Clinical pearls, being happier as a clinician, the role of telehealth and three questions to transform your evaluation - this conversation with Susan Clinton has it all!
Early in the 'sode we dive into the question of where you start with a challenging patient. There's so many different routes we can take and skills we can use, but Susan manages to simplify the start with a different lens.
In fact, one one of the big themes throughout this 'sode is simplifying things for your patient. They're likely only taking in a fraction of what you're saying.
Susan learned this lesson by simply asking her patients after a session: "what's your take home from today?" It was wildly different than what she had tried to communicate.
We also discuss the the three questions she asks every patient in their initial evaluation. These establish the direction of care, get buy-in and show the patient you're listening and understand their issues better than any amount of education you could provide.
Hope you enjoy listening as much as we enjoyed talking with Susan!
Susan Clinton
Susan is a practitioner and educator with programs for both pelvic rehab providers and patients. She is the co-host of the Tough to Treat podcast and runs a clinical mentorship program. Make sure you're following her on Instagram (@sclintonpt) and check out all her information at LTIphysio.com!
About Us
Nicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health. PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016. It grew quickly into one of the largest cash-based physical therapy practices in the country.
Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes. Together, Jesse and Nicole have helped 500+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them!
Get in Touch!
Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).
Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!
Clinical pearls, being happier as a clinician, the role of telehealth and three questions to transform your evaluation - this conversation with Susan Clinton has it all!
Early in the 'sode we dive into the question of where you start with a challenging patient. There's so many different routes we can take and skills we can use, but Susan manages to simplify the start with a different lens.
In fact, one one of the big themes throughout this 'sode is simplifying things for your patient. They're likely only taking in a fraction of what you're saying.
Susan learned this lesson by simply asking her patients after a session: "what's your take home from today?" It was wildly different than what she had tried to communicate.
We also discuss the the three questions she asks every patient in their initial evaluation. These establish the direction of care, get buy-in and show the patient you're listening and understand their issues better than any amount of education you could provide.
Hope you enjoy listening as much as we enjoyed talking with Susan!
Susan Clinton
Susan is a practitioner and educator with programs for both pelvic rehab providers and patients. She is the co-host of the Tough to Treat podcast and runs a clinical mentorship program. Make sure you're following her on Instagram (@sclintonpt) and check out all her information at LTIphysio.com!
About Us
Nicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health. PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016. It grew quickly into one of the largest cash-based physical therapy practices in the country.
Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes. Together, Jesse and Nicole have helped 500+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them!
Get in Touch!
Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).
Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!
In the last 10 years, our field has gone from an unknown specialty to a household name. This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve. In order to help others get better, we need to be better. This podcast will help you to become more confident with your patients, more successful in your practice or business and a leader in pelvic health, and we're going to have some fun along the way. Join us as we rise together. We're Jesse and Nicole Cozine, founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Puddle, and this is Pelvic PT Rising.
Speaker 2:Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine. Hey Nicole, hello Well, this interview, nicole, has been a long time coming, almost four years.
Speaker 1:Yeah, this is pretty ridiculous for me to admit, but I first reached out to Susan Clinton in right when the podcast first started, like way back when the world was shut down and we just long story short, just didn't connect until now. So we are super excited to have Susan Clinton on the podcast here. She has such an amazing background and just a lot of eclectic studies, giving her a very unique perspective to treating folks with pelvic floor conditions.
Speaker 2:Lot of interesting things in her career, a lot of great examples of bringing in things like disparate backgrounds that I think are just going to be really interesting for folks. Started her own business. She is a clinician, a course creator, runs mentorship programs and is also the co-host of the Tough to Treat podcast, which, nicole, I know you're a fan of. So really excited for this conversation with no further ado, no more gilding the lily our interview with Susan Clinton. We are so excited to be having Susan Clinton on the podcast today. Susan, thanks so much for being with us.
Speaker 3:Thanks, it's my honor to be here. I'm glad to finally get here and to be able to talk about some fun things today.
Speaker 1:So I've admired students' work for quite some time and this is a little fun story. It just shows how life can have some twists and turns and schedules get crazy. But I initially reached out to Susan pretty much right after COVID, like one of the first guests that I wanted to have on the podcast, way back when the podcast started in 2020, when the clinic was shut down, and now it's February of 2024. Here we are, so I'm really excited. We have so much stuff to talk about. But, susan, give people that are listening, just like I know you've been practicing for a long time. You're a very seasoned physical therapist, but can you just give the overall timeline, since you're into timelines, of your career? When did you work for someone else? When did you run your own business? What are you doing now and all of that?
Speaker 3:Yeah, it's quite a story. I started off in physical therapy in 1980, a long, long, long, long, long time ago and the doors that were open to PTs at that time were basically hospital and rehab units as well as people who were in private practice. I followed the route that everybody else followed and went into the hospital system Quickly. From that system I laughed and went to work for a private practice for a while just to see what that was like, and then I ended up moving to New Orleans. So I started back in the hospital system and what I did there was I transferred around in the system. We had quite a big, quite a big robust physical medicine and rehab presence in the city at that time, and that was in the early 80s or the mid 80s for sure. So I transitioned up to the rehab unit and worked with people with neurological injuries, from spinal cord to head injuries, to strokes and everything in between, and that was my jam for the longest time.
