Talking All Things Cardiopulm
This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions and patient experiences.The goal is to learn, inspire and bring Cardiopulm to the forefront of conversation.
Talking All Things Cardiopulm
Episode 98: Do Experts Know Everything?
What makes an expert an expert? Is it their experience? Is it their knowledge? Is it their ability to teach/mentor? I can argue that it’s a compilation of all of the above. But do experts know everything? Is it even possible?
I think the question is a set up for the most obvious answer. But maybe it’s not that obvious? A recent conversation spurred this discussion. Join me as tackle this question and take on a soap box or two
I'm so excited to share this 3-day event hosted by my friends The Note Ninjas.
The Innovative Treatments, Effortless Documentation Summit is coming May 6–8… and it's FREE!
They’ve brought together a powerhouse lineup of experts to help you:
✅ Streamline documentation
✅ Discover fresh treatment ideas
✅ Avoid burnout
✅ And reignite your passion for clinical care
*Upgrade to the Clinician Power Pass to earn 20 contact hours (OT) or 20 PT CEUs, plus some awesome bonuses!
🎁Plus, there's a Facebook group with prizes, community, and more!
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Linked-In: Rachele Burriesci
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Welcome to Talking All Things Cardiopulm. I am your host, Dr. Rachele Burriesci, physical therapist and board-certified cardiopulmonary clinical specialist. This podcast is designed to discuss heart and lung conditions, treatment interventions, research, current trends, expert opinions and patient experiences. The goal is to learn, inspire and bring Cardiopum to the forefront of conversation. Thanks for joining me today and let's get after it. Hello, hello and welcome to today's episode of Talking All Things Cardiopulm. I am your host, dr Rachel Barisi.
Rachele Burriesci:Before we jump into today's episode, I wanted to talk about an awesome event that's coming up between May 6th and May 8th. It's a three-day free event hosted by my friends Nicole and Stephanie from the Note Ninjas. If you don't know the Note Ninjas, give them a quick follow on your favorite social media network. They're at all the places Instagram, facebook, youtube and they have an awesome blog as well. And what they did was they brought together a powerhouse lineup of experts across PT and OT to help streamline documentation, discover fresh treatment ideas, avoid burnout and reignite your passion. And I have to say that when you go to these events, whether it's in person or virtual, and you feel the passion from the people who are presenting, it really does ignite something in you and bring something fresh to your treatment. And so I'm happy to say I am one of the presenters at this awesome summit, and so it is a, like I said, three-day free event. You can upgrade to what's called the clinical power pass to earn 20 contact hours in OT or 20 PT CEUs, and they're going to be giving away some awesome bonuses and all kinds of things. So, whether you're a PT and OT, you're in home health, you're acute care, you're a neuro specialty or you know neuro practicing PT, if you're a new grad, if you're a current student, you're going to be able to grab some great insight and actionable insight tailored to you and your patient population. And what I really love about these events, not only the diversity of the presenters. There's everything from neuro to cognitive assessments to cardiopalm. There's everything from neuro to cognitive assessments to cardiopulm, even things related to billing and appeals. So this is going to be a really cool lineup. And what I really find interesting is that, even if it's not your specific patient population, being able to take ideas and translate them into your setting is always where you start to get that spark and you start to make an even bigger difference. And sometimes it's really nice to have outside insight, outside insight, to get even more out of your patients.
Rachele Burriesci:So I'm going to drop a link for the summit. It's the Innovative Treatments Effortless Documentation Summit. Again, it's being held May 6th to May 8th. It is a virtual event and so you can click that link. You'll have 24 hours free to watch all those pre-recorded lineups and if you want to upgrade to the clinical power pass, you'll have access for one year and you'll be granted 20 CEUs, whether it's for PT or OT. So this is going to be a good one. Dropping that link below. Don't miss out, okay Well, link below Don't miss out, okay.
