Explore every episode of the podcast Healthy Wealthy & Smart
| Title | Pub. Date | Duration | |
|---|---|---|---|
| Joseph Reinke: Student Loan Update: What to expect in 2025 | 12 Dec 2024 | 00:41:21 | |
In this episode of the Healthy, Wealthy & Smart podcast, host Dr. Karen Litzy welcomes back financial expert Joseph Reinke to discuss the critical topic of student loans. As the year comes to a close, many are assessing their budgets and the impact of student loan repayments on their financial planning for the upcoming year. Joe, a CFA charter holder and founder of FitBux, shares valuable insights into managing student loans and offers guidance on financial management strategies for healthcare providers, particularly physical therapists. Please tune in to learn about the latest updates regarding student loans and how to navigate the financial hurdles they present in your career.
Time Stamps: [00:01:57] Student loans overview and history. [00:03:41] Student loan forgiveness programs. [00:10:48] Loan forgiveness program explained. [00:12:25] Income-based repayment strategies. [00:15:24] Nonprofit loan forgiveness explained. [00:20:24] Future of student loan policies. [00:24:03] Financial strategies for student loans. [00:27:02] Student loan repayment strategies. [00:31:44] Loan forgiveness and refinancing options. [00:33:18] Student loan management tips. [00:37:15] Money for future self.
More About Joe: Joseph is a Chartered Financial Analyst (CFA) and founder of FitBUX which has helped over 18,000 young professionals on their journey to financial freedom. Joseph has been personally investing since he was 12 years old. In addition, he has experience in student loans, mortgages, wealth management, investment banking, valuation, stock trading, and option trading. He has been on 100s of podcast and has been invited to 100s of universities to discuss financial planning with their soon to be graduates.
He is currently an adjunct financial wellness professor at 15 universities.
Resources from this Episode:
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| Dr. Laurie Brogan & Dr. Tonya Miller: Exploring Professionalism in Physical Therapy | 05 Dec 2024 | 00:40:32 | |
In this episode of the Healthy, Wealthy, & Smart podcast Dr. Karen Litzy hosted Dr. Tonya Miller and Dr. Laurie Brogan to discuss their new book, Professionalism and the Practice of Physical Therapy. The conversation highlighted the importance of professionalism in the field of physical therapy, emphasizing its relevance not only for students but also for practicing professionals throughout their careers. Time Stamps: [00:01:27] Professionalism in physical therapy. [00:06:01] Professionalism in physical therapy. [00:10:20] Professional growth oak tree analogy. [00:12:43] Reflection in professional development. [00:17:16] Definition of professionalism. [00:21:10] Management of self through lifelong learning. [00:24:15] Mentorship's role in professionalism. [00:30:36] Importance of workbooks in learning. [00:32:01] Successful writing partnership dynamics. [00:36:10] Professionalism in physical therapy. [00:39:26] Health, wealth, and wellness.
More About Dr. Laurie Brogan: Laurie Brogan PT, DPT is a full-time faculty member of the Physical Therapy Department at Misericordia University, primarily responsible for teaching cardiopulmonary physical therapy, clinical skills, and professional development. With strong interests in the needs of the older adult population and interprofessional education/practice, she is also an American Board of Physical Therapy Specialists (APBPTS) Board- Certified Clinical Specialist in Geriatric Physical Therapy, a Certified Exercise Expert for the Aging Adult, and a Certified Master Trainer for TeamSTEPPS, a program developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense as a solution to improving collaboration and communication in healthcare settings. Her research and writing centers around interprofessional education and practice, socialization in interprofessional settings, and the development of clinical reasoning in PT education.
More About Dr. Tonya Miller: Tonya Miller, a national speaker, author, and founder of TYM Coaching, is deeply committed to personal growth and developing strong leaders. With over 25 years of executive leadership skills and a Ph.D. in Leadership Studies, Tonya combines real-world experience with academic expertise. She tailors her coaching programs to fit any individual or organization, from coaching front-line healthcare providers to board-room negotiations. Her recent book, "Professionalism in the Practice of Physical Therapy: A Case-Based Approach," is a testament to her commitment, highlighting key elements of professional development for not only physical therapists but for healthcare clinicians and leaders. Tonya is also committed to integrity, accountability, and self-awareness.
In addition to owning TYM Coaching, Tonya is the Academic Program Lead for the Doctor of Physical Therapy program at Harrisburg University of Science and Technology. In this role, Tonya leads the Doctor of Physical Therapy faculty and guides developing professionals in leadership and understanding the healthcare industry.
Tonya believes in community engagement and is an active community volunteer. She serves on several boards, including the America Physical Therapy Association PT Proud Special Interest Group, where she serves as the Vice Chair, and PA Vent Camp, a camp for ventilator-dependent children, where she serves as the Executive Director.
Resources from this Episode: Professionalism and the Practice of Physical Therapy book
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| Kristin Revere: Transforming Birth Experiences: The Impact of Doulas on Maternal Care | 03 Oct 2024 | 00:48:35 | |
In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Stephanie Weyrauch welcomes Kristin Revere, founder and CEO of Gold Coast Doulas. Kristin shares her journey in starting Gold Coast Doulas in 2015, initially as a solo birth doula and expanding to a team of 27 contractors, including lactation consultants, sleep consultants, and newborn care specialists. The discussion highlights the role of doulas as non-medical support persons, emphasizing their importance in providing comprehensive care for families during the birthing process and beyond. Kristin also co-authored the book "Supported: Your Guide to Birth and Baby," which explores the various types of doulas and their significance in an interdisciplinary team. This episode is a valuable resource for expecting parents and those interested in understanding the multifaceted support doulas offer. Time Stamps: [00:02:03] The role of doulas explained. [00:06:48] The evolving role of doulas. [00:10:17] Support during unpredictable birth. [00:18:08] Doula support for partners. [00:20:33] Importance of doulas in healthcare. [00:25:07] Importance of hydration postpartum. [00:30:08] Emotional support during postpartum. [00:31:40] Postpartum emotional support challenges. [00:36:18] Starting a doula service. [00:44:13] Collaboration in business mindset. [00:45:46] Connecting with Gold Coast Doulas. More About Kristin Revere: Kristin Revere is a woman who has always had a passion for supporting other women, both personally and professionally. In college, Kristin served on the Executive Committee of her sorority and organized events on campus related to breast cancer and other women's issues. She later facilitated nonpartisan political trainings for female candidates and volunteered for many nonprofits focused on women's issues. Kristin firmly believes in the power that lies within a woman and has spent her life drawing it out of the women she surrounds herself with. After the birth of her daughter in 2011, a new passion awoke within her. Kristin began reading and studying birth from all perspectives, philosophies, and medical approaches. She joined organizations like the Healthy Kent Breastfeeding Coalition and used her event coordinating skills to build and promote the organization and create community awareness. Kristin's research led her to learn about doulas, and in 2012 she hired doulas herself for the support of her second birth. The level of compassionate care and comfort that she received from her doulas ignited a spark within Kristin that led her to the path of becoming a doula herself. She earned her certification and began teaching Sacred Pregnancy classes in 2013, but as you'll see Kristin is a firm believer in achieving the highest level of education available when providing a service. Shortly after, she earned the following credentials.
Kristin's main passion as a birth and postpartum doula is to offer women and families resources, unbiased support, and understanding. Kristin is a listener, a friend, a confidant, an expert, and women intuitively feel stronger in her presence. She has a Bachelor of Science in Journalism from Central Michigan University and a Master of Management in Marketing from Aquinas College. Kristin is the host of Ask the Doulas Podcast. Her writing has been featured in Rapid Growth Media and First Time Parent Magazine. Kristin was selected as one of the 50 Most Influential Women in West Michigan by the Grand Rapids Business Journal in 2016 and in 2022. Kristin and the rest of the Revere Clan, which includes her husband, her step-daughter, and her two children, live in Grand Rapids and can be found taking in the sights at local art galleries, parks, music concerts, and community events. Resources from this Episode: Gold Coast Doulas on Instagram Supported: Your Guide to Birth and Baby Jane Sponsorship Information: Mention the code LITZY1MO for a free month Follow Dr. Karen Litzy on Social Media: Subscribe to Healthy, Wealthy & Smart: | |||
| 598: The Implication of the Dobbs Verdict for Physical Therapists | 18 Jul 2022 | 01:06:22 | |
In this episode, Founder of Enhanced Recovery After Delivery™, Dr. Rebeca Segraves, Co-Founder of Entropy Physiotherapy, Dr. Sarah Haag, Owner and Founder of Reform Physical Therapy, Dr. Abby Bales, and Co-Owner of Entropy Physiotherapy, Dr. Sandy Hilton, talk about the consequences of overturning Roe v. Wade. Today, they talk about the importance of taking proactive measure in communities, and the legal and ethical obligations of healthcare practitioners. How do physical therapists get the trust of communities who already don't trust healthcare? Hear about red-flagged multipurpose drugs, advocating for young people's education, providing physical therapy care during and after delivery, and get everyone's words of encouragement for healthcare providers and patients, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Dr. Rebeca Segraves Rebeca Segraves, PT, DPT, WCS is a physical therapist and Board-Certified Women's Health Clinical Specialist who has served individuals and families within the hospital and home during pregnancy and immediately postpartum. She has extensive experience with optimizing function during long-term hospitalizations for high-risk pregnancy and following perinatal loss and pregnancy termination. In the hospital and home health settings, she has worked with maternal care teams to maximize early recovery after delivery, including Caesarean section, birth-related injuries, and following obstetric critical care interventions. She is the founder of Enhanced Recovery After Delivery™, an obstetrics clinical pathway that maximizes mental and physical function during pregnancy and immediately postpartum with hospital and in-home occupational and physical therapy before and after birth. Her vision is that every person will have access to an obstetric rehab therapist during pregnancy and within the first 6 weeks after birth, perinatal loss, and pregnancy termination regardless of their location or ability to pay.
More About Dr. Sarah Haag Dr. Sarah Haag, PT, DPT, MS graduated from Marquette University in 2002 with a Master of Physical Therapy. She went on to complete Doctor of Physical Therapy and Master of Science in Women's Health from Rosalind Franklin University in 2008. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women's and men's health, becoming a Board-Certified Women's Health Clinical Specialist in 2009 and Certification in Mechanical Diagnosis Therapy from the McKenzie Institute in 2010. Sarah joined the faculty of Rosalind Franklin in 2019. In her roles at Rosalind Franklin, she is the physical therapy faculty liaison for the Interprofessional Community Clinic and teaching in the College of Health Professions. Sarah cofounded Entropy Physiotherapy and Wellness with Dr. Sandy Hilton, in Chicago, Illinois in 2013. Entropy was designed to be a clinic where people would come for help, but not feel like 'patients' when addressing persistent health issues.
More About Dr. Abby Bales Dr. Abby Bales, PT, DPT, CSCS is the owner and founder of Reform Physical Therapy in New York City, a practice specializing in women's health and orthopedic physical therapy. Dr. Bales received her doctorate in physical therapy from New York University and has advanced training through the renowned Herman and Wallace Pelvic Rehabilitation Institute, Grey Institute, Barral Institute, and Postural Restoration Institute, among others. She also holds her Certified Strength and Conditioning Specialist certification from the NSCA and guest lectures in the physical therapy departments at both NYU and Columbia University, as well as at conferences around the country. Dr. Bales has a special interest in and works with adult and adolescent athletes with a history of RED-S (formerly known as the Female Athlete Triad) and hypothalamic amenorrhea. A lifelong athlete, marathon runner, and fitness professional, Dr. Bales is passionate about educating athletes, coaches, and physical therapists about the lifespan of the female athlete. Her extensive knowledge of and collaboration with endocrinologists, sports medicine specialists, pediatricians, and Ob/gyns has brought professional athletes, dancers, and weekend warriors alike to seek out her expertise. With an undergraduate degree in both pre-med and musical theatre, a background in sports and dance, 20 years of Pilates experience and training, Dr. Bales has lent her extensive knowledge as a consultant to the top fitness studios in New York City and is a founding advisor and consultant for The Mirror and the Olympya app. She built Reform Physical Therapy to support female athletes of all ages and stages in their lives. Dr. Bales is a mom of two and lives with her husband and family in New York.
More About Dr. Sandy Hilton Sandra (Sandy) Hilton graduated with a Master of Science in Physical Therapy from Pacific University in 1988. She received her Doctor of Physical Therapy degree from Des Moines University in 2013. Sandy has contributed to multiple book chapters, papers, and co-authored "Why Pelvic Pain Hurts". She is an international instructor and speaker on treating pelvic pain for professionals and for public education. Sandy is a regular contributor on health-related podcasts and is co-host of the Pain Science and Sensibility Podcast with Cory Blickenstaff. Sandy was the Director of Programming for the Section on Women's Health of the American Physical Therapy Association from 2012 - 2017. She is now on the board of the Abdominal and Pelvic Pain special interest group, a part of the International Association for the Study of Pain.
Suggested Keywords Healthy, Wealthy, Smart, Roe v Wade, Abortion, Trauma, Sexual Trauma, Pregnancy, Advocacy, Pelvic Health, Healthcare, Education, Treatment, Empowerment,
To learn more, follow our guests at: Website: https://enhancedrecoverywellness.com https://enhancedrecoveryafterdelivery.com Instagram: @sandyhiltonpt Twitter: @RebecaSegraves LinkedIn: Sandy Hilton
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Read the Full Transcript Here: 00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy. Hey everybody,
00:36 welcome back to the podcast. I am your host, Karen Litzy. And on today's episode, I am very fortunate to have for pretty remarkable physical therapists who also happen to be pelvic health specialists. On to discuss the recent Supreme Court ruling in the dobs case that overturned the landmark ruling of Roe vs. Wade. How will this reversal of Roe v Wade affect the patients that we may see on a regular basis in all facets, facets of the physical therapy world. So to help have this discussion, I am very excited to welcome onto the podcast, Dr. Rebecca Seagraves and Dr. Abby bales and to welcome back to the podcast Dr. Sandy Hilton, and Dr. Sarah Hague. So regardless of where you fall on this decision, it is important that the physical therapy world be prepared to care for these patients. So I want to thank all four of these remarkable physical therapists for coming on to the podcast. Once the podcast starts, they will talk a little bit more about themselves, and then we will get right into our discussion. So thank you everyone for tuning in. And thanks to Abby, Rebecca, Sandy, and Sarah.
02:03 I, my name is Rebecca Seagraves, I'm a private practice pelvic health therapist who provides hospital based and home based pelvic health services and I teach occupational and physical therapists to provide their services earlier in the hospital so that women don't have to suffer.
02:20 Perfect Sarah, go ahead.
02:22 I am Sarah Haig. And I'm a physical therapist at entropy physiotherapy in Chicago, and I'm also assistant professor and at a university where I do get to teach a variety of health care providers.
02:35 Perfect, Abby, go ahead. My name is Abby bales. I'm a physical therapist, I specialize in pelvic health for the pregnant and postpartum athlete. I have my practice in New York City called perform physical therapy, and I do in home visits and I have a small clinic location.
02:54 Perfect and Sandy. Go ahead.
02:56 Sandy Hilton. I'm a pelvic health physical therapist. I'm currently in Chicago with Sara entropy. And I'm in Chicago and online. Because we can see people for consultations wherever they are, and we may be needing to do more of that.
03:13 So the first question I have for all of you lovely ladies, is how will the recent Supreme Court ruling in the dobs case, which was overturning Roe v. Wade? How is that going to affect people who give birth that we see in our clinics in the hospital setting in an outpatient setting in a home setting? So let's start with Sara, go ahead. I'll start with you. And then we'll just kind of go around. And and and also feel free to chime in and you know, the conversation as you see fit? Got?
03:58 That's such a big question. And I get to go first. So the question was how, how is this decision going to affect people who give birth? And I would say it just it affects everyone in in kind of different ways. Because I would say what this will undoubtedly do is result in us seeing people who didn't want to give birth. And and I think, you know, the effects of that are going to be far reaching and that we I think maybe we in this little group can have an idea of, of the vastness of this decision, but I think that even we will be surprised at what happens. I think that how it will affect people who give birth. Gosh, I'm kind of speechless because there's so many different ways. But when we're looking at that person in front of us with whatever they need to do For whatever they need assistance with after giving birth, we're going to have to just amplify exponentially our consideration for where they are and how they felt going into the birth, how they got pregnant in the first place. And, and kind of how they see themselves going forward. We talk about treating women in the fourth trimester. And it's, I mean, I'm in that fourth trimester, myself, and I can tell you that it would be harder to ask for help. And I'm really fortunate that I, that I have that I do have support, and that I do have the ability to seek help. I have a million great friends that I can reach out to for help, but I'm just how the how it's gonna affect the women, I'll say, I'm scared, but it's not about me. I'm very concerned for other women who won't be able to access the care that they that they need.
06:05 Yeah, Sandy, go ahead. What do you think? How do you feel this decision will affect people who can give birth, especially as they come to see physical therapist, whether that be during pregnancy? As Sarah just said, the fourth trimester, or perhaps after a procedure, or abortion that maybe didn't go? Well? Because it wasn't safe?
06:30 Yeah, so I work a lot with pain. One of my concerns is, but what is the future gonna hold for some people who did not want to be pregnant not added some sort of convenience or concern for finances, both of which, you know, your spot in life determines whether or not you have the the ability to raise another person at that moment. So there are individual decisions that people should make, in my opinion, but also, there's the if something happens to you, that you did not give permission to happen. And then you are dealing with the consequences. In this instance, pregnancy, and you happen to have back pain or have hip pain, or have a chronic condition, or a pelvic pain history, where you didn't not want to be pregnant. How's that going to affect the pain and the dysfunction that you're, you are already happening? And will it sensitize people to worse outcomes and recovery afterwards, because this is a, you know, there's a perceived injustice scale, I want to pull that back out. I hadn't been using it very often in the clinic just didn't seem to change the course of care. But I think that when I'm working with the people pre post, during pregnancy, I think I'm going to pull my perceived injustice scale back out and see if that might be a nice way to find out. If I need to hook someone up to a counselor, a financial counselor, psychologist, sexual therapist, anyone who might be able to support this person, we already don't have good support systems for pregnancy. I just am astounded at how much what a bad choice it is to add more need to a system that isn't currently handling the demand. I know we're gonna need to get creative because these people will need help. But I am a little awestruck at the possible quantum s we're gonna walk into
08:51 an abbey you had mentioned before we started recording about you know, some of the folks that you see that may have a history of different kinds of trauma, and how that may affect their abilities are to kind of wrap their head around being pregnant and then being forced to give birth because now they don't have any alternative. So how do you feel like that's going to play out in the physical therapy world, if they even get to physical therapy if they even get to a pelvic health therapist?
09:34 Yeah, that's, that's one of the things that I was I was thinking about as everyone was chiming in was, we really are just at the precipice in our niche of our profession, where people who give birth are seeking or even hearing about pelvic health and postpartum care, pregnancy care there. Just barely hearing about it. And my I have, you know, a concern, a very deep concern that these people will go into hiding if they have had an abortion in the past, because are we obligated to report that, and what is the statute of limitations on that, and the shame that they might feel for having had an abortion, or having had give birth and didn't want to, and the trauma that my patients who have, for the most part, not everyone who have wanted pregnancies that either the birth is traumatic, the pregnancy is traumatic, they get to a successful delivery, or they have a loss during the pregnancy, the trauma that they are experiencing, and for the most part, I'm seeing adults, and I cannot comprehend children, because it's this gonna be a lot of children who are forced to give birth, or who are having unsafe abortions, and the trauma that they're going to experience, and how, how much it takes for a person who has sexual trauma or birth trauma to get to my clinic, how these young people how these people who feel that shame, I don't know how they're going to get to me, or any of us, except for a real team based approach with pediatricians, with hospitals, with OB GYN, with your gynecologist with people who might see them first before us. I just don't know how they get to us to be able to treat and help treat that trauma. And like Sandy said, that pelvic pain that might be a result of the trauma if if it's unwanted sexual intercourse, I just don't know how we get to them. And that is something that we struggle with now, with, for the most part, wanted pregnancies. And I don't know how we get there. And I don't think we're prepared as a profession. for that. I think the advocacy for getting ourselves into pediatricians offices into into family medicine offices, is going to be so crucial in getting to these patients. But there aren't enough of us. We are not prepared. And our insurance based system is not ready to handle the far reaching consequences of forced birth at a young age and botched abortions. It is not ready to handle that.
12:52 Rebecca, go ahead. I'm curious to hear your thoughts around this because of your work in acute care systems.
13:00 Absolutely. I believe that I'm beyond the argument of whether this is right, or whether this is wrong. I think that as a profession, we're going to have to quickly change to a mindset of can we be prepared enough to handle what Abby was saying the amount of trauma, the amount of mental health I think, comes to mind when when someone's autonomy is taken away from them in any regard. I was very vocal as to how dangerous it was to force, you know, mandates on people even last year. And now here we are, we're at a point in our profession where we have to now separate our own personal beliefs and be committed to the oath of doing no further harm because this will result in harm, having treated individuals after an unplanned cesarean section or a cesarean hysterectomy, because of severe blood loss. They had no choice in those procedures. And they had no choice in the kind of recovery or rehabilitation they would get. I had to fight an advocate for our services, physical and occupational therapy services to be offered to individuals. So when you're looking someone in the eye who has lost autonomy over their body as last choice has gone through trauma that changes you it changes me really as a profession, even on this a professional or even on this issue. I'm now pivoting as quickly as I can't decide, do I have the skills that's going to be needed to address maybe hemorrhage events from an unsafe abortion that's performed? Maybe the mental health of having to try All across state lines so that you can find a provider that will treat you maybe the, you know, the shame around, you know, even finding Well, you know, is there a safe space for me to be treated for my pelvic health trauma from you know, maybe needing to carry this pregnancy longer than then I would have wanted to, there's, there's so much around this that we really have to start looking at with a clinical eye with a very empathetic or sympathetic eye as pelvic health therapists because of the fact that there's so few of us. And because now we're in a scenario where there will be more people who will be needing services but not knowing who to turn to. So my my biggest hope from this conversation, and many more that we'll have is that there's some how going to be a way to designate ourselves as a safe space for anyone, no matter what choice they've made for their body, period, I'm really done with being on one end of the spectrum with this, I'm a professional that doesn't have that opportunity to just, you know, be extreme on this, I advocate for the person and for their choice over their body period.
16:17 I think we need to, and it's just beautifully, beautifully said, the the getting getting some small systemic procedures in place in the communities we live in, is most likely the first step is reach out to the pediatricians and the chiropractors and the massage therapists and the trainers and the school athletic trainers and whoever you find that can have a connection with people and let them know on an individual basis. So like how do you tell people hey, I'm a trustworthy clinic to come to is not usually by writing it on your website. But if you can make connections in your community and be a trusted provider, that's going to go further, I suspect. I'm assuming there's going to be a fair bit of mistrust. And we have to earn it once it's lost. We've got to earn it back. So yeah, I like the proactiveness of that.
17:22 I, I totally agree on something you said Sandy sparked something that I would love for a health care lawyer to start weighing in on is we want, I am a safe space. I think every patient I have ever met who sees me cries. And I hold I hold that part of what I do. Very close to me, it's it's an honor to be someone that my patients open up to. And I know all of you on this call feel the same way because we we are that place that they they I love hearing birth stories. I love it. Even it just gives me an insight into that person into that experience. I feel like I'm there with them. And I understand better what they have gone through. But what happens when the legal system is going to come for us? Or them through us? What happens to that? How do we continue to be a safe space where they can share their sexual trauma, their birth trauma, their birth history, their pregnancy history, their menstruation, history, their sexual history? All of those really, really intimate things? How do we continue to be that for our patients?
18:56 I think we've had to do this I've had to do this previously, for in some very, in situations of incest in for the most part, we need a trigger warning on this. But, you know, there you have an individual that is a minor, or, or for some reason not independent that is being abused in what is supposed to be their safe space. And then that person, the abuser can be like, Oh, look, I'm helping you get better. And they're actually not safe. So there's some things and if the person you're treating is a minor, that adult has access to their records. And so I've worked in places not I don't know how to do with an EMR but I've worked in places where we have our chart that we write down the official record and sticky notes, which are the things that will not get put in the official record. But we need to have written down so people know it. And we've had to do that in situations where the patient wasn't safe. We all knew the patient wasn't safe. was being worked on to get them safe, but they were not yet safe. And you had to make sure there was nothing in their records that was going to make them more unsafe. I don't know how to do it as an EMR, if someone has a clever way to do that, that'd be great. Or we go back to EMR plus paper charts.
20:18 Even to to add to your point, Abby, if we're looking now at possible, you know, jurisdiction, you know, lead legal their jurisdiction or subpoena of documentation, you know, after having intervened for someone who may have had to make a choice that their state did not condone? Yeah, no, I, I'm completely, you know, on guard against that now, and that those are things that I'm thinking about now and thinking about, well, what would my profession do? Would we back, you know, you know, efforts on Capitol Hill to advocate for, you know, someone who, who has lost their, their autonomy, or lost their ability to, to at least have a safer procedure, and we've had to intervene in that way. You know, I think about that now, and I, that makes me fearful that this is such a hot topic issue that, you know, we might not as an organization want to choose size, but we as professionals on the ground as pelvic health therapists, I don't think that we have that luxury and turning someone away. And so So yeah, I think more conversations like this need to be had so that we can form a unified front of at least, you know, pelvic health specialists that can really help with the the after effects of this.
21:38 And I think a big barrier to that legal aspect of it is, you know, what is our legal responsibility. And what happens, if we don't do XYZ is because a lot of the laws and a lot of these states, some of these trigger laws and other laws being that are being passed, the rules seem to be a bit murky. They're not clear. And so I agree, I think the APTA or the section on pelvic health needs to come out with clear guidelines as to what we as healthcare professionals, can and should do. But here's the other thing that I don't understand and maybe someone else can. What about HIPAA? Isn't that a thing? Where did the HIPAA laws come in to protect the privacy between the provider and the patient? And I don't know the answer that I'm not a lawyer, but we have protection through hip isn't that the point of a HIPAA HIPAA laws? I don't know what
22:44 you would think so. But unfortunately, one of the justices who shall not be named has decided that abortion does not fall under HIPAA, because it involves the life of another being in so I can only state what has been stated or restate. But yes, the those are the very things that I'm afraid we're up against as professionals.
23:12 Yeah, I think they're going to try to make us mandatory reporters. for it. I think they're gonna try to make all healthcare we are mandatory. For some things, the thing that's good for some things. Yeah, the
23:24 thing that bothers me about that is the where I'm in Illinois right now, Illinois is a designated, look, we're not, we're not going to infringe on people's right to health care. Just great. But some of the laws and I've lost track, I was trying to keep track of how many have are voting on or have already voted on laws that would have civil penalties, penalties of providers from other states, regardless of the Practice Act of that provider, to be able to have a civil lawsuit against that provider. So that's fun. And then we go back to what ABBY You had mentioned before we started recording about medicine, that that is considered an abort efficient, I have a really hard time with that word. But that is also used for other conditions that we see in our clinics for pain for function and things like that. And then where's our role?
24:33 Right, so does someone want to talk about these more specific on what those medications are and what they're for? So that people listening are like, Okay, well, what medications, you know, so do you want to kind of go into maybe what those medications are, what they're for and how they tie back into our profession. Because, you know, a lot of people will say, well, this isn't our lane. So we're trying to do these podcasts. so people understand it's very much within our lane.
25:03 Well, I yeah, it's just from a pharmacology standpoint, the one of the probably most popular well known drugs that's used for abortion is under the generic name of Cytotec misoprostol, and that's a drug that's not only only used for abortion, but if individual suffers a miscarriage is used to help with retained placenta and making sure that the uterus clears. What other people don't know is is also used for induction. So the same drug is used for three or four different purposes. It's also used for postpartum hemorrhage. So measle Postel, or Cytotec is a drug as pelvic health therapists we should be very familiar with. And we should be familiar with it. Not only you know, for, you know, this this topic, but it's also been a drug that's been linked with the uterus going into hyperstimulation. So actually putting someone at risk for bleeding too heavily. And all of this has a lot of implications on someone's mental health, who's suffered a miscarriage who's gone through an abortion that maybe was not safely performed, which I have had very close experience with someone who's been given misoprostol Cytotec, it didn't take well, she continued bleeding through the weekend, because she lived in a state where emergency physicians could opt out of knowing a board of medications. So as professionals, we do need to know, a board of procedures so that we can recognize when someone has been through an unsafe situation it is, it is our oath as metal as medical professionals to know those things, not to necessarily have a stance on those things that will prevent us from providing high quality and safe care.
26:52 Another one of the medications is methotrexate, and it's used to treat inflammatory bowel disease. And as public health specialists, we'd see people who have IBD, Crohn's and Colitis, who have had surgery who are in flareups who are being treated like that treated with that medication. And it is again used in in abortions. And when you're on that medication, you have to take pregnancy tests in order to still be able to get your prescription for that medication. And as a person who I myself have inflammatory bowel disease and have been on that medication before, I can tell you that you don't go on those medications lightly. It is you are counseled when you are of an age where you could possibly get pregnant, and taking those medications. And it's very serious to take them. And you also have to get to a certain stage of very serious disease in order to take that it's not the first line of defense. So if we start removing medications, or they start to be red flagged on EMRs, or org charts, and we become mandatory reporters for seeing that medication, God forbid, on someone's you know, they're when they're telling us what type of medications they're taking, that there would be an inquiry into that for for any reason is just it's it's horrifying. I mean, it's, we treat these patients and they trust us, and we want them to trust us. But as we get farther and farther down this rabbit hole of, of going after providers, pharmacists, people who help give them information to go to a different state, I just it is. Like I said before, the breadth and the depth of this decision, reverberates everywhere. And if if PTS think that they are in orthopedic clinics, that they are somehow immune from it, you're absolutely not. And for those clinics who have taken on or encourage one of their one of their therapists to take on women's health because it's now a buzz issue. It's really cool. You are now going to see that in your clinic. And you know, like Rebecca was saying before, you know any number of us who have really strong and long term relationships with patients who are pregnant who are in postpartum I have intervened and sent patients to the hospital on the phone with them because they have remnants of conception and they have a fever and someone's blowing them off and not letting them into the IDI and sending them home. And we we are seeing those patients, they have an ectopic they're, they're bleeding, is it normal, they're calling me they're not calling their OB they can't get their OB on the phone. They're texting me and saying what should I do? And they have that trust with me and what happens when they don't? And they're bleeding and they're not asking someone that question and they don't know where to go for help. And so I know I took this in a different direction and we talked about pharmacology, but I just thing that I have those patients whose lives I have saved by sending them to the emergency department, because they are sick, they have an infection, they are bleeding, they have an ectopic, it is not normal. And I don't know what happens when they no longer have that trust with us not not because we're not trustworthy, but because they're scared.
30:26 The heavy silence of all of us going
30:31 you know, it's, it's not wrong. And I think the like, it just keeps going through my head. It's just like, so what do we do? I mean, Karen, you mentioned like, it'd be great if somebody came out with a list of, of guidance for us. And I just, that just won't happen. Because there's different laws in different states, different practice acts in different states. And no one, you know, like you even if you talk to a lawyer, they're going to say, this would be the interpretation. But also, as of yet, there's no like case law, to give us any sort of any sort of guidance. So that was a lot of words to say, it's really hard. I can tell you in Illinois, like two or three weeks ago, I'd be like, like, I'm happy, I feel like Illinois is a pretty safe space. We have, we have elections for our governor this year. And I have never been so worried, so motivated to vote. And so motivated to to really make sure to talk to people about it's not just like this, this category or this category, it's like we really need to take into consideration the ramifications of what this will do, I think there was a lot of this probably won't affect me a whole lot. But I think I'm guessing I think a lot of us on this call maybe I think all of us on all of us on this call, have lived our lives with Roe v. Wade. And, as all of this is coming up, and just thinking about how it impacts so many people, and how our healthcare system is already doing not a good job of taking care of so many people, the fact that we would do this with no, no scientific, back ground, no support scientifically. Like I pulled up the ACOG statement, and, and they condemn this devastating decision. And I really, I was like, it gave me gave me goosebumps. And this was referred to in our art Association's statement. And it makes me sad that we didn't condemn it. Hope that's not too political. But I'm really sad that we didn't take a stronger stance to say, this is not good health care. And we need to do more. Again, and that's like, again, so many words, to say we're gonna have to make up our own minds, we're gonna have to know, our rules, our laws and what we're willing to do, and go through, so that we can provide the care that we know our patients deserve. And that's going to be really hard. Because, you know, if I talk to someone, and if I call Rebecca in Washington State, she's going to have something different than if I talk to Abby in New York. And you know, that so it'll be, it'll be really hard even to find that support. That support there's going to be so much support, I think, from this community, but that knowledge and that, that confidence, we have to pull together so we have to pull together with all the other providers, but also we're gonna have to sit down and figure this out to
33:59 the clarity. So it's, I think a practical step forward would be each state to get get, like, every state, come up with a thing. So pelvic health therapists in that state come up with what seems to work for them get a lovely healthcare lawyer to to work with them with it. And then we could have a clearinghouse of sorts of all of the state statements. I don't know that that needs to go through a particular organization. I I know that they're in the field of physical therapy, two thirds of PTS aren't members. And we need this information to be out there for every single person so that they know
34:44 that we'll have to be grassroots there's I don't think that there's going to be widespread Association support from anywhere. But that being said, I think it's a great idea.
34:58 What are we going to do about it? Hang on issues that are too divisive, you're absolutely right, individual entities are going to have to take this on and just put those resources out to therapists who need them need the legal support, need the need to know how and how to circumvent issues in their states. And, you know, like I said before, even how to just provide that emotional support, there's going to be needed for their, their, their patients, so, and that's okay, if the organizations that were part of are not willing to take a heavy stance, you know, even like last year, if you're not willing to take a heavy stance, on an issue where someone feels their autonomy, and their choice is being threatened, then it's okay, well, we'll take it from here. But, you know, that's, that's really where these grassroots efforts come from and abound, because there are a group of individuals who are willing to say, No, this is wrong. And I'm going to do something about this so that our future generations don't have to suffer.
36:02 Yeah, and I think, you know, we're really looking at the criminalization of health care.
36:09 That is not healthcare.
36:12 And we also know who this criminalization of healthcare is going to affect the most. And it's going to affect poor, marginalized people of color, it is not going to affect the wealthy white folks in any state, they'll be fine. So how do we, as physical therapist, deal with that? How do we, how do we get the trust of those communities who already don't trust health care, so now they're going to stay away even more, we already have the highest mortality, maternal mortality rates in the developed world, I can only imagine that will get worse because people, as we've all heard today are going to be afraid to seek health care. So where do we go from here as health care providers? I,
37:10 Karen, you're speaking something that's very near and dear to my heart, I act as if you had to take this on, I am very adamant that we can no longer choose to stay in our lane, we do not have that luxury. And I as a black female, you know, physical therapist, I don't have the luxury to ignore that because of the color of my skin, and not my doctor's degree, not my board certification and women's health, you know, not my faculty position, I when I walk into a hospital, and I either choose to give birth or have a procedure, I will be judged by none other than the color of my skin. That is what the data is telling me is that I am three times likely to have a very severe outcome. If I were to have a pregnancy that did not go as planned or or don't choose a procedure, you know, that affects the rest of my function in my health. And so given the data on this, you're absolutely right there, there is going to be very specific populations that are going to receive the most blowback from this. And as a pelvic health therapist, I had to go into the hospital to find them, because I knew that people of color and of marginalized backgrounds, were not going to find me in my clinic. And we're not going to pay necessarily private pay services to receive that care. But I needed to go where they were most likely to be and that was the hospital setting or in their home. And so, again, as a field of a very dispersed and you know, not very many of us at all, we're going to have to pivot into these areas that we were not necessarily comfortable in being if we're going to address the populations that are going to be most affected by the decisions our lawmakers are making for our bodies.
39:11 You know, there's something that I think about, often when I hear this type of conversation come up in, in sexual health and in in whenever I am speaking with one of my patients and talking about their menstruation history, and, and them not knowing how their body works from such a young age is I just wonder if we should be offering programs for young people like very young pre ministration you know, people with uteruses and their parents, and grandparents and online, online like little anonymous. Yep. nonnamous
39:51 for it's just
39:52 Yes. Yes, it's it's just, you know, Andrew Huberman talks a lot about having data Back to free content that scientific, that's factual. And I think about that a lot. And I think, to my mind, where I go with this, because I do think about the lifespan of a person, is that creating something that someone can access anonymously at any age, and then maybe creating something where it's offered at a school? You know, it's it's ministration health. And it doesn't have to be under the guise of, you know, this happened with Roe v. Wade, but this it could be menstruation, health, what is a person who menstruating what can you expect? What you know, and going through the lifespan with them, but offering them? You know, I think I think about this with my own children, as our pediatrician always asks the question of the visit, who is allowed to see under your clothes who is allowed to touch you? And it's like, you and my, I have a five year old. So it's Mom, when when when I go number two, a mom or dad when I go number two? And that's it. And you know, I think about that, and I think about how we can educate young people on a variety of things within this topic, and kind of include other stuff, too, that's normal, not normal, depending on their age. Absolutely, there
41:22 was what I was excited about in pelvic health. Before this was people like Frank to physician and his PhD students and postdocs are working on a series of research about how if we identify young girls that are starting their period, and having painful periods, treat them and educate them, then that they will not go on to have as much pelvic pain conditions and issues in the future. So we look at the early childhood events kind of thing, but also period pain. And How exciting would it be if we could get education to young girls about just how their bodies work. And to know that just because you all your aunties have horrible periods doesn't mean that you're stuck with this, just like maybe they just didn't know, let's help you out and constipation information and those basic health self care for preventative problems. So I was super excited about all that. And now it's like, oh, now we have to do it. Because in that we can do little pieces of information. So people have knowledge about their body, that's going to be a little bit of armor for them, that they're going to need and free and available in short, and you know, slide it past all the YouTube sensors. This is this is doable, but it's gonna take time money doing, but we can do it. Well, it sounds like, ladies,
42:52 we've got a lot of work to do. One other thing I wanted to touch upon. And we've said this a couple of times, but I think it's worth repeating again and again and again. And that's that expanding out to other providers. So it's expanding out, as Rebecca said, expanding out to our colleagues in acute care, meaning you can see someone right after a procedure right after birth right after a C section. And, and sadly, as we were saying, I think we they may start seeing more women, I'm not even set children under the age of 18. In these positions of force birth on a skeletally immature body. So the only place to reach these children would be maybe in that acute care setting. How what does the profession need to do in order to make that happen? And not not shy away from it, but give them the information that they need. Moving forward?
44:07 I was just gonna say that I've given birth in the hospital twice. Not at any time was I offered a physical therapist, or did a physical therapist come by and I am in New York City. I gave birth in New York City, planned Solarians because of my illnesses. And nobody came by I did get lactation nurses, any manner of people who were seeing me I was on their service. But that has been something that we needed anyway. We mean to have a pelvic health physio on the labor and delivery and on the maternity floors, who is coming by educating as to what they can start with what they can expect. When can they have an exam if they want to have one? Who is a trusted provider for them to have one. And we need to get the hospitals to expand acute care, physical therapy to labor and delivery and, and the maternity floors. As a routine, it's not something you should have to call for, it should be routine clearance for discharge the same way you have to watch the shaking baby video to get discharged.
45:27 I'm happy older than all of you. I don't have it either. But taking baby video is not something that even existed back in the day. But that makes sense. I mean, I once upon a time was a burn therapist, and I was on call at a regional Trauma Center. And you know, it's like you're needed your, your pager goes off, because that's how long ago it was. And you just came in, did your thing, went back home went back to bed. There is no reason other than lack of will, that PTS couldn't be doing that right now.
46:03 I'm now of the opinion where it's unethical to not offer physical or occupational therapy within 24 to 48 hours of someone who had no idea who did not have a planned delivery the way they expected it who has now and a massively long road to recovery. After a major abdominal surgery, I'm now of the opinion that is unethical for our medical systems to not offer that those rehabilitative services. And I've treated individuals who had a cesarean section but suffered a stillbirth. So the very thought of not providing services to someone who has any kind of procedure that's affecting, you know, their their their not only their pelvic health, but their mental function. That to me is now given the you know, these these, this recent decision on overturning Roe v Wade, is now now we're never, you know, either we're going to now pivot again as pelvic health therapists and start training our acute care colleagues, as we did with our orthopedic colleagues, as we've done with, you know, our neurology colleagues, whatever we've had to do as pelvic health therapists to bring attention to half of the population, you know, who are undergoing procedures, and they're not being informed on how to recover, we will have to start educating and kind of really grow beyond just the clinics and beyond what we can do in our community or community. But we are going to have to start educating our other colleagues in these other settings, we don't have a choice, we know too much, but we can't be everywhere. And not all of us can be in the hospital setting, we're going to have to train the individuals who are used to seeing anything that walks through the door and tell them get over to the obstetric unit. Okay, there's someone there waiting for you.
48:06 Yeah, I totally agree. I mean, when I think back I remember as a student working in acute care and how we had someone who's dedicated to the ICU, we had someone dedicated to the medical floor, we had somebody who was dedicated to the ortho floor, and most of the time they had their OCS, their, their, the one for for, for ICU care, the one for NeuroCare, or they have a specialty. And I think it is just remnants of the bygone era of it's natural, your body will heal kind of BS from the past. It's just remnants of that and it's just, we don't need the APTA to give us permission to do this, this is internal, this is I'm going into a hospital, and I'm presenting you with a program. And here is what this what you can build this visit for here's the ICD 10 code for this visit here is here is here are two people who are going to give you know, one seminar to all of your PT OTs, to you know, so that you are aware of what the possible complications and when to refer out and that kind of thing. And then here are two therapists who are acute care therapists who are going to also float to the maternity floor one of them every day, so that we can hit the we can get to these patients at that point, and that is just that's just people who present a program who have an idea, who get it in front of the board that that it is not permission from anybody else to do it. And, you know, it really it fires me up to to create a world in which you know, when you know people who are the heads of departments and chairs and you know on the boards of directors You know, being in big, big cities or small cities, when you know those people, you know, you can, your passion can fire them up. And if you can fire people up, and you can advocate for your patients and you can in that can spread, you can make that happen. And this is, you know, I feel radicalized by this, I mean, I'm burning my bra all over the place with this kind of thing. And I just feel like, if we can, if we can get to young people, and if we can get to day zero, of delivery, day one, post delivery, or post trauma, then then maybe we can make a dent, maybe we can, maybe we can try, maybe we can really make a go of this for these people. Because, like I keep feeling and saying I, we are not prepared for the volume.
50:54 If individuals are going to be forced to carry a pregnancy, that they may not want to turn because it's affecting their health, we're going to have to be prepared for this. Again, this is not an option really, for us as pelvic health therapists, because we know what's down the road, we've seen mothers who have or you know, or individuals who have suffered strokes or preeclampsia or seizures, or, you know, honestly, long term health issues because of what pregnancies have done to their body. And now if they want the choice to say, you know, I'm not ready, they don't have it anymore. So we really don't have a choice. We have to start expanding our services into these other settings, making our neurologic clinical specialists in the hospital, see people before they have a stroke before they have a seizure actually provide services that can help someone monitor their own signs and symptoms after they've had now a procedure or given birth or even had, you know, a stillbirth, unfortunately, because the doctor had to decide, well, yes, now we will perform the abortion because you know, your health is like on the cliff, I mean, we're going to be seeing these and we just have to prepare. And if it's not our organizations that are laying the foundations, we will, we'll take it from here,
52:15 we need to reach out across so many barriers, like athletic trainers, they're gonna see the young girls, they're gonna see their track stars that is not reds, it's pregnancy. And it could be a very short lived traumatic pregnancy, in girls that are just not develop. They're developed enough to get pregnant, they're not developed enough to carry a healthy baby to term. Kind of just makes me like. But Rebecca is right as we don't get to have an opinion on the right or wrongness of this, we have a problem ahead of us now, that that is happening already, as we speak, that people are going to need help. I love that we have more technology than my grandma did when she was fighting this battle. And we have YouTube and we have podcasts and we have ways to get information out. But we need to use every single one of them in our sports colleague or athletic trainer colleagues. They need to know the signs. Because they may be the ones that see it first.
53:21 Yeah. And Sarah as being the most recent new mother here. What kind of care did you get when you were in the hospital?
53:36 I was sitting here thinking about that. And I mean, I will say that the care I had while I was there, that I had an uncomplicated delivery in spite of a very large baby. And I was fortunate enough to leave the hospital without needing additional help. But I wasn't offered physio. Nobody really they're just really curious to make sure you're paying enough. And that's about it if you're the mom and my six week visit was actually telehealth and that was the last time I had contact with a health care professional regarding my own health so it is minimal even if you're a very fortunate white woman in a large metropolitan area and but I'm working now further north and with a pro bono clinic clinic and in an area where we do a lot of work with communities of color and I'm I'm like I honestly don't even know the hospitals up here yet. But I'm gonna I have so many post it notes of things that are gonna start happening and start inquiring because Rebecca like we need to get into the hospitals like if if I can Do that. And honestly, up until now, like my world and entropy was, and pre this decision was it, there's so many people out there who need help with pelvic issues in general, like we can do this forever. And we set our clinic up so that people who weren't doing well in the traditional health care system could find us and afford us. At least some people could, I realized that it wasn't in companies, encompassing everybody who could possibly need help, but we were doing trying to figure out another way. And so again, like, like, again, the offer of assistance I got was minimal. But also I didn't need much. And I was in a position where also, I knew I could, I could ask for it if I wanted it. And I could probably get it if I needed it. And I'm just thinking about, again, some of the communities I'm interacting with now, in some of my other roles and responsibilities, and I cannot wait to take a look and see, how can we get in there? How can we be on that floor? How can we? What What can we make, make happen like, because it needs to happen, these are these, this is the place where I'm scared to start seeing the stats,
56:21 wouldn't it be amazing if you can get the student clinic part of that somehow somehow and get, you know, young beyond that bias, but younger, most younger but but like the physicians the the in training the PTs and training the PAs the you know, and get like Rebecca had said, let's get let's get the team up to speed here, because there aren't enough pelvic health therapists already. And they're heavens, we need, we need to get everybody caught up.
56:58 And there's so much I was telling you that being around student health care, providing your future health care providers is really energizing and also really interesting. I mean, the ideas that come up with in the in the connections they make and and the proposals they make are just amazing. But two things that I've noticed that I think probably we run into in the real world, real world, outside school world as well, is one. The that's being able to have enough people and enough support to keep it sustainable. So you have this idea, you have the proposal, you made the proposal, how are we going to keep it going and finding the funding or the energy or the volunteers to keep it going. Things ebb and flow, you get a great proposal, you're like yes. And then I literally today was like, I wonder what's up with that one, because it was an idea for a clinic to help was basically for trans people to our tree transitioning and might not have the support that they need. And also I was reached, they come up here for women's health clinic. And I'm going to reach out to them now. Because this again, this decision changes that because it is a pro bono clinic that they would like to set this up in and before it was going to be much more more wellness. And now it could turn out to be essential health care. So that's one thing. But then the other thing is still the education, that in school, we're not taught about what everyone else can do. And I think again, figuring out a way to make sure that future physicians really know what physical therapists have to offer, especially in this space. Most people know that if their their shoulder, their rotator cuff repair, they should send them to pt. But really, we need to get in with OB GYN news, we need to get in with the pediatricians. And I don't want to say unfortunately, but in this regard, unfortunately, we're going to have to really make sure that they know what we're doing. And again, I'm already kind of trying to think like how can we make this just part of how we do health care.
59:20 So I think I'm following in your footsteps by going into education and by by being a part of our doctor of physical therapy programs. You know, I especially chose the program in Washington state not because you know, of just the the the opportunity to teach doctors or incoming doctors but it was also an opportunity to teach doctors of osteopathic medicine and occupational therapy therapists. It was you know, very intimate program and opportunity to make pelvic health or women's health or reproductive health apart of cardiopulmonary content, a part of neurology content, a part of our foundations a part of musculoskeletal and not a special elective course that we get two days of training on, I had the opportunity to literally insert our care, our specialized and unique care and every aspect of the curriculum, as it should be, because we are dealing with, you know, more or less issues that every therapist generalists or specialists should be equipped to handle. So in the wake of Roe v Wade, to me, this is an opportunity unlike any other for pelvic health therapists to really get into these educational spaces where incoming doctors are, you know, MDS or PA programs, or NP programs are our therapy practices, and start where students are most riled up and having those ideas so that they can go out and become each one of us, you know, go into hospitals and say no, to obstetric units being ignored, go into hospitals and give and services to physicians. You know, we need to create more innovators in our field and education is the way to do that.
1:01:12 I just wrote down check Indiana and Ohio, and then I wrote border clinics, because Because Illinois is a it's like a not a prohibition state. Having so many flashbacks, because Illinois, is, is currently dedicated to maintaining health care access for everyone. We have cities that are on the border. And I was thought of that when you were talking, Sarah, because you're up next to Wisconsin now. But we have we have the southern part of the state and the western part of the state. And those those border towns are going to have a higher influx than I will see in Chicago, maybe. But I would anticipate that they would,
1:01:56 you know, and again, this is where laws are murky. Every state is different. It's I mean, it's a shitshow. For lack of better way of putting it I don't think there's any other way to put it at this point. Because that's kind of what what we're dealing with because no one's prepared, period. So as we wrap things up, I'll go around to each of you. And just kind of what do you want the listeners to take away? Go ahead, Sandy,
1:02:33 this is this is frustrating and new, and we're not going to abandon you. We're gonna figure it out and be there to help.
1:02:41 I would say that our clinics are still safe, it is still a safe place for you to open up and tell us what you wouldn't tell anybody else. It's still safe with us. And we still have you as an entire person with all of your history. We are still treating you based on what you are dealing with and not. We will not be dictated by anybody else. Our care won't be mandated or dictated by anybody. Sarah, go ahead.
1:03:22 What I would say is I would echo your safe. If you need help, there is help. And I'm sorry, that that this just made it harder than it already was. And I would say to healthcare providers, please let remember, let us remember why we're doing what we're doing. And, you know, we do need to stand up, we do need to continue to provide the best care for our patients. Because to be honest, I've been thinking like, I think it's a legal question. It's a professional question. But ultimately, if we can't give the best care possible, I'm not sure I should do this.
1:04:01 Ahead, Rebecca,
1:04:02 for our health care providers, in the wake of Roe v. Wade, being overturned, wherever we are, you know, as an organization or on our stance, if we believed in the autonomy of an individual to know all of the information before making a decision, then we still believe in the autonomy of an individual to know all of the information that is best for their body. And that is the oath that's the that's the that's the promise that we've made as professionals to people that we're serving, and to the people that we're serving to those who are there listening to this. You have safe spaces with providers that you trust and we're going to continue to educate one another, our field and also you we're going to put together resources that really bring During this education to your families so that you don't have to feel like you're in the dark and you're alone. This is not something that is per individual or per person. This affects everyone. And we're dedicated to advocating for you.
1:05:18 Perfect, and on that we will wrap things up. Thank you ladies so much for a really candid and robust discussion. I feel like there are lots to do. I think we've got some, some great ideas here. And perhaps with some help and some grassroots movements, we can turn them into a reality. So thank you to Rebecca to Sarah to Abby and to Sandy, for taking the time out of your schedules because I know we're all busy to talk about this very important topic. So thank you all so so much, and everyone thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.
1:06:03 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com And don't forget to follow us on social media
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| 597: Jamey Schrier: 4 Simple Way to Hire and Retain Staff in an Economic Downturn | 11 Jul 2022 | 00:47:59 | |
In this episode, Founder and CEO of Practice Freedom U, Jamey Schrier, talks about hiring and retaining staff. Today, Jamey talks about changing how business owners see employees, the 3X rule, and digging deep to find clarity. What can business owners do to hire the right people? Hear about the importance of being inspired by your vision, successful marketing strategies, slowing down the hiring process, and get Jamey's advice to his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Jamey Schrier Jamey Schrier, P.T. is a best-selling author, speaker, and Founder and CEO of Practice Freedom U, a business training and coaching company. Jamey is a former private practice owner, and his book, The Practice Freedom Method has helped scores of practitioners Treat Less, and Earn More, and enjoy a life they deserve.
Suggested Keywords Healthy, Wealthy, Smart, Business, Hiring, Employment, Purpose, Vision, Values, Inspiration, Interviews, Focus, Strategies, Marketing,
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Read the Full Transcript Here: 00:02 Hey Jamie, welcome back to the podcast. I'm happy to have you on I think you're quickly becoming my most regular guest and I'm really happy and thankful for it. So welcome back. Oh, thanks, Karen. I
00:14 appreciate being invited back and I am honored to be a regular it's like the old school while I'm dating myself here with the Johnny Carson Show. I mean, that's, that's going back and I don't want to date either one of us, but it's like, you know, the regular guests that's on there. They can't find anybody. There. Schreier. He's a felon. He didn't come in there and fill up some time.
00:38 Oh, that's so funny. I think I was watching Seth Meyers and Rachel Drac was on and that's what they said, Rachel Drac is like, you know, someone else was supposed to be there. But I don't know if they got sick, or they couldn't make it. And so they called her that afternoon. She was like, Sure. Tell me about her.
00:55 Oh, I've watched a sports show called PTI. Pardon the Interruption around it takes place right in DC. And one of the guys is called Phil and Frank. It's like, if they ever need anybody, someone's out sick. You know, Frank, I saw he, he jumps in and fills in at any, you know, at a moment's notice. So, you know, I don't know if I'll fill in Jamie. But well, well, you're
01:17 not, you're not filling in, you're just a regular guest.
01:22 Thank you, thank you,
01:23 not a fill in. It's just a regular guest. So today, we're going to talk about something I don't think I've really talked about on the podcast, at least, I can't remember talking about this in great detail. And that is, how to hire people how to retain staff, which, you know, as we were speaking before we went on is a problem, not just in physical therapy right now, but in a lot of industries across the board around the country. So let's dive in. So you have four surprisingly simple ways to hire and retain staff. So let's get to it.
02:03 Yeah, I mean, you know, as we know, it's a difficult marketplace. And I think, you know, this shift isn't just a shift that is, oh, they're gonna have a shift, and it's gonna be all fine tomorrow. No, I'm not gonna say it's not a permanent shift, as far as we're always going to have this difficulty, you know, really finding good people. But I do think it's a shift that is going to stay around as far as what people are deeming important, what people are deeming valuable. And I think it's important for us in the hiring marketplace, that we begin to shift how we as business owners, and that's kind of the position, I always come from being a business owner, and you being a business owner, is how we need to shift our way how we think about employees. You know, it's interesting, you know, I speak to so many people every day, every week, whether there are clients or, or just people out and about and in the business industry, and, you know, I can't tell you, Karen, how many times people talk about employees as a cost, right? It's like, oh, how much are they going to cost and, and I don't know if I can afford them, and all they care about is wanting more money, and this and that, and, um, you know, and it, it kind of, it hits me, because I think the first thing we have to do collectively, at least as a group of business owners is start to shift that your employees besides you, your employees are the most important people in your life and your business life. And if you don't mentally look at them as an investment, just like you look at any other investment you're doing, that will bleed into other things. It'll bleed to how you treat them, it'll bleed into some of the things you say are some of the things that you create or benefits or whatever the case is. And I've seen that so often, I used to do that, because I used to kind of think that way is they were a cost come in, do your job, shut up and just leave me alone type of thing. And you know, that is not the right way. It's never been the right way. But now more than ever, that's kind of the premise of all of this is shifting in these people are an investment. And investments are things that you want to nurture. You want to help you want to grow, you want to be assets. And I think it takes that fundamental shift before anything, because if not, everything just becomes an empty strategy or something but it won't hold. It won't have teeth to it. If there isn't that shift and how we think you know what I mean?
04:54 I do I do and I think that's a really great distinction that you made that you for employers to look at their employees as a real investment, because if that employee is nurtured and you help them grow, if they can help grow and expand your business in ways that you never thought could even be possible.
05:17 Exactly. And it sounds simple, it's easy to read in a book or listen on a wonderful podcast, but actually doing it in the moment is not as easy to do. Because we have wiring ourselves, we have thoughts, we have biases, we have upbringings and influences in our lives, as we all do. And these things, you know, whether you call them, you know, limiting beliefs or negative biases, we have all of these things that start to affect how we think and how we communicate. And how we ultimately, you know, put into action, some of these things. And if you don't feel that way, you don't think that way, it will come out, during how you interview how you post an ad. I mean, you know, I can be very honest with you, I know, you know, my ads used to be going on, I don't even know if it was indeed at the time, but going on whatever the latest thing was Craigslist or something, and just looking at another company and just copying their ad. I mean, I didn't know what to say, I didn't really know what I was doing. But I just thought, hey, if the hospital, you know, put an ad up, they must know what they're doing. Because they got you know, a lot of money and they hire good people. So my ad was basically a hospital ad. And what's interesting is, so many so many people continue to do that they, they put up some vanilla job ad on indeed. And they're like, well, this used to work, it ain't working anymore, you cannot do that anymore. It's not going to get you people, and it's certainly not going to get you the right people. You know, the real, the real thing right now is, you know, truly differentiating yourself leading with the positives. And, you know, I know we'll get into this in a second, but really looking at these people looking at these potential employees as investments and learning, how do you meet them? Where they are, right, there's an old marketing term is, you know, you know, meet your prospects, where they are joined the conversation they're having in their brain, which really means is, understand them, perhaps better than they can understand themselves, do your do your research. And, you know, I never knew anything like that. But I think that that's, that's what we all need to do is pause for a second and really understand the type of person that we're looking for, and learn as much about them. And when you're able to do that, you're able to put together what's what's called an employee value proposition, you know, you've we've heard and and we talk marketing, your unique selling proposition, all kinds of different propositions, but this idea of a an EVP and employee value proposition, yes, our job is to seek out and actually sell people on what we have to offer, why they should buy quotes, what we're selling. And it is a different way of looking at it. And for a lot of people, it's uncomfortable, and it's like, I shouldn't have to do that as as some of the things I've heard, you know, I shouldn't have to do that. They should want to work for me, you know, we give the greatest care and, and we're the best at what we do. And we really care about our people and all that it's like, yeah, but so does everybody else.
09:08 That's what I was just thinking doesn't everybody?
09:11 Yeah, I'm okay. And I know you care just a little bit more than I do about quality care. And I know that I mean, but that's, that's the mindset we come with. What we don't come with is we need to put our best foot forward. And we need to understand these people that we are trying I know we hate the S word. But we are trying to I'll say the P word and said persuade them for coming to interview with us. And then if we liked them, persuade them to commit to working for us. And you know what, when you have the ability to get pretty much any job you want out there, you put a posting out that you got 10 potential offers maybe 20 You're in competition with A lot of other people, and you have to realize that and have to do the work. It's not hard work. But it's focused work to understand more about who you're trying to get than you ever needed to do in the past. So that's kind of the premise of the whole thing. Yeah. Yeah. So
10:19 I was gonna say, Is this part of these, like, we mentioned the top kind of simple ways to hire and retain staff, is this part of it? Or is this the background you need to do to get to?
10:32 I think, I think it's the background. I mean, if I mean, you could put it in there. But you know, for this for this conversation, I'm kind of setting the stage of, of the background of where people need to be coming from. I mean, the bottom line is, why should they work for you? It's really that simple. Why should they work for you, because they can work for someone else, no matter what you say, one an hour to an hour. But there's, there's already 10 other people doing the same thing. So you know, one of the things that now we're gonna get into the specifics, you know, one of the things we talked about, you know, we need to treat them like an investment. But it goes beyond that, we need to understand number one thing that every owner needs to do is understand what their worth is. I did some research on this. There's a recent Gallup poll. And they said 60% 64% of employees said that a significant increase in income and benefits. Was there number one won't. Now, which is interesting. It wasn't necessarily number one, a little while ago, it was never number one. For many years, it was never even a top five money was not the focus. Well, it is now and you can't blame them. Because let's say education is a fortune. Right? Some people No, in our industry are saying, it's not even worth it. If you look on paper, just money, you invest in education. And when you get it back, you might be in debt for 20 years before you actually pay it off. Depending if you have 234 100,000, you have inflation, it just cost more to live in some of these cities like yours, and mine, it costs a lot to live wow, you know, you adjust for the insurance that you get, if you do take insurance. It's not covering that. So they expect the employer to do that. So this, this question of, you know, what is their worth? I've heard from so many people that say to me, you know, I can't afford that. And I say, Okay, well, what can you afford? Well, I don't know. And there's the problem. You need to know what this person is worth to your company at the level that you want them working. So for instance, I like to use a three multiple and a typical outpatient example. So if you're a typical outpatient, orthopedics, not, you know, insurance based, most likely, but it really depends. And your multiple of salary, not benefits, not taxes, and it just salary. It has to be at least three times, meaning that if you pay someone 75,000, that person should produce 225,000 in revenue, a three multiple it's just a ballpark. Could it be less than a three? It could be? It really depends how what your expenses are like, what's your rent, like?
13:42 You know, your other overhead and all that kind of stuff to make sure that you can cover all that and still have money for profit, let's not forget, profit. If it's greater than that, you should be really clear you should be fine. So it's our job to really dial in, what can this person generate? And then use that ballpark three times to determine what you can afford. So this shines a light. Karen and I and I've had some recent conversations with people and analyzing their business is shines a light on people's business models, some people's business models, they have this altruistic will I want to do one patient an hour, I'm like, hey, you know, we don't tell people what your model should be. We just tell you whether it's going to be profitable. And it's going to achieve the goals that you want, especially especially to financial goals. So if you do one patient an hour at $100 a visit, I can tell you right now there is no way you're ever going to be able to afford the people to work for you. That stay with you. It's It's literally impossible, because there's not enough money. Let's say it's one patient an hour that's at the greatest 808 A day Don't eat everyday, which is not going to happen. So let's say it's 30 or 35, you know, a week at 100 bucks 3500, that's 14,000 a month, that's 120 450 $160,000 Eat, you're gonna afford $50,000 therapists. And most people don't look at it like that care. And they go into this. And they look at it in the Yeah, but I want to deliver, you know, quality care one an hour, but they don't they haven't done all the numbers, whether they can actually build a business on that. Now, can they work for themselves and be like you and I were talking about before the show solopreneur? Sure, they can do that, you can just give yourself a job. And you might be able to make some decent money, but that's the job, right? That's just a self employed job. And if that's what you want, that's fine. But if you want to hire people and actually build a business, where gives you freedom, you're going to have to make a decision. But that's, that's so many times where people kind of have the wake up call and be like, oh, man, I need to change kind of how we're doing No wonder I don't have any money in the bank, even though we're 90% utilization. And that's a horrible feeling. When you're working your butt off, everyone's working their butt off, and there's still no money. That's a fundamental flaw. So that's, that's kind of the surprisingly simple way is just get clear on what you can afford. Use the three times as just a guideline and see what a you expect them, how productive do you expect them to be? Is it 80% 85%, whatever visits you want, multiply that by how much you get paid per visit, and just see what that looks like. That's where you need to start, then you can answer the question how much you can afford, you can answer the question what the therapist is worth to your practice, how much they can generate. And at least it gives you more data to know if the person says 80,000, and you never given anybody more than 72 You know what you might be able to afford that. And it might be a really good hire if they're a good fit. So anyways, that's that's kind of a the the number one thing that I'll start with?
17:13 Yeah, I think that's great, practical, easy to understand. What's next, what else can we do to hire the right people?
17:20 Yeah. So number two is a biggie. And this is, comes to Forbes magazine talks about this, I call it be on purpose, be on purpose. According to Forbes, employees want to work for a company that has a purpose, right. And we have a such a deep purpose. Us as as therapists, caregivers, we are healers. We're healing the world. And sometimes that message gets lost. Sometimes we forget that message about what we're really doing. Sometimes we speak about metrics and productivity, and we lose the message about what we're doing this for. And other times, it's all about the quality of the quality. And we have a business that is in financial instability. So how do we become on purpose? Well, the first thing is we have to get a vision, we have to get a vision as Simon Sinek talked about a vision as a just cause there was an interesting TED talk that he was talking about, or maybe it wasn't a TED talk, it was just a video, but he was talking about having a just cause a vision needs to be your Northstar. A vision needs to be inspiring. And the first person your vision needs to inspire is you. If you're not inspired by envision, like, you know, caring if it's like, what's your vision, you share a vision and you're like, so, you know, how do you feel about there and like, whatever. If you're not inspired, you're not going to share that vision to others. And if you don't have a vision, we'll put in values. Your values don't have to be these company values that you see in whatever commercials and they're on some rock outside the thing. Values are your beliefs. What do you believe in? What do you believe about the work that you do? Why is this work so darn important to you? People want to be connected to something they can get a job working anywhere. So why do they want to work for you? What are you about? What is your story in your business? I share my story a lot I've shared it on on your podcast many many times. And more people come up to me and say oh my god, I resonated with your story. I didn't have a fire and burned down my place but I've had some really difficult times. We are story people we love movies. We love plays. We love dying. Begin to stories. What is it about your business? How did you get started what it means to you, because during an interview, that's what people are going to connect to. That's what's being on purpose. So take some time and write down what your vision is, what your story is, what your values are, what does this mean to you? And use that with your current team, of course. But also you can use that in your interview process.
20:30 Yep, I love it. That was a huge part of what I did. You know, maybe two years ago, I was really being intentional and looking at mission, vision and values, and really understanding why I do what I do, why I started my practice, why I decided to go out on my own. And it was really enlightening, and made me appreciate the business that I have so much more. So if if you are a business owner out there, and you haven't, like maybe you've written down like a mission, vision and values A while ago, just to have it on your website, or just to do it, I would suggest go back, revisit it and really think about who you are as a person why you decided to start your practice what is really important to you. Another thing that I talked about at ascend, and that we did in the Goldman Sachs 10,000 small business program was they had us find like a totem. So this totem could be, it could be a phrase, it could be a physical object. It could be a mythical creature, if you will, whatever you want. That encapsulates why you do what you do or encapsulates your vision. And I remember thinking, told them, I don't know what I don't know what that what do I told them? And they're like, yeah, just let it. And then I was like, Oh, of course I do. Because it's been my sort of guidance for, I don't know, 18 years now. So even before I moved to New York City, before I started my practice, I was sort of obsessed with the cathedral by Rodin, which is two right hands coming together. So when you look at it quickly, it looks like a right and a left hand is actually two right hands. So it's two right hands coming together, not touching. So I always looked at that is like therapist and patient coming together with space in the middle to kind of grow and move. But you could take that into you and an employee, it could be you and a partner, but it's coming together, but not fully. But having that space in the middle having space for new things to come. So that was kind of my totem. And I didn't even realize it until I did this went deeper into this process two years ago. So I highly suggest people if you've already done it, do it again.
23:08 Yeah, you know it. I love I love your story in a lovely, what you're sharing, you know, I think that as as highly left brain analytical, very smart people. I think sometimes we have a difficult time going deep. Cal Newport, who actually is here in Georgetown universe, Georgetown, you know, talks about deep work going below the superficial. And we have a tough time with that. I don't know if we have a tough time being vulnerable, which I know we do. A lot of people do. But vulnerability is power. That'll be maybe my next talk here. But I you know, we have a tough time of going below the superficial and going into the real deep, where the real work happens. The feelings, the emotions, the connections of why do you do what you do? You don't have to you can do anything you want. Why this? You don't have to start your business. No one forced you to why it's bigger than I didn't like my boss. That's why he started. It's bigger than that. You have to go deeper. And when you do you get such clarity. And because when clarity happens, you get power. You get confidence and you get dialed in. And when you have that kind of focus, that's where magic happens. Because other than that, it's a noisy world and it's easy to get distracted. I mean it's easy to get distracted by everybody else's stuff. So, so important, because here's the thing when you when you are dialed in on your your vision, your story, what who you are I'll tell you what One thing is going to happen, these people are going to come into your world candidates or whatever they're going to know who you are, they're going to know what you're about, they're going to know where you're headed. Now, whether they choose to be a part of it or not, that's their choice. But there's not going to be a confusion about what you're about. And you know what, give me that every day of the week, because what I don't want is there. They're just there. It's kind of like, everybody else, stand for something, draw a line. And it starts by doing that deep work. So that's number two. My next one is, is one of my favorites. It's higher for traits train for skill. I feel as as an industry, that we have become infatuated with advancement. And I don't, and if
25:52 you mean all those initials after your name,
25:56 well, we'll carry on, let's just say it we've become infatuated with, with with certifications, with initials with with almost to say, Karen, I got 28 initials. Karen, I'm better than you. I'm a good person. I'm a great therapist, because I'm really, really smart. Well, guess what, Karen, you were smart, when you graduated, you're smarter than better than 1%, you know, then the other 99% of the world, you were already smart? How much more do you need for you to look in the mirror and say, You know what, you're good enough. You're okay, because you can't remember 90% of the stuff that you're learning anyways, I don't know where that certification and that more and more is better. I mean, there's definitely a financial part there. Because, of course, people get paid for the more education and there's people that are doing that, that are highly paid. But you know, this idea of the more letters the better all be. Now, here's the problem with hiring with that, because you're like, Jamie, we're gonna how's the connection? The connection is this. Because you can get enamored with a resume with someone that has two things, one, a lot of experience, we love that. And to a lot of initials, because in our head, we've taken that, and I've had people tell me that on so many occasions, well, will they have experience in a ton of certifications? I go, and well, I just assume I go, Yeah, I just hope that they would, I thought that they would what? Well, I just thought that because of that they would just be this amazing person that walked in, and they would do things the way that I would do them. They would just own it. And they would just be amazing. And I said, yeah, no, that's not what makes them amazing. You see, being a professional is not about having all that stuff. It's okay to have it if you want to have it if you want to learn, but you know, what? What are the traits, the characteristics that you're looking for with a person? Whether it's a front desk, whether it's a therapist, whether it's a clinical director? Who are they? Who are you looking for, because that the person that's going to walk in, and that's the person you're gonna get. The other aspects the skill, let's face it, we can train someone for any skill that's out there. There is a course for it. There is of course, a certification for him. There is a continuing ed for which you can't really change who someone is. If they're not a timely person, then they're not a timely person. If they're an introvert, they're an introvert. I mean, if you want an extrovert people person and you hire an introvert with a great resume, you're gonna get an introvert with a great resume. But if you hire someone hungry, if you hire someone that just has the, the, the, the characteristics, the character that you're looking for, who believes in what you're doing, who shares your values, of integrity, of timeliness, of commitment of just doing what's right. Give me that person every day of the week, and I will train them on the other stuff. But Karen, here's where some of the challenges occur. What if you don't actually have a training process?
29:33 What if you don't really have a hiring and onboarding process it's kind of some I don't know just something you kind of do. Their lair lies the problem. The real challenge is you don't have that. And if you don't have that you do the hope and pray method. I hope I the worst that kill me is Jamie. I think I hired a rockstar and I go oh boy. Here we go. Because hiring a rockstar is the hope and pray method. In your mind, they're a rockstar because you are hoping that they are because you don't have time to deal with this. Because you need to move on to something else because you are overwhelmed. Give me someone who's passionate about playing the guitar, and I will turn them into a rock star, but a rock star at my place. I don't need a rockstar at someone else's place. Because rarely, if ever, does that convey in someone being that a player at my place. So that's the biggest thing. really sit down, write down what are the characteristics that you want for this position? Are they outgoing? Hi, Quickstart, you know, talk about their emotional intelligence, are they detailed oriented, they follow through communication skills, you know, relational skills, like really get clear again, on the type of person that you want. And if they're not that person, no matter what their resume says, then maybe they might fit another position. But you want to be really careful about bringing them in, because it's an expensive endeavor that you're making. You don't want to make the wrong investment.
31:14 Yeah, absolutely. And I think I'm just gonna repeat that one more time. Hire for traits train for skill, just so people have that embedded into their freight train for skill. Yeah, yeah. Excellent. Okay, what's the last one? Last
31:31 one, expand your reach? Look, marketing is about awareness. The more you create awareness out in the world, the more opportunities and people come to you, we are in the marketing, of looking for candidates. So we have to use that same mentality, we're trying to find good people, we need to ramp up our efforts. So we need more effort. And we need to expand our reach, we need to explore every channel and open every door that's out there and apply a massive amount of action for a long period of time, this doesn't end we are all Talent scouts, it never ends. As long as you're trying to grow, you're always looking for talent. And if there's a if you find someone, you'll figure out a way to bring them in, because you'll know what they're worth to you. So what are some things you can do LinkedIn, had a friend of mine do LinkedIn strategy, which is basically connect with with people connect with I mean, LinkedIn is a 24 hour, seven day a week networking site, they just connected with people just generally connected with people. And then, you know, said, Hey, by the way, you know, I'm looking for this particular type of person. Do you know of anybody? Would you mind sharing the this as sharing his job description? With your network? I'd really appreciate it. They're like, sure. Now, all of a sudden, he had 567 people 10 people sharing this. Within a week, he had someone in Texas, saying, actually, you know what, I'm just finishing up my rotation, which was kind of weird, because it was at the same place that he actually did a rotation at, you know, some massive sports place in Texas. And the person's he's flying them up for an interview here. I mean, that costs nothing. It costs nothing. So LinkedIn, your staff, if you have a decent staff, they like working there, well guess what their staff there, your staff has a network of people, especially your therapists, give them a referral bonus. Ask them to reach out to their people, you know, great way to network. And we've hired lots of people through people that already worked for us. Your past patients, your contact lists, you know, again, sounds simple. Put it out there, hey, we're growing we're looking for and be specific. We're looking for someone to join our team, someone that has these qualities. If you have to every state has a list you can purchase. Right? I did this several times I purchased a list. It wasn't very expensive. They give you addresses, they don't give you email addresses. It's funny, I can actually go to your home right now, Karen, because you're on that list. I can go to your home in New York. But God forbid I can email you. And you can just you can just say unsubscribe or or just delete me, but I can go to your house. I never really understood that one. But that's the way it is. You can purchase a list, you can send them a letter, hey, put your best foot forward send them a great letter about the position. Are they interested? Do they know someone and guess what? Nobody really gets any good mail anymore. They're going to open up your letter. So that's a little more expensive, but it's still worth it. And of course your network pass candidates students. A longer term approach would be have a student program it is the best way to do a 12 week interview with them. And then you know, you know, obviously there's there's companies out there, there's recruiters out there, definitely a bit more expensive. But if you know what the value is of them of the person that you're going to bring on board, then it might be an investment that's worth it to you. So the key is, if you are a business that's growing, then you can never stop looking for talent. And once you do that, you will start to bring in people quality people, look, most of us aren't these massive companies that need 1020 therapists, one or two people can make all the difference. So let's shift your mind out of the idea that there's nobody out there, there's no good people out there, there are, you don't need a million people, what you need is to get very clear on who you're looking for. And you need to put a massive amount of effort behind it into networks. And I promise you'll find somebody a lot quicker than you think. But don't just put an ad on, indeed, that you got from another person. And think that's all you need to do. It definitely takes a lot more effort these days.
36:11 Yeah. All right. So I'm gonna recap. So yes, understanding what would their worth is. So that's that three times, rule. Be on purpose, make sure you have a purpose, be clear on your vision, values and mission. Hire for traits not trained for skill, and finally, expand your reach. So in all great ways, for owners of any business, of course, here, we're sort of talking about physical therapy. But I think great advice for any business owner in this atmosphere that we are currently in, in an economic downturn in a time where it seems like man, I cannot find good talent, right? So it's looking inward at yourself as to what you're putting out into the world and then putting yourself out there to find those right people?
37:08 Absolutely. I got a fifth bonus one if you want. Yeah, let's do it. Bonus one here, slow it down. Kind of contrary, to put massive effort, but hear me on this. So the biggest challenge we have right now, as people, especially as business owners, the biggest challenge we have is a lack of focus. If we could just focus on what we wanted to get done, we'd get it done, because we're doers, and we can get things done. But we can't because of all of the distractions that's going on. Well guess what, most people hire out of reaction of something else happening. Either someone quit, or Oh, my God, we have an influx of people. So you're reacting to that. And when you react to something like that, this becomes emotional. And when it becomes emotional, we basically just want to solve the problem and move on because we're overwhelmed. When you slow it down, you slow it down in the form of a process. It's a hiring process. Right? One of the one of the most important things that I learned that I did is have actually a clear step by step process and not miss any of them. Because when I did this before, quick little story, I didn't have a process for a long time. You know, I had an ad and I put it out there, whatever, and I hired people. But when I was interviewing people, I wasn't interviewing them. I was basically trying to sell them to come in, I would literally ask them a question and give them the answers to it. Hey, Karen, you know, our values is integrity and honesty. And, and you know, we like to have fun. Is that is that? Do you believe in that too? I mean, that's an IQ test. All you have to do is say, Yeah, I do. I don't I thought you did. Hey, this is a great place. I'd love to have you would you want to come on board? I'll give you whatever you want. Like, just, I don't have time for this crap. I got other things to do. Let me bring in probably one of the most important people that I'm ever going to hire. This was for a clinical director job that I did a half hour interview and that was it. That was the entire interview process, half hour hire the person. Unfortunately, the person ends up getting arrested six months later. Why? Because let's see person improperly touched a woman during a screening process. Well guess what my board found out in Maryland. And I was called in an investigation and asked 156 questions and learned a lot about HR learned a lot about having processes, learn a lot about having policies and procedures. And then I started doing much more of a background check than I ever did. Oh, I did his check to see if he had a license in Maryland. Oh, guess what? In another state. He was on probation for doing something very similar. But he didn't report it to me which was on him. He was supposed to but I didn't even check right out of the have, you know, I just assumed that his references were good? So it sounds like well, Jamie, you're a moron. Well, maybe so. But what I ended up creating was a very clear step by step process that slowed me down to make sure I did a resume review, and did a checklist on it. I made sure I did a phone interview, knowing what questions to ask, then I did an in person interview, then I did a work interview on a work shadowing, then we did background checks. And then we did, I slowed down everything to a process. Now you can go through the process pretty quickly. But you're still checking the boxes, because it was a protection for the company. You see this person getting arrested and doing this stuff. That's on me that's on the owner. And then I come to find out that he was a little creepy to the rest of the staff, who of course, never told me anything, because I was very high on this person. So having a process and slowing things down is critical. Because once you do that, you then can continue to do that for every person you're hiring. And eventually, you can delegate that. So that's my fifth thing is, is slowing it down and creating a process in this. Yeah,
41:20 great advice. That's a crazy story. Holy cow. Oh, yeah. So it definitely behooves you to do a good background check, and really make sure this is the right person for your practice. Wow. All right. So as we wrap things up, what do you want people to leave with?
41:37 Well, I mean, look, this, this is not easy, right now in our world. And, you know, I gave you I gave you, you know, five actual things that you can do right now. And, you know, it's, it's hard. And you know, one of the things that I've that I've created during my turmoil as a business owner for 15 years is I created my own process. And I turned that process, actually into a program into a course called the right fit hire course. And I've used it in my own business ended up hiring really great people, you know, quadrupling my business and ended up selling it. And now I've used it with hundreds of other people. And what I'd like to do is I like to offer that to your audience. The courses is normally for 497. But I'd like to offer your audience take $200 off, you know, just just, you know, you'll, you'll you'll put the link up there. But you know, it's, this is going to save you a ton of time, ton of energy. It's already split up into how to, you know, recruit great people attract great people qualify them, what the interview questions are, how to do the checklist, it even adds job description, sample, job description, sample ads, sample offer letters, it has all the done for you templates, I did all of that stuff. It even has an onboarding process, and even a training process. So it goes through all four of those components, how to bring in people how to qualify them, and onboard and train them. So it's, it's 297, you'll see you'll see all the things that includes on there. But that's, you know, I want to help people during this trying time, and it's just something that I've used, and so many other people have used successfully that I think would be very beneficial
43:26 to your people. That's incredible. So again, if you're listening, head over to podcast dot healthy, wealthy smart.com. In the show notes of this episode, we'll have a link. So one click will take you right to this, this is a great opportunity. So if you are in the hiring mind, I highly suggest for you to check out this course from Jamie, thank you so much. Now, Jamie, where can people find you?
43:49 Oh, they can find me at Jamie at practice freedom. you.com. If you want to email me personally, you can go to the website, which is practice freedom you the letter u.com You can check that out. And yeah, and I'm all over social media, you don't have to look far. And you'll see me all over there. And yeah, if you want to reach out, say hello, feel free to do so.
44:11 Perfect. And again, we'll have all those links in the show notes as well. So last question, what advice would you give to your younger self? Now you got to keep coming up with new pieces of advice.
44:22 This is the hard part. No, I mean, the pieces of advice is you know, and I think about this more and more. It's like, Jamie, be vulnerable. Be open. One of the books I read, you know talked about being a broken, broken, open heart warrior. Be a broken open heart where we all are broken, we're not perfect, but just open your heart allow the good stuff coming in. There's a lot of great people in the world who want to help you. But it's hard to be helped when you think you know it all and you're closed off and you're and you're just resistance and And I've been like that for so long for so many years and my world changed when I just started to be open and vulnerable and saying, You know what, I don't have all the answers. And that's when so many good things started coming in to my life. And I always try to remind myself when I start to get a little bit of too much ego and remind myself a little bit of, you know, be vulnerable. It's a powerful thing.
45:22 Yeah, I love it. That is excellent advice. Jamie, thank you so much for coming back on the podcast. I know this information will help so many people. So thank you so much.
45:33 Thank you, Karen. Appreciate being back. Absolutely. And
45:37 everyone. Thanks so much for tuning in. Have a great rest of your week and stay healthy, wealthy and smart. | |||
| 596: Michelle Hext: How to Price and Package Premium Offers that Sell Themselves | 05 Jul 2022 | 00:45:45 | |
In this episode, High-Ticket Mentor, Coach, and Founder, Michelle Hext, talks about creating successful high-ticket offers. Today, Michelle talks about her story from running Martial Arts studios to high-ticket coaching, the reasons why offers don't sell, and the importance of keeping it real. What counts as a high-ticket offer? Hear about avoiding market research and analysis, determining your pricing, the pandemic's effect on business, and get Michelle's advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Michelle Hext For over 30 years, Michelle Hext has been a mentor, and since she was a child, the business of creating, growing, and scaling high-value products has been a part of her DNA. Michelle has a history of building successful brick-and-mortar businesses and online companies. Her area of expertise is helping entrepreneurs create high-cost brands. This involves launching, growing, and scaling high-cost offerings. So, her clients can only choose to work with high-end clients who want results. Michelle's regular audience is people who want Launch & Scale, a high-ticket coaching brand. She's trained hundreds of coaches and experts a year with her mentor program. So, Michelle has a pretty good idea of the kind of content they listen to.
Suggested Keywords Healthy, Wealthy, Smart, Business, Success, Offers, Social Media, Branding, Packaging, Confidence, Monetization,
Special Offer: 5 Days to 5K
To learn more, follow Michelle at: Website: https://www.michellehext.com Facebook: Michelle Hext Instagram: @Michellehext
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:02 Hey Michelle, welcome to the podcast. I'm happy to have you on. Thanks for joining me.
00:07 Thank you so much for having me. I'm happy to be here.
00:10 Excellent. And before we get into, I'm sure what a lot of people are tuning into here is, how do we create and sell high ticket offers, which I promise we will get to. But before we do, let's talk a little bit more about you. So tell the listeners a little bit more about how you got to this point of where you are helping coaches and entrepreneurs create, sell and position their business for high ticket offers.
00:37 Yeah, so I started, you know, my very first business was back in like, we're going back to the early 90s, the very early 90s. And my first coaching was in the form of martial arts, I owned martial art schools, and along the way, developed a bunch of other things to bring to my skill set. So in 1991, I started instructing Taekwondo, the martial art of Taekwondo. By the mid 90s, I had my own schools. And, you know, you get to a point where you're instructing and teaching people to fight for contact, and grade for a high belt levels, like black belt and things like that. And you know, you're alive as a coach, because a lot of resistance comes up for people. And so I always, am really happy that I had that that early training in coaching about helping people to overcome resistance. Resistance is resistance, it doesn't matter whether it's whether you're going to launch an offer, or whether you're going to go and fight or grade for about, it's all very, very similar. So it really taught me to help extract the best out of people. And it also really taught me that people are very, very different. And you could instruct one person in a certain way or say things to them in a certain way and draw out the best of them. And it would have zero effect on somebody else. So really got a good education in human nature, and how to read people and how to get the best out of people. So I had my martial art schools for a number of years, still trained today. So it's still a very big part of my life, but it's no longer part of my business life. I outgrew the bricks and mortar business model, it just didn't challenge me anymore many, many years ago. And so along the way, I've always been a bit of a natural entrepreneur. So even when I had my martial arts schools Tibo was the thing. And so I decided I was going to create my own Tibo type program. So I called it power. And I had somebody come in and film me. And this was before even DVD. So they recorded them. And I was selling these in martial arts magazines as cassette tapes, like video cassettes with a with a manual, because I wanted to bring that type of workout into martial arts school safely. I wanted them to be able to leverage this new phenomenon, but I wanted them to be able to do it in a way that they felt confident to deliver it. So I created this syllabus and branding and all that sort of stuff and sold that through magazines. And I was always doing different things like that looking for different angles. I became a personal trainer, I as well, to add to my martial arts school, I, I had a full time center and I added a personal training studio was always just looking for ways to increase my bottom line, and to keep myself interested and inspired in the work that I was doing. And in around the 99, I think it was coaching became a thing, it became an actual industry that was making a noise in the US and it filtered its way back to Australia. And I thought, This is what I do anyway. So I'm gonna go ahead and do this. So I went and got myself qualified as a coach. And I've been coaching ever since. So at one point, I had taekwondo school on one side of the street and my business coaching offices on the other side of the street. And I was juggling both and young children and all that sort of stuff. And just over the years, it's been a very I guess I've followed my nose, but the business that I have now, where I work with, you know, high level clients, they invest quite significantly in me because they they want to create some success pretty quickly. And it's all just been an evolution of the same sort of thing. So my first high ticket offer was off of the back of a book that I wrote called The Honorable martial arts entrepreneur. And it taught people how to niche their coaching business, sorry, the martial arts business, how to market it and all those sorts of things. And that was off the back of me launching a women's only martial art school that was very successful.
05:00 And then I moved into the female entrepreneur space and launched a 27 and a half $1,000 mastermind, within like four weeks of launching that brand, and had a $200,000 launch, it did really well, it was a lot easier to sell to female entrepreneurs than it was to martial art school owners. And then I've been doing very similar work ever since that was 2014. But I've just really narrowed my niche now to work with coaches and consultants, because they're, they're the people that I had the most impact over and in this industry specialists who want to move into that coaching consulting space. And so now I work with clients from kind of all around the world. My fee these days is 10,000 us a month for four weeks, which is a long stretch from when I first started, I think I was charging 1200 for 12 weeks or something like that. So it's not necessarily been very strategic, it's just I paid attention to when it was time for me to grow and expand into the next kind of level. And I've just done that, without too much fanfare or drama or anything like that. I've just yeah, really just trusted my instincts along the way.
06:16 That's quite the evolution of being an entrepreneur, you know, starting with the martial arts studios to where you are now. It's quite a journey. And thanks for sharing that. And I think it also at for me highlights, what one bout of let's say, education or position, you know, as a fifth degree black belt, correct? Yes. So your training as a fifth degree black belt has really spilled over and helped to, I think inform you going forward. And a lot of people who listen to this podcast are physical therapists, their trainers are entrepreneurs. And I think it's so important, like, you don't give away your let's say, in my case, I'm a physical therapist, I can use that physical therapy education, to improve coaching programs, and to inject it into coaching programs, because of the years of experience as a PT, just kind of like what you did as a coach.
07:23 Yeah, and nothing is ever wasted. You know, I, I had online fitness businesses as well. And I remember there were women who were coming along and participating in my online fitness programs. And one of them was in my business mentorship program. Last year, we're talking a span of close to 20 years, you know, these women come along and they they participated in my programs, then they became personal trainers, because they were interested in the fitness space. And then they were using me to help them grow their businesses. So it's, yeah, and all of the things that I've learned, whether it's the fitness stuff, whether it's the martial arts stuff, whether it was the taking myself back to school stuff, and never using the course that I enrolled in and, and things like that nothing is ever ever wasted. And I know you're gonna ask me a question about competition, you know, and saturated markets and things like that. And I'm going to kind of segue into that if you're okay with that, oh, for the what, what, I don't believe there is any competition, I don't believe I have competition, I just don't consider that I never have regardless of the business type I was running. And the reason is exactly what I just spoke about, nobody's had the same education experiences, life experiences, or anything else that I have had, nobody is going to have my unique take on things, or my unique approach to the way that I do things and see things and, you know, am I able to take a big picture and simplify it into the, you know, a three point to do list sort of thing, because that's just the way that I've consumed information and processed it and how I you know, all of the different things. And it's the same for any coach, any consultant, you can have, I love to use this, this example. So you can have somebody that is looking for, let's just say a social media coach, right? Say somebody is in the market for a social media coach. And I want you to imagine that there are 20 Social media coaches all lined up sitting at a sitting in a row. And we have 20 people coming along to hire a social, social, social media coach, and they all sit down and it's like speed dating, they get to go and you know, have a conversation with every single social media coach and choose the one that they want. They're not going to pick the same one. Because what's going to come into play is, oh, you've got young kids as well. Oh, I know what a handful that is. Oh, you like martial arts as well. Oh, wow, I trained in martial arts, they're going to connect with the human being and human beings experiences and things like that. And so the biggest thing that you can do to avoid competition is trying to be like everybody else. Just always be 100% yourself and let all of the weirdness and the quirks and, you know, all these parts of you that make you up, be there, you know, I, I would never say, Well, I'm just not talking about martial arts anymore, because that's just not what I do. Like, people remember that I have a fifth degree black belt, you know, it says something about me. It's not relevant to my business these days, but it's something that people will remember. And so yeah, that's my little kind of rant on that.
10:43 Yeah, no, I think that's great. And I oftentimes, we don't, we, we feel like revealing too much personal information could be detrimental. But like you said, that's the way someone's going to connect with you. So it's okay to reveal some personal information, some background information, I'm like, obviously, you don't have to give away like your personal medical history if you don't want to. But it's a way that people can make a connection with another human being.
11:15 They want you to be real, you know, I have this this phrase that I, I'm writing another book at the moment, and it's what I say something along the lines of, they don't want you to be another instance step by step and printer, you know, where it's like The Stepford Wives sort of thing. They don't want that they don't want you to look like every other person on social media, they want you to be you, they want you to be real. And if we have a look at people like Celeste Barber, the comedian and we have a look at in Australia, we have a woman called Mia free, Friedman, who has she hosts a website called Mamma Mia. And she's always looking like a hot mess. You know, she's doing her live streams, putting makeup on and the washing powder in the background and things like that, you know, people I mean, you've got to choose your market, right? Mike, you're not going to see that in my space, because I'm operating in a you know, a different brand. But people love those women, you know, they love the relatability. And so, you know, we've got to walk that fine line between depending on our brand. But for me, it's like wanting to be aspirational and inspirational, but also keeping it really real. So people understand that, you know, I'm just a regular being like I'm wearing I showed you before, I've got a lovely top on and earrings, and I've got my workout gear on down the bottom. So I can race out and go to the gym. And I don't hide that, you know, I talk about that. And so I want people to understand that sometimes, you know, things look so polished in brands, that they just not people feel like it's not attainable. They feel like it's just an overload overwhelms people. So we want to be able to keep things real.
12:52 Yeah, excellent advice. And now let's get into talking about high ticket offers. First question, what is a high ticket offer? What is considered high ticket?
13:03 Yeah, so, um, you know, there are all different, I guess, explanations of what a high ticket offer is. For me, there's no magical figure that you crossed, that puts you into high ticket territory. It's very, very much subjective and individual to the person. So I've worked with clients who were charging $100 for a coaching session. And suddenly they have a two and a half 1000 or $5,000 coaching package, that's high ticket for them. I also work with clients like a client recently sold an $85,000, US dollar paid in full upfront coaching package. And that was a 12 month package. Amazing. She's an E commerce coach. But within about two weeks, I messaged her and I said, we've got to cut that back. That's going to be a six month course you can't be doing that for 12 months. And she's like, Yep, cool. But we sometimes play around with timeframes and things like that to get used to charging the higher prices. And for my clients to feel really confident in selling it because the confidence is a big thing. But coming back to the high ticket offer thing. For me a high ticket offer is a price point that feels really big for the for the for the coach putting it out there. And oftentimes for the prospective client as well. It means that you're purchasing or you're selling a premium offer. The client is expecting a premium level of service and because they get that you have the ability to work more closely with those clients, give them more thought time even if you're not with them. And so the results are better. Always. You know, I had a client sign up. I was in Fiji a little while ago. We had our first session on Tuesday. By Thursday, she had sold two coaching packages two days, you know, which is incredible. So she hit her coaching sorry, her revenue goal within two days. That was the monthly revenue goal that we had set up And so yeah, it's giving them the confidence and all of those sorts of things to go out there and know that they've got a rock solid offer that's going to impact people and all that sort of stuff. And then they, they sell.
15:13 And I'm sure that you work with your clients, looking at market research, and whatever the niche it is that you're trying to sell this high ticket offer in? Do you know what I mean? So, you don't
15:28 know No, no, no, I don't want my clients looking at anybody else. I don't want them doing any research. I don't want them doing anything like that. Because what that does is it distracts them from what is their zone of genius. So it's almost like, if you imagine my, my clients come to me, and they're a glass of perfect water, you know, it's very crystal clear, it's in a clear glass. And then they start to look outside, and they start to get ideas. And every one of those dumb ideas they bring back is like a drop of black ink that goes into the water, you know, and it muddies the waters, and we don't want that. So it's my job, whether it's one on one or through my programs or whatever to help them extract what is unique and special about them that they can deliver into the market. And then we you know, we shape it into a monetize product. But I want them to get clear about what are they love to do? Where do they have the greatest level of impact? Where can they produce the best type of results? What's the work that feels effortless to them? And then the biggest hurdle, the resistance is helping them to understand that that is enough. You know, because typically, they want to add bells and whistles or go learn something or something like that, but they don't need to. Right. So if we look at, for example, your physical therapist, you've created a an incredibly successful practice. Or maybe it's you've created an incredibly successful podcast in this space. And so if you said to me, you know, I want to, I want to teach this, I want to work with clients so that they can do this as well. I'm not going to send you to do right market research, hell no. I'm going to say, Okay, let's figure out, you know, all know, if there's, if it's the offer makes sense or not. Or if there's a market for it or anything like that. And I will tell you straight away, no, that won't work, or no. Like, I've seen that before it doesn't work or whatever it is, but I'm going to help you figure out how we get to harness what you have. How you would do it. And then yeah, create a way to monetize it.
17:41 Yeah, so you don't get into that wheel of like analysis paralysis, right? Where it's just or worse, comparing yourself to others and then get, then maybe you might run the risk of giving up 100%. So
17:55 my client that sold two packages within two days, she would never have done that. If she went around and tried to figure out how other people are doing it. And then getting into this comparison itis because somebody's website's prettier. You know, it's like, no, that's not what we want to be doing. So yeah, my advice to your listeners is go into your bubble, and don't look left or right, like look within because everything, everything you have is inside of you. And if you don't know how to get it out of you, in a way that makes sense in a way to package it. That's when you get help but, but ensure that you you find somebody that's going to help you pull out the best of you not say, Hey, I've got this system, let's just mold you to fit this system over here. We don't want that.
18:41 And, you know, I was gonna go into sort of five reasons why your coaching offer or your high ticket offer isn't selling, I feel like we might have gotten number one, I think we might have one that we just talked about. Right? Is not looking out and looking towards everyone else.
18:59 Yeah. So there are a number of reasons, right? So the first reason is, it's not clear. So they're not clear about what it is that they're actually selling. And the content, whether it's a sales page, whether it's an email, or whatever it is, it's not giving enough detail about what this is about. So we can get in our own head, right? Because we know what we do. We know exactly. And so if we take shortcuts on the explanation, people will miss the point. Another reason people aren't putting enough of themselves on the line. So what I mean by that is you've got to go on, make a big promise and then just back yourself that you're going to be able to back up that promise you're going to be able to deliver it. And so one of my programs is called the for 5k formula for coaches, I first launched this in about 2016, or 2017. It used to be a $5,000 coaching package, four week coaching package. And the way that I sold it is create and sell your first $5,000 offer in four weeks or less. And 90% of the people did, some people didn't, but like, that's the industry we're in, nobody has 100% success rate. And so people were buying that I couldn't keep up with the demand, I had to leverage it as a group program. After that, I couldn't keep up with the demand, because the promise was really frickin clear. Pay me $5,000, I'm going to show you how to make you know, at least that in the first month, most people saw between two and four packages. And like, that's a no brainer, right? It's a no brainer for people to do that. But if I said to them, Hey, you know, I'm gonna teach you how to price and package and position your offer over four weeks, like it's kind of compelling. But it's like they want to sell it like what they want, ultimately, is to make money, they want to be selling this thing. And so for me, that's the big promise, I'm going to show you how to, I'm going to show you where to find that first client and make that first sale. And so a lot of times that that big promise isn't anywhere near compelling enough.
21:19 Yeah, got it. So not enough detail of what it's about which I you know, I've seen so many times I'll be on I'm like, What is this? I don't yet, it's just you know, it's the sales page that keeps scrolling and scrolling. And you're like, I don't know what's happening here.
21:37 So even if people have spent money on copywriting, the copywriter hasn't got the instruction that you've given them about what this is what this isn't, this is what people get when they do it. Like they're gonna wishy washy it all over the place and have beautiful language, but nobody still has a clue what it is
21:52 no clue. Not enough. So not delivering on the promise. Right? So making them not miss making the promise.
22:01 Yeah, right.
22:03 What else? What are some other reasons why your offer isn't selling?
22:09 Usually, it's not about the price, but people think it's about the price. So they'll tell themselves things like, Oh, I think I should charge less for this. And then it still doesn't sell. And it's because of another reason. It's because it's not clear. Or it's because you're not confident in your ability to deliver the offer. And the energy is a little bit funky. And you might be saying one thing, but if all your energy is saying something else, and people pick that up on the internet very, very easily. Yeah, why else be because they're not asking for the sale. It's like, they're creating content to Wazoo all over the place. And they just expecting that people are going to make the the leap from Oh, she's telling me this nice thing that's very useful. Oh, let me go find out if I can work with her. And if there's a way to work with it, and that doesn't happen, right? We're busy, we're scrolling. We've got to stop the scroll. We've got to engage people with our content. But then we've got to say, go buy this thing. Go buy this thing or jump on this call or whatever it is. So yeah, no call to action. There just isn't a call to action.
23:18 Yeah, yeah. And circling back to having this funky energy or, you know, not feeling confident. So, in my mind, I think mindset issues. So how do you work with your clients, when they're in that mindset mind set of maybe not being confident and feeling bad about charging money for their services? I'm sure you've heard that in the past.
23:47 Yeah, yeah. So I'm just gonna add one more thing, and then I'll jump on to that. The other thing is the sales process. So I saw an offer the other day, and it was like $5,000, for four weeks or something like that. And it was a Facebook ad ran directly to a sales page and a Buy Now button. And it's like, people don't buy like that, like, you know, give them a you know, warm them up with a lead magnet or some sort of content, have a on the on the sales page, have a, you know, book a discovery call, or, you know, message me to find out more or something like that. But it's like that sales process is screwed up. And it doesn't make sense. So the higher the offer, the more usually time you're going to have to spend letting people know especially if you're dealing with cold traffic, warm traffic is different. But a lot of people are trying to point $5,000 sales pages at cold traffic, and it really doesn't work. You're just wasting money. So that's that. And when it comes to the mindset stuff, and you were asking me, so if a client, you know, they're not confident and all that sort of stuff. My clients don't pass go unless they're confident. So there's a reason and it's just because I've been doing this such a long time and I see it so so we've got a client and we've got a package So the one that sold to in within 48 hours, like we could have gone with a $5,000 offer, because that's typically where I start my clients. And she's like, oh, yeah, it's definitely worth 5000. I'm like, I'm not convinced that you're convinced. And I said, How do you feel about just selling the first two for two and a half and just get some sales in? And then we can put the price up? She was like, yep. So she went and sold it. Like, it was like nothing, right? And so sometimes I want to manipulate it so that if they feel like 5000, like, I can do it, I can do it. Yes, I believe it. But it's like, I know, they're gonna have to labor emotionally, and do you know, get themselves riled up to be able to go and do that price? Whereas when I create a $5,000 package, and they're all in with the $5,000? And I say, how about we knock a couple of 1000 off, and you just get some quick sales? They're like, Oh, yeah, I can do that. Because it's not the price. It's the, it's the confidence around the deliverability. And sometimes, if this is the first time you've sold this package, you're going to be telling yourself things like, what if I can't get a result, and I always say to my clients, well, I can put that fear to bed right away, because there are going to be clients that don't get results. That's just the industry we're in. So you're gonna have people who don't get results. So we're gonna stop worrying about that. As long as you can put your hand on your heart and know that you did everything that you could to provide the right framework and to provide the right support to get people help you, you can charge that price, and you can make that offer. So yeah, well, we're sorry, what was your
26:37 question? Yeah, that was that was the question. You're talking about mindset? And, and what do you do? If you you're Yeah, you know, you don't want to charge or your Oh, so hesitant?
26:52 Yeah. So I guess it's a combination of mindset work, and practical work, right. So sometimes it is more mindset, where it's just like, you know, I feel really, you know, I feel a bit like awkward about reaching out or during discovery calls and like, well, let's not do on like that. Like, I can make use journal and like, you know, try to get your head right for the next week over this, or we just change it so that you feel good about it. And so they might say, oh, yeah, okay, well, I don't want to do this. And I'm like, Okay, well, how else can we do it? And so oftentimes, the resistance, I think this is really important. The resistance and the mindset work. If you're having to do the mindset work, here it is, if you have to do the mindset work, something's not right. It means you're not confident on some level, you don't feel confident in the sales process, you don't feel confident in your offer, you don't feel confident in your messaging. So figure it out. Because 100% confidence will tell you that you've got you're on the right track. And don't be okay with 70%. You know, do the work to get clarity on your offer and to feel really good about it.
28:03 Yeah, excellent advice. And here's another question, when do you raise your price? Right? So I'd say okay, I'm really confident, I've got an offer at $2,500. And I had this offer up for six months, people are purchasing it. When do you say okay, I think it's time let's raise it to 35, or four or five, whatever it may be.
28:28 Yeah. And so, with regards to my client that I said, let's just go sell a couple, like, the next one will be maybe three and a half, maybe four and a half before we get her up to five, unless she's fully ready. So for me, that's part of my strategy, and she's just going to run with it. But if it was, like me, personally, so back when I was charging 5000 US a month and selling the 5k formula, when people were selling two, three, and for these packages, it's like, I feel like I'm being ripped off charging people $5,000 When they're making this, and then they're gonna continue to make it, you know, they're gonna 20 $30,000 months. It's like, that doesn't feel like enough. So I put my price up to seven and a half. And yeah, and then so my client recently that sold that $85,000 package, I'm looking at my $10,000 a month fee, and I'm thinking it's about time to put it up. So, yeah, I want to get a handful of like, super, super, super high end, ridiculous results, because then that's the same philosophy. I apply to my clients. I want to feel confident, it's like, I know, I'm gonna give them 100 grand, I know they're gonna get 100 grand back in the first couple of months of working with me, so I feel okay about charging 20,000 a month. Yeah,
29:46 got it. Got it. So it's sort of based on what results are you getting for your clients and your How comfortable are you moving to the next level? Yeah, for math. So yeah, yeah, got it. And now over the past two years, obviously we are we have lived through the COVID 19. pandemic, we are still in it in most parts of the world. I don't know where Australia is at the moment, but here in the United States, we are still in the thick of it for sure. So how do you think that COVID has changed the online? Offer space? Right? Because you had a lot of people moving online.
30:32 Yeah, it was incredible. It was like the early days of the Internet was amazing. So you know, I, I've had a lot of people following me for many, many years and had a lot of people that were not reliant on online, who suddenly had to be like this whole online thing you've been talking about, you know, can we have a conversation, so my business definitely picked up, it was easier to sell anything. There are just a lot more people online. And it was easier for me to, or it was easy for me to attract more clients and feel more programs and things like that. But it was equally as easy for my clients were doing new launches, you know, they weren't launching themselves for the first time, because they had eyes on them. It seems it's settled back down to not quite pre COVID. There's still a lot more people online and a lot more people wanting to move their businesses online, or be, you know, all online now and things like that. But definitely it created, it created a massive boom. And the other thing was, you know, the ads were a lot cheaper. The traffic was a lot cheaper, too, because people just stopped. So yeah, it was it was a great time, business wise, for sure.
31:46 And we sort of touched upon this earlier in the interview. But do you think because of that things have gotten overly saturated?
31:55 I don't believe in saturation, I really don't. And I look at the amount of people that move into coaching every year. I don't know what the numbers are. But there's hundreds and hundreds of 1000s of people that are coming into the coaching space. Many, many, many, and you know, there are going to be a lot of coaches out there who fail are going to be a lot of them, you know, but they're going to try and they're going to be needing services. And they're going to need coaching and mentoring and things like that. But yeah, I just don't, but I don't believe in saturation for the reasons that I spoke about before. Like, I'm a business, essentially, I'm a business coach, Online Business Coach, but there's not a lot of people that can compare to the way that I do things. Because there's only one me and people will you know, there are business coaches out there who are focused on lots of different things, right. So there would be business coach, as you spoke about earlier, yes, you've got a business coach is going to send you out there to do market research, and all of those sorts sorts of things. And there are going to be clients who are very attracted to that, because they want that information. And that data to make decisions on my people are not those people. My people are very, they feel their way into decisions. You know, they trust their instincts and things like that. And so those people are never going to be attracted to me in the way that I do things that would freak them out. So yeah, it's, there's always going to be people for your market. So rather than thinking of saturation, think about okay, I own a corner of the internet. This is my show, how do I show up on my corner of the internet, with my people on the internet in a way that helps them to pull the trigger on reaching out on whatever it is like, show up, share your message be consistent about the message. I just had to kick a client's but this morning because I'm like, Who are you? And what are you doing? Like two weeks ago, we were this? Like, we need to get back to you know, focusing on this, this? And so give things time. So work out what do you want to be an if you want to be an influential leader in a space, what is your space? What is the message? What are the things that you're saying? Who are your people get clear about all that and show up for those people? And they will come?
34:23 Yeah, yeah, yeah. Perfect. And you know, we do the same thing in physical therapy. Right? And we kind of use a lot now in physical therapy. People are niching down. So you're, you know, you work specifically in sports or pediatrics or pelvic health and people come?
34:41 Yes. Yeah. I've had three hip surgeries. I'm not going to anybody who doesn't specialize in hip rehab, just aren't doing.
34:49 Sure. Yeah, absolutely. Now, before we begin to wrap things up, is there anything we missed any points that you want the listeners to to to drill into their brains when it comes to crafting and selling these high ticket offers.
35:08 Yeah, I think the first thing that the timing I think is the thing. So if we talk about the steps, the first thing that you want to do is get clear on like, what is your zone of genius? What is your skill set that we can monetize. Then, from there, create a package that you feel excited about, you feel like it's well priced, you've made your big promise, like spend the time developing the offer concept, until you feel really good about it, and then start talking about it. So don't be showing up on social media and all over the place, sharing a wishy washy washy message with no call to action, and people don't really know what you do. Be clear about, okay, I am the face of this, this is who I am, this is the space that I'm leading now and show up there, then you can talk talking about your offer is very, very easy. So you know, right now I've got a pricing and packaging challenge that's going to come up in a few weeks. And so all I'm going to be talking about is how important pricing and packaging is. You know, that's all I'm going to be talking about. So if you're a social media coach, and you specialize in tick tock, don't talk about other things. If you're an E commerce coach, and you only work on Shopify, don't be talking about other things become the Shopify specialists, be the specialist in the space and keep your messaging narrow, so that people know Oh, that's that person that does that. And 100 people in your space might not need you, but one will. And if you're a high ticket coach, you don't need very many clients to make a lot of money. So forget about having hundreds of 1000s of followers, focus on you know, the 10 that you've got, because your your first client is going to be there. And then build from there.
36:52 And love it. So get clear on your zone of genius. Create the package, talk about it all the time. Don't be afraid. And really focus on the audience that you have. Yes. Perfect. All right. Well, that's great. So listen, where can people find you? What do you have coming up? You just mentioned a pricing and packaging challenge. So please tell us all about it and when it starts, and how can people find
37:20 you? Sure. So you can find me on Instagram. So I met my name, Michelle hEXt. My website is Michelle headstock calm. And the challenge is it's your 5k, offering five days, create your signature high ticket offer in less than a week. And it starts on the 21st of July. It's going to be it's $97. So it's just a taster program. And over five days, I'm going to be helping people to unpack all of those different bits and pieces so that by the end, even on day five, I talk about building out your digital assets and things like that, like how to sell it how to onboard. So we're going to start with broadly what is your sweet spot uncovering that, we're going to be covering things like building out your offer framework. So the six, the success pathway your clients will take, we do this first, then we do this, then we do this. I'm going to be talking about copywriting and sales page concepts. And so it's very practical. We're going to start from, like the mind set stuff. And then we're going to work all our way down to being really free. Yes, which is Get ready to make that first sale. And we'll do that over five days, and I can't wait to launch it.
38:34 Sounds amazing. And I think I may take you up on that. That challenge. So again, that starts on the first of July. And we'll have links Sorry, sorry, 21st 21st of July. And again, we'll have links to all of it in the show notes over at podcast at healthy, wealthy smart.com. So if you didn't write it all down, just go to the website, and it will have everything on there. Now, last question, it's a question I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self?
39:08 I would have focused on one thing instead of 27. Like figured out like what is my one thing, and then I would have taken it all the way because when I did that, that's when everything turned around for me when I was trying to juggle too many things. And I had 75 Facebook pages and 75 accompanying Facebook groups and you know, all that sort of stuff. I was very busy and I was making money but I was exhausted and I wasn't a specialist in anything. So figure out you know, become a specialist and focus on the one thing, take it all the way nothing bad will ever come from that because when I did that with the honourable martial arts entrepreneur, I had my first $30,000 a day it was a it was a massive jump up from what I'd been doing. And then when I went to do it next time with another brand I had called The Art of kicking us elegantly. It was faster, you know, because they'd already done it. And I'd learn. So focusing on one thing is, what is my offer? How am I going to sell it? What is the marketing? What is the lead magnet? You know, I just built that system and took it as far as I could take it until it was time to pivot. And then I knew how to do it. Just change the branding and things like that. So yeah, focus on one thing, take it all the way, don't quit, just keep going. Because you know that that image we see where the the man's like got the Pekinese in the cave and they miss it by just an inch. You never know how close you are. So my rule of thumb is give it your full commitment for 12 months. And don't waver, just figure it out. If you love your offer, and it's not selling, figure out why it's not selling, if it's selling, but it's not selling enough thinking, Okay, how do I get more people to buy it, be thinking about how you can make this bigger, better, stronger and more successful? Not this isn't working, I need to try something else. Like be committed, if you know the offer is solid. And you know, you're good at what you do. Stick with it until you get where you want it to be. Because it is just a matter of time.
41:07 I think that is great advice. And I think another takeaway for me, as you were saying all that it's okay to pivot your offer. It's okay to have a different offer. And once you've got the framework in place, it's a little plug and play, right. But it's like you don't have to go to the grave with just one offer.
41:25 No, no, no, no. But you've got to make you've got to know how to make that one offer work. And we've got to know how to make that one offer work and be profitable before we start to scale it or bring other products on board. Yeah,
41:40 yeah. Yeah. What great advice. Well, Michelle, thank you so much. This was great. There, I took so many notes so much so much for the audience to dig there. dig their heels into here and and really, hopefully start to make a change. Because I know a lot of people that listen to this podcast are in this world of trying to figure out how to make their mark in the digital world. And, but but not only that, really find a, an offer that's unique to them that can help others. And that's where I think a lot of people that listen like they just you just want to help other people succeed.
42:19 Yeah, and it's creating that win win, you know, so you're winning, you're signing clients, and they're winning because they're getting the result that they need. For sure.
42:28 Exactly. So going in with a win win attitude is everything. And so with that being said, thank you so much for joining me today, and I'm excited for your pricing and packaging challenge. So thank you so much for sharing that.
42:45 You are very welcome. Thank you so much for having me.
42:47 And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. | |||
| 595: Dr. Karlie Causey: Every Mom is an Athlete: Practical Tools for Postpartum Recovery | 27 Jun 2022 | 00:31:28 | |
In this episode, sports chiropractor, certified strength and conditioning specialist, pregnancy and postpartum athleticism coach, and level 2 Crossfit coach, Dr Karlie Causey, talks about exercise during pregnancy and the postpartum period. Today, Dr. Karlie talks about planning home exercise programs and preparing athletic women for the postpartum exercise phase, and the idea that every mom is an athlete. What are some postpartum conditions or barriers to getting back to fitness? Hear about setting expectations about postpartum conditions, the story behind Jen & Keri, and get Dr Karlie's advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Dr. Karlie Dr. Karlie is a sports chiropractor, a certified strength and conditioning specialist, pregnancy and postpartum athleticism coach, and a level 2 Crossfit coach. More importantly, she is a mom to two, who is ridiculously passionate about helping postpartum athletes and moms-to-be restore their bodies and move with confidence. This obsession led her to establish Jen & Keri, a postpartum activewear brand for athletes, and create her wildly successful Postpartum Restoration Plan. Beyond being a mom and a competitive fitness lover, she has spent the last 17 years of her life studying the human body and learning how it moves. Earning her doctorate of chiropractic and a master's in human biology were just a start; she doesn't plan to stop learning any time soon! She is certified in the Webster technique and BirthFit, and has served as the team Chiropractor for the Seattle Seawolves and as the local medical director for AVP Seattle.
Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Pregnancy, Postpartum, Motherhood, Exercise, Rehabilitation, Athletics, Training, Empowerment,
To learn more, follow Dr. Karlie at: Website: www.karliecausey.com Instagram: @drkarlie
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:02 Hey, Dr. Carly, welcome to the podcast. I am happy to have you on and excited to talk about exercise during pregnancy and the postpartum period. longtime listeners of this podcast will know that that this is a topic we talk about a lot here. So I'm really great to have you on to get a fresh perspective of things. So welcome.
00:23 Yeah, thank you so much for having me. I'm excited for for our chat.
00:28 So before we get into the nuts and bolts, can you give the listeners a little bit more insight into you and as to why you chose this sort of subset or niche of folks to see?
00:42 Sure, yeah, well, I've been a sports chiropractor now for Gwent, this is a will be my 12th year. So I've been doing that for a while. And I've always loved working with women in general, all walks of life, all stages of life. But when I became pregnant, I really as I feel like it happens for many, many healthcare providers, you really start to embrace the stage that you're in a little bit. So I really started to learn a lot about how how women progress through pregnancy, how they can continue working out how we can minimize, sort of, you know, things that can happen to that are detrimental after the baby comes. So I just really, really dove into that area of expertise. And it just hasn't stopped since then. So I found it very helpful to to have someone walk alongside me during my pregnancy, pelvic floor pt. And so now I try to be that person for a lot of my patients, too.
01:46 That's great. And listen, the more help we can give to women pregnant, and especially in that postpartum period, or that fourth trimester is, as it is called, I think the more people who can offer help, the better because it's not like people are not going to ever get pregnant again. So yeah, have that help. It's really important, and a lot of women just don't know. Right? They don't, I don't know what you don't know. And so if you're not in the healthcare field, there are so many questions, the body changes so much you're feeling maybe Weird Things You Didn't feel before. So getting back to exercise can be a little nerve racking. So
02:26 Oh, go ahead. No, go ahead. I think that, um, you know, it's becoming much more common to talk about this, and that women are wanting to work out more. And what's one of the benefits of social media, you know, is that we're seeing some of this stuff and able to get more info, you know, I talked to friends who had kids 10 years ago, and it just, it doesn't exist at all really, you know, and as far as like, information that was readily available. So I'm happy that, that we're trending in that direction, at least.
02:54 Yeah, absolutely. And now, let's get let's get into the nuts and bolts here now. So can you give us some practical ways to introduce rehab, introduce exercise, after giving birth, and I love the that were practical, right? Because we're talking about women who maybe don't have a whole heck of a lot of time, because they have a newborn to take care of. So I'll hand the mic over to you.
03:25 Yeah, exactly. Um, I think one of the things that I really liked to stress is that we don't need to wait until the six week mark, to start doing what we consider, you know, rehabilitative exercises. So if with an uncomplicated birth, I often have women starting, you know, day two, day three, especially with just breathing exercises. And what what I see very often is, as women are pregnant as their belly is growing, what happens a lot of times is that diaphragm really gets crammed up there. And so we start to see that they're not breathing as deeply, they're not able to belly breathe. And that diaphragm, we have to remember is the top of the quote unquote, core, right? So their pelvic floor is the bottom, we have our diaphragm on the top, and then all the muscles surrounding but I just like to remind women of that, because that muscle getting so kind of constricted throughout pregnancy is really a big deal. And really, starting on the breath work early on can be really, really helpful. So that's one thing that I really like to emphasize is, you know, at day two, day three, even if you had a C section, you can be laying in your hospital bed, doing some deep belly breathing, diaphragmatic breathing, and you're actually doing a lot more than than you think you are, you know, you're actually starting your rehab journey right there. So that's my first tip that I always like to give. I'm sure you as a PT would would agree with that, right? Like there's just so much we can start with so. So yeah, that's number one. And then the other thing that I really like to emphasize is time small rehab activities. into your daily life. So getting away from the mindset that we have to like set aside 3045 minutes an hour, whatever you used to do, or whatever you think you need to do, and say, Okay, I'm going to do 10, diaphragmatic breaths, and 10, air squats. And every time I set the baby down, or every time I change the baby's diaper, or whatever it is, you know, you can kind of pick what works for you. But I like to do that. Because then it's, it's adding in movement throughout your day, it's giving you a sense of control of like, having these pieces of rehab that you can add into your day and feel like you're working towards a goal. And it's taking away the stress of like, okay, you have to have this time set aside, everything has to go perfect, you have to have the perfect workout outfit on and your water bottle ready and the right tunes and like it just doesn't happen with a newborn baby, you know. So I think taking that stress off is another helpful tip.
05:57 Yeah, it's funny, I just did a social media post about this subject when it comes to a home exercise program that, you know, ask your patient in front of you, I because I have a woman who said, you know, I can squeeze in a couple of five to 10 minutes a day. So if you give me two exercises that I can do in between patients, she's a psychologist in between patients, I'll do it. Right. She's like, but if you say, Oh, you have to set aside, like you said, half an hour, 40 minutes to do that. She's like, it's just not gonna get done. Yeah.
06:32 Yeah, it depends on the person, right? Because then you also have people who want that 30 minutes, like, give me, I am used to working out an hour every day, whatever it is, I want my 30 minutes of things to do. And so it's yeah, it's just knowing your patient and like taking the time to ask them those questions of what's going to make them more successful. And the other thing I like is, if you've read the book, habit stacking, that's basically what I'm recommending to is, you know, tying an exercise to something else that you're already doing. So you don't have to think about when am I going to do this when you know, it's like, I always tell new moms don't tie it to brushing your teeth. Because sometimes that doesn't happen, you know, if we're being honest, sometimes doesn't happen on a on a day, but, you know, tie it to something like, okay, when you pick up the baby, change the baby's diaper or hand the baby to your partner, those kinds of things that you're you know, you're going to be doing, then that seems to be a recipe for
07:24 success, too. Yeah. And like you said, most importantly, just ask the patient what works best for them. Right? We're not them, we're not in their shoes. Maybe this woman gave birth, and she's got a ton of help at home. Right? We don't know. Or maybe it's a single mom who gave birth who doesn't have a ton of help. So always just ask, that is the easiest way to come up with a realistic and like you said, practical home exercise program. Okay, anything else, any other practical tips to introduce exercise in rehab after in those first couple of weeks or months, let's say after giving birth?
08:06 Yeah, I think another one is, you know, include the baby is always a good one, right? We tend to forget after we have a baby, depending on the activity level of the person beforehand, we tend to forget that walking is actually exercise, especially in the postpartum period. So I like to remind my patients of that I have a lot of patients who are pretty active, pretty high level of athletics prior to being pregnant. And so I have to remind them that walking in a postpartum phase is exercise, and it does count. And you should be finding time for it. Whatever that looks like with a stroller with a front pack, you know, even if you can get out for a little bit on your own is always nice, too, but not often as doable. But so I like to I like to remind people that and also that we don't necessarily need to jump into walking right away. So it's not something that you know, day 234, walking, probably still doesn't feel very comfortable, whether you have a vaginal birth or a C section. And so remembering that that's just like anything else, you want to work into that slowly, just like any other exercise program, you wouldn't jump right into lifting super heavy weights or, you know, join a competitive athletic league of some kind. So, starting slowly there, too, I think is important. Yeah. And
09:27 you hit on something that I want to kind of circle back to is, you said a lot of the women that you work with tend to be really high level athletes. I know you're also a crossfit coach, right. So you're seeing a lot of these high level, athletic women. So how do you kind of prepare them for this postpartum phase where they're not really going to be able to go back to that heavy lifting right away? Because from a psychological standpoint, I would think that would be can be quite difficult.
09:59 Yeah, it is yes, good question, I think what I tried to do is really lean into what I sort of call the negative side of it. And I try to stress to them that the things that are going to get them back to where they want to be, are really boring. And they're really slow. And they're going to be annoyed by them. But if they do them, in the short term, it's going to pay off in the long term. So starting off slow to get back to where you want to go is always always the right choice in postpartum with postpartum women. So yeah, that's, that's what I start with. And I really explained the breath work because again, that sounds like boring and sort of silly to a lot of people. And before I had a baby, I think I was less, I was less into the breath work, because I just found it so boring. And I would listen, you know, to pts and chiropractors, and, you know, ortho, all kinds of Doc's talking about how important breathwork was. And I was always like, gosh, it's so lame. But then once you feel how that diaphragm really doesn't expand like it used to, and you can't connect your breath with your body, like you use, do you realize, okay, this is actually where we have to start. And once we get this down and get this kind of Mind, Body breath connection down again, then we can start to progress from there. So yeah, I always start off people really slow. I developed a postpartum restoration plan. That's eight weeks. And it's more developed for the type of person that needs like, you know, they need their 20 to 30 minutes of like, here's my rehab, here's my, this is going to substitute for my workout for the day, you know, since I'm not doing a cross a workout or, or hit workout, or whatever they do. But I think that's been helpful to have those exercises, have kind of a game plan. And then, and then I can kind of shift those things around for people that want to like, you know, kind of fit things in here and there. So,
11:50 yeah, yeah, great advice. So really setting those expectations even before the baby comes so that they know what to do. So they know what's coming. And that's huge expectations are everything. Okay, so how about any conditions or barriers to getting back to fitness that maybe some postpartum women may experience?
12:17 Yeah, I always like to talk about this. Because there's, there's some things that people aren't really anticipating, you know, I think a lot of women during pregnancy, they sort of anticipate, okay, maybe a little bit of low back pain, maybe some pelvic pain. Even if they're thinking ahead, some upper back and neck and shoulder pain from being sort of hunched forward and nursing and that sort of thing. One thing that people don't anticipate that obviously isn't like a, you know, life ending condition or anything, but I'm sure you've heard of it, and seeing patients with it is the mommy thumb, you know, mommy wrist, however, we want to call it but that's when it really catches people by surprise. And basically what it is, is, can be pretty severe pain and either the wrist or the thumb and it comes from the forearm extensor muscles, and just from holding that baby and kind of that flexed position. So often, women are generally carrying a lot on the on the same side, if you bet shear, they end up sleeping kind of with the arm curled around the baby often, so then they can kind of get stuck in that position. And those muscles get really, really tight. So I like to tell my patients sort of warn them about that prior to giving birth and have them start on some wrist roller, you know, some eccentric, concentric strengthening of both the flexors and the extensors. And nothing crazy, you know, couple of minutes a day, four or five days a week will make a huge difference in that area. So that's one thing that I like to warn about. And if they with new moms that they're starting to feel that right away, I have them try to start some of those loading exercises, because that will, you know, if we catch it early enough, it can nip it right in the bud. But if we let it go, it can be pretty severe, you know, and people end up getting cortisone shots to take care of it and and there's a time and a place for that. But if we can take care of it beforehand, then let's do that.
14:05 Yeah, absolutely. I once had a woman who she was like, I think in her early 50s. And she started experiencing you know what they call mommy thumb or deeper veins. And hers was from they just gotten a new puppy. So her kids were grown and she's like, it feels like it does. She's like my thumb feels like it did after I had my second child. And so I look at how she's carrying this dog around the whole time. That's why
14:33 Yeah, there you go happens to the best of them, I guess. Yep,
14:36 absolutely. So even even to the moms of new moms of our furry, furry children, our little fairy children, it can still happen. So be prepared. What else what other complications or errors have you seen?
14:50 Yeah, I think one that gets a lot of you know, buzzword right now gets kind of a lot of play is talking about diastasis recti time and I'm glad I'm glad that it becomes So much more common to talk about it talk about what it is how it happens. But I think there's also a lot of fear mongering that goes on with that. Again, on social media, there's, you know, whoever can post whatever, right, so I do see a lot of stuff about about diastasis recti, what not to do. And what I always like to remind people is that it's, it's a normal, natural thing that needs to happen for that baby to grow and for the abdomen to expand. So I think that's really important to tell our patients and make sure that they know that it's supposed to happen, it's going to happen, you know, some studies show up to 100% of women have diastasis, recti, I think, like, week 36. And so, so just reiterating that, like, it's okay, it's gonna happen, we're gonna, we're gonna rehab you out of it, you know, but I think, you know, learning about it is great, and then understanding, okay, it's the separation of those abdominal muscles, what's gonna cause more stress on those? Okay, well, any of the flexion exercises, of course, so sit ups, and across the world, toes, the bar, that kind of thing. Any sort of kipping motion, anything where you're losing control, right down that linea alba down the center of the core, so are dancenter the abs. Also with heavy weights, like that's another thing that a lot of people don't anticipate as heavyweight overhead. Can Can just overstrain that tissue. And so there, I usually recommend people switch to dumbbells, you know, that's a pretty common recommendation, switch to dumbbells from a barbell, if you're using a barbell, they're just more forgiving, and allow you to, you know, move a little bit more efficiently and keep your core a little bit more stable. And then talking about in the postpartum phase, what we're going to do to rehab that. And understanding that, you know, nothing you do during pregnancy is going to, it's not going to hurt, it's not gonna hurt the baby, it's not going to hurt you, it just potentially makes it harder to rehab it later. Right. And so, we're always talking about minimizing those activities, seeing what we can substitute in, so you can still keep moving and doing what you want to do. But, but, you know, kind of playing that game of like cost benefit analysis, like, is it worth it to be doing this exercise? Is there something I could do that's a little bit safer, and just sets me up for a little bit more success down the road? So yeah, I think it's important to really talk during the pregnancy about that. And then in the postpartum phase, talk about where do we start, you know, and again, it goes back to the breathing, I hate to harp on it, but it does. And then there's some really simple diastasis recti exercises, that sort of work on engaging the transverse abdominus, you know, that big flat abdominal muscle that kind of wraps around and, and then from there, kind of retraining your core that okay, we can stay stable. And we can keep, you know, a nice pressure throughout while we start to learn to move our extremities and move a little bit of weight. And just like anything going through kind of progressive overload. But with with the core.
18:06 Yeah. And would you mind giving the listeners maybe a quick example of an exercise that you might work with a patient postpartum? Like, let's say that now, like you said, like 99% of women will have a diastasis after pregnancy? So would you mind giving a quick example?
18:27 Yeah, of course. Yeah. So there, there's tons of them out there. And it really depends on what phase of postpartum she's in. Right. So if it's really early on, like I said, we're going to work on some breathing, and we're going to have her one of the cues I really like is, when we're thinking about kind of trying to, to create tension throughout the abdomen, I like to think of kind of pulling the hip bones together, that's one that seems to work well for a lot of people. So you have them take a breath, and let's say they're lying on their back on the ground with their knees bent, have them take a big breath in, feel right on the inside of their hip bones. And then as they breathe out, they're gonna think about trying to pull those hip bones together. And that can start to help engage that transverse abdominus. And of course, you want them in like a neutral spine, in this position. And from there, then we can progress obviously, you know, with some, like heal slides with the leg lifts. Those are pretty sort of traditional exercises. I also like to incorporate when we start talking about, you know, healing through the entire Corps, I like to incorporate some glute work because that's one thing that gets missed a lot. We, we forget that the glutes are connected to the pelvic floor. So when we're trying to heal this whole barrel that is our core, it's really important to, you know, start with some really basic just even if it's glute bridges, some hip thrusts, those sort of things. I think those need to go hand in hand as we work that posterior chain along with the anterior abdomen.
19:57 Perfect. Thank you so much for those examples. Just gives people a little taste. So let's talk about Jen and Carrie. I will throw it over to you. Why don't you talk a little bit about Jen and Carrie and your company's logo?
20:16 Yeah, thank you. So my company is called Jen and Carrie, and it's sort of funny. My name is Carly, obviously, my partner my business partners name is Jess. So Jess and Carly. But whenever people get our names wrong, which is a lot they call us, they call her Jen. And they call me Carrie. And so as we were talking about what we should name the company, we were like, Jen and Carrie, they sound like you're fun mom friends that like know all the deets and have all the advice. So that's, that's our company name. And unfortunately, it's only further that probably problem a little bit because now you know, email and correspond with people. And they just immediately cost Jen and Carrie, but that's fine. We started the company after my first son. And I was, I believe it was, it was a couple months two or three months postpartum. And I was just getting back into the gym and trying to go back to CrossFit class, I'd done all my rehab, and I was really slowly kind of reintegrating, and I was complaining to her that I just hated all the nursing sports bras out there, I hate the clips, I hate the zipper, the button, like all this stuff, I just hated it. And you know, and across the class, let's say you're doing you're working with a barbell you like kind of dig the barbell into those clips with a PowerClean or a front squat or something or you're running and they pop open. It's like, you know, everyone every mom's worst nightmare. And so we started kind of looking scouring the internet for a sports bra that didn't look like a nursing sports bra, we just didn't find one. So we started kind of toying around and, and playing with a bunch of sports bras, cutting them up and, and it grew into basically the sports bra that we developed, which looks just like a regular sports bra, it has a sort of different technology that you pull up the top layer, pull down the bottom layer, so there's no clips, no zippers, none of that stuff. And really, the reason was, I just wanted to be in my workout class and feel like everyone else, like I wanted to have that hour of time for myself, I love being a new mom, I love being a nursing mom, but I just didn't feel like I needed to be advertising it to the world and my like, one hour class, I just wanted it for me. So that sort of spawned our company. And our goal is basically to just empower women to get back to whatever activities they love. And this is just one way we're doing it, we just feel if if a sports bra is gonna make you feel more comfortable and more confident in your postpartum body, and that's gonna get you moving then that we're all for it. So that's sort of how we started.
22:48 And, and the logo, every mom is an athlete. So controversial take may be right, some people may think I totally get where you're coming from, but go ahead and kind of explain that.
23:02 Yeah, so we have a couple of different reasons for are a couple of different meanings behind our logo, every mom is an athlete, we, first of all, we want women to feel like they can be whatever they want to be. So they can continue being an athlete, if they were before having kids, they can become an athlete, if they want to, you know, whatever that means for them, you know, whether it's running or Jiu Jitsu, or strongman competitions or whatever, we don't care, we just want to support you in whatever you want to do. And we also the other thing that we think about that is that being a mom is a really athletic job. So when you think about the stuff that moms do, you know, you think about the mom, carrying the car seat on one side with the toddler on the other hip with the coffee and the hand with the backpack with the all the stuff and that takes a lot of athleticism, whether you consider yourself an athlete or not. Putting your baby down in a crib is a hip hinge, right? Picking your baby up to put them into the car and the car see is is a press and a lift. So everything that we're doing, we try to we try to think about okay, what, what our moms doing and how can we support them in active wear, you know, as just one of the many ways to support them. What can we do to help support them in in this really athletic endeavor? That is motherhood?
24:21 Yeah, I love it. I think it's great. And I agree I do. I do think every mom is an athlete as well. So not so controversial, although I could see where people are coming from on that. So currently, as we start to wrap things up, what would you like the audience to take away? What are your takeaways from our discussion?
24:45 Yeah, that's a great question. Um, I think I would love for them to take away just that. You can continue being who you who you were before motherhood in whatever context that means for you And, and, you know, an entirely different version of that maybe, but like you can continue all the athletic pursuits you had before. That I want women to feel to feel empowered in the postpartum phase. And I try to do that in a lot of different ways, right? Like in my clinic, with my postpartum plan, but doing things like these to just like, talk about, here's some simple things you can do to help reintegrate your core and start building your strength back and just feel stable and confident, comfortable in your new body. That's my goal, really. And so that's our goal, Jen and Carrie, that's my goal, personally, and I think that would be my takeaway.
25:42 And where can people find you? You can list social media websites, where can they find Jen and Carrie?
25:50 Yeah, so Jen and carrie.com, it's JdN and ke ri. We're also on Instagram at Jen and Carrie. And then I'm also on Instagram at Dr. Carly, it's KR, li e. Those are probably the best places. Perfect. And
26:04 we'll have links to all of those in the show notes for today's episode over at podcast at healthy, wealthy smart.com. So if you forgot you didn't write it down. Don't worry, just hop on over. And we'll have direct links to everything. So, Carly, last question. And it's one I asked everyone knowing where you are now in your life in your career, what advice would you give to your younger self?
26:27 Yeah, I know, you asked that question. And I've been like really thinking hard about it. Um, I think I would give the sounds so cliche and sort of silly, but I think I would tell myself to have more fun, because the research shows when we're having fun is when we actually enter that flow state more right? We can talk about that for hours, I'm sure. But I think I would tell myself that because I look back and see the hard work of school, you know, education, but also in sports athletics, through high school college. I just think I if I would have had more fun, I probably would have been more successful. But also maybe, you know, maybe it would have been a little bit smoother ride. So that would be my advice.
27:09 Yeah. And, and as an entrepreneur as well, right? So sometimes, yeah, gets so wrapped up into the day to day that we're like, all stressed out and forget, like, wait a second, we got into this as a business owner, as an entrepreneur, to do things our own way. So why can't that involve having some fun every day as well?
27:31 Yeah, exactly like this. Right? We get to just sit and chat about stuff we love to chat about. This is a good time. This is fun. So yes, great point. Even in the entrepreneurial life, especially.
27:41 Yeah, especially anyway, and you're Listen, I'd love to have you come back on to talk about that aspect of, of your life as well. Because I love having successful female entrepreneurs and talk about their business and, and how they got things off the ground. Because I know people are always interested in that. So you'll have to come back. I love it. Yeah, I think you'll have to come back. And you'll have to talk about your sports Cairo business as well as the Jen and Carrie. So you know, being in that space of a retail space, which I know is not easy. So, so much to talk about. So we will put a pin in that and we will discuss that maybe in a couple of months. So Carly, thank you so much for coming on. I really appreciate it. This was great. I think you gave people a lot of practical easy tips that they can start integrating whether you're a postpartum mom or someone who cares for them. So thank you so much for coming on.
28:44 Yeah, thank you so much for having me. My pleasure. And everyone. Thanks
28:47 so much for listening. Have a great couple of days and stay healthy, wealthy and smart. | |||
| 594: Dr. Joanne Kemp, PhD: How to Manage Hip Pain in Young Adults | 20 Jun 2022 | 00:31:28 | |
In this episode, Principal Research Fellow at Latrobe Sport and Exercise Medicine Research Centre, Dr Joanne Kemp PhD, talks about hip pain treatment and research. Today, Joanne talks about the common causes of hip pain, the difference between men's and women's hip pain, and the outcomes for patients that "wait and see". How can PTs design and conduct evidence-based treatment programs? Hear about treating overachievers, referring out and using other treatments, and the upcoming Fourth WCSPT, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Joanne Kemp Associate Professor, Dr Joanne Kemp, is a Principal Research Fellow at Latrobe Sport and Exercise Medicine Research Centre and is a titled APA Sports Physiotherapist of 25+ years' experience. Joanne has presented extensively on the management of hip pain and hip pathology in Australia and internationally. Her research is focused on hip pain including early onset hip OA in younger adults, and its impact on activity, function, and quality of life. She is also focussed on the long-term consequence of sports injury on joint health. She has a particular focus on surgical and non-surgical interventions that can slow the progression and reduce the symptoms associated with hip pain, pathology, and hip OA. Joanne maintains clinical practice in Victoria.
Suggested Keywords Healthy, Wealthy, Smart, Pain, Hip Pain, Pain Management, Injuries, Research, Osteoarthritis, Exercise, Physiotherapy, WCSPT, To learn more, follow Joanne at: Email: j.kemp@latrobe.edu.au Website: https://semrc.blogs.latrobe.edu.au/ Twitter: @joannelkemp
4th World Congress of Sports Physical Therapy.
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Read the Full Transcript Here: 00:02 Hey, Joe, welcome to the podcast. I'm so happy to have you on. I've been wanting to have you on this podcast for such a long time. So thank you so much.
00:10 Thanks, Karen. It's great to be here, finally.
00:13 And of course, today we're going to be talking about hip pain, hip pathology, that is your zone of genius. So let's just dive right in. So let's talk about some common causes of hip pain in adults. And does this differ between women and men?
00:36 Yeah, look, it's a great question. And I think probably, we, I think we're starting to change our perspective on that difference between men and women and the causes of hip pain. I think that previously, we've sort of been very aware of the burden of hip pain in men and particularly young male athletes that there's been, you know, a growing body of research that's looked at at the prevalence and burden and causes of hip pain in young men. And probably that's led to a misconception that it affects men more than women. But it's only really that the research has been done in men, less and less so in women, like we see across, you know, the whole medical space. So if we think about the common causes of hip pain across the lifespan, when we're looking in sort of the adolescent and young adult population, you know, typical causes can be things like hip dysplasia, and that's actually is more common in women or young girls and women than boys and men so probably affects three times as many girls and women as it does men. And I think the prevalent when we're you know, the prevalence is perhaps higher than we previously thought. So, some studies are suggesting that up to 20% of adults have some form of hip dysplasia are shallow, hip socket shallow, so turbulent, and, and that that does lead to an increased risk of developing hip osteoarthritis in later life in later life. And even as young adults, sometimes we see patients with hip dysplasia, presenting with arthritis who need to go to hip replacement at a really young age in their 20s and 30s. So, hip dysplasia is a really common one. Another one that we've heard a lot about in the last 10 years is femoral acetabular, impingement syndrome, or FAI syndrome. So that's traditionally thought to be where there's impingement between the ball and the socket, either due to extra bone on the ballpark of the hip, which is can morphology or deep or retroverted socket, which has pencil morphology. And that's probably where a lot of the studies have been done, particularly in that young male adult adult population. But what we're now seeing when we look at the big cohorts, particularly of patients that end up presenting to hip arthroscopy is that it's about 5050. It's about 50% men and 50% women. So that burden is pretty equal across men and women. And that's another thing that does lead to an increased risk of hip osteoarthritis in later life. But the risk is not quite as high in FAI syndrome as it is in hip dysplasia. And it certainly is, it tends to be a slower burn. So these patients present for their hip replacements probably in their 50s and 60s, whereas hip dysplasia, we're seeing these patients in their 20s and 30s, with hip osteoarthritis. So that's probably the second most, the you know, the second cause in that younger age group. Then as we move into older adults, so sort of, you know, people 35 Plus sort of middle aged and older adults, that's where we really see hip osteoarthritis presenting itself, and it can be due to dysplasia or FAI syndrome. But it can also just sort of be that idiopathic arthritis that might be due to occupation, lots of different things. And again, that's reasonably equal men and women, but we do see women probably having a little bit more arthritis than men and more women going to hip replacement than men. And the outcomes for hip replacement are not as good in women as they are in men. So that burden is still probably skewed towards being higher in women than men. And then the other cause of hip pain that we see particularly in the middle age and older women is other gluteal pathologies or lateral hip pain, sometimes called you know, TRAQ, enteric, besides gluteal, tendinopathy, gluteal tendinitis, it has lots of different names. But that's a burden that definitely disproportionately affects women, over men. And particularly, once women get into that perimenopause, or menopause or post menopausal age group, there seems to be a relationship with with with hormones and with estrogen levels and the likelihood of gluteal tendinopathy becoming symptomatic as women sort of transition through that change. And so that's another really common cause. And we're now starting to be aware that often these women will present with combined hip osteoarthritis and gluteal tendinopathy. And that's where it can get really, really, really tricky as well. So yeah, look, it does. There's different, you know, different things that you see across the lifespan, but the burden is definitely I think, disproportionately higher in women than in men in a number of those conditions.
04:58 Yes, and I am firmly In the last group that you mentioned, I am just getting over, if you will, getting over gluteal tendinopathy, where I have to tell you it that is some serious pain. And, you know, when you're a physical therapist and you have people coming in, and they're explaining their pain to you, and you try and sympathize or empathize now I'm like, it is painful. Like I couldn't walk, I couldn't stand for more than like, four minutes. Yeah,
05:29 at least I've had the same thing. And, and I've been lucky that mine, I was sort of able to get on to it, knowing what it was and what to do fairly quickly. But it's very, and I think this is the thing with hip pain until you've had hip pain, whether it's glute tendinopathy, or intra articular, hip pain, it's really disabling. And it really affects everything you do in life, you can't sit without hurting, you can't walk without it hurting, you can't stand without it hurting, you can't lie on your side, without it hurting, you're getting in and out of the car, getting dressed, you know, trying to put your shoes on, it just affects every aspect of your life. And you know, and the pain can be quite intense and severe. So it does. You know, for people who are affected by hip pain, the burden is huge. And we see it reflected in the studies as well, where if you look at outcome scores for quality of life, young people with things like displays your FAI syndrome, their quality of life scores are as bad as people who have hip arthritis who are waiting for hip replacement. So it does, it's very, when you've got it, it's very, very impactful. And I think people until you've experienced it, perhaps people underestimate how bad it can be.
