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Imposter Syndrome as a Physical Therapist

I lacked confidence for the first year out of school and had a lot of anxious feelings the first six months after graduating. Was I helping my patients? Will they get better? Would they be better off with another PT?

These are struggles I dealt with as a new grad PT and with more experience, I’ve learned to become more confident. I was able to trial and error, observe and learn patterns, and receive feedback from PTs I looked up to.

I’ve created a list of things that helped me create a mindset for success for those struggling with Imposter Syndrome:

Be over-prepared. I spent time after work studying and getting ready for my next day of patients. And I super-extra prepared for the patients that normally weren’t on my schedule and was very nervous to treat my boss’ patients. The more prepared you are, the fewer curveballs, right? Wrong. Make sure you don’t spend too much time after work because it is still healthy to have time to decompress. So set a certain amount of time aside and try to stick to that (for example less than 45 minutes).

Play out different scenarios in your head. Before you bring patients back, think about how you’d expect them to feel after their last session and also a scene where they’re flared up. Be mindful not to put blame on your own treatment/intervention. Sometimes the patient will reveal that they did something out of your control like a household chore non-stop for 3 hours.

Tone of voice. The way you present the information carries a lot in how the patient will receive it. If you say a lot of “ums” or soft-spoken, it may come off as you’re unsure. Be mindful of how you’re saying things. Or words you emphasize on like “abnormal” or “degenerated” may generate fear. 

Use more confident phrases. For example, “you have” instead of “I think you have” or “you will get better” vs “I think you’ll get better” can be perceived very differently. The patient will have more trust in you if you carry more confidence in your voice and how you say things.

Don’t act surprised when an intervention works. I’ve had it where a patient is surprised after treatment that they feel better immediately. Don’t act surprised with them (even if you are). Tell them that you expected that. 

Give your patients expectations. Be clear in your communication with the patient of what you expect after an intervention. Should they expect to be sore afterward? Should they feel better? After doing a new exercise, do they know what delayed onset muscle soreness is? Giving a patient of what you’d expect, especially if it can be misinterpreted as a regression, can also build confidence with the patient in you because you predicted it was going to happen. So that way when they’re sore a couple of days later, they’ll think, “it’s okay because Pauline told me I might be sore.”

The common theme throughout confidence is clear and direct communication. We went through a lot of schooling (7 years to be exact) to earn our Doctorates in Physical Therapy. We know a lot. It’s okay to not know everything but as long as we keep reaching for resources to learn, things will be more than okay. If you’re having struggles with a patient case or want to talk more, join me for a Virtual Office Hour.

Is Therapeutic Ultrasound Still Being Used?

I took a poll on my IG story last week and the results surprised me.

The majority voted no but, I’m still surprised that 36% of people said that they do. 

I started a new job recently in another outpatient orthopedic clinic and they use ultrasound here… a lot.

I’ve used more ultrasound in the past three weeks than I have in the last 3.5 years of practice!

I tried to do the “let’s try a session without it and see how you do” explaining how the treatment effects are short term and the benefits of an active warm-up instead. But the patients requested ultrasound to be brought back in more than 75% of the time in the following session.

So I’ve collected information and will be doing a clinic in-service on ultrasound in a couple of weeks for the clinic staff. If we’re going to be using it, let’s be sure we’re using it appropriately. 

Keeping in mind, best absorption of ultrasound energy is in the tendon, ligament, fascia, joint capsule, and scar tissue.

Table 1. Indications, contraindications, and precautions for therapeutic ultrasound.

Table 2. Parameters for Use of Ultrasound

Table 3. Comparing the difference between thermal vs non-thermal effects.

Most of these notes were gathered from my PT school notes (graduated 2016).

There’s a concept called “triangulation” we learned in PT school which connects evidence-based practice, provider experience, and patient choice. There technically is evidence that supports the efficacy of ultrasound. And if the patient strongly wants the treatment intervention, they’re likely going to feel better as a result of receiving the treatment, to an extent.

If the patient lacks progress, I’ll pull the intervention and be able to use this as a reason to discontinue the service in replace of another one. But for now, I’m doing it for some patients and it’s a very different practice than where I came from.

Check out this blog post about more differences I’ve found between my last job to the one I’m at now. 

Clinical Rotation Series – Part 4 of 4

Year 3 – Skilled Nursing Facility – 12 weeks

I currently work in outpatient ortho but this clinical rotation alone made me love PT in a skilled nursing facility as well. Maybe it was the whole rehab team that made this rotation and setting so special. On my first day, the staff teased me that I’m in for a special treat at lunch. I was nervous because they wouldn’t tell me what it was. To my surprise, the “treat” was their ongoing tradition to play hacky-sack during lunch. If you’ve been following my page for a while, you’ll know I have very little to no coordination. We never missed a day.

