Peri-pain Education

Allow me to make the case to discuss modern* pain science views with all who will listen, importantly, people who are NOT in pain.

There seems to be support for pre-operative pain education as an effective intervention. Studies have shown improved surgical experience and reduced health care utilization (1), improved short term pain reporting, quicker return to activities and utilization of nonpharmalogical pain management strategies (2). Long term pain outcomes are not significantly effected (that I could find), but it certainly helps the patient in meaningful way (3). Continue reading

THE role for Physical Therapists

HomeRun GwynnImage Credit

There is a clash between knowing that biomechanics and structure are not 100% responsible (ie. a 1-to-1 relationship) for pain, and the fact that (from an Example I got from Mike Eisenhart) some one with a poorly moving C5-C6, (as best we can tell the difference and as valid as our hands may be) has a risk factor for future neck pains and problems.

No. Not causative, but a risk factor.

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Treating in the low socioeconomic climate

My clinic serves a low socioeconomic area. Now, I am sure that there are any number of stranger work conditions, treating in a gang-controlled area, for example, but the conditions and problems of low socioeconomic status (SES) are a niche unto themselves.

Almost everything “straight ortho PT” gets thrown out. Low SES throws a wrench in the gears.

From our clinic perspective, it means lots of un-managed chronic conditions, high cancellation rate and difficulty with adherence to HEPs. Transportation to the clinic is a large issue because it has a cost (either money or time) to the patient that is often a deterrent to coming to appointments. People prefer not to wait for the bus in the cold. Continue reading

G O A L !

What you perceive today as a struggle is not truly due to the task at hand. It has to do with what the goals of the activity are.

The goal determines how the steps will play out. A worthy goal can bring you through any tough time. If the outcome is not of interest to you, no simple/light task is easy. It’s all a struggle if the goal is not meaningful. Continue reading

The Meaning of Cost in Value

We associate many things with money. One example: If it costs more, it’s better.

Money is not just a physical item representative of some good or service.  It has meaning past trade. Having more money does not just mean that you can accumulate more things. Socially, it states that maybe you have accomplished more, are a better decision maker, make better behavior choices, etc. It possesses status and other cultural attributions. Not a surprise. You know this.

The $15 beer will taste superior to the $1.50 beer. It just does, because we know it’s better. It’s contextual priming. That’s why blinded taste trials are often so interesting, because the context is removed and you are left with a singular sensory organ (taste organs of the tongue and mouth, yes and olfaction). Continue reading

The Person Sitting in Front of You

I saw my patient walking up to the door as I pulled up to the clinic. A tall and very thin woman. She was heavily dependent on her rolling walker, I saw that immediately. It struck me. Saturday hours at the clinic were supposed to be simple post-op patients. Quick in and out’s. I think I was even slightly pessimistic at this first glance…because I could tell she was struggling. I estimated this was more work than I bargained for at 8:30 am eval on a Saturday. Four weeks status post a Continue reading

Who is Satisfied?

How are we going to do this?

In other industries customer satisfaction is part of the delivery, but not directly tied to product price. Companies are “paid” by happy customers with more business (referral, word of mouth, etc), or market leverage to increase the cost of service (increased value of product) with customers happy to pay that increase due to increased value, to them.

This works in a market system, where individuals are in charge of their monetary decisions. But that isn’t health care.

In a move towards payment for outcomes, where will customer satisfaction have a role? (we don’t know whether we will be paid better for better outcomes, or paid a set fee for an average expected outcome and it’s up to us to beat that average… who knows)

Is there any talk of adding customer satisfaction directly to payment? Sometimes that’s all we have. No significant change in patient status, but a very satisfied customer with the care, service, advise and input given. Perhaps they leave with an understanding of their condition, ways to manage it and strategies to avoid deleterious effects of their disease/dysfunctional process… but no change in ROM, strength or patient reported outcome measures. Continue reading

Commute = Classroom

Commute time can either suck your life force, or it can become a valuable part of your development. So, yes, there are tons of great Podcasts on the subject of Physical Therapy / Physiotherapy from many angles, and I encourage you to listen and learn. But what I’m going to share today are 3 Non-PT Podcasts… for PTs.

1)     The You Are Not So Smart podcast, hosted by David McRaney.  There are tons of great episodes here, primarily on psychology, cognitive biases, social patterns, scientific thought and all things thinking. I cannot state enough how important these types of topics are for the practicing PT, primarily because, no matter what the injury or body part, we all treat people.  They’re all great, but… Some highlight episodes: Continue reading

Fundamental Finances

Stacks on stacks! You make money, now what will your money make?

In this post I interview Dr. Zachary Stroud, MD, MBA to get some great insights into how to make our money work for us. Zach is extremely passionate about finances/economics and equally passionate on how to make it simple and understandable. (*economics is basically just people interacting, and as a Psychiatrist, he knows people). He also operates with tons of free information, no conflict of interest selling/soliciting, just pure helpful honest content. The guy really brings value to the financial conversation. Let’s Begin…
(Me:) Zach, tell me a bit about why you like economics so much?
(Zach): I would say that I prefer finance to economics. I enjoy understanding money and how the benefits of my hard work in medicine can be utilized to my advantage through investing. Economics is interesting because people as a group can behave just as irrationally as an individual. This can create distortions in prices in the investment world. It requires a certain bit of self-reflection when you invest because you have to know where your biases and weaknesses are. I highly recommend Daniel Kahneman’s book, Thinking Fast and Slow, which talks about some of these biases.
Warren Buffett has stated in the past that you don’t need to be all that smart in terms of investing, you just need to be able to remain calm and keep emotions from ruining investment decisions. As an investor and as a psychiatrist, I wholeheartedly agree with this idea.
Let’s discuss the 3 major concepts we should think about (can be conceptual or pragmatic) when dealing with our investments:

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