Rachele Burriesci:Well, you know it's been an interesting few weeks. I have been presenting in a couple of different places. I did a recent happy hour locally related to respiratory muscle training and I've been working with the Note Ninjas on the summit coming up. So a couple of fun things just re-sparking, some lecturing and potential CEUs in the future. So I have a couple of things brewing, which is always fun, just to kind of reignite things in general and, as I always say, if you have any ideas for podcast topics, specific areas of focus, let me know. It's always great to have insight of what you're wanting to hear, because then I can either bring another expert in to talk about that or we can chat about whatever it is that you're looking for. So if you have any needs, wants, topics, drop them in my DM on Instagram. You can email me I'm a little slower on email, but shoot me a text. My text is right below and that comes directly to me and I will answer you directly back. And so you know. That kind of brings me to the next point, which is what we're going to be talking about today. It's actually about expertise and knowledge, and it's just very interesting to have conversations with people in PT. People have been in PT for years, people who are new to PT. You know, like there's general vibes, there's burnout, there's all kinds of things happening right now. Right, that we had the Medicare reimbursement stuff not really go in our direction, and so there's just a lot of different avenues of focus and concern, which makes me even more, makes me really concerned about some of the things that I kind of hear back, and so this, the title for today is really Does an Expert Know Everything?
Rachele Burriesci:This was a very specific question asked of me by a former student based on an interaction she had at a newer job. I won't even say new because she's been there for a few months and she's a newer grad. But she's not a new grad, she's been out just over a year and so she's in a new state, in a new environment. And, you know, maybe there's some culture things going on at that place based on the conversations we had. But this one really kind of stuck out at me and I was, I wanted to talk about it because she's not the only one, right, it was just a very pointed question and it frustrates me that these are the conversations that are being had, because there's so many more important things that we should be caring about versus fighting ourselves. And I think that's really when I just I can't, I just I cannot deal with PTs fighting themselves, pts pushing each other out of the way, pts downing one another and just not being supportive, right? So this specific question wasn't just like a direct question Does an expert know everything?
Rachele Burriesci:I mean, we all know the answer to this, right. The answer is no, no one knows everything. I don't care how many years you've been doing something, you don't know everything. And what I tell all of my students is the day that you think you know everything. It's time for you to move on, because it's not possible. Things change so fast. There's so much progression in medicine. There are so many new surgeries, devices I just even think about pacemakers. How much change has happened with pacemakers and IABPs and impellas and all of these things right, they just keep advancing.
Rachele Burriesci:So unless you're in that specific thing and that's the thing that you do you're not going to know everything, and you still won't know everything, even if it's your main focus everything and you still won't know everything, even if it's your main focus. It's just not going to happen. I think it's very ignorant. I think it's naive. Maybe it's a little bit of arrogance, but it's upsetting to me to like hear that. Right, because I'm dual specialized, do I think I know everything? Absolutely not. I am always learning, always. There is always a new technique, perspective, physiologic understanding that changes your insight, changes your thought process, changes how you approach things. Have I changed how I approach things A hundred percent? And if you're not willing to do that, that's that is. That's a problem too.
Rachele Burriesci:I actually just had a really amazing conversation this week with a gentleman who's been doing research on respiratory muscle training for 30 years. So much insight, so much knowledge and he's been focused on a specific type of respiratory muscle training, a specific protocol, very detail oriented. So much information, so much insight, so much understanding of the physiology and differences across diagnoses because we're talking about this single treatment intervention. So much insight. When you have these conversations with people who have been in research for 30 years, it is very humbling. I learned so much. Did I know everything? Absolutely not. Did he know everything? No, because you know like one of his specific areas is IMT and so we were talking about IMT versus EMT, versus RMT and I asked a specific question about EMT and he kind of deferred to the other person in the conversation because that's not his main focus.
Rachele Burriesci:This man is an expert. This man was so knowledgeable, so much insight, so smart. Would I call him an expert? A million percent, like hands down. I learned so much just from hearing his explanations of right, even though I have a good understanding. Just hearing the insight, hearing the nitty gritty, hearing more of the why and like digging in just is so exciting and if you cannot accept that you don't know everything, I'm sorry. That is a problem.
Rachele Burriesci:The side of this that is more frustrating than just like the arrogance of the question that if you're an expert, you know everything, and if you know everything and if you've been on a specific unit and this is your home base, you know everything. Right, like, besides that piece of it which is just I don't know I'm going to use a new term cringe to me, like straight up cringe. It's just not accepting, it's just not inviting, right, it's like, oh, I know everything. That's like a wall up. It's the feedback on the other end of this conversation and so the reason why this was had, why this whole conversation was being said, was because this person is very interested in being embedded in ICU or step down and there's a lot of struggle in this sort of happenings. Whether it's because she's new, whether it's because she's a new grad, the list seems to be kind of against her.
