You’ve probably heard that “the soft skills are actually the hardest skills.” But what happens when your interpersonal skills are put to the test in the most chaotic and emotionally charged moments of patient care?
In this episode, we unpack why so-called “difficult” patients behave the way they do, how fear and loss of control drive conflict, and why oncology physical therapists are uniquely equipped to navigate these moments with clarity and confidence.
You’ll hear practical strategies for anticipating patient needs, managing escalating situations, collaborating across disciplines, and checking your own bias before it checks you.
This conversation goes beyond protocols and productivity metrics to focus on what actually determines success in high-stress encounters: trauma-informed care, de-escalation, emotional intelligence, ethical boundaries, and clinical communication.
This episode will challenge how you think about conflict, remind you that human connection is a clinical skill, and leave you with tools to turn tension into therapeutic opportunity.
Mark your calendar for AC-24501 – Managing the Unmanageable, the a-Holes of the Emergency Department
AC-24501 – Managing the Unmanageable, the a-Holes of the Emergency Department will take place on Thursday, February 12, 2025 at 8:00am.
About Rebekah Griffith, PT, DPT
Dr. Rebekah Griffith is a physical therapist, mother to three incredible humans, and thought leader specializing in emergency department physical therapy. She believes physical therapist practice in the emergency department is essential in supporting patients during their most critical moments and is a unique way to make an upstream impact in an otherwise downstream system. Dr. Griffith has been an invited lecturer and keynote speaker both nationally and internationally on physical therapy in the emergency department as well as broader topics of health equity and advanced practice. She is the author of Top of Scope: The Emergency Department Physical Therapist Handbook and is host of In the ED Now, a podcast. Dr. Griffith is the proud recipient of the Innovator Award from the Academy of Orthopedic Manual Physical Therapists and the Service Award from the American Physical Therapy Association as well as a black belt in Tae Kwon Do. Dr. Griffith is a neurologic clinical specialist and fellow-in-training in orthopedic manual physical therapy. She teaches as adjunct faculty at Tufts University and serves as the current president of the APTA Colorado. Passionate about health equity, professional engagement, and therapeutic rapport, she aims to help all clinicians practice at top of scope and elevate the profession as a whole.
Connect with Rebekah on LinkedIn.
About Brandon Morshedi, MD, DPT, NRP, FACEP, FAEMS, FP-C, CCP-C, CP-C, TP-C
Brandon Morshedi, MD, DPT, NRP, FACEP, FAEMS, FP-C, CCP-C, CP-C, TP-C is an emergency medicine physician and paramedic throughout Arkansas and Texas. Originally from Arkansas, he started his career in EMS in 2001 and worked as a firefighter, EMT, and eventually a paramedic, working 12 years on a front-line 911 ambulance while pursuing education and training as a Physical Therapist. After earning his clinical Doctorate in Physical Therapy in 2006 and working four years as an outpatient PT and still also working on the ambulance, he desired to expand his emergency care capabilities and returned to medical school to pursue a career as an EM and EMS physician. He graduated from the University of AR for Medical Sciences in 2014 and then completed emergency medicine residency and EMS fellowship training at UT Southwestern in Dallas, TX. During fellowship, he also completed elite Tactical EMS training and worked as a Tactical Physician and Reserve Specialist in the field for the Dallas Police Department SWAT Team, FBI, Homeland Security, ATF, DEA, and US Secret Service, including VIP and dignitary detail throughout Dallas County. Dr. Morshedi is dual-board certified in both EM and EMS medicine. Prior to moving back to Arkansas in 2022, Dr. Morshedi served as Assistant Professor of EM and Associate Division Chief of EMS at the University of Texas Southwestern for almost four years. He worked clinically at the Parkland Hospital ED, the busiest ER in the country, and was core faculty for the country’s largest emergency medicine residency. Additionally, he served as “MD2”, the Deputy Medical Director for the City of Dallas, including Dallas Fire-Rescue and Dallas Police Department, and for the UTSW/Parkland BioTel EMS System, a consortium of 12 combined cities throughout the DFW metroplex with ~4000 paramedics and 500,000 EMS calls per year. Throughout his career, Dr. Morshedi has given hundreds of lectures for EMS clinicians, pre-health students, medical students, and physician residents and fellows and has won numerous teaching awards. He is an active member of the American College of Emergency Physicians and the National Association of EMS Physicians and a fellow of both organizations. He is a founding charter member and the first president of the Arkansas Chapter of the National Association of EMS Physicians. He has written and published dozens of peer-reviewed research articles, abstracts, book chapters, and FOAMed articles, and has lectured on the state, regional, and national circuits on emergency medicine and EMS topics. Dr. Morshedi now works clinically as faculty at the University of Arkansas for Medical Sciences and multiple community emergency departments ranging from Level 1 trauma centers to critical access hospitals. He also serves as the Associate Medical Director for Metropolitan EMS and the Medical Director for Arkansas State Parks and Air Evac Lifeteam helicopters for Arkansas and Texas. He has been appointed by the Secretary of the U.S. Department of Transportation as the EMS Medical Director Sector Representative for the National EMS Advisory Council with NHTSA, serves on the Governor’s EMS Advisory Council, the state’s EMS for Children Committee, STEMI Advisory Council, American Heart Association’s Systems of Care Advisory Group, and on many other state, regional, and national committees and organizations aimed at improving prehospital care.
