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Why I AM a Manual Therapist

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A few weeks ago I read a blog that really caught my attention. The author explained why, as a sports and ortho Physical Therapist, he chooses not to use manual therapy. I’ve been thinking about his blog ever since I read it – it has frequently been the last thing I think of at night, the first thing I think of in the morning, and I think of it many times throughout the day as I work manually with the vast majority of my patients. My curiosity about this author and his stance against manual therapy has lead me on a bizarre journey finding other blog posts claiming manual physical therapy is a “sham,” “quackery,” and “pseudoscience”. Many of these manual therapy nay-sayers claim it doesn’t do anything meaningful. They say manual therapy is only a way for a clinician to act compassionately and/or cause indirect effects through being attentive to their patients. Essentially, they claim manual therapy’s benefits are an elaborate placebo.

When I came upon the first internet post that introduced me to the world of manual therapy nay-sayers, the post had already been out there on the web for 8 months. I came across it when someone in the online PT circles reposted it on Twitter. This reposting is one of over a dozen, and many more people comment on Twitter sharing their support and agreement. Apparently, there is an international network of physical (and physio) therapists who go from blog to blog verbally patting each other on the back about their distaste for manual therapy. They frequently refer to themselves as “recovering manual therapists,” they reassure each other with confident words about how novel each of them is to have stepped out of the populist belief that manual therapy is a good thing. The worst part about it is, many of these people are involved in professional leadership, research, blogging, and teaching – these people consider themselves leaders.

In this, my first introduction to the world of manual therapy nay-sayers, I was worried and confused and shot a quick email to a colleague. He is a leader, researcher, educator, and blogger – I knew he would know more than I did. In the first day I sent him the email, I heard nothing and nervously began to think, “Oh no, he’s one of them!” I woke the next morning and was comforted by his reply. He’d had experiences in talking directly with the manual therapy nay-sayers about their ideas – he described it plainly as, “a disturbing growing trend.” He is not a fan of these folks and their ideas. Frankly, neither am I.

If you’re like me, this is the first you are hearing of Physical Therapist researchers speaking out against manual therapy. Manual therapy is a corner stone of orthopaedic rehab… right? One of the articles I read over the past few weeks is a blog that has a robust comment chain following the article. The blog is a summary of a research article that claimed to be the end-all of spinal manipulative therapy research,

“Prof Menke concludes that more research is clearly NOT needed… That which is already known about SMT [spinal manipulative therapy] for back pain is quantifiably all that is worth knowing.”

Did you catch that? Th, th, th ,th, that’s all folks! Nothing more to see here. What an asinine statement: This guy summarized spinal manipulation in his research article and has it all handled for us! Here’s the link to the blog: (Spinal manipulative therapy: a slow death by data?) If you are an orthopaedic PT, I recommend you read the comments, they are scary – I, however, do not recommend you dig deeper to further posts and links, it gets downright frightening. One commenter on A Slow Death by Data states,

“My favorite ‘hands on’ technique is what most people call a ‘handshake’.”

He goes on to explain how his superior attentiveness and compassion to his patients are the secrets to his success without manual therapy – to his credit, he admits using his hands for “seeking more serious pathology.”  He then is repeatedly praised for his comments from the world of anti-manual therapy. How can these obviously intelligent and seemingly forward thinking people who are strongly rooted in Evidence Based Practice (EBP) believe that manual therapy is unimportant and, further more, that their treatments performed without manual therapy are superior!? This goes against everything I have ever learned and experienced as Physical Therapist working with orthopaedic patients.

I keep asking myself what could possibly be motivating the manual therapy nay-sayers. From what they write in their posts and comments, I believe many of them have had bad experiences with manual therapy in their careers, and I do not mean that as a slam. Some of these internet authors openly write about past experiences interacting with colleagues who claim manual therapy as a way to keep clients dependent on their services. If this is why they have grown so cynical of manual therapy, I am so sorry for the experiences they have had in the past that soured them to manual therapy. I have experienced similar misconceptions in my own PT career. I started out working in only high-volume sports and orthopaedic clinics through many of my student experiences and many of my jobs early in my career as a traveler. I once saw a clinic owner treat 8 workman’s comp patients in one hour. In the last 5 years, I have worked almost exclusively for clinics that book one hour treatments for their patients. I don’t think I could ever go back to the rat race of 2, 3, and 4 patients per hour, no way! I broke out of my bubble by seeing other models for delivering PT. I would suggest that a therapist who believes that manual therapy is no more than a pacifier go out and gain new experiences in manual therapy. There is a vast, vast majority of us manual therapists out there who use our hands because our patients get better faster and stay away longer – not to feed patients’ dependence on us.

