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03/09/2018

Master Clinician Storyteller - Episode 11

CSM 2018 De-Brief and what we learned!

Joel:                                       00:07                     Welcome to another episode of Master Clinician Storyteller. I am Joel Gaines from the IAOM-US

John:                                     00:07                     And I am John Woolf from the IAOM-US

John:                                     00:21                     Joel two weeks ago we were in New Orleans. Nolan's nylons and Nolens and a man. What an imprint. I am still trying to process all the information that we took away from there. But first, why you've been to New Orleans before you were telling me stories.

Joel:                                       00:37                     Yeah. So I was uh, I was a young man stationed, not too far away from New Orleans, Louisiana and where I was stationed there was very little to do so we would travel on the weekends to New Orleans where there was quite a bit to do.

John:                                     00:51                     Yeah. How did you not get in trouble?

Joel:                                       00:54                     Mostly by luck in the beginning, but, you know, I was a little bit older than probably most of my peers and I was the designated driver most of the time. It was the one, you know, sometimes bodily dragging them out of harm's way.

John:                                     01:08                     Right. Well, that's what good comrades do.

John:                                     01:11                     And uh, yeah, no, I'm still, I'm still recovering because the food was fantastic, the music was incredible. The just the overall experience. So there's nothing like that place. So we survived and that's the good news.

Joel:                                       01:22                     It was, I mean, it was a nice time and the ability to be amongst that many healers and that many people passionate in supporting those healers. I, I, I find that was, it was really motivating. I feel like I came back from New Orleans with some different perspectives on things. Uh, certainly a lot more, a lot more knowledge. We, we always learn a great deal when we get out. We often say there are no answers in the office and we spend a good chunk of our time in the office.

John:                                     01:50                     Well, 17,000 physical therapist, that's a pretty big number for any professional convention and I think it speaks to the power of different sections coming together to allow kind of a cross pollination of all the professions about.  So, um, I thought it was great experience.

Joel:                                       02:07                     I met a lot of students, which was, eh, I mean, that's always great to me when we go to the student conclaves in different, different states. Um, we go to the national student conclave. I didn't really expect to see as many students as we did in the combined sections meeting. It's interesting to see that based on what year they're in, what they are excited about at any given time and you know, you're looking at your third-year students towards the end of their third year. They're kind of excited, but you can see they're exhausted at the same time. Like they're like, I don't want to think about anything but having fun right now. Exactly. And getting through there, the, this part of their studies.

Joel:                                       02:44                     John, how did your presentation go,

John:                                     02:47                     Joel! The presentation went well. It's a uh, you know, I, I presented to the private practice section meeting and there's a bit of a story about this. I thought I thought his presentation was scheduled for Friday morning, Friday morning, 8:00, which isn't so bad. Um, are there times when I've  spoken at these meetings and it was like a, you know, 3:00 on Sunday afternoon when like literally nobody's here, but this was early in the, in the conference I thought was really good and of course you prepare well in advance that I then I literally, I'm Wednesday night, I'm like, oh, what am I going to do in the morning? And I look at the schedule and I'm to be presenting at 8:00 on Thursday morning. So literally I was almost 24 hours late for the talk. So it's a two hour educational presentation to the private practice section meeting. And the title of my talk was patient centered care is a myth, time to lasso the Unicorn. And I've learned that when you're, when you're submitting for presentations to CSM or any hta function, they want something that's going to catch people's attention. And I think I got people's attention.

John:                                     03:41                     There were probably 200 people plus in the session and I took everybody back through this idea why patient-centered care is a myth that I got tremendous feedback because I think finally people are starting to see this idea that it's not just about being patient centered, it's about being relationship centered and I'm, I'm s. I was seeing that theme specifically drift through a number of other presentations, so I would say that the presentation went well. I made it on time. The feedback was very good. The engagement from the audience was very good and people are perked up to this idea that we have to do more skilled development and culture development to really shift this pendulum back from what we started as industrialized medicine process to a truly relationship center process, which is, which is what's necessary medicine, but this whole topic is probably worth another podcast.

Joel:                                       04:31                     My sense is people don't really know what those skills are. I mean if they, if they've ever had them, they probably don't know what those skills are because of the pendulum swing, here's what you need to be doing because we're patient centered now. There's quite in my feet, my sense is there's quite a dichotomy between when it was mostly provider centric and here's the plan and I need you to do the plan and it was a prescription and patient centered models that we've seen sort of kind of took the prescription away and try to get buy in or compliance was not now is about compliance but it was approached differently than compliance so it was kind of like a soft compliance and you don't really prescribe compliance, you don't fire your patients, you know, but then the outcomes still aren't really happening and the alliance certainly wasn't happening in most cases.  And I think now is like, OK, well we know that we need to do patient engagement, but is that really what it is?