Connect with Brandon on LinkedIn.
About Sarah Nechvatal, PT, DPT
Sarah Nechvatal, PT, DPT is a physical therapist and the Supervisor of Occupational Therapy and Physical Therapy at UW Health University Hospital, a Level 1 Trauma Center in Madison, Wisconsin. She provides clinical oversight in the Emergency Department and across acute medical units. Additionally, she leads Occupational and Physical Therapy services for both inpatient and outpatient individuals in legal custody within the state of Wisconsin—a role that demands a specialized focus on safety protocols and unique regulatory considerations. Since 2010, Dr. Nechvatal has specialized in Emergency Department physical therapy, with experience working in the emergency departments of three major hospital systems. She is a frequent presenter at state, national, international, and interprofessional medical conferences, advocating for the integration of physical therapists in emergency care settings. Dr. Nechvatal is the co-instructor of a unique two-day continuing education course focused on Emergency Department physical therapy practice. She currently chairs the APTA Wisconsin Early Access PT Committee, leading efforts to embed physical therapists in every Wisconsin Emergency Department and Urgent Care clinic, and to improve access to outpatient PT services within 48 hours of symptom onset. Dr. Nechvatal earned her Doctor of Physical Therapy degree from the University of Iowa in 2006.
Connect with Sarah on LinkedIn.
Transcript
Elise Cantu (00:19)
Hey OncopT and welcome to this episode of the OncopT podcast, continuing our CSM preview episodes with a very special kind of outside of oncology topic that is very appropriate and still very applicable even within our oncology patient population. But what really grabbed my attention on this particular session was the title. And I have to read it right off the bat because you’re gonna love it. So this is…
Managing the Unmanageable, the A-holes of the Emergency Department. Outstanding title, and I do have to say, I feel like this year’s CSM has really elevated my expectation for awesome titles, but I’m really excited to get into the actual meat and potatoes of this session, because while the title is definitely gonna draw us in, I think what is going to be delivered in this session is really going to help you kind of move forward with maybe some…
⁓ more challenging situations, maybe some patient ⁓ interactions that maybe you have struggled with in the past, this is really going to help you with that. And so I’m really excited to welcome our speakers. First up, we have a return guest on the Onco PT podcast, Rebekah Griffith, who you may know as the EDDPT. Rebekah, welcome back to the podcast.
Rebekah Griffith, The ED DPT (01:36)
Thank
you. I’m so happy to be back again and I’m looking forward to see us out.
Elise Cantu (01:41)
So exciting. And we also have two new speakers, ⁓ new guests here on the Onco PT podcast. So I’m going to go around my screen here. Next up we have Sarah Nechvatal Sarah, welcome to the Onco PT podcast.
Sarah Nechvatal (01:56)
Thanks for having me.
Elise Cantu (01:58)
And then we have Brandon Morshedi Brandon, welcome to the Onco PT podcast.
Brandon Morshedi (02:04)
I appreciate the invite.
Elise Cantu (02:06)
So can we get the obvious right out of the way? Who came up with the title for this session?
Rebekah Griffith, The ED DPT (02:12)
Well, I did. Yeah, because I’m just, one of the reasons that we wanted to give this presentation in the first place is I feel like we’ve come a long way in EDPT programming at CSM and in other places. So we’re no longer having to do those sessions on here’s what EDPT is and here’s how you start an EDPT practice. So we’re past that. So now what people are looking for, because last year at CSM during one of our sessions, I said, raise your hand if you’ve never heard of EDPT before.
