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Body Wash, Shampoos, Conditioners and Bars

"Hey Josh Cleland, how many times have you filled your shampoo/conditioner/soap bottles?"

Wouldn't that be the most perfect question ever that would correlate Josh's training commitment with his hygiene? I mean, we committed to our individual personal adventures back in November, so we're at a stage for bragging rights on just how much training we've done. Josh didn't smell of chlorine back in February the last time I saw him, so I know he's showered.

"None." "HaHa... Well, I KNEW you probably didn't use shampoo or conditioner. Okay, how much body wash have you gone through?" "Oh, probably 20 bars."

My whole blog post is now a fail... thanks, Josh! I most certainly was not anticipating that Josh used bars of soap! Ladies, we need to help Josh out on the benefits of body wash! By the end of the year, we have to convert him to being a liquid body wash kind of guy! Body wash care packages coming your way, Josh! ;)

Now what do I do? I've filled my little 3 oz bottles 5 times since November (rocking out on my commitment) and Josh has gone through 20 bars of soap.  Is he talking the hotel bars or the big 'ol Irish Spring bars?

We have this same sort of problem comparing published literature outcomes with real life patient outcomes. In thinking about body wash, Josh is much bigger than I am. To lather up his body is going to take a lot more product than it will mine. But... if I decide to shave my legs in the shower, well, that's going to alter my usual and customary amount of body wash. (Now... FYI, I don't shave in public showers, but I have seen it done.) Depending on the product and how it comes out of the bottle can also be a factor in just how much product is used to lather up. If you have to yank the lid off and use your finger to snag some out, you'll use a lot less than if it just easily squeezes out. After exercising as proprioception and coordination decrease due to fatigue, if you drop the bottle, then you have spillage which increases the amount of product used too. The viscosity of the product also needs to be considered. The nice thick ones with moisturizers don't come out as easily as some of the manly, man body washes. Do I dare say that I bet more body wash is used after swim training than after run or bike training? There's just something about trying to rid oneself of the chlorine odor that automatically means more body wash would be used.

One of the frontiers evolving over the last 20 years is that of outcomes. Outcomes will be a relevant factor in the future. We have more and more literature publishing outcomes - which is great! We need to be careful though... as we move into using outcome data to support our value, we really don't have a standardized measuring system. What we have is as bad as the shampoo/conditioner/body wash scenario. We really do need to have many of the variables that affect outcomes accounted and considered in the reporting mechanism. Since the big push in the federal system is some alternative payment system for outpatient physical therapy services, we need to think... if claims are going to just be analyzed on an individual basis, I'll make up a word - an intra-patient analysis, then, we're probably okay with using the tools we have. I doubt the future will stay at an intra-patient analysis though and the claims data or outcome data that will probably be submitted on each patient will probably be dumped into a database and inter-patient analysis will happen. This is a huge mistake... Josh and I both started committed training in November. I've refilled my bottles 5 times and he's used 20 bars of soap. How do we analyze that to determine who's more committed?

And, since some have asked... the training update. Josh has been killing it through and through. Two 90 minute swim training sessions... I think he recently did a really long bike race? Long like over 50 miles... and I can't remember the distance he's running, but in the 20 something mile range. (Honestly, I didn't save his updates... I do know it was LOTS of training though.) Guess he has good reason to use 20 bars of soap! His first event of the year is the Mooseman Half Ironman on June 3rd.

I'm killing it in the water! I've got my mile pace down to 34:29 minutes which I am really, really proud of! <sigh> I've only been on my bike three times. I'll admit, I'm slow to change - I'm a girl of habit and just haven't committed to bike training, yet. And, I'm in the 3-4 mile range running depending on the day. My first event of the year is also on June 3rd and it's the Hawk Island Sprint Triathlon.

Obviously, Josh should be using quite a bit more body wash than I am. Let's say I did train at the same level as he is... would the use of our hygiene products accurately capture our training habits? Are we going to have the same problem in the future if the powers that be analyze claims data?

