Get PT 2nd

“out of 137 patients, 100 had been recommended for spinal fusion. After evaluation, the group advised 58 of those patients to pursue a non operative plan of care”
There’s a slogan going around social media saying “GETPT1ST” I don’t know if I completely agree with the saying, but I can’t disagree with that either. The saying could just as well be get PT second. At some point a second opinion has to come in to play for a patient’s dysfunctions or pain. That second opinion, in my belief, has to come from someone without a financial stake in the surgery. This could be a physiatrist, PT, or a separate surgeon, which was done in the study cited. 
The take home point is that 58% of those recommended for spinal fusion were recommended to seek a separate form of care, thus advised to avoid the surgery initially. What this means for the patients is that a second opinion should always be sought out, because the person advising a plan of care is advising it from their perspective. I’d love to say that everyone has the patient’s best interest in mind, but I can’t. In that case, the patient must become more educated and advocate for him/herself. For instance, a surgeon does surgery, a physical therapist does physical therapy and a physiatrist does physiatry. We see problems from different lenses and therefore will advise different plans of care for varying presentations. Some patients need surgery and some don’t. Some patients need physical therapy and some don’t. We can’t say PT first because PT is not magic and can’t fix everyone’s issues. 
“As clinicians, we bring our own biases into the treatment plan for patients”
Want to decrease unnecessary surgeries? Have a multidisciplinary team do evaluations, researchers say. PT in Motion. April 2017:46. 

Do your neighbors know what you do?

Do your neighbors know what you do?

 

“Many of our potential customers can’t tell the difference in therapists from one clinic to another”. This is an age old argument. Pepsi or Coke? Both colas and both had a strong following in the previous decades. I’d like to believe that the brands are losing strength in the days of paleo, crossfit and the resurgence of health and fitness. Not as much as I’d like to see, but it’s a start.

 

Let’s touch on this for a second. Why would Joe Shmoe believe that one therapist is any better than another? To start the argument, the APTA has stated that it would prefer that all PT’s place their licensed initials after the therapists name and then place all of the other qualifications after this. This means that my name is Vincent Gutierrez, PT, DPT, cert MDT, CFT. We get accused of alphabet soup, meaning that we have way too many letters after our names. We could easily cut that down by having the therapists establish themselves based on credentials and not on simply passing the licensure exam. For instance, if I wrote Vincent Gutierrez, DPT this would enable our customers to see that there must be a difference between BSPT, MPT and DPT. I’m not going into the turf war of whether or not one is better than the other, but we could allow clinicians to educate patients on why or why not the clinician chose to pursue one degree over the other. The public has a right to know what we do and how we are educated. This is a start. We make the assumption that a medical doctor went through 4 years of undergraduate schooling, 4 years of medical school and a few years to specialize prior to us going to the medical doctor. Us placing our initials after our names is the starting point to differentiation.

 

Past credentials, another way for Mr. Shmoe to understand the difference between therapists or companies is to soft market ourselves. When I say this, I don’t mean go for the sell, but instead educate the person in front of us while they are there so that the person that is in front of us can make a better choice of which provider to see for their problem when said problem arises. Otherwise, Dr. Superstar is no better than Dr. Squirrely in their eyes.   Every person that we encounter is a potential patient either for me or for one of my colleagues. I at least want to make sure that the potential patient has the information to arm themselves with confidence in making that decision.

 

Your “brand” is how people think of you or your company when the company’s name is mentioned.

 

Coke = Polar bears

Apple = easy enough for a toddler to use

Honda = 200K miles

Marianos = high end grocery shopping

TJ Max = bargain shopping

 

What words do you think of when I say your company’s name?

 

You can see that there are only two companies that my first though was positive for me. I want to exceed expectations for my patients so that when they think of my name they think of excellence and exceeding expectations.