Speaker 3:I transferred over to chronic pain for a while after that and then I eventually moved over to LSU and ran the faculty practice there for a good long time and the interesting intersection for me it's kind of like that was the catalyst for a lot of different things to happen. I was teaching some courses there for them, but my job was to oversee and run the faculty practice, which meant that different faculty members came into the practice and saw clients. They all had different relationships with physicians within the system. We had people with double PhDs doing exercises next to somebody who coming off the street and just kind of a very hybrid mixed type of university setting. The interesting thing to me was when I first started there, everybody was referring to people as two knee patients and an ankle patient and a shoulder patient, which was completely foreign to me because my work was very integrative, being spending my time with people with neurological injuries.
Speaker 2:Oh right.
Speaker 3:The first time somebody walked in that was on my schedule as a shoulder patient. I didn't even really know that as much as I was watching them walk in the door going. Why are they walking like that Quickly? To kind of make a long story short. You know, really, looking at this person had a real big issue with balance. One of the reasons they were having so many shoulder problems was because their balance had shifted them off so much onto one side that their shoulder was just breaking down. With normal activities Working the shoulder wasn't going to clear up the problem. I had to help this person shift and move and do things differently and understand how to get his rib cage moving again and his neck moving again and all of these other pieces, and then, of course, looking to the balance system as well. That was interesting to bring the neural world into the orthopedic world and a different kind of approach. I don't know I would have done that if I hadn't spent so much time in the world of traumatic brain injury and stroke and all the other things that had occurred.
Speaker 3:So Dr Wall walked into the clinic in the early 90s and he's the father of Uroguine medicine and at that time he was at LSU and he said I need a physio. And so it's like, okay, what's this all about? So he actually took me under his wing, taught me everything about uroganicology that he could, and then he said I'll start sending you patients. And I'm kind of standing there looking at it and he said you're a physio, figure it out. And he's like a lot to the library. I went and it sound every book I could on any kind of women's health medicine.
Speaker 3:At that time. It was to solve women's health. I did with clients and I had no courses. There wasn't anything other than he teaching, which was great to have that medical knowledge behind what they were looking at, what they were doing surgically, and quickly found papers by Delancey and the number of people on all the stuff.
Speaker 3:And I just started. I just sat down with them and started interviewing them and finding out what was wrong and what we could do and started treating them the best that I could. And Fatima Hakim was just up the road in Baton Rouge at the time and so I called her and I said I need you to come down here. Yeah, help, I need to either come up there. I need you to come down here. We can have a course, we'll pay you, we'll do something, but I need you and so she really helped me kind of get the processes down around the pelvic health exam and the objectives and all of the things that we needed to do you know, just like the manual, muscle testing and just all the basics pelvic one stuff that everybody needed and so that kind of got that part of the world wrapped up around it.
Speaker 3:And then, as luck would have it, a doctor who specialized in IC and pelvic pain found me and then a couple of colorectal doctors found out about me and I was inundated at that moment. I mean I really the referrals were flying in the door. Again I'm on the phone to these colorectal doctors going all right, you need to tell me what this is that you're doing. I need to understand what you're doing so I understand how to help them.
Speaker 3:In those days, many of them were on a modium protocols because of leakage. They were all being sent to me for fecal leakage and seepage. They were all on a modium protocols and trying to figure that out and trying to figure out capacity with them. And what was going on and listening to them is what really kind of opened up and allowed me to move further into the GI world. Because as I was talking to them, they would tell me things like well, whenever I eat cottage cheese, it's so bad. And I just started making notes of this, like, okay, there's apparently trigger foods to this stuff Right. There's this going on, and there's this going on, and some people had bloating and some people just had straight muscle capacity issues, and then the pelvic pain ones were, of course, the most interesting.
Speaker 3:With the IC they were all getting the installation cocktails at that time, which was really really big in that world, and we were doing a lot of integrative stuff. I think my hands-on work started during all of those years too. I went to and studied with John Uplinger and Baral and went through their courses. So I had techniques that I could use. I had ways to calm the nervous system. I learned a lot about the emotional overplay, long before there was ever Laura Mosley and the other pieces. And then, of course, as I kind of progressed forward, the chronic pain world and the GI world kind of came together for me.
Speaker 3:I left LSU after Hurricane Katrina and we moved to Pittsburgh and I started in a big again payer system in Pittsburgh and ran a residency program for pelvic health and continued to see pelvic health clients, but in a clinical setting and not as an academic. I started working at the University of Pittsburgh as well, helping in their labs and working with them, with all the orthopedic patients. So one of the things that I really wanted to do was get, when we first moved to Pittsburgh, was to get either a PhD or a clinical doctorate or something. I didn't want to go back and do a DPT. I wanted something that was going to have a little bit more meat to it for me.
Speaker 3:Just to see what that world was going to bring. And that's what started my relationship with the University of Pittsburgh a little bit bigger. But I went to Andrews University to their doctor of science program and orthopedic manual therapy, because I thought here's a piece I think that can work really well with pelvic health and it's one that I see missed all the time because people were so pelvic centric and were becoming more and more pelvic centric. So I branched out into that world because I was seeing all of my clients had chronic low back pain, had shoulder pain, had neck pain, had deep pain. They just had a lot of stuff going on. I went off to Andrews to do that program and as I was moving through it it became very clear that working on my fellowship in manual therapy was mirroring my work and in my doctor of science program. So Earl Petman and Bill Thames convinced me to do the fellowship program along with the doctor of science program. So, crazily and amazingly, I somehow got that done and continued to treat patients and run the residency program.
