Four Communication Tips for Clinicians Treating Pain

Now, before we start the show, I have a special announcement about the premium subscription version to the Restoring Human Movement podcast that you're listening to now. If you are a dedicated listener and you've been listening for over 20 episodes, then this is something you're going to be interested in. I have been hearing what you guys are talking about, and I've heard the concerns and what you guys want, and I heard a lot of people want case studies. And so I'm going to do case studies right as I come out of the exam room or on the drive home to be able to be super fresh, to be able to relay how things went, as well as why I picked what I did.

I know a lot of the interns that work with me, they're interested in, well, why did you pick this, not that? And we're going to cover all that kind of stuff, as well as presentation. Obviously, these are going to be anonymous. They're not going to be people that you can recognize who they are. And it's going to be super helpful for you guys to develop clinical reasoning. So please take advantage of that. I don't make any money off the podcast other than this format too, and it's super affordable. Let's keep the show in business. Let's get into the show. Storytelling hopefully addresses the experience they're going to have when they come in and it breaks that stereotype.

Because that stereotype of what they might expect of a chiropractor or a PT is a real stereotype that we all have to battle or accept. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey everyone, it's Sebastian with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time in the show. Welcome. You are late to the game. You're late to the game. This is about 210 plus. I never really keep a hard number of how many episodes I've recorded in this podcast already.

And so, this is a podcast where I've learned a lot over time as a clinician about how to improve my patient outcome as well as communicate better with people in general. So, we try to keep this podcast a little bit more, less techy when possible. And so, we try to keep it really patient-friendly so everyone understands it's just general communication. So, if you're a clinician, you're going to love the show. If you're a lay public and want to learn more about your body, that's fine too. That's perfect. I suggest the show to a lot of the clients and patients that I work with. And I hope you do as well.

So, the topic today is going to be one that I have dabbled with a little bit over time. And I've had someone on as a guest. His name is Alec. We talked about communication. And so, I had some realization with communication over the last month or so as we have a new group of interns in the office. So, I thought I would share with just some of the things that I came up with on the fly. And I realized that I was talking a bunch or speaking with them a bunch recently about. As in the old podcast, I'm going to go off the cuff today. I don't really have a lot of personal stories. I usually share a personal story about myself.

Hopefully, you're just going to get to like me through this show in general. And follow me as a host because some people like Oprah, other people don't like Conan. And, you know, you like to follow your hosts. So, I try to keep things as real as possible and not sort of bullshit you guys at all. Everything I preach on the show, I use in my own life and in my own clinic. And I hope it's helpful for you as well. I know one thing through I am going to try to improve on this year, which I said last year too, is ums, uhs, and things like that, like stall words. And so, I'm really going to try to improve that with this show today.

So, if I pause, it's because I'm trying not to say that word. So, hopefully, that didn't draw your attention to it. Now, the first thing we're going to cover, at least in regards to communication, is trying to predict the future. Okay. So, we'll call this, uh, number one. So, I'm going to write this as I go. Future prediction. And, as I said, a lot of this stuff is going to be off the cuff today. Um, reiterate. So, it might not be the, the best presentation you ever heard, but hopefully, the information is relevant. So, the first thing is, is, uh, uh, predicting the future. And so, when working with patients, people, in general, sometimes the future is not necessarily something they, they want.

Or, um, it's challenging. It's hard. And so, my goal, at least with getting people to come in and succeed at my clinic, is to, to help them reach their goals. I want them to reach their goals. Now, a lot of times their goals are reduction of pain, which is fine. It's a very short-term goal that works. All right. And a lot of people do have it as a, as a first short-term goal. I'm down with it. I like it. But, if their goal is to reach something else, like throw a football, reintroduction into baseball, um, or, uh, even, I know it's cliche, playing with your kids. You know, and everybody wants the goal is to play with the kids.

I don't have kids, so I, I guess I don't quite, nor do I have the inability to play with kids, I guess, uh, since I have a niece and nephew. I, I don't really, like, I don't, I'm not physically, uh, limited in that, but I know a lot of people are physically limited. So, there's, there's certain things that you have to build up over time to be able to get to the point where your body's resilient enough to do all those things that you want to do. Obviously, it's goal-dependent. Someone called the other day and they said, well, I want, my, my son wants to be able to get rid of his shoulder pain. Okay, what does your son want to do with his shoulder?

Well, he just wants to be able to lift. How long will that take? Well, um, if we're only interested in reducing pain and not lifting again, week and a half, probably. Now, if he wants to be an Olympic weightlifter, then maybe a little, then quite a bit more because we're going to find things over time that we need to improve on. So, as I mentioned to her on the phone, I tried to predict the future. I said, look, he's going to come in and he's going to feel really good after about a week and a half. But if he stops there and he's not, he doesn't continue doing the suggestions that we suggest that he do, and that might not, not, might not be things like anything really dramatic.

