical Screening and Diagnostic Training for the Student Physical Therapist:
Much of physical therapy practice is taught from the perspective of the outpatient clinician. From a didactic perspective, students tend to filter patient complaints from a far more cautious and defensive posture. Of course, this is better than being careless when it comes to medical screening. Nevertheless, when such a mind enters the environment of the acute care hospital, especially in the intensive care unit or oncology unit where lab values are almost always critical and everyone is a breath away from rapid response or code-blue,  some of those red flags become a moot point since not treating the patient will ultimately be far more detrimental than treating the patient with physical therapy interventions.

The acute care physical therapy setting allows for clinicians to observe, learn, and participate in live play-by-play diagnosis with physicians, nurse practitioners, physician's assistants, and registered nurses. Additionally, it is really only in this environment where physical therapists can have combined access to hour-by-hour lab values, day-by-day imaging changes, and second-by-second cardiopulmonary responses to exertion. I humbly suggest that it is exclusively in this amorphously intense environment that a student physical therapist is best served when it comes time to learn about acute illness, injury, trauma, and complex pathological medical conditions - in situations that can change within seconds, with patients who are very likely altered in mentation/judgement, with frightened family members scared for the lives of loved ones hanging in the balance, where a day's schedule can mean nothing, in a practice setting where politics and power structures can make or break your efficiency as a clinician and effectiveness in your own scope of practice.

For these reasons and MANY more... I highly advocate for physical therapy programs to explore making an acute care rotation a mandatory part of the didactic experience. This would only strengthen the future of the physical therapy profession and healthcare at large. Logistically, creating a new clinical education model of a 1:2, or 1:3, or even a 1:4 clinician to student ratio would permit facilities to be better enabled to attend to their own operational needs while serving education of students. This model could also allow for a controlled, graded exposure to the intensity found in acute care physical therapy practice. Students can group together to problem solve, think aloud, conduct case conferences, and ultimately perpetuate a collaborative culture of accountability and best practice.

So with that, here are some interesting cases I've recalled for your enjoyment (some of these were discussed in a #solvePT tweet chat):

1. Inpatient Vestibular Physical Therapy Evaluation and Treatment: Chief complaint - Vertigo.
A man in his mid-60's is admitted after a fall outside of a hotel while vacationing from out of town. He is sent to the emergency department to rule out a stroke. The MRI revealed negative for CVA except for some evidence of a past CVA which was known to this man's medical history. Other than the usual contributory heart disease, high blood pressure, and pre-diabetic (DM2) - there is no further evidence in the mind of the neurologist, emergency physician, and internist to keep this patient in the hospital except for a vexing case of vertigo. Despite the fact that throughout this hospitalization process, no one had yet attempted to ambulate with the patient, the attending physician had concluded that the patient was medically stable for discharge and required only that a physical therapist complete an evaluation and recommend outpatient vestibular rehab if appropriate.

Oh. His eyes looked like this example (but nobody seemed to care until I saw it & notified the nurse):

What special tests would you have done? What results would you have expected? What do you think this man's mobility looked like? Do you think this patient was discharged this same day?

2. Physical Therapy Evaluation: Acute Low Back Pain.
A woman in her 50's was admitted to the emergency department after being unable to walk effectively at home for several days. She had been displaying classic sciatic type pain with some minor hip pain which caused the ED physician to order an x-ray, just to confirm nothing orthopedically sinister was present. Due to the massive amount of pain and need for narcotics, the emergency physician requested that a hospitalist admit the patient into the short stay observation unit where a physical therapy consult would be conducted.

The physical therapy evaluation demonstrated a constellation of findings. However, one very important finding was revealed. The patient had a positive straight leg raise. However, when screening supine hip range of motion, the patient complained of pain reproduction during hip flexion (with knee flexed).

Can you name this event? What additional special tests/imaging/diagnostics would you have ordered if you were the provider? What do you expect to find?

Let me know your thoughts via Facebook, Twitter, or the comments section below! I will post the conclusions of each case in my next blog post in this series regarding #AcutePT - and - many more exciting case studies to follow! Stay tuned!

Here's the follow up post on PART 2 of Acute Care: Preparing Students for Direct Access.

Monday, April 8, 2013

5 Tenets of Excellent Patient Education

Patient education is something that is woven into the fabric of a healthcare practitioner. For the physical therapist, failing your patient is a guarantee if the education given is anything but deeply sincere, resoundingly convincing, and perfectly salient. It is under these conditions when the patient performs with "compliance"  (a term I don't quite appreciate) and attains desired outcomes.

I dedicate this post to the many hardworking #DPTstudent's that labor to master this important skill.

