An excerpt from a day in the life of an Outpatient Physical Therapist.
Can you relate?
8:00 am: The day starts well! Hurray! You evaluated two patients. The first patient is progressing well with abdominal bracing techniques controlling his low back symptoms. The second patient, who suffered a rotator cuff injury, is also progressing well with progressive resistance exercises. Happy Dance!
9:30 am: The third patient of the day is an evaluation. According to the script, he/she is suffering from chronic neck pain, and scheduled for 9:30 am. You walk to the front desk but the patient has not arrived. You immediately think, “maybe I can get that progress note from yesterday completed.” You sit down and start working on the progress note. But…
9:35 am: Just 5 minutes later, the front desk calls and says the patient just arrived. Judy, the receptionist, asks if you can still see the patient. Immediately… an internal struggle begins.
Now, several thoughts run through your mind: it would be nice to have 60 minutes to work on documentation or the online training that you’re behind on; but, you also know that you need to meet your productivity standards; if you don’t see the patient, you run the risk of not meeting standards for the week. Your final thought is that you don’t want to be mean and send the patient back home without being evaluated, so you decide to see him/her.
The clinic provides 60 minutes for a spinal evaluation. By the time the patient’s registration is complete, you start the evaluation 15 minutes behind.
9:45am: So now you have 45 minutes to complete the evaluation. Not an ideal amount of time for differential diagnosing, initiating treatment and educating in a home exercise program. You dive into the evaluation and during the subjective interview the patient has difficulty staying on topic and requires frequent refocusing questions. The patient becomes emotional and describes how depressing the pain has been to endure. You want to listen more but you realize that time is precious, so you press on. The objective evaluation indicates hypermobility complicated by a sitting work posture, so you initiate stabilization techniques with postural instruction.
10:35 am: You hand the copy of the home exercise program to the patient. As the patient walks out the door, you sigh. The evaluation documentation is 50% incomplete and you are already five minutes behind for the next patient. You resign yourself that you will work through lunch to complete documentation because you need to leave on time tonight to get your daughter to soccer practice.
Three different job stressors apply pressure to Outpatient Physical Therapists.
- Productivity Pressure: Each clinic/organization has necessary productivity standards. Whether it’s measured in units, number of patients or both, the truth is that the productivity standard demands a response. Sometimes it rightfully boots you out of your chair, but other times it drags you under the surface leaving you gasping for air.
- Professional Expectation: You know that an excellent evaluation includes the following:
- A subjective interview that drives the direction of your evaluation and confirms or denies your hypothesis.
- An objective evaluation that leads to the most accurate differential diagnosis that drives an effective treatment plan
- Initial treatment that initiates the healing process.
- Instruction in-home exercise program.
The patient arrived late. The subjective portion took an extended time due to the patient’s emotions and circular responses. The stressor is choosing to cut something such as skipping parts of a thorough evaluation, initial treatment or home exercise program. All this leads to not meeting your evaluation expectations causing stress.
- Subjective Evaluation: Physical Therapists are compassionate and focused on service. We are in a service business that physically touches the patient. When a patient is describing their frustration, fatigue, lack of sleep, pain, or hopelessness we find it hard to interrupt and refocus the patient. Exhibiting empathy without sympathy or its counterpart, indifference, is challenging. This stress gets compounded when time is limited. I believe these three stressors contribute to professional fatigue and potentially job burnout. In my next blog, I will explore effective ways that Physical Therapists and Rehabilitation Managers can minimize these job stressors.