Detail. Ever since I was a little girl I was always consumed with detail. Some might
classify that as a flaw, but I thought it made me precise, intellectual, and unforgetting. There
have been many trying times in my life where detail has saved the day, and times where it has
ruined me. Then, I got into Physical Therapy School. For four semesters (equivalent to a year
and a half), I sat in 4 hours lectures, listened to professors engrain every ounce of knowledge
that they could into my brain, and focused on every single detail, because this was the
profession I chose to enter and I better damn well be good at it. I found myself fixating on every
word in every slide, recording lectures to make sure that no words said were missed under my
account, and attending office hours for times on end to make sure every ounce of my notes and
understanding was correct. Am I saying this is bad? No. Was this a lot of work? Yes. Did I get
told by my professors multiple times to stop being so detailed? 100% yes. However, these
factors didn’t stop me. I wanted to ace my tests, and be able to construe back every single little
detail that was taught to me to show my superiors, and myself that I was learning.
I do well in school. I mean, I have made it this far haven’t I? I get good grades and put a
lot of work into my studies, but because of my want for more and my eagerness to understand
every bit of information that is thrown at me, I often lose the big picture. The big picture is
VERY important, in every aspect of life, but in this case, Physical Therapy. When in the
classroom, and you are fixating on the degree that the arm needs to be during a TOS special
test, or which glut muscle you are actually affecting with a soft tissue mobilization, don’t. I
know, it is so much easier said than done, but I wish I had this advice going through. It will
come. You have resources upon resources if some bit of information leaves you. When it all
comes down to it, you are there to engage and listen to your patient’s primary issues, give them
an idea as to how you are going to use your best judgement to aid in their recovery, and be a
resource for them as they embark on the journey.
The month leading up to my first clinical rotation I was a nervous wreck. I went through
every single one of my Musculoskeletal Practice Management notes and rewrote them in an
outline fashion that would allow me to access the notes quickly, as well as prepare me for my
evaluations. I studied angles, special tests, and (like I said before), fine detail of each region of
the body. When I arrived at my clinical, I thought I was prepared as I had taken all the necessary
steps to seem prepared for this rotation. I stepped into my first couple evaluations with my CI
present and it’s as if I lost all brain function. The reality of a real patient in front of you with real
issues is definitely not something I was fully prepared for. I had to think on my toes, run tests
on someone who was much bigger than I (as well as in pain), and try to construe back what all it
was that I just did in terms they were able to comprehend. In my head, everything had seemed
to come together. They didn’t have enough left hip extension, the left glut was much weaker
than the right, they walked with overpronation in the forefoot, and not enough eversion in the
rearfoot during their Trendelenberg gait. EASY. Wait..you want me to explain that to someone
else who isn’t in Physical Therapy school? Let me just stumble over my words here for a couple
minutes. This is something that PT school attempts to prepare students for, but once they are
actually put in the real situation, it all changes. At least for me it did.
Being in the classroom for 4 whole semesters prepared me for fine detail, perfection,
and allowed me the ability to sit on a topic for hours or even weeks in order to fully grasp the
material. By no means am I saying that my university did not prepare me, but what I am saying
to all those new PT students reading this, is that these things aren’t allowed for in the clinic. BIG
PICTURE. I will say it again and again. Don’t trip yourself up over the special test that you forgot
to do, or the dermatome you accidently skipped over in your test. The patient in front of you is
there with limitations and pain, and you are there to figure out what those limitations are. Do
you have a test to find out those limitations? Do you have tools to address them? What about
an exercise that addresses those same things? Be confident. I sit here and write like I have it all
figured out, but I undoubtedly don’t yet. Eventually I will, but if I have learned anything from
my first rotation, it is patience and confidence. Be patient with yourself. Practice as much as
you possibly can. Practice. Practice. Practice. There’s only so much book studying can do. Ask
questions, lots of them. Take a step back and realize that you don’t have to have it all together
in your first evaluation, because guess what? They are coming back! Perfection is truly
unattainable in this field, but confidence isn’t. Be okay with that.
I guess the point of this whole post is that being in the clinic is entirely and utterly
different from being in the classroom. There is no proper way to prepare for the clinic. You
never know who is going to walk in that door, but you can have assumptions based on things
you have seen throughout your classmate’s bodies, and within your schooling opportunities,
and of course (your practice). Again, be confident. Do not get so hung up on what you should
see, just see what you find and go from there! Be open to the fact that literally everything
connects, and if something comes up that you think you didn’t learn in school, you probably
learned enough to get to that conclusion, you just didn’t learn it in the way it’s presenting. Be
patient with yourself and your thoughts. Remember, you have all the tools to treat the patient
on front of you, so use your creativity to choose which of those you will use. You got this. You
know far more than I am sure you are giving yourself credit for.
