Why It’s Okay to Be New
Physical therapists have a natural tendency to strive for excellence in all that we do. I firmly believe that if we weren’t dedicated to making the world a better place for a patient, we’d probably be in a different profession. So it’s natural that when we first get started in OncoPT, we are constantly trying to increase our knowledge of all the ins and outs of oncology Physical Therapy.
And sometimes in this quest to master cancer rehab, we sometimes forget to appreciate the process of becoming the expert practitioner. meaning that we don’t stop to learn the little lessons that our patients are trying to teach us.
Now this may seem really counter-intuitive considering that I’m very pro specialization, I’m very in support of always improving and expanding our knowledge and appreciation for expert oncology care. But in today’s episode, I’m going to explain why it’s okay to be new. In fact we should enjoy being new and really lean into our role as novice oncology physical therapists.
What I consider “new”
Depending on who you talk to, new means different things. for me when I’m thinking about being a newer oncology physical therapist, I imagine a therapist choose either brand new to the profession within the first three to five years (yes that includes me still) or even if it’s a good therapist has been practicing for a while but is new to the oncology side of things, again that 3 to 5 year range.
Now new does not mean dumb, slow, lazy, or anything negative. New is a state of opportunity. New means a beginning, to build a foundation upon which our whole career launches.
New is good but I didn’t always feel this way.
When I was doing my final clinical rotation in oncology, I have a fabulous experience, a truly world-class clinical instructor with amazing patients who taught me so much. So when I started my first big PT job oh, I couldn’t wait to be just like my CI. the expert that everyone looked to, that patients requested by name to their oncologist.
So in those first few months of practicing, I was going pedal to the metal, as hard as I could to learn everything I could. In fact within the first 2 weeks of graduating from PT school oh, I was already in a continuing education course. Before I even started my job I had already taken two advanced level courses.
This is not to brag, let me be clear. This is to demonstrate how truly insane I was and how much I still had to learn outside of the classroom.
No in my clinical rotation I learned a lot in a very curated and safe space. This could not be farther from what I experienced when I started practicing. As many of you know I was the only clinician in my clinic oh, no other rehab staff in the building, left largely to my own devices. Now it was fun getting to basically run the Elise show but it also meant I was on my own a lot. This included in patient care and in my clinical decision-making.
I have this weird idea that I was behind. I felt like I did so well in my clinical rotation, only to start actually treating patients as a physical therapist and second-guess my every intervention along the way.
Was I actually helping my patients? Was I implementing the best possible care to actually improve their impairments? So to answer these questions I dove into the research. Every night when I would get home I would read articles to answer that question: was I actually helping my patients?
Well it took me a while to actually answer that question, it’s easy to reflect now that I was actually learning a lot of other things along the way. And when we rush through those early days of being an oncology physical therapist, we’re missing a lot of other important lessons that really transform us into the best clinician possible.
While I know I missed a lot of early lessons, these are the ones that stick out the most to me and that I think we must recenter as we’re learning to become better OncoPTs.
We learn patience.
Cancer rehab doesn’t have the same timeline as much of physical therapy. we don’t usually see patients for two to three times a week for 4 weeks and call it good. some of my patients I still see even after 4 years of practicing.
Progress can be a lot slower for these patients. there’s so much more medically complex and have so many different layers to their physical functioning and ability to either maintain or improve their capacities.
It can be very frustrating to know that we’re doing what we think we’re supposed to, but we’re still not seeing the progress we want to. This is just one of the rules of the game. As we get more experienced, I think we come to expect this oh, but it can be very challenging when first transitioning into cancer rehab to see that progress is not linear and it’s definitely not always on the timeline you want it to be.
We learn that some things just don’t work out.
We can go into the literature and learn exactly what interventions and what dosage helps to improve XYZ impairment. but this doesn’t always tell us if this is going to work for our specific patient. Sometimes the best intentioned treatment plan fails, and for many reasons.
The patient really struggles with their cancer treatment and this causes delays or even problems with our proposed plan of care. For example, the patient Who develops really severe hand and foot rashes and pain can’t even stand up long enough to do their walking program. Their pain is even significant enough that they can’t even do the recumbent bike.
What about the patient who wants to come to therapy, is motivated to get better, but is struggling financially? They’re relying on transportation from friends, family, even a public service that’s unreliable.
Or even the patient who worked so hard towards their goals and ultimately passed away from their cancer before achieving them?
Sometimes Things just don’t work out how we want them to. There’s not always a necessarily happy ending to our work. Sometimes there’s not an ending at all.
What we learn from this lesson is that we do the very best we can with what we have. be realistically optimistic as possible and take the punches as they come.
We learn that the struggle is real.
This is both for us and our patients.