06:33 Yeah, and it can be really, like you said, it's very, very disabling. And it also can can make you very nervous. So you know, when these patients come in to see you. So as the physio, when these patients come in to see you, it really behooves you to sit and listen and really get that whole story so that you can make that differential diagnosis as best you can, if you don't have the diagnostic test to back it up, which often happens. Yeah, absolutely.
07:01 And I think that's the thing when the patient's present to you, and they're complaining of pain in that hip area, you can't just go to one test or one scan and say, Oh, it's definitely these, it's actually there's lots of pieces of the puzzle puzzle that you've got to put together, it can be really complex, and you absolutely have to listen to the patient. And I think fear, like you just said, is a huge thing. And we've seen this in our some of our qualitative work that's currently under review, but others as well that these patients are terrified to move, or to do exercise because they think it's going to hurt more. And they're really scared that it's going to cause more damage. And, and the irony is that exercise is the thing that we know is like is going to make them better. And once they get moving, they do feel better, but they're so scared to move because they're scared, they're gonna break something or make it worse or end up needing a hip replacement that they they don't they don't move. And it fear is a huge problem, you know, with these people.
07:53 Yeah, I mean, even myself as a physio I knew I needed to exercise, I sort of outsource my physio exercises to a friend of mine, Ellie summers, who's on the, on the west coast here in the United States, and she sent me exercises and even doing them, like it's not super comfortable. But within a month, I felt so much better. And now, you know, I'm back to running on the treadmill and doing all the things. But oftentimes, these patients and I may be wrong, but they're not sort of picking up on this within the first month of pain, you know, they might say, Oh, um, it'll go away. Let me give it another couple of weeks and have a couple of weeks. Whereas I was like, Okay, this is really painful. I'm getting to a doctor asap and starting these exercises ASAP. So what have you seen, even through the literature about when patients start to seek out care for this? And how can that affect their outcomes?
08:52 I think it's one of the things with hip pain that patients often will just leave it and they'll wait and see. And so we do know that in the younger age group, like if you think about FAI syndrome, for example, people will often not present for two or three years, they will pull up with the pain because it kind of comes and goes so they'll have a flare up, they'll be bad for a few weeks, it'll go away for a few weeks and have another flare up. And so because it's coming and going, they, I guess remain optimistic. It's human nature to be optimistic that it's going to get better by itself. And so it can often be a couple of years. We see this in the literature, you know, two or three years, but I see that in my clinical practice. And I'm sure you do, too, Karen, that patients, they'll come to you and they'll say, oh look, I've had this for two or three years, I was waiting for it to go away and now it's you know, suddenly getting worse and that's when they seek out care. And I think too, you know if we think coming back to what we were talking about with women is that these problems affect women who are really busy so they are often have busy careers. They're looking after families often, they they might be studying as well. They're juggling lots of things. So for them to try and fit in the medical care or, you know, physio care or whatever they need. It's really hard for them to find to make the time to do that. And I think that that's probably why they potentially delay seeking, seeking treatment as well.
10:12 Yeah, so many factors go into it. But bottom line is it hurts. Now, how let's talk about the physio side of things. So how can PTS design and conduct an evidence based treatment program? For, we'll say, for adults with hip pain? Yep.
10:31 So I think we probably the first thing is to set really good expectations for the patient. So often patients will come potentially looking for the quick fix. And so I think it's important that right up front, we say to our patients, that it does take a while for things to work, you should be starting to improve over that time, but they need to be committed to an exercise program that we know needs to be now at least three months long. So I think both the therapist and the patient need to be prepared for that longer term commitment as well. So I think that's the first thing is setting expectations, right. And then around those expectations, it's also really important that patients understand that exercise is good for them and is not going to cause damage. So you're really trying to get the confident to be able to exercise part of that is an understanding that it will like you just said like when you did your exercises, it's not super comfortable. But that's okay, they need to they don't want to be in a lot of pain, but they will probably have some pain and that that's actually okay and normal to have that. And it doesn't mean that they're causing more damage. That's just a normal part of the body adapting to the exercise process. Sometimes I find with patients to you in order to convince them of that, because sometimes they're a bit skeptical, they don't quite believe you that they give you know, they will do exercises for a week, just look, just have a week off the exercise and see what happens to your pain. And what they find is pain is no better when they're not exercising. But sometimes it's worse, it's usually worse or the same. And so then they're like, Oh yeah, now I understand the exercises and actually making my pain any worse. And so sometimes you might need to do that to get them to buy in. So I think getting them to buy into the timeframe the commitment that they're going to need to do and the fact that they will have a bit of pain, that's probably the biggest thing, then once you've done that, then you can start to develop your exercise program and the foundations of our exercise program. I like to think of it as being sort of two pronged. So the first one is the local exercise that we're doing for the hip joints. So that's where we do a lot of our strengthening exercises. So strengthening up the muscles around the hip. So the hip abductors, and the adductors flexes in the extensors. But then also really focusing on the core and the trunk is important because that controls the acetabulum, which controls the socket. So putting that in and then you know functional exercises as well. So teaching them how to do things like squats and lunges and going up and down stair. So our local rehab exercises should have primarily a strength focus, they might also need to have a range of motion focus as well. But we need to be careful with ranges of motion because sometimes those ranges of motion might be provocative for patients. So going into a lot of rotation or a lot of flexion could provoke pain. So strength is probably our big biggest focus. But then the second prong of our rehab program should be around general fitness in general activity. So you know, we know that the physical activity guidelines say that everybody should be doing 150 minutes of moderate activity a week or 75 minutes of vigorous activity, then that's just to be a healthy person, regardless of whether you've got a sore hip or not. So I think trying to get them to do general fitness, cardio, whatever you want to call it alongside their hip specific rehab is, is the thing that you need to do. And then what I try and do is I try and make that hip specific rehab, sort of normalize it as fitness training, rather than rehab. Because people get, they're going to be like, don't want to do rehab, everyone gets bored of rehab, you know, at home with your little bands. So trying to get them to do things like you know, incorporated as part of their twice a week strength training, where they go to the gym, for example, is really important. And with any strengthening program, you only need to do it two or three times a week to be effective. So people don't have to do it every day. So I think that's important too to for them to know, they'll get they'll have days off where they don't have to do it. But to find two or three days a week where they can commit to this the strengthening component of the program, the cardio fitness component of their program can fit in around their schedule. And something that I really like to do with patients is to sit down and actually look at their weekly schedule and help them schedule it into their diary. So don't just say to them, you go do this, you know, five times a week, you actually have to fight help them find those chunks of time where they can do it and they can find 30 minutes in their day to be able to commit to that exercise program.
14:50 Yeah, I really love that you said to emphasize that the strength thing has to be done two to three times a week, because oftentimes Well, I mean, I'm in New York City where you have a lot of is like very driven, sort of type A folks. And they think if you're not doing it every day, then it's not working. Yeah, you know, so to be able to reframe that for them and say, Hey, listen two to three times a week is what our goal is, and be very forceful on almost holding them back. Do you have any tips on how to hold people back? For those folks? Who are the overachievers?
15:26 It's hard. Yeah, it's really tricky, isn't it? I think sometimes I think people have to learn for themselves. So you kind of have to let them find out the hard way, maybe, and be prepared with some painkillers to settle things down. But ideally, you don't want to do that, if you can help it, I think, I find that presenting the evidence can be really, really helpful. So you know, talking about the strengthening guidelines that that show that two to three times a week is where you're going to get the maximum effect of strength. And if you do more than that, it's not going to really add to that you'll have already sort of hit that ceiling, and potentially give them something different to do on those other days, if you don't want them doing strength training two to three times a week. If there's someone who wants to do something every day, helping them find other things on those other days, so perhaps, you know, mixing it up with some cycling, walking or jogging, if they are able to do that some swimming, you know, sometimes, you know, it might be appropriate or safe for these patients, if they enjoy things like yoga or pilates, they can do that if it if it doesn't hurt in addition to their other things. So I think those type A personalities, you might need to fill the space on those other days. Give me something else to do.
16:33 Yeah, I think that's great advice. And now, sometimes, as physiotherapist we have to refer out. So when is it appropriate to refer out or to use other treatments such as surgery? How do we navigate that as a physio?
16:50 It's tricky. And I think the most important thing is that that has to be a shared decision that we make with our patients. And at the end of the day, they will have their beliefs and their priorities that will probably take them in certain directions. Having that three month rule is a good rule, I think that we know it's probably going to take three months for our rehabilitation programs to reach their full effect. But but it doesn't mean to say you keep doing things for three months, if you're not getting any improvement, we really want to see them starting to head in the right direction, probably within around about four weeks. Within, you know, two or three treatments, you should be starting to see some change even though we know it's gonna take longer than that to get the full effect. I think that if you're not seeing change within that first month or so, you have to start asking yourself questions about well, why why why aren't I getting changed? Do I need to look at this and red flags here? Do I need to potentially refer the patient to their GP? For some imaging, we know that, you know, people have a history of cancer, that breast cancer and the gynecological cancers and prostate cancer really caught the hip joint is a really common point from you know, where the cancer metastasizes. So, I think bearing in mind our red flags, you know, women with guide other gynecologic non cancer, but other gynecological issues, you often get pain in that same area. So, being open minded about some of the non musculoskeletal causes of pain and being prepared to refer on if someone's not improving in that time is important. Imaging, you know, we don't want to jump to imaging straightaway, it's not always necessary, but it is sometimes it is necessary. And I think don't be frightened to refer for imaging. If someone's not improving. The one thing that I and it's different in every country and our health systems are all different. But here in Australia as physios, we can refer for imaging, but I if I'm if I'm suspicious that there's a red flag, that's a medical thing that's outside my scope of practice, I will refer them to the GP for the GP to refer for imaging. And the reason for that is I if you refer for imaging, you need to be able and confident to tell the patient the results of their imaging and interpret them and then refer them on for appropriate care now, for those medical things. I think as physios that's way outside our scope of practice and we shouldn't be you know, if the scan comes back with cancer, like we can't that's way outside our scope and we shouldn't be having to to explain those results to patients, I think only refer for imaging yourself with your confidence of what you'll be able to interpret those findings. So don't be afraid to refer to the doctor. Some patients often need pain relief as well or anti inflammatory. So that's, you know, if you're not getting improvements in that four weeks, you may need to refer them to the doctor to get pain relief or anti inflammatory medication. Things like injectables again, we don't want to inject give people lots of injections but we know that the hip joint is often sign up at green flame. So you know a judiciously used cortisone injection can be helpful in in some cases. So I think it's been not afraid to refer on you know, when you just turn the video off, when you need when you need to, to, you know to those other things and then surgery is probably your last resort, but There are a small number of people who will potentially need surgery as well. So, but you wouldn't actually be looking at surgery until you really finish this full three months of rehab.
20:09 Yeah, that all makes perfect sense. And now as we kind of start to wrap things up, where there, is there anything that you know, we didn't cover, that you would really like the listeners to know, or to take away, whether that's from the literature or from your experience when it comes to hips?
20:31 Yeah, I think, look, I think we've covered most things. But I think what it is, is just being really confident to prescribe a good quality exercise program. And if you don't feel like you have the knowledge or skills to do that, don't be scared to either refer to a colleague who who might have more knowledge or skills, or to, you know, to look up the evidence with, you know, that the evidence is has really grown in the last couple of years. And we published a consensus paper in V jsme, 2020. That was a consensus paper on what physio treatment for hip pain in young and middle aged adults would be. So that's a really good resource, it's got some some good examples in that paper of the types of exercise that you should be doing. And then my colleague from the US might Raman also lead a consensus paper in that same series on the diagnosis and classification of hip pain. So that's another really good resource that you can go to that will help you clarify the different diagnosis in the hip and what what what sort of things you can do to confirm your clinical suspicion and your diagnosis.
21:34 Perfect. And now, you will also be speaking at the fourth World Congress of sports, physical therapy in Denmark, which is August 26th, to the 27th, you're doing to sort of 15 minute 15 minute talks repeated twice. So one talk repeated twice. On the second day of the conference, can you let the listeners know a little bit more about that. And if you have any sneak peak that you want to share?
22:04 Yeah, so I'm going to be doing that talk in combination with a with a great colleague of mine, a Danish colleague, Julie Jacobson. And so we're going to be talking about hip pain in women specifically. So looking at the common causes of hip pain in women and as as physios, or physical therapists, what we should be doing to manage to manage that, because it's a congress of sports, physio, or sports, physical therapy. It'll be slanted probably towards the younger, more athletic population. But I think there'll be some really great takeaways for anyone treating women in particular with hip pain. So we're going to be really, I think, trying to focus on what it is about women with hip pain that's unique and different to men, and really helping the therapist develop a rehab program that really targets the things that are important for women. So the impairments that women have the physical impairments, but also really targeting some of those, you know, we've got to think about the biopsychosocial model. So some of the psychological challenges that people with hip pain have that we've sort of touched on in terms of being fearful to move, but then the social challenges too, because we know that we do live in a gendered environment. And it's no different for women with hip pain, where they might face additional barriers to, you know, in this the way society is constructed to be able to access the best care. So it's also helping helping the clinician really become an help patients navigate some of those challenges as well.
23:27 I look forward to it. It sounds great. Now are what is there anything that you're looking forward to at the conference in Denmark? Have you looked through the program? Are there talks that you're looking forward to?
23:40 I look, there's there's going to be so many great talks there. Like it's such a I can't believe how many how much they've packed into two days, like for two day program, I'm actually really excited. by so many of the different tools, I think the thing I'm most excited about is after two years, it'll be nearly three years by then that we've actually been able to see each other face to face, just to have the opportunity to catch up face to face with so many great colleagues that I've worked with before, but also meet new colleagues as well, and have the chance to travel to beautiful Denmark. You know, I haven't been to the conference venue, but it looks amazing being on the coast. In summer, it's going to be beautiful. I know the conference Organizing Committee has got a great social program as well organized and the Danish conference dinners are always a highlight, I think of any program. So I'm really excited about that as well. Yeah, I just I just can't wait.
24:31 Yeah, it's it. You have the same answer that so far everyone has said as they just can't wait to be in person and to network and to hang out with people and to meet new people. So you're right along with everyone else that I think a lot of the other speakers that are going to the conference, and now where can people find you if they have questions, they want to see more of your research, where can they go?
24:55 So, um, so I'm on Twitter, so my Twitter account is at Joanne L. him. So L is my middle initial. And you're welcome to send me a message via Twitter. But you can also contact me via email. So my email address is the letter j.camp@latrobe.edu.au. And then our sports medicine allotropes sports and exercise Medicine Research Center has a has a webpage and a blog page where a lot of our research is highlighted there as well. So if you just Google up Latrobe, Sport and Exercise Medicine Research Center, that's the first thing that will pop up as well. And we have a lot of, you know, a lot of really good information. We've got a really our Research Center has a really strong knowledge translation arm and so a lot of my colleagues, which credit to all my colleagues who work in this space, have developed a lot of really great resources to infographics, videos of exercises, lots and lots of different things that can be found on our on our research, our centers, webpage and blog page as well. So lots of good resources there.
25:57 Excellent. And we'll have links to all of that in the show notes for this episode at podcast at healthy, wealthy smart.com. So one click will take you to all of the resources that that Joe just mentioned. And last question that I ask everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self? So maybe straight out of physio I pick pick a year, any year you'd like?
26:22 It's great question. And it's funny because I was actually talking to my son's girlfriend the other night, who's at university, and she's finding it stressful and hard. And I actually shared with her something that I'm not afraid to share that I actually nearly failed my first year of university, because I was too busy enjoying the social aspect of uni life. And I think what I would say to my young, and that stressed me out and really upset me at the time. And I think what I would say to my younger self is if you don't get it right the first time. And if it takes you a little while to find your space, that that's actually okay, because it's about the long journey, and you'll get there eventually. And so if you hit hurdles and bumps and you don't, you're not always successful every time, it actually doesn't matter. Because as long as you keep on trying, you'll you'll get there in the end. So don't don't stress about failure. It's about what you learn from that failure and how you adapt and change what you do.
27:12 What excellent advice. Thank you so much. And thank you for coming on to the podcast. This was great. And I think the audience now has a better idea of what to do with their patients when they have hip pain. And if they don't, they can head over to Latrobe, they can go over to the website and get a lot of great resources from from you all and also look up a lot of your research. And if we can also put your Research Gate. Yeah, we can put that up in the show notes as well if that's okay, so that way people can kind of get a one stop shop on all of your research because it's extensive. So we'll have that up there as well. Thanks, Karen. Thank you so much. And everyone. Thanks so much for tuning in listening and we hope to see you in August in Denmark at the fourth World Congress Sports Physical Therapy again, that's August 26 and 27th. If you haven't registered, I highly suggest you get on it and hopefully we'll be able to see you in Denmark. So I look forward to seeing you then. And everyone have a great couple of days and stay healthy, wealthy and smart. | |||
| 593: Governor Martin Schreiber: Advocating for Alzheimer's Caregivers | 13 Jun 2022 | 00:40:48 | |
In this episode, 39th Governor of Wisconsin and Advocate for Alzheimer's Caregivers, Martin Schreiber, talks about the importance of advocating for Alzheimer's caregivers. Today, Martin talks about his book, My Two Elaines, and his experience as an Alzheimer's caregiver. What can the community do to support Alzheimer's caregivers? Hear about therapeutic fibbing, Elaine's own journals, and get Martin's advice to his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Martin Schreiber Martin J. Schreiber grew up in Milwaukee, Wisconsin. Inspired by his father's example as a member of the Wisconsin State Assembly and the Milwaukee Common Council, Martin ran for public office even before he had completed law school. In 1962, he was elected as the youngest-ever member of the Wisconsin State Senate. He was elected lieutenant governor in 1970 and, in 1977, became the 39th governor of Wisconsin. He recently retired from his public affairs firm in Milwaukee and now is an advocate for Alzheimer's caregivers. In addition to caring for Elaine, Martin is passionately committed to speaking out to help caregivers and their loved ones live their best lives possible. He and his wife, Elaine, have four children, 13 grandchildren and seven great-grandchildren.
My Two Elaines: Learning, Coping, and Surviving as an Alzheimer's Caregiver 24/7 Helpline: 800-272-3900 Suggested Keywords Healthy, Wealthy, Smart, Alzheimer's Disease, Dementia, Caregivers, Awareness, Grief, Advocacy, Ignorance, Support, Mental Health,
To learn more, follow Martin at: Website: https://mytwoelaines.com Facebook: https://www.facebook.com/MyTwoElaines
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:03 Hi, Governor Schreiber, thank you so much for coming on the podcast and taking the time out today to come on and talk about Alzheimer's disease, which we are in the month of June. It is Alzheimer's Awareness Month. So I thank you for coming on and sharing your story and experience.
00:22 Well, thanks, Karen, I want you to know that I'm very grateful for the opportunity to be with you. Because there's so much important information that people should be aware of relative to Alzheimer's disease, both for the person who was ill, and also for the caregiver.
00:41 Yeah, absolutely. And now many people listening to this podcast may know you for your service to the people of Wisconsin in the state senate, then you were lieutenant governor, and ultimately, the 39th, governor of Wisconsin. So like I said, Today, you're here to talk about Alzheimer's. So can you tell us a little bit more about the work you're doing as an advocate for Alzheimer's caregivers, and kind of how and why this is personal for you, and how you found yourself here?
01:11 Well, very soon. It I tell you, if if I go, my wife humane is now in our 18th year since diagnosis. And if we you and I go back 18 years, at that time, this disease could not be cured, delayed or prevented. 18 years have gone by and this disease still cannot be cured, delayed or prevented. So what happened was, because I didn't understand this disease, I made my life more miserable. For my dear wife, who was losing her memory, I made my life more difficult for myself, as well as for many other people, because I didn't understand this disease. And so I conclude now, that if Alzheimer's is bad, ignorance of the diseases worse, and when I say ignorance of the disease, I don't mean ignorance of the disease just simply by lay people, but I'm talking even the medical profession, I'm talking even caregivers themselves. I'm talking about churches and congregations and temples and so on, there is just not an awareness of this disease, as it relates to how it should be dealt with. Because you can't fight it, you can't beat it. And so if we can learn a little bit more about it, we have a better chance of having our loved one with the disease, living their best life possible. But also we had the chance of having the caregiver also receive their best opportunity of living their best life possible.
02:51 Yeah. And you wrote about this in a new book that is published this month in June, called my two lanes. So you depict your wife your wife's battle was with Alzheimer's. And you know, like you said, This disease is progressive. And the person definitely transforms from probably the person you knew into, into maybe someone else. So can you talk about how you dealt with that as, as her husband and as the main caregiver?
03:22 Well, first I dealt with it very badly, X extremely poorly. And because of that, we missed out on many moments of joy. What I tried to do in the beginning, because I didn't understand this disease, what I tried to do was to keep her in my world, knowing Lena, it didn't happen on a Wednesday, it happened on a Thursday, it wasn't the Joneses, it was finally, I got the understanding that it is important for me to join the world of the person who now is. And one of the most difficult, difficult challenges that any caregiver has, but which has to happen is what I would call the pivot. And the pivot is when the caregiver gets to the point where you let go of this person who once was. So you can now embrace and help the person who now is because if we don't, first of all, because this disease is incurable at this time, you cannot fight it. There is nothing you can do. And I found out that all of the navies, saline, and all of the armies marching and all of the liquor that's that's distilled and all of the beer that's brewed is not going to stop this disease. And so rather than how do we fight this disease, the question is how can we fight to give our loved one their best life possible? And so within that framework, then there's A number of things that is important for for us to understand about this disease and for us to understand about the challenge of, of caregivers. So as I said, one of the things I learned was to join Elaine's world. Then another thing that I learned was the importance of what I call therapeutic fitting. And again, look here, let me let me just back up before we go into therapeutic fitting, if we can envision a funnel, and if we put the small part of our funnel by your eye, and of course, because the funnel expands, as you look up, you can see the blueness of the sky in the hope of tomorrow. But what happens is, as the disease takes its course that funnel becomes inverted. And now the large part will be by your eye, and you look out and all you see is a little bit that then becomes the world and the life of the person who now is they are not aware of what happened five minutes ago, five hours ago, maybe five years ago, nor are they concerned or aware of what can happen five minutes from now, five hours from now or five years. So it's it's a different world. Now. When I wrote this book, I felt really proud of myself, that I had finally put some of this into perspective. And lo and behold, before we're ready to go on for print, I find a series of notes and diaries that Elaine had been keeping since her diagnosis. Well, I want you to know that we had prayed together. And we had cried together. But Never did I understand the courage that it takes to be diagnosed with this illness, and then that can continue forward. So as Elaine is going through this transition, and now we're here we get to therapeutic phibian. As Elaine is going through this this transition this journey, she asked me once, how are my parents? Oh, I said, Elaine, your parents are both dead. The shock on her face when she realized maybe she didn't say goodbye. The shock on her face, maybe even not attend the funeral. I promised myself I would never put her through that again. So then when she asked me the next time, she said, How are my parents? Oh, I said Elaine, I said your mom is just really doing well. She likes working at church and volunteering. Your dad likes sports. He likes it that makes me feel so happy. Well, that's therapeutic fitting, therapeutic fibbing joining the world of the person who now is now I want you to know that I tried this therapeutic good in the first year of my marriage, but it didn't work so good then, but certainly at this moment in time. But then another experience to give me a sense of this all
08:12 the feet, when he lanes still was able to be mobile. We were having lunch at the assisted living memory care. And we're talking and then she starts to cry. I said, Elaine, why are you crying? Well, she said, I am beginning to love you more than your husband. Well, I didn't ask her what's wrong with your jerky husband. I didn't do that. But I tell you what I learned. I learned that it is not necessary for her to know my name in order for our hearts to touch. And so many times, as I talked with caregivers, they become initially so distraught about the fact that their loved one may be married for 5060 years, children so forth. That person with Alzheimer's does not remember their knees. I would tell them understand that your loved ones mine is broken. And sometimes there's no more of a chance to have our loved one remember our names and a person with a broken leg winning an Olympic championship, a gold medal. And so we we just simply have to understand the importance of joining the world of this person who now is one one of the challenges of caregiving, and there are a number of them. But one of the challenges of caregiving is that you work so hard to try and help your loved one but here let me let me just back up a little bit here. So we go back 18 years. The First Tee lane. That was the girl I met when I was a freshman in high school. School, I fell in love right away. We dated and we went steady and we got engaged, and we got married and four children, and 13 grandchildren, now seven great grandchildren. That was the first Delaine, I would run for public office, you will be the hardest working campaigner. If I would lose, she would never let me feel defeated. She was everything in the world. To me as it relates to any good thing that happened. The second lane began to appear. As I said, some 1819 years ago, when she would get lost driving to and from places she had been going to and from for the past 10 years, the second Elaine began to appear when as a great cook, she messed up her recipe so bad that she would cry, she would be so embarrassed. So that was the beginning of the second lane. So now we get this diagnosis. And I took a marriage route to death to as part I'm going to do all these things. And when Elaine was first diagnosed, she was given the mental mini test. And basically the mantium. The mental mini tests is a simple test asking for example, what day it is. When is your birthday? so forth? Very simple questions. And if you scored 30 or above you would be considered Okay, pretty normal. If you scored 30 or below, what the situation would be is that maybe at signs of early onset, well, Elaine's test score at that point was 28. They say that the average person loses four to five points going down almost every year. And it doesn't happen, you know, arithmetic Li from 20 820-726-2524, it may stay at 28 for a while, then maybe drop down to a 25 and then stay at that point, then maybe jump down to 21 and so forth. Well, what is important here is that you then test it out first at one year, you lose four to five points every year 18 years ago, it gives you a sense of where Elaine's life now is. But with that understanding with the understanding that the mentee meant a mental mini test
12:42 goes down. What what happens to the caregiver is you devote your time and your talent and your energy and your love to this person. And you just step out thank you have this answer. And then what happens is you wake up the next morning, and it's a new challenge. Well, what am I doing wrong? So what happens then is you devote more time and more talent and more energy. And you Okay, flow and all of a sudden, no. So what am I doing wrong? And so I have seen many instances where caregivers develop this so significant guilt, that they're not able to to help their loved one no matter how hard they work, what are they doing wrong? But here's the other aspect that comes along with it not only the self questioning about what am I doing wrong, but the caregiver is also going through a type of depression, and also what I would call an unacknowledged meeting. So I had a dear friend who retired and enjoying retirement, had dinner one night, laid down on the couch to watch the baseball game. Tragically, he died massive heart attack, just gone. Well, there was a funeral. And friends stopped by to express their sympathy to acknowledge the passing of this of this wonderful person. And there was closure. So what happens in the life of care giver is that there never is closure. You see your loved one dying a little bit every day. You begin to feel just so horrible about your guilt not being able to do anything but you're also getting to the point where you're saying, My my my loved one is is leaving me and then that that grieving, you know, just does it's not acknowledged and that's really one of the challenges that caregivers have to face. And that is to face up to the fact that yes, you are going to be grieving. And you should acknowledge the fact that you're going through this grieving at this moment in time, then there's also the depression that comes with it. And knowing what is the future and worrying about that also breeds anxiety. And so you take the guilt, you're not doing enough, you're not maybe getting enough sleep, you're not necessarily going for the walk, you're not getting any visit with friends, because you're focusing and focusing and focusing? Well, I try and have caregivers understand one of the most important facts about this disease, and that is you cannot do it alone. I do not believe, well, first of all, we men are sometimes really stupid. You know, we're not going to ask for directions, because we know it all, you know, I was going to take care of Elaine and so forth. And I let my ego, my own self centered. passion to do Z to defeat this disease, I let that take control over what was really best for Elaine. Because I did that we really missed out some, some great moments of joy. And
16:34 at the time of diagnosis, the doctor said there were four things that we should be doing one of the two drugs, drugs called the Menda and erysiphe. They do not stop the disease, they just simply delay the symptoms. So that was point number one, point number two socialization, you do show to socialization continuing, and then also getting exercise going for a walk, for example, and then also a glass of red wine every evening. Well, you then got three weeks ahead and the glass of red wine every evening and four weeks behind and in the walking. But here, here's the the situation about not joining the life and the world of this person who now is. So I knew we should go for a walk. So in my mind, half an hour walk is sufficient. So we started walking the lane with say, all look at that flower Kimani lane, you gotta get this throw, you know, our look at the bird, no, come on Elaine. And so my focus was not on the here. And the now my focus was getting this work done. So I could go about some other type of, of activity, whether it's trying to work with my business at the same time, and so forth. And the lesson here is Alzheimer's is a tragic disease. We can't cure it. But we certainly can learn to live better with it. And so had I known, then what I know now, I would have stopped with the lane. And we would, we would have admired that flower, watch the bird, we would have even maybe even just stood in the sunshine for a while and felt the warmth of the day. So the life of a caregiver is extremely challenging. We have to know that we can't do it alone. We have to understand that if we if you want to show real courage and real manliness that is shown by asking for help. So gosh, I think you asked a question a while back and I think that that was about maybe three days ago and I still?
19:03 Well, I think I think what you have done is your as you were speaking I said okay, I was gonna ask that I was I wanted to talk about that. But I think what you did you do is you really clearly laid out some real big challenges that caregivers have to face and some really great lessons that you've learned that you've passed along and I know that those lessons are some practical takeaways in the book in sections called kind of what you said what I wish I'd known or what I would have done differently. But it sounds to me like if you're a caregiver, you need to check your ego at the door. You need to be present with the person you need to join their world. And and it may perhaps be a more pleasant or at ties would be a happier existence for not only the caregiver, but for the person living with Alzheimer's as well. And, you know, as someone who like we'd spoken before went on the air Mike grandmother had Alzheimer's. And I can only assume my parents feel the same way that you're feeling now that we used to always Correct, correct, correct her, when in fact, we just should have said, Where's where's your grandfather? Oh, he'll be home in a little while, instead of saying no, he died 15 years ago. And then, like you said, it just can make the patient agitated and confused. And if you want to continue to have those happy times, it's best to be in their world. So I think you really outline that very, very well. And I do want to go back to something that you touched upon, but didn't go into great detail, and that is Elaine's journal. Now you, you put this into the book, some of her excerpts where she detailed her feelings and emotions as she was struggling with this diagnosis. So why was that important to include those? And were there anything in those journals that surprised you?
21:09 There were a number of things. First of all, I wanted to put Elaine's words into the book. I wanted to do that. So. So caregivers and their families would understand this. Great in internal turmoil, being diagnosed with it, but still knowing your mind, then having my your mind sort of slip as I said, you go from a 28 score, maybe down to a 26 score, but you still think you're sort of all right. But then some days, you're not all right. But with her journals. As I said, I learned the courage that it takes to be diagnosed with this disease and continue forward. But I also learned, we talked about the pivot, where the caregiver gets to the point of letting go of this person who wants was to join the world with a person who now is the person with Alzheimer's also has a pivot. And it's almost by the grace of God. And that pivot is when the person with Alzheimer's finally leaves the real world and enters their own world. And I've got, well, let me just read one or one or two of her of her excerpts, of course, in the book, but I wanted to make sure that the reader would understand that the challenge is that that a person has with Alzheimer's, but also how important I was in her life as her lifeline. And I really didn't know that. And I think that if a caregiver understands how important they are as a lifeline to their loved one, they will take better care of themselves. I was lacking sleep, I was lacking exercise. I wasn't eating well, I was like, My daughter, Christine, gave me an article on moderate drinking. And it wasn't because she thought I was drinking too little. That's for sure. So but anyway, so with her excerpts, I want to give you just just a few examples of, of what what she's going on. So she starts off at when she was sort of diagnosed, she wrote a letter to her to your loved ones. And she writes, it wasn't until a few weeks ago that I really had to say, Yes, I do have Alzheimer's, I read up signs that indicate Alzheimer's, like getting overly upset for no reason, and having trouble with names and directions. But I still didn't think it was a problem for me. But in hindsight, for too long, I've been getting lost driving, having trouble keeping days straight, and difficulties with names and schedules. Still, I still felt like I could handle it, it won't get worse. But this morning, I started reading about the mid stage of Alzheimer's, in hopes of preparing myself better and realize I'm not very far away, that is most scary, but I have to accept it. And so also in some of these pages, she talks about how important I was to her life. She said, Please take care of yourself, for me as well as for you. So then, you know and again she is in a process of, of of losing her memory. And she's in the process of getting to this pivot where she loses the reality of life and goes into her world. But to give you a sense of, of the tugging that's going on within in her she writes this, she writes, I am not enjoying my role anymore as Marty's wife because of his Hammond concerns about My Alzheimer's, he doesn't let me be me. He doesn't let me go for a walk if I want to, or the other store loans, I used to appreciate him what I thought was concerned, but he holds me captive much too much, I'm going to try to have a second opinion because I really don't think I have any problem. I know how to drive or walk anyplace I want to, but he doesn't believe me. And I hate the control he has placed on me, I don't even think I have Alzheimer's, per se. And so we see that, and again, my my, we see a human being going through that kind of turmoil. And we think we could have done a better job, or I think I know I could have done a better job. And because of that I wanted to write the book, so that I could help caregivers learn, cope, and survive. Just I want to just read one, one more here than
26:01 that. I don't have the exact date on this one here. But she writes, I wish my Alzheimer's would dissipate. I'd like to be the smart wife and mother I used to be. Now I have to waste so much time just trying to figure out what I should be doing. without seeming as smart as I used to be. I need to rely on Marty for everything. And I'm very lucky, he continues to keep me life gets more difficult every day. So it's it's a bummer of a disease. And again, we can't beat it, we can't fight it. It's not curable at this moment in time, it can be delayed can be prevented. And so what we want to do is fight was our best weapons possible and that is to better understand the disease and better understand the world to which our loved one is passing into. So we can help them on their journey as much as possible.
27:02 And you know, According to the Alzheimer's Association, more than 6 million Americans live with Alzheimer's or dementia. And more than 11 people are their unpaid caregivers. So how can people listening right now support those who are caring for Alzheimer's patients and support the patients as well.
27:23 One of the best things and most important things I think a friend or family member or neighbor can do for a caregiver. Number one, simply acknowledge what they're going through. And that acknowledgement in and of itself is so important. Because people really don't understand one. And because people don't understand Alzheimer's, they they shy away from it. Now. I call Alzheimer's, not a chicken casserole disease. So hypothetically, I get an operation of my, you know, maybe a higher operation. And so I come home, and I'm laid up people will bring me a chicken casserole, I've fallen I break a hip, I'm recovering, they'll bring me a chicken casserole. Alzheimer's, people don't bring chicken casserole, we a person, a caregiver and their spouse may have had friends that they did many things over a period of 3040 years together as the children would grow up. And let's just assume hypothetically, that it would be camping and canoeing. So for 3040 years, they, the families did this together and the children grew up and so forth. And that was the bind holding them. That was the binding thing for them. So what happens is now the spouse gets Alzheimer's. And because the friends don't know about the disease, they don't know how to handle it, and they withdraw as they withdraw. The caregiver not only is trying to deal with this depression, this anxiety, they are grieving the guilt. Now, the caregiver is also feeling abandoned, abandoned by friends at one of the most challenging times. So if you want to help any caregiver, or even work on creating a dementia friendly community, we have to understand this disease and have to understand how we can best deal with the disease. But then, rather than saying, call me if you need help, because we caregivers won't do that. What we will do however is respond by someone saying oh maybe I could pick up medicines from the drugstore. Maybe I could go shopping for you or maybe in other words specific kinds kinds of things, or maybe even taking the person who was ill for a walk so that the caregiver can get some, some respite. But as I said, if Alzheimer's is bad ignorance of the diseases worse and ignorance of the disease by the medical profession, caregivers, as well as family, friends and neighbors, and if people can just simply, hopefully better understand this disease, I think at that point, they can be more helpful in people living their best lives possible.
30:32 Yeah, and thank you for that advice. I think that's wonderful advice for people that are, you know, in the community and in this fear of people living with Alzheimer's. And I also want to mention that there is support online@alz.org, and that's provided to the Alzheimer's Association, or by phone at 800-272-3900. So if people are looking for more resources, they can find them there as well. And of course, your book. Let's talk about that. My two Elaine's, learning, coping and surviving as an Alzheimer's caregiver release is June 13. So we're perfectly within that Alzheimer's Awareness Month and people can get the book, I'm assuming wherever books are sold. That's my understanding. I would assume that wherever books are sold, it's printed through Harper horizon, which is an imprint within HarperCollins. And one last question regarding the book. And this is a more personal question for you. Is it upon writing the book? Did it give you time to reflect? And did it feel cathartic for you? Did it give you any sense of closure around your living with a person living with the disease?
31:51 It certainly was cathartic with without a question. But I think that one, one of the main things I got from this book is much I wanted to do something to help other people not both through what I as ignorant caregiver went through, and also what I might be able to do to help caregivers help their loved one with with dementia live their best lives possible. And the because I think back again, on our past 18 years, and I think how it could have been easier, as difficult as it was, it could have been easier. And it's not a matter of getting enough money to fly to the moon and back. It's it's a matter of just simply understand some some some basic factors and, and dealing with some unknown quantities, but no, it was it was quite an experience to write that book. And I'm glad that we were able to do it. And I want to tell you that I'm grateful for for being able to talk about this. And and also grateful that I think, hopefully we're going to be able to help some more caregivers learn cope and survive.
33:16 Perfect. And where can people find you? Let's say they have questions they want to talk to you they want to get in touch with with you, what is the best way to do that?
33:26 We have a website. That's right, my two Elaine's all one word.com And guys should anything and I have been up until COVID giving talks around the country learning and really everything that I shared with you about what caregivers go through, I can tell you, whether it's it's Newmark, Minnesota, Florida. St. Louis, I don't care where it is, that is simply an overlay of almost every single caregiver as how they're trying to cope with this disease. So but I also wanted to mention you gave the 800 number for the Alzheimer's Association. That's a 24/7 number. And so there are going to be some moments where you're just not going to be able to figure out how am I going to cope with this? Well, if you give them a number, I mean, give them a call, they will be able to help either give you an answer or point you in the right direction.
34:32 Perfect. And before we wrap things up. I have one last question. It's a question I asked everyone who comes on the show. And that is knowing where you are now in your life and given your illustrious career. What advice would you give to your younger self, and that may be that younger self was that freshman in high school when you met your wife or maybe it was in the midst of your being the governor? What advice knowing where you are in Now would you give to yourself as a younger man?
35:05 Live in the moment. And we, you know, it's not only the fact that I didn't enjoy looking at the bird with the lane, it's probably the fact that I was too busy to take time to enjoy playing ball with my sons are too busy to take time to go to the museum with my daughters, and, you know, just, you know, being with them. But really my mind is someplace else worried about some other kind of thing over which I probably had no control over anyway. But I think to, to, to live in and understand and grasp and appreciate, and be thankful for the moment.
35:52 I think that was wonderful advice. Well, Marty, thank you so much for coming on the podcast and sharing, sharing this book with us. And so everyone, again, the book is called my two lanes, it is sold everywhere where books are sold. So I highly encourage you, especially and I'm gonna say this, especially for people in the health care profession. I'm a physical therapist, a lot of physical therapists listening to this, I think, especially for those people, because oftentimes we're with the patient, but we're not with the caregiver. And I think it's really important to get a full view of what the what life is like for everyone surrounding this patient. So I highly encourage you to go out and get this book and read this book. So Marty, thank you so much for coming on.
36:42 There. And I'm very grateful. One one thing, as as we, as we sort of parted company here, when I talk about joining the world of this person who now is to make sure that caregivers as well as healthcare professionals know and understand truly that you cannot argue with this disease. If when I took Elaine to daycare, and we would drive up to the door, and she said that she's not going in, there was no way that I would be able to with wild horses drag her out of that car so she could go into, you know, the daycare. And so it's a matter of redirection. So we would drive around a little bit. Some of the neighborhoods come back, here we are, and she would do that. Sometimes we would be at dinner, and she would reach across the table and grab someone else's wineglass. That's not yours. Put it down. No, it's Elaine. Thanks for finding that wineglass. If you wouldn't have grabbed it, it would have fallen off. And now we're able to give you Lena good feeling about being helpful, but at the same time, not creating an awkward situation. No, you can have that scarf. It's not yours. Well, thanks for finding the scarf, and so on. So, anyway, carry on. I'm grateful to you for what you do. I know that you help out people and that's really special and an honor for me to be with you. Thank you.
38:10 Well, thank you and everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart | |||
| 592: David Wood: The Mouse In The Room - Because the Elephant Isn't Alone | 06 Jun 2022 | 00:38:09 | |
In this episode, Founder of Focus.CEO, David Wood, talks about his new book, Mouse in the Room: Because the Elephant isn't Alone. Today, David talks about the importance of naming your mice, the hurdle of instant gratification and being unapologetically authentic. What does it mean to have 30% more courage? Hear about the art of dealing with rejection, when not to follow your courage, and get David's advice to his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about David Wood David is a former consulting actuary to Fortune 100 companies. He built the world's largest coaching business, becoming #1 on Google for life coaching and coaching thousands of hours in 12 countries around the globe. As well as helping others, David is no stranger to overcoming challenges himself, having survived a full collapse of his paraglider and a fractured spine, witnessing the death of his sister at age seven, anxiety and depression, and a national Gong Show! (https://www.youtube.com/watch?v=YgKwAJieQes). He helps business owners and leaders become the badass leaders people want to follow, creating more authenticity, connection, confidence, and revenue.
Suggested Keywords Healthy, Wealthy, Smart, Courage, Challenges, Confidence, Discomfort, Authenticity, Rejection, Persistence, Commitment, Awareness,
To learn more, follow David at: Website: https://focus.ceo Twitter: @_focusceo Instagram: @_focusceo Facebook: @extraordinaryfocus YouTube: https://www.youtube.com/c/ExtraordinaryFocuswithDavidWood LinkedIn: https://www.linkedin.com/in/focus-ceo
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:02 Hey, David, welcome to the podcast, I am happy to have you on to talk about, amongst other things, a new book release that's coming out today, which is for people not listening. Today is June 13. So we will definitely get to the book, and we'll get to a lot of other things. But thank you so much for coming on.
00:23 My pleasure. And it's nice to meet you.
00:25 Yeah, it's great to meet you as well. So I guess I let the cat out of the bag a little too quickly. We're gonna get to the book towards the end. But let's get to the book in the beginning. And at the end, how's that sound? Yeah, so tell us the name of the book. And I will hand the mic over to you to give us a little snippet.
00:42 Sure. And the I would have mentioned the book because it's going to fit in with the topics we want to talk about, like courage, and practicing deliberate discomfort. The books called the mouse in the room, because the elephant is not alone. And I'm writing this book, because we all know about that expression, the elephant in the room, you see it, I see it, no one's saying anything. Well, that's just weird. And I think we should all address the elephant in the room. But for most of us, many creatures in the room are much more subtle. They're not as huge as an elephant, maybe it's something that I see in you don't see it, or I don't know, if you see it. I think a lot of us are actually putting on unconsciously an act for the world, because we don't want to get in trouble. And we don't want to be uncomfortable. And we don't want to make the other person uncomfortable. So we say what's going to fit into a nice box. The problem is when we do that, we can feel disconnected from the world, we can feel more isolated, lonely. And people won't trust us as much, they won't know why. They'll just know something's off because this person isn't being real. So we're writing, we wrote mouse in the room, so that people can start to notice their mice and go all I'm actually upset about that. Or I have a desire I haven't mentioned or I have a confession mouse over here, or you know what, there's some appreciation I need to bring into this space here. When people identify their mice, and then artfully name them, so that they can come into more connection, more intimacy. And then through more trust, there's good business application to people are going to want to work with you and buy from you and, and follow you as a leader. They may not necessarily know why. But they'll be like, Oh, this person's real. This is someone I can count on. So there's the short version of mouse in the room.
02:37 Excellent. And maybe we'll get into a little bit of those mice later on. But before we get into that, as you were speaking, you had mentioned the word courage. And it I always think that it does take courage to speak your mind. And should we always be speaking our mind? And should we always be using our courage? So why don't you talk a little bit about how would you say 30% more courage? can double your happiness? We have a lot of people who are entrepreneurs who are listening, so we double your revenue. So what does that mean? Can you break it down?
03:14 Yeah. Something my co author said recently that stuck with me was, you can choose the discomfort of wearing a mask, or the discomfort of telling you truth. It's one or the other. And there's a lot more upside associated with one of those things. So I love the concept of courage I found as a kid, whenever I didn't do something that felt right be out of fear. I would like myself a little less. So if I didn't ask that girl out, or if I didn't confront that bully, or if I didn't stand up for myself, I would I just feel smaller. And it's an icky feeling. I don't want anyone to have that. Conversely, I discovered that when I am willing to take a risk and do something that's a little scary, even if I don't get the result that I wanted, I feel better about myself. It's like I went for it. An example of this I went to a conference where I was awestruck by the people that I was hanging out with there was like Jack Canfield from chicken soup and John Gray from Mars and Venus and Don Miguel Ruiz is a member and I'm like, Oh my God. And when I left the event, I look back on it and I realized I made four bold requests that terrified me. Like I asked Jack Canfield if you'd be interested in writing a book together. That was very scary. I figured he probably gets about 100 proposals a day for something like that. I asked someone if she wanted to go out with me and have our first date be a trip to Colombia. I asked an obstacle when Oscar winning producer if, like what it would take for me to do a ride along on his next film shoot. These were all scary things. Now. I didn't get a yes to Everything that I asked for, but I felt complete. I felt like yes, I went for it. They say if you I'm gonna butcher this quote it's, it's something about the trivial quote is, if you don't ask, you don't get you're already starting with a novel. That's the default answer. So I think it behooves us to find our edge like, what is our edge? Is it? If you're an entrepreneur? Is it asking a celebrity to endorse your product? Is it asking 10 people to be affiliate partners that that you think would never give you the time of day? Is it calling 10 people and asking them to become clients? Because you think you could serve them? I don't know where your edge is. But each listener needs to find their own edge, like what would feel uncomfortable and a little scary, but could have some great upside. And again, I'll say the main benefit is you get to feel better about yourself. And as a bonus, you may actually get some yeses, which might surprise you like, Oh, my God, someone said, yes. That's a bonus.
06:12 And do you feel like even if you fail, or even if you get these nose, or even if people don't give you the time of day? Does it help to boost your confidence? Because you're asking the question, and you're putting yourself out there?
06:28 I think it absolutely does. And this ties into the book really well. Because if you're going to name a mouse with someone, you're going to sit like that what I just mentioned at that conference with desire mice, I had like four desires. And so I named them, I felt better about myself, I felt more confident. And I actually got a yes, one of those four questions got me a yes. And was like, Oh, my God, that's really cool. So yeah, and what what we did have as a subtitle is, this is your pathway to connection, confidence, and becoming a badass leader that people want to follow. Because if you hide what you're tolerating, if you hide what you desire, if you hide what you're ashamed of, then those mice get to breed, and you get more and more of them. And that's where shame can really thrive. Whereas if you bring yourself to the world and say, Hey, this is who I am, every time you do that, every time you name a mouse, it gives you a chance to increase your confidence and belief in yourself. Because it's you. It's like, this is my desire. You don't want to grant that. Okay. Thanks. Hey, this is something that's bugging me. Can we change that? No. All right, gave it a shot. We want to get back to like that. That confidence of when we were five years old, for many of us, and we're able to just go for stuff and we hadn't been beaten down by life. And people get back in touch with what's going on inside and then artfully bring it. Now you brought up earlier on? Do we shall we name everything? No. If you go to someone's house, and it looks like a pigsty and you're uncomfortable there, maybe you suck it up for 20 minutes until you leave. And maybe they don't need to know that. Or maybe if you got a gift from someone, maybe you don't have to tell them. But hey, if they've given you that thing, three years in a row, it might be a kindness stood due to speak up. Well, in one of the chapters of the book, we give you a test to work out. Is this worth naming? Is this something that I should bring and could bring? And if yes, how will they artfully do it so that I'm unlikely to trigger a huge response in the other person? And they can be like, Oh, alright, I get where you're coming from. Yeah, let's, let's work that out.
08:49 And what do you say to people who may think well, okay, I can have the courage, I can ask all these questions. But I keep getting no, no, no, no, no, no, no. You know, is that going to kind of reinforce this? I don't want to say, lack of confidence, but maybe reinforce to people that oh, it's not worth it. I keep asking these questions. I keep getting nose and it reminds me of, let's say, actors or actresses who go out for parts because they get a lot of rejection. But they keep doing it. Right. So yeah, what do you say to those people who are like I've gotten enough nose and I don't want to get any more nose.
09:38 Did you know that eight months ago I started acting now and I started acting eight months ago and in three weeks I'm moving to Los Angeles to pursue acting so I know a bit about this by I have two answers two broad answers to this one is if you're getting it so you ask Katie says Byron, Katie says, you can have anything you want in life if you're willing to ask 1000 people. So I think there's real value in asking 1000 people. And if you ask 1000 people and get 1000 knows, there might be something wrong with the question. So that might be where some coaching can come in. It's like, how am I asking? And is there a way that I'm, am I selling the sizzle? And this am I like, you know, so there's two answers, and they're both true. You want to ask in a way that's enrolling. But be careful about getting attached to the outcome. This is what people collapse, and I got this from landmark education. A long time ago, people think it's one or the other, you can be committed to something, I am going to make this happen Martin Luther King, I'm going to free the slaves, Gandhi, I'm going to free India, you can be committed to something. Or you can be unattached, but you can't be both. And so as soon as they get committed to something, they think they have to get it. And if it's not coming straight away, or early on, there's a problem. And I'm going to collapse, I'm going to make it mean something about me. Landmark helped me distinguish the two is that there's commitment, and then there's attachment. And they're two separate things. What if you could be committed to something and how you show up every day is aligned with that? And yet you're unattached, or if the universe says yes. Now, that's a powerful place to stand.
11:44 Yeah. And that's something that, you know, I'm a physical therapist. So as a physical therapist, you know, I often tell younger therapists that you can't detach yourself to the outcomes of your patient. So you can't be judging your success as a therapist, wholly on the outcomes of your patients. Because sometimes people improve, and sometimes they don't, which may be wholly out of your control. But you have to show up and do the best you can based on the evidence that you have. So kind of the same line of thinking great.
12:22 It's a really good example. And I heard an expression recently that I decided to steal because it spoke so well to this. You know, a friend of mine said, Oh, well, it sounds like you're moving the ball further down the field. And I was like, I love that. Because that I can control. I can't control the goal. I can't control what other people say or do. I can't control if I make the sale. But I can move the ball further down the field, I can position it in the best possible way. And I can own Don't ask 500 or 1000 people. If, if, if they want to buy what I have. Recently, I decided to Oh, it's happening in acting all the time. Now, if I was attached to getting a yes to every audition, I'd have to give up after two days. Totally. But the way I'm reframing it for myself is those auditions are my performance that is my acting. And so I'm submitting to 100 plus things a week around the country, and most of them I know I'll never hear back from but I'm playing the long game. I'm playing the law of large numbers. And in the last eight months, I've had a yes to playing the lead in a local paid production of Dracula. I got a yes to doing two commercials that I got paid for six short films for them free to have them paid. Now I had to do a lot of auditioning and submitting because I don't have a lot of experience. And so some of its luck, is keep going until someone says oh, I like the look of you. Let's get that guy in. And when Jack Canfield came to my live event, he got up there and he spoke about the law of large numbers. You need to ask enough people now sure you ask 1000 people you get to know there's something about how you're asking. But don't give up after five or 10 or 50 100. Don't be like that kid in the playground. Say hey, do you want to ride on my tricycle? No. Okay. Hey, do you want to ride on my tricycle? No. Okay. Hey, do you want to ride on my tricycle? Be you that's what the books about like, express yourself. Express your desires. I think at some point someone's gonna be like, Oh, that sounds pretty cool. Yeah, I'll do it in you're like what? Really? I didn't think I get a yes. And then the next time you won't be as surprised and you are you'll hide the shock better.
15:00 Yeah, at some point that key fits the lock, right. And I also love kind of that concept of moving the ball down the field a little bit at a time. And I know for myself, I have always been like, well, it needs to happen. If it's not happening now, then it's never gonna happen. Or if it's not happening, the timeline, I perceive something to happen, then that means Oh, well, it's not going to happen. It's not for me, and I used to kind of tend to give up a little too easily. But now, I have come to the realization that, like you said, if you move the ball down the field a little bit at a time that it doesn't have to happen all at once. But as long as you're making forward progress, and you're working towards the goal, it'll happen. Because let's be honest, we're living in a now everything has to happen quickly, this social media, quick, quick, quick decisions. And if it doesn't, then we're losers.
15:54 And that's a problem for people who want to be successful. Because if there are any good rewards to doing something, let's suppose you're going to start a big business selling widgets. If there are any good rewards for their business, it's not going to be easy to do. Because if it's easy, then the first three people into the market are going to take all those rewards and, and it's going to be flooded by people doing the easy thing. And there'll be less rewards, the rewards are gone. Seth Godin wrote a wonderful book on this called the dip. And if you're not prepared for any kind of a dip, it might be hard to get any good rewards. Now, don't go overboard, you might not decide on brain surgery as a career. Because that's, that's a really big dip. But if you want to start a business, or go and get a better job, or switch careers, or find a life partner or something like that some of those things are going to have a dip to them. And it's good to just know that going in and say, All right, roughly, how long are we looking at? Like, if you're going to start any new business, if you do it well, and work hard, you're probably looking at at least three years to turn the corner and make a profit. Now, know that going in? And then have someone to remind you, when things look bleak, yeah, this is gonna take some time, you gotta keep going at it. I've been doing podcast interviews for three years now. I think I've done 300 interviews. And I think I might only just be starting to get some some traction and to get get known. And people like, oh, yeah, that guy from that, you know, from mouse in the room. And now I'm about to launch a book. And, you know, I'll do six months of beating the bushes, just Yes, a few days ago, I said, decided to reach out to my colleagues and thought leaders and influences. Some of those people are never going to get back to me. They're not even going to respond and give me the time of day because they're busy, or I'm not big enough on the totem pole. That takes something to reach out to all those people. I got to screw up my courage and be willing to be uncomfortable, and then put it out there. And then be surprised by who says yes. And who says no.
18:08 Yeah. And as we're talking about courage, are there times when maybe you shouldn't be following your courage? When are the times that that you say, hey, well, let's pull back for a second?
18:22 Great question. When I was growing up, and I realized I didn't like feeling small. I started leaning into my fears, and is a name for it. Apparently, it's so counter phobic. So if you're afraid of something, you lean into it, and that's my style. And that produced a lot of benefits and rewards and a lot of growth. But I didn't know when to say when I didn't know how far was too far. And you can traumatize yourself, you can burn out, you can push yourself too far. I would go into paragliding and hang gliding because I was afraid of heights. And I've had a couple of accidents and even had a slight compression fracture in my spine. Doing a couple of things that were out there. I was afraid of abandonment. So I thought well, let me see what open relationships is like in dating more than one person at once and see if I can conquer this fear. I found that I have limits my nervous system or my psyche has limits that I need to respect and be humble about. So I think it's about finding your sweet spot. You don't want to stay in the comfort zone your whole life it gets very uncomfortable over time. You need to find your edge but don't go way past it to the point where you might be like, you know killing yourself in a motorcycle accident or doing something completely reckless are going on national TV to speak if you haven't even spoken yet, like find your edge. There's a sweet spot for each person. Here's a wonderful exercise It's very practical, you grab a piece of paper, and right at the top of it, if I was fearless, the big capital I f, if I was fearless, what would I do? And you're gonna have one page for business and work. This is what I do. This is who I asked, this is what I go for I do a TED talk, I get to blah, blah, blah, blah, and then another page for personal. This might be what I'd say to my partner. This is what I might say to my kids, this is what I might ask for. This is what I might do, I might move to Brazil, I might go cross country and move to Los Angeles to start acting like whatever it is for you. Start writing things down knowing that you don't have to do anything on those pieces of paper. That's important. Because otherwise your mind might hide these things from you. You just want to find out what would be edgy. And then you don't have to do any of it. But you might like to circle two or three things that would be in the right at that edge like yep, that would be uncomfortable. And I think I'd feel proud that I did it. Do those, you can start with those and work your way up to the biggest stuff. Or if you like me do the scariest one first. And everything else is easier after that.
21:15 Right? Oh, that's a great exercise. I have it written down here. So I am going to do it. And it's almost like a way to open up your mind to more possibilities. Maybe things that you you you didn't think that didn't think you could ever even imagine doing but I like that you said listen, you don't have to do it. But let's write some stuff down. Just see what comes out of your mind. Because you never know. We start
21:40 with awareness. And it's the same with mouse naming with mouse in the room. You want to become aware of your mice? What are what is going on in your body? What are the confessions that might be looking? What are the desires that haven't been named? The tolerations. The appreciations, you want to become aware of these? Now you have a choice? Am I gonna name it? Well, let me go through the paint by numbers system in the book and oh, okay, yeah, I could do that. And then you're gonna name that mouse, there might be another one. You, you weigh it up, and you're like, alright, I can see the upside. There's also a downside. Like, if you committed a crime, you might be prosecuted, you might be arrested, you could do jail time, your if you if you cheated on your partner, and you decide to go and name a confession mouse, it could be consequences. So it's not for the faint of heart to tell your truth. And you don't have to name all of them. But the book will help you weigh it up and go, Alright, here's the upside. Here's the downside. And here's the downside. If I never seen anything, that's often what we don't address. And so then you can factor it and go, Alright, I think I'm just going to call call this person, we're going to have a chat about it. And we'll see what comes out of it. Even if it doesn't go well. Does that mean it was the wrong move? Just because the first round didn't go well? No. Maybe they need to have their reaction. And then you felt uncomfortable, and you have a bit of space? And then you might say, Hey, can I have a round two? I feel like I could have listened better. And I'd really like to work this out with you. Let's have another one. And then maybe you surprise yourself and you're like, Wow, I feel really close to that person. Now, if you really connected now we've got a great working relationship. Now for closer to my kid. Now I feel lighter. Because I'm being me in the world. That's what I want for people.
23:40 And can you give an example of maybe a mouse or two that you've named for yourself? Just so people have a better idea of like, what is he talking about? When you say saying name name, these mice are named this mouse? So can you give an example or two of maybe a mouse that you've named for yourself?
24:02 I'll give you an example of one from last night that I wish I had named earlier. And I kept it to myself for too long. I had a poker game, had some friends over and at one stage someone else arrived to the game and there's so much commotion and people getting up and noise and whatever. I got anxious. I had a panic feeling. And so, but I didn't say anything. I just tried to deal with it. I went outside I calmed down a little bit on my own. And then I had the resources to say hey, yeah, I got really activated. And I think I'm okay now but I could have said that in the moment. I said wow, really activate I'm gonna go outside for a little bit with someone come out with me. I could have said that. But I was a little bit too triggered to do it. That's, that's um that's what I would call a maybe a medium sized mouse. was pretty big in the moment effect in the moment was huge. We call them rodents of unusual size. For any Princess Bride fan.
25:07 I was just gonna say the RT R O SS. R Us is yes,
25:12 yeah, I'm just gonna restart my video because it went all fuzzy for a second. Then there were, you know, bigger ones that might have stayed with you for years, you might have had them for a long time, I was asked by one of my coaches to make a list of anyone I wouldn't want to pass on the street. Anyone I'd feel uncomfortable seeing or anyone I, I still harbored resentment for. And initially, I'm like, oh, there's no one. But as we dug in, you know, over time, I came up with a few people, and one of them was a bully from high school, like 20 years earlier, who had just really not treated me well and made fun of me. And we used to be friends. And the coach said, All right, call him. You know, we didn't have the terminology, name that mouse. But the coach was like, call him and clear it up. And I said, Hell, no. I'm not gonna call this guy after 20 years, he's gonna think I'm an idiot. And she said, and I'm going to translate it to this language. He said, basically, well, that's another mouse. So start with that. And I was like, oh, okay, I could do that. So I tracked down his number, and I called him and I said, I'm so worried you're gonna think I'm a complete idiot for calling you about this after 20 years? And he got curious. He said, Oh, well, what is it? What do you got? What's going on? I said, you always pushed me around and one off to me, and I tried to one up you, but you were better at it. And I really resented you, and I'm letting it go. You don't have to do anything. I just thought I'd let you know. And he said, the most mind blowing thing. This was the jerk. Like for 20 years, I'd been treating him as a jerk in my head. He said, Well, what could I say or do now to help you or us move forward? It just blew my mind. And if I can call him and call the girl who dumped me twice in high school, and call the guy who ran the company that I sued, to see if there are any ill feelings, and cold the person that I committed a crime against when I was younger, and I could have been prosecuted by saying, hey, it was me. And I'm sorry, can I make it right? I've done that twice. Actually, if I can do that, then just consider what could you do? It might be uncomfortable. And you don't have to do it without the paint by number system we outlined in the book that'll make it so much easier for you. But there are really beautiful things on the other side of that discomfort.
27:56 Right, so So these, these mice are the mouse that you name is just sort of this discomfort or this uneasy feeling that you've been harboring about topic XYZ or person XYZ, you naming it so that you can confront it and move past it.
28:13 Yeah, that might be a there might be a healing for me involved. Maybe the other person's got something going on it that you don't even know. I had my my brother was getting coached. And they gave him homework to call somebody and name a mouse. And he couldn't think of anyone and the coach. And the coach said to him, it doesn't matter how small it is just trust in the homework, go and do it. So he called a girl that he broken up with a year earlier, and said, Look, I just I don't know if you made it mean anything about you. But I want you to know, that was everything about me. I was not in a space to be in a relationship. And I really think you're awesome. And just in case you were thinking anything else. I wanted to let you know. And he said the impact on her was unbelievable. She started crying. And she said she'd been thinking that she was a loser because of that whole thing. And he came back to me and said, Look, I got no money. But that call was worth $10,000 to me. This and he was like 22 at the time. He's like that call was just unbelievable. So the upside of sharing your truth in an artful, ideally blameless way can be extraordinary. Everyone wants to be human. They want to be human and they want to open their heart That's my belief. That's my story. Now it's not going to happen every time you talk with people but even that boss that I called where i i sent a letter of demand and was threatening a lawsuit. We got chatting and he said all look back at the time. It didn't feel very good. I didn't Like, depart with the money, but that's water under the bridge. And I said, Well, how you doing? He told me we never had a personal conversation. He told me about his divorce and what was going on, I felt so close to that guy, I hung up the phone feel like we're buds now, all of it because I just called to say, is there any hard feelings from them? I'm hoping, hoping not. So it's it's a gateway courage in general. And I think particularly courage about the things where we have a bit of charge can be a gateway to connection, confidence, and being the badass leader that people want to follow.
30:37 I love it. And where can people find the book gets out today, which is again, yeah, June 13. In case you're listening to this on the 14th, through the 15th, or whenever,
30:48 or whenever, whenever, yeah, go to mouse in the room.com. And there'll be a link there for you to go to Amazon and get your book, we've got a special going. Special going, we're going to do the Kindle for like something crazy, like 99 cents, because we want to just do a best seller campaign. And so you could get the book for almost nothing, or pay for the you know, pay the 1295 or whatever, whatever for the book. But we'd love you to support the best seller campaign. And the way you can do that is get the book posted on social media that you got the book because it's good idea to have your friends naming mice with you. It's hard to do in isolation. But if your friends and the people around you are like, oh, yeah, this is what can I name a mouse with you? Oh, you got a mouse to name with me? Yeah, shoot. That's what I want for the world. And if you think it deserves a five star review, please leave one because that's what will help us climb in the rankings and hit that lovely bestseller title, which is really just an excuse to bring people together for a party.
31:53 Absolutely. And if people want to get in touch with you, if they have questions, maybe they want to work with you. They want to know how you know where you are in life, where can they find you?
32:05 Yeah, there's a contact form on my website. So mouse in the room.com, might even redirect you to my other website. But then you'll be able to see contact form, you can request coaching from me, I usually get on the phone with people and we see if, if we're a fit. And if it makes sense. If you're interested in mouse naming for your team, or your company, I'm particularly interested in that because we can start shifting the culture and have people sharing their desires and actually not letting things fester. I think it's wonderful for team building. And so you can reach out through the contact form about corporate trainings, or team team trainings.
32:45 Perfect. And before we wrap things up, is there anything that maybe we missed or that you want to really leave the listeners with?
32:56 You're already doing things, right? You got this far, you don't need fixing. And there can be a lot more connection in the world for each of us. And I found if you can just go through some of those scary places of discomfort and just screw up some courage. There are some beautiful things waiting on the other side. And I will, I could almost promise you that on your deathbed. You're not going to go I should have stayed quiet. You're going to say I'm glad I read that book. And I'm glad I spoke up my truth more and more often. And I went in that direction. That's how to live. We don't want to watch movies about people hiding their truth and staying small. We want to watch movies about people being themselves in the world. And that's what I want for the world. I think this is what can really heal the planet is people being more of themselves.
33:55 Awesome. And last question I asked everyone and that's knowing where you are today in your life and in your career. What advice would you give to your younger self?
34:10 At times, it's gonna get very hard. It might get so hard that you don't know if you're gonna make it. But you do you know, even because it's even though it seems like you just can't make it. You're stronger than you think. And you will find something new, you will learn a new way to cope. And then you'll go on and the universe is going to bring you something else. But try to remember when you're in the middle of it. Okay, it feels like life and death, but usually it isn't.
34:42 I love it. That is great advice. David, thank you so much for coming on to the podcast. I really appreciate it and again, everyone run out, get the book, get it on a Kindle, get it in and something in your hands if you can as well. The book is out today the mouse in the room. David, thank you so much for coming on.
35:03 Sure. I'd also say read it to your kids. You want your kids naming mice, you want to name mice with your kids. So, we didn't talk about parenting, but I think it's very as a chapter on on mouse naming for parents. So, thank you. I am excited and I appreciate the chance to talk about it.
35:20 Pleasure and everyone. Thanks so much for taking the time to listen. Get out there, start naming your mice and have and stay healthy, wealthy and smart. | |||
| 591: Leon Anderson III: My Physical Therapy Journey | 30 May 2022 | 00:30:21 | |
In this episode, President and CEO of Sports and Spine Physical Therapy, Inc., Leon Anderson III, PT, MOMT, talks about AAPT. Today, Leon talks about the history of AAPT, working with his father, and AAPT's networking opportunities. Hear about AAPT's mission, encouraging minority students, and clinical research related to health conditions found within minority communities, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Leon Anderson Leon R. Anderson III, is a native of Cleveland, Ohio. He graduated from The Ohio State University Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was as a Systems Analyst/Summer Intern for his fathers company Centers for Rehabilitation, Inc. There he discovered a passion for patient care. Subsequently, he pursued a degree in Physical Therapy at the University of Connecticut. After graduating, Leon was selected for a two year manual therapy residency program earning a masters degree in Orthopedic Manual Therapy from the Ola Grimsby Institute.
Leon is president and CEO of Sports and Spine Physical Therapy, Inc. (SSPT) The company operates three clinics in the greater Cleveland area and one in Charlotte, NC. Leon was inspired by his pioneering father Leon Anderson Jr. who was considered a vanguard of the profession for over 40 years. SSPT's company culture and core values of providing high quality rehabilitation services are a direct result of Leon's life long tutelage by his father.
Leon is a charter member of the American Academy of Physical Therapy. He served as a Subject Matter Expert for the American Physical Therapy Association's Orthopedic Clinical Specialist Exam. He also served as an on-site reviewer of the Commission on Accreditation in Physical Therapy Education. (The accreditation agency for entry-level physical therapist and physical therapist assistant programs in the US and UK).
Suggested Keywords Healthy, Wealthy, Smart, AAPT, Healthcare, Impact, Research, Opportunities, Mentorship, Equality, Connections, Education,
To learn more, follow Leon at: Website: www.SportSpine.com Twitter: @LA3OSUCONN Instagram: @osuconn
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Read the Full Transcript Here: Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35 Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found chosen and get those five star reviews. Right now if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic whim. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net health.com forward slash Li TZY to sign up for your complimentary marketing audit today. Now on to today's episode Dr. Jenna cantor. Cantor is back and being the host with the most for this episode. And we are happy to welcome Leon Anderson the third he is a native of Cleveland, Ohio. He graduated from The Ohio State University's Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was a systems analyst summer intern for his father's company centers for rehabilitation. There he discovered a passion for patient care. Subsequently, he pursued a degree in physical therapy at the University of Connecticut. After graduating, he was selected for a two year manual therapy residency program earning a master's degree in orthopedic manual therapy from the OLA Grimsby Institute. Leon is President and CEO of sports and spine physical therapy. The company operates three clinics in the Greater Cleveland area and one in Charlotte, North Carolina. He was inspired by his pioneering father, Leon Anderson Jr, who was considered a vanguard of the profession for over 40 years. SSP tees company, culture and core values of providing high quality rehabilitation services are a direct result of Leon's lifelong tutelage by his father. He is a charter member of the American Academy of physical therapy. He serves as a subject matter expert for the American Physical Therapy Association's orthopedic clinical specialists specialist exam. He also serves as an onsite reviewer of the Commission on Accreditation, physical therapy, education. So today, they talk about a PT so the history of AAPT networking opportunities and how that branch of our profession that organization within our profession profession came about so big thank you to Leon and Jenna and everyone enjoyed today's episode.
03:15 Hello, Jenna Cantor here with healthy, wealthy and smart I am super excited and honored to be here with the Leon Anderson, who is a major leader in the physical therapy community. He is the president and CEO of sports and spine physical therapy and is also a charter member of AAA, PT, the American Academy of physical therapy. Thank you so much for agreeing to come on Leon.
03:42 Welcome. It's good to be here. Thank you, Jennifer offering this opportunity.
03:46 Oh my gosh, I've just And it's funny, right people, we still we came on, I learned that you were just in Barbados, and you have a bunch of patients there and you were vacationing, that's incredible, you are living a life. There's so many opportunities and you're living that right now. I love it.
04:03 Absolutely. There are opportunities all across the world when it comes to physiotherapy. It's known as physiotherapy in most parts of the world, and physical therapy here in the United States. But just in the islands, you know, there's just a huge huge opportunity to bring the kinds of things that we do here to that particular population, because of the all the different technologies and nuances and things that we have, you know, that we have here. So, I was in addition to enjoying the beach in the sand, I was also enjoying given our advice on how to become a more functional individual, and whatever Island or whatever society or community that you live in.
04:42 I love that. Thank you. Thank you for your service series. That's incredible. I love that. I wanted to bring you on today to actually talk about a PT specifically talk about the history how it became to be in everything So I would love to just start with your perspective specifically, and how it came into your life.
05:09 Well, I grew up with, you can say occupational inheritance. My father was the 16th person in Ohio to be licensed as a physical therapist. He was a vanguard in our profession. He held many, many, I guess positions, if you would say, locally, nationally, even internationally, he was one of the first African Americans to be on the board of directors for the AAPT. In fact, there is a, a room at our headquarters in Alexandria. That is the Black Heritage Room, and it's named after my father and one of his protegees, who's also my mentor, the late Dr. Linda Woodruff, who was just an amazing, amazing mentor, and my father, Leon Anderson, Jr. and since I'm the third, but if you rewind back to when he got started, a PT that started mainly the the PTS of color that were involved in the APTA just didn't feel that their needs were being met, you know, as it relates to our communities. And so there are a couple of different little groups, like blacks interested in physical therapy or charm, I can't remember right now exactly what the term acronym is, maybe I'll think about that. But there are different groups that they would meet at the eight PTA annual conferences. And at some point, I think it was 1989. It was at 1989. In September, in Chicago, about 90 individuals met and I was actually a student, myself, and also donna, donna, it was not a fun doll, then. Now it was done in green Howard, that we were both students at the time. And now these individuals got together and they decided they wanted to do something that was going to be specific for the African American community and meet the needs of those communities that are disadvantaged and poor. And so that's where, you know, it was born out of and we have so many, I mean, just a plethora of talented African American PTS, in academia, in private practice, in the hospital setting, and, you know, in the military, just in all of the different different settings, and very accomplished, very accomplished ones also, I mean, it's just amazing. The BB Clemens, the, I mean, the mayor McLeod's, the Robert Babs, there's just so many that so many people who, who contributed so much to this organization early on, and we've done just many, many, many things to help students and then help our community. So that's, you know, in I hate the Babylon, but that is a kind of how we were born born out of a need, that needs weren't being met by the large the large organization, the APTA.
08:08 Oh, my gosh, this is a nerdy question. Okay. The meeting was in Chicago, was it over pizza? You know,
08:17 believe it or not see. So once again, we have such an accomplished set of founders. It was at like a, a Hilton, or a Sheraton, a Sheraton Hotel, where we all met. And, you know, they used Robert's Rules of orders, it was extremely, extremely organized. But remember, for years prior, there were these little interest groups that would meet over pizza and over coffee and over tea and you know, different things for many years, at the different organizational meetings, whether it be the annual meeting, or the combined section, or what have you. So at that meeting, we actually they actually established, you know, a skeleton of what our current bylaws are for the AAPT right now, so it was a very, very, very industrial meeting. And productive meeting over that weekend back in September 1989.
09:12 Wow, that is so cool. I love it. It really was from the ground up. It just organically. It happened so organically. And it was a major need and it just grew. I love that. That is so cool. And your legacy. Oh, you probably carry it. That was so much pride. I love that for you with getting involved. So your dad's involved. Did you feel pressure at the beginning? Like how did that happen? Because your dad is just so prestigious? And is it doing so many things for the profession? How was that for you?
09:47 Well, believe it or not, my first degree is actually in computer science at a computer science degree from The Ohio State University. And what I found was that by my junior year I was doing some statistics statistical analysis where my father during the summertime didn't do my summer off. And I was at a, a facility for the mentally and physically challenged. And while I was, you know, doing fixing the computers and trying to network computers and things, I also was a transportation aide. And I will transfer the patients from their cottages, to the main Physical Therapy Center. And I found that I fell in love with patient care. Although I'm the nerdy, mathematical computer guy and logical guy in my head, I found it to be extremely satisfaction, I found a lot of satisfaction, I should say, in interacting with these patients. And that's why I fell in love with this therapy, my junior year when I was at Ohio State. So I decided I wasn't going to just throw those three years away, I went ahead and finished out my, my, my career there ha state. And luckily, because my parents said they were not going to pay for a second education, I had to do it on my own. Luckily, I got a scholarship and academic and leadership scholarship because I went to our house State, I was on a board of this organization, students together against apartheid. And I was a peer counselor, I won the black leadership award my senior year. So with those along with my GPA, I was eligible for a scholarship. And I ended up at University of Connecticut, you know, on scholarship, so that worked out great, I wouldn't say that I felt pressure, it's my father just wanted to always want me to do whatever I was I was good at and, and to be happy, and to whatever I did wanted me to be the best at what I did, and to strive for excellence. But once again, I fell in love with patient care that that that summer 19, I think was 1985. And I really haven't looked back,
11:47 I want to get into the mission statement of a PT, I'm going to read them in sections because so that way it can be discussed each part in more depth, although I think it's quite, quite easy to interpret. So the mission statement is the American Academy of physical therapy is a non not for profit organization whose mission is to provide relief to poor and disadvantaged African Americans and other minorities by and let's talk about this first one, promoting a new innovative programs in health promotion, health delivery systems and disease prevention. Would you mind just talking more on the importance of that?
12:26 Well, we just have so many different talented individuals who are in all these different aspects, whether it be neuro, whether it be neurotherapy, whether it be sports and mettam, sports, med Med, whether it be dealing with childhood, obesity, bottom line is, I think it was back in 2010 with the Department of Human Services, Office of Minority Health and Health Disparities disparities came out with all of their initiatives, and we partnered with them. And I think it was probably 20 or $30,000. Grant, but I'm not sure right now. But But the bottom line is, is we partnered with them, because we wanted to really make an impact in our community, as relates to the health care disparities. So whether it's talking about diabetes are having different hypertension, and different organizational would you call them community health fairs, or programs, we even had a program with the Patterson cow foundation that they supported for childhood obesity. Our goal is for our individual members in their communities to make an impact and partner with the organization at large and use us, you know, to help them make the impact in our community using our resources. And our net network.
13:54 Yeah, yeah. It's funny as talking right now, everything you're saying is great. My husband's musical theater and he's singing full out right now. So I just want to acknowledge it is what it is love him. And you know what life is a musical? Isn't that great? Next, encouraging minority students to pursue careers in allied health professions. Oh, can you talk about the need there?
14:17 And on that note, we'll take a quick break to hear from our sponsor and be right back. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's digital marketing solutions have the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about his new integration. Head over to net help.com forward slash Li TZY to sign up for your complimentary marketing audit.
14:59 Also keeps me there, I think that we are still less than 3% of the profession. And the goal is to really expose the minority students to the profession as early as we can. So whether that means are different individuals, whether we're at one of our conferences, when we do some of the community outreach, or just someone in their own community, that's exposing individuals by going to health fairs going to speak at the local professional, and career career days, we've had so many opportunities. In fact, my wife and I, in conjunction with the American Academy of physical therapy, we ran a program called Let's Talk About program that did just that it really expose the kids to different professions until to improving their life skills and to becoming excellent and just empowering them to awaken the genius within them. And once again, that was one of those organizations that partnered with the APTA and use the 501 C three, until we got our own 501 C three, but then continue to partner with them. Because the goal is, if you can expose a child and broaden their horizons, it just gives them more options, on what they what they can do and what they can be when they get older. And it makes it makes perfect sense that if you can see yourself doing something, then or someone like you doing something, it increases the possibility that you have in your own mind that you can actually do it yourself. So when you look at Barack Obama, you have you have no idea how many, you know, kids right now can think to themselves that wow, Brock Obama was president I can be president or rob Tillman, or Leon Anderson, is, you know, high in an organization, doing things to help our community, I can do that same thing, I can make that particular impact. We've also had
16:51 visual affirmations, literally, yes,
16:54 we absolutely. We've also had many educational opportunities to help with our students. And just making sure that once you get into PT school, that you pass the exams, we used to hold many of the exam prep courts of the exam, prep organizations and courses around the country.
17:19 That's great. Yeah, it's all there's so much opportunity in this. It's a big one. It's a big one. And no, this speaks to any, any, anybody would like who is black, or in a minority, this speaks to you right away. Absolutely. And if you are wondering apps, yes, definitely reach out to AAPT. This is, this is part of their mission. Next, and finally is performing clinical research directly related to health conditions found within minority communities.
17:49 Same thing as as before, we encourage our, our members, and our constituents and our stakeholders, to engage with the professional organizations and do their poster research. And, you know, to really see, you know, what it is that our community needs, because most of the research that's done is just is or has been done historically, has been on the typical, you know, American, which may be a five, seven, you know, 40 year old white male. So the key is, we really want to make sure that we get data that lets us know, you know, what is the optimal amount of vitamin D, for a African American and living in the, you know, the Bible Belt, you know, that has this particular type of, of exercise level. There, this particular type of diet, you know, so, over the years, we've had many of those posters and the different organizations, annual conferences, and also in Chicago, Diane Adams, Saulsbury. And Vinod Rosebery, who's who's actually mayor now, they, in conjunction with the AAPT had a phenomenal he was a kid's fitness health club at an actual health club, and they were able to, to glean data on the health of our community, as relates to our kids and how they interact with an actual exercise routine. And a, a place to go that's safe, and also informative, and getting them to where they need to be. It was just it was just phenomenal. It was it was a phenomenal organization, and a phenomenal, healthy place to go.
19:47 I'm so grateful you have this research as part of your mission. I teach people how to treat dancers PTS PTAs. And we had a group discussion, one I, where we, we I pulled research and tried to find research on dancers, black dancers might be, where's that research black female dancers. And there was, there was one and it had clear bias. But it did show a little bit that there needed to be a lot more investigation. And, and then it just it was like crickets, it was crickets, when I was searching on PubMed, trying to find studies, specifically on minority bodies with that purpose for comparative data. And we didn't have in the little time I did to gather, we started talking about vitamin D, like you just mentioned, not from me knowing to bring it up. But from another black physical therapist in the room and other other black PCs in the room. Honestly, that became a topic. And it wasn't from research, it was was just from personal experience is and it's just, yeah, we need we need this information to do better for humans. so badly.
21:09 It's funny that you say that, Jenny, because one of my protegees it's interesting, because in when you talk about the academy, one of the one of the things that I think we're really, really famous for is it's an it's an N. It's been unofficial for many, many years. But we have a navigation program that helps not only students get into the profession, and get into school and stay in school, and then in addition to that, pass the exam, once you get into the to the profession, and how do you even navigate the profession. So when you mentioned the dancers, I immediately thought of one of my previous employer, employees and that one of my previous students, her name is Shane, I know I'm messing up her last name. And I think she's married now. So I'm really messing up her maiden name, but it's ojo, Fatima, I believe anyway, she is the she is definitely the TCS, the top physical therapist with the L Navy dance troupe. I think she might even be the medical director right now, I'm not going to be sure about about it. She's actually the medical director, I know that they really lean on her big, big time. But she's somebody who, you know, absolutely should be should be out front, not only giving you the information that you might need for your Google, you know, search. But once again, she's there to let that young girl or guy, you know, who's interested in dance, know that, you know, not only not only can you be involved in the performance arts as a dancer, but also as a medical or healthcare professional, or navigation program. So I think that she was a patient of I mean, a student of mine, at least 12 years ago, but our communication has never waned. We even talked as recently as last month, about her career, where careers going in and also getting other younger physical therapists and other parts of the country hooked up with her because as when they travel, they need to use local services, local physical therapy services, and whether that means, you know, a practice that they can come into while they're in that city or if there is a opportunity for an intern in a particular city where they are to come and spend some time with him. So our navigation program is so wide and it's so varied. When you look at just my career alone. I had my father I had Dr. Linda Woodruff. I had Rob Tillman. I had Robert Babs, I had at least 10 or 15, close mentors, role models, advisors, who could help me navigate where it is that I wanted to be, whether it's whether we're on Capitol Hill, doing some lobbying for physical therapy codes, whether I'm dealing with Ohio State University and their football team, or, or whether we're talking about trying to have a Howard University accredited exam. I remember I met with the president of Howard University because I was on the commission for accreditation for physical therapy, education. And I was there for an accredited accrediting visit. And now one of the people who's come in under our navigation, Vanessa LeBlanc, she is now a captive reviewer. So the reach is so wide and so long, that, you know, just being being associated with this network affords you such a wide array of opportunities and possibilities.
24:40 Absolutely. I'm just more than this navigation program. People might be perked up going, what is this? What is this? So I'm going to use some outsider terms on this. So yes, this is a mentorship program, but it's different. And it's really about when you connect with AAPT in court I'm where I'm mixing it up or saying it wrong. So when you connect with AAPT, anyone to a PT is they have a very large network of people with different expertise and you get forwarded to the right person. It's not just within the, the heads of the organization, because, I mean, everybody's doing this volunteer why so not? They can't, they can't, I'll take on everyone. But then from there, you go to this huge web, imagine like, Charlotte's beautimous beautiful web that's extremely expanded and connects you to all the multiple people that would advise you and take you through your journey to really accomplish a lot. It's very cool. And, and, and naturally expanding like you just said, with your your student, how you're now connecting her with students, you know, or people who could use her help. I think it's very, very cool thing that AAPT has going on. Did I explain that correctly?
26:00 I think so. I think he did a good a good summary job. Because it's not a instone program, what it is is right, right, exactly the way the way you the way you explained it was very, very, very good.
26:12 Yes, score. This AAPT has, has been around since 1989, as Leon was saying, and is an organization either, too, if you want to get involved, please reach out to them. Volunteers are always welcomed, there's plenty of opportunity, as you can hear from the mission statement. And, yeah, anything else you want to add on AAPT? A topic that I have potentially looked over because this is a big organ, this organization is a big deal. And I don't want to miss anything?
26:45 Well, no, I think you hit on the major things, I will say go to the website, if you have questions, then, you know, go ahead and submit them through the through the website. It's just a, an organization that I think is just very much relevant and needed to make sure that our community continues to be relevant, and get what get what it needs. That to keep us moving forward and moving in the right direction, because we're all connected. And we all need one another at some point, you never know when you're going to need need someone I remember, there was a member that was I would say he would come to the or to the meetings maybe every other year or something like that. I'll leave him nameless. But when he came, and he was actually being attacked by the State Board for a reason, that was not necessarily his fault. But because we had so many members that were involved in academia and also involved in the state boards that were able to help them out. But once again, you don't know what you need a lot of times until you need it. So just be involved, I would say it'd be involved in your, in all the associations that you can get that are professional associations, because you can glean information from from from everyone. Just because you're a member of AAPT doesn't mean you should not be a member of a PTA or any other healthcare or allied health organization that you think you're a possible stakeholder. And so yeah, I think that it just really makes sense to stay connected to the professional organizations because you won't know what hit you until it hits you. So what you want to do is stay ahead of the paddles, which is one of the terms that we use in our business, there's always a paddle coming after us at every every every point where there's legislation, or COVID It doesn't matter what it is. So the key is to be as prepared as you possibly can for each panels that come and if you can somehow anticipate what a panel you know might be booked for comps and by doing that you can be up on the current legislation you can be up on the current trends in the professor because we become about you know the current pitfalls you know, and then you're much more likely to be a successful individual and happy with your professor. I love it.
29:08 Thank you so much for coming on. I appreciate it and definitely to get connected with anyone AAPT like you said check go to that website. Thank you so much for coming on. We absolutely appreciate you Take care everyone.
29:23 And a big thank you to Jenna and Leon for a wonderful episode. And of course thank you to our sponsor Net Health. So again if you are looking to get your clinic found online, increase your reputation and your referrals then dead net house Digital Marketing Solutions has the tools you need to beat the competition get found get chosen get those five star reviews. If you sign up now for a free marketing audit digital marketing solutions from Net Health will buy lunch for your office head over to net health.com forward slash li T zy to sign up for you a complimentary marketing audit today.
30:03 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media | |||
| 590: Dr. Karin Gravare Silbernagel: Tendinopathy Research: Past, Present, & Future | 23 May 2022 | 00:40:09 | |
In this episode, Associate Professor and Associate Chair at the Department of Physical Therapy at the University of Delaware, Prof Karin Grävare Silbernagel, talks about her research into tendonopathy. Today, Karin talks about her historical perspective on tendonopathy, the future of tendonopathy research, and her presentation at the WCSPT. Is pain really worrisome? Hear about tendon loading, chasing the shiny new objects, creating expectations with patients, treating different kinds of tendons, and get her valuable advice, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Karin Grävare Silbernagel Karin Grävare Silbernagel PT, ATC, PhD is an Associate Professor and Associate Chair at the Department of Physical Therapy, University of Delaware, Newark, DE, USA. She is a clinical scientist with a strong record of mentoring clinical scientists (primary advisor for 10 PhD student – completed, and 8 current PhD students). Her expertise is in orthopaedics and musculoskeletal injury with a focus on tendon and ligament injury. She has been a physical therapist for over 30 years and performed research for over 20 years. At University of Delaware, she is the principal investigator of the Delaware Tendon Research Group and the Delaware ACL Research Group. Her work has been directly integrated into the clinical guidelines for treatment of patients with tendon injuries. She has presented her research at numerous conferences and published in peer-reviewed journals (100+ published articles to date). She has also been invited to speak about her research at conferences nationally and internationally. As the principal investigator of Tendon Research Group at the University of Delaware, she is working to advance understanding of tendon injuries and repair so that tailored treatments can be developed. The Delaware Tendon Research Group is an interdisciplinary team focused on improving treatment outcomes for tendon injuries. Her research approach is to evaluate tendon health and recovery by quantifying tendon composition, structure, and mechanical properties, as well as patients' impairments and symptoms. Her research is funded by the NIH, Foundation for Physical Therapy, Swedish Research Council for Sport Science, and Swedish Research Council.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Tendonopathy, Pain, Injuries, Treatment, WCSPT, Education,
World Congress of Sports Physical Therapy
To learn more, follow Karin at: Website: https://sites.udel.edu/kgs https://www.udel.edu/academics/colleges/chs/departments/pt/faculty/karin-gravare-silbernagel Twitter: @kgsilbernagel Instagram: @udtendongroup Facebook: Delaware Tendon Research Group
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Read the Full Transcript Here: 00:03 Hi, Karen, welcome to the podcast. I'm so happy to have you on and really excited to talk about tendinopathy research and treatment and clinical application. Super excited.
00:14 Thank you. I'm equally excited to be here to talk about my favorite topic.
00:18 Yeah. And later on, we will talk about, we'll give a little sneak peek to everyone about your topic. At the fourth World Congress is sport physical therapy in Denmark happening August 26, and 27th. So for those of you who want that fun sneak peek, you'll have to wait until the end of the interview for that. Because what we're going to start with is, I really want to know, the historical perspective of tendinopathy research and how it's been translated into the clinic. So us, as we spoke, before we went on 18 years ago, you wrote your thesis. And so you've got a really great vantage point to look back on, what what tendinopathy research was, where we're at. And then later on, maybe we'll talk about where you see it going. But I'll just hand the mic over to you. So you can kind of give us that historical perspective.
01:20 Thank you. And I think that, as we spoke about, too, I feel like I'm getting older because more and more my historical perspective kind of comes in. But I think it's important when I started as a physical therapist, so I started clinically in 1990. And when I started, we had in my courses and things you know, talked about muscle, you talked about ligament injuries, and all these things. And then the tendon was just this rope that went in between the muscle and the bone. And that was kind of it. And then when I started practicing, and I worked in Baltimore, and we worked a lot with with baseball players and things, and everybody had tendinitis was super undisciplined ages, tendinitis, Achilles tendinitis. So everybody had this inflammation in the tendon that we never really talked about. So okay, I felt like I was no dummy. I learned medical terminology. So I know itis was inflammation. So obviously, they had inflammation in this tendon, because that was the name was. So I thought our treatments then really, were treating the word. So we were really trying to rest because it was acute inflammation. We tried ice we did I onto freezes and fauna, for races, and they weren't allowed to load and all these kinds of things. And surprisingly, hopefully, some patients got better anyway. But that really sparked my interest into tendon in general, like, what is this? And then later on in the 1990s, that came up more and more research, Korean and Spanish started thinking about, you know, Achilles tendon would hurt more maybe when they were loaded, ie centrically and running, so maybe we need to train that and people are starting more thinking about how do we exercise and mostly maybe the lower extremity, tendon tendinitis. And then we had more research looking at if there was inflammatory components in the tendon. So if you took out cells and things too, there wasn't actually an acute inflammation. So this idea is maybe wasn't true. And that really opened the door for if it's not an acute inflammation, what do we do? So then in the late 1990s, beyond the curve is in Standish, it was another researcher knees and we're Tolman that looked at concentric versus eccentric loading. And then Hogan offense on in Sweden to started to have patients that were waiting to get surgery and he started like, okay, we're really going to load them, you know, we got a heavy load them, because maybe that's what they need, if not an acute inflammation, and started to see people get better if you actually load in them instead of resting them. At the same time we did our I started my PhD things, too, we started looking at, okay, should it be more overload, and we used our pain monitoring model versus the standard treatment that was, you know, circulation exercises, bilateral up and down, but not really trying to load it heavy. And what we started to see those exercise program that loaded more had better effect than the more like generic, protective things kind of things, too. So that's really when things started to change. Right. So I think the historical perspective is we didn't do anything. And we started to do things. And we had these huge jump in outcomes, which is brilliant. And our studies then was, you know, we were looking more at, you know, the Sylvan angle protocol, comprehensive, we use pain monitoring model to guide but also the loading and the exercises to kind of low beyond and not be worried about the pain because if the pain wasn't acute inflammation, maybe wasn't so worrisome, and loading the tendon was painful, but that was also the treatment. So we needed something to kind of understand how much could you really load. So we started with this exercises and being able to load and having kind of achieved this kind of change. I think that was really the the ultimate thing that happened in the late night. 90s, early 2000 And it was the combination of Korean and Spanish hooking out for some did we had programs and kind of moving that forward.
05:10 And there's something that you said in that? Well, a lot of what you said in there that I just want to pull out if we can. So, one thing that you just said is, is pain worrisome? And I think that's a really, really provocative question. Because if you ask the person living with the pain, yeah. And so how, as the therapist, if we're treating someone with a tendinopathy, let's say it's an Achilles tendinopathy, and the treatment induces pain, how do we communicate to the patient? That it's not as worrisome as you think it is?
05:53 Yeah, thank you for that question. And I think that's why the pain monitoring model that we've had, and really the pain monitoring model started with roll on to me who was my advisor, in patellofemoral. Pain, and that's when we applied it. And I think from the patellofemoral, pain, we kind of seen the same path, right? Just resting, it doesn't help you need to get strong. And then we will the tendons seems to be the same thing. And I think the pain monitoring model has been a lot of discussion is, you know, we go up to five is okay, and those things, to tell you the truth, I really don't care if it's five, or four, or whatever, I think it's that communication to the patient and communication that waiting for this pain to become zero, if that's the goal. And what I say to everybody was my lecture, and you might have heard that too, I'm like, Well, if that's the goal, I can tell the patient come in here, lie down on my nice little plants here in the office, you lie there, and I'm gonna go get a cup of coffee. And when I come back, you don't have any pain. So I've treated your pain, right. So I kind of start, I think, with the education. So the point is, if you just want zero pain, don't do anything. But that's really not what you want, you want to be able to move. So if you want to be able to move, you also need to get this tissue to tolerate more loading. And in order to do that, we actually need to load it. So we recover. So I spent a lot of time kind of explaining talking about this thing, so that there might be some pain when we're loading it, or without load, you're not getting anywhere. And what happened to a lot of people, they had some pain, the rest of it did last and they tried to do something a pain and they just D decline. And I talk a lot about hardening your tissues, right? This is loading, hardening of tissues. So the conversation is my goal with treatment is to increase the tolerance of your tissue over time, while keeping your pain level the same. So that's kind of the thing. So so your pain level, I'm fine with that you're not going to rupture, which is good thing to say for Achilles tendon rupture. That's like the big catastrophe. If that's not an issue, then we can follow it to and then we have the discussion. You know, above five, it's not good, or I don't know, you've seen Twitter, sometimes Twitter, that I use five, right? And I, I really don't care. I think the point is, there is a point of pain when pain goes from, it's uncomfortable to Ouch, I don't want it to be Ouch, I want it to be in five seems to be around in that round, right? And people can understand the difference in that. And it's, you know, you have the other conversation with the people that says, But I have really high pain tolerance. So this might not work for me. Well, you know, it's subjective. So I always tell them absolutely works even better for people like you. So, you know, sometimes maybe I'm a little silly, but that's. So I think that's kind of the point of really using it. So for me, the pain monitoring model is a way for discussing it and then using it. Some people feel like it's focusing too much on the pain, I actually think is does the opposite, right? Because it removes the worry. So I'm going to put a number on it. And it's just a number and everything else. And then we use training diary. So I use training diaries, you write down, you know, morning pain, worst, lowest everything else that you do. And then if I have three or four weeks, we can start comparing, and then people actually start seeing the numbers change with the activity, or the number stays the same. So I'm using it more of a of a descriptor, because if you just ask somebody you have pain, it's like they're gonna ask them what they did earlier. Right? And none of us remember, we don't remember how much pain was when we not painful. And so that's kind of how we using it in my description.
09:23 Yeah, I think thank you for that. I think that's great. And that also kind of answered my next question is how much load? How much can you load? How much load isn't? Is is enough? How much is too much? And I think you kind of answered that within that. But you want to expand on that a little bit or I feel Yeah, so I think
09:39 I think that's within the pain monitoring model too. Right? We're looking at that. But then you also have knowledge based on how the cells responds how the tendon response and I think that's where the next thing in the history perspective is now we're starting to see you know, which protocol is better. So now they're comparing Silvernail and offer zones or East centric loading, and it's all these. And really when you compare them, it's not that big of a difference. Right? The heavy slow resistance. I just say that you know who canal for some was in northern Sweden, he trained twice a day. I'm from Gothenburg and middle, we do once a day. And then you go down to Denmark, they did the three times a week for heavy slow, right? So Danish people are lazier than you know. But I think the point is, when you're looking at the data, actually, the outcomes are not that difference. You know, there might be some, you know, we can always argue that we're more satisfied with this. But when you're looking at the mechanical properties and things, you don't see that big of a difference anymore. And I think because I think you reached a saturation point, right? We've done no loading to loading now everybody does good. And I think for us as PTS now we're trying to manipulate more and more in that little realm, that for everybody, we might not see it when we do big studies comparing one group to the other, because I think we need to talk about individualized instead of precision rehabilitation and things too. So I think kind of that's where we're getting at. And they've been great studies coming on from unstuffy Agha Gordon Denmark from her thesis looking at moderate versus heavy and patellar tendon. And so I think that for the loading, you need to load them, you need to use the pain monitoring model, we need to do the progressive loading. But I as a PT would less worry about if I if you did two sets too little or five pounds to less, I think that's less of an issue.
11:29 Yeah. And when you said individual, I actually just wrote that down individualized care as you were speaking, because if all of the different protocols have basically the same outcome, then does it come down to what can the patient do, given the constraints of their life? Or their schedule? Or you know, their job? So do you have someone who can do something three times a day? Or do you have does this person might do better three times a week with heavy slow resistance, or, you know, it really depends on what the patient can do. Because the best protocol, I would assume is the one that patient is compliant with.
12:12 And I think you and I have been around way too long for this too, right? So because, you know, when you started, when you were at least when I started when I was young, right? You were so excited for every exercise. So I guess kept on adding to my poor patients like removing something No, no, that's a really good exercise. And you're adding. And what I'm getting to is that if I can get you to do something consistent with two or three exercises, I'm much better off giving you two or three exercises that you do consistently, than trying to think that I'm going to give you a ton of things. And I have patients now that are you know, they they come back, they come back every four or five weeks and see me or they send me an email and they do their exercise, because I told them to do for Achilles like bilateral three sets of 15. And then do unilateral three sets of 15. And do that for your rest of your life. Like you're brushing your teeth, and I'm like, you could probably go down to doing them less, or you can do heavier in the gym. And some people don't go to the gym, they don't want to do that. So you kind of modify it to kind of get some of the exercises there too. So I think that I think the biggest key is that you need to load you need to do things. And then instead of getting too hyped up for all the specifics, I think that's really where we're moving forward. And I had I had a lady that you know, recently with insertional tendinopathy that had been to the doctor been to all these other clinics, and there's thrown all these things on or didn't get better. And then it was massaging it. And it was like dry needling and the instrument assisted and those kinds of things to me, she was just getting worse. And I'm like, Well, I just think you should do these three exercises once a day. And she's doing and she's like, I'm walking. I'm not limping, you know. So sometimes in our eagerness to do good, I think we get a little crazy.
13:49 Yeah, and that brings me to the next thing I wanted to talk about. And it's sort of the shiny new object syndrome that a lot of people will get. And we spoke a little bit about this before going on the air. And I said a lot of it is sort of the theatrics around different kinds of shiny new objects. So how how would you address that to say younger clinicians? In you know, obviously talking about tendinopathy
14:14 Yeah, so I think that that one thing and it's still hard, I mean, I teach Doctor physical therapy students and then they go out and they completely forgot what I said. Right? So I think there's certain things everybody wants to go to clinical course and learn something more hands on and something more specific but I think that to me, the attitude is what we really try to teach them is like what tissue is that? How does that tissue respond right? To start understanding the underlying mechanisms because then you have then you have an understanding to build the other thing on instead of not having the understanding and just thinking that you doing things and then then you might be changing the shiny objects without thinking about the mechanism. So I'm very much a mechanism person in to try to think about why would we do it, but you all No need to realize that just putting the hand on somebody is very, very strong treatment effect. That's not, that's the same as listening to somebody and paying attention. And I have a colleague Now Greg Hicks has done finishing a trial looking at strengthening specifically for low back and an older in the control group who got hot, hot pack and massage as the placebo control. And they did really well too, right. So even we have mechanism, we should not be afraid of doing things that might help the patient in that sense. But we the explanations and things for what you're doing, you got to be really careful for right. And I think that I have a great effect on my patients, because I think I have a good program. We know what we're doing. I know it works. But I'm also not under estimating that if you can Google me, you're going to get better just by coming seeing me because he's going to assume that at least I know what I'm doing. So, you know, I utilize that effect too. So you just need to thinking about what we're doing. And I'm very scared of chasing the shiny objects for the wrong reason, because maybe that shiny object would be really good for a specific reason. And if we throw it on everything, we've lost, what is good for?
16:12 Yeah, if you beat me to it, I was just gonna say also people probably come to you knowing your background, and the work that you do. So they're coming in, like primed, like, this is she is the expert, I'm in the right hands. I know, this is gonna, you know, this is a person who's going to help me and that's a huge part of the rehab process is that trust that you have in the practitioner and that therapeutic relationship, but it also sounds like you're giving realistic expectations, and describing realistic expectations to your patients, which, again, takes time. And I know a lot of therapists like why only have a half an hour with them, how can I how can I spend 15 or 20 minutes talking to them? So what would you say to that kind of a comment?
17:02 Yeah, and I think that's another thing that happens over the years. Like, I feel like I do less and talk more, but that might be just my personality, too. But, but I think that that's without that understanding, when you start that therapeutic alliance or understanding why you're, as you're doing, you're not going to get anywhere. And patients and especially patients with tendon injuries and tendinopathies. I mean, it takes six months to a year, I tell them that right away, it takes six months a year, you can do what I say, I'm pretty sure you're gonna get really well, you might not be 100%, I'm gonna get you definitely to 80 or 90%. If you don't do what I say, we can meet here in a year again, it doesn't bother me. Right? So it's handy because I think when I was younger, I tried to take on the problem and I I'm handing it back right away. I'm like, doesn't bother me if he doesn't do don't do it, you know, you can just come back to understanding and I think the other part from from the young clinicians were tendon injuries is the biggest thing is, this is not a quick fix. This takes time. And what you see a lot with the younger clinicians or maybe younger, my younger self, too, is like your to do treatment for two, three weeks, and they're not there yet. And then you get worried. And when you get worried the patient get worried. And then you start changing things. And then then they get more worried because you don't seem like you know what you're doing right, you know, it's setting the expectations. This is what you're going to do. It's not any cool exercises, this is going to take time, and having the training diaries that I follow over time and they say, You know what, I don't think much of happening. I'm like, Well, you weren't here three months ago, you could only walk one mile, but the pain of five. And now you're jogging for miles. I'm like, I think that's a pretty good improvement. Right? So having those to kind of working on and I think that's really, really important.
18:45 Yeah, and my next question is, is are all tendons created equal? So we sort of alluded to an Achilles tendon and a patellar tendon or we can talk about, you know, a golfer's elbow or tennis elbow. So when we're talking about all these different tendons, are they all created equal? And can we kind of throw the same treatments at each one, regardless of the part of the body?
19:10 Yeah, so again, it's kind of the same thing that attendance is a tendon in certain tendons structures, right? But all tendons are meant to connect muscle to bone and allow for mobility and that help us however, the design of those tendons are also meant for what they're good for. Right? So the Achilles tendon is the biggest tendon in the body because it's generates a lot of force and helps us move it move. patellar tendon is a little bit different isn't big, but it also tries to help change the angle of force around the knees. So then we put a patella and so all of a sudden we have compression and tendons are not very good for compression. The rotator cuff is more of a flatter tendon, that has a lot of curvature and the compression there is a problem right? So the flatter tendon combines more. Spread the force versus around tendon they kill As tenderness and then you're thinking about tendons in the hand, right, they are really long and thin, to be able to manipulate the fingers really gently build up the force gently. So they have different functions. And soon as you have different function, the tendon has to be slightly designed differently, which makes if it's designed differently, the treatment or the loading might be needed to be very differently. So I think one of the biggest thing is a tendon is really good for tensile forces, but not a good for compression forces. So for example, the rotator cuff, when you're talking about these overload tears is usually an inferior kind of compression that slowly degenerates, a tear. And the Achilles tendon is nothing like that at all. It's a high load, that kind of happen because you pull it apart just like Play Doh, you pull it apart from two different ends, and it kind of can rupture. So I think those are really, really important. What we also see as the lower extremity tendons seem to respond fairly similar. They're not as high in central sensitization indexes and don't have those things versus differently when you're looking at upper extremity tended to So there are definitely differences. So you need to kind of thinking about the basics, that it's not probably an acute inflammation that we need to treat it and then you need to start thinking about what does this tendon do? Is it being compressed as a flat? What are the other structures? Right? So Achilles tendon, you know, that is Achilles tendon. The real problem is, it's right there. There's not much else. That's why I study it, because it's easy to study versus the rotator cuff. We talk less about rotator cuff tendinopathy. And we talk more about shoulder pain, right? More because we not so sure. Is it purely the tendon? That's the problem and other things
21:40 add a lot more structures around it than just the Achilles tendon. That can adjust the Achilles. Sorry, but yeah, yeah. Yeah. So the little, a little more complicated area of the body will say, yes, yeah. So, you know, I think it's great to sort of look at that historical perspective. And I love that you kind of talked about where we are now, where do you see research moving towards, in the tendinopathy? field?
22:12 So now we're getting little bit into what I'm going to talk about in Denmark, too. But I think, yes, so one of the big things that we're really working on, is that, okay, I felt like we kind of reached this point, we're doing really well with everybody. But again, you know, if you look at average, with a big group, we're still not 100% On average, right? Some people aren't 100% recovered, versus some people are not. And why is that and we can't manipulate the treatment anymore. I need to figure out who do I treat how right we've been there in other areas, too. So really, what we're doing in our in our research now is really trying to use various statistical models and larger group data to really first evaluate, we'll be starting to call a tendon health, I'm really proposing that tendinopathy might be more of a biological disease, more like you're talking about knee osteoarthritis, there used to be just wear and tear, and now it's a biological disease, I think tendinopathy need to be considered the same way. And the reason I say that is because it's not just that the tendons structure had changed, or that you have pain, there's so many other variables related to it, like you have personal factors too, like BMI or diabetes affects them in differently cholesterol do so you have the metabolic factors, you have the personal factors, right. And you have, you know, the fear factors, and all these kinds of things play a role. So we call that our tendon health model. We really started with function, structure, pain and symptom, psychosocial factors. And then I realized it was a person too. So we actually have personal factors. And based on that we're trying to figure out are there different? Because you can't, we can in clinic, you can treat every person in singular, right? But, but we need to also to have more of the precision health understand what we do in the health system understanding are the various groupings. So who should we treat how to be very efficient. And that's some of the research that we're working on now. It'd be looked at my PhD students try and handle and found like, we have different groups, we have what we call activity dominant, which might be the one so we see a lot of them, the runner's active, they don't have a lot of symptoms, they don't have a lot of deficits, tenant is not that bad. versus group that we've called structure dominant, that are heavier, they have really horrible looking tendon, that poor function. And then we have a group that we call psychosocial dominant, that maybe the worst are not the best, but they're people with higher fear, decreasing function, but the tendon might not be so bad. And when we started thinking about that, well, now you can understand maybe how you can treat them a little differently. And then we can start looking at how should we treat them based on looking at randomized controlled trials because from a researcher perspective, if I threw all of those in, and I do the same treatment, some of them might benefit a lot and some of them don't and then the treatment is seared out right. There is no difference. But then I lost Ask the benefit for the ones that might benefit and I lost learning from the ones that didn't benefit the needed something else.
25:07 Fascinating. And you're going to be talking about this in Denmark.
25:12 Absolutely. And we have new data, how it changes over time and all those kinds of things. Yeah, well
25:18 don't give it all away. Now. Will we want people to go to Denmark to see you present this live? Demo? Yeah. Yeah. I mean, it sounds fascinating. I love the idea of a tendon health structure. And I love how it's it is, seems to be evolving to be more about the whole person, not just someone with a tendon injury. Yeah. Right. Because like you said, it could be like, two people can have the same injury. It could be one could be a postmenopausal woman who has the same injury as a young 30 Something male runner, maybe they both have an Achilles tendinopathy. But are you going to treat them exactly the same?
26:01 Yeah. And I think that's when we need to start thinking about this, some of the programs are maybe the same, but how do you modify them? And what are the expectations? And then what are the other things that you can add on to that, to really make sure that we get more people up to 100%, and really try to focus on them. And as a researcher, sometimes those things get lost. And that makes that's concerning to me.
26:26 But I for one cannot wait to hear that talk in Denmark. Now. Before we start wrapping things up here, what advice maybe give three tips, if you want to give more or less whatever you want. But what would you give to what tips would you give to clinicians who are treating patients with tendinopathy? Injuries? I don't know if I want to say injuries, if that's quite the word, but diagnoses let's say, so what are your top tips?
26:59 So my top tip is to kind of think about what that it is the structure and that structure responds differently than muscle structure and bone structure to thinking about it from that from the tissue level when you're designing the treatment program. And I think the number one is tendon takes longer to recover than other tissues. So setting that expectations right away. I mean, it's a clear indication when you're looking at hamstring injuries, is it purely muscle or is it more proximal with a tendon is clearly evidence to show that it takes longer. So if you have that expectation and sitting down to explain, but just because it takes longer does not mean a tendon has poor healing, it has very adequate healing is just healing that takes a little longer. And sometimes I even explain that that is a good thing. Because a tendon can last you for a very long time. Like for marathon runners, the Achilles tendon rebounds you so you can run a whole marathon, if your muscle was doing that, you'd be fatigued way earlier, and you wouldn't be able to do it. So the low metabolism is beneficial. But this is the rehab, it's going to take your time. So that's one of my biggest thing and taking time to kind of thinking through that. The other piece of advice is do not panic. And my clinician in our clinic, they tell me back to others what I say because I always tell the patient right away, you're going to get better. This is going to take time, and you're going to have setbacks. And I want to tell clinicians that to the patients are going to have setbacks, they're going to come but don't panic when they have setbacks. You know, it just is what it is. And if you set the expectations right away, the patient's going to come in and have a setback. Now they're like, Yeah, I have my setback. But you told me I would eventually have it right? Instead of not expecting them because then we react on a dime, oh, they're worse today. What am I going to do? And what am I to change? Like, no, this is part of life that goes up, it goes down and moving. So I think those two things, and along with really using the pain monitoring model, and training diaries are my key things.
29:04 Great advice. And I love that do not panic, because they know when you're panicking, yes, right? The eye you know, they see it in your face. And like you said, you start throwing everything in the kitchen sink on there. And they're like, Well, wait a second, what just happened here? I thought you said I could just do this. But I always tell patients like this is not a linear journey. It's not like you're going up a roller coaster and it's going to be linear and perfect. Like it's going to go up, it's going to dip down, it's going to come up maybe dip down but not as much and then you're gonna go up again and you know, it's a little bit more of a squiggly line and that's okay. And people really do appreciate that because setting expectations is paramount. I always feel like if I do nothing else, if they hear nothing else, at least they have an idea of what to expect. So that it's not crazy. Just
29:59 And I think the training diary to me, I use it for any patient for anything, I think that was really key too, because that calms all of us down. Let's see, let's go back here five weeks, wherever we're at what you were doing. And then we can see the pattern. And I even had one person that gave me like an Excel spreadsheet, and a color coded the pain. And if you looked over like a year, you can see that red and orange decrease and the green was increased, you know what I mean? Those are the patterns that you want to see. And it's hard to see those in your daily life. So that's why I think that's really important.
30:32 Yeah, that is a dedicated patient. Yes,
30:35 I do. But yeah,
30:38 yes, well, right. Right. But well, this was great. Where can people find you? If they have questions? Maybe you're on social media? Where can people find you?
30:51 I am on social media at kg silver Nagel, I think I'm on Twitter, is the main one is that but I also run the Delaware tendon research group, and attend them on a ligament research group. So on Twitter, we also have the UD tendon group. We're also on Facebook, and we're also on Instagram. And I'm easily found the University of Delaware and Department of Physical Therapy to please feel free to reach out and connect with us, you know, on the social media and those kinds of things that we're doing. And I'm very excited to discuss these clinical things.
31:26 And if you don't mind, can we talk a little bit about the Delaware attending group because you guys have some projects that you're working on to do you want to tell the listeners about those projects? In case you know, you need recruiting or you need volunteers? So go ahead.
31:42 Yes, we always need volunteers. So we actually have we have a lot of ongoing studies, but one of the big ones that NIH funded right now is we're looking at comparing men and women with Achilles tendinopathy. So we're up to 145 recruited patients out of 200, we had a little dip around COVID. So we're actually providing treatment for anybody that is around the Delaware Philadelphia area, please feel free to reach out or send your patients. We're also have ACL studies ongoing. One of the big ones also been relating to tendon is looking at the recovery from patellar tendon grafts to see how they change over time, how does that tend to actually recover? And could that if the doesn't recover fully, can that explain some of the deficits that we do see their ACLs injuries to we're also hoping to soon start more of looking at insertional, Achilles tendinopathy, with treatments we have. And one study with shockwave treatment, we have studies that we're hoping to start now looking more at metabolic factors, and getting a little blood draws and those things. So we have on our website with all of those things going on. So if anybody's interested, please feel free to reach out or look at our website.
32:53 Perfect. And we'll have a link to that at podcast at healthy, wealthy smart.com under this episode, so one click and we'll take you right there. So before we end, I have one question. Question I asked everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self, and you can pick which ever age of your younger self you
33:14 would like. So I'm going to pick myself before I even went to PT school, because one of my mantras is to always have fun, and I will stick to that now. And I'll stick to that younger because if it's not fun, it's not worth doing, even if it's research and those things. So do anything that's fun. But I was did not want to go to school in Sweden, I wanted to do sports medicine wanted to go to the US. But I was very worried that if I didn't get in, when I was 20 that I wasn't going to go to PT school because it took four years and then I would be too old when I graduated before I was ready. So I wasn't going to go luckily I got in and I stayed on. So I think to to my younger self. It's a really long working life. So just keep on having fun and plugging along and learning more things. And I have taken the really long path to academia with the clinician for many years and doing those kinds of things. So that I'm happy for so I'm glad I got in and didn't say I wasn't going to do it. Because who cares if I was 2425?
34:14 Yeah, and that's so young. Yes, but isn't it funny when you're 1819 20? You're like, Oh, forget it. I'll be an old person by then 25 behind the eight ball when of course, now that were a little older, we can look back on that and be like, Oh my God. Yes. And
34:34 I mean, it's like it's, it's a long life to work. Don't hurry to get to the endpoint, right? Enjoy it get experienced during that time, because as I tell our students, I've had a lot of fun during my years and worked with sports workers, clinician travel, research, academia, you know, you got to have fun.
34:53 Absolutely. Well, and on that note, I want to thank you for coming on the podcast and having such a fun conversations. Well, thank you so much. And everyone, if you want to get a chance to see current speak live, then join us at the fourth World Congress, a sports physical therapy, it is in Denmark and August 26 and 27th of this year. And not only will you get to see speakers like yourself, but there's also going to be great networking, activity breaks, things like yoga, or running or walking tours, paddle paddleboarding, all sorts of fun stuff. So it's again, not going to be quite your average conference, and a lot of it is going to be clinically focused and clinically based. So I think that's really important. I think a lot of times people think, Oh, we go to these conferences, it's going to be researchers just talking about their research and how's that going to affect me clinically? Well, this conference is all about that. So I think, right? Absolutely agree. Yeah. So come join us in Denmark. Again, thank you so much for coming on. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart. | |||
| 589: Prof Michael Rathleff: Barriers Between the Research and Implementation | 02 May 2022 | 00:28:55 | |
In this episode, Aalborg University Professor, Prof Michael Rathleff, talks about his role at the upcoming WCSPT. Today, Michael talks about how he organized the congress, creating tools for clinicians to educate their patients, and his research on overuse injuries in adolescents. What are the barriers between the research and implementation in practice? Hear about the mobile health industry, exciting events at the congress, and get his advice to his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Michael Rathleff Prof Michael Rathleff coordinates the musculoskeletal research program at the Research Unit for General Practice in Aalborg. The research programme is cross-disciplinary and includes researchers with a background in general practice, rheumatology, orthopaedic surgery, physiotherapy, sports science, health economics and human‐centered informatics. He is the head of the research group OptiYouth at the Research Unit for General Practice. Their aim is to improve the health and function of adolescents through research.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injuries, WCSPT, Education,
IFSPT Fourth World Congress of Sports Physical Therapy
To learn more, follow Michael at: Website: https://vbn.aau.dk/en/persons/130816 Research: https://www.researchgate.net/profile/Michael-Rathleff Twitter: @michaelrathleff
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Read the Full Transcript Here: 00:02 Hello, Professor Ratliff, thank you so much for coming on the podcast today to talk a little bit more about your role at the fourth World Congress is sports, physical therapy in Denmark, August 26, to the 27th. So, as we were talking, before we went on the air, we were saying, man, you're wearing a bunch of hats during this Congress, one of which is part of the organizing committee. So my first question to you is, as a member of the Organising Committee, what were your goals? And what are you hoping to achieve with this Congress?
00:35 I think my role is primarily within the scientific committee. And one of the things we discussed very, very early on was this, like, you know, when you go for a conference, you go up to a conference, you hear a bunch of interesting talks, and you feel like, I'm motivated, I'm listening, I'm taking in new things. But then Monday morning, when you see the next patient, it's not always that all the interesting stuff that you saw, is actually applicable to my patient Monday morning. So we wanted to try and emphasize more. How can we use this conference as a way to translate science into practice? So the whole program and the like, the presentations will be more about clinical applicability, and less about more p values and research methodology. So not that the research is not sound, but there'll be more focused on how can we actually apply it in the context that were working. That's why also, we had the main title of translating research into practice, which I think will be hopefully a cornerstone that people will see, well, if there's really interesting talk about, it could be overuse injuries in kids, which will be a lecture that I'm having, then they'll also be a practical workshop afterwards to kind of use that what's been presented, and then really drill down on how we can use it in in clinical practice. So the goal is to, to get people to reflect in your network, but also take a lot of the things and think, Wow, this is something that I can use next Monday for clinical practice.
02:09 And aside from a lot of lectures and talks, you've also got in informatics competition. And so could you explain that a little bit and why you decided to bring that into the Congress?
02:23 Yeah, so this was a major, not a debate, but an interesting discussion on how we can even in the early phases of the conference, when people submit an abstract, make sure that the abstract can actually also reach more end users target audiences for that case. So we decided that people actually had to submit an infographic together with their the abstract. So normally, you send in like, 250 words, for a conference, but for this conference, we wanted them to submit the abstract, but also the visual infographic to go along with Olympic Well, am I making an infographic that is tailored to patient? Is that a patient aid that I'm trying to make? Is it something that's aimed but other researchers? Or is it clinicians, so they have to tick off? Which box Am I infographic actually intended for? So when the audience or the participants come and join the conference, they can actually take these infographics for those that want to print them they can use in the clinic afterwards, just another layer of trying to make some of this research more easily communicated to the audience, but also, the things that can be used in clinical practice, like some of the people have submitted abstract, have some really, really nice infographics that I expect will be printed and hang on, on a few clinic doors around the world afterwards, I hope.
03:48 And when it comes to dissemination of research and information from the clinician, to the patient, or even to the wider public, where do you think clinicians and researchers get stuck? Like where is the disconnect between that dissemination of information as we the information as we see, and by the time it gets to the consumer or to let's say, a mass media outlet? It's like, what happened?
04:15 Yeah, that's a big a big question. Because it's almost like why are we not better at implementing new research into our clinical practice? And I think there's heaps of different barriers. We've we've done a couple of studies, something new was also in the pipeline where we look specific, get the official context, and we can see that this barriers in terms of understanding the research, that's actually one of the major barriers that the clinicians out there have a really hard time both finding the evidence, appraising the evidence, and also actually understanding is this good or bad science. And then you have the whole time constraints on a clinical practice because who's going to pay you to sit and use two hours On reading this paper, and remember, this is just one paper on ACL injuries. But in my clinical practice, I see a gazillion different different things. So how am I going to keep up with the with the evidence? Is it intended that I'm reading original literature? Or how am I going to keep up with it? So I think there's a lot of different barriers. But at least one of the ways I think we can overcome some of these barriers is that researchers climb out of the ivory tower and think of other ways that we can communicate, research, evidence synthesis, it could be infographics, it could be sort of like decision age for clinical practice, at least that's one of the routes we're taking in terms of also the talk I'm giving at the conference that we're trying to think of, Can we somehow develop AIDS that will support clinical practice something that scene but the physiotherapist something that's aimed at the patient, that will sort of make it easier to deliver evidence based practice? So we've done one, one tool that's being developed at the moment is called the Makhni, which is something that can assist clinicians in the diagnosis, the communication of how do you communicate to kids about chronic knee pain? How do I make sure that they have the right expectation for what my management can be? And how can we engage in a shared decision making process. And we have a few other things in the pipeline as well, where we want to, to build something, build something practical that you can take in use in clinical practice to to support you in delivering good quality care, because just publishing papers is not going to change clinical practice, I think,
06:45 yeah, and publishing papers, which are sometimes wonderful papers. But if they're not getting out to the clinicians, they're certainly not going to get out to the patients and to people, sort of the mass population.
07:02 I completely agree. It's a bigger discussion, I'm really focused on how to reach clinicians, because I see the clinicians as the entry point to delivering care to patients and parents and, and the surrounding surrounding community. But if you think of, like wider public health interventions, we have the same problem as well. And also we create this sort of like, No, this inequality in healthcare, but that's another
07:30 line, although there can of worms. Yeah, we could do a whole series of podcasts on that. Yeah, yeah. And I agree with you that it needs to come from the clinician. So creating these tools to help clinicians better educate their patients, which in turn really becomes their community. Because there's a lot a clinician can do outside of just a one on one interaction with the patient. And so having the right tools can make a big difference.
07:58 Like in, if you look at a patient that comes to you for an ACL injury, or long standing musculoskeletal complaint, they're going to spend maybe 0.1% of their time together with you and 99.9%, they're out on their own. And I think it's important that we when we're one on one with them, sort of like make them develop the competencies so they can do the right decisions for their health in the 99.9% of the time that they're out there alone, when they're not with with us, I completely agree with you that there's a lot of things we can do to make them more competent in thriving despite of knee pain, or shoulder pain or whatever it might, it might be. And I think that's one of the most important tasks, I think, for us as clinicians is to think about the everyday lives they have to live when they leave us and say see you next time.
08:51 Yeah, and to be able to clearly communicate whatever their diagnosis by might be, or exercise program or, or any number of, of 10s of 1000s of bio psychosocial impacts that are happening with this person. Because oftentimes, and I know I've been guilty of this in the past, I'm sure other therapists would agree that they've this has happened to them as well as you explain everything to the patient, and then they come back and it's, they got nothing zero. And it might be because you're not disseminating the information to them in a way that's helpful for them or in a way that's conducive with their learning style. So having different tools, like you said, maybe it's an infographic that the patient can look at and be like, Oh, I get it now. So having a lot of variety makes a huge difference.
09:48 And I think you touched on a super important point there that patients are very different, that they have different learning styles, they have different needs. And I think it's our role to enlist Send the needs of the individual patient and make up something that really meets those needs. So more about listening, asking questions and less about thinking that we have the solution to it, because I think within musculoskeletal health or care, whatever we call it, some clinicians would use their words to communicate a message that might be good for some other patients would prefer to have a folder or leaflet. Others would say, I want a phone, I want an app on my phone, something that's like learning on demand, because at least that's something we see regularly. Now that we have the older population that wants a piece of paper, we have the younger population that wants to have something that they can sort of like, rely on when they're out there on their own one advice on how do I manage this challenging situation to get some good advice when you're not there? When I'm all on my own? So, so different?
10:57 Yeah, and I love those examples. I use apps quite frequently. And I had a patient just the other day say, Oh, my husband put this, the app that that you use, because I was giving her PDFs, and she's like, Oh, my husband put the app on my phone. Now it's so much easier. So now I know exactly what to do if I have five minutes in my day. So it just depends.
11:21 And I think the whole like mobile health industry, there's a lot of potential there. But I also see, at least from a Danish context, that there's a lot of apps that is very limited. It's not not developed on a sound evidence base, or it's just sort of like a container of videos with exercises. And I think there's a huge potential in like thinking of how can we do more with this? How can we make sure that it's not just the delivery vehicle for a new exercise, but it's actually the delivery vehicle for improving the competencies for self management for individuals? I think there's, yeah, I'm looking forward to the next few years to see how this whole field develops. Because I think there's really big potential in this.
12:12 Yeah, not like you're not doing enough already. But you know, maybe you've just got your next project now. Like, you're not busy enough already. So as we, as you alluded to a few minutes ago, you've got a couple of different talks you're chairing, so you've got a lot going on at the World Congress. So do you want to break down, give maybe a little sneak peek, you don't have to give it all away, we want people to go to the conference to listen to your talks. But if you want to break down, maybe take a one or two of your topics that you'll be speaking on, and I give us a sneak peek.
12:48 I think the talk that will be most interesting for me to deliver and hopefully also to listen to is is the talk that I'm giving on overuse injuries in adolescence, because I think it's we haven't had a lot of like conferences in the past couple of years. So it will be one of these talks will be meaty in terms of of new date, and some of the things I'm most interested go out and present is all the qualitative research we've done on understanding adolescents and their parents, in terms of what are the challenges they experience? How can we help them and also, we've done a lot of qualitative works on what are the challenges that face us experience when dealing with kids with long standing pain complaints, we've developed some new tools that can sort of like, help this process to improve care for these young people. And I really look forward trying to Yeah, to hear what people think of, of our ideas and, and the practical tools that we've that we've developed. So that's at least one of the talks, that's going to be quite interesting, hopefully, also, we're going to actually have the data from our 10 year follow up of so I have a cohort that I started during my PhD. They were like 504 kids with with knee pain. And now I follow them prospectively for 10 years. And this time period, I've gotten a bit more gray hair and gray beard. But this wealth of data that comes from following more than 500 kids for 10 years with chronic knee pain is going to be really, really interesting. And we're going to be finished with that. So I'm also giving a sneak peek on unpublished data on the long term prognosis of adolescent knee pain and at the conference. So that's going to be the world premiere for for that big data set as well.
14:36 Amazing. And as you're talking about going through some of the qualitative research that you've done, and you had mentioned, there were some challenges from the physio side and from the child side in the patient and the child's parents side. Can you give us maybe one challenge that kind of stuck out to you that was like, boy, this is really a challenge that is maybe one of the biggest impediments in working with this population.
15:06 I think I think there's multiple one thing that I'm really interested in these in this moment is the whole level of like diagnostic uncertainty and kids, because one of the things we've understood is that if the kids and the parents don't really understand why they have knee pain, what's the name of the knee pain, it becomes this cause of them seeking care around the healthcare system on who can actually help me who can explain my pain. So so at the moment, we're trying to do a lot of things on how we can reduce this, what would you call diagnostic uncertainty and provide credible explanations to the kids and then trying to develop credible explanation for both kids and parents? That's actually not an easy task, because what is a credible explanation of what Patellofemoral Pain is when we don't have a good understanding of the underlying pathophysiology? So there, we're doing a lot of work on combining both clinical expertise, what the patient needs, what we know from the literature, and then we're trying to solve, iterate and test these credible explanations with the kids. And yeah, at the conference, we'll have the first draft of these, what we call credible explanation. So that's going to be at least one barrier one challenge, I hope that some of the practical tools we've developed can actually help
16:25 i for 1am, looking forward to that, because there is it is so challenging when you're working with children, adolescents, and their parents who are sort of call it doctor shopping, you know, where you're, like you said, you're going around to multiple different practitioners, just with their fingers crossed, hoping that someone can explain why their child is in pain or not performing are not able to, you know, be a part of their peer group or, or or engage in what normal kids would would generally do. Exactly. Yeah. Oh, I'm definitely looking forward to that. So what give us one other sneak peek? Because I know you've got the, you're also chairing a talk on the first day. But what else I shouldn't say I don't want to put words in your mouth. What else? Are you looking forward to even maybe if it's not your talk, are you looking forward to maybe some other presentations,
17:26 I'm actually looking forward to to the competitions we have as well, because I've had a sneak peek of some of the research that's been submitted as abstracts, and the quality is super high. So both the oral presentations but also the presentation that the best infographics because they'll also get time to actually rip on the big screen and present their infographic. And I look forward to see how people can communicate the messages from these amazing infographics. And I think these two competitions are going to be to be a blast and going to be really, really fun to, to look at. And amazing research as well. So I really look forward to the two events as well. And then of course, oh no, go ahead. No, I was just talking about look forward to meeting with friends and new friends and be out talking to people once again in beautiful new ball in Denmark in the middle of summer. It's hard to be Denmark in the summer. We don't have a lot of good weather, but Denmark in August is just brilliant.
18:31 Yes, I've only been there in February. So I am definitely looking forward to to Denmark and August as well. Because I've only been there for sports Congress when it's a little chilly and a little damp. So summer sounds just perfect. And I've one more question. Just kind of piggybacking off of your comments on the amazing research within these competitions. And since you know you have been in the research field, let's say for a decade plus right getting your PhD a decade ago. How have you seen physio research change and morph over the past decade? Have you seen just it better research coming from specifically from the physio world?
19:20 I think it's the first time someone said it's actually more than a decade. So, but that gives me a time perspective. But yeah, I've actually seen that. My perception is that physiotherapy research in general but also sports physiotherapy research went from being published in smaller journals we published in our own journals to now there's multiple example of sport fishers performing really, really nice trials that have reached the best medical journals that have informed clinical practice. So I think we see this both there's more good research Basically out there. And I also see that we've moved from, like a biomechanical paradigm to being more user a patient center, we see more qualitative research, we see that physiotherapist, sport physiotherapist, they sort of have a larger breadth of different research designs, they used to tackle the research. I think, like looking even at the ACL injuries, if you go back 10 years in time, looking at the very biomechanically oriented research that was primarily also joined by orthopedic surgeons to a large extent. Now, today where fishers have done amazing research, they understand all the the fear of reentry, they're trying to do very broad rehabilitation programs, ensuring that people don't return to sport too rapidly. And and also understanding why they shouldn't return back to his board now developing tools that you can use when you sit with a patient to try and and educate them on what are the phases, we need to go through the next nine to 12 months before you can return to sport and so on. So I think I'm just impressed by, by the research. And when I see the even the younger people in my group now, they start at a completely different level when they start their PhD compared to what we did. So I can only imagine that the quality is going to improve over the years as well, because they're much more talented, they're still hard working. And they have a larger evidence base to sort of like stand on. And they already from the beginning, see the benefit of these interdisciplinary collaborations with the whole medical field and who else is is relevant to include in these collaborations? So yeah, the future is bright. I see. Yeah,
21:50 I would agree with that. And now as we kind of start to wrap things up here, where can people find you? So websites, social media, tell the people where you're at.
22:04 So I think if you just type in my name on Google, there'll be a university profile at the very top where you can see all my contact information. Otherwise, just feel free to reach out on LinkedIn or Twitter, search for my name. And you'll find me, I try to be quite rapid and respond to the direct messages when, when possible, at least
22:25 perfect. And we'll have all the links to that in the show notes at podcast at healthy, wealthy smart.com. So you can just go there, click on it'll take you right to all of your links. So is there anything that you want to kind of leave the listeners with when it comes to the world congresses, sports physiotherapy or physical therapy, sorry.
22:52 Be careful not to miss it, it's going to be one of these conferences with a magical blend of practical application of signs, it's going to be a terrific program in terms of possibilities to to network and engage in physical activity, whatever it's running, or mountain biking, and with an amazing conference dinner as well. So I think it's, so this would come to be one of one of the highlights for me this year. So and I think the whole atmosphere around this conference is also that if you come there, as a clinician, you don't know anybody, that people will be open and welcoming and happy to engage in conversation. There's no speakers, that wouldn't be super happy to grab a beer or walk to discuss some of the ideas that's been presented at the conference. So I think it's going to be quite, quite good.
23:45 Yeah. So come with an open mind come with a lot of questions and come with your workout clothes. Is is what I'm hearing?
23:56 Yes, definitely. Definitely.
23:59 And final question, and it's one that I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self, and you can pick whatever time period your younger self is.
24:13 So I think in if I had to give myself one advice when I was in my sort of like, MIT Ph. D, time coming towards the end, I would say to myself, that it's okay to say no, you have to make sure to say yes to the right things because it's very easy to say yes to everything. And then you create these peak stress periods for yourself that would prohibit you from from doing things that is value being with friends or family and so on. You don't have to say yes to everything because there will be multiple opportunities afterwards. So practice in saying no and do it in a in a polite way. People actually have a lot of respect for people that say, No, I don't have a time or I'm I'm going to invest my time on this because this is what I really think is going to change the field. And this is my vision. So So young Michael, please please practice in saying no.
25:11 I love that advice. Thank you so much. So Michael, thank you so much for coming on the podcast. And again, just a reminder, I know we've said this before, but the World Congress is sports, physical therapy, we'll be in Denmark, August 26 and 27th of this year 2022. So thank you so much for coming on the podcast and thank you for all of your hard work and getting making this conference the best it can be.
25:36 Thank you, Karen, thank you for the invitation to the podcast.
25:39 Absolutely. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart. | |||
| Efosa Guobadia: 10th Annual PT Day of Service. Local Impact for a Global Effect | 19 Sep 2024 | 00:36:21 | |
In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Karen Litzy welcomes Dr. Efosa Guobadia, CEO of FFITT Health and co-founder of PT Day of Service, to celebrate the 10-year anniversary of this impactful initiative. Dr.Guobadia reflects on the original vision behind PT Day of Service, emphasizing the core values of community, engagement, collaboration, and service within the physical therapy profession. He shares insights on how the concept has evolved over the years, surpassing their initial expectations and highlighting the limitless potential of service in physical therapy. Join Karen and Efosa as they explore the significance of giving back and the continued growth of PT Day of Service. Time Stamps: [00:01:10] Vision of PT Day of Service. [00:07:24] Burnout during the pandemic. [00:10:44] Compassion in service and health. [00:11:27] Community service in physical therapy. [00:16:05] Falls prevention screenings for community. [00:21:01] Community involvement and engagement. [00:23:28] Movement and community service. [00:26:33] Sustainable systems for movement health. [00:31:16] PT Days of Service. [00:34:08] Rejoice in the beginning.More About Dr. Efosa Guobadia: Efosa L. Guobadia, PT, DPT, is the Founder of FFITT Health; Founder of Move Together, and Co-Founder of the Global PT Day of Service, which has spanned over 80 countries since its inception in 2015. He has contributed chapters to two books: 'Why Global Health Matters", edited by Dr. Chris E. Stout; and "Learning to Lead in Physical Therapy", edited by Jennifer Green-Wilson and Stacey Zeigler. He received his BS in Kinesiology from the University of Massachusetts in 2007, his Doctorate of Physical Therapy from the University of Scranton in 2010, and Master of Business Administration from UMass Isenberg School of Management with a focus in finance in 2024.. He is the recipient of the 2017 Distinguished Young Alumni Award given by the University of Massachusetts/Amherst School of Public Health and Health Sciences, is a 2018 American Physical Therapy Association Social Impact Award Recipient, and the 2023 University of Scranton DPT Program Outstanding Alumni Award Recipient. Resources from this Episode: PT Day of Service on Instagram
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| 588: Dr. Clarence Holmes:Generational Differences: Can They Contribute to Burnout? | 25 Apr 2022 | 00:35:12 | |
In this episode, Owner of Access Physical Therapy, Clarence Holmes, Jr, talks about generational differences in physical therapy. Today, Clarence talks about burnout, the idea of value, and the different ideas of pay structure. Why is the measurement of productivity problematic? Hear about the promise of mentorship for lower pay, the problem of toxic positivity, and finding the better way in each new generation, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Clarence Holmes, Jr Dr Clarence Holmes, Jr is a native of Cleveland MS. He attended Mississippi State University for his undergraduate studies and received his Doctor of Physical Therapy degree from the University of Mississippi Medical Center in 2014. Dr Holmes then completed an orthopedic residency with Mercer university in Atlanta GA in 2015. He has worked in various settings to include sports/outpatient orthopedics, acute care, and the state jail system. Now, he owns and operates Access Physical Therapy, a concierge cash based physical therapy practice in the Atlanta metropolitan area. He also works as a staff physical therapist with Kindred At Home. Dr Holmes has been involved with APTA at various levels to include 2 terms on the Student Assembly Board of Directors, delegate for the state of Georgia to the House of Delegates, and currently serves as a board member for the Georgia Foundation for Physical Therapy. In his free time, he also owns and operates The Travel Doctor, a full service travel agency as well as tackling small woodworking projects. He also scuba dives and enjoys traveling the world with his beautiful wife, Turquoise and their golden retriever and chihuahua/terrier mix puppies.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Burnout, Generational Differences, Productivity, Mentorship, Improvement,
To learn more, follow Clarence at: Website: https://www.accessptatl.com Twitter: @matterundrmined Instagram: @caholmes6 Facebook: @clarenceh3
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Read the Full Transcript Here: Hello, this is Jenna Cantor with healthy, wealthy and smart. I'm really excited. I am interviewing Dr. Clarence a Holmes Jr. Just wrote on Zoom, or we're doing the interview. And Dr. Clarence who said, just call me clearance. I'm like, Okay, hi, Clarence, said that he works with home health and is the owner of a concierge cash based practice, which everybody who listens knows I'm cash based. I'm like, Yeah, hello, Conrad. I love that so much. Let's serve our people, our patients. We are coming on because we met at a conference. And there was a discussion on generational differences in physical therapy. And Clarence had some real interesting thoughts on this. And I was like, this is a podcast in the making. So I approached him right away. And I said, Can we do this topic and a podcast? And fortunately enough, he said, Yes. Like a proposal. It was beautiful. So here we are talking about generational differences in physical therapy. I think this is a really, really important topic. Now. I just let's just start diving in to one we're saying general racial differences, everyone, please don't refrain from getting offended with how we, how we try to describe this, because this is one we're differentiating between ages. And I saw I saw individuals struggling with that trying to be appropriate. So if we do say anything in our descriptions, inappropriate, feel free, please absolutely correct us. But be nice, because we're doing the best we can. But this is a very important conversation. So we'd rather take the risk in in really diving into the topic. So yeah, just let's all be nice. Okay. So regarding generational differences, I'm assuming that we're talking about the more seasoned crowd, people who have been around for a long period of time, compared to newer people in the physical therapy. Oh, right. Correct. Am I missing anything? Or is there any other way we need to define it?
02:39 No, I mean, and honestly, you're talking about me when you said if you recognize people being uncomfortable, trying to differentiate between these these generations, in conversation without trying to fin that was me at our conference. I didn't want to say the boomer generation, I didn't want to say the millennials simply because a lot of people tie a lot of negative connotations to those. And we're
03:03 also missing Gen X, because Gen X is actually the y'all are the youngest practitioners right now. Not millennials. Yeah.
03:09 Yeah. And I think there's a lot of similar Z
03:12 is Z. Oh, my God, ie, Z. Oh, my gosh, I missed the letter in the alphabet. Yeah. It might
03:17 be x. I don't don't hold me to it. But But, but yeah, so that was one. But But no, you captured it perfectly. I do think there is a a riff between the older generation and the younger generation to just put it put it lightly. Yeah. Just simply because and I mentioned it in the conferences that the older generation are the ones who are owning these practices, traditional practices. And the younger generation, our generation are the ones who tend to be more of the employees. And that's natural. But what's what's unnatural? Well, this is also natural to have some generational difference was unnatural is the riff, the, the battle that kind of comes along with it, and how we respond to it. So
04:03 yeah, so let's, yeah, I love that. Let's do what we're aware. I was very interested. Let's go back and and just do one general generational difference at a time and then if we okay, I feel like that's what pops in our head for now. And that's it. That's great. So one, just named one at the top of your head one Gen. Gen. Oh, my gosh, why is this? So? General? generational difference, let's start with one.
04:29 So I mean, there's two big ones that stick out to me. One is just this idea of pay structure. And specifically in the PT realm of, of how long has someone been here? versus what is this person doing for my company? And the best example I can give is me personally, of working in a job my first job post residency. I'm an ortho I'm a lover, or I will consider myself an ortho PT, even though I work in the home health arena, and the concierge cash base, I will consider myself an orthopedic physical therapist. My first job post residency was at a private practice in Atlanta, and I was paid the least amount of all the therapists across the entire company, which was four practices in Atlanta. But I was the second highest producing therapists in the company. And so, you know, generational differences comes down to the old way of doing things was, who has the most experience, they get paid the most? My personal opinion is, that's not logical, we're, I'm a logical being and a lot of my generation are, if it doesn't make sense to us, we're going to be vocal about it. And it didn't make sense to me that I was producing one paper, more money, better outcomes than the majority of the therapists and I was paid the least, that's one major win. And it kind of feeds into the second you asked for one, but this kind of feeds into it. Younger generations, older generations value loyalty. You know, they expect somebody to come in and work for them for 10 to 1520, almost 30 their entire careers. And my generation just, we're not happy, we're going to move on. And so that puts a lot of responsibility on the employer to find out what makes us happy. And sometimes that just doesn't, that doesn't translate well.