John:                                     05:33                     Yeah, it's Buzzword-ish. And the problem as you mentioned is that we're telling people to do it, be patient centered. Well, what does it mean? Well, OK, you have to be nice to the patient. You have to focus and engage with the patient. OK, good. So how do you do that exactly? And there's some set rules out there, you can follow the prescription and just kind of do this. The challenge is it's not. It's not authentic, it's, it's done in a way that doesn't focus on what's important because if you're focused on one part of the relationship, the patient, you're omitting yourself from that equation and you've got increasing demands on you as a provider and that creates this challenge where you're trying to focus on someone else.

John:                                     06:08                     You've got more demands on yourself from the system. Whatever system that's in, wherever you work, you have to do more nowadays than you did before. And that's a. that's an untenable position. You can't stay there. So you really have to shift the whole discussion back to it. And I did a pretty good job, I think, of trying to connect how we got here, how exactly we got to this place of having to be patient centered. Instead of w what I termed either expert centered or industrial center, you know, the, the system centered process. And there's a good history to that. It started when we tried to industrialize medicine, not industrialized medicine, which can be easily confused with work. That's not what I'm saying. I'm saying that we've taken industrial principles from our industrial revolution in the early last century. We try to put that exact same model into medicine, which creates a lot of efficiencies, systems, processes, procedures, you know, it's almost like we've tried to assembly line care and in fact we have the conversation right now is about siloed care and what value based medicine is coming in right now to try to say as well, it can't be solid based care because then you lose this continuity and efficiency because you're treating the wrong thing at the wrong time.

John:                                     07:17                     It's too complex to be a widget production line. So the take home that people go, oh yeah, that makes sense why we got here. The trouble is we swing the pendulum too far as is typical and we failed to recognize where the real, the real magic is for colleagues, which is right in the middle. What's the relationship? So I think it was well received. The people who attended came back and said, man, that's spot on, and I attended a lot of the different presentations and you can see you're the pain science guys are going in this direction right now to kind of shift the shift, the focus, not on just this idea of educating patients, but rather having to engage and be with them in a different way, but it's still a whole language set that people have to get their heads around.

Joel:                                       07:58                     So, that went well. I heard it was a packed house. I didn't get to see it.

John:                                     08:00                     So Joel, you were manning the booth. What were people saying as they walked by?

Joel:                                       08:04                     Primarily we were there to learn to get out of the office so that we can get some answers to questions that we had and learn how to better deliver our learning to others and it's always fun to talk to people, find out what their needs are and see how we can better help. We always try to contribute something when we go to these, these, uh, events. One of the things that we asked about specifically was the need for residency and the changes that [inaudible] is making in that direction is a big deal, isn't it? Yeah, it really is. You know, it's really kind of coinciding with things that, that we had felt in the office and so we got some validation for some things that we felt were important, but we also talked to people about how they like to learn and what they like to learn and what they feel was absent and the learning that they've gotten based on where they were in their career.

Joel:                                       08:52                     We trickle those things down into who we are and see how we can better provide those sorts of experiences to the participants of our courses and our programs. It's just thought it was a great way to hear what's on people's minds and find out where their fears are and you know, what uncertainties they have and what certainties they have and what they're confident about, what they're not confident in about. Maybe an example of this is in New Jersey, dry needling was in the scope of practice for [inaudible] and then they had legislation passed where [inaudible] could no longer deliver dry needling now this month or next month they're going to reverse that. So there just seems to be like a constant push pull on who should be delivering what areas of care. We learned a lot about what people felt they needed.

John:                                     09:36                     You know, I think one of the big concerns that came up and you mentioned it, is the new requirements for fellowship and residency. There's a lot of discussion right now that the profession is moving toward a residency included or residency based formation process, so not unlike the medical model. The physical therapist would complete their studies at the university and somehow engage that into a residency program, which is then the specialty and then if you do a fellowship after that, it's a subspecialty, but it sounds like they're really changing the requirements which is going to have a big impact on all those programs and as we continue to work on our residency, we get to keep all of that in mind.

Joel:                                       10:16                     Yeah, I think there, there's still a lot of push pull about whether residency is mandated or not and we see the profession going in a direction that people have felt it should have been in for quite some time and I think the, maybe the, the where the gnashing of the teeth kind of comes in is how is that achieved and it seems like even that's going through kind of a pendulum swing. Yep. John W, you went to a number of the presentations that were provided there at a combined sections meeting. What were some of the topics that people were presenting on it?

