The Best You Can Be

Are you racing to the bottom or climbing to the top?

By Kevin Hulsey, PT, DPT

Have you ever been a patient? Many physical therapists (PTs) have been a patient. Many PTs have experienced significant injuries during their lifetime. In fact, many PTs are drawn to the profession after having a great physical therapy experience following a significant injury.

Two years ago, I suffered a herniated disc in my lower back. I honestly do not recall the straw that broke this camel’s back, but the terrifying pain is something I will always remember. I self-referred to a young professional who I knew did not have much experience. However, I was drawn by her personality, and I knew I would appreciate working through the rehab process with her. I was desperate for my first appointment. The pain was unrelenting. Walking was the only activity that did not exacerbate my pain. The initial appointment was everything I expected: great front office staff, thorough exam from the PT followed by a great exercise discussion between me, my PT, and my physical therapist assistant (PTA). The PTA and I performed several exercises intended to reduce my symptoms. Then, the PT pushed on my back for a while, and I finished off my first visit with the rehabilitation technician who hooked me up to an electrical stimulation machine and let me lay on ice packs for 30 minutes. Without exception, the ice and electrical stimulation treatment were my favorite parts of my first treatment.

I made an appointment for the next day, and the next day, and the next day. I scheduled five appointments per week for the first two weeks of my injury. I was not able to sleep or work. So my time was best spent at rehabilitation. Each session lasted a minimum of two hours with the longest session nearing three hours. During my appointments, I walked, stretched, suffered, strengthened, trained, laughed, was poked, pushed, and manipulated (physically, mentally, and emotionally), heated, iced, lasered, and “stimmed.” I was ultimately healed, and my back is incredibly healthy (I just knocked on my wooden desk).

Why am I boring you with a story that is mostly only fantastic to me? I share my story because I believe my story is quite average. You all have similar personal stories, and you all have treated thousands of patients who have had similar experiences. The purpose of sharing my story is to remind us all of the incredible impact that more appointments and more intervention provided by a large team of providers can have on outcomes.

My perception reveals to me that our profession is busy racing to the bottom of the health care world. We are racing to provide fewer appointments, fewer interventions during those appointments, and to ensure that those interventions are closely held and only provided by a single practitioner.

My experience with my injury and rehabilitation has confirmed for me that I am not interested in joining the race to the bottom. I am not interested in joining the race to the bottom of the health care hierarchy by suggesting fewer interactions, offering fewer interventions, and insisting that I am the only person able to provide care for my patients. I am choosing rather to climb to the top of the health care market by proving my value to my patients, not by providing less, but rather by providing more.

I am not interested in providing my patients with fewer visits; I am going to offer my patients more appointments. Most patients seek our physical therapist–owned clinics because of pain—why send them away for two, three, or even four days until their next appointment when we have an incredible array of skills and tools to reduce and control those symptoms?

I am not seeking ways to minimize my interaction with my patients; I am seeking ways to maximize our interactions. Why race to provide fewer interventions during a treatment? Why discount the temporary, even if possibly placebo effect, of modalities. During my last knee surgery, I was offered anesthesia. I knew the effects would only be temporary, the anesthesia would eventually subside, and my pain would return. Yet, I still opted for the anesthesia. There is great power in temporary relief. Why not provide temporary relief to your patients while your talents to change muscle, improve joint function, and modify behaviors take their needed time to make long lasting differences?

Why race to minimize our impact on society by limiting the care we can direct? I was thrilled with my team of rehabilitation providers all committed to my progress each and every visit. Why are we insisting that the only impact physical therapists can have on their patients is when the therapist and the patient are having direct and intimate contact? I am committed to having a great impact on my world with my ability to affect many more patients’ lives by directing a team of providers.

I understand many factors are involved with the idealistic approach I am professing—factors such as patient choice, work schedule, insurances (or lack thereof), copayments, and life. I completely understand that every patient episode will not be as well scripted as my personal episode. I am simply suggesting that racing to provide less is not necessarily helping us achieve our goal of climbing to the top.

I am committed to giving my patients everything I have in my arsenal to return them to a pain-free fully functioning status, and I am committed to using a team of wonderful providers to ensure that my patients have incredible outcomes and an incredible experience as we climb to the top of the health care marketplace. 

Kevin Hulsey , PT, DPT, is a PPS director and the founder and chief executive officer of RehabAuthority, LLC. He can be reached at kevin@rehabauthority.com.