06:39 Yeah, I see where these connect, let's focus on the first one, because that is a really good, interesting point, I have definitely mentored some dance PTS who are burnt out, and they are in a situation where, Oh, Gosh, darn it, what is it productivity, productivity is measured. And that has been very problematic for them, because they'll come in, and they see that they are, they know, they're getting paid less. But they're not more because in your case, you actually saw the data, but they're seeing the, they are seeing the exact number of patients as a seasoned professional, there, and they're just they don't understand why they're getting paid less, if they're seeing the same amount, then they were there, they would imagine, I would be seeing less patients, then that would make more sense, you know, but no, that's not the case. And therefore, that income would still be it is assumed that income would still be made. So it's almost like they're being profit, they're more of a profit is being made off of them. They're exhausted, you know, but they're not getting a lighter load to feed that exhaustion, that adjustment, they're getting treated just the same. And so they don't understand that pay difference when they come in. And I'm going to bounce off this a little bit more because of what the reasoning so it's going to get a slightly off topic, but I'm always okay with that is the promise of mentorship as a reason for why they are paying less that can be a reasoning behind it, which still, there are some clinics that actually provide mentorship, but the majority of them do not actually provide that mentorship, so it's more verbage. Or they have some sort of automated system, that's there maybe videos or something. So there, it's not really an extra effort. It's something that's already there that can help streamline what's going on. Especially if you're in a place that measures the productivity. You can promise it as a as a somebody owns a clinic, however, who's the physical therapist, and how much time do they actually have to really mentor? So if there really, it doesn't make sense, right? This reasoning of oh, why, you know, and these are generational, different thoughts, but for I think that's what you're hitting is that the younger generation will speak their minds and say, hey, you know, they're not getting that mentorship, they're not getting that value for them to go. Oh, that's why then because they get oh, you know what, I'm getting great mentorship, kind of like where people think residencies, getting great mentorship that get one in paying less I get it. I totally get it. That's not the case. No, no, in a lot of circumstances.
09:33 Seven years, I think I've been out seven and a half years for a PT school. And I've never been in an environment outside of residency that that had any type of formal mentorship. But you're correct in that I've have had several interviews with several companies that have promised mentorship because that was important to me. I kind of did less the reason I worked at the job that I did that I'm mentioning in this in this interview. This conversation. The reason I took that job, and I knew I was getting paid less than I was worth. Um, the reason I took it was because my clinical manager and the only person who was more productive than I was a personal mentor, who was my was one of my direct mentors in residency. And so I saw it as an opportunity to continue getting mentored. And so I'm getting an exchange of additional mentorship. I will take less pay.
10:32 Okay, yes. And your, your through your apps, you're like, Oh, yes, yes.
10:36 Correct. But there was no formal mentorship. Now, I did continue work with this guy. I did learn a lot from him. But there was no formal.
10:45 That's a big, that's a big deal. It's not exactly,
10:48 exactly. And there's no when is the end point? I mean, when is the point where I say, Okay, I've received enough mentorship now I'm ready to get paid. Okay. Right. There has to be some kind of trade off there. So. But you're absolutely correct that that is there is a common promise of these employers to employees, younger, generational PTS, of mentorship, in exchange for, you know, lower, less than ideal pay, but is delivered upon.
11:20 Right, right. And I think that's the thing, because there's different ways to work around depending on the clinic, and everything that can happen in these rooms for negotiation. So when these different mindsets come into the room, for it to work out, but you got to follow through on both sides. One is providing the mentorship and the other side is accepting, that's what you accepted, and knowing that owning that. So, but it can be I mean, you know, what I was about to go into different things you can negotiate, but this is not a lesson on negotiation. So I'm going to skip over that. So yeah, when you when you are going into a clinic, I feel like that is a way to potentially solve the problem, but it's just not being solved right now. It's it's still, these gentlemen are the we have people who own these businesses who are getting annoyed about the the younger generation talking about money, but then they're not looking at, they're not really listening and taking in what is being said, because it's it's a block that we can get our own bias on how we lived our lives. And, and we need to get out of ourselves. I say that, as a practice owner, myself, we have to always work to get out of ourselves all the time, in order to better listen, to be with the changes of the world. And the reason why there are changes, but the reason why things are fluid, and it's always changing with every generation and so on, is because there's always a better way. Right? And we may not answer to it. But But there's always a better way. And and you got to figure out, you know, what's what's going to if you really care so much about keeping them around for a long time. And that's, that's a big deal for you. And absolutely, totally get that it's great to have somebody there for a long time, then what is it that they care about? What is it that they care about? You know, and how do you and then if you want to do something that is not financial? Because your your clinic can only afford so much? What are those intangibles that you can bring to the table? Or even the physical therapist coming into work for them? What are those intangibles, and that's where you can really come to the table for a better exchange with those generational differences. I think, you know, and,
13:36 you know, and one of the things that you kind of touched on is that we have to be, there's always a better way, and we have to be open to that better way. And I think that's where we run into an issue of when a younger generational PT says, well, this doesn't make sense to me, I want this amount of money. That's not us complaining. And I think that can be perceived as, as as, as a complaint, US whining, because we were known as the whiny generation. We you know, we complain a lot and what compared to what we're told is that we complain a lot, we're whining, we're never satisfied. And it's not that we're whining. It's not that we're sad. It's just that we grew up in the information age, we know what the PT next was making. Well, we know what the average PT makes. And so we come to the table and ask for this. It's not as whining and it shouldn't be perceived that way and we shouldn't be promoted as the whining generation is annoying. Having the information available to us and trying to benefit on or not even benefit just just be pay. We're given what we're worth. You know, we're rainbows and clouds profession. I mean, we we are a just a happy, just beautiful people and we just love people love everybody. And we're so happy go lucky and lovey dovey and I love that about us. But one thing that we do tend to forget is that the word can mean that we are healthcare practitioners first, but this is also a business. We have to be sustainable, to be able to provide the jobs for our employees, we have to be fulfilled in our careers to be able to provide the care the level of care that our patients deserve. And some of the ways that we do that is to ensure that our employees are happy. Somebody brought up at the conference, the idea of valuing your employees. And value in itself. I think, for us as this lovey dovey profession means so many different things, but value in itself as a word is a financial word. What is the value of me as a a physical therapist? I know my financial value, if you cannot meet that, as you've already touched on, if you can't meet what I'm asking for what else can you meet me, meet me halfway meet me with increase vacation days, maybe with an increase a formal mentorship program. We're supposed to meet and you're supposed to meet me where I am as an employee. And so I think that's where there's a big barrier as well. And that sometimes we're a little bit too focused on intangible things where a lot of or several of us are looking for tangible benefits in my generation. So I think that's a big riff. And it's a it's got to do with our identity crisis in our profession that I said this at the conference. Nobody loves pts. As much as PTS love BTS. And that's our issue as as a profession that we have to address. And I think that kind of that kind of flows over into this this generational difference. Oh, my God, it does. It does. Absolutely. Absolutely. And so that's, you know, I don't want to get too deep here, but I want I actually
16:55 want to bounce off you because, yes, because they popped in my head earlier. And I was like, I just let the idea, you know, because I just want to listen to you. But yes, it's the Pete, the best thing to T PTS, you know, and there's nothing wrong with us, the more seasoned professional that I mean, yes, ever. When I say this, I know they're seasoned. Like, I know, they're sick, we're not perfect. But the C's, they they live on this rainbows and clouds. I'm just saying, I know, it's a harsh way to say it. I hear I hear what I'm saying. But whatever I'm gonna say it. And then we have where the younger generation, I think it's Gen Z, because Gen X is before. So okay, so we have the Gen Z, and the millennials are newer in the profession. And they're not afraid to point out things that they think are wrong. But I think then with that in mind, I think from higher up there is toxic positivity. And I think that's where that comes in. Where it's pushed upon, you cannot say anything bad. But then we lose this honesty and transparency in what's going on in the communication. And, and God forbid, something bad is said, you know, boy, and guess who's on social media, everyone? So if you're talking about, you know, like, oh, there's younger people are complaining. Facebook is older people, man, Twitter is older people. Like there's some younger on there too. Yeah. But like the hotspots to be at are tick tock and mostly ticked in my opinion. Tick tock. Yes. And then I think I never looked at the data. So yeah, but I think Instagram is secondary, but that also has to do with like, how I like to watch the videos personally, I can I can scroll through the Tick Tock thing and then I can go to Instagram Instagrams a little bit not as smooth I go back to tick tock okay. So um, but but that's you know, that's where it's so far talking about all the younger they all they do is complain that's, that's all ages baby. That's all ages, we all we we all like don't I think it is so healthy, to have a full well rounded conversation that points out the bad and the good and you don't have to finish with a positive statement in a conversation about it's okay to end in a gray area. It's okay to end in a dark area and both see it you know, yeah, that is I don't have a solution. Like that's actually that's not a good thing. It's okay. But we but this toxic positivity puts anybody going through anything on the spot if you're anybody who might be oh gosh, dealing with somebody who is has poor health in your family and you can't talk about it or mention it at all and you're yet to put on this face. I get it. That's you know, I'm putting in air quotes professionalism, but professional professional only means literally other profession. Everything else is defined by you. Or defined by me. So literally, that's all perfect. Like everything else is like up in the air up for grabs. however you interpret it. So the you know, took like, place these these random rules on what professionalism, professionalism is from that point on is is purely subjective. And that's where that toxic positivity comes in. Yeah. And then in then we get these risks these butting heads, because everybody has different core values, which is great. And I think that is a huge generational difference and where we lose and miss out on opportunities to listen and hear more.
20:29 Correct, correct. And that's where the issue becomes. I spoke on generational differences, as in the context of what is leading to burnout in early career professionals are the career pts. And I spoke on generational differences as one of the things that I thought was a key key difference. And one thing to note to note is that this isn't specific to pt. It's not burnout is not specific to PT, these generational differences is not are not just specific to physical therapy. This is a doula globally, this is definitely an issue in our country. There are, you know, I'm gonna make this a political conversation. But you know, there are, you know,
21:16 whatever all's fair game when you're with me,
21:20 you see, there's a group of people that believe that, you know, there's no, this is the greatest country on Earth. And that this is there, they would, they would know, they would not live anywhere else. And to say anything bad about our country is anti American. And then there's another generation that says, this is a good country to live in. This is, hey, I'm happy to live here. But there's a crap ton of issues that we need to address to make this country as great as it could be. And so that is, I say all that to say that there is no, I don't think we solve this issue. I don't know if there is a solid solution to the issue. But as I stated before, I do believe there are pptx, specific generational difference issues that we can address. And we should address. And as long as everybody is willing to hear each other out. Yeah, compromise, which is kind of where my conversation was with with the gentleman at the conference that we spoke about earlier. I had an opinion, but I heard him out. And I still don't agree with him. 100%. But I can identify a little bit more with where he's coming from. And I think that's key, I think it's important to have these conversations get uncomfortable with being, you know, get comfortable with being uncomfortable. And have these uncomfortable conversations to say, yes, these are the issues we have with your generation. These are the issues y'all have with mine. Where is that common ground? You know, is they always is, like you said better than we are? And so So, you know, I don't know, I don't know, I'm not the visionary, I see that you I can't give you the solution. I
23:08 don't know where I know, it's just to have a conversation. So that's all we're just having a conversation about this, which I think is great. You know, to get your minds and everyone's minds to start to think you know, are there you know, generational differences and everything. And be careful as you listen, it can be very hard because we there are a lot of people we're going to people help, we're a service business. And with that we get these people pleasing mindsets, where we can lose ourselves. And I would actually say definitely big time in the younger, newer generation. And in order to please the generation that has been around longer, we don't listen to ourselves and just agree it's okay to disagree. It doesn't mean you have to disagree. But really keep challenging yourself to get more and more in tune with what you believe in. And greater conversations can happen, greater solutions, greater growth and progress between all of us can happen, which is so cool. And it may not happen overnight, where you feel comfortable to talk about it. But keep I definitely agree with what you're saying. It's just if you can just keep even if it's a little bit challenge yourself a little bit more every time to just, you know, get there, you know, not easy, not easy. No. I love it. Any any other generational differences that you think oh, Jenna this or have we reached kind of your like, those are kind of the main ones where we
24:41 Yeah, no, I I do think those are my, you know, very inter intertwine those two that I talked about. I don't think that as as a this is sort of like a final word if you Yes, yes. I do think that specifically to this country, we value overwork For example, I, you know, I think that we value the the clinician or the co worker, not just in PT, but in general, we value the person who does the things that they're not required to do as a part of their job. That's what we use to determine who is who's that shining employee, who's the one that that goes above and beyond. Right. And it shouldn't be that I mean, for example, I remember, at this same job, we hit a low point, we hit a low point, always in January, it's an outpatient clinic, deductibles reset, so we're January, it was a low period, had a lot of openings on my schedule, so that everyone else and I was sitting in and getting caught up on documentation, going over some things with my mentor, learning new skills, in walks the owner, are asked, What are we doing? I tell him, you know, I'm trying to learn some things. And he says, Well, why don't we are marketing? I say, What do you mean? He said, you know, your patients, your schedule is low, why aren't you are out, you know, getting us new clients. And I'm like, that's not my job. Is that is you are the employer, you hired me to see the patients that frequent your establishment. Okay, I'm not the one to go out and beg these physicians to send us, okay, how much begging you do, the deductibles reset, that's going to be a phenomenon that happens every single year. So, but that's what the expectation from some employers have. Yes, I hired you to see patients and turning the documentation on time. But in also, I expect you to do these things, these these things that I didn't tell you about in your interview, but we expect you to do these things is become an expectation in this country, to overwork to do things that are not required to view and that is how we measure our employees and not on the job that they do. If you see all the patients on your schedule, go home on time, get your documentation in on time, and it's all you did for the rest of your life as a PT you'd never be promoted and you know in traditional practices so I say that's that's another generational thing is that I think we older generations value overwork working you all you need to be busy all the time. And we value we being the younger generations, a healthy balance of work and home life. I think that is another riff all of these are intertwined, but I think that's a another riff that's that's that's causing an issue, not just in our not just in our profession, but but across this whole country.
27:42 Now, yeah, definitely. I love it. Thank you so much for coming on to talk about this. If you are listening to this podcast, and you have some other ideas and stuff, feel free to write in the comments, just keep the conversation going. I think it's always good to just talk about it. And then And then if you're somebody who's about to go in for job interviews, write these things down for you to consider what you're going to bring to the table for your negotiations track on both sides, what was discussed in that interview? So it's very clear. If things come up that are that we're not included, it's so you can have a better chance of being on the same page. Yes, you're correct. We didn't bring that up, or you know what we need to make sure we bring that up, because that does come up, the more we can be on top of that transparency in the communication can better help address generational differences right off the bat, do keep in mind seasoned professionals owning your own practice when these students are graduating, they have a very low sense in general sense of self worth. So for the overwhelming majority, they usually jump at a job faster than they should. Because they are so excited. Anyone wants them. And that is a big thing that happens often at clinics. So just be aware of that them saying yes doesn't necessarily mean they were listening to what they wanted in the first place. Because they feel so grateful that they were not rejected, they were accepted. And that takes over everything. It helps it feeds into them eliminating what their core wants are because they struggle with self value. Alright, that's it. Where can people find you on the social or email, whatever you feel comfortable with sharing.
29:40 So I laugh when you say the old people are on Facebook and Twitter because that's really what I use is
29:48 and I'm in that category. So I feel comfortable saying
29:51 I'm not a Snapchatter I do have an Instagram. My Facebook name is just mine. That's what I'm primarily on. That's where I'm most entertaining. Book
30:00 is it clearance a home's nobody's claiming homes, clients homes,
30:05 parents homes as well. I'm the one that's scuba diving in my photo.
30:11 If it changes to hiking, everyone's gonna get confused.
30:14 I know why it's not going to just all my photos are nice. And then my instagram name is CA Homes six ca h o l mes the number six. Oh, I
30:27 love it California. You're not from there. But it's fun to say. Wonderful. Thank you so much for coming on. Everyone. If you're listening, please be nice. Be nice. Yeah, you can communicate but be kind. If there is any possibility that what you wrote might be in a way interpreted in a mean tone. Don't write it. I just don't I don't see. Like, honestly, it's just why and I'm not being toxic positive. I'm just being real. Like it's only going to just why why? Like go speak to your legislative representative about it, you know that you can actually make changes. Alright, that's it. Thank you for coming on. | |||
| 587: Dr. Luciana De Michelis Mendonça: Sports Injury Prevention: What is the Role of the PT? | 18 Apr 2022 | 00:41:02 | |
In this episode, President of IFSPT, Luciana de Michelis Mendonça, talks about her research and the upcoming World Congress of Sports Physical Therapy. Today, Luciana talks about the importance of the WCSPT and the results from her research. Why are organisations like IFSPT important? Hear about why sports PTs are important in injury prevention and reduction programs, pre-season assessments, implementing prevention programs, and get Luciana's advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Luciana de Michelis Mendonça Luciana is a professor in a federal university in Belo Horizonte (Brazil) and develops research in the field of sports physical therapy. She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organisation of physical therapy services for the Rio 2016 Olympics and Paralympics Games. She was the first female president of the Brazilian Society of Sports Physical Therapy (SONAFE), in a country with many restrictions to women's participation in sport and politics. Since 2017, she has been an executive director of the World Physiotherapy subgroup International Federation of Sports Physical Therapy (IFSPT) and is now IFSPT's president. She is committed to enhancing the dissemination of sports physiotherapy good practice and knowledge globally and to increase equity in sports physiotherapy.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Prevention Programs, Exercise,
Recommended Reading
Sign up for the Fourth World Congress of Sports Physical Therapy To learn more, follow Luciana at: Website: https://ifspt.org Twitter: @luludemichelis Instagram: @lucianademichelis
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35 Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today I'm very honored and excited to have on the program Dr. Luciana de mckaela Mendoza. She is a professor in a Federal University in Belo Horizonte in Brazil and develops research in the field of sports physical therapy. She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organization of physical therapy services for the Rio 2016 Olympics and Paralympic Games. She was the first female president of the Brazilian society of Sports Physical Therapy in a country with many restrictions to women's participation in sports and politics. Since 2017, she has been the executive director of the world physiotherapy subgroup, International Federation of sports, physical therapy or ifs PT, and is now IFSP T's president. She is committed to enhancing the dissemination of sports physiotherapy, good practice and knowledge globally, and to increase equity in sports physiotherapy. And in today's podcast, we will talk about some of her research into injury prevention and the role of sports physiotherapist in those programs. And of course, we will also talk a lot more about the fourth World Congress is Sports Physical Therapy, which is happening in Denmark this August 26, and 27th. That's 2022. So if you want to find more information about that, you can click on the link at podcast at healthy, wealthy smart.com. To find out more about the fourth World Congress is sports physiotherapy, again, taking place in Denmark. So we will talk a lot about that. And we will also get a sneak peek of some of Luciana has talks there. She's speaking and she is moderating. So she's got her hands full for sure. So I want to thank her for coming on the podcast and everyone enjoyed today's episode. Hi, Luciana. Welcome to the podcast. I'm excited to have a conversation with you today. Hi, Carrie. Thank you very much for having me. Yeah, it is my pleasure. And now before we get into the meat of our interview, can you tell the listeners a little bit more about you about your history in sports, physical therapy. And as I mentioned, you are the current president of ifs pts. You can talk a little bit about that as well. So I will hand the mic over to you.
03:06 Okay, Karen, so I'm from Brazil. I'm a sports physiotherapist and I graduated in 2003. So I'm 20 years as a physiotherapist. And I'm also a professor in diversity here in Brazil. I'm based in Belo Horizonte. And
03:28 I started to work. Since the as a students and sports team, I wanted to do physical therapy because of sports. I am passionate about it. And I, I started in this political scenario in the Brazilian society of sports, physical therapy. And I started it was in 2016, it was the year of real to tastic significant part Paralympic Games. So it was a really big challenge. I also work in the physical therapy services during the Olympics and Paralympic game here. And I started being part of the Executive Board of the IFSP CI in 2017. So I learned a lot during the presidency of Anthony Schneider's in Christian torborg. And now I have this big challenge to be IFSEC. President so I'm balancing this actions related to if activity and also with teaching and also research about sports, physical therapy. And my research is mainly directed to injury prevention, and also injury risk profile. So I think that's perfect. And can you talk a little bit more about IFSP T and kind of the importance of having these organizations and what they what they do, what are they there for
05:00 Yes, so the International Federation of Sports Physical Therapy is a subgroup of the word physiotherapy. That's our main our mother organization. So as a subgroup, we have to engage countries all around the world that have specific group related to sports, physical therapy to join the IFSP team. So nowadays, we have 34 member organizations in the SSP T. And our main mission is related to disseminate good practices, support research on sports, physical therapy, of course, and also promote actions to support our members, the whole community. So improve the practices around the world. And also it's a good it's an important way to connect with people. So I think the most amazing gifts that I had, being in IFSP T board is to network with people around the world. So it's a really
06:18 important way to have our professional, our profession, organize it. And so I probably will be in the presidency for the next four years. That's the plan. Yeah, that's, that's amazing. And one of the things that, like you said, as part of the organization is networking, and we'll say this will probably repeat this a couple of times, but the Fourth World Congress is sports, physical therapy is coming up August 26 27th, of 2022 in Denmark, and obviously, you will be there and you are a part of several presentations.
06:57 But like you said, your research is around injury prevention and assessment in sports, in sports. So can you talk about why the sports physical therapist is an important component of these injury prevention programs or injury reduction programs?
07:19 Yes, I just want to stress that, yes, the Congress of sports, physical therapy, it's important action that IFSP t also have, we are one of the main organizations, the main sub groups of world physiotherapy that deliver International Congress. So we have the first one in Bern, the second one Belfast, the third in Vancouver, and now illegal in Denmark. So I, I went to Belfast to Vancouver, and now I will be enabled for sure. So
07:55 I'm sorry, Carrie, I forgot your question. Oh, yeah. No, so my, my question, like I said, you're doing you're doing a ton. You'll be doing a ton in Nyberg. But one of the things that I know you are talking about is about your research that centers around injury prevention, and something that you're passionate about as if the sports physical therapist should really be involved. So why is that?
08:19 Yes. So I always thought that the main action as a sports physical therapy in a sports team, of course, I should be aware that, for me, I need support all athletes available to the coach to the head coach to train. So for me, it's, it was always a good time to have like the physical therapy department, empty without athletes there, because all athletes should be on the fields playing and training.
08:56 So for me, prevention was always important action that we as therapists should be aware of. So I, when I finished my PhD and start to be a teacher in university in Brazil, I started to wander, especially after I started to work in the IFSP. Board, I started to wonder if the prevention, the role that the Sports Physical Therapy had in prevention, and I know that how this works in Brazil because I was sports physical therapist and the volleyball team and soccer team. I was wondering if it was like the same, or I was wondering if it should be the same. Or if we are here in Brazil, we're doing like similar things that other professionals data around the world. So I have a sabbatical year in 2020 and I went to Belgium to work with Eric FitPro.
10:00 I was there in Uganda, the University of Ghana, as a visiting professor. And we started to develop a surveying to understand what role the sports physical therapists had in injury prevention. So I will talk about some of our results, we have two papers about this survey that were that are published in physical therapy in sports. And this helped me to have
10:33 sort of idea about the role. And we have really interesting information about this, that, of course, I will share here in this podcast, and also in the World Congress of sports, physical therapy. And also we develop a Delphi design to establish a consensus on sports injury prevention programs. So this is also an interesting
11:01 study that we could deliver an IFSP participated to, with this Delphi study linking
11:09 people from different countries. So I'm really excited to talk to you about this caring and say something that should make people a little bit curious and participate in the Congress. In Denmark. Yes. So when can can you give us a little bit of info, you don't have to give it all away? Of course, people can go and read the the
11:36 published papers, but in this
11:40 in this study, you had, how many people? What did you find? How did you do it?
11:50 So yes, for sure, I can share some of the data that we had the papers are published. And also you can indicate for your audience, I can send you the links. It's important, I totally understand caring that sports injury prevention area, we need to move forward related to research, we need to understand a lot of things. But I think it's interesting to understand what the professionals what the sports physical therapists are doing, because this can bring up some questions for future research. So
12:29 on the survey, we
12:32 we had 414, sports, physical therapists participating around the world. So I think we had like, people from 32 countries. So I know that the amount is not so high, we could have more people participating, but it was delivered in 2020, during the pandemic. So this is one thing that I should stress because, yes, we had 32 countries participating, but I, for sure, I expected to have more people there. But we had questions in this online survey that was related, link it to the synchronous sequence of prevention that were Matalan delivered, and maybe it's the the most use it, model or to make decisions about prevention. So we ask it if this sports physical therapists participated on injury prevention, sorry, injury registration. It's common here, Brazil, but I didn't know if my colleagues in other countries participating in the injury registration. We also asked if they assess it, the athletes to build the prevention program. So if they did, for example, preseason assessment, that's the more common way at least in Brazil. So I was curious about that. And also, I we asked about their prevention program. So if the pieces participated in this action or not. So about equal registration, the first thing this I think this is an amazing result, because we had more than then 80% of the sports physical therapists that participate in this study, were responsible for me to reverse the situation. So we can now say that maybe the sports physio are the are the person like more important more responsible to properly register injury in their sports team? So this brings brings up a lot of other questions. So for example, maybe we should IFSP T should deliver some actions to maybe
15:00 increase the knowledge and maybe the competence on this matter on our community. Because of course, if we are responsible for this, we want to do an amazing job. So it's, it's interesting. And it's good also to exchange some experience and learn from good examples. So this is really good. And we also ask about the main barriers.
15:29 So for sure now register the injuries. So more than a half of this physios said that lack of time in their routine was the main factor to not properly register injuries. So maybe we need to discuss also about the sports physio routine, inside the sports team. I think we talk we should talk more about this, especially in conferences that we can get together a lot of professionals from different countries, and we can learn from their experience.
16:08 So can I move forward? You have a comment about registration? Nope, I think I think that's good. And I do like that. You said, Hey, maybe this is a chance for us to get together learn from each other. Because perhaps there are ways to streamline this that people just haven't thought of that other people are doing. So you're right. It's a great opportunity for sports organizations, like if SPT to bring sports physical therapist together and say, Well, wait a second, some of you are doing this with some of you aren't. And if it's a lack of time, what can we do to give you a structure that can streamline your process? Yes, exactly. And it's one thing that here needs to be done. We just We can't like, Okay, I'm not going to register injuries, because how can I be sure if I'm going to prevent the injuries if I'm not registering? So if you're not registering, is it like they didn't happen?
17:09 Yes. And another another thing that is really interesting, what is the injury definition? That is sports, physical therapists are using my understanding, we can select different definitions, because this maybe rely on the sports modality.
17:32 But we need to talk more about this, I think we should
17:37 exchange and learned and maybe from this, maybe if aspartate can deliver some guidelines, I don't know, because it's one of our missions. Also to make the FSB T is the main resource for the Sports Physical Therapy community. So I think we will maybe in the future, we are going to have more actions based on the findings of so I'm really excited about this. Okay, so let's move on to preseason assessment. So how many are performing? And what are the barriers? I know that this is this, topics of little bit controversial, I know that we have a group that thinks that we should assess, and another group of sports physio, or research thinks that we, we don't need to. But our survey shows that 77% of the participants perform preseason assessments in their athletes.
18:45 So 222 sports fields, said that they do. This is amazing information. And I didn't expect for this high percentage.
18:59 And I was happy because I believe that we should assess our athletes to make the most tailored, most amazing tailored prevention program for our athletes. I know that this is a challenge. I totally understand this. But if I think about myself as a sports, physical therapy, if I'm working in a sports team, I will like I will do my best to assess the athletes and try to deliver
19:30 into an individualized prevention programs. So but we have like, opposite side here because only 30% of these sports physical therapists that do preseason assessment, customize the provincial program bases in the results of the assessment.
19:54 So this is a point that we need to understand better. We need to understand what is happening. Why
20:00 They sports fees you give energy to assess the athletes, but they don't apply the results to build the prevention program.
20:11 So we didn't
20:14 ask it like specific questions about this. To understand this, we only asked about the barrier. So the main barrier
20:23 that was indicated to not before assessment, it was lack of structure and organization of the sports team.
20:33 So about half of the participants indicated this barrier.
20:38 I understand makes sense, but I'm not sure if this barrier explain 100% of the reasons to not perform the precision assessment. And I think maybe this is also relied on the evidence that we have related to these. We have big discussions about injury prediction probability. So maybe we need to make some advance in research about this topic. And maybe we need to talk more about this to make more like have this issue more clear to everyone, specially the clinician.
21:22 Because I think so now, it's my opinion. Okay. I think we need to assess our athletes, and maybe maybe even the process of assessment should be discussed. Because if we, if we are here in a roundtable with sports, physical therapists, and we ask how you assess your athletes, which tests do you select, probably carrying, we are going to have different answers. So I don't I'm not sure what this means. It means that we don't have standards. We don't have like a protocol. Should we have a protocol? I don't know. But what I know is that we need to talk more about this. Yeah, I mean, oh, go ahead. Sorry. No, no, I just like, I just want to say that I was really happy with the the results that sports fields with a majority is performing a preseason assessment. But on contrary, I was I get a little sad to see that not like 1/3 of them are really applying the Results to Build provincial programs. And yeah, and so I brings up a couple of questions for me, and that is, have you seen preseason assessments? Decrease injury, are they and again, this goes on? I think what you just said that sort of prediction and probability. So if you do a preseason assessment, does that predict less injuries? I don't know. Have you seen? What are your thoughts on that?
23:06 Thank you for asking this caring, I think
23:10 preseason assessment. The main propose is not to predict injury, they may propose is to identify those athletes with more susceptibility or probability to get the injury and then we can act before this happened. I'm not saying that if we perform a preseason assessment and beta prevention program on the results, our athletes not going to get into I'm not saying that injury, always going to happen sports, but we can, for example, decrease the severity.
23:52 So if I have one athlete that I can, for example, I apply the stars question balance test, and I see that this athlete have a really low stability, functional stability in the lower league. So I can include in their provincial program, exercise to improve the stability, and maybe he will, he will, like have the ankle sprain, but I can decrease the severity.
24:26 So I will decrease the time loss. I will make this athlete more available to the head coach at the end. That's my reasoning on preseason assessment. And I think there is a misconception about this issue also. Right? Because I think, you know, if we're playing devil's advocate, some people may say, well, the preseason assessment isn't going to eliminate injuries. Why am I why am I doing it? Right? But like you said, injuries happen. But if you can decrease the severity if you can decrease the time that the athlete is spent out of the game
25:00 Yeah, then that's a win for the team. And it's a win for the coach in the organization. But if only 30% If if you have all of these sport physiotherapist doing a preseason assessment, then only 30% customize the program. Now we have to come up with some incentives for that physiotherapist to customize
25:19 the program for the athlete. And again, that may be like you said resources available to them, if it's one person and 50 players,
25:30 that it's difficult, you know that that's that that's quite difficult. But
25:37 I can understand how this can be a very frustrating part of research, because there's a lot of moving parts. And it's not just the sport physiotherapist, who has all best intentions and at at the heart of, of of their work. But there's a lot of external factors that need to come into play. But
26:03 I do I also like your that idea of being on a round table with sport physiotherapist and saying, Well, what do you do? What do you do? And maybe like you said, I don't know if a protocol is right, but maybe some sort of a roadmap where you have some basic assessments, and then you have the freedom and the ability to get creative, but to have certain certain things in there that makes sense for that sport?
26:31 Yes, I totally agree with you. Here in Brazil, I have a lot of colleagues and friends that came from the Brazilian society of sports, physical therapy. So we talked a lot in exchange a lot. So I, I myself, I have my challenges related to really delivering the prevention program that I i understand that would be like the best thing to do. But of course, this also relies on the relationship with the head coach, district parenting coach. So it's a lot of factors variables that we need to understand. And that's, that's really individual. It depends on the context of each sports team. So that's what I when I say that maybe we don't, we will not have like a protocol, because it depends on the sports team reality. But I agree with you that we can give maybe some roadmap to help everyone to organize better, considering the context, right? Yeah, exactly. Exactly. Oh, that's yeah, that's that really opens up a can of worms for people. That being said, let's move on to prevention programs. So what did you find with that?
27:53 Yes, so about the prevention program, we see that warm up.
27:59 sessions with the physical therapists were the methods more use it to prevent injury. And I think about warm up this was already expected because it was one roadmap that FIFA 11 Plus gave to everyone, not only for soccer, we have evidence on basketball, handball players. So FIFA 11 Plus really helped in this maybe this
28:31 basic organization, and how to deliver some preventive action in a more easy and accessible way. So I think it's really interesting that this survey, like confirm that one map, it's a really good strategy to include the provincial probe on athletes routine, because the athlete will need to warm up. So we have this moment, and why not. So instead of make the athlete do like,
29:06 whatever exercise or just running on the field, why not to be more specific and includes exercise that the athletes really need to do based on the sport modality.
29:20 Epidemiology. So for example, we know that in soccer, we have a lot of famous hamstring strain, we have a lot of ankle sprain, knee sprain. So why not to include some melodic at the size it some balance exercise? I think this is a really
29:38 important action that every old sports physical therapist needs, so be engaged and participate and about the individual sessions with the sports physical therapists. It's important to us and then I really expected some information around this
30:00 because we know that we have some time zone athletes that need a specific exercise that needs to be delivered by the physical therapist. So I was happy to say this because this was the methods more use it more indicated by our participants. And above the barrier, we saw that lack of time in athletes routine was the main barrier to perform the provision. This was indicated by 66% of the participants.
30:34 Of course, I expected results. And that's why warm up, it's important action because this is already in adults routine, we don't need to change the routine to include one more time and period to do
30:51 the exercise related related to prevention. So again, carry I don't know if this only this area only about athletes routine, we can understand why we can't perform major prevention. And as I said, Before, I understand the challenges. I think it's not easy. But I think it's a wonderful, it's a wonderful action that sports physical therapists participate. And it's really, of course, important for our athletes health, not only performance, because we have evidence that provincial programs also increased performance. But also I'm concerned about athlete's health, we need to, of course, help the athlete because no one wants to get into it. So this is really, it was really important.
31:49 For information that is the also indicated and these information helped us. So sort of build the questions related to the consensus, that was our second step during my experience in Ghent University with Eric.
32:11 Right. And so at W CSPG. You're going to show some data about the Delphi consensus, so you don't have to give all that away, people can go to the conference to hear more about that. But if you want to give a little preview, now's your time. So you what are the main topics investigated?
32:31 So about our Delphi, we organized the consensus in three parts. So the first part was related to how the thesis should plan the provincial programs. So this planning was about the information or the reasoning to develop the injury prevention program. So this is interesting, because we have information that, for example, sports, physio, use the reasoning related to biomechanics, or the base decision only on evidence and injury, Epidemiology, or athletes, injury history. So we have this kind of information and result and this is really brings up some discussions. So I hope that on the conference, I can, we can have this moment to discuss about our information, our data. The second part was about the organization. So how work environments before the implementation, how this affects the delivering the injury prevention programs. And the third one is about the implementation phase that I know that there is a lot of discussion and research, we have a specific we have specific groups of research that really go deep in this matter of implementation. So in this third phase, we identify barriers and facilitators to implement the injury prevention programs, and also related to compliance, if visibility. So this is how we organize the Delphi. It was a huge amount of work from all the core authors that participated in this study, and really happy that we can now say that this is accepted in physical therapy in sports generally, we can now really disseminate
34:39 this information, and I'm really happy to be part of this. Yeah, well, congratulations because that is a ton of work. And again, if people want to learn more about this, then you can come to Nyberg August 26 27th The Fourth World Congress is Sports Physical Therapy in Denmark.
35:00 And I mean, who doesn't want to be in Denmark in the summer? Right? I mean, amazing. Yeah, this will be my first time in Denmark. So my I am excited. So of course, no Denmark, but also to meet my friends from Sports Physical Therapy community, specifically before this, sorry, after this pandemic. Yeah. So I really miss my friends. And I really excited to talk more about injury prevention. And so our consensus results, and exchange and networking with everyone there. Yeah. And where can people find you? If they have questions? If they you know, we'll have the links to the studies that you mentioned in the show notes. So if people read that, and they have questions, where can they find you?
35:53 Yes, Carrie, so I am on social media. So I have my Facebook profile, Instagram, it's with my name, no change at all. And also in Twitter, is Lulu the chalice so you can find me there. And we can keep talking about information. IFSEC. I invite everyone for be like in the World Congress of sports, physical therapy, it's in August. So I'm really excited to be there. And I hope to see you there all for caring. Yeah, I will be there. I'm looking forward to it. And now final question that I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self? Good question. Okay. So maybe, first, I would say to my own self, congratulations, you are an amazing woman in you accomplished a lot.
36:52 For sure, I never thought that I would be where I am now. As IFSP President working in federal, probably the most important federal university here in Brazil. So I'm really happy. If I could give her some advice should be be more lighter, less stress, less pressure on yourself, Luciana.
37:23 But at the end, we don't don't care if this increased pressure or stress, help in a way.
37:31 me to be here where I am. Or if I could go through this path. Be more.
37:41 I don't know light. I think the word is like, Yeah, I think so. And, and I love the fact that you said you know, you would congratulate yourself. And I think celebrating wins and celebrating what we do are things that women don't often do. Right? We're always sort of congratulating others and putting others up, but we never sort of congratulate ourselves and celebrate our wins. And, and I think if I were to go back and tell my younger self, something that would be it, like stop making yourself smaller so that other people can be bigger. It's a constant exercise. I didn't accomplished my winnings, my victories so often, but now I can see clearly that I am where I am, because I'm good in what I do. So perfect. What a way to end the podcast. I think that's great. So again, people can see you live in Nyberg, August 26 and 27th. At the fourth world, Congress is sports, physical therapy, you again will have the link on the conference and how to sign up. And we certainly encourage everyone to do that. Like you said, What a great way to meet up with colleagues to get some really great information and be in a beautiful place while you do it. Yeah, exactly. And on August 25, five, we are going to have a network session delivered by FFTT. So we are going to have also this moment to get together and exchange. Perfect. Is there anything else? You know, you're the president? So is there anything else that we missed? Talking about the conference that you want to let people know is is also happening? We are going to have an interesting conference because it's going to be I think the first World Congress of sports, physical therapy that we're going to have specific moments to do sports in the program. So we are going to have this more serious moments to talk more about our practices and research but also light moments to practice sports and be more friendly there. Yeah, so basically bring your workout clothes is what you're saying. Yeah,
40:00 Oh, yeah, that's exactly perfect. Perfect. And I don't think I mentioned that when I spoke to Katie so I'll be mentioning that moving forward that bring your sneakers bring your workout clothes, that traditional
40:13 well here in the US for whatever reason, people like always wear suits to these things.
40:20 So don't don't worry about the suits, but definitely bring your workout gear. Yes. Perfect. Perfect. Well, Luciana, thank you so much for taking the time out today and coming on to the podcast to talk about all the great stuff you're doing. Thank you so much. My pleasure, Kara. Thank you so much, and everyone thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
40:43 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media.
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| 586: Ummukulthoum Bakare: The Unbreakable Young World Athlete | 15 Apr 2022 | 00:25:27 | |
In this episode, Nigerian Sports Physiotherapy Association Founding Member, Ummukulthoum Bakare, talks about her important research and advocacy of sports physiotherapy. Today, Ummukulthoum talks about her research on women's football, the issue of compliance and adherence, and the next steps in her research. What are the challenges for women football players, and how are they mitigated? Hear about her experience advocating for sports physiotherapy, her presentation on The Unbreakable Young World Athlete, and get her advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Ummukulthoum Bakare Ummukulthoum Bakare is a Doctorate Candidate in Sports Physical Therapy at the University of Witwatersrand in South Africa. Her research is focused on women's football and injury prevention. She is a founding member of the Nigerian Sports Physiotherapy Association and is active in disseminating the FIFA11+ injury prevention programme in her native country and across Africa. Her passion has centred around the sports of football, basketball, and para-athletes and injury prevention. She received her Bachelor of Physical Therapy and her Master of Physical Therapy from the College of Medicine, University of Ibadan, Nigeria. Ummukulthoum has worked as a physical therapist since 2001 and has won several awards for her service locally, regionally, and internationally. She is a member of the Medical and Scientific Commission of the Nigeria Olympic Committee and an Associate Editor for the British Journal of Sports Medicine.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Women's Football, Empowerment, Advocacy,
Third World Congress of Sports Physical Therapy
To learn more, follow Ummukulthoum at: Website: https://www.facebook.com/nspa.org.ng/ Twitter: @koolboulevard Instagram: @koolboulevard
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35 Hey everyone, welcome back to the podcast. I am your host Karen Litzy. And in today's episode, I'm really honored to welcome UMO cooltone Bukhari she has a doctorate candidate in Sports Physical Therapy at the University of Witwatersrand in African South Africa. Her research is focused on women's football and injury prevention. She is a founding member of the Nigerian sports physiotherapy Association, and is active in disseminating the FIFA 11 Plus injury prevention program in her native country and across Africa. Her passion has centered around the sports of football, basketball and para athletes and injury prevention. She received her Bachelor of physical therapy and her Master of physical therapy from the College of Medicine University of Ibadan in Nigeria UMO kooltherm has worked as a physical therapist since 2001, and has won several awards for her service locally, regionally and internationally. She is a member of the medical and scientific commission of the Nigeria Olympic Committee, and an associate editor for the British Journal of Sports Medicine. So in this episode, we give you all a sneak peek of what she is going to be speaking on as one of the guest speakers at the fourth World Congress of Sports Physical Therapy, which is taking place August 26, to the 22nd 2022 and Nyborg Denmark. If you want more information on the WC SPT conference, head over to podcast at healthy wealthy smart.com. Click on the link in the show notes under this episode. If you can, I highly suggest signing up and joining us in August in Denmark. So Lumo coutume is just one of many speakers that we're going to be highlighting over the next couple of months. We have a great conversation today about the unbreakable Young World athlete which she will be speaking about Nyberg. So everyone enjoyed today's episode and be on the lookout for more speakers coming up in the next couple of months. Hey, Katie, welcome to the podcast. I'm really happy to have you on.
02:43 It's lovely to be here, Karen. Thanks for having me. Yes. And like I said in the intro, gosh, you are a real rock star in the physiotherapy world. So you are a founding member of the Nigerian sports physiotherapy Association. You are a member of the medical and scientific commission of the Nigerian Olympic Committee and an assistant editor for the British Journal of Sports Medicine. And so that leads me to my first question is How important do you feel these associations are for the profession?
03:20 Thank you, Karen. It's is really very important, especially from my side of the
03:27 of the continent where we have very limited resources. And it's always a good opportunity to connect with other colleagues from around the world. When we first started the the Nigerian sports physiotherapy Association, were just a handful of people who, you know, came together to say, look, if we did start an association like this, it would help us be able to connect with other colleagues and associated other associations from around the world. And then we connected with IFSP T, which also given us a lot of opportunity to connect with the rest of the sports PT world globally. And that has kind of enriched us over the years. And I'm happy to say that Nigeria was also the first African country to be affiliated with IFSP T. And we still have a great relationship till today. And I'm also actually, I think, the first African and the IFSP T board. The executive board. I was elected in 2019 in the last Congress in Canada, for the Nigeria Olympic Committee. That took a lot of work because it's actually by appointment. And over time, it had only just been physicians. There hasn't been any room for physios to get on board, but I think for somehow I just kept well with the National Society. I'd be the Nigel site of physiotherapy, I just kept pushing to get on visit
05:00 ability for physios get us to get, I mean, get the Olympic Committee to also organize specialized training for physios and all of that, and I was doing all this work, making sure that where they were conferences happening, I wanted them to, you know, support people to attend and all that, and a former vice president of the Olympic Committee, and as I look, I think you'll bring your loved one on board. And I'd like to nominate you to be on the on the medical commission. And I was like, Okay. And
05:34 when I got in, I was the only female and I was the only physio. But I am glad that we time a lot of things have changed. Because one of the key things I'm passionate about is to give room to allow upcoming and early career sports medicine stakeholders, be it physio psychologists, you know, doctors, physicians, but give room for the younger ones to be supported and, you know, have access to all the IOC courses and things like that. So I it's been, it's not been an easy journey, but I think you can change a lot more from the inside than the outside. And that's, that's why I took on the assignment. And so far, so good. It's, it's worked out. Yeah, it's slow. But it has worked out a bit. Yeah, amazing. And I was going to my next question was going to be what, what has it been like for you to kind of be the first to have a seat at the table? Right, the first woman which I'm not surprised, and the first physio to kind of have that seat at the table, what has that been like for you? And what lessons have you learned?
06:43 Um, to be honest, it was not a really easy thing to do, especially when you are in the middle of about, you know, 12 other people who, and you probably also are the youngest. Let me add that, even though I don't consider myself young, per se, but in that tool,
07:06 I was the youngest. So but I think luckily, I What sort of helped me was that I spoke with the chairman. And I told him Look, this is
07:18 this is the ideas that I have. And I feel like I know there's a lot of work that needs to go on behind the scenes, I'm happy to do all the heavy lifting, or writing and all that, but we need to push for more things to achieve our mandate. And he was very happy with that. And later, a lot of a lot of the other board members just felt like Okay, it looks like we have somebody who's willing to do all this heavy lifting with you know, writing proposals and stuff. And we just kind of make things work. And somehow they just realized that I wasn't really doing it for any self. For myself, as it were, I was trying to get us to have a better a wider ecosystem for sports medicine resource, be it physios, doctors, you know psychologists, pharmacists, nutritionists and stuff like that. And so far, so good. We've we have quite a sizable number of young, early career people coming on board, a lot more people are not interested in sports, physio and all that. And which is because before now, nobody really wanted to do sports physio, they felt like,
08:26 you know, you're, you're never going to be rich. Like you're always just
08:31 the government is always owing you money. And so why are you a physio per se but then I tell them that look, passion will drive you it is just a calling and you really need to understand that.
08:44 What can in any another prefer in any other specialty or physio? It's quite rewarding as a sports physio as well, if you if you're driven by the right
08:55 circumstances. So yeah, it's not going to be easy, because half the time you'll find yourself like a fish out of water, especially being a female
09:05 where you're working multisport settings and you have to work with male team and all of that you have to hold your own. But it's it is rewarding. And yeah, so yeah. And it sounds to me like some of my students. Yeah, some big lessons. There are one, being willing to put in the work and to opening the door so you can help bring other people in. It's not opening the door for yourself and closing it on everyone behind you. No, no, because there definitely has to be a transitional plan. What is the sustainability of whatever you're doing? Because at the end of the day, your time is going to come and go. So who are the people that you're empowered to continue that journey, the vision and to be able to achieve
09:51 you know, the end goal of making sure that there is that continuity, and that you have, you know, so they pay forward and they can
10:00 didn't pay forward until, you know, for as long as as needed. And we would have a big pool of sports physios because I can tell you that Nigeria is over 200 million people, and maybe about 10 million active Lee involved in sports at a competitive level. And we still don't have enough physios to cater for that number.
10:27 So there's still a lot of work to be done. I can't do it alone. It's a collective team effort. Yeah, I mean, you have to increase the capacity. Exactly. Right. So that that all of these 10 million people, which is a huge number of people cannot be seen by estimating. It could be more, right. Definitely. Yeah. So obviously, you don't have the capacity for all of that. So if you can open that door and bring in a lot of like enthusiastic, like you said, physios, physicians, psychologists, nutritionists to help you continue to build up the capacity of a sports medicine program across the country, you'll be able to reach more people. Exactly. And that's what it's all about. And now, let's talk about your research. So you've got this passion of building up the capacity for sports medicine in Nigeria, let's talk about your research, which I know you're also passionate about. So I'll hand it over to you.
11:31 Okay, so I'm currently working in women's football. I mean, it is what it is because women really don't get much attention for anything, even in football, and for research specifically, as well. But as we all know that the
11:49 increase in projections of the numbers of registered football players has skyrocketed by the participation of women in football. And we know that for women's for women, we are more or less we have certain
12:08 certain factors, that puts us at higher risk of injuries. We know football has burden of you know, contact injuries and all that but can reduce the injury rates of non contact injuries. Now, because women I hire, that when population were what areas due to biomechanical factors, biological factors as a result of hormones and stuff, biological become biomechanical because of, you know, pelvic hip ratio, you know, being at higher risk of ACLs. So you want to be able to minimize that risk. And how to do that is to actively engage in injury prevention. So trying to bridge the gaps, especially in a low resource setting where we don't really have much human resources, infrastructure and all of that, and people still want to play football. So my research is trying to bridge the gap with the population of women playing football, and the use of an evidence based, comprehensive warmup program, which is the FIFA 11. Plus, it is a basic injury prevention program, but it works. But it's not going to work if people don't know about it and compliant with using it. So it's trying to find out what are the challenges in the setting? And how can we mitigate these challenges to be able to improve compliance and adherence, and be able to achieve injury prevention goals, because even on a global scale, compliance, and adherence is a big issue with anything. So, um, since we also know that we have to always tailor things to the broader ecological context, or whatever we're doing. It's not one size fits all, because you have to figure out what are the things that can work in this setting? How can we adapt that can we adjust certain things and whose responsibility is going to take the leadership of the injury prevention philosophy, how this behavioral change is gonna affecting? So this is this is a research that I was working on, or I'm concluding at the moment. And I'm really excited because now I think FIFA also is doing trying to do a lot of stuff for women's football. So hopefully, that can help. You know, in the next five years, we'll see women's football going to a different level than we are right now. Yeah. And you know, as you're talking about that and talking about the resources or lack thereof, it really makes me think I'm in New York City. I'm in the United States where we have an abundance of resources, and people still don't comply with injury prevention programs, right. And so I can't imagine being in
15:00 In a part of the world where you don't have the the manpower, the end all of the things that we have here, yeah, yeah, in order to make these programs stick.
15:13 Exactly. So this is one of the things that I found out is, along the course of my research, is that coaches need to understand that they can be empowered to take charge, rather than coach to see me as a medical person, like trying to take over their job, I'm not trying to take over your job, I'm only trying to help the team so that he can have more players available for selection and team can do better because at the end of the day, it's inversely proportional, the less injuries in the team, the more the team, you know, can can can progress and be successful. So at the end of the day, I think the messaging also matters, the messaging about, Okay, Coach, if you do this, you're going to have more players available for selection. And when you do have more players available for selection, then your team has a better potential to fight for the title to get to win a trophy. And when that happens, you get a bonus or something in your pocket. And it all everybody sort of it's a win win situation when your players do or injury free. They have longer carrier carrier longevity and so many other things. So the reason begins to change, you know, begins to change and at the end of the day. And then another thing I say to them that look, you don't have to think of injury prevention as this thing that is separate. It needs to be integrated. And there is no flexibility to adapt
16:45 and just integrate, it will still work. The most important thing is that you are committing at least twice a week for these exercises to be done. And you will see the difference that it brings to your team. Yeah, it's all about incentives. Right? How can you how can you meet the people where they're at with the incentives they need? And like you said, it's all about the messaging? Yes. Okay, wait, mindset changes, right. And that kind of takes us into I think what you're going to be speaking about at the fourth World Congress is sports physiotherapy, which takes place August 26 and 27th of this year in Nyborg, Denmark, and that is the unbreakable Young World athlete. So talk to us a little bit about that, and a little bit about your presentation. We don't give it all away, of course, you know, we want people to come and see you live, so we're not giving it all away.
17:46 We can dangle some highlights out there.
17:50 Okay, so the first thing is, I think that right now, everybody knows the potential of sports. So
17:58 everybody wants to start young. Now the pressure there on the young athlete is to begin to perform at a professional level at a young age. And that impacts a lot of things in terms of because you know, the type of dedication that you need to, to perfect, whatever sport that you're doing. And, you know, many parents and guidance, everybody wants, oh, I want my child to be Cristiano Ronaldo, I want my child to be messy. Now the pressure is much on these kids. And one of the biggest challenges that then these the burden of having to deal with that kind of pressure, whether physically, psychologically, and every other thing that makes up these young athletes would really be a huge load for young athletes out there. How can we balance that? Now, I will be talking from the perspective of law resource where I'm coming from a lot of many people.
18:57 In the developed countries, they have a lot of support for young athletes. And be it nutrition wise psychology, and so many other things that you we don't have the luxury of that. And many times, the kids who just want to play like they don't want to do anything serious or anything like that. But there's still the pressure and demand on them to excel. Because people see that if you if you're a good sports person, or you're able to make a break in either football or basketball, which is one of the top spots in Nigeria, then we can change our economic situation. And that helps us out of poverty, and all this kind of and all this type of thing. So I'm just going to be talking from that perspective of low resource and how the young athletes
19:50 as much as you want to encourage sports participation, but there has to be that striking balance to enable them to succeed
20:00 That's a lot of pressure on a young kid.
20:03 Yes, yeah. Yeah. Well, I mean, I know I'm definitely looking forward to that talk in Nyborg. Is there anything else that you're working on projects moving forward? Anything you're looking forward to in the future, whether it's future research, speaking gigs, getting more involved in in the profession as a whole? What do you have coming up?
20:30 Okay, so I'm trying, I'm rounding up my doctorate right now. So hopefully, I can get a postdoc position as well to continue to work in women's football.
20:44 That is what I'm hoping for the next maybe six months there about, but other projects that I'm passionate about involves power athletes, I'm very, very passionate about walking with our athletes, because also they too, were like a minority
21:01 group. But I see that they are really the super humans, you know, with everything. And with the limited resources and everything you can think of the still strive very hard I want to get on on the world stage. They are the ones who put Nigeria on the on the on the map for medals, because I was with the team in 2016, in Rio, and
21:27 we won eight gold medals, set new eight world records.
21:33 So I feel like yeah, there's a lot more that I want to learn. And
21:39 I'm also trying to do some technical courses. And
21:44 there's something called classification for power athletes, where it's like, you're trying to make sure that all the athletes are classed,
21:53 in in the desired classes that they can compete on a level playing ground. So apart from the technical officials, they also need the medical people to come and do all the assessments of you know, movement, muscle power, and all these things, just to be sure that, okay, we have classes athletes properly, and they can compete without having undue advantage over the other colleagues in a similar category. So yeah, so I think that's really the next thing that I want to do. It sounds amazing.
22:27 Some of my students trying to move on to postgrads. I've just provide them some of my own shares, some run experience, support them along the way as well. And so that's, that's what I think I'll do. Amazing. Well, it sounds like you have a busy time coming up and doing really, really great work. So congratulations on all of that. And now where can people find you? If they want to reach out to you? They have questions. They have thoughts, where can they find you?
22:56 Okay, so you couldn't find me on social media? You'll see on Twitter, it's at cool Boulevard.
23:04 And it's also the same handle on Instagram at cool Boulevard. So and that's cool with a K, correct? Yes. K with the K Yeah, yeah. And we'll have all of that information and links directly to all of your social media in the show notes for this podcast, so people won't have to search too far. And now as we wrap things up, one last question that I asked everyone, it's knowing where you are now in your life and career, what advice would you give to your younger self?
23:35 Um, nothing is impossible. If you dream it, you can do it. So just surround surround yourself with people who will always find your flames. People will always ginger you to keep going. And I think, you know, the sky isn't the limit anymore.
23:55 You can keep going so that I'll give to my younger self. Excellent advice. And just if people want to see Katie speak in person, like I said a little bit earlier, she will be speaking at the fourth World Congress is sports, physical therapy, August 26, to the 27th of this year, 2022 and Nyborg, Denmark. So again, we'll have a link for that as well. So you can go on and take a look at the whole program and sign up and come to Denmark in the summer, which I'm assuming is going to be great. I've never I've only been there in February when it's pretty chilly and snowy and rainy. So I'm excited for I'm excited to go. And I'm excited to listen. I have never been to Denmark. This will be my first time. So yes, I am looking forward to meeting you. And the rest of the delegates from around the world. Yeah, it's gonna be great. So Katie, thank you so much for taking the time out and coming on today and talking about all the great work you're doing. We are all inspired. So thank you so much. Thank you for having me.
25:00 and looking forward to see you soon. Yeah and everyone thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
25:08 Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media
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| 585: Dr. Kerry Peek: Neck Muscle Training to Reduce Sports Related Head & Neck Injuries | 11 Apr 2022 | 00:31:09 | |
In this episode, Physiotherapist and Sports Injury Researcher, Kerry Peek, talks about sports injury research and the neck. Today, Kerry talks about her research into sports injuries, developing training programs, and evaluating feasibility and adherence to programs. How can greater neck strength assist in reducing head and neck injuries? Hear about measuring neck strength, defining "normal" neck strength, and get Kerry's advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Kerry Peek Dr Kerry Peek (PhD) is a physiotherapist, behavioural scientist, strength-and-conditioning coach, and sports injury researcher with the University of Sydney. She has over 20 years of clinical experience in both Australia and the UK working with many athletes across a range of sports, age groups, and playing levels, including elite athletes in football (soccer), rugby, motor racing, American football, and athletics. Her current research is focussed on mitigating sports related head and neck injuries and has just completed a project on neck strengthening and heading funded by a FIFA Research Scholarship. Kerry has presented to the UEFA medical committee and assisted in drafting UEFA's heading guidelines. Kerry is the Chair of the New South Wales State Council for Sports Medicine Australia.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Injury Prevention, Neck Strength, Exercise, Training,
Recommended Reading
To learn more, follow Kerry at: Website: Kerry Peek Twitter: @peek_kerry ResearchGate: Kerry Peek
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read The Full Transcript Here: Hey, Carrie, welcome to the podcast. I'm so happy to have you on.
00:06 Thank you so much for inviting me.
00:09 And just so people get our connection, I was in Monaco for the IOC conference, and I went to one of the platform presentations, and you were discussing your research, and I found it to be fascinating. So you do a lot of work with the neck and head and I just absolutely loved it. I loved your presentation. I learned so much about it. And then as I dug deeper into you, I realized that you and my friend Evangelos Pappas, there was a connection there. So I texted Evangelos. And I said, you know, Carrie peak? He said, Yeah, I'm like, Oh, cool. Could you like, tell her that? You know, I really liked her presentation, because I was like, and, and I'm, I'm sitting right behind her. I don't know if he texted you that you're like that. It was like a psycho or something. I'm like, I'm sitting behind her.
01:01 He did text me that and it was just really funny to have this funny conversation between Australia and we're in Monaco, and you're American. And yeah, saying, oh, Karen sitting behind you make sure that you introduce yourself. Yeah. After the presentations are finished.
01:15 Yeah, that was funny. But I loved your presentation. So now I can't wait to talk about your research on this episode. So I'll just kind of throw it over to you to talk about kind of the body of your research and why you chose the topic that you did.
01:30 Yes, I am. I'm a physiotherapist. And now a sports injury researcher and I started in the early 2000s, working with Don gatherer, who is the former England rugby physio, and was the Chief Medical Officer The is the Chief Medical Officer. Sorry, I'll start that again. So yeah, so I started as a physiotherapist, I graduated in the late 90s. I graduated in the UK and I worked with Don Gajraj, who was a real mentor to me, and he was the former England rugby physio and also went to two Olympic Games. And he'd really developed a practice which specialized in neck rehabilitation. And this was an area that I don't really remember studying an awful lot at university, like we did manual therapy. And really, as soon as you got patients pain free, they were free to go like I don't remember really doing a lot of neck exercises. And so we had lots of players that played rugby, we had OpSite athletes, and we had Formula One drivers coming into the clinic, who had had a history of head or neck injuries. So concussion, which wasn't really talked about much in the 90s. But looking back, a lot of them work and cast. And we started doing a lot of rehabilitation, and I really am an exercise based physiotherapist. I really like doing manual therapy. And so it was just fascinating to to really come from that perspective to see, okay, what's the mechanism of injury? And how can we replicate this, you know, doing various exercises are really sports specific. I then moved to Australia and had children and got distracted bit by doing other things for a few years. And it wasn't until my son as an eight year old was heading a football, that I thought, actually, we should probably be looking at neck exercises in this cohort, considering they're using their head to you know, deliberately redirect the ball. And that really sort of got me down this, I suppose research rabbit hole, because at that time I was doing my PhD. And since then I've moved to the University of Sydney. And so really what my research is focused on now is how we can mitigate sports related head and neck injuries.
03:39 And so of course, you know, my next question is, what is the rationale for why training the muscles around the neck can play a role in reducing sports related head and neck injuries? Because, boy, it seems like some low hanging fruit right doesn't cost a lot of money, easy to implement. So what's the rationale there?
04:02 So I mean, first of all, I want to say that I don't think that next month is going to solve every head and neck injury. You know, I think it's part of a multifactorial approach where we will look at more changes and look at, you know, whether that's body checking or collision. But it when we're talking specifically about neck exercises, I mean, the notion that greater neck strength can reduce head acceleration, particularly during heading or during collision sports is that stronger, stiffer, next, increase the coupling of the head to the body, and then help to stabilize the head on contact. So whether that's body contact or head contact, and so really, we're looking at the stiffness, which is the ability to resist defamation, and then the strength which is then you know, being able to increase neck stiffness. And so it is really that coupling between the head, neck and torso.
04:54 And how do you explain this to a patient that you're giving these exercises As to increase neck stiffness, because I know a lot of people might think well wait a second, I don't want my neck to be stiff. So how do you can? And I love that you define that? Would you mind repeating it? Because I think it's really important. And how do you explain that to a patient.
05:14 So I tend to explain to my patient by using sort of the picture of a bubble head, so I do call them bobble heads. So you've got this figure, and then this head that moves really freely. And you think if you, if you nudge the, the head, it wobbles, you know, quite a lot. And so that's a lot of head acceleration, even if you touch the body, the head will also move. And so if you think if you are being tackled in sport, or you're heading the ball, then there's a lot of head acceleration there. And we use sort of head acceleration, we measure it, you know, with inertial measurement units, thinking that you know, this, if the head is moving a lot, the brain is moving a lot. And so if you can reduce the amount of head acceleration by increasing the strength and the stiffness between that bubble head and that fixed body, then that's a way to hopefully reduce some of the movement of the brain within the skull.
06:08 And that makes a lot of sense. And I think that is a great way to say that your patient, because they'll better understand what you mean by neck stiffness. Because I can just see, like, eyes getting wide, like, I don't want a stiff neck. But you're like, Well, when I wait a second, that's not what we're saying, We want you to be able to the neck is still mobile, but we want you to be able to accept those forces when they're placed upon you. Right?
06:35 Exactly right. And, you know, we know that head injuries and things are getting more prevalent in, in sport, and whether that's because of increased reporting, or whether it's just because the athletes are getting fitter, faster, stronger. And so some of the hits that you see in American football, and in rugby league and rugby union, I mean, they're horrendous. And, you know, if you've got this head that is really not well connected to the body, and you're being hit by a, you know, 100 kilo athlete, then that's such a vulnerable component. And I think that the neck, really working in this space, it's the last area of the body that we routinely exercise, you know, you would never send an athlete out, whether they're that's a prevention or whether they're post injury, without doing the exercises, you know, you wouldn't have an ACL and say, right, there's no pain there, off you go. And yet we do it quite regularly with the neck.
07:29 Yes, very much. So. And now when we're talking about strengthening the neck, how do you measure this, the strength of the neck.
07:40 So there are lots of ways that you can measure the strength of the neck. And a lot of these different methods have been shown to have good reliability. My issue is whether they're valid, and they're valid within particular sports cohorts. So when you're looking at assessing neck strength, I mean, generally, when you're looking at any assessment of muscle strength, there's reasons why you do this, you might be using it as an outcome measure. But generally, you're doing it to inform the load that you will input you you will apply when you're then exercising. So when you measure neck strength, it has to have some carryover to the position that the athlete is going to be in for their sport. And it also has to have some carryover to what you're trying to resist. So in with the neck, for example, you're trying to resist lots of head accelerations. So generally, you need to assess the neck using isometric or maximal isometric contractions, because you want to resist movements. Most sports are upright, you know, they're running, jumping, walking, running, and, and so you need to be upright when you test them. If that's how you're also going to exercise them. Now there may be differences. So if you're a rugby forward, you're going to be in a scrum position. So there may be reasons why you want to replicate a scrum position to test an athlete. But some measurements of neck strength are done in a supine and prone position. And these can often give you very different neck strength profiles, to when you actually assess somebody's upright. And there's problems if you are assessing someone in supine or prone, but you want to exercise them upright, because because you just don't know what the actual maximal strength score is in that sport specific position. So the way that I mentioned extreme is that I get them fixed in a seated position because I can standardize that position much better. And I use a break technique. So this is really looking at eccentric loading in an isometric position until you can break the contraction, I guess, of the neck. And this is shown in lots of different areas of the body that a brake technique will yield much higher scores than a mate technique. And so again, if you're using the brake technique, particularly because you're generally trying to keep the head and neck still when there's contact placed on the head or body, and then that is sort of like an eccentric load. So this will give us our maximal score, for which Has the flexes extensors left or right side flexes. And then this gives us a much better maximal result that we can use for percentage of one rep max when we're thinking about load.
10:14 And are you using a handheld? dynamometer? for that?
10:18 Yes, I probably should have said that first. Yeah, but I am using a handheld dynamometer with a load cell in series that's placed on the head with a with a head harness. And so yes, you do incrementally load that.
10:31 Yeah. Nice. And now, how, how do we know what normal is? Like? What's a normal strength profile for NEC? And and then how do we know what's normal for a position within a sport?
10:43 And that's a great question. Because when you when you look at the literature that's out there, the first thing I always do is I look at what was the method to assess neck strength. And if it is in a lying position, then I take the results slightly with a pinch of salt, because they too tend to give you a different neck strength profile. So there are a lot of studies particularly in rugby that have been tested using the same method that I that I use. And this was first developed by by Don gatherer. So it's not any great surprise that I use that because we used in clinic for a very long time and tested hundreds of athletes. But now having moved into that research base and had a look at all the different ways that you can test neck strap, it's still my preferred method. And so we've tested rugby athletes, we've tested football players. And what we're generally finding, and this is sort of consistent with the literature. And what we expect a neck strength profile to look like is that the extensors should be the strongest. So if you look at a result, and the extensors are not the strongest, is it related to the testing technique or the position that they're tested in? Or is there a problem there, so it isn't an injured population, that might give you something that's a bit different. So extensors should be strongest flexors are generally the weakest. And side flexors will sit somewhere in the middle there, depending on the population. So in rugby and American football, you often do want to have the side flexes to be stronger, and a lot stronger than the flexes. So they tend to have a very wide sort of neck radar if you were to plot this on a graph. Whereas if you have football players, for example, because of the conditioning from hitting a ball, they may actually have quite strong flexes. So I always have a look and plot the results on a radar. And then I also calculate the flexure to extensor ratio to see what that looks like. And so in the literature, normal is often considered around point six of a flexor extensor ratio, but I have seen it as low as point five as high as point seven. But I always think if in a sporting population, if it's below point six to me, that's that's honestly a red flag, but it's certainly a yellow flag.
12:47 It's problematic, or can lead to can lead to more problems. Yes. And where can people if they're wondering like, hey, where can they find the method that you use to strengthen? Is there a paper? Is there something you can point to because we can sort of put it in the show notes?
13:04 Yeah, so I do detail the the method for assessing neck strength and a paper that we published earlier this year in sports medicine. So we looked at the neck strength of football players, adolescent football players from 12 to 17. And then we implemented an X strengthening exercise program and to see whether by strengthening the neck this actually had an impact on reducing head acceleration during heading, and we found that it did so that the neck strengthening method is is detailed in that paper.
13:34 Perfect. So we'll have that paper, we'll put it in the show notes a link to it so that people can read it at their leisure. Now, we talked about why you're looking at it, how you're evaluating it, what does a training program look like?
13:50 So that's, that's really interesting as well, because I think, because there's not a lot of published literature on neck strengthening, I think you tend to find that you have different camps of people, some that are very pro neck strengthening, and that that certainly is myself. And, you know, a bit like you were saying earlier is that it's low hanging fruit, you know, why wouldn't we try and strengthen it because the potential gain is huge, and it wouldn't not strengthen any other area of the body. So I kind of think what, you know, why wouldn't you do it? But on the back of that, we also have to think what's the best way to strengthen the neck and I think some people are quite negative towards neck strengthening, because some of the papers that have been published, the exercises that they use are sort of self resisted exercises where they're pushing against their forehead and holding that and doing isometric holds. And a number of studies have shown that this doesn't really have an impact, it may not even impact in which increasing strength and it may not have an impact in reducing injury risk as well. And that makes sense. You know, I don't implement those exercises because When you're talking about reducing something like concussion or heading in football, those hits happen in fractions of seconds. So we don't need to have high insurance of the neck or just isometric control over a long hold, what we need to be able to do is fire those muscles really, really quickly. And so we've been playing with some neuromuscular exercises. So it isn't our paper that was published in sports medicine, but I'll try and describe it, but you're kind of in a setup position, but you're rolling backwards and forwards, and you're trying to stop your head from hitting the ground. And so the idea from that is really to try and contract the neck flexors really quickly if the heads in neutral, and then we turn the head to the side and the other side, and we do the same exercises. But the idea is that you've got that anti gravity strengthening, but you've also got, you know, you're trying to stress the muscles to fire really quickly. And that's what they have to do. So most of the the literature that is talking about neck strengthening is sort of indicating that we need to do some sort of isometric exercise, but with ballistic intent, and that's the bit that is often missing, for most of the neck exercises in the literature.
16:10 Yeah, and that's the exercise you described in Monaco, sort of, for people, if you've ever taken Pilates, it's rolling, kind of like rolling like a ball is kind of what that's kind of, you know, that's, that's at least what I got from it. And I remember I got back to my room, and I was like, we're gonna try and see what happens here. And it is it not as easy as it sounds.
16:32 No, and, and it does, it does work the net quite hard. And you can see it, you can see the net contractions in somebody else that's doing it. But the way that we sort of played with this exercise, and I will just credit to bursting, but also, we meet on a regular basis. And we talk about neck exercises. And he's also widely published in the neck strengthening arena, and was part of this paper as well. But what we were trying to do was come up with an exercise that use no equipment that didn't take long. So these exercises take 90 seconds. And that could be added to an existing neuromuscular program. So in this case, we added it to the part two of the FIFA 11 plus. And this is really important because I actually don't think isolated neck exercises is probably going to give you the best bang for buck either. I think we need to integrate it into, you know, other strength and conditioning programs. And again, this is sometimes where you see in the literature that they're just adding neck neck exercises without thinking about, or what is that neuromuscular control to the trunk as well. And how are we stimulating that?
17:31 Yeah, that makes so much sense to not just do things in isolation. I mean, gosh, especially when you're talking about athletes who rare? There's not many athletes that do things in isolation?
17:45 No, no. And and I think that that's just really important to get that adherence as well. Because if they think it's an add on program, and it's going to take ages and 10 minutes to an athlete is actually quite a long time when they're doing so many other areas of the body, that if we could integrate it into existing programs, or integrating into multi joint movements, then it makes sense to them. And it and it's, it's it's integrated. It's not an add on.
18:09 Right? Because of course, as we all know, as physio therapist, one of the hardest things through a rehab process is the patient that doing the rehab. Right, so the best exercise is the one they're going to do. So if you explain it well. And you integrate it, you're more likely to have that patient do the exercise. Have you found that? Have you found difficulty patients adhering to the program?
18:38 So, so we didn't, we did, we did look at the evaluation of feasibility. So my PhD is actually on adherence to exercise. So it was something that was really at the forefront of my mind when setting any exercise intervention, that we need to have some sort of process to evaluate it and see whether the, you know, the players and the coaches found it feasible, and did it take too long could they see the benefits of it, and it's generally scored really, really highly. And I think that is the fact that we tried to just minimize the time that it took that it was complex. So you know, the youngest athletes were sort of 12 years of age, and you know, they all understood what they needed to do, but also to make it you know, applicable to their sport. I think that's really important.
19:21 And what are your thoughts on different kinds of strengthening you know, we see things on YouTube people will see things on YouTube and I don't mean to go down a rabbit hole on that, but you know, tying weights around their head bands around their head doing things with bands and weights with movement of the neck. What are your thoughts on that?
19:44 So there's certainly some crazy stuff on on YouTube or Tik Tok and I think that's not necessarily specific to the neck. I just think that again, what you've got to try and do and, you know, I think exercise therapists, whether that's physios or exercise physiologist that do exercise really well, they understand the sport and they understand the mechanism of injury. And so if you're going to add a weight to your neck, you've got to think, Okay, well, how am I adding the weight? And how is it replicating, you know, the risk of injury, or what I need to do within my sport. And so if you're in a crouch position, which I've seen in lots of videos, where they've got a head harness, touch the neck, and then there's really, really heavy weight at the end. And I kind of think, why you're doing that, what's that for? And maybe in the scram, maybe that's applicable, but you know, I can think of very few reasons why you would need to do that. And when they hang weights off the top of their heads, you know, you think of that, you know, that axial loading that they're doing. Again, why would you want to do that?
20:51 Yeah, I don't know. That's why I asked, and so we got an answer. I don't know, I really do not know why you'd want to do that. But now now listening to you talk about your research, it just makes so much more sense to integrate it in a neuromuscular based exercise, you know, integrating it with other muscles within the body and making sure that it makes sense for the position and the sport of the person. Yeah, absolutely.
21:21 And I think this is about knowing, knowing your patients, knowing your athletes, and, and if you apply that sort of methodology for any exercise, you know, whenever you see someone, so I've been invited to do some work with the RW F here, so the Air Force, and I don't know a lot about PILOTs, but you just go in here, talk to the pilots, and you say, okay, so what do you do? And you know, when does your neck hurt? And? And how long are you in that sustained position? And how much G force are you being exposed to when you're in a fighter jet? And you just kind of start to understand, you know, what, what's happening to this person? And how is that potentially, you know, making them at risk of injury? And then how do we need to train those muscles in a way that stimulates, you know, what they're exposed to as part of their job or part of their sport? I mean, you do that with every other joint of the body? You know, I think we routinely do that. But we just need to do it at the neck as well.
22:19 Yeah, and great advice. And now is there anything as you know, throughout our conversation today that we didn't touch upon, about your research, maybe about your PhD work that you think would be audience would really love to hear more about?
22:37 Um, I think that it's important. I think it's important than I think I sort of said this a bit earlier on that, we really need to make sure that the research in this space is really high quality research, and that we understand, you know, the mechanism of injury, particularly things like concussion, that we don't think that neck strength is going to solve everything. But you know, when we're reading papers, it's understanding, you know, what method did they use, you know, are the results actually believable, or didn't the way that they measured neck strength have given you such an unusual profile that actually shouldn't read any further in the paper, or it's just not applicable to your athletes, for example. And so I think that we need to be much more critical in the way that we apply research in neck strengthening. And I think that, although I'm very passionate about next trend thing as an intervention, you know, I don't think we should overplay what we can potentially do in this space, either. It's just part of our toolbox, but it's not going to be everything.
23:38 Yeah, there. It's not the panacea for all ills having to do with head and neck injuries.
23:44 That's right. And I think that if you don't understand about how to integrate a neck strengthening program, I mean, I'm very happy for people to reach out to me, but, you know, talk to people and, you know, as I say, critically appraise what's going on. And I think, you know, if you're really good at designing exercise programs, get creative, you know, have a little bit of a play of what you're trying to do. And I think that's often how we get really innovative in the way that we approach exercise programming as well.
24:11 Yeah, and it also sounds to me like there's not a one size fits all. Approach, exercise or program. No,
24:21 I mean, I think there's things you don't do. And then everything else is kind of open to Yeah, depending on your athlete. So yeah, don't hang away off your head.
24:29 Yes, that is fabulous advice. And now as we start to wrap things up, I'm going to ask you the question that I asked everyone, and that's knowing where you are now in your life and career. What advice would you give to yourself as a new grad right out of physio school, your younger self?
24:50 I think that's a great question. And I don't regret anything that I've done in my career, but I would say that I've probably come to really specializing in neck strength is a bit too late. So we started in the early 2000s. So my first paper was published in 2005. And as I say, I got distracted doing other things. And I wish I'd continued with it. And I didn't partly because I was having children, and I'd moved to Australia and just life got in the way. And when I came back to it in the probably about 2015 16. So 10 years later, and nothing had moved forward, really. And I just thought that was a really missed opportunity. And so I if I could go back in time, I would probably, yeah, I would probably want to squash those 10 years into maybe 18 months.
25:40 Well, that would be pretty amazing time traveling. So where can people find you? If they have questions, they want to follow you on social media, where can they go.
25:51 So the best place to find me is on Twitter. So I'm at peak underscore Carey, I don't tweet about anything other than my research. So that's the best place to find me. And then you can always drop me a message through there. Otherwise, you can probably find me via Google, at my email address at the University of Sydney.
26:09 Perfect. And just so everyone knows, we will have a link to the papers that we've mentioned today. So if you want to read up on those that don't worry, they will be in the show notes at podcast at healthy, wealthy, smart, calm. And Carrie, I want to thank you for coming on. Like I said, I really loved your presentation in Monaco, which was just a short snippet of kind of the amount of things that we talked about in the podcast today. So thank you so much for taking the time out and coming on.
26:36 No, thank you actually went to your presentation in Monaco as well. And you've informed a lot of what I do as well about, you know, I think that most research is quite ego driven. And I'm not an exception to that. And we think that if we publish a paper that somebody is going to read it and we're going to change the world. And that rarely happens because players and coaches don't read research. And so your presentation was about you know, engaging with the media and doing a lot more in the social media space. And that really hit home to me that we have to try and bridge that gap if we can to translate research to practice. So no, thank you.
27:10 Oh, well, that's nice. I'm glad to hear that I will pass that along to my partner Osman, as well. So thank you for that. And again, thank you for coming on. I really appreciate it. And all of you listening. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart. | |||
| 584: Dr. Philip Goldsmith: What's Your Value? A Novel Payment Model for Home Health | 04 Apr 2022 | 00:36:24 | |
In this episode, Owner amd Founder of Goldsmith Therapy Solutions, Dr. Philip Goldsmith, talks about value based purchasing in home health. Today, Dr. Phil talks about the pros and cons of value based purchasing, and prioritising results over productivity. How will value based purchasing in home health turn out? Hear about OASIS assessments, the difficulties of working with insurances, and get Dr. Phil's valuable advice, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Dr. Philip Goldsmith Philip Goldsmith, PT, MSPT, EMT, DScPT, COS-C, is the owner and founder of Goldsmith Therapy Solutions, a provider of high-quality management, consulting, and clinical solutions for home health providers. Dr. Goldsmith has been a practicing physical therapist for more than twenty years, with experience in home health, skilled nursing, and outpatient orthopedic environments. Dr. Goldsmith received his BS in Health Studies from Boston University in 1996, his MSPT from Boston University in 1998, and his DScPT from University of Maryland School of Medicine in 2011. Additionally, Dr. Goldsmith has extensive experience in leadership and financial management of small and mid-sized not-for-profit corporations and has won more than $200,000 in grants for public safety organizations with which he is affiliated. Dr. Goldsmith lives in Hanover, PA, with his wife and son.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Results, APTA, Home Health, Value Based Purchasing, Insurances, Advocacy,
To learn more, follow Dr. Phil at: Email: pgoldpt@gmail.com LinkedIn: https://www.linkedin.com/in/philip-goldsmith-a81a692 Twitter: @pgoldpt APTA Home Health: https://www.homehealthsection.org/leadership
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: Alright, let's go. Hello, healthy, wealthy and smart. I am Jenna canter here with the Dr. Philip Goldsmith, who we're going to refer to as Dr. Phil, don't you love it? I'm so grateful to have Phil here, because he has a small business owner who runs a business in which he provides Oh, I'm gonna mess this up. And I'm so excited to where he brings stuff to the home health people and they're happy and they smile and say thank you. Without it and I get it.
04:05 That's pretty close.
04:08 Would you mind summarizing in that perfect sentence you just said a second ago of what it is you're more details on your business, like
04:14 elevator speech. It's called Goldsmith Therapy Solutions. And I provide high quality clinical consulting and management services to the home health industry.
04:26 I love it. And that's an elevator speech we all need to have you know for each of our own individual businesses, anybody who interviews with me knows I don't spend too much time going into the bio stuff because that will just be in the people can read it and then Wounaan go oh my gosh, I love Dr. Phil, you know, look at this. Wow, incredible. We are going to dive right into the topic which I know nothing about. I'm a cash pay cash based out of network PT working with performers. So I'm going to ask all the base questions to fully understanding the situation so everyone can better get on the on the same page with this apparently, and I I'm, I'm not saying it's not but just for me, it's new, apparently topic that's like a hot topic, and that is value based purchasing in home health. I know nothing about it. So let's talk about what is that? What is the value? What is that
05:21 value based purchasing is Medicare's new payment model for certified home health services provided to Medicare party beneficiaries.
05:33 Why is that important right now,
05:36 because it's different, how Medicare is moving away from the you go do a visit or provide a service and we pay you for a service to a model where they pay you based more on your outcomes, and how good a job you do at taking care of those Medicare beneficiaries that have chosen to avail themselves of your services.
06:05 That sounds great to me from a physical therapy standpoint, because that's what we care about. So how was this? Let's start with how this is good. And then we can go how this is potentially something that could get in the way of providing care to people fully. So how is this good?
06:20 This is good, because it removes a lot of the artificial drivers that were skewing utilization. Meaning, excuse me until about three years ago. The more visits you the more therapy visits you made, the more money you got. And that was unfortunately driving practice patterns and everybody Medicare, not Medicare kind of agreed. This isn't working. Yeah, yeah. And
06:55 because that's about productivity, not about results. Yeah.
06:59 Right. And it was it was too much widget counting, and a lot of home health agencies were making a lot of money on providing therapy visits that weren't necessarily necessary. Hmm, Mm hmm. So, you know, the the interim step on the way was this thing called pdgm that we're in now where it's all based on functional states and diagnoses? And that's about it.
07:28 Yeah, it's not nothing to push getting them to where we need to get them or to protect them from getting worse. If we're talking about home health. Yes, yes. Okay. Okay. So then let's talk about where this could potentially be problematic.
07:45 So the, the concern is, are you comparing apples to apples, meaning they're dividing the agencies up by state by geography and buy large versus small volume, to try to make apples to apples. But the big issue is, this system works literally by robbing Peter to pay Paul, somebody is going to make money. And somebody is going to lose money. So the other people at the other end of the scale can make money.
08:25 Where could you go and give some details on this? Because I'm not really following on on how this could be? Yeah,
08:31 Medicare is gonna say, Okay, we're gonna take all of the large volume agencies in the state of Pennsylvania. And we're gonna line them up by the outcomes we've chosen, they haven't told us the outcomes yet.
08:46 Deciding what the outcome what outcomes matter,
08:49 they are in the process of that now, who are the consulting
08:52 with doctors?
08:57 So there is what's called a technical expert panel, and we could do that alone. The concept of technical expert panels could be its own podcast, where basically they bring in people in the industry and ask them, What do you think is important? Um, do they pay them? They cover their expenses, do they? Do
09:25 they start to get a financial interest to sway certain ways and their responses? Okay, okay.
09:32 They're representing their industries. So, you know, they can, I could volunteer to be on a technical expert panel. And my job is to bring the perspective of the physical therapy industry. Hmm. They also do us, you know, these big beltway consulting firms that you hear so much about, and they have policy wonks that work at CMS that do this stuff. A lot of its actuaries accountants and lawyers? Because one of the big rules is this is supposed to be budget neutral, meaning the pot of money doesn't change. It's who gets how much of that pot changes, specifically, the agencies that are the bottom performers, they're going to lose it as much as 5% of their reimbursement, so that the top performing agencies gain 5%. See,
10:25 there we go. That's where I think a financial interest could sway what people say, because this could be less money towards their industry. Well, it's problematic,
10:37 home health in general. I mean, this is, it's already, you know, you're already getting paid a lump sum for the care of each individual. And that varies based on those clinical and diagnostic factors that that I talked about before. Right. The scuttlebutt is,
10:55 I don't, but I just need to highlight that. I know I love that you said scandal, but this is great. That means rumors, love it scuttlebutt, I'm going to start using that every day.
11:06 One of the big outcomes they're going to look at is readmission to the hospital, did you keep your patient out of the hospital? Because that costs Medicare more money. And they're gonna look at functional outcomes, like transfers and ambulation. And there may even be a patient satisfaction component because did you know that Medicare mandates patient satisfaction surveys in most settings, you get those annoying Press Ganey surveys? Because Medicare says Thou shalt, and they track those, and those are actually publicly reported data.
11:41 That's actually great. I think the patient what their happiness is everything. Yeah, I think that's great. That's, yeah. Okay. Okay.
11:52 So it's your secrets here.
11:54 So it's it sounds though, like it's a bit of a gamble on where things are going to lie. And what's going to be decided on what these outcome measures are? That sounds like the biggest concern, what are these outcome measures that we're going to be using? Because if we're talking about movement stuff, you
12:15 aren't talking about movement stuff. But, you know, they've already established that all of the measures, the outcomes that are going to be looked at are either Oasis based Oasis being the clinical assessment that's done in homecare at a minimum every 60 days. Okay, Mission recertification discharge, hospitalization, return from hospitalization. That standardized assessment gets done. I have
12:47 a question about that, actually. And this is just from my own experience, it's a completely different audience that I work with. So when I'm working with my performers, I'm reassessing every single time I work with them. I'm a niche practice, though. I'm, I'm small and keeping it small. And so therefore, they get like real top, you know, I know them inside out what's going on in their lives and stuff, so I can best help them. So that is very, very specific. And and I'm lucky to be in that position. So when you're saying 90 days, that sounds like a long time for like a formal reassessment. I believe in oh, gosh, PT, school, it was it was a matter of like two months. So is it because of the the age where things may take longer to see results? Why it's a 90 day spot? Like, why is that? I'm honestly asking, it's not for judgment, I'm trying to be very transparent on my own bias. So I can learn
13:37 that every 60 days, well, every 60 days, that OASIS assessment gets done. However, that doesn't change, that your state Practice Act still applies that you may have to reassess every 30 days or every 10 visits or every 14 days, whatever your state Practice Act says, and Medicare still has the every 10th Visit reassessment requirement in home health, where they expect you to be using objective functional measures, and looking at your plan of care and your goals and saying, Are we getting where we need to be,
14:16 which is what we do in physical therapy. That is we're always asking ourselves that question.
14:19 Okay. This is more of a you know, it's more of a big picture thing. Yeah. Okay. For example, the emulation question. There's independent, there's independent but needs a one handed device independent but uses a two handed device can walk but need supervision at all times. And then there's a couple of answers for wheelchair bound, or bed bound.
14:46 Yeah, I'm not familiar with this, but I'm learning as you're talking about, is there anything about risk of falls because that's like the big a big one.
14:53 They look at that from a process measure standpoint, meaning they ask you, did you assess for fall risk, and there's criteria given a multifactorial objective. So really, it's got to be a two pronged thing. They're not looking at the results. They're looking at. Did you do it? Yeah.
15:17 Yeah. Is there room for? And this may be you don't know, because this is a bit of mind reading. As far as you know, right now, is there room for measurements for neurological disorders where we know that things may they're going to decline over time? You know, are immune immune? Am I saying the wrong thing? I think he's doing the wrong thing. But is there room for that where they have a health situation where things are going to decline? We know that but we're trying to keep them functioning their best as they're going through their process?
15:50 The answer is yes and no. Okay, the questions and answers don't change. What changes is, they can tease out by diagnostic grouping and by what they call risk adjustment, where if your agency has a high population of clients with progressive neurologic disorders, that's the the term in favor now. Okay, thank you, they're going to risk adjust your statistics to reflect that, meaning, we see that you have a larger population of people who probably aren't going to get better. And we're going to do some statistical mumbo jumbo in the background to adjust for that. But that doesn't change the answers that the clinician is using. Okay. There's no, I have to pull a different document because I have a different diagnostic group. There's no, I answer these questions for this diagnosis. And that questions for that diagnosis? Yeah. Yeah, the people who very much a big picture of
17:03 the people behind the scenes, I think I know the answer this question, but I'm still going to ask it, the people behind the scenes who will be assessing the the progress progress, and, you know, if it's fitting, looking at the outcome measures and what we need for that patients, are they medical professionals? Are these just people who are trained to work for this company? Who are the Who are these people?
17:28 So field clinicians who work with clients answer the oasis for each client, the agency, then submits it electronically to CMS. And the risk adjustment is baked in to the computers at CMS that process all this information.
17:50 Also, it's a computer thing. It's all very,
17:53 and that's part of the reason the assessment is somewhat limited in big picture. Yes, it's a it's a computer thing. Ah, it's a i. i, maybe maybe not. But it's a lot of higher level statistics. That's way above my head.
18:11 Right, right. Yeah. Oh, wow. That's what this is so negative for me to say, but what an easy way as a person in CMS to point away and go, Oh, no, it's the system's. That's what they computed. Like, I can't. I'm like, Who created it? Who designed the code? Fine. We'll look at the code person I need to understand. Okay. Okay. So, I mean, it just sounds a little bit like a trip to Las Vegas, where you studied a little bit. So you know, a bit about gambling, you say, let's say you're very educated about that, and you but it's still gambling? You don't really know. I don't know, I just I,
18:53 you know, it's, it's pretty well known how they do the risk adjustment. You know, it's just the statistics of how it's done is pretty high level, but we have a good feel for what they're risk adjusting for and what questions they used to do the risk adjusting.
19:15 I mean, do you think the physical and physical therapy industry home health for this, because that's what we're focusing on? Do you think what the way we have things set up now, the way I mean, that's the whole point is to be measuring their outcomes? That is literally what we're doing all the time. Do you think we're pretty safe with this adjustment? If anything, it'll probably be for the better if you're just overall? I mean, because we did the good versus the bad. Where do you think it's, it's gonna turn out for us?
19:46 It looks like value based purchasing a home health is going to be a good thing. It is going to reward you for doing your job well, and being aware of your outcomes and delivering good health. Quality physical therapy that drives the outcomes? Yeah, there's going to be, it's going to challenge the physical therapist and the PTA to work at the top of their license and to collaborate with the other professionals. Because some of these measures don't happen in a vacuum for lack of a better term, they don't happen unless you're working as a team, and everybody's on the same page. Yeah. And that's really that interprofessional communication is where the good are gonna be separated from the bad.
20:40 Yeah. This isn't my world. Oh, continue,
20:44 there's, you know, definitely the agency is going to have to be very aware of their outcomes and their data. And the understanding of that data is going to be huge. Yeah. And I can tell you, that there are consulting firms and companies, and that can look at those outcomes at a clinician level. And they're going to tease out high performing clinicians and low performing clinicians.
21:16 Yeah, yeah. Yeah. And I'm assuming that's where the concern is, what is, oh, I'm gonna backtrack to actually what I was originally thinking of asking. What is the hot talk on the streets regarding this? What are the big things that other physical therapists and people in the industry are going like, hey, about it? Or do we already cover those things?
21:41 We've covered a lot of it. I think there's a lot of optimism around this. Because the more recent changes over the past couple of years, starting in October 2019 really pulled back on the number of visits. We were seeing clients. And some of that is real. And some of that is artificial. Yeah. And it's gotten me up on my soapbox a number of times, because home health therapists are probably, unfortunately, some of the worst offenders at underdosing strength training. Oh, yeah, you want to get me started? Don't get me started.
22:34 Yeah, yeah. So it's, it would force that that push, I would love. It
22:39 forces us to understand how to deliver strength training, how to deliver the most the best outcomes we can in in fewer treatments.
22:52 Yeah, how to get trust, motivation.
22:55 really gotta understand you've got to be a high performing clinician, yeah. To survive in this market. Yeah, because a home health agency literally cannot afford to have lower performing clinicians that can't deliver the outcomes. Yeah. And a lower number of visits.
23:16 Yeah. Yeah. Absolutely. Absolutely. I definitely get that. So I I mean, I'm all about the outcomes. I've had people a different dance physical therapists asked me about how I do my outcomes and it really does depend on my patient and everything but I have a very I have a special circumstance you know, like I'm very lucky to have this niche that I have. i There are from an outpatient not out push out. Yeah. Out not outpatient. Wait, I'm getting so confused. Ortho. From an ortho standpoint, I'm calling because I'm not, I'm not home health. So I'm just like trying to get back to my my world. There are definitely I'm gonna choose my words specifically. So if you are a person who does own a clinic, that sees a lot of patience, you are a mill, there is no way to paint that there is a reason why there is a name for that. That's like saying, I, you know, I was you know, born from two Jewish parents and I grew up I have my Bar Mitzvah and then and like, I still observe Passover, and then be saying, I don't I'm not Jewish. Like what? Like, no, I'm Jewish, you know. It's very weird comparison. But whatever. That's what I chose. And I'll go with it. We
24:41 get to the point of mills.
24:44 I've always thought that the it was because of the problem with insurance and reimbursement and it's one of those like chicken or the egg kind of thing. What happened first, which I use in defense for any clinic. I'm like, hey, they're trying to figure out how to get reimbursed but at the same time, does in this horrible circle of terrible reimbursement trying to communicate what you did and everything, and people are trying to make money, which is fine, it's okay to want to make money Hello. Is
25:15 we as a profession do wrong to allow an industry to devalue our services like that?
25:24 It's because when trying to guess this is me, because I'm not a network. So, but from what I've seen, it's it's clinics trying, they're doing their best to report what they're doing. They outcomes with the patients, while at the same time speaking the language that the insurances say, they will reimburse. And then also these insurances saying they're going to reimburse, but they're not actually reimbursing, then there are administrative staff calling over and over again, fighting to get those reimbursements, you know, getting better at that. So that's why you have certain people working on the at the front desk, and then and so then they increase the number of patients during that time, because while they're gambling per patient on honestly, this is how I look at it for a patient on getting that reimbursement. Through, you know, the paperwork we've we've been trained to do to report outcome measures and everything. They're not they're not getting paid for it. They're fighting to get paid even on the basic level. So I think, but I don't know what happened first if insurance happened first, or, and, or the, you know, provision of the services, and they decided for it to be a lot of people that's the chicken or the egg thing. I mean, I'm sure somebody could look up the history, but I think that's where people just say, Oh, the healthcare system is messed up needs to be fixed. I, that's where I kind of lean back on to kind of be fair to everyone. Not that there has to be a middle ground. But I mean, that is kind of the truth. If I owned a big business, you're constantly you're like, Okay, I've hired this, these EMR systems, you know, we're we're gonna track and write down things. I hope this is the right system. Okay, this one's not working. Let's do a new one. And then you have your clinicians going, Ah, dang it, we have a new one, I have to readjust. But it's because we're trying to do it. Honestly, we're trying to do it legally. And then insurances just go, now, we're just not gonna reimburse you, we're not gonna explain why. And we're gonna be difficult to get in contact with to discuss and figure things out. So I don't know it's a random tangent, I'm sure people will go be like, Jenna said something wrong. I'm not the person to attack here. I'm just speaking. If you have problems, go talk to the insurance companies and figure it out if you already know how it works. But that's kind of how I look at it being problematic in the Ortho world specifically, because there is a lot of measuring of my brain out there. There's a lot of measuring of what was the word that we use, the more patients you see.
27:56 Counting widgets, counting widgets.
27:58 It happens, it does happen at the larger clinics. But yeah, can you I mean, I'm not saying I'm not saying I'm not saying I agree with it. But also, can you blame on? You know, like,
28:12 you started this to make money. I get that, you
28:17 know, but, but I mean, what I am in the business to hear, I mean, that's what I'm doing my own thing, is it easy to do what I'm doing, is it easy to get the patient Oh, my God. But that's I that's where I put my energy where I put my energy. But I feel like what is happening in the home house, like, Oh, my God, this is hilarious, full circle, but I'm going to connect it, it's going to be amazing. Feel like the Home Health what you're doing with pushing that pushing forth. The outcomes, I would love that I would, but I would love to actually be that not than just saying that. We love their beat. Let's make it all about the outcomes. And honestly, I feel like that's what we've been trying to do the whole time. It's just people aren't. insurances aren't saying there aren't following through with it, what they say they're going to reimburse, they say, We can reimburse up to this amount. It doesn't mean anything. It's horrible. So I would love there to be fixing in that way.
29:13 And I think someday Medicare will come around to a value driven system for outpatient therapies. And until Medicare does, nobody else will mean, Medicare very much still drives that bus.
29:31 Yeah. Wow. I never realized that. That's yeah. How do you know how do you I mean, honestly, asking, How do you know that they're the ones driving the bus?
29:43 Because most of the private insurance is based their policies on payment on what Medicare does,
29:53 because they're so huge. Yes. Mm hmm. Oh, gosh. Not saying it. It's easy to say there's no easy road.
30:02 That's where all the that's the root of all the CPT codes and everything else. Medicare needed a common terminology to wash claims through a computer to pay people. Let's boil everything down to a five character code.
30:21 Right, right, right. Wow. Huh? She's What a hot mess. It just gives me a headache thinking about all of it. I don't like it. It makes I need cake. Or pizza. Oh, not chocolate though. My dad loves chocolate cake. Are you a chocolate cake person?
30:43 I am a chocolate person head on.
30:46 We only put like chocolate cake is so different from chocolate bars come on.
30:51 Yes. But they both have their merits
30:54 F No. Disagree? Absolutely not. All right, if you are a person that if you would handle your stress from chocolate cake, just as much as chocolate bars. Okay, your team Dr. Phil. If you're like No, chocolate, just chocolate actual chocolate, your team? Jenna. I'm interested to see if there's going to be any written debate on this or discussions I'm sure there already has, which is why you were meeting Dr. Phil was like, let's do this topic. And like, I don't know anything about this, which is good. I think it's good because then I get to learn everybody else who listens gets to learn. And oh, I'm going to just say this just because I am not a fan of meanness. Don't attack either of us in this discussion. If that's in your if that's in, if that's in your intention in in hearing this and your response, oh, just at this as a message just for you get out of here. Well, we got to be better together, we need to be able to have these discussions, talk about it, totally fine to speak on your concerns about it or all that stuff. But we're just attacking each other that is not helping out the patients at large. This is about the people we serve. So we're discussing this to see what's going on to better understand what's going on. If you are in an estate, you are close to somebody who is in legislature, the then do talk to them, or see if there's a pre written letter from a PTA right now regarding this through their app, if you're in a PTA member or see if you can get a hold of that letter through a friend or something or I'm sure it's honestly on their webpage for you to easily access to advocate sending a letter to fight this or fight for it, whatever it is, because there's there's positives and negatives and everything. I mean, sometimes there's you know, it's leaning one way, obviously, but we got to just take action. If you want to see something you got it don't just reply on here take action. Well, I just gave so many different messages and one thing at the end, but that's okay, I'm fine with it. Any last words you want to say on this matter that you that we haven't covered? Dr. Phil?
33:15 I think the take homes are twofold. You just said the first one. You've got to be involved in advocacy if you want to see change. Second, value based purchasing, like we're talking about it today is just in the home health arena right now. It is what Medicare wants to bring across the board across all settings. And, you know, they don't they want to get away from fee for service. They want to get away from ID to units. If they're x and a unit. If they're X, a unit of East M and A unit of manual therapy and you need to pay me for it. They want to know a client walked in your clinic with this problem. They had these issues that we're able to quantify. And at the end of it, the client left our clinic and the issues were gone and here's how we've quantified it. That's what they want to be able to pay you for. And if you can't be excellent with that. You're not going to have a successful practice 510 years from now.
34:34 Thank you. Thank you so much. Where can people they wanted to get in contact with you Where can they connect with you on either social media or email?
34:44 I am P gold PT on Twitter. I do have a personal Facebook. I am not fancy or cool enough to have Instagram or Tik Tok or any of those. I have LinkedIn. My email is Easy it's P gold pt@gmail.com. The other place that's really easy to find me is if you go to a PTA home health.org on the leadership page, you'll find my name. Currently the treasurer of APGA Home Health formerly known as the Home Health section. And in two weeks in two days I become the President
35:29 didn't say that at the beginning. I was like, I wonder if you want me to and you didn't say bring it and bring it out? So yes, this is a person. This is a person who's very involved with fighting and spin keeping on top of what's going on for home health. So thank you so much, Dr. Phil, for coming on for your name. I love just saying Dr. Phil over and over again. And just sending you the biggest hug from afar. We got a meet at a conference recently and you are a gem. Thank you so much, and everyone send love to Dr. Phil for for his time. | |||
| 583: Loïc Bel: Navigating Through Uncertainty as a New Graduate | 28 Mar 2022 | 00:47:29 | |
In this episode, Sports Physiotherapist and Researcher, Loïc Bel, talks about his experience as an up-and-coming sports physiotherapist and researcher in the industry. Today, Loïc talks about complexity and uncertainty, clinical work and mental health, and the importance of having a team around the patient. How does Loïc deal with imposter syndrome? Hear about Loïc's experience in Monaco, why he decided to keep getting more degrees, his thoughts on Physiotherapy Associations, and get Loïc's valuable advice, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Loïc Bel Loïc Bel is a physiotherapist since 2.5 years ago. He graduated with a Bachelor degree in physiotherapy in Switzerland and is now in the last semester of his Master Degree in sports physiotherapy, also in Switzerland. He currently works in an outpatient clinic in a small city in Switzerland for 3 days a week, and during the other 2 days, he studies in Bern towards his Masters degree. He is currently involved in the 'Commission for the Promotion of Physiotherapy', that is a branch of his regional physiotherapy association. He is also a board member of 'Le Réseau' – which can be translated as 'The Network', which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity. On an international level, he currently is a board member of 'Long COVID Physio' as an education co-director. A recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Ducrest, Nicolas Mathieu, and Mario Bizzini. The paper was about injury prevention in sports related to performance. Injury prevention is a subject that he tries to develop an expertise in, and he really fell down the rabbit-hole during his Bachelor graduation work that developed into that paper. His professional goals are to end his Master Degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Injury Prevention, Sports, Exercise, Research, Knowledge, Education, Mental Health,
Read the paper:
To learn more, follow Loïc at: LinkedIn: Loïc Bel Twitter: @bel_loic
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Read the Full Transcript Here: 00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35 Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and increasing referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a new offer. If you sign up complete a marketing audit to learn how digital marketing solutions can help the clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net help.com forward slash li T z y to sign up for your complimentary marketing audit today. Alright, so a big thanks to Net Health now on to today's podcast. So my guest today is like Bell. He's a physio therapist since two and a half years ago, he graduated with a Bachelor degree in physiotherapy in Switzerland and is now in his last semester of his master's degree in sports physiotherapy, also in Switzerland. He currently works in an outpatient clinic in a small city in Switzerland for three days a week. And during the other two days he studies in Bern towards his master's degree. He is currently involved in the commission for their promotion of physiotherapy, that is a branch of his regional physiotherapy Association. He is also a board member of labor. So and I'm sure I butchered that, which can be translated as the network which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity. on an international level. He is currently a board member of long COVID physio as an education co director. Our recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Newcrest, Nicholas Matho, and Mario Barzini. We talked about that paper in this interview, and it was about injury prevention in sports related to performance. Injury Prevention is a subject that he tries to develop an expertise in and he really fell down the rabbit hole during his bachelor graduation work that developed into that paper. His professional goals are to end his master degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention. And in today's episode, we talk about a little bit more about the IOC conference that was back in November. And also we talk about clinical uncertainty, mental health of new graduate physio therapists dealing with imposter syndrome, and the importance of our physiotherapy association. So a big thank you to Luke for coming onto the podcast and being so open and honest and sharing his experience as a newer graduate in the physiotherapy field.
03:23 Hey, Lloyd, welcome to the podcast. I'm so happy to have you on and it's so nice seeing you again after it's been a couple of months since we met in Monaco. So welcome. Yeah, thanks for having me. I'm really happy to be to be here enough time to. Yeah, and I'm, I'm so excited to have you on to talk about.
03:43 We'll talk a little bit about your experience in Monaco and your big takeaways from that and tell me your what what you thought and what your takeaways were. Yeah, it was it was a last minute chose to go to Monaco. And, and don't forget that actually.
03:58 It was the second big Congress for me. So it was a bit of euphoria. I went to Geneva when there was the World Congress to So second bit Congress on sports physios. So kind of specialization I'm doing right now. And it was it was bigger than I thought it would be actually. And it was really hard to do some take home, because there was so many things to, to take with so many new ideas, maybe so many new ideas about all ideas that were totally deconstructed. So that was a goal of mine to go in. And be like, Yeah, I want to unlearn what I what I had learned during school and during my students. And I know we discussed it together quite quite some time about the takeaway. So there was one word that came a lot during the Congress. I think it was the context, context matters. So you can have
05:00 The best exercise you can have the best the best plan you can have the best program you want. If people don't do it on buying it's, it won't matter much, actually.
05:12 I think one big thing is that maybe we don't know, as much as we think we did. It discussed it with a smart non on a recent Muscats podcast to
05:25 lots of talk, discussed some things that we thought we knew. And maybe they don't work as planned, or they don't work
05:35 in the nation an efficient way, like we started did. And it was a great, great symposium on the complexity, like everything interacts, you can't just use one factor to to influence the whole situation you have to you have you have to accept the complexity, you can't control everything. And, and yeah, you go home and you don't really know what to do anymore. You don't really know if if you did things right, you don't really know if you will do things, right. So that's kind of the takeaway I took from like for me.
06:13 Yeah, and I would agree, I left like God, I feel like I don't know anything and stuff that I didn't know, I had now have to sort of deprogram myself to
06:25 reprogram with new information and new research, which, I mean, if you asked me that's a sign of a good conference. Yeah, I said the same. If I, I'd be pretty, pretty sad to go to a conference and go with only a big confirmation bias, you know, like, Okay, I did everything right. That's fine. So it's a good thing. Yeah. Like you learn something, if you unlearned things. So yeah, it was great.
06:55 Yeah, I agree. And let's, let's kind of dive into this idea of complexity in practice. Right. So like you said, there's so much more to an injury than just the injury, right? So if someone has an ACL injury, it's more than just the physical rupture of an ACL and then knee. So can you talk a little bit more about complexity in practice, whether it be your personal experience?
07:25 And and how you tolerate that uncertainty in the clinic? I mean, if if we speak about Monaco, the big thing was when when you come home is Watson, how do I apply the things I learned? And what I feel like when I when I go to Congress is or to any symposium that speak about research, I'm always like, Yeah, but in research, we control so many things. We want to control the most things we can to better understand the mechanism. And then you arrive in practice, and it's the chaos. You can't control everything you've gone through in research.
08:03 I have a pretty young conditions, I ended school like two and a half years ago. And every time I discussed the topic with some more experienced clinicians, they always answer with the Yeah, experience helps.
08:20 Yeah, but what do you do when you don't have, you don't have that much experience, you have to build some. So you try to rely on research, you tried to, to you try your things, basically, you have some tools, try to use your tools.
08:37 That gives you some idea when you try what should be best practice in research. But sometimes it doesn't work as planned, and you have to deal with it. So you try to adapt. You try to modify things a bit. And you have to go with intuition sometimes. And
08:54 yeah, it can be a hard feeling to deal with. I mean,
08:58 I tweeted like, a few weeks ago about that, because I had a rough day, I really have a rough day. Like I had three patients, it didn't go as planned. We had to go back to the search, and we had to discuss things. And it's really exhausting. I feel like to come home and nothing worked as planned. You go like with 1214 patients a day. And this tree will stay on your mind like the whole evening the whole evening. You don't know you're just thinking about how could I help? What's next try to plan for you and for them.
09:35 Yeah, I don't know we can you can deal with it. You have to acknowledge that it can happen. And you have to. Sometimes you have to take a step back and be like, yeah, what did I do? Did I do something wrong? Or not? Because maybe you did nothing wrong actually. And how could I figure out a new strategy to to advance and do better? Yeah,
10:00 It sounds to me, like what you do when you have those days, and we all have them where you're like, I'm a loser, like, I can't help anyone, no one's getting better, what am I doing? But that instead of going back and sort of wallowing in it for the whole night, I think you can wallow for a little. But it sounds to me like what you do is you kind of reflect on that re reassess how you did things, and really look at what can I do differently? I don't want to say better, but what can I do differently. And if it's something, then you always have another time to try. And if it's, you know, I think that I did what was appropriate, then maybe it's let's go in and have a deeper conversation with this patient, you know, let's see what other part of this complex person in their ecosystem will allow us to move forward. So that's what I got from what you just said that you really take that time to kind of reflect, reassess, and then move in the next day, or the next time you see them. So they agree, and complexities are also about how it works with the with the other colleagues to other professions around the patient. So you have to reach out for other people, you have to discuss things with them. And you have to you have to explain what you did you have to, to also be confident about what you did. And and that's that can be quite confronting to, to do. So. Yeah.
11:39 Many things to deal with. But in the end, you have to go forward and keep on keep going.
11:45 Absolutely. And you know, as a newer ish grad,
11:49 you know, you kind of
11:52 knowing what you don't know. And maybe knowing what you do know, how do you sort of keep putting one foot in front of the other because I'm assuming imposter syndrome may come up
12:05 every once in a while. So what do you do to keep moving forward? And maybe what advice can you give to let's say, a new graduate that's graduating tomorrow, given the experience that you have over the past couple years?
12:21 You're right, it happens from time to time. And and I mean, social media don't don't help with that. I think, as a whole, yes. Because there are lots of success story. There are not much stories about failure. Well, I mean, here's the thing. No, nobody, nobody puts the bad stuff up on social media. It's only All successes, right? So you have to take that step back and be like, yeah, maybe maybe they fail to. And to come back to Monaco, there was a great great one. That was about the biggest mistakes. So did a motor compress was something about learn from our biggest mistakes. So it was with Yvette for Heigen Carolyn, a bullying Caroline Emery to.
13:09 And I think it was great to have like to be in a Congress with what you can call like, a camera like her from speakers in the world about injury prevention, and, and, and hear them like, we failed. But we kept on moving. We kept on trying. And we did really, really better and we try every day to do better. So it was one good thing is that for once there was there were people that acknowledge that they failed, but they kept on going in and it was it was yeah, they deal with things with the tools they had at that moment and that you can't have everyday data you you want at every moment. So you have to try. And another thing I'd say is that personally, I try to really reflect and reflect on on on what I don't know I try to Yeah, we can speak a lot about metacognition and and identify your knowledge identify your lack of knowledge in some in some topics, so I try to identify my weaknesses. And then I try to read because I can't just be with patients 24/7 So I have to read about them and and and try
14:29 that said so I said I see the things
14:32 there's a quote I like that that say what I believe is a process rather than a finality. I don't know who Who is this this from but I like it a lot like you have it never stops you have to keep on moving don't stay like in a stone try to tie traveled. Yeah, and that's how I said things. Yeah, and I I missed that talk at Monaco. Now, I really wish I went to it on the
15:00 You know, yes, we failed at these things, learn from our mistakes. And I would argue that the most successful people in the world have failed more times than they've been successful. Right? Because they're taking chances. They're putting themselves out there and, and they're making mistakes, learning from them and then pushing forward, which can be your stepping stone to success. Yeah, I'm a pretty firm believer that to, to be successful, you have to fail. Because if you just have success, I mean, first of all, it's not realistic. But I feel like if there was only on the success, and you couldn't fail,
15:42 you'd stop working. You don't anything to do anymore. You. You're not on this planet. So yeah, I think that's you. But every, every failure you have is a small break towards the Big House of success. Basically.
15:59 I couldn't agree more. And you know, in talking about all of this, you know, we're talking about failures and imposter syndrome and not knowing, and you're in a clinical setting, you're working with people. With all of that on your mind, it can certainly take a toll on your on mental health as a clinician. So what what do you do? Or what advice do you have when it comes to that clinical work? And mental health? Your own mental health?
16:28 Yeah, so I feel like we have a really demanding job, from a psychological perspective, because like I said, sometimes you fail, you have that bad day, and you come home, and you're like, Yeah, rethink, everything is worthless. So you have to do to overcome that. And with that, you have to, to add all the pressure about knowing things, because patients want answer answers. So you have to know things, you're the professional they want, they want to know, as sometimes you don't.
17:02 Now to, to put less pressure on me, I am honest with the patient, when I don't know, at the beginning, during my internships, I was always trying to find the right answer. And sometimes I didn't have it. And I try to find the thing to say. And now I feel like yeah, it was really unethical. First of all, and
17:27 no idea, say, I don't know, but we'll try to figure it out, basically. And one phrase I do, I do say a lot, when situations are complicated is that we'll try to improve the best we can. But I don't know until when we can, until what level we can improve, we'll figure it out. But maybe it will be only only a small portion and, and you'll have to try other things and physiotherapy.
17:58 And basically, you have to take care of your mental health and health professional for that. So I'm not ashamed to say that I wanted to psychologist and I discussed this topic, too. I didn't go for that. But I discussed it because it was really taking a toll sometimes my on my health. And now I learned to take a step back to be honest with the situation and discuss
18:24 discussing with patients and be open to criticism from patients to isolate them, you can tell me if if something isn't right, will change what we do. Finding yourself and being confident enough in yourself to say I don't know, is very, very beneficial for everyone involved, because you don't want to make something up.
18:47 Right. So if you don't know, I think what you said, you know, I don't know, but let's figure this out together. I'll look up some research, we'll figure this out. And if we can't figure it out, then I think it goes into another topic that you wanted to cover. And that's having this sort of entourage around the patient. Right? Because it's not your the two of you aren't on an island together, and there's no one else around, hopefully.
19:14 So can you talk a little bit about the importance of that, that team or that entourage around the patient? Yeah. So I think that I'm really lucky because
19:26 I met some awesome people in Switzerland during my studies and when I went to congresses,
19:33 I can mention someone It's Susan God that was in Monaco too.
19:38 She she's she's helping me on a daily basis. Basically. I'm often writing to her and and some other colleagues, some of the friends and colleagues that are my age we try to we try to figure out stuff together too.
19:55 I think
19:57 we are in a profession where
20:00 You can't have all the knowledge and some people already belt, some strong knowledge on some specific topic. So when I have a situation, for example, with Suzanne from with the shoulders, I write to her, because she's the experts in my, in my network, she's the expert on shoulder, so I don't hesitate to, to to write her to ask the patient if I can take, for example a video of or picture of the problematic I have. And I asked, I tried this, I tried that I have this situation right now. It's not have evolving, it's yeah, it's it's staying the same. We don't find a way to, to overcome the situation. What do you think about it, and then we discuss it and, and sometimes she she has some really great things that I never would have thought about. And I do the same with with friends.
20:56 I have some friends with my part time studies. They have the same problem as me. Sometimes they write to me and I try to help sometimes they do say I do thing with them. And sometimes nothing comes out from it. But at least we tried. And
21:15 and yeah, I try to do the best with the tools I have right now. And I feel like they are getting sharper every month, every year. But right now, yeah, it's not the best strain to get the tree with the knife the moment sometimes so. So yeah, it's gonna get better.
21:33 So what made motivates you to kind of to keep going and keep learning and keep sharpening those tools?
21:40 Right now, I think that's the first thing is that I want to help the people I work with, I don't I don't often tell the term patient. I think I work with people not with patient, they're productive. So yeah, I want to help them. So that's, that's one of the reason. And the other reason is that I don't like not know, to not know. So big. So I'm really curious. And I want to know, and yeah, again, you have to cope with not knowing but but I try to dig it always a little deeper and try to understand the mechanism of what I do have of I don't know, special battleship or stuff like that.
22:24 These are the two things, I'd say, drives me the most. And then I fell into sports physio. And I was like, yeah, it can be fun because I, I always liked sports. And I always did some. But it was also because I believe that sports and physical activity as a whole is one of the if not the best tool for health. And you have to understand what you do. I mean, we speak a lot about sickness size, about active therapy, you have to understand what you do. If you just give some exercises and you don't know what consequences can be.
23:05 Again, it's not the best gear you can provide. I feel like so I don't I don't like and it happens sometimes. But I don't like when people go home and they and they come I don't know, two days, three days after the treatment. And they tell me Yeah, I was feeling horrible for for two days. Because we because I did something that was too much volume or too intense. I don't know. But yeah, basically, that's it. And I feel like you have to be a Swiss knife, you have to add some tools to your toolbox. You have to add communication, for example. That's that's one that's the most important tool in in relationship
23:47 with these people and, and personal experience, I feel like is a is a big driver, too. I feel I felt right when I went to the psychologist and I could discuss and I could communicate. So
24:01 understanding what it feels like yourself, drives me to do better for the people that come to. I think it's it's important.
24:12 Yeah, and I'm so happy that you said communication is I would say the communication is most important any relationship period. That's true, whether that be personal professional, client patient, it is number one, and that that is a skill that can be learned. You know, there are books, there are classes that you can take on how to be a better communicator.
24:35 But I think it starts with knowing what you know, and being able to admit what you don't know and learning more. So kind of everything that you said throughout this podcast, I think really comes down to that piece on communication and it's huge. I'm so happy that you brought that up. And on that note, we're going to take a quick break to hear from our sponsor and be right back with more
24:58 when it comes to boosting your
25:00 Next online visibility, reputation and increasing referrals. Net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.
25:35 Why move on to higher and higher degrees? Right? So for you, why do a master's degree in Switzerland when a bachelor degree is enough here in the US? We had started with a bachelor's, I went to a master's. Now we're at a doctorate level clinical doctorate. So why move forward through all of that when Hey, maybe if a bachelor's is enough or a master's was enough, why why keep pushing forward on the degrees? I think it's a big topic in Switzerland too, because we have the other countries around us that all go to the master degree level, we are maybe one of the only country left in Europe that doesn't ask for a master's degree to be in the clinic, maybe I don't know not the last bit. We're not like in the best situation right now. And that's that's me. That's me, critics from our colleagues and other students in PT school actually, to to that I wanted to go further. And some some told me that I wanted to prove that I was better than them, or that I wanted to be paid more, so I can be paid more. I can't ask for more money, because I got a master's degree. So these are not the reasons. But the main reasons from me with were like when I went into my internships, during my degree, I was really feeling clueless. And I felt like I didn't have the tools to do anything.
27:06 I was a big, big, big manual therapy for years. For three years at school until the I was lucky in the last year there was the Geneva Congress, the World Congress in Geneva, and I went to the to the conference from Peter Sullivan and Jeremy Lewis. And it really blew my mind. And I was like, that's what I want to do. And it really changed my perspective on things. And I was like, Yeah, I want to upgrade my skills, I want to get a better understanding of everything. And, and that's, that's what drives me, it drove me in the first place.
27:44 provide the best care.
27:47 And I think you have to, like I said, to better understand that. And I feel like, as health professionals, we have to, we have to think about what we do, because it has a custom sort of site society, basically. And I was happy to go to that conference, because I realized what I what I participated in, when I was only providing passive, passive treatments. And now I think it's like I have to participate in reducing the costs. I have, it can be by by encouraging people to move more it can be by maybe avoiding a surgery, you can you can have ACL conservative treatments, more and more, it becomes a big bigger trend than before. And that's how I see things right now. And
28:43 one other things with the master degrees, that I like to research and you have to have a master degree to do research in Switzerland. So you I mean, you don't have to, but it's way easier with a master's degree. And I always wanted to add my break to the brick house because I really liked doing my beach law, graduation work. And I think that knowledge is a collective thing I published with the with the colleagues of mine, Mario pizzini, the kilometer in France and UK recently the my first paper and I don't feel like it's only my paper. It's like we did this. We did it us for and it's only for people that come and add just a break to injury prevention and non subject so
29:38 that's what I want to do. Basically I want to I want to add Matt, just my break. I don't want to be remembered for it. But I want to help things move on and go further. And domestically. We can help me understand the research better and help me to understand how to conduct it's basically so that was one of the reasons and
30:00 As, as a young clinician
30:03 research I rely a lot on.
30:09 And if we speak about the funnel model from
30:14 evidence based practice, you have best evidence on the top. You know, it's better than me with the conference at that spot physio. So I think that's that's an agreement.
30:26 Research is at the top. Great. But if you can't read research, you can't use it. So that's that's one of the reasons.
30:35 Yeah, well, I think that's a fabulous reason. And just so people know, we'll have a link to the paper that you just mentioned in the show notes at podcast at healthy, wealthy, smart, calm. So we'll have a link to that. Do you want to talk briefly about what give give the abstract, if you will, of that paper? That's exciting. By the way, congratulations. Thank you. It was I worked on it during my master's degree during two years, I didn't think it would last this long to publish it. But we finally made it. But the idea was, was that
31:12 was that we thought that injury prevention programs for the for the lower limbs could improve performance. And the we evaluated that through a numpy review. And the logic behind it is that
31:29 we have a big utterance problem with these programs. So how could we improve the utterance and there was a talk, we can come back to Monaco, again, about never mentioned prevention, we only speak about performance, you know,
31:42 it's it's the main driver of sports, affiliate sports. And I'd say even off amateur sports, you want to you want to win. So how do you sell it to these guys and women's? So elite athletes, athletes wanna want to be the best. So performance is a key things.
32:02 So it was the logic behind it. We want to we wanted to explore that. Does it affect performance, just by doing these programs? And we can say it has, it has an effect, it doesn't have the best effect. I think
32:17 you better trend for performance than doing these warm ups, for example, if you want to improve performance,
32:23 but it's, you can you can say that it could help. But I think more on on not much level, not knowledge level, it won't be strong enough stimulus for them.
32:39 Excellent. Well, thank you for that quick, abstract, or quick synopsis of that paper. And again, it'll be in the show notes for this podcast. Now.
32:49 As we start to kind of wrap things up, I'd love to talk a little bit more about physiotherapy association. So we have in the United States, the American Physical Therapy Association, we have world
33:04 confederation of physical therapy, which was that was hosted in Geneva a couple of years ago, I was there as well. Do you think they're important? Do you think they serve a purpose? Or no,
33:17 I think they are a big key to, to promoting our profession. Actually, I don't know how it is in other countries actually, with the with the contact with the public with maybe the politics too.
33:34 But they out. I mean, you can you can go and ask the politics and the public everything that you want. If you only one, it won't work. If you come as a group, and with tons of people, maybe it will change things. And that can come back to to the master degree. Step. Two, we need people with an expertise to push the job. And that can be made through associations. We have to actually make the knowledge and then we have to do a diffusion of knowledge. And that's a great way to help people we see so many things that are
34:14 pseudoscience on I don't know a low back pain for example, that goes to the public maybe that's if we could promote what we think is best care and what would help people it would it would be great and I think we have to do it as a group as an association, our gateway for that. And I'm on the I'm a board member of the local zoo that can be translated as the network
34:41 I'm one of our I'm one of the if not the youngest, and with the less experienced in the group but
34:49 we want to promote like physical activity for for health. We want to regroup every everyone you don't have to be a physio but everyone working in sports in
35:00 In movements, and oh, by now and go and promote that for everyone. And
35:09 and I'm also on the commission for the promotion of physiotherapy,
35:14 in my region, Switzerland, so we do, we do some, some really versatile stuff. So we are going to public conferences for everyone to attend. So we want to disseminate knowledge in an understandable way for everyone. So we invite speakers, and they tried to keep it short and simple for everybody to understand. And we have some more professional conferences.
35:43 For example, we did one a year ago, a small workshop with Darren brown on long COVID. It was not really discussed at that moment. So I wanted to have people in Switzerland health professional,
35:58 better understand they had the occasion to discuss with Iran for like, nearly an hour. And
36:06 he answered every question, and I Big shout out to them. Because he He's He's amazing. Everything he does seem to push. Yeah. Everything it does. Yeah. I don't have any words to describe him. Yeah, I don't have amazing, but yeah, that's the thing I think we have to do. And again, it's about accumulating, and if diffusion, you have to accumulate the knowledge, you have to defer to big diffusion to concern people. And I couldn't have done it without an association. And it's rich, it's stretched, maybe, I don't know, 120 feet do
36:49 that could treat lung COVID patients better. And that wouldn't just use exercise.
36:59 To try to to improve things, skirted codes, wasn't everything. So it's important to have that and it's it offers a big platform to reach public your wants. So that's why I think that you have you have to go in this association. You don't have to agree with everything. I don't agree with lots of things in the Swiss physical physiotherapy Association, and quite vocal about it. In my regional Association, I say that I don't like lots of stuff. And I tried to make things move from the inside. Not always easy. But you have to try. But yeah, the problem with that is that I'm on the board with the Huizhou. I'm on the board with the promotion of physio, I'm I don't do much to be honest. I'm on the board from long COVID physio to. And that's can be tons of projects, actually.
38:03 With all the side projects with the clinic,
38:07 with my students who have to write my thesis, I only have a few months left, and I'm crawling compare workloads right now. But yeah, you have to deal with it. And that's, that's kind of the situation right now.
38:21 Yeah, I mean, I agree with you on Darren Brown. He's outstanding. I interviewed him for the podcast about lawn COVID. And it was a wonderful interview. We're going back and forth. And I finished I said, Do you have notes in front of you? He's like, no, yeah. He's like, That's, like, yeah, I met him in Geneva, at the Indaba. Part was where everyone can come and just speak, and there were topics, didn't have a clue on the topic. And it was like you everything.
38:54 And at the end, I discussed with him and I was like, yeah, do you know something on the topic? And he was like, no, no, I was just going with the flow and okay.
39:04 But
39:05 he's just like that. He's, he's, he's an awesome speaker is a wonderful person, and I can't, I can say, Yeah, and it's more about him. That's only praises for him. I agree. I'm with you. I have 100% only praise for that man. And I think he's, he is pretty remarkable. And what a great asset to the profession of physiotherapy. And he has that ability to disseminate information to the public very well. So he knows how to simplify things, not dumb them down, but simplify them to make the average person understand and that's a very special skill. And I think he has it inherently so that he can sleep good. Yeah, it. Yeah, it's a great skill to have. Okay, so now that we're really wrapping things up here, what would you like for let's say two or three times
40:00 takeaways of our conversation to be for, let's say, younger physical physio therapists or even physiotherapy students that you can impart to them after being out in the world for the last two and a half years or so. Yeah, the first one I think would be
40:24 don't give up. Could it be an advice? I don't know. But don't give up and don't blame yourself could be a good one, I think
40:32 you have, I think that you have to deal with the situation with the tool you have at the moment you live it.
40:42 Sure, that's now some situations I had like two and a half years ago, I would deal with them better right now. And some that I have right now, I will deal better with them in a few years. But you only have these tools in your toolbox right now. And try to do your best and don't blame yourself you fit doesn't go like you planned it would go if it doesn't go like you would have liked to go.
41:12 You can you can fail then like we said it will help you change the way you do it the next times. And you'll do better. Basically, that would be the first I think
41:26 with that with the mental health. So don't blame yourself because don't take a toll on it.
41:33 I think it's important.
41:36 But to be a second ones.
41:40 Get involved. I think if you believe in your profession, if you believe in physiotherapy, if you believe in health movement communication, tried tried to get involved. You don't have to do every project like like, I think I do, or like I think many people that came on that podcast do, I think you you should choose. Just quick on that. I think that maybe we have culture and physiotherapy where we think we have to accept everything. Don't do it.
42:13 Better, choose the projects, better choose to and do it, do them greatly. And then choose eight and fed them. Choose your projects, but try to get involved. If you if you believe in it, try it, try it, it will be worth it, you will meet some awesome people, you will make some connections and it will be worth it in the end. Anyways. So I think there's that and I think that's that maybe
42:41 maybe to come back on that we should find a way to to propose these projects to young clinicians as at least into a salon. We don't have anything to anything to get them involved. Maybe we should find a better way to propose the projects to to ask them. I think they have an I have a fresh vision on lots of things. And I think that's one of the reasons why we should we should have younger clinicians come in and express themselves. Because we live in an era where things go really fast. And if we only have the same old people that do it for 50 years, maybe that won't make it.
43:26 And let think I don't know, actually, what would be the last thing? Do you have an idea?
43:34 I mean, I think what you said was great, the only thing I would just like to reiterate from this conversation. So the big thing that I took away is that communication is everything. And that really finding a mentor finding, like you said an entourage of people to help you sharpen those tools. Those are my big two takeaways from, from our discussion today. And finally, I always ask, but you probably just answered this, but I'll ask it anyway, since I asked everybody is knowing where you are now, what advice would you give to yourself as a new grad? So not random? New Grad, but you yourself going back in time? What would you say to yourself? So as a new grad?
44:26 I'd say accept, say, say no to lots more things. I say that because sometimes I get really overwhelmed, overwhelmed with the things I do.
44:39 I think I would say that. And if I go back in time even more, maybe like in my first year of PT school, I'd say try to
44:50 try to ask yourself more questions.
44:54 Don't think that everything you learn is true even at school.
45:00 Question things, lots more, even even if it's teachers, even if it's school, a question things, it's not always the best, the best that you learn our school question lots of things.
45:14 Excellent advice. And now where can people find you if they want to follow you? They want to ask you questions they want to get in touch where's the best place for them to reach you? It could be kind of on like on social media, where wherever is best for you. I think that Twitter is the best for everything physio related. You can go on what is it like Bell B, L underscore like, Oh, I see.
45:38 I think it's the best way. Oh, by all by email, if you text me on Twitter, it's my DMs are open. I think I can give you my email if you perfect problem. I think I don't think we need to give give your email.
45:54 Yeah, well, we'll we'll stick we'll stick to the Twitter app for now. So people can find you on Twitter, we'll have a link to that. Well, I want to thank you so much for coming on the podcast and you know, as a newer ish grad, if you are indicative of others in the field. And I think the future of physical therapy is looking really bright. So I want to thank you for coming on and for sharing all this great information with us and your takeaways from Monaco and everything else in between. So thank you for the invitation. It was really great. It was fun. I had lots of fun, at least it's got my pleasure. Good. That's all I liked to hear my pleasure. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Lloyd for being so honest and open with us about his experiences as a newer grad physio therapist and of course, thanks to Net Health. So again, they have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit today to get your clinics online visibility, reputation and referrals boosted
47:10 Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media | |||
| 582: Rob Tillman, PT: Journey to the American Academy of PT | 21 Mar 2022 | 00:40:56 | |
In this episode, AAPT President, Rob Tillman, talks about leadership and diversity in physical therapy. Today, Rob talks about being a leader, effective delegating, and the problem of bad advice by industry leaders. How Does Rob balance his life? Hear about Rob's journey to where he is today, advocating for diversity, and the shortfalls of the industry, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Rob Tillman Rob Tillman is the president of Ortho Rehab & Specialty Centers. In 1986, he received his degree in physical therapy from the University of Missouri. Rob immediately saw the need to attain a level of clinical competence that would allow him to effectively address the complex needs of his patient population. With this in mind, he enrolled in a post graduate residency training program with the Sorlandets Institute which later became known as the Ola Grimsby Institute. He is a Fellow of the American Academy of Orthopedic Manual Physical Therapy and American Academy of Physical Therapy. Rob attained the highest level of clinical certification available in the field of orthopedic rehabilitation. Since then, he has received international recognition for his research on the lumbo pelvic system and has written benchmark works on the thoracic and cervical regions, as well. Rob has presented at several national and international conferences on a wide range of healthcare-related topics. He is also a recognized authority in the arena of sports medicine, having been credited with the rehabilitation design and training programs for many professional athletes and organizations including professional baseball, a Superbowl MVP quarterback, an NBA championship-winning power forward and a four-time golf world long drive champion.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Rehabilitation, AAPT, APTA, Priorities, Education, Diversity, Leadership, Advocacy,
To learn more, follow Rob at: Call the office: 501-975-4040 Website: https://www.pt-orthorehab.com AAPT: https://www.aaptnet.org LinkedIn: Rob Tillman Facebook: Rob Tillman
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:00 Hello, this is Jenna cantor. I am here with the ROB Tillman who is currently the president of a PT and also is in charge of the ortho rehab and specialty centers. He is just a top physical therapist in the profession. We got I had the major pleasure of meeting him in person for the first time at the APTA 100 years Gala. Was it 100 years? It was, yeah, yeah, we were all dressed up, I got to freak him out with my excited energy, because I was so excited to be meeting you, Rob. And I, by luck convinced you to come on this fun ride and do this interview with me on healthy, wealthy and smart. Thank you so much for agreeing to come on. My pleasure. It same. It absolutely is just wonderful. So um, I would love to just start with if people could learn more about how you got to these leadership positions, start from wherever you feel comfortable. But I would love to hear how you got to now. I mean, you're heading these things. Of course, I mean, so many things. So please share.
01:10 Well, to be honest with you, I I didn't really seek to be president or leader of anything. I just really wanted to I went to physical therapy school and I wanted to do sports medicine. So I learned that while I was trying to do sports medicine and orthopedics most patients have that come to an outpatient physical therapy clinic have neck or back pain. So I decided to go ahead and learn something about how to deal with neck and back pain. So I did a residency with a group called Restore Landis Institute, which is now the older Grimsby Institute for four years and did a residency and passed by competencies and became what's called a level two manual therapist by the Norwegian standards. And I think it's still the highest level of competency, internationally recognized in orthopedic manual therapy, started teaching courses, and orthopedic manual therapy after I gained my level of competency and start working with the group was held South back then it was the world's largest healthcare Corporation geographically. And I started troubleshooting clinical operations, and learned how to do the administrative things. And then next thing you know, I'm a vice president. And then I'm a senior vice president, and then they have their accounting scandal. And then, so I started my own company about 18 years ago. And all the while while I'm doing my, my, my core competencies and working, you know, to make a living and moving up in the in the company I was with. I'm at a group called the American Academy of physical therapy that was established about 30 years ago. And
02:54 it was in 1989. Yeah,
02:57 it was it was a black folks that had concerns about access to physical therapy, school and quality care in the black community. And I learned about them through who is now my best friend, Leon Anderson, the third, his dad, Leon Anderson, Jr. is the founding president of the American Academy of physical therapy. And I just really started teaching what I had learned to the group and expose them to the specialty of manual therapy, and I just kind of hung around and enjoyed myself with them because that's the first time I really experienced unconditional love, professionally, in physical therapy, because they just made me feel welcome. A lady who's deceased now named Diane Ellsbury. I call her my PT mom. She'd says, Hey, Rob, baby, how you doing? And just hug me and just what do you need anything? Are you taking care of yourself? You're not working too hard. Are you just like an auntie type thing. And then I became more involved in the operations and joined a committee called the innovative services committee. And innovative services was that's exactly what it does. It does cool and innovative things like create programs, we established a navigation program for mentorship for for our young folks coming through an advocacy wing that was concerned about practice acts and access to care and licensure issues and things like that. In the process, I somehow got appointed to the Arkansas State Board of physical therapy. So that's how I ended up wearing these hats. And while I'm on the board and Arkansas State Board of physical therapy beginning about 1617 years ago, I'm currently still on the board. And it's it's rewarding. It's rewarding. It's a lot of work, but it's rewarding, and I'd rather be at the table than not be at the table for a lot of the things that are going on because our profession continues to evolve. The physical therapy profession continues to evolve. And as an E involves then we have to be able to apply the clinical concepts that we are. In general learning in physical therapy school. State practice acts can hinder your ability to perform the things that you've learned if you're not careful. So we really have to make sure that all of the practice extra current and access to physical therapy is available because we are the most green profession. In healthcare. It's all hands on care and exercise. You can't get anybody stronger by giving them opioids. Okay, you can't correct biomechanics by, you know, having somebody on muscle relaxers, you know, it's kind of hard to strengthen somebody while on muscle relaxers also, by the way, but as we're looking at all these things that I'm doing at the same time, it's just when people ask me to do something, I don't want to be the person that's complaining about things not being done appropriately. I want to be the person that's kind of like a catalyst, or at least an advocate or participant in moving things forward and making things better. And sometimes you don't get paid for. Okay, but but, but that's why I love the Academy because it's the service academy. It's, you know, it's a place to come and serve and love the people that you're with and be loved, have a positive attitude and move some things forward.
06:21 I think sometimes people get caught up into looking at the AAPT or the APTA as something that needs to serve them. The APTA is also a giant service group. If we look at it appropriately, and as we come together, and share concepts and ideas, the current leadership of the APTA has done a lot better on sitting down and really trying hard to understand the challenges of the black community, just so my my hat's off to past president, Sharon Dunn, and also the current president, Roger Ver, and, and Justin Moore, the CEO, and Carmen Elliott, who's vice president over Dei, I think that they're really putting their best foot forward on working towards things. I think that we all have to be patient, and monitoring the progress as we do blend initiatives and work together on things. Because change doesn't happen overnight. attitudes can happen overnight, mindsets take a little bit longer to change as far as our train of thought. But behavior patterns take a lot longer than that, and coordinating behavior with other groups and other people take even longer. So I've learned to be a bit more patients in my practice, and my working with folks. And I've also learned that not everybody that doesn't understand the EI or the hardships that other groups are having. They're not all necessarily opposed to other folks doing well, or what somebody would call a racist or something like that. They just don't get it. And sometimes people want to get it. And those are the ones that we have to engage in conversation with and share ideas and have our thick skin on, to work together on things and not be so easily offended because we've all got pasts. I try not to be so easily offended and angered by things. But also, I have still pretty good intolerance of people that are in denial about other people's hardships. That's a little bit tough to be in full denial about other people's hardships. And there's current legislation that's going through several states that actually don't want America to tell America's full story. Because some people aren't comfortable with hearing about America's past and some of the impressive things that have taken place in this nation. But while we're deleting some truths that need to be spoken about America's past, we're deleting the chance for especially when in this case, black people to tell our kids and society in general, the challenges that we've had, and the reality of how we got to where we are and what we need to do collectively about. So that's another thing that's happening in today's society, but I do believe in general things are moving forward. As far as being president of the Academy, I never wanted to be president of the Academy. I wanted to be the guy that shared the cool clinical stuff. And just got to hang out with people that were just loving folks. I became chair of the innovative service committee. When BV Clemens retired, one of our founding presidents. He was later President second president of the Academy. And when he retired and took a step back, I took over the innovative services committee. And then I was asked to run for the director position, which the innovative services committee reported reports through the director director's position. It's now under the director, our current director, Renee crater Dr. Crater, great lady. Man few years ago, they asked me if I would consider being president of the Academy. Are you sure you want to do that? But my skill set on big A former officer in a large company and my background and all the things that I've been working on and still doing, including being on boards and things like that fit the skill set that was needed for the president at that time. And again, I'm humbled and honored to serve as the president of the Academy. I've done it for the last three and a half years, I can't wait to get the next crew of people trained up and ready to take over as we're pushing forward on things. But right now, it still currently fits my skill set and and and I hope that the academy is satisfied with my leadership and innovation and my quirky ways of dealing with things but it certainly has been my pleasure still serve as president of the Academy.
10:46 I'm so everything you shared, i Nobody sees me. But I have this very excited smile, listening and everything. And I love hearing things. In your own words, you are a very, very humble individual and the amount of service you have provided to the physical therapy profession at large. Thank you.
11:06 So it's my pleasure. It's my pleasure. It really is. It doesn't even seem like work.
11:12 Right? And and that shows anyone who works with you, like I've known you for a blink of an eye. I mean, it's been, gosh, half a year now. Yeah. But like it from for you are so kind you know how to like enter a room, whether it's on email, or text or whatever, in the friendliest way. You are. So I find you to be so approachable. And very, as a leader, it's still no denying what your position is. I just really think you are really, you said, I love what you bring to the table. Love it, just enjoy very much. Yeah, from the from the amount of time I've known you. How do you handle things with being what doing what you're doing? And I've never asked you this before. And that life balance, you know, people talk about work life balance. How do you do that? From what I've seen, you have specific times, you're like, I am not replying back, which is great. Could you talk about that a little bit more where you kind of set boundaries and stuff. So that way, you're able to handle everything and not overwhelm yourself.
12:20 Sometimes I My wife's a surgeon, she's a breast cancer surgeon, the Chief Chief of breast cancer at the University Hospital here. She's comfortable multitasking and doing a bunch of stuff. I really want to make sure I'm a perfectionist and whatever I put my hands on. So if my attention is split, if my attention is split, I know that I'm not going to do the thing that I'm working on, as well as I could. So I do one thing at a time. I do one thing at a time. When I'm in clinical notes. Sometimes I can reply to a text sometimes I can't. But I want to make sure when I fix a problem, that problem that has my undivided attention, my total undivided attention and I'm giving it my best that I possibly can. As I'm trying to resolve the issues that I have in front of me. I love that I feel
13:15 like it's a very attainable way to approach life rather than just going just one thing at a time. Do that. Good. All right. I love that. I've actually even been doing that this week. Not even purposely because you said but now I'm going to be like Rob said this I'm inspired. I've been doing that this week where I I had it upon me to finish up the project we're working on together and I was like nope, let's hone in and now like it's at a really good spot you know now and then I moved on to it. I've already moved on to other things because again,
13:47 that's it's because even in relationships if I know I'm doing the best I can with that relationship even if it goes awry. At least I know for sure I did the best I could with it. Oh I love that. I love that so much that way you don't have any regrets. Yeah, yeah, yeah, it
14:03 makes me think of what that tattoo that that tattoo where it says no regrets but regrets is spelled in properly regards because I love that I kind of want I'm not into tattoos but if I got one it'd be either Disney or that. I love that so much. So now as when you are a leader of a as a leader of a PT how is that different from being a leader at a clinic? Like a clinic owner? How is that different?
14:38 I'll say it's the same it's just the objectives are different. Objectives are different. Okay. Now when when you're dealing with a clinical situation it to me if you're doing it the right way you're focused on your outcomes. Yeah. I'm not in a silo to where you know the orthopedic surgeons are upstairs and they own my my practice you They're gonna send me patients regardless of company, you know, so we're outcome oriented. And we get the things that are a little bit tougher than the guys that have the automatic referral that own their own PT practice. I've learned that competency, burns down barriers. You know, people don't care if your margin, if you know what you're doing and they got back pain, they're going to come and see you. That's true, that's true. But key thing in the key thing in business is to manage as many variables as you possibly can. Because they're variables that you can't manage. So being timely looking professional, okay, incompetent, having the tools that you need to get people better. I mean, how many PTSD see that, that work for a group that owns the practice that doesn't even have the tools to get the outcomes that they need, and they're working with the only resistive equipment they have is exercise to me. You know, you have to have what you need. And I'm our chief proponent of physical therapists independent practice, but I'm also a huge proponent of us owning our own businesses. And not working for groups that own you.
16:14 Yeah, we do. Uh, you know, I really see and feel what you're saying there, I have my own practice. And there's a lot to be said, because we all shine in a different way. We're all doing evidence based, but when we're able to come through as a as the autonomous decision maker that we've been trained to be, we can really help those patients, we can be a best service. I truly do believe that.