Talk to you later,

~Selena

photo via Flickr by takot

Direct Access - You ARE ready!

Where's our confidence?

Tim Richardson recently posted on the upcoming primary care physician shortage. I was going to comment there, but my comment deserves more space & time than a comment.

Recently, via a 4/24/2012 tweet chat on #solvePT discussing direct access, I learned something huge! Via those who contributed their thoughts, the majority aren't embracing direct access! When I see statistics of 15-20% of patients self-referred, that immediately tells me we aren't believing in our value. We are choosing to focus on payer obstacles and barriers. We are choosing to not rock the boat with physicians in the community because we don't want to burn a relationship. Although these are valid perspectives, who are we hurting? We are hurting consumers by our timidness; we are hurting our professional integrity. You read that right... our integrity. We aren't being honest with ourselves with the talent and skill we bring to the world or with our value.

Squeamish about the responsibility of direct access? Fearful of the accountability of direct access? Afraid you'll hurt a physician relationship? I'd like you do do a tad bit of self-reflecting. Does that piece of paper a physician gives to a patient referring to a physical therapist truly tell the whole story? You ARE ready to be a solution in this train wreck of health care!

Take some time to read a thought provoking article by Michael Ross & William Boissonnault (love their work, by the way). Their research doesn't even tell the whole story. Think of the patients you have treated in the past. All of mine are referred from a physician. I don't have time to report case studies on my experiences and neither do you. But I KNOW we aren't a threat to society OR to a physician. I refer back to physicians or specialists ALL the time! Let me give you a quick run down of just a few examples from my career... spinal infection, missed cervical fracture, internal bleeding, drug toxicity reaction, tibial stress fractures, polymyalgia rhematica, depression, myocardial infaction, other cardiac issues, post op infections, blood clots, cancer, suicide, Parsonage-Turner Syndrome, low Vitamin D, shingles in an adolescent, femoral head/neck necrosis... This "relationship" we have with physicians is SO not one-way in nature.

Although all my referrals come from physicians (Michigan is NOT direct access), I view myself as THE musculoskeletal expert. My role is to focus on who needs treatment, who needs further diagnostic testing, and who needs a referral to a specialist. In situations where a patient needs to be referred, my role is to help the physician understand what needs to be ruled in/ruled out. My role is to anticipate expected responses within a defined period of time and to re-evaluate my clinical decision-making when the anticipated responses do not occur. That even means going right back to square 1 and asking is the patient appropriate? Just because a patient walks in with a referral from a physician is by no means an excuse to turn off my clinical, critical thinking. I cannot and will not assume the physician knows best 100% of the time. Physicians need us and our expertise... consumers need us and our expertise.

Direct access is just a law as to how your patients are able to receive your services. Your actions and behaviors with regard to patient care and decision-making should be no different whether you have direct access or not. Our profession is SO ready to step up to plate and be of assistance in this time of need. Nurses aren't the answer for musculoskeletal problems; physical therapists are THE answer.

When will we express our confidence in this type of role? Practice environments will evolve and change to where we traditionally may not be in an outpatient physical therapy clinic. We do not need to be segragated to a traditional clinic - we can practice shoulder to shoulder with physician assistants, nurses and physicians. All it takes to make it happen is triaging phone calls; triaging patients to the best capable provider to resolve the reason medical attention is being sought.

We are ready. Why don't we believe in ourselves? Why aren't we confident we can deliver?

Talk to you later...

~Selena

April #Physicaltherapy filings

I though the ending of  March Madness would have opened up some blogging time but between Springsteen's tour, Kentucky Derby Festivities, and the #solvept movement,  you just have to have your priorities straight.   Because my desk is so full of files, I am going to have to separate this post into two parts.

But first, by way of announcements, I am looking forward to Manipalooza on May 19th. We are doing the 15 min short talks in the morning followed by a business track option in the afternoon which will include a fun case study about the Patient from Hell.  My  short talk is centered on the "outside view" or using perspectives and research from completely outside physical therapy to help solve problems that we face within physical therapy.  Hope to see many of you there.

