@TheOncoPT (00:19)
Hey, OncoPT, and welcome back to this episode of the OncoPT Podcast. I want you right now, if you’re able, close your eyes. If you’re driving, don’t do that. But I want you to think back to your early oncology PT evals

Did you kind of cringe a little bit? Did you kind of like, ooh, catch your breath of, that was kind of painful?

I don’t know about you, but my early oncology evals were so rough. They took forever.

I was frankly lucky if I even got to the treatment side of things when working with my patients. There were some days I didn’t even finish all of my objective measures, right? Like I spent so much time in this objective, kind of sped through the objective, maybe got a home exercise program thrown at them as they were leaving out the door of my clinic. It was rough, right? I imagine you probably had

some similar experiences. Now, hopefully at this point, maybe you’re a little better, right? Maybe you’re a little ⁓ faster. Maybe you have a little better flow kind of situation. But I think these, the evals in particular shine a light on our practice more blindingly, most brightly of all, compared to other parts of our clinical practice. Like with, you know, with a session with a patient.

you can kind of get by, right? Ask them some questions, see how they’re doing. You know, you’ve got some tried and true exercises or interventions that you’re like, these are my tried and true, my ride or die, my besties when it comes to, okay, in a pinch, I can pull these guys out and I know they’re gonna help me with those things. And you can kind of get through your sessions with patience based on those, especially like I said, in those early days, if you’re like, ⁓ my gosh, like I don’t even know what I’m doing some days.

But with evals in particular, number one, this is your first encounter a lot of times with. So you have to be super on, right? We want to show up. We want to make a great first impression. We want to exude confidence and really demonstrate to our patients that they have put their trust in the right professional to help them. And not just that, not to put a little more pressure on all of this, but you

are acting as the representative of oncology physical therapy in that moment in time. know that seems like so much pressure. It kind of is a lot of pressure, but that’s kind of what’s at stake here.

On top of that, you’re also trying to sift through a lot of information. Maybe the patient is aware of what placed the referral to physical therapy in the first place. Maybe they even self-referred, right? That’s totally possible. Maybe they have an idea of why they’re there to come and see you. Maybe they are acutely aware and they’re able to really tell you like, this is exactly what’s happening and this is when it started and this is when it gets…

better, this is when it gets worse, this is what I can do to help, this is what is not helping right now, and da, da, da, da, da, da. You also could very well encounter patients who are not really sure why you’re coming through the door to see them. They’re like, what the heck are you doing here? Who are you? Also, what is PT? And so you also have to be able to work through that.

and feel confident and like, okay, you know, again, I’m showing up as the representative of oncology physical therapy. This is what we do. You know, okay, can you tell me a little bit about why you’re here? That was something I would ask my patients frequently. And again, sometimes they wouldn’t even know why they were in my office in the first place for physical therapy. That’s not their fault, right? They’re seeing, you know, oncology patients on average see, think, 13 specialists.

like at any one time, my goodness, I could not keep anybody straight either. So in that eval, you’re balancing a lot. And again, you’re trying to really establish that relationship. You’re trying to really demonstrate that you are a professional with expertise, that you can help them with this stuff. yeah, and you’re also trying to get a lot of information from the patient asking about their oncology diagnosis, their treatments, their side effects. Maybe you have some notes.

from the oncology team that can help fill in the gaps. That’s still time and effort you have to put into getting that information. You’re trying to get information on the patient on what’s going on, et cetera. and then you’re trying to get, as you’re talking with them, you’re trying to decide on what outcome measures you’re gonna do, et cetera. Hopefully we can get some treatment at the end of it, et cetera. All this to say, evals shine a spotlight on how you practice and kind of the status of

how confident you are in your skills. And as I mentioned previously, when I was first practicing, and probably for the first two years, if I’m being totally transparent with you, my evals were rough. They got better, right? You do so many evals, you tend to get a little better at things, right? Practice, practice, practice. But they still took a while. And that time meant that I wasn’t able to, first of all, finish the eval.