Speaker 3:It was a crazy time in my life but for those of you who are listening, my daughter at this time was growing, got away to college, so it was just myself and the professor and I had time to do these things. At the end of all of that, I left my position at UPMC and opened a practice with my partner, rebecca Meehan at the time. Then I immediately joined Jessica Drummond's Integrated Women's Health Institute and started my work down the road of learning how to be a coach and the coaching techniques and the aspects of it and functional medicine part and, long story short, found my own functional medicine doctor to go through some issues that I was having with auto immunities, and the door keeps opening wider and wider, seeing more and more things that have been going on in pelvic health, which is why I've probably stayed more closely. I still am very, very involved in the chronic pain aspect of things, so I think it mirrors the GI world so much. But this is why the GI world stayed so open for me, just because so many clients had so many issues and even people with chronic low back pain all have GI issues at least 87% of them do, as we know.
Speaker 3:So I stayed in that practice for a while. We loved it, we had a great time. It was a wonderful practice. It was my first venture into cash base and we were excited about it. We did some pro bono work, but cash based, and had a lot of opportunity to travel and teach, and all of that. After the pandemic, my husband decided it was time to leave the university and so, once again, we packed up our stuff and at that point I sold my practice to Becky and I went virtual. So now I'm basically doing virtual work I mentor, I teach, I do client consultations, I work with clinicians who want to bring their client on. We get online and go through everything, and I also have a membership program for mentoring and education. And my outward facing clinical work is health and wellness coaching for women in menopause with GI issues, and most of that is starting to change to just really helping women with health and wellness coaching in menopause. So that's getting rolled out this year. So I'm excited about that.
Speaker 1:Wow, I'm from and where I am now, in a nutshell, that is out of control. So I have probably one of a broad question. I know Jesse's little wheels are turning over here too, but one of the things that came to me when you were saying the over time, all of these things that you have built right and the knowledge that you gained with Brawl and Uplugger and the F-A-O-M-P-T and the getting your doctorate and all of that stuff and then doing health coaching and learning the new functional medicine, and I feel like somebody could listen to that and be like, well, if I'm going to treat like Susan and be so amazing and awesome, then don't I need all of that. So what would you say to somebody?
Speaker 1:And like, how do you know where to start with a patient when you have all of these things? You could go probably a million different routes with one patient sitting in front of you that comes in and says I have constipation, I bloat after eating, I've got stress, urinary incontinence and I've got painful intercourse and my hip hurts and I've had two babies right, it's a pretty like run of the mill pelvic patient, right. But like, I feel like you could go even more directions than I could go with some of the deep things you've done with functional medicine and visceral and all of that. So how do you know where to start?
Speaker 3:What is your process. I love this question, so, first of all, I intentionally took a various to characters will look work pattern. When I look back on it, it's just who I am. Not everybody needs to do all of this stuff and go all of this way. Please don't feel like you have to follow in my circular foot path, cause I've learned a number of things throughout the years, and one of them is you need to keep it very simple. Clients can't and don't want tons of education. They just want you to help them.
Speaker 1:Yeah.
Speaker 3:That's what they want more than anything else, and I've interviewed many, many, many, many many clients and one of the first things, so one of the things that got me back to doing things simple was when I had my practice in Pittsburgh with Becky. I started challenging myself and I challenged myself at the end of every session that I had with somebody. I asked them what their take home message was Be prepared when you do this Like be, prepared because not going to be anything that you think it was.
Speaker 3:And when I started hearing what was coming out of their mouth, I was like I was in shock.
Speaker 3:It was like okay, clearly they can't take in all of this information I'm getting them and they get stuck on one thing and they completely misinterpreted and it was like, oh my God, I'm doing all of this stuff, it's going nowhere, which is where the coaching kind of stuff came in and helped me out. I went back to the very way that I started doing this. When I first started doing public health was just like listening to their story. Tell me your story, let's go through it. I want to hear all of it.
Speaker 3:And then I started doing very simple things what do you think is going on? What do you expect? What are your expectations with this? What do you want? And then the third thing is in your heart of hearts, deep down inside, what are you seriously worried about? So those three questions give us the opportunity to do the things that we know are going to be best for our patients, because in order for them to change, they need to the work that they do needs to be relevant, they need to be safe, so that things get them there right. It establishes a safe space for them and it establish relevance, because I'm going to start where they're afraid. That's where we're headed, because that's what bothers them.
Speaker 1:Yeah.
Speaker 3:It's superficial. Oh yeah, I want to quit Leak, you know, I don't want to paint anymore. No, what's underneath all of that? And then the third thing is it needs to be consistent. So without relevance and safety it won't be consistent.
Speaker 3:And so for those of you who are listening out there, the biggest thing to remember in your brain is everything touches everything. So start where they want to start. Most of the time they'll say to you you tell me where we should start, you're the expert and it's like, but you're the expert in your body and really I want to know where. That's probably an ethical question about expectation, you know, because some people come in expecting different things and if they don't get that, they don't come back. I want to get at what they're expecting and what they really, really, really, really are seriously worried about. Yeah, it will get to everything else, but if we start making consistent changes in one area, you're going to start seeing other things change as well, because it's just the way the integrator system works. So I always, when people ask me that question, I always say I allow my client to lead the way Out of these five things that you're talking about that are really, really interrupting and interfering in your life and why you're sitting in front of me.
Speaker 3:What is the first place we're going to start? Where do you want to begin? We will get to everything, but we can't get to everything today. We can't chase five rabbits, so I want to know where your priorities are, and that, above everything else, helps.
Speaker 3:Like I've got it in my mind. You know I'm still. I can still do pattern recognition and know that we need to probably hit this and I'll take a look at that. But as long as the lens is focused on them, telling me where they want to go, it really doesn't matter what the avow looks like or what the other stuff looks like. You're still going to do some of that stuff. You're just going to do it so that they understand that they're getting, they're being heard and the most important things are being addressed for them. And that's the biggest thing that I would say can help people when they're looking at the complex clients. More is not look at the whole paper with all the little lines drawn on it, but just ask the client what's going on, what do you expect and what are you worried about?