Maybe these nay-sayers have only been exposed to manual therapy styles that they don’t see the value in. I have to admit, there’s a group of manual therapists that I don’t see eye-to-eye with either. I once worked for a private practice that had a manual therapy fellowship program built on a chronic pain background. The treatments were based on the smallest minutia I have ever seen in my life – for instance, a “pelvic ring instability” causing shoulder pain. Yikes! Way too many of the patients the other clinicians treated were getting SI belts to “stabilize their pelvic ring.” The therapists at that clinic – all brilliant, motivated, and extremely well intentioned people – were looking at the smallest details in human kinematics as their manual therapy targets. I am very much different. I consider myself much better with concepts than with the tiny specifics. If something is abnormally stiff, I want to move it. If something is hypomobile in the spine, it’s going to be a whole section of the spine, not a single level that I move. I do not believe in improving extension of one side of one segment of the spine – you just can’t do it, and our hands are not that specific – the research supports me in this belief. As clinicians, we are bad at determining joint mobility beyond three categories: hypomobile, normal, and hypermobile. If you find yourself frequently describing subrankings of these 3 categories (mildly, moderate, etc), research does not support our ability to be that discerning. Our hands may not be as specific as some will claim, but they are beneficial to a patient far beyond a handshake. My point is, I could get on board with a faction of PTs saying, “Hey gang, all this specific mumbo-jumbo is a bit much, lets get back to basics – move what’s stuck, stabilize what isn’t, and manipulate a group of spinal segments when indicated.” ….this is not the message I’m getting from the nay-sayers. Do not lump manual therapy together as one intervention. Manual therapy is many different, specific interventions. Some are more effective than others and the experience of the person providing those interventions matters very much.

OK, it is time to get back to the title of this blog.

So, why am I a manual therapist? Because it works. Not, “In my experience it works,” but because the research shows it works. It does!!! Patients get better faster for longer with manual therapy than without. What could be more mechanical and tangible than putting your hands on a restricted knee and straightening it, then performing a joint mobilization and straightening it further. If someone’s neck hurts, I’m going to see if manual traction helps – because it’s what the research indicates I should do, and because by using my hands, I am less likely to cause an increase in symptoms than traction performed mechanically. Then, if indicated, I’m going to manipulate the patient’s thoracic spine, because the research shows it will probably decrease their pain immediately. The use of hands-on techniques to decrease adhesions in skin or tendons through something as simple as transverse friction is undeniable (and well supported by research). These techniques are all specific things that require skill to apply and have very direct and mechanical effects. If you think the examples I’ve just given are too passive for your liking, and you want a patient more involved in their own rehab, let’s do some mobilizations with movement (Mulligan Concept) – how about some manually resisted PNF patterns? And, I really hope even the most radical of the manual therapy nay-sayers are putting their hands on patients to cue them with exercises and to improve harmful mechanics.

This is truly a case of throwing out the baby with the bathwater. Manual therapy is not one thing, it is a collection of many different techniques. If there are certain manual therapy techniques that don’t work, let’s address those specifically. I’ll gladly accept an argument for specific techniques over others. I’ll also gladly hear arguments that particular manual techniques are working differently than we currently believe they are. But don’t lump all manual therapy together and say it doesn’t work, it’s very well documented that much of it does. Let’s change this manual therapy versus no manual therapy conversation into a what manual therapy works best and when conversation. Those of us having this conversation already, should stop tolerating those that are absolute manual therapy nay-sayers, they make all of us look really bad and inhibit any productive conversation from happening.

As a Physical Therapist, if you’re not using manual therapy with your sports and orthopaedic patients, what the hell are you doing!? You’re not doing physical therapy. Physical Therapists are restoring function, motion, and abilities to hundreds of thousands of people every day – the ones doing it best are using their hands, a lot.

