The MA to DPT Transformation

I’ve been at Lake Washington Sports and Spine since April 2015, and have loved every minute of working here. So it is bittersweet that I will be leaving in late July to start physical therapy school near Phoenix, Arizona. (Know of any hotspots? I have zero experience with Phoenix.)  I have learned so much working as Dr. Chimes’s medical assistant that I am at a loss to put it succinctly into words. However, I can at least try and share some tidbits I have learned through my time at LWSS. The nice thing is that most of these lessons have applications outside the healthcare field. Without further ado, here are a few things I’ve learned, in no particular order of importance.  Maybe I’ll rank them later in honor of Dr. Chimes.

-          Become an expert.

In other words, I want to learn as much as possible regarding physical therapy, the field/specialty I have chosen to pursue. I will never be satisfied, as there is always something new to learn. The biggest mistake I can make is to assume that I know all that there is to know about a given subject. Already I’ve learned about various subspecialties in physical therapy I had no idea existed prior to working at LWSS. I’ll never be an expert in all the specialties, but at least I can be aware of the strengths and weaknesses in order to become a well-rounded, well-informed physical therapist.

-          Admit my knowledge gaps.

This is related to the above point, but an entirely different idea in and of itself. For example, although Dr. Chimes has some experience in all medical fields, he understands and admits that he has definite knowledge gaps. It has been years since he learned about cardiology or hematology, and to further compound the problem, these fields have changed so much in the intervening years. This leaves him in the position that he’s not even sure what he doesn’t know. Did past treatments turn out to cause more harm than good? Are there new diseases that he doesn’t know about? So when patients ask about issues outside of his area of expertise, he gives a clear disclaimer that it is not within his expertise and then refers to another provider who would know better.

What Dr. Chimes is trying to avoid is the Dunning-Kruger effect, which is summed up fairly well by one of the authors during an interview with the New York Times: “… the skills you use to produce the right answer are exactly the same skills you use to evaluate the answer.” In other words, without knowing the skills yourself, you cannot determine whether someone is skilled or not. It then follows, how can you possibly come to an answer without knowing what question to ask? This is a phenomenon I had never heard of prior to working here, but it certainly has shaped how I will treat patients in my future career. I will hopefully get my patients to 100% by focusing on what I know, and referring to, and working with, other healthcare professionals with patients who are beyond my scope of expertise.

-          Know which patients will benefit from my expertise as a physical therapist.

And by extension, and possibly more importantly, when physical therapy is NOT appropriate for a patient. Being able to see patients from the perspective of a Physiatrist, where accurate diagnosis is the name of the game, will help me tremendously as a physical therapist. It is now clearer than ever that I will need to keep an open mind and consider alternate diagnoses if the initial treatment modalities I utilize on my patients do not bring any benefit.

-          Utilize a differential diagnosis process.

Low back pain is one of the most common reasons people go to the doctor. However, there are a multitude of causes for low back pain, and the symptoms often overlap. To compound matters, treatments for one cause are ineffectual for another, or may even make symptoms worse. What I’ve learned from my time here is to tease out the unique features of a patient’s low back pain in order to come to a correct diagnosis. Focusing on symptoms that apply to several possible diagnoses will not help me determine the root cause of a patient’s pain.

-          Be as transparent as possible with my communication.

We have several different iterations of this idea within the office, ranging from a tidy motto to a detailed flowchart/graph. It is never beneficial to be vague with my communication style or vocabulary when talking to another person. Furthermore, not only do I need to be clear with my communication, I need to confirm that the person I am talking to is ready to digest what I’m about to say. Having an disengaged audience can, at best, lead to repetition, and at worst, lead to a complete mishearing of what I have to say.

The above are just a few of the things I've learned while working at Lake Washington Sports and Spine. The effects of these lessons may not even be felt or become apparent for years down the line, but I know that they will only help me in my future as a physical therapist. I cannot begin to express how grateful I am for my time here.