Blog 18

Today was our last day of score. Luckily Mark and Tracy realized this and we had a lighter day than we normally do. Mark luckily had a lighter schedule so for lunch we ordered pizza and hung out together and they told some stories about what the office used to be like At the time that Cory and I began our score project at the office there was only Mark and Tracy working, but what I realized is that before we came there was a point where there was seven people working at once. It was weird thinking about a time where the place was truly busy and there were patients constantly going in and out of the place. Of course Mark is still busy because he constantly is taking in patients but there are less patients now and Tracy has less work because she is taking care of less patients. This also goes to show you the type of person that Mark is when dealing with his business and his patients. Of course there were people that left on because of their own reasons, whether it be having a kid or another job opportunity, but there were also people that he was forced to fire because they just didn’t work out. There were a couple of people who he used to work with that simply were not doing the work that he held his own standards up to and so he felt like he was cheating his patients if they weren’t with him. I really like how personal he is with his business and how he makes sure that each and every one of his patients receive the physical therapy they deserve.

Blog 17

Today Cory and I worked more with some of the patients that I would say are interesting. What I also learned today is that although they come in for one thing that does not necessarily mean that there treatment is limited to that one injury. I like that about physical therapy because it isn’t so limited and it is not so by the book. For example a patient can come in for a shoulder problem and after completing the work on the shoulder the patient can mention some pain in the back and Mark will simply fix it. Some place might make you go and talk with the receptionist and schedule a completely new appointment for your back, but Mark simply does everything he can to help his patients and that is probably why his work is so popular in Manchester. That is one of the things that I respect most about Mark and his business. He is very good with the patients and very understanding of the circumstances surrounding some of them. Insurance companies are very cruel to people and sometimes limit the number of visits a patient can have with a physical therapist even though they might need it. What Mark does is he opens up his clinic to any of his patients that may want to use the equipment even if they do not have an appointment. I really think this is amazing of him and is something that really helps his patients even though he doesn’t have to do it and sees no gain from it. 

Blog 16

Today Cory and I had a rather unique experience with a patient. Like I said in my earlier posts, a lot of the patients that we work with are older just because of the hours that we are there. Today the oldest person that Mark takes care of came in today and there was a slight problem. Well maybe problem is not the right word, I should probably say something more like accident. She came in, she went through all of her normal treatment things, but when she was icing up her ailments she accidentally peed her bed. Now I know that there are accidents and problems that come along with practicing physical therapy but I never expected anything like this. Of course I feel bad for the poor old lady, it was not her fault and there was nothing she could have done to prevent it but I just was not expecting it. Luckily being the guy that Mark is he took care of it and made it so that Cory, Tracy, and I did not have to take care of it. This whole process really goes to show the type of person Mark is and the type of business that he runs. There are multiple physical therapy offices in Manchester but everyone knows that Absolute Performance is the best of them. A lot of times Mark will get patients who have scheduled appointments with him and waited for months to get in because the other places just don’t even compare. All of this is accredited to Mark in the way he runs his establishment and the way he treats his patients and his workers. 

Blog 15

Today Cory and I spent a lot more time with the receptionist again. Tracy is great, like I said earlier with the patients being interesting, she is the same way. She is very interesting to talk to not only because of the stories she has but also because of the what she has to say about the business. Sure Mark is the owner and everything but you can ask pretty much anyone and they will say that the person who runs the business is Tracy. She works with all the patients, knows all their names, schedules all of Mark’s appointments, and then also works with the pesky insurance companies. Not to mention on top of all of that, she keeps the entire place clean. She washes the sheets after every patient uses a room, she is constantly refilling and recycling supplies, and she also vacuums and dusts constantly so that the office is clean. Other than her being an extremely important part of the business I think that she is also really interesting to talk to. For example she grew up in Manchester and has lived here for most of her life. For me it is extremely interesting to hear about what Manchester was like in the 70’s and 80’s because then I can relate it today and see all the things that have changed. Also I know that my dad grew up in the same area at the same time so it is also kind of interesting to think that he was in the same situation that she was in.

