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100% of Your PT Patients Will Die

by Justin Johnson, PT, DPT, OCS

Attention grabbing titles sometimes have a bit of truth to them. This article is about taking a little pressure off yourself. Sometimes as PTs we put too much pressure on ourselves to fix people. I often tell new healthcare workers (therapists, nurses and even physicians and pharmacists) that ultimately what the patient does with our help is up to them. Here are a few things to keep in mind to lighten your mental load.

What you do to help your patients matters less than what your patients do to help themselves.

Placing too much importance on therapy treatment is misled. You can be the best manual therapist, vestibular therapist, or general practitioner around and help a ton of patients. But whose decision is it to continue to perform the home exercises? To stop smoking? To walk daily? To watch less TV? Yours? No! It’s theirs.

How many people actually do the HEP we give them? Not many, in my experience. Habits are hard to break and lifestyles are hard to change, and that is not your responsibility.

Do not place blame on yourself when your patients don’t improve.

If your patient gets worse or they fail to reach goals that you’ve set for them, it is not your fault. Many of your patients won’t get better. If you always consider it a failure on your part you will be miserable, and you will likely feel little personal accomplishment.

Every day I have to tell my patients to perform their activities with purpose. If they don’t get that statement and what it really means, then they will generally not get much better.

Patient care is central to any PT's career, but if you're interested in learning more about the state of the industry, check out our 2019 New Grad PT Report!

I work mainly in geriatrics, so when I say “with purpose,” it usually makes sense to them. Older patients, generally speaking, realize the importance of purpose. When a patient is performing an activity but has no sense of the reasoning behind the activity, they usually are not engaged and the results are poor. You can educate them, but don’t blame yourself or feel bad when someone cannot find a purpose. This is not baggage you need to carry. The reality is that if a patient has lost their purpose in life (many of mine have), your help will fall on deaf ears.

Don’t make their problems your problems.

Many times therapists leave the profession because they take on too much emotional responsibility for their patients. They internalize their patients’ problems and emotions and, in turn, they feel bad about their own professional performance or ability to help. This is called emotional exhaustion, and it can lead to burnout. You must avoid internalizing your patients’ problems.

I’m a national ski patroller. One of the best lessons I’ve learned from my time as a patroller came during my Outdoor Emergency Care training. An accomplished veteran and mentor of mine told us to “Remember that it's their emergency. Don’t make it your emergency.” I could go on but I don’t want to make your problems mine.

You are a guide, a teacher, and a coach—not a miracle worker.

You will have patients who you care about deeply. Many of those patients will find themselves in unfortunate circumstances. You cannot get a complete C4 quad to walk; you cannot reverse 10 years of contractures; you cannot reverse aging. I often tell people “I’m Justin, not Jesus. I’m not a miracle worker.”

This isn't to say you can't achieve successful patient outcomes! But make sure you're setting realistic expectations and goals.

It’s easy to become overwhelmed when you start in a profession. You have a brain full of knowledge, you want to help, and you want to make some dolla dolla bills. The purpose of this article is not to tell you that you don’t matter. The purpose is to take some pressure off of you. You will have a longer and more fruitful career if you realize that you cannot work miracles. You can’t fix everyone. Burning out of therapy is very real, and having the right expectations and not taking on unnecessary baggage will prolong your career and keep you mentally fit.


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