It Takes a Village

Even the restroom lego characters are dressing formal.

Even the restroom lego characters are thinking #NoPolo.

I just finished packing my bag to head off to Nashville for the American Physical Therapy Association’s House of Delegates meeting. To quickly sum up what that is for those of you who might not know: about 500 PTs and PTAs representing different areas of the country, clinical specialties, and/or other interests get together for 4 days to make big decisions about big ideas that will drive the future of the APTA and ultimately the practice of physical therapy. When people talk about APTA doing or deciding this or that, that’s us, this week, and the PTs, PTAs, and Students that attend are all volunteering their time away from their daily jobs. As I pack my two suits and shiny black shoes into my suitcase for the upcoming meetings, I notice how much they stand out in contrast to the rest of the wardrobe I have here in rural Hawaii. I have scrounged together enough  black mid-ankle cotton sports socks to get through the week of meetings – I hope they’ll come high enough to gel with the suits. The most dressed up I’ve gotten in the last month is the polo shirt I put on daily to go to work (Is the #NoPolo crowd throwing a fit right now? More on this later.) Each Friday, I throw on an Aloha shirt for an even more formal Friday – here, in this local culture, an Aloha shirt is considered dressing up. The main Hospitalist wears an Aloha shirt every day. The Vice President of the Hospital wears an Aloha shirt every day. As an average Caucasian male, I’m already in the minority here. If I were to show up in anything more dressy than an Aloha shirt or polo, I would be a serious outsider. Dressing in a shirt and tie would, without doubt, affect my ability to connect with my coworkers and my patients. The culture I was raised in has no bearing on the social norms here and formal wear is inappropriate.

On my very first PT job in 2006, a job I took in a private practice that I had done a clinical with, we looked good. Just 3 guys from Boston practicing PT in the farm fields of Vermont wearing button down shirts and nice ties. Aside from our dress, we were goof-balls. Our staff had some really good chemistry there. We were always rambling on about anything and everything to keep our patients entertained and enjoying their time at the clinic. The schtick was constant and super-funny – “the PT will cost ya, the show’s for free.” In that clinic, not too far from Boston and not too far from New York City, we felt great in our shirts and ties, and it was the right thing for the right place – it did, indeed, take our appearance up a notch and add some professionalism to our otherwise juvenile behavior. But, when I left that practice 6 months later for the vast world of traveling PT which would lead to 10 years on the road, I realized that one size does not fit all, there’s more than one way to skin a cat, and, most importantly, rehab can be done best a lot of different ways.

I've got a couple patients here from outrigger-canoe-related-injuries. I finally took this canoe out with 5 other paddlers the other day. It gave me a whole new appreciation for the biomechanics of the sport. Most kids here grow up with paddling as one of the primary sports. "Doing is knowing" in both biomechanics and culture. Whoa, deep.

I’ve got a couple patients here from outrigger-canoe-related-injuries. I finally took this canoe (the Kula’ela’e) out with 5 other paddlers the other day. It gave me a whole new appreciation for the biomechanics of the sport. Most kids here grow up with paddling as a part of their upbringing. “Doing is knowledge” in both biomechanics and culture. Whoa, deep.

Later on, Colorado would become my home base, but I still continue traveling out of state on contracts most summers. Several years ago, we had word coming down from the top of the hospital that each department would need to decide on a uniform – I believe this stemmed from a JCO initiative for patients being able to more easily identify who is coming and going from their rooms. I advocated that the rehab department dress more formally – button downs, nice slacks, perhaps ties for the gentlemen. But, this is a mountain town we’re talking about. A place where the wild west is still alive and well. I have seen surgeons make inpatient visits in bike shorts, there’s an anesthesiologist that occasionally roams the halls wearing a cowboy hat, people do not care what you are wearing, they just want the best care from someone who understands their activities and lifestyle. Colorado mountain towns are full of aggro weekend warriors – nay, not weekend warriors, they have come to the mountains to make a lifestyle of outdoor sport and activity – for this reason, the mountains of Colorado respect  and understand the role of PTs more than anywhere else I have ever worked. A PT referral is always the first line of defense for all the patients that want the most direct line to getting back out in the mountains and doing what they love. Ultimately the dress code decision was made, there would be no formal dress, the final decision had been made made – black scrub bottoms, white tops, grey (sporty) vest.

I don’t know how I ended up in this place in this blog post. Polos, ties, and sporty vests have nothing to do with the point I’m tying to make.  What I’m trying to get at is that things we may accept as simple, given standards in our world may be very different from those held by someone else. I’ve written about local culture before and the great differences geographically in what the norm is, but I’ve been thinking of culture differently lately as I find myself living in more and more rural places. We so often are all encompassing in what we say – when someone says “the world works like this……”, they typically only know about their own experiences. People are so focused on their own world, that they can’t open up their minds and think about how someone lives their life in a community that has less resources, or that is isolated from all major cities, or that doesn’t want their community to be developed into something bigger and shinier. We are all so different from town to town, city to city, state to state, and especially internationally. We often think our own way is the best way, but the truth is that people are so different across our country because of their individual environments, experiences, and upbringings that we are all destined to value different things than our neighbors. We have a lot in common as well, but it’s the differences that can be divisive. I don’t mean to single out the crowd that thinks we should all dress up for work to make ourselves stand out as the autonomous practitioners that we are (I used to be firmly in that camp), but it is just one example that I can grasp tangibly to say dress standards can vary greatly place-to-place, culture-to-culture.

A few of my Aloha Shirts. Flowers and tikis are culturally appropriate. The Red Sox Aloha Shirt is not culturally appropriate unless you are dressing up as two-time World Series Winner Shane Victorino, "The Flyin' Hawaiian".

A few of my Aloha Shirts. Flowers and tikis are culturally appropriate. The Red Sox Aloha Shirt is not culturally appropriate unless you are dressing up as two-time World Series Winner Shane Victorino, “The Flyin’ Hawaiian”.

Another area that I have been thinking about culture in recently is research. You hardly ever read an article that breaks down the differences in effect of an intervention on subjects by cultural differences. In research, you frequently read something like, “this study was performed on subjects without confounding past medical histories and the results cannot be generalized to all patient groups.” Why don’t we see cautions like, “this study was performed primarily on New England Suburbanites and cannot be generalized to people of varied backgrounds.” I’m having a  little fun here, but I’m serious about the message – people are different and interpret the treatment we administer unto them differently. We cannot hold everyone to our own personal standards and should not expect everyone to have the same values that we do.

I hope that as therapists, we consider the widely varied backgrounds of our patients and that we respect our patients when our best practice patterns don’t align with their priorities. I hope as hundreds of us gather this week to discuss the PT profession that we can open our minds to see how different ways of practicing PT can all be successful for the people who are receiving the treatment and to embrace that difference. Finally, I hope in the greater scope of life that we don’t see people with different political and world views as lesser than ourselves and acknowledge that they merely come from a different set of life experiences.

Travel safe if you are headed to Nashville for the big meeting, I look forward to disagreeing with you all when we get there from our very different places. (just kidding, gosh don’t be so serious)

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