The Conscious Clinician Podcast

Episode 38: Physical Therapist Growth Spurts

In this episode, we share our growth-spurt experiences as physical therapists. We realized during mentoring that ALL physical therapists experience growth spurts. It’s how we evolve our clinical practice! So long as we keep learning, there will always be periods of change followed by periods that are more steady as we integrate the new information into our practice. We also share our signs of being in a growth spurt and tips for navigating these with less overwhelm! 
 
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
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Episode 37: When PT Is Not The Answer

We have spent 36 episodes exploring how to work with someone, build better rapport, collaborate,  move past our own and the patient's roadblocks to improving our quality of care and work. We realized that we haven't talked about when PT is not the answer and how we know we need to end care.
In this episode, we explore the reasons why you may choose to recommend discharge, including what we say and examples of how we handle these conversations. We can practice within our ethics AND support the patient to get the care that’s best for them. 
 
Highlights from our conversation in Episode 37
(0:34) Introduction
(1:24) Ruling out medical red flags
(2:39) Psychological considerations
(7:52) Meaningful participation: cancellations, availability
(15:51) Mismatched PT treatment approach vs patient expectations 
(21:56) Lack of progress 
(33:30) Unacceptable patient behaviors
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Episode 36: Fear Avoidance in Patients & Providers

In this episode, we explore fear avoidance. As humans, we all experience fear and some of us exhibit fear avoidance behaviors. As people exhibit more fear avoidance, they also report higher pain intensity levels. This has consistently shown up in pelvic pain, pelvic girdle pain, and persistent musculoskeletal conditions. 
We talk through Sammy’s patient who exhibited high fear avoidance and how they began confronting it. We also explore how fear-avoidance influenced Monika’s clinical practice and how often we see this with healthcare providers. It’s not just patients who demonstrate fear-avoidance! In order to do no harm, we need to be aware of our own beliefs and how that shapes our practice too. We hope this one helps you consider fear-avoidance in your work! 
 
Highlights from our conversation in Episode 36
(0:34) What is fear-avoidance 
(1:45) A case of high fear-avoidance 
(4:50) Addressing the patient’s fears head-on 
(8:16) Graded exposure to reduce fear  
(12:26) Healthcare providers also demonstrate fear-avoidance!
(17:51) Factors that contribute to our individual differences in fear 
(20:32) Changing our own and our patient’s beliefs 
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 36
The fear-avoidance article we reference! (1:08, 12:41) Rainville J, et al. Fear-avoidance beliefs and pain avoidance in low back pain—translating research into clinical practice. 2011;11(9), 895–903.         doi:10.1016/j.spinee.2011.08.006     
(10:29) Episode 3: Identifying Patient's Readiness to Change
(20:45) Episode 5: All About Pain Catastrophizing 
Pop Up Pro Annemarie Everett, DPT, WCS (21:13) Episode 11: Authentic Evidence Based Practice with Dr. Annemarie Everett, DPT, WCS
Confronting fear avoidance beliefs with Katie (26:38) Episode 20: A Patient's Perspective of Conscious PT Practice with Katie
Additional listening: Episode 15: The Power of Understanding Patient Beliefs with Dr. Mike Nelson, DPT
 
Additional reading: 
Alappattu M, Bishop, M. Psychological factors in chronic pelvic pain in women: relevance and application of the fear-avoidance model of pain. Phys Ther. 2011; 91(10):1542-50. doi: 10.2522/ptj.20100368. 
Fakari F, Simbar M, Saei Ghare Naz, M. The Relationship between Fear-Avoidance Beliefs and Pain in Pregnant Women with Pelvic Girdle Pain: A Cross-Sectional Study. Int J Community Based Nurs Midwifery. 2018;6(4):305-313.
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Episode 35: Telehealth Tips for Physical Therapists