If he's just using the cues that we suggest and doing responsible reintroduction of volume or load management, then he's going to have a flare up again. So, I'm predicting the future. It's not a scare tactic necessarily. And there's another way I'll put this too, because I do mention this to people when we're dealing with low back pain. It's not uncommon for people with low back pain to have residual stiffness there. The second week we work with them, and sometimes some groin pain. It happens. It's common. So, day one, I'll actually talk about that. So, the first week, what you might notice is a lot of the things that you can't do today, such as putting on your shoes or daily tasks, washing dishes, whatever it might be.

You're going to notice that those are going to get a lot easier. And when you start to do them, you're going to be like, huh, I can't believe it's only been a couple days and I can do that. I don't have to think about it. It doesn't hurt. But I still have that stiffness there and, yeah, that groin pain. And, yeah, so you mentioned those are going to come back or those are going to happen. Even though I might not have them now, you mentioned they're going to happen. And so, when they happen, now they know that I know what I'm talking about. And now I can get them over that hump. Because a lot of times there's an order to process, I believe, into getting people to completely feel better.

Obviously, there's the whole conversation of, you know, pain is normal in life and you won't get rid of complete pain. Pain's a normal thing. Yeah, I get it. I hear it. But I think we can all agree that people do not need to be in daily chronic pain. And so, I want them to understand that as they overcome that disabling pain that they're experiencing, there are going to be a couple stepping stones that we need to take along the way. One thing that we did about predicting the future, too, is when we introduced corrective exercise to people, a lot of times we'll do it in a very aggressive fashion in regards to getting the, let's say, we're getting the glutes on or the shoulder girdle on.

We just warn them and say, look, you're probably going to be sore there. Please don't stretch it. Just embrace it. It should feel like it's a large area of soreness. Normal. And so, that way, they know the next day not to freak out because I already predicted the future with them. I hope you guys get what I'm saying with this. And there's a lot of different ways we can spin this thing. Another thing that I've mentioned, too, when we're introducing corrective exercise with people, and this is something I've talked recently with my interns about, is being able to communicate with them and let them know where they should feel it.

And I know that a lot of people will say, well, that's an internal focus. Let's not use that. We want to do an external cue. I get it. I understand. We use external cueing to direct the movement, but we want the feedback from the patient, especially in this, what I would call the tinker state. We want them to understand where this should be felt. Now, granted, they can feel a lot of different areas, but we say, look, you should feel this in the butt cheeks. Well, let's see. Do they know where the butt cheeks are? So I usually grab my own cheeks, and I say, look, it should feel like it's a large handful of cheeks, and it's going to feel really challenging, and it's going to feel effortful on both sides.

If it doesn't, tell me. So I hope everyone understands that I'm emphasizing where they're going to feel that I'm predicting the future. So they know that I'm in control, and I know what's happening with them, and I understand if this is going to be helpful for them. And so a lot of times, if you can tell the future, I think you can build a little bit more trust with your patients or your clients, and they'll understand that where you're taking them is safe. Because when you have ongoing pain, chronic pain, and I know some of you might have never experienced it before, and I encourage you one day to get some type of painful thing and think about it.

Think about what's going on. And if someone were just to tell you, hey, we're just going to do this, you know, these push-ups right here for your shoulder, are you down with that? You know, and you're like, I don't know, man. I don't want to feel like that again, right? So you got over it, and you're like, I don't want to feel like that again. Now, is this fear avoidance of the activity? Sure. Now, are they sweating bullets about it? Probably not, but they have a concern. Most people have concerns. Even when you go on a date, you have a concern. Is this person going to kill me? You know, am I going to have gas when I go there?

Like, maybe I should keep the date shorter because I might have, like, I might be farting or something. I don't feel good today, right? Whatever. Everybody has a concern that's completely normal. However, if you preface that with a possible future prediction, let's just say with the date, and say, look, you know, like, you might have a concern that I'm a serial killer. You know, like, I emailed you all of the, you know, all of the places to check for serial killers, and you'll see that I'm not on that list. And maybe you thought I was, you know, part of that, you know, bank robbery the other day, and so I'm going to give you my alibi, right?

And if you have gas, I want to let you know that you're free to leave at any time. Like, I don't, I won't question why you leave. I'll just assume that you had to leave, and no harm, no foul, and we'll just meet up again. Now, that primes the situation to where there's a little bit more trust, and there's an exit strategy, and there's something, there's a general understanding of what will happen. So, I know I might have went off on a tangent here, but predicting the future of what will happen when you get someone to feel better or when you start implementing a strategy, a system, let's just say, what is going to happen?