 

Testimonials were previously against the law in our state. This changed recently and I recently learned of this. Testimonials seem to be the most powerful use of marketing for a service based profession. We are behind the times in healthcare. Let’s look at one brand and how testimonials are used. Crossfit has made significant gains in terms of business growth. How’d they do this? A simple Google search for “Crossfit testimonials” has yielded over 28,000 hits. This is how you brand a business. The same type of search for “physical therapy testimonials” yields about 4X that amount. Wow! That’s a lot of testimonials. What’s the problem with these numbers? PT has been around for almost 100 years and crossfit has been around for about 10. There are over 200,000 PT’s and only about 7,000 crossfit gyms. We need to do a better job of educating the public about the importance of PT using real people. Those that have experienced the joy of becoming pain-free, living life with improved function or simply receiving a consultation that assisted in a life-saving diagnosis. This is what we do! We need to make sure that our neighbors and their neighbors understand our value.

 

Theme from:

Barron B. Is Your Brand an Experience? The Importance of the “HOW” in branding for physical therapy private practice. IMPACT. January 2017:56-70.

Build you and your brand

Build you and your brand.

 

“…your brand not only communicates who you are and what you value, but also elicits a response from those you are trying to reach.”

 

How many brands can we think of off the top of our head. I think Coke and think of polar bears and Christmas. I think Apple and think of technology so easy a 3 year old can use it, which lessens my fear of breaking it. I think Google and think the greatest search engine in the world. Our lives are surrounded by brands. Some we notice, but the great ones are just a part of our day.

 

“…branding process is about painting a positive picture that will stir an emotional response from your target market.”

 

I don’t know if I necessarily agree with this. Some brands are based on loyalty to the initial need that they made easier. For instance, I didn’t really use the internet before the age of 20, but now closer to 40 I am on it frequently because it is so portable and convenient thanks to the Iphone. Thanks to Amazon, I don’t have to drive to the baby store at night in order to purchase more bottles. Thanks to Facebook, I now have thousands of friends that I never have to see. I don’t know if the brand has to elicit an emotion as much as it has to fill a need.

 

“…a brand is a promise that is conveyed through a ‘combination of logo, words, type font, design, colors, personality, price, service, etc’”.

 

I am looking at the top 500 brands across the world and looking at the logos. There is a consistent pattern that I see with red, yellow and blue. I don’t think of colors when I think of logos, but obviously those much smarter at marketing have figured out that these colors give a response. After seeing this pattern, I decided to look up color schemes for logos and this cool infographic was the first link. I hadn’t thought this much about color, mostly because my wife says that I live in a black and whit world. Oh well.

 

“As a way to broaden your perspective, take a moment to objectively evaluate the other physical therapy clinics in your area and see if you can identify what they are promising”

 

Your brand gives the patient promise. Some clinics have the name of the owner on the front. This tells me that I am guaranteed to see the owner when I come in, but if I don’t see the owner I may not be as satisfied with my experience. Others name themselves after the feelings that they are trying to convey to the patients. The name carries weight when seen from an outside perspective.

 

“Once you are clear about your practice values and what you are offering your community, you can start to develop the visual look and feel of your brand…logo should be unique but also relevant…convey both who you are and what you have to offer.”

 

After reading this article, I scrolled through about 500 logos on Google images (again the only search engine that I use) and this logo was the best that I saw. It clearly states what the company does. It takes a person from a continuum of care from a non-walker to a runner.

 

“As you begin to express your brand, I can’t stress enough the importance of being invested in your community.”

 

This one is the most important for me. I believe that if I get in front of enough people that I will be able to sell my services. This goes back to some of the views from the Gary Vee show. He notes that giving away services can come across as a hack move, but it still gets people to buy. I can remember working for Sam’s club and on the wall would be a huge cardboard check of all of the money that the store has donated to the local charities. It makes the employees proud to know that they had a hand in providing support to the local charities. I am not sure if anyone ever shopped at the store because of it, but it made me feel good that I was able to give to those causes. I’ve volunteered at local races, though I haven’t gotten a single patient from those races. I rarely volunteer at those races anymore. I spend most of my time in the community doing patient education regarding back pain, blood pressure checks and the importance of staying active. These lectures bring in patients. This is how I stay invested in my community nowadays.

 

 

 

EXCERPTS FROM:

Stamp K. Painting a Positive Picture: How to craft an effective brand for your private practice. IMPACT. January 2017: 37-38.

Cover your ears

Cover your ears

 

“Scurlock-Evans et al reference studies indicating that while 69% of physical therapists (PTs) claim to read relevant research only 26% critically appraise it.”