Speaker 2:You know, we've gotten to interview a lot of amazing clinicians on here and I feel like this is one of those understated superpowers that nobody talks about. But it's humility, like of everybody, susan, like you have all of the tools, you've done all of the things. If there was anybody who's qualified to just be like you know what, sit down, shut up. Here's what we're going to do it's you, and yet your approach is exactly the opposite. I think that's fascinating that you know Nicole has phrased it like it's not about you as the practitioner. Does that something that you had to develop in your career? Because I sometimes feel like the more skills we get, the less likely we are to be humble. And yet when I talk to the people who are doing amazing things in the field, like they are the most humble people letting the patient lead, listening, all of those things I'm just so curious about how that develops.
Speaker 3:I'm not sure how it develops. I just know that it's something everybody can learn. First of all, it's not like it's not a hidden, like little secret, like only certain people can do this. I think the honest thing is is be curious, and I think that's what led me on the path that I went, because I was curious, I was curious about this, I was curious about that, I was curious about all of these different things.
Speaker 3:And the longer you stay curious, I think, the more you kind of end up in this position where, because I'm so curious as to what people's stories are and I'm so curious about the path they actually want to take, because generally, when they get a chance to lead, it's nothing like I would have thought for them, and but we still get there.
Speaker 3:You know, yes, it's my job to keep their oars in the water and to help, and some things have to be prescriptive. They just have to be, but with the lens of the client, knowing that if this feels better, then this will help me, then I can move forward to this piece, you know, but they're trying to do it all at once and that's never going to have a very successful outcome. So, yes, we do need to be prescriptive, but there's a way to do it with empathy and curiosity, versus I don't like to use the word dictator, but like dictating to them A, b, c and D. We may need to hit A, b, c and D, but we need to do it in a way that's going to work for this client.
Speaker 1:Yeah, okay. So I have a follow-up question about that. That's going to help people, I think. So then how does a new grad because I feel like that's relatively easy I think a seasoned physical therapist can, or occupational therapist or pelvic health therapist can listen to that and be like, oh, I can do better with that and kind of immediately implement that because we're not also not afraid of not knowing what we're going to do each session. But a newer therapist that's listening to this might still be like, okay, great. So she told me I don't have to know all the things. She told me just to ask the patient where to start.
Speaker 1:But then how do you feel like you would coach somebody into still feeling confident that they know, like, as you said, they're keeping the ores in the water. How would you coach a newer therapist into being like you still can show confidence and some authority with where we're going? Because, like to use the phrase, we have to lead with empathy but a little bit of authority, not dictatorship, but authority in that hey, like I seen this before, I can help you work, I know what we're doing kind of a thing to get that comfort and safety in that way. So what would you say to a new grad, that might be like yikes, I don't know what I'm doing. And now you're asking me to ask the patient. Isn't this the blind leading the blind?
Speaker 3:And that's the imposter syndrome coming out. Right. You all have very strong judges and imposter syndromes and are critics, and doing the work to manage yourself can help very much. You know more than you think you know. I will say that right now. You didn't get through your physical therapy program without some grit and tenacity and knowledge and all of the things that you need.
Speaker 3:Your clients don't need you to be the expert. They need you to care, and when you sit and listen to their story and you ask these questions and you find out what's important to them, it doesn't really matter. There's so many ways you can go. Go in the direction you already know. It's okay. Just do it under the lens that this is what's important to them. So you're not going off to take a course and then coming back and saying so Susan says I don't need to use any of that. Not at all. I'm saying you have tools, but use them under the guide of the client leading the way, versus yourself having to be the person wearing the mantle to fix somebody, because that's never going to go well. It's a burden that you'll be carrying and it will make you an unhappy clinician. So you're partnering with this person to help them find the answers to make the changes in their lives so they can do the things that they really wish to do or optimize where they are at this point and you've got tools to do it. But if you do it with them really talking about what's important to them, and a lot of people will latch on to something, let's get the leaking done, and then we'll worry about this, and the person may be really like, no, I am not listening to me.
Speaker 3:The pain was sexist with.
Speaker 3:My real problem is and oftentimes we kind of make assumptions about what our clients want to do based on what we know, versus they're the expert in their body Let them tell you what's driving them crazy and work on that with the lens of like, yeah, when we still need to get their hips stronger, of course, and you know.
Speaker 3:So part of why we're doing these hip exercises is because it's going to help your muscles being better balanced, so these muscles aren't squeezing all the time, making it so painful for you to have sex. Right, there's a difference between, ok, you have weak hips, you've got a pelvic floor that's too strong and over recruiting and painful, and you've got this and you've got this, and so what we're going to do is we're going to do this and just get this going. There's a difference, right? Instead of like OK. So part of what we're going to look at around the painful sex is we're going to look at the orthopedic input, the neurological input, even some other things Like I really need a little bit more of your history here, Like I want to know do you have back pain?
Speaker 3:Have you had back pain? What other orthopedic conditions have you had? I've had people who have pain with sex because simply laying on their back was not a good position for them because of the back issue that they had, and it caused them pain with sex. You know deep pain and they thought it was all pelvic floor and it was their back. So I mean there's so many ways that we can go through it, but you've got the tools. New people have the tools, just like old people have the tools. I would say that new graduates young professionals is what I like to call them are younger into the field professionals, even though they may be older.