What's a timeline it'll happen in? If it doesn't happen within that timeline, what should they do? Should they come back? Should they assume that maybe you can't help them? And a lot of times, I'll tell them, too, about, like, we'll implement, we call it first aid. It's a simple exercise or position or a movement that I will have them do for the first week, and I'll say, look, there's about three different strategies or three different interventions that I can give you as your first aid. The one that we're using right now looks the most promising, but I've been wrong before. I've had people come back the second time and felt worse.

I've picked wrong. I'm human. I've picked wrong, but we're going off of the information we know at hand here. So, I want you to communicate with me, all right? What we do know is that if you get worse, that gives me a lot of information to help you, and it gives me more information to plug in the right strategy to make you feel better, I'll usually tell them a story after that just so they understand. So, they understand. Oops. Sorry, I hit the mic weird. Just so they understand how good it can go if they communicate with me, again, predicting the future. So, I had a patient. I had someone just a week or so ago that he came in, just lit up groin pain.

He was waddling in like a gingerbread boy. You know, probably the interns will know exactly who I'm talking about with this. He's a very cool guy to work with. I've worked with him over the years with various things, and he's very receptive of our relationship, and he trusts me. And so, I'm happy about that because I picked wrong. And so, he came in on like a Tuesday, and so I tell him, look, if you do this one thing for a couple days, you're going to feel night and day. He was a 9 out of 10 in the groins. He was having trouble walking. He couldn't turn and twist and so on. So, he had a lot of trouble with just normal activities of daily living.

And so, I emailed him on the next day, later in the afternoon. I said, how are you feeling? He's like, I'm still a 9 out of 10. And I said, okay, so we're going to switch gears here because we know now what I was going to suggest or what I suggested that you do is not the right thing. Let's change gears. And so, he changed gears. He did come in the next day, so I was able to test that a little bit further. But by Saturday, 1 out of 10, he's biking with his kids. He came back in the following week on a Tuesday. So, again, one week removed from the first first aid implementation. About five days removed from the second first aid implementation.

We were dead lifting. We were squatting. We were doing carries. And he was at a zero out of 10. So, it was great. And so, again, moving backwards into the predicting the future model. I told him on Tuesday, the first Tuesday. If you do what I tell you to do and I'm right, you're going to feel like not in a day or so. Now, he was worried about that he'd thrown himself back. Like, he just had – because he had done something recently that he knew this might just set him off. And he did it. And that's okay. And I said, look, it's okay. Like, you're – like, this is just a small setback. I know it feels horrible right now and it's very painful.

But I want you to understand that probably by this time next week, you'll be dead lifting and squatting again. And so, Tuesday rolls around again. The next Tuesday, we're dead lifting and squatting again and doing carries. And he's laughing. He's having a good time. So, what might have come of this? Trust. Hopefully, from here on, this person trusts me for programming and recommendations for whatever I think I can help them with. Or even if I have to refer them out. So, and you might wonder, some of the clinicians out there are like, I don't know if I can predict my – predict the future that well.

You should try. You should really try. And you should get a system that works for you. I know over the past few months, we've talked about the five-step patient care system. I'm very confident with the outcome with certain types of cases. You should be too. If you're not, I think you might need to work on one of those five levels and figure out what you're missing there. Because you might be missing something really easy. And I think a lot of good clinicians out there, if you plug in the right strategy and they're confident with it and they're confident in their examination flow and all the information they've gathered, then you can reasonably predict.

Obviously, you could be wrong, like I was wrong. Or you could be partially right and you have to change gears. And that's okay. But if your strategy was right, and as I've told everybody, that if you have the right solution to your problem, you will feel better quickly. If you have the wrong solution to your problem, you're not going to feel any better. And this is where people over and over again, they feel like, oh, I've stretched, I've massaged, I've, you know, I've done what my friend did and it didn't work for me. I don't, I tried everything. No, you tried your friend's solution. They work for them, for their problem.

But it's just not right for you. It could have been right for you, but it wasn't right for you. So, predicting the future. The next one we're going to get into is reiteration, which I hope that you kind of caught on that I was reiterating, circling back multiple times to the predicting the future in the predicting the future step number one, at least in this series of communication. So, number one is predicting the future. Number two is reiteration. Now, reiteration is something that I think we need to spend a little bit more time doing as healthcare providers, coaches, anyone who's really relaying new information to somebody that's information they're really not used to.

