“So what can you actually do for me?”
Through my interpreter, it was difficult to determine the tone in which my elderly patient asked her question, but that raised eyebrow said it all.
It had been 7 months since starting my orthopedic residency in Beijing, China for the University of Southern California (USC) and this question seemed to come up a lot. Which is not surprising, seeing how physical therapy is still a brand new profession in China.
Most individuals in this country have never even heard of physical therapy - let alone actually been treated by a PT.
But things are starting to change. Dr. Joe Godges, the director of the USC orthopedic residency program in Beijing, has been working diligently to improve the physical therapy profession in China. Which was one of the driving forces of why I wanted to come to Beijing.
One of our roles here has been to educate and help train Chinese therapists in the evidence-based practices we use in the United States. It has been a challenging, but rewarding, experience as I work with motivated individuals who want to do better for their patients.
So let’s get back to our patient. What could I actually do for her?
She had tried Traditional Chinese Medicine, including acupuncture, massage, and cupping, but nothing seemed to help her neck pain. After a quick assessment, it appeared quite straightforward in my mind. The patient was constantly sitting in a forward head posture with a stiff upper thoracic spine.
Nothing a few therapeutic exercises and patient education on proper sitting posture couldn’t help with.
Adjusting the plan of care
Passive versus active treatment strategies have had a lot of press as of late. Study after study has shown that performing interventions that the patient has to be involved with are much more effective than only providing passive treatments. This is especially true with our more chronic pain patients. This knowledge is well known in the States, but in China, where they trust an instrument’s ability to determine what is wrong with a patient more than a skilled clinician’s, we run into a little bit of a problem.
How could I convince this patient to try something new? Something foreign? Something that might actually make her sweat a little…?
A lot of patient education! And showing her during her initial evaluation that certain individualized exercises could make her feel better.
Prior to my residency, I spent too much time on my subjective exam and objective testing. I’d have a few minutes at the end to throw in a couple of things they could work on at home, knowing that they would likely come back for their follow up appointments.
Demonstrating the value of physical therapy
This has been one of the biggest lessons I’ve learned from working in China. The education I provide to my patients needs to not only be about their diagnosis, but about what physical therapy can actually do for them. Its has made me realize that patients in the US need that same level of education as well.
Too often I took for granted that they knew what a physical therapist was. But did they actually understand their plan of care? Why these specific exercises were given to them? I know when I return to the States, I will do a much better job at selling my skills.
So what is next for the USC orthopedic residency program in Beijing? Well, the program is expanding, hopefully moving to Shanghai next year with the goal of spreading to other major cities around China. My colleagues and I are optimistic that once more information gets out there about physical therapy, the profession will really take off!