Navigating Challenges: Dr. Nirupama Bhatt's Journey in Physiotherapy

Dr. Nirupama Bhatt (PT): It’s a hard thing to do. So, to make them consistent, especially when I talk about women, they are not bothered about their health at all. When they feel better and the pain is gone, they ghost us. They don’t come for exercise. They don’t care about it. But it was the main thing. Again after 15 days, they will come with the same pain and spend double the amount, if they had learned the exercise and gone then these things wouldn’t have bothered them in the future. So, I'm not talking about those physiotherapists who want to make money and that’s why they call patients for many days. I'm not talking about that. If you give enough time to patients in treating them, it is very difficult to make them understand. Some who are good understand this or if you counsel nicely. My way of counseling is that whatever the condition a patient is having, explain it to them. Out of 100 things they’ll understand 50, if you are using medical terms anyhow, you'll have to use them plus if you are not educating them, not explaining to them what their condition is, by ground level tell them in real-time. Don’t say that it will be all right within 2-3 days. If you share real-time and protocol and tell them that I will do this and this with you and it will take this much time and, these days, this will add on, that will add on, and at last, we will do this and then you can go. If we set a clear picture in their minds, they will build trust in us. And the most important thing is trust, if that is there then leaving 1000 things they will come for 1 physiotherapy. They told me that I would be all right within 10 days and then let me go to them for 10 days. So patient education I guess plays the most important role from what point of view are you making them understand. Because patients come to know. If I am a patient then I will know whether this person is money-minded or they are concerned about treating me. So, these things play an important role. If you understand the psychology of a patient then you will be a good counselor and the patient will listen to you.

Dr. Nirupama Bhatt (PT): So, a few days back, I had shared this. One of my juniors has asked if that is a good scope for females in physiotherapy. So, my answer was that this gender role comes in many places but I believe that being a female you have a plus point in so many things. Like you said, can we go to AMC or not? I can go. I can go to sports also, AMC also. So being a female, I can go there. Plus, it is there in cancer treatment also. Breast cancer patients have to take out their whole clothes for lymph (didn’t understand) treatment. We have to talk about breast removal so that females feel comfortable and confident in front of you so you can work there. Plus, what happens is that women have that inbuilt caring nature, it came from our moms or anywhere but that nature is there that we make things understand very lovingly and counsel them. Being men sometimes get irritated, not everyone but some cannot make that bond. So that’s why I say that it is a plus point that yes, I want to go to her for the treatment. She does it nicely and lovingly. Not just females, but males too. One point which I feel we may lag is manual skills. Suppose your position is not good in your manual skills. What happens with me is that I cannot do manipulations. While doing chiropractic, I don’t know, I don’t get the confidence, I can't force it, I cannot do it. Being a physiotherapist, I know where the trigger point is, where I have to touch so even if there is an athlete with good muscles, he will also cry ‘ouch’ in front of me and he won't be able to put my hand down. So I have done that many times but with manipulations, I face issues sometimes. That I cannot do it properly. But I have looked for alternatives, I use the muscle energy technique and it gives the same result given by manual techniques. So, for me, I am good, I am sorted, and I do not face any issues as such. But yes, it may be there for many women. Plus, one more thing. In home visits, females find it difficult but males can go easily and it is their personal choice that if they want to go, they can go. And in a city like Delhi, you can do anything. I don’t know about outside. Being a female even I think that if I am going to a house, is everything all right there or are there any issues or anything problematic? So, this is very concerning. And at our place even males are not safe so there is not much to think about. Everyone is unsafe. 

Dr. Nirupama Bhatt (PT): I believe that no matter how much you go for clinical things, you need more physiotherapy. I always say that you don’t need physiotherapy if you are concerned about your exercise or Your gym or things like that. If you are doing exercise with the correct methods, then the one who does exercise will not face any problems. I believe that. But, even as a physical therapist, if I don’t do exercise then I will also have back pain, shoulder pain, etc. When I was going to the gym, I didn’t have any problems. So, I have started going to the gym again. But still, it is needed so I have my partner with me. At night, I have taught him manual techniques that you have to do like this and this, press this point. Yes, we need it because we have to do a lot of mechanical work. It's happening and it's working fine. Once in 15 days I even take a session and there is no problem. 

Dr. Nirupama Bhatt (PT): See 3 basic exercises, I can say 3 basic habits I can add on. First, you should go for a walk. If you walk for 30 minutes, then circulation will be good enough for your body. Second, what you’ll do is pay attention to your food, your vitamin B12, vitamin D, and supplements. If those are fine then you will have fewer lower back issues. And the last thing is working your whole muscles. So, I am being smarter, you said 3 exercises and I said to train the whole core so if the whole core is trained, then 4-to 5 muscles will be included so 5 exercises minimum are included   I would say that the abdomen, most core muscle people think is the abdomen. It's not just the abdomen. It includes your whole trunk including abdomen muscles, back muscles, hip muscles, and glute muscles. When we talk about glutes, you can do bridging. When we talk about the abdomen, you can do crunches or side crunches or something that works with the abdomen. When we talk about back Superman exercises that raise one leg, alternate leg raise, and hand raises. That is the best one because that activates deep, intensive muscles, multifidus which holds your spine, it strengthens that. Last is flexes in which your normal leg raise, complete leg raise then it will be good. These are the 4,5 basic exercises which you can do too. You can even do cat camel, cobra stretches, pigeon stretches, or pigeon poses.  So, there are many exercises, but if you do these 4,5 then it's all right. Along with that nutrition and 30 min walk every day for 4-5 days in a week.

Dr. Nirupama Bhatt (PT): When we talk about the general population, it includes youngsters as well as uncle-aunties. So according to me, yoga is something that is for every age group. In weight training, there are some contraindications for small kids whose muscles are not developed, so they will face problems with it. Weight training should be controlled. CrossFit training will not be recommended to those who are geriatric population, they won't be able to do that. But yoga is something which we all can do from the youngest like 3 to anyone. So, I will recommend everyone to do yoga. 

Dr. Nirupama Bhatt (PT): Yes, daily consultation is there means if you talk about mechanical base, then it is okay till that. If you want extensive and if you have not even seen a patient, it is not that effective because they can't understand what you are asking them to do because some things and some special tests are like that if you do it directly then it will be helpful in diagnosis. The patient can't explain it. So few things including mechanical bases like neck pain, and back pain, can be managed through telecommunications. I have done that so I know that I can handle back pain and neck pain issues. But if there is neuropathy, they won't be able to manage it, physical therapy needs our hand to treat them. It is just a way of making money if you say that you will treat neuropathy through telecommunications. 

Dr. Nirupama Bhatt (PT): There are lots of misconceptions. It is like we do sciatica and eradicate all kinds of nerve pain and the basic things that I am doing through Instagram are about exercises, I make videos and try to spread awareness. It will reach more and more people and they will understand. Little by little they have started to understand that it is not like that. Along with it, if you make the patient understand that no this is not sciatica, this is something else. So even while working, while speaking, or through videos nicely if you do then these misconceptions will decrease slowly. So if you are doing your work properly, then even people who are practicing will understand that this is not happening only due to sikai or massage, there are many things that you do that sikai or massage people cannot. Physiotherapists also are to be blamed because there are so many physiotherapists who are doing only manual massage therapy and sikai. So, these things only reach patients, suddenly they don’t come to know that we are doing all this work. So, the ones who are doing this are also from our field and the ones who are treating them are also from our field. So, if you change a patient's mindset with your work then these are the things that we can do to decrease these misconceptions in patients.