Elise Cantu (02:14)
⁓ Not surprised.
Rebekah Griffith, The ED DPT (02:42)
and no one raised their hand, it was incredible. So the audience is ready for something new, something a little bit more advanced. So we were thinking like, what are some of the hot topics in the ED that are harder to manage? And that’s where the a-holes were born, both the literal and figurative ones.
Elise Cantu (03:03)
And then, so Rebekah, as we mentioned, EDDPT is your title, Emergency Department Physical Therapist. ⁓ But we also have two other guests who our listeners may not know a little bit about. So Sarah, Brandon, would you mind giving us a little background on, you know, like, how are you associated with or in this emergency department world and managing a-holes, if you will?
Sarah Nechvatal (03:27)
Yeah, I’ve been working in emergency department PT since 2010 and I have been in three different emergency departments and it’s been a really great experience because you really see a very large spectrum of patients, whether it’s in a level three or level two hospital where some of the diagnoses or chief complaints are a little bit less severe.
Elise Cantu (03:36)
Nice.
Sarah Nechvatal (03:54)
And then now I’m at a Level 1 Trauma Center, which of course, as you can imagine, has a pretty intense emergency department, which has been a lot of fun. But with that, of course, we have a lot of really intense scenarios that can occur in the emergency department. So it’s just been really fun to navigate all of that and to also help kind of… ⁓
know, guide some of the newer PTs in our emergency department and help them manage some of these situations. So this is a fun topic because it really is a, it’s going to be a great resource for therapists who are already practicing in the ED.
Brandon Morshedi (04:33)
And then for me, I’ve been in the emergency department for about 24 years now. For the first 12 years was on the shipping end as a paramedic, dropping patients off there. Overlapped that time as a physical therapist where I did mostly outpatient. I did some acute care stuff, but never really had the pleasure of going down to the ED as a PT. Then I went to further my career as a physician. And so now
The last 12 years I’ve been in the emergency department as an emergency medicine physician, the receiving end of the patient care. Now I work in level one trauma centers and then also some smaller critical access hospitals currently don’t have the pleasure of getting to work with any EDP TVs. I know I’ve been able to do podcasts with Rebekah and did her conference with her. I’m insanely jealous of all the hospitals that do have physical therapists in their ER.
And then I have to pull off my physician hat, put on my PT hat every once in a blue moon, and try to dust off the cobwebs to do some stuff. So for me, Rebekah reached out a few months ago and asked about doing another collab here. And of course, I agreed. And then I saw the title. was like, boy, there’s going to be a lot of people in the audience on this one.
Elise Cantu (05:53)
Ha
man. So a lot of experience present on this panel and from a lot of different perspectives too, both like in what disciplines, but also geographically. We mentioned previously, Rebekah’s Colorado, we’ve got Wisconsin, we’ve got Arkansas. So a lot of different stuff. But I think what Rebekah said is really cool is that I think it’s very much understood by physical therapists that
Emergency department is absolutely a place that physical therapists can be, should be, and can provide a tremendous amount of value in. And with such an intense, I really love that word that you said, Sarah, such an intense environment, it really amplifies a lot of, think, the patient experiences that we have. And I say this as someone who has never been, I’ve never worked in the emergency department. My entire career has been outpatient oncology. So very different circumstances.
but we’ve all encountered some a-holes at some point. So what was your inspiration or your motivation behind, obviously, RadTidal, but the content, the topic of this presentation? Why was this kind of the next step of, people are aware of EDDPT, now we’re gonna talk about this topic specifically.
Rebekah Griffith, The ED DPT (07:16)
I think the best answer to that is that you don’t have to be an emergency department physical therapist to benefit from this conversation at all. My goal really, my professional goal is that all physical therapists are practicing at the top of their scope. In order to do that, we have to manage some of the things that aren’t taught as well in PT school. We can take range motion like a boss, you can do manual muscle testing, all kinds of examination, but when people get into those soft skills, which I think they’re actually the most difficult skills,
Elise Cantu (07:23)
Definitely not.
Yep.
Rebekah Griffith, The ED DPT (07:43)
these a-holes
Elise Cantu (07:43)
Yep.