I am also excited to announce that the Private Practice Section in conjunction with  EIM, the Physical Therapy Business Alliance (PTBA) and Bellarmine University will be co-hosting the Graham Sessions June 2 from 8-4:30 pm in Louisville at the Hilton Garden Inn.  The Graham Sessions are a series of forums for debate and discussion to drive the physical therapy profession forward.  The Annual Graham Sessions are hosted by the Institute for Private Practice Physical Therapy, PPS, and APTA.  With a need to expand discussion regionally in order to gain a broader range of solutions to the issues we face as physical therapists, the regional Graham Sessions were developed.  I have had the pleasure of attending many of the Graham Sessions and for those of you who attend it is a great day of debate, networking, and some inspiring short talks.  Here is one of my favorite bloggers Tim Richardson's perspective on his attendance at a regional conference.  The event is no cost and an added bonus is the user pay option of attending Churchill Down's night time races on Millionaire's Row of which will include admission, racing program, and a buffet dinner!  For more information contact Laurie at privatepracticesection@apta.org.  

 

Ok, now for some quick thoughts:

File under #more to this picture:  

There is an on-going trend both within the profession and by payors to equate lower visits with better outcomes.  I personally think you can make an argument based on some compelling data that would show visits are essentially an independent variable in the outpatient setting. Factors that go into it fall well outside of just what the PT thinks or what a referral source may send.  Copays and gas prices often have a big impact on visits (side note: great to see many states following our KY example of fighting for copay legislation).  In addition, you have to look at recidivism, comorbidities, independent outcome data, and entire episode of care to name just a few.  A compelling case that PT is underutilized is easier to show than low visits are better but let's not let common sense get in the way of payor policy.  An outstanding provider that I know well was just informed that they are now Tier 2 or some arbitrary classification by a payor who shares the same first name as my least favorite airline.  The reason is that their average number of visits are higher than other providers in the area.  The irony is that more and more providers are opting out of this payor because their reimbursement is less than an oil change.  But for the sake of argument, let's play their logic out.  What if there were 8 providers in an area and each provider discharged the patient after one visit and sent them to another PT provider.  This would bring the average visit per patient down to one per the 8 providers and all would be classified as Tier 1.  The patients out of pocket would be the same and in theory the payers amount to providers would be the same.  Maybe this is the right strategy for the absurdity of provider profiling with this payor.

 

File under #fear of consequences:

There is an interesting bill in the making in Missouri.  At this stage, I am unsure where it is at but the idea is to compel payers to equally pay PT providers whether they are based as employees in a hospital or as independent providers. Of course, hospitals don't want to support because they extract higher fees from payers.  While I believe that hospitals really do need us, I can totally understand their concern as private practices have generally done a horrific job of negotiating rates and certainly don't have much leverage in the marketplace with payers.  On the other hand, the assumption that payers will just lower rates to everybody is a little premature as well.  Hospital's yield incredible power legislatively and I can't imagine this bill has any chance.  Hospitals lean toward monopoly or oligopoly and are never in the mood for real competition.   Lately, they  have gone on buying sprees of their competition in a serious threat to payers.  Interesting times for sure.

File under #misery loves company:

Despite the fact that RC-3 passed last your at APTA's HOD, there appears to be an odd end run around by the New York Chapter which arguably happens to also be the most regulated and lowest reimbursed physical therapy state in the U.S..  RC-3 which essentially allows PT's to practice within their practice act and evolving healthcare delivery versus antiquated and stifling current "rules" by APTA and CMS, is scheduled to go into effect this summer.  While it passed a year ago, it's implementation was put on hold pending additional work in defining models of care which I believe are available on APTA communities page (full disclosure, I was one of many on that workgroup).  At least drafts that I have viewed, have NY introducing a "position" that essentially affirms that the only folks who can share oxygen in the same room with a patient are a PT and PTA.   It always strikes me as hypocrisy that we fight for direct access under the logic that a PT has appropriate education and judgement  but at the same time we want to limit that judgement when it comes to using extenders.  There is also a strange fear that if a PT can use extenders that hospital's, MD's, and others will just hire techs to provide physical therapy.  Underlying everything within the profession of course is the principle that a physical therapist is what makes it physical therapy and the PT has to be completely involved in the patient's care but let's not get lost in such a simple, fundamental concept.