Speaker 3:I actually have more of an opportunity to do this because if you let your patient lead the way, they're going to teach you everything you need to know, and so this is the opportunity to actually develop that. So if you listen back to my story when I was sitting there going okay, these people are walking in the door. I don't know what else to do except get curious. Yeah, that's what did it, you know. So don't be afraid to be curious. You're not going to send off something like this person doesn't know what she's doing or anything else. Instead, you're going to be sending messages that this person really cares and wants to know what I want to do and wants to know what I need to help myself. And then, yes, you're going to be doing some prescriptive work. 100%, we have to, but that doesn't mean that we can't help them implement this prescriptive work in their lives. So don't give people a sheet of exercises until you turn it around to yourself and ask yourself do I have time to do all of these?
Speaker 1:Yeah, Totally Especially, I will just say, as just recently, having a baby not that long ago, I was like, oh my gosh, what have I been doing for the last 20 years? I mean, I've already not giving people that much stuff to do on a week to week basis, but even the three things that I was giving people, I'm like no way, no way, as my little one year olds are running around and not sleeping and no Nat McGee and all the things. So shout out to those postpartum people too. It's like a miracle that they're even in our office. Okay, jesse, I know you had a question.
Speaker 2:Yeah well, I've got so many questions it's actually kind of hard to know where to start. One of the things I think this might touch on Susan is one of the things that Nicole had mentioned is that she had heard you talk, I think, at a previous CSM, in the private practice group, talking about reducing cancellations and clinical buy-in. I mean, it sounds like this is also part of that secret right, and Nicole always talks about clinical excellence and how it relates to business and how those soft skills of buy-in. But is that what it's about? When you're getting that buy-in from somebody that asking those questions that they know that you care starts that whole process off right and then you can figure out the rest of it along the way.
Speaker 3:Safety first, safe, relevant, consistent. And so what you want to do is you want to create a container that, even if all you have out there for those of you who are listening only 20 or 30 minutes with the client, you can still make it that safe place for them in that 20 or 30 minutes. Yeah, absolutely 100%. I think there's three things that help with that. Clinical buy-in and moving people along the spectrum is really finding out what they want, getting to that point, creating something that they feel they can do consistently. And if it's only one thing, then it's only one thing, because oftentimes they'll try to take on more and I'll let them. And then they come back and they'll tell me didn't have time to do it, and it's like to me that's gold in the bank.
Speaker 3:Tell me what happened. Tell me, it's so hard. Sometimes we think we've got all this time and then we don't. You know what was the real problem? Like you know, well, I didn't have time to do this and this, and it's like, okay, so when you're mentioning these exercises and you didn't have time to do them, what's the real problem here? Well, there was not time. Okay, besides the time, like your environment, where were you? What was the real problem? You know, I've had people say I just don't want to go lay down on the floor. It's like dude.
Speaker 2:I'm that patient. Yeah, we have hardwood floors. I look like, oh, go get a yoga mat. It's like I don't fit on a yoga mat. Though, yoga mats are stupid. They were designed for five foot two Barbie dolls. Like, don't tell me to get on a yoga mat, I'm not gonna do it. I got Susan. I'm picking up what you're putting down.
Speaker 3:Let's find another way to do it. Uh-huh, oh, let's find another way to do it. Where, now that you've looked at this and you've seen this, where do you have two minutes?
Speaker 1:Mm-hmm.
Speaker 3:Do you?
Speaker 3:have two minutes every day. There's 1440 minutes in a day. We're only asking for two. Yeah, what too big, it's okay. That's how we learn and do that. If you can do that for two minutes every day and they come back and it's like then they'll say to you I do nine times out of ten I hear this. I had more than two minutes. So I actually did this in this to a site Bravo, yeah, that's fantastic. Oh, now wet, now where? What do you want to do? Like? So we keep moving it forward, but we keep the idea on the fact that maybe we're building hip capacity, or maybe we're looking at stronger foot stability as well as public floor strength, or maybe we're looking at calming the nervous system when they pee along those lines, you know, because it's going to help their painful sex, you know. So we're still working on the other pieces, but with the lens, that this is what we're kind of there. That's the end game that they want.
Speaker 1:Yeah, so without you know without fear. Yeah, yeah, yeah. So fun fact. So I know exactly when this talk was. When you talked about cancellations. I believe it was in Denver in 2020. I was sitting.
Speaker 1:I think that this is the first time I actually heard you speak live and so, if I remember correctly, I feel like the the title of it was simply like something like reduced cancellations and I I know that so many there was a bunch of business owners in that private practice section thing and it was the majority and it's gonna be a gendered statement and I don't care.
Speaker 1:But if they were a lot of men, right, and I believe, I really believe that they were like ortho people and as soon as you started Talking, I knew where you were gonna go with it and I was like, oh my gosh, all these people thought that they were gonna get some Nettrick or some business system or some way to track this thing, and they're getting that. They should freaking listen to their patient and I just thought that I was so awesome and that talk was really great. But to our pole point here is that that I call it clinical excellence as part of our business mentorship program, but that clinical excellence buying in piece is not about a hipmob, it's not about a visceral mode, it's about making a connection and however you're gonna do that, I love that you have those three make them feel safe, make them get what's relevant and get it consistent. But there's that, that through line there, I think, with just listening and figuring out what's your patient wants and then go with that, it's wonderful.
Speaker 2:So what was it like then, going from a kind of a hands-on therapist to doing now all Telehealth now that you've gotten to see both sides of that, like it's a big. I think last point in the field would have been the pros, the cons, like what's been that experience like going from like hands-on in the clinic for you know with your people to not being able to do that and finding other ways to get them better.
