Patient Management 101 for the physiotherapist, chiropractor, and massage therapist.

If you are a physiotherapist, chiropractor, or massage therapist this is a MUST listen.  We dive into the key elements of how to develop the doctor-patient relationship, how to communicate your program of care and most importantly establish that trust necessary to be the most effective provider you can.

Participants:

Dr. Angelo Santin - Santin Chiropractic: Thunder Bay, ON

Dr. Parm Badwall - Healthmax Physiotherapy: Brampton, ON

Dr. Jake Hayes - Town Health Solutions: St. Stephen, NB

Dr. Dan Comeau - Town Health Solutions: Saint John, NB

Zoe Leclair, RMT - Town Health Solutions: St. Stephen, NB

Abbi Dunn, RMT - Town Health Solutions: St. Stephen, NB

Dr. Erik Klein - Town Health Solutions - Hampton, NB

Transcript

SPEAKER_05 0:00

Turn the phones off here. All right, folks. So I want to welcome you here to the National Clinic Program Browns. We're gonna have a great time today. We got a whole bunch of people here, all with tremendous amounts of experience. We probably have a hundred years of experience, actually, probably more than that, sitting here. We are the eight millionth most popular podcasts on Spotify. So you know it's big. I don't know why the advertisers aren't rolling in, but you know what? They they're missing out. Anyway, so hopefully at the end of this, we'll be at 7,999,000. Anyway, so today we're going to be talking about something a really important subject with some amazing people here. We got Dr. Angelo standing, he's in Thunder Bay, the chiropractor, Dr. Parm Abobell. You know him from our very first episode. Great insight into CTE concussion and how that and treatment options. We also have uh behind Evenos' audio, we got uh Zoe Flair, RMT. Hi we got Abby Dunn, RMT. Okay. We got Dr. JK. So we're all gonna be throwing all this stuff coming from different perspectives. I'm really happy we have a few RMTs here as well because you know having perspectives from different professionals is always very helpful. And of course, as anyone knows, all of our many listeners, they know that that we all work very well together. And if you want to have a well-running clinic, you need to focus on being interdisciplinary versus just multidisciplinary, where your people are communicating, you're talking. And then uh when you have that, you have that central nias, which is the patient. And we're gonna talk today about how uh how to communicate with that patient, whether it's how to uh provide you know insight into their condition, what their care plan is like. We like to call it talk about call that the report of findings. Also, as time goes on, managing expectations, managing the needs of the patient, explaining the sensations they're having. Sometimes people might even feel a little bit worse after their first visit or two. Um, and and how do you navigate through all these things to develop that relationship that's gonna help uh be hopefully a long-term uh opportunity for both the patient and and the practitioner? So, all right. So, you know, I'm kind of starting off with with this. How about Angelo? You have a lot of experience coaching other chiropractors. Why don't you just throw out a few uh topics you know on in this vein about the if you have a patient coming in, a brand new patient, what are the three most important things that you will discuss? You don't need to go from A to Z on everything, but introduce these topics however you wish. What are the top three things are important when a new patient comes into the clinic?

SPEAKER_07 2:43

That's a great question. I I'd love to ramble the whole 45 minutes on on that top note. Um I think the biggest thing that I hear from you know people, uh colleagues and people in the profession, and even people that I coach is patients just don't get it. Don't get chiropractic, don't get the benefits. They may not understand it. So there's a that that kind of information gap. So I I feel like um us as practitioners, it's our job not not to educate them to death at the beginning, but to take them through the first few days of of their experience and start to um not just educate them, but inspire them, make them excited about their care. Um, so I'm a I'm a huge inspiration guy versus an education guy in those first you know, two, three visits. I I run a very systemized um you know um program where it's day one, day two, you can do them that all into one day, that's fine. But I'm very organized in what we're trying to accomplish with our consult and with our exam and with a report of findings, um, with an idea of why we're doing that, why are we doing a consult, not just rambling off to get you know clinical information is what's the purpose of the consult? What's the purpose of the exam? Which makes, in my opinion, the report of findings kind of a formality if we do those two things uh well, so that a patient at that report is excited and inspired, whether it's a simple, you know, shoulder, elbow, whatever it is, or if it's a more major, uh, you know, complicated case, they need to be inspired and feel hopeful. Um, then the education, I believe, comes down the road. Um, I'm fairly certain no one wants, not a lot of people want to be educated right away. They want to feel uh taken care of, they want to feel heard, they want to feel better. And I think we can all agree on that. They want to feel better, and then they'll start to open their ears up to how is all this working? How does massage work? Um, why am I starting to feel better? How does a shockwave work? Um, so we take a very um, I don't say different approach. We take a unique approach where it's like, we'll worry about that down the road. We really want to lock in our consult exam and that report so the patient can feel inspired um and and really feel hopeful so that they start their care and stay for care and uh and then maintenance care down the road. So um we can break that all down, but that's kind of what we focus on in our clinics.

SPEAKER_05 5:16

Yeah, yeah. No, that that's great. And you know what? We could probably do five different episodes talking about breaking all this stuff down because it goes, it does go deep. And so for me, to kind of, you know, you and I had a quick conversation on my drive down here and Angelo, and you know, to to put things in perspective, for me, I like to develop trust. Um because a lot of people in our profession, they're they're here because they've they they're either the medication wouldn't help the medical doctor, it's going on too long, maybe they've been to other professionals and it ha they haven't had the result that they're looking for. So you need to gain their trust. And I'll say people go and they'll do physio forever. We love physios, we have physios that work with us. But the truth is the average person will go and see a regular physio forever. But as a Cairo, you essentially have about three visits to say you don't need to cure them, but they need to say, oh, we're moving the ball down the field. And so uh say, oh, okay, well, no one else was able to do this. You did it, you explained it, you listened to me, and you you you you spoke about that as well, uh Angela, about uh making them feel allowing them to feel heard. So it's a lot of these soft skills, and so once they gain that trust, like, oh, I didn't know you guys did anything like this. You know, can you help my sister out with her vertigo? Can you do and suddenly it opens up and opens up and opens up? And then that will buy you the time to do things properly, whether it need 12 visits or 24 visits or whatever it might be, they're like, you know what, my insurance is run out, I don't care. I trust you, you're genuine, you're authentic, and you're not just about trying to to nickel and dye me to death. And and that is that is really, really uh important. Um, and so I find using actually uh like the different AI scripts for note-taking has been helpful with that. And I'll tell you why. You know, we use Heidi AI, and uh what it does, it allows you to set it up and it goes, we have it posted so people know that we are doing this, but it allows me to then instead of me sitting here type, type, type, type, uh what elbow was it again? Yep. It was it's now I am now squared up with my patients, and we're having a conversation. And I'll tell them, so in case they wonder, like, are you are you gonna write anything down? I'll tell them it's like the system is taking care of all that, so you and I can have a conversation, we can figure this out, and we can solve this problem together. And people, yeah.

