6. Hemoglobin and platelet count in cancer patients influences exercise intensity + optimising your service structure

Join us in this weeks episode as we dive into optimising your service structure and how we have navigated this from completely different perspectives.

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IG: @remotecontrol.ep

LinkedIn: Remote Control Exercise Physiology

Connect with Courtenay:

IG: @hereducation_ and @herexercisephysiology

LinkedIn: Courtenay Polock

Connect with Nicola:

IG: @theactive.nic, @theactive.eduprogram and @theactivestudio

LinkedIn: Nicola Begley

Websites:

www.remotecontrolep.com.au

www.hereducation.com.au

www.theactiveedu.com.au

Transcript

SPEAKER_00 0:00

Welcome to Remote Control EP, the podcast. I'm Nicola and I am Courtney, and we are here to have the real and the raw conversations about clinical practice, business, and what it really means to be an EP. We would love for you to like, subscribe, share it with your whole EP network, anyone and everyone out there, clinicians, business owners, we'd really appreciate your support. We're actually introducing a new little segment into the show, which we're very excited about because we want to be able to share some things that we learn along the way as EPs. So as we're researching and learning, we're going to share like the physiology fact of the week. Woohoo. Because we are physiologists and we should be learning about this and we want to talk about how it's relevant for health conditions. So Nick's got the first one. She learned something super interesting. Please share with us. Yeah. So I have a client prepping for a bone marrow transplant. And I had no idea what I was doing. So I went and did some research and I actually learned that there is different cutoffs for exercise and different exercise intensities based on different readings of your hemoglobin and your platelet counts. So a certain number means low intensity exercise only or reducing total volume, etc. The most important ones that we need to know are hemoglobin under 70 and platelet clown under 10 means no exercise at all. If you want my full list, slide into my DMs. I'm happy to share it. But I thought that was really interesting. Yeah. Didn't know it. Lucky checks. Because that's such an important part. Like it's a contraindication for exercise, right? Absolutely. Like we part none. Do not do anything. Yeah. And my client, this client was actually coming in, says she was having weekly blood tests, and she was coming in and her platelet count was 10, 12, 15, like right on that threshold of mobility only and no exercise. So if I didn't know that, then you would have been like, we would have been lifting doing strength training. Yeah. Which is so important. And I'm and this is where it's really important to like actually keep doing your research because you know a lot about like treatment. Yeah. Like I feel like oncology I did my master's in. Yeah. Um, I should know these things. Yeah. And it's also a really good uh piece of information to know if you're linking in with someone else, uh, and you have to explain what the importance of an exercise physiologist is for that. So you can you could actually say, hey, did you know if their plate with levels are like this, they should not be exercising. And you can sell the physiologist side of why we're doing like why we are important for absolutely prescriptions. We can communicate so much better. Wow, love it, love it. So it's our first physiology fact of the week. Expect more as we learn. Um, and I'd also just like to say no judgments on anything that we share with you that you think we should know. Yes, sorry, Nate, sorry, because there'll be things that I will be the one learning a lot in anything outside women's health. So um happy to share. But anyway, so moving on to the topic of the week. We are we've covered last couple of episodes. We've done my story as a specialist, we've covered Nick's story as a generalist, and something that um that I guess is both very different for us is the way we actually run our services. Very opposite, very different. And it's something that we've both really struggled to find, I guess, what suits our our businesses, and also I guess finding a balance between everything. So we want to really talk about service structures today. And it's also something I think is really, really important. I've done a lot of research and diving into this from like a business um success side of the conversation I've got I've had in the mentorship program with mentees all the time about developing the service structure and why it's really, really important in the sense of just being able to like rebook your clients and talk to your clients about the importance of, I guess, long-term care, which some of them aren't expecting. So this is something that we really, really want to talk about because I think you've also struggled with this a lot, Nick, with your with your stuff. We've had multiple conversations about this. Yeah. So, like I found being a generalist clinic and a generalist EP, every business coach that I had or group that I went to, or like free little call that I did was like, you have too many service offerings. There's too many things. You need to like simplify it and only have this one thing, and it's gotta be almost like black and white. And I would get things like people would give me their KPI trackers and their like dashboards and like how to track your financials. And it was like one column for services and one column for cost and surprise. Yeah, and I'm like, I don't know how to fill this out. Like, I have so many different options when a new client calls and they're like, What are your pricing? I'm like, I'm gonna send you a copy of the price list because otherwise I'm just gonna be regurgitating numbers to you. Um, and it's been both a hindrance and and a help. It's it's really helped us to get a huge range of clients. Uh, but I think one of the most important things as well is like it's been good for my business to have some structure, but like my clinicians need to understand the service structure as well. So this isn't just for business owners and like optimizing your business outcomes. Clinicians actually need to understand what service structure means to be able to optimize that for clients too. Yeah, but also this is something I talk about in the mentorship when people aren't in working for