16:40 Yeah, I think so. But, you know, by the same token, we have to go the next step, and do what's defined by the way that the APTA is going, and the different academies and specialization. Oh, yeah, I've heard somebody give the worst advice at a three state meeting once and I'm not going to get the states because it might tip it off, it will. But this guy stood up and said, to the students, when you graduate, don't worry about training anymore. You already know enough, you know, you know, everything you need to know, to really make it. And I sit there. And then I asked the question, I said, Well, I think that the APTA is going towards specialization. So how does this fit in with that, but I know darn good. And well, after serving a four year residency in orthopedic manual therapy, that I'm a far better and more competent clinician. Also, you know, even being a co author and co author in some textbooks and defending my my thesis internationally at the First and Second World Congress on low back pain. It helped me to learn more, always active clinician, because I've learned more. And I have a more diverse patient population, because I'm a specialist in orthopedic manual therapy that's paid his dues. And and I believe we get superior outcomes when you go through residency training. Of any comment. Yeah, of any kind. So that was the absolute worst advice I've ever heard anybody give some young kids right out of school.
18:10 I think there's been a lot of advice out there that can be off, but I definitely think that's really, it's off. I'm thinking you got me thinking of I grew up as a ballerina. And ballet is impossible to perfect, however, that every ballerina is trying to perfect it what we're doing with our lines or bodies, you know, it's definitely out of the anatomical positions. And when you first start out like that, you learn all the dance steps, you learn all that, does that mean? I'm done? No. I'm always taking class, I'm always working to get better. And I learned so much from my life as a ballerina, I was pretty intensively in it at one point for a good portion of my life. And I learned the importance of always learning, always practicing and having to be passionate about it. Because if I wasn't passionate about it, I wouldn't be showing up and putting in my best. So having that background and then going into physical therapy as my new profession. Definitely was in line the idea of, of course, I'm always going to be learning Absolutely. What Why would that would make me the worst person to work with if I was start in one year of Tottenham?
19:22 No, I'm haunted by what he said. But it motivated me to teach something different to people in that. Yeah. With me, because I hear somebody saying something in full. He said it in full sincerity. He really didn't think anybody need to learn anymore. Yeah, but that's terrible. So let me go and teach people why they need to learn more. Yeah. Because especially when you're minority or a woman, you had better have it together. If you're out there on your own, you have better have a superior product because you're not in that good old boy network. Well, you're an outsider, also, if you better do it better.
19:56 Yeah, it's yes. And also If we're going off that you're going off with the research at the time that you learned it, we did not do diverse bodies, we do not have diverse bodies in research, we are massively lacking that, you know. So we need to be open and ready and seeking and creating more of that information to learn from to better serve.
20:20 I'm glad you're saying that because not only do we not have diversity, when we're looking at the body types that we have to work with, we're not having systemic diversity at all in medicine, because different people, the guy named D'Amato wrote a book a long time ago called Eat right for your blood type. And he talked about how different types of blood types have different types of foods that they can metabolize, and using their systems and have it not function in a fashion that's detrimental to the person. And lo and behold, different people can eat different things and perform differently. I'm gonna type O blood time, I need dense protein. Some people that are more of a type A blood type may not need as much dense protein, they may be able to make it by carb loading and eating pastas and things like that. If I eat a bunch of pasta before I go into an athletic endeavor, I'm going to suffer versus somebody else may be able to metabolize that and move forward with it. So everybody's different. And I think we're just now getting to the point to where we're paying respect to the difference in the different physiologic physiologies that different people have. And it just so happens that certain physiologies are grouped together in different ethnicities. Yeah, and because of because of that, because of that, then we have we have an evolving ability to specialize care to specific individuals. Yes. When When, when it's all mainly designed for just one certain group, or one certain physiology. Mm hmm. Body Type one certain athletic performance level?
21:59 Yeah, no different different, different, different, different levels of stress and anxiety, depending on what your background is. The stress and anxiety, someone gets the food, the blood type, that all affects healing. Yes. And it can definitely take away from the exercises they're doing.
22:18 Or give you a specific example of that, I'll give you some with COVID. With COVID. They're finding the people that get most sick from COVID have low vitamin D levels. Okay? Now, black people can't synthesize vitamin D, vitamin D is actually more of a hormone than it is a vitamin. Okay. And when you're exposed to sunlight, your body synthesizes its own vitamin D, which is a vital hormone for the basic function of your system, in your in your body. Okay? Well, black people can't synthesize as well, because we have more melanin in our skin. And the melanin reflects the sunlight. And so we have to have an increased exposure to sunlight to have the appropriate vitamin D level. Well, everybody was told to stay home for first three or four months during COVID. And lo and behold, black folks died at a higher rate than everybody else did. Okay, sky like, wet, your black folks have a more problem with high blood pressure, isn't it, and we eat the same thing that everybody else eats. But just so happens that affects us differently. And it may be because certain ethnic groups can't metabolize that metabolize the same foods the same way that other folks can. And so I think as we look at those things, and be more specific with it, we can teach through the whys. We're talking about, you know, masking up and what to do to not get COVID. But we're not telling people in specific you need to have this number of these nutrition nutrients every day. Okay, to where your system is more healthy. And your hydration level needs to be exactly this. I think that we could have done a far better job and still can have telling people what they need to have in their systems to be healthy.
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24:50 I agree. I absolutely agree. And for me, I I haven't even gone into the nutrition stuff in massive detail with my patients and now you're opening up another door I've actually been getting into cognitive behavioral therapy, right now learning about that not to become a therapist, not at all. But to better compliment how I communicate with people who could do well with it or watch out for trigger words, all that kind of sensitivities. Because the individuals I find my patients really do open up to me a lot. They have been through or going through some of the most jaw dropping things in their lives. And yes, that affects their healing. So I need to make sure I'm not triggering them. By my, the way I speak, if anything, complimenting a journey of healing, as we are working towards a healthier, healthier movement, decrease pain in their life. So yeah, yeah, I definitely get it from from where I've been with the anxiety stuff. Yeah,
25:51 you're dealing with people in their complexity. Journey, people that deal with people in the same with patient care. Now, let's go back to them. You know, zoom out zoom. And you've heard me say that, Oh,
26:01 I love that. Yeah.
26:02 So the deal is, okay, let the we've zoomed in so tightly, let's zoom out so that we can see everything again. And now let's zoom back in. Because, you know, you can teach a kid how to hit a baseball, and he can hit every type of baseball pitch at every speed. But what if he gets hit in the ribcage? Oh, you don't want to get hit the ribcage again? Right? So is that going to alter his ability to perform? Well, if he's so afraid of getting hitting and hurting, then it may be in the back of his mind that he's gonna have problems. So you know, it can alter his performance. So yeah, but the mental aspect of performance of any time. You know, my daughter suffers from anxiety disorder. And and it's hard. But we have to work through it. Because, you know, let's let's be sympathetic to us. But we need to be more patient with some folks and see what we can do to integrate them into a functional position in society. You can treat everybody fair. But it's impossible to treat everybody the same. Ah,
27:06 amen. Amen. All right, I'm going to switch completely into another because it just popped into my head. And I was like, oh, I want to ask regarding leadership. I was talking with another business owner, she's actually new to owning her own private practice. And, and then there's another person who's much more seasoned with his pride, like, yeah. And he said, I'm working on delegating more. And further, and I cringe, because we like to really Oh, that is that's it? How could you talk about your journey with delegation, because as you get, you know, the more of the leader, the higher leadership position, you do have to delegate more. How do you do you know, like,
27:51 Well, yeah, yeah, but here's what needs to happen is you've defined your clinical product, okay? You have to replicate that product, either you have to do it or somebody has to be able to produce the same clinical product that you produce. And it just so happens with mine. It's it's specific care in orthopedics with a high level of differential assessment of Neurophysiology histology and Arthur kinematics, and the appropriate prescription of hands on care and exercise from that. So if somebody comes to work for me, especially in the main office, they're not going to have their own patient load for six months. Until they go through the readings. And they they learn the basic clinical practice for dealing with an upper cervical problem, a lower cervical problem, ribcage issue. Problem with a hyper lordotic spine, a problem with a hyper mobile spine, problem with pelvic issue, be it internally, as far as pelvic floor issues, or biomechanically, when the sacred tubers and sick response ligaments are a little bit loose, and they can't withstand the normal loading. But they should be able to, they have to be able to do all those differentials in there to be a predictable application based upon that assessment and diagnosis, to where we're replicating the outcomes that we need to replicate with patients that present with those pathologies. And that takes time. So now let's go back to the guy that says that the students don't need to learn anymore. Well, they're going to get their lunch eat. All right. There are guys out there that then and ladies that have been doing this forever, that have the highest level of competencies, that'll run them out of business. If the playing field is indeed level, and there's access to the same level of referrals, and getting a good outcome doesn't mean that a person comes and says, Well, I hurt when I'm riding a bike for a long period of time. Well, why don't you take a walking instead? Now that's not an outcome. The outcome is when you get them back to doing what they want to do in their lives. Yes, that's it not modifying their life but getting them back to doing what they want to do so that they can maintain the quality of life that they desire, not telling them that well, if it hurts to bend forward, quit bending forward. No, that's not. That's not an outcome. Right? Right. modification.
30:09 Yeah, yeah. And it's so interesting you say that, because always learning, I have my practice where I'm 100% virtual. And that happened from the pandemic, I was not expecting that, and my performers love it for access everything. And it got me very into, you know, I'm not going to go into the details of what I do. But regarding outcome measures, I literally, that's what we very intensely focus on what they ultimately want to do not just like, oh, I have no shoulder pain, you know, they want to know if they can do this arm movement. And when they dance, you know, every time can they do that without having to worry about it. And then we get them there. And that is why I have a massive increase in satisfaction, because we are fully getting them to that to that their specific goals. I love them for
31:01 that. I'm very, very slow to accept praise for anything that I might do. Because the patient's the one that's got to do most of the work at the end. In the very end, and you're really is only as good as your last patient. You're only as good as your outcomes. Say that you are, yeah, doesn't matter how much you walk around talking about how great you are and how smart you are, if the patient didn't get better than you fail?
31:23 Well, because it's not about us. It's not about us,
31:26 it's about them, it's about getting them better, you know, and that is the most rewarding thing. You know, like, it's, it's,
31:35 I've built my company, we've got five facilities now. But it's one patient at a time, one outcome at a time. And most of the patients that we get come by word of mouth. Nice. Yeah. So you just get after it and handle your business and maintain and be a good steward of the opportunities that come to you. And take care of people the way that you'd want to be taking care of yourself. But back to the point of leadership. Yes. Your best, the best leader shows people how to do it, instead of trying to do
32:05 Yeah, and that's a skill. That is a skill. Oh, well,
32:11 the funny thing about it is I've always gone to church, and I've you know, I've always gone to church, and different people have different ideas of spirituality and religion. But there's a difference between believing in something. And living something. Yeah. Okay. There's a big difference in believing something and living something. And I go to church now, the preachers, my brother in law, and I was kind of skeptical because my sister in law married this guy, and he's preaching, I was like, you know, just because you got to church doesn't mean I'm gonna be hanging out at church on time. That's such a good guy. He's such a good guy, and he lives it. So now I went from saying that to actually being a part of the service every Sunday and doing devotion at the start of service. So you know, if somebody sees you living something sincerely, and not saying one thing, and then doing another and behaving in a way that's totally outside of what's your professing in a crowd, and I think that's a lot. That's, that's what a lot of people away from spiritual base. Community, is, people are observing what people are saying. And then they're observing that person's application of what they're saying. And seeing if it adds up. And a lot of times that, yeah, you know, a lot of times does, yeah, and I think that's led to a whole lot of skepticism and a lot of our religious organizations. Yeah,
33:35 yeah. Actions do speak louder than words they do. It's just like, exercises,
33:41 exercises. Think about it. Think about it, you know, you know, the only Torah or Qur'an or Bible that people see in public are the behaviors of those people that profess those religions a lot of times, hmm. So, you know, are we living testimony to the Torah, or the Quran or the Bible? Are we are we living testimony to because if we were as diverse as we are with religious beliefs, if it's obvious that we're living, right, you know, everybody, I think would get along a whole whole lot better if the Pharisees were zeroed out. Yeah,
34:19 yeah. But that's where that's where you you jump in for this leadership and for all this volunteer work, because you want to start being the change you want to see in the world and be rather than just being an outsider. Like, let's take action for this change, which I so appreciate that about you.
34:35 Well, I just I'm slow to accept it. But if I do, I'm all in. Yeah, yeah. If I do, I'm all in. Yeah. It's It's It's humbling to be asked to serve in a leadership role of any form of any form, to be called upon to serve because that means somebody thinks enough of you to ask you to think about doing something and being an agent of change or or a vessel of service. Yeah, and that's what I always think about my wife gets a lot of a lot of requests to serve as well. And so we're very understanding of one another's roles. When we're asked to do things that might eat away from our our family time.
35:16 Yeah. Yeah. Kind of hard. Yeah,
35:19 it's rewarding. It's rewarding. I love that.
35:23 Thank you so much for coming on. I know this can inspire so many people. Just when you speak if you ever are at an event and you see Do not be afraid to approach Him, He is the nicest human. Like, go say hi. Ask questions, everything like you're like, Oh, God, no, I'm gonna get
35:42 this better than others.
35:44 Well, yes, you are still human. Of course, of course. But you're very good at communicating that you're like, Hey, you said that with me. You're like, now's not the time. Let's connect another so we did, which was incredible. So yeah, it definitely just a great leader to know to learn from and just, you're just good people. So just thank you for being you.
36:05 Thank you. Thank you for having me. Yes. Turned out to be the way that you wanted it to be this time.
36:09 Oh, my gosh, this is all every time. I feel lucky.
36:13 We'll do it again, if we need to. Oh, my God, I
36:15 would love to. And then, um, how if people want to reach out and connect with you? What is the best way if somebody wants to reach uncle? Oh, I want to I want to ask them a question.
36:25 Well, they can call the main office here in Little Rock 501-975-4040 Or you can look us up on our website at ortho rehab comm and leave a message there, somebody will check it.
36:41 Wonderful.
36:42 Thank you so much. And also don't forget about the American Academy of physical therapy. If people are curious about that. It's a wonderful service based organization designed to deal with healthcare disparities in the face of black community, but we're trying to help everybody, but our leg laser focus for us is to work with the black community and then try to help everybody else as we can.
37:03 I love it. Thank you. | |||
| 581: Dr. Melissa Farmer: Making Sense of the Mind-Body Connection in Chronic Pain | 14 Mar 2022 | 00:44:44 | |
Episode Summary In this episode, Co-Founder of Aivo Health, Melissa Farmer, talks about the mind-body approach to treating chronic pain. Today, Melissa talks about the mind-body approach, getting patients to be more receptive to the mind-body approach, and how practitioners can recommend psychological care for chronic pain. How can psychology work to treat people with chronic pain? Hear about the gaps in chronic pain measurements, the psychology behind farming pain out, the Aivo Health App, and get Melissa's advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Melissa Farmer Melissa Farmer is a veteran chronic pain researcher-turned-entrepreneur. During her graduate studies at McGill University, she trained with a world-class multidisciplinary team at the chronic pain center founded by pain research legend, Ronald Melzack. She earned a doctorate in clinical psychology and neuroscience. Dr. Farmer went on to pursue postdoctoral training with neuroimaging pioneer Vania Apkarian at Northwestern University, where she specialized in brain imaging of hard-to-treat chronic musculoskeletal and pelvic pain.
In 2018, she left academia to co-found Aivo Health, a startup with Vania Apkarian and a chronic pain patient/entrepreneur. Their mission is to bring insights from the top tiers of pain science directly to people living with chronic pain.
On twitter, Dr. Farmer has an international following of influencer physiotherapists who appreciate her ability to translate basic pain science research into understandable language.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Chronic Pain, Psychology, Treatment, Mindfulness, Meditation, Therapy, Trauma, Pain Relief, Mind-Body,
To learn more, follow Melissa at: Email: melissa@aivohealth.com Website: https://aivohealth.com LinkedIn: Melissa Farmer Twitter: @Farmer_MindBody
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:02 Hey, Melissa, welcome to the podcast. I am so happy to have you on I have heard raving reviews from Sandy Hilton and Sarah Haig about you. So it's great to have you here.
00:15 Thank you so much, it is a pleasure to be here with you. And today we're going to talk about treating patients living with chronic pain from a mind body approach. So before we get into the meat of the interview, can you define what a mind body approach to the treatment of chronic pain is? Sure, a mind body approach to the treatment of chronic pain acknowledges that we are embodied in these, you know, this skin, muscle bone, that we feel emotions in our bodies, that sensations have emotions that are attached to them. And it also acknowledges that all of these conscious experiences like pain and chronic pain arise from the brain. So they're conscious perceptions that are shaped by our thoughts and emotions and feelings and past experiences. So it's an acknowledgement that the body and mind are separate, that they work together they interact. And that impacts the the experience of someone who lives with chronic pain. And now here's here's the hard part as clinicians, what can we do to help our patients be more receptive to this approach when it comes to pain management, because chronic pain, any clinician will tell you is not an people living with chronic pain, excuse me, it's not a it's not an easy road. So what can we do to allow our patients to be more receptive to this? Because oftentimes people will say, so you're saying it's all in my head? And that's not hopefully not what we're saying. So got it? Oh, not at all. So one of the most powerful things I think, that we as clinicians can start with is a simple statement, I believe you, which is something that many people with pain don't ever hear. And it can be such a powerful statement, because then instead of coming to an appointment with, you know, evidence that they've prepared to prove that their pain is real, you know, tests, scan results, etc. You push all that off the table, you say, I believe that you're in pain right now, and I'm ready to help you. That's, that is, I think, one of the first pieces of resistance that we can remove, just by validating their experience.
02:53 And I think especially whenever people have lived with chronic pain, and have seen many, many, many, many doctors, they get used to this feeling that they need to
03:08 convince the person in front of them that their suffering is real. And if we just if we
03:19 if we get up that out of the way, just by acknowledging that common humanity, I think there's there's one level of resistance that's removed quite quickly. And what about providers, or medical professionals who our education, whether it be formal education school, our clinical rotations, has sort of trained us to look at scans and say, Oh, this is it. This is what's causing it. So what can we do as providers to? To break us out of that, if it's in the scan, then that's, that must be what it is. Do you know what I mean? Mm hmm. I think getting in touch with some humility. So crepe is a great way to start. Because one of the issues with scans and test results is that these are things that
04:14 scientists and the medical professional has decided these are measurable, objectively accessible, indices that we've all sort of mutually agreed, indicate that something you know, there's some sort of structural abnormality or whatnot. In other words, we're testing to look for what we know might exist. Another way of saying that is that we're only testing for the things that we've thought about before, and that we know how to measure and there's a lot of things that we don't know about and we don't know how to measure. And just because we can't measure it with an existing tool, doesn't mean it doesn't exist. And, you know, from a basic science perspective, right
05:00 My background is in basic science of chronic pain, we do not know a lot about chronic pain mechanisms. And so having sort of the humility to recognize that
05:18 the nervous system is incredibly complex, the brain is incredibly complex, there are many things we don't know how to measure, and it doesn't mean that they aren't there,
05:30 we tend to cling to tests that reflect our particular training. And from a patient perspective, what that means is that they get different types of snapshots. For instance, if someone has
05:45 lower back pain, they may get MRI scan to one, you know, from one doctor, if there's comorbid, visceral pain, which could be referred, for example, they might get a colonoscopy from another doctor, each of every every, you know, we've talked about silos before, you know, in the general field.
06:06 Each of these silos have their preferences for these different tools, and they all provide small snapshots. And it's sort of like the, you know, the blind men feeling on different parts of the elephant, you know, that really handy metaphor, just because you're a trunk expert, or you're a, you know, a, an, an elephant foot expert doesn't mean that you're able to see the entire picture. So Humility is a great attribute. Yeah. And where do you think this kind of false dichotomy between the body and mind originates from? Is it that, you know, Decart Deyan? Theory, you know, that happened centuries ago that we continue to accept? Or is it that we put more weight to the objective and less weight to the subjective? Or is it both? Or is it all the above and more,
07:06 all of the above, for sure, especially in the pain field, Decart has, he said, really strong influence, and he suggested that the body is like a machine. And you can sort of causally identify almost like a, you know, knocking down a line of dominoes. A cause effect, cause effect cause effect. And that's how you understand a more complex organism. But
07:34 what he, he sort of, it's interesting, he, he essentially said that, you know, like the body, the material, it works on different rules than consciousness. And he sort of made this blanket statement that we all accepted. So in a sense, relying on the words of a philosopher 400 years ago, is the basis for our logic today is a little a little surprising. But it's something that many people haven't questioned. And, unfortunately, in the, in standard medical training,
08:09 I'm sure you're familiar that like, especially in Northern America, in medical school, they receive anywhere between four and 11 hours of pain education,
08:21 there isn't enough time to go into the depth, the proper depth that this subject deserves. So I think that it's a, unfortunately, a reflection of these overly simplistic heuristics that medical professionals and other practitioners receive.
08:40 That that just doesn't do justice, to pain at all. Yeah, and like you said, because pain is so complex, because pain is an emotional and
08:54 physical state
08:57 that I think people are always looking for the answer. I know, patients are always looking for that one doctor, that one test that one scan that will say, Oh, this is it. This is the problem because people like logical things, right? People like well, point A, here's the problem. I can do B and I will end up with C feeling better. But when it comes to chronic pain, we can't look at the body and mind as separate. And I think a lot of people do and that does really is a recipe for some really ineffective treatments for pain. So what what can we do if a patient comes to us and they have sort of accepted that their mind body and mind are totally separate? And their kindness I must have done something I've got I've had this pain. I you know as a practice, I'm sure you've heard it. I hear it all the
10:00 Time, I'm sure I did something again, or I must have done something to flare it up. So how can we respond to that in a way that's accurate and helpful.
10:12 One of my beliefs, and this may not be a popular belief is that
10:19 the body has done nothing wrong, whenever it creates chronic pain, the body and mind it that chronic pain isn't a mistake.
10:29 And I say that from a scientific perspective, because whenever I've studied the mechanisms from the nerve ending on the skin, you know, whenever pain signals or nociceptive signals are transmitted from the surface of the skin, to the spinal cord to the brain, the body is naturally designed in a way that amplifies pain signals. So amplifying pain is how nature works. And it works that way. Because pain is a really important thing to notice. Pain is a primary reinforcer. And that means, by definition, it's aversive, you don't need to condition or to pair it with anything for an animal or for a person to try to avoid something, it's painful. And that's why it's always sensory and always emotional. It's always aversive.
11:23 And whenever, you know, as I've studied chronic pain populations over the years, and I've looked and really considered and reflected on the biological changes that I see all of these, these mechanisms that sort of turn up the volume of pain, whether it's at the nerve and the surface of the skin, or in the spinal cord, or in the brain, they're all there for a reason. And it's because the signal is incredibly evolutionarily important to respond to.
11:55 And the division happens in the brain where once it gets to the brain, and creates a emotional memory, or a fear memory. That's whenever the brain adapts and changes in response to that incoming signal. So in a sense, that's the point where the brain begins to adapt to accommodate the pain in someone's life, rather than just being passively responding to the environment. And that's one of the
12:31 one of the main features of chronic pain, where it's no longer just a, you know, whenever you see a patient to
12:42 has pain that still increases and decreases in response to external stimuli. That's a great sign because it means that the nervous system is still really closely linked with the environment. Once pain fluctuations start to vary independent of the environment, that means that it's become
13:01 more hard coded into the nervous system.
13:05 So that whenever I see patients who you know, who do have pain that's responsive to seeing the environment, I congratulate them.
13:15 But again, the idea that
13:19 it's adaptive to remember what causes pain means that it's also adaptive to create pain memories. It's also adaptive to change how you move in relation to pain. And it's adaptive, to feel depressed, and to feel anxious. Those are all completely normal, understandable responses to pain. And the
13:44 thing that isn't as natural and healthy is the inability to go back to baseline after you've hit that new state. And one of the reasons is that whenever you have chronic pain, so many experiences during your daily life, reinforce that cycle that you don't have many opportunities to learn what the lack of pain is like.
14:07 And something this is something I call relief learning. So it's natural for us to pay attention to periods of escalating pain. It's something it's a skill that can be learned to pay attention to periods of pain relief. And that's something that a lot of patients don't naturally do. And it's something that
14:31 if you don't come at it from a brain perspective, you might not see the importance of it. But anytime pain is decreasing, or it's lower than it normally is. That's the time that you should be focusing on positive emotions, relaxing the body, learning new skills, that's optimal learning time. So of that, one of the reasons I bring that up is that the the brain even though it's responsible for creating this chronic state
15:00 It's also the key to changing it and shifting back and reversing to the pain free state. The plasticity of the brain is is just a never ending thing of beauty. Absolutely. Absolutely. Well, now let's talk about, because it sounds like, and I love what you just said, it sounds like we're really focusing on sort of psychological care, which is part of care for chronic pain. And I love something that you wrote in that if mind based treatment helped my pain, then my pain must not be real. Hmm. Right is maybe something that might be in the back of someone's mind someone living with chronic pain are in the forefront. So how, how can
15:45 psychological care? Whether that be CBT, or mindfulness, or you know, there's a million different kinds of, I'm sure scientists, psychological care. So
15:58 how can people use psychological care, but not D legitimize their pain experience, not make them feel like, well, if, if this helped, then
16:10 my pain wasn't real, because if it were real, then that injection would have taken it away, or that movement or that stretch, etc, etc.
16:20 One of the things about trading
16:25 one of the things about psychology is
16:30 that sort of inherent in this illusion that the mind and body are separate
16:37 is that
16:40 whenever you have a new experience, there are measurable neuronal changes in the brain, there is a physical change that occurs, there is a measurable change that occur that occurs, even if you know we don't have the tools right away to measure it.
16:58 psychological changes are biological changes. And there's what 4050 years of science that reinforces that. So just because a psychological treatment can help doesn't mean that it isn't biological, it just reinforces that this source of the biological change is different from what you expected it to be. So I know that a lot of people with pain
17:27 you know, if for instance, their lower back hurts, or if a certain limb hurts, they assume that the source of the pain must be in that body part.
17:38 And although this is getting a little high up,
17:44 in terms of mechanisms, one of the reasons why we can even tell where our body parts are, is that there are maps in the brain. For instance, you know, one of the examples of this is the homunculus. But there are actually four different maps in different parts of the brain, that help us understand where our body is in space, and where our hand is where our lower back is. So you don't know where your lower back is, unless your brain helps you decipher where in the body map it is. So, you know, in multiple levels, this this idea of separation is really artificial, it really doesn't serve the experiences of people with pain.
18:25 I understand that.
18:28 Also, that one of the reasons why patients may adopt this kind of thinking is because they're
18:37 trying to work with the perspective of the provider who's treating them. If the provider has these assumptions, patients naturally, just to adapt, they have to play the same bowl game they have to in you know, they might do this through Google searches, or educating themselves on the web, or looking into pain, neuroscience education.
19:03 In order to be heard, I need to study the way that this is described online and in the literature, I need to be able to talk to my doctor in a way that they can understand.
19:16 And even that
19:19 even even that point where it's like I need to interpret my internal experience into something else so that someone else will believe me, I feel is sacrificing their internal experience of pain. No doctor
19:35 I almost think that like
19:38 a patient saying that they're in pain is all the proof that you ever need
19:45 to believe that they're in pain. You don't need a test. I really believe this. And so much the point that you know, I've I've I worked with Dr. Vani up caring for many years. The reason why his research
20:00 has been replicated so many times and has been published in such higher to high tier papers is because he looked at the patient's perception of pain and mapped brain signals to that perception.
20:17 He listened to the patients from the very beginning, he didn't say, Well, you have to finish the standardized questionnaire. And that'll tell me, that'll be the way that I measure whether your pain is there or not. He had a moment by moment, measure of pain intensity that he used to extract the signals from the brain during these brain scans. And that's how he found his fantastic findings that have been replicated again, and again, by different by different groups. And those are the findings that reinforced that as pain becomes more chronic, the brain regions that are correlated with the perception of pain change from sensory related regions early on, to emotional related regions within a year. In other words, after a year of living with pain, emotional brain regions are correlated with the sensory perception of pain.
21:15 Another way of saying that is that the sensation becomes emotional.
21:21 And that isn't saying that it's not real that saying that it's so real, you can measure it on a brain scan, you can see the pictures, you can replicate it across studies. It's that real?
21:34 So I feel like I've sort of No, no, gone in a few directions to answer your question. But
21:44 all all patients,
21:47 all we need to do is take patients word for their pain, we don't need any extra evidence that it exists, we just need to take them seriously. And to reinforce that, it's not your fault that you have this pain, you did not cause your illness, your body was doing exactly what it was designed to do exactly what we would expect a healthy person's body to do. It's not your fault. So let's, let's work together and find
22:19 your own path to pain relief learning. Right. And obviously, everyone's path is different and individualized. And I think we can all agree on that. There was something that you had said,
22:31 as you were speaking, that popped something that caused me to think that sometimes I don't know if you've seen this, but is it easier for patients to sort of farm their pain out to sort of third person their pain, versus first person their pain, meaning they may describe it, or they may listen to the way the doctors describe it, and not think of it as their first person pain, but think of it more as third person. And I'll give you an example of what I mean by that. So I have a long history of chronic neck pain
23:07 during my 30s, like, literally, the decade of my 30s For the most part. And I had I was giving a keynote talk a couple of years ago. And so I joined a speaker salon, or speaking group to help with this talk. And it was about they wanted me to talk about my experience with pain. So I went out there and I started it like imagine a patient walked in and had all these symptoms, right. And the woman who is not a clinician, a health care practitioner in any way. She is a writer, director and speaking coach, her name is Tricia Brooke. She said, Well, hold on a second. I'm gonna I'm gonna stop you for a second. I said, yeah, yeah. What is it? She's like, Is this about you? And I said, Yes, it is. And she's like, Well, why are you talking about it in the third person?
23:57 I said, Oh, well, because at the end is the big reveal that it was me and she's like, people know, it's you. You're up there talking about it. Like so why don't we change it to the patient and change it to me. And I started and within five minutes, I was crying so much I couldn't continue.
24:15 And I was like, This is why it's not first person because it was so hard. For me it was a lot easier to sort of third person it out or farm it out. And then going through this for eight weeks, I was finally able to get through the whole talk and someone came up to like, you know, I really liked those parts when we were first doing it when you were crying a little bit. I'm like, that wasn't part of the bit. That wasn't a bit that was me not being able to talk about my experience with pain, because it's emotional and sensory. So the although at this point now I had not had pain in years. To the extent I had it when I was speaking about it right, but to your point
25:00 The emotional attachment was still there.
25:04 So what do we do with that?
25:10 That's such a great
25:13 question.
25:18 I think it's self protective. Initially, whenever just just as you described, it's self protective and that you live with the pain every day.
25:30 It's a way to distance yourself from the suffering.
25:36 So on one hand, I understand 100% Why people do that. And in a lot of the patients that I've seen, over the years have done that too.
25:50 I think that
25:58 something that comes up for me right now, is that the words that one person uses for their own pain are the most therapeutic words that they could
26:10 use.
26:12 In that, engaging in the pain memory, from a psychological perspective, is one of the things that allows you to change that memory.
26:23 And I kind of wasn't planning on going here. But it's, it's an opportunity.
26:29 One of the reasons why psychological approaches to
26:34 chronic pain care have the potential to be so effective is that if pain is an emotional memory,
26:45 we know from 20 years of basic science, neuroscience, that emotional memories can be fundamentally change. There are rules, there are very clear rules.
26:59 The rules are you revoke the memory, on purpose as fully as possible.
27:07 You ideally introduce some type of contradictory experience something surprising, because that really makes the
27:20 the brain state more salient, it makes the brain pay more attention to what's happening. And then within three hours, you induce relief, psychological relief, deep breathing, I've worked with patients where we administered propranolol under the guidance of their you know, their doctors, but deep breathing is enough. And that if you are able to induce in sort of controlled conditions, these experiences where you fully experience pain, how it is for you, using your words, the emotions that come up in your body. That is how you fundamentally changed the memory structure of chronic pain.
28:06 Fascinating, you can do that in little bits across time.
28:12 Under more controlled conditions, you can do it in one big whammy exposure session.
28:17 Interesting, I think I did it in little bits over an eight week period in front of an audience
28:23 in front of a very safe audience of 14 amazing women. And you were also in a sense, potentially reshaping your pain narrative, as you're going through this, too. So you know, per Gillette Abelton.
28:38 You know, working with the pain narrative, and changing the meaning of the pain story over time is one of the another way that
28:48 that your pain story itself can be really therapeutic. Yeah, yeah, it was. It was wild. But it's it's a good example, I think of how even though I had not had pain for years, but the emotional attachment to it was so strong that I couldn't even get through a paragraph of this talk without crying. I was like, I think I need to come off the stage. And then each time it got, you know, it took more and more time, I guess before I would have like a really emotional response. But I have to say since then it was like,
29:28 like a weight off my shoulder. You know, and this is years after not years, maybe like six years after I really had more consistent chronic pain. So it was years and it was it was years after the pain had the chronic pain had subsided.
29:45 That's interesting too, because it suggests that there's a larger memory structure underneath there that even if the sensory aspects have been remodeled, the emotional attachment can still remain. And so in a sense, perhaps
30:00 that experience helped to heal the entire memory structure in a way that it you know, it wasn't quite complete just with the sensory pain being gone. Yeah, yeah, maybe it closed the circuit a little bit, so to speak. But anyway, it was it was highly, that's fantastically effective. But it just goes to show and again, I wasn't working with a professional perhaps if I were maybe I would have closed that circuit a little earlier. Or maybe not. Maybe this was the time, we don't know, too many questions to answer. So it's just right, you didn't just write for us at the right time. So, you know, just goes to show that when we're when we are treating chronic pain, we need to target the brain. Right? I think you need to have psychological care. So what do treatments look like? Obviously, reminding the audience that everyone is different, and everyone is individualized. But what are some examples of how psychology can work with people with chronic pain?
30:57 Well, so there are a number of evidence based approaches.
31:01 So cognitive behavioral therapy is one that everyone knows about Acceptance and Commitment Therapy, Mindfulness Based Stress Reduction, even pain, neuroscience education for some people. And whenever I think about these things that I typically look at the biases of the person in front of me, is the person in front of me a highly logical, rational type of person, I'll direct them to cognitive behavioral therapy, are they more embodied emotional person, they might be more open to mindfulness meditation approaches, or Acceptance and Commitment Therapy.
31:38 I think, especially people who have been in the healthcare system, go around for years and years and have some trauma related to being a chronic pain, patient benefit from pain, neuroscience education, just because it helps them get a better understanding of what they've been working with. So in a sense, you know, we have sort of a number of different tools that we know of in the literature, and adjusting each tool based on the the worldview of the patient is the best way to go. I think that's such a great way to look at it. And what advice do you have for let's say, physical therapists, occupational therapists who are working with patients with chronic pain? What is your advice to us to recommend psychological care? How, how can that conversation initiate?
32:36 And what is the best way for us to refer out?
32:46 I think that one of the best ways to initiate the conversation is by expressing empathy, and compassion, it looks like you're really having a tough time with this.
33:01 And from what you've described, it seems to impact many areas of your life, I see that you feel anxiety, I see that you've experienced some depression, I see that this stresses you out,
33:16 have you thought about support some sort of psychological support? To help you through this, that's, I think one of the most open ways that that this can, this can happen and a lot of physical therapists that I'm that I've interacted with, have taken it upon themselves to learn some of the psychological purchase, because it's almost
33:41 because they've sort of found themselves in the position of being the psychologist whether they liked it or not, or whether they had the training or not. And I've really admired a lot of the physical therapists that I've interacted with, because they've gone extra steps to learn what it is that they might need to know in order to provide better psychological care, as you know, as a physical therapist.
34:09 However, there are lots of times whenever the degree of distress or the degree of suffering, it is beyond training, you know, the training that you might have as a, as a physical therapist. So that's whenever it's time to bring in a professional
34:29 in terms of identifying
34:32 the optimal type of treatment or making referrals. That's very tricky of because there aren't a lot of pain psychologists in North America.
34:47 Even if I were to come up with a list of them, a lot of them that I know of are in academia and the people that
34:55 are in sort of the private sector. They have that specialization just
35:00 because they have lots of experience there. So it's, I kind of, I don't have, I don't have many suggestions. In this case, I do have a suggestion of a tool that I've helped to develop, that could supplement that in a way.
35:19 But in terms of finding the optimal,
35:25 as per the optimal psychologist, I think it would come down to therapeutic alliance. And that's something that each person has to feel out for themselves. And that, okay, you have a person who's highly rational, logical CBT might be the thing for them, have them talk to three different suggests they talk to three different people who feels right.
35:45 Because I'm a firm believer of therapeutic alliance, in the larger sense. And the the foundation of therapeutic alliance was best articulated by drum Frank, in his book, persuasion in healing. And one of the things he described is the healer suffer relationship. And one of the core tenants of the healer separ relationship, the healer believes that they can heal, the suffer, believes that the healer can help them. And they come together and interact with a number of rituals together, that are intended to relieve the suffering. So if you have someone who's on your side, even if they don't have the right training, but you trust them, you feel like they get you, that's more therapeutic than their training proper.
36:35 And that's, it's it's tricky. But for instance, even just talking on the phone for 15 minutes, to three different practitioners is enough to be able to get that feeling. Yeah, that's great advice. Thank you for that. And now, as we wrap things up here, what would you like the listeners to take away from this conversation? If you could wrap it up in a bow? What would that what would that present look like?
37:06 I think
37:08 we all have a collective responsibility to empower people who have been living with chronic pain.
37:20 And I think that,
37:22 you know, based on our conversation, one of the most powerful tools for pain relief is between people's ears. And I really think that that's the most empowering approach as well. And that I, at my core, I don't believe that we, that people need to rely on
37:40 doctors or medications or even approaches nearly as much as their own brains.
37:48 I, I know that it's difficult to get access to tools and psychological approaches that enable that. One of the things I'm doing,
38:00 you know, just from a, from an entrepreneurial background, is working on tools that will help people with that. But the key to long term pain relief, is teaching people to attend to patterns of pain relief, and what really feels like even if it's just a few moments every day. So my overall bold statement would be the key to your pain relief is paying attention to whenever the pain is less whenever you have time, to enjoy things in life to engage in positive emotional learning. Those are the keys to pain relief, because the more you focus on those moments during the day, and the more we encourage our patients to focus on those moments, the better they'll get, and the more quickly they'll get better.
38:50 I love that. And now where can people find you? What do you have going on? What's coming up? Let us know. Yes. So one of the things that I've done in the past few years after leaving academia, thank goodness, is I co founded a startup with Vanya, up Korean and a chronic pain patient, make Mika Michalak. So he's an entrepreneur, finished entrepreneur who has had chronic pain himself. And we
39:18 created a tool that is essentially insights from Bonniers research in an app form.
39:29 And it contains Mindfulness Based CBT exercises and tools that I wrote, and pain neuroscience education that I wrote. So in a sense, it is a expert created tool that is designed to give all of these insights directly to a patient without them having to rely on doctors or any formal care.
39:56 Because one of the apps Oh, the app is
40:00 Ava health app.
40:02 So if you go to www dot Evo health.com, you can learn more about it. And one of the one of the things that I it's a real conviction of mine, the science that's needed to heal chronic pain exists today.
40:21 You know, this is work that Vanya has been doing for years. And the time that it takes to sort of for that knowledge to trickle down to clinicians and to, you know, clinical guidelines, is 10 to 15 years. And one of the reasons why we decided to do this was because if it exists today, patients deserve to have it today.
40:42 So it's, it's a labor of love.
40:46 And I invite anyone listening to this podcast, to recommend to check it out yourself, to recommend it to your patients. And to contact me directly at Melissa at Ava health.com. If you'd like some more information about how to use it to help your patients. I'm very open to that. I love it. And we'll have the link to that in the show notes at podcast dot healthy, wealthy, smart, calm. And again, that website is www dot A i V as in Victor Oh health.com Just so people have the spelling of that.
41:27 And now one last question that I asked everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self, let's say a fresh face out of grad school or maybe undergrad wherever you want, wherever you want to take that starting point.
41:45 I would say Melissa,
41:49 you're either identity is not your accomplishments.
41:55 Think about what
41:58 drives you what creates the most passion in you. It's to help people get better. And to support people while they're healing.
42:08 instead of chasing after the shiny ego cries that other people applaud you for take a step back and focus instead on what makes people feel better now make choices to help people heal.
42:32 Now, don't worry about long term research because long term research won't help people now.
42:39 I love that advice. Thank you so much. This was a wonderful conversation. I always learn such I always learned something new. And this was a lot of new so I want to thank you for coming on. Thank you so much for having me. And I really appreciate it was wonderful and everyone thank you so much for tuning in. Again. If you have any questions for Melissa you can reach her at a vo help calm and have a great couple of days and stay healthy, wealthy and smart. | |||
| 580: Dr. Drew Contreras: Executive Medicine in the White House | 07 Mar 2022 | 00:41:00 | |
In this episode, Dr. Jenna Kantor talks with Dr. Drew Contreras about the rigors of working as a PT for the President of the United States.
More about Drew Contreras: Drew Contreras, PT, DPT, SCS – received his Master of Physical Therapy from Gannon University in 1998 and his Doctorate of Physical Therapy from the University of North Carolina at Chapel Hill in 2008. He is board an APTA board certified Sports Clinical Specialist since 2003. His professional interests are sports medicine; manual therapy; blood flow restriction; bio-technology; musculoskeletal injury prevention, diagnosis and rehabilitation as well as human performance optimization. Serving over 20 years on active duty as a career military officer and practicing physical therapist within the US Army & Department of Defense, Drew has served in a number of settings and military units throughout his career before his retirement in 2020. He spent his early career at Ft Benning, GA and then moved on to Ft Bragg, NC. His skills were put to work extensively in 2006-2007 during a 15 month continuous deployment during Operation Iraqi Freedom where he was the first physical therapist to serve in sustained combat operations with the 82nd Airborne Division. After returning Drew moved to Washington DC to work at the Pentagon Health Clinic where he served as the Director of Wellness and Physical Therapy. During this time he served as a consultant to the White House Medical Unit and was then chosen as a by name selection by President Obama to serve as the first ever full time physical therapist at the White House. There he served as the Physical Therapist to the White House Medical Unit and President of the United States Barack Obama from 2010 until the end of the administration in 2017.
To learn more, follow Drew at:
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read The Full Transcript Here: Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35 Hey everyone, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and referrals, net Hills Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using NET Health's private practice EMR, be sure to ask about his new integration, head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today. All right onto today's episode, Dr. Jenna Cantor is back and today she is interviewing Dr. Andrew contrary us he received his master of physical therapy from Gannon University in 1998 and his doctor physical therapy from the University of North Carolina at Chapel Hill in 2008. He is board certified sports clinical specialist and has served over 20 years on active duty as a military officer and practicing physical therapist within the US Army and Department of Defense. He has served a number of settings and military units throughout his career before retiring in 2020. After retiring drew moved to Washington, DC to work at the Pentagon health clinic where he served as the director of wellness and physical therapy there. During this time, he served as a consultant to the White House medical unit and was then chosen as a by name selection by President Barack Obama to serve as a first ever full time physical therapists at the White House. There he served as the physical therapist to the White House medical unit and President of the United States, Barack Obama from 2010 till the end of the administration 2017. He has worked with a wide variety of government officials as well as police and law enforcement agencies. And today he's going to talk a little bit more about his experience. And it just goes to show you that there are so many options and so many settings that physical therapist can work in. So I think Drew and I think Jennifer great episode. Hello, this is Jenna canter so honored to be hosting this podcast for healthy, wealthy and smart. I am here with Dr. Drew Contreras who just said Just call me Drew. And I was like, Oh, that's so cool. So Drew or gesture is one you want to get his autograph when you know what he has done. This is the the physical therapist for Brock Obama and Michelle Obama. And then the current president and first lady, which is just not and as soon as I learned this, and then got to hear him speak at a conference. I was like, this is somebody that I am desperate and enamored, inspired by must feature on this podcast. And I approached him a complete stranger. At this conference, I sat right next to him dinner and as he didn't know me, and he said, Yes, this superstar said yes to doing this podcast. So Drew, thank you so much for agreeing to come on to this podcast. My pleasure. Right, like
03:54 it
03:55 is I appreciate the kind words thank you very much. Absolutely. And that's how I'm going to be approaching this this podcast as a young professional in the physical therapy industry that saying, How did you do this? How did you get to this point, and we're just talking about executive medicine here to really understand point a point B, I feel like from the conversations I've had with people outside this podcast, there isn't one way to eat a Reese's. It's not some clear pathway if you want to get this way you you're gonna fit in this box and it's very much like the performing industry. It's like there's no it's not one agent that's going to get you that movie. So we're here to just hear hear your story where where you got started and how that led to such a
04:43 prestigious and how honor what an honor, I have a position to get to do. Yeah, um, so I think that
04:55 I think that regardless of like what you're pursuing, right, whether
05:00 That's, you know, working in executive medicine or like you said, working with a performing arts group or, you know, working with a traveling band or a sports team or whatever, right, I think the thing that people
05:14 really de emphasize, which is the exact opposite of what should happen is, you need to be really, really good at what you do. Right, there needs to be no question that you are exceptional about what it is that you provide. And I think that people get lost in wanting the end state. And they, they don't go through the process properly. Right. So just just to be blunt, right? Like, if you've got, you know, 18 months of experience, you probably shouldn't be the person on the sidelines on a high contact sporting event, who's the only person that's available? Right, that's probably not the best plan. And likewise, right, like, you probably shouldn't be the sole healthcare provider on a plane someplace when like, you barely really know what you're doing it. So I think that people get confused with, in order to get to the end state, right, I need to go through these, like, I need to know somebody or I need to, I need to have a, like you said, there's a person who will get me there.
06:17 The only thing that will ever get you there is is being exceptional what you do, right? Because when you start talking about things, especially like executive medicine, you have to realize that the people that make it to this point or this level up are exceptional at what they do, right. And they have made a living off of calling people out on the BS card. Right? Like, they know when you are not exceptional at what you do, because they they've seen it for so long. So if you're not at least there, right, if you haven't found your, your, your apex of your skill set, it's not a place you want to be. Right. So first get there, right, get really, really good at what you do. And then if that's if you've made it to that point, opportunities will unfold themselves, right? If you're prepared if you're really good at what you do. So I think that's the best thing I can say to people is, like you said, there's no, there's no cookie cutter path to getting into this, as there shouldn't be right, because it's certainly not for everybody.
07:23 Yeah, I think that's really well said, and I want to tap on the assessment of what it means to be good at what you do. And this is my opinion, but I'm going to put it in here. And then I would love your thoughts. But don't base your success off of other PTS opinions based off of other patients opinions.
07:47 I think we really mix that up. I think we really do. And it's just not everyone. What are the patients saying? What is your success rate? There are the ones that if they do get do they come back to get I would base it off that I think we worry too much about what our
08:02 comrades that's the word that's in my head right now are thinking. I think you're absolutely right. Right. Like if
08:11 I think there's a difference between
08:15 external validation, right, which is kind of what people say about you. And that can be rewarding, right. It can also be incredibly destructive, but but it can be rewarding for some people. And that's different than than defining
08:31 a level of expertise or level of success. Right. That should be pretty objective. You should be able to measure that with clinical outcomes. You mean, like you said, even just sheer recommendations and referrals from existing patient? Right, or sources? Right. That's it. That's a better
08:51 litmus test than who said, what about you on Twitter? Yes, yes, yes. Or if you're, if you're there a different way. So what about you or say you go to a conference like CSM, and everybody has been in this industry for certain periods of time. And when we create relationships with people, the ones where we are really more connected to we just generally bond with just like our friends in life outside of the business? Are even if they're not, you're not friends with the right people. It doesn't mean anything. It doesn't mean anything. I have a friend who just got on Broadway, she had zero friends who are on board, you know, like, she wasn't like, let me see of friends on Broadway, but not like close, close. You know, I just I think we can get stuck in that. Like, I'm associated with them. So therefore, like I can't, in the, like I said the reality is, even if that association gets you a conversation or a phone call, right? It won't sustain you for very long. Yeah, yeah, absolutely. What is the schedule and
10:00 Life, like in regards to when you're doing such a high profile job? Yeah, you know, I bet
10:12 I think I would average it out to people would call me get a hold of me at least two or three times a month and say like, they wanted to be the White House physical therapist, and I finally got it down to like, okay, um, that's, that's great that you're interested, I need to know, if you're okay with this, you will not have any vacation days throughout the year zero, you can never buy a ticket. That's non refundable to anything, you must be okay, giving up attending any sort of family event, kids sporting games, whatever it may be.
10:47 In the event that you actually do get to go on vacation somewhere, you must be okay with it, they call you you have to leave immediately and come back. If you're okay, with these basic things, we can have a conversation, right? And most people immediately are like, well, that's not what I wanted. I just wanted to fly on a jet. You know, and, you know, have people think that I'm, you know, in this prestigious environment, like
11:11 all these things come in a price, right? It's, it's not, it's not an easy price, right? I will forever
11:19 hold Brock Obama responsible for the fact that we both started there with black hair, and ended up with gray hair.
11:28 super stressful environment, it's long hours, it's unpredictable at times. chaotic, and it's just not an easy place to to exist in, if you aren't already comfortable in your own skin, right? So to basically understand is that
11:47 your professionalism has to supersede what your personal goals are, or your personal life is if you're going to be successful in that environment. And that's just the level of dedication that it takes. When you say professionalism. Would you mind defining that? Because professional means of a profession? And so that can be very vague. Yeah, I think that it means right.
12:12 I think that it means that you need to be willing to put forward
12:19 your best on any day in any place, and do the best you can for those patients, or those people that you're serving. And it's really, you know, kind of a, a selfless service attitude that would make you successful. And that's what I mean by professionalism. Right? It has to come first, right? It doesn't matter if you had, you know, plans to do a thing, or you were supposed to be going out to dinner with your spouse or whatever, right? Like, that's the level of professionalism that's expected. Absolutely. I like thank you so much for that. I was thinking it was singing, it actually really reminded me of swings on Broadway, they have a very similar situation, except they're not the main person, but they have to be available at a moment's notice. So just like and during the Christmas breaks that the leads or the ensembles take, they're the ones that jump in, and if anything comes up, they're the ones that are, I mean, if I want to say somebody who truly has probably the least brake, in the run of a Broadway show, it's the swings. So that's it. That's just where my brain went. because theater is my background theater is my sport, my sport. Absolutely. So I like that. That's so interesting. And, and I think it's always good to know the full picture of what it means to do something. I'm going to compare it to Broadway and musical theater because that's what I know. It reminds me when including myself when you first graduate school and you're a performer, singer, actor, dancer, you're like, oh, I want to make it on Broadway. However the schedule on Broadway, it's six days a week, one day off, the main holidays you are going to be performing that's when you have the most people attending. You're going to miss on so many things that go on in your life for being dedicated to the Broadway show. So knowing that you're going to miss so much of life not just a little like a lot like your nephew's events, whatever you're going to miss everything. And in in your downtime the days that you have one show your whole day is revolved subconscious or consciously around putting on your best performance that night so you have to be careful with your energy everything because that is there that is your main job that's your main go to so it it really does sound so reminiscent of that you got to have a passion for it as much I do think there's a little bit more selfish and that's okay to be selfish. It will regarding performing because you are a person who loves applause loves that stage and everything you are of course giving I would say it's like
15:00 5050 But I do think it would be different compared to the physical therapy job that you're doing. Because the only reason why and we discussed this before, the only reason why we can even say your name in association with a be with these people is because they have publicly said your name, you know, and that's that's an end. But if you didn't have that we would not that's that would we would be doing all this other words to go around it appropriately, you wouldn't talk about in the reality of it is
15:33 another, I was doing something else. And somebody asked me, they were like, What would you consider one of the biggest achievements that you've done professionally? And I would say that
15:44 until after 2017. Right? Nobody knew who I was and what I was doing. Right. And that was that was my goal, right was that nobody knew that. I was a White House physical therapist, nobody knew who I was where I was at the things I was doing, because that was the job. Right? The job wasn't to be. It's not it's not the world's business. Right. Right. And then so, and I think that that's fair. Right. I think then that and I think that that's really important. And then so like you said, you kind of have to understand that like,
16:16 the people who are concerned with the trappings, right with, like, what do I get out of it? Right, will be severely disappointed. And executive medicine, because that should never be what it's about. Right? It should never be about what are you getting out of it? Because if that's the case, you know, you won't be doing it for very long, right? There's, there's a saying in the in the Gulf PT community is, you know, if you want to be around a long time, you don't want to be around all the time. Right. And basically, what that means is like, you should not be trying to be, you know, the inner circle person. Right? You shouldn't try to be the best friend of these, these high profile individuals, if your goal is to, you know, be of service and do your job for a long time. Because you because that's just not the way it works. Right. So that's just kind of a reference point that I, I found, just like you said, very similar to performing arts, right. It's just kind of there's there's parallels and all these different sub communities. I mean, it really goes back to just loving truly loving what you do, and it's okay, if you don't, it's okay. Not every job, or every specific thing is meant for everyone. That's why we have so many different options and more options keep popping up after the pandemic now.
17:34 Yeah, you have to love what you do. You have to love what you do. See, I love being the center of attention, because I'm a performer and a physical therapist. So I know, right off the bat, that couldn't be for me, because for me not to be able to be like them. And the way that I was in like, doing a whole photo shoot there trying out different heels for the photoshoots. All that stuff. Like that would be the I would be the worst person because I'd be mourning getting to do that. It's so right. So there's always the question, people would ask, like, Oh, can you do this there? Or can you do that? Or can you do this? And the answer is always you can do whatever you want on your last day. You want today to be your last day. Feel free to do that. Yeah. Yeah. I mean, it's HIPAA compliance. I mean, that's the biggest thing. It's a HIPAA compliance. And then we have people they're just taking care of the United States.
18:29 That's such a high level. It's such high level, you know, I mean, wow, wow.
18:35 I was wondering for you, because it's this level of executive medicine is very
18:45 high profile. There's a lot going on there. I'm not asking for details behind the scenes. That's none of our business. But I'm, I'm curious about how it affected your stress levels and your anxiety while there and how you manage that during that time to make sure you were able to be fully present and helpful, even though it may have kind of fallen on your shoulders a little bit. And on that note, we'll take a quick break to hear from our sponsor and be right back with Drew's response
19:17 when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about this new integration. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.
19:53 You know the best way
19:58 to kind of describe that
20:00 Is is, I think that it's important to surround yourself with, with people that are understanding of your situation, right? Because because
20:13 it's inevitable that you will have conflicts or that you'll have to back out of things, right. And if people don't understand your situation and the level of service and dedication you have, they just think you're selfish, right? So like the, I'm sorry, I know, I said, I was gonna come to your barbecue, but I just can't, I can't make it now. And, and I need you to be okay with that, and may not provide you an explanation of why. Right? And that's a hard thing, right? And you will find out pretty quickly, like, who, who's accepting of you and who's not? Right, because because most people will just stop inviting you to things right? Or they'll just, they'll just cut you out of their life. And there's some degree rightfully so. Right.
20:52 So I think it's just important to make sure that you surround yourself with that. And if you're a person with the family, right, like, this has to be an honest conversation that you have upfront.
21:02 This is not something that you kind of tiptoe around or like, make it up to you. Like, you'll be saying that forever, you'll never make it up, right? It just needs to be an acceptance of like this is this is part of what's acceptable.
21:17 And that's not like you said, That's not for everybody, right? It's absolutely not for everybody. So I just think that in order to be able to perform at a sustained sustainable level, right, for a duration, not just like,
21:31 once, or like, twice, right, but to continue to do that, you have to accept that. So I will. Another thing that comes to mind is, I once saw an interview with Michael Jordan, who is, you know, arguably one of the greatest basketball players of all time, regardless of what you think. Right? And Michael Jordan was interviewed and, and, and he said, you know, what's, what's it, what's difficult about it, and he said, you know, people who want to be Michael Jordan for a day or a game, you know, like, of course, I'd love to be Michael Jordan for a day or a game. But being me for a season, right? Or for a year, or for a couple of years of a championship run year after year after year, right? The commitment and sustainment that that requires, like, people don't want to do that. Right. And that's what I would say to people to like, it's super cool to work at the White House for a day for a weekend. Right, right. But do it for do it for a year, or an administration. Right? Or be stupid enough to come back and do it again. If somebody asks you, right, like, that's, that's a whole different level. Right? So it's super exciting. You know, it's interesting for for a weekend or a day or whatever, but like, but long term, right? Like, it's a commitment. Yeah, that makes me think of certain roles. I'm always going to bring it back to theater because that's my brain. It makes me think of Elphaba in in Wicked or Vita in Aveda, where Aida and Aida where they are literally doing like vocal aerobics, they don't stop singing. So when they are outside of the show, from
23:09 what I've learned, and especially if you're talking about a Broadway one, so they are doing what is it seven to eight shows a week, they get the one day off, they are not talking much outside of that show. If you want to reserve like or if they do they know what they can and cannot handle. Because the amount of singing. Elphaba I've learned is such a difficult track because of how you're, you're going from one part even if you're not in a scene for a moment you're rushing doing a costume change it's it's a very non stop role. So if you are looking to lose weight, no,
23:47 no but it so it just makes me think of that, you know, different things can cut you out of living your life, which is why I've always said I would love to do Elphaba at a regional theater for three weeks.
24:03 done done like like he's like Michael Jordan said for temporary. I think it's so good to take in this perspective and take things in as a whole. We were talking when we met the group was discussing how really understanding in this is a bigger picture thing but really understanding what physical therapy is before you even decide to join the profession as a big deal that needs to be much more transparent. And we can sit there and see all these shiny other things like oh, I want to trade for Broadway or I want to do executive medicine or oh, I want to work for this sports team. But really asking yourself all the tough questions on what goes into that? Well, I mean, if you're talking about money, great, but like, Have you ever had money and then like how fast did that money go? Did it really make you happy? So many so many things on that.
24:52 But
24:53 the details of the job will that will you enjoy that? That's your life. You're going to spend the majority of your time on the job not
25:00 off the job. So you got to make sure it's something that you like and really do your due do your due diligence in that. But I think it can be very difficult to give and provide the full picture to for anything. I don't know, I don't really know, have a clear way to make it clear.
25:20 I think that
25:23 I think that like part of that, I think is our own fault is PTS, right? I think that the general public struggles to understand what we do as a whole, right? It's, it's easy to do it in in subsets. Like it's easy to understand. Okay, well, I was on crutches. And I had a cast, and then I had to see a PT because my ankle was broke, right? Or the, you know,
25:52 mom had a stroke. She's in rehab, she sees a PT every day, so she can get better and come home. But the hard thing is like,
26:03 the professions bigger than that, right? It's, it's more and we've overcomplicated it instead of really kind of simplifying it down. Because the reality is right. What do PTS do? Well, we help people do whatever it is they want to do. And we get them back to or allow them to do the things that they want to do.
26:24 And that's it, that that's the that's the big selling point of it is, if you're not interested in doing that, I'm, like you said just about every day of your life, this is not the right profession for you. Right? Like, if you thought that, well, I would, I will have a very nice car, and I will have these set hours and I will you know be able to do these things like you're going to be miserable hate because I think that people didn't get into the profession for the wrong reasons, just like any job. When eventually, right? It will be taxing to you. And if you're not down with whoever that person is, it's you're talking to and working with, if you're not okay with, I'm here to get you to where you want to be. So that whatever that thing is, whether that's walking your kid down the aisle at a wedding, whether that's going on a hike, again, whether it's walking the dog, right or like putting your shirt on by yourself, right, whatever those things are. Now in a handstand, of course,
27:26 like if you're not okay doing that,
27:29 we're never going to be happy with with what PT does, right? So I think that that's the thing that people need to kind of understand if I wish, if I had anything to say to anybody who's listening who's like thinking about it, think about that. Are you okay with doing that, that be your role in life? And if that is not appeal to you, you need to find something else. Yeah, absolutely. Absolutely. It really is a
27:55 job board, you're of service, but you have to love being of service in this manner. Like if it doesn't feed your soul, like then how, like no money can ever pay you enough. It's never never enough. It'll never be enough. And that's okay. That's okay. It's I take like, exactly, you got to figure out what you love. I feel pretty lucky. Because I went into school, dreading that I was going to school and I felt like public embarrassment in the musical theater world because I entered school as a quitter. Because that's what it looks like, like, I'm leaving my profession. And so I had people offering me get professional gigs while I was in my first year of school. And I was embarrassed. Meanwhile, other people were posting and going, Oh, I started up in school, because it was a prestigious school and everything. And I was like, quiet for the first at least a year, if not more about what where I was.
28:52 I mean, it's all perspective. But then I learned I got a sometimes don't just take that one experience. And for me, I had that which was beautiful, seeing how it can change people. And yeah, yeah, but if that doesn't work for you, it doesn't work for you. I love that. Yeah, so for you. In executive medicine, I don't know if you know, the data on this. I don't even know if it exists. But is there kind of an average of how, how long medical professionals usually stay within executive medicine? Or is there kind of like, usually it's about five or 10 years or something just because it is such a commitment and you're talking about family and all these things. Just wondering, I think that there's a there's a there's it is a
29:38 Oh, I think there's a short hump and a long term home. I don't think there's a lot of people in the middle. Oh, interesting. Yeah. I think that if most I would probably say two thirds right. It's a short
29:55 I don't know. I'm guessing you know, five to seven year experience, right? The people
30:00 Do that short. Yep. And then
30:04 yes, yes. I think there's nobody that's kind of in that like seven to 15. Year. And then I think you get another the the last third is in the 15. year plus right. So wow, a career choice, or have made that shift for whatever reason. In that direction. I think they kind of stay there.
30:28 But I don't think it's, yeah, yeah. I don't think it's a mid career thing. It's either a stop along the way, or eventually it becomes your, your pathway. The business side, I have a real dorky question here. It's not dorky. And because there are people who be curious, I'm curious about documentation. For some reason, I feel like it's gonna be theirs. Let's compare to a Rite Aid receipt versus a CVS receipt. I feel like it's probably a CVS receipt, am I wrong?
30:59 Here's what I would say. Right?
31:03 If you treat everybody the same, and document the same, you're always okay. That's it. Right? In, that's where you have to be, again, like you got to be good at what you do. And you got to be very comfortable with that, right? Because
31:18 you people, you'll be second guessed right, there will be consultations with other providers. That's just the nature of executive medicine, right. And so you need to be okay with what you're doing. And documentation is part of that, right, making sure that you're you're very clear about your plan of care and the things that you're doing and why you're doing them.
31:37 But if you, you know, if you do it the same, it doesn't matter, right? It's universal precautions, right? If you if you do it the same no matter what you're good to go. So that that'd be my two cents on that. And then we also think it might differentiate and regarding plan of care, because we're talking about exercise adherence, which is something that physical therapists are was talking about, it's one of my biggest passions is getting exercise. And it's so great when it works.
32:03 For your patients in general, that have a high anxiety life, lack of sleep life, how do you achieve that adherence in a realistic way to get results? Does that make sense? I'm trying to generalize, even though every patients different, but this is we're talking about a very specific level of high stress. Right? I think that you have to understand that when you're working in this kind of subset, the biggest commodity for people, their biggest asset, the thing that is the most valuable to them is time, time is their most valuable asset, right? It's not money, it's not, you know, I have stuff do I have, you know, it's not the resources of equipment, or what, like, it's time, their time is very valuable.
32:55 And you have to, you have to be a good steward of that, right? You have to respect that. And so you have to,
33:04 you're not going to give somebody you know, a printout with 15 exercises, that's going to take an hour and a half for them to do and tell them to do it three times a day, right? Like, this is not how this how it's gonna work. Right. So I think that if you understand that concept, in build your plan around that about what is the most effective thing I can do with you, or this amount of time, which is limited, and then you have to understand that that's, it's finite, right? There's not It's not unlimited, that there's a million priorities that are trying to take that time. And if you are, are good about using it and understand that it's a limited resource, then they'll appreciate it.
33:49 I just realize you have unusual, wonderful access to collaboration over there. And I started to think about food. Could I mean, you could No, here's, here's No, there's a purpose, because digestion, if their digestion is off, that actually can have a big effect on their healing process. Have you had opportunities to collaborate with the the shatter? That is so cool. Oh, that is like the best. Right? And again, right, like you, you have to get the most value out of the things that you can write. And it's really interesting in this world is that like, it's, it's usually a matter of making sure that you know, that people are meeting the caloric minimum, right that there because again, they're so busy, or figuring out what is the more effective way of doing this or how can we provide the requirements despite a busy travel schedule, right, or all the other you know, things that are demanding and then right and then also right, like, yeah, work with chefs nutritionist. Work with other
35:00 With personal trainers, massage therapists, you know, other health care providers like you just so cool. Like you're part of the bigger picture.
35:11 If you're there for that it'll work itself out. Yeah, it sounds like I mean, I'm sure there are discussions that have to happen. But it sounds like the dream collaboration because you have access to literally everybody in the picture that you would want to be present in the picture there. That is just so cool.
35:28 Like, Oh, yes. Oh, God, if I said that to any of my performers, hey, can you connect me with your, your nutritionist or your chef, so I can work? And be like, Are you kidding? Get out of here.
35:40 But wow, that's that's really, really cool. That's, that's getting the opportunity for next level. Next level stuff. Um, I was wondering if you have any fun memories from your first day on the job without getting specific about the individual, but just any? Yeah. So. So the very first day,
36:04 you know, I'm working with President Obama, right. It's a
36:09 White House is an interesting place, because
36:13 there's the work areas, there's were offices and whatnot. But then there's also an area called the residence, and that's where the family lives. And it's off limits to the staff, like people don't, nobody goes into the residents. That's their home. Right. So I was going to see the President and
36:33 in order that we were going up through to the president, so we get into their private elevator, right. And it was, you know, people that Oh, my God, he's getting in the elevator with them. And I didn't know any better, right? So I just, I just introduced myself to him. He's like, okay, hey, come with me. We're gonna go on the elevator and go upstairs. And, you know, I'll get changed up and then we'll go start work. I was like, Okay, great. So I come in the elevator, and he's like, you know, Hey, man.
36:58 What part of the island are you from? And I was like, I'm sorry. He's like, You. You're from Hawaii right? Now, in context. He's Hawaiian. Right? And people probably can't see me, right. But, you know, I'm absolutely a Pacific Islander. And I said, Actually, man, I'm from Cleveland. And he was like, wait, what? I said, Yeah, I'm, I'm from Cleveland. He's like Cleveland. And this was big, right at the time, where LeBron James had just left Cleveland to go to Miami. And if anybody knows anything about Obama, he's quite the basketball fan. So he turns to me and says, Cleveland, ah, that's too bad about LeBron. Like, without, like, I just met this man. Like, and, and so like, you know, growing up in Cleveland, like, I immediately got defensive. And I was like, well, that's too bad that Chicago sucks and everything. Right? So like, immediately, like, and then I was like, oh, oh, I'll be shooting that right. Like, but like he put, I just was completely caught off guard and put me on my heels. And I got defensive about clean. He was like, looked at me, and was like, we're gonna be okay, like, we're gonna get along. All right, right. So that's great. Then people always ask, like, What are you talking about? What you know, what things and things I would tell people is, like, we talked about three things for the majority of our entire interactions, sports, weather, and kid. Those are the three topics that we could talk about, if the conversation ever went somewhere else, right? My answer was usually, like, there's probably somebody who could talk about that, but it's not me. But you mean, referred to. And I think the weather is going to be crappy today, right? Like, and I kind of focused on that right to make sure that I was doing my job, right. And those topics we kind of came to through through just general conversations, these topics are safe and easy for us to talk about, and allowed him to be a patient and allowed me to be a clinician. Yeah, because if you want into anything else, Woof woof. Yeah, yeah. Yeah, too much. That's really cool. I like I like how you found a way to be sensitive and helpful with that sensitivity, you know, to give a human a break.
39:20 For real Oh, that's so magnificent. I think this is perfect. We're going to end here thank you so much for coming on. I'm not sure if there is is there a way for people to reach out to you and contact you if they wanted to? I don't know somehow connecting you can probably the easiest way for the general audience is just find me on on social media. Right? You can find me on Twitter, you see on Twitter. Yeah. DC underscore PTS easy to find me. You know, and eventually I'll, I'll look at it and get back to people but that's probably the easiest way for Pete for this audience to get a hold of me if somebody you know, is interested or just wants to you know,
40:00 Here's something else let me know. Thank you so much for coming on and looking forward to people. Hearing this interview I have learned so much and grown so much and honestly just left very, very inspired. Thank you so much drew for coming on. Thank you. A big thank you to Jenna and drew for a wonderful interview. And of course, thanks to Net Health for sponsoring so again they have a new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net help.com forward slash li tz y to sign up for your complimentary marketing audit so you can boost your clinics online visibility, reputation and referrals. Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media | |||
| 579: Colin Carr: Commercial Real Estate and Your Practice's Profitability | 28 Feb 2022 | 00:40:47 | |
In this episode, Founder and CEO of CARR, Colin Carr, talks about commercial real estate for healthcare professionals. Today, Colin talks about the top mistakes healthcare providers make with their office leasing, the financial side of real estate transactions, and important considerations when making decisions on lease agreements. Should business owners buy their space or lease their space? Hear about how and when to negotiate, the importance of having representation, and hear Colin's advice to his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Colin Carr Colin Carr is the founder and CEO of CARR, the nation's leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to help them achieve the most favorable terms on their lease and purchase negotiations.
Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Commercial, Real Estate, Negotiations, Representation, Leasing, Finance, Business,
To learn more, follow Colin at: Website: https://carr.us LinkedIn: Carr Healthcare Facebook: CARR Instagram: @carrhealthcare
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read The Full Transcript Here: 00:02 Hey Collin, welcome to the podcast. I'm happy to have you on today.
00:06 Glad to be here.
00:08 And so today we're going to be talking all about commercial real estate for healthcare, healthcare practitioners. So this is something that you've been doing for quite some time now since 2009. So before we get into the top mistakes healthcare practitioners make when it comes to their office space, can you give us the quick version of how you got into this space working particularly with health care professionals when it comes to their commercial real estate and office needs?
00:38 Yeah, absolutely. So started in 19, Managing apartment complexes back in East Lansing, Michigan, little bit away from where I grew up, moved to Colorado, my early 20s started managing some mid rise, high rise complexes, downtown Denver, and I got into brokerage about 23. And I worked for a gentleman that did a lot of large national retailer. So Walmart's Wendy's blockbuster. And that's how I got into brokerage over the years, I started doing more industrial, more office. And a couple years in, I started doing medical office buildings and working on hospital campuses, Class A medical buildings, and just fell in love with working with healthcare providers. And after a number of years of doing that, I realized that the healthcare industry was one of the largest, most unrepresented segments and all of all of real estate, you know, every time there was a listing, there'd be four or five brokers trying to get that listing, whether it was office or medical. But when it came to actual doctors running around town trying to find space or trying to negotiate, I didn't see anyone doing it. So I've made a focus made an intentional effort to start helping more healthcare providers, and then in 2009, launched our company.
01:47 That's excellent. And as most health care providers can say, we did not go to school for any of this stuff. I can say, as a physical therapist, I didn't go to school to understand how to negotiate commercial leases, and office space and things like that. So having professionals with the best interest of the healthcare provider in mind is so incredibly helpful. And I'm sure you're quite busy. But now let's get to what are the top mistakes healthcare providers make with their office space and their leasing needs, so I will hand it over to you.
02:20 Okay, so we'll have a couple there's, there's more than a few. The first mistake that healthcare providers make is they don't know when to start the negotiation. You've got healthcare providers that are trying to negotiate with two, three years left on their lease, and there's no leverage, there's no incentive for the landlord to do anything for them, the landlord knows they're locked, and they're on the hook in that lease contract for another two or three years. And so they have no posture, they have no leverage. Other side of the coin is they try to negotiate when there's two, three months left in the lease. And the landlord is assuming that they're not paying attention. They haven't hired representation. They don't know the market, they're behind the eight ball. And so you can start the transaction too early. And it's a it's a sign that you don't know what you're doing. And you can start it too late, which is a clear sign you don't know what you're doing. And either scenario, the landlord is gauging how serious you are. How savvy Are you? Do you have other viable options? Are you willing to move? Do you really understand the market? And are you going to fight hard for the terms that are commensurate with the type of property with the the market you're in with the economic climate? Or are you just bartering or bluffing? Are you just hoping for a better deal and guessing? So starting the transaction at the wrong time? That's a that's a big one right there. And
03:38 where and where is the sweet spot then? So it's like, it's like, what is that? Is it the the three bears? Goldilocks and the Three Bears like one bed was too soft, one was too hard to kind of have to find that sweet spot in the middle. So when it comes to negotiating, when should healthcare providers be thinking, Alright, now it's time to reach out to my landlord and start this process?
04:01 That's great question typically is right around 12 months from when your lease is about to expire. If you go outside of 12 months, again, the landlord's just don't have any real incentive to negotiate, because in their mind is I'll deal with it later. They can't go anywhere for 12 months or longer, and so they don't pay attention. But again, if you get too close, if you need to relocate, you don't have time to make that transaction happen. If you need to go to a new property, the negotiation process, the site selection that can take several months on average, you know, getting landlords to respond and negotiating the terms, getting an architect involved to look at the floor plan that takes a few months, it can take a month or two just to negotiate the actual lease contract Once you agree on terms working with the with the attorneys. And then if you need build out and you have to pull a permit or get contractors involved that can take another three or four months as well. So the ideal time is right about 12 months, that gives you enough time to handle each one of those steps that I just mentioned, but it's not too far out there.
04:56 Right. Excellent. All right. So Mistake number One not knowing when to negotiate. Now we have a better idea. What's another mistake?
05:06 Another mistake? And I'd say it's probably the top mistake. It's the do it yourself approach,
05:11 do ya probably be that would probably be was something I would do? Yeah.
05:15 Well, and there's a lot of reasons people take the DIY approach. Number one, it's typically because they're so busy, they don't know who to contact, they don't have time to do the research or due diligence in their opinion. And then it just comes up if the lease agreement shows up in the form of a landlord knocking on their door or property manager saying, Hey, listen, your lease is coming up, what do you want to do, and they just say, hey, send me a proposal. And that that starts the process of them doing it themselves. Or maybe you're looking for a new location or your first office, he started driving around, and you pick up the phone, and you start calling the listing broker landlord, asking questions, and all of a sudden, you have engaged and start the process all by yourself. The problem with this is that that is not the game plan for successful companies. If you take any national retailer that people would respect and say, hey, they do a great job, you take a Starbucks or Chipotle, they don't have some random person calling on properties or asking for proposals. They have a team of in house professionals and they utilize outsource experts that all these people do is negotiate professionally for a living. So when a landlord gets a phone call from a doctor or an office manager, no matter how well meaning that person is, the landlord is going to assume they don't know what they're talking about. And it's not, they're not trying to take shots at the person, they're just going to assume, Hey, you don't know the market, you've not want to look at 10 or 15 properties, you're probably not negotiating with three or four landlords simultaneously going three or four rounds of negotiations. And at the end of the day, if you were really serious about capitalizing and saving $100,000, on your next commercial lease, you would have engaged an expert, it's it's similar to, if you get audited by the IRS, if you don't get a really good CPA involved, you're probably not too serious about getting the outcome you're looking for. If you go to court, and someone's bringing a claim against you, or they ask you to go to mediation and arbitration, and you show up by yourself, you get your signaling, I'm probably willing to accept a much inferior result because I don't have the time, the money, the resources or whatever. And so when a landlord sees a tenant show up on representative, it doesn't matter if it's health care, or, or retail or office, they just assume that that person doesn't know what they're doing. And so that's, that's gonna cost the person a lot of money.
07:31 Yeah, so you really want to have the right professional at your side, so that you're not getting taken advantage of you're not prolonging things. And like you said, I love how you said that they're there thinking that you're willing to accept an inferior result. And as as a health care provider, or a physical therapist, like if, if someone broke their leg, and they need to rehab, well, they're not going to go to their account, and they're going to want to go to a physical therapist, that you don't want to do it on your own, because you're not going to get the right results. So same thing, right? You always want to have the right professional at your side.
08:08 Yeah, I mean, this would be much different than if a patient you know, if you talk to a patient or potential patient, and they needed to rehab something, and you knew it was an advanced rehab, and it's a time you have you have instruments, you have technology of equipment. And their response is, Well, I'm just going to head and figure it out. Like I'm going to search the web and just do some research, your response would be well, there's, there's a better game plan like you can, you can do that. And you can get some type of result or some type of an outcome. Just like a landlord knows, hey, you can you can lease a space without representation, but it's probably not going to be the most effective approach, you're probably gonna waste a significant amount of time. It's probably gonna cost you quite a bit of money. It's very similar.
08:41 Yeah, yeah. Okay, so don't know when to negotiate the DIY approach. What else? What's another big mistake?
08:51 Yeah, another big mistake. And I mentioned it briefly. It's negotiating on only one property. And this is different when you when you compare residential versus commercial real estate, okay. And residential. If you're going to buy a house or buy a condo or townhome, you go look at properties, you search online. And then when you find the property you're interested in, your agent writes a contract for you and they deliver it to the seller. If the seller signs it, you're under contract, you have the ability to cancel that contract with inspection, objections, financing, deadlines, and so forth. But you submit an offer towards one property and if they say yes, you're under contract, it's a binding contract. Commercial Real Estate works on what's called a letter of intent and loi, or a request for proposal and RFP. In either scenario, those are typically non binding. 99.9% of are non binding. There's, there's ways you can make them binding, but they're intended to be a non binding negotiation. And so in commercial real estate, the most strategic gameplan is you go look at X number of properties that meet your criteria. you narrow it down to the top three or four properties that are the best fit, even if one or two property One of your properties are the clear winners, alright, but you still negotiate on three or four properties. And you might even go two or three rounds of negotiations. The reason you do this is because it gives you the true picture of the market. You can't just go off what they're asking as a quote and lease rate on a brochure, because there's too many variables. Is the lease going to be a three year term? Or a 10? year term? Are you asking for no money for improvements? Are you asking for a couple? $100,000? Do you need a free build out period? Do you need free rent Upon moving? Or the annual increases? 2% 3% 4%? Are you going to personally guarantee the lease Are you trying to have your practice or business guarantee it, there's all these variables that are there. And so you've got to negotiate with multiple landlords to get a real feel for what the market offers. And when you do that, a couple things happen. Number one, landlords get more aggressive and competitive when they know they're competing. If a landlord thinks that this is the only property you're interested in, and you tell them, hey, this is my dream location, or you show them your cards, you're not going to achieve the best terms possible. And so being able to leverage multiple landlords against each other, again, respectfully with dignity, not you know, not not doing things in a way that's that lacks integrity, or cuts corners. But if you do it properly, you're going to know if that lease rate is market below or above, you're going to know if that's the right TI allowance, the right free rent package. And if you're getting three or four landlords to do something over here, and another, and another one over here is not one that you can leverage those against each other. And that, ultimately, is how that's one of the top ways that you achieve the most favorable terms possible.
11:31 Got at first, I thought you meant Wait, how many properties Am I getting, but it's not negotiating. It's not for you to have multiple properties. But it's for you to negotiate a single property, but through a lot of different through a couple of different landlords so that you you're kind of getting a better idea of the landscape,
11:52 you're you're gonna pick three or four properties to negotiate with, you're only going to choose one of them at the end of the day. But again, every landlords motivations are different. And so you might have two properties that you like equally, one landlord might be much more aggressive than negotiation. And if you add up all of the economic terms, you might find that two properties that appear very similar, that start out with pretty similar starting or quoted lease rates, you might end up with 100 $200,000 savings on one, or 100 or $200,000, in increased costs on the other. So just because the properties look similar, because they have close to starting lease rates, by time you actually work through all those economic terms, you can end up in a very different economic situation. Oh,
12:34 my God, I love that that is such a good tip. And I'm sure that's something I would never even think about. I would just think, well, I guess I'll just go with one property. So that is a great, great tip. Anything else? What other big mistakes and I know you said there's probably so so many, but maybe we'll keep it to like four or five.
12:52 I'll do two more of this. Okay, you quit, okay, I'm gonna kind of hinted at it. The next mistake healthcare providers make they tip their hand to the landlord, they tell the landlord, this is the property I want, or this would be the perfect space for me, or during a lease renewal negotiation, which is by which is by the way, that's the number one transaction in all commercial real estate, more lease renewals happen every year than any new office or purchase or relocation, okay? The number one mistake they make there is they talk to the landlord, landlord comes their office, the landlord might even be a patient, you know, property manager stops by and they say, Hey, your lease is coming up for renewal, what do you want to do, and the doctor says something along the lines of why don't want to move, or the space works great, send me a proposal. And again, what you have just signal to the landlord is you're not looking at the market, you're not hired representation, you don't know if it's going to be a good deal or a bad deal. And most likely you will accept an dramatically inferior deal. So signaling to the landlord again, you should not be telling the landlord anything that hurts your posture position, and they're looking for you, they're going to ask you questions, trying to get you to tip your hand. So that happens all the time. Here's why healthcare providers get into health care typically, because they want to help people. They're fascinated by the science. They're fascinated by the ability to transform people's lives to help protect lives, save lives, enhance lives. And they're not getting into health care, because they want to be a stone cold killer negotiator. Yet they're going up against landlords that are not playing games that have buildings that are worth 10s of millions of dollars. And those landlords get into real estate because they wanted to be a professional negotiator. So just be very careful what you say the best way to avoid this is to hire representation, let them talk to the landlord for you. And they will keep a very tight posture in the entire process.
14:43 Excellent. Okay, what's number five? Five, the
14:46 last one? Yep. Five. The last one is healthcare providers love talking to their peers and colleagues. And then they take that information that becomes the standard. And that's a really bad way of doing business. So So you might be in a building with with other tenants might be a dry cleaner could be another healthcare provider could be a restaurant. And they'll ask those tenants or neighbors, Hey, what are you guys paying? Or what did you get on your last negotiation, and then they share that information. But what they don't realize is they're asking people who may or may not have gotten a very good deal. We had this scenario, once we were helping a doctor in a building, it was a completely medical building two floors, six or seven doctors on one floor, six, seven doctors on the second floor, and we were talking to the doctor, we were looking at his lease, and he was significantly above market. And we said, hey, who's negotiate and what the last two or three renewals you've done? And you said, Well, I've done it myself every time. And we said, you know, how do you feel about these terms? Because this is exactly where the market is. And I said, How do you know that he goes, Well, I'm, I'm good friends with three out of the six doctors on this floor, we talk to each other all the time, we refer patients back and forth, we've we've swapped leases, everyone's paying the same thing. We're all paying $30 per square foot. And I said, well, like just so you know, their marketing space in the building, way lower than that. And we just negotiated a brand new lease on the first floor for a doctor at $21 per square foot. So you're gonna dollars a square foot above market, okay? And you haven't got any free rent your last couple of renewals. You haven't got any tenant Premadasa, renovate your space, and you're telling me you didn't get those because no one gets those I'm telling you right now, you and your three or four friends have been consulting with each other, you just have no clue what you're doing. So taking advice from somebody who is bad at negotiating or getting a really bad deal is super common. And so people share stories. They're on all these, you know, Facebook groups throughout all these threads, and everyone's sharing their experience, and it is their experience, but it might not be the best gameplan. So that's another big one we see too is talk to your friends about things clinically, when it comes to real estate, talk to real estate professionals when it comes to legal things, talk to attorneys comes to financials, talk to CPAs don't don't talk to other doctors about this. If they don't know what they're doing.
17:05 What a gut punch is, right? That guy must have been like, what $9? Over? Oh my gosh, what a Yeah, what a kick in the pants. That is. Okay, so those are really great. Five Great tips, five mistakes that people often make with their commercial real estate. And throughout that one theme certainly seem to emerge. And that is having representation on your side. So when it comes to commercial real estate agents, let's start with number one. How do you choose the best commercial real estate agent? And then how much does it cost? Because the cost is probably why people end up doing mistake number two, the DIY approach, right? Okay,
17:48 both both great questions. There's a handful of ways to find a really good real estate agent. Number one, if you're a healthcare provider, you want someone that has healthcare experience, it's very different talking to a real estate agent that focuses on million square foot distribution centers for Amazon, than it is someone who's working on a 2000 square foot physical therapy space, very different transaction. And commercial real estate, you got people that all they do is apartments, all they do is Office, all they do is retail, you want to find someone that understands healthcare that works in the healthcare space, number one. Number two, you want to find someone who's only going to represent your interests, commercial real estate, and residential real estate are known for agents that try to work what we call both sides of the deal. They're trying to represent the lammeter seller, and also the tenant or buyer, that is a clear conflict of interest. You can't negotiate for two opposing parties. It doesn't work that way. And so this is the idea of saying if somebody is suing you and you're going to court and you're asking the prosecuting attorney, if they'd give you advice, like that's literally what's happening, their client, the landlord or seller, they have a fiduciary to help that person or that group, make as much money as possible in the transaction and protect their interests, they cannot do the same for you. So you need to find someone that's not going to have a conflict of interest, someone who works in the tenant buyer side, who doesn't have listings with landlords in the area that you're looking because you want an unbiased approach with someone who's going to protect you right now. So those are two really important things. The next thing you say is, well, how do I find those people? You can search online, but typically, in any healthcare industry, you're going to have people that if you ask them, Hey, who do you know that specializes in healthcare, real estate for doctors, you're gonna have lenders that tell you, hey, this person or these people do, you're gonna have architects, contractors that have worked with these agents on a number of deals. And so there's a lot of referral partners in the industry that can weigh in on the topic. And so if you ask a handful, you should be able to get a few names very quickly, people that specialize in that area, and then what you need to do again, and that process only takes a little bit of time. It's not it's not no one's asking you to take a whole week off to spend dedicated towards that. But once you find a couple names, you need to speak with these people. You need to interview them, you need to talk them and say, what would your strategy be to help me maximize my profitability in my next transaction? How are you going to protect my interest? How can I know that you are the best fit for me? And like any other relationship or service provider, you're going to know quickly? What their responses just like a patient would say to you. Hey, how are you going to? How are you going to get me healed up? What is your game plan for me to get restored? Or to get you know, rehabilitated? What do you want to do, and you've got to earn their trust, it's the same way in real estate. And I tell doctors this all the time. If you talk to an agent, and you don't think that agent is the best fit, move on to the next one. And I mean, that's what we do for a living, I tell doctors, then if it's not us move on to the next person. Like it's, there's too much on the line for you to for you to just take whoever's there, don't settle in this area, find the person that you trust that you want to work with, that you believe has your interests in mind. And then that's how you get engaged. Yeah,
20:55 great advice. You beat me to the punch, I was going to ask you what questions to ask how do you vet and you just gave us those answers. So that was amazing. Now, let's talk about the money side of things. Because health care practitioners, yes, we get in to help people, we have our own business, it's also a business. So we want to make sure that we're maximizing our earning potential, if you will. So let's talk about one How much does it cost to hire a Commercial Real Estate Agent?
21:24 Okay, so that's one of the best parts of this entire conversation, it will not cost you as the doctor any money to hire a real estate agent. It's just like residential real estate. If you are a buyer, or a tenant residential real estate, you engage an agent as your exclusive agent, and they receive a portion of the commission from the landlord of the seller. So commercial works just like residential, again, for anyone in residential that's ever owned a house, when you hired an agent, you agreed to pay two Commission's one to your agent, and one to the buyer's agent, Sandman commercial real estate. And this is one of the biggest mistakes that healthcare providers make as well, we could put this as number six, if we wanted to, is they assume they're going to save money by not having an agent. And so they say, You know what, I'm not going to hire an agent. So I'm going to save money. But here's the reality, you're not determining whether or not a commission is paid or not paid. You're not determining what that commission amount is, when you go to a property, that landlord already has money set aside for every transaction. Even if they don't have a listing agents, they're doing it internally, they still have a commission set aside for every transaction. And if you do a deal as a doctor all by yourself, the listing broker gets a double commission, not one, but two, they double up to take both sides of it, or the landlord just keeps that money. And this is this is what happens is, you know, a lot of doctors have this like the do it yourself mentality. I always joke, it's like, every time you see a U haul moving truck, it says move yourself and save, right. But if you're moving yourself and give you a U haul, yes, you save money because no one's offering to pay your $3,000 movie bill. In commercial real estate, there's a commission set aside for the listing agent, and for the tenant or buyer's agent. And when the doctor the tenant doesn't have an agent, listing broker takes a double Commission, or the landlord just pockets that money. So it's 100% free service, it's not going to increase the lease rate for you, it's not gonna cost you money, it'll save you a significant amount of time. It'll help you avoid costly pitfalls, and it should save you a significant amount of money as well.
23:27 Okay, and that leads perfectly into my next question. So you had said earlier that lease negotiations or lease renewals, I'm sorry, are the thing that happens the most when it comes to commercial real estate? So how can healthcare providers or anyone for that matter, save $100,000? Or maybe more on their next lease renewal?
23:52 Great question. So we're gonna take, we're gonna accumulate my prior answers, and we're gonna, those are all the ingredients in that. And then here's what it looks like. So 12 months prior to your lease expiring, and you're going to look at your leisure going to figure out when you're when your dates show that you expire 12 months before expiring, you're going to start the process of finding an expert, commercial real estate agent in your area that represents healthcare, attendance and buyers that knows your industry, you're going to you're going to, you're going to call x number of people until you find the right person that you want to go forward with, you're going to engage that agent and you're going to have an exclusive relationship with that person, okay? That agent is going to take your requirement, and they're going to go to the market and we're going to find every property that meets your requirement. And they're going to whittle it down to the top three or four properties, even if you don't want to move. Even if you think that moving would be a convenient, they're still going to do their due diligence, and they're going to they're going to take their time energy and they're going to negotiate with three or four landlords simultaneously. And they're going to get to what's called best and final term so we're you know, if you were going to move to the property across the street, or down the street or across the city, you're going to know exactly what it would cost to do that, and you're gonna know what the economics would look like if you wanted to transact there. Once you have that information, you can now go to your, that agent can now go to your current landlord, and can negotiate with factual data, and with a very specific game plan. And here's why this is so important. Again, you can get this thing backwards. If you go to your landlord, and you ask them for an offer, you start negotiating. Here's the question, compared to what, how do you know if it's aggressive? You can compare it to what you're currently paying. But again, what if you're above market, and they say, well, I'll bring you down $2 a square foot, you can say why just save a bunch of money? Well, if you can move across the street don't say $5 a square foot. Or if you get a better landlord, or a better space or a larger space, you can't compare your current economics unless you are comparing them to other properties. So your agent goes, the market gets the top options negotiates, and then goes to your current landlord, and says, Listen, we brought to the market, we know what's happening. I'm a market expert, my clients now educated, and we got three or four other viable options, we'd like to have a negotiation and discussion with you, but it's gonna have to meet our criteria, because we've got two or three other properties, that could make a lot of sense for us, if you don't want to get competitive. And when landlords know that you're not an idiot, you know, you're not, you're not ignorant, you're not, you're not, you're not just gonna take whatever they give you, they come to the table with a much different approach. And when they know you're represented by an agent that is an expert, they're not going to waste their time trying to convince an expert that their deal is good if it's not good. So that that's the process. In a nutshell, there's a lot more to it than that. But that's how you get to the landlords, that will actually give you a good deal. Because at the end of the day, if you do move out of that property, they're not going to get the next tenant to pay above market, they're not going to get away with not giving them a tenant proven allowance or not giving them free rent, or trying to gouge them, because the new tenant won't take it, they'll just have go somewhere else. And so the landlord, if they think they've got you know, pushed into a corner, you have no other options, they will stick it to you. If they think that you have the freedom to move that you're willing to move, you got the help to move, they will come with a much more aggressive offer. And typically, at an average space of two 3000 square feet on a five or seven year deal. Those those numbers add up to usually a minimum of $1,000. And oftentimes hundreds of 1000s of dollars, that can be one in
27:23 your favor. Amazing. Again, having the right people in your corner doing your research coming to the table with facts and figures so that you have leverage to negotiate. All makes perfect sense. And now as we start to wind things up here, I just have a one, I think really interesting question, because I hear this quite a bit chatter on social media, when it comes to at least physical therapy business owners is do you buy your space? Or do you lease your space? So can you talk about that?
27:54 That is a great question. That's probably one of the top questions that we receive. The answer to that is you should look at both your options, don't pray determine one or the other, because every markets different, every economic climates different. And you could be in some markets where where you have multiple options to own and it's phenomenal other markets, there's not one option to own. So I mean, if you're doing real estate in a suburban Tulsa, that's different than if you were downtown Manhattan. I mean, you've got to know the different markets. What we tell healthcare providers is listen, we're going to go to the market for you and find the top properties that meet your requirements. And we're going to look at office options to lease and options to purchase, we're going to look at retail options, we're going to look at office options. And we're going to show you the top of what's available, you then are going to choose which properties that you're the most excited about. And then we're going to negotiate on three or four properties simultaneously. And then economics will tell you very quickly which property is going to make the most sense for you. If you can find a property to purchase. That's that's a top property if you love it, and the economics makes sense. We are a huge proponent of owning commercial real estate, you're building an additional asset, if you sell your practice, you can lease out the space. And typically that real estate is going to sell for more than your practice will sell for. We track this across the country, we work with 1000s of providers every year, and the real estate sells for more than the practice over 75% of the time. So if you could be an immediate to pay rent or mortgage either way, you've got to pay a landlord or or pay a company a mortgage company. So you're basically paying yourself in certain aspects of it. You got to make a payment either way, if you can own real estate and economics work phenomenal. A lot of times what you'll find is are you willing to pay more to own than to lease because of the upside. And so you might have scenario where it costs you an extra couple $1,000 a month to own and you get you have to decide is it worth that? Is it worth the extra expenditure to pick up some additional tax deductions to pick up that principal pay not every month you got to check X number of dollars go to pay down principal on the loan, your net worth goes up every month. And so we have those scenarios, if it's if it's 6000, or 6000, at least that's a no brainer at the back, right? If it's 10,000, or 6000, at least, you got a decision to make there a lot of times it's, you know, 12, or $15,000, or 6000. The least. And you have to decide which makes the most sense for your practice. And then you get in another 10, different evaluations, what's the downpayment? What's the cost of entry? What are the economic financing terms available to you? Is this space gonna fit you for three years? Or five years? Because if so, we don't want to purchase that we'd rather lease for three or five years, and then have you purchased the next location, if it's gonna fit you for the next 20 years? Again, that's a different story. So there's all these different variables, there's no one size fits all. There's there's groups that we help lease a couple spaces for that purchase, purchase couple spaces, then lease a lot of variables there.
30:48 Yeah, and and again, that's where coming together with your team makes a lot of sense, and and doing your pros and cons. But I hear that quite a lot. So thank you so much for your input on that question. And now, if you could put a bow on this conversation, what are the top things you want healthcare providers to walk away from when it comes to their commercial real estate questions?
31:17 Yeah, that's a great question. I would say, just realize what's on the line. We're not talking about, you know, did you overpay for a box of gloves, you weren't paying attached, you ran out and you know, you overpaid by $2, for a box of gloves, and you can go, you know, buy in bulk next week, or you have your supplier set, you know, whatever, we're talking about a transaction that you engage in every once once every five, seven or 10 years. If you make a mistake in it, again, the world's not going to end. But it will cost you 10s, or hundreds of 1000s of dollars in additional payments that you could have avoided. And there's a lot of other things that are on the line. Like there's economic terms, there's also business terms, what happens when you want to sell your practice, can you get off the lease, or you get stuck guaranteeing a lease for the person that buys your practice, because you don't have the right assignability class. So I would say this, make sure that you're treating your commercial real estate with the respect that it's still again, I mean, you can still do a lease, you can still stay in practice, etc. But again, the world's not gonna end. But there is a cost or a penalty to messing up here. And it's pretty high. Find a good agent, find someone that you trust, and that person will save you literally 3040 hours of your valuable time, they'll save you a significant amount economically, it's usually usually a minimum of 10s of 1000s, if not hundreds of 1000s. They'll also help you avoid complications and delays that come up all the time in commercial real estate when people are not paying attention. And then the last thing I'll say and I think this is more important than all these is that person's going to give you peace of mind. You're not going to have to wander every night you go to bed and put your head on your pillow for the next 10 years, you're not going to wander Did you get a good deal or a bad deal? You're going to know exactly what what terms you negotiate and how they compare to the market, you're not going to wander if you miss seeing a better property and you should leave somewhere else you chose, you chose the third or fourth best product in the market, he's just would have gone to market you would have known better, you're gonna have that peace of mind. So we can talk about saving time saving money, avoiding complications, delays, pitfalls, but I think ultimately, that peace of mind is invaluable. And for me, that's that's what I'm trying to deliver every time that I work with a client.
33:19 Yeah, you had me at saved 30 to 40 hours of your time. You could have ended it there. But I love having that peace of mind being able to sleep at night knowing that you really got the best deal that you possibly could because you started 12 months ahead of time you hired someone you had a team by your side. So perfect sense. So now, Collin, where can people find you? If they want more information? They have some more questions. What's your contact?
33:49 Absolutely, the best way to get ahold of us is our website. And that is car that US ca rr.us. On our website in the upper right hand corner, we have a couple options on our navbar that are of importance. Number one, you can click the Find an agent in your area. We've got agents coast to coast, we represent 1000s of healthcare providers every year, and we are working, we're working literally in all 50 states plus DC. So click Find an agent in your area. And then that's a great way to start. Another thing we have is a free lease evaluation. If you want to know where you stand in the market, even let's say you signed a lease last year and you got nine years left, we can still do a free lease evaluation for you. And we'll tell you where you stand based upon the market currently, if the market corrects, as we've seen some crashes last two years, who knows what we're going to be tomorrow, let alone five years now we can update that over time. So if you want to know where you stand in the market today, in a few years, we do that all the time, we can do it very quickly. And again, we can give you the peace of mind knowing where you're at and if you're way above market, then we're gonna try to capitalize on the next transaction. If you did a good job in your last deal, again, that gives you peace of mind knowing that you're in a pretty good position. We want to protect that or reserve that in your next negotiation. And then the third thing is we have a ton of resources if you want to study up, if you want to get educated, we got literally hundreds of articles, blogs, educational videos. And if you're interested in commercial real estate because it affects your practice, and you want to know more, we will give you information that will make you the subject matter expert.
35:21 Excellent. That was perfect. Now I have one more question that I asked everyone. And that is knowing where you are now in your life and in your career. What advice would you give to your younger self? So let's say that 19 year old in Lansing, Michigan, what advice would you give to him knowing where you are? Now?
35:39 That's a great question, I would say, surround yourself with the most successful people that you can get around. If you can get around them personally, and they'll spend time with you then do it. If you can't, then get around them through watching their podcasts through reading their books, you know, following their history. And then I would say that there's there's no substitute for hard work, you're gonna make mistakes, you're gonna fall down, you're gonna you're gonna do things that in hindsight, were less than intelligent to say them politely. But you just that's part of the process, owning a practice, you know, becoming a professional, anything in life, working as hard as you possibly can, and then learn from your mistakes.
36:17 I love it. This was so great. Thank you so much for taking the time out. I mean, I was taking notes furiously over here because I think this is such great information for certainly for healthcare providers, but I would say anyone that is looking to get into a commercial space, this was wonderful. So thank you so much. Absolute. It's been a pleasure to be with you. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.
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| Ilana Muhlstein: Reframing Your Weight Loss Mindset | 12 Sep 2024 | 00:43:48 | |
In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy interviews Ilana Muhlstein, a dietician, nutritionist, bestselling author, and mother of three. Ilana shares her personal journey of weight struggles and how it led her to become a passionate dietitian. They discuss nutrition, mindset around eating, and how to talk to kids about healthy habits. Ilana's success as a female entrepreneur is highlighted, showcasing her mission to make a healthy lifestyle more attainable. Tune in for valuable insights on nutrition and mindset from this global health and wellness expert!
Time Stamps: 00:00:02 - Introduction and Guest Introduction
More About Ilana Muhlstein: Dietitian, nutritionist, bestselling author, and mother of three, Ilana Muhlstein, MS, RD, is a highly sought-after global health and wellness expert. At the age of thirteen, Ilana weighed over two hundred pounds and struggled with weight loss, emotional eating, and ineffective diets. This molded her passion to become a dietitian with a mission to show people that a healthy lifestyle is easier and much more attainable than they think.
Resources from this Episode: HWPOD10 for all Ilana Housewares orders over $70 or more. (www.ilanahousewares.com) PODCAST10 to get $10 off your first meal- receive an extra 5% off when you subscribe! (www.ilanameals.com)
Jane Sponsorship Information: Mention the code LITZY1MO for a free month
Follow Dr. Karen Litzy on Social Media:
Subscribe to Healthy, Wealthy & Smart: | |||
| 578: Dr. Sherrill Williams, DPT: DEI In the PT Profession | 21 Feb 2022 | 00:26:16 | |
In this episode, Dr. Jenna Kantor interviews Dr. Sherrill Williams about diversity, equity, and inclusion in physical therapy. Mabout Dr. Williams here: A lifelong dancer and lover of the performing arts, Dr. Williams committed most of her life to studying Ballet, Modern, Jazz, and Hip Hop. It was not until her commitment to losing 90 lbs that she fell in love with fitness, and wanted to find a way to fuse her love of dance with health and wellness. This new mission sparked a fire that led to Dr.Williams receiving her Doctor of Physical Therapy degree from New York University. Shortly after she founded Leg Up Fitness and Wellness, an online fitness company for performers that want their workout to feel less like exercise and more like dance. Leg Up's client credits include but are not limited to The 1st US National Tour of Aladdin, Hamilton, Lion King, Lizzo, Jidenna, John Legend, Todrick Hall, and Complexions Contemporary Ballet. Dr. Williams is a passionate advocate for dance injury pre-habilitation and rehabilitation and loves helping dancers around the U.S. virtually and in person. Follow Dr. Williams: Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35 Hey everybody, welcome back to the podcast. I'm your host Karen Litzy. Today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net house digital marketing solutions, has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how Net Health Digital Marketing Solutions can help your clinic when they'll buy lunch for your office. If you're already using that health private practice EMR Be sure to ask about its new integration, head over to net health.com forward slash li tz why to sign up for your complimentary audit today. And like I've said before I actually use this product it works man did a bump me up in the Google search was awesome. Now on to today's podcast, which is being hosted by the ever wonderful Dr. Jenna cantor. And in today's episode, she interviews Dr. Cheryl Williams, a lifelong dancer and lover of the performing arts, Dr. Williams committed most of her life to studying ballet, modern jazz and hip hop. It was not until her commitment to losing 90 pounds that she fell in love with fitness and wanted to find a way to fuse her love of dance with health and wellness. This new mission sparked a fire that led Dr. Williams to receiving her doctor physical therapy degree from New York University. Shortly after she founded leg up fitness and wellness an online fitness company for performers that want their workout to feel less like exercise and more like dance leg UPS client credits include but are not limited to the first US national tour of Aladdin, Hamilton Lion King Lizzo Jidenna John Legend Todrick Hall, and complexions contemporary ballet. Dr. Williams is a passionate advocacy for dance injury, pre habilitation, and rehabilitation, and loves helping dancers around the US virtually and in person. So big thank you to Jenna and to Sherelle for coming onto the podcast so everyone enjoys today's interview.
02:42 Hello, healthy, wealthy and smart. This is Jenna cantor. I'm here with Dr. Sharon Williams, and I cannot be so grateful. So much more grateful right now to be on here with you. First of all, thank you, Sharon, for coming on to talk. Thank
02:54 you. Thank you for having me. I'm excited to be Yeah,
02:59 I love it. I'm really grateful on so many levels, the one we're friends to. And I think this is where I'm starting with where I'm comfortable and where I need to expand. So I'm just owning up to this. In physical therapy. I don't know a lot of black physical therapists, like holy crap. And so you're one of my few. And when I really took account, I took accountability. And I was like, Oh my God, a few people that I know who are black. So I'm starting with people I know. And then I'll expand out to more and more and more and more and more people and increase my network. But that is sad. After calling myself out. I am really excited to be talking about diversity equity inclusion. I feel like that was a pretty good segue because that is yeah, that is legit. So let's go back. You are a new grad congratulations. Thank you. We made it. We made it made it Sherelle is one of those people who thinks big and then achieves the big. So she's a nice person to be regularly inspired by and I'm super grateful to know you Sherelle. So diversity, equity and inclusion. What rehearing that whole statement in as one what are some first thought that comes to mind when it when it comes to physical therapy? There is no wrong answer. I just want your truth.
04:29 Well, I was gonna say when you like yeah, you're like one of the few black people I know that's a physical therapist. I was like me too, girl. Oh, no, me neither. Oh, I didn't know. Yeah, um, to be honest, I think it was CSM where they had a, a networking event and I was like, oh, there is a little community of us but we're just all scattered or you know around the world. But when I think of the Diversity, Equity and Inclusion within physical therapy, you know? No, I don't want to say non existent, but it's just, it's very small. You know, when I went to NYU, you know, I did visit a few schools. When I was doing the audition process when I was
05:22 Joe and I both are performers, as well. So that's what why audition process came to her mind. That's hilarious.
05:31 When I was going through, like the interview process, and I was looking at different schools, and like NYU, you was one of the few schools that you know, I did see quite a few black people. And I had, there was seven of us in my class, and two men, two black men, which is like crazy that I'm excited about to black men. But like, you don't see it at all.
05:59 No, you don't.
06:02 And it's an it's unfortunate, because it's such an amazing field. And I'm still kind of at the point where I'm like, is it that we are not applying? Because we don't know? Or is it that? You know, they're not letting us in the door? And I haven't really figured that out yet. But I do I do feel like a part could be, we don't know. Because a lot of times I feel like especially in the African American community. And you can also say African because those communities are very different. Culturally, you know, people No, go go be an ND nd ND, ND, ND nd? Or what do we need to do to get more people of color in or black people. Because I think that's going to do wonders when it comes to the community and getting people up. And, and healthy. Because unfortunately, in our culture, not many of us, I think my generation is more, it's a lot more active, but the older generation, not move until I think when we get more more people of color in into the field, and then we're talking about it. And we're excited about it, you know, then the community will come to and we'll see, you know, more people being active. And that's just my theory. That's what I've seen based on, you know, my family when I started school, that's what I'm talking about. I'm talking about moving. And my mom is like, oh, yeah, I'll go get a trainer. Or I'll do this or I'll move or they you know, they see me we can lead by example.
07:42 This is so helpful. Because everything and what you're calling rambling I call a more clear insight into what's true in your mind regarding diversity, equity and inclusion. And it's not just one component that it there's a need to be looking upon. First of all, with defining diversity, equity inclusion for you, like it seemed as though we're talking about black people, right now, we're just in which is that's absolutely, we're not seeing it. i There were very few in my class, and I didn't think anything of it. You know, to me, the fact that there were some people who are black, there were some people who were Asian, there were some people of some sort of Indian descent was like, wow, look at us, but there could be more. I agree from what, yeah, I still as a white person, I did not feel like a minority at all. In that group. In that setting. I felt just like, you know, hey, which is Yeah. My point is, from all these little things, let's start separating out different things that you were mentioning, first of all, with getting people in getting people into the profession, how did you get reached?
09:05 I, to be honest, I sort of think I got into NYU, praise God, I did apply to like 13 schools. I only got into NYU, and I honestly think it's because they had an interview process. Because on paper I didn't have like a four Oh, and I had some C's and I had to retake some classes. But when you get me in person, I can tell you and and why you happen to have an interview process and and I was able to shine in that way. And I think that speaks volumes. I hope that maybe other schools can adopt that because sometimes our paper with we don't, you know, I mean like but that doesn't have anything to do with, you know, how compassionate we are or how smart we are what will be Be like as, as a physical therapist, especially based oh my god, we had the GRE, I
10:08 didn't do the grade on that either. It's interesting, you're saying that because everything on paper only shows part of the picture. So when the schools are making it like that, and they're just looking at paper, I mean, right there, we are automatically going to be leaving a lot of people out, because our school systems are not equal. Yeah, what people are learning are not equal. So if you're just going off of what they happen to be born into, we're really cutting people off. We're really, really cutting people off from opportunity, and therefore, just continuing the cycle of a lot of whiteness in our field.
10:47 And something that I saw that I think would be also be great, like, okay, let's say we don't have time for the interview process, some of the HBCUs. Or if you don't know, historically black colleges and universities, they did like a video, like you had to send in a video and answer a prompt. And that way you get you get to show yourself. And I thought, you know, that was that was great. You know, I mean, it's something that could also be adopted by other schools. To give us a chance, you
11:24 know, I mean, absolutely, I think I think that that's a great idea as a way to be the change be the change. I don't know if you've ever heard this where it's, you know, God, it's a very I don't like this rhetoric, but it's the one where people are saying, not everyone, but people are saying, Oh, well, now people are just getting in because they're black. Can you share some thoughts to that? Because for so you know, I have an angry look on my face and Sherelle rolled her eyes. We're not shy about that. All right, would you mind response to that? Because, I mean, it angers me, but let's talk about this.
12:08 And on that note, we're gonna take a very quick break to hear from our sponsor, and be right back with Shirelles response. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net help.com forward slash li tz y to sign up for your complimentary marketing audit.
12:52 Wow, I've also never discussed this. I mean, if I was just to like speak, honestly,
12:57 yes, please.
13:01 White people get things because they're white all the time. Like not based on merit, not based on skill based on who they know. Or a back door. You know what I mean? And I as
13:17 a person who has benefited in that way, I can absolutely agree. It's Yes, yes. It's true. It's legit happened to me. I like I'm grateful. That's amazing. But like, also, that's so true.
13:32 And, and we're like we said this, the schools are not always even, we don't always have, you know, these connections. But a lot of times when you give us a chance, we go above and beyond, because we're like, hey, my ancestors didn't die for this. So I mean, like, and we deserve the chance, I just think we deserve the chance. The playing field is not going to even and this is our opportunity to try and be able to own probably, I think it kind of goes deeper than just Oh, black you let Black people in. But for so long. We couldn't get education. You know, we were enslaved. We built this. We literally built the US, you know, we couldn't own property. So now it's like, Hey, we're trying to get in these professions, so that we can make something of ourselves we can start building generational wealth. Like for me right now. I am like the person. I am the person right now and 2021 that is trying to start building generational wealth for my family, but why people have had this opportunity to do this and save and know about mutual fund all these different things and I'm just now learning and having the opportunity to get to you've been able To do that,
15:01 oh, for a very long time, and for anybody who says, Oh, the history that you're mentioning, I'm just acknowledging this history that you're mentioning from a bit ago that how black people came into, it's still not 100% there for basic rights for black people, they don't have access to the education that I got, you know, in this, I grew up in California, in a small town, California, if you don't know, if you buy a shed of your own, it can be worth a million cost a million dollars. It's ridiculous. It's a running joke. California is not it's just a well off area to be living, and which is unfortunate. And from that, we are lacking diversity in our areas, and they are people are not getting getting that access. I also feel like that there's an assumption when people are saying, Oh, now black people are getting in just because they're being black. What if? Let's say this black person, maybe it's just one? Oh, you know, come on, like, you know that Gatson is extremely intelligent and more intelligent than you and has had to put a lot more work in to get into prove themselves just to get in? And you actually don't belong? What if? What about what that? What about that? What about that consideration that there could actually be a lot of people of color, who are more intelligent than a lot of people who've been regularly led into school.
16:30 Everything that you just said? That was awesome. Like,
16:36 I love that we're sitting on this for a bit, because getting people into PT school is like the base, you know, how do we reach them? How do we access them and everything. And if then we have people saying it's because they're black. They're people who are black are already dealing with so much this is from what I've learned not experienced, obviously, like you're already dealing with so much discrimination on a regular basis. So to So to finally get that opportunity to come in and then be discriminated against, you've worked your tail off more than the average white person is just preposterous, and we need to call ourselves out on it, in order to be the change. Sure, I was just gonna read this smile. She's
17:25 emotional mom, because you know, it's like, these are the conversations and these are the things that are said within our circles. But then when you have the ally, say, and you see it, and it's like, oh, it's just so nice to be seen and heard. Oh, and then somebody gets it.
17:42 Oh, my God, I do. I do make mistakes. As I go. I've made I've made plenty. And I will continue to do stupid things. But I keep learning and making the changes as I go. But I so grateful that you're on to talk about this. What have you seen, that you think schools are doing that is working to bring in dei and that in schools versus we're taught we've talked a lot about what's not working? What are the schools doing that is working? And what could we do more of pull it out of your buttons fine. Just like brainstorm like, what are the things?
18:15 I mean, like I did say the video. I'm having professors,
18:22 oh my god, I had a black professor. That was the most amazing thing I had ever had one. I remember
18:29 it was so funny. She came in and I was like, Are you a grad student? And she was like, no, actually, I'm a new professor. I remember Mike, one of my classmates, she walked out. We were like in the computer lab. And she was like, now that I see this woman as my, I know, I can do anything. That's what she said. Yeah, so having more black African American ever, professors. If if there can be some type of outreach, I know with my class, so my class isn't good class because I graduated in the middle of a pandemic. So our plan was like, we had many plans and COVID killed the plans. But one of the conversations that I had with a good friend, classmate of mine, she wasn't black, she was a Puerto Rican. And she was like, Oh, I would love to go out to high schools. Let's get a group together and go do it. And then COVID happen and killed everything and we couldn't go anywhere. But I do think in the future. And I know you know, PT school as hard as it is and stressful, but doing some type of outreach in in PT schools and just saying, Hey, this is what you know, get to make it like
19:47 a career day kind of thing. When people come and visit and say, Hey, this is a career you can I do think yeah, definitely. Especially in neighborhoods where my dad's a dentist, okay. I have a family of dentists do Wish total stereotype halacha just brush your teeth, Jenna. So what's my upbringing? Look, I oh my god,
20:10 I missed you.
20:13 The the, but because I had, I grew up with that with people living these amazing careers, I didn't need somebody to come visit because I was surrounded by their neighbors doing a chiropractor friend, one of my best friends her dad was a chiropractor. This was just commonplace. Just in my world. People don't have that. So, uh, yeah, I can even see more. Having people in the profession, someone like my dad even coming and saying, Hey, this is something you could do is great. I think that's, I think that's a really great idea, just literally coming to the schools coming to them. And people don't like if you sit there and just do a social media post and be like, here come to us. Like, it doesn't work that way. Nobody, including any listener, or Sherelle, or myself, we'd like people to just come to us, as we're living our lives.
21:06 This is something I just thought about. I don't even know if it could actually happen. Ooh. Like, can we have like a work study? or some type of like, even be volunteer like work study. And like a student? A student runs an Instagram and it's specific for that school. And it's specifically for, like, adding teens or, you know, people of color and and making content that's relatable. Yeah. So that it's, you know, a track. It's attractive, so people learn more you know about it. I think social media is just such, it's just a force right now.
21:54 It really is it really,
21:56 I don't know what that really looks like. But, you know, yeah. But in talking about, you know, I don't know it just in a creative way.
22:08 No, I get what you're saying. I just, I just recently had a big screening with a ballet company. And I contact a local school and had PT students come volunteer and take measurements and everything was awesome for them to get to experience that would have killed for something like that as a student, but things like that, that other businesses are doing schools are doing, they can have events of some kind to bring that in that that could be I don't know what but because we're like in the like, no mode. But I love that. I love that. Let's let this lay as like the EU, we just let this kind of drop as a potential idea. I have only a few more minutes left with you. I would love to two more things. What have you personally been doing to help bring more dei into the profession?
23:00 I don't know that I necessarily have because I was so engulfed in school by having this conversation. Literally while you were saying that I was like, Oh, I have some ideas. Like I want to start doing this. But I definitely you know, I speak within my family on my social media. You know, I I talk about, hey, let's be more active, I do a lot around how we can move instead of having to go to the MD The MD is going to tell me to take a pill and then sit you don't have bed rest. But I definitely can do more. I can call myself out about that. You know, when I'm back up, you know, hey, I'm going to be very intentful about a purposeful about doing this. I'm excited actually, unfortunately, I passed my boards. I I kind of had this injury and then I wasn't able to do everything that I wanted. So when I'm back up and I'm full, I'm like, Ah, let's go. Let's add this to the list. I'm happy that you asked me that question, which made me get you know, the juices going and Right,
24:09 right. Uh, yeah, I love it. I love it. I give complete credit to Lisa van who's for that question. She said ask this question. I said okay, okay. Where can people we are now coming down to an end. Where can people find you? Sherelle on social media. They can follow you connect. Where can they find you?
24:29 You can find me on Instagram at Lego fitness. I believe Oh, well. I do search my name on Facebook, which is Sherwin Williams. Those are the two places that I live right now. At my website is you know is what is it like up pt.com If you want to see a little bit more about me there.
24:56 And then if anybody might want to email you some people do prefer the email
25:00 Oh yes, my email is right now is just Sherelle w@icloud.com
25:08 I love it. Wonderful. Thank you so much for coming on. You are a force. I frickin love you.
25:16 Thank you for having me. This is so amazing.
25:20 A big thank you to Jenna and Ciara for a great interview on D AI initiatives in the world of physical therapy and of course a big thanks to Net Health. So again when it comes to boosting your online visibility, reputation and referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition they know you want your clinic to get found, get chosen and get those five star reviews. They have a fun new offer if you sign up and complete a marketing audit, so they can help your clinic when they'll buy lunch for your office. Head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today.
25:57 Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media
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| 577: Joseph Reinke: FitBUX: GPS For Your Money | 14 Feb 2022 | 00:32:42 | |
In this episode, Founder of FitBUX, Joseph Reinke, talks about financial planning. Today, Joseph talks about financial planning technology, the three buckets of financial planning, and the importance of focus. How can FitBUX help people with financial planning? Hear about thinking about percentages, self-employed financial planning, and get Joseph's advice to his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Joseph Reinke Joseph Reinke is a Chartered Financial Analyst (CFA) Charterholder and is the founder of FitBUX. FitBUX has helped more than 11,000 PTs manage $1.6 billion in debt and assets. In addition, FitBUX recently partnered with the APTA to provide APTA members with awesome discounts on their technology.
Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Finance, Financial Planning, Income, Expenses, Debt, Money, Technology, Retirement,
Resources FitBUX Investment Round: https://republic.com/fitbux
To learn more, follow Joseph at: Website: https://www.fitbux.com LinkTree: https://linktr.ee/fitbux Instagram: https://www.instagram.com/fitbuxofficial Facebook: https://www.facebook.com/groups/FitBUXOfficialGroup
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 Read the Full Transcript Here: 00:03 Hey, Joe, welcome back to the podcast. I'm happy to have you on again.
00:07 Yeah, I'm glad to be here. It's been a long time. It's the very first time. I think there's like a third time, maybe the fourth time. But yeah, it's been quite a journey. So glad to be back.
00:18 I'm happy to have you back. Especially because today we're going to be talking about financial planning. Now, I know a lot of people might be like, oh, gosh, this is so boring. But regardless of whether you own your own business, you're working for someone else, you have to have a good financial planning, because you want to be able to get through the rest of your life and have the security of knowing you're financially sound. Right.
00:46 Exactly, exactly. So we'll make it we'll make it exciting. We'll give you some, some tidbits that you don't hear anywhere else. So
00:54 yes, excellent. Well, let's let's start out with what are a couple of tips for the audience, that you counsel people on when it comes to financial planning?
01:06 Yeah, so a lot of us to help is all about the technology, and we're there to guide them through it. And it's really geared around a lot of stuff that I learned when I was in wealth management. You know, everybody always talks about, oh, the problem in financial planning and financial education, and this and that. And basically, what I look at used to look at is everybody in the financial industry, they just double down on using the same stupid stuff. And then when the technology comes out, they just put some cute interface to it, and it just doesn't work. Okay. And there's, there's two areas that I could, you know, illustrate on that. One is like, on these apps, so like these budgeting apps, I won't name any names, I won't pick on anybody, but there's a lot of big popular apps out there. Or maybe you just use Excel. And a lot of times what they do is they just throw a bunch of stuff in basically an Excel sheet, and they put a user interface around that. And it's like, okay, well, where does all my money go? Like, this doesn't make any sense. So that's the first issue that we've seen in the second one, I used to joke around about this, this is where financial technology that I used to have, like, you know, a 60 year old client would come in with like, a stack of paperwork with like, an inch or two thick and say, Okay, what am I supposed to do? And to me, all FinTech did was take that makes file and put it on the internet. And just make a pretty little graph around it. It's like, okay, this doesn't tell me anything. Like, what if I want to buy a house versus rent? What if I want to pay off my loans versus well forget? How am I supposed to look at these things? Like, am I supposed to decide this? And so those are the two big areas that is like, how do you do this. And so the first big tidbit on financial planning to satisfy that first problem, just one big thrill plus, you got to think of things in almost buckets when you start stretching out your plan. So you have things like your income and your expenses. And I'm not talking about like your debt expenses. I'm literally talking about your day to day expenses, like food and rent and utilities. So that's like, step one is your income and your day to day expenses that is happening today. The second step is to say, Okay, how much is going towards investments and how much is going towards debt? And that's the step two is over the long term. And then step three is, well, what am I doing to protect my financial plan? Those are things like insurances. So life insurance, long term care, insurance, disability insurance, home insurance. And so the way you can think about it is, this is day to day, this is long term. And and this is risk management, because protection. And when you start thinking about it that way, it makes life a lot easier to do it. And then you know, we'll pause there, and then go into also, you know, what happens like, Well, what about projecting? What about managing this over time? What's an easy way to set this up from there, but that's the primary the main component of in terms of just setting up the plan itself, of those three buckets when you start thinking about this stuff?
04:09 Yeah. And so you suggest people kind of sit down and look at all of those things and kind of write them out. So they have they know their income, they know what their expenses are. They know what they have asset wise, debt wise. So when you're talking debt, can you be a little more specific? Are we talking long term debt like loans or short term debt like credit cards, or bony
04:32 any real debt, I mean, credit card. So with credit cards, if you're paying them off monthly, we don't even consider it that we just consider that day to day stuff. But we're talking about where like you have a monthly payment, so car loans, student loans, mortgages, if you do have credit card debt, and you refinance it, for example, into a personal loan, and you're paying that off over time, if you have business debt, whatever it may be, that's the debt that we're that we're talking about in that step two.
04:56 Yeah. Thank you. Thanks for the clarification on that. And then of course, All the insurances and things like that, that we all need, that we all should have moving forward, I would say especially if you're a physical therapist, and especially if you're in private practice, boy, do you need those insurances to be on point?
05:16 Yeah, exactly the biggest, like the most overlooked one is disability insurance. Because it's like, what do you do if you go to say, well, I can't do my profession anymore. It's like your financial plan completely just ruined if you don't have that. And that's the way you can think about insurance is okay, well, I did my step one, I did my step two. Step two happens over time. What happens if I don't have time because of whatever it is. So like, what happens if I become disabled? My financial plan crumbles. What if I'm married, and I pass away or my spouse passes away? Like we have children like our plan crumbles? What happens if I have a car and I don't have the proper car insurance and I get in a car accident? I don't, I can't buy another car. Now my plan crumbles because I gotta get all this auto debt for another car. So that's what you can think about insurance is protecting just in case time doesn't happen?
06:03 Yeah, fair. Okay, so great. Tip number one, just to recap is to break up into three areas, income expenses, assets, debt, and the third protection, or, and that's where all your insurances come in. Okay, what other what other tip do you have when it comes to financial planning?
06:22 This one is one of the most important and this, this makes life so much easier, both when you're setting up a plan. And also when you're actually like monitoring your plan. Oftentimes, somebody will come to me and say something like, you know, I'm paying $1,500 a month on my student loans. Is that a lot of money? And it's like, I don't know, like, Well, what do you mean, you don't know you're an expert? Don't you know if that's a lot? It's like, well, no, what I mean by that is, do you make $300,000? Or do you make $30,000? Because it's all relative to your income. And money is always relative. Another example of that, like investments, somebody can't come to me and says, I made $10,000 on my investment. And it's like, okay, is that good? It's like, I don't know, like, Did you invest? 20,000? I'm like, Yeah, I'll just do that. But if you invested a million and only made 10,000, like, that's horrible. Like, don't quit your day job, like, what are you doing? Right? So it really just depends on percentages. And you can take that knowledge and apply it to your financial plan. So when you're actually setting these things up, especially on step two, where you're saying, where's What am I investments? Or what am I debt, when you look at percentages of where your money is going and allows you to say, hey, like, I want to focus on, you know, paying off my mortgage? Well, if that's not your biggest percentage of where your money is going, and you're not focusing on that, okay, and this is like, it's funny, because people like, how did you come up with that percentage thing? And I'm like, well, one of the ways I did was when I first started working, I put all the percentages there. And I realized how much money was going to taxes. It was like, Holy crap, like, what can I do to reduce that? So I'm the financial dork that I am, I went and read the IRS tax code. But it's like, those percentages that I assume realized, from a financial planning aspect, it makes life easy, not just setting up your plan, but actually following it. Because if you say, Look, I have 20% going towards my student loans, I have 5%, going towards savings for a down payment for a house, I have 4% going towards my 401k. Over time, your income should be going up. So it makes it very easy. You don't have to think about how much of my money should be going where you just keep the percentages the same and increase how much you're doing in those categories. Or if you get a bonus or a tax return, say great, I take the percentage, I put it to those categories. If I want to do more, I'm fine. But I don't need to I can go out and actually enjoy this money if I want to and not feel guilty about it. Cuz I know I'm following my plan. And then once you're following that plan, let's just say you have a good life event happened. Like let's just say you paid off debt, you paid off a student loan, you paid off an auto loan, well, then great, you just look at the percentage and say, Okay, where do I move this now to meet my next goal? Very quick and easy. Or maybe you have a negative life event, like you get a car accident, You wrecked your car, and you need to buy a new one, where it's like, okay, well, I have I was focusing on this. But if I've moved this percentage and this percentage here, I'm good to go. And that's it. And then you can actually go out and simulate that and I'll talk about simulating that in a minute. But that's the key thing. One of the biggest takeaway that you can take from this podcast as percentages, what percentage of my money is going where and then from there, instead of tracking your dollars and cents, every single place that goes track the percentages are my percentage is going to where I said they're going to especially going towards your investments and your debt. Some people really like looking at those percentages on their day to day expenses too. That's fine if you want to go that into it for me, as long as you're following the assets and debt sureselect don't enjoy. That's the way I look at it. Because that second floor of the building assets and debt, that's the financial plan. So that's the key thing. There's that percentages, percentages, percentages. And, you know, I wish I could talk to everybody that's like 40 and 50 and 60 that have been doing like the dollar amount their entire life. And it's like, I just switched to this. It's easier, like, do that. Yeah. So that's the big takeaway is percentages.
10:26 Yeah, I switched over to percentages a couple of years ago, and it's like a no brainer. You know, so like, when, like you said, for example, a tax return comes in. So I had a tax return. I know it was last year, the year before. And I knew exactly where all of that money was going. Because it was in my percentages. Yep. So it just makes life so much easier. And you'll see you'll accumulate wealth in the places that you need to, because that's your plan.
10:53 Yep. And you'll realize, while if I focus on one, maybe two things, I'm going to accomplish things a lot faster. And so that's where the the behavioral side of finance comes in to. And it's a proven fact that more you concentrate on something that the sooner you're able to realize it. And so one of the big mistakes that we see people make, especially on that step two, they're like, Alright, I'm going to save in a Roth, I'm going to save in a 401k, I'm going to save for my child's 529 plan, I also need to save for a house and I want to save or pay off my student loans. And it's like, you're going to do none of those. Like, if you're trying to do all that good luck. Like seeing the percentages and how thin they are, and how long it's gonna take you to accomplish those is a red light to a lot of people, it's like holy cow, like, will instead I just focus on like, paying off my loans, for example. And your my retirement for the time being, you're gonna be able to accomplish a lot more sooner. And then you can get to those other things down the road. So that's another big takeaway is focus, focus, focus, focus.
11:55 Yeah. And it's okay to move those percentages around as your life changes. And as things change in life. It's good. Yeah. Okay, cool. Yep. So now, yeah. What I mean, this all sounds great. And I'm sure a lot of people are wondering like, oh, okay, how am I supposed to keep track of all this? How am I supposed to do all this? This sounds complicated. I don't work in Excel. QuickBooks makes me nauseous. What can I do? Like, so explain to us how fit books, can I help people with some of this financial planning stuff?
12:28 Yeah, this is where I'm so personally excited. Because this is where we always wanted to take the company even like, it was one of like, five years ago, I first came on the show on your podcast, we specifically we knew this technology was gonna take a long time to build. And so we specifically started the first piece of the technology around student loans to help students, new grads, and then we've been building it, especially during COVID, we've been building out more and more, as long as we don't lose engineers that COVID Every other week. But we've been building out more and more, and we launched the first version out of beta last November. And it literally does all that for you. So when you go to build your plan, like step one is income expenses that two is is your asset contributions, your debt contributions, that three goes into risk management. And then we took it a step further, actually, on step four, you can add in goals and life events. So everything from like getting married or buying a house, or whatever it is that you're going to do. And what that allows you to do is it allows you to say, Hey, this is the plan that I want to follow. And you can actually build out the entire thing and see in the long run what it does, or you can run simulation. So if you're trying to say Hey, should I pay off my loans versus loan forgiveness, or should I rent versus buy, or I'm married, and we just had a child should myself or my spouse stay at home instead of working so we don't have to pay for daycare, you can simulate all those to decide what you want to do. Okay. And then with the technology, once you say this is what I want to do, we take all these complex components, so like your income and your expenses and your assets and your debt. And we bought them all into one data point we called the fitbug score. So you can really easily compare everything and what the fitness score is in the short run, it looks like your risk and your profile and everything else. And then by the time you hit retirement is basically the probability of you hitting retirement and not running out of money. Okay. And so once you say this is the plan that I want to follow, you can then link your financial accounts into the hitbox profile, track yourself right on your profile, and it literally tells you step by step each month, are you doing this right or not. And then if you have one of those life events where you have to change your percentages around you just go back in and have your plan with the percentages around hit save and go back on with your life. So that's why I'm so excited because we've been building that literally for like two and a half years that that bigger technology and it's finally out. So I can actually smile and have a few more gray hairs because of it but it's out So that's where we're at right now.
15:03 Yeah, it sounds it sounds like definitely makes life a little bit easier. And now does this connect to your bank accounts or to your QuickBooks and all that kind of stuff so that it's constantly updating? How does that
15:17 work? Yeah. So it doesn't connect to QuickBooks, it connects to bank accounts, credit cards, some debt. So it connects almost everything not, you know, there's some credit union stuff that it doesn't link into. Some accounts are more thorough. So like the bank accounts, or the savings accounts are all in there. Some debts, like some companies, like first of all, some companies are there, some aren't. Even if they're not, you can still manually put them in. And I just tell people updated like once a month with your transactions. So it can up to date tell you, the big thing is, is making sure that your gross income is in the technology? Because that's how we base everything, are you following your your plan, based on these percentages, and the only way we know that percentage is if your gross incomes, they're not your net, your gross income. Because we want to see, we want you to see where your taxes are going and everything else in your entire paycheck. And so yeah, you can link your accounts, we do it through a company called plaid, which is, you know, the other major banks use them and everything. So that is who we use to link the accounts.
16:17 And can you quickly just for people who don't know, define gross versus net income?
16:24 Yeah, so gross income is what you get from your employer on quote, unquote, that top line, so it's what you're actually paid. And then from there, they deduct out things like your taxes, your Social Security taxes, your unemployment taxes, your Medicare taxes, any contributions to your 401k that you're making, anything that you're paying in terms of like medical care, dental care, whatever it is. And then after that is your net pay. So when you get a deposit into your bank account, that's what we see as net pay. And so you have to reconcile that the gross income. And so what we try to do on the technology to make it easy is is once you put in one of your gross incomes, so like if you get a net pay of like two grand, and then you reconcile it to say 3000. Next time we see $2,000, we automatically reconcile it for you. So you don't have to keep doing it. But yeah, we need that done a few times. So that way the technology updates and can start learning what that is and make those adjustments for you. But yeah, that's the difference between gross and net income.
17:27 Perfect. And let's say you're self employed, and maybe you're so you're not getting a steady paycheck, but maybe your pay can fluctuate slightly from month to month. So how does the technology work with that? Is it like, on our end, when it comes to a little
17:45 bit more, yeah, a little bit more, because you don't know what that income cash flow looks like. But what I tell everybody, like when you're setting up your plan, and you have variable income, so you might not even be self employed, you know, just be based on commission or commission. And what we tell people on that is be very conservative. So like, if you typically make like 80 grand a year and commission or self employed income, do your financial plan based on 60 grand, and do those percentages. And then every month, when you get those waves of money coming in, just take the percentages, and that's what you do. And so again, it makes life very easy. Like if you're putting money to the SEP IRA, or whatever it is, you just know what those percentages are. And that's what you put in. Instead, try where I see a lot of commission based or business owners where they make mistake is actually on twofold. They try to do everything monthly. And then they ended up in a month. It's like, oh shit, I don't have any money. Like, oh, or they go the opposite. They say, I'm gonna do this every six months, I'm gonna see where I'm at, I want to put money into these things. And then six months go by and they're so busy, they just forget. No, they don't do anything. And then all of a sudden, they have 50 or 100 grand sitting in cash, just not doing anything for them. And they don't even realize that it's sitting there. It's like, fantastic. And so, yeah, that's another place where those percentages come in into play big time.
19:09 And do you suggest people looking at, look at all of these percentages every month.
19:16 If they're following the percentages every month, the only real time you need to change them is when one of two things happen. The first one would be is if you have a major life event happen. So things like you get married, you have a child, there's a debt, you're inheriting money, whatever it is, those are major life events, that's when you go in and change it. Or you hit a major goal. So you pay off one of your debts or something like that, and you have a lot of money now that you need to move around. So those really are the two times and that's one of the big reasons why I'm so excited about the technologies because when I was in wealth management to me, it's like this whole model is messed up like you pay 1000 to $3,000 to a person to come up with a plan and then you walk out and it's completely obsolete. And in some of these guys charge $100 a month, but they don't track anything. They don't have any technology to actually even track anything. So what the hell are they doing for $100 a month? So we were like, Okay, well, we give out the financial planning technology, it's free to build your financial plan, you can even talk to a coach, and it's free to build it. And then when you track it, we could charge a monthly subscription fee, that's, you know, 20, or $30, whatever we charge on that. And it's there, you don't have to worry about spending $3,000 a year, any of that garbage. It's like, oh, it frustrates me so much when I talk about it, because the whole model is just like, completely upside down. And actually, the stuff we're coming out with Next, we just started working on it. As far as investment recommendations for allocations and how you had your investments allocated. And I had heart, I'm an investor, I mean, that's what I've been doing since I was like 12. And so I'm just starting to get my tea sharpened on that one, I'm hoping to have it out by March or April this year, where you can literally build your profile. And then it will tell you how your allocation should be on your investments, how much risk you shouldn't be taking. And the big part that's different, we didn't touch on this. We factor in this thing called human capital into our analytics. We ask everything from like, what's your profession to things? Like do you run marathons? Because that all goes to speak about behaviors. And just like healthcare 80% of outcomes and behaviors, it's the same thing in finance. And so there's no point in our technology saying, Hey, you should do this complex plan, when the behavior is not necessarily there yet. And so we factor all that into our algorithm. And that's part of what we're going to be coding next with the investment allocation. Which that's a whole minefield that to me, is that all traditional advice, like, Hey, you're young, like you can afford, you know, to put everything in the stock market. It's like, No, you can't like you know, what happens if you have $5,000 in emergency fund, and you have $5,000 in a 401k and COVID hits and your 401k goes down 50%. And you also just got laid off that $2,500 that just went out the door might be pretty valuable. So why were you aggressively invested at that point in time? Like, it makes no sense? Yeah, so I, yeah, I can go off for hours on that investment allocation stuff. But that might be a far whole nother podcast.
22:27 And that's okay. We'll have you back on. That's not a problem. Well, it sounds like a lot of exciting stuff and a lot of stuff that's really user friendly, and really good for people who aren't financial planners, right? Who like they didn't go to school for this. And they need a little bit of guidance, a little bit of coaching. And this certainly sounds like it makes it very easy for people to do that. Now, what are I know that you said this before? But I'll have you repeat it. If people take away anything from this, what is a big, big thing that you want people to take away from this talk?
23:01 Yeah, keep it easy in terms of how you set it up. So again, today, what's your expenses? What's your income today? What are you doing over time with your investments and your debt? And then the third piece is what am I doing to protect my financial plan, that's insurance. The second big takeaway is following your percentages of your income, it will make your life extremely, extremely easy. And then to your key point, caring. This stuff should be complementing your life not dictating it. And it should be easy. And again, that's one of the hours that retirement of it for a PT when I decided, yes, I'm going to launch the company. And the main reason was because I was like, I always wanted to invent something in terms of technology to help people like, but I'm not. I can't like I'm not Elon Musk, I'm not gonna build neuro link or some of these other companies, right? It's not gonna happen. But I know finances. And it's like, okay, well, if we can develop a technology that reduces the amount of time you need to think or stress about money, that means you can do what you're supposed to be doing when you're going to school, like being a PT. Or if you're an engineer, and you're the next Elon Musk, you don't have to think about money because that part of your life is actually taken care of. So it's my small contribution, if you will, to the technology world. Just funny because everyone's like, you're a founder of a technology company. I'm like, I'm a finance guy. I know algorithms. I know math, and I know money. And I'd like I give it to coders and engineers, right? They do it. Right, right, right.
24:31 Hey, listen, that's why it's we always work better as a team, right? It's hard to do everything on your own, if not impossible. And now where can people find more about all of this info and how to sign up and how to start using this?
24:45 Yeah, so Bostock comm just go on build, your profile is free to go on and you can build like all the tools are accessible to you to build your plan. You can schedule a call with a coach which we highly recommend because this version of the technology We built specifically for people to actually call us and have them help us walk you through the technology to make sure you're using it correctly. And then as we grow, we're building out more and more automation. So that way, it's easier. And then once you want to sign up and say, This is the plan I want to do, that's where you start the subscription and go from there.
25:19 Perfect. All right, so that's fit bucks fit bu x.com. Yep, you're right. All right. So before we end, before we wrap things up. Last question, I asked everyone, and that's knowing where you are now in life and career, what advice would you give to your younger self? I know you've answered this question before answer it again, come up with a new piece of content, you get to say more advice to your younger self instead of just one piece.
25:47 Yeah, this one, I touched on it earlier, and I can't stress it enough as focus. You know, I'm the type of person that like I was at CSM last week. And I pretty sure that I wrote down like seven or eight business ideas. And I'm the type of person that just wants to start working on everything. Like, I used to joke around with my wife. I was like, you know, this was back when I was doing my investment trading. I was like, if I come up with something, I will literally be up for 72 straight hours researching this and figuring out if it works or not. And sure enough, the very first time like, I came up with something, I stayed up, I was on our 71 I thought it was gonna work. And then our 72 is when I found out that it will work. But focus is we're so distracted with things. We're so distracted. You know, that's one of the behavioral things I'll share is like, when you start saying, This is what my focus is, and you have a fundamental reason of why you're doing it. And it's not because you're, you think you're gonna make a lot of money or you think you're gonna do this, but you have a real fundamental, real reason why you're doing it. Focus actually becomes very easy. Like you no longer care about watching TV, like I'm a big sports person. I haven't watched sports in about eight years. Just because there's like, I won't play I was watching a football game. I'm like, Well, this sucks. I'm wasting four hours. And the game's only an hour and a half and watching commercials. So let me TiVo it. And I started TiVoing. And I'm like, wow, they're still wasting an hour watching this thing. Like, I'd rather be doing something else, which I stopped watching sports. And so it's like, if I could go back, I just think about it. Like if I had that same mentality when I was like, 20, instead of getting that mentality when I was 28 or 29. I'm like, my life would be looking a lot different right now. So focus, focus, focus, focus.
27:36 Great advice. Joe, thank you so much for coming back on the podcast, giving us great tips for financial planning. I'm sure everyone will take a lot away from this podcast. So thanks so much for coming on. Yeah, thank you for having me. Anytime and everyone. Thanks so much for tuning in and listening and have a great couple of days and stay healthy, wealthy and smart. | |||
| 576: Prof. Lorimer Moseley: Pain Science Research: Now and the Future | 07 Feb 2022 | 01:11:28 | |
In this episode, Pain Scientist, Clinician, and Distinguished Professor at the University of South Australia, Lorimer Moseley, talks about pain and research. Today, Lorimer talks about his many streams of research, assessing cognitive flexibility, and his MasterSessions. What is cognitive flexibility and how does it affect pain? Hear about the social determinants of pain, COVID's impact on Pain Revolution, the complexity of chronic pain, and the responsibility that comes with doing pain research, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Lorimer Moseley Lorimer is Bradley Distinguished Professor at the University of South Australia. He is a pain scientist, clinician and educator. He has made seminal contributions to how we understand pain and why it sometimes persists and has developed treatments that are now considered front line interventions in clinical guidelines internationally. He has authored 370 research articles and seven books. His contributions have been recognised by government or professional societies in 13 countries. In 2020, he was made an Officer of the Order of Australia for distinguished contributions to humanity at large in the fields of pain science and pain medicine, science communication, pain education and physiotherapy. He lives and works on Kaurna Country in Adelaide, Australia.
Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Pain, Research, Cognitive Flexibility, Chronic Pain, Perception, Responsibility, Recovery,
Notable Mentions Pain and Perception, by Dan Harvie and Lorimer Moseley. Epiphaknee, by Lorimer Moseley, David Butler, and Tasha Stanton. Participate in research (it takes just 20 minutes).
To learn more, follow Lorimer at: Website: https://www.tamethebeast.org https://www.painrevolution.org https://people.unisa.edu.au/Lorimer.Moseley
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 Read The Full Transcript Here: 00:03 Hi, Lorimer, welcome back to the podcast. I'm so excited to have you back on.
00:08 Good. Thanks for having me.
00:10 And so today we've got a lot to cover, because we are going to be talking about some of your current projects, new developments that maybe happened since 2021, where you had well over 30 publications. So you had a very, very busy year, I would say. But as we go, as we kind of go through and talk about some of the things that you're working on, I just want you to let me know if there's anything that you're like, Whoa, hey, I can't talk about that. Or if there is reason to be a little vague, because things might be ongoing trials and things like that. So we'll definitely keep that in mind. Now, let's say you've had a lot of publications over the last year, what are some current projects, or discoveries or developments that really stuck out for you in your most recent research?
