I have very active grandparents. My grandfather hikes all of the time my grandmother goes for walks. I remember that I was getting frustrated in class learning about the older adults because we were taught and how they were undertreated. I really loved FOX because we’re working to try and fight this ageism.
Welcome to FOXcast Physical Therapy, a podcast a for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.
Jimmy McKay, PT, DPT: Welcome to FOXcast PT. I’m your host physical therapist Dr. Jimmy McKay. On the program with us today a colleague from FOX Rehabilitation, Megan Mitchell. Megan, welcome to the program.
Megan Mitchell, PT, DPT: Thanks for having me, Jimmy.
Jimmy: Megan just so the audience knows where are you located within…
I have very active grandparents. My grandfather hikes all of the time my grandmother goes for walks. I remember that I was getting frustrated in class learning about the older adults because we were taught and how they were undertreated. I really loved FOX because we’re working to try and fight this ageism.
Welcome to FOXcast Physical Therapy, a podcast a for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.
Jimmy McKay, PT, DPT: Welcome to FOXcast PT. I’m your host physical therapist Dr. Jimmy McKay. On the program with us today a colleague from FOX Rehabilitation, Megan Mitchell. Megan, welcome to the program.
Megan Mitchell, PT, DPT: Thanks for having me, Jimmy.
Jimmy: Megan just so the audience knows where are you located within the practice footprint?
Megan: I’m in New Jersey central one, so near the monroe area.
Jimmy: And a new grad because you just graduated when?
Megan: I did, I graduated from the University of Maryland in Baltimore. This May, so very recent.
Jimmy: Very fresh as we call them fresh PT’s. You reached out. You wanted to talk about something that had come up in your in your career no matter how new or long it’s been around this topic I thought was applicable to everybody and it’s ethical considerations in managing patient expectations. Why’d you want to talk about that with us and the audience today?
Megan: Yeah a couple of reasons. Most recently I think that’s relevant to everyone is that article that came out, the Readers Digest about the 14 exercises that you shouldn’t do if you’re over the age of 50. The reason why it this applies is because there is this mindset now that older is old and you can’t do certain things. And it’s not new but the more there is in public on social media it makes my job harder because I’m no longer just having to work with the patient. But I’m also having to manage my patients family and what they expect for their patients to do. And this was just something that I wasn’t really taught in school and I wasn’t exactly prepared to do when I got out. It’s not really what sparked it was this that this was a challenge that I have found that I wasn’t really expecting to find.
Jimmy: One of those things that comes up unexpectedly that all of a sudden becomes a big part of your daily life right?
Megan: Right. When I did my internship I worked a lot in orthopedic clinics. There we actually had a lot of patients that have persistent pain. And for me my biggest challenge was try to manage their expectations in a way where like perhaps we can’t reach 100 just yet. Let’s shoot for maybe a smaller goal and work slower using graded activity and graded exposure. But here it’s almost the opposite. My clients have such low expectations for themselves and I’m finding it difficult to try and flip the switch into making it so that they can expect more for themselves.
Jimmy: We’re going to go through some and take away points that the audience can take with them as they go out and work with individuals in their daily lives. Where do you want to start?
Megan: One of the biggest things that I struggled with was how far should I go and when should I stop? Because ultimately it’s my patient care. And I’m supposed to be working with them to reach their goal. And for me I had a very hard time. I’m still obviously having a hard time trying to figure out that balance. So I think one of the first takeaway points is that it’s very important to have a conversation, an open and honest conversation with your patient from the start. I think was something that I didn’t it to with my first couple of clients. So when we were doing the evaluation I would ask them for their goals and then I would just move on and these are great goals. Let’s work towards them but in the back of my mind. I knew that we could have let loftier goals for ourselves because they can reach them. What I started to notice is that when I have that conversation at the very beginning just introducing the fact that they possibly can do more than they had originally thought. I think that’s important. I don’t think that I had set the stage right with my first couple of clients that I noticed now that you definitely can’t go insane. Oh no no well you don’t need a walker at all. We’ll be able to get you walking down the block to get your mail without a walker. Because sometimes that seems slightly overwhelming to them especially if they’ve been told that they have to use a walker so they don’t break their hips so that they don’t end up in the hospital. But they do think that just frankly not in at the beginning so that they’re aware that they might be capable of more than they thought is a really good first approach. Which I wish I had started doing with all of my patients.
Jimmy: So set some reasonable expectations for function for pain whatever it is that you’re actually working on with that individual.
Megan: Exactly. And reasonable in the sense that I think the bigger problem is that they don’t think that it’s reasonable. Or their family members don’t think that it’s reasonable and that’s the biggest challenge that I found working with the older adult population is that the goals that I’m trying to set that they feel that they are too high. It then ends up making me question Should I even be trying to have such high goals for them?
Jimmy: That’s really a good example of why managing those expectations is something to focus on right from the start.