Here are my 5 Tenets of Excellent Patient Education:

1. Assurance
Almost every patient, regardless of setting, is emotionally unsettled with one very simple fact: they are a patient. Especially in the hospital setting, patients are in a very scary, unpredictable, and undesirable set of circumstances. The most important thing you can do is to make that emotional connection with your patient, let them know you care, assure them that "it's going to be okay", and a sense of calm to their experiential equation.

2. Validation
Perhaps a core necessity to the human condition is the need to be validated; "tell me I'm not crazy!" Especially when a person is in a strange, frightening, and disorienting situation, validation is particularly important. Whether it be pain, fear, anxiety, a sense of debility, or complete lack of situational control - validating these thoughts, emotions, and mental states is important in developing a rapport with the patient and family.

3. (Re)-Direction
Most of the time, education will include redirecting a person away from a fear-based-preconceived-notion. Other times, education simply requires for any direction to be given - period - the patient feels lost. Regardless of what is required, it is the job of the practitioner to set the tempo from the get-go. Much like force redirection in martial arts, the power of the human mind must be channeled in the right direction for good patient outcomes.

4. Explanation
Education would not be education unless the situation was thoroughly explained. On the Twitterverse, I have to give credit to Dr. Joe Brence for consistently conveying that the word "doctor" comes from the Latin verb doc─ôre which means "to teach." Being teachers of health is a core function of a healthcare practitioner. When patients fully understand and grasp their situation due to your teaching, they will also begin to trust your expertise, placing their well-being in your hands.

5. Reassurance
I feel that reassurance is the best closure for a patient education experience. Start with assurance, end with reassurance. At the end of even the best and most convincing educational discourse, patients are still in the midst of their situation. I feel that it is very important to the human experience for clinicians to wrap up  moments of patient education with the reassurance that: "We have a plan. I'll be here every step of the way. Everything is going to be okay." Ultimately, healthcare is a person serving another person; we must respect the humanity of each patient experience to be truly effective educators.

Some Closing Thoughts:
Perhaps one of the most important aspects of this topic is that an excellent patient education experience yields highly satisfied patients. To center my own practice upon this, I always try to answer the three cardinal questions that every patient has:
  • What's wrong with me?
  • What can you do about it?
  • How long will it take?
If you can answer these three questions keeping close with these 5 tenets, your patients will be thoroughly satisfied, will trust you and do just about everything you say, and, will achieve the expected results that you set forth.

Tuesday, April 2, 2013

Mickey Mouse Moment: A Follow Up

This post was inspired by my 3rd wedding anniversary for which my wife and I celebrated by going to the happiest place on earth, Disneyland! Of course, this sparked some thought as we enjoyed our time there which I naturally felt was a great follow up to my Mickey Mouse Moment posts from Kettlebell Therapy™.

Backing it up a Bit:
The main take-away's from the Mickey Mouse Moment posts were the following:
  • If physical therapy practice is to follow Disney's success, it must first claim & demonstrate service uniqueness to consumers at large.
  • Physical therapy practice must unify through development of consistent quality of services rendered; Disney is consistent no matter which park, store, or cast member you go to - it is always the same experience (with given accepted and encouraged variances of norms)
  • Physical therapists must create a physical therapy experience that creates self-marketing customer loyalty; Disney does this through nostalgia, what are we doing to make this emotional imprint?
  • Finally, physical therapists need to collectively create an iconic experience to bring all these things together; Disney did this through Mickey Mouse, hence, the Mickey Mouse Moment
A corollary combining both the Mickey Mouse Moment and the concepts from my Consumer Awareness/Access posts is best mentioned from the wisdom found in Carmine Gallo's lecture when he states  that if you cannot express what you do in 10 words or less - you've failed! For this post, my goal is to address a service aspect of Disney, and hopefully, help construct a "10 words or less" definition for physical therapists & physical therapy practice.

Back to Disney:
One of the days I was a Disneyland, I once again came across the sign at entrance to the Tomorrowland:
I think this is such a wonderful concept and statement; in 1955, Walt Disney conceived of such ideas for Disneyland and the rest of the world. I simply found it inspiring and began to ask myself, "What's my vision for tomorrow?"

I realized through visiting both Disneyworld and Disneyland all in the span of a couple months, that the Disney experience holds three attributes that any service industry should make their top priorities. As a guest of Disney, I found that I always experienced the following:

  1. Cast members actually caring about my perspective, desires, and goals.
  2. Cast members putting in the extra effort for a great guest experience.
  3. Cast members keeping the magic alive, no matter what the situation was, or how many times they've done it.
Actually Caring
People can tell, in fact, people always know the difference between sincerity and going through the motions. Sincerity cannot be trained, it can only be lived out. Now, I know that I'm speaking to the choir in regards to a passionate care for people's recovery - and - as such, I want to commend all rehab therapists and therapy staff in that people KNOW YOU CARE! This is something we must dearly hold onto; losing the passion, losing the empathy, losing the compassion, or losing the love for each patient is something that will destory us as a profession. Keep up the care!