01:08 Ah, nice question. Um, one of the things about being a scientist in a clinical field is that here, it's not often that you get a revolutionary discovery, it's quite unusual. So what I think the things that I'm most excited about are not, not so so much particular papers, although there, there are some really tiny phones, there's one that's not published yet, but will will be out in the next couple of months that I'm particularly excited about. And I can allude to that. But I think sort of like these, these streams of research in which I'm involved that are turning me on a bit, the moment and one of those is a continuation of the whole explain pain thing. But over the last sort of four or five years, we have discovered, we've looked really closely at but at the the outcomes of clinical practice in where people are delivering great educative interactions and, and I've had a fair degree of, of influence over them. So I feel really confident that I did, they're supposedly doing well. And those data from a big cohort of people suggests that, in about half of the people with chronic pain, they see they have this shift in understanding of the problem, but a real flip. And it's in a predictable way, you know, shifting towards really deep in your belly can conceptualizing pain as a protective feeling that's being produced for a reason. And we need to work out what that reason is, and it will almost well, it will certainly not be a single reason, there'll be all these little contributors. So real flipping, understanding. And, and I guess, understanding that as pain persists, the system becomes over protective, and, and really embracing that as a reality. And that's a really hard thing to do. But those those half of the people who do it has great outcomes a year later. That's a for me, that's a really exciting discovery. The half of the people who don't don't have great apples. So for me, again, it's a really exciting discovery. The problem is that we're only winning in half the people. You know, we're only nailing it in half the people and the interventions good across seems to be good across everyone. So clearly, our markers are what's good intervention, they're not accurate. So my gut feeling about that was not accurate. So we've been looking deeply at how, how can we expand that group from half to bigger and, and unexpectedly for me, doubling down on the on the criticality of learning. So I've been learning a lot about learning. And that's been infiltrating our research and infiltrating the whole way we go about helping people with chronic pain or at risk of chronic pain. And so I'm really excited about that. And we're seeing its scientists talk about seeing a signal amongst the noise. And in chronic pain, there's just so much noise, right? Because chronic pain is this truly, in my view, truly bio psycho biggest and it's more or less social thing. And if we can intervene and see a signal in that group, that's a really exciting development. And
05:03 I, I'm more excited than I was maybe seven or eight years ago about the potential power of of new and better ways to get people to give people understand. And I started banging on about this in conferences and stuff maybe three or four years ago. And I have this slide that that is intentionally slightly provocative, particularly to the physical therapy world. And that sort of pain science education world, I think in in the US the brand name as popular as paid in neuroscience, education, p and E. These are all brand names, right? PMA expired pain is a brand name. So I like to avoid the brand name. So I call it sort of pain science education or modern pain education. So this slide is meant to be slightly provocative, in say, has education become the objective, instead of learning being the objective, and I think for me, education became the objective. And that was a mistake that, that I made. And I think my research made that mistake, and my clinical practice probably made that mistake. And my own outcomes over the last 10 years, and I get I keep really tight audit data, I can see the benefit of my own development as a, as a clinician, educator, and probably as a human on outcomes. So I'm excited about that, for sure. And I can give a little, a little teaser to the paper that we expect to come out the next couple of months in a big journal near you, which looks at a clinical trial of chronic back pain, where we have done two things that I think are really unusual for our field. One is we've tested, I think, a new complex intervention. And it's made up of less new interventions, but they're all sort of put together into a package if you like. And the other thing that was different that we did that, that are Yeah, I think I'm really proud of the team led by James McCauley is the senior author on it. And Ben once and I were important in sort of formulating the treatment, but Ben's been really critical. But we were all very keen to make the control group the best placebo intervention, we could. So we put a lot of effort into credible brain targeted treatments, matching the educative component. And testing whether people had different expectations or perceived credibility or beliefs about whether they are in treatment or not. So from my perspective, it's a very tight trial. And James and I were fully expecting that we would not see a signal in this. But we would be interested in secondary analyses which tell us mediating effects like what, even though there wasn't an overall effect, where what worked, what what might have been helpful. So that's what we were expecting, but in fact, we saw a clinically important signal. And that's very unusual in back pain trials. It's if you have a control group where you've got a waiting list or usual care, or you've gotten there's been a couple of trials published slightly, or you've got open labeled saline injections, you know, these treatments that will have some sort of effect, but they're no match. Right? So you're not really asking, are the particulars throughout this treatment? Important? All of those treatments will show a signal they all they always do they show exactly the same signal. I've done those randomized control trials. So that's one thing, you can design a trial in a way that you'll show signal. But it's a bit meaningless to us as real world clinicians. Or you can design a trial that we would call an explanatory trial that says, Okay, we've kept all of these things the same in the two groups and the things that we kept the same were as much of that nonspecific therapeutic alliance engagement, credibility expectation, which, which I think is a big part of the whole pain science education thing. So I do think we have to monitor that. You might hear my dog the other
09:38 room. Right. All right. We're pet friendly around here. What's exciting
09:42 about that is that it means there's some sort of delivery bandwidth to be won, I think it might be this new piano that I discovered even better. Yeah. So anyway, so that will be coming out. I can't say anything more about that, but, but it's a really exciting development. And we've got we've got a few trials that are testing versions of these sorts of things for for different conditionals. But uh, going at the moment and the way we're constructing the education component and integrating it with the movement and loading and anti inflammatory component. So that is three pronged approach. Really exciting for me, as I, you know, I've been doing this for quite a while that feels like, I still feel like a kid. But, you know, I have been researching for a while. And this is a really exciting time, I reckon, in the chronic pain world, because I think we're starting to chug forward again, I feel like the field was stalled a bit. But jumping forward. That's one thing. And then then on the other other side research streams, one of our team called Dr. Emma Karen is doing really difficult and really important, work really well investigating the influence of social determinants of health on chronic pain outcomes. First focusing on low back pain. She's published a couple of systematic reviews, and mixed method study on that, that is pretty intimidating. For those of us trying to move the the outcomes in a positive direction, because as we were talking about before, caring that the social determinants of health are very powerful, and they're powerful in back in back pain and pain outcomes. They're really hard to shift, you know, they're very hard to do much about so. At our field, the pain, field musculoskeletal, the the sort of arthritis field has or has engaged with, it's way better than then the non Arthritis, Musculoskeletal pain, pelvic pain, Fibro fields, we, you know, it's remarkable how little attention, it gets the biggest social and when we talk about the biopsychosocial model, we nearly always conceptualize that as a smallest session and the people around you social, which is important. But we haven't really integrated the biggest social Yeah, the world in which you live in your access to health care, illiteracy. Poverty.
12:29 Yeah, that sort of stuff. Absolutely. And I think you kind of hit the nail on the head as clinicians, oftentimes when we talk about the bio psychosocial, we think of the socials, what's your support system at home? You know, do you have, you know, can you get to, can you get to therapy? Do you have access to therapy? But what we're not asking is, do you have access to other medical care? If you need it? Do you have access to fresh foods and vegetables, which we know can play a part in, let's say inflammatory responses in the body? Do you have access to a pharmacy? Do you have access? I mean, all of these things make a huge difference, you know, or do you? Is your social part of that bio, psychosocial? Are you working three jobs and raising children and not having time to fit some of this stuff in? Right? So social part becomes a really big S for a lot of people. Certainly in the United States, like I said before, one of the biggest determinants of health of your health in the United States is your zip code.
13:37 Yeah, it's remarkable.
13:40 So social determinants of health is is high priority. And I think maybe people shy away from it, because it's can be so overwhelming. So I don't know what you guys are finding research wise, if there are way and how you can address that?
13:56 Oh, it's it's overwhelming, for sure. And I totally understand why there is a reluctance to go there. And there are also I think there's very complex ethical considerations about going there. We've we've been planning a study in the northern suburbs of Adelaide where I live, which is an area that's really different to the say, the inner suburbs of Adelaide with respect to all that sort of predictable social determinants. But one question that we've had to look in the mirror about is if if we develop this so we're working on developing a screening tool. If we start to identify people that have significant unmet social needs, and we can't do anything about it, is that is that a ethically defensible position? Yeah, we were able to say to people, okay, we know what the problem is, you know, this, you can't have because we got no mechanism Have of meeting that need. So it's quite a challenging area to move into. Because if you if you imagine that the understanding and overcoming persisting pain is a very slow step by step journey. And now we really have to imagine that instead of going in a straight line, we're almost going in a circle, and we're making slow step by steps of the entire circumference of the circle, you know, and you move a little bit, then you have to stop and move a little bit more somewhere else. Otherwise, you're going to break. And the people who suffer when you break will be the same people, you know, the, the more vulnerable people. So it's a really challenging field. And yeah, I can't, I'm excited to be getting dragged along by Mr. and her colleagues on on this. But I'm also so impressed with how, how robust the approaches to it. So yeah, there's a couple of her papers out already and more, more coming. And I think there'll be really influential in the field. Because no one there are people there. There are people who are engaging in this, but very few people are thinking to themselves, I'll take on that challenge. Yeah,
16:28 yeah. Very, very difficult.
16:31 It's relevant to it's really relevant, or I guess my interest in it was sparked by our work with pain revolution, which is an outreach project program for rural areas. And it sounds like it's similar in the US. But there's there's areas in Australia not far from big cities, what we would call a big city of Adelaide a million people. There's areas two hour's drive from Adelaide that cannot get a GP or a physio, or a psychologist or an occupational therapist, to worth it. And they've got, you know, wanting four of them have a persisting pain problem that affects their lives. There's no, what do we do? What do we do about that. And so pain revolution is, is really trying to ultimately build workforce capacity. In giving people health professionals have some description, when I care what description, in fact, we were, were looking for money to try our non healthcare professional, being coached and becoming a rural coach. But the idea of that is that if people we know I think from other areas of the pain field that if if a healthcare professional of any persuasion, understands deeply contemporary pain, Science and Management, and takes a defendable, scientific, and now evidence based approach, then outcomes can be better for sure. And outcomes will be promoted by engaging in in care locally, the moment the only model we've got is a fly in fly out model, which is where, you know, the health professionals go from the city and spend a day in the country and come back a month later, in my view, of very limited benefit. Or we've got a full five model where the patients, that consumers come down to the city. And in many cases, that's a 810 12 hour drive. Get an assessment? Yeah, there's no there's no way of training those people or providing effective care for these people. So yeah, yeah.
18:55 And I, you know, yeah, no, no, you know, it this, this conversation about this kind of rural outreach and, and maybe training someone who's not in the medical field, reminded me of a documentary that I saw, Oh, gosh, I can't remember the name of it, if I can ever And i'll put it in the show notes. I can't remember it right now. But it was on it was more psychology based around loss and trauma. And there was a woman in Africa, who was not, not a psychologist, she was not trained. But she, she, I think she was trained in some basic coaching skills, but she lived in the community. And people there were more likely to go to her because she understood the community. She was part of the community and they had really good outcomes. So I'm wondering even if training someone who is not a medical professional, but if it's possible to train them even in you know, you don't have to be there in person, but would that person because they're part of this rural community, maybe have better results and someone just flying in for the month and flying out where you have someone who knows the community understands the struggles, and maybe has known some of these people their whole lives. You know, we talked about therapeutic alliances and trust and beliefs. So with people they're more likely believe someone who's part of their community than someone who's doing a fly in fly out. I don't know, it just reminded me of that documentary.
20:24 Yeah, I totally get that. And I guess we were really embracing that in, in one aspect with pain revolution, because we're training rurally based healthcare. And that was the impetus you know, they're connected to their communities and their communities are really well connected more so than certainly in Australia, in the cities. You know, you're the physio, if there is a physio will be on the sideline at the Netball day or the football game, way with the consumer, you know, these, these people's normal lives and accessibility and those things that I think reduce the power differentials that that contaminate a lot of healthcare interactions. Was it a part of our drive to drive pain revolution rurally, to tap into this already, and you know, the vision that we state, the pain revolution is that all Australians and I think we're going to change that to all people will have the skills, the knowledge and access to local resources to prevent and overcome persistent pain. And that's the real emphasis that we embed the knowledge and skills locally. And, you know, that's, you know, I've been talking to 1010 years about recovered consumers being coaches, not the healthcare person, but recovered consumers, because they have all this knowledge and expertise that no one else can have. Right.
21:56 They're very deep understanding of pain.
21:59 Absolutely, yeah. And pain, and not not only the lived experience of pain, but the lived experience of recovery. And I think that's a untapped massive resource. But there are significant regulatory medico legal barriers to us just pushing forward on that, that we're still negotiating. So that's yeah, that's been at least a decade. My perspective. But paint ray of is is so exciting. It's, it's really cool. Like, we are doing it on a shoestring. And I think we now at the end of this year, we will have, I think we'll have about 35 Local pain collective. So these are networks of healthcare professionals around geographical regions that get together, learn more about how pain works, and the best ways of treating it collectively problem solve pain, rave feeds them. curricula, but really, it's a collective problem solving facilitated group. And yeah, I think the panorama was responsible for delivering around about around about 400 community outreach sessions, amazing Australia, in the middle of COVID.
23:17 I was gonna I was gonna ask, How has COVID affected? What pain revolution has been able to do, let's say last year, as opposed to previous years?
23:29 Yeah, it's, well, it's had its impacts, for sure. And depends where you live in Australia. So two of our states have had a longer period of of living in a COVID world I guess. And in those places, there's there's been no face to face. stuff. They are 2021 outreach tour that we do. So we run this circus that gets a lot of attention raises a fair bit of money on our level of what a fair bit of money is, it's got in the commercial sector be like someone's bonus for the week. But in our sector, it keeps us alive. And we go from town to town, and we run these public outreach and health professional outreach events. We're all dressed up in library, we ride our bikes, and it's all this cool thing. And that's part of a wider program with two other projects that dovetail into that dedicated to the region. And we didn't run that in 2021. And we won't run that in 2022. And that's a big hit for us because it's our main fundraising Avenue. So that's that's a real challenge. Some states in Australia have had basically no COVID And one state still basically there's no COVID Western Australia they They pay us closed to the rest of Australia in the world. And I think they're aiming to reopen in February. Tasmania has recently reopened and they're starting to get cases. But now we're where I live. We are, we're at the beginning of our wall of Omicron. And we really don't know what this year looks like. So we don't have the experience that a lot of places do. And we're very grateful for that. But we also clearly like deer in the headlights at the moment. Federal governments are going everything. Rules are changing all the time, we and you know, we're not as prepared as you would expect us to be having had a month's notice. So that will impact pain revolution for sure. The we're a really small outfit we have I think we have 1.5 full time equivalent staff delivering hundreds of programs, or events, and we're very resilient. And yeah, well, yeah,
26:11 we'll you'll get this done. And And if people want more information, they can go to pain. revolution.org, correct. Correct? Yes. All right. So pain revolution.org, if you want more information about what pain revolution is doing, and maybe how you can help or contribute, if you so if you see if it if it aligns with what you believe in, then I suggest go for it because it is a very worthy cause for sure. And now, it's kind of switching gears a little bit something that we were speaking about sort of before we hit the record button here. And it's a concept that I had to kind of look up a little bit before our talking here. And it's that concept of cognitive flexibility. I think it's interesting. I think it's worth talking about. So I will hand the mic over to you to sort of talk a little bit more about what that is, and how does cognitive flexibility fit in with people living with pain and maybe with practitioners treating those living with pain?
27:21 Yeah, well, thanks. And again, yeah, I feel like I don't actually actually do much of the good work, it feels a little bit like because this work is has been done by Caitlin halat, who's a PhD student about to finish and has a background in psychology. We embarked on a new direction probably three years ago, with with a really sensible prediction, I think that possible contributed to not recovering after an acute episode of pain based on if people familiar with Bayesian or other predictive processing models, based on the idea that the outputs that we generate predictions and the system is influencing itself according to predictions, then we need to update the internal models of the models in order to resolve so if I was to cover that really quickly, if we, if we said, when you bend over and you don't have pain, that what what could be happening there is that your brain predicts that this will be safe, your brain produces a feeling that's consistent with that mn let's say you tweak the annulus of a intervertebral disc or something, you get no sensitive data that are that are within the sensory load. And I like to say within the Tampa symphony of Dallas, extraordinarily complex, beautifully evolved system of of information about what's happening in the tissues, we get data that says this is not what I predicted. The evaluator for this is not what I predicted. So we update the internal model to say the back is vulnerable in some way, let's say. And then the new prediction is, well, let's make pain. And let's influence the system differently. And then if we go in the other direction, and every time we've been able to get this nociceptive data within the symphony, and then one day you don't I know you've been over and and you don't get that. And now the theory is the system detects that error says Hang on. That's not what I predicted. So it updates the internal model to say the back is less vulnerable. And now your brain doesn't produce as much pain or produces no pay, and then you've recovered fantastic. So one potential barrier to recovery according to that theory is failure to update yourself. Title model. And and that should happen. If, excuse me, that shouldn't happen if you if you don't detect the error. So if for some reason you don't, your system doesn't detect that the predicted data, the predicted data, which was not receptive, in part hasn't been hasn't eventuated. And therefore you don't update your internal models. So on the basis of that, we became quite interested in this broad field of flexibility, cognitive flexibility, which has been defined in many ways. But I guess the way that we were thinking about it was the ability of your system to change its behavior are when the task requirements or conditions change. So in the language of have that sort of Bayesian idea, and to your ability to update your internal model of things. So we started digging around in this field, or Kaitlyn really started digging around in this field. And often in a PhD, you'll start with a systematic review of the literature on a question that's most most aligned with what our hypothesis will be driving. So. So Caitlin took on what we thought would be a reasonably straightforward job to review the literature in cognitive, mental and psychological flexibility. So the barrel phrases that are used, often interchangeably, particularly cognitive and mental flexibility. And with the question that would help us determine which is the best way to assess it's what's the best way to assess flexibility. And there's two broad approaches to assessment. One is self report, questionnaires. And they have they were developed out of a line of research, starting with personality tests in the 1960s. And that's this sort of this long line of stuff. And someone I can't remember who but in the, I think in the 60s or 70s.
32:18 proposed that I think it was empirically based but propose that good communicators perform the answer these sub questions in a certain way. And that research would describe them as positive and flexible people and are good communicators. And then that infiltrated the field. And we eventually got to this situation, we've got cognitive, cognitive flexibility scales, things like that. The CFS or, and there's a few of those, completely independently from that was the development of behavioral tests. The most famous and most common is a thing called the Wisconsin card sorting test. In that, in that test, you you sort cars according to one of three criteria, shape, shape, or number, I think, sorry, shape, color, or number. And the rules for sorting change, and you only realize that change when you make an error. Yeah, that so you put a card in a certain pile, and the tester or the machine goes about anything, what should work, and you have to work out what the next set of rules. And the people doing these studies somewhere in the 80s. Or maybe it was a bit later than that, call this cognitive flexibility. So we've got two independent lines, joining a company flexibility, and then that's then all the whole field just went nuts cross contaminating and all that. So Caitlin has now published and once just been accepted last week, to systematic reviews that are massive. And she had to contact authors for nearly every single one of these studies to get data, asking the question How well do those two approaches to testing 100 Flexibility correlate? Because if the system the same thing that should correlate quite well, one of those systematic reviews is in Healthy People. And one is in people with a diagnosis clinical groups. And in both of those studies, there is absolutely no relationship between those two approaches.
34:39 So you have two different tracks on how to assess cognitive flexibility, and there is no correlation between them.
34:47 Not at all. And actually a lot of the tests, there's no reliability data for them. Now, there are some cognitive psychologists who won't be surprised at that finding. And they're the informed one Who, who have been working in this field? I guess. But for people like Caitlin and I and the rest of the team on this project, where clinically, it's such an attractive hypothesis, right? Like if if people can't change their, that if people don't easily change their beliefs, explicit beliefs, their implicit beliefs about the vulnerability of their body, what pain means that the targets of pain, science education, then we know those people who don't, don't change some of those targets of pain science education, don't do as well, when we know that. So it's such an attractive hypothesis that they might be less cognitively flexible. But the barrier with hit is so how do we find out? Because we don't actually know what any of these tests are actually.
35:56 What are they actually test
35:57 measuring? Yeah, yeah. So so the direction for that, and I've asked for money haven't got it yet to do that is to devise a a new way of assessing the ability to change your decisions when there is some sort of risk evaluation involved, because I think for, for pain, I think we talked about the meaning of things being important for painting. And I think one way to distill the meaning is about just a risk profile, that every nanosecond, our system is evaluating risk, and its risk, that determines our feelings. And I would categorize pain as a feeling bad. So my anxiety, fear, fatigue, lead to the toilet, lead to a thirst, all these things, in my view, feelings generated on the appraisal of risk. And, and if we don't have any risk, in an evaluation of our ability to change your behavior, under changing circumstances, and I'm even, I'm nervous to use the phrase cognitive flexibility now, because I know that whoever he is that there are three or four main ways that you understand that. And some of those would be totally different from otherwise. So I would prefer to say, if we keep assessing the ability to change your behavior, according to changed demand or environment. without risk, then I think we might not capture what we need to capture for understanding a potential contribution to the development of chronic pain or recovering from initial pain. So so that, you know, that was one of those, one of those PhDs where it's such an important discovery, actually, and and Caitlin's contribution to the field is very important. But it won't get the citation impacts and the Roth IRA. Because what the country contribution says is, hang on everyone. Why, you know, there are a whole journals dedicated to this. But what is it? What is it, we almost have to go back and start again and say, Okay, let's get really clear on what we're talking about. Let's use these phrases. Anyway, so but that's relevant to the very first question, what are you most excited about? I guess I'm, you're tired to be excited about, clearly, deflationary discoveries like that, but they're so important. They're really important, and they're harder to publish. But they shouldn't publish, in my view, they should publish top journal. In your face. Journal. Yeah. Well,
38:49 it's, it's like, yes, it's sort of this deflated response, if you will, to, to the systematic review, but it is important because it's important to use the right words, and to if you're going to label something should be what it says it's doing. Otherwise, why are you doing these tests? And why are you you know, labeling someone as very highly flex cognitive flexibility or low cognitive flexibility when you don't really know. And then exactly, so how do you then so then your treatment, I look at it from a clinician standpoint, how do you formulate a treatment plan around something that's, that's not accurate or unknown? So I think it makes it really difficult but it's it just underlines the importance of this kind of research.
39:41 And oh, go ahead. No, I was just gonna say I think that um, it Kayla's research doesn't doesn't tell us that these tests are uninformative. But what it does tell us is that we don't We don't know exactly what they what they mean. So that speaks to your point exactly Karen, that that. So what do we do about it? That's a difficult thing, because we don't actually understand them well enough, I think. But can I put in a plug for? Yes, a research project of Caitlin. So final project for a PhD that we desperately need participants form? Yeah. Because it's an online study. Okay. And it's, it's to do with this kind of flexibility. And we need people without pain, as well as people with pain. Well, that's a lot of types of it. But basically, everyone, anyone who has 20 minutes spare. It would be great if they just went and did Caitlin's experiment online. And maybe I could send you the link.
40:48 Yes. Yeah, you send me the link, I'll put it in the show notes. And also put it out on social media. So that girl can can take this online study. So if it's people with or without pain that takes in quite a lot of people, like you said, like, one? Yeah, so I'm assuming she wants a robust number.
41:11 We need lots. Yeah. Because we think the signal will be small amongst the noise. Yeah, but yeah, if we did it, and then ask one of their family members or mate, yeah, that'd be fantastic.
41:25 Yeah, I'd be happy to send you the way about that. Yeah, definitely do. And as I was, you know, as you were talking about this cognitive flexibility, or the ability of to adapt your behavior, and let's say cognitive strategies in response to a changing task, or to a threat or something like that, it, it always reminds me of this experience that I had. So most people who listen to this note that I had a very long history of chronic pain, I think you're well aware of that as well, about 10 years or so of neck pain, chronic neck pain. And it was this was a couple of years after I could say I was recovered, you know, of course, those times when you have flare ups and things like that, but largely recovered. And I was I was at Disneyland with Sandy Hilton and Sarah Hague. And we had waited in this long line, like an hour to go on what I thought was like a jungle cruise. You know, this very, like, get on a boat and cruise around the water kind of thing. Yeah. And we get up there. And all everywhere. Once we get inside, plastered everywhere was date, big danger signs, you know, the yellow dangerous sign, the red X, if you have neck or back pain, you know, this guy. And I was like, you know, so talk about a threat, right? So my normal behavior, and like, my hands were sweating, my heart rate was up, my eyes were dilated. My normal response, I guess, would maybe show my inflexibility would have been to find the nearest exit and leave. Yeah, yeah, get out as fast as possible. Right. And so I think, Sarah, and luckily, I was with two very incredible women who are very well versed in pain science, and I think I am as well, but when it's you, you're you're like, a big, you know, mashed potato, you know. And Sandy and Sarah just looked at each other and looked at me, and I was like, almost shaking. And Sandy's like, Okay, listen, it only tilts about 12 degrees, and it stops and goes, you're in taxi cabs, they stop and go, you're fine. It's this much of a tilt, you'll be fine. And then Sarah's like, yeah, and the person in front of us like six, you know, there's nothing over your shoulders. It's not that dangerous. And they kept playing down the danger. And so I did end up getting on it very, very nervous. And then I got off and I was fine. They were right. Then it allowed me to be flexible enough to then go on another ride after that. Whereas if I went with my original strategy, which would have been to leave, then I wouldn't have done anything else for the rest of the day. Yeah, so that threat, if left to my own devices would have gotten the, I don't want to say gotten the better of me, but I would have reverted back to the behaviors I had during the that sort of 10 years of living with pain.
44:24 Yeah. And, you know, I respect I respect both of those approaches where it makes sense for an organism when you see credible evidence that this is a dangerous situation to take a variety of action. Yeah, makes total sense. And I guess the, I think about the flexibility thing was evident, as Sandy and Sarah are problem solving with you gathering more data. And, and then your choice changed. That's the stuff that seems consistent with in quotation marks flexibility, you know that right? In the face of new data. So the new data, it could work both both ways. And I think there are some people with persisting pain problems where they behave the same way, even in the presence of significant danger cues. And that works against them because they the danger, for example, right, right. Yeah, can work both ways. Yeah, I think I think there's a rich there's there's a rich stream of, of understanding in there somewhere for us to, to uncover. But it does feel a little bit like that's going to require the the archaeologist among us to get out. This is a metaphor, obviously, to get out our brushes and blowers and slowly reveal what that stream of gold is, as distinct from the earth blasters obviously just want to revolutionize in a in a rapid way. And I fit more into the second category. You know, I lose steam on the very slow, the finite, made tool discovery thing. I'm very pleased to be around researchers who are excellent at that. Yeah, it's not so much.
46:25 And I always always think about that. What did I think David Butler said they were what did he call them? Oh, I don't know why I'm blanking. I have the book right here. Super. Ah, I'll think of it. It'll come up. It'll come up later. It's from explain pain supercharged, you know, the graph and everything leads. So if you have more, yeah. Dangerous safety Sims. He called them Super Dungeon Sims. Yeah. Jensen says, so he was like, Oh, I think Sara and Sandy were your super Sims at that moment, which is maybe what you needed? Maybe? I don't know. But like you said, it would have been just as valid as if I was like, I can't do this. It's too stressful. You know? Yeah, it's too dangerous. Too dangerous. Yeah. Because those
47:14 were the cues that you were, you're getting? Yeah, yeah. And just take it off. I always say it's important in a situation like this to take a moment to reflect on the contrast between the resources available to you in that moment. Right. Which, okay, Sandy and Sarah? Unique, exceptional, exceptional resources. Like, yeah, scrub exceptional. Yeah. But even without them, take your own resources. You know, you're informed, you're, you're resourced with intellectual and other capacities and understand how things work and biomechanics, you've got incredible resources, and then just take a moment to reflect on the contrast when you and most people? Yeah. And is it? Is it any? Is it any wonder at all that people face those situations? And yeah, there'd be a lot of people with chronic neck pain, even if they're on a recovery journey, who would get into that situation and their neck pain would flare up, they wouldn't even do the rod, that's right, leave and they kind of flare up and, and the rest.
48:24 And everything that comes after that, go back
48:27 to the doctor, get a new script, you know, and we do we attempt to, or they I think there's a tendency in our field to, to look, look down on that approach in some way. But, you know, as they are, that's substantive people. But it's totally predictable. And an excellent, excellent biological organism doing that. And we have to overcome, we just always have to remember the resource differential.
48:58 Yeah. Oh, that's, I never even thought about that. But that is so true. And, you know, it just goes to show you why people living with chronic pain, why the burden of disease is the high one of the highest in burden. It's the most one of the most burdensome health conditions and diseases in the world. In most countries. I mean, just low back pain alone, the burden of disease in the United States, I think is third, that's just low back pain. We're not talking about oh, a and other knee or neck pain, other chronic conditions. It's third Well, I mean, things might be different now with COVID. I don't know. But um,
49:38 you know, it's usually with disability. And they usually for disability metric for iPads way out in front. Yeah. Yeah. Yeah. I mean, on other metrics to use last year's lost, which includes mortality, then it drops down, right, just a bit.
49:56 Right, right. But you know, it just goes to show all of the things that you that you've been working on in 2021 and that you're excited about coming up, let's say in 2022 and all the incredible researchers and PhD candidates that you get to work with it just shows how complex and complicated chronic pain is. And that one or two sessions of pain science education in clinic cut it for most. No, absolutely. And it just shows the complexity of it and how difficult it is from a research standpoint, a clinician standpoint it is a tackle these problems on an individual basis and society as a whole. So I mean, keep keep doing that. Keep fighting the good fight, as they say.
50:40 That's scary. Because yeah, gobsmacked, nice weeks that I get to do this for a job and I get paid for it.
50:52 Yeah, speaking. And speaking of helping people around the world, you've got master sessions coming up. So you did this in 2021. So now you're doing it again in 2022. It's going to be May 13. To the 16th. Depends on where you live in the in the world. But you want to talk a little bit more about the master sessions, who's involved and what it's all about.
51:13 Well, yeah, that I mean, that was that was really cool. We sewing in 2021. No one's traveling, obviously. And noi group UK put, to me this idea of doing something a bit different. And it was really different like I was so that it it, we had two broadcasts, and they were timed friend friendly time zones for Europe or for the Americas. And then Australia and Asia sort of could go to one or the other with not quite as friendly. So for one broadcast, I was starting, I think at 6am. For another broadcast, I was finishing at about 11pm, something like that my time, but it was really well planned really well resource like they are, I'm in a studio basically, I was in that it was in the NOI group offices in Adelaide, but set up like a studio with a producer and sound people and a couple of cameras and Tim Cox working as emcee does a beautiful job on that. And we had a team of people downstairs ferreting around for the papers I was mentioning and all that sort of stuff. And it we were we didn't know how it would go because it was it's not like it's not like a zoom conference. Or, or cause it's really quite different from that there's a fair bit of interaction and it went, it went really well was really good fun, really well received. And the feedback has been overwhelmingly positive. I, I was joined by two people for 2021. social pressure Tasha Stanton came to speak. And she so she did a about a 30 minute talk. And then she and I chatted for about 45 minutes and and then we open it up to q&a and and that conversation between Tasha and I and then the other person who contributed that our two people were Mark Hutchinson, who's professor of everything. Adelaide University, one of the one of the exceptional communicators on neuro immunology, related to pain and defense, personal defense. And so same sort of format with him. And then with David Butler, who everyone knows, if you don't know, David, you, you're missing a key part of life you should have. So it was amazing. It was yeah, it was a really well, it's lots of comments like, I never thought online education could be like this and that sort of stuff. So that was really positive. So in 2022 in, and I think the dates you mentioned are probably the Americas day, so that we're doing to broadcast again, where we got feedback that we're responding to, so the schedule is changing slightly. Mark Hutchinson and Tasha are both coming back to do longer stints. And then we're also having in people with really interesting research and great clinical engagement. So for example, Dr. Jane charmers who's done some excellent work in pelvic pain. So she'll come and she'll do a talk and then we'll, I sort of interview them. So it's the massive sessions are a massive amount of work for me because I need to have my head around everyone else's stuff as well. So I can ask meaningful questions, but the, the feedback is is about how useful those conversations are as well. So yeah, so this Jen channels there's Haley leak, Haley leak has has started working with investigate what people who are recovering from paying value in learning about to publish one paper on that in pain, a beautiful paper, I think that I think should shift research direction of a few groups. Haley also has the probably unique among pain scientists brag point of winning the Australian survivor 2021. So she, she survived. And part of the reason for her survival, I think was her deep understanding of how pain works. And there was some great episodes where she there was one where she I think she was standing on like Pogi point things, Poles, they were all doing this with a with another thing coming slider down lower and lower for six hours.
56:08 And lead athletes x s as people have already fallen out and and so she's she's actually done an incredible job in disseminating modern understanding of pain to the wider community because they've all said, How did you do that. And she's able to talk about her understanding of pain. And pain does not mean damage pain is because it was a thing. So no wonder the host is making these comments like that they're trying to rev up my payment system. So incredible impact and she's got a high profile among the people who watch on Survivor on telly. So she's able to integrate that experience with her research. And she's very interesting person. So she's she's coming Sarah wall works doing really interesting work with younger kids. Looking at how how we can engage with young kids on everyday paints in a way that will help them be resilient later. So really fascinating work that she's doing. And then I'm on there as well. So I think I'll cover about half of the time. And it's great fun. Yeah. And you know, people go look at the reviews and all that sort of stuff. But yeah. Love people to to get involved in that. That's in that's in May. Yeah.
57:30 And is there? You may not know this, but is there like a cutoff date for signups? Or can you sign up like the day before? If you wanted to?
57:39 I think there's a right shift. Okay. I think there's an early bird, right. I think I actually don't know much about that sort of stuff. But they they do have to. I mean, the earlier they get a feel for numbers that they they're able to judge sure how to do it, because it takes a lot of bandwidth and all that sort of stuff.
57:59 Right? Yeah. All that behind all the behind the scenes production stuff. You're the On Air talent, you don't have to worry
58:05 Exactly. Worry about any of that. But But noi group, if they get annoyed by it, they'll learn everything
58:12 about it. Yeah, yeah. And again, I'll put the links in the show notes here. And we'll put it out on social media as well. So that if people are interested, then I highly suggest signing up because it what a great, what a great lineup. And it's not until May. So you have plenty of time to shift your schedule and try and figure out, you know, kind of block the time off so you can be part of it. And one other thing, I believe this is true, you can correct me if I'm wrong. But if you if you're in the Americas, and you you paid for it, you live in New York City, let's say I pay for I live in New York City, I can also watch the other, also get the recordings of the other broadcast.
58:55 That's correct. So you get both and you you don't have to be there live watching it in bed. But if you're not you, you're not engaging in the q&a and all that sort of stuff. Yeah, but you get access to both broadcast and you get access to the thing called the Padlet, which is it was an amazing resource from the first time because this is all of the stuff that the team downstairs is getting while the master sessions around. So let's say Professor Mark Hudson mentions this are really exciting new study from so and so which show this then someone downstairs will get that study put the paper on the Padlet. So it's some incredible resource as well. And they have access to that. I don't know for how long afterwards
59:40 Yeah, yeah, but you but you have it Well, it sounds amazing. And I think it's so great that this is probably something if not for COVID Maybe you would not have done and it's made a big impact, right so
59:54 and and when COVID no longer what it is I'd prefer to do it this way.
1:00:02 Yeah, yeah, amazing. Amazing. And now, I don't want to monopolize any more of your time. But is there anything that we didn't cover that you were like, Oh, I really want the listeners to know this or, or is there a big takeaway?
1:00:18 Ah, I think the takeaway is, it's really consistent over years, actually. Whenever I have an opportunity like this to chat, with such an informed and, and clever interviewer, like you, I'm always struck by how, how important people like you are for our community, because I see my role sort of knowledge generation and, and dissemination in sort of conventional ways, you know, books and articles and things like that. But we need people like you, to spread it, to play the critical role and getting it out to the, to the world in a way that's accurate and engaging and, and it's people like you who put in so much so much effort for your community. And whenever I think about takeaway, I just am reminded of of the potential benefit we can still bring to humanity by doing this chronic pain thing better. And we have made progress, know that we made progress. But it feels to me like were climbing up a really, really tall mountain. And now when we look back, we can see we've actually come quite a long way. But when you look ahead, there's still still a bloody big mountain. So all of these things would have hope. I think there's genuine, realistic, scientifically based reason to hope things will keep improving for people with chronic pain, that will people will have better outcomes. So that's my take home. But can I give a plug to a book that I'm an author on? Yeah, it's a self plug. But I'm not the main author. So Dan Harvey, a truly innovative scientist. And I don't say that lightly. There's not many innovators out there. But Dan Harvey is an innovator. And he's the first author on a book called pain and perception. And the Americans can get that through IPTp. Elsewhere, you can get through no group. And it's a I think it's a beautiful book. It's all about understanding through illusions, and sensorial experiences, more about how pain works, sort of like a coffee table, book waiting area book. The feedback has been fantastic. So yeah, I'm really excited to be involved with that with Dan. And I'll just mention another book that's available in in North America, but not in Australia. And it's called Epiphany. And test Stanton has joined Dave Butler and I to, to write a consumer focused book around the osteoarthritis.
1:03:17 And I will say, I, when I first saw this epiphany, it's not how you would normally spell epiphany. It's, it's, it's an what do they call it? It's an acronym an acronym? Yes. So it's explaining pain to increase physical activity in knee osteoarthritis.
1:03:39 Correct. It's spelled AP IPH a knee,
1:03:45 right? Yeah, very clever. Cuz I was like, epiphany. What did I say? Episode? I don't even know. What's epiphanies? And you're like epiphany. I'm like, oh, yeah, that definitely makes more sense. That definitely makes more sense. But yes. And we'll have we'll have links to all of this stuff, again, in the show notes. And, you know, one last question and talking about, you know, all of the work that you do that isn't in very important work, and it can impact not one or two people but millions of people living with chronic pain. So do you as a researcher, how do you deal with maybe feelings of overwhelm with the responsibility that that place is on your shoulders? Or do you think about that at all? Or am I just projecting what I would feel if I were in your position?
1:04:36 I think you're projecting. I don't, I don't feel overwhelmed in the slightest. I don't feel any sense of responsibility to humanity. That's, that's changed because of what I do. I feel I feel that I have a responsibility. I don't know if I feel I have responsibility. I want to use my resources and my knowledge and my skills, and my connections and my relationships to, to be the best Lorimar I can be if that makes any sense and, and the values by which I judge that are not at all on chronic pain outcomes. I'm a very sort of process driven person, I want to make sure that today I did the best thing I could do. And I don't have any illusion that I, I could use outcomes as a marker of, of how well I've lived my life. Because I just think there's too much noise for, for me to have a measurable signal in the world. So I want to make sure that in this moment, I'm being authentic and true and real. And today, I'm doing my very best, I do my very best. But I do that, because I like myself more when I'm doing my very best. But I feel any burden to humanity. That's different from the burden that I think anyone who grew up in my in my world and life with my skill set, and my influences would have.
1:06:24 Yeah. And I think that's great, universal advice for for anyone. And, you know, normally when we finish the show, I always ask people, What advice would you give to your younger self? So I don't know if any piece of what you said would be maybe part of that advice. But is there anything else that maybe you would give to a young a young Larmour? fresh out of university for first time University, not? Subsequent?
1:06:48 Yeah. I think that I would, I think there would be advice, I don't think it would be remotely relevant to my work, I think it would be love a beloved, look for that, and express and, and value that with the entire depth and breadth of your being. And for me, that includes being a neuroscientist and paying dude with a extraordinary fortune of being able to do the things I enjoy doing for work and resonate with my values and all that sort of stuff. And ultimately, I think we're such a sophisticated organism that, that we may want to one one day discover that it's all just to love and be loved. And I don't know, great advice.
1:07:43 Great advice. Thank you. I'm sorry, not a sage. But no, no, it's amazing advice. I appreciate it. Thank you so much for taking the time out to come on and talk about all the stuff you have going on. And is there a place where people can find you? If I don't know they have questions, websites, something like that.
1:08:07 Yeah, so finding and I've got a homepage at the University of South Australia they can find out about personal pain revolution is doing some good stuff on Annabelle, what we're doing that I I get a lot of emails and I just can't possibly respond to them.
1:08:26 We're not here to give out your your emails, or your personal phone number or anything but I think pain revolution, Oregon and the University of South Australia are great ways for people to find out a little bit more about you because as we said, before we get on the air you are not on social media. So there is no Twitter handles or Instagram or tic TOCs none of that stuff. None of that. So people can find you again, pain revolution.org or University of South Australia's website or you can just do a Google go to ResearchGate read all your papers. There's plenty of ways to find out more about your research and and what you have coming up. So plenty of ways to do that. So again, thank you so much for coming on. I appreciate it.
1:09:12 Oh, thanks so much for having me. You're a legend. Keep it up.
1:09:17 Thank you. Thank you so much and everyone. Have a great couple of days and stay healthy, wealthy and smart. | |||
| 575: Dr. Osman Ahmed: Reflections from the 6th IOC Conference | 31 Jan 2022 | 00:28:53 | |
More About Osman Ahmed: Dr Osman Ahmed is a Physiotherapist at University Hospitals Dorset NHS Foundation Trust (Poole, United Kingdom) and a Visiting Senior Lecturer at the University of Portsmouth (United Kingdom). He trained as a Physiotherapist at the University of Nottingham in the United Kingdom, before undertaking his Postgraduate Diploma in Sports Physiotherapy and subsequently his PhD at the University of Otago, New Zealand. He is employed by the Football Association (FA) in England to work as a Physiotherapist with their elite disability squads and has been a member of the Team GB medical staff at both the 2008 Beijing and 2016 Paralympic Games. He teaches on the FA's Advanced Trauma Medical Management course and has recently been appointed the Para Football Classification Lead at the FA. His PhD was focused on sports concussion and Facebook, and since then he has both published and presented widely (primarily on concussion in sport and technology in healthcare). He holds several governance roles within Para Sports federations including Medical & Sports Science Director at the International Federation of Cerebral Palsy Football, Medical Unit Co-Lead at the Para Football Foundation, and Medical Committee member of the International Blind Sport Association. He is a Co-Chair of the Concussion in Para Sport Group, and a Board Member of the Concussion in Sport Group. Osman holds Associate Editor positions at the British Journal of Sports Medicine and at BMJ Open Sport & Exercise Medicine and sits on the Institutional Ethics committee of World Rugby as an external member. He is also a Scientific Committee board member of the Isokinetic Football Medicine Conference. Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:03 Hey, Jasmine, welcome back to the podcast. I'm so happy to have you on and so happy to see you again.
00:09 Hi, Karen. Thanks for having me. Really good to be back.
00:11 Yes. And so Osman and I both at the International look, Olympic Committee conference in Monaco, a couple of weeks ago, we actually did a talk together. So for the first part of this interview, we'll talk a little bit about we spoke about what we spoke about, and and then get into some of your big takeaways from the conference. And then of course, some of your upcoming projects, papers and all that kind of fun stuff. So why don't I give the microphone back to you, and tell the audience what our talk was, and kind of what we spoke about it IOC? So go ahead.
00:52 Thanks so much, Karen, I probably first thing to say is that we've Omicron raging around the world in the week before Christmas, it feels a bit surreal to think back to what was less than a month ago when we're actually out in Monaco presenting together. So the world has changed very quickly. Hopefully, it changes just as quickly back to the nice, stable world that we were getting towards before then. So I have to see what happens in the coming weeks. But yeah, it was great to present together it was something I think that we've both been speaking about for a while in our respective areas about how clinicians can engage with the mainstream media and social media for injury prevention, and athlete welfare, and just generally for spreading positive public health messages to our patients and clients. And so how we did it, for those of you that weren't in the room, we started off by looking at some different examples of how the mainstream media discusses different injuries and issues. And we took the lens of sport concussion, because that's an area that I'm fairly familiar with. And I've got a bit of an interest in from a research perspective. So I talk through some of the different examples of how concussion had been discussed in the mainstream media starting way, way back with Charlie Chaplin, hitting people over the head, progressing through to the movie concussion, more recently with Will Smith, and also touching upon some South Park episodes, the office and new girl. So other examples of concussion being in the mainstream media. And we had a bit of a brainstorming session, really, it was a nice interactive workshop that we did to everybody. That wasn't a room there. Thank you for contributing so much. He made it a lot of fun and asked a lot of questions and stimulated a lot of discussion between the group. And yeah, I mean, it was quite a nice flowing dialogue between everybody there. And there was some really good examples that people in the crowd shared in terms of their experiences with either engaging in the mainstream media or seeing some negative examples, and some less than perfect discussions and injury representations and illness and medical representations, either in TV shows or in news reports and things like that. So yeah, I mean, session was pretty good. I thought I'm obviously I was one of the CO presenters. But yeah, that was a fun session to be part of. And then obviously, from your angle, Karen, it was really good to hear your thoughts in terms of how clinicians can engage with the media, coming up with some really practical tips for people that would be interested in doing that in terms of how to pitch to journalists, sort of things that you should do when you're reaching out to journalists, and some good examples of how clinicians have worked and engage with journalists in order to get positive, evidence based, accurate, scientifically valid information out to places like the Washington Post and New York Times and kind of upmarket newspapers in that regard. So yeah, it was a fun session to be part of and had some nice feedback afterwards, which was made it worthwhile. And yeah, it was a pleasure to be part of it.
03:51 Yeah, I really enjoyed the discussion within the workshop from with the participants, because a lot of the workshops and we know, we go to all these conferences, and it's usually the person up on stage speaking, and there's not a lot of interaction during the talk, except for maybe someone gets up and asks a question, they sit back down. But what I really loved is that, like you said, people were sharing their experience with maybe being in the media, or really asking the question of like, hey, is this movie concussion? Was this positive or negative? And it was interesting that people had a lot of different views on what they believed as was as positive was this negative? You know, I think we can all agree on some of the things like Charlie Chaplin hitting someone on the head or, or a head injury being the butt of the joke. We can all agree that's not great. You know, that would be a maybe a not so great representation of that. But with the movie concussion, I think they it brought a lot more conversation to the group. I don't know what do you think? Yeah,
04:58 absolutely. I think the noise thing about the topic that we discussed as it's something that everybody's got an opinion on. I mean, arguably, you don't even need to be a clinician to have an opinion on how injuries represented in the mainstream media. But certainly, I've seen lots of workshops and conferences and sessions where I'm not particularly ofay, or knowledgeable about the area that's been speaking about. And I probably wouldn't feel that comfortable in terms of sticking my hand up and joining into discussion in front of lots of other people. But because it was a mainstream topic about the mainstream media, there was lots of people that felt comfortable to do that. So yeah, it was great from that regard.
05:34 Yeah. And I think it gave people some tools moving forward, to maybe reach out to a journalist or to maybe even reach out to say, hey, this article wasn't the best. And do you think you can? Like, I'd be happy to contribute to give you a little bit more evidence to that. And I think that's something that instead of going on social media and complaining about an article or a video, instead, why don't we empower therapists and researchers with the tools, they need to reach out to the journalists to say, Hey, I appreciate you, including physio, therapist, researcher XYZ. But what they shared is probably the not not the most accurate or evidence based. And I'd be happy to give you some resources or speak to you or write a and an article follow up article.
06:31 Plenty, absolutely. And I think we're completely on the same page here. I mean, it's so easy to read something that you disagree with, get angry about it. So you may it's about a coffee time, and then maybe sharing a whatsapp link to your friends and laugh at it, it's a little bit more challenging, but a lot more productive to actually reach out to those people. And like you say, do something constructive, take control of the narrative, as we kept saying, so who is controlling the narrative, we can control the narrative. And that's a good way of controlling that narrative is by reaching out to those people, and suggested some of the things that you said there. So putting some evidence based links in talking about proper scientific evidence, correcting in a nice, gentle way, some of the inaccurate information that may have been shared in the article, there are really, really good things to do. I think so. Hopefully, if people in the audience doing that, and anybody listening, that's picking up between the lines of what we're saying here can do that as well. That'd be great.
07:24 Yeah, and it's easy. It doesn't cost any money. It just costs a little bit of your time. And I mean, like, a tiny bit of your time.
07:32 Yeah, absolutely. I mean, time is money to a lot of people work, especially if you work in private practice. I don't, but I'm sure a lot of people listening here well, but yeah, well, it doesn't really take that long, just drop a quick email or a note to a journalist, to tee up some potentially better ways of reporting on what they've reported on, maybe serve as a link for any future articles. I think it was one thing that we both touched on that, I think is a really nice way of sort of crossing that divide. And bridging that gap is by getting in contact with a journalist or newspaper and saying, Look, I'm a clinician, I work locally, if you've got any pieces that you're putting out about a health related issue or a medical condition, or if you want to check anything with me for accuracy, drop me a quick email, send me a quick text message or WhatsApp. And I'll get back to you about that. And then you're then in a position not to create content for the newspaper, you're not writing their article is not a freelancer for them. But what you are doing is kind of member checking and fact checking and steering the journalists towards more medically accurate correct reporting. So yeah, I think that was a key take home for for me and hopefully, for anybody listening today as well.
08:35 Yeah. And I think that's, that's a great take home from our talk. So from and also a nice transition into what were your other big takeaways and take homes, from some of the other sessions you went to? So if you want to maybe describe the session, and then what your biggest take this session, the speakers and your biggest takeaways?
09:00 Yep, so the one that definitely made a big impact on me was the session on hashtag metoo. So it's about abuse in sports, intentional abuse in sport, and I came up the topic from different angles. So my mount Joy talks about the Larina SAR case that I'm sure everybody listening will be familiar with, which is horrific. And I suppose, because it's maybe slipped out the media attention for a few months now, I wasn't completely familiar with a lot of the graphic and horrific details relating to it. So that was a real eye opener again, for me in terms of how endemic that was and how that could have been nipped in the bud at several stages earlier from the information that we were given there. And I think the other speakers in this session, we're fantastic as well. So Shree Becca, I'm a big fan of sharees work. I went to most of our sessions IOC in Monaco, and, again, she helped deliver a fantastic session around The similar areas as well. And yet, sir to a lackey, who is based at Yale in the US did a really good session about Ghanaian Paralympians, and the perceptions and abuse that they suffer as well back in the home country, with regards to being disabled, essentially, and being an athlete and the barriers that they face and the challenges they overcome. And I thought one thing that was really nice from yesterday's talk specifically was the fact that she sampled the video interviews, and she wove those into her presentation. So you can actually hear and see the Paralympians talking about those things. So unfortunately, like, you can't transport lots and lots of people to the conference to speak as part of your panel. But yes, I did the next best thing, I think in terms of getting the athlete voices literally embedded into a presentation. And that really did magnify and sort of hammer home the points in a really strong way. So for me, that's something that I've since gone back to some of the sporting federations I work with. So I'm involved with the if CPF, which is the International Federation of cerebral palsy, football, and power Football Foundation. And I've spoken to both of those organizations about this and the resources that were provided in that thought were really helpful, just to make sure that we're on top of all safeguarding issues in our sport, I think, for a lot of people listening, I mean, it might sound like quite a boring thing, and quite a basic thing. But ultimately, it's the most important thing I think we can do is to protect our athletes when they're in our sport, and make sure that we've got the right policies, the right procedures, and the right steps in place to look after them. Because as the Larina SRK, showed, I mean that the impacts of getting those sort of basic steps wrong or underestimating those sort of areas of sport are huge and can have profound and very long lasting effects to the athletes involved today. Yeah, for me, that was that was probably the session that had the biggest impact on me. Again, I'm qualitative in my research background, so I was really pleased to be a part of the session with Eva bahagian, Caroline barley, and Christina farga. I thought all three did a really good job of talking about qualitative research. And I think, looking at other talks as well, during the whole conference series, there's a lot more awareness. Now, I think that with athletes and with patients, generally, we don't just need numbers, we don't just need hard cold quantitative analysis, which undoubtedly, is very, very valuable in terms of what we're doing with our athletes and patients, we also need some context to that. And I do feel quite strongly that a lot of that context does come from qualitative research and listening to our players listening to athletes, getting that extra depth to their experiences to either layer on top of the quantitative data or to stand alone and just be independent data that we look at and say this data has got numbers, it's got words, but these are the patient's words. And these are what the patients and players think. And we're going to look at that data, we're going to analyze it, and we're going to respect that data, we're going to act on that data. So Alan McCall, I was in Alan session as well. And he's at Arsenal Football Club, and they do a lot of work there with readiness and return to play. And they collect a lot of data as part of that. But it's really pleasing for me to see some of those high profile as Alan, talking there about the importance of quantitative data and listening to play as the qualitative sorry. Data are listening to players and getting that information as well. So yeah, I mean, I wouldn't call it a revolution in terms of qualitative research. In sports medicine, I think it's a gradual evolution. I think, as we evolve and move through the 2020s as we are, I think there's going to be a greater appreciation, really of the power that qualitative research can bring. And we're going to see a lot more of it, hopefully.
13:43 Yeah. And in comparing IOC 2017 to this one, I don't know that there was much talk of qualitative data in any in any of the talks in 2017.
13:58 I can't remember why for dinner last week.
14:03 I don't. I don't I don't believe there was. And so I think there is this definite shift in thinking that, hey, if we want to keep our players safe and healthy, and reduce injuries, then we have to listen to them. And we have to incorporate this qualitative data into how we as clinicians, because you and I are clinicians, how we work with our patients, you know, it's a little more than, Oh, you just have to listen to them. Because I think you have to listen, and you also have to understand what their words mean.
14:43 Oh, yeah. Listening processing, as well. So you're not just a set of ears, you've got something between your ears as well. And that's the thing that you have to use to process it and then also, act on it. I mean, it's not just a case of listening and processing you need to be Some actions off the back of that change that results from that. So, yeah, completely agree.
15:05 Yeah. Because like you said, from the me to talk with Margo and Sheree, and policies and procedures, yes, of course we need to have those in place. But if you're not listening to your players, you can have all the policies and procedures you want. If the Larry Nasser case says anything, right, they had a lot of policies and procedures in place and USA Gymnastics. Yeah. But they weren't listening to the countless girls and women who are abused by this man over many, many years. Because they did speak some of them did tell people, nobody listened.
15:42 Again, it's the acting management if you're listening, maybe process maybe haven't. But is the acting that needs Yeah, as well. And that's a key part of it.
15:51 Yeah. And I think placing that that athlete in the center. In that case, in particular, it wasn't about the athlete, it was about all the money and all of the prestige that comes with those athletes in your program. So you don't want to blow up the program, they apparent from looking from from an outsider perspective, it's like they didn't want to blow up the program to help save the girls.
16:17 Nine. I mean, in an ideal world, nobody should go to an international sports medicine conference and listen to a talk about that scale of abuse. But I mean, if if there is a positive about sitting in a session like that, so that you can spread the word about it. Take action to make sure that never happens again, in any sport ever. Exactly. Absolutely. abomination that happened.
16:38 Exactly. Exactly. And, you know, one of my biggest takeaways from the whole event is that context is, is everything. If you're not taking, whether it's quantitative data, qualitative data, exercises, application to the, into the clinic, if you're not looking at the context, around the person in front of you, then I feel like it's all for naught. And the other thing, my other big takeaway is like, I don't really know anything. So those are my two big takeaways.
17:11 I think that's always a good thing. If you go to a conference and come away realizing how little you know, I think you've been to a good conference. Generally, I think there's always so many clever people that you listen to and learn from. I went through a cardiology session as well as on absolutely not expert at all. But you go into sessions like that, and you learn a little bit and hopefully take stuff back. And you can apply some of it to your practice. And yeah, it's good that you felt that way. So I did as well.
17:38 wasn't just me, then. Yeah, I left. Oh, I'm the worst.
17:42 How do I not know anything? What am I doing in this job? It really spiraled down on the plane ride home.
17:49 Yeah, so any Junior clinicians or researchers listening, trust us. We're old in the tooth, myself and Karen. So if we feel like this, our stage of our career, then don't ever worry that if you're a new grad, and you don't know everything about everything, but there's something wrong with you, because it really is not, because you get to the end of your career, and there's still a lot of things you don't know, more things you don't know, at the end of your career than you did at the start of the career. So yeah, yes, definitely. Definitely a message I want to share.
18:14 Yeah. Excellent. Anything else from the conference that was for you? You know, a big takeaway from any part of it. Or do you think we covered it all?
18:27 For me, it was just how lovely and nice it was to actually see people face to face again, it just been such a rubbish. 1819 months leading up to that conference had been postponed two times. It was just lovely to actually get to a place. See people do want to give a lot of thanks to the people that hosted the conference. But the organization was next level in terms of how well run it was. Our safe, everybody felt everybody had masks on. I think we were talking about how good it was in terms of the COVID checks going into the venue, everything like that. So although there were, I think, seven 800 people there, there's a lot of people there. It never felt unsafe. And everybody there was glad to be there. And I think everybody seems to have a good time.
19:10 Yeah. And that's what Sheree and I spoke a cup of Sri Becker knights a couple days ago. And we said, you know, the thing that was so great was that everyone there, it felt like, people were there to support each other, and to support sessions and support individuals and, and maybe it's because there hasn't been like, a larger conference like this in quite some time. But it did feel like very inclusive and supportive, and that's kind of the vibe I got and Sheree said the same thing. It sounds like you might have felt the same. So maybe that an NF three is it's it's, it's true then.
19:52 Well, I'm a qualitative researcher, so I'll take those quotes and agree with those quotes. Yeah, I think it was just it was a nice nice yeah. place to be I think for a lot of people that first time they've left their country since COVID. It certainly was for me. And me too. Yeah, I think it'd be nice if that's the that's the vibe going forwards if we do go to a concert and can support each other's research, and there's not academic snobbery, or thankfully, I've not really been to any conferences that have been like that. But I'm aware that every now and again, there can be that element of needle two speeches and feedback and those sort of things. So hopefully, it will stays nice and constructive and supportive and positive objectives.
20:36 Agreed. Now, what do you have coming up? What do you have going on any new projects in the pipeline papers? If you can give us a preview? Obviously, can't give it all the way. But if you can give us a preview as to what you're working on, for 2022 and beyond?
20:55 Oh, okay. Well aware, a few different hats. So one of the hats that I wear is at the BDSM, the British Journal sports medicine. So I think it was announced on social media a little while ago that we're having the first BDSM Live, which is a in person, conference day that's being held in Brighton in the UK in May 2022. So we're quite excited about that. I'm hosting that with Fiona Wilson from Ireland. So it'd be really great to co chair the day with her. And that's certainly something I'm looking forward to. I am also off to the IPF spt. So the International Federation Sports Physical Therapy conference in Denmark in August, where I'm presenting a session with yourself again, Karen, so great to see you there. And again, that's following up on some of the BDSM work that I've done in terms of patient voices and athlete engagement. So I'm really looking forward to that one as well. A lot of 2021 was involved with the concussion and parasport group that I'm a member of so working with international colleagues are involved in Paris sports main concussion. So we released our position statement last year. And hopefully off the back of that there's going to be a lot more studies that take place in 2022. So one of the co authors, in fact, the lead author, Dr. Richard Wheeler, who's very passionate about the area, he's currently doing study looking at the perceptions of blind footballers towards concussion. And so he's done a lot of data collection from that. So I'll be working with him and the other co authors on that paper in the new year, which is exciting. And I'm also looking forward to working with Dr. Mark Murali in Australia, who's a digital health physiotherapist might be one of the best ways to describe him. He's very involved in the tech side of what we do is a professional physiotherapy and physical therapy. And he's got a grant that's been accepted on physio, digital health capabilities, and a model related to that. So I'm going to be working with him looking at that and looking at the digital side of physiotherapy as well. So got plenty of things to keep you busy. And I'm looking forward to hopefully a better year than last year.
23:05 Yes, well, you certainly have a lot to to keep you busy as well. And I should also say that you also work to your clinician.
23:14 Yeah, so my full time day job is at University Hospital, still on the south coast of England, and I'm a full time clinician, I also work part time for the Football Association as a clinician with their elite power football squad. So that's disability football. And in the new year, I'm also going to be starting a part time role there is the power classification lead for the elite disability football program. So looking after the classifications across all the athletes, power football, sports, I'm looking forward to that role as well.
23:44 Nice. And obviously, you'll eat and sleep at some point in between.
23:51 If you ask my wife, there's a lot of eating, and we missed out on those too.
23:56 Good and a little bit of relaxing and a little bit of fun, right?
24:00 Definitely. Always got time for fun. Excellent. Well,
24:03 before we wrap things up, where can people find you if they want to join some of the things you're doing? They want to have more information, they just want to say hi, where can they find you?
24:14 Yep, so probably the easiest way to get ahold of me is on Twitter and my handles, Osman H. Ahmed. And I think you'll probably share the link in the podcast. So that's probably the best way to find me and I'm pretty responsive on there if people do want to get in touch. Certainly if you're interested in concussion in disability sports, or want to talk more about our work that we've done with the mainstream media and how we can engage with them, then I'd love to hear from you.
24:39 Excellent. And yes, that will I will have that link at podcast at healthy wealthy, smart calm in the show notes in this under this episode. And finally, I think I've asked you this question before, but I'll ask it again because maybe you have new advice, but what advice would you give to your younger self knowing where you are now in your life and in your career?
25:03 For a couple of things really, don't take yourself too seriously. I think that's probably a key thing for any young clinicians that certainly when I was working in university, there was a lot of people that were really stressed and anxious to make a mark in the profession. And obviously, that is good. And that's commendable when you want to keep that about you. But also, I think, being relaxed in terms of the way that you do that, and doing it in a collegiate way, I think is probably a really good way to progress your career. I like to think I did that. So that that's less advice to me and more advice to other people. forced myself when I was younger. I'm not really sure to be honest, I'm, I'm pretty happy with the decisions I've made through my life so far. So yeah, probably. I don't know. Pass. Sorry, Karen,
25:52 know that the piece of advice that you gave, don't take yourself too seriously, is perfect. It's perfect. And I think that a lot of people will enter into we're both physio therapists into physiotherapy or healthcare. And kind of like you said, they really want to move their career forward. And so I think it's important to remember Yes, you want to move your career forward, but your underlying Why should be to improve the health of everyone to improve the health of your community, your population that you see, versus getting best of XYZ, or award for this and award for that. I did this look at how great I am. But instead, how are you really impacting your community through your work?
26:38 Absolutely. So keeping everything patient centered. I think that's basically what you're saying there. I think probably the other thing as well is your career is a marathon. It's not a sprint. So you don't have to achieve all of your career goals by the age of 30. spacings out and don't be afraid to reinvent yourself if you find you're in a career or a job that you're not massively enjoying. It's a big profession out there. You're not wedded to one job for your career or your life. There's other places that your career can take you with a degree in the skills that you've got.
27:11 Perfect. That is great advice. Well, thank you so much for coming on to the podcast again.
27:16 I really appreciate it and look forward to seeing you again in person in August. So thank you so much for coming on. Thank you, Karen. And everyone. Thanks so much for listening today. Have a great couple of days and stay healthy, wealthy and smart. | |||
| 574: Eszylfie Taylor: Mind Body Money | 24 Jan 2022 | 00:37:35 | |
In this episode, Founder of Taylor Insurance and Financial Services, Eszylfie Taylor, talks about balancing and prioritizing the mind, body, and money. Today, Eszylfie talks about wearing many hats, how yoga has changed his life, and his work on Mind Body Money. How is short-term gratification hindering our progress? Hear about how Eszylfie fits so much into his life, how he picks himself up after a failure, and get his valuable advice for 2022, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Eszylfie Taylor Eszylfie Taylor is the president and founder of Taylor Insurance and Financial Services, and serves as financial advisor to individuals, business owners, and high net worth families. Over the past decade, he has been widely recognized as one of the most accomplished producers in the industry, receiving the National Association of Insurance and Financial Advisors (NAIFA) award, "Agent of the Year: Los Angeles" in 2010-2012. Additionally, Mr. Taylor is a 15-time "Million Dollar Round Table" qualifier, the last four of which he has been a "Top of the Table" producer, ranking him in the top 1% of all producers worldwide, and was the recipient of the 2015 Top Four Under Forty Award by Advisor Today Magazine. Mr. Taylor began his career at age 22 with New York Life Insurance Company, where he soon ascended to the Chairman's Council, reaching the ranking of #1 Broker in Los Angeles (2006-2013), and #1 Agent for the Company's African-American market (2006-2013). In 2007, he began building his own firm, Taylor Insurance and Financial Services. Mr. Taylor currently sits on the board of three non-profit organizations dedicated to business empowerment, children's health, and social services. He is the founder of the non-profit, Futures Stars Camp, which provides basketball training and life coaching skills (www.futurestarscamp.org) for kids. In addition to his passion for business, Eszylfie loves being a hands-on dad. Eszylfie holds a Bachelor's Degree (magna cum laude) in Business Management from Concordia University. He has also earned the Series 6, 63, 65, and 7 licenses, and a Life and Health Insurance license.
Suggested Keywords Healthy, Wealthy, Smart, Finance, Financial Freedom, Success, Perseverance, Yoga, Mind Body Money, Long-Term Goals, Consistency, Resilience,
To learn more, follow Eszylfie at: Website: https://www.mindbodymoney.com https://www.futurestarscamp.org Instagram: @EszylfieTaylor LinkedIn: Eszylfie Taylor
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:02 Hi, Eszylfie welcome to the podcast. I'm happy to have you on.
00:07 Thank you for having me.
00:08 And I'm excited to talk about you and your journey and all the different hats that you wear in your, in your professional and in your personal life. So let's break all of this down. So you are a financial advisor. You're a yoga instructor, you're an entrepreneur, and you're a girl, dad, and I have a soft spot for I'm one of three girls, you've got three girls, I totally I get it. So if we can, let's first talk about how does all that happen in one life? How do you put that all together?
00:43 Yeah, I think, for me, when I was graduating college, I made a promise to myself that I would never look back at my life and say, what if what if I did this? Or what if I try this? And what if I went here? I just say I just say yes. Right? And as as as a result of that I'm a huge failure, probably arguably, the biggest failure you've ever met in your life. And that's also why I succeed, right? So I would rather try something and fail miserably might fall flat on my face and say, Okay, that wasn't for me and check the box, then just wish or assume. Right? And because, you know, again, I think I didn't want to be a grizzled old man sitting on my porch one day thinking of all the things that I could have done with my life that I should have done with my life and then look back with regret, no, no, no regrets?
01:32 And how do you pick yourself up after each one of those failures? Because, I mean, maybe my skin's a little bit thinner. But I would just I don't know that I would have the fortitude to continue to pick myself up and move forward again. So how do you do that?
01:48 I think for me, you know, sports sports played a big role in helping me create grit. You know, I have a nonprofit that I founded called future stars. And then I teach kids and I'm actually doing a camp right now for kids. And, and I told the kids today, I said, you miss 100% of the shots, you don't take this 100% of the shots you don't take. So my contention is, is I just tell myself, I tell others to be bold, right? Because only something good comes from being bold. Either you're going to get something you've never had, or continue, which you didn't have what you didn't have anyway, right? You're going to get something you didn't have or continue not to have what you didn't have anyway. So what do you lose? To your point? It's really just ego. Right? That's, that's right. Right. And so I'd rather hear or know, or face rejection and say, Okay, well, I didn't have it anyway. So what have I lost? That, you know, nothing, right? Yeah, I look at it, you know, it's, it's only it's only greed, right? It's only only upside.
02:50 And so you've so you say you've had all these failures, okay, I believe that, but you're also incredibly successful in multiple areas of your life, one of those being a financial advisor. So talk about how you got into the financial advising game, and then we'll maybe get since we're in the beginning of a new year is 2020, to maybe get a couple piece of pieces of advice from you, on how to set yourself up for success from a financial standpoint. But first, let's talk about how you became a financial advisor. And we'll take it from there.
03:29 Yeah, I started my career fresh out of college, I'm in the business which is unique, right, so the average financial advisors probably a 55, six year old white male, right, so I'm anything but that I had one simple, you know, modest dream coming out of college that was to become a millionaire by the time I was 25. Right. So 22 I figured what three years is that's that sample time, right? It's reasonable, you know, by three years, that's, you know, that's, that's that should happen. Um, and, you know, I was at a job fair at my university and you know, I'm going from from booth to booth and all the companies are kind of telling me the same thing. I'm gonna make somewhere between 4050 grand a year, and I'm scratching my head and I'm like, okay, like, I'm not the smartest guy in the world. But that doesn't add up, right? Like I get to a million bucks that way and so you know, by by chance, uh, you know, I found my way into this world of financial services and what drew me to the industry was that it was an industry as a field where I was paid for my work I work ethic and aptitude not my age or tenure. Right and so at the end of the day, I was gonna eat what I kill right I was gonna I was gonna I was gonna make as much money I was going to have as big an impact in the community in the world as I worked tap right and so you know, it's funny against the against the better advice of my father who told me no, you know, get go work for someone else get a job right? Go get a paycheck on the first and the 15th and I just like i Dad, I think, I don't know I like You know, I can't even tell you how I'm gonna do it. But I just believe doing it this way me being in control of my fate is just a better way to go. And 20 years later, you know, here I am.
05:12 And I, I can totally relate with the just get a job and get the paycheck. And because I remember leaving college, I thought I would get a job and a hospital or a clinic and I would work there until I retired. Right, because sometimes those worlds aren't open for you right away, and you have to kind of really forge your path. Now you were very successful, as are are very successful as a financial advisor. And then you moved into becoming an entrepreneur, starting your own brokerage. So we'll get to that in a second. But before we do, let's give people a little bit of advice for their financial success in 2022. What's your best advice for us?
05:55 Yeah, I mean, one of the guiding principles of creating financial security is the idea of paying yourself first, right? And, you know, tell people you if you work for a company, right, and and and they didn't pay you, would you continue to go to work? Virtually everyone says, Well, no, rather not go to work, have a good day. But my contention is, you get your paycheck, and you pay rent, and you pay your car lease, and you pay your credit card, and you pay your cell phone bill, right, and you don't put any money away, right? No money in savings investments for you, you just work for free, because none of that money went to create wealth for you. Right. So the the one thing that I would tell people is to pay yourself first. And this really comes first and foremost with creating a budget. Right? You have to have a plan, right? I would say if you aim at nothing, you'll hit it with amazing accuracy. Right? So you have a certain amount of money coming in. Okay, so if I make five grand a month, okay, well, what are your bills? My bills are three grand a month. Okay. That that gap between your income and your expenses? That's called your discretionary income? That's do I make dinner at home tonight? Or do I go to that steak house? That's do I, you know, do I go on vacation? Right, you know, to to Hawaii? Or do I just go camping, you know, down down down the road, right. And so those are your choices, right? Those are your choices. But I always tell people pay yourself first. And the reason and I wanted to drive home the importance of this, you want to get to the point where you can live off of interest, you want to get to the point where you've saved, you've accumulated so much money, that the yield the earnings from your money covers all of your expenses. That to me is retirement. It's not about being 65 or 67, or 70. It's the point at which you remove the half twos from the equation, you do things because you want to do them not because you have to do them. And the more money you put away, right, the longer it's working, the greater rate of return you're earning than the faster you get to that point, right. And so I don't care where it is, it could be a savings account to start. It can be a brokerage account, stocks, bonds, mutual funds, insurances, whatever, right? But something you must pay yourself first. Right? And that's, that's the first guiding, no first guiding principle.
08:10 And I love that I started doing that a couple of years ago has changed my life. Yeah. And it's like, it's so I feel like I have like less worry and less burden on my shoulders. Does that make sense?
08:23 Well, it does make perfect sense. And the challenge is, is people go oh, well, you know, I, my lifestyle will be, you know, be interrupted. And no, it won't, right. And if you think about this, and I love breaking down, and this is maybe a challenge that the listeners can can join in on, take the amount of money you're looking to save on a monthly basis, and break it down to the day makes it even more palatable. So you think about it. If I go, Hey, I want to save, you know, I want to save $1,000 a month. That's my target. Right? So what's that roughly about $33? A day. Right? So you get a lunch every day, Karen, you had to take me to lunch, right? Would that change your life? Would your life suffer? We just ended a living change? Probably not right? You're ready to retire? If I said you have $2 million in your retirement account. Would that help you with that? Would that change your life? I probably wouldn't hurt.
09:19 Yeah, it would be good. I'd be I be okay with that.
09:22 Right. And that is what you're giving up. So it's like we have to give up smaller short term instant gratification things for the long term greater good.
09:31 Yeah. And I think that's that mental shift is so important because we live in a world now where instant gratification is everything right? And so how do you counsel your clients who are used to an instant gratification world to be like, Hey, listen, this is going to come to you but you have to wait. Well,
09:50 I think the principle of saving and investing or paying yourself first doesn't mean you can't have fun. It doesn't mean you can't enjoy the fruits of your labor and I think people tend to, you know, live in these extremes, right? Like either save everything you must, you know, not spend don't have any fun like your life is over right? Or, or like, we only live once I'm gonna spend it all right and, and the reality of is there's a balance, you know in the middle, right? And so what I'm saying pay yourself first in that example if I make five grand a month and I have $3,000 a month of expenses, and I decide I'm gonna put away $500 Well, there's still 1500 bucks to go to the movies to go to dinner to go buy that, you know that handbag to go buy those shoes. You want it right, like, but you made yourself first.
10:36 Yeah, yeah, I love it. Like I said, that mentality has just changed and shifted everything for me. So hopefully, the listeners will take that and hold on to it through 2020. Now, like I said, you wear a lot of different hats. So financial advisors, one new or very successful financial advisor working for someone else. Right? And then you kind of made a shift, you kind of reached the point where, oh, I feel like I've got all this stuff. But I'm not sure that I'm happy in the place where I'm at. Is that right? Yeah, I
11:12 think, you know, for me, I realized I draw the analogy, I felt like I was a shark in a fish tank. Right. Like I had, I had outgrown, you know, the system that I was in. And in order to continue to to flourish, I needed to swim in larger waters, right? I believe in life, you know, you're green and you're Brown, you're growing and you're dying, you're getting better, you're getting worse, there's no staying the same, right? And so for me, I'm always looking to grow, I'm always looking to get better. I'm always looking to be pushed, and challenging. So you know, what better thing than, you know, leaving a 13 year career, you know, and multi multimillion dollar practice than to go out break out on your own and try to build something bigger. So that's exactly what I did.
11:57 And again, not easy. Now, was this around the same time that you started getting into yoga and becoming a yoga practitioner? And how did that change? What you do as a financial advisor and even as a dad and as a person? Kind of connecting that mind and body?
12:18 Yeah, I think it was somewhat around the same time I've been been practicing yoga for about 14 1415 years and and I've been independent now my own brokerage about 910 years and I think what yoga taught me not only what it did for me physically, but it I was very idealistic visit undermanned, right, this will happen, this lab, this will happen, right? I was very rigid, right? This, this, this. And what yoga taught me is it taught me to detach myself from outcomes. It taught me to detach myself from outcomes and to just focus on process. Right. And so there's a little Mater that I that I shared in the listeners can can take part in this as well. And you got a challenge in your life. Right? You got an issue in your life, you ask yourself questions, three questions. Do you have a problem? No. Okay. Don't worry about it. Right? No problem doesn't worry about. Do you have a problem? Yes. Can you do something about it? Yes. Okay. Don't worry about it. Do you ever problem? Yes. Can you do something about it? No. Oh, great. Don't worry about it. Which basically means all paths lead to not worrying about it. Right? So I believe that everything happens for a reason. And it's exact, perfect timing, even the crappy stuff. Right? Even the stuff you're like, This isn't fun. This hurts. Right? And, and, and, and one of the things that yoga has taught me is this just changes my mantras. I mean, even teaching it right, I have all these intentions and things that I that I that I share with with my students and that I have to also live by I can't say it not believe it or not live with it, right. And even this past week, my watch for classes that ease is a greater threat to progress than hardship. Right? And so through adversity through challenges, that is where we that is where we grow, that's where we get product progress, that is where grit is developed. And so for me, Yoga has softened me in so many ways. And let me accept things right, except that sometimes I will get exactly what I want. And sometimes the door will be slammed in my face and it's okay because if a door gets slammed in my face it was supposed to get now now the challenge is in the big so do you need me Sophie, every time you get rejected, you just accept it like know what I mean by trusting the processes. If I have done what is required of me, if I have done everything that I can do, then I can detach myself from the outcome. I don't mean that I'm sitting at home flipping TV. going like, I'm going to make a million dollars this year. Are you working today? Like no, but it's coming to me I'm manifesting. There's two keys to success in life. Number one, you have to believe that's the first part, those that think they can do something and those that didn't, they could not do something about usually right, then the second piece, then you have to do the work. Right. So what I always had was a tremendous work ethic that I always had. But what was flawed, flawed, or what was underdeveloped, if you will, was that mindset that, that that that positivity, that manifestation? That that, okay, this, this is what will happen, okay? This is what I want to happen, okay, and then go out and do the work.
15:38 Yeah. And boy, that second parts, the tricky bit, right, having to do the work. That's the hard part. And I know, and then, what I see a lot, and you probably see this on social media is people will say, Oh, I put it on my vision board, and it just happened. Or I manifested it, and it just happened. And then you're sitting there like, what, like, if that work is
16:02 because people people typically aren't posting their losses, right, people are posting their wins, you know, and the reality of it is, is that, you know, you take any anyone in any any arena sports, entertainment business, right there, they're all failures, all of them. They just were too stubborn to stay down. Right. And that's, that's the difference. I've come to believe that the most successful people in life are simply those who can endure the most pain, who can endure the most rejection who can in you know, indoor, and I think that's how I became successful in my business. I think, I think that I coined the phrase at the time when I was new advisor, I put in the phrase, tactical persistence, right? I'm going to be persistent tactfully. I think, in the first couple years of my career, people ultimately just did business with me, because I like, if I don't buy something from this guy, I think he's ever going away. Like, I don't think he is ever. Right. And so, you know, I was just there, they're there. And they're like, fine, right? I mean, you've developed a relationship and people know, right, then he's not going anywhere. He's gonna be here. Right. And, and, and, and I think I think that's, that's, that's important. I mean, anyone, uh, any one of the listeners, you know, of this program can tell you what is the easiest way to put off a salesperson or a telemarketer the easiest way to um, one simple phrase, call me later. And 99.9% of the time, they will not and you're off the hook. You don't even have to reject it. You did. So call me later because they didn't follow through. Right? Right. They didn't follow up. So you didn't have to actually, you know, say no, even right. And so, that's the thing for me, like, No, I'm gonna follow up and I'm gonna follow through and I'm gonna do everything that is required of me. Right. And if you ultimately type he's not right or my services are right then. Okay. Right. But I will not fail because I didn't do what was required. That will happen.
17:52 Yeah, yeah. That makes perfect sense. And, you know, speaking of tactful persistence, the other hat that you were is a dad to three girls, so I can only imagine tactful persistence comes in handy. So how has all of this your experience in business, your experience in yoga, your experience in life? How does that come together when it comes to raising three, three gals?
18:17 Yeah, um, you know, I, when I was a younger man, I used to pray to God that he'd sent girls to hang all over me. And he took me literally and it's like, here you go, here's three of them. Right? So be careful what you ask for my kid. I've got these three girls. And this is a prime example of you don't always get what you want, but you get exactly what you need. Right? me growing up as an athlete, I was a force for Letterman. In high school, I went on to play college basketball. You know, I recently got inducted into the Hall of Fame in my high school for sports. Right? So of course, I want Boys, boys continue to legacy and go on. And then I get three tall girls, two beautiful girls like oh, man, like God, why? But you know, just, I'm a different man. I'm a different father because I have these three girls. And I think, you know, my, my role and the one thing that I say is like as as a as a man, right of girl, Dad, if you will, I'm the first man they fall in love with. So it's my responsibility to show them, you know, respect and true love and chivalry, because that's where they're going to carry on in their relationships as they get older. And so I think, you know, I feel very blessed. Although, they are sisters and they're they're all flesh of my flesh and blood of my blood. There are three completely different people that represent three completely different sets of challenges and, and, and things to deal with. But I've been blessed because they're good girls, right? And I wish I could say it was because I'm such a great dad. But, um, you know, I think that they're they're just inherently they've got good sweet spirits, which is, which is a blessing to have. And then I'm just doing the best I can to guide them. I think we all can attest to this being as we get older, we become adults, we look back at our parents, and we realize every one of us has said this at some point, like, wait a minute, our parents didn't know what the heck they were doing. Right. Like, and some of us even called our parents out, right? Like, you were just winging it. They're like, Yeah, you know, and so I feel like, you know, I feel like, we're just all doing the best we can, you know, and that's, I'm doing the best we can as much as I feel like, you know, I'm doing all the things from I can from my, my daughters, I'm sure they'll tell you. Yeah, but he didn't do this, or this or this, but, but what they will definitely say is that, you know, I'm president and that I'm, I'm, I'm, I'm consistent, I'm a consistent, you know, consistent force in their life. Right. And that's, you know, that's the most important thing to me. I don't need them to always like me, I don't I don't need them to always agree with me, but I do need them to, to respect and honor Me and then with the love that we have, you know that that's something that you know, is so special, and then I feel blessed to be there for their father. Yeah.
21:20 Amazing. And you're putting all of this together, your financial advisor role your entrepreneur role, your community mindedness, your girl, Dad, your yoga, into mind, body money. So what is it? And what can we expect?
21:42 Yeah, Mind Body money is a docu series that I created. I have actually filmed all of season one, I'm in the process of talking to a variety of networks now to get it placed on on national television COMM And q1 Next year, so stay tuned. I've also created an app that's on the App Store mind dot body dot money that's on the app store as well. But the idea is that how do we become the best versions of ourselves? And we become the best versions of ourselves balancing those three areas in that order. Mind. Body, money, right? Mindset first manifestation, manifestation. Every day when people ask me how I'm doing I Thomas, the best day of my life, I say that every single day. Now, does that mean that everything is going well in my life at all times? Nope. But that's what I say. I'm manifesting positivity. Right. But health alone is so important. We're getting one body, right? Never no one's ever on their deathbed wishing they had more money. Right? So you got to take care of yourself. And then money, good stewardship of your money, right? Money can't buy you happiness, but it can pay your bills. So I can do a lot of stuff by hand. And so typically, what I find is people are unequally yoked right you might have the money hungry driven person and And admittedly, I was that person coming out of school, I want to be a million dollars. I want to, you know, you know, have a nice house nice car and buy stuff, right? But lacks substance lacked connectivity. Oh, right. And, and, and when I got all this stuff, what I realized, like, oh, an empty because it's not about the stuff. It's not about money. Right? It's about connections about love. Okay, and then you got the other people that understand spirituality? No, it's about mindset and in spirituality, and, and peace. And that's great that you feel like that you want to go on this yoga retreat. But I got a question for you. How do you pay your bills? Right. And so it's that it's the balance between those three areas. And that's what the show features different athletes, celebrities, entertainers, all the way down to your common men and women, and how the journey in life, right, you know, is navigating those three areas. And the one thing that I'll tell you, between all of the people, there is always a story of failure. There's always a story of doubt, or uncertainty that they all press through. And that's the one thing that I say common thread, like the most successful people, right that I've met in my life all can tell you a story where they were down and out or they didn't know what's gonna happen next, but they persevered, right? There's a, there's a, there's a little meme that I that I share when I'm doing my my talks and it has it's a photo of a goldmine that you can envision this in a person with a with a with a pitchfork, and they're digging in, they're digging, and they've dug like a 10 foot ditch and they get frustrated, and they turn around like, like I'm finished right? And they were only one foot away from actually hitting goal but they're like I've done so much And then the mantra here is don't don't ever give up. You never know how close you are, to, to your, to your goals to your dream. So So you swing away, you swing away until you get it. Right. And maybe maybe you'll get there in a week, they will take a year, they will take 10 years, right? Maybe Maybe it's not meant for you. Right. But But again, right, don't leave this earth wondering what if?
25:25 And out of all of the episodes that you've done and the people that you've met through mind body money? Is there a particular story that sticks out for you that you can share with the audience?
25:40 Yeah, there's two stories that come to mind. Actually, I'll share first one guest we had was on the show was Jordan sparks. She was the youngest American, I
25:51 love her. She's great.
25:52 She's awesome. Just as lovely. Off off screen as she is on screen. She shared with me so she goes on American Idol. She comes here to actually to Pasadena where I live, she cheats. She auditions at the Rose Bowl and gets cut. She didn't even make it to go see Simon and all those guys, right? She gets cut, right? And she says she remembers walking out, you know, through the parking lot with all these girls. And at the time, she was young. I think she was like 17 or so. But at the time, she said she remember seeing all these older girls and older by but I mean like 2526 year olds, I thought, Oh, my life is over. This is my only chance to make it big. And I'm done. And she thought to herself like, no, like, I'll come back don't get another way for me. So she goes back, she lives in Arizona. So she goes to a regional regional competition in in in Phoenix and wins, right and wins. And the prize for winning was a chance to go to the next city, which was in Seattle, and try again, audition again. And on that second audition, she gets picked up and then ultimately wins
26:58 the show. Amazing.
27:00 And so that story is when we're like wow, you know, like, wow, you know that what level of perseverance and just believe that like not this, isn't it? And how many of us would have faced that rejection or or stumbled in the live live? Yes, it wasn't in the cards for me. Right? But again, as long as you have breath in your body, keep pushing. Right. The other story I'll share is I had David Hasselhoff he was on my radio show my Ask the Experts radio show. And we're interviewing him. And David Hasselhoff was one of the principals of one of the first billion dollar TV franchises Baywatch, right? Um, I personally think that Knight Rider was cooler but for the for you. Gen Xers with me. But anyway, but but the US, you know, first building our franchise Baywatch, right, and we're talking about that. And again, what a lot of people don't know is that they watched initially was cancelled. It was cancelled after the first three episodes. Because yeah, they killed like five people in the first few episodes and and the viewers didn't like it. So the show got canceled. So in an attempt to revitalize the show, because like I need financing, so in little known, but David Hasselhoff in Germany is like he's huge, right? Like he's like, he's like, yeah, he's like, the biggest thing he's Yeah, yeah. Right. So he goes to Germany's like, they'll give you money, right? It goes in Germany. He raises some money. He gets like 1,000,005 to bring back the show, and comes back and does the show, right? Well, what happens is, they run out of money. They run out of money, they can't finish the episode. So like, man, we got 22 minutes of content, we need 25 And we don't have any more money. What can we do? How can we make the episodes longer slomo that is where slomo comes in. Slo Mo was to stretch out the scene so that they can get their minutes so funny that the most iconic part of the show was really a mistake was really because they didn't have money right? So story after story after story like that, that I've heard in my 22 year career most certainly in filming this Docu series is follow doc that like wow, like so many times people put a lay down so many times people could have you know, given a peck Jeff basals worked at McDonald's guys. You have like, like, like so so when somebody next to you when you're when you're working in Starbucks and the barista next to us like I'm going to be a billionaire and all scoff right you never know.
29:34 It can happen you never know. I love these like insider stories. I think it's so cool. So as we start to wrap things up, where can people find more about you about mind body money? Maybe see some little clips things like that. Where can where can people go?
29:53 Yeah, I'm pretty easy to find. My name is so unique. There's not a lot of me out there. He Sophie Taylor, Mama variety of social media platforms Instagram, Facebook, LinkedIn, that's at a selfie Taylor s ZYLF ie Taylor at the Sophie Taylor. For the show, we actually have a website, in addition to the social media platform. So we have a website Mind, Body money.com. So mind body money calm, you can also get information on the app store as well. You can download the app, the app store at mine dot body dot money, as well. And so yeah, we're out here we're continuing to push out new content, and, and keep everyone posted on the release of everything. But I'm super excited for what 2022 is going to bring and look forward to sharing. I feel like the bottom line for me is like when do you watch television? And and learn something? When do you watch television and feel better? And that's what I'm going to bring? That's what I'm going to bring to the world?
30:56 Well, the world certainly needs it at this point in time. So it sounds perfect to me. And now before we end, I asked everyone this same question. And it's knowing where you are now in your life and your career. What advice would you give to your younger self?
31:12 I would remind my younger self, that the road to walk a mile begins with a single step. No shortcuts. No matter how talented you are, no matter how smart you are, no matter how ambitious you are, right hard work is undefeated, you must do the work, right foot in front of the left one step at a time you'll get there. I think one of the biggest reasons that I'm successful today, it's all the slow, boring stuff. All the get rich quick, I'm gonna make a million dollars in a month and change the world all that stuff crashed and burned.
31:47 Right? So you mean all the stuff you see on social media?
31:51 Yeah, all that stuff crash and burn. It was it's the slow and steady. You know that? That is why you know, is why I'm here. Right. And so that's why I remind my younger self and it's hard, right? It's hard to listen, my long term plan at 22 was 25. Right? That was my long term plan. Right? I love that. Right? I mean, I was like, man, three years, that's 25 years old. Right? And so, you know, I can still couldn't even see past 30 like, well, what is what is that? You know, and, and then you you you blink? Right? You blink and you're like, well, 10 years has gone by 15 years gone by 20 years has gone by, you know and so that's what I would remind myself is just stay the course. Don't get you on the highs don't get too long. The lows the road to walk a mile begins with a single step. Just go.
32:37 I love it. Great advice. And Sophie, thank you so much for coming onto the podcast one more time. Where can people find out more about you?
32:48 Social media at ie Sophie Taylor, Facebook, Instagram, LinkedIn, at Mind Body money, Instagram as well. And at the mind body money.com site as well as a mind body about money on the App Store.
33:03 Perfect. Thank you so much for coming on. I appreciate it. I appreciate you. And I wish you all the best in 2022, including your show.
33:13 Awesome. Thank you. Thank you. I'll take all the well wishes and blessings I could get. Thank you very much.
33:18 You're welcome. And everyone. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart. | |||
| 573: Dr. Sheree Bekker: A Contemporary Vision for Sports Injury Prevention | 17 Jan 2022 | 00:36:43 | |
In this episode, Social Justice and Sports Medicine Research Specialist, Sheree Bekker, talks about social justice in sports, medicine, and research. Today, Sheree talks about the conversations around physiology and injuries, and the different environments that affect the ACL injury cycle. How do clinicians implement the findings in the research? Hear about Sheree's qualitative research methods, the importance of recognising the social determinants of injuries, tackling systemic experiences, and get Sheree's advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Sheree Bekker Dr Sheree Bekker (she/her) was born in South Africa, grew up in Botswana, completed her PhD in Australia, and now calls Bath (UK) home. She is an expert in 'complexity' and research that links social justice and (sports) injury prevention. She has a special interest in sex/gender and uses qualitative methods. This underpins her work as an Assistant Professor in Injury Prevention and Safety Promotion in the Department for Health at the University of Bath. At Bath, she is Co-Director of the Centre for Qualitative Research, and a member of the Centre for Health and Injury and Illness Prevention in Sport (CHI2PS), and the Gender and Sexuality Research Group. Internationally, Sheree is an Early Career Representative for the International Society for Qualitative Research in Sport and Exercise, and a founding member of the Qualitative Research in Sports Medicine (QRSMed) special interest group. In 2020 she was appointed as an Associate Editor of the British Journal of Sports Medicine, and in 2021 she was appointed Qualitative Research Editor of BMJ Open Sport and Exercise Medicine. She completed a Prize Research Fellowship in Injury Prevention at the University of Bath from 2018-2020, and received the 2019 British Journal of Sports Medicine Editor's Choice Academy Award for her PhD research.
Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Social Justice, Injury, Prevention, Gender, Sexuality, Physiology, Sociology, Environment, Research, Change,
Resources: Anterior cruciate ligament injury: towards a gendered environmental approach
To learn more, follow Sheree at: Website: https://sites.google.com/view/shereebekker/home Twitter: @shereebekker Instagram: @sheree_bekker
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:02 Hi, Sheree, welcome to the podcast. I'm so excited to have you on. I've been looking forward to this for a long time. So thank you so much for joining.
00:12 Thank you for having me. Karen. I am delighted to be talking to you today.
00:16 And today we're going to talk about some of now you had a couple of different presentations at the International Olympic Committee meeting in Monaco a few weeks ago, and we're going to talk about a couple of them. But first, I would love for you to tell the audience a little bit more about you, and about the direction of your research and kind of the why behind it. Because I think that's important.
00:43 Mm hmm. Yeah, I've actually I have been thinking about this a lot recently, over the course of the pandemic, and thinking about where my research and my work is going and why I'm so interested in in kind of social justice issues in sports injury research in Sport and Exercise medicine. And I guess for me, there are two reasons for that both of them related to my background. First of all, I was born in South Africa. And I grew up in Botswana. And I think, you know, growing up into countries that have interesting pasts, you know, South Africa having post of apartheid and Botswana having been a colonized country, I think I grew up in places where we were used to having difficult conversations about social justice issues on a national level. And I think, you know, that is something that has influenced me definitely in the way that I see the world. The second part for me is I studied human movement science at university. And my program was in a Faculty of Humanities and Social Sciences. And I didn't realize at the time that most people get their sport and exercise medicine, sports science, human movement, science training, in medical faculties, or in health faculties, whereas mine was very much social sciences and humanities. And I only realized this later that my training in this regard was quite different in terms of the way that I see the work that we do. And so now, I've landed here at the University of Bath, and I'm in a department for health. But once again, I'm back in a Faculty of Humanities and Social Sciences. So it's been a really, really nice connection for me to come back to these bigger social justice questions, I guess, that I'm interested, you know, in our field. So for me, that's really the why I think of why I do this work.
02:42 And, and kind of carrying along those themes of social justice and really taking a quat. Know, a quantitative, qualitative, sorry, qualitative eye, on athletes and on injury, let's talk about your first talk that you gave it at IOC, which is about the athletes voice. So take us through it. And then we'll ask some questions. So I'll, I'll shoot it over to you.
03:17 Yeah, so um, my first talk, the first symposium that I was involved in at IOC this year, we had titled The athlete's voice, and those of us who were involved with it, we're really proud to be able to get this topic, this kind of conversation onto the agenda in Monaco. I had so many people comment to me afterwards, that this was the first time that we've been able to have this kind of discussion at this specific conference. And, you know, previous editions, I think, have been very much focused on that biomedical that I was just talking about, given that it's Sport and Exercise medicine. And it was the first time that we've been able to bring athlete voice into this space. And so this symposium in my talk in particular, was really focused on qualitative research. Even though when we pitched the symposium, we kind of decided that we couldn't call it qualitative research, because it wouldn't have been accepted at the time. And, and now, it's amazing to me how far we've come that we can actually talk about qualitative research in these spaces. So what I spoke about, and what I was interested in is, you know, what are the kinds of different knowledges and who are the people that we might listen to in Sport and Exercise medicine and sports injury more broadly, that traditionally we maybe haven't scented and haven't listened to? And I was interested in those kinds of social meanings of injury and of injury prevention and how we might do things differently. So you know, for me, it was that Recognizing the value of alternative perspectives, and working across disciplines and advancing our research and practice in this way. And so that's really what I spoke about was, you know how we might do these things differently by actually listening to the people at the center of our work and listening to athletes themselves. And that was really the focus of that symposium.
05:26 And in looking through some of the slides from the symposium, some of the quotes that I'm assuming we're taking from the qualitative work are, gosh, they're kind of heartbreaking. So what do you do with that information once you have it, right? So you're conditioned not to quit, you turn off your emotions, you become a robot as soon as you step onto the field or the pitch or the court. So how do you take that qualitative research? And what do you do with that once you have it?
06:01 Yeah, so you know, my talk, the way I kind of structured my talk was to talk about how we generally do injury prevention. And what we generally do is we, you know, figure out what the issue is what the injury problem is, we develop an intervention, and then we implement that in intervention and hope that it works. And, and some, you know, that's the kind of general cycle that we use. And what I decided to do in my talk, which was only a 10 minute talk was to dedicate two of those minutes to a video that I showed, that was just set to music that flashed up all of these quotes from athletes. And there were quotes that I'd collected from a number of different sports, a number of different athletes and spaces over the years, that really speak about their experience in sports and these toxic environments, which is something that I think we tend to kind of put to the side, maybe sometimes and ignore, sometimes in sport, when we put sport up on a pedestal and only think about the good things that happen in sports. And those quotes are also, I guess, a throwback or connection to one of the other talks that I had at IOC, which is not something that I think we'll speak about today, but about safeguarding and recognizing safeguarding as an injury prevention issue. And so we had these, like two minutes of these quotes from athletes. And I think that video really signaled a palpable shift in the room in recognizing what athletes are actually saying, and what their experiences are in sport about needing to, I guess, you know, put their their kind of robot hat on and be this strong person within sport where they can't break down where they can't have injuries or anything like that. Otherwise, they're going to be the team. And just for us to come back and to recognize that humanity in that experience, within sport, I think is really, really important, especially when we're at a conference where we're talking about injury prevention and interventions, we have to recognize the human at the center of those experiences. And so for me, coming back to your question about what do we do with that information? I think that's really powerful information, in terms of how we think about what injury prevention is, and does. And I guess we always focus on bodies, and you know, body parts, the ankle, the knee, the hip, the growing. You know, that's, that's kind of been a big focus of injury prevention. And I think we often forget that injury prevention is and can be so much more than that. And that there are these social factors, or social determinants, that to play into injury and its prevention. So the social aspects of our lives in terms of, you know, abuse that might happen in these spaces, or just being exposed to toxic spaces, you know, how that does actually render us more susceptible to injury, and how that can thwart our injury prevention efforts in these spaces. So for me, it's about integrating both of those two things I think together, and that's what I'm kind of getting at with qualitative research.
09:19 And, and that leads me into something else I wanted to talk about, and that is a review from the British Journal of Sports Medicine that you co authored with Joanne Parsons and Stephanie Cohen, anterior cruciate ligament injury towards a gendered environmental approach. And what you just said, triggered in me something in in reading through that article was that there's intrinsic factors and extrinsic factors that can lead to injury and injury prevention programs, if done well, should incorporate both of those. Right but they often concentrate on the biomedical part of the The, whether it be strength training, or landing, or, you know, whatever it may be when we look at a lot of these injury prevention programs, but there are so many contextual issues and extrinsic issues that can impact any of those programs. So I'll kind of let you sort of talk through that a little bit and talk through some of the main points that you found in that paper. But gosh, it really gets you thinking like, Well, wait a second, it could be, like you said, if you are, depending on the environment in which you live, can have a huge impact. And it's, it's more than just, especially when it comes to girls and women, it's more than just oh, it's because you have your period. And that's why this happened. Or if your hips are wider, that's why you got injured, right? So go ahead, I'll throw it over to you. And you can kind of talk through that paper a little bit, and then we'll see what comes up.
11:04 Mm hmm. You know, I'm so happy to hear you say that, because I'm so I'm not a clinician, but it has been amazing to me to hear how this paper has resonated with clinicians and people working in this space in terms of your own experiences and what you see and what you hear from the people that you're working with. So yeah, you're absolutely right. I mean, this paper was born out of conversations that Steph and Joanne and I had in terms of how we were frustrated by I guess, the discourse around sports injury, particularly for girls and women, often being blamed on our physiology on our bodies, right. And to us, that seems like a bit of a cop out. And just to say, oh, you know, girls are more susceptible to ACL injury, because they have wider hips, so there's nothing that we can do about it, you know, so that's really pitched us that intrinsic risk factor that girls and women are just inherently weaker, or supposedly more fragile than boys and men, and there's nothing that we can do about it. So we're just going to have to kind of live with those injury breeds. Right. And, and we found that this kind of thinking had really underpins so much of the injury prevention work that we'd seen over the last 10 or 20 years. And we wanted to problematize this a little bit and to think through what those kind of other social and I would say structural determinants of sports injuries are. So I'm starting to talk about this idea of the social determinants of injury. So not just what are those intrinsic things, but actually, what are the what are the other other social modes, I guess, that we might carry that might lead to injury. So in this paper, we speak about how we, as human beings, literally incorporate I think, biologically, the world in which we live. So our societal or ecological circumstances, we incorporate that into our bodies. And so we can start to see how injury might be a biological manifestation of exposure to that kind of social load. So for girls and women, how our gendered experience of the world might render us more susceptible to injury, rather than just positioning ourselves as being more weak, or more fragile. So we were interested in how society makes us and skills in women more weaker, and more fragile. And so in this way, we speak about how you know, from the time that we're babies, girls are not expected to do as much physically we are brought up differently to young boy babies might be when we go through school and play sport in school, we play different kinds of sports, and again, you know, on average, or in general, and girls, goes out, you know, not encouraged to be as active and to do as much with our bodies as boys. And we then go in right to have this kind of that cumulative effect of less exposure to activities and doing things with our bodies. Actually, that is what leads to us being more susceptible to things like ACL injury over time. And this is carried on in the kind of elite sports space as well. So we see how girls and women's sports are devalued in so many ways and how we're not expected to do as much or to perform as well. Or to train as hard I guess, as boys and men So an example of this that actually happened a couple of weeks after we published the paper was the NCAA March Madness. I don't know if you remember, there were those pictures that were tweeted all over social media, about the women's division, only being supplied with one set of teeny, tiny Dunda. Whereas the men's division was given, you know, massive weight room with everything that they needed to be able to train to be able to warm up and do everything that they needed to do in that state. And the first that was just an excellent example of what we're talking about in terms of girls and women being expected to and actually being made, I guess, weaker than boys and men are in exactly the same sports spaces. And so that's kind of a rundown, I guess, of what we wrote about in the paper.
15:53 Yeah, and I look back on my career as I was a high school athlete, college athlete, and not once was it, hey, we should go into the gym and train with specific training programs, because it will help to make you stronger, maybe faster, better, less prone to injury, but the boys were always had a training program. You know, they always had a workout program. So I can concur. That is like a lived experience for me as to what training was like, comparing the boys versus girls college straight through or high school straight through to college. And yes, that March Madness thing was maddening. Pun intended. I couldn't you could not believe couldn't believe what we were seeing there. That was that was completely out of bounds. But what I'd like to dive in a little bit deeper to the article, not not having you go through everything line by line. But let's talk about the different environments that you bring up within the article, because I think they're important. And a little more explanation would be great. So throughout this kind of ACL injury paradigm, you come up with four different environments, the pre sport environment, the training environment, the competition environment, and the treatment environment. So would you like to touch on each of those a little bit? Just to explain to the listeners, how that fits into your, into this paper and into the structure of injury prevention?
17:31 Yeah, sure. So um, yeah, what we did with this paper was we take we take the the traditional ACL injury cycle, and that a lot of us working in sports injury prevention are aware of, and we overlay what we called gendered environmental factors on top of that, so we wanted to take this this site, call and think through how our gendered experiences and girls and women, again render us more susceptible, and over the course of a lifetime, or a Korean. And so starting with the pre sport environment, you know, that goes back to what I was just saying about girls and boys being girls being socialized differently to boys, when we're growing up. So that kind of life course effect, gender affects over the life course, in terms of what we're expected to do with our bodies. That really starts in that pre sport environment when we're babies and young boys and young girls. And then we track how that works throughout the ACL injury cycle. So moving into the next step, coming back to this NCAA example, you know, what the training environment looks like, and how it might be gendered in ways that we might not even pick up on. So another example here, and this is a practical example that we've given to some sports organizations, since then, is, you know, the kind of gendered language that seems like everyday language and sport that can actually be really harmful to both men and women. So for example, you know, talking about girl push ups, you know, that really does set a precedent for what we think about girls and women in sports spaces. When you say, Oh, you go over there and do some girl push ups, it really does render girls and women as being more weak, you know, weaker and more fragile than boys and men. So those kinds of gendered experience in sports spaces, and you're an example there is really key. But then we also talk about kind of during injury and post injury as well. And this comes more into the kind of rehabilitation space and so on how, again, expectations of girls and women's bodies might play into what we expect when we go through rehabilitation as well and, and how that plays into that ACL injury cycle of recovery, as well. So that's really for So it was overlaying gender, across all of those spaces. And I think that gives us a really powerful way of looking at ACL injury differently and to, to conceptualize what we might do both in injury prevention, but also once injury has happened to help girls and women differently.
20:20 And in reading through this paper, and and also going through the slides that you graciously provided on Twitter, of of all of your talks at IOC, as a clinician, it for me, gives me so much more to think about, and really sparked some thoughts in my head as to conversations to have with the patient. So what advice would you give to clinicians, when it comes to synthesizing a lot of this work? And taking it into the clinic, talking with their patient in front of them and then implementing it? Because some people may say, oh, my gosh, I have so much to do. Now, I have to read all of this. Now I have to incorporate this, do you know what I mean? So it can some be somewhat overwhelming. So what advice do you have for clinicians? Yes,
21:13 so I really do think and as I said earlier, I think a lot of what we're seeing here is what clinicians are doing all the time anyway, I think, especially people who are already connected to this kind of idea of this social determinants of health. And so I guess, for me, it is really just being cognizant of, and being able to have those conversations with athletes, with patients with people that you work with all the time, about their social conditions of their lives. So not again, not just reducing people down to bodies, but recognizing that people have you know, that the social conditions of our lives play into our injuries and our rehabilitation, and holding space for that, you know, when I'm teaching, that's what I say to my students all the time, but I know that that you know, this, and clinicians know this better than I do. You, you know, it's not just about saying to someone, go away and do these exercises, and come back to me when you know, that person might have a full time job with three kids to look after. And, you know, a lot of other things on their plate as well that that one exercise or exercise program isn't necessarily going to be the silver bullet or the answer to, you know, the way that they need to be dealing with that injury. So I think for me, it's again, that re humanizing and being able to have those those conversations and recognizing those social determinants of injury or recovery, and so on. And so I think for clinicians, it is about not simply seeing rehab as a biomedical issue alone to solve, but thinking about it as socially and politically and materially oriented as a practice that you might incorporate in your way of thinking. That's really it. It doesn't need to be any more than that. We don't need to complicate it. Any more than that.
23:10 Yeah. Perfect. Thank you for that. And as we start to wrap things up, is there a, are there any kind of key points that you want to leave the listeners with? Or is there anything that we didn't touch on that you were like, oh, I need I need people to know this. This is really important. Hmm.
23:36 Yeah, I think, you know, if we kind of connect the conversations that we've kind of had today with the different points that we've connected to, I think, you know, what I saw in IRC at the IOC conference in Monaco is I really felt especially on day one at that athlete centered symposium that we had, I really felt like a palpable shift in that room. And in the conversations that I've had afterwards, with people I've had so many people come up to me to say that, you know, that it was really inspiring, and it's helped them to be able to go away and have different kinds of conversations, incredibly have different kinds of conversations about the work that we're doing in injury prevention and in Sport and Exercise medicine more broadly. And so I really think that we need to focus on that idea that injury prevention and a contemporary vision for injury prevention needs to be athlete centered and human focused. And I think if we truly committed to this, I think the ways in which we develop our interventions, and the ways in which we might go about our work, more generally in Sport and Exercise medicine, in physiotherapy and so on, it needs to reflect the socio cultural, so meaning those social determinants of injury in cluding the ways in which things like sexism, and misogyny, and racism, and classism, and ableism, and homophobia and transphobia, how that all can and does actually lead to injury. I think those are larger conversations that we need to be having enough field that we've started to have very slowly, but they are difficult conversations to have. And we often cut them out when we only think about injury as a biomedical thing, again, only thinking about bodies. And so for me, I think those are the those are the thing that we now need to get uncomfortable, you know, about, we need to have those uncomfortable conversations about our complex, messy realities, and that we're dealing with that athletes are human beings, that these are our experiences of the world, that sport and exercise medicine needs to reflect that as well. In terms of our composition, we need to reflect the communities that we serve as well. And Tracy Blake talks about that often. And you know, those are the conversations that I'd like to see our field having going forward. And I do think there was a shift in being able to say those things at Monaco this year.
26:16 Yeah. And so what I'm hearing is, was the big takeaway for me from Monaco is context is everything. And we can't, we can no longer take that out. And focus, like you said, just on the biomedical aspect of this person in front of us as if they don't have past experiences and emotions and thoughts and fears and concerns. And context is everything. And for clinicians, it sounds like a challenge to start having these conversations at more conferences. I know it's this little kind of bubble of clinicians, but if it can start there, perhaps it can make a ripple out into the wider public and into having these conversations with your athletes and patients and not be afraid to have these difficult conversations, or to ask the probing questions to the person in front of you. Because they're more than just their ACL injury, they're more than just their back pain. So I think challenging clinicians to have these conversations, whether it be one on one like this, or within large groups at conferences, and then take that back to your, to your practice and really start living it and understanding that this can is as important, maybe, in some cases more important than the biomedical injury in front of you.
27:41 Oh, I could not agree more with that statement. I mean, something that I've spoken about a lot before is that, you know, sport isn't neutral. It's not a political. And it's the same for the work that we do. It's, you know, for far too long, it's been positioned as a neutral science thing that we do. And I think we're now starting to recognize the context around that, that our values and our principles and people's lives and experiences, you know, as you say, play as much as if not more of a role in their experience of sport, and injury, and rehab, and all of that. So I would agree with you completely, we need to be having more of these conversations, we need to recognize this within our research, we need to recognize this within our practice. And we can't keep going on as if you know, none of so if we can remove all of that from the practice of working with human beings and being human beings as well. You know, all of this is connected for me. And as you know, as we're seeing now, it's for all of us who work in this space, once we start to have these conversations, we can start to ask different questions, we can start to think about things differently. And I think that that's really powerful for the future of our work in this space.
28:55 Yeah. And I think it's also important to remember that we can start to ask these questions start to have these conversations that the answers aren't going to come tomorrow. So that instant gratification that has become the world that we are now living in that if it doesn't happen within the next couple of days, that means it's not going to happen, but that these ripples will take some time. Yeah, absolutely.
29:19 And, you know, so a lot of my work is in complexity theory. And what I say about that is, you know, there probably are not going to be hard and fast answers here. But it will bring up new considerations and it will bring up I think, I'd like us to move away from this idea that we can solve things, but actually move closer towards the idea that this is an ongoing practice. And that that's always going to be I think, more powerful for me when we see things like injury prevention as a process or a practice. That's not necessarily going to solve things. But that is you know, really To the context in which we live in our lives is an ongoing thing. And I think that's what we brought into the ACL injury cycle. Papers. Well,
30:09 yeah, I think it takes away from the clinician as being the MS or Mr. Fix it to, okay, we are layering ourselves into people's lives. And we need to be able to do that in a way that fits the person in front of us as best we can.
30:26 Yeah, exactly. Beautifully said exactly. We can't necessarily solve those things for them. But these provide considerations, things that we can do. And yeah, we can move with that.
30:39 Yeah, absolutely. Well, Cherie, thank you so much. I mean, we can go on and talk for days on end about this stuff. And perhaps when one of these days we will we'll have a bigger, wider, broader conversation and and make it go on for a couple of hours, because I'm sure it will bring up a lot of questions, maybe some answers, and perhaps some changing of minds when it comes to injury prevention and what our role is as clinicians. So thank you so much, where can people find you?
31:13 Thank you, Karen. And I love that I think broader conversations are so helpful in this space. So people can find me on Twitter at Shree Becker, that's probably the best place to find me. I'm always over there and happy to have broader conversations with everybody. So please come and find me on Twitter.
31:32 Perfect. And we'll have links to everything, including the paper that we're talking about. From BDSM. We'll have links to everything at the show notes at podcast dot healthy, wealthy, smart, calm. So one question left that I asked everyone and that is knowing where you are now in your life and in your career? What advice would you give to your younger self?
31:51 Oh, so that's a really good question. And it's I think it's my Elan series, again, connected to what we saw in Monaco. And something that I've said for many years now is connection is greater than competition. And something that I live in that I feel like I wish I had done earlier is to hold on to the power of connecting with people who are at the same career stage and doing work with people who are at the same career stages as you especially someone who has and is an emerging researcher, or researcher clinician in this space, because I think the exciting new conversations that we're seeing in this space are coming from people who are you know, recently merging, I guess, in these researchers faces and so it's okay to collaborate rather than being in competition with people who are doing great work in your area. So that would be my advice.
32:54 I love it. I love it and couldn't agree more. So Sheree, thank you so much for coming on. Thank you again. I appreciate it.
33:02 Thank you so much, Karen. And everyone. Thanks
33:04 so much for tuning in and listening and have a great couple of days and stay healthy, wealthy and smart. | |||
| 572: Dr. Heidi Jannenga: Student Loan Debt in PT - The Rizing Tide Foundation's Solution | 10 Jan 2022 | 00:37:02 | |
In this episode, Founder of the Rizing Tide Foundation, Heidi Jannenga, returns to the podcast to talk about fostering diversity in the physical therapy industry. Today, Heidi talks about the incredible work being done by the Rizing Tide Foundation, the process of awarding scholarships, and future Rizing Tide developments. Which changes still need to be made in the industry? Hear about the growing student debt problem, how you can get involved with Rizing Tide, and get Heidi's advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Heidi Jannenga Dr. Heidi Jannenga, PT, DPT, ATC, is the founder of the Rizing Tide Foundation, which seeks to inspire more diversity and inclusiveness in the physical therapy industry. Each year, Rizing Tide presents scholarships to five promising BIPOC (Black, Indigenous, and people of color) students who are on the path to earning their Doctorate of Physical Therapy (DPT) or furthering their PT education by pursuing a residency program. In addition, Heidi is a physical therapist and the co-founder and Chief Clinical Officer of WebPT, a nine-time Inc. 5000 honoree and the leading software solution for physical, occupational, and speech therapists. As a member of the board and senior management team, Heidi advises on WebPT's product vision, company culture, branding efforts and internal operations, while advocating for rehab therapists, women leaders, and entrepreneurs on a national and international scale. Since the company launched in 2008, Heidi has guided WebPT through exponential growth. Today, it's the fastest-growing physical therapy software in the country, employing over 600 people and serving more than 90,000 therapy professionals - equating to an industry-leading 40% market-share. In 2017, Heidi was honored by Health Data Management as one of the most powerful women in IT, and she was a finalist for EY's Entrepreneur of the Year. In 2018, she was named the Ed Denison Business Leader of the Year at the Arizona Technology Council's Governor's Celebration of Innovation. In addition to serving on numerous non-profit leadership boards, Heidi is a proud member of the YPO Scottsdale Chapter and Charter 100 as well as an investor with Golden Seeds, which focuses on women-founded or led organizations. Heidi is a mother to her 10-year-old daughter Ava and enjoys traveling, hiking, mountain biking and practicing yoga in her spare time.
Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Representation, Scholarships, Diversity, Inclusivity, BIPOC, Student Debt, Education, Opportunity,
Resources Higher Education? By Andrew Hacker and Claudia Dreifus. Apply for a Rizing Tide Scholarship.
To learn more, follow Heidi at: Website: https://rizing-tide.com Twitter: @HeidiJannenga LinkedIn: Heidi Jannenga
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full Transcript Here: SUMMARY KEYWORDS rising tide, scholarship, pt, students, people, heidi, industry, physical therapist, foundation, profession, podcast, scholarship program, year, works, residency programs, physical therapy, pts, residency, crest, education
00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35 Hey everybody, welcome back to the podcast. I'm wishing you all a very happy New Year and welcome to the first episode of 2022. We've got a great one in store. But first, a big thank you to Net Health for sponsoring today's podcast episode. So when it comes to boosting your clinics, online visibility, reputation and referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and get five star reviews. So they have a new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using NET Health's private practice EMR, be sure to ask about his new integration, head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit. Okay, on today's episode I'm really excited to have back on the podcast Dr. Heidi J. Nanga. She is the founder of the rising tide Foundation which seeks to inspire more diversity and inclusiveness in the physical therapy industry. Each year rising tide presents scholarships to five promising bipoc students who are on the path to earning their doctorate of physical therapy, or furthering their PT education by pursuing a residency program. In addition, Heidi is a physical therapist and the Co Founder and Chief Clinical Officer of web PT, a nine Time Inc 5000 honoree and the leading software solution for physical occupational speech therapist. As a member of the board and senior management team Heidi advises on web PTS, product vision company culture branding, efforts, and internal operations while advocating for rehab therapist women leaders and entrepreneurs on a national international scale. Since the company launched in 2008, Heidi has guided web PT through exponential growth. Today, it's the fastest growing physical therapy software in the country employing over 700 people serving more than 90,000 therapy professionals, equating to an industry leading 40% market share. In 2017, Heidi was honored by health data management as one of the most powerful women in it. She was a finalist for he wise Entrepreneur of the Year in 2018. She was named Ed Dennison, Business Leader of the Year at the Arizona Technology Council's governor's celebration of innovation. In addition to serving on numerous nonprofit leadership boards, Heidi's a proud member of the YPO Scottsdale chapter and charter 100 as well as an investor with golden seats which focuses on women founded or led organizations. She is also the mother's 10 year old daughter Ava enjoys traveling hiking, mountain biking and practicing yoga in her spare time when that spare time is I don't know. So today we are talking about the rising tide Foundation. And if you are a physical therapist and you are hoping to go into residency or you're in your residency, you must listen to this episode because you can win a scholarship from the rising tide foundation. If you're listening to this today, Monday, you have until Friday in order to to submit an application to the rising tide foundation to get a scholarship for your residency. So get on it people a big thank you to Heidi and everyone enjoyed today's episode. Hey, Heidi, welcome back to the podcast. Happy to have you back on.
04:02 Hey, Karen, so great to be here. Thanks so much for having me.
04:05 And so today we're going to be talking about a foundation called the rising tide foundation. So what is it and why did you decide to start this foundation?
04:19 Well, thanks so much for having me on. And to be able to talk about this because it really is a has been a labor of love. And a true way for me to give back to a profession that has given so much to me. The Rising Tide foundation really started after a few years of us doing the real estate of rehab therapy industry report which you and I have talked about on this podcast, and every year. There doesn't seem to be a change into two major things that we ask the serve the people that we survey, one was what you mentioned student debt, and actually, not that it hasn't changed, it's actually increasing. And that's a big burden, as you can imagine, to an industry. And then second was actually the biggest emphasis, which is the the, the lack of diversity within our profession. And being a person who identifies as a person of color. The fact that we have this lack of diversity has been a real, real issue, that hasn't made much change, despite, you know, the APTA and others sort of bringing attention to the issue. But the percentages as far as what the makeup of our profession looks like, has not changed has not really changed at all, in the last five years that we've been doing that survey. And so that was really the two major impetus behind me starting this foundation, I've been lucky enough to have financial success with web pt. And so had started the rising tide Foundation, not knowing what I wanted to do with the foundation back at the end of 2019. And then with everything that happened through 2020, it just sort of hit me over the head that this is something that I can personally make a difference in, within our profession. And
06:39 what exactly does the rising tide foundation do?
06:45 It is a scholarship program. So we have two tracks of scholars. We have the crest Scholarship, which is actually geared towards new and new students coming into the profession. And so we provide $14,000 scholarships to three participants, or three scholars, three scholarship winners, that is renewable for the three years PT school, and then we have to serve scholarships, which actually is for physical therapists who are going on to residency programs. And those are $10,000 each, for the one your usual one year program of residency. How, how
07:41 are these winners chosen? What give us a peek sort of behind the curtains, if you will, as to how the process works, so that if people listening to this, whether you are a physical therapy student, or you are one of those people like Gosh, I really want to do a residency, but I don't know how I can make it work financially. So how can these folks apply to the program and and like I said, gives a little peek behind the curtain on how it all works?
08:12 Sure, well, first and foremost, you have to qualify and so if you go to rising dash tide.com, you will find all of the specific sort of qualifications that are required. So for example, for the crest scholarship, you are either an undergraduate who is applying or an undergraduate who is applying to PT school. So you have will have graduated from an undergraduate with an undergraduate degree going on to DPT program, or you're a PTA that's entering into a PTA Bridge Program, which is there's only a couple of schools that do that. But we are also providing scholarships for any PTA who they want to go on to get their DPT so there is a actual physical, like documentation style application, which you have to fill out as well as writing three short essay that include questions like What inspired you to become a physical therapist? And, you know, what does it mean to be a community member? And then also, you know, we really wanted to dive into the essence of who the scholars are. Because we feel like we want to invest in professionals who who are really going to want to make a difference in the profession. So the last question is talking about sort of a failure that you've experienced in your life and what you've really learned from that training. Did you know dive into a little vulnerability and understanding of who they are at the core of the person. And so you also need some letters of recommendation, and transcripts in the normal sort of thing that you might think about in going through a scholarship. So once you you send all of that information. We have a selection committee, which I'm really, really proud of. I was honored to gather quite a few thought leaders from the industry including a fossa, Joe Badea, Maria Gonzalez seen Sharon Wang is actually not from the industry. We wanted to bring together our selection committee, which I call our Beachcombers, hopefully see that sort of nautical theme here. Wendy HARO, who is a software engineer actually works with me with PT, Moyer Tillery, who is also a PT, and then Jean shamrock rod. And those folks make up our our base comers who were to which our selection committee, so we scour all of the applications that come in for each one of the scholarship programs. And we narrow it down to around 10 finalists, and each of the finalists and have to go through an actual live video interview with the selection committee. And from there, we then get the really tedious and hard, difficult decision to narrow it down to the three winners. We just went through the crash scholarship selection process, and it was absolutely amazing. And, and we we were able to narrow it down. But having been our first process, it was just an incredible experience. And we had so many great applicants that we actually ended up awarding five scholarship winners, three of the full scholar, scholarship cross winners, and then we actually started two new sub winners, which are the what we're calling our rising stars, which actually got $5,000 scholarship towards their tuition and, and fees, they might be paying towards PT school.
12:35 That's amazing. And how many people applied for the crest scholarship?
12:44 Yeah, you know, Karen, you know, all about startups right in that first, first year, you kind of are working out the kinks, you're trying to figure out the right processes to have in place. And we had a fairly short window of about 60 days, 45 to 60 days that we opened up the application process this year, for our first cohort of crest winners. And our goal was to get 20 applicants. And after a social media polish and the PR, including, you know, me talking on a few podcast, we actually got 40 applicants which I was so so thrilled about. So we doubled the number that we wanted, then, obviously through that process, it's was so great that we couldn't actually just narrow down to three. So we actually awarded five scholarships and I I just wanted to give a shout out to the amazing scholars that did winner that are part of this first first cohort we had three winners from Northwestern University, Ruth Morales Flores is actually a second year students. Ricky Loki, who is a first year in Jackie Hua, who was a first year as well, just phenomenal, phenomenal students. And Alicia lead from Washington, St. Louis University and Tyrrel McGee, from Regis University. So a really broad spectrum of really interesting and thoughtful students who I know are going to make huge impact on the industry moving forward.
14:29 And you know, you had mentioned that part of the application process was interviews. So a lot you had the members of the committee interviewing 10 Different students and you're reading through 40 different essays. So what did you learn about the PT education system through hearing from all of these applicants and the eventual winners of the scholarship program?
14:59 Well, for First and foremost, as I mentioned, one of the goals and the mission of rising tide is all about improving the diversity of the workforce within our industry. And so, obviously, you know, the number of students that have been accepted to PT school in order to really receive this scholarship and qualify for the scholarship has to be people of color. And so the fact that we were able to get the number of scholarships applications that we did, in such a short period of time, was amazing to me. And, and I attribute a lot of that to the physical therapy, schools really putting diversity as a high priority in terms of their recruiting process of really also trying to change the face of who we are, and to become less homogenous, and more reflective of the society in which we live in. And so that was a real, I want to say, eye opener, but but pleasant surprise, that, you know, despite the fact that we haven't seen the numbers change, that it is something that is a huge priority, and is now after a few years of changing processes, and changing how the recruiting, where they're recruiting from and how they're actually going through the actual student selection process. For example, there are many schools now that are either eliminating, or D prioritizing SAP scores as an entry component, or GRE scores as it goes into graduate school, as a as a component of the process, and putting a higher priority on interview and essays and other things and more more, I guess, tangible areas of interest as they go through the, the selection process for their incoming classes. And so that was a that was really positive for me to really hear that. But it more than that, it was the passion that the students had for the industry. You know, I don't think much has changed in terms of why people get interested in the PT field, most of them had had experiences, whether it was personal or with family members, that really sparked that inspiration to to go into the PT field. Some of the other things that were just amazing about these students is almost every single one of them were working full time jobs, at the same time as going through PT school, some of them more than one job. We heard stories of, you know, students who basically had to decide whether they were going to pay for food, or pay for a book. And so the determination and just the sheer passion around why the and what they're able to do in order to accomplish their goals, was just astounding. And I don't know that, you know, most people understand the sort of path that, you know, underserved populations sometimes have to take in order to accomplish those goals.
18:54 Yeah, that's amazing. What a great group that you you got to meet. Now, after talking with these students, aside from the fact that hey, schools are kind of changing the weight of inclusion criteria, what further changes do you think need to be made within the industry? And on that, we'll take a quick break to hear from our sponsor, and be right back with Heidi's answer. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing Audit?
20:01 Well, we know as, as we you, you started talking about in the beginning of the show is the student debt ratio that pte students are coming out with post graduation. We've seen that time and time again, in our state of rehab therapy industry report, as we surveyed, you know, 1000s, of therapist to understand their biggest woes, as they are navigating through this profession. And, you know, I, there's a huge segment of of the folks that answered that survey that have more than $150,000 of debt post graduation. And that was a 5% increase over what we found those numbers to be in 2018. So just in a few years, that number has grown significantly. And so that's to me, it's just not sustainable. When you compare what the compensation is, for an average, you know, new grad, being somewhere between depending on the type of PT services that you're delivering anywhere from 60 to 90 grand. That's just not commensurate to be able to be able to live and then pay off that debt, which you know, $150,000 in PT school usually means on top of another 100 grand at minimum that you you've accumulated through undergrad. So we're talking a huge, tremendous amount of debt. And so what I know is also happening is looking at shortening the timeframe in which it takes to get a doctorate degree, there are universities and colleges like South College, that are changing the way we think they're trying to change the way we think about PT school, where it doesn't have to be 100% in person that, you know, a large portion of the time spent can be done online. So that cuts down significant amount of debt in terms of having to pay for housing and other things. And it just becomes more accessible to more people, and decreases the cost of the overall educational process. So I really think that the cost of education, rethinking how we do the curriculum, of what truly is necessary to be in person are things that that really need to be looked
22:40
23:21 No, I don't think that happens very often. As a matter of fact, I think, you know, especially in the times that we're in right now, you know, the the 5%. Five to maybe 10% increase year over year is probably what's on average. So, you know, it's gonna take you a while, especially if you're you're starting out as a new grad in that maybe 60 to 70 range to even get to the, you know, the six digit. Right. And so, yeah, it takes a lot to try to balance the price of education to what we actually are getting paid as, as clinicians.
24:05 Yeah. And and if there's a really great book, Heidi, I don't know if you've ever heard of heard of this book, but it's called Higher Education question mark. And it's by Andrew hacker and Claudia Dreyfus. And they talk about the cost of higher education. And what are some of the extraneous things happening on college campuses that aren't going directly to the education of the students, but yet is being reflected in the price of admission. So if people want to learn more about that, I would highly suggest reading that book.
24:40 Yeah, absolutely. There's a lot of debate happening right now around higher education and the need for it. You know, I know even within our own profession, there's a lot of question marks around the DPT on whether it was worth it or not. But at the end of the day, we are here we are At level professionals, but we do need to figure out if we are going to continue to grow and have an attract the top talent that we want to continue to have our profession, you know, be recognized as adding, you know, tremendous value to the overall healthcare system. We definitely want to, you know, remain viable and relook and relook at how perhaps we're doing some of the things because I just don't think that the way the path that we're on today is truly sustainable.
25:38 Yeah, I agree with that. And now, let's say you're a student out there, or you're going into residency, how can they get more information to apply for upcoming scholarships? And is there are there any scholarship applications that are due soon?
25:55 Yes, I mentioned we have the crest scholars, but we also have the search Scholarship Program, which is for residency programs. And that current application process is open right now. And so it will be closing on January 14. So if you are a current resident residency program participant, and would like to apply for the surge scholarship, and you are a person of color, you can apply at res rising dash tie.com. If you go to search scholarship on there and just hit the Apply button, it will take you right to the page in which you can fill out all of the information, upload any documentation that we're requiring. And then we will definitely take a look at the application and put you into the process.
26:55 Yeah, so that means if you're listening to that, listening to this podcast today, on the 10th, you have until the end of this week, so get on it if you want money to help you get through your residency, so you've got like you've got five days, so get on it.
27:14 And this is an annual annual renewal process. So we will launch a new cohort every year. So if you miss out this year, but you're going through your residency programs, this year, you will get another chance at the end of this year to apply for the scholarship. And definitely any students out there who might be listening or interested in the field of PT, and you are going to be a new grad in this upcoming year of 2022. Or I'm sorry, a new student to PT school this year. And please, please, please think about offsetting some of that student debt through a scholarship program like rising tide.
27:55 Excellent. And now what's new with the foundation? What do you have coming up aside from these amazing scholarship opportunities,
28:03 while being part of rising tide means you're part of our community. And so one of the really awesome things that we are going to we are doing with our cohort is getting them together annually for sort of rising tide retreat in which we're going to have thought leaders from the industry come together to help be mentors to these students. Each cohort will be building on itself. So as we have this first group of 2021 Slash 2022 go through this year, they will then come back and be be mentors to our next cohort of students that will be coming through so part of the sort of surge and crafts together where you've got, you know, physical therapists going through residency programs will help to be mentors to these up and coming students. And so creating this community of connection, and education is really what we're planning through 2022.
29:15 I see what you did there. I like it, I like it. And now let's say you're a physical therapist like me, and you're like, wow, I am loving this rising tide. How can I can I donate to this? Can I be a part of this? What can I do?
29:32 Yeah, that's a great question. Karen and I, since launching this this past year in 2021, I just been so honored by the amount of outpouring of support that people have wanted to give to this program, including financial. I mentioned that it was self funded. And you know, We've had many, many years of scholarships that are going to be awarded. But with this outpouring of support of people who wanted to donate financially, I, I went ahead and change the 501 C three status to allow me to have donations. And so in March of 2022, we will be opening up the rising tide foundation to people who want to donate. And my hope is to actually double the number of scholarships that we're going to be able to award in 2022, that we we were able to do in 2021. And so if we can continue to do that every year, so that would mean we would award 10 scholarships in 2022, rather than five for at least the cross scholarship and then four of the search scholars, I think that would be absolutely amazing. And as you can imagine, if we did that year over year, we would be funding almost every PT student in let's say, 20 years.
31:05 Exactly. Hey, that's that big blue sky dream, right? The be hag? Yes, yes, the big big dream. And and, and it's a great dream to help future physical therapists not be saddled with the amount of student debt that a lot of students over the past couple of years have, unfortunately, had to deal with. So I think it's a wonderful foundation. And I applaud you for taking the initiative to putting this out into the world. And again, where can people find Oh, you said it a couple times, and we will have a link to it in the show notes. But where can people find more about the scholarship and about rising tide?
31:49 Yep, it's www dot rising with a Z r i v i n g dash tide.com. And I'm sure many of you have heard the saying rising, a rising tide raises all boats. And that's really where it came from. It's something that has that thing has really meant a lot to me, in how I perform as a leader, and what I sort of prescribed to as sort of my own personal culture of wanting to help people. And so that's where sort of the name sort of stems from. But yeah, go to rising tide.com. And you can learn all about our foundation and scholarship program, you can sign up for our blog subscription, we have a monthly vlogs, coming out about all kinds of things that has to do with how students can improve sort of how they think about becoming a physical therapist, too, just thought provoking ideas as we go about wanting to sort of change the face of the PC profession.
33:05 Perfect. And I'll also add that you're also on Instagram, and on Twitter. So if you go to the website, you can go down to the bottom and click on the little icons, and you can follow rising tide on Instagram and Twitter and LinkedIn as well. That's right. Yeah, perfect. All right. Well, Heidi, as we start to wrap things up, I know, I asked you this before, so you're gonna have to think of something new. What's another piece of advice you would give to your younger self?
33:41 Well, I would just say be open minded to a path that you may not have thought that you might go down, go down. I will just say that, you know, starting a nonprofit, and a scholarship program was really not on on my radar. And as things have unfolded, just like starting in that entrepreneurial mindset, like it works in your professional life, as I'm sorry, it works in your personal life, as well as your professional life in terms of finding problems that need to be solved and figuring out a way to do that. And so stay staying really open minded to things that come your way that may not be necessarily what you think, or had planned to do. To find ways to just try to try new things and be open minded to those options and they can take you down path of trim adding tremendous value and to others but also just in, in in to yourself as well.
34:58 Yeah, excellent advice. keep your mind open. And if something aligns with with your vision and values, then go for it. Great advice. Heidi, thank you so much for coming on to the podcast today talking about rising tide. And again, if you're going to mention this one more time, if you're going into your residency program, check out rising tide, check out the website. We mentioned it several times, also in the show notes at podcast at healthy, wealthy, smart, calm and apply, because you've got a couple of days if you're listening to this on the 10th of January 2022. You've got until the 14th to apply for the surge scholarship. Is that That's right, right.
35:44 That's right. Okay. Well, you got until the 14th until the midnight of the 14th and mentioned that you heard it on rising tide or on the healthy wealthy podcast. And we'll just move you to the top of the stack.
35:56 Yes. So So do it. People get on it be a part of the rising tide. Heidi, thank you so much for coming on.
36:04 Karen, it's always a pleasure. Thank you so much. Yeah,
36:06 of course. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Dr. Heidi Jenga for coming on the podcast to discuss the rising tide foundation and of course, thank you to Net Health. So again, they have a new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net health.com forward slash li te zy to sign up for your complimentary marketing audit to get your clinics online visibility, reputation and referrals increasing in 2022
36:45 Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media
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| 571: Dr. Jenna Kantor: 2021 Wrap Up: The Highs, the Lows, and In-between | 30 Dec 2021 | 00:49:42 | |
In this episode physical therapist and podcast cohost, Dr. Jenna Kantor talks about the highs, the lows, and everything in-between from the past year. We talk about:
More about Dr. Jenna Kantor: Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, Regional Dance America Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre. Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia. During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media. Jenna Kantor currently holds the position of the NYPTA Social Media Committee, APTA PPS Key Contact, and NYPTA Legislative Task Force. She provides complimentary, regularly online content that advocates for the physical therapy profession. Jenna runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online course for performing artists called Powerful Performer that will launch late 2019. To learn more, follow Jenna at: Website: https://www.jennakantorpt.com/
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here 00:00 Hey. Hey, Jenna, welcome back to the podcast for our annual year and Roundup, if you will. And I want to thank you for being a great addition to the podcast and for pumping out really amazing podcast episodes, you're great hosts, the energy is fantastic. And the podcast episodes are always great. So I want to thank you for that.
00:27 Oh, my God, you're so sweet. I like I was definitely not as much of a podcaster this year, I acknowledge that. But hey, listen, we've all been adjusting this year to pandemic and now pandemics still happening, but also recovery. And I'm just grateful to still be a part of this podcast in any manner to be in this interview right now. Because I really, you and I are very much on the same page regarding remaining evidence based and speaking to people that we respect in this industry, and also people that we want to see just rise and have great success. So I'm just grateful to be honestly, I am humbled to still be in the room here with you.
01:11 Thank you. That's so nice. So kind. Now, let's talk about this past year. So 2021, obviously dominated by the ups and downs of COVID, which is still going on as we speak. We're we're both in the northeast, so we're experiencing an incredibly high surge at the moment. So COVID is obviously a big story. And I think part of the COVID journey that isn't being talked about as much. But I think general public, certainly the mainstream media, are people now living with long COVID. It is just something that seems to be skimmed over. And we know that at least at least the bare minimum is 10% of people diagnosed with COVID will go on to have symptoms of long COVID. And instead of some of the studies that I have read recently, those percentages are much, much higher. So what I guess, what is your take on all of that? And what do you think we as physical therapists can do to keep this in the in the forefront of people's minds.
02:23 We discussed this before, but I think there's going to be bias within this. So I want to acknowledge that we all have our biases. That being said, I think we need to first acknowledge there was a phase where there was a part of the world that did not think COVID was real. So based on the research that is out there, and personal experience of a lot of people getting it, as well as personal friends very close personal friends working in hospitals in New York, specifically COVID is real. So I want to say that first. I'm not going to differ from that I really wish there I'm I think we're past that in the world. I think there was never a clear cut of like, Oh, I got it, I see that it's real. I was wrong. I would have liked that moment, because that hurt people in the process. But I just want to say that first. So COVID is real. Okay. Now, let's not belittle it. And I think in regards to the patient care. I think this, the reality of long COVID needs to be just as respected. Just like when you have a patient that comes in the door and says they're in pain, and you don't believe them. We need to stop that. So we need to believe them and their symptoms, and what they have and what it's from and treat it accordingly. Because if we go in the door to help out these individuals who are struggling with this, they're not going to get better. What are your thoughts?
03:59 No, I agree. I agree. And I've heard from people living with long COVID that people don't believe them even their own family members, people in who work in medicine, they don't believe them. So I think that's a huge takeaway that if as clinicians we can do one thing sit down Listen, believe because the symptoms that they're having are real. We did a couple of episodes on long COVID thing was back in August and spoke with three amazing therapists and they're all involved with long COVID physios so if anyone out there wants more information on living with long COVID I would definitely steer you to long COVID physio on Twitter and and their website as well. Because they're a wealth of knowledge. These are people living with long COVID their allies, they are researchers and I think they're putting out some amazing information that can help not just you as the clinician, but if you know someone that maybe you're not doing directly treating maybe it's a family member living with long COVID I think the more information you have, the more power you can kind of take back to yourself.
05:10 I love that. I love that. It's the biopsychosocial model. I mean to that I from working because I work specifically more with performers, the psychosocial component, my my patients, my people I call my people, my people would not be getting the results they're getting if I didn't have to deal with that, with them standing by their side, holding their hands helping them through and out of their pain. There's symptoms every day and this that goes for anything.
05:41 Yeah. And and we now know, speaking of performers that a lot of Broadway shows are being sort of cancelled, and then restarted and canceled and restarted because of COVID outbreaks within the cast. So this may be something people might think, Oh, I work with performers. I don't have to worry about long COVID Well, maybe you do.
06:01 Yeah. Yeah. And for them, it's the, from the performance that I'm in contact with on Broadway that, you know, it's I'm, I'm, I'm very connected. I've been in the musical theater industry for a very long time. So for the people who are on Broadway, the individuals I spoken to, they're doing okay, which I'm really, really grateful for. It is a requirement for the performers to be triple vaccinated, and now they're getting triple vaccinated. I know one performer on Broadway, who was about to get her booster shot, and then ended up getting COVID, which was quite unfortunate. She's doing okay, though. Grateful, no signs of long COVID Right now, but for the performers, you're talking about dance, there's endurance and breathing that is necessary. If the singers even if they're, they're not dancing, they still dance, they're still asked to do things, they still have out of breath, emotional moments, were breathing is challenged. So I'm just bringing up one component with long COVID. But that's, that's a big standout for performers specifically, that need, it needs to be kept out for them. I remember one time during, oh, goodness, during 2020. And it was the latter portion of the year. And I was doing virtual readings with performers. That's how I was staying connected with my my friends and people in the industry. And it was our way of being creative. In the meantime, while we're waiting for things to open back up. And one individual is she what I just cast her to read as the lead in the show, and she was so good. It was my first time hearing her perform first time meeting her. She was Outstanding, outstanding. And at the end of it, we were going around checking in with each other how we were doing and she started to cry and opened up about losses and her family due to COVID. And that she didn't think she would be able to sing like that again, because she had been dealing with her breathing problems for so long. And so then we all get emotional with her. I'm getting emotional just thinking about it. So yeah, it's it's a it's a real thing. We didn't have the vaccination then. So I'm interested to see statistically where we are at with long COVID with having the antibodies in our systems. Obviously, everybody is different, but I'm hoping that there's less of it because of the vaccine.
08:25 Yeah, time will tell right? Yeah, we have we need those data points. So aside from obviously COVID being, I think the biggest story of the year, certainly within healthcare and even within our field of physical therapy. What else have you seen over 2021? Or maybe it was in an interview you did or a paper you read that really stuck out for you as as a big part of the year you know, it made it's made it it made its mark for you.
08:58 Oh, I'm going to focus just on the PT community. And I want to emphasize with community I see our community at really, we've always butted heads there's always things that we butted heads on. But I'll just give the instance that really made me go whoa, I was in a room with a bunch of intelligent wonderful human beings and discussing something I said a term that I thought was really common especially because in the musical theatre industry. We are fighting for dei diversity, equity inclusion all the time. Like if this is a topic of conversation all the time. It is a huge thing in regards to casting what is visually out there the most at like the highest level and, and bipoc the phrase bipoc was unrecognized by a good portion of physical therapists in this room and I was disappointed Did I was it said so much it doesn't. It's not saying that a person is evil for not knowing no. And that is not my point. But it is a problem that it's not being discussed to the level where these common extremely common thing phrases are not just known. That just says a lot to me, because it's in regards to people getting in the door access and being reached, in lesser, lesser affluent areas, that to me, it shows that it's not being discussed, it's not being addressed. If it was, then bipoc would be, and this is just one instance. But I thought that was very eye opening. Because it's just like saying, I'm going to eat today, someone saying, I'm not going what you're not eating, I don't know. And that was a bad example. But just something that is or you wake up you breathe, that is how known the phrase bipoc. Same thing with LGBTQIA. Plus, in my community, like, for me to go into another room and for things to need to be defined. I know we all have different worlds. But I think as physical therapists, there, there's a disconnect, unfortunately, depending on wherever we are from, and we need to fix that. Because I can't live everywhere. I can't treat everyone in the world, I can't treat all the performers in the world, I don't want to I like having my niche practice and treating select individuals, and boom, my people do very well. And if it gets to a point that it starts to grow, I'm going to be passing them along because I don't want I don't want that I don't want it to be huge like that. And with that in mind, I need more people who know and therefore are our allies. To me, it's a lack of ally ship, of just not knowing the basic language. And I and I apologize to anyone who's listening on my intention is not to sound like a white savior at all. It's not. But with my limited knowledge at this point, I'm already seeing something that is really, really lacking amongst each other and we need to fix it. I don't know if it's books or I don't know, I don't I don't know the answer to that. But I'm just addressing that was that was the biggest standout thing for me this year.
