As my long time readers know, I occasionally use the Ehell blog as a platform for public service announcements based upon my own experiences. May is EHell’s own Melanoma Awareness Month after I had been diagnosed with malignant melanoma and underwent a 4 hour operation and biopsy (all clear!) seven years ago. February is the month for Ehell’s Gynecology Cancer Awareness instituted after I had a hysterectomy 3 years ago to treat uterine cancer. (My oncologist said if one has to get cancer, mine was the “best”, i.e. least aggressive, slow growing and I did not need radiation or chemo. Ask me about the Da Vinci surgery robot! It’s awesome!) I have been gratified and thrilled when readers have privately messaged me to report that, based on those PSA posts, they saw their doctors and discovered skin cancer early enough to treat successfully or had pelvic exams/PAPs and caught a cancer early. *That* is what makes publishing a blog so worthwhile.
October is National Physical Therapy Month and we are celebrating it here on Ehell because I’ve been in Physical Therapy since July of this year for first a shoulder problem I had put off for months and then as fate would have it, I injured my already compromised pelvis and started PT for that. I retired from wedding planning about 7 years ago in large part because my lifelong problems with my hips were worsening and I just couldn’t physically do the standing and walking needed throughout the wedding day any more. So I started PT on my hips with a great deal of trepidation and fear of those big spasms I knew I could experience.
I bring a blue hand towel (affectionately known as “Old Blue”) with me to PT sessions which I use to cover my face and head during the TENS/Stim and heat pad segments, the better to hide tears of frustration sometimes. But my PT Guys have consistently been positive and encouraging because they have a long term perspective and confidence in physical therapy’s evidence based treatment modalities. I’ve peeked out from under Old Blue, with tears glistening in my eyes from a tough PT session, to see a PT Guy squatting by my table telling me I am not going backwards, that all of this is normal and expected. RAH! RAH! Cheer me on, PT Guy! And sure enough, after over 18 months of near constant pain and spasms in the left hip, that all ended within weeks of starting therapy. It’s a freaking miracle! I began to refer to my left hip by its new name, “Maximus, The Gladiator Glute”. The right hip is my problem child taking a lot longer to decide that spasm tantrums are not the road to happiness before we could progress to improving strength. It would not be an exaggeration to say that physical therapy changed my life in a way I did not realize could happen. Thanks, PT Guys!
Lest anyone think that all my PT sessions are characterized by crying, twitching and pain, there has been a lot of joking going on, too. I try my darnedest to get the office receptionist and the PT Guys to laugh and I usually succeed. Look forward to a future Feel Good Friday where I reveal my ongoing “behind the scenes” running joke with the PT Guys.
Physical Therapy is unlike most medical professions in that the patient and therapist spend a considerable amount of time interacting with each other. I’ve spent far more hours in hands-on therapy with the PT Guys than all my oncologists, allergy nurses and PAs combined. So, it stands to reason that with that much interaction going on, there should be etiquette guidelines to frame expectations and how to relate as patient to medical professional. And thus I present Ehell’s…
Physical Therapy Etiquette
1. Physical therapists are medical professionals. Doctors of Physical Therapy attend 3 years of postgraduate studies to acquire that degree, must pass licensing exams, and adhere to strict ethical and board standards. They are not massage therapists, fitness trainers, or masseuses so don’t call them that. Ever. “Masseuse”, in particular, can having an icky connotation so don’t go there.
2. Do your homework. I think some patients have an unrealistic expectation that going to PT once or twice a week will miraculously cure them of what ails them with no expenditure of their own effort towards their recovery. PT is a therapeutic alliance between the patient and the therapist where the maximum benefit is achieved when both parties do their best job. When only one part of that equation is working, results will be mixed at best. Don’t lie to your therapist claiming you did your home exercises and stretches because while your lips are telling fibs, your pathetic muscles are telling a different tale and therapists have an uncanny ability to hear your muscles’ whispers of woe.
3. Watch those boundaries! Because there is more time for talking during multiple sessions, there can be a temptation to cross verbal boundaries both intentionally and unintentionally. There are social and personal boundaries your therapist may not want to cross. I try to pay attention to what the therapist is NOT saying and use that as a guide as what areas of conversation I should avoid. For example, your therapist may refer to his/her spouse and children but if he/she never mentions their names, don’t ask for those names. If your physical therapist brings up a topic of conversation, it can be safely assumed that you can enter the conversation, too. I try to avoid contentious topics such as politics solely out of self preservation. Topics like that make me tense which seems to defeat the purpose of being there. When in doubt, ask. Unsure as to whether giving a small Christmas gift (a book) to both therapists’ small children was appropriate, I asked the office secretary for guidance.
