Yesterday I was at the pool in my apartment complex. Many students live there, so it is common to see other Palmer people. I did not know the two girls I saw there yesterday. As the sun streamed onto the patio, I could hear their words wafting over me; I could tell they were in 3rd quarter. The gist of the conversation was that an upcoming test would be "straightforward." It suddenly occurred to me that I was once like that too. I once thought things were simple.
The 3rd Quarter Change
While in quarter three, it is easy to think that information is coming together. In reality, it is... but not in the way I once thought. In quarter three, I was at the stage where I was starting to know things--about anatomy, about physiology, about some chiropractic techniques, about physical exams. I synthesized this information and began to make some clinical prediction rules for myself. I thought I could give all sorts of advice. So did these girls. They were advising each other on various topics from sunburns to headaches, using the vocabulary that they had just made vernacular. It made me smile with the bittersweet nostalgia that a parent might feel--children becoming adults, students becoming doctors.
The problem with this change is that it isn't complete. Quarter 3 is the end of the first academic year. One year into the curriculum, students know enough to be dangerous and cocky. I did too. There are three more times this happens. After qtr 5 when all the chiro techniques have been learned, after qtr six when anatomy lab ends, and after the first part of boards when everyone is an "expert" on microbiology and pathology. At each of these times I felt like I ruled the world. Little did I know how much more there was to learn.
Now
Patients make all the difference. No one presents like a textbook, no one will comply with a treatment plan without patient education, and unfortunately, no one knows the things students take for granted. All of this is valuable information to know, but it also makes an interesting distinction: as I have reached the terminal end of my education, I know enough to know that I don't know much of anything.
A New Frontier
I love star trek. The thing I love most about it is the idea that we can explore new places and discover things for which we do not have even a concept. I feel like this experience is well paralleled by Palmer Florida. Before setting out into space, humans have no idea what is out there. We can't conceive of things we have never been exposed to. There is a certain amount of certainty to this position. We know a variety of things and we don't even have language for anything else. It isn't until we get into the upper quarters that we realize being in school means essentially nothing. Practice is a big galaxy full of things we have never even thought of. Luckily, as a student I learned all the information I am going to need eventually, but I will never again be arrogant enough to think that I "know" anything for certain.
The other day, I was talking to my mentor in the clinic, Dr. Beres. She made a very interesting point. One of the most interesting things about evidence based practice is that it changes all the time. Since new things are being discovered and proven through research and experience constantly, it is never wise to scoff at anything. Anyone who says he/she has "the way" to practice is misguided and conceited, because no one can know what is out there in the healthcare "galaxy" without a vehicle for traveling there. A student's best vehicle is openness to realize how little we actually "know."
Monday, May 23, 2011
Monday, May 9, 2011
Too Long
I haven't blogged in a ridiculously long time. Sorry readers! As my life in the clinic has ramped up, I have been forgetting things. I suppose that is reflective of a very good problem--having plenty of patients!
The last time I wrote about the clinic I was rather overwhelmed. In retrospect, I can see that everyone felt that way when we started. At the time, however, I felt like it was just me--drowning in a sea of paperwork. Now, everything is starting to seem easy, and it feels so fantastic.
The most fantastic thing about clinic is seeing patients. This is what we have been waiting for, after all... And even better than seeing patients is seeing patient become well. I have learned a few things over the last several months about patient care, which I think are worth sharing.
Less is usually better
As part of a conservative care plan, we sometimes get into a habit of giving everyone all the modalities we can possibly think of. We do this because we have learned such a large body of information about care. We think, "well, if one thing is good, then everything must be better!" Humans are like this in general, just think of crash dieting and weekend warriors to get the picture. In my experience with patients--however brief--I have noticed that the less I do, the better the outcome. Careful decision-making between treatment interventions leads to more patient-centered, specifically-tailored care, which can only be beneficial. So instead of employing all your tools at once, methodically choose a few and carefully measure the outcomes. Which brings me to my next point...
A Better Understanding of Evidence Based Care
During the younger quarters of Palmer Florida, the term "Evidence Based Care" gets thrown around a lot. Unfortunately, it got sort of a bad connotation among some members of my class. This was mostly due to a misconception of its components. Due to its name, some of us started to believe that it included only those treatment modalities which have been irrefutably scientifically proven. In reality, these fully-studied treatment interventions account for only 1/3 of the Evidence Based Care Model. Another third is supplied by clinical experience of the majority of the profession. So if a specific technique or treatment model has been shown to "work" by a significant portion of the population, it is included in the EBC Model. The last third--and what I consider to be the most important aspect--is made of patient goals and expectations. This portion is so important, it needs its own heading...
Patient Goals/Expectations
During undergrad, in my study of Medical Anthropology, I saw countless studies on patient beliefs and care outcomes. One of the themes that ran through these is the relationship between patient involvement and positive outcome in conservative care. When people feel like they have an important "job" to do during their care plan, they seem to improve more quickly and more completely. All this being said, in the EBC Model, we give patients the tools they need to be a partner in their own healthcare journey. Tools which will get them to whatever goal they have. This goal may be simple--to get out of pain, to run a mile, to pick up a child without difficulty--but these goals can also be more complex. (ie. losing weight, feeling "well," increasing athletic performance.) No matter what the goal, the EBCM Practitioner will assist the patient in meeting those goals, all the while, educating the patient on all relevant aspects of healthcare. This gives us a title, in addition to diagnostician, clinician, and technician, which I believe to be the most important of all: Teacher. After the goal is met, the patient may be released from care, or may set a new goal. Either way, the patient is responsible for a portion of their wellness and therefore, empowered to make decisions and get well.
