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Admit weaknesses

“You don’t always need to talk with experts;sometimes the consumer, who just might be a friend or an acquaintance, is your best consultant.”

Blake Mycoskie

This is more apparent now than it has ever been.  As a practicing clinician for over 10 years, the patient’s/consumer’s/acquaintance’s input mattered, but it played a small role in how I would change.  Not to belittle the advice, but I was getting great outcomes in patient care and was just making great strides clinically over the past decade.  My patients had little to offer in terms of things to change.

Fast forward to now and I am a clinic director taking on the same struggles that other new businesses face.  Not many new patients are walking through the door.  I will always be my biggest critic, but at this point, the words of wisdom given to me by patients and family members is worth gold.

“You have no visibility from the street.”

“No one knows that you are here.”

“You need to get out more to the older communities.”

“You should advertise in the local newspaper.”

“You should give more talks to churches.”

“You should go to neighborhood associations and speak”

All of these are great pieces of advice.  Some are more doable than others because advertising takes money.  Fortunately, since I have time on my hands, I am reaching out to different organizations for speaking opportunities.

Listen to your ideal client because they know how to reach more people like him/her.

 

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Be the change

“Be the change you want to see in the world”

Mahatma Gandhi

This quote gets thrown around, but how often do we stop to analyze it?

What is the change that I want to see?

1. I want all PTs to have easier access to research.

2. I want the public to be more aware of the difference between good PT and bad PT services.

3. I want the public to know that a. PTs exist b. how PT is covered by insurance related to out of pocket costs c. and how PTs can help with physical issues.

4. I want PTs and students to be humbled and ask for help when needed and offer help when able.

Hello 2018, I got some lofty wants.

How have I started to accomplish these goals

1. Writing a blog and putting out videos describing the research that I am reading on a daily basis.

2. Giving community lectures educating the public regarding what to expect from a physical therapist. Educating the public on the core values and how some practices may demonstrate the practices. Unfortunately, I also highlight how some may not practice according to our profession’s core values.

I also started posting reviews of some of the neighboring clinics on social media when these clinics aren’t practicing in an ethical fashion.

3. Again, the blog and community lectures serve to educate the public of our existence and during these lectures I typically explain Medicare Part B regulations and coverages so that the potential patient can feel more comfortable about their responsibility financially.

4. To help others in areas of my strengths I do one-one conversations on FB, via telephone and in person. I readily ask for help when I am stuck and believe that I have a team of Avengers that I can reach out to at all times of the day.

How will you be the change in 2018?

 

Archilochus

“We do not rise to the level of our expectations. We fall to the level of our training”

This quote is taken from the Tim Ferriss book Tools of Titans.

In PT, we all believe that we will change the world. We have visions of grandeur in which we take patients from wheelchair to playing field. Preventing surgeries, curing world health problems and wearing a red cape with a big “S” on our chest…okay maybe not all of us have these dreams.

In the end though, our patients are doomed to fail if they see a PT that has not lived up to his/her professional duties of continuing education. In Illinois, we are required to obtain 40 hours of continuing education every 2 years.

Let’s think about this number. It’s been said that one needs about 10,000 hours to master a topic. That’s a lot of years if one takes the minimum amount of hours. At that pace, one can never become a master of anything other than a long commute.

When choosing a therapist, there has to be more thought put into it than your next vacation. You are spending your hard earned money…or the insurance company’s money…don’t you want to know that the person treating you is actually good at what they do?

Have they taught classes? Have they studied independently? Are they giving back to the community?

HELL, let’s start at the basics…do they pay attention to you when you’re in the clinic? Not in a three ring circus kind of way, in which they are just managing the acts that come in and send the patient from machine to machine, but are they paying attention to YOU?

I’d love to think that everyone in this profession of PT is operating up to his/her expectations, but deep down I know that we operate at or below our training. Not all PTs have the same knowledge.

https://movementthinker.org/2017/10/17/not-knowing-versus-not-learning/

Having spent time in the profession, I can state that I’ve seen the top 5% of the profession, and they are awesome. Unfortunately, it’s only the top 5%. The rest go nameless like worker bees to support a queen. There are very few queens in this industry and if you do a quick search, you can find those companies that make the most, are worth the most, are publicly traded etc.

We just want to help people. That’s the number one answer I hear from students entering the field, unfortunately not everyone continues to practice in this mentality once out of PT school.

We need to live up to our expectations more and improve our training to reach those expectations.

Salute!