12:27 And it for those of you who maybe are not familiar with the American Physical Therapy Association, they have what's called House of Delegates. So they had a meeting in September of this year during the APTA centennial celebration. And in that they did pass a resolution that the APTA would be an anti racist organization. Now, were you in the room when that passed? Jenna?
12:54 No, I was not in the room, I was actually there at the House of Delegates a bit discouraged this year, I know. i The fact that they were able to figure out any manner to put it on is is a feat to be had after 2020 20. However, the in person when you go and if you are not a delegate, which I was not this year, you can usually sit in the room, and just be in the back and listen, because the because of the space that they got in the way it was set up, there were chairs in the back of the room, but there weren't that many and it filled up. So they already preemptively set up another room where you could watch what was happening on a TV, which did not sit well with me. Because I could have stayed home instead of flying in for that. So I was definitely not in the room. I definitely was less present this year. Because of that I was I was bitter, I was bitter. I was bitter. I felt like I I already know you it's through elected and know who you know, to become a delegate, but I really felt disrespected and unimportant. Being in a separate room, watching from a TV rather than actually getting to be in the room because there are ways that they hold the meeting where you can stand up to say a point of order to speak on some points from the from the back of the room. And I just wasn't even going to wait to see how they figured that out. I just felt like not a not an important voice. So I wasn't present for that. But I do know about that. I think it's wonderful to get that on the docket. But the same thing when we voted in dei unanimously. How?
14:41 What comes next? You mean? Yeah, well, yeah.
14:45 What is the game plan? Because for me, I can say a sentence like that. But then what are the actual actions and that's where it's like, is that going to happen? Two years down the road three years. What are we at what are we actually doing? What are the measuring points and take action? and not meetings on it, not being hesitant on making mistakes. Let's make mistakes. Let's just go for it. That's the only way we're gonna learn. There's no such thing as a graceful change, no matter how hard you try,
15:11 right? Yeah, yeah, I agree. I think like you said, what comes next is? Well, I guess we'll have to wait and see what are the action steps they're going to take in order to create that and, and live up to the, the words of being an anti racist organization? Because it was passed overwhelmingly.
15:32 Right? And then I'm sure they applauded for it, you know, like, this is great. But to me, I think it's, I it's just like, okay, you know, like, what, but now what? Because from DJI and the I heard that they're trying in the battle in this behind the scenes, trying to move forward, but I have not seen action there. And maybe I'm missing something, you know, feel free to call me out Call me whatever. Like, I'm, I would love to be wrong.
16:07 Yeah, these big organizations are slow ships to steer. That's not any excuse whatsoever. But I understand there's a lot of layers that one has to go through to make things happen. As you know, you've been volunteering for the APTA for a long time. So you understand that, but I think a lot of people who don't don't, so that's why I just wanted to kind of bring that up and saying, like, yeah, it takes it takes a long effing time to get stuff done, you know?
16:33 Yeah. And I mean, you can hear it, I'm frustrated by I'm not, I'm not happy about it. And but it's, it's because of my friends, the conversations I have, and I, I'm, I'm lucky, I'm a sis white, stereotypical female. So like, the way the world has been made, and the way it caters to humans. It fits me, but it doesn't fit everyone and I'd like I can't imagine what it would be like to just be left out of a lot of things in everyday life. I think that's horrible.
17:05 Yeah, agreed. What else? What else do you think was a big something that you saw within the profession? Or even trends in health and fitness that might have really changed over this past year? For better or for worse? I can think of one I think and this is just my opinion that the the communication via social media has gotten a little too aggressive. Is that a nice way of saying it? Like I don't understand it, I don't get it. I took like a little break because I was Oh, can't say I was bullied because I feel like bullying. It's that sort of like you know someone is having like a sustained go at you. So I don't know
18:01 it's bullying is bullying. Yeah, bullying is bullying. That's the thing is that we have a lot of bullying that happens but then they gaslight you about their bullying. It's like Whoa, it's next. It's almost like a strategy. Like they're playing a game of Monopoly, and they have down how to win. Like, yeah, people barely there is a lot of bullying.
18:20 Yeah, a lot of bullying. A lot of threatening, like, I get like threatening DMS or people threatening me, you know, on their Instagram stories or whatever. For I can't imagine I look back at that interactions. And I'm like, I don't get it.
18:38 Yeah, I don't get it. Yeah.
18:41 So I and my first reaction was to like, when people will do this and be so aggressive as to send like a Taylor Swift GIF. Of her song, you need to calm down. And then I have to take a step back and be like, that's not gonna help the situation any. Right, right. Right. Don't do it. I just sort of back off. But I think because of that, bullying or threatening behavior, I've
19:05 really like I'll say it bullying continue. I've,
19:09 I've just like, for the past couple of months, I've really taken a backseat to any kind of social media just to like, give myself like a mental health break, you know, like meeting I don't comment on things. I might post some things here and there, but I don't really make any comments, unless it's to. And that's mainly and I'm going to say this because from what I can tell it's true, is it happens to be men in the profession who are a little more aggressive than the women, like women can seem to have a bit of a nicer conversation around whether it's a question or, you know, something, but when a lot of the men it's just become so like ego driven, that there's no resolution, and it's just mean. Mm hmm. And so I was like I need to take a break. So I saw a lot more of that this year. I don't know if it's because of lockdowns and because of a heightened sense of what's the word? Stress to begin with? And then yeah, or something else on top of it? I don't know. But I, I saw that this year, definitely for the worse, because I just think, gosh, if people outside the profession are looking in and watching these exchanges, what are they thinking?
20:28 Yeah, yeah, I've definitely seen it in sis males specifically.
20:33 Yeah, yeah.
20:34 I'm not it honestly. doesn't it's not a specific color of skin. But specifically sis males.
20:43 Yeah, I would I would agree with that. Yeah.
20:46 I have. I have experienced a little not not to the level, but I've definitely experienced that. And it's for 2021. And it's not okay. No, it's not okay. However, I ever look at it as a blessing. And this is where I get I love looking at it like this. Yes, please, please, thank you. Thank you for identifying that you have no space in my room, my shelf my space at all. I will not take advice from you in the future. And I will not heed any, any value to what you have to say, because of your willingness to chop me down. Thank you for identifying yourself. I'm now in the debate of blocking you from my mental health. And that's it. And that includes in person. That's it. That's it. And I really don't look as blocking as like, wow, for me, I'm going like, No, I don't want to know you. I don't want to know you. And my life is so much better because of it when I was at the PPS conference, because of just going No to the to the people I don't want to know and just saying like, just straight up like I like I don't need you, I don't need you. I want to be a service to people who need physical therapy period. So people are going to just, you know, find ways of you know, and spend their time writing some angry thing. Have that that's on them that's on them. Like I'm like, like, and if it and honestly I will likely block you.
22:18 I love that I love like you're you're it's not just that you're blocking the person. You're blocking the energy blocking the energy they're bringing into you and draining you down. So then you're not at your best well, or with your friends or loved ones patients, even with yourself. Yeah, you know, if you have to ruminate on these people. I love that. Yeah, it's not it's not just blocking you from social media, it's blocking the energy that you the the bad vibes, if you will, that you're Brown. And that affects you that affects your mental health that affects you emotionally. And it can carry through to a lot of other parts of your life and who needs that? Yeah,
22:59 and, and for anybody who's trying to saying like, I can a bully did it or like it. Okay, let's, let's look at it this way, when you're messaging an individual something, first of all, we all know this. When you write in text, everybody's going to interpret it with different tone. So as soon as you write in text, we all know this, and we're taking advantage of that fact. So that way, you can later go, oh, I said it in a nice tone, Bs when you're typing it, it can be in whatever freakin tone and you know what you're doing. Also, when you're not talking to a person, the only time you show up is to say something negative. Yeah, that's you're not your voice is not important. And you know, your voice isn't important.
23:39 It's so true. What I've actually seen is a lot of these, these kinds of people, they're not getting the attention they used to get. Mm hmm. Do you know cuz I think more people are of the mindset of like, I don't need this anymore. Like this was maybe this was funny. Maybe this was cute a couple years ago. Ah, not anymore.
24:01 And also I love I don't like having down moments, but we all have our down moments in our career and in our life. But I what I do love about the down moments in the career in life, the people who are around at that time, those are your friends, those are the people you want to know. So I love my moments in the PT world. When I'm in a down moment because the people who want to talk to me then those are the people I want to know. Whereas when I'm you know, can candidate for the private practice section, you know, which is awesome. And then people want to actually talk to me then. Oh, wait, I'm gonna wait and see when you know, I'm not that. Am I still someone you want to speak to? That is those are the people I want to invest time in. Those are the people I want to invest time in. I want to see you you do well and vice versa. I want to be able to get to know you as a human more and more and more. I just want the children Relationships, it doesn't mean I'm going to have time or you know, we're gonna have time to talk every day. But I want those true relationships. So for me, those downtimes, when I might not look the most graceful, I might be messing up or maybe not messing up. Maybe I'm actually making a change here speaking on something or getting people to think differently ever thought of that, you know? Awesome. Like, are you gonna be here to chop me down? Or just be here to have a conversation and having a conversation? Set up a phone call? If you really care? Like if you really could you don't? People don't care that Oh, reaching out, they don't care about you cannot be when they're reaching out to give feedback. Let's have a comfort. No, they just want to get into an attack mode. No, we No, no, don't try to decorate it. We know that's what's happening. And yeah, that were to town. There's enough going on.
25:52 Yeah, there's enough going on. And you know, this conversation really made me reflect on the past year, and I think what's been a good thing has been the deepening of good relationships. So like, nobody has time for that other, like bad stuff anymore. Like there's enough bad stuff happening. I don't have time for that. But what you do have time for is the relationships that are two sided, you know, a nice bilateral relationship that you're willing to invest in, and allow that relationship to come deeper and grow. And I feel like, you know, and like, you don't have to be friends with 1000 people, you know, you can be friends with a handful you can be friends with one person. And if that person, it's it's real and deep and meaningful, then isn't that wonderful? And I think years ago, I used to think, oh, the more
26:46 people you know, the better. Me too. Me too.
26:49 And now I think because of the upheaval of the last couple of years now, I'm really finding like, you know, I need like couple of good people that I can count on to have my back to, like you said, lift you up when you need to, and maybe to like, give you the honest truth when you need it as well. Right? Exactly. So I've been really, really happy that over the past year, I've made some really nice deeper connections with people than the physical therapy World Sports Medicine world. And I'm really, really happy about that. So I think that's been a real positive for me,
27:26 I totally agree with you, I mean, that our relationship is naturally growing over time, which I appreciate and, and I really do I completely on the same page completely on the same page. And and for me, when I go to conferences, like I'm really isolating more and more, who are the two are the people that like I must spend time with? And and then if other people want to join sure, you know, absolutely. But I I'm not overwhelming myself, oh, I need to be friends with that. No, I don't need to. And you know what, like, that became very apparent when I seen people speak, even at PPS, where the goodness, they were showing slideshows with their friends, and it was like, literally all people who are elected in the higher positions are all best friends with each other. It is it's true, you can't deny it. If you're up there. If you're one of those people. It's true. And you know what, I look at it like this, my friends may go up there to that, mate. That's not why I'm friends with you, though, you know, in friendship through because I like you as a person. So I'm gonna let that lay and not even explain and go into more depth and let people interpret that how they want and the right people will stay in
28:44 my life. Exactly. So what are they? What are they? Let's, let's sort of wrap this up on a positive note. What are their positive things came to you this year, whether it be professionally, personally,
28:59 oh, I think being more comfortable in my skin at conferences. So I had the I mean, absolute honor. Like I was really overwhelmed with happiness at the private practice conference this year. It was just so cool to be nominated. And I felt so much more comfortable in my own skin going up there. I you know, there there are a couple naysayers not realizing there'll be naysayers that, you know that I had to deal with but going up and it was a small moment. But we had you have this rehearsal. I don't know if it's done the same way. For the nominees where they go, you practice when your name is called going behind the podium and then walking down the stairs so you know what to do when you're asked to go out there and give your speech. And I went out there and I did a great vine to my spot. And I mean, I was so happy I did that because I was feeling it and that's what I would do. I did a great fine. And I know that silly, nobody else paid attention to me honestly probably knew that I was doing it. And some were probably like, Oh, but I didn't care. I was like I am on this freakin stage right now, this is the coolest thing. And to be at that place of like more self acceptance, because I know I don't have the stereotypical personality and energy, you know, that that is normally accepted amongst the vast community. So to be more me in that moment, I felt very proud. I felt very proud of myself. And that was really cool. I'm really, really happy about that. And then I like Dan, you know, sat down and ate some more bacon, it was great.
30:46 Well, and you know, being comfortable in your own skin that then comes across to the people who are in front of you. So when the speech actually came about, I'm sure people picked up on that picked up on the fact that you're now more comfortable in your skin that you're more comfortable, perhaps as a physical therapist, and because you found you're not that you've, you've already had this niche, but you sort of found your niche. You know, what, you what you're in the physical therapy world to do. Does that make sense? Yeah, yeah. Yeah.
31:19 Absolutely. Absolutely. And I got a little bit picked on for being too perfect with my speech and everything. And I was like, I you know, in reflection on that, I was like, they just haven't fully accepted my energy. That's okay. Don't get there. Okay. That's it. Don't get there. I'm like, I'm a performer. So it's gonna happen. You know, do you want to join a British company dialect? That's,
31:47 that's a weird comment. That's a weird criticism. Yeah, but yeah, you know,
31:53 but I felt I felt I felt like I had to reflect to go No, I actually felt really good, because I've definitely put it on before. No, I practiced it to be to deliver it. Me as me. And now it's so fun. So fun. Oh, my God. Yeah, I was just that that was a big, positive. Awesome, awesome feeling. I work with so many people who are in the PT industry, who want to be dance physical therapist or physical therapist assistants and imposter syndrome is super real. And so I like that I'm practicing what I preach and self love. And and it's awesome. How are you doing all that this year?
32:36 I'm better. I mean, imposter syndrome, I think, for me is always there, like always kind of underlying the surface, if you will. But I think that's pretty normal. You know, the more and more I listen, or I read about, like, these famous people who are up on stages and in movies, and you know, people who think oh, they have no, they must be like, amazing. And no, they it's the same thing. So I think for me, accepting that it's normal has actually helped decrease it a little bit. Instead of feeling like, oh, boy, everyone else here is like, amazing. And I'm like the loser trying to keep up. And then I think, no, that's pretty normal, because I think everyone else feels that way as well. Yes. And then once once I was able to accept that it makes going up on stage, like, I don't get as nervous as I used to, and it's been. It's been much, much better for me even speaking. Like I was joking, I could say I now I shared the stage with FLOTUS, because at the future physical therapy summit, I spoke for literally a minute and 45 seconds as a spokesperson for the brand Waterpik. So Waterpik has these wonderful showerheads. And they sponsored the future physical therapy Summit in Washington, DC back in September. And so the sponsors got to go up and say a little something. So you have literally less than two minutes, and I had to get all their talking points in. But I also like, decided to make it funny. So I was just saying things off the cuff. And afterwards, everyone's like, that was a great bit. I love that bit about your parents. I'm like, I didn't think of it as a bit. But okay. But then the good news was afterwards, people came up to the table, the Waterpik table, you know, in the, in the hall area, and like the one guy was like, I wasn't gonna come up, but then after that talk, I had to come up and see what you guys are all about. I needed to find out what you were doing and hey, can you do this? And so, for me, I felt as nervous as I was to go up and speak be mainly because it wasn't about me, it was about Waterpik. So I wanted to do them proud, you know, and afterwards, they got so much great feedback and possible partnerships selling through clinics with 700 locations? And can we do a study with Waterpik? On wound care? Can we do a study with Waterpik on people living with CRPS and using these, like, and that's exactly what they were looking for. So that made me feel like much better and gave me a little bit more confidence. And it was also fun to be able to do such things kind of off the cuff. You know,
35:25 that's so cool. Yeah, I love that. You should definitely be proud. That's so cool.
35:29 So that was really fun. And then the next speaker, it was it. The next speaker a two speakers after me was the First Lady of the United States Dr. Joe Biden. So yeah, there you go. No big deal. No big deal. Yeah. FLOTUS. So that was really fun. And was that yeah, for me, I think that was a big highlight of of the year for me, I guess professionally, which was really cool. is cool. That is so cool. It was it was cool. Anything else that for you? Did we miss anything that you wanted to get in?
36:02 Yes. For the Yes, yes. Yes. Okay. I now live in Pittsburgh and and was visiting New York had a great time. I got to see Karen at one of my favorite salad places, although I didn't get my normal favorite salad, which now I'm in regret until I go back again, to get my favorite salad from Sweet greens. It's the kale salad. It's so good. Caesar kale salad. I highly recommend it if you're going and you want to save some money because I love to be cheap in New York. Okay. said that. Now I'm not sponsored by sweet green. I just love sweet green. Okay,
36:31 I know we're dropping. We're dropping a lot of like,
36:33 I know. Like suede. And also get Levine's cookies. Okay, yeah. When you go, I never have gone to the tourist areas. I avoid it. But I spent a lot of time in Times Square because I was going to see Broadway shows. And it's also one of the few Disney Stores that still is open. So I had to go in there. I got a wreath I didn't need but I needed you know, and Okay. Rockefeller Center. So I go there to meet Stephanie. Why rock as you and I didn't have enough time with your Stephanie. But while we were waiting, there's a whole show of lights. A GG know that you knew this that like it's with music and everything like Disney. I had no idea. What's the store that darkness said yes Avenue, Saks Fifth Avenue. And it's like castle and lighting. It was I was just joking. If you don't know, I love Disney. I love Disney so much. And this was a Disney experience. And I just we weren't waiting in the cold. I'm like, all bitter. You know, I just I'm not happy in the cold. So I'm like, and then the light show on Japan?
37:45 Yeah, it's spectacular. It was
37:47 so great. I had no idea and it goes up like every few minutes. It's quite regular. So if you like oh, we miss it. You're fine. Just wait a few minutes. It'll start again. i Oh, go see it. Go see it. Don't stand in Time Square for New Year's. But go see that that was such a wonderful, positive, beautiful moment. And, and just great. It was great. Also, there are a lot of great photographers in New York. So if you're visiting New York, and you want to get stuff for social media, that is the spot to get it. There are so many talented photographers you can get reasonable prices and and build your social media real fast. All right, that's it.
38:26 Perfect. Well, before we wrap up the year, where can people find you if they want more information about you in any of your programs? And also let us know what you have coming up in 2022?
38:38 Okay, well, most immediately, you're going to find me at Disney Land in February this year in 2022. Because I'm going to be there my birthday. If you go there on the 16th of February. Just let me know. And we'll like meet up with you. But no, I'm going to be eating junk food all day. So if you're expecting me to be held a healthy influence, I will not be alright. For me, I'm going to be continuing with my private practice, working with performers and continuing with helping people live their lives as dance PTS helping you on the business and treatment side with my dance PT program. But most importantly, because I'm always like I'm a performer and physical therapist. I'm doing all this work right now. I am getting back into performing which I'm really happy about so I'll be submitting a lot more which I'm just super stoked. I feel like all my work stuff is is being is much more easier to handle now I've got it down. And the systems are in place if you will get to audition more than I'll be a movie star just like that because it's so easy. It'll be great, but I'm really excited about that. What about you Karen?
39:55 Oh, that's exciting. Gosh, I'm not gonna be a movie star. Anything So what do I have coming up? Let's see, um, this past year I finished the Goldman Sachs 10,000 small business program, highly recommend anyone to apply to because it's really amazing. How many more plugs can we drop in this episode? And so I'm going to this year, I'm looking to hire another PT for my practice, right? Mm hmm. Which is very fun. Exactly, it grows, but
40:31 you're like, I'm not going to take all the patients. It's gross,
40:34 but time to bring on someone else. Right. And then continuing to work with just a couple of people. With business coaching, I like take four people at a time for me that I get it handle, it's good enough for me, I'm happy to do it. So that will open back up again. Maybe end of January of 2022. Because like you said, when you know what you can handle and you know that you can help the people who want to be helped, then it becomes so much easier. So now I feel like I've got this under control. I know how to split up my time and manage my time. And so I'm really looking forward to that in 2022 and we'll see what happens.
41:24 I love that. That's awesome. Yeah. Yeah, are so cool. I love what you do.
41:30 Where can people find you? Oh,
41:33 yeah, so I have the dance physical therapists Facebook group. So that's one specifically for PT so you will find me in their active conversations once talking about performing arts research all that stuff. You can find me at CSM Oh yeah, social media, dance physical therapists on Instagram. I am also musical theater doc on there. But I really associate people more regarding musical theater, not other pts. So dance physical therapist, is that and then on Facebook, Jenna cantor. And yeah, pretty much Jenna Cantor from Twitter and Jenna cantor. Yeah, your website. Jenna cancer, PT, calm.
42:18 Perfect. Perfect. Excellent. Well, Jenna, thank you so much for coming on and wrapping up 2022. And for all of your help and friendship throughout the year. I really appreciate it. And appreciate so
42:31 much. I have to just say that joke that keeps coming to my head every time you keep saying wrapping up. I feel like I should be wrapping a present. I just it's a stupid joke. But I just need to put that in there. Thank you. I said it.
42:43 Tis the season when in Rome, right? Yes. All right. Well, thank you again, so much. And everyone. Thank you so much. On behalf of myself and Jenna, for listening to the podcast all year and for supporting it. And you know if anyone has any suggestions on anyone they'd like either one of us to interview please let us know. You can find us on social media. I'm on Twitter at Karen Litzy. NYC and Instagram at Karen Litzy. You can email me Karen at Karen Litzy. Calm it couldn't be any easier. Or you can find me at Karen Litzy calm. We're super easy over here. So let us let us know if there's any topics or people that you're like man, I really want to hear from this person. We'll be more than happy to see if we can get it done. So thanks again. Everyone have a very, very happy new year and a healthy 2022 And of course stay healthy, wealthy and smart. | |||
| 570: Dr. Morten Hoegh: Not Everything that Hurts is an Injury | 21 Dec 2021 | 00:39:12 | |
In this episode, Specialist Sports Physiotherapist, Morten Hoegh, talks about pain and injury management and research. Today, Morten talks about his workshop on pain, the problems in the research around pain and injuries, and embracing the patient as the expert. What is nociplastic pain? Hear about the injury versus pain narrative, treating the perception of injury during pain, the problem of over-treating pain, and get Morten's advice to his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Morten Hoegh After qualifying as a clinical physiotherapist (1999) and completing several clinical exams, Morten was granted the title of specialist physiotherapist in musculoskeletal physiotherapy (2005) and sports physiotherapy (2006). It was not until 2010-12 he made an entry to academia when he joined the multidisciplinary Master-of-Science in Pain: Science & Society at King's College London (UK). From 2015-19 Morten did his PhD in Medicine/pain at Center for Neuroplasticity and Pain (CNAP), Aalborg University. He is now an assistant professor. Having spent more than a decade as clinician, teacher, and business developer, he decided to focus on improving national and international pain education based on the International Association for the Study of Pain (IASP). Morten was vice-chair of the European Pain Federation's Educational Committee from 2018-20 and has been involved in the development of the Diploma in Pain Physiotherapy and underlying curriculum, as well as the curricula in nursing and psychology. At a national level, Morten has been appointed to several chairs and committees, including the Danish Medicine and Health Authorities and the Danish Council of Ethics. He has co-authored a textbook on pain, and written several book chapters, clinical commentaries, and peer-reviewed basic science articles on pain and pain modulation. Morten's first book on pain in layman's terms will be published in January 2021. Morten is regarded as a skilled and inspiring speaker, and he has been invited to present in Europe and on the American continent. He is also a prolific debater and advocate of evidence-based and patient-centred approaches to treatment in general. Morten is motivated by his desire to improve management of chronic pain, reduce stigmatisation of people with 'invisible diseases', and to bridge the gap between clinical practice and neuroscience research in relation to pain.
Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Neuroscience, Pain, Injury, Rehabilitation, Research, Experience, Treatment, Management,
Resources:
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Read the Full Transcript Here: 00:02 Hi, Morten, welcome to the podcast. I'm very excited to have you on. So thanks so much. Thank you for having me, Karen. It's a pleasure to be here. Yeah. And today, we're going to talk about your really wonderful, wonderful workshop at the IOC conference in Monaco. That was just a couple of weeks ago. And you did a great workshop on pain, which is one of my passions.
00:27 But I would, I think
00:30 the best thing for us to do here is to just throw it over to you. And let you give a little background on the talk. And then we'll dive into the talk itself. So go ahead.
00:43 Thank you. And, you know, I'm really happy that you liked it. It was a great pleasure to present that the IRC was my first time there as well. A lovely place to be and very lovely people. And he really well organized conference as well. Well, back to the background. So the tool was, the workshop, as it were, was actually originally something I planned with Dr. Kieran or Sullivan, who is now in Ireland. Unfortunately, he couldn't come due to turn restrictions and all of that for COVID. So we had to change it slightly. But over the period of the last sort of year or so I've been working with colleagues at all university where I'm affiliated and test Denton and Steven George of Adelaide and, and to university respectively. And together with them, we sort of have written up this idea that there is a difference between having an injury and being in pain. And the reason we came about that was because we wanted to try and look into what is actually the sort of narrative definition of a sports injury. And and some one of my colleagues are actually two of my colleagues Kosta, Luke, and Sabine Avista. We're looking into this and trying to sort of find out what the consensus what they came up with, when they were looking at the last 10 years of of sports related research is that the same articles could use injury and pain for the same thing. So it was being used almost as well, not almost, but as sentiment synonymously throughout the program, or the manuscript, and others will stick to pain and others will stick to injury. But if you then try to go down into the methods and find out what is an injury, really, some would have definitions, but there weren't really anything. And definitely, there wasn't a clear distinction between when is the tissue injured. And when is the athlete suffering from pain that is keeping them from not doing what they want to do.
02:50 So we came up with this idea to write an editorial for the BDSM. We couldn't get it accepted as an editorial, we were under the impression that maybe the topic was a bit too narrow. So it really wouldn't have any impact. But we had a we had some some help from from
03:12 sorry, you can cut that bit out. I was just losing her name. Let me just get it here.
03:21 Oh, that's she was such a great help. I'm really sorry for not being able to I definitely think we should put her name in there.
03:32 Oh, here we go.
03:35 So we wanted to do the editorial first. But we were under the impression that we couldn't get the editorial through because the topic, you know, is probably a bit too narrow. But fortunately, Madeline Thorpe, who is working with TAs in Adelaide, she helped us create this infographic that sort of conveyed the message of the difference between what we call a sports related injury and a sports related pain. So after a few revisions, the BJs took it in as an infographic with a short text to describe what we mean. And and it's been. It's been, you know, quite well cited afterwards. So we're very happy with the the attention that this idea has got. And then of course, what we really are trying to do here is to create two new semantic entities as we say, Where where it's clear when we do research, but also when we talk to athletes, are you really injured? Is the tissue injury that needs healing and where you might need you know, specific treatment for that injury versus Are you having pain as a consequence of an injury or even without an injury, which is what we call sports related pain. So that's sort of the broader concept and and I hope I've I've done right with my co authors.
05:00 because they've Of course, been been a huge part of both the development and the writing of these, these, this infographic.
05:09 Yeah. And can we now sort of dive in a little bit deeper? So, injury versus pain? Right. I think a lot of people will think that every time you have an injury, there's pain. So used a really nice example in your talk. So does tendon tissue damage lead to pain? Yeah. But is the pain in the area of the tendon equal to damage to the tendon?
05:38 Maybe not. Yeah. Right. Oh, so yeah. So let's, let's have you kind of dive into this injury versus pain narrative. And if you want to go into those pain mechanisms that you spoke about, we can dive into that as well, because I know that that people had some questions on that on social media. So let's first talk injury versus pain. Yeah, again, my my perspective on this with my background, being a physio and, and sort of a neuroscientist is that I come from it, I would say from a pain, scientist pain mechanistic approach. And what I try to do is to understand what goes on in the human that could explain why they feel pain. And in some instances, and for instance, in low back pain, we we think, in about maybe 80 to 95% of the cases, we don't know what's going on. So we're pretty sure that the risks are mechanism, perhaps are quite complicated. One there has multiple factors that are interrelated, but there's probably something. So that's really difficult to study. Again, consider consider, you know, if you were tasked to, to come up with a, you know, a model where you could study this model would be, for instance, an animal model. So not that I would encourage people to go out and, you know, do bad things to other animals. But just, you know, for the sake of the example, let's imagine that you wanted to do an animal model of low back pain, or even a herniated sorry, a groin injury, you could say, in sports.
07:20 If you know, the most basic thing to do would be to create an injury. If you don't want to create an injury injury, what you could do is induce inflammation, you know, inject capsaicin, or put something under the skin or down into the tissues, and that makes your immune system go, you know, make inflammation. And that inflammation makes your nervous system respond more powerful. We call it sensitization, I think many people have heard of that word by now.
07:49 And that's a really good way to create that sensation of pain in humans as well. So we can inject capsaicin again, and people will usually feel pain.
08:00 In that case, that's what happens or that's how we understand what happens in the case of a tissue injury. So when there's a tissue injury, there's inflammation, and we understand that pain. So when the tissue hit healing period, is sort of crossing from what you could say, the inflammatory phase, into the prolific face, pain should go down. And in most cases, that's what happened. But what when the pain persists after the inflammatory phase. You know, from the science perspective, we don't know that. But we still know that this person is in pain. So whether that be an athlete or non athletes, they're still in pain. And in this in sort of the pain research world, we have a definition of pain that doesn't necessitate any type of injury, not even any activation of those, we call them nociceptors. But nociceptive system you could say.
08:53 So we acknowledge that people can have pain and not be Do not be damaged, not be injured, not have pathology. And that's sort of the idea that we are trying to bring into sports medicine as well, which has been over the you know, many last decades I've you know, I've been in in sports medicine or as a sports physio, for 20 odd years and sort of dominating belief. And also perhaps, trajectory has always been sort of the orthopedic sports related and to some extent, also pharmacological approach, combined with and that's important, combined with a non pharmacological physio, perhaps approach. So there's been this interrelationship collaboration between doctors and physios and other health professionals, which is quite unique. As I see it in the musculoskeletal system. We don't see that to the same extent, for instance, for low back pain or neck pain, but sports has done that. But maybe there has also kept people within the realms of sort of orthopedic approaches trying to understand what goes on. It's
10:00 tissues, and why did they hurt, and then when you couldn't find out why they hurt, we've just looked deeper into the tissues, which is, of course, a good idea from a scientistic or scientists perspective, because there are definitely things in the tissues that we don't know today, which will, you know, make us become more aware of what goes on, you know, as, as late as in the beginning of October, wasn't it where the Nobel Prizes were given out, there was given a Nobel Prize out for the person, I might do violence to his name, but it's part of Putin, I think he's last name it.
10:36 I didn't, I suppose a Putin or something like that. I do apologize for not being able to pronounce it. But he got the Nobel Prize was shared the Nobel Prize for his work on a peer to two receptors, which is a quite new phenomenon and sort of the longer perspective, but it might learn us over time, why could movement hurt? Which is something we don't know today? So if there's no sensitization, why does it hurt to be moving? And that's really interesting. But again, coming out in the clinic, we don't know enough. So we will have patients in the clinic where we simply do not know why they hurt.
11:14 And you could say that doesn't matter. We can call it anything. But then if you take a clinical look at what goes on what happens again, if you look at the signs, what does it mean, when people are hurting, and they think they're injured? They This is what a percentage again, they seem to be thinking that they're being in pain is the same as being weak. If you're weak, you're not, you know, you're not allowed to be in on the team, you might lose your position. So it has a lot of negative connotations. And I mean, that in itself is wrong. But what if it's based on a misconception that just because you're hurting, you are also injured? And couldn't we help people who are hurting with their pain,
11:59 just as well as we could if they are injured with a tissue injury. So what we are saying is that the two are different. They're both real, they should both be addressed. And they're not, they're not opposite ends of a dichotomy, you will have injury and pain in one end, but you will have pain without injury on the other end. So we need to pay attention to both of them separately. Yeah, it's because sometimes a person has a pain problem
12:29 may not be a specific tissue problem, but they have a pain problem. And so this pain problem may, like you said, cause certainly a an athlete to catastrophize. And to really play out to the point where maybe now they're fearful to get on the pitch or the court or the field. And so where does that leave us as physio therapists when it comes to their care? How do we help manage someone, or I should say, help someone manage their pain in order to play their sport, knowing that their every time they go out and play, they're not compounding, quote, unquote, tissue damage?
13:14 Yeah, and interesting, let's say someone has the perception that their tissues are injured, and every time they move, that's a sign of their tissue injury, or even when they hurt more, the injury is bigger, then that person, I mean, if that's a person like me, I would think that I should do something about that injury so that I don't hurt. But pain is always a symptom of something underlying it. Whereas we know from pain research in for instance, low back pain, that pain can in itself, be the disease, what the ICD 11 is now describing as chronic primary pain. So you can have that in your body, you can have it in your tendons, you can have it all way where your tendons are, you can have it where you know, where the bones are, where the where you feel the muscles are. And it's the pain itself is the problem. So rather than looking specifically at a tissue, which needs strengthening or some sort of treatment, then we can look at the person and say, What is it really that you need? A very, very simple example here, which is unlikely to be, you know, the case for everyone. But let's imagine we have someone with knee pain. And the thing that happens is that when they start running, their knee pain gets worse. But if they've been running for a kilometer, or two kilometer or miles, whatever, you know, whatever metric you use,
14:40 then the pain might be the same. So it sort of comes from nothing to let's say, five in the first mile, and then it stays at five, maybe six, and that person wants to run two miles perhaps. But what's the problem in that? I mean, the problem of course, is if pain in this case is a sign of an injury
15:00 that we should attend to. So we need to understand that it's not an injury.
15:06 Once we've done that, why not help this person, deal with the pain and maybe deal with it when they run, just like we would say to someone, if they have, again, back pain, for instance, and they have pain when they work, but their pain is not necessarily worse when they work, should they not be working? I mean, of course, if, if your pain can go away by two days of rest, and graded exposure, that's fine. But in some cases, and they're not as rare as I think most people believe they are, that we just need to work with that person and help them do what they need or want to do with that pain. And why is that, you know, of course, it's not the optimal it would be much nicer is if we would just kill the pain. Or if they could kill their own pain. But we're not there yet, we are still working to get it. And we're not giving up, there's a lot to do. But currently today, and tomorrow, we need to help people work with their pain, that's the best thing we can do now, and and, you know, giving people that agency to actually manage their pain. So in the case of the runner before, maybe the best thing we can help them do is share with them ideas and make them take agency over their pain by you know, using perhaps a cold pack or heat pack or a rest regime or watching you know, something that takes off their mind of their pain for a minute look at you know, watching dope sick on Disney, whatever they need to do to get their mind off, you know, the pain that they have, so that they can recharge, and they can be as you know, their normal again, before they go out for another run. So all of these things would make absolutely no sense if we didn't acknowledge that pain in itself is the problem, because it's not helping anyone's tissue injury, if there was a such to become better. So again, that's the infographic in its essence is that on one end, you use those inspiration to how to manage pain, what that means and how pain is influenced. And on the other side, you will have tissue injuries, and how to manage that, for instance, loading. In sports medicine loading is a big issue. It's probably the one thing that you know, everyone is doing when you're rehabilitating some someone after an injury or pain. But pain doesn't necessarily necessarily sorry, pain doesn't necessarily respond to loading. So you can have the same pain, whether or not you're loading. But there could be tons of other things such as the way you think about your pain, the way you respond to your pain experiences you've had before the context your work in. So you can run in one context without too many pains or problems. But in a completely different context. For instance, when you do a competition, or if you know, if you need to do something, because that's the bar to get onto the competition you want to do, then pain can be a much, much bigger problem. So we need to understand that context of beliefs and experience really influences pain, whereas loading may not. But it could have caused, but it doesn't have to. So pain is a much larger, much more complex topic of which we still don't know too much. We do know quite a lot. And as long as there's an injury, we understand the pain that goes with it. But when it comes to these pains that are there by themselves, the ICD 11 type chronic primary pain, then that's the type of pain that we you know, we've really, we don't have the sort of blueprints on that. So we can't help everyone. And we can't say this is right for you or wrong for you. We need to do individualized care for all of these people and help them find the best tools to support themselves. Yeah, and I think that was something that people who weren't at the conference and kind of reading through tweets,
19:08 that certainly brought up some questions, one of which was the pay mechanism, no sub plastic pain, where we can't fully explain it. And so then there was a question of, we can't fully explain it, why even bring it up? So I'll throw it over? Yeah. It's, again, it's a good question. And especially if you're a clinician, why would you use it, though, they're basically what they are. They're ways that scientists understand the pain. So again, imagine you're standing at one end of the road and you're looking at the other end by the end of that road, a very long road, you have pain. And then the way the place you're standing at is how you explain how to get to that end point. And if you're standing at a place and you know there's a tissue injury, there's inflammation. We understand that as
20:00 Part of the normal normal nociceptive system. So we would call it nociceptive pain.
20:05 Underneath that there is a range of different changes and modulator modulators of the system that leads to, for instance, peripheral and central sensitization. So they're not unique to anything that is there also in nociceptive pain, but it's induced by, for instance, a tissue injury.
20:24 If you have a different tissue injury, the one that hits your nervous system, we call it a neuropathic pain, so you have a nerve damage, along with pain, we call that a neuropathic pain. So again, you're standing on this long road, but in this case, the road itself is sort of gone wrong. But we still know what's going on. Again, if you want to use the study metaphor, you can, you can design a study, you can just take an animal, and you can compress or do something to the neurons, and you can create this similar pain experience, or at least the behavior that it assimilates this pain experience in animals, other than humans. And then finally, we have this new, we call it a mechanistic descriptor knows a plastic pain, which is much much blurrier. And perhaps it's more like a waste bin. As it is now it's, it's where you would say we acknowledge that people have pain.
21:24 And a lot of things goes into it. So just like in nociceptive, and neuropathic pain, sensitization is definitely part of it. It could also be part of the note of plastic pain. But unlike the other two, you don't have the inflammatory response that could explain it. And you don't have the neuron damage that could explain it. But the person experiencing the pain could have a similar experience. So what is it really? How do we a scientist tried to understand that pain, and that's what most plastic is at the moment. And there is a little bit of debate that whether or not you can actually use algorithms to diagnose or, you know,
22:09 maybe
22:11 justify at least that you yet the person in front of you are experiencing this type of pain mechanism or pain related to this mechanism, we definitely have a very, very, you know, widely embraced algorithm used for neuropathic pain. And some very, you know, high profile researchers has just recently come up with a paper suggesting that the same can be done for noisy plastic, sorry, for noisy plastic pain. But personally, I don't think we should, because unlike so nociceptive and neuropathic pain, they're both well understood by signs and we can separate them, they are different. So you can have both, but you would have different qualities to it, there'll be a nerve damage in one and there wouldn't in the other, for instance.
23:02 But we don't know about most plastic pain. So it could be changes in your nervous system, it could actually be, you know, increased responsiveness of your immune system in interaction with your nervous system. It could all be all of that. So it could be sensitization, but it could be tons of other things as well. So how can we start when we don't know what the mechanism is? How can we start to clinically differentiate? So I don't personally think we're quite there yet. Although I like the idea that maybe we can at some point, what I'm afraid of, if we start to use these clinical descriptors, sorry, these mechanistic descriptors, as clinical guidelines, is that what happens to the people who are now embraced and validated in their pain experience by scientists saying, Well, we know what you have, it's mostly plastic pain. But what if we made up an algorithm? And we used it for people? What about the people who fall out? Do they need, you know, a fourth descriptor? Are they just weird? Do they have unknown pain? Are they back to the psychogenic pain? So we've come quite a lot of way, embracing the clinical aspects of pain into the pain research world. And I think using you know, these three mechanistic describers, as you know, trying to really differentiate them and create perhaps treatments that is directed at either one. At this point, or especially anatomy is specifically directed at most aplastic point pain. Just because we know something doesn't mean we know everything.
24:34 So yeah, that's that's the issue. There was a bit of off topic. I'm sorry. But it's such an interesting topic. And I think that the most important thing about no plastic pain is that it is a construct that researchers use. It's embraced by the IRS, the world pain Association, the pay Research Association, and it validates that all pain is real. And there's, you know, it's still real even though we can
25:00 not understand it from a science perspective. I think that's important. And I would hate to see that we misuse it. To say that some really has it. And some don't. Because that's just, you know, that'll be I'll be sad. Yeah. And and can't one's pain experience?
25:20 Everybody's pain experiences individualized. But one person's nociceptive pain experience may be exactly like someone's neuropathic pain experience or someone's no support plastic pain experience, because it's in so then to categorize the persons Oh, well, my pain is like this. So it means this, so I can't have this. And I think it can get people a little confused. And when you have more long term or chronic pain, it's like, the the pain is there. Pain is pain. Some people need the the label or categorization, but like you said, Is it is it really helpful? And it kind of leads me to the one of the last slides in your presentation, and it was like pain prevention is well intentioned, yay, thumbs up, sometimes unrealistic, and possibly unhelpful? Yeah. So do you want to expand on that a little bit? And what you meant by that slide?
26:23 Yeah, that's slide was. That was actually the whole idea when, when I started to talk with Dr. Kieran Sullivan about workshop is that we see a lot of people, athletes. So both of us are still clinicians. And we see and we hear stories of a lot of athletes who have been treated and treated and treated again, or assessed and assessed and assessed again. And again, because they have a pain that we cannot objective eyes. So we can't find anything on scans or blood samples or clinical tests. So rather than acknowledging that pain can be there, so let's say nosey plastic pain, those are, there's something going on in your nervous system that gives you this pain, and we don't know what it is, we can't see it, that will be the, I would say the proper thing to do. So rather than doing that, we tend to keep sending people off. And it ends up with too many scans and too many assessments and too much worry. And in that process, we know the athlete is unlikely to be performing optimal during that period of time. Partly, of course, due to the pain, but also due to the insecurity to you know, if nothing is found on the first scan and a second scan that at some point, they probably start to wonder whether or not they're completely broken, or if it's a really rare disease or even if it's gonna kill them. And these are things that we might feed into by overtreating. So, of course, we should try and prevent pain. Statistics suggest that that's quite tricky. And we, you know, it would be great if we could or even perhaps what we can do is give people tools so they can take agency over their pain when it flares up. But having this idea that when you are in pain, you are damaged is very unhelpful. We think. So we really wanted to highlight the fact that sometimes pain is is that it is pain is still disabling. It's that feeling of pain, and nobody can feel whether or not their pain is due to an injury or not, it feels just like pain. But we identify all pain as if there was an injury, when in fact, it's it's quite unlikely that the majority of cases would have an injury attached to it. And just coming back to one thing you said before that it was quite subtle, but I think it's a really important point you made there, which is that all pain is real, it's always experienced as pain, whether that be of any of the descriptors or for any reason, it always feels like pain, and the quality that we attached to it, it's a muscle pain, or it's whatever is something we do it's our perception is our belief about what the pain is. And maybe that's what we need to also address in sports medicine is that disbelief about what your pain is caused by is a potential target for treatment, we call it psychotherapy or psychoeducation. Or, you know, and that doesn't have to be paying neurobiology education that's unlikely to be better than any other good education and listening and embracing. So there's a range of different interventions that are combining or embracing the fact that you need to talk to your athlete or your patient and help them make sense of their pain in a way that gives them empowerment will give them agency over their pain.
29:51 And something that came to my mind as you were saying, oh the pain it's it's in the muscles, the tendons, the bone, it's the joint and can't that all
30:00 So be a coping mechanism of the athlete. So they may say, oh, it's, you know, this is just a muscle strain. It's so it's their way of coping of saying it's nothing I can continue to to move forward. Do you know what I mean?
30:16 Yeah, absolutely and, and I think as long as it empowers them, if you know if you have the pain that you again, think about Dom's, or delete onset onset muscle soreness. That's an empowering pain, isn't it? I mean, I have Dom's, I was doing exercise yesterday. And if you really want to, you know, be good at something, then perhaps Dom's is your sort of reward even, even though it's painful, it should be awful, it might actually feel like a reward. So in that case, you interpret the pain that you are experiencing, as a reward or something you want it to happen. And I definitely think that some would say that this is just a minor thing, again, think about general health and male, you know, older men, like myself, tend to not go into, you know, the GP for what we consider to be minor things, but in fact, that might be killing us. Because we say, no, no, that's nothing, no, that little spot, that's not cancer. And I would say I don't, I don't think it's a lump, it's probably just something that's here this week. So we should be much better at listening to it, and giving it you know, you know, the quality or the, you know, the meaning that it should have. So it's on both ends of the spectrum, sometimes we neglect that pain is there for a reason, and we should listen to it. And sometimes we should understand that the pain is there without anyone really knowing what it is. But it doesn't mean just because we don't have a universal tool that can treat all pain, which is what we say when we say there's no treatment for chronic pain. In fact, there's quite a, you know, a variety of well established evidence based treatments, that can reduce pain, but they need to be targeted, and individualized so that each one find their, you know, their way through their pain. And of course, one way to do it is to go to everyone you know, who has a, you know, any background in health and ask them what to do, probably the best thing to do is to talk to someone who knows about pain, and then get advice about what seems to be working for you. Embracing that the one in this case, the athlete with pain, they have perhaps one or two years experience with their pain, they know much more about their pain than I do. But I can act as a consultant, I can listen to them, I can help them structure, I know what you know, patterns out there. So I can listen for that. And then together, we can try a few things. But over a period of maybe weeks, they should know as much as I do about pain generally, but with their focus on it. And and that should give them you know, with a bit of practice the ability to find out what works and what doesn't. And rather than thinking of pain management, in the case of a sports related pain, as an on off thing, so either it works and the pain is not there, or it doesn't work, it only reduces the pain a bit, we probably should be realistic and say that most people can have reductions in their pain, perhaps 2030, perhaps more percent. But the majority of people will experience from some sort of management of pain reduction. But it doesn't mean that the pain is going to go away. And it doesn't mean that thought is going to be absolutely pain free. But we need to find a balance between the two so that we understand when pain is actually a sign of either injury or possible injury. But also understand when pain is something that might just be part of life. And the best way we can do the most evidence based approach to that would be to find your way through it, you know, in perhaps, together with a
33:56 clinician of some sort? Yeah. And my gosh, I was just gonna say as we wrap things up, would you like to put a bow on it on your talk and at at the IOC conference and to this talk today, and I think you've just done it? I think you'd beat me to the punch. But is there anything else that you'd like to add?
34:18 That, that you want the listeners to take away?
34:22 I think the most the thing that I always want to stress is that people who meet or live their life with pain, they're experts. And we as clinicians, and researchers should embrace that much more. So the patient as an expert, is something I feel deeply about.
34:44 And I think we should be able to understand that as you know, as a scientist, you might know, you know a lot about groups.
34:51 As a clinician, you might know a lot about people who come to you with a similar symptoms, but as a person who have pain, you have two or three years
35:00 perhaps have experience with your own pain. And I think the best way to you know to get all of these together is by everyone being aware that we have different aspects and different competencies, and we should bring them together. And I think that's the best we can do right now. But still, don't give up hope we should definitely try and cure all pain from the planet, but maybe not by opioids. Yes, I would agree with that. And now more and where can people find you if they want to learn more about what you do? Read your research, where can they find you?
35:39 I think the easiest way would probably be to either find me on on Facebook, or go on Twitter. My handle is at MH underscore DK. And I'm also on Instagram. It's at MH DK underscore Dr. Moulton. Whoa.
35:57 Excellent. And one last question. It's a question I asked everyone is what advice would you give to your younger self, knowing where you are now in your life and in your career?
36:09 Remember, things take time to cope with sometimes you have a good idea. And you can't imagine, however, too, you know, you hear something and everyone else knows it. And you're like the only one who doesn't get it. But give it a bit of time. And, you know, I we have a saying that Rome wasn't built in one day. I think it goes in English as well. So give things time and and make sure you stick to good ideas if you think they're good, but also leave them if they're not.
36:37 Excellent advice. So Morton, thank you so much. This was a great conversation. And like I said, your talk at IOC was really wonderful. There's if people want to see his slides, there are tons of tons of tweets with all of his slides and great descriptors. You could go to IOC p r e v 2021. That was the hashtag for the conference. And as you look through, you'll see a lot of tweets from his from Morton's workshops. So thank you so much for coming on and expanding on that for us. I appreciate it.
37:13 Amazing. Thank you. It is a huge pleasure and privilege to be here. Thank you, Karen. Thanks so much. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. | |||
| 569: Drs. Bryan Guzski & Tim Reynolds: Movers & Mentors in the Physical Therapy World | 14 Dec 2021 | 00:47:41 | |
In this episode, Bryan Guzski, Director of the Orthopaedic Residency Program at the University of Rochester Medical Center, and Tim Reynolds, Clinical Assistant Professor of Anatomy & Physiology at Ithaca College, talk about their work on Movers & Mentors. Today, Bryan and Tim talk about their book, Movers & Mentors, and they get the opportunity to be the interviewers for a portion of the episode. Why is it important to have mentors? Hear about the motivation behind the book, some surprising interviews they've done, the value of having a team, finding your 'why', and choosing when you say 'yes', all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Bryan Guzski Bryan Guzski PT, DPT, OCS, MBA, CSCS, is an outpatient orthopaedic physical therapist practicing in Rochester, NY working primarily with patients with spine related issues and persistent pain. Bryan earned his Doctor of Physical Therapy degree from Ithaca College in 2014, completed an orthopaedic residency program through Cayuga Medical Center and received his Orthopaedic Clinical Specialist certification in 2015, and earned a Master of Business Administration degree from Simon Business School at the University of Rochester in 2021.
More about Tim Reynolds Tim Reynolds PT, DPT, OCS, CSCS, is a Clinical Assistant Professor of Anatomy & Physiology at Ithaca College and a part-time physical therapist practicing at Cayuga Medical Center in Ithaca, NY, where he predominately treats patients with spine or lower extremity impairments. Tim earned his Doctor of Physical Therapy degree from Ithaca College in 2014 and completed both his orthopaedic residency and spine fellowship through Cayuga Medical Center, and currently helps mentor and teach in both of these programs as well.
Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Academia, Movers, Shakers, Mentors, Prioritizing, Self-care, Self-improvement, Values, Motivation,
To learn more, follow Bryan & Tim at: Website: https://www.moversandmentors.com Twitter: @moversmentors Facebook: Movers and Mentors Instagram: @moversandmentors LinkedIn: Bryan Guzski
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:03 Hey, Brian and Tim, welcome to the podcast. I'm happy to have you guys on to talk about movers and mentors. So welcome.
00:11 Thank you, Karen, thank you for having us today. We're sharing this sit down chat with you.
00:15 This is great, Karen, thank you so much.
00:17 Well, thank you guys for including me in your book with over 70 Other pretty illustrious folks in the Movement Science physical therapy world. So let's start with the basic question that I'm sure a lot of listeners want to know. What is the why behind the book?
00:40 Yeah. So Karen, Tim and I were going through residency orthopedic residency together. Back in 2015. We both graduated from Ithaca College in 2014. And we both entered into a residency program at ethika are in Ethica, in 2015. And as we were going through the coursework there, and kind of taking different classes and really kind of immersed in the PT literature and physical therapy, space and various different content. We started noticing a lot of reoccurring names and reoccurring themes. And so, you know, different names like Tim Flynn, Josh Cleveland, surely sermon, Stuart McGill, you know, all these all these names that, you know, names in our rehab space that I've done a lot of really cool things and have put out a lot of different research that that, you know, we follow to this day. So we started noticing those names. And Tim and I were also reading a book by Timothy Ferriss called Tools of Titans at the time. And we really liked that book. And we enjoyed it. We got a lot out of it. He interviews people like, you know, Arnold Schwarzenegger, and Oprah Winfrey. So various different industries and various different spaces. But we like the model that book and we started to ask ourselves, well, I wonder how, you know, individuals and movers and shakers within our industry would answer questions that we have. So fast forward two years. That was 2017 2018 at that point, and Tim and I started putting together a list of questions and a list of names. And at that point, you know, we kind of we kind of took it from there. And Tim has a little bit more info on how we how we came up with the names.
02:29 Yeah, so it's one of those things that we could have written a 5000 page book in regards to the movers and shakers within the physical therapy industry. And I think one of the most important things that Brian I have tried to stress is that this is a living project. This is not a one and done situation where there are movers and shakers that are currently developing and changing the practice. And so I think that's one of those things that, yes, there are people within the pages that I'm that are, we're happy to have there. But at the same time, there's so many other people would want to reach out to, and we look forward to have the opportunity to potentially talk to those individuals in the future, and are excited to see how does the profession change in the next five to 10 years and who are going to come up and literally shake the industry that we have the opportunity to be part of. And so as we started to go about this, like Brian said, we're diving into this literature, I had the opportunity to do spine fellowship after doing my orthopedic residency. And so the amount of Tim Flynn articles that I've read over the past three years was obnoxious. And so we started to make this almost like PT Dream Team, if you would, where we said okay, from, from a literature standpoint, who do we do we invest ourselves into a lot of, and like Brian mentioned, John John Childs, and we have Josh Cleveland. And then we have Tim Flynn, and the surely SARM and Gwendolyn Joel, there's these names that we have read multiple articles from and so kind of selfishly, we put together this list of people that we would really appreciate reaching out to, because we've been so invested in their in their literature over the past several years. And then from there, we kind of spread our net a little wider, because we had to see who's moving the industry from a clinical practice standpoint, right. So not necessarily from an academic or research standpoint, but from clinical practice. And who's moving it in regards to social media influencers? Because as someone who works in academia and works with the up and coming physical therapy generation, those are the people that they're following on Instagram and on Twitter, and so they're moving and shaking the industry in that format. And we looked at who's been guest speakers at recent conferences and who's putting out podcasts and how He was really trying to have the opportunity to get our profession to move in a positive direction. And so from there, we created this sort of master list, we reached out to all of them, and some have the opportunity to participate, which we're super thankful for. Some respectfully declined based on the fact that they had other stuff going on. But I think one of the things to remember, Brian is sort of given us timeframe, this was right pre pandemic, that we started to reach out to all these individuals. And what's been such a blessing is that we've been able to cast a wide net across multiple different countries across multiple different professions. But at the same time, we reach out to people in Australia, and there's Australian wildfires. And so we're trying to really respect individual's personal physical well being while navigating global pandemic while trying to also conduct interviews. And so it took us a little over two and a half years to be able to accumulate everything and be able to put everything out into a book format. But I'm super thankful to have those people within the pages. And like I said, I'm excited to have the opportunity to reach out to more in the future.
06:14 And so it takes, you know, a couple of years to get all this together. How did the two of you kind of keep the momentum going? Number one, because that's hard. And then number two, how did you kind of kind of temper your excitement and your expectations? Because I know, I'm the kind of person who's like, let's just get it done. Let's go, go go. But here, you know, you've really taken your time, over two plus years. So can you talk a little bit about that?
06:52 Yeah, I think from the outset, Tim and I both thought, I will send out some emails, you know, we'll get a handful of responses. It'll be a cool book, maybe we'll sell to maybe, you know, five, including our siblings, and parents, that sort of thing. And it really from the first batch of emails that we sent out, you know, Tim and I were really, every time we got a response, we would text each other, shoot each other an email immediately, Hey, Peter O'Sullivan responded, or David Butler responded, or Karen Litzy responded, you know, this is awesome. Like, we're actually doing this thing. So I think it you know, you spoke to momentum, Karen. And that's one thing that Tim and I, you know, we've never really hit a point where we were at a lack of that, or hit a dull moment, if you will. Because every time we got we did another interview, or we got another email, or we set up a, you know, maybe a podcast, it was definitely adding fuel to the fire. And, you know, they kept us pretty engaged and pretty excited throughout the whole thing. So, yeah, I mean, to I think if you asked us when we first sent out our emails in 2018, hey, you know, this is you're going to publish this in 2021, we'd say, No, it's going to be next year. And then life happens and pandemics happen and several other things. And, you know, it turned into a two and a half year project. But you know, it's been a lot of fun the whole time. And Tim and I still are still excited about it and excited about about the future, too.
08:16 And I think that's one of the things. There's kind of like Christmas every single time we had a response because it was super cool. You send out these, these emails, or you give a phone call to people that you've literally have had as your mentor from afar for years. And it's like, oh, my gosh, I cannot wait to have the opportunity to sit down. Like Peter, I saw that I've watched a lot of Peter softened videos from pain science standpoint, from spine fellowship work. And having the opportunity to sit down with Peter resolve them for an hour and 15 minutes was like, amazing. I was super stoked. And so so all those opportunities to talk to these people definitely continue to keep flame burning. And at the same time you talk about how do we sort of balance that, that excitement and try not to do too much too quickly. Brian and I have known each other for years, this has been such an amazing project to be able to find a partner that you want appreciate and to after two and a half years don't hate. So I think that's like a really good thing. And I think we balance each other out very well, where we're both skilled in a variety different formats. And then at the same time, after reading your draft manuscript, probably like five times through and through, you really do not want to read one more time. And there's points where we're like, I think it's good. I think we just just push it out, call it a day. And then Brian could probably agree that I'd say well, let's just read through it one more time, and then you catch one or two small mistakes. And so I think it's one of those things that just finding the right person that's willing to invest and stay motivated to push you and challenge you From an entrepreneurial standpoint, from a business standpoint, your partner is is everything. And so I think that's been one of the blessings that we've had this for this project.
10:11 Yeah, I love it, I think that's great advice is to have that person who complements you. Right and because you don't want to have just like a yes person, but instead you want something that's going to complement you and push you in, in a positive direction. And, and I will second the Peter O'Sullivan, he is just what a nice person and giving and charitable and gosh, I had an interview with him at CSM a number of years ago. And I had to ticket it. Because it was live at CSM. And we actually had to ticket it so that only 25 people could go and I it was only for students. And by the end of the interview, he was laying on the ground, you know, students and stuff. It was just so it was such a great experience, because he's just one of those very kind of electric personalities.
11:08 Definitely. very warm, very electric.
11:10 Yeah. Were there any interviews that you did that surprised you?
11:20 Um, in
11:21 a, in any way that doesn't have to be good or bad. Just surprise you because perhaps the persona that this person has, whether it be their research, social media clinical that you thought they had, and then when you interviewed them? It it surprised you?
11:46 Yeah, I would say. Obviously, when you when you interview over 75 individuals, you get a variety of different responses, you talk to a variety of different personas, devided different characteristics. And I think going into it, knowing the background of someone's, I use the metaphor of like the front cover of a book, we all have like front cover worthy attributes or accomplishments. And then it's like, well, what's on the inside of those pages. And so we see everybody's bio, and I've been on X, Y, and Z shows or published this many papers and, and so we see all that stuff. But we never really hear some of those people talk or talk personally about some of their successes and some of their failures. And so I think everybody had the opportunity to have some elements of surprise. But I think what was also cool as Brian, I made up this master list, and it was basically just based off of accomplishments and achievements, or their influence on the profession. And so, for instance, I was looking through and like talking to Michael Radcliffe, who is who is a researcher that I've read your research, but I, I never really pictured what you would look like. And I never really perceived that you would have such amazing responses within this book. So I think it was those individuals that I might not have been so invested from like falling on social media, or have watched your YouTube videos, and really getting a chance to know them in an hour, hour and a half. Those were the interviewers that really caught me by surprise, but at the same time, I think I walked away with so much more, because there is so much unknown that they're willing to offer me. Um, and so I think I think that was the most exciting part or the most surprising part for me.
13:42 Yeah, I think kind of, because of the types of questions that we asked, we really intimidate joke about this, if we want to know, you know, surely Simon's recommendations for motor control. We can find that online. We can we can Google that. Right? If we want to know, you know how David Butler opens his pain talks, we can probably find that somewhere and explain pain or explain pain Supercharged. But you know, how Heidi genetica who's the CEO of versio Excuse me? Why pte how she structures her day. And what her favourite failure is it those are things that you can't find you can't find that in textbook you can't find that online. So the types of questions that we asked really opened, opened it up to knowing these people from a different perspective, which we thought was pretty cool. I'd say that one of the individuals that really stands out in my mind, Tim actually did this interview, but I transcribe it so I got to listen to everything, literally word for word was Stanley Paris, who's one of the founding fathers of orthopaedic manual physical therapy and then the United States and North America for that matter. And I mean, this guy is is just incredible from sailing around the world to swimming the English Channel to founding St. Augustine to being, you know, a founder and president of various organizations like the guy has done it all to owning a winery or several wineries. I believe he's just, you know, a jack of all trades. And I think listening to that interview, I was like, you know, he's, I think 83 Now, and my jaw was dropped to some of the some of his answers and some of his experiences. So that was, that was really cool. But, I mean, we had so many so many great interviews, Jeff Moore was a terrific interviewer. Peter O'Sullivan, like we talked about Kelly star it gave, you know, exceptional answers. So we were really, really lucky. And, you know, positively surprised, I should say, surprise, in a positive way with with all of our guests.
15:55 Yeah. And it it, it does kind of, like an education for you. Right,
16:02 definitely. Yeah. 110% Yeah, I mean, it was one of those things. I had the opportunity to speak with Michael shacklock. Um, and such a well spoken. Such a thoughtful, mindful person. And back in residency, Brian Knight did some research with neurodynamics and your mobilizations. As I was like, Oh, my gosh, like, you're the Dude, that was like, given us all this information. And now we have the opportunity to actually speak to the source. So I think back to being like eight or nine years old, and have all these posters of Major League Baseball players up on the walls, and just like, thinking about how cool it was to have their pictures, and to think about what it would be like to play baseball with them. And now to be able to communicate with some of these movers and shakers within the industry, and have them be peers, and be able to carry out a conversation with them learn from us as much as we're learning from them in that conversation is just such a rewarding opportunity.
17:08 And do you feel like it has changed your clinical practice at all? How you are with patients? Did any of the answers or just even the interactions with some of these folks change the change the way you practice? Um,
17:24 I think yes. I would say I've slowed down, and I'm more intentional. Just based on a few, I guess, specific responses, but one that comes to mind is oh, shoot, pause. This might be a Karen, you might have to take this this out. And then wait,
17:48 wait, wait a mess up. Or 25? I
17:50 know. We were crushing it. Dude. Millet mark. I don't know. I want to say more. Mark Milligan. So we'll jump back in. Yes, I would say more mindful and intentional. And I've slowed down in my practice, one response, or several responses from Mark Milligan definitely kind of changed the way I think and operate within the clinic. And I've definitely tried to be more intentional and kind of think about my thinking a little bit more in the clinic from a specific, you know, tactical exercise prescription perspective, not so much. Because that wasn't really the focus of our book. But just, you know, Mark's mindset, and kind of his, his recommendation to all young professionals to really kind of invest in themselves and to take care of themselves mentally and physically so that you can take care of your patients better, I thought was really powerful. So yeah, I'd say, a little bit more intentional, focused, and I've slowed down.
19:00 Yeah. And I think sort of piggybacking off of what Brian was saying, less so about the actual clinical approach to what sort of treatments are you providing? And I think that was one of the the most exciting things about the book was we were not talking about what's your favorite three exercises for X y&z Because there's so much saturation, I'd say from a social media standpoint, which is great. I think that's one of the things that's challenging the profession, that anybody has the opportunity to put out content, and it's one of the curses of the profession that anybody has the opportunity to put out content. And so I think the opportunity for young graduates and PT students, and individuals interested in the Movement Science field that is sift through a lot of information to be able to find out what is truly valuable for them. And like Brian was saying, These are the answers questions that aren't necessarily within a textbook, but also probably not necessarily on people's social media channels also, right? No one really steps up to the plate and says, you know that one time when it took me three tries again to PT, school, Dad was really a good important point in time, my life, or, yeah, I remember when I failed the boards. Those are things that I think can really influence and the sort of career life changing for these individuals, who, as a current college professor, writing final exams, getting ready to watch by an influx of tears in my office in the next bout 48 hours, who perceive a failure as such a detriment to their potential growth, and well being as a person, I got a B plus on this test, all my friends got A's, I cannot necessarily navigate that situation. That's like conversation that I hear all the time. And so talking about how has things changed in my practice, I'm currently part time in the clinic, more time from an academia standpoint. So I think it's changed my communication opportunities, with the next generation, being able to literally use this book as an encyclopedia. And knowing the responses that people have given flipping to their name, and saying, I need you to read this chapter from Mike Reinhold, where he talks about becoming an expert, because you're not there yet. Because you shouldn't be there yet. Because you haven't gained clinical judgment and clinical experience. And it's going to be okay. But go read this come back in five minutes. And so I think that's how I've been able to sort of benefit from this, from this experience and how I've taken it influenced my own practice.
21:51 Excellent. And, and as a side note, Tim, the, my podcast episode coming out tomorrow, my podcast is with Silvia Zubaan. And she's a clinician 50% clinician 50% academia at St. Louis University in Washington, Washington University in St. Louis. Sure. And surely, sermons. Yeah. And it was a really nice conversation on how to navigate. She's been doing it for 15 years now. clinician and academia and academia. So it was a really nice, really wonderful conversation on how to navigate that those two worlds successfully and how to be vulnerable when you need to be and with whom, and because it can't always be great and perfect, like you just said. So if you have a chance, I would come out tomorrow, I would listen, I'm excited. Currently to edit this part out. I don't need to plug my own podcast within a podcast. He was a little self indulgent. But because you, you're kind of in a similar position. She's just been doing it for a lot longer.
23:10 That's awesome. I appreciate that. So
23:11 check it out tomorrow. It was really, like, such a good conversation. She's super cool. She should be in your next book. There. Yeah, like it. She's super cool. Yes, Silvia it's CZ you PP o n. Yeah. And she does some research and and she's written some papers and things like that, but she's super cool. Okay. So, um, is there anything? Before we sort of flipped this a little bit? Because I know you guys were like, Hey, would you like to expand on some of your answers, which, you know, is fine. So we'll flip this in, in a bit. And I'll have you guys host and I'll be your guest. But before we do that, is there anything else kind of about the process of of compiling and publishing the book, that you would love people to know, because it made such a big difference in your lives?
24:23 I think one of the blessings of our profession is the lat orality component to your growth as an entrepreneur, but also as a professional. We graduate with a clinical doctorate, or and this can be transcribed across multiple professions, but you go to school to be able to learn how to learn right and in our profession where you sit for a board certification, which gives us the opportunity to practice as a clinician within that. You can wear multiple different hats and I think what was nice with this is That title allowed for us to speak to a variety of different people and have this mutual commonality, which was physical therapy, or Movement Science or the treatment of individuals with certain pathologies. And I think this would never have happened if we didn't make ourselves vulnerable and uncomfortable. Because who are Brian and I? And why should we have the opportunity to talk to Karen Litzy? Or why should we have the opportunity to talk to David Butler? Or why should in so we had this idea, and it all stemmed from the courage to be able to reach out and ask because you never know, unless you try. And so I think sharing one of these thoughts with your listeners is, I think we all have dreams and aspirations that are slightly beyond our scope of practice. And sometimes we can limit that opportunity for us to navigate those ideas, because we are either potentially afraid of failure, or just don't know what the outcome is going to be. And so since that's an unfamiliar territory, we just assume, and therefore we never attempt. And so I think the one of the best things that I've learned from this is accepting failure for what it is, what's the worst that they're going to say? No, I do not want to be part of this, thank you for the opportunity. And the best thing that we could do is create a relationship, create a mentorship opportunity, and have sort of this professional friendship that stemmed from a cold call email. And so I would, I would recommend, at least my thoughts would be challenged, challenge yourself to step beyond your comfort zone, because the benefits of that can be significant if you're if you're willing to try.
27:02 Yeah, Brian, right. Yeah.
27:04 Yeah, I think there's some level of kind of normalization of failure and imposter syndrome within this book. And I think when you dive into it, and you dive into the responses, everyone has been there, everyone, I'm speaking to, you know, students, new graduates, young professionals here, but guess the message kind of spans anyone in any part of the PT space or industry with however many years of experience, you know, everyone's felt that level of imposter syndrome, or, or fear of failure, and the kind of ability to, to kind of push through that, overcome that and almost use that and leverage it to, to push further or overcome obstacles is really powerful. So I think of it like if you're ever kind of at the top of a mountain, in terms of, you know, imposter syndrome, if we look at it, like, like a curve or like a mountain, if you're at the top of it, then you know, what's really driving you and what's what's pushing you forward, if you're kind of somewhere along along the line on the slope, then you have some level of uncertainty, some level of fear, or some level level of imposter syndrome, and that's actually going to feel fuel you to learn more and be better be more effective. And again, one of the main themes of this book was finding a mentor and the importance of that and how valuable that can be in any, any track or any, you know, facet of our profession. So kind of find that person that's doing something similar or doing exactly what you want to be doing. And, you know, don't hesitate to reach out to them. Because we're in the, we're in the business of helping people and thankfully, we have a lot of professionals around us that that want to help other people but also want to help you know, students, young professionals, so don't hesitate to reach out. I think you'll be surprised with with, you know, the the feedback or the the return on that. So, definitely, definitely find a mentor and, you know, don't don't fear stray, stray away from the imposter syndrome use that as fuel.
29:20 Yes. And I will say I got a piece of advice several years ago from a fellow physical therapist, son. So her name's Cecily de Stefano. She's a physical therapist outside of DC. And we were in Chicago for a one night q&a With Lorimer Moseley. And the next day, we were walking around, she had her five year old six year old somewhere around there, young son with her, and she was sort of walking up ahead and he was walking Next to me, and he said this, Karen, would you like to have a play date? And I said, Well, I don't. I don't have any children. And he was like, no, just you. And I said, Oh, um, okay, well, I think we should probably ask your mom first. And then he gave me a great piece of advice. He said, Yeah, because if you never asked the question, the answer is always no. And I was like, and I said, that's the best piece of advice I've gotten in years, and you're like, five. So just to begin with what you guys said, If you never ask the question, the answer is always no. And I've never forgotten that, since he said that. And so now I just always add, ask the question, because the worst that can happen is it's no and so okay, you move on. But you never know. Unless you try. Okay, so true. So let's, uh, we'll start wrapping things up here. But now I, again, thank you for including me in this book. It's a real honor. So if you want if you guys have any questions to I guess I can expand upon or, you know, anything else that that may be? I don't know, you go ahead. Talk about being out of your comfort zone. Go ahead. And you asked me, I'll hand the mic over to you guys. And I'll see, we'll see what we can do here.
31:21 Sure. Karen, thank you, again, for being a part of this. I really liked your response. We were speaking about failure a little bit before. And I really liked your response on failure in the last comment, here you have, I'll read it right from the book, it says, failure has taught me to be more introspective to have an open mind to trust in others more. And to know that in the end, it will all work out the way it is supposed to. I was wondering if you could expand on the to trust in others more? Do you have a specific example that you're thinking of, or examples, or just, you know, have other people come in at really important times to help you out when you're, you know, in a in a, you know, event of a failure?
32:07 Well, I can't think of one person or one incident in particular, but what I will say is, I am personality type a driver. So someone who likes to get things done, who likes to be in the driver's seat who I don't need help, I don't need help, I can do it on my own, I can do it on my own. And as a result, I think that yeah, I've had failures, because I tried to do it all by myself. And it just doesn't work. You know. And so there's a great team building exercise called lost at sea. Google it, I won't go into detail as to what exactly it is. But you have to you fill out. They give you a list of things that maybe you need when you're lost at sea, and you fill them out what you think you would need from one to 15 or 16 or something like that. So you do it on your own. And then you you do it as a group? And then you find out, like, did you do better on your own? Or did you do better when you had someone helping you? And better meaning like, did you survive? lost at sea? Or were you eaten by sharks? Right? And time and time again, and the group that I did it with? Everybody did better with the group. Right? And so for me, and I learned that I took the Goldman Sachs 10,000 small business program, and it was part of that program. And the big part of that program is learning how to be part of a team and learning how to have people around you that make you better. And so I think my biggest failures came because I didn't ask for help. Because I always thought no, no, I can do this on my own, or I can handle this and quite frankly, I couldn't. And so it resulted in a failure resulted in a less than optimal outcome. It resulted in stress on me and and perhaps some mental and emotional anguish, when in fact, I could have just had a team around me ask for help. And that task probably would have been done better than if it's just me and so yeah, I always so when I said that line, I didn't have one particular person or event in mind, but rather that like sometimes you have to like suck it up, you know, and admit that you can't do things and it's okay. It's just part of life. Like I had interviewed a woman Her name's Stephanie Nikolaj and she said you know trying to do it all will keep you small and she's right. You know, you can it's hard to grow as a person as an entrepreneur as a clinician, my God if you just did everything I Your Own I mean, you'd be like, I don't know you'd stop growing from the day you graduated from college right from your PT program. So you you need the these people around you need people around you, who can lift you up and and make you a better person, a better clinician, a better entrepreneur, whatever it is. But you'll never be that evolved person if you're on your own, it's just impossible.
35:26 Yeah, I think, Karen, like the number of hats that you wear as a business owner, a podcast as a volunteer and advocate, right? You, you kind of need people like that in your ecosystem, and it for so many projects, and especially the bigger the project, it really does take a village, and you need people that specialize in certain aspects to come together as a team. You know, Tim and I have talked about this kind of checking, checking your ego at the door sometimes and just kind of leaving that, as you said, Karen, you know, kind of admit that you can't, you can't accomplish it all by yourself. So I that was a that was a really great answer. And, you know, I think you spoke to some of the points about being more introspective and having having an open mind as well.
36:09 Yeah, and being able to trust people, clearly, I have trust issues. But you know, I think finding like, like you guys said, like you found each other, you knew each other for many years, you have this really nice trust and bond. And I don't know, maybe it's like 20 years in New York has made me a cynical New Yorker or something. You know, but really finding those people that you can connect and trust that they have your back and you'll have theirs. I think it's really important.
36:37 I think, another question that I would have just to sort of elaborate on, obviously, we have a variety of individuals that are listening, right now clinicians, non clinicians, entrepreneurs, and one of the questions that we asked within the book is, what advice would you give to a smart driven college student or a young professional entering the quote unquote, real world? And I think one of the things that you mentioned, that was really valuable was that it is easy to say yes to everything, when you believe it will further your career, I would advise you to only say yes, the opportunities that align with your values and goals, as the saying goes, saying yes to one thing is saying no to something that might be a better fit. I think that's really powerful. Because I think we're in a society of more is better, or the perception that doing more is better. So knowing knowing who is listening to this and having the microphone if you would, for for a minute baseline question. Can you elaborate on that? Or if you had to give that sort of monumentous speech regarding that topic? I think that can be really valuable for a variety different people this?
37:48 Yeah. And I think that saying that saying yes to everything, or only saying yes to things that align with your values? I mean, yes, you have to really only say yes to things that align to your values. But I think that speaks to speak to that 30,000 foot view of society in general, and of social media and what we're seeing everyone else do, right, so you may scroll through your Instagram or Twitter, Facebook, Tik Tok, whatever it is, you're on. And you may say, Well, gosh, this person just, they wrote another article, or Gosh, this person speaking here, and they're doing this and they're starting an app, and they're, they've got a podcast, and how come I'm not doing all that? Should I be doing all of that, so I should be set? Why, you know, I need to be doing XY and Z and, and, you know, you've got that, that FOMO disease, you know, your fear of missing out, and then you bombard yourself with things that you think you should be doing because other people are doing them. But it's not even something you believe in, but you think you should believe in it? Because Because other people in the profession are doing it and look at how many followers they have, or, or look at all the success and I use that in quotation marks because we don't really know someone's true success out on social media, right? Because we only put the good stuff on social media, you're not going to put the shitty stuff on social media, right? And so I think this saying yes to everything. I think a lot of it is based on societal pressures, what you're seeing on social media, maybe what a colleague or someone that graduated with you like, oh my gosh, they already started their own practice. And I didn't do that yet. So I guess I have to do that. And I have to say yes to this, that the other thing and it's, I think you really have to especially now like take a step back. Know who you are, know your values know, know your what your individual mission statement is, right? I know you guys said you have a mission statement for your book, but I would challenge everyone like you have your own mission statement as whether it's a clinician or you're in academia. But really you have to know deep down what your values are, what you're willing to take and what you're not willing to take, and, and really know yourself in a very deep, meaningful way. And I'm not saying I know myself in a deep meaningful way yet, but I'm trying, right? It doesn't mean and again, it doesn't mean you have to know that. So again, that's another thing people think, Oh, I have to do this now. But you know, in researching a talk for CSM that I'm actually doing with how do you Janemba my, the part of my talk is increasing your self awareness as an entrepreneur, and how do you do that, and I came across a really great quote, he who knows others, as wise, He who knows himself as enlightened by louts Lao Tzu, la Otz, you I hope I'm pronouncing that correctly. And I saw that quote, and I thought, Oh, that's so perfect, right. Because as, as clinicians, and as physical therapists, our job is to get to know the patient in front of us or the student in front of us or whoever it is in front of you that oftentimes, I think we give away big parts of ourselves without taking it back and looking inward.
41:16 And so you kind of get this like, drain on your empathy, and your energy goes on as the day goes on. And I think that happens a lot. And in these kind of giving professions that we are in, whether you're a professor or a clinician, or even a researcher, right, you're going to give all of your energy to that. And then you see you're always looking outwardly all day. And do you take the time to come back at the end of the day and look at yourself inward? And say, Well, what, what am I doing? Like, why am I doing this? Am I doing it for the likes? Or to get more followers? Or like, what is your goal? Right? And so I think that's kind of where that saying no to things comes in, if you know, your why behind what why you're doing things. It will make it easier for you to say yes, and to say no, because it's going to align with with who you are. But that takes time, you know, so as a new as a student, or a new professional, maybe you do have that all figured out. And if you do awesome, come on the podcast, let's talk about it. How did you do it, but you know, if it takes time, and you have to kind of find your groove and, and really know, where you want your career to be headed. And some people do know that right off the bat, I didn't. But it doesn't mean that other people don't have a very clear path of where they want their career in life to go. You know. And, and there's obviously that changes here and there. But I think that's what I meant by that, quote is looking for those opportunities is to really know yourself, and what your How much are you willing to take? How much capacity do you have for XYZ? And if you don't have the capacity for it, then don't do it? Because it's going to be done like half assed, you know, and nobody wants
43:19 nothing. That's great. Yeah, great advice. Yeah, finding, finding your why and staying true to your why and finding things that that sort of line up with that to allow for you to not have that emotional, physiological draining. If you would find things that fill your cup not not dump your cup out.
43:37 Yeah, exactly. Exactly. Yeah. It's a nice way to put it.
43:42 Um, yeah. So Karen, thank you so much for, you know, kind of expanding and elaborating on some of those. You know, as Tim and I mentioned in the, in the beginning, I think when we were chatting probably before we were recording, Tim, and I want to probably get a podcast started at some point in the future. And, you know, we'd love for you to come on and be one of our guests, so we can talk more about this stuff.
44:06 Yeah, I'd be happy to. And now before we wrap things up here, where can people find you guys? Where can they get the book? Let's go. Go ahead. The floor is yours.
44:18 So we have a website. The website is movers and mentors calm on there is all of our social media information and links directly to Amazon where you can find both our Kindle version and paperback version. If you have questions, comments, please tag us send us stuff on social media. Tim and I love that we you know, we've been very fortunate we've had really engaged you know, an engaged audience up until this point and so you know, we're looking or looking for more of that and shoot us an email if you want and with with comments or feedback. We love to hear that as well.
45:00 Great. And how about where can people find you on social media? Oh, yeah. Yeah,
45:08 it's in those that thing tendons got our handles there.
45:11 Yeah. So my, you can message me on Instagram. But Tim Reynolds DPP would be my thing. That's my Twitter routes, and would be my Instagram. And we'll send you that Karen. So you can sort of tag along for the podcast. But I like Brian was saying, I think the opportunity to interact with our, with our audience is one of the most exciting things, getting somebody that reading the book from South America and is so excited to receive the book is one of the highlights of our day. And I think having the opportunity to have our our audience also send us Who do they think should be the movers and shakers in our potential upcoming volumes of this would be something that we'd really appreciate. There's so many people within the profession that we do not know of yet. And so obviously, appreciate having their insight and input in that as well.
46:08 So I'm at at Bryan, Bryan, Gaskey, and Instagram and then we're at movers and mentors, both on Instagram and Twitter.
46:16 Perfect. And all of that will be in the show notes at podcasts at healthy, wealthy, smart, calm. So before we wrap up, what is question I asked everyone, what advice would you give to your younger self? So let's say fresh out of PT school at Ithaca? What advice would you give yourself?
46:36 I would tell myself, stay curious. Because I find that when I'm curious and asking questions, that means I'm engaged. And I think engagement. If it aligns with your your purpose and your passion, then you have kind of all three things in alignment. And that, you know, lends itself to a happy, fruitful and hopefully, you know, effective career.
47:05 Excellent. Tim, go ahead.
47:08 And I would say sort of piggybacking off what we were talking about earlier, Aaron would be continue to search for the why. And it's okay not to know. And I think that's one of those things where finding your why and staying true to the values is one of those things I'll add to life journey, continue to search for that throughout the lifespan. But I think actively checking back to is this lining up with my Why would be one of the things that I would want to do, either from a journal reflecting standpoint, or just from like a quarterly check in. But then also, the acceptance of it's okay, not to know not necessarily not to know what your y is, but not to know certain things in part of your life. Um, and I think being 20 to 2324 and try to navigate your 20s. And I'm thinking that everybody in that sort of FOMO aspect is having the solutions and answers. And it is okay that you do not know yet you are enough, you will be enough, challenge yourself and have the opportunity to allow for that growth and expansion.
48:23 You guys, that is great advice. Thank you so much for coming on the podcast and sharing your book. Again. It's movers and mentors, and it's available on amazon.com. Go to their website, go to the social media. Everything again is that podcast out healthy, wealthy, smart, calm. One click, we'll take you to any thing you need for both Brian and Tim. So thank you so much, guys, for coming on.
48:49 Thanks for having us, Karen. Yeah, thank you, Karen.
48:53 Pleasure and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart. | |||
| Hilary Silver: Money Mindset and Million Dollar Messaging | 05 Sep 2024 | 00:39:58 | |
On this episode of the Healthy, Wealthy, and Smart podcast, Dr. Karen Litzy discusses setting boundaries, raising prices, and managing difficult situations with guest Hilary Silver, LCSW, an entrepreneur and thought leader in personal development and relationships. Hilary shares her journey from social work graduate to private practice and offers valuable insights on navigating these challenging aspects of business. Tune in for expert advice on maintaining boundaries and handling financial decisions in your professional life. Time Stamps: 00:00:02 - Introduction and Guest Introduction More About Hillary Silver: Hilary Silver is an entrepreneur and thought leader in the realm of personal development and relationships. After 15 years as a successful clinical psychotherapist, Hilary closed her thriving practice in 2017 to launch "Ready for Love," an online coaching and wellness company that helps smart, single women become just as successful in their love lives as they are in their professional ones. She grew her company into an empire, generating over $13 million in revenue in 6 years, helping thousands of women work through her program with an over 95% success rate. Hilary's passion and deep understanding of the root causes of the struggles of her clients helped her develop her signature methodology, rooted in radical responsibility and being centered in self. She now works to educate and inspire everyone to radically change the way they think about themselves so they can live a fully liberated life on their own terms. Resources from this Episode:
Jane Sponsorship Information: Mention the code LITZY1MO for a free month
Follow Dr. Karen Litzy on Social Media: Subscribe to Healthy, Wealthy & Smart: | |||
| 568: Dr. Sylvia Czuppon: Life as a Clinician in Academia | 07 Dec 2021 | 00:39:55 | |
In this episode, Dr. Sylvia Czuppon, Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine, talks about balancing her role as an academic with her role as a clinician.
More about Sylvia Czuppon: Dr. Sylvia Czuppon received her Bachelor of Arts in Psychology in 2000, Master of Science in Physical Therapy in 2002, and her clinical Doctorate in Physical Therapy in 2011, all from Washington University. She received her Certification as an Orthopaedic Clinical Specialist from the American Board of Physical Therapy Specialties in 2010. Her work has been published in British Journal of Sports Medicine, PM&R, Physical Therapy, and Journal of Orthopaedic & Sports Physical Therapy. Dr. Czuppon is currently an Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine in St. Louis, Missouri. She divides time between outpatient clinical practice treating musculoskeletal pain patients and teaching orthopaedic content in the professional DPT curriculum at Washington University. She has given local, state, and national presentations on lower extremity injury rehabilitation and return to sport. She volunteers her time educating coaches, parents, athletes, and the community about youth injury prevention strategies.
To learn more, follow Sylvia at: Twitter: @czuppons
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:03 Hey, Sylvia, welcome to the podcast. I'm so happy to have you on.
00:07 Thanks for having me, Karen.
00:08 Of course, of course. And, you know, we were talking before we went on the air about, you know, not seeing people in person and going to conferences. And the last time we saw each other was in Vancouver, at the third annual World Congress of sports, physical therapy.
00:30 Yes, right. That's right. Yeah,
00:32 I think that's correct. Yeah.
00:33 I can't believe it's been that long.
00:34 I know. I know. 2019. Right. Beginning of 2019.
00:39 I think it was. Yeah, it was COVID. Year, but it was before all that stuff. Yeah, yeah,
00:43 exactly. And, you know, shameless plug, the fourth annual World Congress on sports. PT is going to be outside of Copenhagen in August of 2022. Absolutely. So I encourage people to try and and your fingers crossed, it'll work. I keep saying 2022. It's gonna be the year. So shameless plug for that. Now, let's move into you. So today, we're going to be talking about life as a clinician and academia. And I love this topic, because I think there's a lot of clinicians out there who are wondering, well, how do I get into academia? How do I how do I do that? So why don't you give the listeners a little bit more about your background and how you did it? Sure. Yeah. So
01:38 I've been fortunate to be on faculty at Washington University in St. Louis for 15 years now. I think, approximately, it's been a while. And yeah, I sometimes I'm like pinching myself. I'm like, How is time flown that way? How 15 years? Yeah. 15 years? I graduated in 2002. So yeah, yeah, it is, oh, my gosh, I
02:05 can't believe it, I can't believe it.
02:07 So. So when I, when I joined the faculty, honestly, it was it was a nice, it was a nice mix of events. When I came out of PT school, I knew I wanted to do a little bit of teaching, but the Washington University at least, recommends that you have about a year of clinical practice under your belt before you join an academic institution. Like lab assisting. So that's how I got my start, I started lab assisting in classes that had orthopedic content. And when a position on the faculty opened up, I, I basically jumped at the opportunity got lucky enough to be hired. And away I went. So when I first started, my split, I think was 90% of my time was in clinical practice. And about 10% of my time was in, it was in teaching and it was all a lab assisting. And over the years, that is at has morphed considerably. I'm about 5050 right now. So I spent 20 hours a week in the clinic and 20 hours a week, teaching or doing teaching related things. And it's been a I don't think I'll ever go below that. But who knows what will happen. But I like that balance that I've struck right now, I can't ever see myself coming completely out of the clinic into teaching, like some of my colleagues have done, you know, you go to PT school to become a clinician, you don't go to become an educator, otherwise I go to, you know, to get my teaching degree. And I think that's probably been one of the biggest challenges is I am a PT, learning how to provide high quality education without an education degree. So there's been a bit of a learning curve associated with that as well.
03:42 And what do you feel are the advantages of being a clinician and, and working in academia? So what does your clinician hat bring to your students?
03:55 Yeah, you know, I think it's interesting. So, um, as a clinician, what is nice is I can give them I don't want to call it real world application, but it really is. So they students, we teach them in the ideal scenario, like, Okay, your your patient comes in, they have this positive test this positive test this positive test, what must be their diagnosis? Is any patient ever that cookie cutter clean No, 99% of the time, they're not right. So we teach our students in the best case scenario, the easiest ways to understand and so being a clinician, I can still give them a little bit of perspective, but like, here's where the gray areas come in. And this is why we teach you that ideal scenario so that you recognize the ideal, but here's how you can kind of think more with the clinical hat on it's a little bit similar to being like a clinical instructor. I think that's the greatest part about being a clinical instructor and shameless plug for those of you that are out there that are not clinical instructors. We need a lot more of them there. You know, our students are. It's such a rewarding experience. It really is. It's time consuming, don't get me wrong, but it is very, very rewarding, but I'm so be so being a clinician and being able to, to give the clinical the true clinical perspective on some of the things that students is learning, I think can be, can be invaluable. Like I have students all the time. They're like, Sylvia, this this sounds like a load of hooey like this doesn't even make sense, like help me understand when I would ever do this, and to be able to tell them look, you know, this is exactly why you need to know this level of detail, or this is why as a, even though, you are determined to go into sports, physical therapy, or you're determined to go into orthopedics. This is why you need to understand neuro for example, like, this is why they teach you neuro related things. I think I posted on Twitter, you know, like a couple of weeks ago, I've been to patients this year, that I think I'm, you know, not to toot my own horn or anything, but it's unfortunate, these people fell through the cracks, I think, in referring them out, both of them have gotten a diagnosis of ALS that nobody caught before this point. And it was based on what history they had given me, as well as some of the signs and symptoms that I saw with it within them. They referred to me like one had scoliosis, and horrible back pain, and another one that was a total knee replacement. And those are not diagnoses, you would expect to have ALS diagnoses associated with them. But some of the other things they were describing, it was terrifying. And just, again, like these are things to help students understand that they all do go together, you're treating a person that doesn't come in with a strict diagnosis, you're treating a whole person. And they don't always get that in the education setting when we're giving them fabricated cases.
06:27 Yeah, I couldn't agree more. And that's, that's amazing, by the way, from a clinical standpoint, that you were able to refer them to the right people to get the right diagnosis. Yeah. And that's, you know, and again, that's where physical therapists come in. And I'm sure that this is part of your teaching to your students that, you know, we can be that kind of primary care provider, you know, and even the second opinion,
06:56 sure, sure, yeah. And it is, it is one of those, you know, Missouri is not a direct access state. And so it's interesting, like teaching in a non direct access state, because we do typically get the patients they have the referral, it's generally pretty accurate, but you get some of these that fall through the cracks. And it's why we get the training that we get as physical therapists, you know, for those scenarios. But even again, in a non direct access state, these patients had been screened by other physicians, and it possibly just the complexities of their care, it just things got missed. So
07:33 amazing. Well, now, let's talk about what your responsibilities are, as a clinician, educator, so if you want to break it apart clinician educator, separately, or just let because I think it's important if people are interested in in, going in this direction, they need to know what it entails and what their responsibilities. Sure.
07:59 So I think it's a little bit different if you're so so my position is a faculty member means that I split my my time, assume a 40 hour work week, you know, nobody who actually works that when they're a faculty member on any any academic program, but, um, so I split my time for many people that come from a physician, whether lab assistant, in addition to holding a full time job, that's usually hours, in addition to whatever your hours are in a week. So when I was working as a lab assistant, before I joined faculty, I was working 40 hours a week plus lab assisting X number of hours a week, so there was a little bit of that, because very few employers will give you that time off and say, Oh, you want to live six, eight hours, we sure only work 32 hours here, like, it's very difficult to get that. And then depending on when the classes are during the day. So we have labs from like one to three, some people couldn't do that it's smack in the middle of prime, you know, treating hours. So that is definitely a consideration that people want to make. If you're working part time, it becomes a whole lot easier. Your schedules are a lot more flexible, as a faculty member, so I have 20 hours a week, again, dedicated to patient care, 20 hours for teaching. So in my patient care responsibilities, I basically have a set schedule that is has to be designed around the times that I'm supposed to be in class. So that has to probably be the worst for the person for my for my clinic boss who has to come up with the clinic schedule. He's working around everybody's class schedules and the times that we can actually physically be in the clinic. And so I treat in our clinic, we have a one on one model, so we don't overlap patients, you know, and so that's, that's really nice. We do have physical therapy assistants that we work with as well. And so I balance my caseload, I feel like any like I would anywhere else, I have autonomy to decide when I want to delegate when the patient needs, needs to come back to CV, frequency, duration, all of those kind of standard, standard types of things. Um, I am fortunate because I've been there long enough that I do get a little bit of flexibility and asking for the patient. Two types that I want to see. So I love the postoperative knees and any knee, really. So I do get a little bit more of those than maybe some others do seniority, it's great. And then my academic hat is complicated. So I'm depending on what semester in the year that we're in. And we're also going through a curriculum renewal right now, which is a whole nother whole nother topic of discussion. But in some semesters, I am a course master for for a class. And so that entails doing everything you would expect from a course to making sure the syllabus is up to date, to organizing exams, practicals, lab assistants, supplies, outside lectures, patient labs, etc. to an other the other semester I am, quote, unquote, just a course assistant, so facilitating the course master with all of those duties. So those hours are kind of wrapped up in our actual academic time. So if I have 20 hours a week, and I'm only in lab for 12 hours, my other eight hours are supposed to be spent doing all these other behind the scenes things which are, which easily kind of add up. So it is a little bit of a mix, and the curriculum renewal that I was talking about. So Wash U is going towards more of competency based education, which I think is the movement in education as a whole. And so we're we're in the beginning stages of that our first year classes going through the start of our new revised curriculum, and I am helping to craft the second year curriculum. So that's a huge task, taking what we currently have reorganizing it, restructuring it into an even better product than what we currently have. So there's a lot going on, that is certainly more than 20 hours a week. So yeah.
11:49 And can you explain competency based education versus what's currently happening? I don't know if that's like opening a huge can of worms. But let's go for
11:59 Yeah, yeah. It's also challenging my my full understanding of this, because it's all it's all this is like a complete foreign language. It's like going through, as I as I kind of alluded to earlier, I'm going through, I'm becoming like, I feel like I'm going through to get my education degree in the process of learning how to teach the this material better. So with the competencies, it's essentially like saying, Okay, you're competent in gosh, there's domains, there's, there's all sorts of terminology, but basically saying that, like, okay, that you have this one domain of patient and client care, within that you have different competencies, like, I'm able to take a, I'm making stuff up, because I don't know them off the top my head, but like, able to take a complete history for like, able to do communicate with respect and dignity for the patient and care provider, like things like that. So there's different things that this student is now having to pass and show competence in these competencies, a pass individual competencies, versus getting a grade in a class to say, you're good enough for that grade, it could be really strong in one area, but really not great and another, but their overall grade is enough to move them forward. We want to kind of raise the bar a little bit and say, You know what, that was good. But we can do better. And taking it to like each one of these competencies you need to pass in order to continue on curriculum. Got it?
13:15 Got it? Well, that makes actually makes a lot of sense.
13:19 Does now trying to make every lesson plan, every lecture that you give mapped to every competency that you have is a whole nother topic of discussion. Yeah,
13:32 good luck. Yes. Yeah. Good luck with that. And now something that you kind of alluded to before, which I want to dive into is, so your 20 hours practice care, 20 hours teaching, and I put 20 hours in quotation marks, right? So we know as clinicians, it's always more than 20 hours, right? And in teaching Gosh, it's definitely more than maybe what you signed up for. So how do you and here comes the question, how do you balance all of that with the rest of your life? Because you've got kids?
14:09 I've got two teenagers. Yes, got a dog.
14:12 I've got two dogs, actually two dogs, you've got a home, you have got a life outside of all of this. So what do you do to balance it all?
14:22 Yeah, so that was probably the most challenging thing that if I could have gone back in time and talk to my younger self, I would have been like, don't say yes to everything. That was probably the first thing that nobody really ever told me. Because I thought that if I said, No, nobody would ever asked me to do anything again, you know, you feel like this. Oh, this is a fantastic opportunity. I don't know where the time is gonna come out of but I really want to do it. And so I just started I would say at the time yes to pretty much anything that sounded interesting. And even yes to some things that I was like, I'm not sure if this is what I want to do, but I feel like if I don't say yes, I'm going to lose this. They're going to think I'm not interested in it. Think so, naively when I was when I was a younger faculty, um, that's what I did, I said yes to literally everything and almost put myself in a horrible spiral of I had so many issues in terms of that work life balance, I didn't have any it was work, work work. And then life was like a tiny fraction of that. And that was when my kids were little, I've got teenagers that are 17 and 14 now. Um, but what I discovered over the years was that those opportunities are at least and I still believe this, if those opportunities were meant to be, they're going to come around again, if people really want you, they value your expertise and your knowledge and your skill set, they will come asking around again. And you know, just saying no, one time, and just even saying like, No, you know, what, now is not the right time, I'd love to help you out. Can you come back again, like, you know, if you have another project, just ask me. I mean, hopefully I'll have time at that point, you know, there's no, there's good ways to not just firmly shut the door right to leave that still open. Um, so I've found a better balance for myself now, because I've figured out what is super important for me, and what is not, like really important. So I started saying no to different class commitments that I had previously done, because it was it was stuff that was okay. But it was not my passion in teaching. And so I started whittling down to the things that that made me honestly, the maybe the most happy to think about teaching or be involved in. And when I started doing that, I did become happier with with how that balance was shaping up, because some of that work really wasn't work anymore. You were enjoying doing it, versus looking at it and saying, Man, I got three more hours of this that I've got to prepare for, and I'm just not feeling it. You know, there's a reason nobody's ever asked me to be an anatomy lab assistant. And it's, I mean, enjoy anatomy. Don't get me wrong, but the level of detail I just, that would that was not my forte. No, that was not my forte. And it's like, I want to know the applications and things that I'm interested in. But some of the things that they have to learn for PT school, it just wasn't wasn't in my wheelhouse. You know? Yeah. So it's like, things like that, where, where I just prioritize a little bit better.
17:06 Yeah. And I was gonna follow up question I was going to ask is, How did you? Like, what methods did you use to decide what was best for you? And what methods did you use to break down? Like, no, like, this is a No, maybe not forever? But uh, no, for now, this might be a no forever. This isn't a solid? Yes. Do you know what I?
17:30 Yeah, yeah, it wasn't in certainly not easy. Um, it came again, across several, several years to try to figure that out. So part of it came down to okay, I was lab assisting in multiple classes. And did I really want to stay lab assisting in that context? If the context, if there was a, there was an immediate hesitation in my answer, then I thought, okay, that can't be the number one priority that I really want to stay in that class. So then I started adding up hours, and how many hours a week? Or really, am I spending in that class? What could I replace it with? Um, is there another opportunity right now that I want to replace it with? So it was sort of like, figuring out the timing of things would be one thing? And then some of it was just just deciding, okay, well, I know it's gonna throw me over the, the 20 hours or whatever that I have right now. Am I okay with that for a little while. And for a period I was and then now that I'm older, I'm not, you know, I've got I've got a, I've got a teenager that's going to be leaving the house in two years. And I've decided, you know, what this would, this is the time I actually I want to spend with her, you know, not that I didn't want to spend it with her as a little kid. But now I'm like, feeling that like, empty nest feeling starting to grow. And I'm like, I don't want to miss, you know, all the things that she's doing. And, and so I've just prioritize, you know, what, no, I'm gonna say no to that. Or I'm gonna say, you know, I can't do this this year, or I can only do this for part of the time, like, admissions committee, you know, figuring out who we accepted to our program. Like, well, I can't do it the whole year, but I can do it for part of the year Will that be okay, you know, and try to work out compromises with the people that are there looking for my time.
19:11 I love it. And, you know, so often women have such a hard time with this. Yes, you know, yes. Because we think if we say no, like you said, That's it, we're done, or we're gonna be labeled difficult, or, you know, someone that you know, she doesn't, she's not interested. We'll never get back to that. Right. So I think it's, as a woman, we really have to kind of get over that kind of thinking and and realize like, Hey, if you say it's a no for now, but not a no forever and the people are like, Oh, God, she was setting it up, well, then they're probably not your people. Right? And that's okay to let that go as well. Right.
19:52 I think what also complicates it a little bit is this whole Superman thing, right, like women that believe they can literally do everything. So you've got to be the best parent, you've got to be the volunteer at all the PTO, whatever school stuff, the sporting team, the in then at school, and then it works the same thing, I got to be able to handle this whole load and show nobody a crack in my facade, you know, so that they can see that I can do it, you know, and if I do you crack, then they're gonna think that I'm weaker, you know, just stereotypes that way. I think that's obviously it's really unfortunate that that still exists. Um, but, uh, I, we're not super human, like we have, you know, we have breaking points too. And we need to know what those are for ourselves for our own sanity, you know, for the sanity of our family members, our friends, all the people around us, you know, the pets, yo, all of that. So,
20:43 yeah, and your students as well, like Have, have you ever kind of displayed that vulnerability, whether it be to your employer, obviously, your family, and that's a different story, but maybe to your employer or to the university, to say like, I'm reaching a breaking point. And so how did you do that?
21:04 Yeah, definitely. to the employer. Um, yeah. So So there have been times where and unfortunate our program director, gammon Earhart is amazing. And her predecessor, the CCD singer, was was great, too. And they've always been wonderful with this sort of open door policy. So when you hit that point, or you feel like you're coming up to that point, I felt 100% comfortable going to them and saying, Hey, guys, look, I am, I'm over my head right now. And I don't know what to do. Like, I really need some help. And they kind of talk you down a little bit and say, Okay, well, how can we make this better, I have been very fortunate to be supported in that role. Same thing with even my immediate supervisors within the clinic. Same kind of idea. I had some personal struggles earlier this year, unrelated to COVID. And having and knowing that I had that support system, by being in a good place, I think this is true of any job. But being in a in a in a supportive environment, where they were like, take the time that you need to get your your self. Right. You know, it was it was very nice to know that I had that kind of support.
22:12 Yeah. And so I think the moral here is, it's okay. Absolutely, to let people know that you're not okay. And it's okay to be vulnerable. And if you're the people you're working with or for don't accept that, then I think it's a clear sign to say, Well, wait, wait a second, what am I doing here?
22:38 Right, right. Yeah. And I would love to say like that, I have been fantastic. And always being vulnerable. That is definitely a lie. Nobody, nobody, nobody, nobody is and I, I, you know, grew up in a, in a, in a household where perfection was like, required, it wasn't even, you know, it was it was an expectation, just as you know, my hair is black. And it will say, well, it's gray now, but that it'll say one color like it was the expectation you will be perfect you will be you will not show or have any flaws. So bringing that into a scenario like I am in right now and telling somebody I'm not like I'm vulnerable, I'm hurting, I need help, like even asking for help was was a huge, huge deal for me. But again, I had I had a good support structure, even within my workplace environment to allow me to do that.
23:24 Yeah. And it is, it's hard to ask for help, you know, because because you don't want people to think you can't handle it. All. Right. Right. Right. So asking for help is I know, I have a really hard time asking for help. But I'm getting better at it. Yeah. But it is, it's hard to reach out, it's hard to ask for help. Because you're afraid that someone will maybe think of you as less than or incapable or whatever, you know, all those bad things that spin around in your head, right?
23:55 Or just that if they're thinking about asking you to help out with something that you really want to do, they're not going to ask you anymore, right? Like, you know, and kind of where I'm at as a as an associate professor trying to rise to the professor level in a couple of years, trying to take a larger leadership role in our curriculum, there was definitely a fear of well, wow, if I tell them that I can't handle what I've got right now. There's no way they're going to ask me to do X, Y, or Z. So do I risk doing that? Or do I just drown? And I wasn't willing to drown? No, no, no job is worth that. My personal happiness was not worth that. And again, fortunately, everybody was very understanding the the fear that I had built up in my head was no near nowhere near what I experienced at all. Like it wasn't there. They were like, You know what, we get it. Take the time that you need, it's fine. We'll figure it out. And we'll help you figure it out. We'll give you whatever resources you need, whatever support you need. So it was wonderful. It's really wonderful.
24:47 Yeah. And it's so important to kind of voice that because like you said, you're trying to kind of climb up this academic ladder. So if you never voiced that maybe you would never, you would never reach that Professor level. because you would have burned out left. Absolutely. Yeah. Right. So why not put those fears out there and and find the things that like not to use Marie Kondo here. I don't know if you know Marie Kondo she's so Marie Kondo is like this organizational guru. And her thing is if it doesn't bring you joy, get rid of it. Yeah. And so I wrote that down when you were talking about how, you know, anatomy lab, not for me doesn't bring me joy. This does. So I'm sticking with this. And and what you find is when you do the things that bring you joy, this sort of Marie Kondo method, I mean, she doesn't like, you know, does this shirt bring you joy? And if it doesn't know, this book, this, you know, tchotchke, whatever it is, but you can you can apply those principles, I think, in this scenario, when deciding what to say yes, and what to say no to? And even if you have nothing else on your plate at the moment, you can still say
25:58 no, sure. Absolutely. Absolutely. Right.
26:02 You can still say no, and that's okay. Absolutely, well, this oh my god, I'm so glad that we talked about this is so good. So let's, let's talk about now, I would love to get from you, maybe two or three pieces of advice that you would give to a clinician who's trying to break into the world of academia. Yeah,
26:27 so, um, I think with with clinicians, the first thing is that you've, you've got to know what your, what kind of teaching you want to do, right. So like, if you're, if you're an orthopedic just being happy with, I'll take any orthopedic class, that could take you from going geometry and manual muscle testing, to examination and treatment kind of thing. So knowing sort of what level you want to be involved in helps. Because when you're then approaching the education division director of a program, that's usually who you send your resume or your CV to, when you're interested, they can have a better idea of whether there's a need honestly, in the in the curriculum, for another lab assistant for another lecture, if there are certain topics that you know very well, that you are passionate about, that he would love to lecture on. I'm even offering that up, like, hey, you know, I have a special interest in blood flow restriction training, but I'd love to be able to share that with your students. You know, this is my experience and background with that, let me know if there's there's any any availability for that, I think that's that's another part of it. I do think that it is, um, it is nice if you have a connection to the school, I mean, obviously, like, I got fortunate, I graduated from Washington at school, I'm now in faculty here. So I already had a connection to the program, it made it easier for me to get my foot in the door, because they already knew me as a student. And then as a clinician, because I was in the area. I do believe it is harder when you don't have those connections. But that's where I think networking in general is huge, right? So like you and I, we met through the Twitter verse, and then of course in Vancouver, but like making connections because people that you connect with have connections elsewhere, right. And they might know, just in talking to you. They might say, Oh, wait, I remember Sylvia said that they were looking for X, Y or Z at their at Wash U, maybe you should reach out and talk to her and see if there's anything going on. You know, I think connections are the other part that that people value, but you don't necessarily value maybe as much as you should. As a clinician, I think I take for granted that. And I don't know, if you feel the same way, we travel a lot, we get to go to a lot of conferences, we get to get a lot of all these pre COVID, we went to a lot of conferences. And that's where a lot of the networking happened, right. Clinicians do have to take continuing education in order to keep their their licenses active. But I feel like clinicians are probably taking the cheap local easy place near them to take on it because they don't probably have the benefit, always a funding behind it like I do at an academic institution. And I think that's, you know, you do what you have to do, but finding other ways to network, whether it's through your state organization, like the Missouri Physical Therapy Association here, through the national organization through some of the sections like sports section, ortho section, you know, getting involved that way to make connections, you don't have to attend conferences to do this, but you can get involved. I mean, everything's through zoom right now, you know, and so being involved that way to make connections can get you in the door in other ways. And I think that's probably an underappreciated part of the whole, how do I get my foot in the door?
29:41 Yeah, I would agree with that. And I love all the options that you just gave for clinicians and even students who are thinking, hey, one day I want to do both. Sure, right. So let's know what kind of teaching you want to do. Reach out to people in the school if you have a connection if you don't have a connection start making those connections. Absolutely right. And as a student, I think connecting through whether it's a PTA in general, or the components or your state is a great way to do that. And I would also say, stay in touch with the with your professors.
30:17 100% 100%. Yeah, I mean, and your clinical instructors as well, I mean, for me, my first job coming out of PT school, was because I went back to talk to one of my clinical instructors, and she's like, Hey, by the way, we have a job opening, would you be interested in applying? And I said, Oh, I'm not sure. And she goes, Well, I already submitted your name. And literally, that's how I landed, my first job was like, Okay, well, I guess I have to like, contact them now. So it was great. Yeah.
30:41 Yeah. I love it. I love it. Okay, so now, as we start to kind of wrap things up, is there anything that maybe we didn't hit in the conversation that you came in? Like, ooh, I definitely want to talk about this. Did we miss anything?
30:55 The one thing I will say is, is being on faculty, what did help me was naturally meshing and getting myself a mentor on the faculty. So not all academic institutions, like I know why she didn't have it at the time. They didn't really have like sort of a mentoring program for new faculty joining. And I don't know if this is true for all academic institutions. But for anybody that's interested in doing that, or joining an academic institution, as a clinician, academic, or as a researcher academic, is understanding if there is some kind of mentoring program because without the guidance of my mentor, Marcy Harris, Hayes, there is no way I'd be where I was at today, Marcy was like, kind of like my voice of reason, she was the one that was just like, Okay, you your interests are like humongous Sylvia, you need to narrow it down a little bit, you cannot keep saying yes to everything. She was the one that pushed me in certain directions, because she knew that a gentle nudge would help me get to where I wanted to be, even if I didn't want to take that leap for myself. If I was doubting myself, she would be the one that would say, you can you can do this. She was the first person that put me in front of a crowd of 300 people at CSM. So I have a lot to say, and I never would have, I genuinely never would have done that without for encouragement. And her understanding that I was ready for it. As well as it was something that was going to help me in the future. And that I'd appreciate it later on down the line versus my fear, again, of doing it on my own, would have prevented me from getting that far. So so definitely identifying a mentor. And again, this is for clinicians, even to in the clinic, like don't go into a clinic, and just expect to just learn it all just on your own or through Con Ed guy, I would hope that whatever clinic somebody joins into, has some kind of mentoring program as well. So that you can learn you can shadow you can get experience from other people. And it's different than just being able to say to your your pod mate, hey, I had this patient that was a little complicated. What do you think like truly having a mentor, I think is a big, big thing. To help enhance the level of clinician you are as well as again, if you're an academia, how to get up that level ladder and how to navigate it to I think that was the other thing Marcy gave me was some advice on how to how to get a little bit further because she was ranked ahead of me, and she had some great personal experience. Pros and cons, I guess you could say, to navigate that.
33:25 I love it. I think that's great advice. And I love how you said not only get up the ladder, but navigate it as well. Right? Because there's a lot of things that are gonna push and pull you along each rung of that ladder. Absolutely. So I think that's amazing advice. Okay, where can people find you if they need a mentor? Or they have questions?
33:47 Yeah, so Twitter's the easiest place. So I think you've got my contact information, but I am on Twitter, and an email is perfectly fine as well. So they can find my email address just to the washi website. Or really, if you just Google my name, it's pretty impossible to miss. There's not that many Soviet coupons out in the world. There's none, in fact, so it's pretty easy to find me I come up readily on a Google search.
34:10 Excellent. And we will have all the all of those links in the show notes. And now I have a question that I asked everyone at the end, but you already answered it, but I'm gonna ask it again. And that's what advice would you give to your younger self?
34:27 Yeah, totally. My younger self would be learn how to say no, and how to prioritize what you really want to do. prioritize what's going to make you happy. What's going to make you the clinician, the person that you wanted to be when you grew up, you know, because if you sacrifice what you want for what everybody else wants, you're not going to be happy. Perfect, I
34:52 love it. Thank you so much. I appreciate this conversation so much. I appreciate you for coming on. This was wonderful. So thank you so much.
35:00 Yeah, thank you so much for giving me the opportunity to be on I appreciate it
35:03 too, of course, and hopefully we will see each other in person soon. That
35:07 would be fantastic. Indeed, indeed. All right, and everyone,
35:10 thank you so much for listening, have a great couple of days and stay healthy, wealthy and smart. | |||
| 567: Dr. Meagan Duncan: Creating PT Safe Spaces for the LGBTQ+ Community | 23 Nov 2021 | 00:34:26 | |
In this episode, Physical Therapist at Kelly Hawkins Physical Therapy, Meagan Duncan, talks about creating safe spaces for the LGBTQ+ community. Today, Meagan talks about trauma-informed care, navigating trauma during the subjective exam, and the importance of consent. How can PTs make clinics safe spaces for the LGBTQ+ community? Hear about the discrimination faced by the LGBTQ+ community, doing community advocacy work, and get Meagan's advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Meagan Duncan Meagan Duncan is a Chicagoland native who earned an associate degree as a Physical Therapist Assistant in 2013 from Kankakee Community College. She then worked for six years in an orthopaedic setting while earning a Bachelor's in Interdisciplinary Studies from Governor State University in Illinois. Later, she moved to Las Vegas to earn her Doctor of Physical Therapy degree from the University of Nevada Las Vegas in 2020. As a PTA, she developed and ran a pro bono clinic at her first post grad job in her hometown of Joliet, Illinois. She now practices in Las Vegas and specializes in pelvic health after completing a specialty clinical rotation with the VA Hospital in Las Vegas. Duncan currently works at Kelly Hawkins Physical Therapy, a prominent outpatient physical therapy company in the Las Vegas area. At Kelly Hawkins, she built a successful pelvic health program that she has overseen and grown over the past year and a half. Duncan also works for NPTE Final Frontier, a premier national physical therapy exam preparation company that works with domestic and foreign trained students to help them pass the board exam. In this role, she tutors PT and PTA exam candidates and assists them with content development. She advocates for students and professionals to balance life outside of physical therapy. Outside of her profession, Duncan enjoys hiking, biking, paddleboarding and anything she can do outdoors with her husband and dog. She is excited to welcome a new addition to her family soon, as her first child is due in a month.
Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, LGBTQ+, Inclusion, Trauma, Pain, Discrimination, Sexual Violence, Advocacy, Consent, Pelvic Health,
To learn more, follow Meagan at: Email: mduncan@kellyhawkins.com Website: https://www.kellyhawkins.com LinkedIn: Meagan Duncan
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:02 Hey Megan, welcome to the podcast. I'm happy to have you on.
00:06 Hey, Karen, awesome to be here. Thank you for having me.
00:09 Yes. And like I said in the intro, today, we're going to be talking about creating physical therapy space, a safe spaces for the LGBTQ plus community. So before we talk a little bit more about that, can you let the listeners know where your passion for this community comes from?
00:27 For um, so I guess I feel like I'm just kind of a fan of the underdog in any situation. And I can't say that I have personally experienced, like so much in this community, aside from having a lot of relationships with people, and seeing what they go through and what life looks like on that side of our world, because it's a very different experience from what I've had as a heterosexual, white female. So when I was in high school, I just kind of ended up best friends with a gay man. And he kind of brought me into the circle of his friends, which ended up being just a really large, wonderful welcoming circle of people on all spectrums of the LGBTQ plus community. So I got really interested in just kind of gay rights and things like that went to marches and did all of that. Tried to advocate for the community as whatever I need to do as a 16 year old, which was not very much. And now I found myself in this position that I can do something which is awesome. And it's not even necessarily something I thought about when I went into the niche that I'm in. But I am really happy to be able to finally say that there's like some baggage behind this lifelong commitment that I kind of said that I had towards the community, but was never really doing anything about it other than like, your like Facebook posts here and there that talk about, you know, advocacy or supporting a community that's not well supported. So I'm happy to be able to do something about it now.
01:56 And let's talk about what you can do, or what we can do as physical therapists to help support this community, because I'm sure a lot of people may be listening to this and say, Well, what does the community need? That's so different from the rest of of other communities? So what is it about this community in particular, that perhaps they're more exposed to certain things? Or do they not get the care that they need? So go ahead, I'll pass the mic over to you.
02:27 Yeah, absolutely. So just discrimination in general, it's a problem in so many realms of social issues, being gender and sexual preference, of course, is one of those huge ones. So people feeling like or actually having less access to healthcare, getting denied health care, or getting given less than optimal treatment, or not really getting the best of their provider because of discrimination or because of biases that those providers have. Likewise, they might be afraid to go to facilities or go get treatments for things that are going through because they've experienced poor care before. So my niche actually, is pelvic floor physical therapy. And in this, there is so much that I can do for the community and physical therapists as well. And I was thinking about this podcast and thinking, what actually makes my job so different from the way everybody should be treating everyone. And I think there's a lot to learn, aside from just treating in pelvic floor PT. But in pelvic floor PT, I see a lot of people in the community because they are much more exposed to sexual violence and sexual trauma. And that correlates really significantly with pelvic floor dysfunctions. So we know from studies that gay men can undergo sexual violence at twice the rate of straight men, transgender people will usually experience about 50% of people will experience some kind of sexual violence in their life, which is a huge number 50%. And then it's even more if they're a minority. So that's a huge community of people where like, most of them need our help or need pelvic floor PT, or need more support than they're getting. So I think that we can play a big role in advocating for people and making spaces where they feel like are welcome. Or be that person that they can come to and after bad experience, bad experience or bad experience in healthcare, they can come to you and feel comfortable. And that's a really great feeling from my end. And I hope that other physical therapists out that out there feel better experienced that because it's awesome.
04:29 And you know, when you're talking about sexual trauma, or sexual assault within this community, I mean, the thing that sticks out to me is trauma. And so there is more and more research. And I think more and more people are now aware of trauma informed care. So can you share with us some of the principles of trauma informed care and why physical therapists should care?
04:56 Yeah, so this is kind of one of those things I was thinking about. trauma informed care and pelvic floor physical therapy is like, every class every time, we're always talking about every continuing ed course, because the nature of the work is so intimate, and very personal. And we're asking questions that make people uncomfortable, and hopefully not too much, but putting people in uncomfortable positions a lot of times, and it takes a lot for somebody to even come into my office to tackle these issues. But I think we should all be kind of treating in that same way. Because we don't really know like, of course, I know, when people come in for pelvic floor PT, they're probably uncomfortable. Like most of the time, people don't really like, want to be there. They're there because they need it. But that goes for a lot of things in physical therapy, right? Like people don't want to have back pain and come in and like, a lot of people don't want to get like touched and massage like, that's not what they intended on doing. But here they are, because they need it. So being trauma informed in any discipline is really important, because you just don't know what somebody has been through. So talking about trauma informed care, I think understanding a little bit more about trauma is probably a good place to start. So I do kind of think everybody should
06:10 reflect a little bit on what that means. So I was thinking of a good example. And I think that trauma can be kind of like pain, where we don't have a measurable, like objective measure for like, what pain is or what trauma is. So I know if a patient comes in says they're in six out of 10 pain, I have a patient with that same diagnosis that might say they're in two out of 10 pain. Or maybe I see, let's say I see somebody with a knee replacement. And I know that like a good healthy knee should have zero degrees extension, right. Or before they leave the hospital, we want them to have 90 degrees of flexion. But like I can't say to somebody, like you have a 15 degree trauma contracture. Like that doesn't make sense. There's no reference point that we know of other than what that person's experienced. So it's important to understand that trauma is different for each person. And some people could be really traumatized by an event. And some people could not really be traumatized by the same event. And that could depend on what factors they have in their cultural background in their other life experiences or the lens that they see things through. So somebody could experience their parents getting divorced, and maybe they came out of that fine. And they're like, Well, I came out of that fine. I don't know why it's so hard for everybody else. But you don't know what it was like to experience that with these other issues around you with being a minority or having financial distress or anything else like that. So understanding traumas is the most important part first. And then when we talk about trauma informed care. And this is from a Substance Abuse and Mental Health Services Administration, there's kind of the principles of trauma informed care, what does that mean? So the first part of that is to realize that trauma is a widespread issue. And it is invasive, and pervasive, and it affects people in a lot of different areas of their life. And then also realizing that there are pathways to potential recovery. After that, we should be able to recognize the five signs and symptoms of trauma. So recognize what is trauma look like? Sound like? How does that patient act? How can we pick up on if they're a traumatized individual. So seeing a patient being uncomfortable in your clinic, they might not make eye contact with you, they might not want to face you directly, you might see their body language is a little bit off, their arms are crossed. Things that we've all seen. We all have patients probably every day ranging anything from like that super bubbly, happy patient to the one that comes in and has done PT before and had bad experiences, and they're really unhappy. So recognizing what does that look like, and then responding by implementing that knowledge into practices and policies within just not just yourself, but the the facility as well. So using what you know, to actually change or adopt practices better, going to be more inviting or more informed and make more comfortable spaces for people that are traumatized. And then we have resisting retraumatization. And this, I think, is the most important part for us as clinicians. So thinking about what we can do to make an environment that does not correlate with any kind of trauma, anybody has had to make them have to revisit that. So and that could be anything again, like there's traumatic events that range from, you know, like really terrible sexual violence, and these are maybe things I hear about, but then there's also the trauma of like, having been misdiagnosed or having been told this or that by that provider or getting a hopeless diagnosis or being told that there's nothing that can be done for them. Those are things that we can actively try to resist re traumatizing that patient in. So being on honest and informative, making sure that we're not making false promise promises, but also that we're providing hope. And then thinking about what our space is like. And this is probably relative, maybe a little bit more for like LGBT, t plus LGBT plus community, where I am making sure that my space has signs that say All are welcome here. And things that make people feel invited, because they very possibly have had an experience before where they walk into a facility and like, immediately feel discriminated against or immediately feel like, this is not a place that I want to be here, this is not a place that's going to give me good care, and maybe the Carolinas without a dentist, but at any rate, they've experienced that and probably are very likely more than once. So I want to make sure that whatever I'm doing is not recreating any of that for them.
10:54 And when you are, understanding what trauma is, and really trying to understand the trauma of the person sitting in front of you, right, I would assume a lot of that comes through our subjective exam. So do you have any advice for therapists who are navigating these waters, even newer therapists perhaps are navigating or who maybe aren't, are not as well practiced in the art of the interview? Or in that process of, of that subjective exam? So do you have any like, what types of questions do you ask that kind of stuff?
11:34 Yeah, sure. Um, so I asked a lot of questions and pelvic floor PT. But I think the more important concept around that is, um, sometimes instead of asking questions, I, and that's not that we're talking at patients. But I do take a moment to do this. And if I am getting a sense from a patient, that they may have experienced trauma, that they're not going to share that with me. And that is probably more likely than not, especially on the first day, when I'm doing my initial evaluation, they don't know me, they don't trust me, they don't really want to share any of this with me, let alone even be there. So, a lot of times, I'll take the opportunity to talk about how trauma or how other experiences can relate to pain. So I might say to, let's say to my pelvic floor patients, I don't need to know or I don't need you to tell me any details or anything. But I am aware that trauma increases pelvic floor dysfunction increases pain, and it can really affect the way that people recover. So if there's anything that I can do during this treatment to make you more comfortable in any way, let me know if we need to stop anything. We're doing them, you know. So I might just take it as a piece of information, instead of asking a direct question, like making them tell me, maybe they'll do that later on in another session or two. Maybe I might need to know more at some point. But I've really never ran into that situation. A lot of patients will tell me the extent of it right there. They might do it another session or two. But it's not something that I really want to force out to people like day one, because if if I do that, like are they going to come back? Because that re traumatizing them? Have they been forced to talk about it before. I'm not a psychologist, I'm not a psychiatrist. I'm maybe not the person that they want to share all that with. So I want to make sure they have the open door to tell me about it. But I'm not like dragging it out of them.
13:22 Yeah, that's, that's wonderful advice. I really love that. And the other thing is, that I heard a couple of times during kind of these principles is creating that safe space, creating that space, where like you said, Everyone is welcome. How do you have any other tips and it could be from the person at the front desk all the way to, to the therapist and every employee in between? So are their conversations with the all the employees who work at the within that space? And and this may seem kind of like a silly question, but I think it's important, but colors on the wall artwork, things like that. I think it makes a difference. Right. So what do you what do you think?
14:10 Yeah, so I think that maybe places are a little bit hesitant to, like, fly this giant rainbow flag outside their door, right? Like, I would totally do it if I have my own clinic, but I recognize that I'm like, you know, working we're still working in a world that like from a business model. Maybe we don't want to do that because we want everyone to feel welcome, right? But it doesn't really take much. I think it's about really small gestures. So in our clinic, starting from paperwork, like they fill out paperwork online. And gender, for example, has every option that you can think of. If it is a paper form, gender is a blank space, so that blank space leaves people the option to write how they identify. And I love that option because That's even better than having to choose from like an overwhelming amount of options, or not finding the option that you're looking for. So a blank space for gender is fantastic. And then what we have in our clinic, like I said, small gestures, I think small gestures are really the thing, we have very small little flag stickers, like on the Plexiglas from our front office. Just little flag stickers for like every flag that you can think of, or it has like all the colors that represent different parts of LGBTQ plus community. So that little flag makes such a big difference, because I'll tell you, a lot of our patients are not going to notice it, like your patients that don't identify in any of those ways are not even going to notice it. But those people that do are going to see it, and they're going to love it. And we get compliments on that all the time. They think like, Oh, my God, people are so thankful for this little tiny sticker, we got like four pack on Amazon for like, probably a couple bucks, you know, just doesn't take much. And then another thing that we have in our waiting area is a sign that says All are welcome here. And that's such a simple thing, because that's not offending anybody that's making all people feel welcome. And people that are looking for that in their space, they know exactly what you're talking about when they see that fine. And everybody else is just like, oh, that's a nice thing. And they might not think very much of it. But it's certainly still a good thing to hear like, older people are welcome. Younger people are welcome. Everybody's welcome here. So it's really easy option.
16:29 And I love that these are all really easy, inexpensive, and accessible ways to show that you are working hard on creating a safe space for everyone. And like you said, a safe space for the LGBTQ plus community who oftentimes can't find those safe spaces.
16:48 Yeah, yeah. Another another small thing that I do personally, because I want my patients before I even go into their room maybe to like understand that I'm an advocate, I just have like a rainbow water bottle. And that's what I drink out of that work. And they see that sitting on my desk, and maybe some other stickers on like my laptop and stuff like that. But something that they might see like, Oh, that's my therapist, and they see like a rainbow water bottle. And it's just like a little thing that makes them feel more comfortable. I love it. I love my water bottle, so everybody's happy.
17:19 And do you go out physically into the community for advocacy work or as part of the clinic just so that people know that you're there? You know, like, how, how does that work within your community? Because I'm sure there are people who I mean, I'm in New York City, right? So I talk about like a large amount of people, right? So how do people know how to find? So how do people, especially in these marginalized communities know how to find the people who are creating spaces for them? Yeah,
17:49 so most communities, I'm in Las Vegas have support centers or community centers that support or provide or refer to services like my own or other providers that they know, create these safe spaces. So we have a support center here in Vegas, I've spoken to a little bit, I'm not necessarily within everybody's insurance providers. So that makes things a little bit harder. I'm in pelvic floor PT, I get so many patients from all over. And I've had a very long wait time, it's been tough to go out and mark it. And I'm also leaving for maternity leave actually in a couple of weeks. So I have plans for when I come back to reach out a little bit more, but I have been swarmed with what I have. But going out into these community centers, just letting them know who you are dropping off some cards, I have done that. And that is a really good way to at least get started. Get your name or your clinic out there. And maybe you're not what every person is looking for. But if they have your card handy, and they are providing social services to somebody, they might say, it sounds like you could benefit from this I know a great physical therapist that you could go to. And then, of course, we're a little bit bound by insurances. And that's definitely something I see in my future is trying to provide a little bit more preventive care to people that are uninsured or under insured. But that's probably a future problem for me at the moment. Right.
19:18 Right. And I think that's great advice. So if you're in a city, reach out to local community groups, community centers, things like that, and I think that's a great way for you to get out and in the community and really make a difference. And now there's one more thing that I want to talk about before we start wrapping things up. And that is the importance of asking patients for consent. So you touched on this a little bit, right? But especially in the pelvic floor world. Where does this explained explain to the to myself and to the listeners, how you go about asking for consent And why this
20:01 is yeah, this is definitely like if we can take home anything from if listeners could take home anything, it's to be more vigilant about asking for consent. And I can kind of trace this back to like how I've evolved in asking for consent. And I think about an IC O I think probably hope I'm probably not the only one guilty of this. But when I started, I started as a physical therapist assistant. So way back, when I graduated as a PTA, I went to work at a facility where the, the clinic was pretty manually aggressive, a lot of manual therapy, a lot of kind of aggressive manual therapy, which can be a little jarring for patients that are maybe not prepared for that. But I think about how many patients, I just went into the room and like started palpating, or like, Okay, I'm going to check this and then just like put my hands on them. And I think now about like how strange it would be to just like, grab somebody like psi SS without like telling them where you're going, like grabbing the back of their hips or having them like face a wall and then touching their back. And that can be like a very, that can like reiterate some traumatic events for people being grabbed from behind. That's, it's, I can't believe that I did this being the person that I am now. But I did, I did it every day all the time. And I never really thought about consent, I just figured the patient was there, maybe the provider before me had probably done similar the same things as a PTA, so I assumed PT had done the same. And I just think how crazy that is. Now, to me, it just is like so out there that I would have done that. Um, but asking for consent is something that should be ongoing and all the time. So from the initial evaluation, and education is a big part of asking for consent, I think too, because in order to consent to something, people have to understand what it's going to entail. And for me and pelvic floor, that's certainly relevant because I do do internal pelvic floor exams. So they need to know exactly what I'm going to be doing. And I use a model to demonstrate and to talk about what that's going to entail, and then discuss that they have the option to consent to that or to not consent to that, if they don't, there's other things that I can work on that I can help with. So I don't want them to feel pressured, that they have to consent to anything that I asked for. So consent, those should be informing the patient pretty much every step of the way. So instead of saying, I'm going to check your pelvic alignment, nobody knows what that means, like our patients don't know what that means. So I might ask, Is it okay with you if I touched the front of your hips, and then that's how I started just kind of simple and explaining in layman's terms, what I'm going to do. And a lot of times, I'm asking a patient or giving a patient options. And this is kind of part of trauma informed care is enabling or empowering the patient to make choices or have options. So instead of saying, say I want to do soft tissue work, instead of saying, I will be right back, I'm going to go grab some lotion, and then the patient knows I'm going to do soft tissue, but they didn't get an option to consent to that. I just went to go grab it. And now they feel like they're stuck there. And I'm going to come back with lotion and they're going to get a massage and they don't have a choice. So I might say, I would like to work on this. This is why. So we can do that. If you don't want to do that. We can work on mobility in this other way. So that way they have an option for what they want to do or how they want to do it. So providing options, I think is a really important part of concern. Um, I think yeah, I think that's mostly what I mean with consent.
23:42 Perfect. Yeah, I think that's great. And listen, I used to do the same thing. And I can't believe I did that either. Yeah, just like walking into a room and just like touching. Like, I wouldn't want someone to do that to me. I can't believe I did that.
23:55 I know. And I wonder is that like, a time? A time thing? Like 10 years ago? Was it just more like then we're just more informed now? Or was I just like totally oblivious? Because that's certainly
24:05 possible. I think it's just we're more informed now. I'm gonna I'm gonna go with that, you know, and yeah, and and maybe a little bit of a being oblivious? I don't know. But you're right. Like, I would just come first of all stand up and you just be like, hands on the pelvis. And it's like, what is like, how, what, what was?
24:25 And like next to I think, like, we were just yeah, like not grabbing,
24:30 grabbing onto people's heads and everything. What's that about? I would never do that. Now. You know, even if I'm just going to touch someone's arm. I was like, I'm just gonna put my hands here if that's okay. And we're gonna. Yeah, it just makes so much more sense. And I love the fact that you tied that in with the patient education component. Because I think like you said, you can't have one without the other. It's just so important.
24:55 Right? And I think that we underestimate like how much the patient wants to be educated about things. So and that's a lesson, I think I've learned pelvic floor PT, because so many people did, like they don't even know they have a pelvic floor or what it does. So education's been a huge part of my practice, like the whole first session is really education and training, and bladder and bowel training and things like that. But patients want to know, they want to know all the details, like they love it, tell them so they know what you're doing. So they know if they want that done or not.
25:24 Yeah, absolutely. At your right patients want to know, and it doesn't matter the age, they want to know, what's going on with their bodies and and what they can do to be a part of it. So it's also a great way to empower your patient to understand and take control over their, over their bodies. You know, and and give, give the patient some autonomy and some confidence.
25:49 Yeah. And to give that the patient the opportunity to, like collaborate with you, instead of be told what's happening. So to have the opportunity for them to feel involved and to have a voice in their decision making and understand even why they're making a decision, like so that they might know. Yes, I do want this internal pelvic floor exam done. Because I want to know more about the tone of my pelvic floor so that I can know why I have pain or why I have difficulty emptying my bladder. I want them to be able to make that connection in their head and be able to consent to it. Knowing why.
26:21 Yeah. And it's all part of patient centered care. I mean, that's what we're all supposed to be doing. Right? Yeah, absolutely. It's not patient directed care. It's patient centered care.
26:33 Right. And just as relevant as it is for me and pelvic floor. I think it's the same anywhere else across the board.
26:39 Yeah, across the board. Absolutely. Well, I, you know, I want to thank you. I think this was a great conversation. I feel like I've definitely learned a little bit more about trauma informed care. So I thank you for that. Now, where can people find you? If let's say they have questions, they, you know, they want to know how they can implement some of the things you're doing in your clinic in their own clinics.
27:06 Yeah, sure. So I typically use my work email for anything like that. So that is M Duncan at Kelly hawkins.com. And I like I said, I'm not much of a social media person I wish I could say I was that's probably not the best way to contact me.
27:24 I know you're not missing anything. Don't worry about it.
27:27 Yeah, but I'm always happy to check emails and respond that way. For people trying to figure out where to start. I did want to mention CSM has a lot of great topics on this, I've certainly gotten a lot of information, or directed myself onto what things I'd like to learn more about by going to CSM and going to these discussions. There is some information on trauma informed care at CSM this year, as well as introductions to pelvic floor PT, for those that are interested. And there are always platforms and other lectures on what we can do for the LGBT Q plus community. Excellent.
28:04 Thank you so so much. And before we wrap up, I'll ask you the question I asked everyone. And that's knowing where you are now in your life and in your career, what advice would you give to your younger self?
28:14 That's fine to not just go around touching people.
28:18 Yeah. That advice to each other.
28:21 I think I'm fortunate that never really panned out to be anything too negative, but I would love to go back and not do that. But what I do tell people and recommend as far as career is to find a niche. So my niche is pelvic floor PT. Within that my niche is being passionate and treating the LGBTQ plus community treating patients that are transgender, that is a great niche to be in, not everybody is doing it, it is so needed. If you can find a niche that you're passionate about, and that is needed, you are never going to struggle for work or for satisfaction. Um, it really is kind of been if you build it, they will come situation. And people told that to me when I began pelvic floor pt. And that's what I did, I built a pelvic floor program, the company that I work for now. And like I said, I am very busy, very satisfied with the way my career has gone in. So find a niche and it's not something that every new student is going to know right away. But get out there and explore like go shadow and go find places that are outside your comfort zone. Like I wasn't I didn't think I was going to go into pelvic floor PT. I don't think a lot of us that end up in it do. It's maybe not something I would have thought to shadow I would have been like, that does not sound good. I don't want to do that. But again, outside your comfort zone, go shadow and find therapists that are doing things that you don't think you would ever do, and see if you can find somewhere that you're going to land and be successful.
29:50 I love it. That is great advice. Thank you so much, Megan. I really appreciate your time and your knowledge sharing with myself and the Audience So thank you so much yeah thank you and everyone thanks so much for tuning in and listening have a great couple of days and stay healthy Wealthy and Smart | |||
| 366: Dr. David Logerstedt:Get a Load of This!: Effects of and Response to Mechanical Loading on the Knee | 16 Nov 2021 | 00:34:59 | |
In this episode, Associate Professor at the University of the Sciences and Director of BTE Laboratory, David Logerstedt, talks about monitoring and responding to load injuries on the knee. Today, David talks about the most common loading injuries on the knee, difference between external and internal loads, and how to improve tissue capacity. What is mechanical loading? Hear about David's most recent research paper on mechanical loading and the knee, how therapists can monitor and respond to loads, how clinicians can apply the information in the paper, and get David's advice to his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about David Logerstedt David Logerstedt, PT, MPT, PhD is tenured Associate Professor at University of the Sciences and Director of BTE laboratory. He graduated with a Bachelor of Science degree in health and human performance from the University of Montana and a Master of Arts degree in exercise physiology from the University of North Carolina. He earned a master's degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and movement science from the University of Delaware. Dr. Logerstedt has been a practicing rehabilitation specialist for over 25 years and is board certified in sports physical therapy. He has presented his research on knee disorders at national and international conferences and has published in high-impact sports medicine journals on ACL injuries. He has co-authored several clinical practice guidelines on knee disorders. His goal to improve the implementation of clinical research into practical and accessible for all clinicians.
Suggested Keywords Healthy, Wealthy, Smart, Knee Injuries, Loading Injuries, Tissue Capacity, Stress, Research, Rehabilitation, Recovery, Physiotherapy
Resources: Effects of and Response to Mechanical Loading on the Knee
To learn more, follow David at: Website: David Logerstedt's Bibliography Twitter: @DaveLogPT LinkedIn: David Logerstedt
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35 Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health so when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about his new integration, head over to net health.com forward slash li tz why to sign up for your complimentary marketing audit. And it's great, I use it and it works. So I highly recommend it. Now onto today's episode. So I'm really really happy to have Dr. David lager stead on the episode today. And we are talking about monitoring and responding to load injuries on the knee. So Dr. Lager stat is a tenured associate professor at the University of sciences and director of the BT EE Laboratory. He graduated with a Bachelor of Science degree in Health and Human Performance from the University of Montana and a Master of Arts degree in exercise physiology. from the University of North Carolina. He earned a master's degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and Movement Science from the University of Delaware. He has been a practicing rehabilitation specialist for over 25 years he is board certified in Sports Physical Therapy. He has presented his research on knee disorders at national international conferences and has published in high impact sports medicine journals on ACL injuries. He co authored several clinical practice guidelines on knee disorders. His goal is to improve the implementation of clinical research into practical and accessible, make it practical and accessible for all clinicians. So yeah, so today we're talking about a new paper, that he co authored the effects, the effects of em response to mechanical loading of the knee to great paper, you can go to podcast at healthy, wealthy, smart calm, to find a link to the paper. And a big thanks to Dr. Lager stead for breaking it down for us and everyone enjoyed today's episode. Hey, David, welcome to the podcast. I'm happy to have you on.
03:04 Thank you for having me. Yeah, and I'm excited. Today we're going to talk about a new paper that your co author on that came out on to be very precise, October 20, of 2021. And it's the effects of response to mechanical loading on the knee. So of course, my first question, I'm sure this is the first question everyone asked you is, why write this paper? What is the why behind it? You know, as a, as a clinician, as well, as somebody who is now in academia, I've always kind of had this question myself, you know, what kind of loads are on the knee? And I've always had this, you know, concern about dosing and trying to figure out like, how can we can best dose exercise around the knee. And as I, as I really started to think about this more, really started to find that there hasn't been any review, or any kind of clinical commentary kind of brings at least the concept of mechanical loading, kind of in one place. And the knee is always a good model, because it does seem to have a lot of a lot of research around it. And it's an area I'm familiar with, because of my work in ACLs. And so I, we, you know, we just started, started thinking about, okay, how can we best talk about what kind of loads are being placed on the knee and, and some of it kind of kind of came out of some conversations I had with another colleague of mine, where we've really started to talk about the use of inertial measurement units and how those can start to give at least some general indications of what loads are occurring through the lower extremity. And so we decided to just kind of put a team together
05:00 who had expertise in in loading? And then expertise in specific structures related to the knee? And so that's kind of how it kind of came together. And when we're talking about loading of the knee, so in this, in this paper, you're talking about mechanical loading. So let's, let's go with some more definitions here. So what is mechanical loading? And why is it important in respect to the knee will stick to the knee? Yeah. So, you know, in the paper, we really describe mechanical loading, this is the physical forces that act on are free to make demand on the body, either at the system's level, or even on structures at a specific organ or tissue level. And so if you think about mechanical loading can kind of subdivided into different variables, such as, like the magnitude of the load, how long the load is being applied, how frequent it might be applied, or even maybe the direction or the nature of that load. So
06:05 so when we think about loading, though, all those components kind of interact, can interact with one another, and then create different loading patterns that can impact again, the knee is the organ itself, or specific structures within the knee. And when we're talking about loading, I think most people think of loads as external, so something that we are placing on that knee, but there are external loads in their internal loads. Can you kind of differentiate those for the listeners? And how, and why are both important? Yeah. So when we think about, you know, external loads, to kind of think about is like, really kind of that work that's being performed? So like, how far did I run today? Or how high did I jump? So when we think about like, like that, it's almost, it's almost kind of like that outcome in, in an essence when we think about external load. But when we think about internal load, you can either think about what what's the physiological process that's going on inside the body related, potentially related to the external load, or maybe even the psychological. And again, maybe even that biomechanical response to that external load? So So usually, when we think about internal load, it's like, you know, how what, you know, what is your heart rate doing related to how far you run? Or what is the extra? Or what's the amount of stress that's being placed on the knee after you land from a jump? Yeah, so so both are important, especially when it comes to knee injuries, and loading injuries. So let's talk about what are some of the common loading injuries on the knee?
07:54 Yeah, so if you think about some of those different types of loads, you can kind of really subdividing at least at Deneen to kind of three major categories. In essence, whether it's a compressive load, a shear load, or a, you know, a tensile load that occurs, there's some other loads that can occur, such as some hydrostatic pressure loads, but the primary ones are really related to that. And so then if you break that down into specific structures, such as a ligament, you know, like the ACL, which is one of the more common injuries that occurred the knee, you know, that's usually related to some kind of tensile load that's occurring on that ligament, it can occur either from, you know, cyclical loading, where you can continue to put stress on that ligament until that ligament ultimately fails. But usually, it's one usually large load that occurs that relates in, you know, a traumatic tear. That's probably an example of kind of one of the more common ones. But, you know, we, you know, we commonly see other tissues damaged, you know, the meniscus is another common injury. And that's usually again, that's really related more to some compressive with shear load. And then, you know, cartilage also kind of was kind of relies on
09:24 a shear load to be damaged. So
09:28 all those different loads occur on the knee, it just sometimes it depends on again, all those other variables that we've talked about, you know, the nature of it, or the compressive versus the shear versus the tensile load, but then again, how quickly does it occur? Maybe at what angle your knee is bent that can impact all those types of things? Yeah, I would think angles, speed, fatigue levels, hydration levels, you know,
10:00 All of that I can only imagine goes into
10:04 a type of injury from one of these loads, right? And you say, you know, and if think about, you know, again, you have that that external load, but then, you know, think about some of the other internal loads, you know, the muscles around the joint contracting, to maybe unload the knee at a specific time, because, you know, we have, you know, you've seen many athletes like they cut and pivot 1000s of times in a career, why is it that one certain time, they do the exact same maneuver, they've done 1000 times before, their ligament tears or their meniscus tears. So there's, there's so many other underlying factors that lead to it.