Rebekah Griffith, The ED DPT (07:44)
are some of the things that we need to be able to manage. So I’m going to tell you what they are so that everybody who’s listening can get a sense of maybe this presentation is exactly what I need, even though it’s in setting of the ED. And the reason the ED setting is so important is because all of these behaviors or conditions are really amplified and exacerbated in this high stress setting. So even if your clinic setting is like ED light, that’s okay, this will still help. So our a-holes are aggression,
Elise Cantu (07:49)
Please do.
Yes.
Rebekah Griffith, The ED DPT (08:14)
anxiety, altered mental status, abuse, and arrogance.
So I don’t think if you’ve been a healthcare provider at all in any setting, you’ve encountered all of these things. So we’re gonna talk about how each one of these can be present in the physical therapist, it can be present in the patient, it can be present in people that you’re working with, and how to manage each one of these A-holes from a 360 degree approach. And the reason it’s called the A-holes of the emergency department are that they’re kind of holes in our training, they’re gaps where we need to learn how to like fill that to be a little more successful.
Elise Cantu (08:55)
A Gaps doesn’t have the same ring as A Hole, so I really love that.
Rebekah Griffith, The ED DPT (08:57)
It sure doesn’t, does it? No, it sure doesn’t.
And there’s already a Mind the Gap conference. This is more fun than that.
Elise Cantu (09:02)
Also…
Right. I also appreciate this was something that as y’all were kind of introducing this topic of we might also be the a-hole sometimes. I know like, again, I think, you know, this is like, it’s a very sexy title in a way of like, my attention is, is peaked. And I think we’ve all had probably a patient interaction that we look back on and we’re like, whoo, that did not go well. But also like,
Rebekah Griffith, The ED DPT (09:13)
100%.
Elise Cantu (09:32)
How often have I been the a-hole in the situation that made that patient interaction much, much worse? So when you, could you go ahead and say the a-holes one more time for me, Rebekah?
Rebekah Griffith, The ED DPT (09:42)
Yep,
we have aggression, anxiety, altered mental status, abuse, and arrogance.
Elise Cantu (09:54)
Are these some of the more common, maybe challenging kind of situations or how did y’all kind of discern and decide on these ones specifically?
Rebekah Griffith, The ED DPT (10:09)
because each patient can have all five of these. you know, presenting patient presents with aggression, anxiety, altered mental status, concerns for abuse and arrogance. You know what I mean? Like there could be all of that in one patient. But I think in this particular case, arrogance doesn’t necessarily apply to the patient.
Elise Cantu (10:13)
So true.
Mmm. ⁓ so good. So good. With in y’all’s experience, you know, again, for maybe the clinician who has only worked in a particular setting hasn’t really been in the emergency department. Can you give us and I’m asking you to basically take your entire professional experience into like an elevator pitch. What are some what are some of the maybe
lesser known lesser appreciated aspects in emergency department care that really require that soft, those soft skills, those interpersonal skills on a different level than like maybe elsewhere in healthcare.
Brandon Morshedi (11:16)
I think for our patient population, they’re in the emergency department. They’re usually at their most vulnerable, a lot of them on edge. ⁓ Maybe we gave them some horrible news. Maybe they’re there just because they don’t have the ability to cope with certain unfortunate things going on in their lives. They don’t have the resources available. So it’s really not a great time for that person ⁓ in life at that moment. the ability for
me as a physician to go in there when I’m seeing, you know, four or five patients an hour trying to separate who’s quickly dying from who’s slowly dying. I don’t have the ability or the resources to give them the time that they deserve to really alleviate those fears, those concerns. And then you throw in some of these a-holes in there it really complicates the encounter even more. ⁓ Someone like a physical therapist coming in there and they ED who
Elise Cantu (11:52)
Mm-hmm.
Brandon Morshedi (12:14)
possesses the skills, the ability to navigate these a-holes, really brings tools in there that I don’t have. And so for me, it’s an amazing resource. And the more people that can come and learn these tools, the better for me to be able to take care of my patients.
Sarah Nechvatal (12:34)
And I agree with everything you just said. And I think the other resource that therapists have that you don’t have as a physician is time. You know, it’s something that we can spend some time with those patients when they’re at their worst, when they’re terrified, when they’re scared, anxious, all the things, all these a-hole examples. It’s something where…
Elise Cantu (12:43)
Bingo.
Sarah Nechvatal (12:58)
those patients can potentially feel a lot more relaxed and reassured when you have someone that spends time with them and really takes time to explain what’s happening and give them some, you know, hopefully some good news and some hope that things are gonna be okay.
