@TheOncoPT (00:19)
Hey, Onco PT and welcome back to this episode of the Onco PT podcast. Over the past few episodes, we have talked a bit about how to pick a good patient case, not just good, a great patient case for your upcoming oncology case report. But we haven’t talked about a problem that can often happen around this time, which is you have multiple really wonderful options for your case report. You’ve identified

a few different patient cases that would make really good case reports. But you don’t know how to pick which one. And a lot of times from the outside, this can seem like a fantastic problem to have. Instead of, I don’t even know what case to write on. Like, do I even have a case report? You’re facing multiple options in front of you, multiple vetted options. And that sounds like such a great problem to have until…

You are stuck having to make that decision and not sure if you’re making the right decision, right? Like, I feel like this is kind of a FOMO situation of I could pick this one, but what if I was actually supposed to pick that one? And the worst thing that can happen in this situation that we’re trying to avoid is that you start writing a case report on a case that you chose, but you’re you’re questioning your second guessing if that was the right decision.

and then you pivot, you drop that first case that you were working on and then pivot to the other one. At that point, you’ve lost writing time. You’ve lost not just the writing effort you have put in, you have also lost time. And we have to be real here. When we’re talking about the ABPTS oncology specialty certification application process, there’s a deadline associated with that. So there is a time sensitive element to all of this that we wanna keep in the back of our brain. So today’s episode is going to help you really cut through that

noise of I have multiple great options and I don’t know which one to choose so that you can get clear on what is the best one for you to choose so that you can then move forward from here. So what usually happens the mental dialogue that I have personally experienced but also have seen other oncology physical therapists kind of have this argument with themselves of okay I have multiple options in front of me

I’m not sure which one to go with. Let me kind of do a pros and cons. Let me get out my yellow legal pad and write down strengths and weaknesses of each of these. This case is more complex over here, but do I have enough evidence to support what I did in that very complicated patient case? This case, on the other hand, feels safer. Like I know

I could find reliable, ample literature to support the interventions that I chose. But does it really show my expertise, my specialty understanding of oncology rehab? And you can make a case for each of these options and more, which is what makes it so hard in the first place. So instead of moving forward, most PTs are going to sit on this decision.

for way, way longer. What this looks like is, you know, I’ve picked out a few potential patient cases in all of this. I’m just gonna, you know, I wrote them down. I’m just gonna leave them there. I’m gonna let them sit. I’m gonna come back to this later, you know, after I’ve really given it some thought and then I’ll write my case report on it.

I’ve seen that happen. all, I’ve men seen people get right up to the deadline and say, you know, I’m, I just still haven’t decided which case report to do. My friend, please don’t do that. So that’s kind of one train of thought that I see people go down. The other one is to go back and forth on their decision. So they have narrowed it down to maybe like two to three possible patient cases and they’re switching back and forth between them. Like, you know what? This one’s better. I think I’m going to get started working on that.

No, actually, this one’s better over here. I think I’m going to start working on that. No, this one’s actually better over here. I think I’m going to move forward with this. Or they are going to choose. They’re going to choose a patient case. And then as they start the writing process, they second guess themselves the entire time and always have that nagging itch at the back of their mind. Asking themselves, is this

actually the best patient case for me to write on and you are questioning yourself and your choice the entire time you are writing a case report. That is not where we want to be. That is not the headspace that we want to be in as you undertake this very important, very taxing process of writing your case report. And this second guessing does not go away magically once you start writing, unfortunately. I wish it would.

It’d be much more convenient if it did. But oftentimes, if you are really uncertain about your patient case, which one is the best, that is not going to magically resolve itself once you start the writing process. So as we’ve mentioned previously, and we’re going to continue to emphasize, the goal is not to pick the most interesting case. And it’s also not to pick the most complex case.

in all of this. You need to pick the case that gives you the strongest foundation upon which you can build your case report that really shows to ABPTS, I am an emerging specialist in oncology, physical therapy. I have demonstrated my worth. I know what I’m capable of. And this is the kind of specialty level care I am delivering in my community to my patients.