SPEAKER_07 7:41

Yeah, you mentioned something about trust, and that's how you build trust, exactly what you're talking about, is sitting knee to knee with them, right? Is is uh are we gonna get every single clinical question every single time? Probably not. And I I think a diagnosis and a clinical impression comes with time. Um uh and you're not gonna get it accurate 100% of the time right on the first day. It actually will develop and you you get better as time goes on. So you're better off getting what you need clinically, but focusing more on that knee to knee. And I want to hear your story. And I think that builds trust. It does. Um, not to say the clinical questions don't, but I think uh the trust builds with builds with us closing our mouth and and and opening our ears. So I train our kairos and even our physios to you know what brings you in is the first question, and then they're not allowed to talk. You're not allowed to say anything after that because the average patient will talk for about 90 seconds.

SPEAKER_05 8:39

Yeah.

SPEAKER_07 8:40

Oh, 90 seconds. So if we can't give that person 90 seconds without interrupting him, yeah, you know, so so it that builds trust to be able to listen to someone for 90 seconds and let them tell their story in whatever, you know, even if it's irrelevant, let's listen to them and then start to counter with some questions. And yeah, I love the the the AI note-taking. I personally am an efficient, I love efficiency all over the place. I prep my intake form to match my clinical questions. So it's pretty much 50-60% of it's done already before they come in. It's already loaded in. So, you know, whatever low doctor for care to whatever you want to ask, most of it's done. And I'm asking touch-up questions, and I'm actually focusing more on um why are they there. I finished that consult to build trust again, which I believe is important, uh, is to go, okay, now you told me you're here because your backs are, but why are you really here? Um, we call it goal-oriented-oriented care. No one's allowed to leave without figuring out what's the real reason why they're there. Okay, because I believe that helps a patient stay, gets motivated to stay, and then stay longer if we can reveal or clarify their goals. So, really simple questions like, you know, uh, what have you had to give up? Yeah. You know, and how, you know, uh, you know, if I had a magic wand and we waved it, what else would you be doing that you're not doing? And those questions are universal to physios. We've got RMTs on here today. Those aren't Cairo questions, those are universal questions you can ask us like, why are you actually here? Well, I haven't been able to pick up my grandkids or play pickleball for six months.

SPEAKER_05 10:20

Yeah.

SPEAKER_07 10:21

Bingo.

SPEAKER_05 10:22

That's how it's affecting your life. It's not a technical assessment, an objective assessment. It's not a uh Oswestri. It's I can't pick up my grandkids. I I love playing pickleball. I'm gaining weight because I can't go out and my mental health is suffering because I like hanging out with the girls on the pickleball court on Wednesday mornings. You know what I mean? Bingo. Yeah.

SPEAKER_07 10:39

And and if you can tie, again, whether it's RMT, PT, whatever, if you can tie whatever report of findings you're gonna do to what how you examine them, and with that goal saying, well, here's your problem. It's basic marketing and sales. Here's your problem. We have a solution. We believe we have a solution based on our experience and our expertise to be able to walk you towards your problem, uh rectifying your problem, that's your report of findings. I mean, we have to do other things, obviously, in a report, risks and benefits and all that kind of stuff. Yeah. But um, that's actually the meat and potatoes of for me, a report of findings is if you don't clarify their goals, um, in the exam, there's some neat things you can do too. If you don't clarify their goals, you know, the report is really um, you can't move forward on a report in a larger schedule because you don't really know why they're there. Um so so that first three, four, five minutes uh for me is critical, no matter what discipline you are.

SPEAKER_05 11:36

Yeah. No, absolutely no. That's that's great. Uh thank you, Angela. So, Parm, I want you to jump in. We've had a few comments. When you first see someone, so uh Parm is the CEO of HealthMax, uh a large chain in uh in southern Ontario. He's currently in Brampton. Uh and so for Parm, for you, I know this is uh of interest to you, and and you guys have been through tens and tens of thousands of patients over the years. So, how do you approach that that first new patient that comes in? How do you coach your staff to to talk and how do you develop these relationships?

SPEAKER_04 12:11

For sure. So uh definitely uh thanks for again. I would love to join these podcasts, and this is a very important one for me amongst the organization. So your guys' points are very key. Um, I actually back I have my I pulled out an old document that I made in 2012 and revised, and I've kind of made it up and can kind of just keep revising. And I give this to my providers and associates, contractors, whenever they onboard, in addition to I get my higher lead admin teams involved to go through points of a report of findings. So uh when you know, we came out of school and stuff, obviously, you know, you're not really taught these things. Uh, there's a huge clinical management hat and a business management hat that you have to wear, um, which can sometimes make things a bit complicated, right? Because you're like, well, I want to get you better, but we try to be, we can do everything in one shot, and we realize very quickly that there's a story involved and there's a plan involved, and we gotta kind of go with the patient. So without touching on some of your guys' points, because you guys have already mentioned them, I can give you guys a brief summary of that what we do. Um now you have to remember we're in the GTA in Ontario, it's extremely um uh competitive here, very aggressive. Uh you got clinics on every street, like um in some plazas, you got multiple clinics, put it that way. Like you're really having to um be a very stellar and above and beyond practitioner or a clinic or administrative team in order to keep patients here. It's just a very different scenario. So I just wanted to plug that. So I think authentic um genuine um structure for a report of findings is your glue. If you don't have a good report of findings, you could have a very detailed one or keep it very casual. But if your report of findings doesn't touch on at least explain to the patient in very, very simple terms what's going on. This is what I, you know, your condition. Um, you know, I we use a lot of props, models, charts to show them. Patients are people are very visual, you know. You show them that said the glute meat is contributing to your SI issue, which is what's contributing to your knee or low back issue. So you always want to use props where you can. And this is for everybody. RMTs, I have a lot of RMTs with me. Um, physios, our physiotherapist just joined here, one of them. Um, so I think props are very important.

SPEAKER_05 14:29

Perm, perm, jump in.