I’m talking just like the working with a patient through this, let alone the documentation afterwards. It was just such a long process for me. And again, it was all of this, like if I wasn’t spending time looking things up on my lunch break, I was documenting all through my lunch break so that I wouldn’t have to stay hours after, although that wasn’t always a guarantee.

And struggling through those evals, I think was really the marker for me of knowing like, I have a lot of improvement. I have a lot of area of growth. And that’s what a lot of physical therapists tell me too, of like, man, daily sessions are fine, right? If, know, once you get through that, you can kind of figure out what to do next. But dang, those evals are really, really struggling. And that was the truth for me.

until I started going through the specialization process. Before specialization, evals took forever. ⁓ They were rough at best. I didn’t know what I was doing all the time. I was making a lot of decisions on the fly and then never truly finished things up within that one session. And it often bled over into my next sessions. As I started going through the specialization process and spending time really learning,

about what are the side effects that you can really start to see and expect with your patients who have been treated with this or have this diagnosis. What does that look like? How do we measure that? How do we treat that, et cetera? The absolute collapse in time.

that did to my evals was mind boggling. And yeah, I used templates beforehand and they kind of helped me guide like the flow of my eval, but it didn’t help the decision making that was happening in my evaluations until I started spending that time with the material in my specialization prep process. And I think where it really came from for me,

was the sitting, like, you know, I’d learn something and then I’d try to implement it in practice and then reflect on it afterwards. And I’d say, ⁓ my God, I’ve been doing this completely wrong. Or, you know, I actually have been doing this right. I’ve just been doing it the hard way. One of the things that I really was able to change and transform in my evaluations, when I…

would first, so pre-specialization, when I was asking patients questions, again, trying to get a good history, I would ask every question under the sun. And maybe you feel this way too. Asking every question under the sun, trying to get as much information as possible from this patient so that I could then make an informed decision on like, okay, here’s what I’m gonna screen for, here’s what I’m gonna assess for, here’s what I’m gonna maybe pause on and come back to later. Going from asking,

beaucoup de questions, to being able genuinely to start with like three or four questions and to be able to sit quietly as the patient is answering the questions, I was able to start picking out words or phrases or sentences that the patient was telling me and able to fill in the gaps of

they’re totally talking about CIPN right now. my gosh, this patient is totally experiencing chemo, know, like cancer related fatigue. Or, hmm, this patient is probably at a pretty significant risk of lymphedema. Maybe they’re already at stage zero based on what they’re telling me. I need to make sure that I’m doing circumferential volumetric measurements, et cetera. Literally, sitting with material

and sitting with myself on how was I practicing while that was not working and then being able to make real time adjustments and corrections. So being able to, you know, learn and do some studying after work, go into practice the next day, implement what I had learned about, said that worked, that didn’t work, I’m going to make a change and being able to replicate that day after day. ⁓ my God.

evaluations, it was life changing. No longer having to spend literal hours of time prepping for the evaluation, doing the evaluation, and then finishing the evaluation, including documentation, just shrunk. Wasn’t overnight. I’m not gonna pretend to you that it was like on a Monday, it was this many hours and by Tuesday, it was only one hour. That’s not real.

It’s not logistically feasible. But seeing this happen over the course of a month.

life-changing, game-changing, especially frankly, as I was practicing and like COVID was starting to ramp up and seeing like my job was very unsecure. Like I didn’t know if I was gonna have a job when I would go to work for a period of time. And then after I was furloughed for a period of time, all this uncertainty around me and kind of around the work that I do as a physical therapist.

but being able to still show up for my patients and know with confidence, I know what I’m doing and I’m actually seeing the real-time improvements in my, like, again, for example, evaluations. That was frankly, I think what kept me sane a lot of times, especially when like the outside world was so, so crazy.

And the reason that I bring up the evaluation example is because, like I said, I think this is really where a lot of physical therapists struggle and see where a lot of their weaknesses are. And through this process of specialization, because a lot of our learning up to this point, before you start the specialization process, is through random exposure. You’ve heard me talk about this in an earlier episode. You learn what you see.