Blog 14

Today Cory and I manned the front desk for a little while because the receptionist Tracy had to leave for a little while. She had to go to a doctors appointment but the problem was that the only time she could go was during the hours that she had to work. In came Cory and Max to save the day though because she had taught us enough of the front desk operations to be able to hold down the fort for about an hour. Basically what we knew how to do was check on times of future appointments if patients asked, check to see who was coming up on the schedule and check them in when they came, and we also had to answer the phone while she was gone and find spots on the schedule where we could put new people in. Most of the time when we were doing things like this though we had Tracy over our shoulder to check on us and make sure that we were doing everything correctly and that we weren’t messing up the entire business. This time though we were completely on our own, but luckily we stepped up to the task and everything went according to plan. I would almost go as far to say that I enjoy doing all the front desk stuff more than working on the physical therapist stuff just because it is more interactive. Sure talking with the patients and listening to Mark can be interesting but at a certain point you just want to get up and do something that is what we do with Tracy. It is a very hands on part of the job and that is what I really like about it.

Blog 13

Today Cory and I worked some more with patients that we are beginning to see more often. For example in the beginning we worked with what seemed like a new patient every half hour every day, but because there are only so many people in the town of Manchester then we were bound to have some repeats at some point. Well by the last week of our SCORE program we have finally begun to see people we have already seen. Although it can be interesting what Mark can teach us during the physical therapy process, most of the time it is more interesting learning about the people that we are working on. Some of the people that come in are very interesting people, or they are very interesting to listen to them talk. Most of the people who come into the office are older because we are only there during the day and older people are more likely not to be working during those hours. I like seeing mostly older people though because I think that they can be very interesting people. Also because I know so many people in town through sports and my dad growing up in Manchester there are a lot of people that come into the office that know me but I don’t know them. For example today two people came in that said, “hi max” and all I could say back was hi because I had no idea who they were. They ended up being a friend’s father I never met and my best friends neighbor but it just goes to show the powers of a small town. 

Blog 12

            Today we worked on another patient who required more work in the weight room. Most of the time we spend here we work on patients who require simple work on their afflicted muscles but after they have more and more appointments they need to begin using more weight in order to strengthen their injured muscles. I like this part of the job a lot more because it is more exciting. I always think it is interesting when we sit in on a patient but sometimes it can get a little boring. When we are sitting in on the weight room then there is more to watch and it can be more interesting. Today we had a lady that had her hip replaced even though she was extremely young to have it done. She was not even 40 but because of an over extended hip joint, her hip was constantly being pulled on which ended up requiring an early hip replacement surgery. This surgery was a little more unique than most of the hip replacement surgeries though because she wants to be extremely mobile like she was before the surgery. One of the problems with a hip replacement though is that they are not permanent. Most of the time whenever someone gets a hip replacement they need to get it redone in another 10-20 years. The main worry is that because she is so young that she may need it redone again and again, especially if she plans on being as active as she wants to be. The main thing we worked on in physical therapy today though is strengthening her hip so that she can be mobile and so that her chances of needing another hip replacement goes down.

Blog 11

Today we saw some very interesting people. The first person we saw was an older man who was experiencing back pain. He was really interested in getting his back back into shape because he was really into golfing. Every summer he would play endless amounts of golf at the local Essex County Club. He would play almost every day and then once the cold weather and winter arrived he would take his talents to Hawaii and play as much as he could down in Hawaii too. He did not have anything serious wrong with his back but in order for him to be pain free he needs to come in and see Mark a lot. One of the parts of the job that I really enjoy is the talking that you get to do with all of the patients. For an hour to  a half hour it is usually just Mark and the patient and so in order to make it not awkward there is a lot of talking about their lives and what they have been doing lately. Also because the clinic is in Manchester and a lot of wealthy people are from Manchester, there are a lot of really interesting people and stories that go through the clinic. For example there was one guy that came in because he was surfing and when he was on a huge wave he fell off of his board and fell into the water, but while he was tumbling around in the wave the edge of his board came around and broke two of the plates in his back. He was lucky to be alive let alone walking again but that is just one example of the kind of stories that I get to hear on an everyday basis.