SPEAKER_04 14:30

So is this like a care talk kind of prop where you're pulling things out of the no, just anatomy, like you have like anatomy MSK uh posters in the rooms and stuff. You're just showing them, or you can have props of knees or a spine, you know. Just if you can have some visual, it's important. Um, absolutely, yeah. Um, so um, sorry guys, I'm just gonna, I just thought I lost you guys there. So, generally speaking, keep it very simple, explain it to the patient. Now, you have to remember, um, patients don't really want to hear a long, drawn-out report of findings, like how we're taught in school and like the whole much based on my clinical experience now. Like, you're in pain, you want to kind of like get started on me. I want to get some treatment and let's get moving, right? So, a lot of times, what I tell my practitioners, including myself, is let them know what's going on. Keep it very, very simple. Um, we're very big on a global approach, global assessments, functional therapy. Show the other reasons why they're having the condition so they can see, okay, this is not just a simple knee issue. This could be coming from my foot or an imbalance in the hip or the low back or whatever. That's very key because then the the the you have to remember before patients come to us, especially in the GTA, they've already tried out other clinics, they're just trying us out as well. I've been told by my family, friends, physicians, whatever to see you guys, you guys are great. So they're testing you. So they've already heard all this reported findings from very many different, many, many clinics. But sometimes they're like, I just want to get started. So obviously, we have our responsibility to do a proper diagnosis, DDX, explain to them what's going on. And then we always like to um showcase the global approach or the other functional act contributors to the complaint. That's very key. Um, and then we always like to, at some point in that report of findings, I keep them maybe five to seven minutes. They're not very long, drawn out, because sometimes, as we're even talking, patients, they they're already thinking, I gotta get home, I've got to make dinner, I've got to pick up my kid from school. So they're not sitting there like gonna be wanting a whole seminar on this, right? They just want to be like, get me better. But one part in my report, our report of findings, very we want we really want to touch on is pain. Pain is subjective. For example, um, we're gonna definitely be measuring your discomfort, but we're also gonna look at your range of motion. Um, how are you functionally improving um with the treatment? And this is what we're gonna do chiral, physial, laser, shockwave. You give all the modalities and tell them how it's going to help. It's very important to educate that patient from the start. That's that's why the report of findings for me is the glue. You could be the the uh a very unfortunate, you know. We've had practitioners that work for us or people in the past, we visit them, the bedside manner, just not really great. But if they have a very strong report of findings, you know, and the patient understands them and their care, they'll give them a shot. You know, they'll they'll understand it. Um, so I think really honing in on the patient to get them to connect with you is number one. You've got to come down to their situation, really understand them, empathize, that's key. You gotta connect with them. If you can't connect, none of this will work, right? Then you have to draw it down to what's the condition, simple terms. Um, you know, then you go into obviously global approach, then frequency of care. What's the responsibility of coming in? You know, um, we want to see you two or three times a week. Why is that? A lot of patients don't understand that concept. Like, well, um, especially around here, it's very like medical still, even though it's a lot better. No, I I just want to get better in my pain and I'm out, right? So you want to educate them on, well, you know, use the similarities, they know it's like working out twice a week, you know, learning a skill, playing a piano. If we're trying to have an effect on your nervous system or your neuromuscular acetal system, we have to see you a little bit more regularly in the start to create a change and an effect. If you're not gonna reach that, then how are we supposed to get to that place that you want to get to? Right? So I really make sure that we put the onus on the patient that you also are responsible to be part of this care plan, right? Um, a lot of times, you know, it's communication. We'll get, I can't tell you how many times patients will say, you know, um, you know, I wasn't really aware of my commitment or my frequency plan. They go to the family doctor after the treatments here, and they'll be like, Listen, I'm not getting better. Well, how many times did you go? Um, you know, Scott? I only went once or twice. Well, you know, you got to give it a chance. You gotta give them a proper solution to help you. So I I believe strongly that, you know, after you do all the informed consents and stuff, um, we want to um, I mean it's respectfully, you want to dumb it down as much as you can to the patient. So it's quick to the point, but they have to know their commitment. They do need to know a little bit about pain physiology, um, how that works, because it's subjective. If you just keep it on pain every day, how are you doing today? I I talked to my PTAs a lot, my team. I really work with these guys on that, versus saying every day or every second day they treat them or whatever. Um, how's your back pain today? Fine, we need to know that on VAS. Let's say it's three out of ten. Next day, how's your pain today? Oh, today it's a two out of ten. Great, I'm getting some results. How's your pain next week? Let's be flash forward. Oh, my pain's an eight out of ten. Oh, what do you oh my gosh, right away what what do practitioners think? Oh my gosh, is it me? Maybe my treatment's not working or something's up. That's really right, right. That's the first thing practitioners will start to think that is it maybe something I'm doing. But ask the questions. What did you do yesterday? Oh, I was playing football for the first time, or I was playing pickleball or whatever, and I haven't done that for a while. Hence, I'm having discomfort. Okay, let's walk through that. You know, um, you're getting better. Do your palpatory exams, whatever it is, to reinforce to the patient that there is some results occurring, but are you moving better now? Do you have less discomfort? Do you have more feeling a lot, you know, less heaviness in the area? You have a bit more mobility. Does it come out as does it come on as much? No, it doesn't. Well, that's the improvement that we're looking for. It's not just about pain. So I'm very, very um big on that with my teams and and all of the other clinics of health max because I believe strongly as clinicians in um you know manual therapy, neuromusculosal medicine, whatever you want to call it, you have a lot of other factors that are are contributing to the pain model. You got chronic pain, mental health, metabolic issues occurring, a lot of other things. So are you gonna do this again on all on one visit? No. I was my last point here was I split up the report of findings. If I see that you have to read the room, if I see a patient has a fracture or they have a disc herniation, they're not gonna want me to go through a full they're gonna be like, I I they can't even like handle that. So I'm gonna keep it very simple, and then I try to get to those other points. We're an interdisciplinary team, you're gonna see a team-based approach. I want you to see my massage therapist, this is why. The physio, this is why. At some point, you want to get them to trust you. If you can't get them to trust you, like Eric said, and we have the same like kind of thing here, usually patients here, especially for Cairo, even for physio, but I would say yes for Cairo more. Three visit number is very interesting. It's like they give you around three visits, and if they don't see any results, they start to stop booking. They're like, okay, you know what? I'm not seeing it. You know what? I'm just gonna come when I want, or my schedule, I don't know when I can come back. And I don't blame my practitioners for that. I don't. I blame the situation where the communication of you connecting or the patient connecting to you as a practitioner, something failed there, right? And let's figure that out. Like what happened there that they didn't understand. Right? So that would be what we do. And we're very so we read the room. Am I gonna a lot of patients are like like our oakful patients, they're gonna be like, no, I want to know everything. I want to know what's going on, what my condition is, what's the problem, how did it happen before you do anything. So now you gotta really go into that model, right? Um, which I actually like. I like those types of patients, right? Because then you know that they'll stick around and because they understood you. Um, so that's where I'll end off from my end. I can talk about this, you're right. Like we can talk about this for a long time.

SPEAKER_06 23:07

Oh, yeah.

SPEAKER_04 23:07

Uh, because reporter findings is really the glue for management. If you don't do one, and uh I respectfully, your your RMTs there, they're great. I can see them. Eric, you've spoken to me about them, but RMTs in our organization have this issue big time. Um, respectfully, they'll just do the massage treatment, right? For example, and we always explain to them when do you want to see the patient next? You want to explain that to the patient, you know, is it once a week, is it once a month, is it bi-weekly or whatnot? What you'll see is a lot of times it's kind of like see me as you need me and stuff. And a lot of times patients love massage. For sure, anyone wants they're gonna run and get it. You'll especially out in the GTA, if you the patients will just forget or they'll just kind of move on. So I find it, you gotta find a place in your scope where you can is it three goals that you so I do the same thing, Angela. In the first visit, we always give the patient three goals. What three goals do you want? And I revisit those three goals after reassessment, six to eight visits that say, did we reach those? And if we haven't, like pain, range of motion, uh being able to lift my granddaughter, kids, whatever it is, then the patient will then start to trust you. And when they trust you, you can start to uh um access other things that they require, right?