And if you don’t see a particular patient population, a particular diagnosis, treatment, side effect impairment, yeah, you can read about it, but it doesn’t mean that you can actually go out and then do the thing. So this results in a very patchwork quilt of knowledge. It’s good, a lot of the information is there, but it’s kind of just laid down randomly. There’s not necessarily an order.

or an organization to it in your brain, like in your mind map, if you will. But when you spend very intentional, intensive time learning this information through the specialization process, this learning goes from patchwork to structured, from random to related and intentionally so, right? You can think of it kind of like a concept map of

You know, this connects to this and this is how this relates to this area over here. This is what really transforms how you practice in being able to very confidently pull that information out of your brain, know how it kind of fits into the big picture of this person and what they’re going through and being able to then say, I can think my way through this, think your way through this and then implement a plan you know is going to work with this person.

And one thing I really appreciated about specialization is by, again, spending this intentional time, this intensive time learning about stuff, structured learning instead of the random patchwork is that I was better able to recognize patterns when they happened.

I missed, and I’m curious if you feel the same way, looking back, I missed so many things as a physical therapist when I was first starting. And I’m not just talking about like the first couple of weeks of practice. I’m talking the first couple years of my practice. Again, just trying to survive, just trying to learn on the fly, just trying to learn as I go and put it together somehow in my brain.

And I truly believe because of that randomness of just trying to like, I saw this today, I’m gonna go home and read about it. ⁓ I saw this today, I’m gonna go home and read about it or look it up online on my lunch break, whatever that is. When I went from that into this shifting into this intentional intensive learning, this is where those clusters of knowledge like I talked about really started to come up and being able to pick up

on those subtle things that sometimes patients talk about when you’re asking them questions and whatnot. This is also why I said I learned to sit and be silent in my evaluations and just let the patient talk to me. There were so many more things I was picking up. For example, a big part of my practice is lymphedema. As a certified lymphedema therapist, this is probably 50 % of my caseload at any given point across my career.

and being able to listen for very specific things that my patients are telling me to now assess even before I look at them.

what’s going on, what could be going on, right? Because this is often where we can catch a lot of stage zero potentially lymphedema. my God, amazing. You know, I can discern like, hey, what’s worked for them? What hasn’t worked for them? Also their attitudes towards these things. And I do think that’s a very, that’s more of like the softer interpersonal skills, but being able to clock in on, hey, my patient might be kind of resistant to this. I need to spend some more time

digging into that with them and seeing if that’s like a hard pass, you know, like that’s an absolute boundary for them. Or if maybe they had an experience previously that was really negative and we could really spend some time, but they might be actually receptive to trying it in the future. Those are the kinds of things that I think really took my practice from good to great and being able to pick up on these patterns and these, you know, these almost like clues.

from my patients, instead of having to ask a bajillion and one questions, they would tell me the things if I just knew to listen for them and to look for them.

And boy, howdy y’all. Did that just, again, shrink the amount of time that I needed to spend on the subjective? I still spend a lot of time on subjective. Again, lots of therapeutic alliance building in that case.

But for me, that has been infinitely transformational in how I practice and helping me get to the core of the problem sooner instead of having to do my evaluation over a session and a half and then trying to come up with a plan and all of this. And through this pattern recognition is where you really start to build that confidence in yourself. When you shift from, I think I know what I’m looking for, okay, I…

I’m gonna listen for these things to, aha, and these are the questions I’m going to ask, and specifically that’s going to give me this kind of information, and not having to ask a bajillion and one questions, but maybe like three or four questions. And that’s enough to get me started with so that I can dive into those objective measures, I can get that data, and then I can immediately move into treatment so that my patient can walk out of here feeling a little bit better than when they walked through the door.

Man, that feels so good to have the confidence to be like, bam, bam, bam, thank you, ma’am. I’ll see you next session. And that person either walks out of the door or I walk out of their door and they know they’re in the right place with the right professional who can help them and is going to help them achieve their goals and who understands them, who gets them.