 

This is disheartening. Tradition trumps evidence in certain cases and without actually reading and attempting to understand the evidence, we will continue to treat using a little bit of evidence and a whole lot of tradition. We are a doctoring profession. I went back to school to get this piece of paper that says doctor. I am also clinical faculty at GSU and have worked as a clinical instructor in both private and non-for-profit practices. I have seen first-hand that some (more than 90%) of students don’t have the passion, will, time, or knowledge to actually read anything more than is handed to them in PowerPoint. I have actually had students get upset when I give them reading assignments to do. Once students graduates, they enter the real world of the profession. If you didn’t have the time to read and take your studying seriously when all you had to worry about was the 40 hours of school, how is the switch going to flip and all of a sudden one will begin studying when leisure time is taken up by other priorities? We have to represent our profession…if for nothing else than for our patients and personal pride. Our profession is supposed to live by these core values, but unfortunately those that display all of them are highlighted instead of the norm. One person that is highlighted, for good reason is the founder of PT Haven. I had the pleasure of meeting Efosa before he graduated and he had his priorities in order then and has lived up to the standards that he set for himself during our conversation. This is but one of many PT’s that practice all aspects of the core values of our profession. I say many, but know that I can’t say all.

 

Back to the point, if we aren’t able to critically read the research, then we can’t confidently apply the research. So much for EBP or “evidence informed practice”.

 

“It has been estimated to take an average of 17 years for research evidence to fully integrate into clinical practice”

 

Are you F’N kidding me?! I know this to be true. I wish I had a thousand dollars every time that I heard a student say that they were told that the information learned was taught because it would be on the boards! I’d be retired by now. There is so much information that is outdated, but students continue to learn it because they will be tested on it. At this point, I can’t state that schools are attempting to produce clinicians, but instead are producing students that can pass a test. We are a doctoring profession. The damn well better be able to pass a test or they shouldn’t be treating patients!!! With that said, it is the school’s responsibility to ensure that not only can the student pass a test, but also be able to treat a patient with confidence and critical thought. This is where I believe that the school’s are failing the students. Should the student end up in a clinical rotation that doesn’t practice the core values of the profession, then the student will learn in a “trial by fire” by being thrown into treating patients although they are fully unaware of the mistakes that they may be making in the process. They aren’t prepared for this type of training. I have taken students for about 10 years and in 10 years I have had 2 students that I could say that I had nothing left to teach by the end of the clinical. I felt like Mr. Miyagi watching the crane kick by the final weeks. As you can see though, this isn’t the norm. Part of this is that school’s haven’t fully integrated the evidence to teach the students. I get it. I hear it from professors… “there is only so much time during the day”. I don’t know where the blame for a lack of preparedness comes into play. It could be the governing body of PT programs for not changing the required learning prior to taking the PT boards, it could be the universities for not embracing clinical practice but instead teaching from books that are at least 5 years outdated (don’t get me wrong, the students need to know the basics from the books, but this is the students responsibility due to the lack of time), it could be the lack of quality clinical rotation sites from which to learn from those therapists that not only practice using best/current evidence but also utilize the core values on a daily basis and finally it is the students fault for not taking more ownership over his/her education. There is a lot of blame to go around, but in the end it is the patient that suffers from this cycle of inefficiencies surrounding learning.

 

Schuppe V. Viewpoints: Exploring the knowledge-to-practice gap. PT in Motion. March 2017:6.

If it hurts it must be bad, or good, or whatever. Vincent Gutierrez, PT, cert. MDT

Louw A, Puentedura EJ, Zimney K, Schmidt S. Know Pain, Know Gain? A perspective on Pain Neuroscience Education in Physical Therapy. J Orthop Sports Phys Ther. 2016;46(3):131-134.

 

  1. “Pain is a normal human experience and essential to survival”

This portion is rarely spoken of in PT school and we spend our time in school learning how to shut down the pain, either in an ideal way of dealing with a mechanical problem or in a way in which we “trick” the brain of not seeing the pain for a short period of time. When working with patients, I often describe the gate control theory as the “Three Stooges” way of treating pain. For instance, if you have a headache and I hit your foot with a hammer, what happened to your headache. I stole the example from my dad, because this is how he would always respond if I told him my arm was sore after baseball practice. This was way back in the 1980’s and he was a laborer by trade. The gate control theory makes sense to most people, but we can also see the example and understand that it is probably not the best way to fix a problem, as we end up with a broken foot from the hammer.