SPEAKER_05 24:22

So yeah, no, absolutely. And we're all touching on very similar points, we all have experience, and I find that new graduates, we see this with every crop, whether it's chirophysial or or or an RMT, when they come out of school, they are talking way too technically. And so we all know the lizard brain versus the wizard brain. So new grads come out and they hit that wizard brain, and they're talking very technically. You have uh second-degree whiplash associate disorder that is stressing these tissues using a lot of anatomy and physiology, and it's just going way over their the head, and and they really focused on that and they can go on and on and on, and they really lose that that patient. Whereas the lizard brain, again, is this trust formula where then okay, we're now opening the door so that down the road you can dribble this stuff out. Obviously, if you have a nurse or someone experienced or maybe a physician is in the office, they want to know. They still give it to them. You can go on and do whatever you want. But for the average person, like Angela was saying, you've got to you've got to dumb it down. Actually, no, it's prime, you you've got to dumb it down. And not that doesn't mean people are stupid, it just means they need to be able to connect with the information. So if it's too high level, they're not gonna connect with that information. So just because you spewed it out, that is not a success. If there is no reception, uh the reception is a success. And that's kind of what we're talking about, is how to get that message received. And and one thing, so Dan, Dr. Dan Como is joining us from St. John New Brunswick. Uh, he has a fantastic way, so he so it's really interesting. I love the fact you popped in now uh because Dan uses these wild analogies. Everything has an analogy, everything has a story, we call them danisms. So, Dan, why don't you take us through when you're explaining various situations? Maybe give us two or three examples of a Danism, come your few of your favorites about how the eggs. If I told you just to talk, you you'd go on midnight. But anyway, so let's go through a couple of your favorites and how and the meaning behind it and why it tends to resonate with your with your patients.

SPEAKER_02 26:30

I think it resonates with my patients because humans are inherently storytelling animals. So like I don't have I have I have some skill sets, but like I can't play an instrument, I can't keep a beat, I'm like not good at drawing, but like I am really good at telling stories. Um, which uh something I learned from Eric's father-in-law one day was you never allow the truth to get in the way of a good story. Not super not super clinically applicable, but uh just before I get into it, I just want to touch on a couple things that that you guys were talking about. Um, the whole dumb it down idea for the patient, and and everybody's like, you know, respectfully, like, you know, not saying that it's just we take for granted talking about anatomy all day, every day. Like everyone knows what all the anatomical terms are, right? Like when you come out of high school, and most most people, like some people have more education than that, less education than that, but like even if if you come out of high school and you go to university and you do uh arts degree or an engineering degree or anything like that, like you know, you go to college, you're you know, you're a pipe fitter or a welder, um, you don't ever learn how to take care of your body. You don't learn any words for it, right? It'd be like if I went and talked to, I don't know very much about cars, like hardly anything. So if I go to talk to the mechanic, the mechanic doesn't tell me that the the flux capacitor is is the thing that's broken, right? Like I'm never gonna like if he just keeps dropping $15 words the entire time I'm in the shop, he's gonna be like, and it's gonna be six grand. I'm gonna be like, this guy's taking me for a rip. Like he's he only he only used like the 15 syllable scatter cat uh what do you call it, scrabble words the whole time. Um, so I think that the you know, meeting people with where where they're at, and and that I use analogies to do that is is really good. And kind of Parm talked about that three visit number. Um, I approach that right up front. I'm like, you know, you can kind of tell what somebody's coming in with based on the chronicity of the problem and that type of thing. And I think you're absolutely right. You get three visits, maybe five if you if you front load them. I just tell people like, and I got this from Eric, I want to try to move the needle. If you know they've had it for eight months and nine months or 10 months or 10 years, like, listen, man, you've had it for 10 years. I'm gonna try to move the needle in five visits, right? I'm not saying that you're gonna be 100% better. I'm saying you gotta give me five to see if I can if I can move it. If not, that doesn't mean I can't move it. It just means that maybe I didn't start on the right pathway. And getting into that, one of the one of the things I say to people is when I'm doing my report of findings and we're talking about possible interventions. Uh, I think one thing that a lot of chiropractors find is people come in, they'll be super hesitant about being adjusted, right? And I one of the one of the analogies that I use is like, listen, man, like my job is to get you to the top of the mountain. That's you know where your goals are, where you're you're feeling better, where you can lift your granddaughter, da-da-da-da-da. Um, and I am like the Sherpa and you are the rich dude who paid me to be here, right? So, like my job is to get you to the top of the mountain. Now, the fastest way up that mountain is, you know, in your case, it's gonna be a spinal adjustment. Uh, if they're uncomfortable with that, like my job as the as the mountain Sherpa is to get them to the top of the mountain in the way that they best feel comfortable. Like if the if the spinal adjustment is blazing a you know, short rope in the guy and dragging them up the hill, uh, I'm very comfortable doing that. But the the patient might not be comfortable with that. So we might have to take the trail that has all the little switchbacks on it, and that might be using a combination of you know exercise and spinal mobilizations and maybe you know some grade two, grade three uh manipulations instead of like grade four manipulations. Uh so that's an analogy I use with patients all the time is I'm the Sherpa and you're you know you're you're paying me to get to the top of the mountain, and we're gonna go whichever way you're most comfortable with. Because I don't, I again, and I think a lot of Kairos get this in their head, like that they have a preference of what they are gonna do. Like, I'm gonna do this. It's like I don't care what I do, man. I just care that you get better, right? So like I'm gonna do the thing that you're most comfortable with. My job as uh as a as a doctor is to give you all of the possible options, tell you which one I think is gonna be the best, thing what you know, but if the best option is kind of like that Cochrane's evidence-based stool uh analogy, right? So you have the evidence, you have the doctor's experience, you have the patient's uh belief system. So if their belief system is that adjustments are scary, well then that's not a great intervention for that patient. So that means, you know, we're gonna take the little long trailer around the mountain, whatever you call that, where it goes in a circle, um, instead of instead of going up the side. Um, the other uh analogy that I use with a lot of people is is you know, the question that comes up all the time is, how long is it gonna take? And I'm like, I don't have a crystal ball. I can't possibly tell you how long it's gonna take. Um, but I always tell them, like, I'm like the I'm like the lumberjack in the woods, right? Like you've you've you've you're lost in the woods, you're lost with this this problem that you have, and you've stumbled onto my cottage. And I I'm pretty good at what I do, right? So, like, if we're really lucky, you've been walking in a big circle out in the woods and you fail my cottage, and my cottage is near the fucking highway, and we're gonna like blaze a trail straight through to the side of the highway. We're gonna call a guy, he's gonna come pick you up, you're gonna be great, it's gonna take three to five visits. Um, if we are unlucky, you've had this problem for 15 years. You have been walking in a perfectly straight line into the middle of the deep woods for 15 years. I happen to live in the middle of nowhere, 15 years walking into the woods. Um, that doesn't mean it's gonna take us 15 years to get you back out. I know all the tricks, I know all the paths, I know all the all the all the signs to avoid all the dangers, but it's gonna take more than a day for us to walk out of here. So at that point, that that people understand that. They're like, okay, yeah, you know what? I I actually have had this since I was 15 years old, and now I'm 45, and that makes sense. Okay, I'm not I'm gonna give this guy that that five visits to move the needle. Um those are probably the two that I use most commonly. I have a bunch, but they all come up organically. I've never ever written them down.