We had spoken, me and an intern spoke the other day about recapping things at the end of the session. And he's like, oh, I really like when you recapped it at the end. It brings it all nicely together. And I said, you know, I do that because there's a lot of information flying around and really I want them to understand not all of it. I need them to understand what they're responsible for doing and simply come back. Because a lot of the questions they have this time, I might have asked them or pushed them off to next time because maybe the question wasn't relevant at the moment. Or their question will be answered next time.

And I make sure to reiterate because, again, there's a lot of information flying around. I remember when I had taken my dog to the vet and she had a dog ACL injury, CCL. And so the doctor, the vet was very thorough, very thorough. Four-hour appointment. I literally went home and fell asleep and it was like four o'clock in the afternoon. There was so much information flying around and I appreciated all of the information she gave me, but it was too much. And at that point in time, when there's that a lot going around, I know that I feel this way a lot of times when people kind of give me all this information.

It's like, all right, what do I need to know? What's the most important piece of information I need to know and what do I need to do? Now, you might wonder, why am I giving them so much information in the first place? It's just to let them know that I've been thorough. Now, I'm sure there's ways I can improve my communication about this. And there have been some shortcuts that I've taken throughout time that hopefully cut down on the amount of information so they don't get confused. One strategy I've used through a lot of new patient encounters is say they came in with a hip problem. And I'll say, look, all the stuff you probably read on the internet about what it could be about cancer or tendinitis or bursitis or impingement or whatever, I'm checking all of that.

And if I don't mention it again, it's because I don't think it's part of your problem. In the same thread, if you wonder, should I use ice or heat or stretch or do that or do this or don't do that? If I didn't bring it up again, it's because I didn't think it was that important. I'm going to highlight and reiterate the things I think are important. So they can have a choice to talk about that stuff, but at the same time, it's just more information that's not really relevant. So that's how I try to cut it off in the past right now. But if there is a thing that happens throughout the session where they stop and ask a question and it's a blockade or a hindrance point to get them to do what I need to do, I'll do that information at that point.

An example would be if I really want, and I've had people I've worked with like this too. I try to get them to do an exercise and they sit there and they want to talk about it for a bit and wonder why it's helpful and blah, blah, blah, right? And so I've taken this one of two ways. I'll say, look, I'll explain all the reasons why it's helpful to you. And if that works, then great, we use that route. Another thing, as I say, look, to fully understand it, I can, we can talk about this a lot if you want to, but it won't necessarily make you feel better. So I suggest, why don't we just try the exercise?

If it hurts or it harms you, we'll stop. But it's not going to just all of a sudden make your body explode. Like you'll start to feel stuff creep up and that's good information. It helps us. So if you're open to trying it, we just try it. So I try to cut down information that way because the more information you give, the more you have to filter. And so reiterating things throughout time helps bring it back home. So I might bring it back home in the very end saying, look, all those things we went through, they're tests. I don't need you to test them again at home. I just need you to do these two or three things or whatever I decide to do.

Reiterating things because there's a lot of information flying around. It's a very emotional time for a lot of, for a lot of them, especially if they're in acute pain or even chronic pain. Subacute, I think is a little realm where they're like, ah, you know, like this is, I just need, I just want to get rid of this. Tell them what to do. Like you're really not as emotional about it. They're not, they're not bent out of shape about it. But, um, there's a lot going on that we, as the non-patient don't always understand. It's like they, sometimes we think like we're having a casual conversation with someone and that's not necessarily the case.

They're really, really concerned about this thing. And even the way you say certain things could lead them to believe, um, and, and focus on something else. And I think, as we know, from just from a coaching perspective, if they focus on one thing, they'll ignore the other things. Um, and this could be good or bad. Now, let's just say if I had someone in my office and the first time, um, I examined them, I said, look, yeah, you know, like, uh, I think you had some hip impingement going on, but you know, like there's, I've seen someone that had cancer there. And they, they, you know, they, they, um, they had a chemo for the thing, but you know, don't worry about that.

And it's probably just impingement. They're going to be like, uh, you just said I might have cancer. Right. And so they're focusing on that and they might not remember anything else that you said. Same thing happens with MRI x-ray findings. And I think a lot of us do this. And I think I want to take this time right now to tell us that we should not, we should be very cautious of how we talk about imaging findings. And I know I might get bashed about this, about, yeah, structure does matter and all that stuff. But it's important to realize that some of these things are not going to change for these people.

You have arthritis, it ain't going to change. Right. But I'll usually, uh, take it the approach of saying, look, um, yeah, your imaging had some degeneration or arthritis with it. You know, my back is, is probably the same. I had an image done a couple of years back. There was also arthritis too. I don't have pain and you don't need to either. So it's not always related. And I do believe in calling this the gray hair of the spine type of thing. And so I just let them know that like you're in the same boat as a lot of other people that, you know, that don't have pain. They also have arthritis. They also have whatever imaging finding you want to plug into this conversation.

