Resilience

The resilience of the healthcare practitioner is something that we are not talking about.  Where does the health and well-being of the practitioner fit into the picture of healthcare?  In my experience, many healthcare practitioners get into the field because they want to help people.  Patient care is the primary focus; but taken to the extreme, many practitioners start to feel burnt out and look for an escape. Not only does the practitioner start to feel tired, overwhelmed, and frustrated, but the quality of care starts to suffer in parallel.

In graduate school, it’s all about “ evidence based practice”.  In clinical practice, it’s all about “patient satisfaction” and “clinical outcomes.”  Where does the well-being of the practitioner fit into these ideas?  I think we mistakenly or assume that the practitioner has their life together and are operating at their best.  The pressure to be productive, more efficient, and see more patients is only leading to more burn out and a greater need for balance in the clinician’s lives outside of work.

I think we need to start having more discussions about how we can help healthcare practitioners become more resilient.  We need to teach practitioners how to maintain balance in their lives.  This is not about being selfish, this is about clinicians being in a better place mentally and physically so that they can function at the highest possible level.  Decision making only gets better if the clinician is well rested, physically fit, and mentally engaged. 

So where do we start?

References: 

Ten Commandments for the Resilient Practitioner (http://bjgp.org/content/66/651/528)

Resilience:  what is it, why do we need it, and can it help us? (http://bjgp.org/content/65/639/e708?trendmd-shared=0)

 

The Modern Hippocratic Oath (Credit to the Freakonomics Podcast)

If you have never read the Modern Hippocratic Oath written by Louis Lasagna, former Dean of Tufts School of Medicine, take the time to do so.  It will make you reflect on your own clinical practice and ask yourself whether you are behaving in a way that is consistent with this incredible document.  It's important to note that this was written in 1964, and yet you will see components that are equally applicable today.

Some highlights from the oath with the themes that I think are applicable today:

"I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh a surgeon's knife or the chemist's drug." (Evidence-informed practice and the importance of empathy)

"I will not be ashamed to say 'I know not,' nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery." (Intellectual Humility and Inter-professional Collaboration)

"I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability." (Biopsychosocial Model)

"I will prevent disease whenever I can, for prevention is preferable to cure." (Focus on Prevention and Wellness)

Take a read for yourself and see what sticks out to you.  Then think about how you can change your clinical practice to match these guiding principles.

Link to a copy of the oath: http://guides.library.jhu.edu/c.php?g=202502&p=1335759

 

"Productivity is for robots" (Credit to Kevin Kelly...Again)

Insightful quote from Kevin Kelly in an interview with Tim Ferriss.  In the current healthcare environment, clinicians are constantly pressured to be more productive and more efficient in providing care to their patients.  On a big picture level, this makes sense, with the demand for healthcare far outweighing the supply (hence 6 to 8 week waiting lists to see your physical therapist or primary care physician).  But on an individual level, I think we need to be careful to not fall into the trap of just being more productive and efficient.  In essence, we can't become robots, mindlessly applying the same treatment to every patient.

So how do we do this?  Here's some ideas based on another quote from Kevin Kelly's interview:

"Where humans are going to be really good is in asking questions, being creative, and experiences." (Kevin Kelly).

- Ask better questions of our patients:  What are their goals and expectations?  How can we help them?  Why are they really here?  What are they fearful of? How is this problem affecting your life?

- Be Creative:  How can we take the best research evidence and blend it with our creativity and patient's input to come up with a customized treatment plan tailored to the realities of our patient's life?

- Experiences:  How can we make the experience of our patients better?  How can we earn more of our patient's attention and trust?  How can we make the patient walk out of the clinic and think "that was way better than I expected?"

Let's be better than the robots.  Let's ask better questions, provide creative treatment solutions, and create better experiences for our patients.

"Sit, Sit.  Walk, Walk.  Don't Wobble." (Credit to Kevin Kelly):  Single Tasking in the Clinic

"When you sit, just sit.  When you walk, just walk.  But whatever you do, don't wobble." (Ummon, Zen Saying)

One of the most powerful things you can do to be a more effective clinician is single-tasking.  Look at your patient and ask one question at a time.  Listen to their answer intently and openly.  Perform one test at a time.  Focus on what you're feeling and how the patient is responding.  

The current healthcare environment is not conducive to single-tasking.  We are asked to complete fifty tasks all at once, and do them now.  So our knee-jerk reaction is to multi-task all day, every day.  The problem with this approach is it's easy to lose sight of the reason we are there:  To help people and treat patients.

Resist this urge, and focus on one thing at a time.  When you ask a question, do so with intent.  When you teach an exercise, focus on just that.  But whatever you do, don't wobble.

Links

http://podcastnotes.org/2016/06/08/tim-ferriss-kevin-kelly-ai-virtual-reality-and-the-inevitable/

https://connect.gonzaga.edu/bormann/zen-quotes-6

http://www.mdedge.com/jfponline/article/103873/practice-management/ehr-use-and-patient-satisfaction-what-we-learned

http://www.wnyc.org/story/infomagical-challenge-1/

 

 

The Value of Having a Movement Practice

This post has two goals:  defining Movement Practice, and describing the lessons I have learned through my own Movement Practices that have made me a better clinician.