SPEAKER_05 32:07

Um those those are the two that I was kind of hoping. I didn't want to leave this. Those are the two that I was hoping you would you you would come up with.

SPEAKER_02 32:13

Yeah, those those those are those are like two of my pocket ones that I come up, but like I just come up, I'm I'm pretty absurd most of the time. I live a fairly like like the comedy I enjoy is absurd comedy. So like I just talk and come up with stuff on the spot. I made three up this morning, can't remember what they are. Someday, someday I'll remember them again and I'll be like, oh, that was a good one.

SPEAKER_05 32:33

Yeah, so there's a good mix here all around. We're talking like there's you know, coming from various different vantage points, but essentially the messaging is is the same as is conveying that information to the patient. So I want an input from an RMT here who wants to, uh you don't need to go on for a long time, but who's got some uh insights? You guys have been practicing for a long time into how you communicate, especially with massage, getting uh making sure they follow care plans. Massage don't always follow care plans. We have uh we've had RMTs who are like come back when you want, but that's not a care plan. So, you know, how do you how do you guys bridge that gap and create that connection to people?

SPEAKER_01 33:14

Well, uh my name is Zoe. I've been a massage therapist since 2009. And when I trained in Ottawa and worked in a big city, it was a bit different than building a rapport with people from a small town that I will then see at the grocery store. You know, it's uh so one of the main things to build trust and to make sure people continue on their care is to actually remember their name and use it throughout the treatment. And uh then they see you every time. It's it seems to be a synchronicity of things. They'll see me and then they're like, oh yeah, my exercises, you know, they and and it adjusts their memory, but also giving them clear instructions as to what what the exercise is, demonstrating it and then getting them to do it. Once they have the muscle memory, there's much likelier chance that they'll actually do it. And then it's not usually that difficult to get them to come back to massage therapy, but sometimes it's there's still a trust that has to be built, built. They they'll wanna get on the table right away. They're like, wait a minute, we gotta do our assessment because the the worst technique at the right location will actually have an effect. The best technique at the wrong location is kind of pointless. You know, we're both wasting our time. So uh to to get the assessment in and just explaining, okay, let's take five minutes of this hour. We have time to manage the time, respect their time, to actually get to the root of why they're there and uh what they want to accomplish today and bring it back to today. Because sometimes with an hour with a person as a massage therapist, you get to deep stuff, you know, but you might not want to be unraveling their birth trauma the very first day. So you gotta kind of gauge where they are. And I look at the person before they start talking. You look at their body language when they come in, you look, oh, I notice. And then once they start talking, like, oh yeah, my back, and you're like, yeah, I notice when you're getting off that chair, you're kind of leaning, and all these little things, they're like, Oh, this person sees me. If they see seem feel seen and heard, then they wanna they feel like they've got someone on your team on their team. So if you're you're on their team, they want to perform and they're they're more likely to have uh energy to actually get themselves better because they're there's a witness there for them.

SPEAKER_05 35:48

Yeah, no, that that's those are really, really uh good points. So uh I think what we'll do is a couple more people I get some insight from. Uh Abby, if you have anything to throw in. And I actually mentioned Jake. Jake is the youngest person in this in this discussion. So I'm interested from you, Jake, about how you started day one. Now you did have you weren't pretty lucky. You got to hang out with us and see what we did. So you weren't talking starting cold, but it does take time to kind of figure your own path. And I know that Parm is on a little bit of a clock, so we'll then we'll bring back to Parm to see if he has any comments uh to tie everything together, and then and then that we can we can finish up the conversation. So, Abby, do you have anything you want to add to what Zoe said?

SPEAKER_00 36:31

I mean, I'm I agree with everything Zoe said. I think one of the main things that helps with my clients is just to check in with them, see if there's anything holding them back when getting better, if there's anything that um they have concerns about, and I give them that space to kind of talk to me about it and I listen and make sure that the treatment's going the way they would prefer. And if it's not, I see how I can do better, or if there's maybe a referral that can be made. But I always want to give my clients that space to kind of tell me how I can help them get better.

SPEAKER_05 37:04

Yeah, perfect. Excellent. So, Jake, yeah, so you graduated, it's been about five years now, I believe, 2021. Uh, and so you know, you've been working in St. John and St. Steve, so you have a city and a uh and a town. So when you started when it came to how you were communicating with patients and where you are today, how did that journey come about? Yeah.

SPEAKER_03 37:28

I think my big thing when I first started off was it was overcommunication. Like there's almost too much info thrown at the patient. Yeah. And Dan, I don't know if you remember this, but we dealt with a bicep tendinopathy once as a kid in high school, and you asked me, hey, like, explain to this kid what a bicept tendonopathy is. And I went just off with right, like, you know, I'm I'm going over, like, oh, it goes into the labrum, and then like, you know what a labrum is? Oh, let me explain what the labrum is. And then I was just going down like a rabbit hole, and this kid's like, oh, yeah, yeah, yeah. And then afterwards, it's Dan's like, Do you understand anything this guy just said? It's like, no.

SPEAKER_02 38:08

And then I do remember that, and in your defense, it was actually a spectacular explanation.

SPEAKER_03 38:15

Oh, but for sure. But for that kid the wrong go. Do you remember what you said? I don't, but I can imagine what it might have been. Well, basically, he's like, You know what a pulley system is, right? And the kid's like, Yeah. He's like, Well, you know how the rope goes through the pulley? Yeah, sometimes that rope gets frayed up, and it sometimes doesn't go through the pulley as well, get stuck. And he goes, Oh. But again, when you can like simplify stuff like that, I think that's important. And another thing that I felt like I never did a great job at until probably like three or four years ago is after trying to dig out like what the person wants to get out of the treatments. Because I dealt with it in particular with men, they say, Well, I just want my back to feel good. And it's like, what does that mean? Like, what's good? Like, is that just no pain? Like, what's good? Like, that feels good on my arm, but like what can you elaborate on that? And then sometimes you do have to kind of pull out of them, like, well, you know, I'd like to go hunting again. And it's like, okay, yeah, we could we could focus on that hunting. Hunting. And I just felt like over the years it took a while to really focus on just outside of things that mean more than just pain, yeah, right? Because you know, you might still deal with yeah, life, right? Because even with like, especially with the stenosis patients, it's like, okay, like we're gonna have to like modify your life a bit here. You're not gonna be able to go to the Olympics, but like, can we get you to the point where like if you want to do a hike with your family, like, yeah, that might be attainable for you, but the absence of pain, depending on what we're working with, sometimes it just isn't realistic.

SPEAKER_05 39:56

Yeah, no, absolutely. And everything is is relative, right? Like, there's a two out of ten for one person, it could feel like an eight out of ten for another person. We all know spleeny people. Do you guys use that term in Ontario? Word spleeny that uh or is that uh a Charlotte County?