John:                                     10:47                     You know, I think the still the big topic across the, especially in orthopedics is about pain. I think the opioid crisis is front and center, so you start to see a lot of, uh, those who have studied pain increased the frequency of presentations, which I think is good because we need to continue to learn, learn about it, and then try to figure out, well, what specifically is our role in this opioid crisis? So Stephen George, anytime anybody sees that guy's name, you should read his stuff or a tennis conference. So I went to Pacific conference where he took for researchers and he basically mashed them together, kind of a mash up so that each of those researchers presented their specific scientific based research and then provided a kind of a panel discussion, rounded. I, it was brilliantly done in steven. Georgia's one of those is one of those, uh, researchers and thinkers that has pushed everybody a little bit further in regards to pain sciences and the efficacy of what we do.

John:                                     11:43                     I talked to him afterwards. I kind of shared with him that I'm working on my phd in psychology. It was great. We are right now diving into psychology research because we're going to have to draw on what's contained in that body of knowledge in order to kind of blow out and enhance what physical therapists are dealing with. So he says he's got psychologists in his laboratory and is constantly collaborating. So I thought that was the firming in the direction that we're going. I also went to a couple of presentations cutting through the federation. Now this is an interesting section where people are kind of doing a new and different things, so I went to a mindfulness one. I'm always interested to know what's going on in private practice, so I went to a couple of talks in their. Overall, I think there's a just a giant movement towards this value based medicine.

John:                                     12:29                     Back to what we mentioned earlier. It's like, well, we've got this siloed approach to healthcare and I think the big shift is going to be how it is that we can begin integrating physical therapists into a systematic process of care and in the entire delivery system. I don't think anyone's got this down yet. There's a lot of players who are trying to pull this together with private practice section is scratching their heads to figure out, well how do we bundle everything and by bundling, which means we get to decrease the cost overall and we should have some gain share about that, but it's still. It's still a moving target. No one really knows. And I think the big also conversation was around a Jeff Bezos and Warren Buffett who have basically thrown down and said, hey, you know, I think you guys are dummies, healthcare people, a health insurances, government run anything.

John:                                     13:13                     We're just going to do it ourselves, so they're going to create a whole healthcare system that I believe is going to be a major disruptor. Everyone gets to stand by and watch carefully about how the CEO and Creator of Amazon and Warren Buffet, one of the smartest guys on the planet about creating wealth is going to try to create value for employers because they are employers by creating an efficient, truly efficient process of delivering healthcare. One that isn't hindered by a giant middleman called insurance and there's probably a way to do it, but there's a lot of slack in the system and I think they're going to extract that.

Joel:                                       13:46                     Yeah, I've heard a lot of people say that what they're actually trying to do is just completely democratize healthcare. It's an amazing concept. I don't know if I'm even smart enough to really wrap my brain around what they're trying to achieve. It'll be interesting to see how that goes. It really well.

John:                                     13:59                     Hmm. Because it's broken. I think everyone, everyone you're trying to fix a broken thing and I think what they're going to do is just take a hammer and smash it and say we're starting from the ground up because what you guys are doing isn't working. I was trying to send it's time to sunset that. Exactly. And, and that's tough because you've got a lot of special interests and this is why the system doesn't move because everyone has a dog in the fight. I mean the pharmacy lobbyists have, you know, they're interested in protecting their position, health insurance companies themselves. I mean their monsters and listen, they're controlling the access. It's pretty ass backwards. So I think it's going to be interesting. And then we had some good conversations with vendors also, didn't we? Joel? I mean there are people trying to make the lives of our patients better with innovative things.

John:                                     14:42                     And when you walk around the, uh, the exhibit hall, you see a lot of technology coming on board. So you're starting to see measurement processes, a screen based feedback systems to help learn how to do something a little bit better. You see gamification, which is kind of a motivation strategy and achieving whatever either activity goal or movement pattern goal.

John:                                     15:03                     Of course, we hung out with some guys who are really trying to punch the ceiling on the engagement platforms. So that company Keet (keethealth.com) that we, uh, we spent some time with learning about how, you know, they know that success in physical therapy means being engaged with your patient at multiple levels and so integrating with software platforms in order to stay engaged with your patients in a way that's safe and HIPAA compliant and meaningful and measurable, all those other things. Those guys are doing some pretty cool work.

Joel:                                       15:30                     So definitely swinging for the fences. I mean, they're really trying to make some changes .

John:                                     15:34                     Yeah, and they need to, you know, back to my concept, a concept of many, not just mine, but you know, it's about relationship. If we can have a sustainable, scalable relationship with our patients, we're going to make a bigger difference. You know, patients just get better when they trust us at every single level and we can stay in connection with them. The trouble is we don't have the time to stay in connection with them. We can't possibly do that with our entire caseload of between 60 and 90 cases. So we have to do is we have to find a way to scale that and get into a more, more successful engagement. Even some at some level, maybe a management program with them

Joel:                                       16:09                     And it's more than just throwing the same money at the problem differently. I mean it's actually how can we impact the lives of our patients differently than we ever have in the past and have that be scalable as well.

John:                                     16:09                     Right.