 

  1. “The pain neuromatrix explained our knowledge and understanding of the functional and structural changes in the brains of people suffering from chronic pain”

To simplify, we have pain because our brains tell us that something is painful. This could be due to past experiences, actual painful stimuli eliciting Nociception, super excited nerves , so on and so forth.

 

  1. “biomedical models may induce fear and anxiety, which may further fuel fear avoidance and pain catastrophization”

It is very common for a patient to come into the clinic and say that he/she is avoiding a particular activity because of a history of a herniated disc. There is research that shows that a herniated disc can become “unherniated” (for a lack of a more layman’s term) over the course of 6 months. The patients are never educated regarding this point. Once a herniation, always a herniation is just not true. This biomedical or pathoanatomical (patho=bad and anatomical = body parts) model of health care is outdated and simply is not as useful to use with the general public because research demonstrates that the patient may become “sick listed” and from there stop participating in previously enjoyable activities.

 

  1. “a plethora of papers have been dedicated to a mere 20-millisecond delay of abdominal muscle contraction, yet despite the enormous amount of time, money and energy spent on this science, clinically it has yet to provide results superior to those of any other form of exercise for low back pain”

Doing the vacuum pose while lying down is no better than doing a general squat or learning how to utilize your diaphragm during breathing mechanics. As the layperson, there are many people that want to take your money in the health care industry. (I hate to say it like this, but healthcare is a huge business and the public needs to see it as so.) When the new fad comes out to solve back pain, don’t buy into the infomercial and as a matter of fact, turn off the t.v. and go get a book from the local library. You will spend hundreds of dollars less than what is proposed on the infomercial and be better off after having read the book. Nothing beats knowledge and the smarter you are at taking care of yourself, the better armed you are when you actually get in front of a health care practitioner. Remember, it is a business and we all want your money if you will give it to us. A better use of your time is to come educated so that I don’t have to teach you the basics of posture for 30 minutes, but can instead can teach you how to perform more high level movement patterns instead of sitting properly to reduce your pain. Oh wait, pain is normal. I’d lose my job if I sold this to all of my patients, but instead the patients need to be educated between hurt and harm.

 

  1. “In all health care education, be it smoking cessation, weight loss, or breaking addiction, the ultimate goal is behavior change.”

Speaking as a physical therapist, I can’t stress to the patients enough how the therapy experience is a team. Smart people call it therapeutic alliance, but I’ll settle for team. My part is to educate the patient and attempt to solve the puzzle of the patient’s pain, but it is the patient’s job to take the information that they have gained during the session and go home and apply it to their daily lives. For a patient to do nothing at home, AKA make no changes in behavior, and come to the following session thinking that the pain will go away is similar to :

 

https://spencergarnold.files.wordpress.com/2013/01/snatch-miracle.jpg

 

Patients may come hoping for a miracle, but it is not to be. The patient and therapist have to work together to attempt to solve the pain problem. If one side of the team is not doing their part, then the PT has to be willing to discharge the patient or the patient has to be willing to fire the PT.

 

  1. “…when PNE (Pain Nueroscience Education [pain is a normal human response]) is paired combined with either exercise or manual therapy, it is far superior in reducing pain compared to education alone”

From this I take that teaching the patient and then moving the patient is better than just teaching the patient. We can all agree that low level exercise is good for people. If we don’t agree with this, then we are saying that it is safer long term to live like a slug then to get up and walk around the living room. It just isn’t so. People will refuse to get up and walk around the living room when they start experiencing low back tightness, leg fatigue, or the dreaded “Fran cough” (look it up and btw I am an advocate professionally speaking). We as a society have to start moving more and learn about how our body is supposed to work. This can not be done from infomercials that have pictures of pulsating backs or frowning stomach fat.

And this is my two cents for the night.
If you are in need of physical therapy or would like to sign up for a complementary discovery session (a conversation to determine if therapy is right for you), contact me. 

Functional Therapy and Rehabilitation 

(Now part of the Goodlife family)

903 N 129th Infantry Dr. 

Joliet Il 60435

815-483-2440