Clinical confidence takes into account the “Three C’s” according to the American journal of medicine: caring, communication (listening and explaining), and competence. As a new graduate I have very rarely felt “confident” in clinic. Yes, there are times where I feel comfortable knowing that I will not make someone worse. I have also felt excited when I have caught a red flag condition…however, confident is not the word I would use.
Looking up this definition though makes me realize that maybe I should realize that it is not all about “fixing” someone. As a clinician I feel that my strongest attribute is my ability to care and communicate with patients. I believe this stems from me feeling like I am really not all that smart. I just know that things need to be broken down into infinitesimal parts when the problem is complicated, such as low back pain, chronic pain, or the human body at all. I know when I go to the mechanic and they start talking about rotors, spark plugs, and different lines and I am just standing there like Kel…
What good does it do to explain to someone that they are hyperlordotic and their center of mass is anteriorly displaced further than mechanically appropriate so they are increasing the compressive forces on their lumbar spine which may be contributing to their increase in symptoms…aka your back would probably hurt less if you lost your beer belly.
Of course this isn’t the scenario in all cases, but I just wanted to throw out the insane verbiage that some clinicians use and unintentionally instill fear into their patients. One of the things I have learned since being out on my own and evaluating 4-5 patients a day is that it doesn’t matter what your idea is, movement helps people. Research shows us best practice for interventions, but it is much more important to meet the person where they are at. In a very unique population, I have the opportunity to work with patients battling psycho-social issues who may not be ready to hear everything is mechanically fine with them. It is always a process towards improved function. As Jeff Moore once told our Ducklegs group, yeah you could go in and hit them over the head with pain science, but you’re likely to miss the mark. It is much better to sprinkle in the fact that movement is medicine and one with very few side-effects.
If you are a new grad I would assume you have had a similar moment like me where you know someone else, whether it is a professor, an old CI, or some of the amazing clinicians on Facebook would likely be able to “cure” your patient. However, while you can reach out, ask questions, and look for guidance, when it comes down to treatments it is going to be up to you. I have heard dozens of times that people learn more in their first year out of school than they ever did while in school and I can totally understand why. Unfortunately sometimes we aren’t the best clinician for the patient, but that doesn’t mean we have to give them a bad healthcare experience. You can never go wrong by explaining to someone in pain that things are going to get better and that movement will help them. A new grad (or any person in general) should not need continuing education to learn how to care for another human being.
Here are just a couple of things I do to try and show my patients that I am in their corner:
I hope that any new graduates out there that have experienced these moments of being distressed in clinic realize they are not alone. Yes we passed our boards. Yes we can practice independently. No we are not even close to being the clinicians we will be 1,2,5,20 years from now. This process takes time and in any profession you have to put in the time daily. Don’t worry about the failures, learn from them. Take continuing education courses if you are struggling. I recently took the MDT A course and felt much more confident walking into clinic that next Monday.
Most importantly just care about your patients. Talk to them, do what you can for them, and if you’re not able to treat them every day, make sure to keep an open line of communication with your support staff. We are all in this to improve the patient’s experience and symptoms.
Thanks again to anyone who took the time to read this! Hopefully you found a little value in my thoughts and maybe come Monday before the Thanksgiving holiday you will find yourself being very thankful that you are in the position to help so many people.
Happy Thanksgiving everyone!
I am a new graduate DPT and am interested in personal growth and becoming a connector within my profession.