themselves and they're in another person's business and there maybe isn't a great service structure in place and they're like, how do I do this? It could also just be like how you see the client journey for that person too, right? Like it could just be like the way you deliver your treatment and thinking about it as like a mini service, or maybe it's about talking to your boss about how what is our service structure. If I had an employee that came to me and said that I'd like you are a gold mine, like yeah, you're staying in this business because that is actually so true. Um, but I think on the flip side, for me, like I have one service. Like mine, if if anyone follows her exercise physiology, you'll see my marketing strategy is very much like I do a 12-week program, it's for rehabilitative, like a service where I I guess fix someone and then send them on their way. It's not very long-term at all. But like I definitely fit into that one service. And I actually developed this because I I come from a PT background and personal trainers do an excellent job at going, this is what I do. It's weekly PT. We sign up for six months, they're on direct debits. There maybe there's a a program, a home program that comes alongside it. Maybe they have access to group classes if it's more boutiquey, but they have got really great service structures. And when I was working in clinics where I'd been renting space or just had friends running clinics, it felt like, oh, we just rebook the client, like maybe in a couple of weeks, or if they can't afford it, we do every month. But like I'm trying to sell them into a, well, not sell them, but I'm trying to get them to book in, and I feel bad telling them to book in. And there was no like, this is the process, this is the service structure. And I was almost like so at opposite ends of the spectrum that I tried to like merge it together. Like, what do PTs do really, really well? What do EPs do really, really well, but what do they both do poorly? And how do we make that like fit into sort of a service structure? And that's where mine came from. Um, so I think my service structure was also based around adherence to exercise. I found like getting these people to book in was hard. I don't do group classes where Nick does now. We'll talk a little bit about that, but it was much much more about how do I get this person to see the importance of doing more than two or three sessions. I'm gonna see them regularly. I want them to do their exercises. How do I get adherence? And so my service structure was set up on that, I guess, more than pricing per, like yours is more about like the NDIS stuff and Medicare and like workers' cop and like the different funding programs. Yeah. But we also have people that like we've got clients that come in every day. We've got clients that come in two or three times a week and will for the rest of their lives, but we also have people that come in for a monthly home program or a six-week review or just come in for their five Medicare sessions a year. Um, like we have so many different options for people, but with our like private paying clients, I guess you were one of the big reasons that I brought in memberships or that I like thought about doing it. Like, I think it was probably a year review being like, you need to, you need to bring in memberships. Like this is what you need. Every time we caught up, it was like, have you done it yet? Where's your memberships at? Yeah, get mad at people. And it was a big shift for clinicians at first. It felt like you were, it was felt salesy to try and sell them onto a direct debit. And we had this big shift in like, what do you actually believe is the best treatment plan for this client? If they're coming, we had 10 10 week packs that also didn't have an expiry date. So like Betty would be like, I have got book club next week, so I'm not coming, and then they don't come to exercise for the whole week. And then oh, I've got this lunch, and then like it actually turns out that they do two sessions a month because they don't come. 10 sessions last the year. Yeah. So it was like I actually sat down with clinicians and was like, Do you actually think that you can help people achieve their goals in the way that clients are attending currently? Where they miss a week here and then they don't do that, and they are just like, oh, I'm gonna skip that session. And it was like, well, no, like we can't actually achieve outcomes, we can't get strength improvements, we can't actually reach their goals. And that shift to like, okay, this is for adherence. It's not salesy, we're not signing them up to a direct debit. They can pause it, they can cancel it whenever they want to. Um it's about getting them committed to their goals and what we need them to do to actually achieve that. Yeah. I that's something I want to talk about too. I have if I do my 12-week blog over every two weeks, they catch up with me, and I actually pushed it to three ones because I was like, oh, some of them don't really get the adaptation in the two weeks that I'm looking for, but they stop doing the exercise after the two weeks because I've got three weeks to do these home exercises. Like, and they fell off the adherence, you just didn't have a point regularly enough. Yeah, it's like, okay, you'll see me every two weeks because and I literally tell my clients, I bet you at the two-week mark, you start to get bored of your exercise and you'll stop doing them. And if we push it out to three, you don't do that. And some of them will be like, No, they push it out to three, and they're like, Oh, I've got something on, or like whatever something comes up and they push out, or I'm I'm away or something, and they're like, You were so right at that mark, I stopped doing the exercises. And I'm like, Yep, that's why we do two weeks. Yeah, it's for adherence, it's not because you actually need changes to your program in two weeks. Yeah, you haven't got physiological change. Yeah, you're still working on the same thing, but we're keeping you accountable. And we're signing you up for 12 weeks because you will stop doing your exercises after four when that motivation initially wears off. And you need someone to go, nah, we're still doing this, we need you to get to here, and it's how long it's gonna take me to at least get you to a self-management phase if that's what you're after. And that's I think that's