The Class of 2023 returned from their first clinical rotation at the end of September and had some time to reflect on their experiences. A few of them are written up as short stories of lessons learned below. Take a trip to the Gila River Indian Community, AZ, Oregon City, OR, and Grand Junction, CO.
Carson Ariagno – Gila River, AZ
I was exceptionally nervous going into the beginning of my first clinical. I hadn’t prepared as much as I’d wanted to, I’d had to last-second book new housing as my original plan canceled on me the day before I left, and I’d gotten a speeding ticket while on my 13-hour drive down. Not my best start. But once I was welcomed into the clinic, all that fear and confusion melted away. I realized relatively quickly that I needed to be a face of calm confidence for many of these patients. This became a personal goal for myself in addition to the spread of more typical academic and professional goals I set with my clinical instructor (CI).
I spent my first clinical experience on Gila River Indian Community land just outside Phoenix, Arizona. This group of tribes have lived in southern Arizona since around 300 BC and have endured aggression and marginalization at the hands of the Spanish and American governments throughout history to this day. Most notably, their primary water source in the Sonoran Desert, the Gila River, was blocked off and dried up in the late 19th century by American farmers. The Gila River tribes were given federal aid in the form of processed and canned foods after almost 40 years of mass starvation on the reservation. These cheap foods may have saved lives from starvation but helped lead to widespread obesity and diabetes, two conditions which still disproportionately affect the community. As of a 2008 study, there was a 47% adult obesity rate, a 50% adult type 2 diabetes rate, and a 20 times higher rate of kidney failure than the general American population. This ongoing health crisis affecting the community creates more complex patient presentations, especially in PT.
Nearly every patient that my CI and I saw in my six weeks was diabetic and about three quarters of them were overweight or obese. A couple had had amputations related to their diabetes; more were threatened with the risk of needing one soon if their condition didn’t improve. This level of additional complication combined with relatively difficult presentations created cases that really challenged me for my first time in clinic. This difficulty and the endless support of my CI made this experience more enriching than I ever could’ve imagined. Along the way, I learned from our patients bits of their language and much of their history as well as many aspects of day to day life for those still living on the reservation. One patient in particular opened up to me with some personal stories on the third or fourth time I saw him. He’d lived a very difficult life growing up in poverty on the reservation, experiencing some tragic losses along the way. He had a variety of health problems begin to develop around the time he turned 30, diabetes and a torn knee ligament among them. He lamented to me about how difficult life had become in the nearly 20 years since then as he gained large amounts of weight while being unable to receive sufficient medical care for so many years. But now that he’d started PT, he felt like he was beginning to regain control. The relatively recently-opened outpatient center our clinic was in gave him access to so many services he really needed and was so thankful to receive. He has now lost his first 50 pounds and is well on his way to successful rehab of his knee and back.
This was a running theme with varying severity for many patients – this health system was their first and most consistent source of care in a long time if not ever. It was wonderful to see the progress many of them finally were able to make and the difference that truly attentive, available care can make for people in need. Every provider was interested in providing as much patient education as they wanted to hear to continue breaking down the barriers of healthcare hesitancy that exist in the older members of the community. Many of them had felt, seen, or heard stories from the not-so-distant American history of medical and governmental mistreatment of their people. Especially now as we tried to promote the COVID-19 vaccine, there were still walls of deep-seeded distrust to be broken down. Progress is being made and more and more people are getting the help they need. The Gila River Health Care organization is doing invaluable service for the community on the reservation and will continue to improve their health outcomes and relationship with healthcare as a whole. My time there was extremely well-spent and I cannot thank them enough for taking me in.
David Shaw – Oregon City, OR
This story is about an ongoing learning process that really took center stage during my first clinical experience. As a developing physical therapist, I am learning how to best utilize my time and attention while working with patients. Having worked in clinics as a physical therapy aide for 4.5 years before beginning physical therapy school, I understand the importance of maximizing time in the clinic. Furthermore, I have discovered the most valuable use of time is often patient education. Whether this entails educating patients about anatomy, tissue healing times, avoiding harm, and/or exercises to do on their own, all forms of patient education should empower people to take matters into their own hands.
I hold a large amount of pride in my work, and I know that a lot of people do; however, the amount of pride I have sometimes leads me to feel like I didn’t provide the best experience possible for a patient. In hindsight, I would like to reflect on one patient interaction that I will remember forever. (I will be leaving out a lot of information for the sake of patient privacy.)
Before seeing this patient, I was briefed by my clinical instructor (CI) of what his hypothesis was, and how to navigate the patient and their mother while in the clinic. However, my CI emphasized that I should try to create my own hypothesis as it would be great to have a fresh set of skills to provide them with another opinion. The child came into the clinic with their mother, who was curious about the existence of a motor tic disorder and had been seeing a neurologist about it. The tics were few and far between during my time with the patient. I was beginning to question what the real issue was. It seemed as though the patient was consciously producing the tics, and seemed to coincide with pain in their shoulder. I’m not convinced that the child shared this information with anyone before me that day.
