Why are you crying?

No seriously, why?

If you don’t know me very well, seeing that question may piss you off.

But trust me when I say that I ask this question with no malicious intent.

As a new professional (or student), whenever you’re given negative feedback or told that you’re lacking in a certain piece of knowledge, sometimes one gets defensive. Sometimes one will just cry in frustration.

So you have to ask yourself, why did you react that way?

As a mentor to a student or resident I take immense pride in making sure that after your time with me, you will have leveled up as a practicing clinician. The one key way of making this happen is making sure that you are made aware of what you don’t know and where you can improve in your clinical skills and decision making.

What would really happen if all I did was provide you positive praise and feedback ALL THE TIME?

You’ll go on practicing with a false sense of confidence and mastery of your craft. You won’t be aware of the pitfalls in your clinical reasoning or the gaps in your knowledge base.

(Not to mention that you’ll probably be incredibly cocky and super annoying.)

You see its in your mistakes where you truly grow. It’s the only way.

Let me get back to why someone would react defensively or just cry in frustration.

It’s simply ego.

I get it. You’re a driven person and throughout your life, academically you’ve worked to get everything right. Getting things “wrong” academically is significant in testing situations. You’ve worked your ass off to get most if not all things right to make it where you are today, as a licensed physical therapist.

And so because of this, whenever you get something wrong in clinic it hurts. But now is not the time to shy away from this challenege. Now is not the time double down on only what you know.

Now is the time get super comfortable with the unknown.

As a new professional, you just so new. You have lots of books smart to work in theory, but now is the time to practice. This is clinical practice – not clinical mastery.

So instead of getting defensive or sad or upset, now is the time to change that mindset with your learning. Now is the time to actively engage to uncover what you don’t know as a practicing clinician.

If you don’t know the best special test for one clinical presentation, now is the time to immediately look it up.

If you don’t know the best way to order your subjective examination, now is the time to set up time to practice with a colleague or practice by yourself at home.

If you don’t know what you don’t know…now is the time actively engage with a mentor that can be brutally honest with you and coach you through how your practice and why you practice.

Don’t let ego allow you to be in a false sense of clinical mastery. You need to earn it through your mistakes. So get to work. What’s stopping you?

The one mistake you do not want to make.

Let’s just put this out there right now.

We all do not want to be that bad therapist aka that bad PT.

We all like to think that we’re not that person. That that could never ever be me.

But like…are you sure?

How would you really know?

One of the absolutely key elements to what makes a residency/fellowship experience unique above all other training forms (clinicals, classroom learning, or proprietary company orientations/training) is the mentorship.

A true mentorship calls you out on your shit.

And guess what, when you go through a true mentorinship for the first time, it hurts. Alot.

I’d like to believe everyone experiences their pain in different ways, but what really “hurts” is your ego. Your ego gets bruised, beat up, and sometimes out right annihilated.

But from that pain and recognition of where your knowledge is lacking, where your manual skills are poor, or where you clinical reasoning is so so bad…you grow and get stronger as a clinician.

You would have never experienced this if you didn’t have the guidance from a mentor to show you how much further you can go.

Now what if you don’t have a mentor?

What if you are not in a residency or fellowship program?

Are you doomed?

Not necessarily. You just have to do this one thing: Be self-aware and brutally honest of what you don’t know, then fix that.

You see the core of what makes a bad PT bad is that the bad PT does not know what he/she does not know.

They are completely and utterly clueless. Don’t forget too that the ego could be pretty powerful, so you’ll find clinicians who sometimes get super defensive or even refuse to acknowledge that they could do better.

So don’t be that bad PT. There are plenty of them out there already, and goodness we do not need any more of them.

Here’s what you could do right now.

Pick one patient in your week, and be super critical of what you’re doing with that patient. Always ask yourself with each session, what could you have done better? Question everything that you’re doing. You may even feel silly doing so, but trust me that everything you’re doing affects patient care and so there are many areas to improve upon and do differently.

I won’t get into the finer details, but here are a few places you can start:

  1. How is your subjective interviewing setup? What could you do better? How could you be more efficient?
  2. How is your objective examination setup? How could you order your tests and measures better? What test would have been better to rule in or rule out a potential diagnosis? How could you be more efficient?
  3. How was your therapeutic communication? (did you even know that was a thing?!) Were you being too nice? Did you make rehab expectations clear? Were you being too mean? Did you talk about yourself the entire time? (if you did, you really should stop.)
  4. What does the latest evidence say about this (insert clinical problem, diagnosis, prognosis, clinical technique, etc here)?

I really could go on and on, but hey just keep a look out for more content from me. There are really a lot more where you can be critical and improve upon.

Oh and don’t forget to write down what you find on paper. It’s important to document your own self-reflection. You’ll surprise yourself and have better clinical practices revealed to you. Also, you’ll now have notes to yourself that you can use as reference later. (This started my love affair with Moleskine notebooks back during residency. I have a box full of those guys.)

So there you have it. DON’T BE THAT BAD PT. Get hyper aware of your own thoughts and actions in the clinic. Document them. Self-reflect, then act on getting better.

Welcome to my newest endeavor.


Thank you for visiting my website.

This is, I believe, my 3rd or 4th iteration of re-engineering ryanbalmes.com.

So for those of you who’ve been to this website before from the very beginning…thank you for coming back.

For those of you new to the site, and you may have found me via Instagram or my Twitter account, welcome!

My goal for this website is to share my thoughts and takes on everything and anything on the physical therapy profession. Because I am fortunate to have both Board Certified Specialities in Sports and Orthopaedic Physical Therapy, I will be strongly biased to make content for those areas of practice.

As of this writing, I have now been practicing for 8 years. I have always had a passion for teaching and mentoring, and I have truly enjoyed my short stints serving in those roles years ago.

But because opening my own practice (I’ll write more about one day), I haven’t had the opportunity to really serve as a formal mentor or teach as much as I’d like.

Thankfully, because of the internet, I really don’t have to wait for a faculty position to open up, and I don’t have be part of a residency or fellowship program to mentor and teach.

I hope to live out what I enjoy doing, mentoring and teaching, out here on the internet for you. And as you get to know me, you’ll know that I’m still pretty optimistic of what the internet can achieve in this world. I’m here in Atlanta, Georgia drafting this blog post, but you may be reading this in a completely different part of the world!

So if you’re a practicing physical therapist, and you’re open to knowing more about how to really enjoy being a true practicing clinician (not a manager…more on that later), then you’re in the right place. I believe wholeheartedly that when we get to a better place as clinicians with practice, then ultimately the patients and clients we serve will really benefit and succeed.

Thank you coming by the website. I hope you come back soon, and often!

Dr. Ryan Balmes PT