I am a gregarious extrovert and I have no problem talking with complete strangers. As the proverb says, “In an abundance of words, sin abounds”, and the more one talks, the odds of saying something really stupid increases. And trust me, I can definitely say stupid things quite innocently and then realize later that what I said wasn’t the best choice of words. Fortunately my Dr. PT Guy is exceptionally adept at diverting the conversation to new topics, a conversational skill Ehellions know and refer to as “beandipping”*. He does it so seamlessly that I often don’t realize he’s masterfully changed the subject. Dang, he’s good at it.
And it should go without saying that sexual innuendos and references to sex are completely off limits. Yes, I know we live in a hyper-sexualized culture where even dog food, adult incontinence pads and Chlorox are advertised on TV using sex and you have to cover your children’s ears during the evening news on the latest political drama. But suggestive comments, deliberate innuendos and any sex talk is a major disservice to your physical therapist who is bound by state and board ethics standards. Don’t lead your therapist into temptation by doing or saying anything that could make them feel instantly awkward around you and potentially damage his or her career.
4. Put the cell phone cell/camera away. Some clinics have very explicit directions to put away the cell phone and strict prohibitions against cameras in order to protect the HIPAA privacy of other clients. It makes sense that if you, as the patient, are to devote your attention to following your therapist’s directions, you need to not be distracted with looking at a cell phone or taking phone calls. Your scheduled appointment time will likely be paced to include any number of modality treatments and if you are delaying that by talking on the phone or looking at some text, you will not benefit as fully from PT and you risk running over into someone else’s time.
The camera thingy should be common sense but no, some things are not always obvious. During PT for a shoulder issue, I wanted to take a photo of a pulley system I had been using so that my husband could see it and make one for me. Another patient was using the piece of equipment and while I knew enough of privacy to not take a photo of the patient, neither the physical therapist nor the patient were privy to my understanding or intentions. My physical therapists are great guys but none of them possess the talent to read minds despite their uncanny ability to know when you did not do your home exercises. All my physical therapist could see was me preparing my iPhone to take a photo so he calmly and quietly asked me to not take that photo. I was baffled because I was intending to only take a photo of the equipment and queried him further, “Why?” He replied, “It’s a HIPAA issue.” I was still confused…how can it be a HIPAA issue to take a picture of a piece of machinery? Is this a guy joke? I remember scanning his face to see if there was any indication that he was pulling my leg. He does have a very dry sense of humor. What seemed like seconds ticked by while I tried to read his face and mentally sort out my own confusion. Finally the corner of his mouth went up in a small smile which I interpreted to mean “Please” and I nodded “yes” slightly to convey that I understood him and I put my iPhone away.
It was only later that the full ramifications of what I had done hit me. I had placed my PT Guy in an awkward position where he was compelled to protect another patient and had I been obtuse and continued with my goal the situation could have escalated to at least one of us being unhappy. None of us is entitled to make other people’s lives more complicated or difficult.
5. Clean thyself. That means come to physical therapy having showered before and wearing clean clothes. I added this “rule” at the recommendation of several Ehell readers who apparently experienced patients in states of varying degrees of uncleanliness. I’m sure, as medical professionals, physical therapists have seen, touched and smelled it all but, please, don’t inflict more of that on your hapless therapist.
6. Give your therapist the benefit of the doubt. Not every protocol or modality works with every patient and since your body is different than everyone else’s, your therapist may have to try different approaches to find the right treatment that fits your needs. Early on in my therapy on the hip, PT Guy tried a common massage technique of pressure and release which, under usual circumstances, disrupts muscle spasms. It had the opposite effect on me and within seconds things went from ouchy to epic miserableness. I couldn’t see his face but I imagine his reaction was, “Holy CRAP! What just happened?! Gotta fix this!” I could have hobbled out of that clinic that day believing more harm than good had been done and itching to write a scathing online review but I trusted the long term vision, trusted in the PT Guys’ belief of a positive eventual outcome and stuck with it. Best decision ever.
6. Say “Thank you.” My PT Guys have a strong desire to see people get better and I appreciate that level of career dedication. Sometimes a PT session isn’t as fun as everyone would like but say “Thank you” anyway. If someone is changing your life to be better, expressions of gratitude confirm to them that at least one patient acknowledges the work they do. Having an attitude of gratitude makes you a happier person, too!
*”Beandipping” refers to the conversational tactic of changing the topic of discussion by redirecting people’s attention to talking about something entirely different. The classic Ehell example of beandipping is being at a party and someone asking an impertinent, invasive question or strays into a topic you would rather not engage in and you respond saying, “Have you tried the bean dip? It’s especially delicious. Emma made it and her dips are always so tasty.”