Dominique Gilbert

What did you find most rewarding about the specialty program?

The CPA specialization program was offered at a time where I was reconsidering my practice. I thought myself a pain specialist, but then so did every other clinician. While writing the clinical reflections and the case based discussions, I was able to clarify for myself the importance of physiotherapy in the management of persistent and debilitating pain. It became clearer that the scientific literature supported the treatment approach I favoured and that the treatment differs from that used in other specialities. I was finally able to understand for myself how my practice differed from sports medicine or orthopaedics, because I had to take the time to write down my thoughts and I had to defend my views to the assessment team, with supporting documentation.

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“[Completing the program] gave me the confidence necessary to apply to the Société des experts en évaluation médico-légale du Québec (SEEMLQ), a group consisting mostly of medical specialists( MD and PhD) with a medico-legal practice. My candidacy was accepted and I am the first physiotherapist accepted to the SEEMLQ.”

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What were your reasons for applying to the program?

I knew many other physiotherapists treated all their patients with modalities and exercise programs geared to the acute and sub-acute stages of healing. On the one hand, physiotherapists were not interested in considering chronic pain patients as a different type of clientele, needing a different treatment approach. On the other hand, third party payers and physicians would comment on the ineffectiveness of physiotherapy treatments in managing chronic pain patients. I would get frustrated, but had difficulty expressing ideas and opinions on the subject of pain management. The specialization process provided an opportunity to express these ideas and opinions in a more effective manner.

Where do you hope to see the profession in 25 years?

Hopefully, physiotherapists will be able to assess and treat the patient in a global manner: taking into consideration primary gains, secondary gains, patient’s understanding and beliefs, as well as integrating pathophysiology and psychosomatic presentation in their clinical evaluation.

What impact do you think specialization will have on your specialty area?

Our practice is very different from that of orthopaedics, neurology or sports medicine, for example. We approach our patients and our treatment plans differently and there is some satisfaction in having this recognized by our national organization. It may also help in improving professional credibility to the legal and governmental organizations, so that we are consulted.

What is the value of the specialty program to candidates?

The specialization program is a journey of self-discovery for the physiotherapist hardy enough to participate in the evaluation. We are provided with an opportunity to reflect on our practice that we would not normally take the time to do, because life goes on and other priorities happen. Another useful aspect is that in explaining oneself to others, at an advanced clinical level, the clinician has to integrate information from multiple sources, be able to retrieve it and organize it in a manner that necessitates in-depth understanding of this information. This exercise can only improve the candidate’s clinical practice. It also conveys a sense of achievement and confidence that becomes apparent to others, whether they are patients or peers.

Have you used your specialist network and if so how?

I always enjoy meeting or talking to Janet Holly and Michael Sangster. They challenge me to think outside my comfort zone. However, we have had too few such discussions because of distance and schedules.

What are important things to consider for those who are interested in pursuing their clinical specialty?

The evaluation process is time consuming and demanding. If one thinks about it, there are many excuses not to go through with it. Once started, the need to explain one-self to others and to clarify or justify our treatment choices stimulates the reflections that bring our practice to another level. This fuels the energy necessary to go through the whole process successfully. To prepare the submission and to complete the evaluation process will take at least 3 months.

What new skills or enhanced skills did you obtain going through the specialty process?

The evaluation process confirmed for me that my treatment approach in the treatment of chronic musculoskeletal pathologies is the most effective.

What advice would you give to applicants going through the specialty process?

Be humble: having your performance evaluated is never a very pleasant experience. Keeping an open mind will foster self-improvement.

Be patient: the evaluation process is time consuming and demanding.

Be thorough: do not expect to pass based on your reputation or publications. You will have to submit documentation to support your findings or statements, and you will have to clarify your treatment choices with supporting scientific documentation.

What impact has the specialization designation had on you and your career?

It gave me the confidence necessary to apply to the Société des experts en évaluation médico-légale du Québec (SEEMLQ), a group consisting mostly of medical specialists( MD and PhD) with a medico-legal practice. My candidacy was accepted and I am the first physiotherapist accepted to the SEEMLQ.

Email: dominique.gilbert@nociclinique.ca

Online: www.nociclinique.ca