Blog 10

            Today because the physical therapist Mark Dickson had a lighter day, Cory and I worked more with the receptionist and watched how the behind the scenes of the physical therapy business works. Usually we spend most of our time following around Mark and learning and watching what he does. Today on the other hand we followed around Tracy the receptionist and learned more about what she does on an everyday basis. We helped her do laundry, there is a washing machine and a dryer right behind her desk, we helped her change the sheets on the beds that Marks works on patients with, and we also helped her clean all over the office. Although this is only a small part of her job it is extremely important. There are patients cycling in and out of the office basically every half hour and because of sanitation laws it is extremely important to keep everything clean. It isn’t her main job but it is one that isn’t easy, isn’t popular, but is extremely important for the success of the business. While we spent a lot of time working on cleaning the office, we also did a lot of business oriented work. We checked insurance company information and figured out which patients still owed money and how many appointments some patients had left. We also received calls from patients and learned how to work the system and schedule in people where there were available time slots. Today was a good day of shaking things up so that we weren’t doing the same thing every day.

Post 9

            Today while working with some of the patients I began to realize the importance of physical therapy to some people. The benefits that it can have for some of the patients is borderline amazing. Now that I have been going in for a couple of weeks now I have begun to start seeing patients more than once. More than once I would see a patient and they are miles ahead of where they were the first time I saw them. It’s small things that Mark does but it goes miles for the confidence and abilities of many of the patients. Although Mark can help so much there is one problem with the physical therapy practice. An appointment is extremely expensive and so it is tough for a patient to schedule a lot of them which would help them get better quicker. Also Mark is only one person and his practice is so popular that sometimes it is very hard for him to get patients in to see him. As of right now there is close to a two month waiting period just to get on his schedule. Of course it is not his fault that he cant get everybody in all the time but it is just an unfortunate part of the business. One of the other things that is very important for a patient is that they do their exercises outside of their time in the office. Like I said earlier Mark can only see people at the most once a week and so in order to get better quicker they need to work hard at home too.

Post 8

            Today we finally worked with a patient who was not in an evaluation. This poor old lady was someone who fell and broke her hip a while ago and is still working on being able to walk and concentrating her balance so that she can stand for long periods of time. For most of our time Cory and I have been stuck in the patient rooms watching him massage and work on patients like that, but today was the first time we got to see someone working in the weight room and learning about the other parts of the job. We came out and we worked on some easy things but it was nice to learn about the other things that come along with the job. We hooked her up to the stretching band machine and she worked out her legs and hip that way. After that we moved onto more simple things and it is amazing how such simple exercises can be so beneficial for some people. After the band machine we went over to the middle of the gym where there was a bench set up about 6 inches off the ground. All he asked her to do was step up and step down off of it but it was really making her work and as she said it was really helping her improve in performing every day activities. Next we did some simple squats before we had her walk around some more around the clinic. Compared to before the appointment it was amazing how much Mark could help someone in only a half hour appointment.

Post 7

            Today when I showed up to the office I came in and sat down with the receptionist Tracy. We talked for a little bit about the whole scheduling part of the business and I thought it was pretty interesting. At first glance the schedule that they use is not very easy to follow. It is very blocky and not conventional, and I thought that it would be like your everyday calendar with names and times on it but that wasn’t the case. After sitting down and looking at the schedule though it made me realize that it is actually really easy to follow. Although Mark is the head physical therapist and the owner of the entire business, Tracy is the one that I would say almost runs the business. She books all the patients, does all the business parts of it, works with the money aspect of it all, and I learned a lot from talking to her. One thing that I learned that I didn’t expect at all was the way the money worked. As is any medical business, most of the payments come through the patients insurance company but there are also instances where the patient is expected to pay out of pocket. What really surprised me was that if a patient’s insurance company does not pay their bill then there is close to an 80 % chance that they will not receive the money at all. Sometimes it amazes me how much people are willing to do to avoid paying for something they need to pay for.

