I have made some good choices and some ehhh choices. Even before finishing college, I was sure i wanted to teach. To overcome my inability to speak smoothly in front of a crowd I did take some classes for my juniors. When i taught, weather my students accept it or not- it came naturally for me. I was in my elements. My introvert behavior did vanish slowly. Sadly, teaching was a constant battle with me getting into trouble with the management or the Principal. When I was pushed out for the last time- I said enough of this. I had enough of working for uneducated and insecure principals.
My wife was pushing me to start a clinic and even found a wonderful place which was way beyond our budget. But we took it. We started it today 8 years back. I had no idea what or where to but anything necessary for starting a clinic. Saravankumar took care of everything from the weights to couch. Just before the starting of the clinic i went to Europe to study- so from the board to the furniture - everything was done by my wife. As usual the only thing I did was sit in the chair. Like everything else this could not happened without to my wife
As i have a awkward and blunt way of taking- it suited the teacher in me not the clinician. So the transition had its own headache. My patients still don't like my way of talking, some have cried, some I have told them to go and find someone else, as I find them incorrigible (thats a better word). Well after 8 years - less people cry, but I still send away more patients. Some patients don't like it that i don't see the "prescription" some dont like something -well humans are always different. None of it mattered when I taught. If a student did not like me- my attitude was there is the door go home and cry to mama. But cant do that with patients. My depression has also not helped sometimes- I will not answer phone calls from patients and prospective patients or just close it half way and go home and sleep.
The other issue I had with starting my own practice was "will I be able to practice EBM". When I was mulling this over, Richard told me something very important. He said "well if you are going to give something low value make your patient understand that". So, Whenever i had to make a choice between money and value- I told my patient- this is not that useful, but the exercise which i taught is the "treatment". I know some of my patients did not get it- but hey that was my starting point.
But still I think I have a "loyal" following of patients. I have patients who bring patients so that i can say the "truth". I have learned to be more smooth when it comes to giving bad news. I have learnt to be patient with "listening" to patients. Learnt not to worry if the patients don't like "my" way of treatment. I have nearly stopped electrotherapy and told my patients if they want it- they can go 2 street down the road. I have also learnt if lose patients who call me asking do you have IFT- my answer still is I have but I am not selling it or this is not a pharmacy or no madam I give PT not IFT- depending upon how rude they are or how irate I am. I do want to change that- and I am. I am now politely saying please find some other PT clinic.
In the meantime I had Revathi who is clearly my intelligent student in years and the best of what i can teach as a clinician. I still believe she will make me proud and one of the departments where she works she will apply what we did in my clinic- do high value care with all the limitations the system imposes.
Teaching and research which I thought was my calling- became boring, brought about probably by midlife crisis and nihilism but I do love treating patients. Boring them to death teaching the importance of active life style, explaining low back pain in Tamil and English, telling them it is not eating calcium it is exercise which makes you stronger and much more.
I also love to shout from the top of the mountain- I do high value evidence based treatment. Here are some of it:
1. LBP- exercise and some advice and enabling education
2. Always told any patient with Adhesive capsulitis - It will take anywhere from 3 - 6 months- patients dont mind hearing the truth
3. Never followed someone's plan- followed the best science- still patients dont run away
4. Never did passive treatment for neuro-rehab
5. Never told them -10 days IFT or 10 days exercise and you need to "attend" my clinic
6. I always give them the option- do your exercise at home- I even allow them to video the whole exercise routine- or come here and do it, if you need it.
7. I don't have treatment for this- patients with no activity in the upper limb, trigger finger and some others ( no the world is still standing) or this will go away in 2 -7 days by itself - like a simple strain
8. So, what are the disadvantages- well as i said some patients will not happy -as the "doctor" told them or that what they have been doing for years- so you lose some patients. You also have to "work" not just on and off the switch.
and much more- but I like to assure young people you can still do high value care. If someone says otherwise- make a fist and extend the middle finger.
படிப்பது ராமாயணம்; இடிப்பது பெருமாள் கோவிலா? no you dont have to do that
Enough of bragging about myself.
Its our anniversary- Thanks to:
1. Saravankumar
2. Revathi
3. Miya
All my patients who have faith in me. I assure you- I am doing the best science possible
Love
Hariohm
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