One of the few positives from the pandemic was the widespread access to telehealth medical services. Our bet is that it’s here to stay. We have been providing telehealth PT since March 2021. We recognize that while it’s convenient for patients and providers, it does change the way we interact with our patients. Additionally, providing telehealth from your own home creates unique challenges for providers. 
In this episode, we focus on how to prepare and care for yourself to provide telehealth. We explore the way that communication changes when it’s virtual and we offer tips that have helped us be more comfortable over video. Finally, we discuss the unexpected benefits of not touching patients, for them and for us. Whether you currently provide telehealth or not, this episode will stir up questions for you to consider that can advance your connection with patients! 
Highlights from our conversation in Episode 35
(0:34) Introduction 
(1:37) Ensuring patient privacy
(3:37) Curating your workspace 
(9:58) Self-care tips for clinicians providing telehealth from home  
(14:38) Building rapport 
(16:14) Identifying who to refer to in-person PT 
(19:08) Nonverbal communication 
(21:10) Expressing empathy over video 
(25:58) The unexpected benefits of losing physical touch
(32:58) Our thoughts on the future of telehealth 
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 35
Nocebo effect (17:31) Episode 12: Our Words Have the Power to Heal and Harm
Legislature and bills for telehealth (34:42) APTA Advocacy for Telehealth
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Episode 34: Managing Your Time In a Visit

Picture this: It's a long day. You're behind on notes. You're running late to see the next person and it just feels like the whole day is slipping away from you. And you're thinking, “What happened here and how am I going to dig myself out of this hole?”
In this episode, we focus on time management and the self-reflection required to identify strategies for change. We need to take a hard look at what factors are causing us to run behind, because it's not as simple as like, ‘Oh, I'm just running late all the time.” If you've tried all the basic time management hacks, and it’s not working, then it's not you! Those things aren't addressing the primary driver of your time management difficulty. 
We share strategies for change using The Seven Habits of Highly Effective People as our framework of discussion. We focus on the first three habits today: #1 Be proactive, #2 Start with the end in mind, and #3 Put first things first. Let us know what your favorite time management tips and reflections are in the comments!
Highlights from our conversation in Episode 34
(0:34) Introduction 
(2:03) Habit #1 - Be Proactive Prepping note, reviewing the documentation 
(4:06) Habit #2 - Start With the End in Mind
(9:33) Habit #3 - Put First Things First 
(13:13) Sticking with a plan long enough to see change 
(15:04) Developing your clinical reasoning 
(18:05) Self-reflection is our greatest tool for improving time management 
(24:45) Discussing time management with patients 
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 34
(1:43) The Seven Habits of Highly Effective People
(4:12) The Mountain Metaphor Episode 2: The Mountain Metaphor for a Healing Journey
(11:16) Pain Catastrophizing Episode 5: All About Pain Catastrophizing 
(11:34) Impostor Syndrome in Episode 18: Impostor Syndrome in Healthcare Providers and Episode 24: How to Thrive, Not Just Survive with Yolanda Johnson, MD, FAAP
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Episode 33: Providing Patient-Centered Care with Students & Observers

Picture this, you’re working with a new student or have someone shadowing you. They are eager to learn about your field and have tons of questions to ask you AND the patient. While you love their desire to learn, it’s also affecting the flow of the session. 
We’ve certainly been there, so in this episode, we dissect why and how having another person in the room affects patient-centered communication and care. This applies to observers, interns, students, mentors, and anyone else who might be a third body in the treatment space. 
We discuss 
How having an additional person in the room affects the way we providers interact with the patient
The power dynamics between all three (or more) of you  
How we can prepare the observer(s) and the patient for this interaction
The mindset shift that helps us create a collaborative win-win environment for the patient and observers 
Ultimately, when you're the person with the most experience in the room, it really is on you to use that experience to guide the session in a way that everyone wins or at the very least guide in a way where the patient gets what they need.  
Highlights from our conversation in Episode 33
(0:34) A case example 
(3:22) How another person affects dynamics between patient-provider 
(5:44) Preparing students/observers for the visit 
(8:27) Preparing the patient for the visit 
(9:28) Getting enthusiastic consent for an additional person
(13:34) Introducing students & mentors
(16:32) The patient is #1
(18:05) How does the dynamic change with 3+ parties in the room?
(23:46) The benefits of working with interns/students 
(25:40) Self reflection for clinical instructors/mentors 
(31:42) Outro
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 33
(9:28) FRIES Consent Model in Episode 32: Empowering Folks During Pregnancy, Birth, & Beyond with Dr. Tasha Darden, DPT, Doula
(26:37, 28:24) Impostor Syndrome in Episode 18: Impostor Syndrome in Healthcare Providers and Episode 24: How to Thrive, Not Just Survive with Yolanda Johnson, MD, FAAP
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Episode 32: Empowering Folks During Pregnancy, Birth, & Beyond with Dr. Tasha Darden, DPT, Doula