Um, and they don't have pain. Let's make you that person. Okay. So you have this, it's, it might be part of your problem. Don't worry. I'll show you how to deal with it. So you reiterate, don't worry. I'll show you how to deal with it. You have to tell the person what, if, what the, what they have, if it's part of their problem. And they certainly, you, you should dissect down imaging findings, but those are big, scary words, man. They're big, big, scary words. And so going back and reiterating that it does not matter that much in their case is important. So at the end of the appointment, here's what I want you to understand.

We did go through the imaging findings. We went through and examined your body. I, I load tested you head to toe, and I don't see any reason why you can't do what you want to do again. Between this time and next time, here's what I need you to do. Do this, this amount of times, do that, that amount of times. I need you to communicate how it's working to me. What is unacceptable is to ghost. And I haven't had this conversation in this manner to people say, look, the reason why you're probably not getting better is because, because no one has a beat on what's going on with you because you, I'm, I'm the 15th person you've been to, right?

I want you to at least email me and tell me what happened because between this time and next time, this is a long test. It's a week long test to figure out if we're doing things right. So communicate that with me. If it goes wrong, if you get worse, if you get better, tell me. It's important because I can then tell you what to do next, even if you're not going to me. You have to communicate. Okay. So do you understand any questions? No. Okay. I, you know, I haven't gone the route of having them repeat, but I do go the route of having them do a video again, because I think it's important that people have a lot of information going on and they're probably going to forget.

I totally get it. I've been there too. I have a dog had a CCL tear, right? And so I totally understand. So I like people to videotape me talking about this section and doing the exercise and showing the cues when they're, when they, when they can. Also too, on a side note, I've had people reach out later and like, Hey, so I, do you have videos on those exercises? And I say, no, or if I'm being nice, I say, yeah, but I say no in the beginning. Um, and right when they come in, uh, or right when they're leaving, because I want them to know that, that this is their opportunity right now to have a videotape of this personalized to them.

So they need to take advantage of that. Now, really quick break from the show. I want to invite you guys to check out a series, a clinical series that I just put together. It is the five steps of patient care series. We start with the hip and we'll go all the way through referred symptoms. Um, it's a step-by-step exam through loading type of workshop. East workshops, about two to three hours. There's videos. You will get access to it, um, for quite a bit of time, uh, in the hip one. I cover labral tears, FAIs, referred, uh, referraled symptoms, uh, blah, blah, referred symptoms. Gosh, as you guys can tell, I don't do some severe editing in the show, which is okay.

I, I, I've gotten a lot of feedback that you guys like the conversational tone. We also cover rehab options. And I know that a lot of things that I've heard from, uh, interns and, uh, young clinicians that have come out of school. They said, Hey, we know a lot of, we know a lot of rehab. We know a lot of exercises. I know the dead bug, but how do I use it? When do I use it? What patient do I use it on? Can I use it on a hip? How do I cue it to use it on a hip? Cause it, with this hit, this hip case that I'm, I'm using it on, it's not working. It's making their hip clunk. Well, so we go over cueing in there and we also cover loading based upon the pathology.

It's not just your standard crap. Like, Hey, here's how to teach a barbell squat. It's stuff that is based upon how clinicians can teach loading to get the person where they need to go. Cause we know, we know their case better than their strength coach does at this point in time. Yet later, their strength coach will be the one that who will, who will do a better job of, uh, coaching that for performance purposes. Cause that's not our job. So I want to invite you to go through the step, uh, uh, the series one through six in order. Numbers five and six will absolutely blow your mind. Absolutely blow your mind.

And the intention that I had was that we would stop treating, um, inefficiently. Our patients don't want us to treat it inefficiently. Sure. Our pocketbooks do our businesses do. It'd be nice to get 30, 30 visits out of every it band that comes in because it just won't stick. But why don't we just get it to stick? And so in five and six, I, I present the idea of pseudo syndromes and different types of the hand, wrist, elbow, shoulder, hip, knee, foot, ankle, pseudo syndromes, the things they don't teach you in school. So please go through there. Every intern that I have is required now to go through all of this video content before I will even work with them because it is that important.

This is what I hope for you. I hope you interns or you young docs are better than I am. And I'm in my 12th year, 12th year, 12th year of practice. I want you to be better than I am because how are we going to improve this profession and improve the knowledge that we have? If we don't learn from people who have already been there first, I learned from other people who have been there first too. So don't reinvent the wheel every time. And please take this, um, in the light that it was intended. You need to get this course, p2sportscare.com slash products or products or get the product tab and go down and get number one of six.