SPEAKER_07 40:11

Never heard that one before. Um still don't know. Actually, if Dan could give me an analogy, that would be great.

SPEAKER_05 40:17

Essentially, the person just everything hurts, and it's just so off, you know, uh out of uh just way over the top. You you touch, you start doing just a little soft tissue work, and they're they're they're jumping and they're afraid of everything, they're scared of the little cat. We say these people are spleeny, and these people usually come in, at least around these parts, and be like, you know what? I'm a little spleeny, so don't worry about me, just do what you got to do. They will own it, they'll own it. They're they're honest, they're honest about it. So, Param, coming back to you, brother, because I know you were really keen to talk about this stuff. So, take everything that you know from your perspective, it's always awesome to see different perspectives on things. Um, how would you tie up your thoughts on on this whole subject?

SPEAKER_04 41:01

Um, I think we've all got a very common thread. We've all nailed really, really important points. But even your your RMTs there and your your um your young Cairo there. Um once he says stenosis, my brain went to, oh my god, we've had so many stenosis patients, and those are just you have to just manage them as you go. And it's called supportive care, really, right? Yeah, so um, and we do forget that we're not 20 or 15 anymore, and as age, you know, he things don't heal as quick. So uh I think reported findings, I like I've honed it into my organization. I'll conclude with that is it's literally the glue for your ability to provide uh program of care. You can we're all trained on how to be um kairos, physios, massage therapists. We know how to use our hands, our assessment skills. We've been trained in that, we've got experience. Clinical experience is always the the key, it's number one, as we learn a lot from our patients. But I think the report of findings is uh respectfully, I think is very much neglected. And a lot of um I I get consulted out here as well to other clinics and chains that need support in certain things sometimes, and I've done that happily. And some of my colleagues and friends have done that just to help out because they're like, you know, we're just not finding the rhythm of the clinic, we don't know what's going on. And literally, when I dissect it down, it's it could be the practitioners for sure. I mean, we're they're not not everybody can hold a patient or treat. It's the truth, it just happened. Um, it's a report of findings, they're not even going into the explanation of it. And then you're leaving that patient to make the decision of their care. You're leaving that patient to make their own management plan, and at that point, they've taken control of the situation, right? So at that point, you don't you lose your authority as a health professional to say, well, wait a minute, um, you know, let's fix let's talk about your retention or frequency again. Um, because at this point they've known that we've spoken about it. So I can't tell you how many clinics um when we talk to them, there's no report of findings, very minimal. Um, I think that's a big mistake, especially we're in private health, we're not OHIP or whatever funded, you know. You you have to you have to explain program of care. I feel strongly. Um, my managers here are like I've literally like ripped like a thread on my practitioners that you know your responsibility as per your association college profession is to be delivering a program of care to your patient explaining that. If you haven't done that, you've essentially failed that patient because um they're coming to you for your expertise, right? Um so I feel strongly about this. Um, the last point I I was thinking about uh as we were talking is I was just I was just treating a few patients. Uh, even today I did a home care before I had to come here, a chronic pain, really bad situation. But just a little clinical pearl for you guys for report of findings is for if you're pain based is a lot of times, um, and I think it was Ashley, I think it's your massage therapist there. Was it Ashley or sorry? Zoe.

SPEAKER_05 44:02

Zoe.

SPEAKER_04 44:03

Zoe and uh Ashley, too, right? Abby, Abby, Abby, sorry. They touched on that. Is um a lot of patients don't want to open up sometimes, right? That injury or pain areas are safety points, right? Neurologically, neurophysiologically. They don't want you to really get into that QL, let's say, or that, you know, quad or hamstring, because they're really trying to protect that. So now you're going in there, you're trying to release it. Great, you're educating them on that. But sometimes they just want to hold that and they're just like, you know, they they really want to hold on to that due to a lot of other factors, mental health, chronic pain, a lot of other things. So it's so important to explain to the patient that, you know, this is gonna be discomforting. I I forgot to say that point here. My thing was really make sure you we discuss hurt and harm. What's the difference between hurt and harm? Um hurt, it's gonna hurt when we're treating uh an area that's discomforting. A lot of times what patients will say is, hey man, you hurt me, or you made it worse, or what did you do? I'm not coming back to you again, or they'll go complain to the family doctor, hey man, you know, uh Dr. Bin Lau was great, but you know, I was very sore for four days after, right? Uh, I don't know if I want to come back, or they'll tell our staff, I'm gonna take a little break. It's very important to explain to that patient again in the report of findings. There's always a safety. You're gonna have places that neurologically we're protecting, and we got to get into those points. And if we do, things are gonna open up. But with that, you're gonna be sore, you're gonna have discomfort. If anything, we want that to to you know start promoting healing. Um, because you want an inflammatory response sometimes to create a new um, you know, um healing pathway for circulation and stuff, so I can get into the physiology of it. So you want to keep it very simple, but I think um so if you said all this to the patient, you've gone through a very simple, nice, you know, casual discussion. I I I would unless the patient obviously financial reasons or schedule doesn't uh fit with your schedule to book, whatever it is. I don't I can't see why a patient wouldn't want to give you a chance and to try to move forward with you. Um strongly, I I that's been my experience, and so that's where I would end that. I think safety is very key. Um, sometimes you'll have practitioners like some of my suicides, they'll be like really hitting on that spot really hard, right? To open it, right? And I'm like, well, maybe we should look at the associating areas that are around it to modulate and then get to that. Sometimes you have to use those clinical skills to because again, you don't want to piss off or um scare that patient in your first for me, it's the zero to three visits. I'm trying to get them to say, like, hey, I got you, I'm gonna listen to what you say now, you help me, versus I'm gonna go into that spot and just start, you know, adjusting hard or doing some ART or accu, whatever it is. So you gotta read the room, is what I'm saying, yeah, right away.

SPEAKER_05 47:00

Yeah, no, absolutely. How often, tell me, and we'll come back and bring bring you back in, Angela, here in a second, but uh how often do we see clients and patients who come in and said, I went to clinic A, B, or C, and they said, uh, or they saw a specialist or whomever, and they said, I have, I said, what did they tell you? And they said, Well, they treated me for seven or eight visits, nothing changed, I didn't get any better. I said, Well, what did they tell you? What did they say you had? I said they didn't explain anything. I just got on the table and just started doing it. There was no communication whatsoever. They just went with the hot packs and the ultrasound, and and and of course it it was had minimal effect. And so that is so common. And you know, um, I'm gonna throw in one one final thing that I really like more from the practical side of things is if you can show a patient a before and after, so either an improved movements or a change in movement pattern or a change in perception. Uh, you know, they can do things, and you know, so I have things I can do to say, okay, well, um the shoulders are the are the easiest way to do that. You have an impinged so you can have a small rotator cuff, uh, rotator cuff chair, might have an impingement. Suddenly they they can't get up past here. They have no abductive strength, obviously positive, positive with your ortho uh orthodoneurotest. And then uh you do the right treatment protocol, and suddenly they're over, they have strength in one visit, and they might have done 15 visits somewhere else. Suddenly they are perfect, and I say, okay, I just just want to preface this. You have strength now, the the everything is sitting correctly, you're still there's been a lot of tension through the capsule, through the tendons, they're afraid. So you're still gonna have discomfort, but you will have freedom of movement, and now those things have an opportunity to heal and they see it and they feel it and they believe it, and then they're like, Eric, you can do you and your team can do whatever you need to do now is this is incredible. So the more wizard-like stuff you can do, the better, and it doesn't have to be that complicated. So, uh Angelo, uh, you've heard you you started us off, you've heard lots of stuff. How how would you finish this up here? And I'll give Dan an opportunity to chime in as well.

