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How Embracing 'Failure' Can Build a Winning Practice
Physical therapists, like all health care providers, share a dedication to one thing: helping people. You got into the business to improve, even save, lives.
Of course, this noble dedication can lead to frustration when you can't help a patient and be unfairly considered “failure." But, Jane Borgehammar, PT, Dip. MDT, has learned to reframe failure as a signal to recognize "red flags" of potentially serious issues and to get the patients to the most appropriate health care provider.
"Surgery, medications and injections are not necessarily bad," Borgehammar says. "When these are non-emergency, quality-of-life decisions, the responsibility ultimately rests on the patients. It’s our job to educate."
Sometimes that honesty is vitally important. Borgehammar has handled cases that not only require surgical intervention, but more sinister diagnoses like cancer, multiple sclerosis or mental health issues.
Yes, even with advanced imaging and diagnostic techniques, this vital form of modern medicine can still miss the mark. There are still false positives and negatives. So, physical therapists, who are typically utilized after medical evaluation, take on great responsibility, Borgehammar says.
"When you're classifying them appropriately, it's not that the system has failed. The system has helped you figure whether they belong in your clinic or not," she says.
The system she's trusted for nearly 15 years is the McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT), which she says allows her to reliably find the right answers quickly.
"With MDT, you have such a thorough history and examination, you can determine things early on," Borgehammar says. "All those little details MDT brings out really, really make a difference.
"I'm not guessing. A lot of times by the end of day one, I typically know if I can help them or not," she says. "I don't waste their time and money, and I think patients appreciate that honesty."
MDT separates her Synergy PT practice in other ways.
"Many of the other approaches are about findings; reacting to one answer," Borgehammar says. "This can send you down the wrong path.
"[MDT] is not a conversation that's waiting for one answer," Borgehammar says. "If you take things at face value, you might only do one thing."
The evidence-based MDT system begins with a thorough mechanical evaluation to establish a "cause-and-effect" relationship between historical pain behavior as well as the response to repeated test movements, positions and activities.
A systematic progression of applied mechanical forces utilizes pain response to monitor changes in motion and function to classify the disorder. Clinicians then develop a plan of care that empowers patients to treat themselves when possible.
"You don't have to sell them," Borgehammar says. "When you get to the treatment, they are understanding the problem with you."
And even when that problem is determined to be a non-mechanical issue or requires management outside of physical therapy, referring people away from her clinic doesn't come with a negative impact.
"If you have to refer them or send them back to their doctor, you've actually done your job successfully," Borgehammar says. "I'm finding the longer I practice that even the people I couldn't treat, but helped classify, often make referrals to me."
As it turns out, practice sustainability and clinical honesty actually go hand in hand.
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