Rachele Burriesci:The part that was frustrating for me and obviously I'm a third person party on this and you know you're just hearing pieces of the conversation. But you know I trust my kids and so when they're having these episodes and they're upset because they want to do more, they want to learn more, they want to be in it, they want, they want to understand and be in medically complex situations, like, first of all, as a mentor who is, you know, a small specialty area, even acute care. Like acute care has taken off even since I have started in PT, but we're still a smaller niche, right, cardiopulmonary acute care. It's not like what most students you have a class of 50, maybe you get five to 10 that want to do something more outside of like the outpatient PT area or neuro like neuros are huge area as well you have people who are interested and you just kind of like push them away. It just feels what are we doing? I mean that is really my question. What are we doing? I mean that is really my question. What are we doing? How does that help anyone? And there was a comment basically said like you shouldn't be here because this person who's been here for 20 years, knows everything and they can answer any question. Okay, that's wonderful. That sounds like someone who should be grooming and mentoring other people who are interested in a specific area, like, instead of pushing people down and pushing people away and almost making you feel small, right, like if you're a new grad and you're amped up to learn and you're excited about this profession despite all of the chaos that is happening on so many different levels right now. Why is that? The response Take that person under your wing, teach them, show them, give them your insights and guess what? You might learn something different.
Rachele Burriesci:And this is an interesting piece too, having been someone who has moved across the country and worked in different states different states have different things. We watched trends move across the country with us. So when we were in New York, we were doing something called rapid rehab right, this was like 2009 to 2013. It was brand new. I'm on a study where it was like one of the first post-op day zero initiatives in the country. That's just post-op day zero rehab now, right, like it's not even a thing, but we watched it move with us across the country. And when we moved to Michigan, it was just starting up. Well, guess what? We've already done that, right. So you have people who are interested in doing this thing because it's coming out in the research and you have people who have already done it. Well, what happens when they collaborate? Wonderful things.
Rachele Burriesci:But why would you push people who have outside experience, other experience, experience that you want away? Right, it doesn't make sense when you have people who have worked in other places. It's a beautiful thing, it is. Diversity is a wonderful thing, and I mean that across so many different layers, you need a different perspective. Different perspectives make you stronger, make you smarter, make you integrate better. It's common sense, right. If you have all of these up like, oh, you did it that way, we do it this way. What's more efficient? Oh, you did it that way, we do it this way, how can we get the best out of this?
Rachele Burriesci:And this is not a dig to any place that has people who have been there for 20, 30 years, because that in and of itself, is a positive thing. Right, for someone to want to stay in a place for 20 to 30 years probably has some good culture, or at least I hope. If you stay in a place for 20 to 30 years, yeah, I hope you like it, because otherwise, why are we doing that to ourselves? But when you've been in the place for 20 to 30 years and you don't have a lot of outside perspective and you've been, and I know everyone has heard the saying this is how we've always done it Whenever you say that you should have a catch like, oh, I just said that, and if you have that thought, then you should maybe say well, what is the other ways? Are they better? They might be, well. What is the other ways? Are they better? They might be, maybe they're not, like I don't know.
Rachele Burriesci:But unless you have the open-mindedness to have the conversation, you're just going to stay stuck and not grow and not advance the profession. Right, like, I think that's the biggest part. For me, it's the ownership of who we are as practitioners and clinicians. There's just so much stuff within our own profession that it's hard to even deal with the other stuff. We have to stop fighting each other ourselves, putting each other down, pushing each other away, not having collaboration, not trying to progress the profession, not getting stuck in a rut, not going backwards in what we do and I have said this so many times and I feel like a broken record but when you stop doing the things within your skill set, you stop doing the things within your skill set. You stop doing the things within your skill set, and people don't even know that you can do that.
Rachele Burriesci:Like, wearing a stethoscope as a physical therapist is a thing. It should not be a thing, especially in the acute care setting. Like, if there's any place where a PT could and should wear a stethoscope, it would be in an acute care setting. But the fact that it is so taboo is wild, right, those are the things that we should be advancing. That shouldn't even be a question.
