Building Relationships with Older PTs

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“Arhhhhhh! I don’t care!”

That’s what I remember thinking when a physical therapist with many years of experience tried to correct me when I was only out of PT school for a year or so. She was trying to tell me about how great her Neuro-Developmental Technique (NDT) skills were and that doing some NDT pelvis work with a stroke patient in side-lying (who was already quite mobile) would restore their pelvic movement. I kindly accepted the recommendation but opted to do nothing with it. To be honest, I don’t really care for NDT anyway.

Working with older PTs and other clinicians (RNs, OTs, physicians, etc.) when you are a new grad can be wonderful. It can also be physical therapy hell. I had a similar occurrence when I was working with a different stroke patient and had another older PT try to correct me on a sit to stand exercise I had my patient working on.

The challenges and benefits of working with older PTs

We are all going to go through it - those awkward interactions with older, more experienced physical therapists who are likely just trying to help...but it feels like we're being undermined. Working with colleagues who have more experience is generally a great thing and let’s face it, one day we will be the therapist with a billion years of experience, so we might inadvertently wind up doing the exact same thing to new grads one day.

Luckily, I successfully negotiated those two situations smoothly while saving face for both of us. It was hard and I had to take some uncomfortable steps in order to make sure that situation did not happen again.

Save face for both of you if possible

Instead of starting your response off by saying, “I know what I’m doing!”, try your best to say “great idea” or “interesting” when speaking to older PTs who have given you advice.

For example, below is a good, productive response:

Dinosaur PT: “Justin, you really should have started with a slide board transfer.”
Me: “Interesting, thanks for the suggestion. I’m going to try this for now.”

Here is the quick and easy, but sometimes damaging response:

Dinosaur PT: “Justin, you really should have started with a slide board transfer.”
Me: “Ummmm, no. I know what I’m doing, I have a DPT you know!”

The first response acknowledges the older PT's experience and suggestion, but lets them know that you have confidence. The second response gives the impression that you are not open to suggestions and that you think you already know it all. It is also quite snarky.

Discuss the situation in private at a later time and do not gossip about it

When the older PT corrected me in front of my stroke patient with their family present, I was pissed, and rightfully so. I could have let it slide, complained to my supervisor, or confronted the PT in an immature way. Instead, I asked the PT if we could meet privately at lunch. She pleasantly agreed.

We sat down and she said, “I should not have corrected you in front of the patient and the family, you were doing just fine. “

I responded, “I appreciate you helping, but can I ask for your help before you give it? You have lots of knowledge that I’d like to gain.”

We actually had a big hug after that and our working relationship was excellent from there on out. She even invited me to her family Christmas party that year.

Disrupting long-standing beliefs

Be careful when disrupting experienced PTs' long-standing beliefs and practices. I have come into a few situations where I was discussing billing and rule changes with older PTs and they had no idea what I was talking about because they do not keep up on the subject.

Just this past year I was working at a hospital and we were discussing some billing issues related to productivity. I informed the PT who had well over 20 years of experience that physical therapy services are not reimbursed in the same way for patients who are admitted to the hospital as they are for outpatients. Physical therapy services are included in the DRG payment for patients admitted to the hospital.

I experienced a similar situation when I was working for a skilled nursing facility. I was helping a sister facility with some evals for the day and found out that the regular PT and physical therapy assistant (PTA) were putting short wave diathermy (SWD) on nearly every patient…this one was really strange.

I informed them both (after they asked me my opinion of course) that short wave isn’t really promoted in PT school anymore because it is a passive modality and its benefits are questionable. I also stated that I don’t really agree with doing it on everyone. Yes, it may help a few people, but everyone? They responded well enough, but probably continued to use SWD.

Don’t be a know it all

After 3 years of grad school, 3 or 4 internships, and a bunch of studying for the board exam, new grads have a wealth of information stuck in their heads. In particular, new grads have excellent anatomy and physiology knowledge that many of us more experienced therapists forget because we do not use that specific knowledge every day.

That information is useful (most of it) in the right context, and finding the right context to relay that information is the key to working knowledge. One recommendation I have for new grads working with more experienced therapists is, do not be a “know it all” at work.

I know this because I’ve had to learn over the years to keep my mouth shut. I’m a know it all and outspoken at times (especially when it comes to sports) and I have been humbled more than once (more often than I like to admit actually).

Over the years, I have learned to rephrase my statements or just keep them to myself. A bit of humility goes a long way. If you need to correct a coworker, pick the right time and be strategic and diplomatic. We all want to be a valuable part of the team and we do need to display our knowledge, but it's HOW we relay this knowledge that matters.

Ultimately, we all do want to be important and one way of achieving this is by sharing your knowledge. I encourage you to share your wealth of information, but make sure you are not doing it in a “know it all” fashion.

Making mistakes

I would encourage all new therapists to seek advice from more experienced clinicians and older PTs, but not to be afraid to chart your own way and make mistakes as you go. We learn by making mistakes and if someone is always correcting you, then you will not learn for yourself (think helicopter parent). We try to prevent mistakes in healthcare, but we are humans. Sometimes IVs get pulled out or you accidentally chart on the wrong patient. Learn from it, move on, and be kind to yourself.

Here is a quick recap

Being able to save face for both you and the more experienced therapist, especially over a topic of contention, will benefit you both in the long run.

Try and limit gossip, especially negative gossip, and discuss serious matters in private at a designated time if possible.

If you are disrupting an experienced therapist's long-standing beliefs, try to be non-judgmental. Do not be afraid to let them know current practice and evidence. Just recognize that their belief is likely long-standing and has probably helped them in their career.

Try not to be a “know it all". State your opinion, facts, and all that wonderful (and expensive) knowledge that you have, but make sure you use humility as well.

Last but not least, don’t be afraid to make mistakes! No one is perfect and we all learn by making mistakes.

Charting your own road and learning along the way is how we mature and eventually become those experienced (dinosaur) therapists…you know, the ones who are super annoying ;)