Let’s hug it out, the comments section is below. Please share your thoughts.

-By James Spencer, PT, DPT, OCS, CSCS,

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Borientation

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Travelers. We are trained and practiced in hitting the ground running under any circumstances. After a few assignments, every traveler realizes that all documentation systems are bad, but not equally bad, some are far worse than the others. Aside from a few operational issues, the job is the pretty much the same where ever you go, and it’s not too hard to blend into most teams quickly.

After a traveling on a few assignments, I realized a long orientation can be torturous. Given the choice of a HIPAA presentation, a JCAHO powerpoint, or walking on hot coals, I would take the hot coals in a hot second… besides, I’ve always wanted to try that.


 
Thanks for that, Adam Sandler

For a few assignments, I tried telling supervisors that I didn’t need much of an orientation. “Show me where equipment is, give me a quick run through the paperwork, and I’ll figure out the rest.” This tactic went well for a few assignments, and probably gave me a leg up during a couple interviews. But, it finally backfired last summer. I showed up to a private practice gig up in AK and had seven initial evals on the second day of work. Whoops, that’s too much work for the beginning of any assignment, I definitely over-played my hand.

So, now I’ve toned it down a bit – I have been accepting whatever orientation is bestowed upon me. There’s one phrase that I hear over and over again when I have a light caseload for the first week or two, “Enjoy it while you can.” I guess that’s the lesson I have learned. Orientation isn’t that bad. Easy work, easy money. If I’m allotted an hour for a test on JCAHO regulations, I can hammer it out in fifteen minutes and the extra 45 minutes will break even on a really busy day later in the assignment. Time for a fun side story: I once had four JCAHO audits in one year. Every one of my three facilities that year got audited while I was there, and, also, one of the staffing agencies I worked for was audited. I did an interview with the JCAHO auditor for the staffing agency. At the end of my interview, I got a chance to ask her a few questions. She said that there are over 300 staffing agencies accredited by JCAHO… that’s a lot and really amazes me.

Anyways, the strategy to just take whatever orientation is given to me has totally run-a-muck. I am currently in week 8 of a 12 week contract and finished my last orientation class just a week ago. To give my boss some credit, I am very well prepared. On the other hand, I have been completing online modules until today. I am officially done with orientation and will have only 5 weeks of work without any orientation.

There has to be some middle-point where in the future I can effectively express that I need some orientation, but also that I am seasoned and will be good to go early in the assignment. I haven’t found the happy-medium yet, but I’ll keep on trying.

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International Travel – Reflection (part 4 of 4)

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Reflections

How could Amy not bust out a move at a time like this!?

How could Amy not bust out a move at a time like this!?

So after all of that, all of the waiting, searching, and more waiting, was it all worth it? Most definitely. We were told by those that have traveled to the Middle East before us that our worldview will change from living and working here, and it no doubt has.

From a Physio perspective, there are so many opportunities, so many ways that I can contribute to the department I am part of, and so many things I can learn from others. I am working with people from over 50 different countries, in 1 hospital. The hospital is world class and offers me all that I am willing to accept. I can formulate a research hypothesis and have the means and staff to assist me in carrying it out. We have top physicians, Physios and speakers from around the world presenting topics to us and consulting with our team to make our hospital a better place. It is quite an amazing to be part of something so unique.

One more shot of Doha from the water a night.

One more shot of Doha from the water at night.

From a personal perspective, we have learned how to adapt to different living conditions and more importantly to different cultures. I have learned that being open, non judgmental and genuinely interested in others has allowed me to create trusting relationships with my patients, coworkers, and friends.

I have learned, most importantly, that people are genuinely nice, despite their class, country or religion and that we are all fighting the same battles. We have met wonderful people from our drivers (yes we all tend to have drivers out here!) to CEO’s, tried new sports (squash), adapted our old sports (“mountain biking” in a flat desert) and had our share of love-hate relationships with everything from traffic, to food, and the eternal sunshine that is Qatar.

I hope these posts have kept you engaged and maybe even gotten some to want to jump on a plane and move abroad tomorrow. Thanks for letting me share my thoughts with you!

