Episode 1633 - Dealing with doubt

Dr. Zac Morgan // #ClinicalTuesday // www.ptonice.com

In today's episode of the PT on ICE Daily Show, Spine Division leader Zac Morgan discusses dealing with doubts in the clinic, how adopting a fitness forward approach can help solve a lot of "What if?" problems that arise when trying to pick "the best" intervention, the concept that doubt is bilateral, and how a fitness forward practice style can help build confidence with both patients & providers.

Take a listen or check out our full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

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ZAC MORGAN Alright, good morning PT on Ice Daily Show. For those of you who don't know me, I'm Dr. Zac Morgan. I lead in the Spine Division with both Cervical and Lumbar Spine Management. Great 2023 with all of you all on the road. Exciting 2024 ahead of us. So we've got a lot of changes coming with ice, so keep your eyes peeled. You've seen some of the certifications roll out. You're seeing courses pop up there on the website regularly. We will have more to offer there as well. So we're not fully booked with Spine, but we're getting close. So eyeball some of those dates. We'll cover those in a little bit. Let me start off by kind of debuting today's episode. DEALING WITH DOUBT So I kind of want to set the stage with a little bit of an overview of what I'm talking about when it comes to dealing with doubt. And why I think using a fitness-forward approach in the management of your patients with really any musculoskeletal issues or whatever issues they're coming to you with, I think using that fitness-forward approach adds so much certainty in those doubts. So what is fitness-forward PT and how is it different is a good place to probably start. Thinking about the concepts of fitness-forward PT and how that might differ from other approaches, I think this for me is obvious when you see it. Fitness-forward PTs are trying to at any corner to bleed fitness into their plan of care. They're trying to bleed health concepts into their plan of care. So rather than your first choice always being mobilization, or manipulation, or dry needling, or any of those things that we also love, you might see fitness-forward PTs just as equally choose something like isometric loading to reduce pain symptoms, use cardiovascular exercise to reduce pain symptoms. More on those types of things later, but I just think it's important to understand that those things could be utilized for the management, for the modulation of symptoms just as much as manual therapy and in fitness forward care you will see that. So we love highlighting these things. Let me tell you a little bit personally about why this episode is important to me. Early in my career the biggest thing that plagued me, the biggest thing that got in my way of helping patients when I think back to those times It was my own personal doubt. So I had a lot of personal doubt in the approach of care that I was delivering to people. That approach, for me, when I first started in this profession, centered a lot more around manual therapy. That was basically where my head was at, was trying to figure out the right mobilization for that person, doing it in the right direction, the right level of vigor. These types of concepts were always running through my mind in the middle of that evaluation. I wonder if this person would respond to thrust manipulation. I wonder if I should try grade 3 moving immediately. All of these concepts were bouncing around and I'll be honest with you all, what it led to for me was a lot of confusion and a lot of concern that I might be selecting the wrong technique for the person. "DOUBT IS BILATERAL" And what that ended up leading to clinically was doubt that was bilateral. So what I mean by that is that my client, they could start to tell that really what I was doing was somewhat bouncing around interventions trying to solve their problem. The problem was it wasn't solving their problem. So as we switched from intervention to intervention, that client often started to develop some doubt in my point of care. Perhaps just as importantly, if not more, I started to develop doubt in my plan of care at this time in my career. So I wasn't sure what was going on. I knew I was recognizing some patterns in front of me, but whenever I would see them, I wasn't sure exactly what the best solution might be for that person. And so I had a lot of doubt. And I think that then allowed space for that patient to also create a lot of doubt. OVERCOMING DOUBT So let's talk a little bit about dealing with this and what I think this kind of manifests as for most of us clinically. And I think this happens the most at the front end of your career versus the back end, but it happens really regardless. It's imposter syndrome. So if you're not familiar with imposter syndrome, this is that feeling you have where you're not quite sure you're good enough. where you think you might not be the right person for that client in front of you. If they had gotten the therapist next door, they would have been way better off, might be a thought that's going through your mind if you have a lot of imposter syndrome that you're dealing with. And I know I dealt with this tremendously, and all of the newer graduates that I talked to on the road, the ones that we mentor here at the clinic, all of these things, they often lead to imposter syndrome, and we get to the point that we're not quite sure what's going on with the patient, And that leads us to the spot of, I'm not quite sure I can help, and they would probably be better off with someone else. Well, team, we have to pull through that because we all have so much value we can bring to clients. And as you get further in your career, you start to believe that more, and it becomes a little bit easier to somewhat sell that plan of care to the client in front of you, to build them the bike, to get them moving forward. This happens to all of us at some stage. And so I think it's important to understand if you're there, what are the moves that I can make to get out of imposter syndrome? And if you're not dealing with imposter syndrome, it could always come back up. It's something that even to this day, there will be times where I'll have that moment where I'm like, man, I'm not quite sure. So it is something you will deal with clinically and it's something you want to be well prepared for because it has some clinical impact. The clinical impact that I was talking about before of lack of confidence, both for you delivering things to the patient, but also for the patient receiving those things from you. there is no doubt that there's clinical impact to imposter syndrome and we want to get rid of that. That way that clinical impact is all positive. The way I believe that we're going to do this is by shifting the manner in which we manage our patients. MOVING TOWARDS A FITNESS FORWARD MINDSET What I mean by that is if you're not already, you have to move towards a fitness forward mindset. You have to kind of underline your care with fitness forward. The issue with the way I did it early in my clinical career of being more like manual therapy focused. is that you're constantly using all of your brain power to try to figure out which mobilization the person would respond to. To try to figure out what direction, what level of vigor, how long should you do the mobilization. All of these factors are running through your mind clinically. And a lot of times, the answer doesn't live with manual therapy. The answer lives with what that person does for the remainder of the hours of their life when they're not on your table. That's a huge portion of what's driving people's pain scenarios. And the beautiful thing about that is the things that work for all pain scenarios are lifestyle changes. They're these fitness forward approaches. So you take something like cardiovascular training. So getting the heart rate up, whether it's for a sh