I had two-CI’s but mainly worked with one. She was so respectful, warm, and kind to all of her patients. She had a smaller frame than me but she made transfers look so easy. All of her patients loved to work with her and she would always make them smile. She had a way of sweet-talking even the grumpiest patients participate in physical therapy. I think we were turned down maybe 1x the entire time I was there.

I felt myself looking forward to each day because I had so much fun with the team there.

This reflection really showed me how much I valued the team I work with and want to enjoy my time at the place I work.

One of the most memorable moments in this rotation was a time when working with a patient s/p R CVA. He had been living in an adult foster home and was admitted requiring MaxA for transfers and bed mobility. He was oriented x3 but often had his eyes closed during transfers and when we were talking to him. We had been working with his sit to stand transfers in the parallel bars and progressed to a few steps in the bars with 2 person assist using max verbal and mod tactile cueing for step initiation. We had been working with this patient for a few weeks. One day his daughter who was in college came to visit and observed our session. We helped this patient ambulate with CGA with WC following using FWW for approximately 5 feet. She was brought to tears. She even took her phone out to start recording us. When he sat down in the chair, she went up to him, held his hands, and cried. She told us she hadn’t seen him walk in many months. Obviously I had tears.

I truly value our profession and the power we can give to our patients.

Consistent hard work and effort can help a person walk again. Achieve goals that maybe people didn’t expect. My CI never gave up on her patients and was always so encouraging. Her ability to help patients with her kindness, support, knowledge, and mighty strength inspired me to be the same with my patients. 

Clinical Rotation Series – Part 3 of 4

Year 3 – Outpatient Ortho – 12 weeks

I was fortunate to have my last two affiliations back near home in Oregon. My PT program was located in Pomona, CA. My last day in Cali was a final and a celebration with my class (there may have been a party bus) and when I got home, I woke my husband up (around 3 am), took a 30-minute nap while he showered and we hit the road. 18-hour drive back to Oregon.

My last affiliation was at a private practice run on the 30’s. We worked 4-10’s and it was perfect and I loved the schedule because we had 3-day weekends. I learned so much in these twelve weeks. My CI enjoyed being challenged with clarifying questions and would give me mini-assignments that if I didn’t know an answer to a condition, he’d have me look it up and tell him the next day. I’ll never forget Marfan’s syndrome/EDS because that was one of the many things he assigned. 

Instead of telling me what those conditions were, he had me seek out the answer myself.

We co-treated for most cases and he was amazed at how fast I could type. Our teamwork was so fluid that by the 6th week, it took little effort to organize and plan out our schedules. He was in the treatment room with me for nearly every patient and I preferred it that way. He’d always use the phrase, “can we talk shop?” to the patient when he’d pause for a teaching moment. 

I learned from him as a PT but also with his expertise in finance.

He was the first person to get me interested in learning about how to manage my money. He had me start with “Rich Dad, Poor Dad” by Robert Kiyosaki which I hadn’t read before. He shared with me his strategies and a side business of rental properties which had inspired me to get smart about investing instead of spending.

I am grateful for the time with him because he challenged me in the clinical perspective but also in life skills and sparked an interest that I never had before. When I told him that I bought my first house 2.5 years later, he responded, “Congrats. Where? When da party?”

Clinical Rotation Series – Part 2 of 4

Year 2 – Outpatient Ortho – 12 weeks

My CI was the clinic director. She had specific programs for each body region including manual therapy (STM and joint mobilizations) and exercises. Every person with a shoulder problem got the same shoulder protocol and low back pain followed the same low back protocol. She had built a lot of rapport for her patients and it wasn’t until week 5 or 6 before she let me lead some patient cases. She had told me from the beginning that she usually only takes 3rd-year students and that I wasn’t ready. So the first half of the rotation was observation and documentation. I would scribe for her during her treatments/evaluations. 

And when I tried to do something out of the protocol, she’d let me try it but then she’d recommend something that she’d normally do. So I learned early that it’s better to do it her way. And that’s okay.

She had been working for almost 10 years and I didn’t want to disrupt her groove. 

What I valued most about her was her ability to market to doctors. She had time blocked out of her schedule to deliver goodies to doctors’ offices and make an appearance. One time, I attended a lunch meeting that she scheduled with a doctor’s office and staff. She so easily made friends with the staff and started recommending bachelorette locations in Vegas for one of the nurses. On the car ride back to the office, I remember her saying something along the lines of,

“We don’t need to talk about physical therapy. They know what we do. But they won’t easily forget that conversation about Vegas.”

This is true. The marketing lunches between PT offices may blur together but she used casual/easy conversation that was memorable to stand out.

I’ve done marketing meetings with MDs in my outpatient PT job and if I’m leading the lunch, I tend to take her approach. I would rather connect with the doctor by sharing more about me as a person and my values and vice versa.