It’s hard to put that feeling into words. It genuinely gives me a glow inside like I’m smiling right now thinking about it. I had a patient interaction the other day. So new patient, this patient calls and says, hey, this is what I’m dealing with. I get her to come on in and she brings her partner with her. And I feel like the patient was really more on board, but the partner was really resistant. And I think it’s because

the patient had done a little more digging into what she was experiencing, the partner didn’t have that same level of knowledge. And so when I was explaining like, okay, here’s the plan, here’s what we’re gonna do. At the beginning of the session, this partner walks in and I could tell was like, I don’t think this is gonna work at all. Like, I don’t think this is a thing. When they left, patient was totally on board, partner was like 50 % of the way there. I like, okay, that’s fine.

We can keep working on that. But then when I saw them, ⁓ what was that? A couple days later, I think it was a couple days later for the followup, the patient comes in and is singing my praises because what we did worked really well, which is always a good thing. But that partner was now like, okay, my eyes are open. I have seen what you have done. That for me,

I think truly happened because of the confidence that I went into with this particular patient encounter and being able to also have that conversation with the patient and any caregivers that are with them and being able to really establish that relationship with confidence on my end and trust on their end is what really allows me to get to the core of the issue that this person is experiencing and ultimately implement a plan that works for them.

and is going to help them achieve their goals, et cetera. That shift in confidence did not happen because I just woke up one day and said, I’m going to be more confident. That confidence comes from knowing your stuff.

And again, you can spend your time researching, looking up articles, Googling things, going to piecemeal, educational opportunities to kind of patchwork this knowledge together. It’s doable. People have done it and it’s totally okay to do that.

But if you want a faster way to get to that point of being able to walk into a patient encounter with confidence, like I just described, and know that even if you don’t know everything that’s going on, you know how to think through the situation in front of you, and you know how to help that person in front of you confidently. again, instead of waiting for that to happen, you can make that happen. And again,

I believe wholeheartedly because I have seen this transformation in myself. I’ve seen this transformation in other PTs year after year. That comes through specialization.

It’s like the easy button. You know what? I don’t want to say that. It’s not easy. Specialization is a process. It is work that you have to put into it. Big picture, I do think it’s the easy button, but I’m going to think of a different phrase or term for that.

It’s like the fast forward button. And I know that’s a little irrelevant today, but you know, used to be, God, I sound old saying this. You’d go to the video rental store and you’d buy, not buy, my God, you’d rent a VHS, we’d take it home, ⁓ my God. We rented the movie, Big Green, so much growing up that eventually the video store just…

gave it to us. They’re like, why don’t you just take this? But, you know, getting to fast forward through the commercials to get to the actual movie part. Like that’s where the good stuff happens. You know, that’s when good triumphs over evil and the big green soccer team wins against the big bad scaries. Sorry if I spoiled it for you, the movie came out in like, I don’t know, the nineties. But getting to fast forward through the commercials to the

Good part, the movie that you actually wanna see, AKA the part of your practice where you can show up, know that you can think through what’s happening no matter what walks through your door, and you can come up with a plan that is going to achieve both your goals and the patient’s goals and help them do the things that they wanna do, man, that is the good stuff. So specialization, that’s what it is. Specialization is the fast forward button in all of this.

to get you from where you are today to where you want to be as an OncoPT. I’m really proud of that fast forward button. I’m I’m glad I got there. This is a process that not a lot of people see, right? And it’s kind of hard, especially when you’re in it, like you were deep in the throes of it, you don’t always appreciate the tiny steps that are happening, right? The constant motion forward that you are putting into this process to ultimately get to that

But you are going to look up one day when you are going through that specialization process and say, ⁓

That was easier than I thought it was going to be. Wow, we made really good progress on that. my God. I helped that person do XYZ.

That feels so good. It’s often invisible until you get to that point, but it is those steps over time through specialization that really make that happen.

If you are considering specialization, I highly encourage you to check out my free webinar, which I have linked in today’s show notes and in your podcast player called How to Specialize in Oncology Physical Therapy Without Stress or Overwhelm. Again, that link is in your podcast player and in the show notes that are linked. This is going to guide you through what the process of specialization looks like and what

it is actually going to require you to go through as well as next steps to get to that point. And in that webinar, I also talk a little bit about my signature program oncology specialist bootcamp. I sincerely hope that I get to see you inside of that webinar. But 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.