Rebekah Griffith, The ED DPT (13:13)
think to your point, Sarah, with the time and Brandon also, if you take just the patient who might be altered, if Brandon has roughly 52 seconds to spend taking a history from that patient, if that patient has dementia, but they’re making it through that conversation with him pretty quickly, pretty easily, but then we spend a little more time with that patient and their loop resets, and now they’ve said the same thing three times in a row, to Brandon, they might have come across as really reasonable and appropriate.
But now that we’ve heard the same tape play four times, we know there’s a bigger gap. Or we have a patient who’s aggressive and anxious, but if we can help regulate that patient, that aggression melts away, that anxiety melts away, and we’re able to get that patient the appropriate care.
Elise Cantu (13:43)
Mm-hmm. Mm-hmm.
Brandon Morshedi (14:02)
Yeah, maybe with me, I just see them as aggressive and a jerk and I’m trying to figure out how to medicate them. You guys spend more time with them. You actually learn that that aggression is driven by fear. And now you have the time to give them some reassurance that I didn’t. It’s just a much more positive encounter for that patient in the end.
Elise Cantu (14:02)
though.
Mm-hmm.
And again, emergency department, mean, people don’t go to the emergency department because they want to spend their afternoon hanging out at the hospital. Like that’s not how this is. And one of the things that I’ve really learned so much over the years from Rebekah is how much the emergency department is really a safety net for so much of our community because of the state of healthcare in the United States, not just today, but also what it’s been over the past few, not few years.
how it is in the United States and really being able to be that safety net, be that catch all and have those layers of interaction like y’all are talking about to where, again, maybe Brandon as the physician is getting this brief window to just kind of discern like how urgent does this person need care? Are they dying right now? Are they not maybe dying right now?
and then bringing in that other team members, such as the physical therapist that we’re talking about here, to really kind of just have that time to sit with the person and kind of get through maybe some of those, again, layers of what is this person experiencing, how are they presenting. Without giving us your whole presentation, obviously, what are some of the maybe strategies or, you know,
tools that therapists are going to take away from your presentation on how to work with patients in these situations where maybe we are dealing with a-holes. And again, I am including us, the healthcare professional in the a-holes like bucket here.
Rebekah Griffith, The ED DPT (16:01)
I think one of the tools, hopefully we’re gonna send people away with some A-hole fillers, but one of the things is to check your own arrogance. Because I hear a lot of times, especially on Instagram reels and stuff, people will be like, ⁓ the emergency department’s only for emergencies. That’s like.
such an arrogant attitude realistically. And I think anybody who’s practiced in the emergency department knows that, that would be ideal state. That’s not realistic state because one of the issues that leads to a number of these a-holes is access. And so patients don’t have that access and they also don’t have an understanding. They have anxiety, they have confusion, they don’t know why they need to be there. They don’t know where else to go. They need help. And so I think checking our own arrogance, both from our perception of the patient, our perception of why they’re there,
Elise Cantu (16:23)
Mm-hmm.
Mm-hmm.
Rebekah Griffith, The ED DPT (16:49)
whether we think it’s an emergency or not, and then also that arrogant attitude that we might have about collaborating with others. The emergency department is the best team sport practice I’ve ever had. So being able to collaborate effectively and adapt, adaptively with your colleagues, I think is really crucial. So we’ll talk about some of those components.
Brandon Morshedi (17:16)
I know also in looking at the outline that Rebekah put together, they’re going to walk away with some de-escalation strategies if they haven’t learned those before. That’s kind of like learning basic first aid when you’re starting out in healthcare. So those are foundational skills. ⁓ Trauma-informed care is a very important topic that if they’ve not had any specialized training in that.
everything that these patients go through in the ED is traumatic. I mean, we’re talking about your personal life while you’re sitting in between two curtains with someone else right on the other side of that. Being able to stay sensitive to that. And then I think also there’s, we’re going to do some small group stuff, like case study type stuff, Rebekah, if I’m not mistaken. So they’ll be able to immediately apply what they learn in some cases there.
Elise Cantu (17:52)
Mm-hmm.
Mm-hmm.
Yeah.
Rebekah Griffith, The ED DPT (18:11)
There might even be an opportunity for participants to manage some unexpected de-escalation needs in the middle of the presentation.
Brandon Morshedi (18:20)
Do I get to be aggressive?
Rebekah Griffith, The ED DPT (18:22)
Ooh. I think it’s gonna be Sarah.