Speaker 3:It goes back to curiosity. So in the clinic, when I was asking the questions about their take home, I started looking at can people take in? It changed the way I taught. It changed the way I worked in the clinic, because People can only take in 10% of what you say, no matter how good you are and how wonderful you are, and they love stories. So I got curious and tried to become a storyteller, because they remember stories. They don't remember facts and figures.
Speaker 3:The second thing is is that I started challenging myself to see how much I could get done with somebody without putting my hands on them, just because my conformational bias was so strong in my manual skills and I was like, wait a second if I'm gonna embody this person to do more for themselves and maybe I need to do a little bit less but still do what I need to do. But how much can I do before I need to do it? So as just being curious, you know, of course I could jump in at any time and I did and we did. I still did manual work and stuff. So the biggest change for me going into telehealth Was really making sure that the person that I'm working with, if I'm doing a consultation with a person who needs physical therapy, I'll do everything that I can to help them. It's clear to me that people need hands-on work too, and I partner with them to find a practitioner in their area, because you just need to do that. It's like I'm not gonna tell you know, I'm gonna help people kind of have a conversation with their doctor if they need a metabolic panel or they if I feel like, based on your symptoms, it'd be really great if you could convince your PCP to do a full thyroid panel for you. Can they check your B vitamins and some other things? And here's how you have the conversation. We can talk about it, but they still need to see their physician, right, they still need to have somebody look at that and feel their throat and you know, look, I mean they just there's no pieces of the physical exam we can't let go of.
Speaker 3:Yeah, but if we think along the lines, just kind of thinking for Forensically out there, we also have to remember we have a population health problem and if we just concentrate on incontinence as the population health problem, which you know as a big one, it's worse than low back pain.
Speaker 3:We need to figure out what ways to get in front of people and help them, and the esculine of one-to-one care is at the very, very top of the pyramid and there's no way on this earth that we can help the people who need to help one-to-one.
Speaker 3:So telehealth helps us reach out to Geographical regions that don't have anybody else. That can help guide their biofeedback over telehealth or guide Exercise, you know, and hopefully they can once every six weeks or every eight weeks can see somebody that we have a lot of really cool, durable medical equipment now. We can guide people with dilators, we can help people with East End machines and other things that can work. They're getting more and more sophisticated and the market for women is wide open and we need to. Instead of saying this isn't as good as a Physical therapy appointment, we need to probably start saying if we can get in front of more people, we can help them, and we can help them in a meaningful way, like don't ditch, it depends, just start doing this too, so that you don't have to buy so many.
Speaker 1:Yeah, I feel like I just had a little bit of an epiphany, because I feel like I have been very much resistant to having our field say that Telehealth is as good as in person. I always want to say, like well, it's not though. Yeah, I feel like I just had the epiphany of like it is different. But I feel like we and I love that we need to be honest with the difference. And that's where I feel like when we went a little awry, and not for our own fault at all, because when COVID happened, it was like that was a necessity. We had to pivot fast and we had to make sure that we could still have businesses and be relevant to people and that kind of stuff. So I do feel like that changed the trajectory of where telehealth is going. But I love the reframe of it's different and it still has value in and sometimes even more value in certain instances. Like you said, with the pyramid, I like that, yeah, being able to expand.
Speaker 2:I'm here for it, the folks there, and I think one of the other things that's really interesting about that, susan, is People are gonna seek help from somebody. It should probably be somebody who knows what the hell they're talking about, right?
Speaker 3:because otherwise it's some kid who's been to like a weekend nutrition course or Somebody who just like looks good on Instagram that they're gonna be getting their advice from, instead of somebody with a freaking doctorate in Like the exercise movement all the things that you guys know, right how we can get our message out there to that we can help people is, I think, the most important thing of all, and Mythbusting is good, but I think we also have to realize our conformational biases and realize that each segment of the industry Probably is all working with the same altruistic motive to help people, and if we embrace each other and work together, I think we can get a lot further along. So you know, if you look at the, the ads for Depends products or wearable garments for people who are leaking, they're solving a problem for people because They've got the 40 year old female wearing yoga pants at the park with her son.
Speaker 3:Yeah, and you know what people are gonna look at that and go. They solve my problem. Now I can wear the pants I want and I can go to the park, and that's what I want to do. And so I think we need to partner with that and say Don't stop going to the park, let's do the other part of it too.
Speaker 3:And you may not be able I mean some people, just you, as you have just so lovely and vulnerably stated it's a wonder they're even in her office after having a baby. Telehealth can solve that problem Right. You can meet, you know they can sit there with their baby and nurse and have a conversation with you about what's next. And so, yes, they may need to pad up or wear a garment, but they also are getting the help that they need to regain the strength or capacity or reduce pain or whatever it may be. You know, without having to take a two-hour car ride with a new infant somewhere, you know, into a medical office where nobody wants to get sick anyway. I mean, there's those so right in the way. But I think that you know just kind of like really realizing that Some of the things we might have seen were not as favorable as our conformational bias monitored them to be. If we look at it from a Population health standpoint, I think there's we need more integrative work amongst the different players.
Speaker 1:Versus the silence yeah love that, I love it. Just what do you have to say about that?
Speaker 2:I think that's actually really interesting to. It kind of just goes back. I feel like the through line of this whole episode, susan has been meeting people where they are, listening to them what their goals are and right. It doesn't have to be an all-or-nothing approach. It's meeting them where they are, which I think is a welcome mindset shift. Yeah, I'm having to be that person, having to be the fixer person.
