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The Heartbeat of Excellence
Monday November 23, 2009


Some therapists point to interactions with patients, teachers, or colleagues as defining moments that inspired excellence in their careers. Others say it was the way they were raised to view the PT profession and its vital role in easing the ailments of the human condition. One PT says she discovered her own journey toward excellence after she had an experience she didn’t want.

Human Spirit
Liberty Miner, PT, MS, learned from a patient that to provide therapeutic care that is “a cut above,” therapists not only have to consider diagnosis and prognosis, but also the human spirit.

When Miner, a physical therapist at Texas Health Arlington Memorial Hospital, first read through the patient’s paperwork she couldn’t help but wonder whether there was anything she could do to make him better. The 60-something-year-old man, “Buster,” was in intensive care and suffering myriad complications, including kidney failure, after a routine cardiac bypass. Buster underwent 13 surgeries but was sedated and unaware of them all, Miner says.

“The first time I saw him, he was ‘passive range of motion.’ He was non-participatory,” she says. During her first interaction with a lucid Buster, he told her that he wanted to go back to his lake house. “He had a goal in mind…. He just had an indomitable spirit that he was not going to quit,” she says. It reminds her of a quote: “If you take your eye off the goal, all you see are the obstacles. [Buster] never saw the obstacles. He just kept his eye on the goal.”

Buster went from being able to sit up, to standing, to eventually taking care of three yards, including the one at his lake house.

“Really, it was a testament to his spirit, where his spirit prevailed over his body,” Miner says. “We have to treat each patient as if they are our next miracle. Because we don’t know which ones are and are not going to be, and a piece of paper is not going to tell us that.”

High Expectations
Mary Massery PT, DPT, of Massery Physical Therapy, Glenview, Ill., also says patient experiences have helped shape her journey toward excellence. One experience, Massery says, happened early on in her 32-year career.

“There was one very influential teacher, Donna Frownfelter, my cardiopulmonary teacher at Northwestern,” Massery says. “I had never even heard of cardiopulmonary PT. Donna’s was the last class we took, and the topic and her passion excited me to be passionate, as well. It actually changed my career.”

Frownfelter instilled the idea that PTs could achieve better outcomes when treating the whole patient, and that included the cardiopulmonary system, Massery says. “It made me look at the whole body,” she says. “It would have been easier to just treat the neuro patients as neuro patients, and orthopedic patients as orthopedic patients. But that’s not likely to get the best outcome.”

A valuable lesson: Therapists who practice with excellence treat the patient as a whole, not just as the sum of his or her parts. Donna Frownfelter, PT, DPT, MA, CCS, RRT, FCCP, now assistant professor physical therapy at Rosalind Franklin University of Medicine and Science, North Chicago, Ill., says leaving the hospital setting in 1988 helped her define excellence in her career.

With the constraints of diagnosis-related groupings, or DRGs, Frownfelter no longer believed she could deliver the quality PT to which she aspired. Frownfelter left and started a private cardiopulmonary practice, with the goal of providing the care that she believed her patients needed. Her business name is Committed to Excel-lence Inc.

“Excellence is not perfection. I think that excellence says you have a sense of mission — you are striving to do more than just the ordinary,” Frownfelter says. “There was one definition that I really remember liking. It was by Booker T. Washington: ‘Excellence is a common thing to do in an uncommon way,’” she says. Payers might be able to take away the quantity of PT visits, Frowfelter says, but they can’t take away quality. “So, when you talk about excellence, you say, ‘OK, the patient only has four visits. What can I do in those four visits that’s really going to impact this patient?” she asks. “In those four visits, I need to be as good as I can possibly be.”

In some cases, PTs might need to advocate for patients by requesting additional visits. “I expect more of myself and want to deliver more. It’s important to me in terms of fulfilling a personal mission. It’s not just about being a PT; it’s about who am I, and what my role in this world is,” Frownfelter says.

Healing Connection
A patient helped teach Frownfelter about the rewards of being the best she could be. It all started when Frownfelter provided cardiopulmonary PT for the man when he was in intensive care.

“He had had pneumonia and went into respiratory failure. And for a period of time … he wasn’t very responsive. But I always felt, with all the patients on ventilators in intensive care, that it was important to touch them and talk to them, rather than just go in and start turning or exercising them; I would put my hand on their shoulders, [introduce myself, and tell them what I was about to do],” she says.

This particular patient recalled those times when Frownfelter talked to him once he started coming to. He looked at her one day and said, “Oh, that’s you. I remember — you were the one who talked to me.” Throughout the years, he would always ask for Frownfelter when he was admitted. But it was his wife who asked for Frownfelter on the eve of the patient’s passing, which was Christmas Eve.

“I was working Christmas Eve and he had been admitted to the hospital. It didn’t look good, he was in respiratory failure, and in that last year he had been in the hospital a few times with exacerbations,” Frownfelter recalls. His wife said they wouldn’t request PT because he was so sick, but Frownfelter saw she needed to be comforted. Frownfelter spent time with her that night, just talking.

A year later, Frownfelter came home to a large poinsettia plant. The sender — the man’s wife. In a letter to Frownfelter, she wrote about how much PT had helped her husband and how they both appreciated Frownfelter for what she did. “It’s a privilege to be able to come along with people during those times,” Frownfelter says. “It’s how you connect with people, personally. I think that’s a really important part of being a PT.”

Striving for excellence is an ongoing process, even for the PTs who have devoted decades to the profession. “If I weren’t looking for excellence, I would get out,” Massery says. “I told myself the minute I was bored with learning in this profession, that I would switch careers. It has been 32 years and I hope to have another 32 years.” •

Lisette Hilton is a contributing writer for Today in PT.

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Monday November 23, 2009
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