Brandon Morshedi (18:26)
Okay. I can pretend to be the jerk ER doctor.
Sarah Nechvatal (18:27)
I can get that way sometimes, especially when I’m hungry.
Elise Cantu (18:35)
I attended Rebekah’s, one of Rebekah’s session last year on the communication. It was with you, Adam Matichak and Jamie McKay. And all of a sudden, Rebekah was shouting at me and it was like, my God, it was part of the presentation y’all. But it was a really good kind of opportunity to kind of sit in that moment because it was so unexpected. mean, like, you know, dear listener, you’re not always going to have.
someone’s chart and it’s going to say, hey, this patient interaction is going to be difficult, just be heads up. Like it is oftentimes a surprise. And so being able to really manage that in real time and work with the surprises like that, I think is what really enables us to be able to again, manage the a-holes in these situations, including us. ⁓ And so I’m excited. I know it can be a little intimidating for maybe someone who’s like newer to the profession, newer to the conference.
This is where the magic really happens at CSM is those interactions and the application and the practice of this so that you can take this information home and apply it on Monday morning with your own patients in your own community. And so I would encourage you if you are a little scared about that, go to this presentation because that is how you are going to be able to practice and start getting better at this. Because as we have talked about in this interview, this is not something that we
We learn in PT school. You know, again, we spend so much time on the anatomy, which is very important. All these things are very important. The anatomy, the range of motion, the MMT, the blah, blah, blah, blah, blah. But actually being able to sit with the human in front of you as a fellow human and connect and be able to kind of break through some of those layers to really establish that rapport, that therapeutic alliance that you need to get to that next step together.
That’s hard. That’s a really challenging skill and we don’t oftentimes have a lot of experience with that, a lot of knowledge or education on that unless we seek it out and this is a really golden opportunity to seek out an opportunity like this.
Rebekah Griffith, The ED DPT (20:43)
It’s the art.
Elise Cantu (20:45)
⁓ yes. Yes.
Rebekah Griffith, The ED DPT (20:46)
just to take the A theme all
the way. Because as you imagine, there’s gonna be some mirroring A’s to fill the holes, okay? That’s the art. You talked about alliance, but that’s the art. All of that, how we fill these A holes, is the art of physical therapist practice.
Elise Cantu (20:52)
I love this.
I love this so much. I’m so excited for this session. It’s gonna be so good. We’ve talked a little bit about the strategies and whatnot that people are gonna take away from this. Let me rephrase this. Why is it so important that attendees should go to this session and should show up and should be like, I am ready to learn?
Sarah Nechvatal (21:32)
I think it’s also about anticipating, once again, another A. It’s not just reacting to all of the A-holes that we encounter. It’s about anticipating it. It’s a high stress environment. Patients are scared. We can anticipate that they’re not going to be their best selves. So if we can anticipate that and utilize some of the resources that we’re going to provide the attendees.
Elise Cantu (21:38)
Y’all are killing it.
Sarah Nechvatal (21:56)
⁓ I think they’ll be more successful. They’ll be more successful, the patients will be more successful, and the whole interdisciplinary team will be more successful.
Elise Cantu (22:15)
I was just waiting to see if anybody else wanted to contribute. No worries if you didn’t. It was a really good answer, yeah. ⁓
Rebekah Griffith, The ED DPT (22:16)
That was a great answer. I mean, was a great answer.
Brandon Morshedi (22:23)
Nothing else to add to that.
Elise Cantu (22:26)
I’m curious to see how many A’s y’all can really fit into this presentation because I feel like y’all have dropped so many already. I’m very excitedly anticipating to see what people are gonna walk away from with this session. What is one thing?
that you can tell a listener today who’s listening to say, is one thing that you will take away from this session that you can start using with your patients when you get back Monday morning.
Rebekah Griffith, The ED DPT (22:58)
I
of reconnecting to like the sacred ordinary in human interaction. Like that’s my goal for you, Elise, if you come to this presentation is that when you walk out, you remember that everybody who’s presenting with any of these A’s, whether it’s abuse, whether it’s altered mental status, whether it’s arrogance, there’s something behind that that’s so profoundly deeply human. And we have to remember that like our interactions with patients, like what a privilege that is to like touch people’s lives.