Speaker 1:Yeah, and I also feel like, as I'm like my wheels are turning right now, I feel like if we look at ourselves in our profession, then, as I feel like it also we have to embrace them, that we know more about the body than Just the movement system, then right, because if we take that, that view, that lens, and we broaden it out to be like, oh, we know about the nervous system, we know about Physiology and GI physiology and all that kind of stuff, like those interventions don't just have to be colon massage Right, it can be to your food, it can be are you eating? It can be what are you eating? You know, it can be a lot, of, a lot of different things that still fall under the rehab Category. So I like that a lot.
Speaker 3:Yep, even heart rate variability, cardio has totally.
Speaker 1:I have one other question you said is something that we're gonna go back, and I know, jesse, sometimes I'm like, wait, go back and talk about this. And he's always like guys, sometimes you just have to leave things unsaid, but not this one. So, when you were talking a little bit about conformational bias, when you are looking at somebody right, and especially with some of our manual skills and having to resist the urge for that, how do you reconcile conformational bias with objective, like pattern recognition, like there are some things that just happen more frequently in my experience. Maybe this is I'm having a second epiphany Challenge of conformational bias. Yeah, I don't really know if I'm asking a good question then now that I'm speaking out loud, but do you kind of know what I'm saying? Like there's a difference. I feel like there's a fine line between conformational bias and truly seeing like patterns in people. Do you have any like comments about that?
Speaker 3:Yes, I think I hear what you're asking. I will answer it in the way that I'm interpreting your question. Pattern recognition exists. That's part of the human experience. If we don't have pattern recognition, how do we know if we're stumbling into a pond that's full of poison? Right, we have things in place for survival, and pattern recognition is one of those things that we can use in a really expanded version. People who are looking at science under our microscope are looking for patterns how many molecules of this versus molecules of that? The microbiome work is that way. We may have an expectation about something, and so where we can get in trouble with conformational bias is when the pattern recognition becomes the expectation. So, jurassic Park I don't know if you remember the movie.
Speaker 3:I do they set the computers to look for however many velociraptors in the park. I think it was tracking. I don't remember how many it was. Let's say it was tracking 20. So every day they turned it on, yep, the 20 velociraptors are there. Every day they turn it on, yep, the 20 velociraptors are there. And when they realized the dinosaurs were breeding, the one guy that was really smart decided to open up and make the. Oh my God, there's 45 velociraptors. No, there's 60. So sometimes that's when our conformational bias, pattern recognition can be limiting. So it's good to have it as a framework that the curiosity piece is what pulls you out to look at things from a different perspective.
Speaker 1:Okay, does that help? Yeah, totally. I feel like yes, 1000%, and it's one of the things that I mean I teach in one of my courses that a little bit of this, right, you have to have a prior going into it, because otherwise then you're just like guessing. So if you go in and you have a prior and then you need to test that hypothesis, essentially to see, so that would be making sure that you are and if you have the same output, the pattern recognition is there, and then to avoid the conformational bias, is that you make sure you test the system or the assumption or whatever, to make sure that you don't, that doesn't become solidified in your brain. That that's always.
Speaker 3:Or what am I? Is there something else in there that I haven't looked at? Right, I got this part. What else might be influencing what else? Yeah, Cool.
Speaker 2:So I want to take a little bit of a sharp veer as we kind of come to a close to the conversation. I loved a phrase, susan, that you used a while back. See, I don't have a problem going back in a conversation Cool.
Speaker 2:You use the phrase I really love the unhappy clinician. You become an unhappy clinician when you're there, and I know you've talked a lot about imposter syndrome and you've mentored folks with this. We see this a lot, I think, in this field of burnout, of people leaving the field, of people feeling like they have to start their own business because they're unhappy where they're working, and then they get in to start their own business and they realize all of their problems follow them, that there was no magic panacea for life. When you use that phrase, I feel like that's something that you've thought deeply about. What do you feel is making folks? What's the root of that? For a lot of things? I know it's probably multifactorial, but when you use that, what's driving that for a lot of people and how do we combat that?
Speaker 3:Speaking in the works that I am the most familiar with. We all have inner critics. We all have them. Some people call them the itty bitty, shitty committee that runs our brain. But the thing that we need to kind of understand is we have a sympathetic brain and we have a very strong voice from the sympathetic brain called the judge. This is the positive intelligence work. It just takes inner critic in all of these people and puts it into one big kind of thing there. This part of our brain exists for two reasons Number one to keep us individually alive and number two to allow us to survive from childhood to adulthood. But it's not necessary and it doesn't need to be so loud. The problem is that it's never tempered. As we get older, People are very unhappy. They don't like their choices because they're being made from the wrong side of their brain. The idea that I work with, with people, is to help them shift, and since it's all practitioners here, I want people to shift to their mid-prefrontal cortex.
Speaker 3:The reason I want you to shift there is.
Speaker 3:That's because where the serotonin is and that's where the endorphins are and that's where the oxytocin is, and that's where we can shift from judgment to discernment, from avoiding to activate, from hypervigilance to mindfulness, paying attention, from all of these types of things.
Speaker 3:So we're riddled with this really loud voice and the saboteurs that go with it, and it makes us very unhappy and so people start looking for like I need to do this and I need to do this and I need to get this degree and I can't treat this patient because I don't have enough knowledge and not really sitting more into their sage brain where it's like I'm enough. I have empathy for the situation, empathy for the person across the table for me, because I have empathy for myself and there may be a course I need to take, but that doesn't mean I'm an ineffective practitioner. And so really being able to silence that and to move through their day with a different mindset can help people see the gifts and opportunities in the situation they're in. It may be that they're not in the best situation for them being a clinician, but there's gifts and opportunities there.