SPEAKER_07 49:16

Yeah, just briefly on that thing, because I believe it's easier to show somebody than to explain uh something. So, what you just talked about was you're you're demonstrating. Yeah, so you should be demonstrating on every visit, but definitely on that first visit uh during exam. The exam often young docs, I see, is it's for them, and they're in they're engrossed in what they're doing, and they're not they're not engaging that patient. Is that's that's for them. That exam is for the patient. Um, and and I think we can all agree with clinical experience, you're gonna know, oh, that's a L5S1 disc just by you know the paperwork coming in, or you're you're gonna lean towards that diagnosis pretty quickly. Yes, you're gonna do those orthopedic tests, but really that exam is for that patient to know that we know what's going on and we're showing the loss of function. So, what you just touched on there, I think is extremely important, not just on the first exam, but on your daily visits, showing loss of function, showing improvement of function. And that's what a progress exam or re-exam, whatever you want to call it, is now we're showing you we have the answer to your issue that you're having. We're showing you, right? Um, because I I think analogies, Daniel, like your analogies are are are awesome. And I I actually went out to learn analogies so I can relate with the way that you explain things because uh I I think I was a little bit like uh Jake, where I was like, I was thinking I I had the best, you know, report of findings, and and one of my mentors said, Okay, do me a favor, go and ask a patient uh tomorrow what you said in the report of findings. Wait till the next day. I'm all proud and watch this, and and I did that with about 10 patients, and I was extremely humbled to realize they couldn't even repeat back probably five percent of what I said. And I I then knew I needed to go out and be a better communicator, um, which school won't teach us. So I can really relate to Daniel on the analogies. I use the train, uh, how long it's gonna take, the trains needs to slow down first and then stop, and then it, you know, you have to get the engines rolling, then you have to go backwards before you know. So that there's an I use analogies all the time. You know, we can paint the ceiling towel, we can go up and reshingle the roof. What would you like to do? Like I talk in terms of analogies all the time. So I can really relate to that. I think there's some really gems there for people that are listening, or even on this call, is uh don't underestimate the power of stories and proper communication. And Eric talking about demonstrating, I think that's extremely important. The way that I view the report of findings, uh, I'll give one more analogy. Um, Daniel, like this one. I I look at at the consult and pre-consult as kind of dating, you know, people are you know viewing you social media, and then you look at your is your clinic the right fit? Did someone smile at the front desk? That's kind of all you know, nervous dating, and then they let you uh examine them. That's kind of the engagement. And if you do a good job with the dating and the engagement, the wedding day is kind of a form a mere formality. Um, you have to show up, you have to say the right words, um, but they're probably going to say yes 95% of the time. Um so we we need to kind of get out of our way and do those first two things well. And and parm is right, you have to have a certain recipe to it. Absolutely. You know, you should be saying this and risks, and then you should be telling them based on this, you need that. That's the wedding day. You got to go through and sign the thing. But I think a lot of people, um, and I'm not saying it's wrong, is they put so much into that report of findings where they're missing um the first uh two elements of that. And then I'll kind of end on on lastly, is I think the education continues. So we have a duty to educate, I would say to a certain degree, but being humble and realizing people weren't listening and weren't getting it, I realized it had to be stripped out. So whether you're three visits, six visits, twelve visits, twenty-four, whatever you're attempting to do and whatever they agree upon is part of our regular uh adjustment visit or treatment visit, whatever you want to say, has a formula. Have to do three things. You have to uh touch and tell them something uh about what's going on with them before they tell you, whether it be muscularly, you know, I like the tone, I don't like the tone. You're tender here, you might you know whatever. You gotta tell them something and you gotta let them know that you found it and you're gonna correct it that date, and then you wanna give them some education to leave, some, you know, predict some changes. I always think, let's predict what we think we're gonna we're gonna see, not with guarantees, but with I want you to watch for this. And and I don't think we get enough credit. RMTs, uh PTs, we work our butts off, and and sometimes I used to find patients will go and go, I'm getting better because I bought vitamin D for my migraines, right? And it drive me absolutely insane, right? And uh we're all laughing, but it's like I went to yoga uh and it's starting to get better finally. And I'm like, oh my god. So I took it upon myself a duty to I'm gonna predict some changes. So I want you to watch for more movement, more flexibility. People under regular chiropractic care, regular massage, regular therapy will see more flexibility, more movement. Sometimes they'll sleep a bit better. You know, you're not saying because of today we're gonna cure that, but you're giving them something to educate them. Because I think that education um will has to happen after the report of finance. And that's how you get them to a re-examination, like you know, excited at a re-examination. And then at the reexamination, if you're not quite because we asked, we talked about maintenance care, I think, before on before we got hopped on here, is that's how you get to an easy maintenance conversation is you understand their goal, you're educated them each visit, you just said it, you're gonna demonstrate that they've improved. So wait a second, these people are nice to me, they listen to me, they speak in terms of regular language. Daniel gives great analogies, and so does you know. And and and I, okay, wait, I'm I can see that my you know flexibility is improving. I'm not ready to play pickleball yet. Um, so then as a practitioner, like, what do you think you need? I always feel like at the beginning, you tell them what they need, and uh as Param said, you give them that's your duty to tell them. I feel as they get towards the re-examination or progress, I go, okay, you've had enough care here. Like, you know, Daniel, what do you think you need? We know here we're going towards this goal here. You've had enough care. What do you think you need? And when they volunteer, like, sheesh, yeah, I think I want to kick, boom, there's your maintenance schedule, right? So um, I think everyone had great ideas. I kind of just bring it together, but I love pieces of it. Um, and to me, it's it's fun, and I love doing this uh kind of stuff, and I love watching a patient stay on for care um because I believe their health. This is my personal uh vision, is people are healthier when they're in our offices. Bar none.

SPEAKER_05 56:15

Oh, absolutely. You know what? We've had some fantastic points here, and the themes have been very consistent. Uh, and so yeah, Dan, anything you want to add uh quickly at with with everything you just heard?