And as Brandon said, in some of most vulnerable moments of their entire healthcare journey, like what a gift that is. And so I don’t want you to be afraid of the darker parts of humanity, the more sketchy parts, the parts that are like truly the A-holes. I want you to be able to feel like I could be an A-hole whisperer when I walk out of here, because I’m on the A team. So that’s what ⁓ I think. I just want you to be deeply, profoundly humbled by humanity and ready to like support, support someone.
Sarah Nechvatal (24:02)
I think something that I heard recently from an emergency physician that has really ⁓ stuck with me is that, you know, when we talk about the arrogance, it’s, you know, usually it’s not the patient, it’s usually a provider, whether it’s medical, whether it’s the therapist, you know, whoever it is. I think about when there some people who work in the emergency department and sometimes they’re a little bit arrogant, so they think that they know it all. ⁓ The saying that the physician told me was,
If you’re not humbled in emergency care, you’re about to be. And so I think that that is something that I tell every single person I interview for a PT position in the ED. It’s so necessary to be humble, not just about your knowledge, but about knowing the exact scenario that that patient is in in that moment. You might get an S bar from a provider or a nurse, but you walk into that room and you might get a totally different story.
So you can’t walk into a room thinking that you know it all about what’s going on with that patient. You let the patient tell you because they’re going to tell you exactly what’s wrong with you, what’s wrong with them and you maybe. So I think just having people set their mind so that when they walk into that room, be ready to learn from the patient.
Elise Cantu (25:12)
I’ll tell that.
Brandon Morshedi (25:25)
Yeah, everything about that encounter is going to be challenging in ways that the PT’s not probably had to experience before. You know, it’s an undifferentiated patient for the most part. There’s all the individual a-holes that we’re going to talk about related to that encounter before you ever walk in. ⁓ The unpredictable environment of it. I think most PTs that will leave this session will probably leave with…
maybe a little bit more appreciation for how challenging that environment can be. And if they really want to try and push themselves professionally, hopefully they feel encouraged to maybe take the leap of faith and go try to get into the emergency department. Really, really make a big difference with patient care and outcomes in this world.
Elise Cantu (26:15)
Brandon, something you said really resonated with me, is kind of viewing the patient as undifferentiated. ⁓ When we walk into an encounter and an interaction with a person, kind of leaving what we think we know at the door to, like Sarah said, really let that patient tell us what is happening. And I have a saying that if you shut up long enough, a person will tell you what’s going on with them and what’s…
what is most important to them. And I think that folds in nicely with exactly what y’all are talking about. And just to give this a little oncology spin or maybe reframing for the listener who’s like, know, just like emergency departments, not for me. That’s okay. But the number of times that I have experienced this and you will likely experience this in your practice, which is where you are working with a person, you know, maybe over the course of days.
weeks, what months, what have you, and you think you know how a session is going to go, and then they come in and they have received life altering news, terrible news. And in my case, many times it’s, hey, we are stopping treatment, there’s nothing more that can be done, it’s time to put your affairs in order. That is an opportunity, and I’m not saying that patients are a-holes in this situation, I’m saying that exactly what
Rebekah and Sarah and Brandon have been talking about this whole session of being able to manage those different layers of emotions and what this patient is experiencing. This is a session that will prepare you to better.
deal with that address that be able to sit with that patient and really show up in the way that they need in that moment. So if you are still listening to this and you’re like, I just don’t think this is appropriate for my practice friend, go back and listen to this interview again, because I think you missed the point of all of this. ⁓ And I will definitely be very anxiously attending this with bells and whistles on because this is a really, really good session that people are going to take a lot from and be able to more positively impact.
their patients and their communities by implementing this information. So let’s talk a little bit about the logistics of your presentation. When is it taking place at CSM?
Rebekah Griffith, The ED DPT (28:39)
Thursday at 8 a.m. bright and early. We’re gonna kick out.
Elise Cantu (28:42)
What
a perfect time. You know what? I can’t remember if my session is Thursday at 8 a.m. or not. I would just, as you said that, I was like, wait a minute. I think that’s when my session, you know what? I’m going to have to skip it. I’m sorry. Like Alex and my team can take care of it. Alex, Kelly and Kelly. I will just have to be at this session. I’m sorry. I’ll have to double check on that. But this session is taking place
Rebekah Griffith, The ED DPT (28:50)
⁓
You’re gonna have to dance, Peters, I’m sorry.