April was a busy month. More later.

Thoughts?

@physicaltherapy

 

Direct Access to Physical Therapists Can Reduce the Physician Shortage

Think physical therapists' patients have it rough because they don't have direct access to our services?

State laws preventing direct access to physical therapist services still exist in four states:

• Alabama
• Indiana
• Mississippi and
• Oklahoma 

But, this recent article in The Atlantic by John Rowe, MD and professor at Columbia University exposes the plight of nurses and the political hypocrisy of physician organizations.

"...nurses are only permitted to practice independently to the full extent of their training and competence in 16 states and the District of Columbia. The remaining states (34) impose regulatory barriers that limit their scope of practice."

A 2010 Institute of Medicine (IOM) report on Advanced Registered Nurse Practicioners (ARNP) found...

"...the report concluded that properly trained APRNs can independently provide care primary care services as effectively as physicians."

But, according to Dr. Rowe, attempts by nurses to expand their scope of practice are blocked by physician organizations at the state level, such as...

• The American Medical Association
• The American Osteopathic Association
• The American Academy of Pediatrics
• The American Academy of Family Physicians

Social and cost pressures are growing to allow nurses greater decision-making authority. Physical therapists should also participate in this "flattening of the medical hierarchy".

But, physical therapists need to first practice more like primary care providers by providing basic screening care, like measuring blood pressure, according to this new study by Diane Jette and Dianne Jewell in the April Physical Therapy Journal.

Listen to PTTalker interview Dr. Jette here.

The problem is that physical therapists don't see themselves replacing physicians as primary care providers.

According to Drs. Jette and Jewell...

"...physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome."

Further, physicians cannot and perhaps should not be asked to provide all of these services.

Zeke Emanuel, MD, PhD argues in the May JAMA that we should "Shorten Medical Training by 30%":

"Years of training have been added (to the physicians' curriculum) without evidence that they enhance clinical skills or the quality of care.  

This waste adds to the financial burden of young physicians and increases health care costs.  

The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care."

There will be no physician shortage in America - not if physical therapists can step up.

And I think we can.

Comments?

Tim Richardson, PT

(re-posted from PhysicalTherapyDiagnosis.com)

Manipalooza 2012 “Nothin’ quite like Texas on a Saturday night”

Tim Flynn here to let you know that “everybody’s goin’ San Antonio” for Manipalooza 2012 on May 19-22 at the Crowne Plaza Riverwalk. This 4-day music themed event will feature world-class training with some of the most noted clinicians, educators, and researchers in the field in an energetic and interactive atmosphere. See presentations in a forum setting and receive quality one-on-one, hands-on training with skilled instructors on techniques you will be able to implement immediately into your practice.

If the 4-day event won’t squeeze into your schedule, spend Saturday, May 19th with us at the Saturday Mosh and the new Business Track. The Saturday Mosh is free to PT students.

Check out this year’s topics:

• How Manipulation Works & What It Means For Clinicians
• Advance Practice Physiotherapy Triage of Spinal Surgical Patients
• Where's the Lesion?...Does it Matter?
• The Treatment Based Classifications System- "The Rumors of My Death Have Been Greatly Exaggerated"
• "Outside Looking In" - Decalcifying the Patient
• Cervical Manipulation - Dangerous but worth the risk?
• How to Design a Winning Physical Therapy Business Model
• Patient's Revenge - What do you do when patients tell everybody about their horrific experience in your clinic via social media and the internet?
• Management of Whiplash Associated Disorders
• Mobilization with Movement
• Cervical Thoracic Junction & Upper Ribcage Manipulation
• Advanced Cervical Manipulation
• Advanced Exercise Intervention for the Lower Quarter
• Advanced Hip & Knee Manipulative Management
• Managing the Aging Spine - Lumbar Spinal Stenosis

Instructors for the event include Larry Benz, Rob Wainner, Andrew Bennett, Jim Elliott, Kyle Kiesel, Shane Koppenhaver, Jack Miller, Paul Mintken, Deydre Teyhen, Mike Walker, and Julie Whitman!