10:50 And so part of this papers, at least trying to describe some of those things, so people have an understanding of what is the underlying loads that can can lead to an injury. But then,
11:03 what can we do after that? How can we use those exact same parameters of same loading parameters to rehabilitate them? Because the same, a lot of the same stresses that caused the injury
11:17 also are some of the same stresses that you can use to rehabilitate the injury? Right, and I would think have to use to rehabilitate the injury. Right? Right. Yeah. So so they, so they can adapt to that stress and be ready to handle the stress the next time it occurs. Exactly, exactly. And now what one of the figures we were talking before we went on the air within this paper is figure four. So for everyone who is listening to this, we'll leave a link to the paper in the show notes. But when you go through, you'll see there's one figure it's figure four, it's a conceptual model of loading of the knee. And it's like a monster of a figure like it is. It's large, it looks very intimidating, and very complicated. So can you break it down for us? Yeah. So this is how, you know, we started to think about taking a lot of these other models that have been out there that have described, you know, maybe the physical stress model, or many people have commented on the,
12:24 on the die model, related to the envelope of function, and also the dynamic recursive model related to injury, probably the, is the best one, best way to describe it. But you got to take into all those factors that can influence or just leave somebody susceptible to an injury,
12:52 as well as including this their underlying physiology. And again, that could just be related to those non modifiable factors such as your age and your sex.
13:04 And then again, your underlying physiology, you know, your genetic makeup, maybe even just some kind of a little bit of your underlying fitness level. And then what are some things that can predispose that tissue to injury? And again, it could be, you know, do you have a strong tissue or a weaker tissue? Does the, you know, do you have certain types of muscle fibers, you know, that can influence again, things like fatigue? And then what are the external factors that lead into it? So, some of these models have already been kind of described in the ACL related literature, you know, you know, shoot a surface interactions, whether that occurs out there is, is it turf versus grass. So, those types of things can all potentially influence an injury and then,
14:00 you know, moving into the next part, then you just think about the mechanical load. So, again, all those factors related to magnitude and duration and frequency. And then we wanted to kind of
14:15 try to articulate that, again, if you took, you know, just conceptually took it is looking at each of the different major structures in the knee that could be impacted, and then talked about how those tissues respond to some kind of stress and strain. So, you know, if you put it,
14:39 again that load under a specific type of compressive versus shear strain, how does it respond to that, and William Thompson did a really nice review in ptJ a couple of years ago, looking at some of the Meccano therapy and McKinna biology that occurs at specific
15:00 tissues that Karim Khan had kind of initially proposed back, God 10 years ago or so. And then if you take all those things account, and the stresses and strains, so then you start to look at how that impacts how the tissue adapts to those stresses and strains. And, you know, using kind of the fitness model, or the fitness fatigue model is, is if you apply the right stresses at the right time. And you do that consistently over time, it basically builds up into tissues adapt to it, and it gets stronger, and fitter. But if you don't do it, or you do it at a delayed time, it may stay at a homeostatic level, or than if you do it too infrequently, or the loads are too much, too frequent, then you can actually fatigue the tissues. And, of course, if you get too much fatigue, and you get the right amount of load placed on it, then that can result in injury. And then you kind of go through, go through again, and go through it again. And again, that's part of the rehab process is taking all those things into account. And so
16:22 that's how we tried to really try to conceptualize it and think about, you know, and so we really kind of focused more on the the tissue levels and the response to injury, and how you can use that kind of this conceptual model of kind of stress and strain along those other factors, too. I think it's important to note that we're not only talking about ligaments or meniscus when we're talking about the tissues around the knee, ligaments, meniscus tendon, articular, cartilage bone. It's not just, we're not just talking about ACL 10. Lien, you know what I mean? There's, it's really the all the structures that that make up that knee joint, correct? Correct. Yeah. And, I mean, I think that's even a really important point to like, when we're rehabbing. You know, somebody and you know, you take somebody with a meniscus tear, not only are you impacting the meniscus that you're working on, you're also impacting a lot of the other structures around it. And so you can influence the all that rehab, or that rehab impacts all those tissues, depending on how you're providing the specific load. Right? Absolutely. And, you know, one of the the words that's in that figure is tissue capacity. And so during the rehab process, certainly after injury, but even, let's say, without injury, right, I think one of the goals is to always improve tissue capacity. So can you kind of talk about what exactly that means? What that What does tissue capacity mean and as physical therapists, what where do we stand in the improvement of that capacity. And on that note, we'll take a quick break to hear from our sponsor and be right back.
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18:55 Kind of an in a general layman's term, you think about just tissue capacities, it's all related to the under I think sometimes so the underlying tasks that's being performed, right, you can have a certain level of tissue capacity that allows you to, to walk or run the tissue can meet the demands of that load placed on placed on the body by that specific task. Right. But if the task is too high, or the load is too high, relative to what the tissue can handle the tissue than this doesn't have the capacity to handle that load. And again, it may be able to handle that load one or two times. But over a repeated bout, it may fail much quicker. And so I think sometimes tissue capacity is it's also related to the task that's being performed. may know most of us have enough tissue capacity to to walk community levels and things like that. But you know, we might
20:00 not have the tissue capacity to run a 10k, even though that we may have the underlying structure that we could build up to that, I think those are the things you have to take into account. And from a rehab perspective, you know, you always have to think about kind of that starting point of what people can handle, and then how, how you can adjust the rehab process to improve that capacity over time. So that that leads into what are some ways we can monitor load and respond to that load? So we're the therapist, we're taking care of our patients, how can we monitor and and, and change that load as necessary? Yeah, so.
20:46 So from, you know, a clinician standpoint, you know, most of us probably in the clinic, you know, we don't have high tech equipment, like global GPS units are inertial measurement units to measure
21:01 acceleration, and
21:04 you know, how far people have gone
21:08 a certain amount of distances they walked or jogged or done the whole thing, like you have seen with some of the devices like catapult or, or
21:18 I measure use IMU units. But I think from a clinician standpoint, we still have a lot of great tools that I think are that we still under utilize, to some degree. So,
21:32 you know, I, I always like to tell my students
21:38 that you really are kind of training to look at how the joint is reacting to the, to the loads that you're placing on it? And are you making the tissues more irritable or less, irritable, measuring irritability is probably the best way to describe it. And the knee, you know, you can see things like, you know, increase swelling, you know,
22:02 which is a common, probably a common measurement to see for, for increased irritability, but it can also be, you know, is the joint getting sore versus the muscle getting sore, right? And so trying to be very clear,
22:20 with
22:21 the person you're working with is, you know, does it hurt inside the knee, or is it just hurt in the muscles around the knee, because we'd expect to see some muscle soreness if you're working those, right, but you don't want the, you know, the irritation to be in the knee. Um, so those are probably the two major major, major ones that I like to use. But
22:44 you can also look is, you know, do Did they have a sudden decrease in a range of motion, you know, which can be an impact, or, you know, a factor of them, having some irritability, has their strength gone down, which is probably a little bit harder to assess more consistently, but those are probably the major things I would consider looking at is, if you're starting to see some of those means the tissues become a little bit more irritated. But if you don't see those, then you know, the next, you know, maybe the next session, the next couple sessions, you can start to slowly increase the load a little bit, and see how they respond. And I think that's always the challenging part. Like, I like to challenge my students with is, but that's one of the great things about being a therapist, who is we get to see them again, and see how they respond to our treatments. And we can regress or progress them as needed. Yeah, and and I think that's a really great thing that you said at the end, we can regress or progress as needed. So if someone if you give someone some exercise or some loading, and they come back with like an angry knee, it doesn't mean stop everything and go back to passive range of motion. It means okay, let's just take it down a notch. But continue. Yeah. Yeah. And I think when the the last one I meant should have mentioned is, you know, just even just ask them how they feel. Mm hmm. You know, how are you how do you how does it feel today can give a lot of information then you can use things like you know, a session RPE schedule, you know, scale, say, Okay, your knees a little bit angry. Let's back, let's back your exercise session down two or three today, instead of working at a seven. Mm hmm. So you can still do something still keep the knee moving. Still keep it kind of moving forward, but you've kind of backed off in gave it a little bit time to, to calm down. Yeah. So it's, it's sort of this combination of what you're seeing objectively and then asking them how novel What a novel idea you're doing or you're having
25:00 Having trouble? Yeah. The other day you were doing stairs really well. And now you're having trouble doing stairs, you know, some of these functional day to day things? Yeah, exactly. I mean, I think, like you said, those are just really simple tools, I think we, we get so focused on, you know, what we like to call the objective data, instead of just asking people, how do you feel today? Yeah.
25:23 Absolutely. And now, how can we and I say myself, we, I'm a clinician, how can how can we clinicians use the information in this paper to start applying load to a REIT to the rehabilitation of an injured knee? Or post surgical knee? Or what however you want to categorize? Yeah, yeah. I think, you know, as we were talking before, there's a, there's a, there's a lot of data in this in this paper, too, that the clinicians can think canoes, and so I don't want them to get overwhelmed with all the numbers in the data, but it's really there to be is it as a resource for clinicians to say, Okay, I have somebody who has a pretty irritable knee, and these are the activities that we're doing before, you know, and we can get a sense of, okay, that that activity, you know, was, you know, three times body weight, I need to find an activity, that's maybe two times body weight.
26:27 So we can regress them a little bit. And this is an activity that kind of fits that or this was an activity that put this amount of stress on the ligament, we know that that stress is still within us safe range to, to push it a little bit to the next level.
26:47 Because, you know, I think some of the, some of the fear is, is that if we're putting stress on the ligament that we're going to injure it, or even on any tissue, right. But we, as we know that, especially after the initial inflammatory phase, you need to start putting a little bit of stress on the healing tissues, because that's how tissue gets stronger is that it has to respond to stress. But if you're putting, you know, if you're putting state and I'll put an air quotes, safe, safe stresses, or stresses that are below kind of the the below the failure rate, and you're monitoring the knee for those inappropriate responses, then you can use that information to slowly progress them through a rehab safely and adequately the healing structure to then kind of into the next level of repair. The one of the tables, we talked about this, again, before we came on, was table seven, within this paper, where you have some activities where it's like this is like you said, maybe it's 1.4 times body weight, or this is 20 times body weight, or this is eight times body weight. And I think that's a really nice guide for clinicians. But I think it's also a really great educational tool for the patient. So you can show this too, because most patients get it. I think a lot of times we underestimate our patient's ability to understand. Yeah, a lot of these concepts, you know, and and so I think if we can say the patient, hey, listen, this is X amount, your body weight, this activity is less than that. And let's say you're a month out of like some sort of surgical procedure, hey, let's go with the one that's less times body weight than this. And because people say, well, what's the big deal? It seems like it would be fine. But I love that because I think it's a great way for clinicians to use the paper also is a great educational opportunity. Yeah, no, no, I think that's a that's a really valid point, is it? I think if we can educate the patients on, you know, these are the activities that you should be doing right now. And as you strong, get stronger and get better than you can move into these activities the next time, right. And so they're always asking, patients are always asking, like, what can I do now? What can I do now? And so, you know, this table can give them some insight of, okay, this is where you're at. These are the things that you start doing now. And these are the things that probably wait a little bit longer. I think that the patient will really understand the why behind, you're giving them the exercises that you're giving them. Yep. And that's really important, because if people understand the why then maybe they're more likely to do it. Yeah. And follow through. Yep. So I mean, I think it's great. I think this paper is great. Is there anything
30:00 thing that we didn't touch upon in the paper, the process of doing this paper that you would like to share before we start to wrap things up, no, you know, I'd really like to, you know, first of all, thank my co authors who were willing to, to sit down and write this, it was, it was no small feat, you know, pulling together, clinicians from around the world to, to do this. And so, you know, definitely want to, you know, think tour MacLeod, Brian higher shyt, J uebert. Tim Gavitt and Brian eckenrode, for, for agreeing to do this, you know, this, like I said, this was a paper that had been mulling around in my head, probably since I was in PT school, you know, for a long time. And, you know, this just felt like the opportune time to pull it together. And fortunately, you know, in the last several years, last 20 years or so, we have, we have the data now to support a lot of the things that we do is physical therapist that I think intuitively, we've always done. But I think now that we can, we can demonstrate a lot of what we do, and some of the value that we bring to, to rehabilitation into to patients and to clients. Yeah, and and I mean, I like this paper from a rehab standpoint, but I think it's also really great from a strength and conditioning standpoint, right? Because as physical therapists, we don't have to just be the people there when the athlete or the person is injured, we can also be the person that helps to keep them strong and kind of improve, especially in I know, in a lot of professional settings. You've got strength and conditioning coaches, and athletic trainers and pts. But for the average physical therapist, like if you're in a small town, maybe you're it. Yeah, you're doing it all. Yeah. So I think this paper is really helpful not only to progress, people after injury, but to kind of look and say, Hey, this is the load that we can place on you that will hopefully help to decrease your chances of getting injured. Yeah. So I appreciate that in this paper. And now, where can people find you? And like I said, we will have a link to the paper in the show notes. But where can people find you if they have questions of you specifically? Yeah, I'm fairly active on Twitter. And so that's primary, my primary social media outlet so you can find me It's Dave, log PT. You know, if there's any questions or anything like that, that's probably the best, best way to reach me is either directly through DMS, or, or through my Twitter feed. Perfect. And now before we wrap things up, I have one more question. And it's a question I asked everyone is knowing where you are, in your life and in your career? What advice would you give to yourself? Let's say as a new grad, right out of PT school, I would probably, I would say, at that early stage advice, actually was given to me before is don't always don't say no. Always say yes to opportunities, especially in that, that early career, that if an opportunity comes along, take it, it may or may not be the perfect opportunity. It may not be what you dreamed of, but it more likely or not, will
33:32 be the a value to you. And many times it's a huge stepping stone. I would say you know, an opportunity comes along, say yes. Especially when you're young. Yes, yes. Young and full of energy. I think that's great advice. So listen, David, thank you so much for coming on the podcast breaking down this paper. It's a great paper. So congratulations on that. So thank you for coming on. You. Thank You, anytime and everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Dr. David lager stat for coming on the program and talking all about load parameters around the knee joint and of course, a big thank you to Net Health. So again, their digital digital marketing solutions can help your clinic win by allowing you to get found get chosen and get those five star reviews on Google. They have a new offer if you sign up and complete a marketing on it to learn how digital marketing solutions can up your clinic when they'll buy lunch for your office. Head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today.
34:41 Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media | |||
| 565: Dr. Jessica Schwartz: Concussion Myths and Concussion Corner Academy | 09 Nov 2021 | 00:34:23 | |
In this episode, Founder of the Concussion Corner Academy®, Jessica Schwartz, talks about the nature of concussion treatment. Today, Jessica talks about her concussion experience and how it has shaped her work leading up to the Concussion Corner Academy®, the reality of long-term concussion symptoms, and some of the top concussion myths. Is it ever too late to have your concussion symptoms treated? Hear about treatment barriers, some of the surprising statistics in concussion and TBI research, and the importance of education, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
"2015 was the first academic year in which there was a formal training for both TBI and concussion if you were a neurology resident." "2017 was the first year on the International Consensus Statement that we identified concussion as a rehabilitative injury."
More about Jessica Schwartz Jessica Schwartz PT, DPT, CSCS is an award-winning Physical Therapist, a national spokeswoman for the American Physical Therapy Association, host of the Concussion Corner Podcast, founder of the Concussion Corner Academy®, and a post-concussion syndrome survivor, advocate, and concussion educator. After spending a full year in rehabilitation, experiencing the profound dichotomy of being both doctor and patient, Dr. Schwartz identified the gaps in concussion treatment and management in the global healthcare community. Her role has been to identify the cognitive blind spots and facilitate collective competence for healthcare providers, physicians to athletic trainers, focusing on comprehensive targeted physical examinations, rehabilitative teams, and concussion care management.
Suggested Keywords Healthy, Wealthy, Smart, Concussion, Research, Statistics, Physiotherapy, Neurology, Concussion Corner, Myths, Healthcare, Rehabilitation, Injury, Loss,
To learn more, follow Jessica at: Website to Join the Program: The Concussion Corner Academy® Facebook: Concussion Corner Twitter: @ConcussionCornr Instagram: @ConcussionCorner LinkedIn: Jessica Schwartz YouTube: Concussion Corner LinkTree: https://linktr.ee/ConcussionCorner
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Read the full transcript here: 00:02 Hey Jess, welcome to the podcast. Finally, I'm so excited to have you on.
00:07 Thank you so much for having me. I can't believe we haven't done this yet.
00:10 I know it's like absolutely insane. And just so people know Jessica and I both live in New York City, and we actually see each other quite a bit. And this is the first time I've had you on the podcast. But I'm really excited to have you on today because we're going to be talking about concussion, persistent post concussion symptoms, and you'll talk a little bit more about that name changed in the bulk of the interview. But before we get into some common myths around concussions, I would love for you to let the listeners know a little bit more about why you decided to really specialize in this niche within medicine and rehabilitation.
00:52 Awesome. Well, I thank you for the softball pitch care know. For those that don't know, Karen used to play softball on Central Park quite a bit. But yeah, no, I mean, I thank you so much for having me on. First. I've been listening to healthy, wealthy smart forever. So just thank you again. And yeah, I mean, gosh, I think back to I was a we were one of the first six residents actually, we were the first six residents in orthopedics at NYU in 2010. When I finished up grad school and all that jazz, and we I had it, I got the dream job, right, got the dream job. I had to leave New York City for it, which sounds crazy. But I think a lot of folks can connect to that, you know, working in, you know, the old adage, Jay, we used to call mills and things like that are seeing three or four patients plus per hour. And I was like, this isn't why I went into physical therapy. This is not why I wanted to do this. And I found this great clinic out in New Jersey during residency and we saw one to two patients per hour. And we had a support staff and they were emotionally intelligent. They were physical therapy owned, and they let us grow. And keep that like use of excitement, right? I don't know about you. But I'm hopped up on caffeine and too little sleep as we launched a new business this week. But it was great. And it really it fed my soul. It was wonderful colleagues and we ended up I ended up starting kind of in the opposite end of things, a civilian prosthetics program. So I was, you know, volunteering and showing up at the Manhattan VA, which has a wonderful prosthetics program. And then we also launched a breast cancer program and be launched a concussion program. So that was kind of like my first entree into concussion about 1011 years ago. And we were the only really only office in New Jersey with that type of rehabilitative practice at approaching concussion. And so very Dunning Kruger ask, it was like, you know, you don't know what you don't know until you kind of are made self aware of it. I got hit by a car. So I was hit by a car in October 3 of 2013. And right before then, oh, actually, it wasn't even right before then care. I'm sorry about that. But it was two years before it was our last day of residency. We saw that there was a conference at NYU at the hospital. And it was on concussion and it was NY us first concussion conference. Now this was 2011. So my best friend from Italy Beatrice, you know, hi, BIA. She's in Lucca. She's a great physio, if you're out in Italy listening in. And we were like, What do you want to go and it was our first weekend off for residency. I mean, we were exhausted, excited. And we're like, let's do it. So we went to this conference, I fell in love with it. And so we were at least aware of what this program was at NYU. Fast forward two years from there. And I was actually hit by a car here in Manhattan. So that's really where it's my life's work and passion is to become because I actually live with persistent symptoms. So and went through quite a recovery. So that's kind of how it all kind of came together and coalesced.
03:49 And when you suffered a concussion, and this was in 2013 It did you did you have kind of the self awareness at that time to think, well, you know, I've been learning a lot about concussions, I think I can I can kind of help myself here and did that then really propel you to learn more and to dive in even more.
04:19 So when I was hit, I was hit by an unlicensed driver from behind and my airbags did not go off. I was in my Toyota Prius you may have even been in that car at some point. And I didn't think anything of it but I knew I when I said the story is I I got out of the car. I want to get out of the car. I got hit so hard. I was stoplight at a red light wasn't looking behind me because we were stopped. And it was the traditional traffic right care like we're just inching forward. And I was probably on that block of 12 Street between Fifth and Sixth Avenue for about two or three light cycles because of traffic. So I just got Walt from behind and so the New Yorker in May right so born and raised New Yorker You know, unbuckle the seatbelt and get out of the car to give this guy the business. And I was just so dizzy care. And I held onto the top of the hood of my roof of the car and I was like, I gotta sit down. Fast forward. I thought this was quote unquote, just going to be a concussion. And at that time, we really thought concussions were pretty much resolved spontaneously within seven to 10 days based off of the literature from 2002. From Brolio and McCrea at all from the NCAA study. But we don't have that's false. And we have so much updated information we can chat about if you'd like. So I thought it was just going to be seven to 10 days. I went back to work for for a week, I thought, you know, I would just be sore, kind of like a whiplash or like a Dom's. And now, I just kept D compensating and then from there went from 10 to 14 hours of rehab a week for 14 months.
05:53 And how did you continue to work and continue to function during all this time?
05:58 I did not. So I went off of I went out of work, mind you, I was just promoted to junior partner the week I got hit. So I remember I was like directing a prosthetics program, we had all these other programs, I just became junior partner, which would have been a profit share with a company and I loved my job, I would still send people back to that clinic, those four clinics in New Jersey in northern New Jersey. So essentially what happened was, it was a conversation that went on for months. So I was on short term disability for six months. And I say this to all physical therapists, physicians, OTs, PTs, whoever's listening to this, when you're young, make sure you have extended disability on yourself, because our bodies are so fragile at the end of the day. And again, I was an athlete, I was a cyclist I was training for, for a century bike ride and life changes in the blink of an eye. And I was underinsured with a $50,000 policy policies for car insurance to go up to 300,000 to 3 million for certain policies. And it would have been an extra $12 a month. But again, you're a new grad, you're just out of residency, just out of DPT school and you know, you're thinking about student loans and just being out of school. And so you don't really plan that far. So that's a whole other conversation we can have on another podcast. So I was on short term disability and we all know the legality of and we all have our own cognitive biases about this, right? So when people are involved in litigation, we know that their care tends to go a little bit longer. So I just I knew that. And I didn't want to, I almost didn't want to set myself up for failure, right? I just wanted to be a good soldier, show up for therapies, neuro psychology, vision therapy, talk therapy, vestibular therapy, regular musculoskeletal for the whiplash therapy, and just be a good soldier and show up as a good patient, just thinking that I would get better and slightly different than a musculoskeletal injury. The difference is with with brain injury is that there are cognitive and behavioral impairments that differentiate those from brain injury from musculoskeletal injury and rehab. On top of that, add the environmental aspect, and that's a whole other aspect of the injury. So there's no finite, you know, six to eight weeks of tissue healing or things like that, when it comes to brain brain injury, that it's a very gray area. So I was on disability for six months. And then that ended and that was petrifying. So two weeks before disability ended. I wanted to burn it down. That's when I got angry. And I think that's when I really went through that whole grief cycle, because I just kept showing up to therapy thinking I was going to get better, and then I did not. So went back after 14 months, I had the no fault car insurance, which helped pay some bills back home with mom at the time. And that was it. So after that, when I went back to work, I actually realized I had a vision handicap with overhead LED lights. So I still live with persistent symptoms, I still live with neuro fatigue, I still have an ocular motor disorder. But we learn how to manage and cope and I have wonderful support systems and definitely a grit that a lot of people don't have as well, I think I'm missing a chromosome there somewhere.
09:03 And you know, and this was eight years ago. So I think it's important for the people listening to understand that, you know, when one is diagnosed with a concussion, it's not just like you said over and seven to 10 days or maybe a week or a month or even a year, and that there are symptoms that can persist. And I think that's a great segue into what are some common myths around concussions. So I asked Jessica give me like maybe your top three common myths that surround concussion and and post concussion. So Jessica, I'll throw it over to you. So what would be Myth number one that is circulating out in whether it be layman's world or even the medical world? Well,
09:53 um, I was actually I'm going to give you something that we didn't speak about. I'll kind of combine one of them with three but One of them, actually two that we didn't speak, I'll surprise you as well. But there's actually no evidence based definition agreed upon international definition of concussion or traumatic brain injury. And that kind of will segue a little bit into two is that there's actually been zero phase three clinical trials on TBI concussion in over 30 years. So, when we're talking about research, I mean, talk about ground floor ground level, I mean, we were in the basement 10 years ago, just not having any idea what we were looking at. So I even I try to tell people like when we're talking about this, and looking at the literature, the medical legal literature got ahold of this injury 50 plus years ago, and it's been in the trapped with closed head injury and medical legal literature, but really not until 22,004. And on how we've been talking about this as a rehabilitative injury, and things like that. So, you know, historically, when we don't know what to do with someone in medicine, we tend to send them down to trajectories, we send them, we allude that they're milling, lingering, or looking for a secondary gain, or we tell them that's all in their head, and it can't be real, right. So that's what's kind of happening with these patients that we know up to 30% of folks now have persistent symptoms of concussion, they don't just spontaneously. You know, in even two weeks, we even actually, because we didn't really know what we're looking for right care. So we didn't have an agreed upon definition. So how can you know what you're looking at unless you know where you're looking for. So that's so very important to connect to is that a lot of the mismanagement of concussion was so much more prevalent in a well cared for patient.
11:38 That's wild. And so before 2004, basically, if you had persistent persistent symptoms after a concussion, it was like, good luck.
11:50 Yeah, you were allude that you're faking it. You were looking at this, that it was a psychological injury. Yeah. You know, and
11:57 that, that in and of itself is crazy making?
12:00 Yes, well, that's the whole thing and the chicken or the egg, right. And you can't deny psychological conversations when it comes to the brains like Hello. However, you know, it's really the chicken or the egg, you have these somatic things that we have the ability today in 2021, in a well versed clinician to validate the patient's symptom profile by doing targeted, comprehensive physical examinations as it pertains to concussion. So we actually the best thing that we can do for a patient like this, and I'm sure you've had all the chronic pain people on your podcast and things like that is validate their symptom profile. Listen, you're not crazy for seeing words coming up off the page. No, you didn't drop some LSD or an illegal drug. You have an ocelot Xia? You know, but the difference between the moderate and severe TBI is is that these folks have the self awareness to know that something's not right. But they do not have this objective language to express the what or how they feel with brain injury. So what do we do all day care? And how are you feeling? What's your pain level? What's your number? How are you feeling? But brain injury folks do not have the subjective language to express that so when they go to the mall and our fear avoidant of that, or they go to the supermarket, and they are don't like to be in a complex visual sensory environment, because the colors may blur, and things like that, that is then looked at as a fear avoidant behavior. And that's been sent to psychological counseling for decades. So how can we as physios how do we get these guys first and gals? So not to Detroit too much to keep you on track. But those are two. The first two is that there have been there are over 43 working definitions of concussion. One of them is evidence based. And to that there are zero phase three clinical trials in over 30 years for TBI concussion.
13:42 Wow. Wow. Wow, those are two biggies. Two big myth.
13:46 I would think so then I'll combine the last three because there are points. So the third one is, you know, I really, I'm really into education care. And I really believe that if we can teach one we can serve many, okay. And that's just what I've been privy to. And this implicit trust in the last, like eight to 10 years with this injury, that I've been invited to all different conferences for emergency physician athletic training, PT, you name it, because we all need to be on the same page here. So folks really need to I always say that we need to have a really humble approach when we come here because and I say this with kindness and I but I say this very firmly, is that with concussion, we have infinite ports of access to entry to care. Okay, you can go to the urgent care the emergency department, you could even be at your OB GYN appointment and you might have had this fall and a ski injury over the weekend and in your annual or biannual you know OBGYN appointment if you're a woman. And you know, you could have had you could have pre presented with signs and symptoms of concussion and not be aware of it. So I see that because there's infinite ports of entry on like cancer or unlike cardiology, you have a heart attack, where do you go care and you go to the emergency room, right? And then you see the cardiologist just right or you get diagnosed with cancer or your PCP or you start losing weight, you have some red flag showing up. Where do you go? Yeah, young colleges right to the oncologist, right. So that's a, that's a defined pathway. With concussion, we don't have a defined pathway. And that's not necessarily a bad thing. However, it's where a lot of this mismanagement has come up over the last few years and decades, and that's where patients start to suffer. And that's where it healthcare, we've actually imparted something that's called AI atherogenic suffering, which is where actually the health care system where your doctor is actually part of a way of suffering on a patient. So I bring that to our attention with these three quick facts. I'll say them quickly, and then we can chat about them. Go for one 2012. That's the number you got to know. 2012 was the first year the international consensus statement discuss the cervical spine in terms of examination treatment, that whole stick that connects the central nervous system to the peripheral nervous system and runs the autonomics up and down, right 2012. We just started talking about the cervical spine internationally. 2015 was the first academic year in which there was a formal training for both TBI and concussion, if you are a neurology resident. So if you were a brain physician in 2015, that was their first formal didactic year, they had training in concussion and brain injury. So just let that settle in there for a second because that's, that's just wow. Again, this is a place to build up, not tear down, but that was taking place within the behavioral neurology section of the American Academy of Neurology. And the third one was that 2017 was the first year on the international consensus statement that we actually identified the concussion as a rehabilitative injury. 2017. So, like, what? So if you think about it, as physical therapists, congratulations, happy 100 years care. We just had our centennial, right. So we were rehabilitation aids, literally in the trenches 100 years ago, like now, and we were treating what we were treating brain injury, what are we doing in the ICUs for treating brain injury? We're getting them up, we're getting them moving. But what do we prescribe when we don't know what to do with someone and healthcare rest? So we now know that that's not the ideal thing to do beyond the first 72 hours, but yeah, 2012, cervical spine 2015, brain physician started learning how concussion and 2017 was we call the rehabilitative so that's my third.
17:29 Wow, that's, it just seems like that cannot be possible.
17:33 Yeah. And, and it seems like that and because we know better, right? But imagine then being, you know, having deficits and having trouble thinking and processing, and what's our most valuable resource attention, but then you can't process. So it's, it's so horrible when you're a patient, and you have to negotiate the system, if you go through a no fault, or you go through a worker's comp, and there's all these other aspects, you know, of that of, of the injury. So I always say, sorry, I always say is that concussion as an injury of loss of it, I am, so you have to really pay attention to where your patients are in space and time when you when you meet them.
18:10 And it all seems to me like just not having a clear pathway. To me sounds like barriers to treatment, and barriers to to improvement. And then my question, I just one quick question. It. If you if the patient doesn't quite know who to go to, they don't know that they're they they have a concussion? Because some people like oh, you know, he got his bell rang, or whatever. And they don't even go to see a doctor, but they're having some symptoms, but they're not quite sure who to go to? Is it that the longer your symptoms go on, the less likely you are to recover?
18:50 So there's a yes or no answer to that. I don't want to say it depends. But the good news is, is that we have folks five and 10 years out who may have not sought treatment, like the patient you just alluded to, or sought treatment, then kind of plateaued, the brain wasn't ready yet. And that's totally fine. And we've got to tell patients that No, hey, maybe we need to take three to six months and just kind of let this settle. Let's reset, regroup, and then let's come back. Because the brain just may not be ready. You cannot force this. This is not about grit and resilience, in terms of being sore and pushing through. You've got to listen to the brain and I talked about it with like the knee effusion principle. You know, we have residency in orthopedic so I talk ortho all the time, although I love the neuro, neuro world these days as well. But you know, it's like the knee effusion principle, right? You do too much the knee fuses, we want to give it if it doesn't come down in two days, we did too much. Let's cut in half, right. So it's the same thing with concussion except the difference that is super frustrating to both patients and clinicians that aren't in the know is that you can have delayed symptom onset. So you can do something within the therapy office or they can do something like for example, have a vestibular migraine, where they feel good while they're walking outside and they feel okay walking But as soon as they stop their body like isn't really caught up to them yet. And then they get this distributor migraine within 20 to 60 minutes, and then they feel like garbage. But then they don't know what even to associate with. And that right there, Karen will make you feel crazy. So so it's very important to have somebody in the know, but you said something right before that question about barriers? And you're absolutely right, there are barriers, but I'll do you one better is that we're not only have barriers to accessing quality care for concussion, we also have i atherogenic, suffering, where they come and I, as a provider may not know enough about concussion to look at this from 360. So we have providers that don't know, they may be maybe in 2021, we'll be able to pull up the international consensus statement. But that's only for sport, and it's very limited. So it doesn't go through the nuance of the suffering and the delayed symptom onset and things like that. It's very white paper esque, right? So we actually then cause harm by quote unquote, just treating the neck, not looking at the vestibular system, not looking at sleep, not looking at the ocular motor system, not looking at is the the migrant or aspect of it, not, you know, all these other things and aspects that make concussion concussion. So from a symptom profile standpoint, so if you feel typically I should say,
21:15 yeah, and, and, you know, like you said earlier, you're all about education, and getting people to therapists, and whether you're a physical therapist, occupational therapist, you've been a personal trainer, physician, really understanding the ins and outs of concussion. And so I'm going to, I'm going to plug your educational entity that is that is launching, and it's concussion, corner Academy. And so now, I really like that you're coming at this from the patient and the provider standpoint. So talk a little bit more about concussion, quarter Academy, and what separates it from other educational programs. Because, you know, as you know, there's a lot out there in the world, right? So how, what, what is it about this that makes it different, and that you're really proud of as you should be?
22:08 Oh, I appreciate that care. And, golly, I mean, talk about like, your life's work, right? And I really, I just get goosebumps thinking about this. And I'm like, wow, this is this is really just a dream. And I'll be very honest with you, this is a we're in a pandemic, still, some people may not want to admit that. But we're, we're still in a pandemic. And we all kind of went through something, right, especially in New York City, we really went through it initially in the acute phase of this pandemic. And I did, I lost a good chunk of my practice, and I had to really sit with myself and I said, Gosh, just what do you want to keep doing? You know, what do you want to do with your life, I had patients no less than four years, some 11 years as patients. And I was like, I'm not doing this again, I just don't have the energy. And that was from just a like a, like, almost like a burnout aspect. I just couldn't imagine re building up my my practice again, I have no problem seeing patients, if they call me but I have no desire to market. Now. I was like, Well, my ideal life based off of my symptoms and persistent symptoms. You know, I really work every other day. So yeah, I can push through every five days and do a regular work week if needed, but I don't feel well. And then I'm not pleasant. And it's just, you know, I just know my limits. So with the neuro fatigue and the stuff that I live with, I said, Well, what's, uh, what's, what's something I can do? Well, if I could work remotely, that was kind of it. And I said, How can I help the concussion community? So we decided, and my partner is a graphic designer and in to animation and editing and all of this stuff. We said, how can we make this beautiful, and deliver it? Because the user experience was so important to us? And then how can we deliver it internationally to where it's accessible? So we're, we formed the academy, and essentially, the goal has always been to promote healing, decrease suffering, increase support, and deliver it with kindness to this mismanage patient population, but we need to have access. So I have a tremendous faculty. We're launching we are we have a nonprofit partnership. We have the faculty are actually the people on the international consensus statement. They're the people treating the the boots on the ground, their clinician scientists, and they get it, they get concussions, and they're vested in concussion. So it's going to be a 12 week online course for our first cohort. It's fixed. It's from January 16 to April 10. It's going to be two hours per week one posted for you and one live on Sunday mornings at 10am. Eastern which will allow for our European friends and our California friends as well on the West Coast. And it's going to be 24 hours of CEU activity for for for physical therapists and athletic trainers. As long as we have 10, ot speech pathologists, neuropsychologist, psychologists, social workers, we can see you them as well, but it's the first round so it's kind of a lot of investment here. So I'm just going with PT and 80 to start unless we have 10 of the others. And we're going to have a nonprofit partnership, but the the beauty of it all is already I'm actually going to have, we're going to be doing research on our students. So we're actually going to be looking to change outcomes based off of evidence based practice and education. So we're going to be able to study our students, and then link up with our nonprofits as well to support them because it's really an underfunded sector of research where cancer gets billions and trillions and and TBI and concussion tend to get hundreds of millions. So we're really going to try and support the folks you know, who are boots on the ground.
25:29 I love it. It sounds so great. Where can people find more information about it?
25:34 Sure. It's going to be it? Well, it's already at it's at concussion corner.org.org. If you follow the podcast, we tried to give things away just like you do with healthy, wealthy smart. So we've had the concussion corner podcast is 2018. I hosted the Super Bowl concussion are moderated, I should say, the Super Bowl concussion conference in Minneapolis and we launched it then it's been around in over 50 countries, it's been so well received, we have a lovely community. So we're going into education, and how can we have a supportive community with open office hours and open office hours and things like that, that will what will provide our students with, with eventually a rehabilitation video database, where that's going to be searchable for folks as well. So they can search, you know, cervical spine examination intervention, what's the referral process look like. So it'll be a robust program, but we're going to be beta in January with I just want to point out, we're going to have a referral program. And, again, I'm a person and have one right, so we're not going to have an early bird special, like we're used to at conferences. But the whole thing is to spread this word of mouth. So instead of taking $100 off, we're going to give a $75 referral. If you have seven to eight people that you refer your whole tuition is paid for Plus, you get your 24 hours of CEU. So we want to really just want this to be word of mouth, from from like grassroots, let's build it by conversation and internal marketing and get people in who are invested in wanting to learn about this injury.
27:02 Awesome, awesome. And of course, we'll have a link to it in the show notes here at podcast at healthy, wealthy, smart calm for anyone who wants to learn more about the program and about the modules and how it's set up. Or you want to just get some more information. Or if you're ready, you heard this and you're like, I see people with concussion all the time. I'm not 100% comfortable, I need to learn more, or this is something I want to learn more about, I think now you have the perfect opportunity to learn. So we'll have a link there in the podcast notes for anyone who is ready to pull the trigger and join Jessica in January. So now just is there anything that you really want the listeners to take away from this conversation around concussion and rehab of concussion?
27:58 Yeah, so I'm sure there's, there's so many things off the top of my head, really connecting to that concussion is a rehabilitative injury. And if we can connect to that the injury of concussion is an injury of loss. It's a loss of your I Am your I am funny, I am husband, I am wife, I am Doctor, I am surgeon, you're I am. So if we are sensitive to that and connect to that concussion is an event, it's not an event there, it has to be a mechanism of injury, don't get me wrong, but it's not an event, it's an actual process. And we have this neuro metabolic cascade. And then we tend to have this loss of function in our in our environment. So that is really what I want folks to connect to. Because we have to make sure we're meeting our patients where they are and their moments of recovery. So that's really the big thing to connect to is that folks tend to really connect to the event of the concussion, you know, the post traumatic amnesia, the domestic event, the loss of consciousness, and less than 10% of those folks, but they're not connecting to where those folks are in their trajectory. And how many folks have they seen before you on average, people see six to 10 providers before they walk into my door. Okay, connect to that. Do they trust healthcare providers before they've talked to you? Did they have physical therapy in a hospital gym that wasn't really, neurologically sensitive to their needs, their smell, their sound, their lights, things like that. So connect to your patients in a different way. I can guarantee you if you're a new grad, this is going to this is going to get you excited. And if you're a little more seasoned, like Karen and myself and you're feeling a little burnt out, this is a great way to look at your patients 360 We're looking at autonomics we're looking at neurology, vestibular ocular motor. The physiological aspect of its sleep, nutrition, neuro endocrine, let's talk about sexual dysfunction and concussion. That's a whole other podcast. But it really is something that you can hear my passion about, or these patients are being mismanaged much more probably than they're being well cared for. And we can change that and there's no reason that we can't change that for next day. Not Knowledge Translation in the clinic, so I challenge your listeners to that care.
30:03 Amazing, amazing. And now I have one more question to ask. And it's one that I asked everyone. And that's knowing where you are now, in your life and in your career, what advice would you give to your younger self, let's say, you know, straight out of straight out of Ithaca physical therapy school.
30:21 Um, let's see here, straight. So I've honestly joined Twitter, I have had so many, I've had so many positive experiences, the 99 that I've had positive and the one negative, you know, and you really have to conduct yourself in a certain way, of course, but I joined Twitter, I've had so many amazing opportunities. I was invited to the Super Bowl, I was asked to be one of our spokeswoman like you for American Physical Therapy Association, I've been invited to speak at conferences and, and just network with people who I would never have access or touch points to. And I really think it was the most powerful thing I've done for my education, besides, you know, maybe a residency postdoc, really. So I really do and we wouldn't have met the same way either. So I think it's been great.
31:05 All right. Well, that I think that might be the first time I've gotten that. What advice would you give to your younger self is to join, join Twitter and join social media. So thank you for that. And like you said, you have to make it your own, and you have to approach it, approach it in the right way. So I think that's great advice. And now, again, people can go to concussion corner.org. To find out more. And of course, like I said, we'll have all the links at podcast at healthy, wealthy, smart, calm. So a big thank you, Jessica, for coming on the program busting some concussion myths. So thank you so much.
31:42 Oh, thank you so much for having me and to all your listeners. Thanks so much for your time and attention. I really appreciate it.
31:47 Of course and everyone thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart | |||
| 564: Paul Wright, Seven Critical Mistakes Which Reduce Profits, Increase Stress and Chain You to Your Health Business | 02 Nov 2021 | 00:46:22 | |
In this episode, Creator of Practiceology, Paul Wright, talks about 7 critical mistakes that healthcare professionals can make that can hurt their bottom line and their business in general. Today, Paul talks about Perfectionist Syndrome, the implications of discretion, and doing your own PnL. What is the true role of your business? Hear about the danger of falling in love with your product, packaging an outcome-driven solution, and maintaining effective recruitment and internal systems, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Paul Wright Paul Wright is a Physiotherapist and former owner of multiple allied health clinics in Australia (which he rarely visited). He is the author of the Amazon Best Seller "How to Run a One Minute Practice", founder of the Practiceology™ health business freedom program, and has helped thousands of allied health business owners across 57 countries, earn more, work less, and enjoy their lives.
Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, PT, Business, Practiceology, Supply, Demand, Mistakes, Solutions, Healthcare, Entrepreneurship,
Resources: Get a hard copy of "How to Run a One Minute Practice" ($4.95AUD. Use promo codes below) Promo Codes:
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Read the Full Transcript: 00:02 Hey Paul, welcome to the podcast. I'm happy to have you on.
00:06 Absolute pleasure to be here. What a boss.
00:09 I know it's so we're doing a little podcast swap here which I love. I love being able to swap podcasts with other hosts where you come on mine I come on yours and we get to know each other better. So it's been really great leading up to these podcasts. And today, you are going to talk about seven critical mistakes that healthcare practitioners can make. That can really hurt their bottom line and their business in general. But before we get to that, can you tell us your story of your career and how you ended up where you are so the listeners get a better idea of who you are?
00:52 Well, I'm I was born for a young Karen. Now I'm from from a small country town. I'm obviously Australian by my accent. I live in beautiful Newcastle but an hour north of Sydney. But I grew up in a small town about seven hours northwest of Sydney in the middle of the outback. They talk about Australia next so I'm in the outback. And what does what does a young kid do as in a small country town he Bhikkhu like sport, he becomes a physical education teacher. Because that was all I thought you could do as as a kid. I love sport. So I went to Newcastle University studied my physio, field education qualification, and then didn't even know what a physio was, but I met a physiotherapist at a party. And I liked anatomy I liked physiology. I thought, gee, that sounds cool. I don't think I could be a teacher for a long time I had an entrepreneurial streak I think so I didn't know I could work for someone else for my rest of my life. So I'll get into this physio course went to Sydney Uni did my physiotherapy degree and within two years after graduating I had started my first practice I then ended up with six of them in Sydney, one in Newcastle and five in Sydney. And I think my claim to fame Karen is I as I went through this journey I didn't go to them I was fortunate that I stumbled across the E myth by Michael Gerber very early in my business career and and I'm trading at my window counter in my practice and and looking out on the road that goes past in Sydney and there's a bus keeps going past one on the side of the bus why most small businesses fail and what to do with that is on the side of the bus and I'm getting there watching the sun come up in the morning watching the sun go down like most most help business owners and this bus kept going past and I'm getting better now I wasn't good there but I'm better now that the universe was telling me something followed up with this with this he ended up getting it to a Michael Gerber seminar read the book EMF and then I created then systematize the practice and as I said eventually had six didn't go to any of them and I then sold them which is a lesson for all of you guys the major role of a business is eventually to sell it and then started teaching other health business owners how I did it how I was able to run the remotely and how how you can still be a great health professional and have a successful business and still have a great quality of life which I think most of us miss out
03:19 yeah that's a great point talking about quality of life and I think that we'll probably get into that throughout this interview so without yeah without further ado, why don't you share with us these seven critical mistakes that can reduce your profits increase your stress and really not allow you to live your life outside of your business. So let's start with number one.
03:47 Well the first one having said I've done all of these by the way so you have earned the right to
03:52 I can't I kind of I kind of assumed that so I've done
03:57 I've done all of them but the smart people learn from other people's mistakes so hopefully you'll listen to what's happening now. That Mistake number one that I identified early is failing to understand carrying the true role of your business and if you think about what what does what does your business do for you and if it's robbing you of your life it's not what it's there for the role of your business is to serve you it's your certain needs to give you more life yet when you ask most health business owners why they started this I I wanted to be my own boss or I wanted to make my own decisions or the guy was working for before was an idiot. Whatever they like to say but is this really happening now and as Gerber talked about when I first read it you're now doing the hands on work of the practitioner plus you're also doing the business stuff the marketing the recruitment in any wonder we get overwhelmed so early. And and that's why Gerber talks about it's true. I was probably better off opening a plumbing business because I couldn't do it. plumbing work I was better off opening a business that I couldn't physically do then I could list run the business and that's the whole idea of this. My brother who's a plumber would be staggered because I'm hopeless with power tools and I he's banned me from using any sort of manual labor things but the idea of the businesses to serve you and one thing I suggest you look at guys, his his work out what I call your freedom score. And your freedom score is simply how many hours per week on average? Do you spend treating patients at your practice? How many hours per week do you spend physically treating patients and if you're telling me that we've done this in seminars, 50 6070 I've heard I've had one guy doing it five hours. And they're still trying to run the business, you just, you just can't do that. So and we talk about this thing between practice ology, right is law, which is, which is as your number of team members increases, your freedom score must decrease, you can't keep adding team members to your roster, because they time suck, they have to take energy out of you, and still see all the patients, there's going to be this balance. And that was how I was able to run it. But when that being said, you have the choice of how you run your business. Now my model was to replace myself, get therapists in do the work for me. So I had freedom of time and freedom of money. But some of our clients have a Mr. X. Mr. X is the guy that runs healthcare practice, but he runs it on his own terms or her own terms. Doesn't work, school holidays, start at nine finishes at two sets his own hours or her own hours charges, what they feel it. And guys I'm thinking about that don't even have sometimes receptionist though, sometimes if the surfs up, they don't turn up at the practice, they just gave surfing. But the patients know that's the deal. If you want to see this person, that's the model. But even in that case, Karen, the business is still serving that person. It's, it's it, you're the master, but not the other way around. And I don't know if you've ever made that. But that's understand what you want your business to do for you. And make sure it does it. Otherwise it'll suck the life out.
07:17 Yeah, and I think that's why when you look at your business, whether you're just starting, you've been in it for a couple of years, you've been in it for 20 years, if you've never written down what your goals are for your life, not what your business goals are, but you know, do you want to spend, do you want to be able to watch a movie a week workout five days a week, spend dinner with friends, pick up your kids from school, drop them off, you have to write those goals down while you're looking at your business. Because that's that's how you're going to have that freedom. And that's how you're going to have your own life outside of the business.
07:58 And the natural recourse for all health business owners is typically to see more patients, regardless of what happens in their business. Regardless, they need more money, they see more patients, team member leaves, I'll see more patients. So that that's that's the recourse their natural recourse is to go back to what they know. We teach our clients sometimes that's the worst thing you can do. You need to do something exactly the opposite. And one point also to this is that this is probably one of my worst moments. You've got understand to the concept of current bank and future neck when you think about your business. Now I had a current bank business meeting. I had one of my practices earlier was inside a fitness center. So I had a physiotherapy practice inside a fitness center in Sydney. And it was a good business. It was a cash cow. But what I didn't realize at the time was it was fragile. So it was it was making me lots of money at the time. How I knew was fragile. I got a phone call from one of my clients would have been a Thursday night. He said, Paul, I've got some news for you. The owner of the gym I've heard hasn't paid rent for three months. Okay, this is a $300,000 business like I'm running here. Oh, that's the good so I ring the owner who when you will do the gym tonight what's the deal? He said it'll be sold out Don't worry about Okay, I arrived at the practice the next day cancer that patient list hard to track proceeded to put everything inside the trap that day. So by Friday, five o'clock, I've been everything inside the event saying what are you doing wrong? What are you doing? Well, I said I'm taking everything out because I don't know what's happening here. This is all a bit unstable because I went to give the owner the gym my rent check for the month and he didn't accept it. He said hold on to that for a second. Roger, you might need it. So okay, the writing's on the wall, drove off in the truck and everyone's saying Ronnie, another another gym Chad's gonna buy this place, you'll be back open on Monday. So when I open on Monday, I'll bring the truck back and I'll check everything back in then I'll be fine. But I'll tell you, I never again set foot inside that building. It shut that day and I never will went back in there. So overnight, a business goes from 300 grand to zero. What's the lesson I had a current bank business, there was nothing. I was relying on someone else's rent someone else's tenancy. If you're leasing a space in a Medical Center in a fitness center in something else, you think you've got a business you can you can sell. There's no real future banking, that you are at the mercy of your landlords. So it's not a bad way to test the market to see if there's available market. But that's not your long term gig. Because there's a problem with it, and I've suffered badly. Anyway, yeah, yeah, start number one.
10:41 Big mistake, mistake number one. So let's talk about Mistake number two.
10:46 All right, we do this all the time. We fall in love with our product. We fall in love with the idea of being a therapist, like I fell in love with the idea of being a physio, but I didn't know was there a market for that? Was there a need for more physios, I just wanted to be one. But we do that all the time, we fall in love with our product of therapy, what we got to fall in love with is, is the market, you got to fall in love with the market once, so you might have a passion for trading on that elbow pain in one arm. Gullfoss, that might be your passion. But if there's not enough one arm golfers out there, you're not going to do any good. So the market doesn't care what you want, find what the market wants. So your job is to listen to all of your patients, listen to the doctors, listen to the community, what's missing, your job is to fill the need. And if you do that, you'll be successful in business. My favorite one, hope you guys watch Shark Tank, you guys have shark tech in the States. That's shark tank with a my favorite one is the guy that turned up with the pad for guys shirts. So now that so you put up your stick to pads on the ROM so your shirt didn't get all sweaty, there was his product. The Sharks wouldn't touch it. I said I'm not really interested. And they said how many have you sold? I've been doing it for seven years now. I've sold about 500 so in seven years, and out the back the entity in there. So what are you gonna do now he said, Our, I believe in this, I'm gonna keep going I fell in love with this product, the market had already said they didn't want to move on. So find the hungry market and satisfy that need. If you do that, you will be okay. And you see that lock county if people so they open a practice in, in a country town or regionally because they might have identified there's a market for that service. So they've done well. But the part that missing is the available labor supply. Because there's two drivers of every business available market available labor, you haven't got enough labor, you're going to be staffing that thing yourself for the rest of natural life. And that happens all the time. So be very aware, don't, don't fall in love with a product, fall in love with the market, what's the desperate need in your community? solve that and you'll be halfway there. And that's that's kind of what I did in my second my next career because I I knew help business owners struggle with business and finance and marketing and other things. And it happened to marry up with something I liked and was good at. So that was a fortunate thing. But you've got to find the hungry crowd first.
13:18 Yeah, do your research. If you don't do your research first. You're in big trouble.
13:22 I had a guy come to me once and he said, Paul, I want to open seven practices on the northern suburbs of Sydney That's what he said to me in the seminar. I said oh is there is there enough market for that automatically sell so i think so he said he just he cuz he wanted to do it. Karen he wanted to open I saw Kenya available. I was a bit tired. Can you staff those seven practices? Will you find your start? I'll just advertise. There's a guy with his head in the sand. It's not funny. But I think the key thing I want to do I want to do this. Now that's okay, if that's a passion project. But if you want to generate a revenue and a business successful and you can sell it down the track if that's what you want to do, solve solve the desperate problem. Yeah, yeah,
14:14 turn it around. It's not about you. It's about you, but it's not about you all the same time, right.
14:21 If you get married up, it's great if you can find that that thing but be careful of what you do. So make sure there's a hungry market for an audit this we found out in one of our practices, there was a real market for lymphedema treatment. So massive market lymphedema and we had a guy who knew all about it the therapist and knew all about it. So we got him doing the lymphedema program. It was great. But But don't be Dora here didn't get him to train everyone else on how to do you know what happened? The guy leaves. Three years after we're still getting phone calls from people wanting lymphedema treatment and every time they rang it killed me. So Solve the desperate problem. Yes. But then protect yourself with the viable labor supply if you're doing something like that.
15:06 Yeah, absolutely. That's a great example. Okay, what's number three. So we've got failing to understand the true role of your business falling in love with your product, your product number two, what's number three,
15:18 we'll do this falling in love or falling victim to our own perfectionist syndrome. I was probably fortunate, I had some good mentors early in my career, and they'd tell me, Roddy, it's better to be 80% and out the door than 100%. And in the drawer. And it's so true, we just worry so much about putting something out there, because it's not quite perfect yet. Reed Hoffman, I think, was the founder of LinkedIn. one of the founders, he said, if you're not embarrassed by the first version of your product, you've launched too late. If you're not embarrassed by the first version of your product, you've launched too late. Meaning put your put something out there and you see if it's got traction, is it going to get some market share? Is it going to work for me? If it does, then you can then do version two, then do version three. But so many health professionals I get so caught up in making it perfect. I just want to do this, I just want to finish this, I just want to do this. And they end up not doing it. They wait that long, and they just slowly implement. Maybe it's because we're analytical thinkers, we're sometimes slow to implement, and we just, we drag the China bit. And I like this expression to, to the blind man, the one eyed man is king. But one of my mentors said to me, Roddy, you don't have to be the best in the world. You just got to be the best in their world. Say there might be a nice specialist down the road, who's who's a superstar does all the courses and is on all the all the seminars and other things and you've got your own new program. That's great. But don't let that stop you from what you're doing. Just be the best in your clients world at it. You don't have to be as good as that guy. You just have to be the best in the client's world. And, and that also, I think, Karen, sometimes maybe it comes from our universities that that we want to be anointed or we want to be awarded, or we want to wait for someone else to recognize me. Don't Don't wait to be anointed by your profession. Don't that's too slow, anoint yourself. Someone. Someone says to me, Roddy, who's the best health business mentor in the world? Well, I want to do wait for the National Association of physical therapists to make the announcement I'm not going to wait for that I am. And I think we're going to have some balls do that. But people take you at your own appraisal aren't going away in? And if not, that's your choice. But that's it again, don't wait to be annoyed because it's just too slow to do it that way. So don't fall victim to perfectionism because it's just a curse
18:12 for us. Yeah, very, very common. Especially I think I see it more in women than men. Men will often center feel like I'm just gonna do it and see what happens and women are more like, okay, it needs to be like this, it needs to be perfect. And I think sometimes our women judged more harshly than their male counterparts for things. There aren't as many women in leadership positions so you don't have that person that looks like me in those leadership positions as a point of reference, and so I think oftentimes women tend to keep putting things off because it's got to be as almost perfect before it goes out because we don't want to get judged harshly on something. And I see that consistently. Again and again. And a lot of men will just throw shit out there and it's like, yeah, this is fine. Who cares and women are like a
19:12 you got to remember littering once I was I did electric in the fitness industry years ago and in the in the personal training space. And I remember doing anatomy lecture one day to a group of trainers and I in the audience was my anatomy tutor from uni, like a superstar like this person, you everything about everything and I'm at the front talking anatomy and and it was a pivotal moment for me because I'm so self conscious about what I'm saying in front of this, this mentor. But no one asked her any questions. They all asked me the questions. I was at the front of the room. I had the clicker. I was in charge. I was the best in their world. She was the best in mind, but I was the best. There's that's it. I'll leave all of you to make the comments about Gaza girls, I can't say that sort of stuff. So knock yourself out cam
20:05 Yeah, yeah, I'm just that's just what I've seen, you know, over and over again, is, is that women tend to be a little more hesitant at putting themselves out there. And I get it, you know, as someone who has and who does put themselves out there, the criticism is harsh people can be mean, mean spirited, especially when it comes to social media can be a little toxic and, and you are judged very harshly and people say really mean things. So you have to grow a thick skin, I think if you're going to want stepping into kind of those leadership positions
20:43 that was published one of the key things, I think my management style of the business that you had to have a thick skin to work for us. I mean, maybe I was more suited to being an owner back then that I would be now I don't think I'd be as quite as sensitive as I'd need to be now. Anyway, that's if one of my mentors said to. And I love that when I say this, if you haven't upset someone by midday every day. You haven't said anything really important. What everyone's gonna agree with you You don't you don't have different doesn't have to agree with you. You just you haven't you have the right to have your opinion in this, but I think you need to do you'd have to agree with me, that's just what it is. But if everyone's agreeing with you, are you really saying anything of any importance possum?
21:24 Right, right? Very true. Very true. You don't want to surround yourself with Yes, people all the time, that's for sure. Because then you'll never move forward because you're never kind of grow and challenge yourself. Okay, let's, let's move on to number four.
21:40 Number four, ineffective, non existent. And unsupervised internal systems. You we've seen it, we've seen it, countless times someone goes to a seminar or they or they get an idea and they launch it into their practice. And, and they seem so excited about it. But the team have seen this before they've seen you come in with an idea and they've seen you launch it and they know you'll just it'll blow over. Once you get you'll see more patients and get busy so so that sometimes they do it for a while and you can see this owner because you'll say to them, do you have for example, you have a follow up system in your practice? I think we did here we look we did do something like that. Ryan, are we still doing that follow up system so that they haven't followed up and measured it. So one of the best things give you the tip, one of the single biggest and most effective things you could do in your practice is to tighten up the report of findings conversation. That's that's after I've done your history of January, your examination, and I'm saying what we're going to do to fix you that's the chiropractic wellness report the findings in their words, it's the action plan or it's our treatment plan, get get that script, right? Get that conversation, right? Write it down, sit the person next to you and write it down Mary to get you back running in that marathon in two weeks time. You need to see me three times a week for the next two weeks. I'll reassess you then and we'll get you ready for that race. How does that sound like that? Does that conversation that that currently is not done? Well in most practices? And and because I'm an analytical guy can often How do I measure that? How can I control that conversation. So I created an action plan a written plan. And, and the penny dropped for me when there is a number at the bottom. So the numbers at the bottom was how many how many sessions, how many times a week for how many weeks. So that's three times a week for two weeks, I had a number six, so that person needs at least six sessions before the next assessment. So I then made it mandatory that every patient would walk out at the front counter with that sheet that would give it to the admin person who and would verbally hand over that patient current to get married back to her run in two weeks time she's doing a marathon she's gonna do it really well. She needs to make three appointments for the next three weeks for the next two weeks and we'll get there admin to person books in in. And then I then got a spreadsheet that we created that has consults on plan. So that would be a six, the column next to it, consults booked. So you recommended six and how many were booked. Now if I if I then log into that spreadsheet and I see that my therapist has recommended six and a booking one so 616151 to one with it's a one on that on that booking column. I've either got a therapist problem or I've got an admin problem. Has the therapist not been good enough to get the confidence in the patient or is the admin under pressure and hasn't got time to book those sessions in advance. And you will know the dangers of a session by session appointment diary. It's just it's a recipe for disaster it's but that's that's an example of a system Karen you've got to put in to your business that you can then measure and stay on top. And you'll love this. So in true Polaroid style there was only one time in All of my practices where the therapist did not have to do one of those sheets written physical shit. And I get them all in a room and say guys, what's the only time that you can get away without doing one of these things? And they'd say, the person need to go and see a specialist or I ran at a time or whatever else that said, Now none of those things. The only reason I'll accept the no completion of this form is if the patient dies during the consultation and they've got a chuckle it's a chocolate gets a check. I want to talk about it now. But there's an element of truth to it. Everyone else gets one. Now that's that's the problem with most health businesses, we don't enforce our systems, we don't put them in and we don't make them mandatory. One of the keys to business success, remove discretion at the operating level of your business. Remove discretion, remove the chance for seminar I was going to give them a plan but I didn't think they needed it or the Garda see the surgeon or like, I want to look at the that report and say, Okay, what happened with Mrs. Johnson yesterday said news about Mrs. Johnson. She didn't make it through the consultation. And the therapists were Hi, can I get it ready? And then I can say, Man, I've noticed Mrs. Jones didn't get an action plan either. What's happening here is, is something that I'm wanting to do not sinking in, is there, imbalance here? And if it happens a third time we're gonna have a serious discussion. Now that's that may be used multiple that's hardcore. But
26:37 would you tolerate a therapist turning up without a shirt on? Would you tolerate that? horrifically bad breath? Would you tolerate them being late all the time? What are you going to tolerate? removed discretion?
26:53 Yeah, yeah, she just, Yep. Yep. That's a great system. Yeah. So really making sure that you've got systems in place that work for your practice, because every practice is different. And so you have to know what works for you. What are the KPIs that work for your business?
27:12 And quints of non compliance? What if you don't do it? Unfortunately, can we notice it now with with available library a bit short? Too many owners don't enforce this systems because they worried the therapists will leave so they're trapped they're trapped because they can't enforce this system. So what if they leave Well, what are they costing if they stay you know there's a cost for them to stay you're happy to where the cost make the decision. We've got a client in practice soldier now he's got an admin person just off sorry, a therapist, but just might want follow that action plan system to the letter, but he's got a labor supply issue. We know our numbers, we know what she's worth to the practice. We just made a decision to tolerate it for the moment that we could jump on if one day but it's not worth the fight because we're gonna have trouble with that off. Better Off fighting our battles in the right order. But it's a decision. It's a strategic decision.
28:07 Yeah, yeah. makes sense to me. Okay, let's move on to number five.
28:13 Number five, using your accountant to do your p&l for you. is a mistake because most accountants on average your account but assuming even give you a p&l, like most accountants, their job is to keep you out of out of jail and to make sure you pay enough tax and that's pretty weird. But what we want to know is, is a down and dirty profit loss for your practice. We want to know take out all the dodgy expenses take out the trip you took to the conference in New York take out all that. Even the year there was a conference there, but it's a bit dodgy like what take everything out of the car, all the other things that are legally claimable, but aren't really required for the business, get a down and dirty profit loss on a calendar month basis. Revenue we build, this is what we spent a know your numbers every month, and you shouldn't be able to wait for the end of the month to come to track your numbers. And one thing you must allocate Karen, you must have an owner consulting wage in there. Which is not the amount of money your accountant told you to take. It's not the dividend. It's a reflection of your consulting effort. So how you do that freedom school, so how many hours per week you're at the practice, multiply that by what it would cost to replace you, as a therapist, assistant your replacement costs, that money is not changing hands, by the way, the accountants looking after that. But this is we've got that in our p&l as a reflection of your consulting time. Because I can tell you now from having done this a long time, the only way sometimes you can get over practice to drop their consulting is to show them a down and dirty profit loss and show them that it hasn't changed or has improved if they dropped their consulting hours. Then you got it and you don't do that with your accountants p&l because it's a different spreadsheet, you got to deal with a down and dirty p&l. But because our natural recourse, Karen is to just consult more, whereas as a result of that we're not mentoring our team. We're not recruiting, we're not marketing. We're not with the kids, all these other things we're not doing.
30:17 Right? Yeah, no, that makes perfect sense. Yeah, I yeah, yeah, it's different. I mean, my accountant does do my p&l. But I also do monthly p&l is for myself. So on a month to month basis,
30:32 it can work if you're if you're doing a percentage of grossmith. But I just the problem with most therapists, we don't know their personal contribution to consulting and the overall scheme of things and we've show owners if you if you cut your hours, 20 hours a week, we can maintain your profit. Would you be happy to do that and see it because they're their natural recourse is to see more patients that just happens all the time. Sure. Anyway, can do it? He's know the numbers, the numbers will set them free.
30:58 Yeah, absolutely. Absolutely. No, I like that. And so when you're saying putting your consulting numbers in, you're talking about not just the time that you're with patients, but time that you're working on the business as well. Or just time when you're
31:14 just you're just you're face to face consulting time, because everything else is part of your profit margin. Right? Right. But the other thing is product and it's the other stuff is discretionary. You You can do your marketing when you want you can cancel a staff track you can you can you've got freedom to that, but your patient list. That's that's the one that use you're stuck in. So that's when you would change your business. Got it? Yeah. And, and most of ours, we try and get that down to zero. We try and get your owner consulting wage to zero maintaining your profit, then they have discretion. They can go to work if they want to say they're doing they're seeing patients because they want to not because they have to. Yeah, that's a differentiation. Not enough of us, Mike.
31:55 Got it. Okay, that makes sense. All right. So let's go on to number two to go six.
32:02 ineffective recruitment systems is a is a classic problem. And I know what it is we just we take it personally if they don't, if they leave we we don't get the right people always stuff this recruitment stuffs a nightmare. And I think it comes back a lot of it. As an owner, you have to make make a big decision regarding your team. Do you want to be liked? Or do you want to be respected, to be liked, or to be respected. I believe too many health business owners worry so much about being liked by their team, they can't have those difficult conversations, they don't have the respect of the team. And you're not always going to be like just accepted as an item of business. You know, there was going to be popular, you control the way ours you control the wages, you control everything in the business. It's important to be liked all the time. And if you're trying to be liked, it's going to be very difficult for you. Everyone is replaceable, except that and if they're not you want to make them replaceable. You need to think about the systems in a bit like my lymphedema God big mistake. I, I had an epiphany one night, I often have these epiphanies there. So there I am. And my admin, I had an admin superstar one of the practices and she knew everything. And she was so good everything she just did everything. And I had an I'm in there in bed one night, when I bought up right? What happens if something happens to Gina and I remember I couldn't sleep the rest of night. So I rang Gina, June at nine o'clock in the morning, I want you to come in, I've got someone to replace you at front desk, I've got my camera, you're going to show me everything. And we sat in the back room with the camera, show me how to do this show me how to do that show me and we just that we did that for a whole day. And I had all this stuff so if something happened you can watch the Gina file that someone can do. If you aren't doing that you are you are in all sorts of trouble. So recruitment systems, people are replaceable, except they're going to move on Don't take it personally. One of my mentors, we did a recruitment training program recently and one guy said, Just accept the fact that people are gonna, your business is like a train journey. People are gonna get onto certain station, get a bit down the track and then they get off the train. That's just that's what this journey is like they're not going to stay with you till the end of the line. Don't expect them to that's just just accept they will move on. And the final one and are running in the time, final one, not packaging your services, not packaging it into into an outcome driven solution. The bite write program for TMJ, the run marathon pain free program, whatever you do, we had a corrective orthopedic rehab program with exercise so name it something because once you are the only person that has that program, you can't be compared on price. If I'm bringing around the practices and you're charging 80 bucks and someone's charging 75 you're commoditizing yourself but If you're the only person with the x y Zed migraine program, because no one else has got that you can't put a price on that. So So you got to make sure you don't you have to package your services as a solution driven outcome, not just as a session by session deal. If you do that you're reducing the church have been caught up as a commodity. Now we've got time for one bonus mistake, I think. Yeah, all right. This is one bonus mistake. And too many owners do this. They, they think, well, they put a monetary value on their family time. They put a monetary value on their family time. Meaning I could finish at four o'clock in the afternoon. Or I could I could if I stay I'll make an extra $1,000 whenever I stopped but but I'll miss my daughter's concert. There's there's a so we put a monetary value if I do that, it'll cost me this. You just there's some things in life, you can't put a monetary value on. You just you can't put a monetary value on your family time. And people who told me that it's that it family time, I don't have much but I have quality time. And again, I don't want to guilt you into this stuff. But there's no such thing as quality time with your family. Family time is quantity time. things just happen. When you're around them. things just happen. I'm on. I'm on the back porch of my house. My second youngest daughter was about 17 on home a lot as I was on the on the back porch in she comes in she stands at the door. Not a crier young Jade. She's a very, very stout young lady. And she I said okay, down, and she dissolves like just the tears coming up. Right? a Cadillac for five minutes. Yeah, Caden are just a few things happening at school done. Um, right now, as you took off, yeah. I couldn't plan that.
36:59 I can't, you can't. You can't plan that. That just happens because you're around. And again, I'm not I'm not guilting you guys. Yes, you have bills to pay, they have other things to do. But the business is there to serve you. You do what you need to do to make sure your family is happy and fed and everything else but don't put a monetary value on it. Because it's it's a it's just not a fair comparison. You can't price it. It's just ridiculous to even think about it. Anyway. All right. Sorry to guilt everyone into something but that's the deal. Now I've lost you can you muted yourself.
37:40 There's a loud siren going by sighs just
37:44 could not go to Yes.
37:53 That was allowed one. Well, obviously edit this out. But I was like, I couldn't even I couldn't even It was so loud. Because it must have been like right in front of my apartment. So we'll edit that out. So annoying. That's that has not happened in a while that was allowed one. And didn't I don't even know what it was. Anyway. So we'll just sort of I'll do a little clap, and then we'll start. So this helps me for editing. But uh, you're killing me. I know, he's, I don't like it's fine by me. You know, I don't even realize he's there. But okay. So all right, so we went through seven mistakes, plus a bonus, which is great. And, you know, if you weren't taking notes, don't worry, we'll have all of these written out in the show notes to make it really easy for you and to follow along. But now, where can people find out more about you get some more resources so that they don't make all these mistakes.
38:59 best place to start, we do a monthly demonstration of practice ology. It's a webinar we do every month. And we'd basically show how our clients across 54 countries earning more, working less and enjoying their lives, even during a pandemic. So we talked about some of the principles to talk about today. And it's really a very interactive demonstration of how we do it. So if you go to my practice, ology.com forge forward slash Litzy li Ts Ed, why obviously. So my practice ology.com forward slash, let's see, you'll get the you can log in and register for the next next session. And if you want to get a copy of the book, I wrote a book how to run a woman a practice, as Karen explained at the start. It's not a it's not a big book, I didn't want to write it. It doesn't make sense to have a massive journal for how to run a woman in practice. It's got to be a woman's book, you should read that in less than an hour. Just covers a lot of the action plans and the bookings and there's great resources sample action plans you can get from the book If you just get to one minute practice.com forward slash book sales. So one minute practice.com forward slash book sales. And if you just put in the code, Karen Oh s for overseas. So if you're not Australian, which I don't imagine you will be if you're not Australian, do Karen r West. And it'll take 15 bucks off and you get it for $4.95 Australian which I think's about $1 us. That's a bit more than that. But it's not it's a pretty good deal. If you happen to be Australian, listen to it put in Karen, au, s t. So I'm going to practice.com forward slash Bob sales. Karen Oh s get it for if you're if you're outside Australia, or Karen a USD if you're Australian, and you get that for $4.95. And we'll post it out for you. And my social media platform is LinkedIn believer not I'm an old school, LinkedIn. So follow me on LinkedIn. Paul, right, Newcastle, I'd love to have a chat. And I hope you can join it for join us for a webinar and get some of those great resources from the book. And posted sorry, posters is a bit slow, I think we've covered but once you, once you buy the book, you do get the PDF of the book straightaway. And there is a second page, a link to all the resources and the action plans and all the scripts and stuff. So that's perfect.
41:16 And we will have links to all of that at podcast at healthy, wealthy, smart, calm. So one link will take you to the webinar to the books and to your LinkedIn page. And before we wrap things up, I'll ask you one last question. And it's one that I asked everyone knowing where you are now in your life and in your business and in your practice. What would What advice would you give to your younger self?
41:40 Oh, you love this one? Okay. I would probably be a podiatrist or an optometrist. You're sitting thinking, Okay, what are those things got in common? Well think about it. They've got a product arm. They've got a range of products, because I, I did what we talked about earlier, I became a physiotherapist because I wanted to be a physiotherapist. I didn't know I could be limited in what I can sell our products. So if I could go my time again. podiatry, I would, but I don't like feet. So maybe it's a problem. optometry, I'd be okay. Maybe orthodontics? I'd want a product range. That would be that would be why don't go and say all my diamonds done. Put a product range in your current business, if you can. That helps. But the idea of relying on your hands and trading time for dollars, I'd probably do differently.
42:38 Right? Well, great advice to your younger self, for sure. Thank you so much for Paul, for coming on and sharing seven mistakes that you've made and probably a lot of us who have been in business for more than a couple of years or more than a year have made and hopefully all the listeners out there you will not make those mistakes because we have covered them here. You've got them in your head. You'll sign up for the webinar and you won't make up and it'll be clear sailing. Fingers crossed. So thanks, Paul, for coming on and sharing all of that with us. I appreciate it.
43:14 Absolute pleasure, your superstar. Thanks for having me.
43:17 Thank you and everyone. Thanks for listening, have a great couple of days and stay healthy, wealthy and smart. | |||
| 563: Luke Hollomon, SPT: How to Keep up with Research While Staying Sane | 30 Oct 2021 | 00:32:23 | |
In this episode, Founder of PT Crab, Luke Hollomon, talks about the importance of reading, dissecting, and understanding research. Today, Luke talks about how PT Crab can help PTs, the most common research-reading pain points, why reading the abstract isn't enough, and how to make the whole research process easier. What does it mean to keep up with the research? Hear about how to find exactly what you're looking for, how to understand what the research says, and how to apply the research to your clinical population, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Luke Hollomon Luke Hollomon is a writer, teacher, and student from Richmond, Virginia with a special interest in sharing complex information with those who need it. Using his background in physiology and education, he started PT Crab, a newsletter that brings physical therapy clinical research, awesomely brief to the inboxes of thousands of physical therapists every week. His true passion is helping people understand and use scientific information. When not writing The Crab, he writes science and technology articles as a freelancer and is currently finishing his degree in physical therapy from Virginia Commonwealth University. Afterward, he plans to pursue a PhD in exercise physiology and study the limits of human endurance. When not doing all of that, he's a bikepacker, rock climber, and trainer of his deaf adventure dog, Kiwi. If you're ever in Richmond, look for her in her trailer behind Luke's bicycle as they explore the city together.
Suggested Keywords Healthy, Wealthy, Smart, PT Crab, Physiotherapy, Research, Papers, Reading, Keywords, Critical Thinking, Science, Knowledge,
Resources:
To learn more, follow Luke at: Website: PTCrab.org Facebook: PT Crab Twitter: @lukehollomon
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 | |||
| 562: Dr. C. Adam Callery: Post Covid-19, Resetting Business for Continuity | 21 Oct 2021 | 00:37:19 | |
In this episode, Managing Director of Sagesse Lumiere, Dr. C. Adam Callery, talks about small In businesses in the wake of the Covid-19 pandemic. Today, Dr. Callery talks about the implications of the pandemic on future business strategies, the importance of agility, and understanding cashflow. How often should a business of any size check their financial status? Hear about some emerging trends, three critical activities for success, how Dr. Callery helps other entrepreneurs, and get his valuable advice, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Dr. Callery Dr. Callery is an entrepreneur and higher education educator. For the past eleven (11) years, Dr. Callery has worked directly with the start-up and emerging business communities at a national level. For ten of the eleven years, Dr. Callery has held the roles as facilitator and trainer for two (2) nationally recognized small business growth programs, the US Small Business Administration's Streetwise MBA Program in Chicago and the Goldman Sachs 10,000 Small Businesses Program. His company, Sagesse Lumiere, a small business coaching and consulting firm, was established seven years ago to complement the work he was doing in these programs. To date, Dr. Callery has advised over one thousand small business founders while participating within the national programs cited above. Dr. Callery, as a coach and consultant, works with small business owners on approaches to effectively build value by deploying new business practices and processes to improve financial performance and operational efficiency. Prior to working with small business owners as a business coach, Dr. Callery worked for several Fortune 1000 companies such as IBM, Dow/Dupont, Pepsi, United Airlines, and First National Bank of Chicago. His broad industry experience has prepared him to be a capable business consultant. Since leaving the corporate arena, he has become a trusted advisor for many small business founders. As a higher education educator, he has served as an Associate Dean for workforce development programs and currently works as a tenured faculty member for Harold Washington College, one of the City Colleges of Chicago. Dr. Callery has earned a Bachelor's in Chemical Engineering from Illinois Institute of Technology; a Master of Business Administration from University of North Carolina, Chapel Hill; and a Doctorate in Higher Education from National Louis University, Chicago.
Suggested Keywords Healthy, Wealthy, Smart, Small Business, COVID-19, Research, Success, Cashflow, Entrepreneurship, Mentorship, Finance
Resources: The Goldman Sachs 10,000 Small Businesses Program WSC1998: AVOIDING THE BLUES FOR AIRLINE TRAVELERS
To learn more, follow Dr. Callery at: Website: https://sagesselumiere.com Twitter: @callerysagesse Instagram: @callery_sagesselumiere LinkedIn: Dr. C. Adam Callery
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:03 Hi, Dr. Callery. Welcome to the podcast. It's an honor to have you on. So thanks so much for joining me.
00:10 I'm so happy to be here. And so glad you invited me to attend your podcast.
00:14 Oh, this is great. And you know, like I said in the, in the intro, you were our lead instructor for the Goldman Sachs 10,000 Small Business program. So I owe a lot of my being a therapist and having to be a business owner to now being a business owner who happens to be a therapist to you and the rest of the staff and business advisors. It was really life changing. So thank you so much.
00:40 Well, I think I thank you for being a participant in the program. It's a hard program, we asked a lot of you for an extended period of time. And I have to say, I cannot do it solely by myself. It really is just a good strong team that covers so many different areas of business management that's needed for most small business owners. So I'm just having to have good people around me, that helps make the process very smooth.
01:05 Yeah, absolutely. And today, we are going to talk about sort of small business owners, and the effects of COVID-19, which we have been in for the last 18 months and doesn't look like it's ending anytime soon. But we are back to work. There are mitigation factors in place. But now, how do we position ourselves for the long term in this new world? So my question is, what are some of the lessons you have learned over the past 18 months? And what are the implications for your future business strategies?
01:50 Well, I think that's a great question. Because myself, I'm also a business owner, I am a small business coach. And I would have to say for the last 18 months, that's been a question that's been raised many times, I can think back to March, when we first moved into COVID. Everything shut down. And to be honest, it seemed very dark at that time. And then for the next three to four months, I was working with a lot of small business owners, and we were having those discussions, what are what's next, you know, how do I get out of this. And in fact, if you started to look at the newspaper, you'll see headlines saying this is the worst crisis since the depression or behind closed doors, there's calamity. And when you read those phrases, it actually diminishes your ability to be a leader, and organizer of your business. And so what I had to do as a coach started having different discussions and say, we must look forward. And the way I did that was having a time with individuals to stop and say, Hey, if we take a look at the Great Depression, or the great recession of 2008, those same phrases were being said then, yet, we were still standing in 2020. So we have to believe that we're going to pass through this period as well. And so the discussion became, how do we do that, and in most cases, and then bring back or I should say, shorten your horizon from looking out two to three years, to just make it now bring it down to three months down the six months, make it manageable, it was easier for you to see out three months, it's easier for to see how six months, and then just be very tactical. And so during that last quarter of 2020, through the beginning of the initiation of 2021, many of the conversations with business owners have centered on that, how can we focus on some short tactical goals that keep the lights on, they keep my current employees satisfied, so they stay with me to make sure the customers I do have still like the services are providing or the product that they're buying from us. Therefore, we have to maintain the same level of quality. So just being very tactical that way. And then hopefully, when we're on the other side, we can then return to a posture where we're thinking longer term.
04:06 And all that, to me just sounds like a small business owners that we have to be really agile, and we have to be able to pivot. And so can you speak to a little bit more about agility as a business owner, and how we can foster that if it's something that we're not used to?
04:28 Well, agility, you know, it's a strong word, right? So it means that we're flexible. But again, coming through this COVID period, it didn't seem like flexibility existed. Everywhere I turned, something was shutting down. So I've seen closer to the end, then something that was gonna be an opportunity in the future. And I came across a quote, it came out of the book called Good to Great. That was written in 2001. And I wrote it down someone just read it verbatim because it's a unique quote, but I think it addresses issue. It says never confused. That you will prevail in the end. So that saying this thing of, I have faith that I'm going to win, I have faith that my business is going to win, it's going to be successful, and I'm gonna make a lot of money from it, or I'm going to be fame, I'm going to become famous from it, you have this faith, you got to have this confidence, that's probably a better word, I got to have the confidence that I will make it through. But here's what the rest of the quote says it says, I can never lose that confidence. However, I must have the discipline to confront the most brutal acts of your current reality. So the current reality of 2020 was, everybody's impacted at the same time, my competitors, my peers, people across the ocean, everyone is getting hit with this calamity. So now I have to think out of the box, and I also have to think very practically, so that's where the agility comes in, I didn't have a lot of time to wait six months to see if it's gonna work, because I may not be here. So I may have to take some cost cutting measures that are going to be very draconian, but necessary, I may have to talk to my staff and negotiate with them, and maybe get them to take a cut and pay, letting them know I'm trying to keep everyone alive here, I may have to talk to my customers in a different way and find out, are you still here? You know, are you still viable, because my customer is also impacted by this. So then I can sort of forecast what my sales potential could be. Because many of the customers went out of business for many of my clients. So agility means that you are being sorry, that you're focusing on today. And you're being very practical, very tactical, you're using your experiences, from your I should say, your past experiences as a business leader, and a business owner. But you also are willing, and here's the key, you are willing to take in advice from subject matter experts who are in your industry, and also outside your industry to help you navigate this because this was so unknown, a lot of unknown territory that we were crossing through.
06:55 Absolutely. And I would also think that in that time, I'll use the example of the physical therapy profession, but kind of acknowledge acknowledging emerging trends during this time. So for the physical therapy world, certainly here in New York City, we were close, literally shut down ghost town from March to almost June or July of 2020. So what do you have to do to keep things going? So the emerging trend was telehealth? Yeah, telehealth has been a trend and it has been coming up and coming up. But I think as a PT, if you didn't acknowledge that that trend existed, and didn't hug that trend, like it's your best friend, you you were in trouble, right? So what other kinds of trends Did you see within the small business world that people had to acknowledge and embrace in order to not only bring them through 2020. But I'm sure a lot of those trends have continued well into this year.
07:56 I agree 100%, the hardest trend, and I don't know if I can call it a trend, that's probably more of an action, the action that I may have to return to what I was before. And what I mean by that is, maybe we're a sizable business, you had 50 employees, or maybe employees and contractors working for you that accounted for about 50 people that you're responsible for, had a fairly good customer base that you're working with COVID hits and everything shuts down. Now, you may have to go back to what you were three years earlier, that's when you started the business where you were a smaller company, not as nimble because you were smaller, but you were very focused and very targeted. And that was the trend, I was saying that people say I'm at the roll back to where I was before. And that by rolling back doesn't mean I'm failed, which is another trend element. It doesn't mean I'm failing, it means I had to adjust, you know. So it's realizing that businesses aren't always going to go up with hockey stick and grow, grow, grow, grow without interruption, that there will be these troughs. And if I hit a trough, I may have to back up a little bit. In this case, people have to back up a lot. A great example of that would be the restaurant community. Here in Chicago, I've seen it all over where people physically had to change the menu, they may have 30 items on the menu. And they just took duct tape and started covering over things and reduce the menu down to something that they could manage based on staff based on a cost of the ingredients based on just pure demand, because now they're doing just takeout services, no longer doing to sit in services. why they do that, because I have to still pay the rent, I still have to pay some utilities, I still have to pay something. So I have to have some money coming in. And I want to be here for the next day. So I may have to swallow deeply. And Take another deep breath and say I have to go back to where I was maybe when I started the business so I can survive this period not knowing if you remember not knowing back in April, how long is this going to go? Because the predictions were two months, six months, two years, five years. Nobody knew. So You had to be very specific and very intentional about how far you will go back in time in order to survive and be here for the future.
10:09 Yeah, I mean, gosh, back in March, when New York City shut down, I was like, ah, six or eight weeks, we'll
10:15 be back up and running. Let's see, 18 months later,
10:21 not quite back to where we were. But getting closer. But to your point, yeah, I thought it would just be like six or eight weeks. And this will be a little adjustment that I'd have to make in my business. But it, it actually turned into a long term adjustment that I love. And I'm glad now that it's part of my business. So that ability to pivot quickly actually turned into a big positive for my company, because now I can actually see more people because I don't have to see them in person.
10:51 I agree. I agree. And I stole something else out to you. It's not so much of a trend, but it's probably a revelation. So we know a lot of business owners have different backgrounds, and they come from different walks of life. And so if we put an academic hat on, we have individuals coming out of MBA programs, and they have knowledge around business. The key is what does an MBA program teach? What MBA program teaches is that you need to go out and look at the environment that you're in. So that means you research on what some of these latest trends are. When we have a situation like COVID, I know many business owners typically don't worry about what the trends are, they worry more about what's going on in their daily environment in their community, and their marketplace, and they're just focused on can I sell something tomorrow, I think COVID has opened up a new reality that if you want to be successful moving forward, you have to be ready for these unexpected change as well. How can I reduce the number of unexpected changes, I start to do some research, I start to do some reading in my industry and also outside of my industry. So I can see those trends that you were talking about earlier. So telemarketing has been or tele health rather, has been around for a long time. People talk about it, but it wasn't economically feasible. Then when I need it, those who knew about it jumped on it. So but I had to know about it, I needed to have that information. So this is an important time as business leaders now to say, what else do I need to know? Do I need to join my industry associations? Do I need to go out and and go to conferences, go to particular training programs, where I can start to learn about what is going on around me so I can be better equipped for the next situation may not be a pandemic? Or it could be droughts, if you're out west? Who knows? It's going to be something so how can I be prepared for the next something?
12:39 Yeah, because you know, something that you had brought that you brought up in our kind of communication before we recorded this is and I like this phrase you put in quotations, you can't be afraid to act fast. But you don't want to be reckless. Yes, yeah, right. And so by doing the research, you can act quickly, and not in a reckless manner. Because you know where you are, you know, what the industry is holding, and you've got that research. So you can act quickly with authority. And with some sense of operation.
13:15 I agree. And ask where, you know, we want to say, you want to be intentional. And that's what that word really means. And especially when we're in our programs, we use that word a lot. But it's good to unpack it. So you just mentioned and that reckless, and I'm not trying to be strong willed. So when I'm talking to my employees, I'm trying to hit them over here with a club, but I'm intentional. So I have I know where I want to go, I've taken the time to do some research. So I've set a goal in mind, I've also decided on a path that we can take, but I'm also willing to ask around to see if that's the best path. So that's where I'm not being reckless, I'll go ahead and qualify it by talking to other subject matter experts, talk to other people in the industry and say, This is what I want to do based on my capabilities. What do you guys think? What do you people think? And that can help me then to minimize risk? Because we'll never eliminate it. We're just trying to minimize risk. So we can be successful.
14:10 Absolutely. And so now, we've we've sort of identified research we have we spoke to people, we got advice. Now we want to move forward. So we need some sort of formal operations. So these operations, as you said, they kind of revolve around three critical activities. So can you share with the listeners what those critical activities are, to make that those formal operations successful?
14:38 So I can that'd be beautiful. We've met through the Goldman Sachs program and what I've learned over the last 10 years in that program, is that you have to take a step back sometimes and attack a problem formally. And so we start off with the purpose, what is your business purpose? And what that means, of course, is what do you think? to do in your marketplace, who you're trying to sell to, why you're doing it, why are you actually involved in this work? The second thing we try to do is examine how we actually do the work. And this is the operational piece. So how do we actually do the work? How do we earn our revenues? How do we manage our team? How do we actually produce the product or service? Are we doing it efficiently? And then the last piece I call her reflection, but that's the research piece. I've been doing this for five years, I've been doing it for 10 years, is this the best way to do it now, based on the changes in the business environment, changes in government regulations, changes in social trends, changes in the number of competitors, or the type of competitors that so the three pieces are looking at my purpose? Why did I get into this business? Why do I want to do this or continue to do this kind of work, I look at my model my business model in general, and think about how I currently conduct business and see there's a better way I can do it more efficiently, more effectively. And then last but not least, I have this reflection or research activity that I do continuously continuous learning to make sure I understand my marketplace, understand my industry, understand what's happening with competitors around me also start to probe and find out are my customers still satisfied with what I'm doing? And if not, what do I need to do to reach them?
16:21 Yeah, and I'm glad that you said that you're continuously looking at this, because this isn't something that you do when you start your business, you assess your purpose, your model and solutions and reflect. It's not like you just do it once. Yes. Like how often would you say do you recommend even the business owners that you work with, kind of go through these three critical activities?
16:47 Well, I think we can take the model from the corporates. Now you understand corporations are huge, billion dollar places, but they are billion dollar places for a reason. And that is because they do take the time to annually look at what they do, and assess whether or not is making sense. So if I was any business owner, I don't care what size you are, I would make it a point to say maybe in the fall, that November period, Christmas period, when it's kind of quiet, people focused on vacation or focus on the holidays, you take that time, sit down with your management team and say, hey, let's think about how our last year went. Is there something that we want to do better, right doesn't mean that you did anything wrong? Is there something that I can improve upon? Or are there some new things coming down the pipeline that I need to be aware of, or we'd need to be aware of, that we need to plan for starting in January. So doing an annually isn't a bad practice. And if you do it formally, and you do it every year, it just becomes part of your routine. And you'll start to think about the questions you want to ask each other during those sessions. And you'll be able to flesh out what is happening with the business. In fact, you probably want to go ahead and bring in some of your key employees that sit them around a table, get some insight from them on what they're experiencing, when you're engaging your clients, when they're engaging your suppliers, or if what they see, in general, they may see some things in the market that you have missed. And it's a good time to sit back and get their feedback as well.
18:16 And how often would you say suggest to a business owner small of any size, but let's say a small business owner, to really look at the financials of their business once a quarter every month, every week, every night before you go to bed? Like is there overkill? Or? Or what? What are your thoughts on that?
18:40 That's a tough question is a tough question, right? Because Is there any should you have any limit on when you look at your numbers, because for instance, everybody will tell you, you need to know your numbers. So if I'm sitting in front of an investor, or a banker, they're going to say you need to know your numbers. But I guess the question is, what are they really asking me? They're probably just asking, do you know enough about your numbers to tell me whether or not you're profitable? That's really the question they want to know. And they want you to be able to tell them that, tell them you're profitable in a confident manner. And they can easily see if you're sort of dancing around the question, right? Because you really don't know your numbers today. They can sense that in the way you respond, your eye contact, and so on. So to your direct question, how often should I look, if I put on my accounting hat, we typically look once a month. So every month we take a step back, and we see how the business is performing financially. In order to do that, we probably need to have some type of system in place. That could be a QuickBooks system, or it could be a cell spreadsheet. It depends on the complexity of your business. And that's when we have to define a small business. So small business can be defined as any business with less than 500 employees. That's a big business. But let's say I'm a mom and pop I have less than 10 employees. In fact, I am the key employee and everyone else is a contractor. If I'm that size, once a month is probably still appropriate, I need to take the time to stop. And look, I cannot just assume that because my bank account has money in it, that I'm actually in a good position. So if I take the time, look at it once a month, that's probably enough. The furthest I would like to go out is probably three months, you know, quarterly, but want to go beyond that. Because a lot can happen to a business in two days, let alone in 90 days. And if I'm not keeping track of my numbers, I may find myself in a very dire cashflow position, and maybe find myself going out of business fairly quickly.
20:42 Yeah, excellent advice. Excellent advice. Thank you for that. And you know, as we start to wrap things up, what would be if you could give one or two pieces of advice to let's say, a new small business owner, so their business is less than a year old? What is your best advice for those business owners?
21:04 I think it's extremely important for the person just getting started to do some of the things we're talking about earlier, you have to position yourself or maybe carve out specific time for you to really learn your industry. So that could mean joining an industry association, going to those industry association meetings. So that's gonna take time, read some of their white papers that they generate about your industry. So for instance, I was at one time I was looking at buying a limo service, I love this guy service used to take me to the airport all the time, all his drivers were professional, his cars were clean, well maintained. And all I knew about the business at the time was the fact he took me in a limo to the airport. But that's not knowing the business. So I went ahead, I contacted limo Association, they sent out to me information on the business, you know, on the industry, the cost factors, the maintenance issues, some of the trends in the industry. After reading all those materials, and learning that it was a very highly capitalized business, I realized that it wasn't for me, at that time, still like the business. But I knew I was not in a position where I had enough capital to keep the cars up to spec to meet the requirements of running a limo business. So if I'm starting a business, whatever it is, I need to know as much as possible about that industry and the business model itself. How's the business make money? What are the cost factors? What are the what are the cost influencers, I need to know that like the back of my hand, then when I'm running the business on a day to day, I need to be in the business to see how it really operates. I've met some people that have started a business. And I've started another one that started know when I started another one. And I now ask them I said, Well, how do you possibly run three businesses at the same time? Well, I got people working for me. And what comes to mind is something someone told me many years ago, is that you have to smell the people. And what this is gain from Business School, and the professor was saying, you have to be close enough to the operations to know what's going on. And if you're too far away from it, there's too many things that can happen to the operations that will shut you down. And so if you're just getting started, your focus needs to be in the business and getting the business to a place where it's stable, and is sustainable. That usually means creating cash reserves, that usually means bringing in solid employees, it usually means having a great understanding of your customers so that you know you have returning customers that'll help keep the business afloat.
23:42 Excellent. Thank you so much. I know a lot of people that listen to this podcast or maybe budding entrepreneurs, they've been in business for maybe a year or two. So I think that advice is really great for that group. Now, is there anything have we not covered something that you were like, I want to hit this point during this podcast?
24:02 I think it's important, we haven't used that key phrase. And that's cash flow. It is extremely important whether you are a existing business owner, or a new business owner to truly understand what cash flow means. And so when we talk about cash flow, what it means in general, is that we're talking about the money that's coming in. And that's where most people focus is, Hey, I'm making revenues, things are going well. But you can't just stop there, you got to think about the cash outflow. And people say I write the checks every day, I know how much money is going out. The third piece is timing. You have to think about when the money has to be paid out. When does that liability has to be paid out, and whether or not I'm going to have enough cash on hand to pay it on time. Because once I default on that payment, I'm now in trouble. The bank is knocking at the door. My creditors are knocking at the door, my investors are knocking at the door and I'm going to have problems paying my employees so on and so on. So cash flow is very important. And it's important from the standpoint of you have to truly understand the definition of it. And what it means is inflow is outflow. And it's also timing. When is the money coming in to pay those current debts that I have? Will I run into a situation where I don't have enough coming in to pay those debts? And if I do, what am I going to do about it? Am I going to reach into my personal account and pay it? Am I going to run down to the bank and ask for a line of credit? Do I need to run out and find investors? Who can give me additional cash to help me close that gap? So cash flow is critical?
25:36 Yeah. And I think, as you were saying that the thing that popped into my mind is, ooh, this is why Ponzi schemes ultimately fail.
25:44 Yes, yes. Because the money stops coming in. And their commitments outweigh our Yeah, extend beyond the, the amount of money that's coming in.
25:54 Right. Right. Yeah, that is why a Ponzi scheme fails. And, and I agree that cash flow is so important. And it's something that I didn't really wrap my head around fully until the Goldman Sachs program. You know, I knew like, yeah, money's coming in. But once I started doing cash flow statements, I was like, Ah, okay, yeah. Now I got it. No, I know, I can now I understand this as, as one of the three sisters, you know, your cash flow statement, your balance sheet, and your income statement.
26:32 Exactly, exactly. And it's the cash flow statement, and we never talk about, you talk about it. If you again, be school, we talk about all the time, but most people just stop at the income statement. In particular, they stop at the income side, then when you introduce the balance sheet, I don't see why I really need it. I don't have any assets. But they don't combine the two to come up with the cash flow. And that's what you really want.
26:53 Yeah, yeah. Excellent. All right. Now, where can actually let's talk before we before I asked, Where can people find you? Why don't you talk a little bit more about your business? And how you help other entrepreneurs, your coaching business and what you do to help entrepreneurs?
27:12 Well, what I do is I focus in the business development area, as well as the operations or organizational development area. And what does that mean? So I come in as a business coach, not as a consultant, I sit down with my clients, and we have discussion. So it's like we're doing now and we focus on the issues that are facing them. So in a business development side, for instance, such as a marketing issue, we're not talking about social media, what we're talking about is more around a target market. Have they identified the right persons, or the right audience? When it comes to marketing? Also, you got to think about the delivery of the product and service. Are there some challenges in terms of quality, some challenges in terms of delivery, that they're facing? And then we start to peel back a little bit? And this is where we get into the operations? Why are you having those challenges? Is it a capability issue is a capacity issue, these things have to be fixed, or the marketing, social media really won't matter? So I focus on a business development sort of working backwards? What are you trying to sell? What are you servicing? How are you working with your clients? And what are your business capabilities, what is what is your business capacity, in order to essentially achieve the goals that you've set for the business or to meet your current demand for your customers, those are all very important pieces, because most businesses will suffer or in a trough when they get to that third and fifth year when they try to scale up. And they always find, hey, I have this resource deficit. And I usually think it's money but it's not so much money, it's really capacity and capability, they may not have the right people on hand, they may not have the skill themselves in order to scale up and they need to go back, build up those skills so that they can grow. And that's where the coaching comes in and sort of help the build up those skills.
28:57 Awesome. Now where can people find you?
29:00 Well, they can find me right on the internet. I have a website out there, my, my company has a very unique names, it's called suggests luminaire and will suggest and stores wisdom, and then luminaires light. And so right out there on the internet, I have a web page where you can contact me through that or you can come back contact me through LinkedIn. So I do have a LinkedIn profile out there. That's probably the best way most people will contact me through LinkedIn. And then we'll set up an appointment and we go from there.
29:29 Perfect and we will have direct links to all of that at podcast at healthy wealthy, smart, calm and the Show Notes for this episode, so don't worry if you didn't have a pen you can take it down. totally get it we will have one click direct links to all of that. And now, Dr. calorie for the last question, which is a question I asked everyone, knowing where you are now in your life and in your business, what advice would you give to your younger self
29:57 so what I would tell my younger self I'm fully invested in entrepreneurship, I would tell my younger self is that you can do it, you can actually be an entrepreneur. To be honest, when I came out of school or coming came out of undergraduate, my mind wasn't there, my mind was I had to go through this career track, because that's the only possibility that entrepreneur thing, or that small business thing was just too far out there. You have to literally be born into it. It has to be a legacy relationship in order to start a business. Today, I recognize after meeting so many people in this space, that's really not it is really tied to have any interest. People use the word passion, but I go beyond the same passion, you really have that ambition that you're willing to give all in order to accomplish this. And so I would tell my younger self, that you do have that ability, you do have that ambition, just go out and do it. Bring people around you who have the knowledge that you need, because you're not gonna know everything. And if you adapt that knowledge, you'll be successful.
31:03 And I think that's great advice. And especially for a lot of the physical therapists who listen to this podcast, because so often we graduate, and we think, well, I'll work at a clinic, I'll work at a hospital, I'll do that for 40 years, and then I'll retire. You know, it's like, it's never it. Because in school, we're not really given any entrepreneurial mentorship or classes, you really have to seek it out on your own. And so I think that's great advice for any students listening or newer graduates, who think, Well, my mom wasn't wasn't an entrepreneur, my dad or I don't, I don't have any real role models in my immediate family, but that you can do it if you surround yourself with the right people, and you have the ambition and passion to do it. So I think that is excellent advice. So thank you for that. Well, and thank you again, for coming on the podcast and for being a great instructor in the Goldman Sachs 10,000 Small Business program, I can put a link up to that too, if people are interested in learning more about the program because it is a life changing program. It was for me and I'm sure as an instructor, it must have been for you as well.
32:13 Oh, it hasn't. It hasn't, I have to say, I never, I never thought I'd have this experience. It's been now going into my 11th year and I've actually set before 1000 business owners never thought that could happen in my wildest dreams and having the ability to have conversations like we're having now. Again, it's opened up my mind to say the The possibilities are limitless in this country when it comes to being able to create something that you want to create. And that's the beauty of it. So it's it's a fantastic opportunity. Fantastic country fantastic. Time, even though it's difficult time, it's a fantastic time to to do something that you want to do.
32:57 Excellent. And on that note, I will wrap things up by saying thank you again and thank you to all of the listeners for tuning in today. Have a great couple of days and stay healthy, wealthy and smart. | |||
| 561: Schellie Percudani & Rebecca Rakoski: The Importance of Cybersecurity | 14 Oct 2021 | 00:37:13 | |
In this episode, Managing Partner of XPAN Law Partners, Rebecca Rakoski, and Senior Account Manager at Contango IT, Schellie Percudani, talk about cybersecurity, especially for small businesses. Today, Rebecca and Schellie talk about business privacy and security practices, cost-effective steps that you can take to protect your business, and the importance of cybersecurity insurance. Why do small businesses have to worry about cybersecurity? Hear about ransomware attacks and how to react to them, data privacy laws and how they impact your business, and the value of hiring lawyers, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More About Schellie Percudani Schellie is a Senior Account Manager at Contango IT located in Midtown, Manhattan. With 75 people, Contango IT services their clients through 4 key areas of technology. IT Service/Support - We offer unlimited onsite and remote support for all covered users and devices with up to 60-90 second response time. In that same fixed monthly price, we also include asset management, budgeting breakdowns, disaster recovery planning, compliance requirement review and planning, technology road mapping, and a lot more. IT Infrastructure / Cabling - Moving offices? Contango IT handles the technology side of the move through Cabling and IT setup. Cybersecurity - 45 people strictly in Cybersecurity keeps Contango IT on top of the biggest buzz In technology. Risk? Compliance? Reach out, looking to help in any way possible. Even if it is just second opinion or advice. Custom Programming - Front-end or Back-end development, Android, iOS, Web-based and much more. Winners of the Microsoft Best Use of Technology Award and the NYU Stern New Venture Competition Any technology questions, reach out! With hundreds of clients over 4 services, Contango IT has seen it before.
More About Rebecca Rakoski Rebecca L. Rakoski is the managing partner at XPAN Law Partners. Rebecca counsels and defends public and private corporations, and their boards, during data breaches and responds to state/federal regulatory compliance and enforcement actions. As an experienced litigator, Rebecca has handled hundreds of matters in state and federal courts. Rebecca skilfully manages the intersection of state, federal, and international regulations that affect the transfer, storage, and collection of data to aggressively mitigate her client's litigation risks. Rebecca is on the Board of Governors for Temple University Health Systems, and an adjunct professor at Drexel University's Thomas R. Kline School of Law and Rowan University.
Suggested Keywords Healthy, Wealthy, Smart, Cybersecurity, Small Business, Privacy, Security, IT, Insurance, Legal, Hacking, Ransomware, Malware, Data, Technology, Data Breaches, Encryption
To learn more, follow Schellie and Rebecca at: Website: https://www.contangoit.com Twitter: @XPANLawPartners Instagram: @schellie00 LinkedIn: Schellie Percudani
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here: 00:02 Hello, Rebecca and Shelly, welcome to the podcast. I'm very excited to have you on to talk all about cybersecurity. So welcome, welcome.
00:13 Thank you for having us.
00:14 Yes, thank you. And
00:16 so this cybersecurity this for me as a small business owner, is brand new to me. Although it probably shouldn't be, but it is, but that's why we're talking about it today. But before we get into it, can you guys give a little bit more detail about yourself and what you do so if the listeners understand why I'm talking to you guys today?
00:41 So I, Rebecca McCroskey, I'm a co founder and managing partner of x Pam law partners, we're a boutique cybersecurity and domestic and international data privacy law firm, which is a really fancy way of saying we help organizations with their cybersecurity, and data privacy needs, right? I have been a practicing attorney for almost four years. I hate to admit that sometimes I'm like, I'm dating myself. But what's great is we really help businesses, small startups, all the way that big multinational corporations because right now businesses are it's, it's really a brave new world that we're facing today. And businesses are getting attacked literally from all different sides. And so we started x pant to really help businesses understand what their legal obligations are, and what their legal liabilities are. And I tell my clients, my job is to avoid those problems for you, or do my best or put you in the best position to address them if and when it becomes an issue. So that's
01:48 what I do in a nutshell. Great, thanks, Shelly. How about you?
01:53 Yes, my name is Shelly perky. Donnie, I am an account manager with contango it and we help businesses and our end organizations if I could speak, we help them manage their day to day it to help build a strong security posture. We also help them with cybersecurity, we have 45 people strictly in cybersecurity, we have 25 penetration testers, eight ethical hackers. So we have a strong, you know, posture to help businesses build a posture so that they at the end, I wouldn't say that they're not going to be attacked, but they are prepared for anything that could happen. And so we help them with that. Got it.
02:43 Well, thank you both for being here to talk about this, because we are seeing more and more things in the news lately about ransomware and cyber attacks. And so oftentimes, we think of that as only happening to the big businesses, right? So why should small businesses, which a lot of listeners that listen to this podcast, are entrepreneurs or small business owners? Why should we have to worry about this?
03:10 So, you know, from a legal perspective, obviously, anybody who's ever come into contact with the legal system knows, it's not just for large businesses. So from a legal perspective, you're going to be subjected to liability from your people who whose information you're collecting, call them data subjects, you can, you're going to have contractual obligations with your vendors and third parties that you use and share data with. So put that and then just put that aside for a moment, then you also have small businesses have a reputation. And in the small business community, I am myself a small business, I'm a small law firm, Chief law firm. And you know, your reputation is everything. And so part of your reputation nowadays is how you're handling security and privacy. What are you doing the data. And so it's really important for small businesses to realize it's not just the big guys, we hear about them in the news, the colonial pipelines and the JPS foods and the Equifax is of the world. What you don't know is that every single day law firms like mine are getting a call from small businesses going help. We just clicked on a bad link, we just got ransomware, what do we do? And that happens all the time. It really you hear about the big guys, but it's the little guys that are really, you know, bearing the brunt of it, I think.
04:32 Now, I would agree. And what we all have in common between the small businesses and the large businesses is we're all human. And like Rebecca said, it's human error. Somebody clicked on an email, and they didn't know you know, they weren't trained. Hey, this is a spoofing and phishing email. This is what they look like, this is what you need to look for. And so that's where we come in, and it's we're all human and we all make mistakes. It's just no Like, you know, you this is what to look out for.
05:04 Got it. And so what are some of the issues facing businesses today, when it comes to cybersecurity?
05:12 What ransomware is obviously one of the biggest issues, right. And for your listeners who don't know what ransomware is, it is, what happens is somebody clicks on a bad link, download the bad, you know, attachment to a file, and the ransomware is downloaded to the system. Depending on how sophisticated the hackers are, they can either deploy it immediately, which means your system starts to, they start to encrypt your files, or it can be that they sit in there and wait for Oh, I don't know, the most inopportune moment that your business has. And then they deploy the ransomware. I've had clients where they deploy ransomware, or they first delete backups before they deploy the ransomware to really add insult to injury there. So but so that's one of the big things and then the your entire system gets encrypted and you can't unencrypted it without the encryption key which you then have to pay for the ransom part of it. And, you know, we hear about the big ransoms, again, the 4.4 million from colonial the 11 million from JBS. But you know, I was speaking with a colleague the other day, and a law firm got ransomware for $50,000. Now, that's a lot to a small business, it's a lot to any business, but they try to make it it's almost like it's commercials with what they think that they can afford and pay and so that they'll pay because they want you to pay the ransom. So that's I think, I think that's probably the
06:35 number one I would say so too. And then you now you're on their list, because you've paid your
06:41 SIR now. Wow, they paid
06:44 from now you're on a list of this hacker of like, Well, you know, was easy to get in before. Yeah. So let's see how we can get in again.
06:55 Right? Oh, my goodness. Hang in and you know Rebecca's right.
06:59 And that's where you know, also patching and monitoring your systems having a good strong it. posture is important. Because they see that stuff, they see little inklings of, Oh, well, something's going on here. somebody's trying to get in, you know, so they can see that. And you know, you're only as good as your last backup, and where is your backup being stored? And you know, is that in a secure location? Because if not, guess what? It doesn't matter. Because your information is gone.
07:33 Oh, my gosh, yeah, that makes so much more sense. Now, even just explaining what ransomware is. I didn't realize so they hold the encryption key ransom. And that's what you're paying for.
07:46 Correct you in order to get your data back, you have to pay to get the encryption key. And people think Well, okay, so I'll pay the ransom. And I'll get the encryption. I'll get the encryption key. And it's like, like magic? Yeah. You do, to some extent, although there used to be honor amongst thieves. It's not always the case anymore. No. But the other thing is to keep in mind encryption is not perfect. So you're not going to get it back exactly the way it was before. And a lot of laws have been changed now. So the fact that you were ransomware, it is in and of itself, a reportable event for a data breach. So that's another aspect to it. I mean, we're talking more about the technical aspects with the ransomware. But this is the other part where you know, I always say like, ransomware is like three explosions. The first one, oh, my God, my computer has exploded, but yeah, my computer's, what do I do? And then the second one, which is how are we going to, you know, get back up and running. And then the third is really the legal liability that flows from it and holding it together.
08:55 Also to I mean, Rebecca, are you finding that now, too, they're not only holding it, they're selling the data? Yeah. So they're still older data copied it, they're giving you back access to it, but now they're gonna sell it?
09:12 Yes. So what it comes down to is yes,
09:15 there's a lot to do. At that point to now you've got to tell your clients, hey, I've been
09:23 hacked. And that's where that whole reputation part comes in, you know, where you're, you know, these are people who are interesting information to you data. You know, I mean, as a law firm, we obviously hold our clients data. But you know, if you're a business, you could be holding personal information of your clients and business partners. You could be holding sensitive data on your employees or social security, financial information, information about their beneficiaries, which could be kids and things like that. So it really is a problem that just expands exponentially. It's a rabbit Well, I guess you're falling down that rabbit hole for a while.
10:04 You're like Alice in Wonderland.
10:07 Right? Oh, my gosh. Well, now you mentioned Rebecca about laws? And does that? Could you talk a little bit more about like certain data privacy laws and how that works? And if you're a small business, what does that mean?
10:24 Sure, so different. So there are two sets of laws that you need to really be businesses need to be concerned about, right. So one of them are your your data breach notification laws, which won't really be triggered unless and until there is a data breach, there are 50 states, there are 50 different laws, it's super fun for businesses who have to deal with us, then you have data privacy laws, and because nobody can seem to get their act together to come up with a federal law, we are stuck with, again, a patchwork of laws. So different states have passed different laws. And that is in and around a data subjects rights, about the data that's being collected about from them. So for example, California has a law, Virginia passed the law, Colorado passed a law recently, I know there's a proposed one in New Jersey in New York, Pennsylvania, Texas. So you name the state, and it's probably considering Washington State has tried to have made several passes into data privacy law. And what's interesting about this privacy laws is it they're usually, there's usually a threshold, sometimes small businesses will meet that threshold, but you need to understand that and it's all about the data that you're collecting. So the data you're collecting is going to trigger or not trigger requirements under some of these laws. That same data is the attractive nuisance, if you will, to the hacker they want to, they want to so you know, I always say you can't have privacy without security. So they really do go hand in glove.
12:00 What would be like an app if you know this at the top of your head, but an example of data privacy law from one of those states that has them on the books like what would be an example.
12:13 So California has the California consumer Privacy Act, the ccpa, which was amended in November, when the good citizens of California had a ballot initiative to pass the California Privacy Rights Act or the cpra. And those types of so in and around that you have different rights, the right to deletion, the right to correction, or right to a ratio of three, you know, the right to be forgotten is what's commonly known as, or just some of the rights that you're entitled to. And so businesses that fall under the within the purview of the ccpa, which is in effect right now, the cpra, which will go into effect in 2023. And so if you are a data subject, and the business is is under those laws, you can, you know, say to the pay, I want to know what you're doing with my data, hey, I need you to correct or delete my data. And the business has a set statutory period of time to respond to that data subject Access Request. It's about transparency. So anybody who saw all those updated privacy policies online, that's all driven by privacy laws, there's one in Europe called the GDPR, the general data protection regulation. And it really is in and around transparency, and data collection, storage and sharing practices. So that's, I could go much deeper, but I don't want to put anyone to sleep as I talk about loss.
13:42 I think I think that's really helpful just so that people get an idea of like, well, I don't even know what that is, you know, and if you're a small business owner, you've got a million other things on your plate, because you probably don't have a dedicated IT department, you don't have a dedicated cybersecurity department, oftentimes, you're a solopreneur. Or maybe you have less than 10 employees, you know, so all of a sudden, all of this stuff has to come on to somebody. So I think just getting an awareness out there that it exists, is really important so that you can maybe look it up in your own individual state.
14:20 Yeah, and one thing I would say and I know that this is a problem amongst entrepreneurs and startup is within the startup community is that they think well, we can do this ourselves. We can like cut and paste the privacy policy online and somebody Shelley's laughing at me over here. But you know, the purpose of these laws is to provide information about what that business is doing with data. So if you're borrowing it from somebody else, you could be in trouble twice because you're now you're not accurately reflecting what your laws are, what you're doing with the data. And you've basically taken this information and maybe obligating yourself under other laws of regular So for people who are listening, I know nobody likes talking to lawyers. I swear we're not that bad. But hiring a dedicated privacy or security attorney who understands this is really important because you told what to, you know, have an Ono moment on top of it. Oh, no moment when you're you know,
15:19 exactly. You definitely were Rebecca Sade is absolutely correct. There are people that do that they try to manipulate it and do it themselves. What they don't realize is once you're hacked, it's not just, Oh, no, they've got my information. Now I have to pay this ransomware. But guess what, oh, if you weren't following those privacy acts, you're also gonna get fined on that data, too. So you definitely don't want to be fudging any kind of information. You definitely want transparency.
15:47 Yeah. So hire lawyer. I'm a big fan of lawyers. I hire lawyers for for everything, because I don't I'm not a lawyer. I don't know how to do any of it. And I want to make sure that I am protected. So I 100% get it. Now, what? So we're talking about the pitfalls of what could happen if you have a breach, or issues facing businesses. So what can businesses do to help with cyber security? What are some things we can have in place to give us some protection and peace of mind?
16:20 Well, I would like to answer that this is Shelley, I'm someone who's there for simple and very effective basics that you could do as a business owner. And they're very cost effective. In fact, you know, you already have some of them in hand, as far as like Microsoft Office 365, all you have to do is enable your multiple factor authentication, that's a huge one, it's like leaving your light on in your house, if you're going out to dinner, they're gonna move on to the next house, because you have that layer of protection. And then, you know, security awareness training, educating your employees, educating yourself a lot of spoofing and phishing email looks like, that's huge that you know, it, it makes them aware. And that also, you know, it shows your employees that you're protecting them, you're protecting your clients, you know, it shows stability. And then also, you know, monitoring and patching your systems, you know, making sure that someone has an eye on what's going on. I'm looking for those little ticks that someone may be trying to get into your system, because a lot of people that you can have websites, you can tell by is your website going slower, that's usually a sign that someone might be trying to hack into your system. You know, so it's little things like that. And then also, you know, software and hardware encryption, that's a huge one. A lot of people, I know we have all our devices, it's our fingerprint or face that opens it. But if your hardware is not encrypted, they could just steal your laptop, pull out the hard drive, plug it in somewhere else, and guess what the data is theirs. And it's just the simple things that can help a business.
18:10 Yeah, so So to recap, the multiple factor identification that I get, and I do security awareness training, what what are these emails look like? What not to click on? monitoring and patching systems? So when you say patching systems, what exactly does that mean?
18:27 Well, that's where someone is patching in and they're, you know, they're making sure that your system is secure. And it's going somewhere in that secure like firewall, everything like that. So that is exactly
18:39 the basic there. There are systems like so for example, the Equifax data breach was a vulnerability in an Apache struts operating system. And when they found this vulnerability, it was it was a problem. People write code, people make mistakes, you need to fix it. Once they discovered the problem. They went, they were like, Oh, you need to apply this patch. It basically fixes the code. Well, if you don't apply the patch, if you don't have somebody who can help you do that you're not you're leaving your back door
19:11 open or even Yeah, or even like software, like it needs to be updated. So they're patching and updating, they're constantly monitoring, updating any software so like have you ever had where your phone doesn't work and because you haven't upgraded your system? Well that's kind of like it is for monitoring and patching. They make sure that everything is up to date everything is to code
19:34 right because if you're not patching and updating like Shelly said, you can actually leave a hole Yeah, and you're not the it's a lot easier for them to get in because you would not that system isn't being supported anymore by the Microsoft's or the Googles because they've moved on. You got to move on with them. Otherwise, you're you're gonna have a problem.
19:52 Got it. Got it. Okay, that makes a lot more sense.
19:55 They could do that themselves. Like oh, I can do this. I can do this. But as they're growing Their business, they don't have time to focus on that. And that's how little cracks happen.
20:04 Got it? Okay, that makes a lot of sense. And number four was making sure that your software and your hardware was encrypted. Right? And does that. I mean, this might be a stupid question. But does it come that way?
20:19 No, that's not a stupid question. I mean, a lot of us think that because, you know, I mean, we're on a computer right now that if I shut it and locked it, I opened it again, I could put my finger on it, it would open it, I wouldn't have to type my password in. But if my hard drive wasn't encrypted, didn't have that same protection on it, where someone could steal it, and then just pull out the hard drive, because these people are very talented, plug in the hard drive. So you need to make sure that your hard drive has that same protection with your fingerprint of code that, you know that if they would have to, they wouldn't plug it in somewhere else, they're gonna have to know that code, because it's not going to work.
21:06 Keep in mind, too, that encryption, like we're always talking about is, in most jurisdictions, if you have an encrypted hard drive, if even if they get it, they can't access it. It's not a data breach. So I like to say encryption is your get out of jail free card in most jurisdictions, okay. There are 50 of them. There's a lot, but in most of them, that's your get out of jail free card. So it's one of the biggest, that multifactor I guess, are probably two of the biggest bang for your buck. There they are. And how do you
21:37 know if your software and hardware is in is encrypted? Again, perhaps another silly question, but I just don't know.
21:43 So first of all, I don't encrypt my own hard drive. I know a lot about technology. But I, you know, I don't go to my dentist for brain surgery. professionals, who are IT professionals, like Shelley's company, and I say, here, encrypt my hard drive, and they take care of it for you. So having it's really important
22:06 night. Yeah, I can. And does that literally mean you hand your computer over to someone and say, encrypt my hard drive? Not necessarily No, no, okay.
22:16 No, no, no, a lot of times what you know, like our text can do, they can come in, they can work in remotely in and you know, just like when they have when we monitor and patch, they do it remotely. You know, if you don't even know what's going on. It's just and it shouldn't, it shouldn't interrupt your day, it should then to wreck your workflow. It should be seamless. And usually, you know, it's something that, you know, our techs are very, you know, highly educated, I love text, I always think, Oh, my gosh, what they do is so cool, because they can just, they can fix everything, and they just go in and they're they're magicians.
22:56 Got it? Got it. Okay, how it should be you.
22:59 I mean, a lot of times, and this is true, too. I think Rebecca, a lot of rules now are making sure that you actually have a credible IT team. Because if you don't, you can now get fined. Or
23:14 Yeah, there are different laws where you can if you're not doing the things you're supposed to be doing, if you're not monitoring if you don't have your asset, you know, management, those kinds of things. I mean, one of the classic examples of that is is HIPAA. Now they don't say you have to have it on teaching but they do say you have to encrypt your heart you know, encryption, or they say you show it or they say you have to monitor monitor your devices and let's face facts, do you want to be I don't want to be monitoring my devices, I want my IT guys or gals to be monitoring my devices, I want to be practicing law. So that's the beauty of it is that it's it's Charlie says it's running seamlessly in the background, and you're doing what you should be doing much with running
23:55 your business. Got it? All right. Now let's move on to so let's say you have all of this in place. You've done your basics for cybersecurity. Do you have to have cyber security insurance? Or can you just say, Well, I did all this. So what do I need the insurance for? No,
24:15 that's like driving around without your seatbelt on. Like, you know, I, I frequently wanted to ram the car in front of me, but I don't I don't do that. So cyber insurance. When I will tell you this as when I started my own law firm. The first thing I bought was malpractice insurance. The second thing I bought was cyber liability, a separate standalone cyber liability policy. They are getting more expensive, but for a small business depending on the data you're collecting, they can be very reasonable. But I sleep at night because I know that if something goes horribly wrong, it's there. All of the things you're doing. me that all The good cyber practices that Shelly and I have been talking about that just means they're going to cover you when the when the stuff hits the fan. Because if you're not doing all of that, you've probably told they've sent you a questionnaire with your cyber liability policy and you filled it out and you're like, Oh, do I have multi factor authentication? Oh sure. I encrypt my hard drive. If you lie to them, they don't cover you. But if you're doing all these good cyber practices, and you have insurance, it's you know that every single one of my clients first thing I ask, Where is your data? What is it doing? Where is your cyber liability policy? Those are the
25:35 those are the big three Yeah. Okay. To help you too, because how are you going to get that money out? Right, how do you get that money back? How do you recoup your business? I mean $50,000 is a lot Oh yeah. And you know, you're a small business and yeah, you you could take a hit you can take a loan but wouldn't it be better if somebody covered it for you it's kind of like you You get a car accident you know, it was like that rental car where your car is getting fixed. You would like to get a new car that new car smell
26:11 Yeah, cyber liability insurance is absolutely critical for small business every this statistic might be a little bit old, but I will pull it out anyway for just as an example 60% of small businesses will go out of business within six months of a data breach without live liability insurance. So that's an I know that statistic has gone up it's a it's a little stale, but I think that's about a year old and every year they put out new stats I just haven't brushed up on my statistics today. But
26:41 well that is true because as many business owners as I talked to in everything, you would not believe how many of them I've had friends that had successful businesses and everything was going great. They got hacked, and they just couldn't recoup the money that they need it breaks my heart because they never thought it would happen to them because they weren't trading money they weren't doing anything like that. It was just common goods like e commerce that they were just like, yeah, and then something happened.
27:09 I mean, I get a call at least once a week from a crime business person literally tears I don't know what am I going to do? I have a little bit of a policy or something. It's like a rider on my my general liability policy, but now it's going out because it runs out like that and so quick, and they're like now what do I do? I don't I don't have an answer for them. They're gonna have to you know, they have to pay for it out of pocket. A lot of them can't It is really heartbreaking.
27:37 Yeah. Oh my goodness. Well, so you know, we talked about some issues facing businesses today. basics for cybersecurity, the need for cybersecurity liability, which I am in the process of getting after speaking with Celli a couple of weeks ago, so I'm there I'm doing it I'm in. You don't have to I You don't have to tell me twice when it comes to important insurances, I will get it. So is there anything else that you guys wanted to let the listeners know when it comes to cybersecurity for their businesses?
28:14 Um, I think the first thing that businesses need to do is take a proactive posture. So doing the technical things that Shelley's talking about, shoring up some of their legal obligations, like I'm talking about with, you know, appropriate privacy policies, contract language and things like that. The other thing is, they have to also be aware of their vendors, which I think is another big issue facing organizations if you look at data breaches, it's not caused by an employee in the company it's caused by an employee at one of their vendors. And so you know, it's a big issue and so I would say that for all small businesses, all of the technical aspects and then make sure your your legal, you put yourself in a legally defensible position because unfortunately, these things are going to happen. And you want to make sure that you not just survive but thrive after after an event like this.
29:09 Yeah, and I agree with Rebecca, those are the key things that you need to do as a business owner, but it's also helping yourself to educate been growing your business and I know at times it can be scary because like, Oh my goodness, I got to talk to a lawyer. That's more money. Oh, I gotta have someone you know, outsource it person. When I've had my cousin, he knows computers, he knows everything. You know, everything's going but if you're looking to move your business to that next level, and you're looking to flourish, you really just like anything else, you need to make sure you understand and you are doing what is required of you to do to help your business flourish.
29:53 Got it. Well, this was great. I mean, hopefully people listening to this, it will set a match under them. To get them to really take a look at this in their business because like you said when you're a small business owner you've got a million things going on. But this is super important and I think something that people really need to focus on so I thank you for bringing this topic to me Shelly and for bringing Rebecca on because I think this is really great and I do hope that all the listeners out there will now start to take a better look at their businesses and are they protected Do they have the right things in place so thank you thank you now where can people find you? if they have questions? If God forbid they have a breach and they need a lawyer or they need someone to help do an IT assessment of their business so where can people find you? So
30:47 I obviously have a website expand law partners com Also you can follow us on Twitter and on LinkedIn please connect you can connect connect with me personally and my business we put out for small businesses out there who have a lot of questions we are constantly pushing out different topics raising issues bringing attention to different ones so please act x Pam law partners connect with us and hopefully will will provide you with some of that information that Shelley was talking about
31:23 excellent Shelly Go ahead.
31:24 You can reach me at contango it calm is our website I can also link in with me you know I love to meet new people and I always like to offer any kind of advice or second opinions I can help with if I if there's anyone I can point you into the direction to you know help your business I would love to do that.
31:46 Excellent. Shelley is a great super connector for sure. So definitely reach out to them now ladies one last question and I asked everyone this is knowing where you are now in your life in your career. What advice would you give to your younger self?
32:01 see somebody asked me this I'm gonna have to steal from my prior answer was start my law firm earlier. I wish I had done it earlier. I cherish the time I spent at a large law firm but I love what I do now. I love helping businesses so this I would do it earlier. So amazing. I would become an ethical hacker. Love that. I want to change my answer. That's a great answer. I love it.
32:35 I love it. Well, ladies, thank you so much for coming on the podcast sharing all this vitally important information. I do appreciate it. Thank you so much for having us. Pleasure and everyone. Thank you for listening. Reach out to these ladies if you are a small business because you may need some cyber help. Thank you for listening, have a great couple of days and stay healthy, wealthy and smart. | |||
| 560: Dr. F Scot Feil: Eliminating Student Loan Debt with Multiple Revenue Streams | 05 Oct 2021 | 00:39:50 | |
In this episode, Physical Therapist and Educator, F Scot Feil, talks about understanding and eliminating student loan debt. Today, F Scot talks about the different kinds of student loans, his different revenue streams, and the value of having a diverse set of skills. How does the debt-to-income ratio affect student loans? Hear about eliminating student loans, managing multiple revenue streams, and get F Scot's most important piece of advice for students with debt, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about F. Scot Feil Dr F Scott Feil is a husband, a father, a physical therapist, a professor, and, most recently, an amazon best-selling author. F Scott is also a business coach and mentor, despite starting his journey as an English major before landing as a Physical Therapist. He is one of three co-hosts of the Healthcare Education Transformation Podcast, which aims at breaking down the silos between healthcare professions and trying to find best practices in teaching and learning throughout healthcare academia. His goal is to help at least 222 professors (one from every PT School at the time of publication of his book) and clinicians pay off their student loans quicker by using multiple revenue streams. If he helps some others with terminal degrees, or other healthcare clinicians, along the way, then it's a bonus!
Suggested Keywords Student Loans, Student Debt, Financial Planning, Education, Skills, Income, Revenue, Profit, Opportunities, Physiotherapy, Healthy, Wealthy, Smart
Resources: FREE PT Educator's Revenue Idea Generator Professors Of Profit Facebook Group
To learn more, follow F. Scot at: Website: https://pteducator.com Podcast: Healthcare Education Transformation Podcast Facebook: PT Educator Twitter: @FScottFeil_DPT Instagram: @PTEducator LinkedIn: F Scott Feil YouTube: PT Educator
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full Transcript Here: 00:02 Hey, Scott, welcome to the podcast. I'm happy to have you on. It's great to see you and to speak with you.
00:09 Yeah, Karen, thank you so much for having me. I'm a longtime listener, first time caller here. So this is exciting. I've been waiting to do this for quite some time now.
00:17 Yeah. And I'm happy to have you on. And today we're talking about a topic that is near and dear to many, many physical therapists. And that is we're talking about student loan debt, and not only talking about it, but how to maybe understand it a little bit better, and how to eliminate it. So let's start with some definitions. And what is the debt to income ratio? And how does that affect your student loans.
00:50 So, you know, I'm not a student loan expert, by any means. I'm more of an elimination expert. That's that's where, you know, my specialty comes in. So I've had to learn this stuff, too. And, you know, one of the best ways that I've gone about doing this is going to certified financial planners, especially once you understand student loans, and talking through, you know, where I'm at what what plan looks like, it's going to work for me, what are my plans in the future? What is, you know, my vision look like? You know, do I want to start a family, buy a house, buy a car, all those things kind of factor in to your big plan. And then from there, you've got to come up with a foundational blueprint or a roadmap that you're going to follow based on what your student loans are. So the debt to income ratio is very simple, you know, it's the amount of student loan debt that you have, right? over your current income, and you just, you know, do the math and divide, right? So, realistically, the highest that you would want your debt to income ratio to be is approximately 1.01. To one, right. So if you had $100,000 worth of student loan debt, you're making $100,000 salary. That's not a terrible debt to income ratio, right? Unfortunately, especially in the field of physical therapy, we're finding that students are graduating with 150 175 200,000 plus worth of student loans, and they're coming out and they're getting jobs at 65 75,000 a year. And those are some pretty risky debt to income ratios, right? those, those get a little heavy, because, you know, if you don't know anything about it, and you you have all this debt, and you've accrued this debt, that's just massive, your payments are going to be massive, right, your student loan payments, if you just do the standard repayment, mine started out at 1700 a month, right. And I only had 140,000, when I graduated, that was with two doctoral degrees. So you know, it was one of those things where I got a little nervous at one point, because I didn't even know that I wanted to use the doctoral degrees, the way they were kind of meant to be used. But then I kind of settled down talk to a couple people both both on the business side of things, and on the Certified Financial Planner side of things, and created that roadmap, I went from the generic, you know, repayment plan at 1700 a month down to the income driven repayment plan, which for me, looked like about 700 a month. And then again, after really doing a deeper dive with the Certified Financial Planner, where I was at in my life and how I was planning on attacking my student loans, we've finally got it down on the repay plan or the revised Pay As You earn plan. And that's about $135 a month. And that stretches it out over 20 years now. So the difference that I'm making between the, you know, 135 a month and the 700, I was paying, I can now take that and have more liquid assets to do something with right I can have more cash in hand to invest or to start a new project or, you know, to make payments on other stuff, you know, so it's taken me some time to kind of learn this stuff. And again, like I said, I'm by no means a student loan expert, but I am learning through the bumps and the bruises and going through it and being in the thick of things there. And realistically, like I said, the best way to learn about this stuff and what's right for you, because it's going to be different for everybody is to talk to a certified financial planner that knows about student loans. So that would be my first recommendation.
04:15 Yeah, and that is great advice. Great advice. I've been working with a certified financial planner myself. And it really, it's really great to have an outside view of your finances and everything that surrounds them by a professional who can go in and not be emotional about it, and not have biases built in because we all have emotions around our money and around our debt and our loans. And so it's great to have that outside perspective. Yeah, you
04:45 hit the nail on the head there, you know, especially when it comes to business and money. We tend to be very emotional beings and you really have to be objective when it comes to that. And that was that was you know, a big takeaway that I found when when starting up businesses and you know, figuring things out. I've had a bunch of deals in the last couple months kind of crumble and fall through and it's like, Man, that's a bummer. But at the end of the day, you realize it's just business like, it's not a big deal. Not personal, that, you know, can't get emotional beat up over, you just got to move on it's business, you know?
05:15 Absolutely. It's it. But I mean, it does suck.
05:20 It does. It does. And it's okay to kind of recognize that, you know, you know, exactly, but at the end of the day, okay, it's business. What's my next step? How do I pivot? How do I recover? What comes next? You know, I think that's really what entrepreneurs are doing these days is trying to figure it out, you know, just keep rolling with the punches until they, they get it right. Yeah,
05:38 absolutely. And now, you spoke a little bit about those different kinds of student loans. And so I'm assuming there are different approaches one can take, can you speak to that?
05:50 Yeah. So you know, again, like I said, I'm not exactly a student loan expert, there's several different kinds of student loans out there, the biggest thing to try to do, if possible, is not to privatized your loans, right, try to keep as many of your loans federal as possible, because the federal plans are the ones that work with you a little bit more, there's a little bit more give to them, right? You can restructure them a little bit. Like I said, I went from just basic repayment plan to income driven repayment plan, which is based on, you know, the amount of income that I would make as a new grad, down into the revised Pay As You earn plan, which, like I said, that one kind of starts you at a lower bracket. And year over year, as you make a little bit more, it creeps up a little bit, you know, but it also, again, it stretches it out over a longer period of time. So you know, they're their differences are time dependence, you know, how quick you have to pay him back. But you know, things happen, like COVID, right, and all of a sudden, the Federal plans have all kind of stopped, they put a, you know, a pause on them until the new year. So, you know, that's one of the ways that they can give you grace, you can go into a deferment plan, if you need a month or two, you know, though, they'll work it out with you, and they'll tack it on to the end or whatever, you know, there's just a lot of forgiveness. And then at the end, there's a big forgiveness. But with federal loans, you just have a lot more grace, right? Once you privatized the loans, you're stuck, that's it, they are what they are, and you've got to pay him back, there's, there's no getting rid of them, right. Because, you know, student loans are loans that we just, we can't go bankrupt on we can't, you know, get out of there just gonna be there forever until you pay them off. So, you know, it's super important to recognize the difference between a private loan and you know, a federal loan. So big takeaway there is try to keep as many of your loans federal as possible for as long as possible, because those will have the most options for payoff and forgiveness and forgetting, you know, you know, any sort of programs that are available that may come and go, right, there's the one program where if you work for a nonprofit for 10 years, right, X amount is forgiven. Now, there's been kickback on that saying that, like 99% of people don't get approved for it at the end, they cross the finish line, then all of a sudden, the finish lines moved, right. So you know, there's some fine, fine print, you've got to read there with all these. But you know, at the end of the day, most of the federal loans will give you a certain time period. And as long as you make your payments all along that time period, at the very end, there will be some form of forgiveness. Now, the only caveat with that is the way you're forgiving those loans is you get taxed on the amount of forgiveness as if you made that income that year. So, you know, for me, it'll probably be a 20 year repayment plan, at the end of those 20 years, I'll have $100,000 left, it'll be forgiven. And then it'll be like I made that extra 100,000 on my salary that year, so I get taxed on it. So in those 20 years, I have to come up with some sort of plan to save up and to make money to repay that one year, when I have that influx in salary, even though it wasn't there. It was a loan forgiveness. So just something to think about there, too, when you're planning out your loans and your repayment plan.
09:04 Yeah, yeah, I don't think people realize that you have to pay taxes on that loan that is left. So each year, you want to make sure that you're putting money aside and putting money aside so that you're in an account that maybe you can't touch so that when it comes you're not like, Oh my gosh, where am I gonna get this money from, but you're like, Oh, I know exactly where I'm gonna get it from. Because I have this account of money I haven't touched for 20 years, you can pull it out from there. And that can be like, it doesn't have to be a savings account at the bank. Exactly. That could be an account that is actually generating, maybe, you know, 4% or something like that, right? So you're making money on it, especially if your loan is only like 2.3%. So you could take that money that you would be paying toward that loan, put it into an account that's maybe making even if you're making 4% You're still making money on on that money in there so that when the time comes to pull it out to pay your taxes, is number one, you're not penalized. So it's not like you're putting into a 401k plan or an IRA or something like that, but just putting it into some sort of an account that can make you some money on the way.
10:12 Exactly. And that's where a certified financial planner comes in, because they can set you up with a savings plan over those 20 years that can get 810 12%. So you're actually saving a ton more money, and you're paying way less when it comes to it. And the you know, the rate the APR is, is even lower. So I don't, I don't want to throw out a bunch of like, you know, terms and, you know, definitions and stuff that are just kind of boring and not very sexy, to be honest with you. But we do have to kind of know a little bit about this stuff. You don't have to be an expert. Again, I'm not. But I know enough. Now I'm educated enough, because I took the time to talk to that certified financial planner and figure this out and sit there, it only took maybe an hour or two, to sit there with them and go through the plan and look at it and say, Alright, here's where I am. Here's my goals and plans. Which program is best for me. Okay, great. Let's get on that program. And then you know what, now let's figure out how we're going to pay it out. You know, and there's several different ways to do that, too. Right? You just have to come up with that number at the end of those 20 years. So how do you want to do that? And, you know, that's where my expertise kind of comes in? Is the elimination part of it? Yeah.
11:17 Yep. So let's talk about that. Let's talk about how do you eliminate that debt. And I know one thing that you speak about is having multiple income streams, I'm sure that's part of this conversation, but I'll throw the mic over to you. So you can talk about the elimination part. What does that mean? Yeah, so
11:33 originally, when I wrote my book, right, peak educator, student debt eliminator, I thought I could just start a side business or to write and make a bunch of money, and then throw all that money that I made toward the student loans and pay them off in a year or two and be done. That was my plan. And realistically, I probably could have done that, I probably could have knocked them out in about three to five years total, and been done. But that's kind of what the banks want you to do. Right? That's what these loans, processors wants you to do. They want you to pay all your loan off as quick as possible. So they get all the money and make all the interest, right? Well, after talking to the Certified Financial Planner, I said, Okay, well, if my loans are gonna go down from you know, 700 a month and 135 a month, that leaves me a good extra chunk of money that I can do stuff with, right? And he's like, Yeah, absolutely. He's like, in truth be told, as long as you're putting your a lot of money every month into your savings plan, or whatever, you know, investment plan, if you will, to pay off that 20th year, you can do anything with the money, right? So I figured, okay, well, could I invest it in stocks? And he's like, yeah, you could do that. I said, What about crypto? And he said, you could do that? What about real estate? Can I do that? Yeah, absolutely. So that's been kind of my plan is like, Okay, let me start a couple of side businesses that generate income and revenue for now. So that I can put it toward investments that don't kind of take me on the long term. Right. And I think realistically, you know, I think almost every millionaire has several different streams of revenue, right. And I think that we need to start thinking about that, as soon as we either enter grad school, or immediately after we finish grad school, you know, what is our plan for long term wealth? Right? How are we going to take care of ourselves, as well as our family, you know, that might not even exist yet. As well, as, you know, future generations, you know, we're talking generational wealth here. And it's not like, you've got to be a millionaire, right? But you know, a couple of six figure incomes, that can help a lot of people, right? I mean, you can take care of a family, or two or three down the line, even, you know, making several six figures over the course of many, many years, you know, and then if you invest it, right, you can put it in places, like we talked about, like rental properties, or something like that, where, you know, once those pay off, the mortgages are done on those in 15 or 20 years? Well, now you're going from making two or $300 a month in rent, up to, you know, 18 or 2000 a month, per per house, right? And that's where you get into that generational wealth. So, you know, for me, it started out as a simple mobile PT practice, right? I was by myself in a car with a table and some sheets and a bag with some equipment in it. And I was just driving around, you know, Waco, Texas, just kind of helping people in their homes or their offices or the gyms. Because I knew I could do that. I knew I could start that business, right? I had enough expertise in the physical therapy world to be able to run a small practice on my own. And I didn't really want to be tied down to the brick and mortar. I didn't want to have a high overhead. I didn't want to do any of that, you know, so I just started my own little business. And it started out with a crossfitter, too, you know, and that was not my demographic. It was just people in the community that I knew that asked if I can help, and so I did. And then Luckily, one of the women that I worked with, her husband had some shoulder and elbow issues and he was a big tennis player. So she said, You treat the arm in the elbow and choice it. Yeah, absolutely, I can do that. So once I started talking with him, he's a CEO of a small business in Waco there. We got him better, we got him back in the tennis court, he was feeling great. And so then he started referring me to all his other CEO buddies, and the CEO buddies and C suite level execs, right, and all these busy businessmen and business women. And it was great because I was I was selling them time, right, it wasn't so much about the physical therapy, or whatever it was, it was, I was buying them back time because I could come to their home or their office or their gym, and they love that. So it was just the right niche for me in the right, you know, they had expendable income, most of them because they were, you know, own their own business. So it was a really good group to get into, and a really good niche to break into. And, you know, word of mouth spread. And that kind of took off? Well, once that kind of happened, I really started having to figure out how to like market myself better, and how to do some, like digital marketing, you know, Facebook ads, Google ads, stuff like that. And I just didn't know that I didn't have that skill set, you know. And so I had to take a course in that and learn from it and kind of invest in myself. But once I did get better at that, you know, I even took a copywriting course and read a bunch of copywriting books as well. And once I started getting better at that a bunch of my buddies that I graduated PT school with saw what I was doing with Facebook ads, and they said, Hey, could you do that for our business? And I was like, yeah, I'm sure I could probably figure it out. They said, We'll pay you and I was like, Okay, great. That sounds awesome. You know, and that's where my agency kind of started, right. But one of the second pillars of revenue for me. You know, I kind of started a little bit of a digital marketing agency unintentionally. And so I did that for you know, that a year or so. And that even brought me outside of the field of physical therapy as well. I did it for a couple local businesses, some home renovations, some roofers, pool builders, stuff like that. And it was really working pretty well.