Max: Week 2, Blog 6

Today I saw something at my score project that I had never seen before. There was a patient in the office today that probably shouldn’t have been there. She was sent from her doctor with an order for 6-8 weeks of physical therapy after she tore the muscle connecting her shoulder to her neck. When she arrived it was clear that the doctor made a mistake. She could barely move her arm with being in excruciating pain and it was just clear that physical therapy would do her no good. Every time Mark would touch her shoulder or move it at all she would squeal in pain and it was just wasting every one’s time to put her in that much pain. Eventually all we could do was put her on the stimulation machine and hope that that relieved her pain. Mark told her to go and call her doctor immediately and set up an appointment so that she could get surgery on her shoulder even though her doctor didn’t want that. This is just another example of like I said earlier, sometimes a physical therapist needs to diagnose and sometimes they are the ones that are the most correct. Another thing that I did today was that I read an article on an up and coming physical therapy technique. Mark had me read it because he was trying to teach me something about the field and it was actually really interesting. It was all about how some people can treat patients with only using there thumb and then putting pressure in the perfect spots. It was an extremely interesting article and it also made me learn a lot more about physical therapy.

Blog 5

Although I love my score project, the only thing that I was concerned about it was that it may not be my main focus of career in the future. Despite not exactly wanting to be a physical therapist in the future, a lot of the stuff that we are doing is very informative. Everything that the physical therapist, Mark, does he then stops and explains it in both lemans and regular terms. This makes it very easy to learn and follow what he is doing throughout the entire process. While he is working on a patient it is clear that he is teaching me a lot as well as the patient that he is working on. One thing that I did today that was very interesting was I worked more with the receptionist in the office Tracy. Mark is often very occupied with the physical hand on aspect of the business and so Tracy often takes on the business side and works that part of the business. It was very interesting to talk and learn from her how a business is run and the ins and outs of doing. She brought me through the process of gathering insurance information from the patients because that is often times how they get paid, and she also showed me how to make sure that all the numbers work out together and fit to make everything work. One of my favorite things about this project is that it is physical therapy but it is also a small independent business and so while im learning about physical therapy I am also learning about what it takes to run a small business

Blog 4

            Today was a more interesting day at my score project. Today we got to follow around a couple of patients and see what they were doing for treatment. What I learned today that I didn’t know before about physical therapy was that it is also part of their job to diagnose some patients with their problems. Doctors will send him notes telling him to evaluate and treat, which leaves the physical therapist on his own to decide what is wrong with a patient and then find a way to treat the patient and make him or her better. I thought that was really interesting because it really made me realize that there is more to the physical therapy profession than simply giving people massages. You are actually like a doctor and in some ways diagnosing people with their problems. Another thing that was cool about today’s work was that we got to look at a patients MRI. Well obviously looking at an MRI is not that big of a deal because it is very easy to simply google it and look at one online. It is very rare though to be able to look at one with the guiding hand of a trained professional with a medical degree. It was very cool going through a real MRI with a certified physical therapist and watching him point out all of the important areas and finding the problem with this specific patient. This was probably the coolest thing that I did all day just because it was so interesting and I had never had that chance to do that before.

Blog 3

Today was my third day of score and it was definitely a busy day at the office. There was a hefty schedule of patient after patient and it was clear that they wanted to get a lot of work done today. Like I said in an earlier post there was a lot of down time because of the time in between patients and also because the patients spent a lot of time icing down the areas they worked out but today they really worked on minimizing that down time. Instead of time in between patients they scheduled for the next patient to come in while the last one was being iced down. I really liked this tactic because I felt like they were getting a lot more done and after a while too much down time can get a little boring. Because I couldn't touch any of the patients though I was stuck to watching. Most of them were very nice and had very interesting stories. There was one man that was hit in the neck with his surf board when he fell off and was nearly paralyzed. I thought that was an extremely interesting story and it really made me enjoy the personal aspect of being a physical therapist. Although after that story I thought for a little while and although there are going to be plenty of cool and interesting people there are always going to be a group of weird gross people that they have to work with. There are both benefits and down sides to working in such a personalized profession.

