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Things we wish we knew as a new hand therapist
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What are some things you wish you knew as a new therapist! Josh and Miranda converse back and forth about things we wish we knew when we first started our careers.
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Transcript
Introduction and Topic Overview
00:00:06
Speaker
Hey guys, I'm Josh McDonald. And I'm Miranda. And we're here to talk to you about things we wish we knew as a new hand therapist. So you're just getting into the field.
Understanding Patients' Lives
00:00:15
Speaker
What are some things that you wish someone would have told you or you wish that you would have discovered much sooner than what you did?
00:00:23
Speaker
So we have a couple here. There's always a ton of stuff we wish we had known, but we picked a couple of high points here. You probably have some different ones if you've been treating for a while, but maybe you're new and these would be helpful for
Incorporating Personal Goals in Therapy
00:00:33
Speaker
you. So I'll go first. I have on here, I wish I was more aware of asking patients about their occupational profile, all the stuff they do in their daily life.
00:00:45
Speaker
As new students, new grads, we get caught up in getting all the goniometry right and the strength tests and nerve tests and what you do for a job. But then asking things like, do you take care of anybody? Do you have an adult you take care of? Do you have kids you take care of? What does your day-to-day look like? And what do you like to do for fun? Because that can totally change my plan of care. I can instead go off on, well, I've had someone who was
00:01:08
Speaker
four weeks post-distiratus fracture. She was 75 and she had horrible range of motion and was not in pain. She said, you know, I think I'm done. Like, wait a minute. We have all kinds of progress to make. She's like, I sit around and watch TV all day. I use the remote. That's what I do. And I make some food for myself. I can do all that. So in her mind, she was totally ready to be done. But based on her occupational profile, that was okay with her. So
00:01:30
Speaker
I wish I had known that earlier on to get a bearing of not just where I think they should be, but maybe this person wants to get back into rock climbing and cage fighting and we have a different set of goals than if they're just watching TV and type them on the computer for fun. So I wish I knew that a little bit earlier on. Yeah, that's definitely true.
Communication with Physicians
00:01:47
Speaker
And I think you made me think of something when you're talking and is that if you know your biggest obstacle that's going to be
00:01:54
Speaker
to the treatment or the patient getting better. And if they can identify it, then you can overcome it, right? So by taking a good profile, if you know this person works five to seven every day, how are they going to have time to come and do their therapy? You know, so I guess taking a bigger picture of what the situation's like so you can help them overcome some of those things. Yeah. Yeah. Getting outside our little box of just looking at the injured body part and measuring it, treating it, but the whole person and their life outside the clinic.
00:02:22
Speaker
Right. Right. Definitely. All right. One of mine was, um, making sure you get the operative report and that you're building and communicating with the physician. So if something's not in the off report, you know, I remember as a new grad being terrified to contact the physician or even contacting the physician's office, but it can be so helpful. Like knowing that the doctor only expects this patient to get 45 degrees of flexion at the PIP.
00:02:49
Speaker
like, okay, great, I know that, you know, we're not gonna be going for a hundred degrees collection. So just kind of knowing the doctor's expectations, what the operative report says, how much damage was actually done can be so helpful in your treatment and also managing the patient's expectations, right? So when you're coming to the end and you're realizing like, wow, I didn't get full range of motion back, like, you know, you, and then you as a therapist are disappointed and the patient's disappointed, but the physician thinks it's great because he only expected you to get 45 degrees.
00:03:19
Speaker
And it's a huge deal to get that operative report. That's hugely helpful to know, you know, what kind of repair was done, maybe some other things. Cause sometimes I'll have patients come in and say, yeah, the doctor told me I ruptured a ligament. No, no, it's a tendon. It's a flexor tendon. It's something completely different. So that's a really important thing to have.
00:03:36
Speaker
but then that open dialogue with the surgeons too, so that we're on the same team, and some doctors are better about that than others, but reaching out even to the institution to say, okay, we need some extra information, and getting that gives us so much more rich information about what the patient needs.
Setting Realistic Expectations
00:03:52
Speaker
Right, and I'll have new grads or students tell me, but yeah, the doctor won't send me that operate portal. I'm like, well, then you send someone from your office to go get it. Yeah, exactly. You need it, right? You need to know, is that a ligament or a tendon? That's a big difference in how we treat patients.
00:04:06
Speaker
Absolutely. Yeah. And we need to know, like, were there complications? Were there other things the patient maybe didn't even hear the doctor say he did in post-op? They're like, oh, well, that's also a big deal to know. So yeah, that's important. Right. Like if it was a partial tendon, you know, if the tendon was cut 20%, then we know we don't have to hold them back. They can be moving much sooner. They can be getting back to work much sooner. Yeah. Yeah. Yeah.
00:04:29
Speaker
All good stuff to know for sure. Definitely. We need all that stuff. All right. What's your next one? All right. My next one I have is the secondary injuries that can come along with
Recognizing Secondary Injuries
00:04:37
Speaker
the patient. So kind of piggybacking off of that, but more of the concept of if they come in with a distal radius fracture within two or three weeks, they may start to get a frozen shoulder.