From a patient side of things, all those upbeat pictures of patients emaciated yet smiling while receiving their chemotherapy is complete baloney. Most of my patients feel like trash and I’ve actually gained weight as a result of the copious steroids they’re on during treatment.
And from a therapist’s side of things, we struggle too. In very different ways than our patients but we can still struggle.
For example, trying to balance treating patients, keeping up with your documentation, writing all of those other notes to justify why you’re doing what you’re doing as the skilled therapist, staying on top of other work tasks, taking time for yourself at the end of the work day to exercise, eat, play with your dog, hang out with friends and family oh, and oh yeah stay on top of the ever-evolving research around cancer rehab. How are we even supposed to do this?
I think the short answer is we can’t. work-life balance is a myth. The best we can do is work life integration.
Anyone who looks like they’re doing all of these things and doing them well it’s probably drowning just like you under the surface or they have someone helping them.
We learn that, sometimes, the growth is in the struggle.
There’s definitely valuable lessons in struggling through those early days. There will be times when you feel like you’re juggling a dozen glass balls and they’re all shattering on the ground around you.
The simple answer is to just not juggle all of the glass balls. But that’s not realistic. I think this overly simplifies our desire to be considered a team player, the therapist who has it all, or an adult.
When we look around us and see the shards of what we’re trying to do scatter them around us, we have the opportunity to see what we’re really most disappointed about dropping or not doing. And from this perspective, we can start to really prioritize what is most important to us and what we’re trying to do while we’re on this planet.
Maybe this means you can’t actually commit to all of those extra projects at work. You know what I’m talking about. maybe it’s the social media creation that’s not actually part of your job description. maybe it’s the marketing you’re expected to do outside of Patient Care hours, even though there’s a marketing team who’s paid to do this exact thing.
This also means sometimes embracing the seasonality of your life. At different points throughout the year, I know my practice varies and how many patients I’m seeing, what diagnoses I’m tending to see, etc. Leaning into this concept of different seasons bringing different challenges, different time commitments, & different responsibilities helps us become better practitioners.
By expecting change, we’re less scared by it. We’re better able to adapt when change comes. This is one of the biggest lessons I’ve learned, is that I don’t have to do everything nor should I try to do everything. But knowing that sometimes I can commit to more things and sometimes I can’t
I Wish I didn’t have to struggle through this to learn this lesson, but I’ve come to know that I think I need to struggle in order to really learn what I’m supposed to & to grow as a human.
We learn the little things are actually the big things.
Cancer is a life-changer for a lot of different reasons. but one of the things that surprised me the most when I first started treating patients on my own, is how focused some of my patients would be on the really small things, or what I perceived to be the small things.
Patients would talk about regrets they had, relationships they let lapse, opportunities they never pursued. And these weren’t always the monumental Life events I expected. Sometimes it was truly the smallest of interactions, details to me, but to the patient they were huge.
What this means for us is the physical therapist in our care of these patients back from the plan that we had for the day. I remember I had a patient who had been doing really well, making great progress, always seemed to be in an upbeat mood.
Then one day she came in, and it was clear that the wind had just been sucked out of her. The treatment plan I had for that day quickly derailed oh, and I remember thinking in that moment, how in the world am I going to bill for this?
I still cringe today thinking about that. definitely not my finest moment.
Thankfully that mentality quickly shifted as my patient dissolved into tears and recounted the morning’s events. We sat and held hands and cried together. We ended the session with a hug and my patient went on her way. Before she left she told me how much she appreciated the listening ear & the hand to hold.
And As much as that hopefully meant to her, it meant even more to me. the hour that I spent with that patient, away from the notes, away from the emails, really helped me refocus on why I do what I do.
My good friend Tori Crook talked about how she knew she needed to be able to take time with her dog and to exercise, and if she couldn’t do those things oh, she needed to walk away from the job. And guess what: she was in a job or she wasn’t able to do those two things that were so important to her and she walked away.
Was It easy? No. Was it a really challenging thing to navigate? yes.
Is everybody in a position to make this decision? No. But I think having this perspective equips us to really look at what we’re doing and how we’re doing it and ask ourselves is this right for me?
For me, after that one session with that patient, I really started asking myself the hard questions I had buried for so long, including if this was really my dream job after all.
I share all this not as an expert clinician who has it all figured out, but as a still new oncology physical therapist who’s learning that it’s okay to be new, because we still have a lot to learn.
I Hope this episode was impactful and encourages you that it’s okay to be new. In fact, it’s a really good thing. And I hope you lean in to being a sponge, both as an excited oncology physical therapist ready to learn all the things about cancer rehab, but also as a person learning more about you and how you want to make this world a better place.
So now I want to hear from you: what did I miss? What else would you include in this episode about being new? Message me on Instagram and let me know.
Until next time this is Elise with TheOncoPT. And remember you are exactly the physical therapist that your patients with cancer need. So let’s get to work.