~Amy

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International Travel – Sponsorship, Benefits, and Qualifications (part 3)

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In the previous post, I discussed the importance of researching locations. In this blog, I’ll share my experience in three big topics to consider when moving abroad – sponsorship, benefits, and education qualifications. Where you will be, either in the US or at your new international home when you are dealing with these topics will depend on your unique situation. My husband was able secure his job from the US, which secured his benefits and sponsorship and also took care of attesting his documents. Because I was in the process of interviewing with my potential company when I moved to Qatar (not to mention learning much of this as I went along!), I took care of these things while here. My suggestion is to do as much as you can from the US!

Exploring the local desert. Beautiful vistas.DesertinaSedanSponsorship and Benefits.

How does sponsorship work in Qatar? Sponsorship is usually required in some form if you are working abroad, and is where the company you are working for vouches for you. If you are not sponsored, you cannot obtain a work visa, and then you are just another tourist. Every country is a bit different on this. Qatar is on the more paternalistic end of the spectrum.
Sponsorship, particularly in Qatar, affects your life in many ways and is somewhat tied into the company’s benefit package. In Qatar, it allows you to get residency, to bring your family over (if you make enough money), to take your driving test (yes as Americans we have to take a test, other European expats do not!), to buy a car, to apply for a job, to sign a lease, to buy alcohol for home consumption, to send your kids to school, to have your kids’ school paid for, to have paid flights home and, most annoyingly, to leave the country. Sponsorship is linked to a lot here.

Given that sponsorship and benefits were closely connected, the questions for the two overlapped. Benefits to consider are housing and car allowances, a furnished apartment or an allowance to buy furniture, relocation assistance, paid flights home, assistance with required documentation (attested diplomas, passport, etc), paid time at the completion of a contract and health insurance locally and at home.

Qualifications.

In the US, just stating your University on your resume is sufficient for proving your college education. Many countries require a firmer confirmation of your education qualifications. This I wish I knew earlier, because finding this information took some time. If you are already in contact with a company, they may assist you in getting your documents in order. For Qatar, I needed my University diplomas and a background check “attested.”

Many companies require that your University Diploma, aka certificate, (as well as any other legal document) be attested by the US State Department and the equivalent department in that country. So how do you do this? Here’s a starting point: http://www.state.gov/m/a/auth/  . It pretty much requires you to send your diploma (or a copy of it) to the State Department, where the Secretary of State (in my case Hilary Clinton) has to sign it. If you know where you are working (in my case Qatar), it can be sent to the country’s embassy in the US for verification, otherwise you bring your US attested copy with you abroad, and get it Attested by that country once there. It is then considered a legal document in that country. An easier way to do this is through a proxy. I used http://authxperts.com – who by the way were awesome! They are costly, but they do all the work for you and quickly. If you are lucky, like my husband, your company will do all of this for you (another important question to ask!).

Amy’s husband Joey kicking it with some new friends Doha-style

Since I was working in healthcare, I needed a background check. This one is more sensitive than the Certificate Attestation. In Qatar, the background check was time sensitive. They did not specify if I needed a state or federal check, even after asking multiple times. So to be safe, I got an FBI background check. You can find information on this here: http://www.fbi.gov/about-us/cjis/background-checks/submitting-an-identification-record-request-to-the-fbi . I again used Authexperts to assist me in this process, which took about 8 weeks.

It is also worthwhile to find out if you need your birth certificate, marriage certificate or any medical tests that are required to be attested as well. Again, it will save time and frustration if you are prepared! If you do not know what you will need before you leave the country, it is best to bring along your diplomas, birth certificates, marriage certificates, vaccination record, and fingerprints (needed for background check). This will save your friends and family from searching through stored files and sending sensitive material overseas.

 

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PT International Travel – The Prep Work (part 2)

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This is part 2 of a series on travel abroad as a working Physical Therapist. For previous posts, click “previous blogs” on the menu at the top of the page.

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Whether you are following a significant other somewhere or you are looking to relocate abroad on your own, there are a lot of things you want to consider before and during the transition process. Hopefully my story will help those of you thinking about travel abroad decide to take that leap out of the US and help you figure out how to do it. The process is never ending, but the better prepared you are, the less frustrated you will get!

Souq Waqif, a marketplace and one of the favorite tourist spots in Doha.