16:58 And then, you know, COVID, started hitting and things kind of got a little crazy. And I was still working full time in the clinic, too. And so with my wife being a type one diabetic, and already being immunocompromised, I had to kind of step back from that a little. And I stepped away from the clinical side of things. And that same week, the head of the program at university, St. Augustine emailed me and said, Hey, are you still interested in teaching because I spoken to him at the ETD graduation in 2018. And, you know, I said I wasn't, but now it's actually looking like a pretty good option. So I stepped out of clinical work, I headed into academia. And while I was doing that, you know, it really became a good fit for me, because, you know, I talked online most of the time, and then I had to go up and be there for labs. But it also gave me a lot of free time to work on my side hustles, and my side businesses, you know, and that's kind of how I fell into the consulting gig as well, like, that wasn't something I ever thought I'd be doing either. But I worked for workman's comp company as well up there in Waco. And I said, Hey, we should be educating these businesses to injury prevention and wellness and how to properly lift and ergonomics and all that. They said, Oh, no, we're not going to do that, you know, that's gonna eat into our PT numbers. And I said, No, it won't. Because I can't stop somebody from running over someone's foot with a forklift, it's gonna happen, accidents are gonna happen, you know? And they said, Well, no, we're not going to do that. So I said, Alright, fine. I'll do it myself, you know. And so I just went around to all the companies locally there that were sending us workman's comp people. And I said, Hey, would you like to lower your workman's comp numbers? And they were like, Yeah, sure. And so I go in, and I educate the workforce. And, you know, you can charge good money for consulting. I mean, I was able to charge you know, 1000 bucks to 1500 bucks an hour for two hours worth of work. So now it becomes a matter of, Okay, do I want to see patients at $200 an hour, which is a pretty fair rate for physical therapy, right? Cash pay at a network? Or do I want to work two hours and just, you know, educate these people and use my add my education background combined with my PT background, to kind of help them with injury prevention and wellness. Right. So again, it just kind of one of those things that fell into my lap, that wasn't ever something I thought I would do it just the opportunities were there. And I just kind of sees, you know, it was like, seeing like these opportunities out there and just realizing that holy cow, this is where I knew I was fine. Having a PT, you know, DPT and an add, not necessarily wanting to use them even though now I am, you know, more traditionally. But being able to leverage those degrees into other opportunities. You know, I'm not a huge believer in luck, I kind of feel like you make your own luck, you have to work hard and you have to network and leverage, you know, with the right people at the right times about the right things. And then you'll start seeing those opportunities, you know, kind of open up and you have to be ready to jump on those opportunities when they present themselves. So, you know, that's, that's kind of where a lot of these streams of revenue started from. It just kind of happened, you know, and I fell into them and I got better and better and better at it. I went, and then I was able to help more people with them as well.
20:04 Yeah, it sounds like you've gone from one to the next to the next to the next, which is, which is good. You're sort of keeping yourself open and you're learning and, and understanding like, Hey, I don't know how to do this. So I'm going to educate myself and learn a little bit more, and be able to do things that may not be at face value, what you went to, quote unquote, school for, but yet they are.
20:32 Yeah, I mean, we learn so many amazing skill sets throughout grad school, you know, whether it be the DPT program, or the ed d program, systems, right processes, standard operating procedures, things like that, like clinical development, and, you know, clinical thinking skills, critical thinking skills, all these things that we learn, are a lot higher level than a lot of the general public already know and deal with. So we can help by kind of bringing those things down and simplifying them, just like we would talk to a patient, right, if you're using layman's terms, you know, and I think the key here is to realize that we have a lot of these skills already, you can keep one foot in the healthcare boat already. Or you can diverged and go a different route. And you know, some of these skill sets, you're gonna have to learn because not everybody's, you know, born a natural with a lot of these skill sets. And that's okay, I've done that. But it's a good combination of taking as much as you already know, and pushing in on that. And then adding and supplementing a little bit here and there, when you find that you need it. You know, and that's where I think taking courses and paying for mentors, and doing all that stuff speeds up your timeline a little bit. You know, and that's why I'm a big believer in that I've had many coaches, many mentors over the last couple years, and they've totally sped up my timeline and showed me mistakes that they made and made sure I didn't make the right, you're still gonna make your own mistakes, there are a lot of them are going to be different than what your mentors went through, right? That's totally normal. But it's, it's realizing that they're not failures, they're just learning opportunities, you know, and I think we as pts are really good at being lifelong learners. And so it really shouldn't be a problem to dive into a skill set you're not familiar with, and just, you know, put your ego aside and being like, Alright, I don't know this, I need to learn it, here's a good resource, here we go, you know, just keep kind of attacking it until you get it right. You know, and I think at the end of the day, these multiple revenue streams now that are kind of growing are great, I love them, I'm very passionate and energized about them. They're definitely like passion projects for me, you know, and zones of genius for me, but it's a good way for me to get an outlet of creativity, I think, because I was an English major before I was a PT, right. So, you know, that to me was was a big transition in itself. But that's also helped me monetize blogs, monetize my book, right? monetize, SEO, and email sequences and copywriting. So, you know, again, all those things kind of fall into that consulting, revenue stream. But, you know, I had to learn how to adapt that English major into copywriting or into email marketing, or whatever it may be, you know, and I think the one key takeaway that I've had with all these revenue streams, is you've got to do one at a time, and you've got to get it flowing. And then you can step on to the next stream of revenue, then get that up and running, then get that flowing. And then step onto the next one. And again, you know, if you don't do that, you're going to fall for that shiny object syndrome, right, and you're going to be kind of chasing around, Ooh, that looks cool, that looks cool. I could do that, oh, I could do that, oh, that person's doing that, Oh, that looks really good. They all work. And you can do all of them, for sure. But you've got to get one down first, and then move on to the next and there's going to be you know, arguments and debates over what number is the right number to walk away from the first one and go on to the second one. I don't think it matters, I really don't just get it up and running, make sure it's making you some money, make sure it's profitable. And then when you're ready to step on to the next project, you're still gonna go back to the first one, you know, you're still who knows, you may even hire somebody to take over that portion for you. You know, but just knowing that there's multiple opportunities out there for physical therapists for healthcare providers, I think it's a great stepping stone for you to kind of open your mind a little and get out of that nine to five clock in clock out clinician mindset, you know,
24:15 and where are you now with? How many streams of revenue Do you have at the moment? And if you could put it in a pie chart, what is what makes up what? Because I think people would really be curious as Jeff, you mentioned a whole bunch. So where are you now? And what does it look like?
24:32 So I essentially what I teach, you know, all my students, I have what's called the feelgood method, right? Which is not just a clever play on my last name. It's also you know, how I make my students feel good about staying organized with their streams of revenue, right. So there's an umbrella on top and that's your holding company, right? For me, it's feelgood industries. pllc. Texas recommends if you have a professional license that you get a pllc it's different for every state. But, you know, doctors, lawyers, dentists, they all have pllc Alright, so since I started as a mobile clinic, I started as a pllc. then underneath that I had about four or five different revenue streams or tubes of revenue, that each of those was a DBA, or doing business as underneath the pllc. Eventually, I'm probably gonna have to turn some of those into their own individual LLC and make the pllc an actual holding company, but I'm not there yet. So, you know, with each stream of revenue, like I said, I have a couple little numbers next to each stream. And those are the checklists, things that you have to get done in order for that stream to start running. So I made a shift recently, because of my changing career, you know, like I said, the goal is to try to, you know, kick the bucket of the nine to five and do your own thing, you know, and go all in on entrepreneurship and your own business eventually, right? That's the hope. For me, my story's a little bit different, because my wife is a type one diabetic. And we need not just medical benefits, but good medical benefits, right? My nine to five might always be there. And I'm okay with that. I've learned how to kind of find the best possible job with the best possible benefits. and academia has afforded me that right now. So I'm able to do that, you know, at a little bit lower rate of like 32 hours a week instead of maybe 40. And that gives me more time then to work on the businesses. So while I was doing a lot of the mobile PT at first, that's kind of decrease now, because like I said, it's like, do I want to treat patients for $200 an hour do I want to do consulting at 1500? An hour, right. So I would say overall, you know, I've got the mobile business, I've got my online business and PT educator Comm. And then I've got my consulting, business, FTI consulting, and those are kind of the three main revenue streams. Now in those revenue streams. There's probably, I don't know, three or four different services, if you will, that are offered. You know, the consulting can be anything like injury prevention and wellness, because I've got that systemized. And I've got templates for that now where I can just come in, do the tour, see what's what, and then put together a presentation overnight. And then that also will have my copywriting little digital marketing. It'll have you know, Facebook ads, Google ads, it'll have copywriting, email, all that stuff underneath the consulting. And those I can charge, you know, for just one little piece, or put together a package where I'm like, Hey, here's what you need, here's what I recommend, you can go ahead and do it based on my outline, or if you need my help, here's my price, right, my fees. And then PT educator comm is just like I said, my online site where I do a lot of my blogs, I have a lot of the courses for sale and stuff like that. And that's just really to kind of keep me up to date on my writing. And, you know, my blogging skills and stuff like that just recently passed them the mark for 1000 subscribers and 4000, watch hours for YouTube. So I cannot monetize that as well. So the vlog cast, which I do one episode a week of an interview with somebody who's done that particular side, hustler side gig, starts out on YouTube, and then eventually makes it to the podcast in audio form. And that actually, the podcast hasn't even come out, that'll start September 1. With the first few episodes, I'll probably release three or four and the first one, and then do one a week after that. So if you want the new fresh content, you go to YouTube and watch the video if you want to catch up, you go to the podcasts. But if we're if we're giving it a breakdown, you know, I would say we're probably at about 60% of consulting at this point. And coaching, I kind of put coaching underneath that as well. And then I would say, you know, the the online business is probably about 30% at this point. And then treatment is just at this point, word of mouth, close family and friends here in the Wimberley area, you know, 10%? If that?
28:54 Yeah, got it? Yeah, I think that's really helpful for people to hear so that they're like, wait, I don't understand how, how is someone doing all of this at one time? Do you know what I mean?
29:03 Yeah, and let me make this clear, too. So 32 hours a week is still dedicated to my full time job and Right, right. So that gives me maybe eight hours extra to get to a 40 hour week, and then I work 50 or 60 hours a week, there's you know, I love that stuff, though. I would do that for free if I could all day every day, because that's what gets me excited, you know, the passion projects, helping people figure out a business model. So you're, you know, figure out what they can do for side hustles and side gigs. Even if it's just making an extra 500 bucks, you know, a week or something like that, you know that that could be huge for somebody who's having to pay 2000 bucks a month for student loans, right or 1500 bucks a month for student loans. So if we can figure out a side hustle or side business to get you started, at least, maybe you grow it big enough to the point where you can walk away from that nine to five and that's great if that's what you want to do. You know, but but I'm also to the point where I was working 60 or 70 hours a week for someone else and trading time for money and just wasn't cutting it. So I've scaled back, I've been able to, you know, increase my value on certain things and, you know, raise the prices on things enough to where I'm working less time and making more money. So it's like PRN rates don't even, you know, don't even cut it for me anymore. It's not even something I would look at. It's just not worth my time, because the money's nice, right. But the time freedom is really what you're looking for, I think, you know, I think people are, are looking to claim back a lot of that time with their family, not having to work weekends, not having to stay, you know, all hours at night at an outpatient clinic, doing notes and trying to, you know, stay on top of things. So, I know I've been there, man, it's a grind. And, you know, it's nice to be able to use my add and teach and to use my DPT and use that knowledge toward you know, something as trivial as a fantasy football injury course, right? That was one of the first courses I ever made. And then, you know, video gamers eSports, I did an Esports ebook on injury prevention for gamers, right? Like, that stuff is just fun to me, you know, I love that stuff. And we can use our knowledge to help those people and solve those problems. So why not do that? Right? Why not find a hobby or something you like? And just go all in on it, you know, and use your knowledge to help people. You know, so that's been a big a big finding for me over the last year or two, it's just that, you know, you don't have to work as hard. You know, you can scale back, you know, charge what you're worth, and make a lot more money in a lot less time. You know?
31:29 Yeah, that all makes sense to me. And what would be your says, we kind of come come to a close here, what, what is your biggest, your most important piece of advice for people listening, if they could take one, if you were like, oh, man, if you just took one thing away from this talk, this would be it.
31:51 Yeah, I think physical therapy or your profession, your career just has to be the tip of your iceberg, right? I mean, again, like I said, we as physical therapists can do so many things, we can help so many people, and it's like, if I go and treat a patient, you know, one on one, that's great, that one person gets better in that hour, maybe times eight hours a day, there's eight people, right? If you want to have a bigger impact, and you want to affect more people, right? Then maybe you coach somebody or teach somebody, you know how to start their own business. And now that person's treating, you know, 50 people a week. So now you're impacting 50 there, and the few that you were teaching, then you coach somebody else on something else, and they're helping, you know, 20 businesses, you know, with their patient intake model, and they're, you know, they're doing things, you know, at a higher rate. So now you're helping 20 businesses with 50 patients each, right. And so I think more impact can come if we realize that we're more than just a physical therapist that goes in and treats eight people a day, or 20 people a day, or 30 people a day, or whatever you're treating, right? Like we can do so much more. And we just need to think outside the box a little bit, you know, and be a little bit more than that nine to five clinician that clock in and clock out, you know, and then again, by having a bigger impact by helping more people, right, and then coming at it with a servant's heart. Money is just a byproduct, you can then take that money and pay off your student loans quicker if you want or invest in things that are going to make you more money down the line so that you can pay off the student loans, should you want to do it over a longer period of time. Either way, you know, it's just about opening your eyes and seeing that there's a whole lot more out there than just you know, going to outpatient clinic every day and seeing your patients.
33:29 Excellent, excellent advice and great takeaway. Now, where can people find you if they want to learn more about you what you're doing and how to get in touch with you?
33:37 Yeah, sure. So all of my tags are pretty much at p key educator on all the social medias. And then the book is on Amazon. It's available in softcover. And in Kindle, it's called PT educator, student debt eliminator, multiple streams of revenue for healthcare, academicians and clinicians. definitely have a second edition coming out pretty soon. So check it out, out while you can. You know, I'd love to see people hop on the second edition as well, because there are a couple of key changes with all the stuff that's going on nowadays, with cryptocurrencies and, you know, all sorts of investing strategies and stuff like that. So I'm still learning, you know, lifelong learner for sure.
34:13 Absolutely. And last question, what advice would you give to your younger self, knowing where you are now in your life and in your career? Yeah.
34:22 Don't Don't worry, as much, you know, just leverage the heck out of your, your career and your degrees. You know, use them to do what you want to do and what you enjoy doing, you know, leverage the heck out of it, you'll be fine.
34:37 Excellent, great advice. I've heard that many times on this show. So, Scott, thanks so much for coming on. This was great. I think you really gave people a lot to think about and some inspiration on maybe how they can use their passions and and think outside the box a little bit. So thanks for coming on.
34:57 Absolutely. Thank you, Karen. It's been a pleasure.
35:00 Absolutely and everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart. | |||
| 559: Dr. Lisa Folden: Diet Culture and Fat Phobia in Healthcare & Physical Therapy | 30 Sep 2021 | 00:38:17 | |
In this episode, Physical Therapist and Owner of Healthy Phit Therapy & Wellness Consultants, Dr. Lisa Folden, talks about diet culture. Today, Lisa talks about the pervasive nature of diet culture, how to reconcile diet culture with physical therapy recommendations, and how to support patients who are on their weight loss journey. What is diet culture? Hear about weight biases and phobias and how to deal with them, the Health At Every Size movement, and get Lisa's advice to her younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaway
More about Lisa Folden Dr. Lisa N. Folden is a licensed physical therapist, mom-focused lifestyle coach, and the owner of Healthy Phit Physical Therapy & Wellness Consultants in Charlotte, NC. As a body positive women's health expert and health at every size (HAES) ambassador, Dr. Folden assists women seeking a healthier lifestyle by guiding their wellness choices through organization, planning strategies, and holistic goal setting. Dr. Folden is a mom of three, published author, and speaker who understands the complex needs of the modern busy woman. Therefore, she considers helping busy moms find their 'healthy' as one of her of top priorities. Dr. Lisa is a regular contributor to articles on topics related to physical therapy, health, wellness, self-care, motherhood, body positivity, and pregnancy, and has had the distinct honor of being featured in Oprah Magazine, Shape Magazine, Livestrong, Bustle, and several other local & national publications. Additionally, she is a member of the National Association of Black Physical Therapists, the Association of Size Diversity & Health, The Know Women, Alpha Kappa Alpha Sorority, Inc., and serves as an expert panelist for H.E.R. Health Collective (2021).
Suggested Keywords Diet Culture, Weight Loss, Body Positivity, Acceptance, Stigma, Body Size, Fitness, PT, Physiotherapy, Symptoms, Healthy, Wealthy, Smart
Resources: Health At Every Size Community
To learn more, follow Lisa at: Website: https://www.healthyphit.com Facebook: Healthy Phit Twitter: @HealthyPhitPT Instagram: @healthyphit Pinterest: @HealthyPhit YouTube: HealthyPhit PT
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full Transcript Here: 00:02 Hey, Lisa, welcome to the podcast. I'm happy to have you on today.
00:07 Thank you so much for having me. I'm so excited to be here.
00:11 Yeah. And today we're going to be talking about diet culture, in health care, and specifically in physical therapy, which is not something that I've ever spoken about on this podcast. And so I'm really happy to have you on to talk about this. And I remember speaking with Dr. Lisa van who's, and we were talking about biases in health care. And she said, one of the more accepted biases in health care is against overweight people. Yes. And so I'm happy to have you on and dive into that a little bit deeper. And so let's, let's talk about first diet, diet culture, you know, its impact on our not just our physical health, but also our mental health as well. So why don't we first start with what do you feel diet culture is? Let's define that.
01:13 Sure. So it's nuanced, of course, but essentially, diet culture is it's this pervasive thought process that we're kind of born into, that fosters the belief that we're never like enough, we're never thin enough, we're never healthy enough, you know, we've never gotten it right. And so it feeds into, you know, this multibillion dollar industry that says, you know, buy this tea, by this waist trainer, by this weight loss program by this because you always need to be getting smaller, shrinking yourself, doing something to change yourself, because, you know, you couldn't be healthy, you know, there's no way you're healthy, especially if you happen to be someone who was born into or developed into a larger body, there's no way you're healthy. So diet culture is sort of the constant reminder to you that something's wrong. You need to fix it all the time. And it's a deep part of our healthcare system. It's a deep part of, you know, like Hollywood and television, things we watch every day. So it's it seeps in without anybody really knowing that it's happening. And it's so common and so accepted, that we just look at it as you know, health, like a lot of things that are really diet culture, a lot of us would just look at as Oh, that's health, that's fitness. And it's and it's not, because it's actually corruptive. And it, it breaks us down. And it's not good for our mental health or for our physical health. It results in a lot of weight cycling and bingeing and restrictive in disordered eating. And so, you know, it's really bad. I mean, that I don't call a whole lot of things good or bad, but diet culture is one that I kind of just categorize is bad and unnecessary,
02:53 really. And so looking at that through the lens of a physical therapist, how do you reconcile that culture with what we do as physical therapists, because so often, if someone is, let's say, an example, someone is coming to us with osteoarthritis hips, knees, one of the recommendations is weight, weight loss of whatever that weight loss is, I don't think the recommendation is to be a size zero or two. But that recommendation is weight loss. So how do you? How do you kind of blend these two this diet culture, which knows very bad, but yet, in certain populations, it can be helpful to take off some weight to unload those joints. So how do you reconcile with that as a PT?
03:40 Yeah, that's a great question. And it's obviously something I've had to kind of deal with head on as a physical therapist still treating in the clinic. You know, like I said, in the standard outpatient practice. So here's the thing, there's physics, right? physics exists, when there's more pressure, you know, from gravity and weight, you can feel more pain. Like that's, that's a fact. But there's also, you know, this idea that we all have different sort of thresholds for our pain. And, you know, you know, like, I know, you can look at someone's, you know, x rays to people, and they can have identical things happening there, you know, at the structural level, and have completely opposite symptoms, one with severe symptoms and one with none. So, when I address the issues of pain that could be could be contributed to from weight, I just, I approach my patients from the lens that even if weight is causing some of the issue, the reality is the research shows that what weight loss doesn't really work for most people. 95% of people who lose weight, gained it all plus more back within one to two to three years, and they don't really have research beyond the five year point because nobody typically makes retains it. So the reality is, even if if you know if that is the suggestion, that's kind of what we've been taught as physical therapists, I know that it doesn't work. So I'm not helping my patients by saying, hey, you really should lose some weight. So I approach it from the lens of I'm going to treat them as if this osteoarthritis, this this issue, whatever they're dealing with, has nothing to do with their weight, and everything to do with all of the other possibilities in my toolbox as a physical therapist. So are we dealing with, you know, restricted, you know, soft tissue, tight muscles, you know, imbalances, muscle imbalances, are we dealing with, you know, just lack of flexibility and other things, can I do some manual therapy that can help, like, what other things can I do, because even if weight is a contributing factor, me telling them to lose weight is in the long run, not going to help them because for like I said, most people aren't going to maintain that weight loss any way, or if they ever achieve it in the first place. And it can be so daunting, when people in larger bodies go to health care professionals, and no matter what is going on with them, if they are in a larger body. The suggestion is weight loss literally across the board, not just you know, in our profession with, you know, things regarding the joints and osteoarthritis, you know, other things like that. It's literally everything, I'm having stomach pain, lose weight, I'm, you know, they literally here for everything. And so I just don't want to be a part of that. And I don't think I don't think that it helps our clients to get better in the long run.
06:28 Yeah, and it, might it add one more thing to this person's plate, so to speak to maybe, then they will say, Well, I'm not even gonna go back to this PT. Yeah, is there a way to meet people where they're at, and through exercise and other modalities, if they were to lose some weight great, not make that the singular focus?
06:54 Absolutely. And that and that's just what it is. Because, you know, adopting new health behaviors is good for everybody, whether you lose weight or not. And you know, just just just increasing the synovial fluid in the joint from, you know, more activity can be great, you know, so weight loss really is a byproduct that some people will experience and other people will not. And, and coming to terms with that has been a journey for me as a professional, and then in my own personal life and my own, you know, struggles from the past with weight loss and diet culture, but it's really freeing, and it helps people eat, I can just this year alone, I've had at least four clients, all of them were women, but they all had the same story, like severe trauma, from interacting with other healthcare professionals, like figuring out something's going on with them, and then being told, like, Oh, yeah, you just got to get that weight off, you just got to keep that weight up, and just kind of hearing it over and over again. And so coming to me was like a, sort of a breath of fresh air for them. It's like, you're the first person, it's like, not telling me I need to lose weight. And it's like cash. Like, I couldn't imagine that being the discussion. Every time I go to the doctor, every time something's bothering me, you know, as if to say, thin people, and people in larger bodies don't experience some of the exact same diagnoses and issues, you know, if weight were the problem, then that would be the situation then people and, and fat people would not have the same diagnosis. And we know that's not true. So yeah, you're right, it adds a whole nother layer of trauma that they have to deal with.
08:28 Yeah. And, and sticking with that theme, let's go into some of the the biases. So the weight bias, fat phobia and healthcare, we could talk about PT in general, like I said, and speaking with Dr. van Who's she sort of said, Hey, listen, this is apparently one of the accepted biases that you can have, you know, so let's talk more about that. Go ahead. I'll give the mic over to you and just kind of what's the situation on the ground here?
08:58 Yeah. And, and she's, she's right with that. It's like, it's like the legal bias. It's like it's okay. And, and even people, what's disheartening to me is interacting with people in larger bodies, they often will just accept it, because it is the norm. And they begin to believe that inherently something is wrong with them. They haven't figured out the magic formula, they're not doing something right. And so there's something wrong with their body. And they're almost Okay, in a sense being discriminated against or dealing with the biases because it's just so much a part of what we do. So it you know, it shows up in everything, like literally from the time you're born. You know, I had a great discussion on my Instagram with some people we were talking about, I did a summer body challenge. So I had everyone like, put on a sports bra and black bottoms and just show it and be proud of your body and we said it was the Being confident and proud of my body this summer and always, you know, not feeling like I gotta lose weight, two summers coming, you know, warmer weather doesn't mean I have to get to the gym and lose some weight or cut back on my calories. And a recurring theme in those conversations was just this idea that like, it starts at home, like my mom, you know, said, Oh, you're putting on a little weight, or you're getting a little chubby, or it's, it's this pass down fat phobia, it's like, do whatever you do, don't get fat. And it's like, oh, my gosh, we, we think we literally think in our society that no one should be fat. And if they are fat, it is because of poor health choices. So we create this hierarchy, where I'm better than you, I must make better health choices in you, because I am thinner, and you are fatter. And it just couldn't be farther from the truth. Because, you know, we, a lot of us like to believe we have a whole lot of control over the size, shape and weight of our bodies. But so much of that is genetic, you know, so much of that has a genetic component, we only have so much control. And even within the window of our control, without going into disordered eating patterns, it's still a very small, you know, amount of change that you can expect to see. So, you know, we hear it from our parents, we hear it at home, we see it on television, you know, when you get on a plane, and the seats are barely big enough for an average adult, you know what I mean? Like, barely, like we're squeezed in there. So imagine that humiliation, you know, as someone in a larger body having to either buy two seats or figure out how to squeeze into that seat. You see it in doctors offices, there's small seats and doctor's offices, even though we treat a huge variation of people in their body sizes, the lobby looks like everybody should be the same, you know. And so those are, you know, things that I want to see changed and considerations I want to see being made, especially in healthcare, because, you know, we we have the privilege of working with people, you know, from largely diverse communities, especially as it relates to their size. So, at the very least, that should be a comfortable experience, you know, you're going to your doctor should be a comfortable experience, you're going to your physical therapist, it should be a comfortable experience. So yeah, there's more I could say, but
12:36 I have a question for you that. So as a physical therapist, so let's say you're talking to you're talking to a group of pts about this, what advice do you have, that they can put into action to challenge these biases, and to make their spaces more inclusive?
12:55 Yes, that's a great question. So the first thing is to start within, and just avoid all of those assumptions that we like to make. So just you know, unlearning, that's where it starts like unlearning this idea that people in larger bodies are inherently unhealthy, or have inherently made bad decisions. Because one, it's not going to help you get them better, or make them feel better. And to it's not true for a lot of people. So getting rid of those, those preconceived notions about what someone in a larger body, you know, has going on, or what kind of health status they have. Also, if you're in a setting, where you have the privilege of sort of, you know, making decisions about the clinic setup, you know, thinking about the furniture, thinking about, you know, having things that are accessible, we think about this, and we're talking about people, you know, with varying levels of ability, if they're in a wheelchair or on crutches, you know, we think about making sure the doorways are wide and this and that, and height, adjustable seating and things of that nature, we should do the same thing for people in larger bodies, people come in different shapes and sizes, and we should do as much as we can within our power, you know, to accommodate them. The other thing is, especially when we're dealing with people who have dealt with the weight, stigma and all that trauma, we need to reassure them, we need to let them know like my patients are literally floored when I tell them like there's nothing wrong with you. You know what I mean? Like we have to abandon this thin ideal, like everybody is not gonna be thin, no matter how hard we work, no matter how hard they work, no matter how many calories we cut, everyone in the world will never be thin, nor do we need to be. It's okay to have variations in size. I truly believe in the concept of Health at Every Size, which is an excellent book by Dr. Linda bacon. But you know those things so I'm learning, reassuring your clients, you know, avoiding the assumptions. You know, there are people in large bodies that can do just as much as you can do or more, you know, but then when you do encounter someone in a larger body that is having trouble because of You know, their mobility issues or their body size, you need to be quick with the modifications, you know, we're good at that, like that. That's what pts do. So you know, give them the opportunity to try it full out. And if they can't, or you see them struggling, jump right in with a modification and you reassure them and you let them know there's nothing wrong with this, like exercise movement is for every body. And if you can't do it this way, well, guess what? I got another way you can do it, oh, that didn't work, I got another way you can do it. Or let's try this one. instead. It's, it's okay. And people need that reassurance. Because in the healthcare setting, especially if they've had that trauma, they're so nervous and so uncomfortable. And again, they feel like there's something wrong, you know, with them. And so, you know, we learn this in PT school, we treat the whole person, you know, we don't see a person and this is a knee, no, we're treating the entire person and all of that all of their preconceived notions, all of their trauma, all of their hardships that comes with them into the clinic. And so we have to figure out a way to work with them, ease their you know, their minds and give them the tools that they need to get better. And so I typically, I take weight out of the equation, I just, I assume that their condition is being caused by something other than their weight, and I treat them based on that
16:14 period. Now, here's the question, how about if you have a patient or client coming to you, who they want to lose weight, or they're in the middle of this weight loss journey, and they're committed to it, because they want to feel better? for themselves? Not for anything else. But you know, we're coming off of a really difficult year where a lot of people might have gained weight over COVID. And so how do you or how would you suggest PT support the patients that are coming to you, they're saying, Hey, listen, I, I'm on this journey, this is what I'm doing. I'm moving, I'm exercising, I'm eating better? How can you give them a little extra support? With out perhaps leading them into an extreme version of that?
17:04 Yeah, what I find in those cases, your role is more of a, I don't want to say a silent partner, but you're there for the supporting piece of it. But the goal is to not. Okay, I'll say it this way, I respect body autonomy. So essentially, I know the research, I don't think that, you know, chasing weight loss is a great idea, really, for anyone, despite COVID I know, people are like I gave the quarantine 15. I'm like, Listen, you're alive. That is such a blessing with the year we've had, you know, the year plus we've had at this point, so but I respect body autonomy. So if you believe like, this is not a weight I'm comfortable with I'm not, I don't feel good, I don't think I look good, I want to do something different, then by all means, go about, you know, the process that you feel comfortable doing, I am going to be here to support you by way of giving you evidence based solutions. So if you tell me, Hey, I'm doing this, you know, 30 day detox, I'm only going to be drinking lemon water. And shakes, I'm going to tell you, I don't think that's a great idea. And here's why. But ultimately, you are an adult. So you get to make all of these choices for yourself. Before I became you know, haze or Health at Every Size aligned and anti diet, I did, I did all kinds of things. And I would not have taken kindly to someone telling me, oh, you're wrong, you need to stop it. So people need to have the freedom to do what they want. And I just as a therapist, I just want to be there. And in my role as a health coach, I want to be there to support them, but provide them with the evidence that's out there. And then, you know, as they go through their process, I'm happy to fine tune, I love to give people workouts, you know, that's, that's what we do is PT. So yeah, I can give you some workouts. If you talk to me about like, I feel really weak in my glutes, I want to be able to do this or I want to be able to benchpress or daily, oh, I've got you, I can give you a great program, you can work on it, you know, we can follow up with me. But whenever you're talking about extreme dieting, and crazy restrictions and weighing yourself incessantly and you know, tracking your movement on your Fitbit all day, I'm gonna kind of bow out and give you the, you know, the freedom to do what you choose. But just let you know that I don't think that's going to really support your goals
19:26 overall. Yeah, and, you know, it's the same as as if we would talk about a return to sport after an injury. So we can help guide the patient through their rehab process. And when we get to that decision making point, it's a shared decision making point where it's you, the client, maybe it's a spouse, a child, a partner, the doctor, whomever might also be within that decision making framework, and exactly what you just said, You're giving the best evidence based information. You can to that patient, and then that patient can make an informed decision on what they can do next, or what feels good, what is the best decision for them? So I just want the PTS out there listening to understand that this is not unlike any other shared decision making that we would do. And it's not a you do what I tell you to do. Because we're biased against people who are fat. Yeah. Because you're overweight, you clearly can't make a good decision. Right? which is not the case. And it's maybe they need information to make a better informed decision, just like someone coming in after an ankle sprain or an injury or low back pain.
20:43 Yeah. And you know, and that that's a great point that you bring up because you're right, it comes up with injuries, people will Google it. And listen, I love Google, no disrespect to Google, I google things all the time. Know when somebody is coming in, and they're dealing with some type of injury or medical condition. And they're going solely based off Google. It's like, Yes, we have a responsibility as a trained professional to say, Hey, here's what I think you should really know. But ultimately, you're right, they they're going to have to make the call. You can't you know, get someone better in physical therapy, just you know, when they come to you, it has to be their follow through at home and their decision making. So that you're absolutely right. That's a great analogy, for sure.
21:27 Yeah. And now, you said this a couple times. But I just want you to talk a little bit more about the Health at Every Size movement. You mentioned it a few times tell the listeners exactly what that is, and what its significance is to diet culture.
21:43 So the health and every size movement is it was sort of tagged by Dr. Linda bacon. I don't really know the lifespan, how long it's been around, I don't think it's been before, like the 90s. But it's essentially a movement that believes in body respect, and body positivity or best body neutrality, and respecting and understanding that we're supposed to be different sizes. And we don't have to lose weight to be healthy, you can literally be healthy at any size. So it's it's really the antithesis to diet culture. It's everything that diet culture is not it's not a movement that is rooted in, you know, being sedentary and eating McDonald's every day. But it is a movement that's rooted in people making their own individual health choices, and and creating health habits that improve their health without any focus on weight loss. So the Health at Every Size movement sort of omits the idea of like, let me check my way, let me weigh in this week. Let me let me measure this week, let me see where I am. It's it kind of throws all of that out of the window. And so the book is actually Health at Every Size by Dr. Linda bacon, that was sort of my introduction to it. And it's been life changing for me again, personally and professionally. So I recommend it to essentially everyone.
23:03 Nice. And because I think oftentimes when people look at someone who's overweight, they think, oh, they must have heart disease. They must be a diabetic, they must have this, but you can have normal labs and be overweight. Yeah, yeah. So and I think that is one of the biggest biases not just in healthcare, but in society in general.
23:27 It is it is. And that is the premise behind Health at Every Size is recognizing that you can't look at someone's physical body and know what their health status is. And we're just so used to making those assumptions and it's so counterproductive to true health and it's so damaging, you know, to people, you know, I personally know people and my own personal story. I'm only 411 I know we've never met in person, but I'm very short.
23:55 A short and you come across way taller.
24:02 It's the hair.
24:04 The hair gives you an added oranges.
24:07 I am short. I've always been short. But genetically, my family my mom's side of the family, they're more like apples shape. So they carry weight in the stomach. They're usually just you know, they got big solid legs. My dad's family was a little bit more Hourglass OR pear shaped so very lower, larger lower bodies. And so literally my entire life here and I have never, ever, ever ever not been overweight. Ever according to BMI which is a whole nother topic but I believe it's trash. So I have always my entire life they considered in an overweight category. I have never had high blood pressure, high cholesterol. AB issues doing any physical activity I used to run once upon a time I ran 25 K's I've never had an actual health issue, but I have always been considered over weight, and that stigma because that you know, value was created by a mathematician, you know, that really even said that it wasn't supposed to be used to like actually measure health into BMI, the BMI. But because of that, being sort of what our healthcare system is run on in our insurance markets, kind of, you know, utilize for everything. I have never, for my whole life, I felt like something was wrong. It's like, I'm not running enough, I must be eating too much. Let me stop having carbs. Let me switch to this diet. Let me and that is it. You know, it's not just my story. That's a lot of people's stories, especially here in this country. And it's like, if we could just stop for one minute, and ignore the weight and ignore the BMI, and just focus on health activities, health behaviors that make you feel good. If it's walking for you, if it's running, if it's skating, if it's dancing, if it's height, whatever it is, for you know, joyful movement, that's kind of you know, that's a part of the Health at Every Size, mantra, it's like joyful movement. Eating when you're full stop eating when you're hungry, stopping when you're full, trying different foods and just living a life and, and managing the other aspects of your health, like your mental health, your emotional health, your spiritual health, if we could just focus on that, instead of the scale, or the measuring tape, BMI, we will be so much healthier. So so so much healthier. So yeah, I, like I said, I could talk about BMI forever, but I just I really, I love what health and every size stands for because it, it's really about valuing body diversity, that's what it is. Because the bottom line is, we're not all going to be the same size, we're not all going to be thin, we're all going to have different dimensions, and our bodies will change over the course of our lives, age, stress, hormonal things, pregnancy, you know, all kinds of stuff. And so we have to get more comfortable with that fact. And not try to create this, you know, there's the whole snap back movement with pregnancy, like, have a baby lose the weight. It's like, wait a minute, let's just be you know, let's adjust to motherhood and whatnot. Um, so yeah,
27:08 yeah, it's it. I can't even get into the BMI. Because I cringe when I when people start talking about their BMI is and what it should be. I mean, for my height for BMI. I am right now, like a tick away from being overweight. And I would if you saw me, you wouldn't think oh, she's overweight. But according to the BMI, I'm like, a tick away. And for me to be in that sweet spot. I would look emaciated. Yeah, exactly. You know, so, like, 100 pounds. Let's like, stop with the BMI stuff. You know, and, and I just had all my labs and I could not be healthier. Absolutely. So there you go. But yeah, I'm with you on the BMI. We could talk. We can go on about that for a while, but we won't. So let's talk about, you know, we talked a little bit about what, what can physical therapists do to look at their own bias and fat phobia in health care? Is there any Do you have any other tips for health care providers out there, when it comes to their bias and phobias?
28:30 Yeah, I would say, you know, in addition to what we talked about earlier, and then on learning practice, you know, we have to just stop telling people to lose weight, it's counterproductive, it's not effective. And again, most people aren't able to even do that consistently and maintain it. And then we have to offer the same treatment options we would offer offer someone who was thin, like it, you know, we just have to treat them with some, you know, equality or you know, equitably, and giving them the same options. And then I know in physical therapy, this has come up before and that's one of the sort of issues that the fat acceptance community has expressed in dealing with with healthcare professionals, is they are less likely to be examined to be physically examined, because of their body fat. And I get that, you know, when you go to physical therapy school, and we learn all these manual techniques, oh, it's much harder to try to palpate things, you know, when there's more adipose tissue, of course, but that doesn't mean you don't do it. You know, so my advice is to do it, it might be uncomfortable, it might be awkward, it might be challenging, but guess what, you grow as a professional and then you at the very least give that patient the the decency and the respect of trying what you know best to do, you know, in that you know, situation. So, um, you know, just being being supportive and not being demeaning that playing into the weight biases. And first really acknowledging that you have them that that's that's the first part because a lot of people don't think that they have until they're put in a situation where they have to face them head on. So recognize them. And then stop telling your patients to lose weight offer people in larger bodies, the same treatment options. You offer people in smaller bodies, and then don't shy away from manually and physically examining them because of their body weight.
30:19 Yeah, great advice. And hopefully people listening to this podcast will take that advice to heart. Now, where can people find you on social media websites? All the good stuff? If they want to reach out to you they want to work with you. Where can they find you?
30:37 Yes, well, my favorite social media is Instagram. I'm pretty much on everything. But if you really want to reach me, you can find me on Instagram and I'm at healthy fit. And that's h EA l th y pH it. I'm also again on YouTube and everything else. But I live there. I'm on the peanut app, which is kind of new. If you're a mom, and you want to have talks about body positivity and changes to your body through motherhood. I'm on that app. You can find me there Dr. Lisa folden. And then my website is www dot healthy fit that calm.
31:10 Awesome. What is this the peanut app? Yeah, this
31:15 is really cool. It's like club friends, but it's for moms. And so they have tons of discussions on there. But um, I was requested by the I think the creators to serve as like a professional and do talks on things in the health realm. So yeah, so I go on there every, every other Friday, and I host talks on things related to body positivity, Fitness, Health, Exercise, things like that.
31:38 Fabulous. Congratulations. It's awesome. Thank you. Now last question. It's out when I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self? Maybe like fresh out of PT school?
31:53 Oh, yes. Oh, fresh out of PT school that changes things, let's see, or high school or undergrad or whatever you want somewhere in there. I think you know what I think the best advice I would give to myself is it's going to be okay. That's really it. Because I was one of those like type A planners, like let me figure everything out. And I just remember being stressed all the time, like wanting my life to work out a certain way. And so it would have been nice. If you know, my older self this Lisa could reach back to that Lisa and just pat her on the back and say it's gonna be okay, honey, you're going to be fine. You can calm down. I just Yeah, that would that probably would have helped me relax a bit more during that process, you know, going through PT school and like, I felt, I just felt this heavy, you know, weight on my shoulders to like, get through and pull through and be great. And so if I could say anything to myself, it would be to just you know, relax. It's going to be okay. Enjoy the ride. You know, for sure.
32:51 Yeah. It's a very common piece of advice from a lot of people on this podcast. Obviously not hard to believe. Right. Right. Right. Lisa, thank you so much for coming on the podcast. It was a great discussion. And, you know, my hope is that people will take away from this all of the great tips to really examine your biases, and just start treating everybody like the people they are. Absolutely. Thank
33:18 you so much for having me.
33:20 Anytime. Anytime. You want to come back. You are welcome. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart. | |||
| Dr. Jared Pelo: The Future of Healthcare: Leveraging AI for Longevity Medicine | 30 Aug 2024 | 00:33:37 | |
Dr. Karen Litzy interviews Dr. Jared Pelo, co-founder of Bionic Health, about leveraging AI in medicine to improve patient care and physician-patient connections. Dr. Pelo shares his journey from emergency medicine to founding Bionic Health, driven by a desire to address healthcare issues proactively rather than reactively. Tune in to learn more about the intersection of AI and medicine in revolutionizing healthcare practices.
Time Stamps: 00:00:02 - Introduction and Guest Welcome
More About Dr. Jared Pelo: Jared Pelo, MD, Chief Medical Officer and Co-Founder of Bionic Health
Dr. Jared Pelo trained and worked in emergency medicine before founding iScribes, an early ambient AI health tech company. iScribes was acquired by Nuance Communications a Microsoft Company and was developed into Dragon Ambient eXperience. Dr Pelo started Bionic Health after a family tragedy and being inspired by the power of AI in medicine. Passionate about AI in medicine and preventive medicine, Dr. Pelo advocates using advanced AI tools and compassion to enhance patient-physician connection and patient care.
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| 558: Kirsten Franklin: The Importance of Mindset in Increasing Productivity and Creating Balance | 27 Sep 2021 | 00:38:14 | |
In this episode, CEO of CS Thrive, Kirsten Franklin, talks about mindset. Today, Kirsten talks about what mindset is, why we should care about it, and how it affects our outcomes, results, and everyday life. How can we leverage mindset to change the results of things we don't like in our lives? How can we change our core beliefs? Hear about Kirsten's four questions, her stopwatch strategy, and get her advice on how to manifest as a conduit, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Kirsten Franklin Kirsten is a world-class rapid transformation coach who has helped change the lives of over 1000 individuals. She is the brains behind the unique MVP method that is responsible for helping her clients rapidly transform their Mindset, raise their Vibrations, and modify their Processes, so they can achieve their dream lives. She helps people overcome fears, adversities and traumas while improving their clarity, focus, performance, communication, relationships and thinking, so they can fulfill their ambitions. Many of her clients are seen as being highly successful and seek her out to help them define and achieve their next-level. She has spent over sixteen years studying mindset, positive psychology, behavioral science and neuroscience and she is a master of techniques such as Neuro-Linguistic Programming (NLP), Strategic Intervention (SI), Cognitive Behavioral Therapy Coaching (CBT), Timeline Therapy, Mindset, Mindfulness, Meditation and more. Kirsten received her Juris Doctorate from St. John's University School of Law in 2001. Now retired, she owns multiple companies and is the CEO of CS Thrive, a coaching and consulting company that helps executives, founders, small business owners and athletes become unfu*kwithable in their business and lives. In free time, she is the host of the podcast Girl on Fire; writes for "Mind-Flux," a publication she created on Medium.com; writes fiction and non-fiction books, and hosts live events. She has been featured in Thrive Global, NBC, CBS, and Fox.
Suggested Keywords Mindset, Mindfulness, Fears, Psychology, Behaviour, Therapy, Awareness, Manifest, Conduit, Abundance, Action, Reality, Subconscious, Liberty, Results, Outcomes, Positivity,
To learn more, follow Kirsten at: Website: https://www.kirstenfranklin.com Podcast: https://bleav.com/podcast-show/bleav-in-girl-on-fire Facebook: Kirsten Franklin Instagram: @kirsten_franklin Twitter: @CSThrive LinkedIn: Kirsten Franklin Clubhouse: @kirstenfranklin
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript: Speaker 1 (00:01): Hey, Kiersten. Welcome to the podcast. I'm so excited to have you on. So thanks for joining me today. Thanks Karen. It's great to be here. It's nice to see you again. I know, just so everyone knows I was on Kirsten's podcast a couple of weeks ago, and we will talk all about that podcast and where people can find it a little bit later, so you have to wait to get the good stuff. But in the meantime today, we are going to talk about mindset. So I feel like mindset can mean a lot of things. So what is it really? Yeah, so that's a great question because it's one of those words like coach or like this, or like that, that we hear all over the place and for me in the way that I use it. So it was actually originally coined by Carol Dweck and she was talking about eight thought process, like being fixed or growth mindset, meaning you believe that you were given a certain sort of limitation and that's the highest you can go and that's fixed. Speaker 1 (01:04): Right? And that no matter what you do, you'll never going to go and surpass that level of ability. And growth is one where you feel as though, you know, you have the ability to change it, right? You can, you can go beyond the quote limitations. There are no limitations. And the way that it's sort of been more used frequently is in discussing the subconscious mind. And that's something she references back to because that's actually where all the magic happens. And you know, the way I use it is really talking about that subconscious language. It's about the core beliefs that you hold about yourself. It's almost like the rule of law that you have decided is true for you and you're going to live by it no matter what, Hey, even though you don't really know, you kind of created those laws. So it gets a little tricky in that people understand the difference between conscious and subconscious, but as you talk to them, they really believe many times that they know what they're thinking. Speaker 1 (02:02): And the funny thing is is you don't until you catch it and you really kind of latch on and you're like, oh, why did I say that that way? Right? And, and you kind of have to dig into it, but you can, you can understand your deepest core beliefs by the language. And actually just take a look around you. Is there something in your life that you don't like, or maybe you're kind of feeling attracted towards or repelling against, then there's something out of alignment in those core beliefs, because whatever you believe is what you're going to see in your reality. And so when we use the term mindset, is that dependent upon our core beliefs? You know, or is this, I mean, obviously mindset is something we can change, but if people say, oh, well I have these core beliefs and they're not going to change. Speaker 1 (02:51): So then how can the mindset change? Does that make sense? Yes. And actually there's a perfect example. So a lot of times I like to ask for questions when somebody is in a certain emotional pattern, right? Let's say, oh my God, I have anxiety. I can't drive over bridges. Right? Like, or, or whatever it is. So I'll ask four questions and I ask the first question, like, could you let that feeling in like, are you willing to just feel it? Because if you're not willing to let it in and you're constantly pushing it away, well, you can't get rid of it because you're, you're, you're not willing to work with it. Right. The second question I'll ask is, do you believe it's even humanly possible for you to eliminate the feeling of anxiety? Could it ever just go away? Right. And these are just yes or no questions. Speaker 1 (03:35): And if the answer, yeah, I think I could get rid of it. Like that's totally possible for me. Right. The next question I would ask is, would you let it go? Are you willing to let it go? Okay. And again, it's a yes or no. The reason I ask these questions is a yes or no fashion is at any point when you say no, no, I'm not willing to let it in. Then you can't let it go. No, I don't believe, I don't believe it's possible that I could just eliminate it then. Guess what? You will not eliminate it. Right? No, I don't. I, you know, I'm not really willing to let it go. Okay. Well then, you know, you're going to keep it for some reason, right. Or if you say yes, all the men in the last one says, okay, well, when, when are you going to let it go tomorrow? Speaker 1 (04:15): Okay. There's a reason why you're not today. Right? So, so the thing about what you had just said is that whatever you believe is going to be true. So if you believe it's not possible, it's not going to, it's not going to, it's not going to be possible for you. Right. And so, so it's a, it's a, it's a tricky little thing, you know? And so how can we, how can we change our beliefs? How does that work? That's a, that's a long process and a short one. So you can actually just change them. That's the fastest way to change them is to literally just change them. What is it that you wish you believe? What is it that you hoped you live? How is it that you would hope things would be, and then just believe them? And it's actually that simple. Now I know a lot of us thinking like, yeah. Speaker 1 (05:06): Okay. You're funny. I, I that's. I'm like, yeah. Okay. Yeah. Right. But I want you to think of the moment. There has to be a moment in your life where you're so off. So fed up, so done with something that it was done. You're never going to take that, do that, see that, feel that again, and you walked out on it. Like it typically happens in relationships. I'm never going to have that. You don't, you're done, never happened again. Right. Because you're done because whoever you were that got yourself into that situation, you were done with it and you were not willing to accept it and you won't ever accept it again. Right. Whether it's like somebody who speaks to you in a certain way or does something or whatever, or even the way the grocery bag of groceries, you know, bags of groceries. Speaker 1 (05:47): You're like, yo, you like it. You know, it's just done. That's the same thing in our head. Sometimes we can just be so over something that we're done with it. And it changes right there in an instant. Right. and then more typically it's we think a lot about how we wish it could be how we wish it should be, should be as a, as a dangerous one for me, because it's a comparative thing. Oh, I should be here, but I'm not, oh, like, I shouldn't be married, but I'm not, oh, this should be this way. And that starts a spiral of depression because your life doesn't look the way you want it to, then it's no good and it's all wrong. And then it comes down. And as you know, when we have these stressors and emotional things, they come out physically. Now you have neck pain. Speaker 1 (06:33): Now you, now you get headaches. Now, all of a sudden, your knees hurt. Right. If it's not a physiological difference, then it's typically coming from an emotional space it's coming from inside. Right. So how do we change them? I mean, look, I'm going to be totally honest. You can like, go, am I allowed to swear? I'm going to try not to sweat. You could like Google this stuff. Okay. Like there are affirmations, there's hypnosis. There's, self-hypnosis, there's positive cycles. There are a million different ways. And I don't believe in one size fits. All right. So I could lay down some techniques right now. And you know, a third of y'all will get it, do it, try it. It'll work. A third of you will be like, yeah, I'm not even bothering. And a third of you will try it and it's not going to work. Speaker 1 (07:13): Right. But even that is in your head. So if you are someone who doesn't believe that talking things out helps anything. Then if my method is talking things out, then it's not going to work for you. So that's the power of our brain. Let me tell you how powerful our brain is. I was just having this conversation. So, you know, I was talking to somebody and there's a blind spot. So meaning your eye, witness identification, all stuff, all bad. Why? Because we interpret things so differently and we can create blind spots. So you ever had that moment where you're like, oh, can you get me that book on the shelf? Right. And the person's like, I don't feel like getting you up, but you're standing right next to the shelf. Just grab it to me and give it to me. Okay, fine. What's the book it's not here. Speaker 1 (07:55): Right. And all the fighting goes back and forth. You finally get up from your seat. You walk over to the shelf right in front of the space is the book he or she literally couldn't see it because somewhere the command was given no book. You don't have to get it. You don't want to get it. It's not there. This is stupid stuff. Right. And so it literally happened. And so it's kind of crazy. Like, I can't tell you all the science behind it because we're studying it every day. In fact, you and I, before this, this packets were just talking about how they figured out. They think the, the place in your brain that lights up when you're deciding whether something is going to get stored in your subconscious mind. Now that's a really interesting place to play because I mean the magic that we can make happen right there, who knows. Speaker 1 (08:40): Right. But you know, it's, it's many different techniques to change it. You know affirmation again, you can Google that, you know, but it's really important because what you deeply believe will always play itself out for you. So I always tell people, take a look around your life. If there are areas or places that you are just simply unhappy, you really need to dig into your beliefs about yourself, the way it's supposed to look how it's supposed to be, and you'll see how that's playing out. Yeah. So I, it sounds to me that you're saying not, there's no one size fits all for this. And I think that's the realest answer. You know, like you said, I can tell you this or this, and it might work for some and not others. And so it sounds like you need to figure out what is going to work best for you and then seek that out. Speaker 1 (09:42): Yeah. And it's a testing thing, right? I mean, you really do have to go through things. Like I have a mindfulness email that I send to everyone it's 52 weeks. And why, because it's literally 52 different ways to practice the same thing. Right. Mindfulness. Right. But the goal is, is that okay? You try it one week. Some people get bored with stuff really easy. Right now it's a new thing they could do every week. Right. But the goal is that at the end of it, it doesn't matter whether you picked up or found your thing, you just did it for an entire year, 52 different ways, but you did it. So at the end of the year, you still have the result, even though you didn't realize you were kind of doing that, you know, here I'll, I'll tell the audience one thing that they can do that works for everyone period. Speaker 1 (10:23): And it's only if you do it. So just remember you have to do it, actually do it. And it's something I do with all my clients. And it's called no negative and try it for a week. Try for a few days, it's really about awareness. And what I started them off doing is I literally have them take their phone, their stopwatch feature on their phone. When they wake up, they started the very first instance where they feel, say, or do something in the quote negative. They have to hit the stopwatch button, record the time, write down kind of what it is. They were doing, what it is, they're feeling what it is or how I was saying. So you wake up, you hit this, do you start the thing? Like, oh crap. I got to go to work. Gosh, 12 seconds, 12 seconds elapsed. All right. Speaker 1 (11:06): Oh crap. I have to go to work. All right. Start the button again. Okay. Brushing my teeth, got to pick out clothes. I got dressed. All right. Hit the button. Right. And, but that's it because you'll see, even by the end of the first day, people are shocked at how many, how many, but also how often and frequent things come because you live your life on autopilot all day. You don't realize that you're living sometimes in this hugely negative space. You think you're fine and you can't figure out why you're grumpy by the end of the day. Well, if you're telling yourself, oh, every five seconds, this isn't good. That's bad. Oh no. We've got to think about this. Yo of course, you're going to bring your vibration down. And your day is going to suck by the end of the day, every day. You know what I mean? It just is. So, so that's a technique I like to do. And that's only part of the technique, but that, that, that level of awareness, just as eye-opening most of the time. So that's a fun one to do. Oh, that's great. I'm going to try that. Oh gosh. Look, I'm already negative. No, no, no, no. Speaker 1 (12:08): Yes. All my new Yorkers let's do it. We all know how we are. We think we're funny. We're really like sarcastic and negative. Yeah, exactly. Oh my gosh. Yeah. I'll try that tomorrow. And we'll see what happens. I will report back to you. So, so obviously we know mindset is something that can be altered. Can't be changed. It can be positive. It can be negative. So how does that affect our outcomes and in how we live our life every day? Yeah. So, so let me give you an example. I call it the kindergarten story because I think it's kind of common for a lot of us. So I want you to imagine that you're in kindergarten. If you're listening to this outside of the country, it's a one year about four or five years old. It's the first level of school you go to here in the United States. Speaker 1 (12:58): And we have this thing called Valentine's day. And at the kid level, we just, you know, get a bunch of candidates together, throw a bunch of cards and give one out to each member of the class. But sometimes there's that special Valentine. Right? So, so let's say little care. It's kindergarten. And she's all excited. Turned her mom made all the little Ballantine things she's handing out. But Joey, her best friend, well he's has the special Valentine. And she's going to ask him to be his, be her beer Valentine. Right? So Karen goes up to Joey, we made a special bone. That'd be, will you be my Valentine? Joey loves comedy. He says, oh my God, Kimmy just asked me. And she's super cute. I'm going to totally be here Valentine. Now little Karen's like, wow. Now little Karen's had picked up this message, but it wasn't said, but this is what you heard. Speaker 1 (13:46): You're ugly. You can't get the guy. Oh, and Kimmy with brown hair and purple eyes. She's that's that's that's the ultimate cuteness. Like that's that's it. Now she's four. She goes home cries. Mom, mom fixes it. Everybody has dinner next day. You're for you, Joey and Camy. By the way, you're all besties. You're hanging out. Like nothing happened. You, you feel like you don't feel it. It was a split-second. It was a moment it's gone. It's not really gone because let me tell you what happens now. She matriculates she's in middle school and Karen has to ask a boy to a dance. It's one of those Sadie Hawkins thing. So the girls have to ask the guys. And so her and her bestie and most people at this age have faced some kind of rejection, whether it's in the girlfriend, boyfriend, lover section or, or any other part, like not getting the baseball, you know, position, whatever it is. Speaker 1 (14:34): So we understand rejection. So we're fearing a little bit and we're nervous. So it's natural. Right. And everybody will tell you that. Oh yeah. It's natural. Don't worry. Just go ask anyway. So you and your Bessie, of course, it's Kimmy go. And you're like, okay, all right, we're going to ask our guys. So Kimmy goes first. Can we ask the boy? And he's like, yeah, sure. What out? Right. So Carrie was like, yeah, I'm going to ask Tony. She goes up to Tony. She asks him. Tony was like, man, I wish I could go. But I can't. Now what Karen doesn't know is that Tony is a son of the local preacher and he's not even allowed to go to school dances. Tony is secretly actually in love with her. But he has to say no anyway, but all Karen hears, not consciously, but subconsciously because she doesn't remember five years ago, she all she hears subconsciously is yo dumb. Speaker 1 (15:19): Don't you know, you're ugly. Why you try to do this? That making a fool of yourself. You know, you can't get the guy just stop. You are not pretty. You are not enough. You can't get him just up. Okay. Underlying, underlying thought the overlying crunch thought, oh man, I can't believe it. I'm so to the point and maybe he doesn't like me, right? Like, why is it so easy for Kimmy? Why isn't it the same for me? Like, it becomes that now you can't leave Karen out. Karen's like, all right, she's going to high school. She's like, you know what? I don't even care anymore. I'm bringing to the new high school, new me, everything. She goes out, she becomes a head cheerleader. Everybody loves her. She's popular. She's gorgeous. She's smart. She's funny. She's nice to everyone. And so she's, she's the girl, there goes Joey from kindergarten. Speaker 1 (16:08): He's the captain of the football team. And you guys are of course still talking. So Hey, what up? You start dating on the outside. It it's like the ultimate thing. Like, you know, you've made it right. You've arrived. Like this is it. Like, this is everything that everybody dreams of. Right? Prom, king prom queen. We're going to do it. You know, Joey's all happy. But Karen Karen's like, dude, Tom feels weird. Why doesn't it feel right when you think he's cheating on me? Like you think like, what's going on? Like, like I know we, we look so good together. It looks, it looks like it should be perfect. This is actually everything I ever wanted since kindergarten. But I dunno. I think, I think, I think he talks about, look at, look at him, smile. Look at him, smile at that girl that just walked by. Speaker 1 (16:51): Look at him, say hi to everybody. Right? She starts going, yo crazy lady. I take taken his phone, looking at his text messages. Eventually poor Joey. Now she's creating damage and Joey, but you always like, all right, forget it. I can't, I'm done. Right. And then Karen thinks, oh yeah. That's because you're right. Your cheater, you're doing something right. And she has to solidify in her mind. What's going on? So now Karen gets smart in college. She's a psych major. She's not going to play this game. She thinks she's good. She finds herself a man, they get married. They have kids. But again, something's not right. Like it feels wrong. Like it doesn't feel good. It's supposed to feel amazing. Right. But, and then she starts picking on things like, why can't you take the garbage out? Why can't you take it on time? Why can't you put it in the bin? Speaker 1 (17:36): Right. Right. And all this weird things has nothing to do with the garbage in the bin. And it has to do with this internal, emotional strife that she can't release because she's not quite sure why she doesn't feel right. But the truth is it's because she's too ugly to get the man, this man she doesn't deserve. It's not right. He couldn't possibly be there for the right reasons because she's not good enough like that. And it plays out in this way. That's why it's important. Because every day when you wake up and you have those negative thoughts and you enter these scenarios and things come crashing into your universe, it's usually in your head, that's created it at some point or is receiving it in some way. Right. And you're being reactive, like a five-year-old to it. And you don't even know you're doing it. Speaker 1 (18:18): So if you want to have a nice, happy, easy, joyful life and wake up bounding out of bed, like if a kid on Christmas, this is the head game you got to play with yourself. It takes work. Right? No. Yeah, yeah. Yeah. I mean, you know, just like anything else, it does take, it takes consistent effort in, in getting it done. And actually to be honest, sometimes it doesn't sometimes just the awareness of the thing makes the thing go away. But you have to remember, you have been imprinted every second of every day, since before you were even born in utero with an impression and emotion, something okay. To date. So if your brain decided to take all those impressions and make a big deal out of them, well, you're going to be undoing a lot of stuff. And that's why it's layers. That's why it's kind of like, you know, when I'm working with CEOs that are, you know, in multimillion dollar companies, and now they're about to go into something and like close to a billion and they have all this stuff going on. Speaker 1 (19:13): Or, you know, I was just talking to an athlete who started a business and he was like, I should have been so much further. And you know, and you know, we broke it down that the work that he did to become an athlete, to become an MMA fighter is not the same level of work he's doing in his business. Right. He, he, he practiced every day. He, you know, ran, kicks every day. He had people watching him, critiquing him, helping him, mold him. He spends like three hours a day in his business, but he wants it to be a superstar rocket, you know? And it's like, well, you didn't get into the octagon and fight and win your first fight by, you know, being around for three months. You've been in this business three months. But you think you should be like a millionaire, like where is that coming from? Speaker 1 (19:54): Right. So it's, it's, it's all it's, it's it's in your head. Yes. I, I understand. I get it. I get it. I do. Now let's talk about, if you have something let's say in your life that is not going maybe the way we want it to, which let's be honest. I think that happens too. Can we say everyone at some point? Oh, of course. How can we leverage our mindset to change this so we can change our results? Okay. So I'm gonna, I'm gonna, I'm going to go a little woo on you here. So it's a combination of your thoughts and your energy, right? And so you know, just to, to focus on the mindset aspect of this, you can really dig into, you know, how would I deal? You have behaved, have responded, have done something. And how did you, you do it. Speaker 1 (20:55): What's kind of the difference. And how do you step into ideal you? How do you make decisions from that higher place? Right. just taking business, you know, let's say you're going to go into, I don't know, marketing and you have to pay marketing people. Well, you, you might say yeah, that's really expensive. I'm not doing that, but higher, you might say, Hey, actually I understand the long-term game. I'm willing to wait it out to six months. It'll probably take for me to recoup money back and let's go for it. Right. I would ask the right questions and it would know the right information and it would make the right decision. Right. So, I mean, when it comes to mindset and looking around your life and finding the things that you don't like, that's the start, but now what are you kind of leaning towards and what are you pushing away from? Speaker 1 (21:41): What have you settled for? Okay. Like notice that, because a lot of times in our lives, we settle for certain things. We want this ideal image, but then we're like, oh yeah, it's okay. You know? And so look at all these things because they all add up. I mean, there's a, there's a bunch of questions you can ask yourself, but I would really just start with, where are you, where did you want to be? Why did you want to be there? That's a big question. Okay. So, you know, think about all the people that go to college at, went to college and pick a major that had nothing to do with them. Right. you know, I wanted a big house in New Jersey when I first became a lawyer because I grew up and that's what everybody had. I didn't realize I don't even want to live in New Jersey. Speaker 1 (22:25): And I don't think Jesus, you know, I mean, like it, but because it was so familiar to me, I thought that's what I should be doing. And I wanted nothing to do with it. And so it caused every time I wanted to go look at property or do something, it always fell through, it always didn't happen. Well, it was the universe saying peace woman. Like, what are you doing? Just stop. But in the, my reality in that moment, it was frustrating. Like I tried so hard trying so hard and it's not working out. Right. And it was just like but you do get the signs. I mean, I think the biggest thing is, you know, again, with no negative, you start to look at your stressors too. You start to see the common themes of what you're saying to yourself, what you're hearing and really stop. Speaker 1 (23:08): You know, one of the, one of the, another thing that I love doing is when you're really in it in the moment. And when you're super about to be reactive, you know, about the Chuck that, that coffee across the room, just throw a big red stop sign in your head. It's called a pattern. Interrupt to stop, throw the sign in your head, just see it and just stop, stop, stop, stop, stop, stop, stop, stop, stop. And just stop. Because what you're doing is actually stopping that subconscious chatter. When you do that, and that's like an immediate thing that you can do that you don't have to deal with everything that's going on around you, because sometimes you can't because it's so in your face. But as long as you stop, as long as you stop that thought pattern, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop. Speaker 1 (23:49): Right. That actually just practicing that alone starts to stop the mental pattern that you have going on. All you have is a mental pattern, a little talk pattern, a little, you know, little repeat on loop, right? That's what you're stopping that alone can elevate you like everybody listening to this, you know, if you think of your life right now on a scale of one to 10, 10 million, like, oh, yo upper rockstar, one being like, dude, am I still alive? Like, how am I even still here? Didn't I like do something last week. That caused me to not be here because it's so miserable, right? Like that level. Okay. So on a, on an overall one to 10 rate yourself, then do no negative and stop just the pattern. Interrupt. Stop yourself every time. You're when the, when the bar reset. Isn't fast enough. Stop. Stop, stop, stop. Speaker 1 (24:33): Stop. When the dog just, you know, somebody else's dog ran across your foot. Stop, stop, stop, stop. Stop. When a door closes on your dress, your skirt, and you're about to get stop. Stop, stop, stop, stop. Just stop. You don't even have to think any further, just stop that's at the top. Move on, do it for a week. Now again, one to 10, how do you feel rate yourself? Your number is going to go up and then your brain is going to start with this. Oh, but nothing changed. Why do I feel? But, and then you're gonna question it don't it just is. And it's actually just that easy. So excellent. That's a great exercise and very, very easy. Anyone can do that. It takes nothing. You just have to stay, say stop. Yep. And those, when that those thoughts start rushing in and we all have them every single day. Speaker 1 (25:24): Yes, we all have them. I think that's great. So now, as we start to wrap things up, what do you want the audience to take away from our conversation around mindset? Well, I mean really just the basics. I mean, the fact that it is important, you have to pay attention to it. The reason you're here, wherever that is in your life is because you didn't, maybe you didn't know, maybe you didn't care to, maybe it wasn't as bad yet, but if, if you're still trying to get to that next level, then you have to pay attention to what you're saying yourself at this level. And I don't care what level you're going to or where you're coming from. That's just it, you know, where they're coming from, coming off the streets to your next level, or you're coming from your, your $50 million company and you want to make it a hundred million. Speaker 1 (26:10): It's the same thing. You have to hear what you're saying, because it's dictating your reality period. And so it's really important. And that there's a lot of resources out there. I mean, I can give you some resources as well, but you know, there's tons of stuff out there and it really is simple. It's just, it's, it's simple and taking action and everything changes and it can change in minutes. Yeah. It's the taking action part. That's the hard part, right? Everybody can read. You can understand the action that has to happen. Let me tell you, let me just really quickly tell you that that's my too. So you have to live into the being. So let me just give you an example. So I was very athletic when I was younger. You know, I didn't work out at all. When I had my child, my child is now 12. Speaker 1 (26:52): At the time that I had to do this to myself, she was 11. And I was like, oh, I'll kind of get into that place where you still look good with clothes on, but not so much when you take them off. So I was like, maybe I should work out. And I thought, oh, this is second nature. I'll just go work out. I live on central park here. So I'll just now. And I did everything. The micro habit, the be dressed in your sleep thing, the sneaker girl, if I tell you that at some point I felt proud that I got out the front door and want a cup of coffee to come back. And that was my workout. And I had to do my own techniques myself, which is what is it? I believe like what happened? I obviously no longer believe I'm an athlete because if I did, I mean, this is easy. Speaker 1 (27:30): Right? And that's what I thought I believed consciously. Well, when I dug down to it over the past, you know, 10 or so years, my friends had been getting a little snappy with me saying things like, oh, you eat like an a-hole, you still look good and I didn't work out. So then they knew that like, how do you not work out? And, and we work out 10 hours a day and what's going on. And there was part of that, that seeped into me that was like, oh, that's right, girl, eat whatever you want. Look good. You don't, you don't need that. Right. And well, it worked for 10 years, but obviously I needed to change. And the second I realized that I was letting those things come in, that it was easier to hang out in bed that I always had tomorrow that, and I changed that core belief. Speaker 1 (28:11): And I, and I really had to dig down into why, like, I want to be the grandma who like flies through the trees on zip lines with her grandkids. I can't do that in 10 years. If I don't exercise now. Right. I had a drill into my head. Oh my God, I love running by the way. Don't really, but I love running. I love running. I love running the second I did all that stuff. Right. And it actually took overnight. That's all I did. I did it one day. I wrote down the thing. I said it to myself again and again. I said it to myself in the mirror and I was like, yo, you, you have this, like, what's wrong when you have this right now woke up the next morning. I actually ran a whole mile. Now it doesn't sound like much, but 10 years sitting on my. Speaker 1 (28:47): Pretty good. That's great. Yeah. That's nice. So it's really convincing yourself that you are the person who does the thing. If you are the person who loves to do all this weird, you know, personal development stuff, and you'd love to say stopped yourself and you've loved it. Guess what you're going to do. You're going to do it. That's it? It's that simple. Yeah. Yeah. Oh my God. That's such a good example. Thank you for that. Now, speaking of resources, where can people find you, your podcast? Talk about the podcast, your resources, everything else. Yeah. Awesome. I mean, you guys can go to just my name.com. So it's Kiersten franklin.com. And I don't know if you're able to put that in the description. And then the podcast is just girl on fire. So if you want to just Google girl on fire, it's unbelief B L E V network. Speaker 1 (29:36): You can find it anywhere, apple, iTunes, all that good stuff. Yeah, that's it. Yep. And D and we will have links to everything, to all of her information at podcast dot healthy, wealthy, smart.com and the show notes under this episode. And we'll have your on social media. Do you want to give a shout out to your social media handles really quick? So someone can find you really easily. That would require me to know what they are. Well, it's all on your website. Yeah, we got it. We got it. No problem. We will have, I will put them all in the show notes individually. We're good. Don't worry about it. Now, the last question I always ask everyone is knowing where you are in your life and in your career, what advice would you give to your younger self? Speaker 1 (30:29): I would tell myself that none of it is a big deal. It's not as big a deal as you think it is, you know, all that lost time on stressing out and trying to make things happen and living by force, as opposed to living as a conduit where everything's flowing through you. Massive difference. My whole life has been lived by force winning, winning, winning, getting by force. I probably could've gotten the same exact stuff, Ben, the same that, and just nice and easy, you know, massive difference in life. Let me tell you. Yeah, I was relaxed. I love it. And I've heard that several times from people guests on this podcast. So there's clearly something to that. So for all of you, new new grads out there, college kids listening, relax. And I love, can you say that again? You want to be sort of a conduit versus a forest. Speaker 1 (31:25): Can you repeat that one more time? I mean, I, you know, listen, there's two ways to manifest, right? There's the manifestor force, right? Like, like you're going to get it. You're going to get it. You're gonna do everything class. We're going to fight, fight, fight. It's by force and you're gonna get it versus actually when you open up and you let the universe and all of his power flow through you, you're going to get the same things only. It's nice and easy, right? When, when something doesn't happen or someone candles or it moves when you know that it's okay, that it's all just going to be fine. It's your life flows through you. You are a conduit. I it's true about finances, about love, about anything, right? If you, if you're having financial difficulties, right. And this is going to sound crazy, I know it's gonna be painful for some, but if you open up and you just let it flow through you, all of a sudden you're going to just have more and more and more money, right. Speaker 1 (32:15): Because it's not about you getting money. You're the conduit. So the university saying, all right, I'll throw money at you because you're giving it here. You're helping people there. You're doing this. Right. And it just, just like, love like energy. It's just things you're, you're, you're a vessel it's supposed to come through the gifts that God gave. You are not for you. They're supposed to float through you so you can help others. If that makes sense. Yes. It, and thank you for that. I love it. So Kiersten, thank you so much for coming on the podcast and spending the time with us today. I really appreciate it. Absolutely. Thank you so much for having me. It's so fun. I always love seeing you. Yeah, my pleasure, my pleasure, and everyone tell the listeners out there. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart. | |||
| 557: Jamey Schrier, PT: The Mindshift for Practice Growth | 20 Sep 2021 | 00:51:38 | |
In this episode, CEO and Founder of Practice Freedom U, Jamey Schrier, talks about creating success by changing mindsets. Today, Jamey talks about developing a growth mindset to achieve greater success, what the biggest problems are that owners face, and how to 'fix' those problems. What's your goal for the next 30 days? How do you keep your energy tank full? Hear about the different growth mindsets that owners get wrong, reacting versus responding, and get some valuable advice on how to grow and become more successful, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Jamey Schrier Jamey is the founder and CEO of Practice Freedom U, and the best-selling author of The Practice Freedom Method: The Practice Owner's Guide to Work Less, Earn More, and Live Your Passion. He is a sought after speaker on systems, marketing, and elevating the patient experience. Over the past decade, Jamey has helped hundreds of physical therapists, occupational therapists, speech therapists, and mental health professionals build their highly successful practices and create more financial security without working longer hours.
Suggested Keywords Owner, PT, Physiotherapy, Business, Entrepreneurship, Purpose, Mindset, Success, Actions, Thoughts, Leadership, Freedom, Productivity, Busyness, Progress, Reacting, Responding, Self-Care,
Jamey's Book: The Practice Freedom Method: The Practice Owner's Guide to Work Less, Earn More, and Live Your Passion.
Discovery Call: https://www.practicefreedomu.com/discoverycall
To learn more, follow Jamey at: Website: https://www.practicefreedomu.com Facebook: Practice Freedom U Twitter: @jameyschrier LinkedIn: Jamey Schrier YouTube: Practice Freedom U
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full transcript here: Speaker 1 (00:01): Hey, Jamie, welcome back to the podcast. I am happy to have you back. I always love having you on, well, Speaker 2 (00:08): Thank you Karen. I am so happy to be here. Speaker 1 (00:12): And so every time you come on, we talk about some aspect of the physical therapy business, which is great because I know a lot of the listeners want to know more about how to run a business, how to be successful, what's going on in the market. So let's kick it off with what is in your opinion, the biggest problem facing physical therapy, practice owners today, Speaker 2 (00:42): Karen, you're just going, you're just right out of the gate. Like you're just like, you know what? We're not messing around. Hey, Jamie telling me about yourself or, or give it. It's just, I'm going fast ball down the middle either. You're going to hit it or you're going to strike out and we're going to be done. Speaker 1 (00:57): Yeah. They, they, they know who you are. You Speaker 2 (01:01): That's a good sign though. Right? what's the biggest problem facing practice owners today? That that's a really great question. And the answer may not be what people might think the answer is. The biggest province, really what, the topic that we're talking about simply put it's how we think it's just that simple. There, there's a, there's a simple formula that, that I've been following for years now, years and years and years. And basically it's just says how we think, how someone thinks, determines the actions they take and the actions they take, including their communication and their stuff. They do produces results. And too many times I've heard people that are not happy with their results, whether it's referrals, whether that's revenue, whether it's profit, whether it's hiring, whether it's retention, whether it's time, God forbid, people want time and control. They don't have that. Speaker 2 (02:03): So if you reverse engineer the result back to, well, why isn't the result we want? Is it some strategy? Is it some technique and answers? No. It's how an owner thinks. I mean, let me, let me give you an example. We went to school, right? All your listeners went to school. We are highly educated, very smart people. Now who educated us, right? We had professors in school and we, and, and, and PT school. We had professors who were educating us on what they were educating us on how to be a clinician, more specifically, how to pass the boards, because that is what schools do. They help you pass the boards. So then you can become a licensed clinician, licensed physical therapist. So you do that, whatever one year, you're five years, 10 years, and you have this urge, you have this thing inside you that says, I want to be a business. Speaker 2 (03:07): Now I want to run my own thing. So do you go back to school? Most people do not go back to school care and they don't get an MBA. They don't get any kind of, maybe they read a book, hopefully my book, right? The practice, freedom method, plug, shameless plug, but they, they just signed the dotted line. And now they're an LLC. And what are they doing? They are making decisions with the brain that was built and created with all of the information of how to be a talented clinician, which they are. But now that same brain is making decisions around business and there lies the problem. Speaker 1 (03:48): Okay. So you just described most physical therapy owners. So how do we fix this? How do we, what do we do if this is, if this is our mindset or if this is where we are, this is where we're thinking. And you know, everybody gets, I think people start their own practice because they want to help people. They want to see patients the way that they feel they should be seen, et cetera, et cetera. Right. So how do we take off the clinician hat and put on the owner hat? Or, or do we split it into, how does that work? How do we fix it? Speaker 2 (04:27): Yeah. So there's a great quote by one of my mentors, Dan Sullivan, and it says the eyes only see the ears only hear what the brain is looking for. And we've seen this, right. You know, you're, you're thinking about buying a car. You know, the last car I bought was a Jeep. Right. I bought a Jeep. I've never seen Jeeps on the road. Oh my God. I feel like the whole world has a Jeep. Right. You're seeing them everywhere. Did they magically all of a sudden become more Jeeps in Maryland? No, because you started your, you started to tell your brain Jeeps, Jeeps, Jeeps. So it really starts with recognizing that this is an issue and you don't know what you don't know. And Karen that's, that's hard for a lot of people that was very hard for me because I'm a smart person. Speaker 2 (05:24): I did really well in school. So did you, so did everyone, I haven't really made a million mistakes in my, at least academic life course. We wouldn't have been through school, but then you get in the business and you realize that, you know what, I, I don't necessarily know how to do this. Maybe I should get help, whatever that means. Like, I think it's just recognizing that I shouldn't be an expert at all this business stuff, because I'd been taught. I've never been trained. I haven't done self-development and work on that. I think that's one of the biggest things we just need to recognize. We'll get into, you know, I have some specific things that people can do, some tangible things they can do. But I think I just want to get people just to recognize that that's the issue, because if you don't think that there's a problem, even though you're working 50, 60 hours a week, you're not making the revenue you want your, your staff is coming and going, or you can't get them to actually do what you want them to do. Speaker 2 (06:30): So you're taking on some of their job, all those things that we complain about, if you don't actually say, look, you have created this model. So the only way to uncreate this model is to start to change how you're thinking about the business. And that starts with how you think about yourself. You have got to look at yourself as the owner, the CEO, the entrepreneur, the head honcho. You have to see yourself like that. That's scary, right? I don't think myself, I'm just a PT. The problem is that's how everyone else is looking at you. And you have to own that. Now you are playing multiple roles here. I've said one time, multiple personalities. It's not really multiple personalities. It's multiple roles, but your role as a clinician own it when you're treating treat. But when that ends, you have got to shift your mind to perhaps the role as the director, and then you have to shake. Speaker 2 (07:36): It shifts your mind. The role as the owner, the mindset you have for each of those three is so different, especially between the clinician and the owner, how you see your business, how you see your staff, how you communicate to people. That's very different than a clinical mindset. So I think that's the first thing we have to own it. The, the, the other big thing is success is 90% preparation and 10% perspiration people may have heard that they may have heard it in different types of things. 99%. This 1% that I've heard that before, never really understood what it meant. What does that mean? It means that we are by human beings. We are naturally doers. We do do, do I call up the home Depot model, you know more savings, more doing we're here to help the doers. So doers like to do they get off on doing stuff. Speaker 2 (08:38): And then those people like to be busy, busy, busy, busy, which is, seems to be the mantra of everyone nowadays, what are you doing? I'm really busy, but that is very different than being productive. That is very different than being efficient. So being busy is not an owner mindset. An owner mindset is how can I be more productive? How can I run things more efficiently? How do I utilize my time? Better? That alone will change what you focus on and how you start putting your business together. So this 90% preparation stuff is all about. How about having time to think about your business. If you're busy all the time, constantly filling your schedule with patients, with meetings, with putting out the fires in your business, just constant stuff. Where's your time Karen, to just think about what is it, where's my business going in the next month or three months or week. Speaker 2 (09:39): You don't have that time. You're just on the hamster wheel of doing, doing, doing busy, busy, busy, and the results don't really significantly change or worse. They start to improve a little bit, but they improve only because of the effort and the work that you're doing. So now you're trapped because if you shift that all of a sudden the results will, will go down. So you get trapped by that. So that, that, that motto of 90% per preparation and 10% perspiration and having this shift of you have to slow down, you have to pause and you, we have to spend more time getting out of the immediate present. And that is my first mindset shift. Speaker 1 (10:30): Yeah. It's hard to sometimes get out of your business so you could work on it, you know, and how, if you can make that mind shift, I think you still, so you can make the shift of like, Hey, I'm the owner. I need to not just work in my business, but work on it. Be creative, things like that. So what advice do you have for people to, let's say once they've gotten that mindset, okay. I am a business owner. There are other things I have to do here. What, what can they do to get to that, that area of creativity and of, well, let's look at how we can streamline things and be more efficient if you're always like, well, I have to treat patients because if I don't treat any patients that don't have any revenue coming in and that's not good because I don't have a business. Right? Speaker 2 (11:26): So unless you bought an existing practice, we all come in as what we call it at practice freedom, you a committed clinician, right? Your solo preneur, that's it. Maybe you have an, a, maybe you have a part-time PT PTA or somebody, but it's really just you. Okay. That's how we all come in. That's how I came in. That's how you started your business. We all do that. Now committed clinician. The biggest challenge, because the challenges are different between the two examples I'm going to give the challenges with that person is, well, you got to get busy and most of your bills, dizziness is going to, or you got to get busy, meaning you got to generate more work referrals and get your schedule busy. So your job is to start delivering great care, maybe going out, meeting some different referral sources. That's what most of us do. Speaker 2 (12:17): And your schedule will get busier. It always happens. Then there's going to come a point where you're like, I'm running at a time. Every time I start to mark it by place gets busy. And when I stopped play starts to go down. So we call that kind of, that role of poster. And you start teetering on the next slide level of business ownership. And the next level is called overwhelmed operator. Love that term. I coined that term years ago because it just describes that type of owner. This owner has hired people. And when you start hiring people, you probably don't have a lot of organization and systems in place. You just kind of doing it. You're trying to, you know, I got some good people. I know how to judge people, but you're you still have your schedule. You're still doing your stuff. When you hire people, now you're responsible for them. Speaker 2 (13:12): So now all of a sudden this whole HR there's human resources stuff comes into play. Ignorance is an excuse. It doesn't matter if you're ignorant. Like I broke the law department of labor, reached out to me and say, Jamie we got to investigate you because you're doing some illegal acts. What? Well, you're supposed to be paying overtime to certain employees. I'm like, I didn't know that. I thought they were a exempt from that. Like, no, these are exam these. I mean, then all of a sudden I'm like, well, I didn't know that. And I'm like, well, you're going to find out, cause we're going to find you. And I'm like, okay, from now on, I will make sure I have someone on my team that knows that stuff. So what happens with the overwhelmed operator? You start bringing in staff, not only do you have your job now, Karen, but you start taking on other people's jobs. Speaker 2 (14:01): Maybe not the whole thing, but you're taking on a little bit of it. Right? And there's reasons for that. The biggest problem with the overwhelmed operator from I call it crossing the street crossing well sometimes. So it's a big, big, huge river crossing over to more of this idea of practice freedom, which I'll get to that in a minute is there's not organization in place. There's not systems in place. There's no control over one's time because you're busy, busy, busy. That's why I started with the idea of the problem is we're not thinking like an owner. You are still an overwhelmed operator thinking like maybe not only a clinician, but you're probably playing the role of clinical director is not an owner director. So leadership position in your company, but it's not where the practice owner needs to be. Right? If you're a director, you need to remove yourself from that position. Speaker 2 (14:58): That's where people are. They're in one of those two categories. So if you're, if you're a committed, if you're an owner, if you're a committed clinician, your job is to start bringing people in. But the more you can bring people in, in an organized systematic, having some things in place way, the less overwhelmed you'll be later on, there's still going to be somewhat overwhelmed. It's just kind of part of growing a business, but there's a way to do it where it's not so much. So one of the things that we that, that, that I want to share with the group, one of my mindset shifts that nobody spends any time on. I never did. Cause I thought it was a waste of time, whether you're committed clinician, whether you're a overwhelmed operator is the mindset shift of the best is yet to come. Speaker 2 (15:52): The best is yet to come. I won't get into the story around this, but really what it means is the future is brighter than the present. And it's brighter than your past. The future is brighter. You have a vision, you, you have something that you want. Is it written down? Have you taken the time to describe it? John Lennon CRA wrote, imagine, right? Talking about peace and unity. Martin Luther king has I have a dream, not, I have a project plan. I have a dream little kids go to Disney world and Disney land. But when you get older, you think that's stupid. Why? Because you're too busy doing it, doing it, doing it, doing it. You don't step out of the fray and say, where is this all leading to you? And I, before this call, we're talking about you know part of, part of the program that you're taking is focusing on, well, what are your personal goals? Speaker 2 (16:58): What's your purpose about what are you about Karen? See, we all have something we're about. And when you start to create that and develop that, that gives you your north star, that starts to give you direction. That's a shift. We all have to have to make, you know, I love Bruce Springsteen like the next person, but let's not have glory days. Our favorite song. Cause that means the best is in the past. So we have to shift that. Why is that important? Because it gives you a a plan. It gives you kind of like the horizon to know the direction you're moving the company. What, it also does, little known secret. What it also does is let people that you're hiring, know what they're a part of. Most of us, most of the owners, at least I can share my own story. Most of the owners I've talked to Karen. They don't have a clue, dental have anything written down a lot of a plan. They don't have a vision. They don't even have, they couldn't even articulate just a dream. Like the, you know, I just imagined the place being like this. It's usually a half a sentence of kind of, sort of, because they're just overwhelmed and busy and that's the place we have to start. Speaker 1 (18:17): Yeah. And, and I think getting, making that shift in the beginning, I know I can speak, well, I can speak for myself. Is uncomfortable of like, well, wait a second. I'm not in the, in this role. Speaker 2 (18:34): So Karen, why I agree with you, but is it uncomfortable? Speaker 1 (18:39): And, and again, I think it's, it's I, and again, I'm just speaking for myself. It's hard to like, let go of that control. It's hard to step away from being the clinician because part of my identity as a person and an owner is wrapped around being a really good physical therapist, not an entrepreneur. Speaker 2 (19:01): So what you're really saying is a there's some fear there. And the fear is, and this has been my experience working with hundreds of practice owners. What if I'd only achieve it? Yeah. Karen, I'm not used to failing. What if I don't achieve it, then I'll feel like a failure. I'm already overwhelmed. I'm already feeling bad about myself. I'm already feeling ashamed that I didn't deliver what I said to my spouse and my friends, what I would do when I opened my practice. See, I think it's more about that fear of failure. And that's one of the things we have to learn to embrace because this isn't school, business is all about trying things, failing, learning, and trying again. That is business. And if we want to protect ourselves in a little too Kuhn, you're going to be miserable. And I hate to see that I was miserable for so many years. Speaker 2 (20:03): You'll never hear anyone say it because I've been there. I've been in the private practice section. Now for 10 years, I've never heard one person ever telling me they're not doing well. Even though the odds are 85% of them are, how is that? Because it's pride and you don't want to tell people that stuff, but it's really happening. So by writing it down just for you, this is the exercise. Just write it down, create what's your vision. I don't care if you use six months, a year, two years, something reasonable, but just write it down. If anything was possible. And remember anything you want to do has been done a hundred million times before. There's nothing you're going to want that some other company hasn't created. So it's not like it can't be done, but anyone that helps you, you come to me, first thing I'm gonna say is, well, what do you want? Speaker 2 (20:58): Well, I don't know. Then how can I help you? I don't know what you're trying to keep. If you're going to hire someone, a good somebody, a good person that is going to work for you, better ask you. So what's your vision? Where are we going with this? Because they're looking at themselves as what is my growth opportunity here. So it is your duty as an owner. And to your point, yes, we as practice owners have an identity crisis. We actually don't know who we are. We have to embrace the fact that we are in owner. I know I'm going against what probably people have said before. You will always be a PT. Yes, you will always have a license. You always be a PT, but mentally you have to embrace it. You're an owner because you chose to go into business ownership. You didn't have to, it's a free country. Speaker 2 (21:49): You chose it. And there is more that you want. So how about we embrace it? And when you embrace it, it's amazing what you're going to be able to achieve. And you're going to make this whole process a lot more easier right now. You're making it difficult because you are battling these two kinds of brains. You're battling that clinical brain, that kilt brain that I don't know who I am. I'm just a PT and all, but I want this. I want to go on vacation for three weeks. Oh, I want him, I want to make money so I can put money away and write a check for college or, or have this or buy this. I want to help more people than I'm doing right now. And right now I'm not helping enough people. So it's your purpose. Your impact has to be the keys to this. Speaker 2 (22:32): So that's one thing. I do want to share a, another one. If I may. The other a growth mindset shift is focus. First one is the best is yet to come. The next one is focus. What you focus on, what you pay attention to grows. Now here's the caveat. It includes crap. You focus on a flower. You cultivate that flower. You put that little seed in there and you water it and take care of it. You're going to get a nice blooming flower. You cultivate that piece of crap and make it really nice. That maneuver is going to wreak real good. So whatever. So what does that mean? What's the manure stuff. It's the stuff that you're doing. That's not moving the needle in your business and in your life. It's the things that, although may be important. It's not what you should be doing because you can't do it all. Speaker 2 (23:42): And having the mindset of, I gotta do it all. I'm a great multitask. If I get one more person, tell me how great of a multi-tasker they are. Do you realize we are all researchers and science people? There's no, it's impossible for the brain to multitask. It can only focus on one thing at a time. All you're doing is focusing on a lot of one things really, really quickly. And then there's this thing called residue. This delay, right? If you're focused on something for a while and you focus on something else that delay, that thing stays with in your brain for a period of time, come on. You're not going to have a badge of honor saying what a great multitasker you are. Now. I'm not talking about the moms out there. And I, yes, yes. That's a whole nother world and I've seen it with my wife, but I'm talking about business owners, oh, I'm doing this, I'm doing this. I'm doing this. When they do that to me, they do it like they're bragging. And I go, why, why, why would you want to do that? You don't even like half the stuff you're doing. Why can't you get rid of it? And then we get back to the identity crisis. Well, I can't let it go. And there lies the issue. So focus having laser focus is like taking a magnifying glass to your business, letting the sun come in and dialing that energy. That is so strong. It can burn through wood. Speaker 2 (25:07): You have to have as an owner. And I've never met a successful business owner, entrepreneur, CEO that didn't have laser focus, never in any industry. Never because they couldn't be in that position. They couldn't have the level of success. I've met CEOs that their company wasn't great. Oh, they're all over the place. I've seen that plenty of times. So I don't necessarily what I had my practice. I didn't call myself the CEO. I couldn't get around that day. Those two corporate is it doesn't matter what you call yourself. Just think of yourself as you're the leader. This is your business. This is your thing. But it doesn't mean Karen that they have to do it all. No one said to dude, do it all. You're making this up. You're taking it all on. And it ain't working. If it was working, I'd be like, keep doing more, do more. Speaker 2 (26:07): Don't worry. We'll add more hours to the day. Do more. We'll take more time away from your family. Do more. It's not working. So focus. How do you, do you ever see the video? The invisible gorilla talk about focus, type invisible to grill. It's also called monkey business illusion. So here's what it is. There's six people, three in black shirts. I believe three. And white shirts. They're passing a basketball, right? And the, the, the exercise is count. How many passes? The white shirt? People throw to each other. That's it? That's all the directions is. I've seen it before. The first time I saw it at the end, the person goes, did you see it? And I'm like, see what? That was 18 passes. Yes. The number of passes were 18. Did you see the gorilla? And I went gorilla fricking no gorilla. There was a gorilla that come out. Speaker 2 (27:09): I'm gonna ruin it for people, but you have to see it. There is a grill that comes through the screen that starts dancing around and then walks off the screen. 50% of the people that see it, don't recognize it. Gorilla. This was a psychology experiment by, by the person that who the psychologist who did this. So being the smart Jamie, I just watched this the other day too. I've watched another version of it. Here's what's crazy. Of course. I saw the gorilla cause I was looking for the gorilla, but you know what? I didn't see. I didn't see the background completely changed colors. I didn't see one of the people that were passing the ball leave, like it's wild. What the brain is looking for the brain will see. So we have what's called and I don't want to get too technical here, but we have, what's called a bias. Our brain has a bias. Every single one of us, more specifically, it's called a negative bias. No matter how much we think we know, we can't think outside of our own bias. Speaker 2 (28:17): So the way you can kind of play with this a little bit is getting very clear at what you are focused on. Thinking through what you're focusing, then executing the plan. That's the only way to get through the bias except to have. And this is what I absolutely recommend. Someone else, someone else that's mentoring or coaching you, you don't know what you don't know and you never will, no matter how smart you think you are. And that's one of the problems we have because we are very smart people, but intellectually smart around physical therapy and anatomy. Yeah. That's great. But that's not going to help you with your business, right? So what you focus on, what you pay attention to grows. If you want more referrals, if you want more time than focus on the things that are going to help you do that. Speaker 2 (29:17): But the mindset shift is you have to be very honest with yourself. You have to ask yourself, do I like the results I'm getting? Do I like the income? Do I, I know we feel really weird about money and income, but it does pay the bills. Right? Can't pay the bills in likes, right? Oh, I got a thousand likes. Okay. Well how much you make nothing. Okay. You know, it does take money. It's okay to make money. What about time? Do you have control of your time? We call it freedom of time. Are you controlling your schedule? You're missing your kids' games. Are you missing events with your friends? Are you doing notes on the weekends? And so I was talking to someone yesterday, say, Jay, man, I do notes until 12 o'clock at night. I go, this is your business. And he goes, yeah, I'm working for a lunatic right now. Speaker 2 (30:06): Right. But that was kind of funny. So so that's, that's the thing. So I like to break it down for most of the committed clinicians and overwhelmed operators out there. 30 days, we, we have, we have a tool called a 30 day sprint. You can use that to 30 day goals. What's your goal for the next 30 days? Not 90, not a year, 30 days. What does it do you want to accomplish and choose one thing. Karen, just blend it because it's going to be hard for you to choose one because you're used to doing 20 and not achieving really any of them at least completed. So that's, that's an exercise that everyone can do. What area do you want to improve? Like I said, I gave you, I gave a bunch of examples. There's one, there's one code. I'm not monopolizing this conversation about, you know, that you're like, this is great. I have Jamie on 32 minutes. I'm like, thank you. Speaker 2 (31:06): I'm still answering the first question. Right? Henry David Thoreau. Great, great quote. It says it's not enough to be busy. So two are the ants. The question is what are you busy about? So by focusing more, you change your busy-ness to being intentional with what you're doing, that moves to being productive. The difference between productive and busiest productive is moving towards something that is desire busy. It's just activity. And there's a whole dopamine thing that we all have in our brain that, oh, but when I'm busy and I, I, you know, I take a post-it note and I throw it I feel so good about myself. I'm like, I know it's that quick dopamine hit that you achieve something. But the reality is you throw all of them away. You keep creating new ones and then you step back a little bit and you realize you haven't moved anywhere. Speaker 2 (32:02): You're still kind of doing the same stuff you were months ago or even years ago, you know? There's a, there's, there's, there's one more thing that we have, do we have time? Are we good? We're good. There's one more thing I wanna, I want to leave your audience with a growth mindset tip. And that is and this is probably now not probably it's the most important one and that is keep your tank full. And when I re referred to the proverbial gas tank, I'm referring to your energy level. We have all been in places where we are exhausted. Our energy is zapped. Our brain is fried and we just want to be left alone. If you have kids, you've been there many a times. If you have lots of patients, you've been there many a times. If you are running a business, you've been there many a times. If you've got annoying friends, you've been there many a times. Speaker 2 (33:05): And if something happens when you are in that state of just exhausting fed up, what's happening is your energy take low, near empty. A problem happens. How do you see that problem? Well, according to research in our beautiful little amygdala or my daughter calls it, the Amy, the gala, when emotion is high, such as when you're exhausted, fed up too much, intelligence is low. Your brain is hijacked. This goes back millions of years ago. When the Tiger's coming after you, you're not going to rationalize the tiger. Your body's going to go into overdrive and start running. However, what hasn't changed, even though we've transformed and we've we've, we've, we've, we've got all this new way. And in the neocortex, this is all old school brain stop. Something can happen. And you'll still get that feeling. You'll still get that emotional, like, oh my God, I got to react to something. Speaker 2 (34:12): And when your energy is low and your tank is low, you start to make really bad decisions. And when you make a bad decision with your friend, you yell at her, right? You yell at your friend, you yell at your kids, you yell at your spouse. You yell at your boyfriend and girlfriend, whoever you yell at people. And then later on you say, I wish it ends. I apologize. I shouldn't have said that. But when you make a bad decision in your business, oh boy, this is a decision that will, that could cost you thousands of dollars or tens of thousands. I've seen hundreds of thousands of dollars with literally one decision. It can cost you employees. It can cost you culture. It can cost you time and it can cost you a hell of a lot of frustration. Now imagine you're making these types of decisions, some grander than others, all the time, that's what's happening. Speaker 2 (35:10): Karen, we are making way too many decisions when our tank is well below halfway, and we're doing nothing to bring our take back up to full. What is a full tank? A full tank is your highest, most creative, innovative place. It's the place that you just feel on top of the world. It's the place of the highest level of confidence. It's the place that your friend says something stupid. And you're like, oh, you're foolish and come on. But that same person says something. When your tank is empty, you're going to bite our head off in business. You have someone asking you a question or someone coming to you for the umpteenth time that so w w if I want to take off next week, what do I have to do? And you just blow up on the person next day. You're like, yeah, yeah. You know, I'm sorry, whatever that person doesn't forget. Speaker 2 (36:09): Something like that. And when you start doing that and you start reacting, there's a difference between reacting and responding. Responding is what we do when the tank is full. Reacting is what we do when the tank is near empty. Reacting is an emotional response. Responding is a rational response. So what can we do? The fastest thing you can do when your tank is down is evoke physiology. What we do. So what's going to turn around deep breaths, count to 10, take 10 deep breaths. I guarantee whatever the problem is, it will subside. And you will think differently about it. Exercise. I know for me, when I exercise, God, I feel great, right? Anytime. And I've, I've, I've infused as I'm not perfect at it, but I've infused as, especially the last few years, especially last year during COVID when I think I might've come on here. Speaker 2 (37:20): And you're like, Jamie, what's the secret to dealing with. COVID pause. Just pause. Just stop. Just take care of yourself. Take care of your team. Like just personally. So I'm a great thing to do is don't make any decisions until after you exercise. I don't care if it's a walk. I don't care if it's, you know, basketball, I'll give it a round of golf. If you consider that exercise whatever it is running, you will think differently about the issue. If you have a problem with an employee, take some deep breaths and pause, do not address it in a high level of emotional state. This, if you just stop doing this so often, I will promise you, your business will get better. I promise because you'll just stop making these decisions that you don't even realize. We don't even realize we make these decisions, but then all of a sudden problems happen. Speaker 2 (38:16): And then we justify why. And I guarantee, at least with me, the justification was well, Jamie it's because you're in a high emotional state. That's why this problem. No, I started looking for someone to blame. I look for the prop, the answer to the problem, somewhere outside of where it really came from, that gets expensive. That causes you then to hire people you shouldn't hire to pay. I mean, I paid so much money in marketing and stuff like that. Why I was in a really bad emotional state. And I was just trying to solve it, writing a check on it. Wasn't it, it wasn't, it, it wasn't a rational thought through issue. And I did that again and again, and I did that with a lot of other problems too. So you know, when emotions are high intelligence is low. Karen, this is an opinion. Speaker 2 (39:09): This is a fact. We like facts as PTs. This is a fact. So pause 10 seconds, 10 deep breaths exercise before decision. And you don't have to wait for your, for your tank to get low. I know we do that. Like I'm, I'm one of those. Not only does the light come on, but that, that thing gotta be at the line. Or even below the line for me to go to the gas station. We can't do that with ourselves. When that thing gets around half, half full it's time, start, start doing some things, put this into your regular routine. Here's what I've learned over the years. I didn't realize this. So I started talking to a bunch of people around this particular point of keep your tank full. And I don't know the exact number, but it's overwhelmingly more than I would say, 80%. When you, when you get busier, when things get busier at work in the office, there's one thing that you sacrifice more than anything else. That's your, self-care you exercise. Normally you stop going to the gym, right? You do yoga, you stop it, you meditate, you stop it. You go, you stop. The thing that actually is keeping you sane and keeping you mentally strong and mentally fit. That's when you have to pause and saying, I'm the most important person in this company, my thinking and how I think about this business affects everyone in the business, including the staff and the patients and the community. So when I'm feeling like that, I know it's time to do some serious take care of me time. Speaker 1 (40:57): Yeah, absolutely. So now, if we start to, we'll start to kind of wrap things up here. So I just want to review some of the things that you said that physical therapy owners can do to kind of change their mindset around them being clinician, a PT an owner, to help them be successful. So you just talked about not making decisions on an empty tank or a near empty tank. We talked about changing we talked about some little like mindset tricks and tips and things like that. What else? Speaker 2 (41:40): Well, the, the three things that specific thing could be talked about, cause a lot of them have to do with that is growth mindset tip number one, the best is yet to come. The exercise for that is take 15, 20 minutes. You can, you can, you can handle that. Write down what the heck you want one year from today, one year from today, if you and I had a conversation and we were going to look back on to this moment, what would happen for you to feel happy about your business, about your bank account, about your family, about your personal life, what would you, what would have to happen? Write that down. I don't care if it happens or not. No, one's going to call you on it, but I want you to go through what it feels like to actually put that down on paper. Speaker 2 (42:27): Don't type it out on the computer. There's something special about writing it out on paper, right hand to paper. That's number one, that's number one, number two, focus, growth mindset. Number two, focus. What we focus, what we pay attention to grows. So what are you focused on? One thing for the next 30 days? What is one outcome? One goal that you want once you do that reverse engineer, that and then say, okay, in order to achieve that goal, what happens? What do I have to achieve this week? Say that exact line. What do I have to achieve for this week? Do that four weeks in a row. And I promise you, I promise you, call me out. If I'm wrong, you will be either hit the goal, go way past the goal or make significant progress, which you won't be is where you are. Excellent is the 80 tank. Speaker 2 (43:28): Keep your tank full. If you get into a high level of emotional state resist making decisions, or if you have to make a decision deep breaths count to 10 exercise, something that helps you increase your energy level. And then of course the second part of that is incorporate that on a regular basis every day, maybe a couple days a week, three days a week, but on a regular basis. And for whatever you do, no matter how busy and crazy life gets, do not sacrifice your time, your self care is the most important thing. There is you are not a hero by killing yourself. You don't strengthen the weak by weakening, the strong you killing and sacrificing yourself is not helping anyone. You don't need to do that. And then of course the overarching thing that we've talked about is, you know, some of the ideas around really thinking of yourself and considering yourself and talking about yourself as a business owner, right. If you're treating tree, that's great. But other than that, you own a business. Speaker 1 (44:49): Yeah. Perfect. All right. Where can people find you? Speaker 2 (44:55): Yeah, learn more. You can just go to my website practice freedom, U the letter u.com. I got some goodies on there. You can download my book on there. What I would recommend if people want to dive in deeper with me and, and just kind of, you know, you want to have a conversation. I am offering a, what we call a discovery call and we'll see kind of where you are mentally. We'll see where your mindset is. We'll see where your business is and we'll see if there's ways we can help you. We do have programs. We'll see if it's a, if it's the right fit for you, if not definitely give you some things that you can do in the meantime, maybe point you in some other directions. So you can go. I'm sure you'll put that in, but you can go to practice freedom, u.com/discovery call. Speaker 1 (45:41): Perfect. And yes, this will all be in the show notes at podcast out healthy, wealthy, smart.com under this episode. So last question, Jamie, what advice would you give to your younger self? Speaker 2 (45:53): Oh my God. Overcome your ego. Jamie it's okay. You don't know everything enlist. Some help invest in yourself, invest in your business. It will pay off dividends in the future. Not only to you, not only to your family, but for everyone that's around you, including your staff and community. Speaker 1 (46:15): Excellent advice. I love it. I love it. And I feel like you've given different pieces of advice each time you've been on very impressive. Cause I've asked this question before and the advice is always different, so well done. You so thanks so much for coming on and sharing. This was great advice for anyone who is a current owner or who's maybe thinking about becoming an entrepreneur. So I thank you very much. Speaker 2 (46:41): You're welcome. Thank you so much, Karen. Speaker 1 (46:42): Yeah. And everyone who's listening. Thanks so much for tuning in, have a great couple of days and stay healthy, wealthy and smart.
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| 556: Dr. Rachel Zoffness, The Money & Science of Pain Management | 07 Sep 2021 | 00:54:22 | |
In this episode, Co-President of the American Association of Pain Psychology, Dr. Rachel Zoffness, talks about treating chronic pain. Today, Rachel talks about the failed biomedical model, pain neuroscience, and effective non-pharmaceutical pain treatments. When is the right time to refer someone to a pain coach? What are some multidisciplinary approaches to pain management? Hear about the biopsychosocial nature of pain, how pain treatment in the US is actually about money, how thoughts and emotions affect pain, and The Pain Management Workbook, all on today's episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
More about Rachel Zoffness Dr. Rachel Zoffness is a pain psychologist and an Assistant Clinical Professor at the UCSF School of Medicine, where she teaches pain education for medical residents. She serves as pain education faculty at Dartmouth and completed a visiting professorship at Stanford University. Dr. Zoffness is the Co-President of the American Association of Pain Psychology, and serves on the board of the Society of Pediatric Pain Medicine. She is the author of The Pain Management Workbook, an integrative, evidence-based treatment protocol for adults living with chronic pain; and The Chronic Pain and Illness Workbook for Teens, the first pain workbook for youth. She also writes the Psychology Today column "Pain, Explained." Dr. Zoffness is a 2021 Mayday Fellow and consults on the development of integrative pain programs around the world. She was trained at Brown University, Columbia University, UCSD, SDSU, NYU, and St. Luke's-Mt. Sinai Hospital.
Suggested Keywords Pain, Psychosocial, Emotional, Physical, Neuroscience, Treatment, Thoughts, Management, Healthy, Wealthy, Smart, Coach, Physiotherapy, Healing,
Dr. Zoffness Latest Podcast: Healing Our Pain Pandemic Dr. Zoffness's Book: The Pain Management Workbook
To learn more, follow Rachel at: Website: https://www.zoffness.com Twitter: Dr. Zoffness Instagram: @therealdoczoff LinkedIn: Rachel Zoffness
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full transcript here: 00:00 Okay, so whenever so I, you will know when we're recording because like I said, I'll do like I'll do a quick clap. And then I'll just say, hey, doctor's office. Welcome to the podcast and off we go. Okay, ready? Perfect. Okay. Hi, Dr. softness. Welcome to the podcast, I am excited to have you on today to talk about chronic pain and treating patients with chronic pain. So this is a real treat. So thanks for coming on. I think you are very cool. Karen Litzy. And I'm excited to be here. Excellent. So what I what we're going to talk about today, just so the listeners knows, we're going to talk about kind of treating chronic pain from a bio psychosocial standpoint versus a biomedical standpoint. So I know a lot of people have no idea what those terms mean. So doctor's office, would you mind filling in the listeners as to what a biomedical model is and what a bio psychosocial model is? to kind of set the tone for the rest of the podcast?
01:10 I totally Can I talk about this all the time, because it makes me so mad. Okay. So the biomedical model is the one that we all know the best, because it's the way we've been treating pain for many decades. And the biomedical model of treating pain and health in general, is essentially viewing and understanding and treating pain as a problem that is purely the result of bio biological or biomedical processes like tissue damage and system dysfunction, and on anatomical issues, and then throwing pills and procedures at it. That is how we've been treating pain for many decades. And of course, we know it isn't working, we have an opioid epidemic, the opioid epidemic is getting worse during the COVID pandemic. People are really suffering, chronic pain is on the rise. It's not being cured. It's not magically disappearing. incidence isn't even decreasing. So the way we're doing it is broken, and also very expensive for people living with pain. However, what science tells us is that pain is not purely biomedical. It has never been purely biomedical. It's actually this different and more complex thing, which surprises nobody, which is bio psychosocial, which is a big and complicated word, but makes intuitive sense, once we start talking about it, I think to people who have experienced pain, which means that yes, of course there are biological processes at work when we're living with pain, acute and chronic. And I can say what those mean to short term pain versus long term pain, longer term pain.
03:02 Yes, and there are also many other processes that work too. So if you imagine this Venn diagram of three overlapping bubbles, which I draw a lot, but I cannot draw right now, we've got the biological or the biomedical bubble on the top. And then we've got the psychological bubble. And that's the one that I struggle to explain to people the most, because I think there's so much stigma around this idea that cognitive and psychological processes might be involved in this experience we call pain because there's so much shame and embarrassment and stigma around anything to do with psychology, which is so unfortunate. But in this psychology bubble of pain, there's a lot of stuff that I think people know intuitively can amplify or reduce pain. So there's thoughts about your body and about your pain and just thoughts you're having about life in general. There's emotions, like stress and anxiety and depression, even suicidality. And we know that negative emotions amplify pain. And we know that positive emotions can sort of turn pain volume down, there's memories of past pain experiences. And those are stored in a part of your brain called the hippocampus. And we know research shows that memories of past pain experiences can change your current experience of pain. And also in the psychology bubble, we've got coping behaviors. So that's quite literally how you deal with the pain you have. And a lot of us who have lived with pain, and that does include me engage in a lot of coping behaviors that make sense in the moment. But actually, they can make pain feel worse over time. And a great example of that is the resting indefinitely plan or the doing nothing plan, as I like to call it which is totally, you know, normal and natural for those of us who pay into Engage in because when your body is telling you, you know that you're hurting, it's understandable that the thing you think you're supposed to do is stop all activity. But ultimately, what we know about that particular coping behavior is that it makes chronic pain in particular worse over time. So the do nothing plan or the stay home or rest indefinitely plan is a coping behavior that lives in the psychology bubble that can actually make pain feel worse. And of course, there's coping behaviors that can make pain feel less bad, like the counterintuitive things like leaving your house and seeing people and walking and getting out into the sunshine. And, you know, these things that we don't necessarily know can help pain. And then the third, overlapping bubble, and our bio, psychosocial Venn diagram, is the social or the sociological domain of pain. And that's what I like to call the everything else bubble. So it's socio economic status. And family and friends have culture and race and ethnicity and access to care, and socio economic status, and history of trauma and early adverse childhood experiences, and culture, and context. And environment, like quite literally, everything else your environment, believe it not changes the pain you feel. And in the middle of those three things, and I know that's a lot of things, is pain. So when we try and pretend that pain is just this simple biomedical thing, the treatments don't work. And I think all of us who have lived with pain know that our pain is much more complicated and sticky. I know that was a lot of words.
06:44 No, and, and I'm glad that you described everything in the way that you did, because I think that gives the listeners a really good idea of what's in each of those bubbles. Number one, and number two, how complex pain actually is. Exactly, it's not. So if I think if the listeners take away anything from this conversation, if pain is complex, and doing one single thing repeatedly over years, and years and years and years, that has not worked, it's probably not the right way to go.
07:15 That's right. And you know, the other misconception that we all understandably have is that, you know, the way to treat pain is just by going to your physician. And, of course, that makes perfect sense. But we have this misconception in western medicine, that either you have physical pain, and you see a physician, or you have emotional pain, and you go to a therapist, or a psychologist, someone like me, and the really fascinating thing about pain, and the reason I love studying it, and treating it and talking about it so much is that neuroscience tells us that pain is never purely physical, it's always also emotional, because the part of your brain called the limbic system actually processes pain 100% of the time. So pain is always both physical and emotional. But most people don't know that most people have never been told that. But the limbic system plays a huge role in the experience of pain. And we know that, you know, emotions are always changing pain volume all the time. So this idea that pain is either physical or emotional, is not actually a thing, you know, and the way we treat pain by going to a physician exclusively is not actually nine times out of 10, probably more than that going to actually, you know, be the answer for any sort of chronic pain problem.
08:37 And so I'm glad that you brought that up that yes, we know emotions play a role in pain. And as a matter of fact, the International Association for the Study of pain, change their definition of pain in 2019, I believe to include that it is an emotional experience. And I think that really set the stage for greater discussion and research, which I think is amazing. But when you say to someone,
09:05 let's see, can I interrupt the flow to say, they did change the definition, but the the word emotion was always in there? Oh, was it? It was? Okay.
09:16 Let me so when we talk about kind of the emotional part of pain, and I have had patients say this to me, which probably meant I was explaining it incorrectly, and I take full responsibility for that. And I'm sure you've heard this before his patients saying, so you're saying it's all in my head. Totally. And how do you react to that?
09:42 Yeah. I love that. You asked that question. I think probably the worst thing about being a pain psychologist is you know, you're the last stop on the train. You're the last person anyone wants to see nobody wants to go to a psychologist or a mental health professional for a physical experience like pain. And I know you can't see me, but I'm putting air quotes around the word physical. Because again, pain is not a purely physical experience. It's physical and emotional. But of course, no one wants to go to a pain psychologist for pain, right? You think you're supposed to go to a physician, and a referral to a psychologist means you must be crazy or mentally ill or the pain is on your head. And no, that's not what it means at all. And I find that the way that I most effectively target that is by explaining, believe it or not pain neuroscience. And I, I usually do that in the simplest way, I know how just by distilling down that, that, you know, it's easy to believe that pain is something that lives exclusively in the body, right? Like, if you have back pain, it's so easy to believe that that pain lives exclusively in your back. But what we know and what neuroscience has taught us is that actually, it's your brain working in concert with your body that's constructing this experience we call pain. And we know that because of this condition called phantom limb pain, wherein, you know, someone will lose a limb like an arm or a leg and will continue to feel terrible pain in the missing body part. And if pain lived exclusively in the body, no limb should mean no pain. So if you the fact that you can continue to have terrible leg pain, when you have no leg tells us that pain can't possibly live exclusively in the body. And I find that when I explain this to the patients who come see me, first of all, there's more buy in that the role of the brain in pain is really significant. And second of all, it sort of gives me some leverage to then explain that, again, one of the parts of the brain. And one of the most influential, influential parts of the brain that processes pain is your limbic system, which is your brain's emotion center. So unless we're taking care of your thoughts and emotions, we're actually not really treating this thing we call pain effectively, we're just treating one small component of it. So that's, you know, and I also always, by the way, validate that, of course, you have, you know, of course, it feels like someone's saying that the pain is on your head, or that it's a psychological problem. Because of this, again, this like false and ridiculous divide we have in western medicine between physical pain and emotional pain, when neuroscience has known for decades that that's not actually a real distinction, like your head is connected to your body 100% of the time, you know?
12:24 Yeah, absolutely. And as let's say, as a practitioner who's not a pain psychologist, a physical therapist, occupational therapist, maybe your yoga Pilates, and you are working with someone with persistent pain? How, how can we encourage our patients or recommend to our patients, that, hey, you might really benefit from seeing a pain psychologist, without them thinking that we're telling them they're crazy? Yeah.
12:57 I do think that taking 30 seconds, or maybe even 60, to explain, you know, this basic painter science thing. And the phantom limb thing is a really, really effective strategy. So anybody can use that. That piece of information. You don't have to be a pain psychologist. So that's thing one is just like taking a few moments to talk about how pain works in the brain. I think patients are so grateful to learn that no one's ever told them this before you're going to be the first person to ever let them know. And then the other thing that I always do is a trick that I learned from a really nerdy journal article I read years ago by a guy named Scott powers. And he said that one trick that we can use is to call pain psychologists or you know, therapists who are trained in things like cognitive behavioral therapy for pain, pain coaches, and I love that. So I usually tell physicians and other allied health professionals to refer to me as a pain coach. And the way I pitch that to families and tell other health care providers to pitch it to their patients is to say, if it's okay to go to a soccer coach, to get better at playing soccer, it is surely okay to go to a pain coach to get better at living with chronic pain. Because living with pain is so hard. And you deserve support. You know, and usually that removes the stigma and the stigma, especially when you present that in conjunction with some science that supports the role of the brain and the role of cognitions and the read the role of emotions and coping behaviors. In the experience of pain, I find that that really is super effective.
14:41 Yeah, that's really helpful and a great way to frame how to frame that recommendation to someone coming from someone like me coming from a PT because people often come to physical therapists I mean, it's in the name Because they want us to heal or to fix their physical problem, which in this case is persistent pain or chronic pain. And so then that leads me to my next question is, as a physical therapist or as someone who's working with the body, when do we refer this person to a pain coach or pain psychologist?
15:25 I'm curious to know what you're going to think of my answer. Ready? Here's my answer. I once had a friend who said to me, man, like, everyone's always going around talking about how many miles they ran today. And you know, how you like the Strava app, like, you know, how many miles they biked? And how many hours they did yoga this week? And can you imagine what it would be like if everybody, you know, came, came to each other and started bragging about how many hours they spent working on their shit? Like, what I spent three hours working on my anxiety today, or like my family stuff? Or like, my complicated relationship is, like, just why do we prioritize working on the body over working on our minds? You know, it's so strange. So my honest answer is if you're ever treating a patient who's living with chronic pain, and again, that's pain that's lasted three or more months, I think it's worth a referral to a pain psychologist or therapist who's trained in cognitive behavioral therapy. I just, I can't imagine any human being who wouldn't benefit from the opportunity to navigate the complicated experience that is living with pain and having someone in the role of support and coping behavior coach is just, you know, and partner and in processing, the experience of it just just seems to me like such a great gift to be able to give to patients.
16:51 And my answer to how I react to it is I agree. And, and again, this takes into a takes into account really this multi discipline, multi disciplinary approach to pain and approach to pain treatments and management. And so in your opinion, what makes that multidisciplinary approach effective for that patient?
17:20 I mean, what the research shows is that trying to approach and treat pain from just one angle is usually not sufficient, because as we were saying at the beginning, pain is such a complex, bio psychosocial thing. So if we're just looking at the biomedical components, we're not really doing our job, if we're just looking at the psychosocial components, we're not really doing our job. So, you know, a multidisciplinary team as a team made up of, you know, psychologists and pts, and OTS and physicians and nurses and biofeedback providers, and all these different people who are sort of coming at this complicated things from maybe slightly different angles and perspectives. And when we do that, what the research shows is, we have the most robust outcomes, the care is most effective, and the most comprehensive, and people walk away with a whole tool belt of tools to use when treating their pain, you know, across scenarios and across symptoms. So multi disciplinary is really like, how can we all come together as a team with our unique backgrounds and our unique training because, you know, as you know, trainings, especially in the United States, the disciplines are also siloed. You know, like, psychologists are trained in this one way, and pts are doing this thing over here. And OTS are over there. And anesthesiologists are over there as physiatrist. Or, I mean, it's just it's so fractured. So a multidisciplinary team is hopefully working together to target this complex animal that we call chronic pain. And what's really interesting is, you know, I have a private practice, where I see a lot of patients with chronic pain. But I feel like the bulk of my work sometimes is coordinating care with this really complicated treatment team. And I'm seeing a really complicated patient right now who has crps complex regional pain syndrome, which is a really tricky, chronic pain syndrome. And, you know, the way that we his case has been so complicated. It's been many years of treatment. And I think today as a team, we finally decided upon a treatment plan. And it really wasn't until we all were talking that that came together and jelled. So I think that's one of the most important components of treatment actually.
19:38 Yeah, I, I agree. And and when you're in private practice, like you said, sometimes it can be a little bit more difficult, but the more communication you have with people on that team, again, we're doing all of this for the person in the center and that's the patient and so being being able to provide vied so much coordinated care for that patient. Like you said, the research has shown that this is that this works versus a piecemeal, one person's doing this over here. And someone's doing this over here, and they're hearing, and then the patient's hearing contradictory treatment plans. And so it gets really confusing.
20:21 Yeah, it gets super confusing when there's, it's almost like too many cooks in the kitchen, if you're not working together, because they're getting all this different advice from all these different people. And oftentimes, and I'm sure you've seen this, too, they're on, you know, 40, they've tried 40 different medications by the time they've gotten to you. And, you know, I mean, I think what it leads to is like, this treatment, burnout, where like, our patients are just so burned out on all the treatments they've tried, and they have this sense of hopelessness, like, nothing's gonna work. Nothing's working. So far. I've tried all these things. I've seen 40,000 million doctors, and, you know, I've, yeah, I've tried herbs. And yeah,
20:58 I've heard that from people like, they're like, I don't want to go to one like I'm all doctored out, if I have to go see one more doctor, or take one more medication, or do one more procedure, or one more scan, like I'm done. I don't want to do this anymore. Yeah. And I blame them. Yeah, it's exhausting. It's totally exhausting. And you know, we've been talking about things that don't work. Right. So we talked about all that being on medication after medication, opioids, we know these, they don't work for people with chronic pain. So let's talk about non pharmacological treatments. And what does work or what can work for people with chronic pain, so I'll throw it over to you.
21:44 Yeah, so non pharmacological treatments, there's like a whole host of them, there's a wide range of them. And there's a lot of literature on a bunch of different things. So what I use the most in my practice, because I really love it and have found it to be so effective is cognitive behavioral therapy, or CBT, which is different by the way than CB, cb, D, that's something different CBT cognitive behavioral therapy. And an arm off of that is a treatment called Act, which is acceptance and Commitment Therapy, which is become very big in the PT world, which by the way, originated from CBT, and was adapted for pain. There, there's also Mindfulness Based Stress Reduction, or mbsr, which has a huge literature base for the treatment of chronic pain. And there's other things too, like biofeedback, I happen to really love as a treatment for pain. And there's a whole host of other things, too. But, yeah, God,
22:43 I was gonna say, could you explain briefly what biofeedback is so that people understand what that is? Exactly.
22:50 I'm so glad you asked. I've been doing this for so long that I forget. I just forget that. Certain things are not known entities. But I also did not know what biofeedback was when I first started treating chronic pain. And so I'll someone said to me, oh, you're treating patients with pain, you should refer them to biofeedback. And I said, You know, I don't refer my patients to things that I don't understand. So I did a buttload, of reading about biofeedback for pain, and I got a bunch of books. And then I found myself a biofeedback provider. And I went to this gentleman, his name is Dr. Eric pepper. Dr. Pepper is just a great name for any doctor. And He is a professor at the University of San Francisco and I admired him right away, he was obviously very smart. And he sat me down in a chair. And he hooked me up to this machine. And he said, This machine is going to read a bunch of your biological outputs, it's going to read muscle tension, galvanic skin response, your finger temperature, and a bunch of other things, your heart rate. And I was like, what that's really interesting. And he showed me which monitor was, you know, giving me feedback about which thing and hopefully you're picking up on the fact that there's biological processes that you're getting feedback about? And he said, and now I'm going to teach you to raise your finger temperature to 90 degrees, using your mind. And I said, Excuse me, sir. I am a scientist. And I do not believe in Voodoo. And he said, Well, how about you just try it out and see how it goes. So he did a couple of techniques with me had me close my eyes, he did some relaxation strategies, and diaphragmatic breathing, and he used imagery of like hot soup and hot air flowing down my arms from my shoulders into my fingertips, and autogenic training and autogenic phrases and that's when you say things to yourself that are suggestive like my arms are heavy and warm. My hands are heavy and warm. And as I was doing, as I was doing all these things, I noticed, because the machines were giving me feedback about my biology, that my hand temperature was going up. And within two sessions, I was able to warm my hands using my mind. And I am a person with chronically cold hands, because I'm stressed out all the time. And no one had ever told me that cold hands and feet, by the way, are a sign that you are stressed out. So I can now warm my hands on command, which is absolute magic. And when I teach it to my patients, they oftentimes say things like, Oh my god, I can make fireballs with my hands with my mind, what else can I do? And that's exactly what we want. For people living with pain, this idea that the mind and body are connected 100% of the time, and that you have more agency and control over your body than you thought you did. And you can make changes to formerly unconscious biological processes like skin temperature and muscle tension and pain. And biofeedback teaches you some skills to do that. Which is why I really like it so much.
26:13 Yeah, it sounds so like sci fi doctor who kind of stuff. Dr. Pepper. Exactly. Yeah, right. Exactly. Right. But yeah, it just sounds like Wait, what? But yes, I mean, I've never I have not done biofeedback myself, but it is something that I'm just constantly interested in for the exact reasons that you just said, like, Whoa, I can control what my body does. This is pretty cool.
26:41 It's worth it, I highly recommend it. It is so worth it. It's it makes you feel like, you know, it's this sense of like, if you almost feel like the Incredible Hulk like gotta have all this untapped power and potential that I just didn't even know about.
26:55 Yeah, it's, it's wild. Thank you for giving us that kind of definition of biofeedback, because I guarantee a lot of people who are listening did not know that at all. I didn't either, I totally didn't either. Very, very cool. So now, all of this, these non pharmacological treatments, CBT, a CT, biofeedback, we can maybe put physical therapy, occupational therapy into that as well. I mean, obviously, all of these things, cost the system money cost the patient money. But let's talk about the money aspect of treating pain, especially here in the United States. So what, you know, when people think about treat treatment of chronic pain, they often don't think about the money involved. So I will throw it over to you to kind of elaborate on that, and what does what that means for the patient and for the system.
27:52 You're actually making me realize that when you asked me about non farm approaches, I of course, immediately went to like, you know, like psychological treatments for pain. But yeah, of course, you're right, PT, OT, all these things, of course, are all the things and approaches. Yeah, absolutely. So yeah, it was a really sad day for me, when I realized that the treatment of pain historically has actually been about money. That was a really sad wake up call for me. So I used to be a member of this organization called the American pain society, it was very well established, very well known organization. And they went belly up after it came out. And I don't know if this is proven or not. But I should say, after they were accused of taking money from Big Pharma, to promote the use of opioids for the treatment of pain, despite the fact that it was known that opioids a were highly addictive, and habit forming and B sensitize the brain to pain over time and are therefore not actually effective. Because if you go off of them, as most people who have tried this, no, pain feels worse, your brain is actually more sensitive to pain. And so they went belly up, and they were, and then I read this book that was formative for me, by Anna Lemke. Le MBKE, who is now a friend of mine, called drug dealer, MD, drug dealer, MD, a very controversial and very compelling title. It is a thin, little book, I think it came out in 2016. If I'm not mistaken, I read it. Or I should say, I consumed it in a couple of hours. And I am not someone who writes in books. But I must have written on every page of this book. You must be joking. Oh Mfg. Like curse words and exclamation points. Because essentially, it's the story of how pain medicine has been about earning a buck off of people who are suffering and as we all know, with these lawsuits that are now how Like with the Sackler family and a lot of and also big pharma, you know, what we're learning is that despite the fact that these people and these companies have known for many, many years that opioids are highly addictive, highly habit forming not actually effective over time. And, you know, especially in high doses. Yeah, it's sort of this story of like, you know, follow the money. It's sort of horrifying. So, you know, I also have had conversations with physician colleagues who say things to me, it's a true story that, you know, it's clear that pain psychology plays a huge role in pain and pain management, and would be hugely helpful as with all of these psychosocial treatments, but that a lot of the times because insurance doesn't reimburse these treatments, they either don't get recommended, or they don't get integrated into pain management programs, even at hospitals sometimes, because insurance reimbursement is so crappy, which is just like another eye opening moment like we wait. So you're saying that, you know, these things work? You say that, you know, they're effective, but we're not recommending them and we're not hiring pain psychologists, because insurance doesn't reimburse. So again, it's a money thing. What? So the effective treatments are out there, they're known entities. But, you know, big pharma has billions of dollars to, you know, promote this idea that pain is a purely biomedical problem that requires a purely biomedical solution. So as long as you believe that you're going to buy into that model, and you know, as long as insurance companies are not reimbursing non farm approaches to pain, then you know, we're going to say stay stuck in this loop of treating pain, like a biomedical problem when we know it's a bio psychosocial one. So it's really complicated. Just this discovery that pain medicine has historically really been about the dollar. And it's sort of nauseating and horrifying.
31:56 Well, I mean, I think you can take away pain from that and just say medicine.
32:00 Yeah. Insert health condition here.
32:03 Yeah, yeah, I think it doesn't matter what it is, right? Because it's always going to come back to following the money and where, where can you get the biggest bang for your buck? And unfortunately, that, like you said, Those non pharmacological treatments are oftentimes not covered. So you're getting zero bang for your buck. So as a business, which a hospital is, even if it's not for profit, or an outpatient clinic, are you going to do things you're not going to get reimbursed for? Right, you know,
32:35 no, you know, that's true. And like, I don't mean to sound on empathic. Like, of course, yes, hospitals are businesses, and they have to stay open, and they have to earn money. So so the question for me, like, as I roll along, in this world of this totally insane world of pain medicine, and build my own business, by the way, like, how do we change the system? Like, yeah, we really are patient, patient centric, and like our goal, actually, at the end of the day, is to help our patients get well, what needs to change first, like, does public perception and understanding of pain need to change first? Like, do we need to be training our healthcare providers across disciplines better, like in PT, school, and in OT, school, and in psychology programs like mine, where By the way, I was in school for 40 100 years, and I got zero training and pain, like in my undergrad, brown neuroscience class, we learned about pain, and I became obsessed, and then like, wrote papers and stuff, but but that was it, like not, I have two master's degrees never learned about pain. At no point in my PhD program, did we get training and pain? So? So like, do we need to go, you know, backwards and insert pain education programs in medical schools? Yeah, I know, I know, you and I have talked about this, like the statistic that I'm obsessed with, like 96% of medical schools, in the united in the United States and Canada have zero dedicated compulsory pain education. So it's like, where do we start with this problem, isn't it? Do we like go after the insurance companies and reimbursement rates? where like, where the it's the system is so broken, I sometimes get discouraged, like, where do we start? But I think I actually think what you're doing is a really great place to start, like educating healthcare providers, and the general public about pain, and getting enough people riled up and angry about the way pain has been mistreated, and the way we're Miss educating our health care providers are just not even bothering. Maybe that's the place to start. Like maybe if there's enough of a clamor, and enough people are pissed off about it. Something will change.
34:38 Yeah. And and I agree, I think education, education, education, it has to start there. And especially in medicine, in medical school, especially with the physicians who are oftentimes they are the frontline providers, right, your your regular, your local PCP, primary care physician is often your frontline person and But they're also the people who were traditionally prescribing opioids for everyone, when they would come in with back pain instead of saying, Hmm, maybe maybe you need to see a physical therapist or a pain psychologist, let's sit down and talk to you. How can we let's find out what your needs are, what your bio psychosocial needs are. And so I think if, as the practitioner if you're not getting any education in that you don't know what you don't know. So you're not going to do it. And then I agree, I think, and I think insurance companies need to reimburse doctors and therapists across the board to talk to their patients. Talking doesn't get reimbursed procedures get reimbursed. Right. Right. What's the most important part of diagnosis when you're with a patient? talking to them, understanding what's going on with them, like that is paramount, and that needs to be reimbursed. But insurance companies won't do that they won't reimburse you for talking with your patient. Especially if you're like a PT, we get reimbursed by codes. And and none of those codes are, I'm going to really sit down and try and get into the nuts and bolts of what my patient's problem is. So
36:20 yeah, we need to code for pain, education, community, healthcare provider to patient.
36:25 Yeah, yeah. And some people say, Oh, you could use like the neuromuscular, neuromuscular treatment code for that. But there should be a code for let's talk to our patients, there should be a code for the subjective exam. Yep. Yeah. Oh, yeah. Because how were you supposed to learn about their bio psycho social situation, if you can't talk to them? And ask those probing questions, ask those open ended questions, like you said, In the beginning, bio, psychosocial, a lot of things go into that bucket. And we as the practitioners need to learn as much as we can about all those things that go into that bucket, if we're going to treat this patient efficiently.
37:10 There's so many things in the bucket. And I think, when we assess issues that have to do with pain, we really are assessing the biomedical bucket like 99% of the time. And, you know, if we really are thinking about this as this Venn diagram with three bubbles, if you're only assessing or looking at the biological domain of pain, you're literally missing two thirds of the pain problem. It's just wild to think about it that way. Yeah, if not more? Yeah, yeah, exactly more right now. So like, maybe all of us should be assessing for history of trauma. And maybe all of us should be assessing for aces, the adverse childhood experiences, which we know there's like this slew of studies that show that aces impact, you know, the development of chronic pain and illness and adults, maybe we should all be assessing for, you know, abuse and, you know, poor access to care. And just like so many things that we need to assess for if we're actually going to, you know, do a workup of pain, and instead of just this, you know, tell me about your anatomical issues. And let me do some scans.
38:14 Right, right, on a scale of zero to 10. How would your pain? Oh, it's a 10 out of 10? Well, this is like my little soapbox is what I hate. I see this a lot in physical therapy, student Facebook groups, things like that. Yep. And you know where I'm going with this? They'll say, Oh, well, if someone comes to me, and they're 10, out of 10, I'm going to call the ambulance because they must need to be in the emergency room. Poor education, that therapist was not educated on pain. No, I've not. No, that's wild. Yeah, I hear this all the time. Or those similar Sam 10 out of 10. It's a really, because if like I chopped your hand off, that would be 10 out of 10. So what's your pain now?
38:57 Right? Like this? Right? This lack of awareness that pain, by definition is a subjective human experience. And whatever your patient says it is, that is what it is. And you you actually don't get to argue with them about it. You don't negotiate down someone's pain. Right. And I mean, I think what I've learned over time about pain is there's really valuable clinical information when your patient tells you, like I hear a lot of times like 11 out of 10 literally what your patient is communicating to you is I can't handle this anymore. It's beyond my capacity to cope with this level of suffering. That is what they're saying to you. And usually also, at least for me as someone who really, really likes and appreciates the pain catastrophizing scale, the PCs, which is a potentially controversial term, some people don't like the term catastrophizing, I happen to appreciate it. I think it's very valuable, but don't want to go down that rabbit hole. But the pain catastrophizing scale, but they're also telling me is that when people tell me their pains, Out of 10 or an 11 out of 10, there's a high likelihood that their thoughts around their pain are very intense and catastrophic, and that they're having very intense emotions around their pain too. So it's good clinical information. You know, like you said, You can't bargain with someone about their pain number. Yes, we don't pain haggle. Right. Right. It's not like being at the market. No, like a price price that you get on fish. But but there's rich clinical information in there, if you're willing to, like, Listen for it, they're telling me that they're having an emotional experience that's beyond their ability to
40:37 navigate. Right to cope. And, and that's where I think like, I'll ask that question to all of my patients, because for me, that's my window to crawl in, and really get down to maybe the psycho or the social part of their pain experience. So like you said, if someone says to me, oh, my pain is like, it's at 12 out of 10. Today, and I'll say, Okay, well, can you tell me a little bit more about that? You know, what are you? What are you? What are your feelings around that? Or what's going on at home? What are your responsibilities at home? How does, you know? How does that play into why this pain is? 12? out of 10? Today, right? Right, you know, so it is, like, I always ask the question, but it's a nice way to kind of get in and be able to ask more questions. And, and just because someone says their pain is 12 out of 10, it doesn't mean you call the ambulance, they shouldn't be in the emergency room, they probably worked all day have to go home and have two kids to take care of. Yeah. And they're doing all of this at a 12 out of 10. because like you said, they've reached the end of their way to the ladder. And our job as clinicians is to increase their capacity to handle that. And how and to do that, like you said before, through a multidisciplinary approach to pain management is really the way to go. Because now you have more people who can add to that capacity. Yep. So anyway, that's my soapbox. I will come down stepping down from the soapbox. I appreciate your soapbox. I think Kevin, I'm Sherif share box, but it drives me crazy. Okay, so we talked a lot about different treatments. And I want to talk about treatment that you have created the pain management workbook. So let's talk about that. And how this book that you wrote, can help people who are experiencing pain.
42:40 One of the nicest emails I got in the last couple of weeks was from someone named Karen Litzy, who responded to my email and said that she really liked the pain management workbook and was referring to her patients. And I happen to admire Karen Litzy. So I was really flattered by that. So so the pain management workbook isn't on its own, like some new fangled treatment plan. But rather, I got really frustrated by what I felt like was a lack of resources out there for people living with pain, and also for healthcare providers. In particular, you know, I am a nerd, like a real nerd. And I think pain is just so interesting, and complex and fascinating that I have like, amassed all of these books and journal articles and, you know, resources. But I felt like there really wasn't something that synthesized it in language that all of us can understand and easily give to our patients. So I took a lot of stuff that I loved and was reading, like there's a book called pain, the science of suffering, that I happen to really love. And there's all this work by Lorimer, Moseley, and Adrian low in the PT world, I happen to really love the way I love the language they use for explaining pain. And there's all this neuroscience literature out there that I think is so fascinating and so useful, like melzack, and walls, gate control, theory of pain, and all the things that have evolved from there. You know, and there's all these workbooks on cognitive behavioral therapy for pain, but I couldn't find something that, in my mind, put together all of it into one resource that, you know, anybody with pain can pick up and use right away and use have exercises and guided audio and handouts and all that stuff. So So I wanted to create something that was very user friendly, and I felt like especially during COVID, having accessible and affordable resources could not be more important because here we are talking about how pain at the end of the day is often about money and care is so expensive, and you know, cognitive behavioral therapy and these other things that are not easily or readily reimbursed, end up costing families and patients, sometimes many 1000s of dollars and it should Then be that way. So I literally took everything I was doing in my practice, and everything I was reading and stuck it in a workbook. So it's a lot of pain education. And I have to say, you know, a big thanks to Lorimer Moseley, and Adrian Lowe, who both of them were kind enough to agree to read through my pain education content and give me feedback and consultations and edits, which was like, so kind, and they didn't even charge me anything. And I offered to pay them both. And I wish they had taken my money. But yeah, I wanted them to vet the content. So there's this pain education piece, and then it's a series of chapters of tools. So, you know, again, affordable, accessible care isn't just, by the way, here's how pain works. It's now what can I do about it? So I wanted to make sure that I was offering, like a tool belt of options for healthcare providers to offer their patients like here are 17 different pain management strategies that have evidence of effectiveness that come straight out of the literature, you know, pick a few that work for you, whether it's mindfulness or using guided imagery, or, you know, cognitive strategies, or, you know, sleep hygiene and nutritional tips, like, how do we put this all together to create a unique pain management plan for each one of our unique patients who walk through our door with a unique profile of suffering. So that's how that happened. And I should also say that the book almost did not happen, because my deadline was in 2020, which, as everyone knows, was a shit show of the year. My, my bandwidth was zero, I would sit down to edit, you know, my lovely publishers would send me a couple of chapters, and they'd say, here are some edits, go ahead and make some changes. And I like, couldn't even read through the work I had written, I like my brain just was on overdrive. And I was trying to process what it meant that we were in the middle of a global pandemic. And I sent them an email, and I was like, you guys, I don't think I can do it. So the book almost didn't happen. But in December, it was actually shockingly painstakingly born. So I'm more proud of it than anything I've ever done. I don't know if anyone will ever read it. But I, I'm very proud of it. So I hope it's of use to health care providers to people living with pain.
47:21 Yeah, absolutely. And is this only for adults.
47:25 So the pain management workbook I wrote in language that's usable for everybody. I mean, it's not only for adults, it's. So the book I actually wrote first is called the chronic pain and illness workbook for teens. So it has a lot of similar content, but I wrote it for kids, because there just isn't anything out there for kids. And there's even less for health care providers who are working with kids with pain. So this is adapted from that it has like twice as much content, I would say and is expanded content. So the pain management workbook is sort of intended to be for everybody. And the chronic pain and illness workbook for teens is more specifically for kids in the health care providers working with them. But I've been told by people who just have that book that they have used it successfully with adult patients, too. So
48:14 yeah, so excellent. And where can people find all of this and find you if they want to get in touch with you? They have questions. They want the book, they just want to chat, where can they find you.
48:24 So the pain management workbook. And the chronic pain and illness workbook for teens are both on Amazon. And they're like 20 bucks, which is so much less expensive than around of cognitive behavioral therapy. But I do recommend oftentimes to healthcare providers that they offer the book to their patients, and then offer to go through it with them. Because it's just so nice to have a pain coach to be going through a treatment protocol with. But of course, it can be used as a self help book, you know, on your own. I
48:50 just like love that. I
48:51 love the supportive model. So yeah, there are those are on Amazon. And yeah, I have a really dorky website that has a ton of resources on it. It's just my last name. It's softness, calm. And there's a resources page with like, apps and websites and books and podcasts and guided audio and all sorts of stuff for people living with pain and their healthcare providers. And I also joined Twitter during the pandemic, because I don't know, it seemed like social media was where everybody was, and I couldn't see any of my friends and I couldn't go to conferences. I couldn't have conversations with cool people like you. So I joined Twitter and Twitter, my Twitter handle is at doctors office. That's been really interesting and fun. It's been a really interesting platform. That's I think that's actually how I found you. And then I'm also on Instagram where I post some pain education content too. And that's at the real Doc's off, because I couldn't think of a better name and I got really nervous because social media makes me nervous. So
49:49 well, at least now people know where to find you. How to get in touch with you where to get your book. So this is great. This was a great talk. I you know, I could keep going on and on and on too. about this, I could do like a 10 hour podcast, just on on pain alone. Because it's something I'm passionate about. And it's there's just not enough good information out there for people to access. So hopefully people listening to this will then access some of your resources and education, education education right. Now, before we end, I have one last question for you. And that's knowing where you are now in your life. And in your career, what advice would you give to your younger self?
50:33 What advice would I give to my younger self? Oh, wow, you know, the advice I would give to my younger self is keep doing exactly what you're doing and follow your gut. And trust your intuition and know that following the path of the thing that you love is the thing that's going to bring you to the place you need to be professionally. Like, I wanted to live at the intersection of medicine and psychology, and education and science writing. And I couldn't figure out how to do that. So I had all these different jobs. You know, I was like, a science teacher at the Wildlife Conservation Society. And I was a science writer at a Science Magazine, and I worked at the NYU child Study Center, and I got a PhD and I just couldn't, but but I think, you know, organically what happened over time, just from following my passion, my like, actual passion is that I was able to do all these things. So now I have a private practice. And I'm seeing patients, and I'm writing books. And I have a column in Psychology Today called pain explained where I do a lot of science writing about pain, and I'm teaching pain education at Dartmouth, and at UCSF, which I deeply, deeply love because I get to connect with physicians and other health care providers. And, you know, it's just sort of the it is sort of naturally and organically, exactly what I feel like I was called to do you put it out, you put it out into the universe, and it happened. Yeah, I mean, but not without a lot of trial and tribulation. But I think I would just tell my younger self to trust your gut and trust your instinct and you you actually are on the right path. If you're doing something that you love, you are on the right path, even if you don't know
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