Speaker 3:They can't see them because they're too busy being in their negative state. Being a fixer is a burden and the quicker we move out of needing to fix people and really empathetically trying to help people find their way forward is going to make us so much more pleasant people to be around and a better regulated nervous system for that co-regulation that's needed for our patients.
Speaker 1:Yeah, I love that. I think that that's a very powerful segment that you just had. So I feel like people need to push, pause and rewind and embody that and work on it, and it is a work in progress that doesn't come naturally to a lot of people, so I feel like almost the permission there to that it doesn't even that doesn't have to be perfect. You're not going to be perfect at getting rid of the inner critic immediately, it's not like oh, just because Susan Clinton said that on the podcast.
Speaker 1:Now I'm cured, I'm better. That won't ever happen again. That doesn't work like that. No, no.
Speaker 3:It's a good thing that we're doing this, but it we can build neural pathways and we have real science behind it that shows six weeks of working at this in the positive intelligence program. We've got real science that shows the shift in the neural pathways. Yeah, so this can be. It doesn't take a lot, takes like six minutes a day. There's a lot of a lot of really good stuff. Kristin Neff's work and you know compassion, you know self compassionorg has shown to to make healthcare workers so much more happy or impositive in their work and all they're doing is a five minute meditation every day. Yeah, wow.
Speaker 3:Well, this is not a jump to the pinnacle. This is a climb that is easy to do. It's a nice pushback trail rather than a straight up. That's awesome.
Speaker 2:Right, when you guys are telling your patients to go home and do 30 minutes worth of stuff every day, here's five minutes of homework for your own cells.
Speaker 3:For your own dough.
Speaker 2:Everybody is listening. Well, Susan, I just wanna thank you so much for being on.
Speaker 2:Whenever we have one of these conversations, I feel like we could talk for four hours and just love everything that you're doing to push the field forward, everything that you're doing and teaching. I think one of the really things that struck me from early on is like when you first started in pelvic, it was off to the library to try to find research articles, figure this stuff out, and because of you and people like Nicole, this is like the best time to be in pelvic rehab. Like you have so many more resources and options than ever before, and it's thanks to creators like you guys, and so I just am so thankful for that. Where can people best get in touch? We're gonna have your information in the show notes, but if they wanna find out more about your courses, if they wanna follow you, hear more about this stuff, how do people get in touch with you?
Speaker 3:So my website is LTI Physio Learn, think, innovate Ah cool. My handle on Instagram and Twitter is sclintinpt. You can find me on Facebook under LTI Physio or Susan Coel Clinton. My email is Susan at LTI Physio.
Speaker 1:The one thing that we cannot forget also that we didn't even touch on today, but it is excellent is the Tough to Treat podcast with you and Eric Amello. So make sure for all of you clinicians. It's a wonderful podcast where you guys talk through cases and think about cases that are tough to treat, and I love how you guys have the outcomes of those people on there. So I love that podcast and make sure you check that out as well, susan. Thank you. Tough to treatcom yeah, tough to treatcom. All right, well, thanks, susan. Thank you so much for being on. I appreciate you so much and look forward to working with you in the future. Sounds great, thank you.
Speaker 2:What a fun conversation, nicole. I always feel like with our podcast guests, we could literally go on for hours and hours. There's no end to these conversations.
Speaker 1:It's so good yeah you know, it's a good episode when you feel like you could continue to talk, and that is certainly what I felt like after this episode. It was just such a good conversation. I hope you guys took a lot away from it. There's tons of clinical pearls in there, Even one point. I had said to you guys like you need to stop rewind and listen to what Susan just said again. So that is a wrap on that.
Speaker 2:Yeah, did you just change your mind about telehealth?
Speaker 1:Oh, you know, I think I did. I did have a real epiphany. In fact, when we stopped recording I was like Susan, I actually did have like that real epiphany about my thoughts about just reframing how we view telehealth. I still probably believe that that in person PT, OT, rehab is the gold standard of care, but I do believe that Susan brought up some really great ways to reframe how we can better reach patients through the use of telehealth to enhance our reach to folks.
Speaker 2:I thought that was a great point of communication there was. I think no one, neither one of you guys, thinks that telehealth is the gold standard or is better than or even the same as in person. But being able to see, hey, there are some situations where it is able to expand reach, get care to people who otherwise might not get it.
Speaker 2:I thought that was a very interesting conversation, but I thought one of the best things, nicole, that I heard through that were the three questions that Susan suggests or asks at the beginning of all of her appointments that what do you think is going on, what do you expect or what do you want from this appointment, what do you want to get out of this? And then I like that last one too what are you most in your heart of hearts, what are you most worried about happening or what's the worst thing that can happen? And really using that to kind of guide where you go, where you start.
Speaker 1:Yeah, man, it's all about number three. That's where our bread and butter lies. Right Is getting down to what the patient is actually worried about happening if their symptoms don't resolve, and if we can get down to that and build that from the beginning, as Susan recommends. Like man, we are going to be game changers and, as I said on the podcast, it doesn't matter what hip mode we do after that. Man, it's like we got you, we are going to help you through this together, in an alliance with your patient. And so I really feel like, again, rewind this whole podcast episode, listen to it again and just solidify those clinical pearls in your little brains.
Speaker 2:Thanks so much to Susan for being on Loved having her as a guest. Her information will be down in the show notes to make sure you are following all of the cool stuff she is doing. As always, we'd love to hear from you. Thank you so much for listening. Let's keep this conversation going and let's continue to rise.