In this episode, we examine pregnancy, birth, race, and consent through Dr. Tasha Darden’s unique lens of pelvic physical therapist and doula. During her pregnancy, she realized “​​that it was really hard to find a doula that looked like me” and since has become the provider she needed. She shares all you need to know about doulas and how they support people in birth. But we can’t talk about improving birth outcomes without talking about consent and obstetric violence. Tasha shares the Planned Parenthood model of consent: FRIES along with tips for discussing birth trauma postpartum. Finally, we dive deep into the effects of misogyny, patriarchy, and racism on pregnancy and postpartum experiences. This is a MUST listen-to episode for anyone working with pregnancy/postpartum folks! 
--
Dr. Tasha Darden PT, DPT is a Pelvic Physical Therapist and Full Spectrum Doula. She is the owner of Physiodoula, which has a mission to help women shift from surviving to thriving in all phases of their lives. She is passionate about being an advocate in the birth room and in the greater Los Angeles community and has created a program called Reclaim Postpartum. It aims to support Black women and families in postpartum with supplies for parents and babies, meals, hands-on support, and access to free resources such as lactation consultants, physical and occupational therapists, mental health services, etc. 
Dr. Tasha feels that there is a lack of accessibility to basic pelvic and sexual health, especially in black and brown communities. She is active on Instagram sharing knowledge about all aspects of women’s health including self-care, holistic approaches to healing, optimizing pelvic floor function, body literacy, labor preparation, postpartum recovery, the impact of racism on health, and debunking pelvic health myths.
Highlights from our conversation in Episode 32
(0:34) Introducing Dr. Tasha, physiodoula!
(4:57) How pelvic PT and doula practice have helped her provide a holistic view with clients
(8:42) Defining birth trauma 
(12:47) Screening for birth trauma as a pelvic PT in a trauma-informed way 
(19:11) What is a doula, what they do, their training, barriers to and benefits of working with a doula
(30:31) Racism - not race - is responsible for poorer health outcomes 
(33:31) Defining obstetric violence
(36:00) Obtaining true consent with FRIES 
(43:40) What would happen if we started by saying we are partners in your care?
(53:11) Tasha’s Lightning Round
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 32
(2:09) Reclaim Postpartum Community Initiative in LA 
(23:20) Episode 26: Supporting New Parents’ Health with Catherine O’Brien, MA, LMFT 
(36:24) FRIES Consent by Planned Parenthood
Let’s Connect!
Follow Tasha @physiodoula on Instagram
Check out Tasha’s website www.physiodoula.com/ for more on her Pelvic PT and Doula Services 
Email Dr. Tasha via physiodoula@gmail.com  
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Episode 31: Patient Centered Plan of Care Development (SOAP Series #4)