Spots are limited so don’t wait to register!  Click here for registration info.

“It’s honky tonkin heaven underneath the lone star sky!”

Tim

  

Caring and Steering

Normally I do some of my best thinking either in the shower or while I'm training for triathlons. This weekend the shower thinking was a complete bust. I learned I can't think while showering in water that smells as horrible as sulfur! Do I ever have empathy for any of you with that kind of water situation! The post-sulfuric fumes led to an odd thought.

As I reflect on the physical therapy profession, I sometimes wonder if the ambiance of graduate school and the level of competitiveness I experienced was a huge negative. I wonder if what I experienced is common and if so, if it has lasting ramifications on our profession. My memories are probably peppered with errors, but it sure seemed as though, as a whole, the attitude was one of selfishness. As students, the "me" attitude permeated. It's always good to look out for "me," sure... but the world we live in is one in which an attitude of "we" leads to greater success. Our training, our education and our "caring" seem to be solely directed toward patients versus simultaneously molding us to be team players while working together to solve problems. That engrained competitiveness affects the opportunity to create change. That competitiveness is a barrier - WE are a huge barrier.

As we become more experienced, some of us become very good at not only caring about our patients, but also steering our patients into a particular pathway to lead to successful outcomes. We can move our focus from "me" to that patient and we can put ourselves into the moment. While we are focused on the patient and in that moment of interaction, we are actually creating change and gently steering that patient toward a desirable outcome. We are very good at this - we do it all the time.

Now, to turn the tables on you... how often have you thought of one of your colleagues? How often have you taken the time to really care and help steer your colleague to help your colleague be more successful? As a profession there are lots of obstacles and barriers to what we may envision for our profession as a whole. Instead of tackling the big, huge seemingly impossible goals, what if we really focused on truly caring, supporting and steering each other? What would happen to the strength of our profession if we really and truly cared, believed, and supported each other? What if we saw a colleague struggling and helped steer that colleague toward a more rewarding experience? What if we truly supported our colleagues in whatever their passion? Could we begin to have a more solidified team?

Dearest Josh Cleland... you should have a surprise waiting in the mail for you some time soon (or maybe already)! It's all in the spirit of caring and steering... One day, I'd LOVE to kick your butt in the water! :) For those of you wondering what?? Josh is training for his first Ironman, while I'm training for my first Olympic distance triathlon. In the spirit of caring and steering, my best friend will be receiving the same surprise in her mailbox too! My best friend and I will be going head to head in the Oly. Cheers to our summer goals!

Do you think of any of your colleagues? What have you done to show you care? How do you help steer them to success?

Talk to you later...

~Selena

 

What Does Direct Access Mean?

The majority of us practice in a state that allows some level of direct access. I love the easy language of the World Confederation for Physical Therapy, "Patients/clients should have direct access to physical therapist services."

I slept horrible last night. It was very, very bothersome to me to learn about the state of affairs with direct access via the #solvePT tweetchat last night. Don't get me wrong, I appreciated hearing the perspective of many colleagues. I find reality really, really disheartening. How much time and money does it take to achieve direct access? How many meetings and conversations have to take place to convince legislators of our qualifications and minimal risk to public? Guess what? I'm just going to bluntly say it... what a waste! Really... the majority of you fought hard - for what? Nothing's changed. When I hear figures of 10-30% of patients being treated via direct access in a direct access state that means the collective we have not embraced this excellent opportunity to provide services to consumers! We save patients money... we reduce third party payer expenses! Our expertise is actually better than physician gatekeepers when it comes to musculoskeletal conditions!