Rachele Burriesci:I made a podcast episode about where the damn stethoscope? It was very early in this podcast creation. Since that podcast, I have been asked at least another five times from other professions. I had a nurse the other day. It was literally just the other day again day. It was literally just the other day again, and it was an interesting question. So, you know, I have to, I have to put my guard down when, when things like that get asked, because my immediate is, of course, I do. So I have to put my guard down, I have to. I have to make a mental note to have a conversation versus, you know, shutting this person down, because that doesn't help either, even though it's that internal like fire that builds up that just wants you to like react.
Rachele Burriesci:The question was you're wearing it's not again, not a question You're wearing a stethoscope. Do you do both? That was the question. Do I do both? What Like? Are you a nurse and a PT? No, I'm a PT, I'm a doctor of physical therapy, I have a specialty in geriatrics and I have a specialty in cardiopulmonary. I work in an acute care setting. What do you do with that? I auscultate lungs. It's also very helpful when you need to take a manual blood pressure, and the best part about the conversation was not rudeness, which happened in that first episode, but, I think, a growth mindset.
Rachele Burriesci:They didn't realize that we learned how to do that. Now they do, and it's part of the conversation. Right, so I can understand it when it comes from other professions, because I don't learn everything that a, you know, an NP does, a PA does, a nurse does, an RT does. I don't know what your curriculum looks like and everything that's in it, and I'm sure you don't know that about ours either, and that's okay. The problem becomes when we do it to ourselves, when we put our own profession down. We should be supporting each other, mentoring each other, advancing, doing more in the sense of better quality care that's evidence-based, that we are interjecting ourselves in places that we belong. We belong at the table, but you don't get a seat at the table if you regress in what you do and you only get stuck doing this one thing or doing it the way you always did. So I'm going to go back to my original list of things here.
Rachele Burriesci:Does an expert know everything? Absolutely not, it's impossible. Expert know everything? Absolutely not. It's impossible, even if and I'll just I'll use cardiopulm as the example right, I have a cardiopulm specialty Within cardiopulm, even though it's a small niche, right, like we're still one of the smallest specialties in PT, even though it's a small niche, there's still a ton of variety in that setting. Right, you can just do cardiac right, and a lot of times in hospitals, if you're, if you are like you have to choose, like you might have to be on the cardiac team, and if you're on the cardiac team, well then, you're not seeing the lung disease population. You're not seeing the patient with CF. You're seeing post-CABG, post-lvad, people on IABP, people who have an impella, people who are maybe on ECMO right, that might be a crossover point ECMO. You might just see heart failure, though that within itself has so much specifics. So, if I don't work with LVADs every day, or I don't work with ECMO patients every day, do I know every single little thing about it? No, and do I know what's going to come out in the future? No, if we're talking about lung disease, right, we have patients who run vents, patients who have trachs? Are you suctioning Patients with CF, patients with specific infections because of CF? Right, like there's just so.
Rachele Burriesci:This is like only touching the surface Within cardiopulmonary, you could be in the acute care setting, you could be in the ICUs, you could be on the floors, you can be in outpatient cardiac or pulmonary rehab, you could be in telehealth cardiac rehab, and then that's going to change. You know this. Specifics too. I think to ever say and I think this is just like this might be a me thing, and if you feel strongly about this too, you know, shoot me a message. I think when you are so bold to say that you know everything, it just it just hits me wrong, because you're always going to be learning. Even when you're in the field for 30 years, like I'm doing this now, 16 years I still learn something new every day, every day, and that's okay, and I think we have to like be okay with that. There's also so much that happens, that is going to happen Change in medications, new findings and research. They changed the LVAD. This LVAD is no longer in existence because maybe they had too much risk factor.
Rachele Burriesci:Something that we had in Michigan was something called the total artificial heart. If you go back to another great episode with Tina Fields, we talk about a whole bunch of things within cardiopulm, but I asked her. I was like, do you guys still have the total artificial heart? It was Syncardia was the company, and right when I left Michigan there was talk about that company going under. I have never seen a total artificial heart since leaving Michigan and I don't know if they're still in operation, right? So if you've never seen one, how are you going to know everything about that thing? You might know it exists. It's just something that really, I think is unfortunate to have that sort of mindset.