Blog 2

            Today was my second day of my score project and it was very similar to my first day. Unfortunately because I don’t have a medical degree or a degree in any sort of physical therapy field I am unable to work with any of the patients personally because of liability reasons. As a result I am forced to do most of my learning by watching. It is still interesting to see someone like Mark at work on an every day basis because he is so good at what he does. If I am going to learn anything during this score project I am glad it is going to be from him because he definitely knows what he is doing. As a result I spent most of my time today learning, watching, and picking Mark’s brain about his job. I learned a lot about his history, where he went to school, his career path, and just a lot of stuff that gave me a better understanding of the sort of path I would need to take if I was interested in pursuing a career in physical therapy. Like I said earlier there isn’t a lot of stuff to be doing around the office because it is a small office with limited resources and there probably isn’t a need for two interns, but luckily everything worked out and Cory and I’s AP class schedules are pretty much opposite and so we don’t spend a lot of time together. When we are together it is nice to be with someone else who is learning kind of the same things but on the other hand it is also nice to be alone because there isn’t always a lot to do around the office.

Blog 1

            Today was my first day of score and as expected it was fairly uneventful. To start off my colleague Cory McCollum and I went in to talk to the head physical therapist Mark Dickson about how we are going to be spending are time with him and to go over our school schedules and how much time we will be spending at class. I have worked with Mark a lot as a patient for my own physical therapy, but it was a lot different working with him on a more professional level. In the life of a physical therapist there is a lot of downtime. You spend about an hour with every patient but after that there is a lot of down time. Also whenever you finish with a patient they usually like to either put heat or ice on the area they worked out that day so that gives you even more down time right there. All that quiet time made me realize the importance of having people around you that are pleasant to work with. Mark’s receptionist Tracy is very helpful in doing the little things and also a very interesting and nice person to work with. One other thing that I learned about being a physical therapist is that you not only have to be smart and know what you’re doing, but you also have to be a people person. Unlike a doctor you have to spend a lot of time with your patients and so you have to be able to talk to them for long periods of time.

Max Nesbit SCORE Outline & Theis

Max Nesbit

3/14/13

SCORE Outline and Thesis

Original Question:

 In the long term is it more beneficial to get selective surgery or to strengthen the muscles around the problem and deal with the injury?

What would be the strength difference between people who got the surgery and people who didn’t?

Thesis- The benefits of an elective surgery greatly outweigh the other option of intensive physical therapy as long as the situation and the person are in the right position for the surgery.

Point 1:

            The surgery that is recommended makes the surgical site stronger and ends up creating an area that was equal to if not stronger than the surgical area previous to the injury.

·         The area of injury is often times weak in an injury that requires elective surgery, physical therapy can make it stronger but the treatments need to be maintained to maintain the feeling of less pain

·         If an athlete then often times they come back even stronger than they were beforeà more successful than if they tried to simply play through the injury

·         Prevents a patient from further reinjuring the areaà making the injury worse. Also someone can injure another part of their body by compensating one side of their body. Ex. Hurting your left arm by using too much since your right arm was already hurt

·         Mention personal experienceà my own story about how I could play but decided to get surgery and how I made my shoulder stronger. Not sure if I could do something like this… Could also use Adrian Peterson as an example of the athlete improving their game

Point 2:

            Surgery with modern day medicine is a lot safer route to take than it was in the past

·         For an elective surgery it is very unlikely to have any problems that would make your situation worse and even less likely that there would be serious medical problems following the surgery

·         Advances in noninvasive surgery has made it a lot safer

·         More and more outpatient surgery (surgeries that require no overnight stay in a hospital)à means less expensive, can recover at home (easier), etc.

