SPECIALIZATION: THE GOOD, BAD & THE UGLY
adversity like the patient not responding to their treatment. I have heard it many times with patients stating that what a provider, either a PTor MD, was doing in treatment was fine, so in other words the patient was the problem. That is the big ugly about specialization. A specialist is sometimes unable to bend to change their way of care to help a particular patient that does not quite fit the mold. Some are and do it quite well. Others are basically lost or choose to be lost and go to the next person in line to share their area of specialization. Another ugly part of specialization is recognizing MANY things can cause or mimic knee or meniscal pain. Just
I can remember growing up in the 50’s when most of the physicians were family doctors. Yes, there were some specialist around like orthopedist and general surgeons, however, even general surgeons performed a great deal of orthopedic surgery. Fast forward today and it seems like even the orthopedic specialists have sub-specialties like
being primarily involved with hand or shoulder injuries and the like. They study all of it in school and thenmove toward a particular area of interest during their residency and internships. This is no different for physical therapists. We also get a broad overview during our time in school taking the same anatomy and physiology courses that have been given by decades of study to both PT’s and MD’s. All of us come from different schools of thought which we have been subjected to bias from the day we were born. We come to the table, if you will, with generations of opinions as well as experiences that tend to formour interest. These are then followed and either reinforce our interest or we get exposed to things we really had false perceptions about and we continue on down the road until we land somewhere else. Now the good in all of this is you are dealing with a person who has an interest in your specific problem and who also has a great deal of information about it usually from years of study and practice. In the case scenario of best outcomes, surely you want to have surgery on your knee from a person that deals primarily with knee problems. The same holds true for physical therapy. Let’s take knee problems such as a meniscal tear for instance. You really want to have a physical therapist who deals with this type of injury on a regular basis. Preferably someone who has hadmore than just a little of exposure tomake sure they are covering all the bases. This would be considered the “good” part of specialization. Now don’t get me wrong when I say this. I am speaking of generalizations and not specifics. Sometimes when folks have a knee injury, they can be treated from another professional who does not practice specifically on just knee or lower extremity injuries. In regards to the practice of physical therapy, any PT should be able to treat a person with a knee injury without difficulty. We all have heard of the saying “there is more than one way to skin a cat.” Nothing against cats. It was just the saying I thought of that illustrates this in my humble opinion. All PT’s have worked with multiple cases of folks with knee injuries many times over in their career. Maybe this is outside of their immediate exposure to folks they treat at the time however it should not preclude a patient from getting care if they cannot get in to see the person with the specialization at the moment. It’s not all about the specialization. It’s all about the person and their passion and experience in the way you get treated. There are many ways to treat a person with ameniscal problemand sometimes if you get a person who specializes in this type of injury, they are more rigid in the way they treat you which can be good and also the bad as I am discussing. Sometimes you need a different look or a different opinion as all meniscal tears are not quite the same. Now for the ugly. Yes there is even the ugly in getting treated by MD’s and PT’s. We do not like to talk about it but you know it is true. Actually we see it in folks who are in other occupations like painters, builders, mechanics, etc. Sowhat do I mean about ugly? There is a wide variety but for the most part this comes from the extreme specialists who cannot or will not change their opinion of what is going on even in the face of
because folks have a click or catch or pain in the knee does not correlate immediately to a meniscal or cartilage tear. Now with the age of MRI’s, a patient is sent to get one of these famous and expensive tests and low and behold, it is read by a specialist who states the patient has ameniscal tear. And so the saga continues. I can give youmany hundreds of situations where a person was treated inappropriately and ended up with the same problem only after having a surgery or treated in some other inappropriate way. This is very discouraging to say the least. Yes they may have had a meniscal tear even shown by an MRI but that may not have been what was causing their symptoms. One of the other items regarding specialization are the many tests that are out there or have a patient perform to rule a condition in or out. There are books written just for these things and when you look at the research that backs them up, well they are less than decisive and they all state that. That is why we have multiples and I mean multiple tests to figure out what is going on with a selective tissue. The reason there are so many is that none of them is decisive enough to hang your hat on. It has been suggested that a PT or MD perform several of these and if all of them point you in the same direction, then you could state it was a certain tissue at fault. Well, just because a person gives a patient 5 tests shown not to be worth very much does not equate to 5 tests that decisively point in one direction. If all of them are poor to say the least, how do 5 tests that are poor raise the bar at all? Thankfully I was reading in a medical journal this week where a couple of professionals came together and stated it is high time these tests were put out to pasture and we move on. We have been stating this for at least 15-20 years. We totally agree with their recommendation. Now please do not go out saying I stated that a lot of folks are being treated inappropriately. Not at all what I amsaying. In fact I amsaying you better communicate appropriately and do your homework to find the professional you feel most comfortable with performing anything on you. You will know by the way they listen and answer your questions. Again do your homework and ask folks who have been to that practice or person. Again this is true in any facet of life. The same applies to school teachers, ministers, counselors, mechanics and the like. I will leave you with a quote from Dr. Janet Travell, MD (1901-1997). “In this age of specialization, few clinicians are broad enough to see the whole patient and his/ her problem… understanding the delicate interplay between the patients mind, body, environment is a paramount importance in helping a patient overcome an illness.”
ARTWORK AT THE OFFICE Gayle has volunteered her time and talent photographing newborns and children for a programcalled “Hand In Hand” at the local hospital. In her spare time when not behind the camera, you can find Gayle spending timewith her family or riding her horses. She and her horses compete in 30 and 50-mile endurance rides throughout the state of Virginia. She is married 35 years to her husband, Douglas, and they have 2 children and 3 grandchildren. Gayle and Douglas are members of Covenant Presbyterian Church in Harrisonburg and they live on their 30 acre farm in the beautiful Shenandoah Valley of Virginia with their sweet pup and 6 horses. View her website at https://gayledriverphotography.pass.us/ gayledriverart/
Harrisonburg Artist: Gayle Driver, Digital Photography. In this body of work I concentrate on the facial expressions of my subjects (whether people or animals) trying to capture the emotion of the moment when my subject is looking directly at me. The eyes are windows of the soul… a
Pinehurst Artist: Gwen Dumas. I graduated from Peace College with an Associate of Art Degree and from Meredith College with a Bachelor of Science Degree in Interior Design with a minor in Art. After college, I worked in commercial interior design for Raleigh Office Supply in Raleigh, NC and Design Logic in Asheville, NC. I have also had the opportunity to work as an artist for Camden Field, a painted furniture company in the mountains of North Carolina. Currently, I live in Whispering Pines, NC. I love art and wake up every day ready to paint. Pinehurst Artist: Sarah Hendrix. I grewup on a beach in Southern Californiawith an artist for a mother. My first training was absorbing her knowledge of painting. She would call me to ask if I had seen the clouds that day or looked at the sunset. Through her, I learned to look at the beauty that surrounds us. My paintings are mostly landscapes and I lean towards seascapes from my beach bum days. Over the years, I have taken instruction from various artists-including Frank Pierce, Mike Rooney and recently Connie Winters.
phrase that I think about as I amworking withmy subjects. There is something captivating tome about looking directly into someone’s eyes and knowing how that person is feeling. When that person or animal starts to feel comfortable with me is when I can capture that special image. I focus my camera on their eyes and by adding a soft blur behind the subject helps draw the viewer into the detail of the face. Of the animals that I photograph, the dogs and cows have a special place in my heart. I love their interesting, unique faces and I try to show their sweet personalities in my photograph.
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