Online presence

I think that this sums it up. If we aren’t posting online on our personal websites, on social media (SoMe) or on a work website then we are missing out on contact points with over a third of the population. Our role has to grow larger than treating the patient that walks in the door with a referral. We, as a profession, have to go out there and educate the public, medical doctors, podiatrists, dentists, laborers, plumbers, and at times other therapists.

We don’t get to sit in our offices anymore and wait for patients to come to us, but we have to go out and educate!

How are you establishing a presence in your community, your workplace and your profession?

Leave comments below.

A quick story

“Twenty years from now you will be more disappointed by the things you didn’t do than by the ones you did do…Explore. Dream. Discover” Mark Twain
Where do I start? I come from very humble beginnings. We were a family of 5 growing up on the East side of Joliet. I have 3 brothers and one sister. This changes over time so follow closely. Growing up on the East side wasn’t easy. Access to drugs was though. I smoked my first joint before some kids learned to read, although I learned to read before smoking the joint. My dad used to make me sit down with the Joliet Herald News and read the comics to him. This was from the age of 3 onward. Anytime I would ask him a question, one that readily comes to mind is “why is Australia called the land down under?” He would tell me to look it up. I WAS FIVE! This was before the days of Google. We actually had to go to someone’s house (Terri Graves) of someone that had the old set of encyclopedia Brittanica. I learned the answer from somewhere in that stack. My dad would always say that he was doing it to make me learn, but I don’t think he actually knew the answer and was taking the easy way out. If you knew my dad, he’s never at a loss for saying what’s on his mind.
I smoked my first joint at 5. Before I got hit by a car on Clay street, which is another good story that I will get to. Marijuana was so easy to come by on the East side. Hell, we were growing it in the backyard. (When I say we, I mostly mean my brothers). I am the youngest of the bunch…the runt of the litter you could say. Wasn’t planned, but i’ve come to accept that over time. Drugs were commonplace, and access to guns was even less restricted. At one point growing up there were guns in almost every room, but that because of a Hatfield-McCoy quarrel that my family had with one of the gangs on the East side in the 1990’s.
How does a kid from that environment go on to become a Doctor of Physical Therapy? How does one get out of that mindset of drugs, gangs, teenage pregnancy, and high school dropout to go on to study under some of the best minds regarding back pain and dizziness that our country has to offer? Why would that same kid go “straight edge” for over 20 years?
Finally, why would that kid ever want to come back to the streets and city that started it all?

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.

Results based care

Results based care

 

I’m going to get away from typing out all of the quotes, which is what I have been doing for the previous year, for the sake of time. I have opinions that can be expressed without the need for the direct quotes. I’ll still link to the article so one can go back to read it if interested.

 

Health care is changing. We are moving from a fee-for-service type of setting to pay-for-performance setting. Some of us are thinking “about damn time!”

 

Fee for service indicates that a person gets paid for doing things to do. For instance, if I keep you for 90 minutes and do a bunch of stuff with you, then I would get paid much more than if I only spent 45 minutes with you. Now, if I see you for 90 minutes and see you 3 times per week for 4 weeks, then I would make a lot more money from the patient than if I saw for 45 minutes 1-2x per week. There is absolutely no incentive to get a patient better quickly. Do the patient’s realize this? I hope that this article goes viral so that the patient’s have a better opportunity to read this information. Some health care providers would hate for this to happen and other are thinking “HELL YEAH!”

 

Pay for performance: Some of the ways that this is being done is that a certain dollar amount is allocated for a specific diagnosis and this amount is paid regardless of how often or how many times I see the patient. I now have a huge incentive to get you better fast and to make you as independent as possible so that you no longer need to seek treatment for the same issue. If the patient can get better faster, then there is more money to be made in healthcare because we are not treating out of fear, but instead out of ambition. Some companies are afraid to discharge a patient because there may not be another patient taking that spot anytime soon. I’ve worked in these situations multiple times before, so I am not talking out of my A$$. Treating out of ambition allows the therapist to apply the evidence as best fits for the patient in front of us in order to get that patient better faster. No offense, but I want my patients to get better and leave. Hopefully, to never come back for the same thing again. I was listening to an episode of Mechanical Care Forum in which the therapist (Mark Miller) was describing an embarrassing moment in which Mark had a patient returning to therapy for the same complaint that the patient was there previously. He was proud because he thought the patient was coming back because he did such a good job the first time and the patient was satisfied with the treatment, but Robin Mckenzie, one of the most influential PT’s of the last century, noted that if the patient was actually better and if Mark did his job then the patient would know how to address the situation without seeking help again. I want to treat with the hope that the patient will only come back because they have a separate issue that needs a consultation for treatment. This is the ambition that I am talking about.