Rachele Burriesci:And I think a teacher, an educator, a mentor is always learning, and we learn from each other, we learn from our students, we learn how to say things differently, we learn how to articulate the message in multiple ways. We learn the physiology better and better as we educate others on it. I learned so much when I'm teaching. I am learning, and part of it is just being able to articulate the message better, right? Because if I can't explain it to you, then you're not going to get it on the other end. So it's just about breaking it down and breaking it down, and breaking it down and really synthesizing that information and I love doing that, like I will break it down until I can just make it make sense. That is skill. It takes time to learn how to do that. And can you do it with every single aspect of every single thing in your profession, in your specialty? Probably not, I just you know.
Rachele Burriesci:I think the bigger part of that story is less about the knowing everything and the arrogance that sort of comes along with that conversation, but more about the pushing the person away that is interested in bettering themselves and learning more and becoming a part of a team. Right, I think that just is such an off-putting mindset to me. Like, support each other, teach each other, mentor each other. Like, make each other better. That I mean in life, the grand scheme of life. That is kind of the point here. Right, like that you're bettering things, you're bettering each other, you're bettering yourself. In my opinion, right, I guess in my opinion, is an important one. In my opinion, right, I guess in my opinion is an important one.
Rachele Burriesci:The one thing I will say about the term expert is when you are a specialist, right, and you are embedded in a specific niche, you are able to break down things that you don't even know yet, right? So I'll get questions all the time. Nikki and I work in two different hospitals a few miles apart across state lines, so sometimes they have something that we don't have and we have something that they don't have and we call things different than they call it. I mean, it's quite wild. The nomenclature thing is like I could just talk about nomenclature all the time.
Rachele Burriesci:I think my favorite nomenclature thing and I don't know if I've said this recently, when I moved here, I was being oriented to the unit and I was, you know, had to go through like a checklist, like do you know what this is? Do you know what this is? And we're going through it. And we came across CorePack. I was like I have no idea what this is and they're like you don't know what the CorePack is. And I was like no, I've never heard that word. I don't know what that word is. So then they start describing it to me and I'm like a Dobhoff. And they're like what's a Dobhoff? And so we Google it and sure enough, and I don't even know which way is which now, but one is a brand name and one is the tube name. So you know, like there's always going to be something like that.
Rachele Burriesci:I have one crazy hair sticking out here. If you're watching me on YouTube, sorry, it's driving me insane. Sorry it's driving me insane, but my point to that, as I went off, as I went off the rails, I'll get questions like hey, have you ever heard of this? And I get those texts all the time and I'm like, give me some context, like put it in a sentence. And so they'll tell me just I don't know a piece of information about it, whether it's with a diagnosis or it's like a surgical intervention, or they just give me one more piece of information and I'll say something like I don't know a hundred percent what that is, but it sounds like. And then I break it down to like physiology, based on nomenclature and the context that I was given. And then, of course, obviously I look up to make sure that I'm on the right track. I'm like, oh yeah, that's spot on. And that's, I think, the piece of like being a specialist and being an expert, to be able to hear a word, a name of a thing or context of a situation and be able to break it down. And I think that's what happens, right.
Rachele Burriesci:The trick of it all is something that I always say. It's about the basics. When you understand the basics, the underlying physiology, and like you can get it, everything else is easy. Meds are easy, Surgical interventions are easy, like if you understand the basics, it helps you articulate everything else. And if I am learning something new, I'm breaking it right down to the physiology, because if I can understand the physiology of why or how something is working, then I can explain it and I can understand how it's going to affect the rest of the body or the rest of the system, right, whether oh, that sounds like this is going to result in hypoxemia, or they're probably going to need oxygen, or maybe they're making decision about vent versus. That's where expert knowledge comes in, right, like you're able to break it down, you're able to understand it, you're able to explain it, you're able to pick it up just with, you know some quick facts about it, because you understand the basic physiology in depth, in detail, at expert level. And when you you can do that, then everything else is easier.