In this episode, we finish with part 4 of the SOAP note series: Plan of Care & Prognosis. Often the plan of care is an afterthought, something we consider when documenting or perhaps the last 5 minutes of the evaluation when we schedule follow-up visits. So we asked ourselves “How do we form a mutually agreed-upon plan, which is realistic and considerate of the patient and the provider?” 
We share the tips which have helped us create more collaborative plans with patients and the assumptions and fears which have gotten in the way. Our own fears and psychosocial factors can affect the way we develop and show up for the plan of care. At the same time, we realize from this episode that there are so many ways to connect with patients to create a meaningful plan. We hope you enjoy this wrap-up of the SOAP series and would love to hear your thoughts on creating a patient-centered plan of care! 
Highlights from our conversation in Episode 31
(0:34) Introduction 
(0:52) Presenting the plan as an array of options for the patient 
(3:24) How do we get people to invest in the plan?
(7:05) Assessing readiness to change 
(7:58) Centering the patient within the plan 
(10:50) Redefining a successful plan of care 
(14:03) Understanding the patient’s goals and gauging their participation
(18:37) Do we have the physical, emotional, and spiritual space to support this person throughout their plan?
(22:05) Moving past our own fears to create a collaborative plan 
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 31
(6:22) Episode 2: The Mountain Metaphor for a Healing Journey 
(7:16) Episode 3: Identifying Patient's Readiness to Change
(14:11) Episode 6: History Taking Pearls & Pitfalls
(23:12) Episode 27: Evolving Pelvic Physical Therapy Practice with Meryl Alapattu, DPT, Ph.D. 
Missed an episode in the series? 
Episode 28: Taking a Patient-Centered History (SOAP Series #1)
Episode 29: Performing A Conscious Clinical Exam (SOAP Series #2)
Episode 30: Empowering Assessments (SOAP Series #3)  
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Episode 30: Empowering Assessments (SOAP Series #3)

In this episode, we continue with part 3 of the SOAP series: The Assessment. We have broken this section out into three key considerations: 
What is our assessment of the patient?
What information do we share with the patient? 
How do we keep reassessing throughout the plan of care? 
In addition, we also discuss examining our own biases in assessment, practicing new conversations with peers/mentors, focusing on solutions rather than impairments, and how to fold in biomechanical explanations in an empowering way. Tune in next week for Plan of Care tips! 
Highlights from our conversation in Episode 30
(0:34) Introduction 
(1:06) Shifting to a patient-centered assessment 
(6:45) Examining our own biases 
(8:19) How can we share our findings and plan with the patient in an empowering way? 
(15:14) An example: low back pain 
(17:49) Including tissue damage/healing into the biopsychosocial explanation of pain 
(20:11) Ongoing assessment 
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 30
(1:23) Episode 3: Identifying Patient’s Readiness to Change
Missed an episode in the series?
Episode 28: Taking a Patient-Centered History (SOAP Series #1)
Episode 29: Performing A Conscious Clinical Exam (SOAP Series #2) 
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Episode 29: Performing A Conscious Clinical Exam (SOAP Series #2)

In this episode, we continue with part 2 of the SOAP series: the Objective Exam. Most of us learned explicitly and implicitly from our training that the purpose of the exam is for us (the provider) to learn about the patient's body in order to create an appropriate plan of care. However, we’ve realized that the patient is actually learning about their body during the exam as well! 
Everything that we do during the exam process is teaching the patient something about their body. They are internalizing our language and reactions - for better or worse! So in this episode, we focus on tips to help us center the patient during the exam, to tailor each exam to the individual, and empower them with the exam process. Tune in next week for Assessment tips! 
Highlights from our conversation in Episode 29
(0:50) Start with enthusiastic and ongoing consent
(3:17) Paradigm shift: the exam is where BOTH you and the patient learn about their body  
(5:35) Empowering the patient by being mindful of our language 
(8:34) Shifting away from pain reproduction to symptom modification
(14:06) Selecting meaningful and easily reproducible exam measures
(22:35) Keeping the patient’s goals in mind 
(23:50) Modifying exam intensity
(26:50) Asking direct questions and giving succinct instructions 
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 29
This is part 1 of a 4 part series. Check out Episode 28: Taking a Patient-Centered History (SOAP Series #1)
(2:50) Episode 8: Trauma Informed Pelvic Health Practice with Dr. Krystyna Holland, DPT
(8:16) Episode 12: Our Words Have the Power to Heal and Harm
(12:51) Episode 10: Grounding Techniques for Patients and Providers
(19:21, 20:24) Episode 2: The Mountain Metaphor for a Healing Journey
(19:25) Episode 4: “The Fixer” Role of Healthcare Providers
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