 

The article speaks of staying up to date on the literature, regularly attending continuing education classes, learning new approaches, tracking outcomes and adjusting treatment according to the patient. I would love to say that 100% of PT’s are performing all of the above in the list, but I can’t. There are countless articles speaking to the reasons that PT’s give for not staying up to date with the research, which indicates that there are some aren’t doing their professional or social duty. I take this stuff seriously. It’s Easter and I am typing about the stuff I just read. It sucks to take time away from work in order to find the articles, read them and then try to put the information out on the World Wide Web for patients and other therapists to read and criticize. I’d love to relax with my beverage of choice and just not think about it, but my patients and society, as a whole deserves better from my profession and me.

 

Anyway, Medicare is moving more towards a pay for performance method of healthcare and their goals are pretty aggressive. Medicare will have up to 50% of patients on this type of fee schedule by 2018 and for those that are still fee-for service, medicate will tie the payment to outcome measures in 90% of the cases by 2018.

 

I’m doing my part to educate, educate and overeducate the patient in order to get the patient on board with treatment. If I can get the patient to play an active role in the treatment, then I know that I have a better chance of getting that patient better.

Themes taken from:

Jannenga H. Tracking for success: Why outcome measures are essential to your practice. IMPACT. Jan 2017:53.

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.

Keeping the customer/patient happy

 

“…owners and managers an no longer rely solely on the relationships they have built with referral sources to grow their practices”

 

Look at the drug companies…they know how to peddle their wares. Once it became mainstream to advertise directly to the consumer we have what is now known as the “opioid epidemic”. If we can advertise directly to the consumer, and give the consumer what they want…business will boom. We have to know what the consumer wants first though. Don’t try to sell them what we have, know what they want and then create the product. We know that patient’s primarily want education first. Give them a taste of the education during a seminar and then tell them that they have to schedule an appointment in order to get the rest of the information. It’s funny. I remember working for Bill Curtis at PT and Spine and he would refer to the magic treatment. In that patients are looking for that magic so that way they can take control of their own issues. If one is the owner, we want to give the patient the magic…but not on the first day. If we got paid for outcomes and not for the patient coming to the clinic, there would be more incentive to help fix the patient at the initial visit and not carry it on for the national average of 8-16 visits for the average orthopedic issue.

 

“Even five years ago physicians largely dictated our referral patterns…hospital-based clinics and physician-owned practices are aggressively attempting to keep their patients “in-house”.

 

Everyone in business wants money. THEY WANT YOUR MONEY! There is incentive to keep you going to the same company for every service performed. If you need an MRI, X-ray, PT, sports physical, etc it is very convenient if it is all under one roof. Now, who is making the money? I’m going to make it easy. If your mechanic finishes looking at your car and then says that you need $10,000 dollars worth of work, but he can do it all at once, what are you going to say? What if I say that you need $20,000 worth of work? How high do I have to take that number before you realize that it may not be legitimate needs to continue? The doctors/hospitals that own all of the above “services” may be doing the same thing, but you never see the costs because the insurance “covers” the cost.

 

“We are aware that patients can choose to receive therapy wherever they would like…”

 

Are the patients aware of this? If you go to the doctor and get a referral for therapy (it’s like a referral to any other practitioner), but the referral has the name of a specific clinic on it, does the patient realize that they can still go anywhere? IF YOU ARE A PATIENT AND ARE READING THIS…YOU CAN GO TO ANY THERAPIST THAT YOU WANT TO GO TO! Not all PT’s have the same training or even the same specialty. If you don’t see progress with your therapist after 6 visits, and you are given the words “it just takes time”, find a new therapist. Some things do take time, but hear it from 2-3 different therapists before you actually believe it.

 

“We are not here to ‘fix’ a patient; we are here to partner with them in their rehab”

 

This is huge. I don’t fix you…I help you fix yourself. I play the role of cheerleader, teacher, listener, advisor, but at no point am I the “fixer”. When I see you for 2 hours per week, there are so many hours throughout the week in which you have to help keep yourself fixed by what you learn in the clinic.

 

I realize that I can come across as negative with regards to the business of healthcare and unfortunately it is more of a realistic view than either pessimistic or optimistic. I have had discussions with those that audit clinics, researched the Department of Justice website for healthcare fraud, shadowed/worked/observed in unethical clinics and have heard patient stories from their times in other clinics. My view is personal, but real. When I say get a second or third opinion, it’s because you may have to go through that many different clinics before you find one that has your intentions at the forefront.

 

Excerpts taken from: Stamp K. Happy Customers: How to create a positive patient experience. IMPACT. July 2016:31-32.