Rachele Burriesci:One more piece of this picture when you're deciding on specializing, if you are going to specialize, don't rush into things. If you're a new grad and you're like figuring out what you like. Don't just do a specialty to do a specialty. If you embed into an area and you're like I love this and you really start to kind of get passionate about a specific population, a specific intervention, whatever it might be, that's when you start leaning towards specializing. But don't just specialize to make a point, to prove something, because it'll backfire. You're going to spend a lot of time, a lot of money on something that you kind of have to care about. This stuff. If you're going to keep going in that focus direction, right, like if you're going to focus in a direction, then go for it. Right, like, if you're going to focus in a direction, then go for it. But if you're still figuring it out and you're like I don't know if I like neuro, if I like cardiopalm, or if I like cardiac, if I like pulmonary, if I even want it, you know if I like acute care versus this, take your time on making that decision.
Rachele Burriesci:I have another podcast episode. Apparently, today I'm just going to talk about my prior podcast episodes on three roads to specialty and, part of you know, deciding whether you're going to specialize or not, like I'm going to give you the truth about all of it. See, here it is again the good, the pros, the cons. Right, it's important to like think about why you're doing something. Think about why you're doing something. It's okay it's actually more than okay to know a lot of different things.
Rachele Burriesci:The one concern I do have about specializing me myself as well is that when you really start focusing in, you lose some of the other stuff. Right, because you cannot focus on everything you can't. It's just physically impossible. Right, when you start really focusing into one area, you start losing some of the other stuff. So, especially in acute care, it is wildly beneficial to have variety in your knowledge. Like, be okay with taking a CEU on vestibular CEU on balance, a CEO CEO CEU on objective measures that that makes you really well-rounded. Rounded Places like the ED right, I'm thinking of Rebecca right now the EDPT. If you're in the ED, like you have to keep up with your outpatient manual skills as well as, like, your diagnostic skills, and I think that's an awesome place to kind of embed and get a lot of variety and keeping those skills.
Rachele Burriesci:The coolest part about the PT profession is how much range we have in our skill set, and it is one of the reasons why I really think PTs in the primary care setting will hopefully eventually become mainstay. I believe it's Colorado. I think it's Colorado Hopefully I didn't mess it up Just made a really big push. In the primary care setting, pts have a lot of skill and we have a lot of ability to dissect information and put the puzzle together Like it's part of our what's those tests that you take when you're trying to get into grad school or like college. We have very specific skill sets and we're very good at looking at the whole picture, pulling from different areas and then bringing it back to the problem. That's the stuff that we should be doing. Right? Like, we need to be showing off that skill set, helping others get there. Like, oh, when you see this, this and this, it's likely going to pull you here.
Rachele Burriesci:That's how you help everyone get ahead. It's not by gatekeeping. Right? Like? Teach people, teach people who you work with, and the more you teach, the better you get. And the more you teach, I guarantee you, the more you're going to learn. And I will say it to finish this episode off the day you think you know everything is probably the day that you either need to step back and reassess or decide if we need to go in a different direction, because there is always, always, always something to learn.
Rachele Burriesci:So, with that being said, if you have any questions, feedback, agree, disagree, you've had a similar episode? Shoot me a message. I'd love to chat about it. I really think we just have to support each other. We need to bring each other up, we need to mentor each other and, you know, bring our profession forward, not backward, backwards, backward, all right, I think that's all I have. I'm sorry if that was a little soapboxy for you, but this one hit me and sometimes, when you know you just got to, just got to chat it out. But this one hit me and sometimes, when you know you just gotta, just gotta chat it out. And if this person had this said to them, I know someone else had the same thing said, because it just happens that way. So if this resonated with you, let me know. If you've had something like this said to you, let me know. If you're on the other end of this conversation and you disagree with me, let me know. Okay, all right, I think that's all I have for you.
Rachele Burriesci:Before I sign off, link in the show notes for two things If you want to sign up for my newsletter and the summit. If you are PT, ot, student, click that link. Free access for three days, 24 hours of pre-recorded information, and then you can level up with a PowerPass upgrade and that's going to give you 20 CEUs, whether you're PT or OT, and you'll have access for an entire year and you get to see a little bit of me, if that interests you. All right, I hope you all have a wonderful day and whatever. No-transcript. No-transcript.