The situation makes me think of Halloween or Easter. Ever had a kid brother who would hoard his candy? He's got a bag of candy given to him... he's not eating it, he's hoarding it and basically taunting you because yours is all gone. Guess what? Sadly, I think the majority of physical therapists are like that kid brother. Why are you still practicing in a traditional manner and not getting out there in your community and informing and changing mindsets? Why the heck are you choosing to hoard your skill and expertise? Oh, sure... you get a few direct access patients because they KNOW you and what you can do! Or maybe if you are lucky, your patients talk about you and refer customers your way. You have an opportunity that has been extended to you and you are wasting it. Think about that. You fought for it; you probably paid something for it to happen; you won... and NOTHING changes? What was the point? To cross off some goal? Yep, got THAT accomplished.

And before I hear the third party payer excuse that a referral is still required... just stop and think! Let's see... @ptfromou mentioned he tends to get patients direct access via the local schools - athletes who need services after an injury. @PhysicalTherapy mentioned a really awesome reality - create a relationship with employers! Employers might embrace their employees seeing a physical therapist first for musculoskeletal conditions. You know, employers might like it enough, especially if you educated them about Virginia Mason Medical Center, that they just might demand their benefit policies be changed to allow physical therapists first without a referral for musculoskeletal conditions.

I'm sorry, but it's just not good enough to HAVE direct access and sit back and wait for something to change. Many of you have your work cut out for you. There are a LOT of people out there who hurt who may have no clue you could be of assistance. And... you never know... some people may just want to pay you and forego the insurance company. And seriously... if every single one of you educated your community, the physicians couldn't hold a grudge and eliminate referrals because you are collectively educating. Besides, working on this aspect now is probably a good thing - there will be a physician shortage looming in the future. Do you want nurse practitioners stepping it up a notch and taking over musculoskeletal care?

Think of all the knowledge you have... your knowledge isn't something that stays within the boundary of someone having a condition. Direct access also allows you to get out there in your community and offer other services... older adults have a high fall risk, can you help with that? Your local athletes could be at risk of knee injuries, could you reduce the incidence of injury? Quite a few older adults are scheduled for arthroplasties... could you offer educational sessions to prepare those folks and have realistic expectations created?

Direct access means moving out of your comfort zone and getting out there and communicating to more than just your patients. Of course your patients love you... of course they are going to be your champions - but that isn't anything new! Step it up a notch! If it feels a little uncomfortable, is a little bit of work, and feels a little bit scary, I say GO for it (whatever it is). For those of you who have embraced direct access, definitely share what you have done! Your colleagues (and consumers) can use your experience to help them.

If we need to create a compilation of evidence of our value/benefit, let us know. There IS evidence! Maybe the creation of an evidence portfolio would be a good thing?

Talk to you later...

~Selena

The Original Treatment-Based Classification Scheme

I thought this illustration of the treatment-based classification system was humorous, and even something my simplistic mind is able to digest. Kudos to Mike Jones, one of our EIM Fellows at St. Joseph Physical and Sports Therapy in Kokomo, Indiana.

John

The Pulse of Physical Therapy

What do quite a few physical therapists mention as the best part of most conferences? Is it the programming or the serendipity of joining colleagues in a discussion? What is more engaging and memorable? It's now over 2 months post CSM and what is more fresh in my mind - the sessions I attended or the people I spent time with? I have to say - I smile and fondly remember the discussions in which I engaged with others. Since it's not cool to blab the details, if you spent time with me, you are engrained in my memory and you've changed something about how I may have viewed things.

The world is becoming smaller... it's actually easier to be a part of engaging discussions. Okay, nothing substitutes for face to face interaction AND eating together (I love eating)... but we can be engaged in our own homes. We can share our thoughts. We can learn and grow. I even think we can create change.