So in order for us to get there, we have to pick a patient case that is going to enable us to do this. So if you’re working with a few different options, here’s the process that I want you to walk through to arrive at that decision. And this is very intentional, like this is very action oriented. Arrive seems a little passive, like you are going to get there because you are taking the steps to get there. You are taking the steps on this journey.

So if you’re choosing between a few different options, these are the questions that I would come back to. Walk through which case most clearly demonstrates my clinical reasoning, right? It keeps coming back. It’s because it’s really important and it is what I need you to lead with on your case report forever and always. Does this case…

clearly demonstrate my clinical reasoning. And this is a point at which you could, I feel, bring out that yellow legal pad, that the pros and cons, the strengths and weaknesses between the different patient cases. And instead of doing like check marks or, you know, yes, no, I would actually encourage you to write little blurbs or little notes about each of the cases you’re considering in these domains. So for case A, does this

demonstrate my clinical reasoning and asking which case most clearly, most definitively demonstrates my specialist level clinical reasoning. Question number two, which case gives me enough depth to work with? And again, don’t stop at just yes, no. Write notes, write blurbs here so that you can really evaluate which case does give me more

depth, more progression information to work with so I can really flush out this case report. And then question three is, which case will be the easiest to support with evidence? And I want to pause here. Easiest maybe isn’t even…

the best word here? I think the word is like best supported with evidence. We’re not looking for something that you can just like easily do a quick little search and be like, yep, I see that this is totally supported. If that happens, that’s great. That’s amazing. Which case is best supported with evidence? I think is the better question to ask yourself here. And what are maybe some of the points that will be supported in the literature?

as you’re evaluating, you know, discerning between these different patient cases. And notice what’s missing here. This isn’t about which case looks the most impressive on the surface level. It’s very tempting to do that because again, you want to demonstrate to AB PTS that you’re a specialist and that carries a degree of impressiveness with it. And in no way am I trying to diminish the amount of work and effort and intention that you have

put into this journey of yours to becoming an oncology specialist in physical therapy, an emerging specialist in oncology physical therapy. That is impressive. You have done impressive things to get to this point, but I don’t want you to settle for what is impressive on the surface level and that carrying you through this case report process because it’s unfortunately not going to do that.

This is not about what looks most impressive at first glance. This is about what really holds up when you actually start building your case report.

So if you are stuck right now between a few different options in your case, really pause and think through those three. And I would, like, I’m a big writing things down to compare them, especially when I’m sitting with a really big decision. And this is a big decision. Let’s not kid ourselves here.

When I’m sitting with a really big decision, I don’t like to type things. I like to write things out. Something about just that tactile act process of writing just connects with my brain and like the decision making process better. I don’t know. I’m sure there’s a reason. Don’t ask me what that is. I don’t know what it is. I would encourage you have a piece of paper, you know, have a notebook that you can write this out so that you can really feel and think and sit with this decision.

And this might even be an opportunity for you to talk with other specialists, other physical therapists, other even like healthcare professionals, know, those you trust in this, you know, in decisions that you make, this would be a good place to get some potential outside feedback, outside input, for example, so that you can feel really well informed. Now, at the end of the day, because I do this too,

I sometimes will default to letting someone else make a final decision and then I just go along with it. Friend, this is your decision. You are the one who needs to make that final decision because you cannot halfway through this case report say, I shouldn’t have listened to blah blah. You need to make that case report decision confidently and you need to make it yourself. You can take input from others. You can take the information that I’m giving you here. You are ultimately the one that has to make that decision.