After talking with the patient more and performing some examination measures, I conveyed my hypothesis for this patient to them and their mother. My hypothesis was that they were experiencing episodic shoulder pain due to inflammation related to overuse of a specific muscle in their shoulder. However, what this patient really needed was more stability and strength coming from other muscles so the affected muscle and its tendon wouldn’t inflame and cause the patient to be limited in their daily life. What I didn’t consider at that moment is the effect the words that I used would have on the patient, via their mother who works within the pharmaceutical industry.
The words “inflammation” and “inflame” caused the patient’s mother to believe that all they needed was anti-inflammatory drugs and rest. This took a rapid adjustment from me to educate them about working through comfortable motions in order to improve shoulder stability and strength overall, so that their shoulder problem doesn’t become a chronic issue. It took some attention to detail to attempt to change their mindset. Reflecting on how I went about what I said, I know I could have done a better job. When this experience came up with my CI, I was able to begin letting go of the related burden I immediately felt when they left the clinic.
Physical therapists (PTs) can help everyone, not everyone feels that they need help from a PT. It’s our job as PTs to contribute to healthy and positive healthcare interactions for all patients. We should always ask for consent and know when to treat or when to refer. We should always reflect on our approach and methods and continue to improve from within for the sake of others. Finally, we should want people to trust in our knowledge, experience, and honesty, so they may feel comfortable thinking of us as their primary care providers (PCPs).
Although healthcare is a large system, I have seen that a PT being someone’s PCP is possible. But just because it is possible, doesn’t mean it is necessary. After all, we should be advocates for people seeking to improve their health, physical therapy or not. We must continue let go of our burdens to learn from prior experiences and move on to help the next patient. For some this may require a regularly scheduled vacation, meditation, and/or further education. But one metaphor must remain in the back of our minds: “You can lead a horse to water, but you can’t make it drink.”
Alan Scheuermann – Grand Junction, CO
In August and September of 2021, I spent six weeks at a clinical rotation working in the outpatient unit of Community Hospital in Grand Junction, CO. This was my first clinical experience and was full of so many unknowns and new and challenging experiences that parts of it feel like a dream instead of a formative professional and personal journey. While the overall experience was undoubtedly positive, there were certainly difficult and uncomfortable experiences, both anticipated and unexpected.
I spent the week leading up to clinical trying to review information I thought would be relevant in order to have as much information fresh in my mind as I could. My greatest anxiety in the days before my first shift was looking silly in front of my clinical instructor (CI) because I forgot what nerve innervates a specific muscle or couldn’t remember the normal range of motion values for a shoulder patient. What I came to realize fairly early on was that there is a chart for everything, and while there are certainly specific values and landmarks that it helps to be familiar with, the world would not explode if I had to look something up. Besides, I was happy to discover that I retained much more information that I thought I had from my first three semesters of PT school. I felt that I could carry myself in such a way as to give patients confidence that I had rationale for exercises I would ask them to do, and that they would ultimately benefit from my care, despite being a student. I found my CIs to be incredibly supportive, thoughtful communicators, and overall good people who I enjoyed spending time with and working under.
Apart from my CIs and patients at the clinic, I had relatively little social contact with other people during my clinical. I was in a town where I knew only one other person, a childhood friend’s brother, and felt so burnt out at the end of most days that more social interaction was the last thing on my mind. I usually consider myself to be someone who does fairly well being alone, but I had to admit to myself that by the end of my rotation, I was ready to be back in Denver with my girlfriend, cat, family, and friends. I found myself wishing for the comfort and ease of hanging out with old friends or having a quiet night at home that I was unable to recreate in Grand Junction. I took advantage of the world class mountain biking and trails in the desert surrounding Grand Junction and loved every minute of it but would find that there was a need for social support that was going unmet in the time between bike rides and work shifts. As I begin to rationalize what my second clinical will be like, I know that developing relationships in an unfamiliar city will be key to enjoying and growing from my experience to the fullest extent.
One of the highlights from my clinical rotation was working with a patient who I’ll call Cheryl, which is not her real name. She was an older patient who had fallen while out walking and broken both of her kneecaps, one of which required surgery to repair. Despite this significant trauma, Cheryl was generally upbeat, excited to be at therapy, and was very validating towards me as a student PT. Naturally, we were working on lots of balance work with Cheryl, and she frequently commented that she felt safe performing difficult balance tasks with me guarding her to prevent her from falling. She approached PT as a way to find things that she did not feel comfortable doing and working to improve in those areas. She was always eager to challenge herself. On my last day of clinical, Cheryl took several minutes at the end of her session to look me in the eye and tell me that she enjoyed working with me and truly believed I will go on to be a great PT. The sincerity and thoughtfulness of her comments acknowledged the professional transformation I had undergone during my first clinical and helped to push back the soft voice of insecurity lurking in the back of my mind, and I will forever be grateful.
Looking for more stories from CE I? Find a second year on campus and ask, there are so many more to tell.