When it comes to physical therapy, 'more isn't always better'
By Louise Kinross
Chun Kim has worked as a physiotherapist in Holland Bloorview's child development program for 24 years. He assesses and treats kids in our neuromotor program and consults with our orthopedic clinic, supporting children and families before and after surgery. "When you see the kids, it's the same joy I felt the first day I was here," he says. "They bring such a fresh perspective to life." Chun spoke to BLOOM about some of the changes he's seen over the years.
BLOOM: How did you get into this field?
Chun Kim: At the end of high school I fell in love with understanding the human body. I took a physed class that looked at human physiology and human anatomy and I found that really interesting. I started looking into the field and really liked the aspect of problem-solving and being able to support people in terms of their journey to get them to their optimal level. In my second year of physio school I did a placement at SickKids. I really enjoyed the interaction with kids and families and decided I wanted to work in pediatrics.
BLOOM: What is a typical day like now?
Chun Kim: I have two different roles. In the role where I assess and treat kids in the neuromotor program, I might see four to five kids a day. With that hat on I will assess therapeutic needs from post-surgery to post Botox or just gross motor development to optimize their gross motor abilities.
My other role is as a consultant in the orthopedic clinic. I work with orthopedic surgeons. We see 15 to 20 kids a day, where we're deciding if surgery is something they can benefit from.
As a physio in the clinic I provide a holistic look at the client: what their functional abilities are, how they're moving around, whether they have pain, and whether therapy has improved or not improved their functional level. I speak to the family and the child's therapists and other professionals and bring that background on the client to the team.
BLOOM: You'd also have a much better sense of the rehab process if they do have surgery.
Chun Kim: We're better positioned to answer questions about what rehab looks like and what to expect. The surgeons aren't intimately following these kids, so they won't have that fulsome picture. We're a voice for families to be able to discuss their concerns and questions.
After the surgery we again look at the situation holistically, not just on a medical level of bone and muscle healing. How is the child recovering from the procedure? Do their clinicians have areas of concern? We can comment on what families can expect in three months and six months.
BLOOM: What's the greatest challenge of your job?
Chun Kim: Our wait list for services is significantly high, especially for orthopedic services. To get into the orthopedic clinic might take six months to a year, and then it could be a year before a surgery is scheduled. The waits have negative consequences on a child's ability to recover and the outcome.
BLOOM: Is that due to the pandemic?
Chun Kim: The pandemic exacerbated it, but this is something we've been dealing with for 15 years and it's become worse. We don't have the capacity in the system. We don't have enough orthopedic doctors and physios and nurses and staff to staff the operating rooms.
This is what we're seeing across health care right now. People are leaving. The reason they got into health care is to try to help, and when they're not given the tools to do that in an appropriate manner, it becomes very stressful. We're competing like everyone else in the system for resources.
BLOOM: What's the greatest joy?
Chun Kim: Just spending time with the kids. When you see the kids it's the same joy I felt the first day I was here. They bring such a fresh perspective to life. The lens they look at the world is so pure it's a joy being around them.
The other part is that because I've been here so long, I get to see the kids grow into young adults. They'll come back for a transition visit and come and say hi and I'll catch up with them and get to hear about their future goals. Some want to get into media or computer tech or become lawyers. These things are rewarding to hear.
BLOOM: What emotions come with the job?
Chun Kim: I would say gratitude, humility, frustration and joy.
BLOOM: How do you manage frustration?
Chun Kim: I realize there's only so much I have control over. I'm trying to do my best within the system and the resources that I have access to. As long as I feel I've done the best I can, then I can go home and enjoy my time with my family. I have two kids who are 13 and 11.
I don't feel that I have a lot of stress. I accept there's a lot in life we don't have control over and trying to seek control over those things is non-productive and can lead to more frustration. I do the best with what I've been given and have control over.
BLOOM: What qualities do you need to be good at your job?
Chun Kim: Empathy, a desire to learn, compassion and a holistic perspective. A really broad world view is so important to understand that people have different world views and most of life is not black and white. What's important for one family may not be important for another. Tapping in to what factors directly impact on bringing a particular child and family joy and happiness and contentment and fulfillment gives me better direction as to how to support them.
BLOOM: You've been here for 24 years. What are some of the changes we've seen over that time?
Chun Kim: We have greater demand for our services. More and more kids need therapy and orthopedic services.
I've also seen growth in our understanding as a health-care community in how to best support children with disabilities and their families. In the past, we were a lot more focused on the actual functional or body impairments—on the physical range of motion or alignment or even their strength.
Today we have a better understanding of quality of life. A child's physical function is only a small aspect of their whole quality of life, and improvements in their body impairment don't necessarily translate into improved quality of life. That forces me to balance the cost of intervention with the expected benefits.
We know any intervention we recommend has a cost to the client and family—whether it's physical discomfort or pain, resources in time, or emotional resources in terms of parents' energy in having to do the intervention or feeling guilty because they haven't done it. The outcome has to have a direct impact on quality of life. More isn't always better, and many times less is better.
BLOOM: If you could change one thing about children's rehab, what would it be?
Chun Kim: We need more help. We need more people so the needs of children with disabilities in pediatric rehab are met in an appropriate and timely manner.
Another issue is the amount of my time that's taken up with admin work. I used to be able to dictate all my notes and someone would transcribe them and that would cut my documentation. Because of our move to the Meditech electronic health system, I have to do my own typing, and that takes three times the amount of time. We need to find more efficient ways to get the information into the electronic health records so that clinicians can spend more of their time seeing clients.
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