Megan: Exactly exactly. That’s only half of it. You have to start with this dialogue and have this kind of conversation with them. So that when you then say. “OK well we’re going to try without the Walker today.” They’re not thrown off because their goal is to walk with a walker to their mailbox.
Jimmy: So what’s the next takeaway point that the audience should pay attention to?
Megan: I have to have a very honest conversation with myself and just remind myself of what my role is as a physical therapist. Because I think I struggled with trying to find that balance of working with my patients toward what they want because ultimately it is their health care, it is their plan, their treatment, their life. With knowing that as a healthcare professional that I want to get them to the safest most optimally functioning, living their lives as possible. I guess I had to just take a look inside and didn’t really figure out for me what was most important. How I can treat my patients where I am being honest with myself as well as doing what they need. Because I think if I were to just treat my patients with the goals that they set, I think I would be ultimately doing them a disservice. Because I think that they can do so much more. The ultimate problem is society setting these lower expectations for older adults. And it’s not so much that they physically can’t do it or that they don’t want to do it but they don’t even know that they can do it.
Jimmy: How do you figure that out. How do you figure out how much to push and push individual and how far can you push?
Megan: I would love to know the answer to that. So I have two wonderful mentors with FOX, Heather and Kim. As well as I work with a Physical Therapist and an occupational therapist and we had this conversation a lot. Because we often struggle with we want to do what makes our patients happy. But we also want them to be able to live meaningful and fulfilling lives. It’s definitely a case by case scenario. And I think where I draw the line is if I’m trying to push a patient and it’s to the point where they no longer want to participate in therapy, that’s when I draw back. Because I’d rather have them do something then nothing. But if they are feeding into the program and they are succeeding then I want to see how far I can go with them so that they can rejoin society. I think I work a lot most of my patients are in assisted living facilities. I find that that setting sometimes is often more challenging because everything is right there for them. They are very content with just walking from point A to Point B. In yet there they’ll come to me and tell me that they wish they could do more that they wish that they could go out with their friends or go outside because some of them are even too afraid to go outside. And I know that they want it, it’s just trying to find the right way to get them there. Finding the right balance is definitely hard. If they’re still participating in therapy and we still have that trust and good rapport then I’m going to go as far as I can with them. Because I want that to have a happy and fulfilling and active life doing the things that they want to do.
Jimmy: Last takeaway point for the audience working on ethical considerations when you’re managing those expectations. What’s your final takeaway?
Megan: I think this one is more for students and educators. I felt like there was a lacking in education on how to deal with patient expectations. I certainly have patients that have higher expectations than what we might be able to achieve in a particular time frame. It’s one of those soft skills that we need to develop more and work actively toward. Being a great manual therapist or skilled in evaluations is essential. But the soft skills of being able to talk with a patient build rapport and their trust and then be able to lead them in effective plan of care. It’s challenging and it’s definitely something that we have to continue to work on. I would love to have more conversations with people on this on how we can develop these skills to be better for our patients.
Jimmy: Glad you brought this up because I know it’s something that comes up and likely comes up in silence especially with new grads who who maybe run into this but don’t know how to address it at all because as you mentioned before it’s not always brought up in school or if it is it probably isn’t brought up enough.
Megan: It was definitely mentioned and it’s hard because I understand how much information we have to learn and so maybe it’s something that we do outside of the curriculum. But yes it’s so essential for us to be able to connect our patients and then ethically know where we should take it. How far can we push them and how much is that really if this is what they want then that’s OK.
Jimmy: Last part of the show here on FOXcast is your FOXtale. Meghan why did you decide to work with older adults?
Megan: I have very active grandparents my grandfather hikes all the time my grandmother goes for walks. I remember that I was getting frustrated when I was in class learning about the older adults because you were actually how they were undertreated. And I remember bringing this up with my grandfather and writing just a little piece just for him about how I wanted to work with athletes or those active individuals and those that maybe aren’t active but want to be active. And you he brought up you know well why don’t you specify that you want to work with older adults? And I said why do you see yourself as a separate category why don’t you see yourself as an active individual? I really love FOX because we’re working to try and fight this ageism. Yes we are treating only the older adult population there are individuals that have health care needs and that just want to get back living an active lifestyle.
Jimmy: Megan Mitchell a physical therapist new grab with FOX Rehabilitation in New Jersey. Appreciate you taking some time out of your busy schedule to talk to us today.
Megan: Thanks you so much Jimmy.
Jimmy: Thanks for Listening to FOXcast PT. It’s brought to you by FOX Rehabilitation. Fox clinician’s work hard love their work and get the respect they deserve. Sound good? Then you’ll love the autonomy to work in your own style and the support you get to achieve excellence. Plus freedom and flexibility to have a personal life. Whether it’s your first day or you’ve been around for a while. Your contribution is acknowledged and rewarded. That’s what makes FOX a success. Happy well-trained clinicians make great health care. Are you a fit for Fox? Find out now at FOXRehab.Org