Souq Waqif, a marketplace and one of the favorite tourist spots in Doha.

 Like I mentioned in the first post, having a contact may be your greatest advantage in landing a job abroad. Think of a friend or family that lives abroad, a coworker that worked abroad or even someone that knows someone that worked or has contacts abroad. Six degrees of separation may work here! That is generally how most of us foreigners here in Qatar ended up where we are.

Since my husband was the one who took a job that was placing us overseas, I had to do a ton of research on the possible countries – Chile, Australia and Qatar – to see if any of them would be a place I could practice. Unlike many other professions, healthcare workers usually have either the burden of proving their proficiency through re-examination (who wants to take the boards again!) or through verification.

So, before you start packing your bags for some beautiful coastline, there’s a few things you will want to research, and then continue to research throughout the process. I’ll try to keep this as condensed as possible, but here’s some quick links if you don’t want to read all of it.

On the water looking back at Doha

On the water looking back at Doha

Given that we had 3 potential locations we could move to, I started by looking into the culture and the requirements for a PT in each country. A good place to start is the World Federation of Physical Therapy (http://www.wcpt.org). They have contact info for a ton of countries, including websites, emails, phone numbers and addresses. Awesome.

I started by emailing the contact for Chile. The biggest questions I was asking at first were 1. Do they accept a US licensure carte blanc, on a case by case basis, or do they require all international PT’s to take an examination? 2. Is Spanish (or Arabic for Qatar) a requirement or are there hospitals where the primary language among healthcare workers is English? I also checked out Chile’s physiotherapy webpage that I found on www.WCPT.org and googled hospitals in Santiago, Chile. Everything was in Spanish. The email I received from their PT association was in Spanish. Fluency seemed like a must at this point. So for Chile, I waited on proceeding until I had a better idea if we would end up there.

Next was Australia. I started by checking out http://www.physiotherapy.asn.au but also contacted a college professor as well, knowing that she practiced there. In Australia, they evaluate each candidate on a case by case basis, but chances are, an exam was likely. Now, being 6 years out of school, I would want to know that I would be here for at least a few years if I was going to study for another board. Again, further search was put on hold. But I couldn’t help to check out New Zealand, since I was looking in that part of the world. http://www.physioboard.org.nz/index.php?Registration-Overseas-QualifiedPhysiotherapists . Now this is the kind of information I was looking for! Direct information on how to apply as an international PT. Perfect. Now only if we were going there instead!

I saved Qatar for last. This is where we ended up and was probably the most complex process I have ever endured! I began with checking out background information on Qatar which is a moderately liberal/conservative Islamic country in the middle east. We have to be married to live together. I can drive, walk around, and do most things as I would in the US. It is respectful to have my shoulders and knees covered when in public. English is the common language given the hundreds of languages that are spoken here. So it seemed I should be able to transition here with moderate ease.

We then started by asking my husband’s company a ton of questions to find out if I should come over with my husband of if I needed to wait before I made my move. The big questions – sponsorship, benefits and education qualifications. I will get into these topics in the next blog and the details of what I specifically had to do to be eligible to work in Qatar.

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PT International Travel – An Introduction (part 1)

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People are ALWAYS asking me about travel abroad. Unfortunately, I have never traveled abroad to work and know very little about it. Recently, a friend, packed up her bags and headed for Qatar where she has now resumed work as a Physical Therapist. She has been kind enough to put some of her experiences to paper and share them with us.

Over the next month or so, we will post several blogs by Amy Sheridan about her experiences finding work abroad and the logistical and cultural obstacles that she has contended with.

Without further a-do, here is an introduction to Amy and we will soon follow-up with the next several pieces.

-James
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Doha, Qatar largest city. A population of about 1 million.

Doha, Qatar’s largest city. A population of about 1 million.

Ever think of working as a PT abroad? My husband and I had been throwing that idea around for a year or so before a great opportunity arose for him as an engineer in Qatar. We jumped, and I left my physical therapy job in the US and followed him there. Why Qatar? Why work abroad when you can work as a traveling PT in the US? Well, hopefully our tales will give you some background on not only work and play life abroad but also on the process that I had to go through to work in Qatar.