I wanted to write on this topic because I have seen recent campaigns by both the APTA and CPTA to re-brand physical therapists as movement specialists. In order to be a true "Movement Specialist," I think you need to have a Movement Practice of your own.  Knowing, doing, and teaching movement are all equally important parts of being a Movement Specialist.  It is really hard to label yourself as Movement Specialist if the "Doing" part is missing.  Having a Movement Practice and learning new movement practices will make you a better clinician for many reasons, including reminding you what it's like to be a beginner and student again.  

What is a movement practice?

There is no consensus definition for what is a "Movement Practice," so I'm going to make up my own.  I think a movement practice moves beyond exercise, and is any situation where a person is moving their bodies with purpose, and is mindful and attentive to their performance.  Reflection on the quality of performance, and planning future practice sessions with the goal of refining and improving their movements are equally important.  Yoga, pilates, feldenkrais, dance, martial arts, soccer, football, crossfit, weightlifting, running, biking, swimming, gymnastics, and even walking can all be considered movement practices.

How does having a Movement Practice make you a better clinician?

Some of my most pivotal experiences as a clinician have come during my own movement practices.  My first experience was learning different running styles in an attempt to make myself a faster, more efficient runner.  I explored Pose running, Chi running, Barefoot running, Natural running, along with trying to piece together my own running style based on the research.  It was a long process with a lot of ups and downs to learn what running style clicked the best with my mind and body.  I had multiple instances where I felt like it was so easy, but then the next day ran like I had no control over my legs.  Learning how to run differently and to refine your running technique is similar to what we are asking our patients and clients to do when we ask them to walk different, stand different, or squat different.  

Lessons I learned:  

1.  Learning how to change how you do something that you've been doing for a long time is difficult, and I need to be patient with my clients and patients when I ask them to do something different.  

2.  Really paying attention to how you move, with something that seems as natural as running or walking, instead of just tuning out, is the biggest difference between exercise and a movement practice

3.  The learning curve when learning to move differently is not linear, it's more like a roller coaster with ups and downs.  Expect this, and educate our patients and clients to expect the same thing.  It will save them a lot of frustration and doubt. 

My second experience was my experience was at San Francisco Crossfit when I started to learn all the different movements for the first time, including olympic lifting, powerlifting, and gymnastics.  Learning how to deadlift, snatch, clean and jerk, and kip was challenging, and a constant roller coaster of excitement and frustration. When I became a coach and started to learn how to teach other people how to do these same movements, it was like I was starting all over again.  I could do the movements with some basic proficiency, but teaching other people was a whole new ballgame.

Lessons I learned:  

1. Learning the basics of a new movement does not need to be complicated, but actually mastering a movement takes years.

2. Being a beginner again is a great, but humbling experience.   Taking the beginner mindset and being open to learning is critical when you start anything new.

3. Knowing, doing, and teaching a movement are different skill sets that all require a different level of understanding.  

4. There are a lot of different types of movement out there, and the more you can expose yourself to, the more you will start to see commonalities and differences between movements.

 

Choosing a Crossfit Gym

I just listened to a great podcast with Dr. Karen Litzy and Dr. Rick Daigle on the Healthy Wealthy Smart Podcast 217: Crossfit: It is for You? w/ Dr. Rick Daigle and I thought they had a great discussion about how to choose a Crossfit Gym, along with a lot of other Crossfit-related topics.  

In light of that podcast, I'm posting my thoughts on actionable steps you can take if you want to figure out if Crossfit is for you, and what the best gym is for you.

1. Be open, leave your pre-conceived notions at the door.  Walk in with an open mind and see first hand what it's like for yourself.  Relying on the internet or social media will leave you with certain impressions of Crossfit that may or may not be accurate.

2. Ask to observe a class, and hang out for the whole thing beginning to end.  Get a feel for the culture, community, and general vibe of the gym.

3. Ask if they have a class that is open to the community to try out.  If they do, take it!  There's nothing like experiencing a Crossfit class first hand to figure out if it's something that you might enjoy.

4. Ask to talk to a member, and ask them what they like about the gym

5. Find out the gym's schedule, and see if you can realistically make their class times.  Be honest with yourself.  There's enough barriers to working out already!

6. Ask about their on-ramp / introduction process.  Do they have an introductory class or series of classes? This can be a very helpful step to get you comfortable with the Crossfit class and gym setting, especially if you've never touched a weight before.

7.  Ask your family, friends, or co-workers who you know already go to a crossfit gym, and see if you can tag along with them to observe or take a community class.   The social aspect of Crossfit is huge, and if you have someone that you already know to goes to a Crossfit gym, you'll feel more comfortable going in for the first time.

That's it!  Comment below with any suggestions of your own.