SPEAKER_02 56:26

No, I think everybody's everybody's covering it to to speak on what Angelo said. I once uh had a patient come in with Dequervens Tennessee Vitis in their hand, and I did a bunch of grastin on a bunch of other stuff. And the guy comes back the next day and like vitamin D for the migraines, right? And he goes, Oh man, he goes, My hand feels like so much, probably not the next day, like a week later, he goes, My hand feels amazing, like it's so much better, you know, 80, 85% better. Something like that. It was really, it was really banger treatment. And he goes, I don't think it had anything to do though with what you did, but the cream that you used, I could just buy that. And I was like, Oh my god, man, absolutely. I'm you know, I'm I'm I'm glad that we found something that worked for you. I was like, you don't even have to buy it. I said, I will give you it. I was like, they don't even make it anymore. And he goes, Oh, they don't make it anymore. I said, No. And what it was is I was out of regular lotion in the clinic that day. Yeah, I had an old tube of Avon hand lotion that belonged to my mom. And it had like it couldn't even be any better. It had a penguin on it wearing a like a stocking cap. And I dug it out of the drawer and I gave it to him. And he's like, What do you mean? I was like, This is this is the cream I used, and he's like, but this isn't this is just regular hand lotion. I'm like, yeah. And I'm like, I'm pretty sure Avon's out of business, man. Like, I'm I'm 90% sure this is like a one-off. And he's like, Oh, it was what you did. I was like, Yeah, it was. And he's like, I was like, you shouldn't, maybe a little bit though. Like, yeah, it was sweet, sweet vindication. But I think we're all talking, we're all talking on the same thing. It's you know, everybody's touched on, as Angelo said, everybody's touched on different things, but like we're all talking the same game. We all do demonstration, we all do, you know, hopefully a half decent report of findings. I feel like I need to talk to Parm a little bit. Mine could probably be a little better. Um your back's jacked. I'm gonna see you for a few visits, it's not gonna be jacked anymore. How's that?

unknown 58:18

Yeah.

SPEAKER_02 58:20

Jordan sweet, they come in three visits later. I'm like, how's your back to look less jacked? I'm like, hell yeah, brother.

SPEAKER_05 58:27

Yeah, you know, it's funny, Dan. I I I use that exact example. I said when I started out, like everybody else, I was very excited. You have Facet syndrome and L4 on the left hand side, it's referring here, blah, blah, blah. Now I'm like, your back's messed up, get on the table. Yeah, obviously more complicated than that, but you know, uh, that's something that the old the older guys, like for the old farmers and stuff, that's what they want. You know, I mean, that's usually, you know, after after I have a bit of a relationship with them all down the line, but yeah, so then we can have some fun, read the room. So, you know, I think some of the big takeaways here, you know, is communication is so important, developing trust is so important. Being able to communicate the situation in a way that they will understand and will be retained. Education is a it's a continuing train. It will it will continue to roll along as as the journey progresses. And you know, and and and uh allowing the patient to feel heard, trustworthy, and know that you know what, what help them see the difference? What is the difference in being uh and being obvious about that saying you know, they don't get that many clinics. It is shocking. Dan and I will comment about people do not do this well, like this to us in this conversation is common sense. This built our our successful practices across the country, but it is not common, which is shocking too. It is shocking, and everyone will say, I'm not busy because my uh the color scheme on Instagram is wrong, or uh, you know, I I'm not my I'm using the wrong Google Ad word or whatever. It's like, no, you're you 80, I'll look at stats. 76% of your patients don't return after the second visit. Well, that's uh you know, you're you're I know you're not a terrible practitioner, I've seen you, but like you're you're clearly not establishing that rapport at all. And we do see this, and I know a lot of young grads say, I need them for three visits. We're talking about you have three visits to prove your case to the jury, you know, and we're but they're just trying to make it to three visits. And and that is a very quick way to a very dissatisfying career. Uh, and you're not gonna be able to run a practice like that, and the because simply the patients are not getting any better because you haven't given them the tools to get there. And we are we are doctors, we're also facilitators, we're educators, that's what doctor means. It means it means teacher. I mean most people don't teach.

SPEAKER_07 1:01:01

So yeah, you know, and I I think just one quick is is the young practitioners is there's education behind beyond your education, yeah. Uh right, right, and and people blame schools and all stuff. No, school's giving you foundation, it's up to you to do exactly what you've learned and you've learned, and the massage therapist learns, and Jake learned, and Daniel. So that that you should you have to do that. That's not negotiable, is you have to continue your learning beyond your four years. So um, I think that's what made us successful.

SPEAKER_05 1:01:33

Yeah. And you if you if you no longer want to learn, you might as well pack it in. Yeah, you know, you know, you're not happy, you're not serving anyone well. You know, I used to say, like, you could be one day before retirement. If someone came up to you say, Hey, you want to see my awesome, neat trick for telephenol syndrome? You're like, Yes, I do, I do. I'm checking out tomorrow, but I want to know, I want to know because that thirst for living, that thirst, the curiosity, that's what drives people. And you know what? It's not even what you say, it's how you say it. The medium is the message, you know, that old uh the the cut these TBC commercials. It's like they pick up the vibe and the energy and the excitement. And you'll even have people come in. I've done this. People come in with really weird things and they have pain and be like, oh, this is exciting. You know, I have said that. And you know, and and no one's ever been offended by it. And they say, you know, I'm happy someone's excited about it. That's usually the response. That's usually the response. You know, I say, you know, we love we love seeing crazy things. We have success. I can't promise you anything. And you start taking the through and say, exciting things, you know, I've published papers, you know, the people around here, they they want to help people that can't be helped elsewhere. And so you're gonna get our best, and we're gonna do everything possible. And and they they love that energy and they love that thirst for knowledge. I said, and you'll have cases like like Parm, we talked with a fellow with CTE, he did the podcast, he did all sorts of things because it's a complex situation that a lot of people will not realize they might be on the path towards. So if he can help educate others, that's important. So they will pick up on your energy. If you're just checking boxes, filling out your low doctor for Cara, and you're like, okay, okay, okay, okay, they pick up on that energy. If you're staring at them and you're knee-to-knee, and you're like, you know what, we're gonna take you through this journey through the Alps and whatever and through the woods, you know, and we're gonna do our absolute best to get you to that beach, which is lined with your grandkids that you're gonna be able to play with in the water, then that's what we're gonna do. And you will get my best. I can't guarantee absolute results, but you will get my best. And that connects. That connects. Cool. All right, folks. Well, thank you very much. I think we came up with some fantastic comments here, the stories, the themes are all the same, slight different variations. It's all good. Uh, and you know, um, people can learn from this conversation that we've had. Like, you know what? This is a good, good conversation. So thank you, Dr. Angelo Santon, A, Dr. Pern Bobwell in Brampton, Ontario, Dr. Dan in uh St. John, New Brunswick, and Zoe Abbey and Jake here in St. Stephen, New Brunswick, and uh uh near Maine. And uh, you know, I'm Eric Klein, and and you know, thank you for listening. Um, and you know what, this this was fantastic. Like people could really learn. This should be mandatory listening for all fourth year students and anyone who's been in practice for less than three years. So, yeah, thank you very much, folks. Appreciate it. Uh, and signing off, and we'll uh we'll hopefully be able to extrapolate this on another another episode and and talk more. So, wonderful people. Thank you guys, folks.

SPEAKER_04 1:04:52

Take care.

SPEAKER_05 1:04:53

Yeah, cheers.