Prior to jumping ship, I worked as a Sports and Ortho PT in a private outpatient clinic in Boston. I had been working there since graduating from Northeastern University in 2006. Having a boss that traveled to the Middle East for 10 or so years to treat athletes actually prepared me to work abroad. I always thought it would be awesome to start traveling with him there. Instead, I ended up here myself.

Amy getting around Qatar via some local transportation.

Amy exploring Qatar via some local transportation.

The number one reason we ended up in Qatar, of all places to relocate to, was contacts. And patience. My husband must have posted his resume on 50 job websites for work all over the world without a single reasonable follow-up (very frustrating, I might add!) before a conversation with a subcontractor led him to a brilliant contact and a job. My job also came from a contact I made 3 years ago at a conference. If that’s not an ad for keeping old business cards, I don’t know what is!

Over the next few blogs, I’ll share the seemingly never ending production of preparing to relocate, the millions of questions we asked before and during the relocation process, securing visas and residency, idiosyncrasies of living in another country, culture shock, and finally what it is like to work in Qatar. I’m hoping that my experience will guide any of you looking into it or in the midst of the process.

-Amy

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Emergency Room Physical Therapy

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I’ve been wanting to write about this topic for a while. A few recent events compelled me to put some thought down on proverbial paper.

The 3 things that compelled me: 1. Working in the ER, 2. Attending ER PT meeting at CSM, 3. Chatting with a friend at CSM who is an ER Physician.

I need to define my nomenclature before I get rolling here. I use ER (emergency room) because while I acknowledge this area of a hospital is larger than one room, the abbreviation ED makes me giggle.

I like working in the ER. Things happen in an ER that you don’t see anywhere else on this earth. Bring use you mangled, your acutely and traumatically injured, your impossibly intoxicated, and (most importantly) your clinically insane. I like the ER because it is exciting and it breaks up the day.

At this recent meeting at CSM…

I must break for a moment and fly my APTA flag. 13,000 PTs, PTAs, and students attended CSM this year. This is the most ever, and the numbers have been growing by a large margin every year. In addition to CSM attendance, APTA membership has risen over 80,000 with 22% of those members belonging to my favorite section, Orthopaedics. One last quick plug before I move along: If you’re a PT or PTA and not an APTA member, you’re missing out on being a part of one of the greatest times for our profession. The public is learning how well educated and trained Physical Therapists are and the entire healthcare community is realizing how unique and essential our skill set is in every setting.

At this recent meeting at CSM, a group of PTs who work in the ER go together and discussed exactly what it is we do. The answers were varied, some PTs are dedicated full-time to the ER, but many are there on an as needed basis. Some PTs are there as a musculoskeletal first line, diagnosing and practicing true direct access PT, but the majority are there as another part of the team following physician orders.

I have already written more than I like to in these purposefully-brief blogs, so I think the best I can do is to share my experiences in the ER. On my very first travel assignment back in Lowell, MA, we were occassionally called to the ER when the decision to admit or discharge was based on mobility. This is my 3rd at the hospital hear in Aspen where we are called to the ER multiple times every day to address the many LE injuries that occur in a town with four ski mountains. We typically are called in for gait training and brace fitting, but our greatest gift to the patients is what we teach them. We have a knowledge of their impending recovery and rehab that no one else offers. While surgery is a frequently necessary and vital part of their journey back to health, it only consumes a few hours. We are the experts on the rest of their 2, 4, or 6 months of pain, healing, and ultimate return to activity. Research shows that with PT involvement in the ER patient recovery is faster, patient satisfaction is higher, and costs over the course of this patient’s injury are lower. PT should be an important part of every emergency room. I have some work to do in the ER here to increase referrals for conditions outside of the legs. On your next assignment you can ask about the ER and see how much PT is used.

The group of PTs that held the meeting at CSM have an online list serve where PT and ERs are discussed. If you have any interest in Emergency Room PT or are just curious, you can sign up at: http://health.groups.yahoo.com/group/ptined/

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Tulum – A Travel Photo Journal

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Tulum, Mexico was a very cool trip. We showed up in the pitch dark of 6:30 PM in what seemed like the middle of the jungle. It was pitch black, and the 6 of us walked through the dense palm trees on sandy paths with headlamps

to the check-in desk.

