I have a vow to myself to get better. I have a NEED to be a more effective doctor of physical therapy. This is because I don’t want to just settle and cruise with where I am. And I mean more then just technical skill. For my patients that are excellent candidates for physical therapy, I want them to succeed and meet their goals.
Case #1: Patient was referred for low back pain with prior medical history of fusion of right ankle. Now, I have my own opinions of fusion surgery to someone’s ankle. This is because unless it is absolutely medically necessary, ankle fusion can completely destroy the kinetic chain during functional movement–like walking, for example–all the way up to the neck. I treated this patient for pain because that’s what the patient wanted. She was a hard-working mom and daughter-in-law, and she didn’t want to do any of her strengthening exercises. She only wanted the manual treatment to get out of pain. I gave her numerous talks about how important strengthening exercises can help her with long-term gains. I saw her for 1 1/2 years with each time her insurance running out for that annual year. She was a loyal and happy patient, thus a returning patient every time. Until one day, she had a new back pain with radicular symptoms. Because of the complexity of her old low back pain, I couldn’t completely resolve her new back pain. However, I was able to reduce it and I was able to give her some exercises, as well as coping techniques with positioning and self-care techniques, to help her get through her day. But it never fully resolved. She still didn’t want to do her strengthening exercises. On the last day I treated her, she told me that she had to go in for surgery and she didn’t want to do it because of her prior experience with the fusion surgery to her right ankle. I never saw her again after that.
This is a case that I think about when I wasn’t skillful enough to stop a co-morbidity that was completely preventable.