In addition to these exciting revelations I've had these last few months, I have made some neat plans. One of which includes a student work Visa for India!
Clinic Abroad Trips
Here at Palmer Florida, when a student reaches quarter 10, he/she can apply for a clinic abroad trip. These trips go to a variety of developing nations and provide primary and chiropractic care to residents of these nations at no cost. Each of these trips lasts around 3 weeks and includes about 20 students, which some from each of the Palmer campuses. In June, I'm leaving for India. I'm very nervous, actually, which not my normal state. I'm excited too, though. I am looking forward to practicing my primary care skills in an environment where I may be the first doctor these patients have ever seen. During the trip, I hope to blog about the experiences in here. It is something I would have wanted to read about as a prospective student.
So all in all, I think that the clinic has majorly changed me--both as a clinician and as a person. My paradigm has been more solidly established, and I'm looking forward to finishing my requirements and implementing some of the things I have learned into my practice in real life. I only have to wait until December 16th, 2011. :) It gets closer every day.
The last time I wrote about the clinic I was rather overwhelmed. In retrospect, I can see that everyone felt that way when we started. At the time, however, I felt like it was just me--drowning in a sea of paperwork. Now, everything is starting to seem easy, and it feels so fantastic.
The most fantastic thing about clinic is seeing patients. This is what we have been waiting for, after all... And even better than seeing patients is seeing patient become well. I have learned a few things over the last several months about patient care, which I think are worth sharing.
Less is usually better
As part of a conservative care plan, we sometimes get into a habit of giving everyone all the modalities we can possibly think of. We do this because we have learned such a large body of information about care. We think, "well, if one thing is good, then everything must be better!" Humans are like this in general, just think of crash dieting and weekend warriors to get the picture. In my experience with patients--however brief--I have noticed that the less I do, the better the outcome. Careful decision-making between treatment interventions leads to more patient-centered, specifically-tailored care, which can only be beneficial. So instead of employing all your tools at once, methodically choose a few and carefully measure the outcomes. Which brings me to my next point...
A Better Understanding of Evidence Based Care
During the younger quarters of Palmer Florida, the term "Evidence Based Care" gets thrown around a lot. Unfortunately, it got sort of a bad connotation among some members of my class. This was mostly due to a misconception of its components. Due to its name, some of us started to believe that it included only those treatment modalities which have been irrefutably scientifically proven. In reality, these fully-studied treatment interventions account for only 1/3 of the Evidence Based Care Model. Another third is supplied by clinical experience of the majority of the profession. So if a specific technique or treatment model has been shown to "work" by a significant portion of the population, it is included in the EBC Model. The last third--and what I consider to be the most important aspect--is made of patient goals and expectations. This portion is so important, it needs its own heading...
Patient Goals/Expectations
During undergrad, in my study of Medical Anthropology, I saw countless studies on patient beliefs and care outcomes. One of the themes that ran through these is the relationship between patient involvement and positive outcome in conservative care. When people feel like they have an important "job" to do during their care plan, they seem to improve more quickly and more completely. All this being said, in the EBC Model, we give patients the tools they need to be a partner in their own healthcare journey. Tools which will get them to whatever goal they have. This goal may be simple--to get out of pain, to run a mile, to pick up a child without difficulty--but these goals can also be more complex. (ie. losing weight, feeling "well," increasing athletic performance.) No matter what the goal, the EBCM Practitioner will assist the patient in meeting those goals, all the while, educating the patient on all relevant aspects of healthcare. This gives us a title, in addition to diagnostician, clinician, and technician, which I believe to be the most important of all: Teacher. After the goal is met, the patient may be released from care, or may set a new goal. Either way, the patient is responsible for a portion of their wellness and therefore, empowered to make decisions and get well.
In addition to these exciting revelations I've had these last few months, I have made some neat plans. One of which includes a student work Visa for India!
Clinic Abroad Trips
Here at Palmer Florida, when a student reaches quarter 10, he/she can apply for a clinic abroad trip. These trips go to a variety of developing nations and provide primary and chiropractic care to residents of these nations at no cost. Each of these trips lasts around 3 weeks and includes about 20 students, which some from each of the Palmer campuses. In June, I'm leaving for India. I'm very nervous, actually, which not my normal state. I'm excited too, though. I am looking forward to practicing my primary care skills in an environment where I may be the first doctor these patients have ever seen. During the trip, I hope to blog about the experiences in here. It is something I would have wanted to read about as a prospective student.
So all in all, I think that the clinic has majorly changed me--both as a clinician and as a person. My paradigm has been more solidly established, and I'm looking forward to finishing my requirements and implementing some of the things I have learned into my practice in real life. I only have to wait until December 16th, 2011. :) It gets closer every day.
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