00:04:47
Speaker
or they may start to develop some lateral epicondylalgis stuff, or a patient with some tennis elbow stuff may have a cervical radiculopathy. And so I kind of get into this microscope thing as a new hand therapist of seeing just the diagnosis that came over on the script and not saying, what's going on with you today? What brings you in to see us today? And these patients will sometimes talk about something that's completely unrelated, but it's their bigger issue because the doctor just wrote, eh, carpal tunnel.
00:05:15
Speaker
And I say, well, what's going on? Oh, I have numbness down my whole arm. Well, there's other things than what the primary diagnosis is. And sometimes those things develop after an acute injury. And sometimes it's part of why they were sent to us, but the doctor didn't, maybe we didn't get that cohesive view in the, in a one diagnosis code script. Yeah. So I think doing a more proximal screening is really key, right? With your patients, like making sure they can lift their hands overhead behind their back.
00:05:39
Speaker
you know, not just the range of motion at the wrist. Yeah. Yeah. And with most of our patients, maybe there's some exceptions, most of our patients, we should be doing a kind of total upper quarter screen with them and say, can you reach overhead? Can you touch the back of your head? Can you touch your low back and say, you know, like, you know, I'm obviously going to be careful with the flexor tendon injury. We're going to do it in a guarded way, but
00:05:59
Speaker
how is that upper body moving? And maybe we need to make sure we're just getting good edema reuptake by doing, you know, some light reach overhead stuff in that pumping movement of the reach overhead and how, so incorporating all that stuff into the full quarter, uh, upper quarter eval. Yeah. And then I say too, as part of your eval, watch the patient walk in, right? Watch them walk back to where you're sitting. Watch them check out at the front desk if you can, you know, watch them do functional things. Are they really guarding and protecting their arm? Are they holding it up or are they swinging it normally?
00:06:28
Speaker
You know, those can really clue you in on to what maybe some of their other problems are going to be and what some of their goals are going to be. Or the patient on their quick dash says they're unable to carry a shopping bag or briefcase and they carry their person in that hand.
00:06:42
Speaker
And we're saying, okay, I wanna call you out, but I kinda saw you carrying a purse. Tell me how that matches. A briefcase is much heavier than a purse. Right, right. Not some of the purses I see coming in. That's probably true. Yeah, that's very true. But then like Josh says, you can't call them out because you're trying to build this trust and rapport, but also keeping it honest. Yeah, for sure. All right, what's another one for you?
Building Trust as a New Therapist
00:07:07
Speaker
Um, I think for as a new grad, one of the hardest things for me to overcome was telling them as like a 26 year old new grad, like why you should trust me to guide your care. You know, like, are we really going to take off this postoperative brace? You just had a five hour surgery and you know, they, they don't trust you. You are young, you look young, you maybe are nervous. You know, so I think, um, one that was a new therapist or as a younger therapist, you know, having them sit down, you know, tell them,
00:07:36
Speaker
you know, ask them all their questions and then start getting into, you know, what you're going to do and what your plan is and why you're going to do that plan is really key as opposed to just jumping in and you know, maybe removing that post-operative
00:07:48
Speaker
stressing right away. I think sometimes you can get away with a little bit more as an older therapist because they have more confidence in you and probably because you have more confidence in yourself. And then just being really honest, if you don't know something, don't pretend you know it to the patient. Be like, I don't know, I'm going to have to ask my supervisor or I'm going to have to ask your surgeon that question. So do things to build that trust and rapport early on.
00:08:11
Speaker
And if you know it's the right answer, it's the right thing to do, speak from a place of confidence and authority, even if you don't feel like you have it, convey that to the patient because that's that sense of authority that they are looking for. When the post-op nurse says, don't take your dressing off for two weeks till you see the doctor again, and you know full well that doctor wants them moving and you got to make a splint, they're like, no, no, no, no, they told me after surgery, like explain to them, that's what they tell everybody after, you know, a foot surgery and a heart surgery and after everything, that's what, that's just a blanket and start,
00:08:40
Speaker
So speak for that with that from a place of confidence and authority to say I know what I'm doing but then also be willing like Miranda said to say let me double check on that one if you don't if you aren't sure about
Conveying Confidence and Uncertainty
00:08:50
Speaker
it. Yeah I feel like people can tell you know usually people can tell when you're being genuine and when you know and when you don't know so I think just you know being honest and then also knowing that you do come you've had you know seven years of schooling or whatever it may be you have a lot of training and expertise in this area so knowing that you do have some of those skills and you
00:09:08
Speaker
has spent a lot of time studying those things. Yeah. Yeah. And they are the authority on their hand, but you're the authority in their world. You're the authority on doing the next step of what's to come. So have confidence in that training that you've had. Yeah, definitely. All right. So those are some tips of some things we wish we knew. There's many, many more, I'm sure, and many things that Josh and I missed, but since we're kind of at our time limit,
00:09:33
Speaker
We'll be signing off
Contact Information and Conclusion
00:09:34
Speaker
now. For more information or suggestions, you can email us at info at handtherapyacademy.com or you can find us online at handtherapyacademy.com. See you guys.