Putting in the Extra Effort
Disney cast members are trained to put in as much extra effort as possible during service recovery opportunities. To do so, being sensitive to people's needs is a must. Making this extra effort can make even the worst office wait time seem not as bad. Something I like to do in the hospital is end my encounter with each patient (and family) with, "Is there anything else I can do for you at this time?" I don't care what it is: a blanket, water, food, getting the nurse, making the temperature of the room hotter/colder... I want every patient to know that I regard my time with them as the very most important thing which deserves the utmost efforts from my personage.

Keeping the Magic Alive
I feel that for any job, it can get easy to get lost in the reptition. However, this is something that Disney cast members don't seem to struggle with (at least not on the outside). I mean, imagine being the cast member running the queue for dark rides like Snow White or Alice in Wonderland; it is perceivable easy to sourly say the same spiel over and over again - this almost never happens! Every time, the cast member will do their very best to try to bring you into that world of Walt Disney's imagination so that your experience is truly magical. Physical therapy has a similar magic; each time a patient feels out their joint mobility and realizes it doesn't hurt anymore, each time a patient learns to walk the first time after a spinal cord injury, each time a patient realizes they are able to play with their grandchildren again - this is the magic we MUST keep alive. It's not just functional mobility, joint mobs, transfer training, neuromuscular re-education, and the like... it's about restoring people back to their livelihoods and being a support during their greatest time of need. THAT is magical!

Bonus Material: Make a WOW moment!

Enough said? I think so. Let's make THIS type of service impact on our customers!

Couple more thoughts on Disney:
Okay. It's true. I'm a huge Disney freak. I love it for personal reasons, but, I also love it for the professional success the firm continues to demonstrate - for the models they've made and areas they continue to pioneer. I feel that the Walt Disney Company is a fantastic place for us to seek business wisdom, even if all we do is study merely through observation. What I gleaned most for this experience was that the Mickey Mouse Moment must carry a meaning beyond a symbol, product, or service - it must carry an emotional content that links service with remembered satisfaction. The symbol, that Mickey Mouse Moment, should be a trigger to recall each fond memory of the physical therapy experience; so fond, in fact, that the customer cannot wait to share it with EVERYONE they talk with.

When you are truly satisfied with a restaurant experience, what do you do? Typically, you'll share about it! Whether via a Facebook post, a Tweet Pic, or a Yelp review - you will share of things you are happy with. Maybe this is the basic wisdom we need to apply in healthcare practice for REAL patient satisfication. So I ask: what are we doing to keep the magic alive? What are we doing to tap into this secret of creating self-marketing customer loyalty?

10 Words or Less:
Finally, to dovetail off of Mr. Gallo's advice, can you define physical therapy practice in one sentence, generally ten words or less? And, let me charge up the pressure a bit more - can you do this to accurately encompass ALL settings of physical therapy practice? I believe it's possible, however, I also believe this isn't a one person mission - this is something that both we as producers of our service AND the patients/clients as consumers of our service MUST DEFINE TOGETHER.

This is my latest way of defining "what I do" with the given understanding that a physical therapist is a healthcare professional (which is, at best, an assumption for much of the public - some people hear "therapist" and immediately think "psychology" or "counseling):

"I specialize in pain, mobility, and restoring ability for life."

ABSENT the working assumption that the individual I am conversing with knows that a physical therapist is a healthcare professional:

"A physical therapist is a healthcare practitioner specializing in pain, mobility, and restoring ability for life."

Am I satisfied with these definitions? Eh... for now, I guess. Why am I not satisfied? I haven't gotten a good consensus from my consumers to detect that this is indeed an accurate and favorable description of what I do. So, I'll pause for this moment to say: Please let me know your ideas via comments, tweets, or post to my Facebook!

I still hold strongly that clearly defining the physical therapist "Mickey Mouse Moment" is pivotally important to our profession. Once this happens, the physical therapist service brand will no longer be ambiguous, inconsistent, and scattered. However, there IS hope! We are indeed gaining grounds. I was pleased to see that even the Aflac Duck was receiving physical therapy! (April Fools much??? *insert smiley face emoticon HERE* LOL!)

My next post is dedicated to the #DPTStudent as I'll get into my 5 Tenets of Excellent Patient Education.

Until next time - I remain Yours in service,
-Dr. Ben Fung