Professions are always in flux. Ten years ago, getting your DPT was all the rage and direct access was a buzz phrase that everyone on the cutting edge was backing! But now that we have become recognized as doctors, now that we are the first stop on some patients’ list of practitioners, are we prepared to truly become primary care providers?
D*mn straight we are.
Four times a year, STAND (Sustainable Therapy And New Development) travels to Haiti and over the span of two weeks treats around 1800 patients. We bring teams consisting of PTs, prosthetists, orthotists, and general medical practitioners. We work as a team for every patient. The situation invokes a collaborative environment within and between professions in which there is no testable right answer. You are the only one this patient may ever see. You’re it. This is Haiti.
Haiti has taught me a lot about what PTs can do. I have seen PTs work alongside each other, collaborating on the situation of a challenging patient, truly open to what the others have to offer. Many patients’ care is the outcome of multiple brains and backgrounds in our clinic. But it’s not just the open air, no walls environment that lends itself to this situation. It’s the lack of egos predominating within the walls of the STAND clinic.
“There’s no textbook for working in Haiti” we always half jokingly say to prospective volunteers. In Haiti, we see situations that no outpatient PT could have imagined. We are the acute care, we are the rehab, we are the chronic pain clinic. If someone was in a major accident 8 months ago and survived…we are seeing and treating the aftermath: the nonunion fractures, the still dislocated dislocations, the insane amounts of scar tissue, fear, dysfunction, and ramped up nervous systems.
I truly believe that it is because of this, because no one has been treating these cases in the states, that egos get checked at the door. There is no expectation that you must or should be right and know it all. This is not a test; this is the one chance for your patient to get the best and most effective care possible. Basing patient care decisions on teamwork and humility is one of the necessities for PTs to become real primary care practitioners…the PC-PT!
Another side of the coin is, of course, cost. All about da benjamins. Now we know from study after study that when a patient #Get(s)PT1st, the system saves money and patient outcomes are better. As a profession, we are becoming more confident in our knowledge and skills, more willing to encourage patients to skip the imaging and the drugs.
In Haiti, the access to any of these is limited at best. PTs are forced to use their skills, their deductive reasoning. Thoughts of reliance on MRIs and doc scripts are a null point. It’s you and your brain (and the brains of your team) and your patient. Go!
And the outcomes are amazing! Most patients through the STAND clinic doors have never seen a western medical practitioner. They are blank slates waiting for you to draw the picture of health for them and this image is powerful and effective. When you are the patient’s only chance, when there is no one that you can send them to see next week or next month just in case… you step up. You become the responsible, knowledgeable, compassionate medical professional you were trained to be!
If we truly want to become PCPTs stateside, this is an attitude adjustment that we need to work with. It’s one thing to experience the necessity, to assert yourself in a situation that demands it. But the transfer can prove more difficult. Our system does not expect or encourage PTs to provide the level of care of which they are capable. There’s a pecking order in most places (see now those darn egos at work again) and referral sources we need to keep happy (benjamins be back). But if we are to be respected as PCPTs, these can not dictate how we choose to treat. Choices should be based solely on what will be best for the patient.
This blog could go on, as I believe there are many more facets to a PT’s work and efficacy as a direct access practitioner and as the first point of access to the medical system for patients…but I bet you’ve all got charting to get back to, so I’ll leave you with this:
There are many lessons to be learned from working in Haiti, and learning to step up, to do your absolute best in a situation that demands it, is one of them. Thanks to Haiti, I have become a proud Primary Care Physical Therapist.
STAND is currently in need of PTs and general medical practitioners for our upcoming May trip! For more information on how you can volunteer with STAND: The Haiti Project, contact Dr Morgan Denny DPT at firstname.lastname@example.org or check out the website at www.standhaitiproject.org.
Check out STAND’s video for visual reference at https://youtu.be/rrbMq4d_rRc
-Dr. Morgan Denny PT DPT
Facebook: STAND Haiti Project