As luck would have it, a very lively discussion began on Twitter. There was maybe just a handful of us back and forthing, but the line of mentions was eating away characters. For those of you not familiar with Twitter, you share your thoughts in 140 characters or less. Talk about learning to be concise! That evening the topic seemed to revolve more around referral for profit situations and how to help patients understand how the pitfalls of the conflict of interest situation affect them. Out of this very simple discussion, something new and exciting happened.

#solvePT We now have a way to monitor issues in our profession. Anyone can share thoughts. Sure, it'll probably grow to include live chatting, but the beauty... 24/7 access to sharing your thoughts and hearing responses to your thoughts. Those who check in on #solvePT will want to comment, share and discuss.

Forbes got it wrong... physical therapists don't have one of the "happiest" jobs. Physical therapists have a very rewarding role in the medical world. Happy? Far from it.

For those of you curious about what the online savvy physical therapists are thinking, you just might like checking out the Pulse of Physical Therapy - Live. The main focus of the discussions revolved around the train wreck of how costly education and the resulting loans influences the practice setting a physical therapist chooses. The steep educational cost seems to create a huge focus on salary when a choosing position. Oh, there are twists & turns highlighting best practice and regulations... it's quite interesting.

A huge, huge thank you to Mack Collier... he is host to #Blogchat which gave me the idea for #solvePT. He also took time to respond to my curiosities. For now, #solvePT is just a 24/7 type of thing with no concrete format. I'm sure it'll grow... I don't quite get how Mack manages and interacts via #Blogchat because I get lost trying to keep up with #solvePT.

How do we create a reasonable return on investment after spending so many educational dollars?

Talk to you later...

~Selena

 

 

Rest in Peace, Dennis Hart

"Talk to you later."

That's how he ended every email with me... "talk to you later." Oh, he'd mix it up a bit and inconsistently preface his final line with "keep up the good fight" or "have fun." Sadly, "talk to you later" is where it was left... there is no later. Time ran out; there is no more.

I remember first meeting him back in 1995. I was still in my first year post graduation. I met him on a plane - somehow we were on the same flight. I really don't recall how we struck up a conversation - knowing me and my curiosity, I probably asked him something and from there I learned he was involved in measuring outcomes. Back then I was timid and shy; I remember awkwardly handing him my business card and telling him I was definitely interested in knowing more. Well... that was that because I never really heard from him due to that chance meeting.

Ah... but I remembered his name and I followed his work. Genius. Mathematical wizard. Challenging. Seriously, I'm kind of a geek and enjoy the concept of mathematics used in physical therapy. In a weird way, his work did to me what sitcoms probably do to couch potatoes. Always, always on the alert for something he published - it would always be the first article I'd read. There was no competition.

You know how they say books allow you to visit places in your mind? Well, blogs, twitter, email and especially MyPhysicalTherapySpace have done so much more for me than any book. Our paths crossed again via MyPhysicalTherapySpace. We actually met up at CSM 2009 prior to me presenting at a session. Thank goodness he came prior to me speaking because by talking to him, I was able to shift gears and forget the butterflies in my stomach and enjoy being in his presence - the questions and the discussion. And from there we had multiple email discussions/conversations.

Sadly, I only know him one dimensionally. I'm generally slow at building relationships. We have this odd thing in our society that kind of creates boundaries. My pre-25 years I was always just "one of the guys." I could hang with any of the guys I knew and there was never any awkwardness or any preconceived misinterpretation. He's one person I really would have liked to have known a bit more than just professionally. What I do know - he exuded confident passion, yet was able to appropriately exhibit flickers of humbleness. I think he loved questions and thinking about the impact of those questions... and then using questions to search for a way to improve. He was aware of obstacles and differences of opinion, yet he didn't let those situations squash his passion. Our profession has lost a key person who was wired much differently than the majority of us - someone who knew and believed statistics and mathematics were needed to tell our story. Someone who believed and knew that one day testimonials for physical therapy effectiveness would not be enough. Someone who professionally took a different path than the majority of us to change and alter status quo so our profession would be ready when data was required. He's gone... sadly, I didn't get to thank him in person for his contribution.

Talk to you later...

~Selena