Elise Cantu (29:12)
Thursday, I believe that is February 12th, bright and early at 8 a.m. What a fantastic way to start your conference, y’all. If you are looking for this, it is in the acute care section of APTA. So if you’re looking through the app, if you’re looking through the website, the full title is AC24501, Managing the Unmanageable, the A-holes of the Emergency Department. And again, don’t let that emergency department
buzz phrase deter you or scare you from this presentation. This has wide ranging applicability application for your patients no matter where you’re working or who you’re working with. And again, just from this brief conversation, I can already pull some stuff out that I can definitely be using in my own oncology patient population. So thank y’all so, so much. Is there anything else that you’d like to leave my listeners with today?
Rebekah Griffith, The ED DPT (30:09)
give a shameless plug for another session that I’m leading on that’s on Thursday in the afternoon. It’s called Hands-On in the Hospital, Manual Therapy and Acute Care. Again, this is another one of those conversations that while it’s geared towards the hospital, manual therapy is an intervention that I feel like if we don’t go into outpatient orthopedics, sometimes we forget about it and we leave that toolkit by the side. It’s just a reminder of how, when, and why to pick up that tool set.
Elise Cantu (30:14)
Yes, please.
I love.
her.
Rebekah Griffith, The ED DPT (30:37)
so that you’re giving your patients the biggest bang for the buck.
Elise Cantu (30:43)
Outstanding. Sarah, Brandon, anything you’d like to leave my listeners with.
Sarah Nechvatal (30:48)
I just want to add, you know, it’s not lost on me that this is Oncology PT podcast, right? So I think something potentially that oncology PTs might not think about very often is that your patient, whether you’re an outpatient therapist or inpatient therapist, your patient, most likely over the span of their recovery or treatment that they’re undergoing, they’re going to be in the emergency department a lot.
Elise Cantu (31:15)
Yes they
Rebekah Griffith, The ED DPT (31:16)
Yes.
Elise Cantu (31:16)
are. Yes they are.
Sarah Nechvatal (31:16)
and we see them
there. And they’re there because they don’t feel good. They might be getting so much weaker and they come into the emergency department and they think, is this it? Was that the last time I slept in my bed last night? Was last night the last time I slept next to my spouse? So those are the emotions that are rampant in the ED because it is full of uncertainty.
And so I just want to plant the seed that your patients, your oncology patients are in the emergency department all the time. And actually, we need your help to help teach us how we can best treat those patients. Because truthfully, I’m not an oncology PT. That’s not my expertise. But I could learn a lot from oncology PTs in order to manage those patients better. So ⁓ that’s one of the awesome things about the ED is that there is such a wide variety.
but your patients are with us a lot. So there’s a lot to learn with that group for sure.
Elise Cantu (32:21)
Lots
of crossover. Absolutely.
Brandon Morshedi (32:26)
Had way too many actually in the last few weeks in my EDs. I worked in three different ones, 16 days in a row in the ER over the holidays. And it was just extremely tragic holiday season, lots of terminal illnesses and cancer. So yeah, Sarah, you’re absolutely right.
Elise Cantu (32:36)
with.
Yeah.
Brandon Morshedi (32:50)
And yeah, last words from my standpoint, I know I’m not currently a physical therapist, but that’s my foundation. And certainly I’m very comfortable in the emergency department and hope to be able to tie these two worlds together. And definitely appreciate Rebekah for thinking of me and giving me the opportunity to attend my first CSM. All years as a PT, I never even got to go.
Elise Cantu (33:16)
man.
Brandon Morshedi (33:20)
I’m super excited.
Elise Cantu (33:20)
⁓ Brandon, you are in
for a treat. man. So exciting. Once again, the CSM session that we’ve been talking about is in the acute care section AC24501, managing the unmanageable, the A-holes of the emergency department slash also oncology physical therapy. So, my friends, that’s why you should absolutely attend this session. ⁓ Like I said, I may not be there because I might be presenting, but I will be there in spirit.
And I cannot wait to hear how the session goes. Thank you so much once again, Rebekah, Sarah and Brandon for coming on the Onco PT podcast. We are so, so grateful for your time and expertise and sharing it with us today. And I’m very excited to get to hear about this session and hopefully attend. Like I said, if I’m not presenting, I will be there with bells and whistles on. So I’m looking forward to seeing all of y’all there. And once again, thank you so much for your time, y’all. Thank you listeners. And until next time, this is Elise with the Onco PT.
And remember, you are exactly the physical therapist that your patients with cancer need. So let’s get to work.