Public or Private

[Diane]

Nari, you are right. I shudder to think of the pain I probably dished out, personally, along with my services 3 decades ago when I was newly unleashed out into the world and had
1. a young, painfree body
2. a young but not so painfree mind, that didn't really have too many clues about physical pain
3. a need to prove myself to myself and others
4. a set of ideas from the dark ages about pain imparted to me from my well-intentioned school. (Well, maybe a bit later, Descartes era)
5. an array of peers before me who were stern and had few qualms about what was for the patients' 'own good.'
6. a militaristic/factory-like hospital system to learn in/work in that stressed me to my limits
7. NO EXPERIENCE YET!!

I remember walking into the PT inpatient ward at 8:00 AM the first day of clinical training, and my eyes being met by a long room, rows of tables up each wall, each one occupied by a suffering human with various expressions of RA, each with a pail of ice water beside them and a stack of towels, each set of eyes looking back at me, the "new student PT." It was daunting. My job that morning was to wring out umpteen towels in the ice water and apply them to these peoples' bare skin over various joints. I nearly passed out myself, from the ache of non-stop ice on my own hands for an hour, imagined awfulness of the contact of the ice, and from the "exercises" that I was told to help them perform after with my own now icy numb hands, to "help" them...

Another training vignette: walking into a different hospital PT inpatient dept, but like deja vu, same row of tables, this time all tipped, this time about 20 people all coughing and hacking with sputum cups (anyone else remember those things?) beside them. My job, to "assist" them to upheave secretions from their lungs by doing chest percussions. No idea at the time how hard or not hard to do it. At that time the PT world had no concept of how to use subtler reflexes to assist breathing and coughing, or that it wasn't necessary to turn the patients upside down to drain those bottom lobes. We all heard the coal miner/bronchitis stories out of Britain (out teachers were all Brits) and we faithfully replicated all the mean 'memes'...
(:x)

Whew! Glad times changed and PT allowed a bit of humanity into itself. A Polish, black belt PT came through the country teaching a much kinder way to help chests, based on afferent input of an extremely gentle sort. (Wish I could remember his name..) Drugs for RA got better, so there was way less hospitalization.
Diane

[BB]

Diane and all,
I am curious of your stories of how you eventually ended up where you are now. Does anyone else still work for a hospital, or is everybody running their own practices? As someone who is in a hospital system, and is frequently frustrated by the system, I am just curious and enjoy reading of others experiences.

Cory

[bernard]

Cory,

It is a good subject of topic, perhaps I can split this one to create a new one in the general discussion board?

[nari]

Good idea. I spent 20 years in the hospital system, at senior levels and not-so-senior, in three different areas. Now, out in the community with public health, it is a totally different world with great autonomy.

Would like to hear others' thoughts on the joys and woes of the hospital systems.

Nari

[ian s]

Hospitals......

If you keep an open mind and link into a variety of clinics it is invaluable to see end stage and typical biomedical problems ......You see red herrings,red flags,trauma and the flipside - the inability to see outside the confines of the biomedical model . I worked in two camps for a while, a pain clinic and an orthopaedic one ....The latter clinic I saw every facet of shoulder upper quadrant dysfunction which were sometimes amenable to the surgeons considerable skill and experience......However there was a lot of iatrogenic disability , an enormous amount of psych/social distress which no one really bothered much about ......The complex body mind problems sometimes were made considerably worse ......
I got to see that the grey zone between ortho and pain science was the most interesting ,challenging and also most ubiquitous issue in health care...This is a natural area for PT to take on board but not much chance I feel .....

Clinics
I work in Primary Care ......Some of the work is pointless and unchallenging ....The experience in the Hospital helps to home in on red flags or any obvious trauma quickly, the primary care has helped me develop as a person .........People live in their inherited behavioural and social networks and this dictates their health or illness behaviour more than anything else......I have learnt a lot about social behaviour, when things are beyond me and why people don't change much .The GP's are really great where I work and it is obvious that the art of the consultation is the critical thing .....Patients tell me who they like and why and this helps develop my own communication skills.

Private practice is tempting but there is a security and ethical issue for me ...family to support and I might find it difficult making ends meet if I practised as I do at the moment -- telling people the truth ,making problems simple and making things as behavourally based as possible ....I do the occasional private work where I spend a lot of time hands on/ off and usually the patients don't need to come back !

[Diane]

If there is no legal restriction, or no personal energy restriction, you could have it all! You could have a private practice without having to quit your day job.
Diane

[nari]

My planned version of my public/private experiences and thoughts on both are almost identical to ian's.....
For the last 24 years, I did my best to avoid orthopaedics in the hospital, and succeeded. I disliked that very physically-oriented area to the extent I failed 2nd year ortho - my first failure ever!
Large hospitals are geared primarily to get the patients OUT, and whether they like it or not, physios are employed to get them out....and the workload is such that psychosocial issues are almost not permitted! In quieter areas, such as respiratory, there is room for broad-based therapy; and several gungho physios radically changed the way we treat 'chests'. Fortunately!
I spent 10 years with acute brain-injured, spinal surgery and stroke patients and found a niche I did not know existed. I could do whatever I saw fit, tons of time/space for clinical reasoning, changing ancient protocols and very close work with the neuropsychologists. Wonderful stuff, but I burnt out, and when I started to get snappy with the surgeons and nurses, the writing was on the wall, and I moved off the acute scene.

Private work? four years of locums in four different practices - standard 20 year old physiotherapy by the text; Nordic (excellent philosophy there!)
manual therapy+++ and McKenzie+++. What bothered me the most was charging patients for MY time and expertise...but I got over that one.
I was not happy with Workers' Comp and third party comp - the system was so abused it was depressing. The big plus for private work is that the patients are more motivated (they have to pay) but expectations remained the same.....passive physiotherapy with sheets of exercises: that is what the doctors, patients and some physios wanted and expected.
Goodwill was precious, and I valued that aspect as best I could, and generally behaved myself..ie, I conformed.

I still believe that the biggest difficulty facing physios is our relatively high profile and no-one really understands what we do. The word is synonymous with exercise, heat, massage and ultramachines. That is our fault, of course.
In the hospital, where there is virtually no competition from others (chiros, osteos, masseurs) our job is easier in a way, the profile is more noticeable. In the public health centre where I am now, it is more difficult.
A gentleman who came to me for review of his neck and shoulder pain; he attends the masseur 1xfortnight, the chiropractor 1x fortnight and wanted massage from me. The chiro had given him exercises, EPA, and mobilisation. After a discussion, I said there may not be anything I could do as it may clash with outcomes from the chiro; he was surprised.
A pleasant man, we reached an agreement- he would continue with the chiropractor and masseur, and if nothing was changing (and nothing WAS changing except he had increased pain for some days after the chiro exercises) he would come back for an assessment with me.

Good memories of the hospital system abound - colleagues, generous supervisors; full-on exciting learning experience as a supervisor of 14 physios; developing dept protocols, attempting to change ancient dogmas (and getting rapped on the knuckles for it) and challenging the doctors re appropriate physio for this patient or that.....

None of this is really available in the private sector, I think, or if it is, on a much smaller scale.

Both have lifetime learning benefits.


Nari