In the zona hotelera of Tulum, there are no power lines. Everything is quite literally off the grid. All phones and credit card swipers are cellular, and computers are connected by… I don’t really know how. The resorts are mostly bungalow/palapa-style housing run on solar power for all electricity. Our bungalow had the luxury of having a door in order to keep the outdoors out, but had no outlets and only two lights hard-wired into the “solar-system.” Don’t let me confuse you, I am not complaining. I absolutely LOVED it. I felt very relaxed and will maintain that I slept in every day, because there were no clocks to contradict me. When I did get up, I would go for a nice run on the beach then enjoy some of the best coffee I’ve ever had from the restaurant across the street from our hotel.

Tulum is a special place. There are scenic Mayan ruins right on the ocean, a secluded setting, a relaxed mood, and great restaurants. I do fear all these great things will soon be the downfall of this place as larger resorts replace the small ones and phone wires are inevitably hung; but, for now, Tulum is a special place.

I’ll let the pictures fill in the details, click on the thumbnails to see the full picture.

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I Am Spent.

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It’s been a crazy few weeks. Wedding, after wedding, after bachelor party, after wedding… I should be clear, I’ve had a freakin’ blast.

Did they know we were coming? - Oceanview Inn, Gloucester, MA

Each weekend has been so much fun. Friends that I sometimes see once in a year, I’ve seen 5 times this summer.  It has been so cool going to weddings on boats, to weddings at summer camps, and to parties in foreign countries, but come on. I’m tired.

I’m headed into the first weekend I’ll actually spend at the apartment I’ve been living in for 6 weeks. I am so excited for all the sleeping in I’ll do and the French Toast on the horizon. There’s an autumn festival up the street and a couple craft beer festivals going on around the state if we get restless around the studio apartment.

Anyways, Hobohealth has suffered from my social indulgence. Spammers, or more accurately spam bots (computer programs that register for websites and create general electronic-anarchy), have over-run the discussion boards and this blog has gone untended for far too long.

I’ve started working on a new forum for discussion, hopefully it’ll be up in the next couple weeks. While Hobohealth has headed in the direction of a blog, I’ve always thought the strength of it was natural, uninfluenced discussion between travelers and wanna-be-travelers. So, hang with us while we fix up our discussion board and continue to slowly, but steadily grow.

Other than Eric Gosselin, perpetual Traveler of the Month, there are few people I would drive with to Montreal for a 3-day bachelor party.

As we move forward, think of what you want to ask other travelers on our new forum, think of your best experiences as a traveler you’d like to share, be our Traveler of the Month, or even consider being a guest writer on this blog. Also, if you like to have input, the blog comments are up and running for your pleasure.

Well, gang, happy autumn. “They” say our foliage here will peak in 2-3 weeks. I’ll try to share some photos at that time and keep you entertained with witticisms until that point.

 

James

 

Boothbay Harbor, Maine

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Motivations

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As travelers, why do we travel? Why do we choose the assignments we do? What are our motivations?

I think if you ask a bunch of travelers, you’ll get a bunch of answers. The obvious answer is to travel… duh. Some people do it to help pay off loans and choose their assignment based on the pay package. Sometimes it’s a transition to try out a new area of practice or new geography. Travel PT is an awesome oppoprtunity no matter the reason.

On this last assignment, my prioritiess were: 1. getting close to the location for our wedding for frequent weekend trips to prepare;  2. staying in outpatient practice; 3. and stocking away enough moolah to pay for the wedding.

Mission accomplished. While the area of Maine I’ve worked in over the past 3 months has offered a pretty difficult patient population (See “Disparity” 5/20/11), the job has been good. Good boss, good co-workers, good environment.

Which brings me to my next point. You can do anything for 13 weeks. Some assignments are good, some are bad, but usually it boils down to who you supervisor is. Essential travel PT tip of the day: On your interview, ask questions. On the assignments I haven’t liked, my asking a couple of obvious questions on my interview would have saved me a lot of trouble.

Anyways, I’m off to get married in Northern Maine this week. We’ll then travel to the Dominican Republic and Colorado before starting a new assignment. When we return, Hobohealth will undergo some long needed maintainance and we hope to make another surge to connect travlers to e