Now back into the show. Now the third thing I really like to communicate with people about, especially with new patients, perspective patients, perspective clients, people who have not really been in yet. Um, and they're on the phone, they're just scouting to see who they want to go to. Um, and I know that, uh, or so if you've been listening to my podcast for a long time, you've heard, um, way back in the day, probably almost a year ago. Now we had something called the ring ring game. I still have my intern and staff do ring the ring ring game because it's important to be able to get inside the person's head enough to get them to come in.

So you can help them. It's all talk. It's all talk until you actually get them in the door. Um, and you're able to prove what you can do for them, uh, and get them to the results that they want. And so recently, um, I started talking to some of the interns about addressing stereotypes. So a common thing, we're not, we're not the cheapest place. All right. We don't pretend to be the cheapest place, but in the past I used to say, you know what? I'm going to save you some time because you're probably going to call and shop around where the most expensive place you're going to call today. But there's a reason.

And I would explain the reasons why and so on. And so I started realizing over time that these people would not call back. And I started wondering why, you know? And so recently I've been trying the strategy and this might be a wrong strategy, but it's something that we're testing right now is addressing the stereotype. And so let's just say if, um, each appointment with us is $150, that's, that's more than most places, um, that they're going to call today, especially if they have insurance coverage or something like that. So I might as well, I could ask them what they expect, or I can address the stereotype and, and cause they're going to ask, well, how much is it cost?

Is it going to cost to fix this problem? Well, it really, I mean, I think we all know it depends on how many times you see the person, uh, in person or with telehealth, uh, the more times they see you or the more nurturing they need, the more it's going to cost them. I think we all kind of know that, you know, cause it's time spent. So eventually I started asking them like what, you know, what their expectations were. And they're like, well, you know, like, I don't know, I think I can afford it. Cause one 50, you know, two to three times a week is, it's kind of a lot. Like I don't, I don't, I don't really have the budget for that and blah, blah, blah.

Right. And so finally, finally, once I started getting that answer, I was like, wait a minute. So do you think you're going to come in here two to three times a week? You know, and they're like, yeah, well that's, that's kind of like what, you know, that's what rehab is. Not here, you know, so how much are you paying at the other place? Well, 40 buck, 30 buck copay, whatever, right? Let's just say it's 30 bucks times three, 90 bucks a week. And so you go in there, spending your gas and all this kind of stuff, right? I want you to realize that actually coming in here, if things go really well, we're going to see you day one, say today, we're going to see you today.

It is going to cost more because we're very thorough, right? And so, but we're not going to see you again for a week probably, right? If things go well, we're not going to see you for a week. And if things go well, you're going to be 50% better within the week. And you're going to come back wanting to know what you got to do next. And we're going to tell you, we're going to tell you what we're going to do, what we need to do next. We're going to give you some exercises to do at home. Now, if you want to come twice a week to have us watch you do them, you can, but it'll cost you more. But I think we all like the recommendations are going to change.

If you do the exercises well and you retain the way we need you to do them, just do them. It just comes up to you, right? And so we're not going to see you again, probably for another week. And after that thing go well, you're going to be like, wow, I feel like 95% better. I feel so good. Now, what do I do? Can I go back and overhead press at the gym? Well, once you overhead press today, why don't we see how it goes? Ah, it still hurts to do this. Okay. So why don't we scale this a little bit? We'll do some overhead pressing. We'll cluster that set. I'm going to give you some cues that'll work for you.

But realize you haven't been overhead pressing for quite a bit of time. It's been like a year or so. So why don't we just, why don't we just scale that up a little bit more? But why don't we do an incline press? We'll also do an overhead pull down and a horizontal pull as well. How's your squatting going? Oh, I don't squat. I hurt my back in high school. Oh, why don't we teach you a squat as well? And so the reason why we're doing this is we're building a nice program for you. What I want you to do when you go home for the next two, three weeks is just do this program. Do the cues. Let's think of that exercise, that overhead pressing one is the main focal point.

It's like the Super Bowl. And all the other stuff is the commercials. This is killing time. Obviously, it's nice killing time because you're doing some work. But I want you to really focus in on that thing and do it so they're all pain-free. Focus on the cues that we taught you because those weren't painful, right? Yeah. But it hurts when I get to 10. Okay, so go to 8. Does it hurt to go to 8? No, it doesn't. Do 8. Then wait and do your extra 2. Wait like 30 seconds. So we'll cluster it up a little bit. So the person on the phone then, I'm hoping they're starting to realize that we're talking about like three months of care where you might see me six times.

And now all of a sudden the price isn't the same anymore, right? So addressing that stereotype or at least storytelling. I do believe in storytelling. I know my storytelling can get better. Storytelling hopefully addresses the experience they're going to have when they come in and it breaks that stereotype. Because that stereotype of what they might expect of a chiropractor or a PT is a real stereotype that we all have to battle or accept. Whether you practice that way or not, I don't. I have a different timetable so people come back just because of the strategies we use. If they come in expecting three times a week and five minutes of an adjustment, they're going to be disappointed because that's not what I'm going to give them.

On the flip side, if all of a sudden they experience me and then they go to New York and they want to go to someone else and they go to there and they're getting five minutes, three days a week, they're not going to be happy either. So whatever stereotype they might have on the phone is one that we have to address head on, I believe, and break it. Because now they know what type of care they're going to get and they can budget a little bit more accordingly. Now, the last one, I think that, and this is something that I need to be doing more aggressively. I have not been doing this, but it is something that I'm hoping one of my interns listens to this and they're like, hey, you didn't do that today.

I'll say thanks. I need to do it more. And this is based upon the principle of Dan John saying, the goal is the goal. And the goal is the goal really comes down to, like, what do you want to do? You know, and if you say get out of pain, great, we can do that for you. Take about a week and a half, two weeks, and, you know, there's not much else that you wanted. Now, if you told me that you wanted to play baseball again, the goal is the goal, right? Here's the skill sets we need to do to get to that goal. And unless something dramatic happens in your life and you realize that you hate baseball or you move and you move to, you know, Alaska and it's the wintertime all the time and there's no fields there or a different country where there's no team, maybe the goal changes.

Okay, but if your true goal is to play baseball again, recreationally for me, then the goal is the goal. So, Doc, how do I get to this goal? Well, I'm going to lay out a plan of attack and we're going to do it. Okay. Now, it's challenging when people's goals change and they can rationalize this many ways like, oh, you know what, you know, money, you know, like money's an issue and, you know, or, you know, I'm not really in pain anymore. So, but I started playing second base versus the outfield, so I'm okay. So, did you want to play outfield again? I mean, like, yeah, you know, like that was my original goal, but I realize I'm older now and I can't throw that far.

Well, no, your goal changed and that's okay. Do you want to play second base? Well, no, I'd rather play the outfield. Okay, let's hit your goal. And so the reason why I need to get better at this is because it's a really hard conversation to keep people accountable. And this goes with people who drop out of care. Why? Hard to tell sometimes. They dropped out. They didn't communicate. They didn't like the way we smell. Whatever. Like, I'm a big believer in communication and follow-up. And we do our very best to the day after someone comes in, we have one of the interns, the intern that shadowed that exam calls up and says, hey, this is Mary Lou.

Like, I want to see how everything's going, how those exercises going. Well, the exercise is going really well. He had a question on this, you know. Great, good question. Let's sit. And so that intern is well-versed on what we did. So they've logged it in their memory bank. And so they can guide that person on those other questions that might come up. Or, remember what I talked about earlier, maybe they say, well, yeah, that's way better, but now this is that. Well, remember when Sebastian Gonzales said that, you know, you might have a little bit of wrist pain associated with that, too, the day after or a couple days after?

Oh, yeah, I do remember that. So that's normal. So that reiteration I talked about, or predicting the future. So follow-up, the follow-up, though, I think is important. And we've been trying to do a better job, or I need to, I've been doing this when I've been calling, but I kind of feel like it's cheesy. So maybe I need to find a better way of saying it, but it's really what I believe. Look, Joe, you paid us a lot of money to help you out. I'm calling because this is the part of the care and the attentiveness that you paid for. So I'm calling you. You have not been in in three weeks, and we needed to see you the next week to dissect down what the examination findings were or how your progress is.

Call us back. We're going to email you as well, okay? And we're only doing this because you told us you want help. They don't always call back. They don't always email. Now, is this me? Is this us? I mean, I want to believe not, but maybe I'm sure there's a better way or a better way to get a response from people. But I don't know what it is. Now, I feel like people just are very dismissive, and they're just okay with just not communicating. I think it's complete bullshit. You know, people are not accountable for things, you know, all the time. Like, all I asked you to do was email back. You can say, I can't afford it.

I moved away. It didn't help. You stink. Whatever. How are we supposed to know how to help you if you don't communicate? Vice versa, how do you know what to expect from us or what we expect you to do to help yourself if we don't communicate? And that's why I'm doing this podcast today is to hopefully improve our communication. I'm sure there's many different ways we can and touch points we could have done today, but it really comes down to can we communicate? So, I want to make sure that my goal is to be able to get people to their goals, and I need to improve our communication somehow. And I think it comes down to, at least from our side, after the first or second patient encounter, or at least people dropping off, I might need to have to do a better job of now predicting the future again of what we're going to do.

Now, I'm hesitant to doing this more because it's more information, more information, like just more things to tell the people. But let's just say after the end of the first time, say, look, it's not uncommon for people just to drop out of care for some reason. They got busy. They forgot. Whatever. I want you to know that we're going to call you until you tell us to stop. Here's the reason why. You're here because you have a thing. You're paying us to help you, and we need to keep you accountable. So, help us help you, but at some point, we're going to feel like we're kind of like a turd, you know, and it's like, I don't want to feel like we're being salesy and telling you to come in just to collect your money, but you're telling us your goal, and we need to keep you accountable.

But at some point after like a month of calling and emailing, if we don't hear from anybody, we just stop. But I want you to beat us to that punch. If for some reason you don't like the way the office feels, maybe you, whatever reason, talk to us. We will not be offended. And I think that's the accountability thing that I need to, or the thing that I need to get across is we're trying to keep them accountable. And it's not a business money thing, although it helps our business time, our bottom line, because it helps with patient visits, you know. But I didn't, I don't know about you guys, I don't like reading books that are half finished.

I mean, like, I don't like stopping. I'm in the middle of Lord of Flies right now. I like it, you know. If I didn't finish it, you know, a year later, I'm like, damn, I didn't finish that book. I wonder what happened in that book. I'd probably pick it up. People who discontinue care, or I discontinue care with them, or I, like, say I couldn't even help them. Those are unfinished books. I kind of want to know the end of these things. And I know it's probably, like, yeah, yeah, but it's about the patients. Yeah, but I'm saying I have a genuine interest in how that panned out. So, I'm keeping you accountable for yourself, and because it's going to drive me crazy.

I want to know what happened. So, the four things, let me reiterate the four things that we touched on today. Future predictions. Two, reiterations. Three, addressing. Stereotypes. Four is the goal is the goal slash follow-up slash accountability, whatever you want to call that thing. So, that's all I really have today in regards to sharing stuff on the podcast. Again, if you have been a listener over time and you're wondering, hey, what else does Sebastian have to share? Like, I think I mentioned in the other podcast is I don't make any money on this podcast, but if you're looking for really the best clinical-based information I can give you, it's all already on the website, and I don't plan on creating anything else for a very, very long period of time, because what I created there was, it's called the Five Steps of Patient Care.

There's one through six. I've seen a lot of you have bought one. I'm kind of wondering when you're going to buy the second, third, and fourth, and fifth, because actually five and six are actually the best, but you can't go out of order because you'll miss a lot of chunks in there, and I know they're long, and so I assume a lot of people are probably, they're getting buried down, because the first one I think is three hours long, but get them all. I would really get them all. I tell any intern that comes in now that if they want to learn anything that's worthwhile or original from me, they need to listen to that first or watch that first because a lot of the stuff that we cover from a clinical reasoning standpoint and thought process, they're in those webinars, and I put them there specifically to make my life easier and get all my thoughts done on paper.

Now, my thoughts might change a little bit, and they probably already have changed since I recorded them, but those are kind of like the basic frameworks, and if you guys want to improve your clinical skills or if you're wondering about a lot of things that I talk about on the podcast and you're like, I don't know how he's going to do that, and like, I don't know, I can't, a week and a five-day get rid of growing payment, I don't know. No, truly, it happens, and if you're not able to predict those outcomes, I challenge you to see if you can. If you're challenged with telehealth, a lot of the strategies we show on those modules, they also carry over to telehealth, too.

It just comes down to good coaching. So, if you're interested in those, it's in the link description or go to p2sportscare.com. It's P, the letter, two, the number, sports is plural, care.com, and just go in and look at the product section. You'll scroll down, you'll see one through six, two through six, blah, blah, blah. Just buy one through six first. If anyone really wants to buy all six at a time, I don't have any coupon codes at this point, but I'll make you a good deal because I really want everyone to experience all of those. Similarly to patient care, get them all. Like, I want to keep you accountable, and I want you to reach your goal, and if your goal is to become better, remember, I don't pretend to know everything, but I know a lot of things, and I know a lot of things that work well for us that are different than other clinics.

If you want to get better by all six, one will not get you there. One is scratching the surface. Thanks for listening to the podcast. Share it with any of your friends, your colleagues, and there's always patient-friendly ones that are symptom-specific or case-specific that come up at random, too. Subscribe to the podcast. Talk to you next time.