where we we started well live, set mine up like that, and then kept being like, Yeah, didn't say this is why your 10 weeks is turning into six months. Like, yeah, yeah. And like from a business perspective, helped so much with cash flow um and knowing like what was coming in every week, and not being like, Oh, a 10 pack was purchased here, but I don't really know when they're gonna purchase their next one. Uh, so that really helped from that perspective, but from like a client perspective, like goals were achieved so much quicker and like so much better. And people were actually seeing improvements in their strength, and it was just better for outcomes all around. Yeah, there's a reason why memberships are there, right? They work, yeah, exactly. For everybody, yeah. I think there was a barrier for you of fear of people not wanting to pay a membership though. Yes, and not wanting to be on a direct debit because I do have an older demographic of clients. Um, but it actually hasn't been that bad. And the way I see it is they pay for their Netflix subscription on a direct debit. So yeah, what do they prefer? Netflix or they trust Netflix Netflix or you? Which is all controlled by us. Yeah, so true. Very true. It's crazy, isn't it? But I think um this is something that we wanted to talk about because we're sort of working on remote control EP and finding the balance between service structures. I actually had a client coming to me um through remote control, but had seen all my marketing for her exercise physiology. Because if if you're a bit confused, her exercise physiology is kind of like my personal brand as a clinician. I was just as a sole trader, I guess, then. Yeah, and that's all my women's health stuff, but everybody sees me under remote control EP for women's health, so it's kind of like the women's health banner. Um, but yeah, she was like, Oh, I just don't know if I'm gonna fit into your niche of like I I really need this help and I want the support, and but I'm I'm just a bit scared that I don't fit into the niche. And I was like, wow, okay, my marketing strategy is doing an excellent job at getting the right niche. Yeah, but from the marketing strategy, I was like, oh, I also don't need to just stick to that. Yeah, it doesn't rule out too many people. It does kind of it does rule out some people that may that don't fit in. And every time I do a discovery call for people in even, you know, before remote control, some people don't actually fit that 12-week model. And I'm like, oh, you don't really need that much support. Or there might be, I've got a program already that I just want to talk through safe for my pregnancy or my fertility journey, and I don't really need that. So I've then had to add in like a little bit more of a like flexible service model that's like, no, no, no, we can just do this as it fits your needs. Expectation was I'm probably gonna see you fortnightly, but not for the same reasons, and we're not doing the the similar type of um rehab stuff, but it is important to be also flexible, so even though we've both got like like yours is quite structured now, yeah, in a way. Yeah, for each service. We've got like multiple services. Option, like I still have multiple different service structures, but I know when I'm in that initial consult, my job is to figure out what which one they fall into and then deliver that to them and talk through it with them. It's almost like the treatment plan, yeah. That's how I see it. Yeah, it's just the financial side of the treatment plan. Like how does this fit into the business model and the payment side of things and their commitment? Um, but this is the treatment that they need. And that's I guess that's that's actually so relevant if you're a clinician in someone else's business. It's your treatment model. If you haven't got a treatment model for someone or each different type or what you think the journey would look like, that's essentially what a service structure is. Yeah. And it doesn't have to be the same for every client. It shouldn't be the same for every client. It should be different, it should be individualized, but you know you've got those options there. Yeah. And it's figuring out which one they fit into when they're sitting in front of you. And I think that's what we're really trying to find with remote control is how do we find this perfect balance? Because your business has been one end of the spectrum, my business has been the other. And like how can we get the best of both worlds? Yeah, yeah. And it's all a very different way of delivery. So with the journey. More about journeys. We're still working on bits and pieces of that. Yeah. But and it's that's another thing though. It's okay to take your time and trial and error. Oh, absolutely. And get feedback from people. Yeah. Yeah. What's worked, what hasn't worked, and what they've enjoyed, what they liked about the offer that you gave them. So maybe to take control for this. Time to take control. I guess writing down your service structure. What does that look like? Or do you have multiple offer? And if you don't, or you can't write that out, it's probably time to reflect and figure out how to write it down. How to write it down and what you're actually doing. Yeah. It's a good uh I get this in the mentorship all the time. Like, what do you what does the journey of the patient look like? If you can't write that down, you need to work that out, at least for one type of client. If you're seeing everyone like a generalist, and you're like, oh my god, I've got so many different things, like just pick the one that you see the most of and then start to like look at all the different others. And like, is there a common theme that you're seeing? It's like, yeah, I do see everyone one-on-ones and then filter them to groups, or maybe they come in for initial, go into certain groups. Maybe it's yeah, there's a million different options. They're seeing you fortnightly or doing a home program review every six weeks. Like, there's so many different options. Uh, but knowing, having clarity around that, and that is your thing to take control of this week. Um, yeah, thanks so much for being here today. Yeah, we appreciate your time and listening and spending uh however long this has been listening to our voices. We appreciate your like, subscribe, share it with your friends. Thank you for being here. We'll see you in the next one. Bye.