·         Find a percentage of successful surgeries in this field (elective surgeries)

·         How likely are people to reinjure themselves in both scenarios? Find a stat for that

·         Doctors recommend most people to get the surgery (exception old people)

Point 3:

            The option of surgery does not have to be immediate. Elective surgery is defined as something that can be scheduled at the patient’s convenience. The patient can do the surgery at a time that is most convenient for him/her and make it easiest for them either financially or time wise.

·         No emergencyà the patient can wait years for the surgery if needed

·         Just as easily as a patient can wait they can also get the surgery immediatelyà a lot of options whereas therapy has only one

Point 4:

            What it all comes down to is the situation of the patient and what best fits for them.

·         A huge part of medicine is informing patients of the decision that they are making so that they can make the right decision that fits their situation

·         Older people are more likely to face complications with surgery and often times don’t need the surgeryà they live such a dormant life that they often times don’t use the area causing pain enough to require surgery (ACL tear)

·         Athletes are more likely to get the surgery because they need to be completely healthy for their professionsà may wait till after the season to get the surgery though

·         Younger people are more likely to get the surgery because they want to be healthy for the rest of their long lives

·         Middle aged working class people are less likely to get the surgery because it is often times more expensive than physical therapy and they can’t afford to miss the time from work that they would need to miss if they got the surgery

Points against:

·         It is very consuming to recover from surgeryà a lot of physical therapy, a lot of resting, etc.

·         It is very expensive to get surgeryà surgery itself is expensive, physical therapy is expensive, any medical appointment can cost extensive amounts of money

·         May not be the right situationà non-athletes are less likely to NEED the surgery, they may be able to live fairly easy with the pain

·         Depending on the injury it could simply be easier and more effective to get therapy than to simply get surgery

           

·         http://aspiruslibrary.org/literacy/Kruzik.pdf (importance of talking to patients and elective surgery facts)

·         http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1791005/ (why people should be informed about their surgeries)

·         http://www.encyclopedia.com/doc/1G2-3406200139.html (facts about the surgery)

·         http://clinicaltrials.gov/ct2/show/NCT00597012

·         http://www.apta.org/Media/Releases/Consumer/2008/9/11/

·         http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219937/

·         http://www.sgptr.com/evaluatingArthroscopoicSurgery

·         http://www.uchospitals.edu/specialties/minisurgery/orthopaedic/

·         http://www.coastpt.com/index.php/articles/63

Works Cited

"Arthroscopic Surgery vs. Physical Therapy for Treatment of Osteoarthritis of the Knee." Strulowitz & Gargiulo Physical Therapy Rehabilitation. N.p., Sept. 2008. Web. 15 Mar. 2013.

Bossing, Alexandria. "Study: Arthroscopic Knee Surgery No Better Than Physical Therapy." APTA. N.p., 11 Sept. 2008. Web. 15 Mar. 2013.

Ford-Martin, Paula. "Elective Surgery." Encyclopedia. N.p., 2004. Web. 15 Mar. 2013.

Gabbor, O. "Surgical versus Non-surgical Treatment of Chronic Low Back Pain: A Meta-analysis of Randomised Trials." Ncbi. N.p., Oct. 2006. Web. 15 Mar. 2013.

Katz, Jeffery N. "Comparing Knee Cartilage Surgery Versus Standard Physical Therapy in Treating People With a Meniscal Tear and Osteoarthritis." Clinical Trials. N.p., 8 Jan. 2008. Web. 15 Mar. 2013.

Kruzik, Nancy. "Benefits of Preoperative Education for Adult Elective Surgery Patients." Aspiruslibrary. N.p., Sept. 2009. Web. 14 Mar. 2013.

"Minimally Invasive Orthopaedic Surgery." Uc Hospitals. N.p., 2013. Web. 15 Mar. 2013.

Pens, Chad. "Dryden Sport and Spine Physical Therapy." Sciatica Treated with Physical Therapy vs Surgery. N.p., n.d. Web. 15 Mar. 2013.

Wearne, Mike. "Informed Consent for Elective Surgery—what Is Best Practice?" Ncbi. N.p., Feb. 2007. Web. 14 Mar. 2013. 

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