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Sunday, May 17, 2009

I am no longer an RT, I am an Internal Therapist

I am no longer an RT, I am now an IT. I am in and of myself, and with a few other top notch RTs, a new type of respiratory therapist (to see the other six types of RTs click here).

We are an extension among the Learner (optomist) RTs, and we are always making an effort to go above and beyond the call of duty.

In short, I am IT. I am the one person nurses call in times of crisis, and they trust and rely on my expertise and clinical judgement to determine their course of action to the benefit of the patient.

I am a patient internal specialist. Sure I know respiratory therapy inside out, I also know the rest of the body and how it relates to breathing. The following are some recommendations I might suggest:

  1. Anxiety: Xanax or Ativan
  2. Wet lungs & poor urinary ins & outs: Lasix or Bumex
  3. Dyspnea not controlled with Ventolin: Morphine
  4. Perceived Bronchospasm: Ventolin or Xopenex
  5. Stridor or Croupy cough: Racemic epinephrine and/ or systemic corticosteroid

Often times -- more often then not -- the nurse will heed the suggestion of the IT and call the physician with the recommendation. Often times -- more often than not -- the physician will heed the recommendation of the RN and the IT, who are working together as a team.

The RN and the IT together are a member of the Patient Internist Team (PIT). They work together as part of the PIT to the benefit of the patient. Regardless of their feelings for the patient, they do what is in the best interest of the patient, and that is using their skills and wisdom to the best of their ability, and heeding the wisdom of other members of the team, including IT.

So, by definition, what is an Internal Therapist:

Internal Therapist: A type of respiratory therapist who participates in critical thinking in an attempt to assist the nurse and physician in resolving the patient's crisis. They consider the concept of holism, the body as one unit working together, and therefore understand that the whole body effects the function of the lungs, instead of only thinking in terms of the lungs. The internal therapist does not diagnose, he or she deduces the best possible cause of the symptoms and the best possible solution.

You don't become IT overnight. It takes two years of RT education, an RRT degree and many years of RT experience. Plus, it takes a special individual. He has to have the ability to prioritize, to think outside the box, to do extensive critical thinking, and to use common sense.

Along with that, he has to have the special ingredient: he has to have the ability and the desire to never stop learning. He has to learn from reading respiratory and nursing books and magazines, he has to learn on the job.

Yet, at the same time, he remains humble. Because above it all, he knows that medicine is based on science, but at the same time it is an art. And while science is all based on perfection, every patient is far from perfect, and each should be treated as an individual -- as art.

So, I am still a licensed and registered respiratory therapist (RT), I am now a fully qualified IT. I am IT. I've been this way for a while, though. It didn't just happen over night. At what point does the transition occur? I have no idea. That, too, is an individual moment.

Are you an Internal Therapist too? Are you a member of the PIT?


Glenna said...

Yes and Yes!!!!!
I read the other post about the other six types of therapists and you're absolutely right. In my dept too, on any given night with 20 people working, there will be about five who are truly leaders and IT's, happy to work with nurses, be pt advocates, talk to docs, change therapies as needed, etc.. Another 5 who are happy and IT's with their own pt's but don't want to lead or take on anything extra, another five who do their jobs well but don't care about learning anything new, and another 5 who only do enough to not get fired and don't really care. They just crank out the tx's and never think about the pt or how to make anything better. Amazingly, the last five are the complainers too. But I've always thought the cliche was true that you get out of anything exactly what you put into it so those first 10 therapists are the ones who are happy to be at work, happy to be at home, and make life better for everyone wherever they go. I always want to be one of those people and if the day ever comes that all I want to do is crank out tx's and complain, I hope I'm a big enough person to get the hell out of the field.

Glenna said...

You know, actually now that I think about it, I think I misspoke. On any given night there are usually on about 2 therapists who really don't give a crap and are just putting in time. While there is a middle road of folks who do their jobs well but don't necessarily want to invest themselves, we are pretty lucky in that we only have a few who truly don't give a rat's butt.