Be happy with that decision and then see that decision through to completion, AKA finishing your case report and then submitting it to ABPTS. Take ownership of this decision. Make the comparison chart. Really sit with and write notes, thoughts, blurbs on each of these areas for the case report, ⁓ ideas that you’re considering.

so that you can make an informed decision in all of this. It may not be, after doing this process, it may not be the case that you totally thought it was going to be at the outset. I know that’s how it was for me. When I was originally considering which patient cases to write for my case report, I had a few different options. I knew that the multiple myeloma case, I talked about that in the previous podcast episode, if you’re wondering. So,

Definitely go back and listen to that where I talk about this a little more. I knew that I was considering my patient who had multiple myeloma, but there were also a few others. There was one in particular, ⁓ kind of in this time period I was considering. She was a very young individual and she had a really rare soft tissue tumor. I had never heard of it before. ⁓

I, it’s the only one I think I’ve ever seen to this day. It’s not, it’s like, it’s a very rare diagnosis. And so part of me was like, Ooh, that’s interesting. I’m definitely considering that. But when I took each of these cases through that list, that those questions that I asked previously, which one most clearly demonstrates my clinical reasoning, which one gives me enough depth to work with, which one will be easiest to support with evidence.

Number one, the evidence question was absolutely weaker when it came to that soft tissue tumor, because there’s just not a lot out there to really connect, hey, this patient population benefits from rehab. These are the specific benefits we can see. These are the kind of interventions that would be beneficial. There’s just not a lot out there. And so a lot of it was me kind of making things up as I go or trying to pull from like ortho stuff just based on the kind of treatment that this

person had for her specific rare type of cancer, I was really piecing things together from a very hodgepodge place. And sometimes that is how oncology physical therapy works. But I knew in that specific case, that was not going to give me lot of evidence to really pull from to show this is why I did what I did. I think that, I don’t think, I know this, when it came to the clinical reasoning question, the multiple myeloma case

far and above demonstrated that much more clearly than that soft tissue tumor that I was talking about previously. As far as enough depth and progression, I saw both of those patients for a decent amount of time. We made good progress in working with the different impairments and whatnot. So those were kind of equal. So you can see that there are certain areas where

You know, maybe at just first glance, or if we look at the case from a whole perspective, it might have been easy in my brain to kind of look at those two cases and say, you know, I’m considering both of them for my case report and I’m kind of stuck between the two of them because they were both interesting. I both, you know, I learned a lot from both of them and I think there’s elements of specialty reasoning that emerged from both of them. That’s, that’s accurate. But when you break down cases,

into these different components and really ask these different questions and force yourself to sit with and really think through and kind of argue in support of each of these, I think that’s where you can really start to see where that really starts to emerge of that multiple myeloma case is a much stronger option for a really great case report that’s going to demonstrate to ABPTS, I am an emerging specialist in all of this. There were interesting parts.

about that soft tissue tumor case that I mentioned. There were things that I think would have demonstrated my clinical reasoning, but not as strongly as that multiple myeloma case, which is what I ultimately chose to write my case report on. Sit with these questions. Literally take your case report options through those three questions that we talked about and write notes and then compare. Don’t compare the big picture cases

Zoom in on these components to really discern what is going to be the best option for me to write a case report that has a strong foundation that I can really build from here. At this stage, if you are discerning between different options, you don’t need more ideas. So I would pause here if you are like, you know what? I just haven’t had the right idea strike. Probably not. That’s probably not the problem here, my friend.

You don’t need more ideas. You need to be able to trust your decision and know that you really evaluated all your options thoroughly to make an informed decision here. And that certainty comes from knowing you have a way to evaluate what is in front of you thoroughly and completely to make a confident, competent decision.

for your case report.

Now, if you’re currently in this exact position where you have multiple patient cases and you are stuck and you are like, they all are kind of apples on the same playing field right now, I walk you through this process more detail, more step by step in a video that I’m releasing on YouTube later this week on my channel so that you can actually work through that decision in real time with me a little bit more clearly.

What you can do, if you haven’t already, make sure that you subscribe to the Onco PT on YouTube and you’ll get a notification when that video goes live. I will also link them in the show notes and whatnot when they release. The fastest way to make sure that you see that video when it drops though is to subscribe to us on YouTube. So I’m looking forward to seeing you over there. We are building a mighty presence on YouTube that I’m really loving. This is a new process that I’ve started actually at the beginning of this year and it’s been a lot of fun. I feel like you can really expand on these.

podcast ideas and whatnot that I’m having. cannot wait to see you over there on YouTube, but until next time here on the podcast, 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.