Saturday, March 3, 2012

What's Up Doc?

"I find that a duck's opinion of me is greatly influenced by whether or not I have bread." - Mitch Hedberg

When I was teaching Physical Therapy students in the clinic many years back, I would always try to direct my teachings with interventions that were unique to what they would encounter elsewhere. To direct me, I tried to realize how nervous they must be and by remembering how nervous I was when I was in their shoes. One of the things they had to do was to interview new patients and gather a history. This is essential to coming up with a good game plan on how to treat them. I told them, most importantly, they had to try to understand what was important to the patient. If you just open the door with something simple like "So, what's going on with your shoulder?", and then shut up, the patient will usually tell you 50% of everything you need to know, and then you can go from there. If you try to understand the patient, they will trust you to try to get them better, which is HUGE in PT.

I remember, several years ago, I sat in a Doctor's office, and when she asked "What brings you here today?", I answered, "Well, I'm a long-distance runner and lately when I get to mile 12-15 of a long training run, I'm feeling more tired than usual...I mean really shot!". The doctor stared at me for what seemed to be ages, then put her head in her hands, and shook it. Questions like "Why do you run that far?" were not the questions I wanted her to ask. After some useless in-office clinical tests, I think she might have given me some vitamins or something, but I left there feeling like we weren't exactly two puzzle pieces fitting together.

When I sit down with a new patient at my Physical Therapy clinic, I go through the usual range of motion and strength tests, get an accurate history of the problem, and try to calm the patient that despite what their well-meaning friends told them, I am not going to try to kill them! It doesn't matter if the patient is very athletic looking with a shoulder problem or a little old lady trying to get over a total knee surgery, I always ask the patient "What kind of things do you want to get back to doing?". A patient may HAVE to return to work, but they may REALLY WANT to get back to bowling, walking, crocheting, working on their car, hunting, golf, RUNNING, etc. The "have-to" and the "want-to" are two very different animals with very different levels or degrees of desire to work towards that goal. And the goal towards "want-to" usually far exceeds the goal towards "have-to".

However, even with me being a PT/runner, I have noticed that a runner, especially a marathoner, or worse, an ultramarathoner, will do nearly anything to keep on the road or the trail. At least I can empathize with this athlete. The problem is that most healthcare providers do not understand (much less empathize with) these athletes and the runner does not understand the clinician. Can you imagine the delemma the non-running doctor or therapist is put in when the ultrarunner comes in seeking care and advice for an injury that occurred at mile 87 of a 100-mile event? Most of the time the answer is “Do not do that again”. The clinician will fail to recognize, specifically for ultra-endurance athletes, that the mental fortitude and commitment to their sports is immense. On the other hand, if a runner can feel the clinician is really listening, and at least trying to understand, then the process can progress much smoother. The practitioner must understand the sport in order to treat it fairly. If I, as a PT/runner, tell this runner not to run, I want him to believe I mean's more than a suggestion.

There are many injuries, aches, niggles, and knacks that you can run through, but there are many levels of running (speed, hills, level, short, long, and so on) and it helps to have a health professional who understands the limits a long distance athlete will adhere to. An endurance athlete cannot make that decision rationally by themselves, and will usually push too hard or too far (guilty in the first degree!).

When you make a decision to see a healthcare person, all you can ask for is someone that will listen to your goals, your complaints, but mostly understand your "want-to's". I don't have an answer how you stumble across this pearl of a medical person, but I find the most time proven way is to ask around. There is nothing more glowing or more damning than the old word of mouth. Same with buying running shoes, getting your oil changed, or who serves the best lasagna in town. So, you ask your fellow runners where they got proper care - not necessarily if the doc had a magic pearl, but rather, did they empathize with your inabilities to do the "want-to's" and one that did things that actually appeared to reflect a thought process with a goal to get you back to that precarious balance act between running healthy and injuring yourself again.

There are many docs, PT's, chiropactors, massage therapists, etc, that are runners (or participants of a similar sport) and will empathize with you. They will give you care with the understanding of an athlete. They understand what the small goals are that will lead to your BIG goal. All you want is this understanding along with their expertise. I won't make any recommendations here, but I am one of those folks you can ask for a recommendation as we run down the trail. As a long-distance runner for 30+ years, and a PT for 40+ years, you can say I've been around the block. Don't misunderstand me, there are many,many good health professionals that will give you great care and have never run a step, swam a lap, or cycled a single crank revoloution. It's difficult to trust someone with your health, and being an athlete should NOT be the main criteria for your choice of the guy who's going to get you back chugging happily. But to get you back on the road, or trail, go with one that understands why you do what you do. At least you won't have to answer the question "Why do you run so far?".

I'll see you all on the healthy roads - AL

"One child lost is too child saved can change the world"

No comments: