Healthy Wealthy & Smart podcast

558: Kirsten Franklin: The Importance of Mindset in Increasing Productivity and Creating Balance

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In this episode, CEO of CS Thrive, Kirsten Franklin, talks about mindset.

Today, Kirsten talks about what mindset is, why we should care about it, and how it affects our outcomes, results, and everyday life. How can we leverage mindset to change the results of things we don’t like in our lives? How can we change our core beliefs?

Hear about Kirsten’s four questions, her stopwatch strategy, and get her advice on how to manifest as a conduit, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “What you deeply believe will always play itself out for you.”
  • “Sometimes just the awareness of the thing makes the thing go away.”
  • “When you’re really in the moment, just throw a big red stop sign in your head. What you’re doing is actually stopping the subconscious chatter. That alone can elevate you.”
  • “If you’re still trying to get to that next level, then you have to pay attention to what you’re saying to yourself at this level. You have to hear what you’re saying, because it’s dictating your reality.”
  • “It’s the ‘taking action’ that’s the hard part.”
  • “None of it is a big deal. Relax.”
  • “There’s two ways to manifest. There’s the manifest by force versus when you open up and let the universe and all of its power flow through you.”

 

More about Kirsten Franklin

Kirsten is a world-class rapid transformation coach who has helped change the lives of over 1000 individuals. She is the brains behind the unique MVP method that is responsible for helping her clients rapidly transform their Mindset, raise their Vibrations, and modify their Processes, so they can achieve their dream lives.

She helps people overcome fears, adversities and traumas while improving their clarity, focus, performance, communication, relationships and thinking, so they can fulfill their ambitions. Many of her clients are seen as being highly successful and seek her out to help them define and achieve their next-level.

She has spent over sixteen years studying mindset, positive psychology, behavioral science and neuroscience and she is a master of techniques such as Neuro-Linguistic Programming (NLP), Strategic Intervention (SI), Cognitive Behavioral Therapy Coaching (CBT), Timeline Therapy, Mindset, Mindfulness, Meditation and more.

Kirsten received her Juris Doctorate from St. John’s University School of Law in 2001. Now retired, she owns multiple companies and is the CEO of CS Thrive, a coaching and consulting company that helps executives, founders, small business owners and athletes become unfu*kwithable in their business and lives. In free time, she is the host of the podcast Girl on Fire; writes for “Mind-Flux,” a publication she created on Medium.com; writes fiction and non-fiction books, and hosts live events. She has been featured in Thrive Global, NBC, CBS, and Fox.

 

Suggested Keywords

Mindset, Mindfulness, Fears, Psychology, Behaviour, Therapy, Awareness, Manifest, Conduit, Abundance, Action, Reality, Subconscious, Liberty, Results, Outcomes, Positivity,

 

To learn more, follow Kirsten at:

Website:          https://www.kirstenfranklin.com

                        https://www.csthrive.com

Podcast:          https://bleav.com/podcast-show/bleav-in-girl-on-fire

Facebook:       Kirsten Franklin

Instagram:       @kirsten_franklin

Twitter:            @CSThrive

LinkedIn:         Kirsten Franklin

Clubhouse:     @kirstenfranklin

 

Subscribe to Healthy, Wealthy & Smart:

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Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73

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iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927

 

Read the Full Transcript: 

Speaker 1 (00:01):

Hey, Kiersten. Welcome to the podcast. I'm so excited to have you on. So thanks for joining me today. Thanks Karen. It's great to be here. It's nice to see you again. I know, just so everyone knows I was on Kirsten's podcast a couple of weeks ago, and we will talk all about that podcast and where people can find it a little bit later, so you have to wait to get the good stuff. But in the meantime today, we are going to talk about mindset. So I feel like mindset can mean a lot of things. So what is it really? Yeah, so that's a great question because it's one of those words like coach or like this, or like that, that we hear all over the place and for me in the way that I use it. So it was actually originally coined by Carol Dweck and she was talking about eight thought process, like being fixed or growth mindset, meaning you believe that you were given a certain sort of limitation and that's the highest you can go and that's fixed.

Speaker 1 (01:04):

Right? And that no matter what you do, you'll never going to go and surpass that level of ability. And growth is one where you feel as though, you know, you have the ability to change it, right? You can, you can go beyond the quote limitations. There are no limitations. And the way that it's sort of been more used frequently is in discussing the subconscious mind. And that's something she references back to because that's actually where all the magic happens. And you know, the way I use it is really talking about that subconscious language. It's about the core beliefs that you hold about yourself. It's almost like the rule of law that you have decided is true for you and you're going to live by it no matter what, Hey, even though you don't really know, you kind of created those laws. So it gets a little tricky in that people understand the difference between conscious and subconscious, but as you talk to them, they really believe many times that they know what they're thinking.

Speaker 1 (02:02):

And the funny thing is is you don't until you catch it and you really kind of latch on and you're like, oh, why did I say that that way? Right? And, and you kind of have to dig into it, but you can, you can understand your deepest core beliefs by the language. And actually just take a look around you. Is there something in your life that you don't like, or maybe you're kind of feeling attracted towards or repelling against, then there's something out of alignment in those core beliefs, because whatever you believe is what you're going to see in your reality. And so when we use the term mindset, is that dependent upon our core beliefs? You know, or is this, I mean, obviously mindset is something we can change, but if people say, oh, well I have these core beliefs and they're not going to change.

Speaker 1 (02:51):

So then how can the mindset change? Does that make sense? Yes. And actually there's a perfect example. So a lot of times I like to ask for questions when somebody is in a certain emotional pattern, right? Let's say, oh my God, I have anxiety. I can't drive over bridges. Right? Like, or, or whatever it is. So I'll ask four questions and I ask the first question, like, could you let that feeling in like, are you willing to just feel it? Because if you're not willing to let it in and you're constantly pushing it away, well, you can't get rid of it because you're, you're, you're not willing to work with it. Right. The second question I'll ask is, do you believe it's even humanly possible for you to eliminate the feeling of anxiety? Could it ever just go away? Right. And these are just yes or no questions.

Speaker 1 (03:35):

And if the answer, yeah, I think I could get rid of it. Like that's totally possible for me. Right. The next question I would ask is, would you let it go? Are you willing to let it go? Okay. And again, it's a yes or no. The reason I ask these questions is a yes or no fashion is at any point when you say no, no, I'm not willing to let it in. Then you can't let it go. No, I don't believe, I don't believe it's possible that I could just eliminate it then. Guess what? You will not eliminate it. Right? No, I don't. I, you know, I'm not really willing to let it go. Okay. Well then, you know, you're going to keep it for some reason, right. Or if you say yes, all the men in the last one says, okay, well, when, when are you going to let it go tomorrow?

Speaker 1 (04:15):

Okay. There's a reason why you're not today. Right? So, so the thing about what you had just said is that whatever you believe is going to be true. So if you believe it's not possible, it's not going to, it's not going to, it's not going to be possible for you. Right. And so, so it's a, it's a, it's a tricky little thing, you know? And so how can we, how can we change our beliefs? How does that work? That's a, that's a long process and a short one. So you can actually just change them. That's the fastest way to change them is to literally just change them. What is it that you wish you believe? What is it that you hoped you live? How is it that you would hope things would be, and then just believe them? And it's actually that simple. Now I know a lot of us thinking like, yeah.

Speaker 1 (05:06):

Okay. You're funny. I, I that's. I'm like, yeah. Okay. Yeah. Right. But I want you to think of the moment. There has to be a moment in your life where you're so off. So fed up, so done with something that it was done. You're never going to take that, do that, see that, feel that again, and you walked out on it. Like it typically happens in relationships. I'm never going to have that. You don't, you're done, never happened again. Right. Because you're done because whoever you were that got yourself into that situation, you were done with it and you were not willing to accept it and you won't ever accept it again. Right. Whether it's like somebody who speaks to you in a certain way or does something or whatever, or even the way the grocery bag of groceries, you know, bags of groceries.

Speaker 1 (05:47):

You're like, yo, you like it. You know, it's just done. That's the same thing in our head. Sometimes we can just be so over something that we're done with it. And it changes right there in an instant. Right. and then more typically it's we think a lot about how we wish it could be how we wish it should be, should be as a, as a dangerous one for me, because it's a comparative thing. Oh, I should be here, but I'm not, oh, like, I shouldn't be married, but I'm not, oh, this should be this way. And that starts a spiral of depression because your life doesn't look the way you want it to, then it's no good and it's all wrong. And then it comes down. And as you know, when we have these stressors and emotional things, they come out physically. Now you have neck pain.

Speaker 1 (06:33):

Now you, now you get headaches. Now, all of a sudden, your knees hurt. Right. If it's not a physiological difference, then it's typically coming from an emotional space it's coming from inside. Right. So how do we change them? I mean, look, I'm going to be totally honest. You can like, go, am I allowed to swear? I'm going to try not to sweat. You could like Google this stuff. Okay. Like there are affirmations, there's hypnosis. There's, self-hypnosis, there's positive cycles. There are a million different ways. And I don't believe in one size fits. All right. So I could lay down some techniques right now. And you know, a third of y'all will get it, do it, try it. It'll work. A third of you will be like, yeah, I'm not even bothering. And a third of you will try it and it's not going to work.

Speaker 1 (07:13):

Right. But even that is in your head. So if you are someone who doesn't believe that talking things out helps anything. Then if my method is talking things out, then it's not going to work for you. So that's the power of our brain. Let me tell you how powerful our brain is. I was just having this conversation. So, you know, I was talking to somebody and there's a blind spot. So meaning your eye, witness identification, all stuff, all bad. Why? Because we interpret things so differently and we can create blind spots. So you ever had that moment where you're like, oh, can you get me that book on the shelf? Right. And the person's like, I don't feel like getting you up, but you're standing right next to the shelf. Just grab it to me and give it to me. Okay, fine. What's the book it's not here.

Speaker 1 (07:55):

Right. And all the fighting goes back and forth. You finally get up from your seat. You walk over to the shelf right in front of the space is the book he or she literally couldn't see it because somewhere the command was given no book. You don't have to get it. You don't want to get it. It's not there. This is stupid stuff. Right. And so it literally happened. And so it's kind of crazy. Like, I can't tell you all the science behind it because we're studying it every day. In fact, you and I, before this, this packets were just talking about how they figured out. They think the, the place in your brain that lights up when you're deciding whether something is going to get stored in your subconscious mind. Now that's a really interesting place to play because I mean the magic that we can make happen right there, who knows.

Speaker 1 (08:40):

Right. But you know, it's, it's many different techniques to change it. You know affirmation again, you can Google that, you know, but it's really important because what you deeply believe will always play itself out for you. So I always tell people, take a look around your life. If there are areas or places that you are just simply unhappy, you really need to dig into your beliefs about yourself, the way it's supposed to look how it's supposed to be, and you'll see how that's playing out. Yeah. So I, it sounds to me that you're saying not, there's no one size fits all for this. And I think that's the realest answer. You know, like you said, I can tell you this or this, and it might work for some and not others. And so it sounds like you need to figure out what is going to work best for you and then seek that out.

Speaker 1 (09:42):

Yeah. And it's a testing thing, right? I mean, you really do have to go through things. Like I have a mindfulness email that I send to everyone it's 52 weeks. And why, because it's literally 52 different ways to practice the same thing. Right. Mindfulness. Right. But the goal is, is that okay? You try it one week. Some people get bored with stuff really easy. Right now it's a new thing they could do every week. Right. But the goal is that at the end of it, it doesn't matter whether you picked up or found your thing, you just did it for an entire year, 52 different ways, but you did it. So at the end of the year, you still have the result, even though you didn't realize you were kind of doing that, you know, here I'll, I'll tell the audience one thing that they can do that works for everyone period.

Speaker 1 (10:23):

And it's only if you do it. So just remember you have to do it, actually do it. And it's something I do with all my clients. And it's called no negative and try it for a week. Try for a few days, it's really about awareness. And what I started them off doing is I literally have them take their phone, their stopwatch feature on their phone. When they wake up, they started the very first instance where they feel, say, or do something in the quote negative. They have to hit the stopwatch button, record the time, write down kind of what it is. They were doing, what it is, they're feeling what it is or how I was saying. So you wake up, you hit this, do you start the thing? Like, oh crap. I got to go to work. Gosh, 12 seconds, 12 seconds elapsed. All right.

Speaker 1 (11:06):

Oh crap. I have to go to work. All right. Start the button again. Okay. Brushing my teeth, got to pick out clothes. I got dressed. All right. Hit the button. Right. And, but that's it because you'll see, even by the end of the first day, people are shocked at how many, how many, but also how often and frequent things come because you live your life on autopilot all day. You don't realize that you're living sometimes in this hugely negative space. You think you're fine and you can't figure out why you're grumpy by the end of the day. Well, if you're telling yourself, oh, every five seconds, this isn't good. That's bad. Oh no. We've got to think about this. Yo of course, you're going to bring your vibration down. And your day is going to suck by the end of the day, every day. You know what I mean? It just is. So, so that's a technique I like to do. And that's only part of the technique, but that, that, that level of awareness, just as eye-opening most of the time. So that's a fun one to do. Oh, that's great. I'm going to try that. Oh gosh. Look, I'm already negative. No, no, no, no.

Speaker 1 (12:08):

Yes. All my new Yorkers let's do it. We all know how we are. We think we're funny. We're really like sarcastic and negative. Yeah, exactly. Oh my gosh. Yeah. I'll try that tomorrow. And we'll see what happens. I will report back to you. So, so obviously we know mindset is something that can be altered. Can't be changed. It can be positive. It can be negative. So how does that affect our outcomes and in how we live our life every day? Yeah. So, so let me give you an example. I call it the kindergarten story because I think it's kind of common for a lot of us. So I want you to imagine that you're in kindergarten. If you're listening to this outside of the country, it's a one year about four or five years old. It's the first level of school you go to here in the United States.

Speaker 1 (12:58):

And we have this thing called Valentine's day. And at the kid level, we just, you know, get a bunch of candidates together, throw a bunch of cards and give one out to each member of the class. But sometimes there's that special Valentine. Right? So, so let's say little care. It's kindergarten. And she's all excited. Turned her mom made all the little Ballantine things she's handing out. But Joey, her best friend, well he's has the special Valentine. And she's going to ask him to be his, be her beer Valentine. Right? So Karen goes up to Joey, we made a special bone. That'd be, will you be my Valentine? Joey loves comedy. He says, oh my God, Kimmy just asked me. And she's super cute. I'm going to totally be here Valentine. Now little Karen's like, wow. Now little Karen's had picked up this message, but it wasn't said, but this is what you heard.

Speaker 1 (13:46):

You're ugly. You can't get the guy. Oh, and Kimmy with brown hair and purple eyes. She's that's that's that's the ultimate cuteness. Like that's that's it. Now she's four. She goes home cries. Mom, mom fixes it. Everybody has dinner next day. You're for you, Joey and Camy. By the way, you're all besties. You're hanging out. Like nothing happened. You, you feel like you don't feel it. It was a split-second. It was a moment it's gone. It's not really gone because let me tell you what happens now. She matriculates she's in middle school and Karen has to ask a boy to a dance. It's one of those Sadie Hawkins thing. So the girls have to ask the guys. And so her and her bestie and most people at this age have faced some kind of rejection, whether it's in the girlfriend, boyfriend, lover section or, or any other part, like not getting the baseball, you know, position, whatever it is.

Speaker 1 (14:34):

So we understand rejection. So we're fearing a little bit and we're nervous. So it's natural. Right. And everybody will tell you that. Oh yeah. It's natural. Don't worry. Just go ask anyway. So you and your Bessie, of course, it's Kimmy go. And you're like, okay, all right, we're going to ask our guys. So Kimmy goes first. Can we ask the boy? And he's like, yeah, sure. What out? Right. So Carrie was like, yeah, I'm going to ask Tony. She goes up to Tony. She asks him. Tony was like, man, I wish I could go. But I can't. Now what Karen doesn't know is that Tony is a son of the local preacher and he's not even allowed to go to school dances. Tony is secretly actually in love with her. But he has to say no anyway, but all Karen hears, not consciously, but subconsciously because she doesn't remember five years ago, she all she hears subconsciously is yo dumb.

Speaker 1 (15:19):

Don't you know, you're ugly. Why you try to do this? That making a fool of yourself. You know, you can't get the guy just stop. You are not pretty. You are not enough. You can't get him just up. Okay. Underlying, underlying thought the overlying crunch thought, oh man, I can't believe it. I'm so to the point and maybe he doesn't like me, right? Like, why is it so easy for Kimmy? Why isn't it the same for me? Like, it becomes that now you can't leave Karen out. Karen's like, all right, she's going to high school. She's like, you know what? I don't even care anymore. I'm bringing to the new high school, new me, everything. She goes out, she becomes a head cheerleader. Everybody loves her. She's popular. She's gorgeous. She's smart. She's funny. She's nice to everyone. And so she's, she's the girl, there goes Joey from kindergarten.

Speaker 1 (16:08):

He's the captain of the football team. And you guys are of course still talking. So Hey, what up? You start dating on the outside. It it's like the ultimate thing. Like, you know, you've made it right. You've arrived. Like this is it. Like, this is everything that everybody dreams of. Right? Prom, king prom queen. We're going to do it. You know, Joey's all happy. But Karen Karen's like, dude, Tom feels weird. Why doesn't it feel right when you think he's cheating on me? Like you think like, what's going on? Like, like I know we, we look so good together. It looks, it looks like it should be perfect. This is actually everything I ever wanted since kindergarten. But I dunno. I think, I think, I think he talks about, look at, look at him, smile. Look at him, smile at that girl that just walked by.

Speaker 1 (16:51):

Look at him, say hi to everybody. Right? She starts going, yo crazy lady. I take taken his phone, looking at his text messages. Eventually poor Joey. Now she's creating damage and Joey, but you always like, all right, forget it. I can't, I'm done. Right. And then Karen thinks, oh yeah. That's because you're right. Your cheater, you're doing something right. And she has to solidify in her mind. What's going on? So now Karen gets smart in college. She's a psych major. She's not going to play this game. She thinks she's good. She finds herself a man, they get married. They have kids. But again, something's not right. Like it feels wrong. Like it doesn't feel good. It's supposed to feel amazing. Right. But, and then she starts picking on things like, why can't you take the garbage out? Why can't you take it on time? Why can't you put it in the bin?

Speaker 1 (17:36):

Right. Right. And all this weird things has nothing to do with the garbage in the bin. And it has to do with this internal, emotional strife that she can't release because she's not quite sure why she doesn't feel right. But the truth is it's because she's too ugly to get the man, this man she doesn't deserve. It's not right. He couldn't possibly be there for the right reasons because she's not good enough like that. And it plays out in this way. That's why it's important. Because every day when you wake up and you have those negative thoughts and you enter these scenarios and things come crashing into your universe, it's usually in your head, that's created it at some point or is receiving it in some way. Right. And you're being reactive, like a five-year-old to it. And you don't even know you're doing it.

Speaker 1 (18:18):

So if you want to have a nice, happy, easy, joyful life and wake up bounding out of bed, like if a kid on Christmas, this is the head game you got to play with yourself. It takes work. Right? No. Yeah, yeah. Yeah. I mean, you know, just like anything else, it does take, it takes consistent effort in, in getting it done. And actually to be honest, sometimes it doesn't sometimes just the awareness of the thing makes the thing go away. But you have to remember, you have been imprinted every second of every day, since before you were even born in utero with an impression and emotion, something okay. To date. So if your brain decided to take all those impressions and make a big deal out of them, well, you're going to be undoing a lot of stuff. And that's why it's layers. That's why it's kind of like, you know, when I'm working with CEOs that are, you know, in multimillion dollar companies, and now they're about to go into something and like close to a billion and they have all this stuff going on.

Speaker 1 (19:13):

Or, you know, I was just talking to an athlete who started a business and he was like, I should have been so much further. And you know, and you know, we broke it down that the work that he did to become an athlete, to become an MMA fighter is not the same level of work he's doing in his business. Right. He, he, he practiced every day. He, you know, ran, kicks every day. He had people watching him, critiquing him, helping him, mold him. He spends like three hours a day in his business, but he wants it to be a superstar rocket, you know? And it's like, well, you didn't get into the octagon and fight and win your first fight by, you know, being around for three months. You've been in this business three months. But you think you should be like a millionaire, like where is that coming from?

Speaker 1 (19:54):

Right. So it's, it's, it's all it's, it's it's in your head. Yes. I, I understand. I get it. I get it. I do. Now let's talk about, if you have something let's say in your life that is not going maybe the way we want it to, which let's be honest. I think that happens too. Can we say everyone at some point? Oh, of course. How can we leverage our mindset to change this so we can change our results? Okay. So I'm gonna, I'm gonna, I'm going to go a little woo on you here. So it's a combination of your thoughts and your energy, right? And so you know, just to, to focus on the mindset aspect of this, you can really dig into, you know, how would I deal? You have behaved, have responded, have done something. And how did you, you do it.

Speaker 1 (20:55):

What's kind of the difference. And how do you step into ideal you? How do you make decisions from that higher place? Right. just taking business, you know, let's say you're going to go into, I don't know, marketing and you have to pay marketing people. Well, you, you might say yeah, that's really expensive. I'm not doing that, but higher, you might say, Hey, actually I understand the long-term game. I'm willing to wait it out to six months. It'll probably take for me to recoup money back and let's go for it. Right. I would ask the right questions and it would know the right information and it would make the right decision. Right. So, I mean, when it comes to mindset and looking around your life and finding the things that you don't like, that's the start, but now what are you kind of leaning towards and what are you pushing away from?

Speaker 1 (21:41):

What have you settled for? Okay. Like notice that, because a lot of times in our lives, we settle for certain things. We want this ideal image, but then we're like, oh yeah, it's okay. You know? And so look at all these things because they all add up. I mean, there's a, there's a bunch of questions you can ask yourself, but I would really just start with, where are you, where did you want to be? Why did you want to be there? That's a big question. Okay. So, you know, think about all the people that go to college at, went to college and pick a major that had nothing to do with them. Right. you know, I wanted a big house in New Jersey when I first became a lawyer because I grew up and that's what everybody had. I didn't realize I don't even want to live in New Jersey.

Speaker 1 (22:25):

And I don't think Jesus, you know, I mean, like it, but because it was so familiar to me, I thought that's what I should be doing. And I wanted nothing to do with it. And so it caused every time I wanted to go look at property or do something, it always fell through, it always didn't happen. Well, it was the universe saying peace woman. Like, what are you doing? Just stop. But in the, my reality in that moment, it was frustrating. Like I tried so hard trying so hard and it's not working out. Right. And it was just like but you do get the signs. I mean, I think the biggest thing is, you know, again, with no negative, you start to look at your stressors too. You start to see the common themes of what you're saying to yourself, what you're hearing and really stop.

Speaker 1 (23:08):

You know, one of the, one of the, another thing that I love doing is when you're really in it in the moment. And when you're super about to be reactive, you know, about the Chuck that, that coffee across the room, just throw a big red stop sign in your head. It's called a pattern. Interrupt to stop, throw the sign in your head, just see it and just stop, stop, stop, stop, stop, stop, stop, stop, stop. And just stop. Because what you're doing is actually stopping that subconscious chatter. When you do that, and that's like an immediate thing that you can do that you don't have to deal with everything that's going on around you, because sometimes you can't because it's so in your face. But as long as you stop, as long as you stop that thought pattern, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop.

Speaker 1 (23:49):

Right. That actually just practicing that alone starts to stop the mental pattern that you have going on. All you have is a mental pattern, a little talk pattern, a little, you know, little repeat on loop, right? That's what you're stopping that alone can elevate you like everybody listening to this, you know, if you think of your life right now on a scale of one to 10, 10 million, like, oh, yo upper rockstar, one being like, dude, am I still alive? Like, how am I even still here? Didn't I like do something last week. That caused me to not be here because it's so miserable, right? Like that level. Okay. So on a, on an overall one to 10 rate yourself, then do no negative and stop just the pattern. Interrupt. Stop yourself every time. You're when the, when the bar reset. Isn't fast enough. Stop. Stop, stop, stop.

Speaker 1 (24:33):

Stop. When the dog just, you know, somebody else's dog ran across your foot. Stop, stop, stop, stop. Stop. When a door closes on your dress, your skirt, and you're about to get stop. Stop, stop, stop, stop. Just stop. You don't even have to think any further, just stop that's at the top. Move on, do it for a week. Now again, one to 10, how do you feel rate yourself? Your number is going to go up and then your brain is going to start with this. Oh, but nothing changed. Why do I feel? But, and then you're gonna question it don't it just is. And it's actually just that easy. So excellent. That's a great exercise and very, very easy. Anyone can do that. It takes nothing. You just have to stay, say stop. Yep. And those, when that those thoughts start rushing in and we all have them every single day.

Speaker 1 (25:24):

Yes, we all have them. I think that's great. So now, as we start to wrap things up, what do you want the audience to take away from our conversation around mindset? Well, I mean really just the basics. I mean, the fact that it is important, you have to pay attention to it. The reason you're here, wherever that is in your life is because you didn't, maybe you didn't know, maybe you didn't care to, maybe it wasn't as bad yet, but if, if you're still trying to get to that next level, then you have to pay attention to what you're saying yourself at this level. And I don't care what level you're going to or where you're coming from. That's just it, you know, where they're coming from, coming off the streets to your next level, or you're coming from your, your $50 million company and you want to make it a hundred million.

Speaker 1 (26:10):

It's the same thing. You have to hear what you're saying, because it's dictating your reality period. And so it's really important. And that there's a lot of resources out there. I mean, I can give you some resources as well, but you know, there's tons of stuff out there and it really is simple. It's just, it's, it's simple and taking action and everything changes and it can change in minutes. Yeah. It's the taking action part. That's the hard part, right? Everybody can read. You can understand the action that has to happen. Let me tell you, let me just really quickly tell you that that's my too. So you have to live into the being. So let me just give you an example. So I was very athletic when I was younger. You know, I didn't work out at all. When I had my child, my child is now 12.

Speaker 1 (26:52):

At the time that I had to do this to myself, she was 11. And I was like, oh, I'll kind of get into that place where you still look good with clothes on, but not so much when you take them off. So I was like, maybe I should work out. And I thought, oh, this is second nature. I'll just go work out. I live on central park here. So I'll just now. And I did everything. The micro habit, the be dressed in your sleep thing, the sneaker girl, if I tell you that at some point I felt proud that I got out the front door and want a cup of coffee to come back. And that was my workout. And I had to do my own techniques myself, which is what is it? I believe like what happened? I obviously no longer believe I'm an athlete because if I did, I mean, this is easy.

Speaker 1 (27:30):

Right? And that's what I thought I believed consciously. Well, when I dug down to it over the past, you know, 10 or so years, my friends had been getting a little snappy with me saying things like, oh, you eat like an a-hole, you still look good and I didn't work out. So then they knew that like, how do you not work out? And, and we work out 10 hours a day and what's going on. And there was part of that, that seeped into me that was like, oh, that's right, girl, eat whatever you want. Look good. You don't, you don't need that. Right. And well, it worked for 10 years, but obviously I needed to change. And the second I realized that I was letting those things come in, that it was easier to hang out in bed that I always had tomorrow that, and I changed that core belief.

Speaker 1 (28:11):

And I, and I really had to dig down into why, like, I want to be the grandma who like flies through the trees on zip lines with her grandkids. I can't do that in 10 years. If I don't exercise now. Right. I had a drill into my head. Oh my God, I love running by the way. Don't really, but I love running. I love running. I love running the second I did all that stuff. Right. And it actually took overnight. That's all I did. I did it one day. I wrote down the thing. I said it to myself again and again. I said it to myself in the mirror and I was like, yo, you, you have this, like, what's wrong when you have this right now woke up the next morning. I actually ran a whole mile. Now it doesn't sound like much, but 10 years sitting on my.

Speaker 1 (28:47):

Pretty good. That's great. Yeah. That's nice. So it's really convincing yourself that you are the person who does the thing. If you are the person who loves to do all this weird, you know, personal development stuff, and you'd love to say stopped yourself and you've loved it. Guess what you're going to do. You're going to do it. That's it? It's that simple. Yeah. Yeah. Oh my God. That's such a good example. Thank you for that. Now, speaking of resources, where can people find you, your podcast? Talk about the podcast, your resources, everything else. Yeah. Awesome. I mean, you guys can go to just my name.com. So it's Kiersten franklin.com. And I don't know if you're able to put that in the description. And then the podcast is just girl on fire. So if you want to just Google girl on fire, it's unbelief B L E V network.

Speaker 1 (29:36):

You can find it anywhere, apple, iTunes, all that good stuff. Yeah, that's it. Yep. And D and we will have links to everything, to all of her information at podcast dot healthy, wealthy, smart.com and the show notes under this episode. And we'll have your on social media. Do you want to give a shout out to your social media handles really quick? So someone can find you really easily. That would require me to know what they are. Well, it's all on your website. Yeah, we got it. We got it. No problem. We will have, I will put them all in the show notes individually. We're good. Don't worry about it. Now, the last question I always ask everyone is knowing where you are in your life and in your career, what advice would you give to your younger self?

Speaker 1 (30:29):

I would tell myself that none of it is a big deal. It's not as big a deal as you think it is, you know, all that lost time on stressing out and trying to make things happen and living by force, as opposed to living as a conduit where everything's flowing through you. Massive difference. My whole life has been lived by force winning, winning, winning, getting by force. I probably could've gotten the same exact stuff, Ben, the same that, and just nice and easy, you know, massive difference in life. Let me tell you. Yeah, I was relaxed. I love it. And I've heard that several times from people guests on this podcast. So there's clearly something to that. So for all of you, new new grads out there, college kids listening, relax. And I love, can you say that again? You want to be sort of a conduit versus a forest.

Speaker 1 (31:25):

Can you repeat that one more time? I mean, I, you know, listen, there's two ways to manifest, right? There's the manifestor force, right? Like, like you're going to get it. You're going to get it. You're gonna do everything class. We're going to fight, fight, fight. It's by force and you're gonna get it versus actually when you open up and you let the universe and all of his power flow through you, you're going to get the same things only. It's nice and easy, right? When, when something doesn't happen or someone candles or it moves when you know that it's okay, that it's all just going to be fine. It's your life flows through you. You are a conduit. I it's true about finances, about love, about anything, right? If you, if you're having financial difficulties, right. And this is going to sound crazy, I know it's gonna be painful for some, but if you open up and you just let it flow through you, all of a sudden you're going to just have more and more and more money, right.

Speaker 1 (32:15):

Because it's not about you getting money. You're the conduit. So the university saying, all right, I'll throw money at you because you're giving it here. You're helping people there. You're doing this. Right. And it just, just like, love like energy. It's just things you're, you're, you're a vessel it's supposed to come through the gifts that God gave. You are not for you. They're supposed to float through you so you can help others. If that makes sense. Yes. It, and thank you for that. I love it. So Kiersten, thank you so much for coming on the podcast and spending the time with us today. I really appreciate it. Absolutely. Thank you so much for having me. It's so fun. I always love seeing you. Yeah, my pleasure, my pleasure, and everyone tell the listeners out there. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

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  • Healthy Wealthy & Smart podcast

    568: Dr. Sylvia Czuppon: Life as a Clinician in Academia

    39:55

    In this episode, Dr. Sylvia Czuppon, Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine, talks about balancing her role as an academic with her role as a clinician.   More about Sylvia Czuppon:  Dr. Sylvia Czuppon received her Bachelor of Arts in Psychology in 2000, Master of Science in Physical Therapy in 2002, and her clinical Doctorate in Physical Therapy in 2011, all from Washington University. She received her Certification as an Orthopaedic Clinical Specialist from the American Board of Physical Therapy Specialties in 2010. Her work has been published in British Journal of Sports Medicine, PM&R, Physical Therapy, and Journal of Orthopaedic & Sports Physical Therapy. Dr. Czuppon is currently an Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine in St. Louis, Missouri. She divides time between outpatient clinical practice treating musculoskeletal pain patients and teaching orthopaedic content in the professional DPT curriculum at Washington University. She has given local, state, and national presentations on lower extremity injury rehabilitation and return to sport. She volunteers her time educating coaches, parents, athletes, and the community about youth injury prevention strategies.   To learn more, follow Sylvia at: Twitter: @czuppons   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:03 Hey, Sylvia, welcome to the podcast. I'm so happy to have you on.   00:07 Thanks for having me, Karen.   00:08 Of course, of course. And, you know, we were talking before we went on the air about, you know, not seeing people in person and going to conferences. And the last time we saw each other was in Vancouver, at the third annual World Congress of sports, physical therapy.   00:30 Yes, right. That's right. Yeah,   00:32 I think that's correct. Yeah.   00:33 I can't believe it's been that long.   00:34 I know. I know. 2019. Right. Beginning of 2019.   00:39 I think it was. Yeah, it was COVID. Year, but it was before all that stuff. Yeah, yeah,   00:43 exactly. And, you know, shameless plug, the fourth annual World Congress on sports. PT is going to be outside of Copenhagen in August of 2022. Absolutely. So I encourage people to try and and your fingers crossed, it'll work. I keep saying 2022. It's gonna be the year. So shameless plug for that. Now, let's move into you. So today, we're going to be talking about life as a clinician and academia. And I love this topic, because I think there's a lot of clinicians out there who are wondering, well, how do I get into academia? How do I how do I do that? So why don't you give the listeners a little bit more about your background and how you did it? Sure. Yeah. So   01:38 I've been fortunate to be on faculty at Washington University in St. Louis for 15 years now. I think, approximately, it's been a while. And yeah, I sometimes I'm like pinching myself. I'm like, How is time flown that way? How 15 years? Yeah. 15 years? I graduated in 2002. So yeah, yeah, it is, oh, my gosh, I   02:05 can't believe it, I can't believe it.   02:07 So. So when I, when I joined the faculty, honestly, it was it was a nice, it was a nice mix of events. When I came out of PT school, I knew I wanted to do a little bit of teaching, but the Washington University at least, recommends that you have about a year of clinical practice under your belt before you join an academic institution. Like lab assisting. So that's how I got my start, I started lab assisting in classes that had orthopedic content. And when a position on the faculty opened up, I, I basically jumped at the opportunity got lucky enough to be hired. And away I went. So when I first started, my split, I think was 90% of my time was in clinical practice. And about 10% of my time was in, it was in teaching and it was all a lab assisting. And over the years, that is at has morphed considerably. I'm about 5050 right now. So I spent 20 hours a week in the clinic and 20 hours a week, teaching or doing teaching related things. And it's been a I don't think I'll ever go below that. But who knows what will happen. But I like that balance that I've struck right now, I can't ever see myself coming completely out of the clinic into teaching, like some of my colleagues have done, you know, you go to PT school to become a clinician, you don't go to become an educator, otherwise I go to, you know, to get my teaching degree. And I think that's probably been one of the biggest challenges is I am a PT, learning how to provide high quality education without an education degree. So there's been a bit of a learning curve associated with that as well.   03:42 And what do you feel are the advantages of being a clinician and, and working in academia? So what does your clinician hat bring to your students?   03:55 Yeah, you know, I think it's interesting. So, um, as a clinician, what is nice is I can give them I don't want to call it real world application, but it really is. So they students, we teach them in the ideal scenario, like, Okay, your your patient comes in, they have this positive test this positive test this positive test, what must be their diagnosis? Is any patient ever that cookie cutter clean No, 99% of the time, they're not right. So we teach our students in the best case scenario, the easiest ways to understand and so being a clinician, I can still give them a little bit of perspective, but like, here's where the gray areas come in. And this is why we teach you that ideal scenario so that you recognize the ideal, but here's how you can kind of think more with the clinical hat on it's a little bit similar to being like a clinical instructor. I think that's the greatest part about being a clinical instructor and shameless plug for those of you that are out there that are not clinical instructors. We need a lot more of them there. You know, our students are. It's such a rewarding experience. It really is. It's time consuming, don't get me wrong, but it is very, very rewarding, but I'm so be so being a clinician and being able to, to give the clinical the true clinical perspective on some of the things that students is learning, I think can be, can be invaluable. Like I have students all the time. They're like, Sylvia, this this sounds like a load of hooey like this doesn't even make sense, like help me understand when I would ever do this, and to be able to tell them look, you know, this is exactly why you need to know this level of detail, or this is why as a, even though, you are determined to go into sports, physical therapy, or you're determined to go into orthopedics. This is why you need to understand neuro for example, like, this is why they teach you neuro related things. I think I posted on Twitter, you know, like a couple of weeks ago, I've been to patients this year, that I think I'm, you know, not to toot my own horn or anything, but it's unfortunate, these people fell through the cracks, I think, in referring them out, both of them have gotten a diagnosis of ALS that nobody caught before this point. And it was based on what history they had given me, as well as some of the signs and symptoms that I saw with it within them. They referred to me like one had scoliosis, and horrible back pain, and another one that was a total knee replacement. And those are not diagnoses, you would expect to have ALS diagnoses associated with them. But some of the other things they were describing, it was terrifying. And just, again, like these are things to help students understand that they all do go together, you're treating a person that doesn't come in with a strict diagnosis, you're treating a whole person. And they don't always get that in the education setting when we're giving them fabricated cases.   06:27 Yeah, I couldn't agree more. And that's, that's amazing, by the way, from a clinical standpoint, that you were able to refer them to the right people to get the right diagnosis. Yeah. And that's, you know, and again, that's where physical therapists come in. And I'm sure that this is part of your teaching to your students that, you know, we can be that kind of primary care provider, you know, and even the second opinion,   06:56 sure, sure, yeah. And it is, it is one of those, you know, Missouri is not a direct access state. And so it's interesting, like teaching in a non direct access state, because we do typically get the patients they have the referral, it's generally pretty accurate, but you get some of these that fall through the cracks. And it's why we get the training that we get as physical therapists, you know, for those scenarios. But even again, in a non direct access state, these patients had been screened by other physicians, and it possibly just the complexities of their care, it just things got missed. So   07:33 amazing. Well, now, let's talk about what your responsibilities are, as a clinician, educator, so if you want to break it apart clinician educator, separately, or just let because I think it's important if people are interested in in, going in this direction, they need to know what it entails and what their responsibilities. Sure.   07:59 So I think it's a little bit different if you're so so my position is a faculty member means that I split my my time, assume a 40 hour work week, you know, nobody who actually works that when they're a faculty member on any any academic program, but, um, so I split my time for many people that come from a physician, whether lab assistant, in addition to holding a full time job, that's usually hours, in addition to whatever your hours are in a week. So when I was working as a lab assistant, before I joined faculty, I was working 40 hours a week plus lab assisting X number of hours a week, so there was a little bit of that, because very few employers will give you that time off and say, Oh, you want to live six, eight hours, we sure only work 32 hours here, like, it's very difficult to get that. And then depending on when the classes are during the day. So we have labs from like one to three, some people couldn't do that it's smack in the middle of prime, you know, treating hours. So that is definitely a consideration that people want to make. If you're working part time, it becomes a whole lot easier. Your schedules are a lot more flexible, as a faculty member, so I have 20 hours a week, again, dedicated to patient care, 20 hours for teaching. So in my patient care responsibilities, I basically have a set schedule that is has to be designed around the times that I'm supposed to be in class. So that has to probably be the worst for the person for my for my clinic boss who has to come up with the clinic schedule. He's working around everybody's class schedules and the times that we can actually physically be in the clinic. And so I treat in our clinic, we have a one on one model, so we don't overlap patients, you know, and so that's, that's really nice. We do have physical therapy assistants that we work with as well. And so I balance my caseload, I feel like any like I would anywhere else, I have autonomy to decide when I want to delegate when the patient needs, needs to come back to CV, frequency, duration, all of those kind of standard, standard types of things. Um, I am fortunate because I've been there long enough that I do get a little bit of flexibility and asking for the patient. Two types that I want to see. So I love the postoperative knees and any knee, really. So I do get a little bit more of those than maybe some others do seniority, it's great. And then my academic hat is complicated. So I'm depending on what semester in the year that we're in. And we're also going through a curriculum renewal right now, which is a whole nother whole nother topic of discussion. But in some semesters, I am a course master for for a class. And so that entails doing everything you would expect from a course to making sure the syllabus is up to date, to organizing exams, practicals, lab assistants, supplies, outside lectures, patient labs, etc. to an other the other semester I am, quote, unquote, just a course assistant, so facilitating the course master with all of those duties. So those hours are kind of wrapped up in our actual academic time. So if I have 20 hours a week, and I'm only in lab for 12 hours, my other eight hours are supposed to be spent doing all these other behind the scenes things which are, which easily kind of add up. So it is a little bit of a mix, and the curriculum renewal that I was talking about. So Wash U is going towards more of competency based education, which I think is the movement in education as a whole. And so we're we're in the beginning stages of that our first year classes going through the start of our new revised curriculum, and I am helping to craft the second year curriculum. So that's a huge task, taking what we currently have reorganizing it, restructuring it into an even better product than what we currently have. So there's a lot going on, that is certainly more than 20 hours a week. So yeah.   11:49 And can you explain competency based education versus what's currently happening? I don't know if that's like opening a huge can of worms. But let's go for   11:59 Yeah, yeah. It's also challenging my my full understanding of this, because it's all it's all this is like a complete foreign language. It's like going through, as I as I kind of alluded to earlier, I'm going through, I'm becoming like, I feel like I'm going through to get my education degree in the process of learning how to teach the this material better. So with the competencies, it's essentially like saying, Okay, you're competent in gosh, there's domains, there's, there's all sorts of terminology, but basically saying that, like, okay, that you have this one domain of patient and client care, within that you have different competencies, like, I'm able to take a, I'm making stuff up, because I don't know them off the top my head, but like, able to take a complete history for like, able to do communicate with respect and dignity for the patient and care provider, like things like that. So there's different things that this student is now having to pass and show competence in these competencies, a pass individual competencies, versus getting a grade in a class to say, you're good enough for that grade, it could be really strong in one area, but really not great and another, but their overall grade is enough to move them forward. We want to kind of raise the bar a little bit and say, You know what, that was good. But we can do better. And taking it to like each one of these competencies you need to pass in order to continue on curriculum. Got it?   13:15 Got it? Well, that makes actually makes a lot of sense.   13:19 Does now trying to make every lesson plan, every lecture that you give mapped to every competency that you have is a whole nother topic of discussion. Yeah,   13:32 good luck. Yes. Yeah. Good luck with that. And now something that you kind of alluded to before, which I want to dive into is, so your 20 hours practice care, 20 hours teaching, and I put 20 hours in quotation marks, right? So we know as clinicians, it's always more than 20 hours, right? And in teaching Gosh, it's definitely more than maybe what you signed up for. So how do you and here comes the question, how do you balance all of that with the rest of your life? Because you've got kids?   14:09 I've got two teenagers. Yes, got a dog.   14:12 I've got two dogs, actually two dogs, you've got a home, you have got a life outside of all of this. So what do you do to balance it all?   14:22 Yeah, so that was probably the most challenging thing that if I could have gone back in time and talk to my younger self, I would have been like, don't say yes to everything. That was probably the first thing that nobody really ever told me. Because I thought that if I said, No, nobody would ever asked me to do anything again, you know, you feel like this. Oh, this is a fantastic opportunity. I don't know where the time is gonna come out of but I really want to do it. And so I just started I would say at the time yes to pretty much anything that sounded interesting. And even yes to some things that I was like, I'm not sure if this is what I want to do, but I feel like if I don't say yes, I'm going to lose this. They're going to think I'm not interested in it. Think so, naively when I was when I was a younger faculty, um, that's what I did, I said yes to literally everything and almost put myself in a horrible spiral of I had so many issues in terms of that work life balance, I didn't have any it was work, work work. And then life was like a tiny fraction of that. And that was when my kids were little, I've got teenagers that are 17 and 14 now. Um, but what I discovered over the years was that those opportunities are at least and I still believe this, if those opportunities were meant to be, they're going to come around again, if people really want you, they value your expertise and your knowledge and your skill set, they will come asking around again. And you know, just saying no, one time, and just even saying like, No, you know, what, now is not the right time, I'd love to help you out. Can you come back again, like, you know, if you have another project, just ask me. I mean, hopefully I'll have time at that point, you know, there's no, there's good ways to not just firmly shut the door right to leave that still open. Um, so I've found a better balance for myself now, because I've figured out what is super important for me, and what is not, like really important. So I started saying no to different class commitments that I had previously done, because it was it was stuff that was okay. But it was not my passion in teaching. And so I started whittling down to the things that that made me honestly, the maybe the most happy to think about teaching or be involved in. And when I started doing that, I did become happier with with how that balance was shaping up, because some of that work really wasn't work anymore. You were enjoying doing it, versus looking at it and saying, Man, I got three more hours of this that I've got to prepare for, and I'm just not feeling it. You know, there's a reason nobody's ever asked me to be an anatomy lab assistant. And it's, I mean, enjoy anatomy. Don't get me wrong, but the level of detail I just, that would that was not my forte. No, that was not my forte. And it's like, I want to know the applications and things that I'm interested in. But some of the things that they have to learn for PT school, it just wasn't wasn't in my wheelhouse. You know? Yeah. So it's like, things like that, where, where I just prioritize a little bit better.   17:06 Yeah. And I was gonna follow up question I was going to ask is, How did you? Like, what methods did you use to decide what was best for you? And what methods did you use to break down? Like, no, like, this is a No, maybe not forever? But uh, no, for now, this might be a no forever. This isn't a solid? Yes. Do you know what I?   17:30 Yeah, yeah, it wasn't in certainly not easy. Um, it came again, across several, several years to try to figure that out. So part of it came down to okay, I was lab assisting in multiple classes. And did I really want to stay lab assisting in that context? If the context, if there was a, there was an immediate hesitation in my answer, then I thought, okay, that can't be the number one priority that I really want to stay in that class. So then I started adding up hours, and how many hours a week? Or really, am I spending in that class? What could I replace it with? Um, is there another opportunity right now that I want to replace it with? So it was sort of like, figuring out the timing of things would be one thing? And then some of it was just just deciding, okay, well, I know it's gonna throw me over the, the 20 hours or whatever that I have right now. Am I okay with that for a little while. And for a period I was and then now that I'm older, I'm not, you know, I've got I've got a, I've got a teenager that's going to be leaving the house in two years. And I've decided, you know, what this would, this is the time I actually I want to spend with her, you know, not that I didn't want to spend it with her as a little kid. But now I'm like, feeling that like, empty nest feeling starting to grow. And I'm like, I don't want to miss, you know, all the things that she's doing. And, and so I've just prioritize, you know, what, no, I'm gonna say no to that. Or I'm gonna say, you know, I can't do this this year, or I can only do this for part of the time, like, admissions committee, you know, figuring out who we accepted to our program. Like, well, I can't do it the whole year, but I can do it for part of the year Will that be okay, you know, and try to work out compromises with the people that are there looking for my time.   19:11 I love it. And, you know, so often women have such a hard time with this. Yes, you know, yes. Because we think if we say no, like you said, That's it, we're done, or we're gonna be labeled difficult, or, you know, someone that you know, she doesn't, she's not interested. We'll never get back to that. Right. So I think it's, as a woman, we really have to kind of get over that kind of thinking and and realize like, Hey, if you say it's a no for now, but not a no forever and the people are like, Oh, God, she was setting it up, well, then they're probably not your people. Right? And that's okay to let that go as well. Right.   19:52 I think what also complicates it a little bit is this whole Superman thing, right, like women that believe they can literally do everything. So you've got to be the best parent, you've got to be the volunteer at all the PTO, whatever school stuff, the sporting team, the in then at school, and then it works the same thing, I got to be able to handle this whole load and show nobody a crack in my facade, you know, so that they can see that I can do it, you know, and if I do you crack, then they're gonna think that I'm weaker, you know, just stereotypes that way. I think that's obviously it's really unfortunate that that still exists. Um, but, uh, I, we're not super human, like we have, you know, we have breaking points too. And we need to know what those are for ourselves for our own sanity, you know, for the sanity of our family members, our friends, all the people around us, you know, the pets, yo, all of that. So,   20:43 yeah, and your students as well, like Have, have you ever kind of displayed that vulnerability, whether it be to your employer, obviously, your family, and that's a different story, but maybe to your employer or to the university, to say like, I'm reaching a breaking point. And so how did you do that?   21:04 Yeah, definitely. to the employer. Um, yeah. So So there have been times where and unfortunate our program director, gammon Earhart is amazing. And her predecessor, the CCD singer, was was great, too. And they've always been wonderful with this sort of open door policy. So when you hit that point, or you feel like you're coming up to that point, I felt 100% comfortable going to them and saying, Hey, guys, look, I am, I'm over my head right now. And I don't know what to do. Like, I really need some help. And they kind of talk you down a little bit and say, Okay, well, how can we make this better, I have been very fortunate to be supported in that role. Same thing with even my immediate supervisors within the clinic. Same kind of idea. I had some personal struggles earlier this year, unrelated to COVID. And having and knowing that I had that support system, by being in a good place, I think this is true of any job. But being in a in a in a supportive environment, where they were like, take the time that you need to get your your self. Right. You know, it was it was very nice to know that I had that kind of support.   22:12 Yeah. And so I think the moral here is, it's okay. Absolutely, to let people know that you're not okay. And it's okay to be vulnerable. And if you're the people you're working with or for don't accept that, then I think it's a clear sign to say, Well, wait, wait a second, what am I doing here?   22:38 Right, right. Yeah. And I would love to say like that, I have been fantastic. And always being vulnerable. That is definitely a lie. Nobody, nobody, nobody, nobody is and I, I, you know, grew up in a, in a, in a household where perfection was like, required, it wasn't even, you know, it was it was an expectation, just as you know, my hair is black. And it will say, well, it's gray now, but that it'll say one color like it was the expectation you will be perfect you will be you will not show or have any flaws. So bringing that into a scenario like I am in right now and telling somebody I'm not like I'm vulnerable, I'm hurting, I need help, like even asking for help was was a huge, huge deal for me. But again, I had I had a good support structure, even within my workplace environment to allow me to do that.   23:24 Yeah. And it is, it's hard to ask for help, you know, because because you don't want people to think you can't handle it. All. Right. Right. Right. So asking for help is I know, I have a really hard time asking for help. But I'm getting better at it. Yeah. But it is, it's hard to reach out, it's hard to ask for help. Because you're afraid that someone will maybe think of you as less than or incapable or whatever, you know, all those bad things that spin around in your head, right?   23:55 Or just that if they're thinking about asking you to help out with something that you really want to do, they're not going to ask you anymore, right? Like, you know, and kind of where I'm at as a as an associate professor trying to rise to the professor level in a couple of years, trying to take a larger leadership role in our curriculum, there was definitely a fear of well, wow, if I tell them that I can't handle what I've got right now. There's no way they're going to ask me to do X, Y, or Z. So do I risk doing that? Or do I just drown? And I wasn't willing to drown? No, no, no job is worth that. My personal happiness was not worth that. And again, fortunately, everybody was very understanding the the fear that I had built up in my head was no near nowhere near what I experienced at all. Like it wasn't there. They were like, You know what, we get it. Take the time that you need, it's fine. We'll figure it out. And we'll help you figure it out. We'll give you whatever resources you need, whatever support you need. So it was wonderful. It's really wonderful.   24:47 Yeah. And it's so important to kind of voice that because like you said, you're trying to kind of climb up this academic ladder. So if you never voiced that maybe you would never, you would never reach that Professor level. because you would have burned out left. Absolutely. Yeah. Right. So why not put those fears out there and and find the things that like not to use Marie Kondo here. I don't know if you know Marie Kondo she's so Marie Kondo is like this organizational guru. And her thing is if it doesn't bring you joy, get rid of it. Yeah. And so I wrote that down when you were talking about how, you know, anatomy lab, not for me doesn't bring me joy. This does. So I'm sticking with this. And and what you find is when you do the things that bring you joy, this sort of Marie Kondo method, I mean, she doesn't like, you know, does this shirt bring you joy? And if it doesn't know, this book, this, you know, tchotchke, whatever it is, but you can you can apply those principles, I think, in this scenario, when deciding what to say yes, and what to say no to? And even if you have nothing else on your plate at the moment, you can still say   25:58 no, sure. Absolutely. Absolutely. Right.   26:02 You can still say no, and that's okay. Absolutely, well, this oh my god, I'm so glad that we talked about this is so good. So let's, let's talk about now, I would love to get from you, maybe two or three pieces of advice that you would give to a clinician who's trying to break into the world of academia. Yeah,   26:27 so, um, I think with with clinicians, the first thing is that you've, you've got to know what your, what kind of teaching you want to do, right. So like, if you're, if you're an orthopedic just being happy with, I'll take any orthopedic class, that could take you from going geometry and manual muscle testing, to examination and treatment kind of thing. So knowing sort of what level you want to be involved in helps. Because when you're then approaching the education division director of a program, that's usually who you send your resume or your CV to, when you're interested, they can have a better idea of whether there's a need honestly, in the in the curriculum, for another lab assistant for another lecture, if there are certain topics that you know very well, that you are passionate about, that he would love to lecture on. I'm even offering that up, like, hey, you know, I have a special interest in blood flow restriction training, but I'd love to be able to share that with your students. You know, this is my experience and background with that, let me know if there's there's any any availability for that, I think that's that's another part of it. I do think that it is, um, it is nice if you have a connection to the school, I mean, obviously, like, I got fortunate, I graduated from Washington at school, I'm now in faculty here. So I already had a connection to the program, it made it easier for me to get my foot in the door, because they already knew me as a student. And then as a clinician, because I was in the area. I do believe it is harder when you don't have those connections. But that's where I think networking in general is huge, right? So like you and I, we met through the Twitter verse, and then of course in Vancouver, but like making connections because people that you connect with have connections elsewhere, right. And they might know, just in talking to you. They might say, Oh, wait, I remember Sylvia said that they were looking for X, Y or Z at their at Wash U, maybe you should reach out and talk to her and see if there's anything going on. You know, I think connections are the other part that that people value, but you don't necessarily value maybe as much as you should. As a clinician, I think I take for granted that. And I don't know, if you feel the same way, we travel a lot, we get to go to a lot of conferences, we get to get a lot of all these pre COVID, we went to a lot of conferences. And that's where a lot of the networking happened, right. Clinicians do have to take continuing education in order to keep their their licenses active. But I feel like clinicians are probably taking the cheap local easy place near them to take on it because they don't probably have the benefit, always a funding behind it like I do at an academic institution. And I think that's, you know, you do what you have to do, but finding other ways to network, whether it's through your state organization, like the Missouri Physical Therapy Association here, through the national organization through some of the sections like sports section, ortho section, you know, getting involved that way to make connections, you don't have to attend conferences to do this, but you can get involved. I mean, everything's through zoom right now, you know, and so being involved that way to make connections can get you in the door in other ways. And I think that's probably an underappreciated part of the whole, how do I get my foot in the door?   29:41 Yeah, I would agree with that. And I love all the options that you just gave for clinicians and even students who are thinking, hey, one day I want to do both. Sure, right. So let's know what kind of teaching you want to do. Reach out to people in the school if you have a connection if you don't have a connection start making those connections. Absolutely right. And as a student, I think connecting through whether it's a PTA in general, or the components or your state is a great way to do that. And I would also say, stay in touch with the with your professors.   30:17 100% 100%. Yeah, I mean, and your clinical instructors as well, I mean, for me, my first job coming out of PT school, was because I went back to talk to one of my clinical instructors, and she's like, Hey, by the way, we have a job opening, would you be interested in applying? And I said, Oh, I'm not sure. And she goes, Well, I already submitted your name. And literally, that's how I landed, my first job was like, Okay, well, I guess I have to like, contact them now. So it was great. Yeah.   30:41 Yeah. I love it. I love it. Okay, so now, as we start to kind of wrap things up, is there anything that maybe we didn't hit in the conversation that you came in? Like, ooh, I definitely want to talk about this. Did we miss anything?   30:55 The one thing I will say is, is being on faculty, what did help me was naturally meshing and getting myself a mentor on the faculty. So not all academic institutions, like I know why she didn't have it at the time. They didn't really have like sort of a mentoring program for new faculty joining. And I don't know if this is true for all academic institutions. But for anybody that's interested in doing that, or joining an academic institution, as a clinician, academic, or as a researcher academic, is understanding if there is some kind of mentoring program because without the guidance of my mentor, Marcy Harris, Hayes, there is no way I'd be where I was at today, Marcy was like, kind of like my voice of reason, she was the one that was just like, Okay, you your interests are like humongous Sylvia, you need to narrow it down a little bit, you cannot keep saying yes to everything. She was the one that pushed me in certain directions, because she knew that a gentle nudge would help me get to where I wanted to be, even if I didn't want to take that leap for myself. If I was doubting myself, she would be the one that would say, you can you can do this. She was the first person that put me in front of a crowd of 300 people at CSM. So I have a lot to say, and I never would have, I genuinely never would have done that without for encouragement. And her understanding that I was ready for it. As well as it was something that was going to help me in the future. And that I'd appreciate it later on down the line versus my fear, again, of doing it on my own, would have prevented me from getting that far. So so definitely identifying a mentor. And again, this is for clinicians, even to in the clinic, like don't go into a clinic, and just expect to just learn it all just on your own or through Con Ed guy, I would hope that whatever clinic somebody joins into, has some kind of mentoring program as well. So that you can learn you can shadow you can get experience from other people. And it's different than just being able to say to your your pod mate, hey, I had this patient that was a little complicated. What do you think like truly having a mentor, I think is a big, big thing. To help enhance the level of clinician you are as well as again, if you're an academia, how to get up that level ladder and how to navigate it to I think that was the other thing Marcy gave me was some advice on how to how to get a little bit further because she was ranked ahead of me, and she had some great personal experience. Pros and cons, I guess you could say, to navigate that.   33:25 I love it. I think that's great advice. And I love how you said not only get up the ladder, but navigate it as well. Right? Because there's a lot of things that are gonna push and pull you along each rung of that ladder. Absolutely. So I think that's amazing advice. Okay, where can people find you if they need a mentor? Or they have questions?   33:47 Yeah, so Twitter's the easiest place. So I think you've got my contact information, but I am on Twitter, and an email is perfectly fine as well. So they can find my email address just to the washi website. Or really, if you just Google my name, it's pretty impossible to miss. There's not that many Soviet coupons out in the world. There's none, in fact, so it's pretty easy to find me I come up readily on a Google search.   34:10 Excellent. And we will have all the all of those links in the show notes. And now I have a question that I asked everyone at the end, but you already answered it, but I'm gonna ask it again. And that's what advice would you give to your younger self?   34:27 Yeah, totally. My younger self would be learn how to say no, and how to prioritize what you really want to do. prioritize what's going to make you happy. What's going to make you the clinician, the person that you wanted to be when you grew up, you know, because if you sacrifice what you want for what everybody else wants, you're not going to be happy. Perfect, I   34:52 love it. Thank you so much. I appreciate this conversation so much. I appreciate you for coming on. This was wonderful. So thank you so much.   35:00 Yeah, thank you so much for giving me the opportunity to be on I appreciate it   35:03 too, of course, and hopefully we will see each other in person soon. That   35:07 would be fantastic. Indeed, indeed. All right, and everyone,   35:10 thank you so much for listening, have a great couple of days and stay healthy, wealthy and smart.
  • Healthy Wealthy & Smart podcast

    567: Dr. Meagan Duncan: Creating PT Safe Spaces for the LGBTQ+ Community

    34:26

    In this episode, Physical Therapist at Kelly Hawkins Physical Therapy, Meagan Duncan, talks about creating safe spaces for the LGBTQ+ community. Today, Meagan talks about trauma-informed care, navigating trauma during the subjective exam, and the importance of consent. How can PTs make clinics safe spaces for the LGBTQ+ community? Hear about the discrimination faced by the LGBTQ+ community, doing community advocacy work, and get Meagan’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Gay men can undergo sexual violence at twice the rate of straight men. 50% of transgender people will experience some kind of sexual violence in their life. It’s even more if they’re a minority.” “Being trauma-informed is important in any discipline because you don’t know what somebody has been through.” “I think it’s about really small gestures.” “Starting with paperwork, gender has every option you can think of. If it’s a paper form, gender’s a blank space.” “We have small flag stickers for every flag that you can think of with all the colours that represent different parts of the LGBTQ+ community.” “Be more vigilant about asking for consent.” “Asking for consent is something that should be ongoing and all the time.” “Education is a big part of asking for consent, because in order to consent to something, people have to understand what it’s going to entail.” “Providing options Is a really important part of consent.” “It’s not patient-directed care. It’s patient-centred care.” “Don’t just go around touching people without consent.” “Find a niche. If you can find a niche that you are passionate about and that is needed, you are never going to struggle for work or for satisfaction.”   More about Meagan Duncan Meagan Duncan is a Chicagoland native who earned an associate degree as a Physical Therapist Assistant in 2013 from Kankakee Community College. She then worked for six years in an orthopaedic setting while earning a Bachelor's in Interdisciplinary Studies from Governor State University in Illinois. Later, she moved to Las Vegas to earn her Doctor of Physical Therapy degree from the University of Nevada Las Vegas in 2020. As a PTA, she developed and ran a pro bono clinic at her first post grad job in her hometown of Joliet, Illinois. She now practices in Las Vegas and specializes in pelvic health after completing a specialty clinical rotation with the VA Hospital in Las Vegas. Duncan currently works at Kelly Hawkins Physical Therapy, a prominent outpatient physical therapy company in the Las Vegas area. At Kelly Hawkins, she built a successful pelvic health program that she has overseen and grown over the past year and a half. Duncan also works for NPTE Final Frontier, a premier national physical therapy exam preparation company that works with domestic and foreign trained students to help them pass the board exam. In this role, she tutors PT and PTA exam candidates and assists them with content development. She advocates for students and professionals to balance life outside of physical therapy. Outside of her profession, Duncan enjoys hiking, biking, paddleboarding and anything she can do outdoors with her husband and dog. She is excited to welcome a new addition to her family soon, as her first child is due in a month.   Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, LGBTQ+, Inclusion, Trauma, Pain, Discrimination, Sexual Violence, Advocacy, Consent, Pelvic Health,   To learn more, follow Meagan at: Email:              [email protected] Website:          https://www.kellyhawkins.com LinkedIn:         Meagan Duncan   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hey Megan, welcome to the podcast. I'm happy to have you on.   00:06 Hey, Karen, awesome to be here. Thank you for having me.   00:09 Yes. And like I said in the intro, today, we're going to be talking about creating physical therapy space, a safe spaces for the LGBTQ plus community. So before we talk a little bit more about that, can you let the listeners know where your passion for this community comes from?   00:27 For um, so I guess I feel like I'm just kind of a fan of the underdog in any situation. And I can't say that I have personally experienced, like so much in this community, aside from having a lot of relationships with people, and seeing what they go through and what life looks like on that side of our world, because it's a very different experience from what I've had as a heterosexual, white female. So when I was in high school, I just kind of ended up best friends with a gay man. And he kind of brought me into the circle of his friends, which ended up being just a really large, wonderful welcoming circle of people on all spectrums of the LGBTQ plus community. So I got really interested in just kind of gay rights and things like that went to marches and did all of that. Tried to advocate for the community as whatever I need to do as a 16 year old, which was not very much. And now I found myself in this position that I can do something which is awesome. And it's not even necessarily something I thought about when I went into the niche that I'm in. But I am really happy to be able to finally say that there's like some baggage behind this lifelong commitment that I kind of said that I had towards the community, but was never really doing anything about it other than like, your like Facebook posts here and there that talk about, you know, advocacy or supporting a community that's not well supported. So I'm happy to be able to do something about it now.   01:56 And let's talk about what you can do, or what we can do as physical therapists to help support this community, because I'm sure a lot of people may be listening to this and say, Well, what does the community need? That's so different from the rest of of other communities? So what is it about this community in particular, that perhaps they're more exposed to certain things? Or do they not get the care that they need? So go ahead, I'll pass the mic over to you.   02:27 Yeah, absolutely. So just discrimination in general, it's a problem in so many realms of social issues, being gender and sexual preference, of course, is one of those huge ones. So people feeling like or actually having less access to healthcare, getting denied health care, or getting given less than optimal treatment, or not really getting the best of their provider because of discrimination or because of biases that those providers have. Likewise, they might be afraid to go to facilities or go get treatments for things that are going through because they've experienced poor care before. So my niche actually, is pelvic floor physical therapy. And in this, there is so much that I can do for the community and physical therapists as well. And I was thinking about this podcast and thinking, what actually makes my job so different from the way everybody should be treating everyone. And I think there's a lot to learn, aside from just treating in pelvic floor PT. But in pelvic floor PT, I see a lot of people in the community because they are much more exposed to sexual violence and sexual trauma. And that correlates really significantly with pelvic floor dysfunctions. So we know from studies that gay men can undergo sexual violence at twice the rate of straight men, transgender people will usually experience about 50% of people will experience some kind of sexual violence in their life, which is a huge number 50%. And then it's even more if they're a minority. So that's a huge community of people where like, most of them need our help or need pelvic floor PT, or need more support than they're getting. So I think that we can play a big role in advocating for people and making spaces where they feel like are welcome. Or be that person that they can come to and after bad experience, bad experience or bad experience in healthcare, they can come to you and feel comfortable. And that's a really great feeling from my end. And I hope that other physical therapists out that out there feel better experienced that because it's awesome.   04:29 And you know, when you're talking about sexual trauma, or sexual assault within this community, I mean, the thing that sticks out to me is trauma. And so there is more and more research. And I think more and more people are now aware of trauma informed care. So can you share with us some of the principles of trauma informed care and why physical therapists should care?   04:56 Yeah, so this is kind of one of those things I was thinking about. trauma informed care and pelvic floor physical therapy is like, every class every time, we're always talking about every continuing ed course, because the nature of the work is so intimate, and very personal. And we're asking questions that make people uncomfortable, and hopefully not too much, but putting people in uncomfortable positions a lot of times, and it takes a lot for somebody to even come into my office to tackle these issues. But I think we should all be kind of treating in that same way. Because we don't really know like, of course, I know, when people come in for pelvic floor PT, they're probably uncomfortable. Like most of the time, people don't really like, want to be there. They're there because they need it. But that goes for a lot of things in physical therapy, right? Like people don't want to have back pain and come in and like, a lot of people don't want to get like touched and massage like, that's not what they intended on doing. But here they are, because they need it. So being trauma informed in any discipline is really important, because you just don't know what somebody has been through. So talking about trauma informed care, I think understanding a little bit more about trauma is probably a good place to start. So I do kind of think everybody should   06:10 reflect a little bit on what that means. So I was thinking of a good example. And I think that trauma can be kind of like pain, where we don't have a measurable, like objective measure for like, what pain is or what trauma is. So I know if a patient comes in says they're in six out of 10 pain, I have a patient with that same diagnosis that might say they're in two out of 10 pain. Or maybe I see, let's say I see somebody with a knee replacement. And I know that like a good healthy knee should have zero degrees extension, right. Or before they leave the hospital, we want them to have 90 degrees of flexion. But like I can't say to somebody, like you have a 15 degree trauma contracture. Like that doesn't make sense. There's no reference point that we know of other than what that person's experienced. So it's important to understand that trauma is different for each person. And some people could be really traumatized by an event. And some people could not really be traumatized by the same event. And that could depend on what factors they have in their cultural background in their other life experiences or the lens that they see things through. So somebody could experience their parents getting divorced, and maybe they came out of that fine. And they're like, Well, I came out of that fine. I don't know why it's so hard for everybody else. But you don't know what it was like to experience that with these other issues around you with being a minority or having financial distress or anything else like that. So understanding traumas is the most important part first. And then when we talk about trauma informed care. And this is from a Substance Abuse and Mental Health Services Administration, there's kind of the principles of trauma informed care, what does that mean? So the first part of that is to realize that trauma is a widespread issue. And it is invasive, and pervasive, and it affects people in a lot of different areas of their life. And then also realizing that there are pathways to potential recovery. After that, we should be able to recognize the five signs and symptoms of trauma. So recognize what is trauma look like? Sound like? How does that patient act? How can we pick up on if they're a traumatized individual. So seeing a patient being uncomfortable in your clinic, they might not make eye contact with you, they might not want to face you directly, you might see their body language is a little bit off, their arms are crossed. Things that we've all seen. We all have patients probably every day ranging anything from like that super bubbly, happy patient to the one that comes in and has done PT before and had bad experiences, and they're really unhappy. So recognizing what does that look like, and then responding by implementing that knowledge into practices and policies within just not just yourself, but the the facility as well. So using what you know, to actually change or adopt practices better, going to be more inviting or more informed and make more comfortable spaces for people that are traumatized. And then we have resisting retraumatization. And this, I think, is the most important part for us as clinicians. So thinking about what we can do to make an environment that does not correlate with any kind of trauma, anybody has had to make them have to revisit that. So and that could be anything again, like there's traumatic events that range from, you know, like really terrible sexual violence, and these are maybe things I hear about, but then there's also the trauma of like, having been misdiagnosed or having been told this or that by that provider or getting a hopeless diagnosis or being told that there's nothing that can be done for them. Those are things that we can actively try to resist re traumatizing that patient in. So being on honest and informative, making sure that we're not making false promise promises, but also that we're providing hope. And then thinking about what our space is like. And this is probably relative, maybe a little bit more for like LGBT, t plus LGBT plus community, where I am making sure that my space has signs that say All are welcome here. And things that make people feel invited, because they very possibly have had an experience before where they walk into a facility and like, immediately feel discriminated against or immediately feel like, this is not a place that I want to be here, this is not a place that's going to give me good care, and maybe the Carolinas without a dentist, but at any rate, they've experienced that and probably are very likely more than once. So I want to make sure that whatever I'm doing is not recreating any of that for them.   10:54 And when you are, understanding what trauma is, and really trying to understand the trauma of the person sitting in front of you, right, I would assume a lot of that comes through our subjective exam. So do you have any advice for therapists who are navigating these waters, even newer therapists perhaps are navigating or who maybe aren't, are not as well practiced in the art of the interview? Or in that process of, of that subjective exam? So do you have any like, what types of questions do you ask that kind of stuff?   11:34 Yeah, sure. Um, so I asked a lot of questions and pelvic floor PT. But I think the more important concept around that is, um, sometimes instead of asking questions, I, and that's not that we're talking at patients. But I do take a moment to do this. And if I am getting a sense from a patient, that they may have experienced trauma, that they're not going to share that with me. And that is probably more likely than not, especially on the first day, when I'm doing my initial evaluation, they don't know me, they don't trust me, they don't really want to share any of this with me, let alone even be there. So, a lot of times, I'll take the opportunity to talk about how trauma or how other experiences can relate to pain. So I might say to, let's say to my pelvic floor patients, I don't need to know or I don't need you to tell me any details or anything. But I am aware that trauma increases pelvic floor dysfunction increases pain, and it can really affect the way that people recover. So if there's anything that I can do during this treatment to make you more comfortable in any way, let me know if we need to stop anything. We're doing them, you know. So I might just take it as a piece of information, instead of asking a direct question, like making them tell me, maybe they'll do that later on in another session or two. Maybe I might need to know more at some point. But I've really never ran into that situation. A lot of patients will tell me the extent of it right there. They might do it another session or two. But it's not something that I really want to force out to people like day one, because if if I do that, like are they going to come back? Because that re traumatizing them? Have they been forced to talk about it before. I'm not a psychologist, I'm not a psychiatrist. I'm maybe not the person that they want to share all that with. So I want to make sure they have the open door to tell me about it. But I'm not like dragging it out of them.   13:22 Yeah, that's, that's wonderful advice. I really love that. And the other thing is, that I heard a couple of times during kind of these principles is creating that safe space, creating that space, where like you said, Everyone is welcome. How do you have any other tips and it could be from the person at the front desk all the way to, to the therapist and every employee in between? So are their conversations with the all the employees who work at the within that space? And and this may seem kind of like a silly question, but I think it's important, but colors on the wall artwork, things like that. I think it makes a difference. Right. So what do you what do you think?   14:10 Yeah, so I think that maybe places are a little bit hesitant to, like, fly this giant rainbow flag outside their door, right? Like, I would totally do it if I have my own clinic, but I recognize that I'm like, you know, working we're still working in a world that like from a business model. Maybe we don't want to do that because we want everyone to feel welcome, right? But it doesn't really take much. I think it's about really small gestures. So in our clinic, starting from paperwork, like they fill out paperwork online. And gender, for example, has every option that you can think of. If it is a paper form, gender is a blank space, so that blank space leaves people the option to write how they identify. And I love that option because That's even better than having to choose from like an overwhelming amount of options, or not finding the option that you're looking for. So a blank space for gender is fantastic. And then what we have in our clinic, like I said, small gestures, I think small gestures are really the thing, we have very small little flag stickers, like on the Plexiglas from our front office. Just little flag stickers for like every flag that you can think of, or it has like all the colors that represent different parts of LGBTQ plus community. So that little flag makes such a big difference, because I'll tell you, a lot of our patients are not going to notice it, like your patients that don't identify in any of those ways are not even going to notice it. But those people that do are going to see it, and they're going to love it. And we get compliments on that all the time. They think like, Oh, my God, people are so thankful for this little tiny sticker, we got like four pack on Amazon for like, probably a couple bucks, you know, just doesn't take much. And then another thing that we have in our waiting area is a sign that says All are welcome here. And that's such a simple thing, because that's not offending anybody that's making all people feel welcome. And people that are looking for that in their space, they know exactly what you're talking about when they see that fine. And everybody else is just like, oh, that's a nice thing. And they might not think very much of it. But it's certainly still a good thing to hear like, older people are welcome. Younger people are welcome. Everybody's welcome here. So it's really easy option.   16:29 And I love that these are all really easy, inexpensive, and accessible ways to show that you are working hard on creating a safe space for everyone. And like you said, a safe space for the LGBTQ plus community who oftentimes can't find those safe spaces.   16:48 Yeah, yeah. Another another small thing that I do personally, because I want my patients before I even go into their room maybe to like understand that I'm an advocate, I just have like a rainbow water bottle. And that's what I drink out of that work. And they see that sitting on my desk, and maybe some other stickers on like my laptop and stuff like that. But something that they might see like, Oh, that's my therapist, and they see like a rainbow water bottle. And it's just like a little thing that makes them feel more comfortable. I love it. I love my water bottle, so everybody's happy.   17:19 And do you go out physically into the community for advocacy work or as part of the clinic just so that people know that you're there? You know, like, how, how does that work within your community? Because I'm sure there are people who I mean, I'm in New York City, right? So I talk about like a large amount of people, right? So how do people know how to find? So how do people, especially in these marginalized communities know how to find the people who are creating spaces for them? Yeah,   17:49 so most communities, I'm in Las Vegas have support centers or community centers that support or provide or refer to services like my own or other providers that they know, create these safe spaces. So we have a support center here in Vegas, I've spoken to a little bit, I'm not necessarily within everybody's insurance providers. So that makes things a little bit harder. I'm in pelvic floor PT, I get so many patients from all over. And I've had a very long wait time, it's been tough to go out and mark it. And I'm also leaving for maternity leave actually in a couple of weeks. So I have plans for when I come back to reach out a little bit more, but I have been swarmed with what I have. But going out into these community centers, just letting them know who you are dropping off some cards, I have done that. And that is a really good way to at least get started. Get your name or your clinic out there. And maybe you're not what every person is looking for. But if they have your card handy, and they are providing social services to somebody, they might say, it sounds like you could benefit from this I know a great physical therapist that you could go to. And then, of course, we're a little bit bound by insurances. And that's definitely something I see in my future is trying to provide a little bit more preventive care to people that are uninsured or under insured. But that's probably a future problem for me at the moment. Right.   19:18 Right. And I think that's great advice. So if you're in a city, reach out to local community groups, community centers, things like that, and I think that's a great way for you to get out and in the community and really make a difference. And now there's one more thing that I want to talk about before we start wrapping things up. And that is the importance of asking patients for consent. So you touched on this a little bit, right? But especially in the pelvic floor world. Where does this explained explain to the to myself and to the listeners, how you go about asking for consent And why this   20:01 is yeah, this is definitely like if we can take home anything from if listeners could take home anything, it's to be more vigilant about asking for consent. And I can kind of trace this back to like how I've evolved in asking for consent. And I think about an IC O I think probably hope I'm probably not the only one guilty of this. But when I started, I started as a physical therapist assistant. So way back, when I graduated as a PTA, I went to work at a facility where the, the clinic was pretty manually aggressive, a lot of manual therapy, a lot of kind of aggressive manual therapy, which can be a little jarring for patients that are maybe not prepared for that. But I think about how many patients, I just went into the room and like started palpating, or like, Okay, I'm going to check this and then just like put my hands on them. And I think now about like how strange it would be to just like, grab somebody like psi SS without like telling them where you're going, like grabbing the back of their hips or having them like face a wall and then touching their back. And that can be like a very, that can like reiterate some traumatic events for people being grabbed from behind. That's, it's, I can't believe that I did this being the person that I am now. But I did, I did it every day all the time. And I never really thought about consent, I just figured the patient was there, maybe the provider before me had probably done similar the same things as a PTA, so I assumed PT had done the same. And I just think how crazy that is. Now, to me, it just is like so out there that I would have done that. Um, but asking for consent is something that should be ongoing and all the time. So from the initial evaluation, and education is a big part of asking for consent, I think too, because in order to consent to something, people have to understand what it's going to entail. And for me and pelvic floor, that's certainly relevant because I do do internal pelvic floor exams. So they need to know exactly what I'm going to be doing. And I use a model to demonstrate and to talk about what that's going to entail, and then discuss that they have the option to consent to that or to not consent to that, if they don't, there's other things that I can work on that I can help with. So I don't want them to feel pressured, that they have to consent to anything that I asked for. So consent, those should be informing the patient pretty much every step of the way. So instead of saying, I'm going to check your pelvic alignment, nobody knows what that means, like our patients don't know what that means. So I might ask, Is it okay with you if I touched the front of your hips, and then that's how I started just kind of simple and explaining in layman's terms, what I'm going to do. And a lot of times, I'm asking a patient or giving a patient options. And this is kind of part of trauma informed care is enabling or empowering the patient to make choices or have options. So instead of saying, say I want to do soft tissue work, instead of saying, I will be right back, I'm going to go grab some lotion, and then the patient knows I'm going to do soft tissue, but they didn't get an option to consent to that. I just went to go grab it. And now they feel like they're stuck there. And I'm going to come back with lotion and they're going to get a massage and they don't have a choice. So I might say, I would like to work on this. This is why. So we can do that. If you don't want to do that. We can work on mobility in this other way. So that way they have an option for what they want to do or how they want to do it. So providing options, I think is a really important part of concern. Um, I think yeah, I think that's mostly what I mean with consent.   23:42 Perfect. Yeah, I think that's great. And listen, I used to do the same thing. And I can't believe I did that either. Yeah, just like walking into a room and just like touching. Like, I wouldn't want someone to do that to me. I can't believe I did that.   23:55 I know. And I wonder is that like, a time? A time thing? Like 10 years ago? Was it just more like then we're just more informed now? Or was I just like totally oblivious? Because that's certainly   24:05 possible. I think it's just we're more informed now. I'm gonna I'm gonna go with that, you know, and yeah, and and maybe a little bit of a being oblivious? I don't know. But you're right. Like, I would just come first of all stand up and you just be like, hands on the pelvis. And it's like, what is like, how, what, what was?   24:25 And like next to I think, like, we were just yeah, like not grabbing,   24:30 grabbing onto people's heads and everything. What's that about? I would never do that. Now. You know, even if I'm just going to touch someone's arm. I was like, I'm just gonna put my hands here if that's okay. And we're gonna. Yeah, it just makes so much more sense. And I love the fact that you tied that in with the patient education component. Because I think like you said, you can't have one without the other. It's just so important.   24:55 Right? And I think that we underestimate like how much the patient wants to be educated about things. So and that's a lesson, I think I've learned pelvic floor PT, because so many people did, like they don't even know they have a pelvic floor or what it does. So education's been a huge part of my practice, like the whole first session is really education and training, and bladder and bowel training and things like that. But patients want to know, they want to know all the details, like they love it, tell them so they know what you're doing. So they know if they want that done or not.   25:24 Yeah, absolutely. At your right patients want to know, and it doesn't matter the age, they want to know, what's going on with their bodies and and what they can do to be a part of it. So it's also a great way to empower your patient to understand and take control over their, over their bodies. You know, and and give, give the patient some autonomy and some confidence.   25:49 Yeah. And to give that the patient the opportunity to, like collaborate with you, instead of be told what's happening. So to have the opportunity for them to feel involved and to have a voice in their decision making and understand even why they're making a decision, like so that they might know. Yes, I do want this internal pelvic floor exam done. Because I want to know more about the tone of my pelvic floor so that I can know why I have pain or why I have difficulty emptying my bladder. I want them to be able to make that connection in their head and be able to consent to it. Knowing why.   26:21 Yeah. And it's all part of patient centered care. I mean, that's what we're all supposed to be doing. Right? Yeah, absolutely. It's not patient directed care. It's patient centered care.   26:33 Right. And just as relevant as it is for me and pelvic floor. I think it's the same anywhere else across the board.   26:39 Yeah, across the board. Absolutely. Well, I, you know, I want to thank you. I think this was a great conversation. I feel like I've definitely learned a little bit more about trauma informed care. So I thank you for that. Now, where can people find you? If let's say they have questions, they, you know, they want to know how they can implement some of the things you're doing in your clinic in their own clinics.   27:06 Yeah, sure. So I typically use my work email for anything like that. So that is M Duncan at Kelly hawkins.com. And I like I said, I'm not much of a social media person I wish I could say I was that's probably not the best way to contact me.   27:24 I know you're not missing anything. Don't worry about it.   27:27 Yeah, but I'm always happy to check emails and respond that way. For people trying to figure out where to start. I did want to mention CSM has a lot of great topics on this, I've certainly gotten a lot of information, or directed myself onto what things I'd like to learn more about by going to CSM and going to these discussions. There is some information on trauma informed care at CSM this year, as well as introductions to pelvic floor PT, for those that are interested. And there are always platforms and other lectures on what we can do for the LGBT Q plus community. Excellent.   28:04 Thank you so so much. And before we wrap up, I'll ask you the question I asked everyone. And that's knowing where you are now in your life and in your career, what advice would you give to your younger self?   28:14 That's fine to not just go around touching people.   28:18 Yeah. That advice to each other.   28:21 I think I'm fortunate that never really panned out to be anything too negative, but I would love to go back and not do that. But what I do tell people and recommend as far as career is to find a niche. So my niche is pelvic floor PT. Within that my niche is being passionate and treating the LGBTQ plus community treating patients that are transgender, that is a great niche to be in, not everybody is doing it, it is so needed. If you can find a niche that you're passionate about, and that is needed, you are never going to struggle for work or for satisfaction. Um, it really is kind of been if you build it, they will come situation. And people told that to me when I began pelvic floor pt. And that's what I did, I built a pelvic floor program, the company that I work for now. And like I said, I am very busy, very satisfied with the way my career has gone in. So find a niche and it's not something that every new student is going to know right away. But get out there and explore like go shadow and go find places that are outside your comfort zone. Like I wasn't I didn't think I was going to go into pelvic floor PT. I don't think a lot of us that end up in it do. It's maybe not something I would have thought to shadow I would have been like, that does not sound good. I don't want to do that. But again, outside your comfort zone, go shadow and find therapists that are doing things that you don't think you would ever do, and see if you can find somewhere that you're going to land and be successful.   29:50 I love it. That is great advice. Thank you so much, Megan. I really appreciate your time and your knowledge sharing with myself and the Audience So thank you so much yeah thank you and everyone thanks so much for tuning in and listening have a great couple of days and stay healthy Wealthy and Smart
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    366: Dr. David Logerstedt:Get a Load of This!: Effects of and Response to Mechanical Loading on the Knee

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    In this episode, Associate Professor at the University of the Sciences and Director of BTE Laboratory, David Logerstedt, talks about monitoring and responding to load injuries on the knee. Today, David talks about the most common loading injuries on the knee, difference between external and internal loads, and how to improve tissue capacity. What is mechanical loading? Hear about David’s most recent research paper on mechanical loading and the knee, how therapists can monitor and respond to loads, how clinicians can apply the information in the paper, and get David’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “A lot of the stresses that cause the injury also are some of the same stresses that you can use to rehabilitate the injury.” “Most of us have enough tissue capacity to walk, but we might not have the tissue capacity to run a 10k.” “You really are trained to look at how the joint is reacting to the loads that you’re placing on it. Measuring irritability is probably the best way to describe it.” “Even just asking how they feel can give a lot of information.” “If people understand the ‘why’, then maybe they’re more likely to do it and follow through.” “Don’t say no. Always say yes to opportunities. Especially in that early career, if an opportunity comes along, take it.”   More about David Logerstedt David Logerstedt, PT, MPT, PhD is tenured Associate Professor at University of the Sciences and Director of BTE laboratory. He graduated with a Bachelor of Science degree in health and human performance from the University of Montana and a Master of Arts degree in exercise physiology from the University of North Carolina. He earned a master’s degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and movement science from the University of Delaware. Dr. Logerstedt has been a practicing rehabilitation specialist for over 25 years and is board certified in sports physical therapy. He has presented his research on knee disorders at national and international conferences and has published in high-impact sports medicine journals on ACL injuries. He has co-authored several clinical practice guidelines on knee disorders. His goal to improve the implementation of clinical research into practical and accessible for all clinicians.   Suggested Keywords Healthy, Wealthy, Smart, Knee Injuries, Loading Injuries, Tissue Capacity, Stress, Research, Rehabilitation, Recovery, Physiotherapy   Resources: Effects of and Response to Mechanical Loading on the Knee   To learn more, follow David at: Website:          David Logerstedt's Bibliography Twitter:            @DaveLogPT LinkedIn:         David Logerstedt   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health so when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about his new integration, head over to net health.com forward slash li tz why to sign up for your complimentary marketing audit. And it's great, I use it and it works. So I highly recommend it. Now onto today's episode. So I'm really really happy to have Dr. David lager stead on the episode today. And we are talking about monitoring and responding to load injuries on the knee. So Dr. Lager stat is a tenured associate professor at the University of sciences and director of the BT EE Laboratory. He graduated with a Bachelor of Science degree in Health and Human Performance from the University of Montana and a Master of Arts degree in exercise physiology. from the University of North Carolina. He earned a master's degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and Movement Science from the University of Delaware. He has been a practicing rehabilitation specialist for over 25 years he is board certified in Sports Physical Therapy. He has presented his research on knee disorders at national international conferences and has published in high impact sports medicine journals on ACL injuries. He co authored several clinical practice guidelines on knee disorders. His goal is to improve the implementation of clinical research into practical and accessible, make it practical and accessible for all clinicians. So yeah, so today we're talking about a new paper, that he co authored the effects, the effects of em response to mechanical loading of the knee to great paper, you can go to podcast at healthy, wealthy, smart calm, to find a link to the paper. And a big thanks to Dr. Lager stead for breaking it down for us and everyone enjoyed today's episode. Hey, David, welcome to the podcast. I'm happy to have you on.   03:04 Thank you for having me. Yeah, and I'm excited. Today we're going to talk about a new paper that your co author on that came out on to be very precise, October 20, of 2021. And it's the effects of response to mechanical loading on the knee. So of course, my first question, I'm sure this is the first question everyone asked you is, why write this paper? What is the why behind it? You know, as a, as a clinician, as well, as somebody who is now in academia, I've always kind of had this question myself, you know, what kind of loads are on the knee? And I've always had this, you know, concern about dosing and trying to figure out like, how can we can best dose exercise around the knee. And as I, as I really started to think about this more, really started to find that there hasn't been any review, or any kind of clinical commentary kind of brings at least the concept of mechanical loading, kind of in one place. And the knee is always a good model, because it does seem to have a lot of a lot of research around it. And it's an area I'm familiar with, because of my work in ACLs. And so I, we, you know, we just started, started thinking about, okay, how can we best talk about what kind of loads are being placed on the knee and, and some of it kind of kind of came out of some conversations I had with another colleague of mine, where we've really started to talk about the use of inertial measurement units and how those can start to give at least some general indications of what loads are occurring through the lower extremity. And so we decided to just kind of put a team together   05:00 who had expertise in in loading? And then expertise in specific structures related to the knee? And so that's kind of how it kind of came together. And when we're talking about loading of the knee, so in this, in this paper, you're talking about mechanical loading. So let's, let's go with some more definitions here. So what is mechanical loading? And why is it important in respect to the knee will stick to the knee? Yeah. So, you know, in the paper, we really describe mechanical loading, this is the physical forces that act on are free to make demand on the body, either at the system's level, or even on structures at a specific organ or tissue level. And so if you think about mechanical loading can kind of subdivided into different variables, such as, like the magnitude of the load, how long the load is being applied, how frequent it might be applied, or even maybe the direction or the nature of that load. So   06:05 so when we think about loading, though, all those components kind of interact, can interact with one another, and then create different loading patterns that can impact again, the knee is the organ itself, or specific structures within the knee. And when we're talking about loading, I think most people think of loads as external, so something that we are placing on that knee, but there are external loads in their internal loads. Can you kind of differentiate those for the listeners? And how, and why are both important? Yeah. So when we think about, you know, external loads, to kind of think about is like, really kind of that work that's being performed? So like, how far did I run today? Or how high did I jump? So when we think about like, like that, it's almost, it's almost kind of like that outcome in, in an essence when we think about external load. But when we think about internal load, you can either think about what what's the physiological process that's going on inside the body related, potentially related to the external load, or maybe even the psychological. And again, maybe even that biomechanical response to that external load? So So usually, when we think about internal load, it's like, you know, how what, you know, what is your heart rate doing related to how far you run? Or what is the extra? Or what's the amount of stress that's being placed on the knee after you land from a jump? Yeah, so so both are important, especially when it comes to knee injuries, and loading injuries. So let's talk about what are some of the common loading injuries on the knee?   07:54 Yeah, so if you think about some of those different types of loads, you can kind of really subdividing at least at Deneen to kind of three major categories. In essence, whether it's a compressive load, a shear load, or a, you know, a tensile load that occurs, there's some other loads that can occur, such as some hydrostatic pressure loads, but the primary ones are really related to that. And so then if you break that down into specific structures, such as a ligament, you know, like the ACL, which is one of the more common injuries that occurred the knee, you know, that's usually related to some kind of tensile load that's occurring on that ligament, it can occur either from, you know, cyclical loading, where you can continue to put stress on that ligament until that ligament ultimately fails. But usually, it's one usually large load that occurs that relates in, you know, a traumatic tear. That's probably an example of kind of one of the more common ones. But, you know, we, you know, we commonly see other tissues damaged, you know, the meniscus is another common injury. And that's usually again, that's really related more to some compressive with shear load. And then, you know, cartilage also kind of was kind of relies on   09:24 a shear load to be damaged. So   09:28 all those different loads occur on the knee, it just sometimes it depends on again, all those other variables that we've talked about, you know, the nature of it, or the compressive versus the shear versus the tensile load, but then again, how quickly does it occur? Maybe at what angle your knee is bent that can impact all those types of things? Yeah, I would think angles, speed, fatigue levels, hydration levels, you know,   10:00 All of that I can only imagine goes into   10:04 a type of injury from one of these loads, right? And you say, you know, and if think about, you know, again, you have that that external load, but then, you know, think about some of the other internal loads, you know, the muscles around the joint contracting, to maybe unload the knee at a specific time, because, you know, we have, you know, you've seen many athletes like they cut and pivot 1000s of times in a career, why is it that one certain time, they do the exact same maneuver, they've done 1000 times before, their ligament tears or their meniscus tears. So there's, there's so many other underlying factors that lead to it.   10:50 And so part of this papers, at least trying to describe some of those things, so people have an understanding of what is the underlying loads that can can lead to an injury. But then,   11:03 what can we do after that? How can we use those exact same parameters of same loading parameters to rehabilitate them? Because the same, a lot of the same stresses that caused the injury   11:17 also are some of the same stresses that you can use to rehabilitate the injury? Right, and I would think have to use to rehabilitate the injury. Right? Right. Yeah. So so they, so they can adapt to that stress and be ready to handle the stress the next time it occurs. Exactly, exactly. And now what one of the figures we were talking before we went on the air within this paper is figure four. So for everyone who is listening to this, we'll leave a link to the paper in the show notes. But when you go through, you'll see there's one figure it's figure four, it's a conceptual model of loading of the knee. And it's like a monster of a figure like it is. It's large, it looks very intimidating, and very complicated. So can you break it down for us? Yeah. So this is how, you know, we started to think about taking a lot of these other models that have been out there that have described, you know, maybe the physical stress model, or many people have commented on the,   12:24 on the die model, related to the envelope of function, and also the dynamic recursive model related to injury, probably the, is the best one, best way to describe it. But you got to take into all those factors that can influence or just leave somebody susceptible to an injury,   12:52 as well as including this their underlying physiology. And again, that could just be related to those non modifiable factors such as your age and your sex.   13:04 And then again, your underlying physiology, you know, your genetic makeup, maybe even just some kind of a little bit of your underlying fitness level. And then what are some things that can predispose that tissue to injury? And again, it could be, you know, do you have a strong tissue or a weaker tissue? Does the, you know, do you have certain types of muscle fibers, you know, that can influence again, things like fatigue? And then what are the external factors that lead into it? So, some of these models have already been kind of described in the ACL related literature, you know, you know, shoot a surface interactions, whether that occurs out there is, is it turf versus grass. So, those types of things can all potentially influence an injury and then,   14:00 you know, moving into the next part, then you just think about the mechanical load. So, again, all those factors related to magnitude and duration and frequency. And then we wanted to kind of   14:15 try to articulate that, again, if you took, you know, just conceptually took it is looking at each of the different major structures in the knee that could be impacted, and then talked about how those tissues respond to some kind of stress and strain. So, you know, if you put it,   14:39 again that load under a specific type of compressive versus shear strain, how does it respond to that, and William Thompson did a really nice review in ptJ a couple of years ago, looking at some of the Meccano therapy and McKinna biology that occurs at specific   15:00 tissues that Karim Khan had kind of initially proposed back, God 10 years ago or so. And then if you take all those things account, and the stresses and strains, so then you start to look at how that impacts how the tissue adapts to those stresses and strains. And, you know, using kind of the fitness model, or the fitness fatigue model is, is if you apply the right stresses at the right time. And you do that consistently over time, it basically builds up into tissues adapt to it, and it gets stronger, and fitter. But if you don't do it, or you do it at a delayed time, it may stay at a homeostatic level, or than if you do it too infrequently, or the loads are too much, too frequent, then you can actually fatigue the tissues. And, of course, if you get too much fatigue, and you get the right amount of load placed on it, then that can result in injury. And then you kind of go through, go through again, and go through it again. And again, that's part of the rehab process is taking all those things into account. And so   16:22 that's how we tried to really try to conceptualize it and think about, you know, and so we really kind of focused more on the the tissue levels and the response to injury, and how you can use that kind of this conceptual model of kind of stress and strain along those other factors, too. I think it's important to note that we're not only talking about ligaments or meniscus when we're talking about the tissues around the knee, ligaments, meniscus tendon, articular, cartilage bone. It's not just, we're not just talking about ACL 10. Lien, you know what I mean? There's, it's really the all the structures that that make up that knee joint, correct? Correct. Yeah. And, I mean, I think that's even a really important point to like, when we're rehabbing. You know, somebody and you know, you take somebody with a meniscus tear, not only are you impacting the meniscus that you're working on, you're also impacting a lot of the other structures around it. And so you can influence the all that rehab, or that rehab impacts all those tissues, depending on how you're providing the specific load. Right? Absolutely. And, you know, one of the the words that's in that figure is tissue capacity. And so during the rehab process, certainly after injury, but even, let's say, without injury, right, I think one of the goals is to always improve tissue capacity. So can you kind of talk about what exactly that means? What that What does tissue capacity mean and as physical therapists, what where do we stand in the improvement of that capacity. And on that note, we'll take a quick break to hear from our sponsor and be right back.   18:18 When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about this new integration, head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.   18:55 Kind of an in a general layman's term, you think about just tissue capacities, it's all related to the under I think sometimes so the underlying tasks that's being performed, right, you can have a certain level of tissue capacity that allows you to, to walk or run the tissue can meet the demands of that load placed on placed on the body by that specific task. Right. But if the task is too high, or the load is too high, relative to what the tissue can handle the tissue than this doesn't have the capacity to handle that load. And again, it may be able to handle that load one or two times. But over a repeated bout, it may fail much quicker. And so I think sometimes tissue capacity is it's also related to the task that's being performed. may know most of us have enough tissue capacity to to walk community levels and things like that. But you know, we might   20:00 not have the tissue capacity to run a 10k, even though that we may have the underlying structure that we could build up to that, I think those are the things you have to take into account. And from a rehab perspective, you know, you always have to think about kind of that starting point of what people can handle, and then how, how you can adjust the rehab process to improve that capacity over time. So that that leads into what are some ways we can monitor load and respond to that load? So we're the therapist, we're taking care of our patients, how can we monitor and and, and change that load as necessary? Yeah, so.   20:46 So from, you know, a clinician standpoint, you know, most of us probably in the clinic, you know, we don't have high tech equipment, like global GPS units are inertial measurement units to measure   21:01 acceleration, and   21:04 you know, how far people have gone   21:08 a certain amount of distances they walked or jogged or done the whole thing, like you have seen with some of the devices like catapult or, or   21:18 I measure use IMU units. But I think from a clinician standpoint, we still have a lot of great tools that I think are that we still under utilize, to some degree. So,   21:32 you know, I, I always like to tell my students   21:38 that you really are kind of training to look at how the joint is reacting to the, to the loads that you're placing on it? And are you making the tissues more irritable or less, irritable, measuring irritability is probably the best way to describe it. And the knee, you know, you can see things like, you know, increase swelling, you know,   22:02 which is a common, probably a common measurement to see for, for increased irritability, but it can also be, you know, is the joint getting sore versus the muscle getting sore, right? And so trying to be very clear,   22:20 with   22:21 the person you're working with is, you know, does it hurt inside the knee, or is it just hurt in the muscles around the knee, because we'd expect to see some muscle soreness if you're working those, right, but you don't want the, you know, the irritation to be in the knee. Um, so those are probably the two major major, major ones that I like to use. But   22:44 you can also look is, you know, do Did they have a sudden decrease in a range of motion, you know, which can be an impact, or, you know, a factor of them, having some irritability, has their strength gone down, which is probably a little bit harder to assess more consistently, but those are probably the major things I would consider looking at is, if you're starting to see some of those means the tissues become a little bit more irritated. But if you don't see those, then you know, the next, you know, maybe the next session, the next couple sessions, you can start to slowly increase the load a little bit, and see how they respond. And I think that's always the challenging part. Like, I like to challenge my students with is, but that's one of the great things about being a therapist, who is we get to see them again, and see how they respond to our treatments. And we can regress or progress them as needed. Yeah, and and I think that's a really great thing that you said at the end, we can regress or progress as needed. So if someone if you give someone some exercise or some loading, and they come back with like an angry knee, it doesn't mean stop everything and go back to passive range of motion. It means okay, let's just take it down a notch. But continue. Yeah. Yeah. And I think when the the last one I meant should have mentioned is, you know, just even just ask them how they feel. Mm hmm. You know, how are you how do you how does it feel today can give a lot of information then you can use things like you know, a session RPE schedule, you know, scale, say, Okay, your knees a little bit angry. Let's back, let's back your exercise session down two or three today, instead of working at a seven. Mm hmm. So you can still do something still keep the knee moving. Still keep it kind of moving forward, but you've kind of backed off in gave it a little bit time to, to calm down. Yeah. So it's, it's sort of this combination of what you're seeing objectively and then asking them how novel What a novel idea you're doing or you're having   25:00 Having trouble? Yeah. The other day you were doing stairs really well. And now you're having trouble doing stairs, you know, some of these functional day to day things? Yeah, exactly. I mean, I think, like you said, those are just really simple tools, I think we, we get so focused on, you know, what we like to call the objective data, instead of just asking people, how do you feel today? Yeah.   25:23 Absolutely. And now, how can we and I say myself, we, I'm a clinician, how can how can we clinicians use the information in this paper to start applying load to a REIT to the rehabilitation of an injured knee? Or post surgical knee? Or what however you want to categorize? Yeah, yeah. I think, you know, as we were talking before, there's a, there's a, there's a lot of data in this in this paper, too, that the clinicians can think canoes, and so I don't want them to get overwhelmed with all the numbers in the data, but it's really there to be is it as a resource for clinicians to say, Okay, I have somebody who has a pretty irritable knee, and these are the activities that we're doing before, you know, and we can get a sense of, okay, that that activity, you know, was, you know, three times body weight, I need to find an activity, that's maybe two times body weight.   26:27 So we can regress them a little bit. And this is an activity that kind of fits that or this was an activity that put this amount of stress on the ligament, we know that that stress is still within us safe range to, to push it a little bit to the next level.   26:47 Because, you know, I think some of the, some of the fear is, is that if we're putting stress on the ligament that we're going to injure it, or even on any tissue, right. But we, as we know that, especially after the initial inflammatory phase, you need to start putting a little bit of stress on the healing tissues, because that's how tissue gets stronger is that it has to respond to stress. But if you're putting, you know, if you're putting state and I'll put an air quotes, safe, safe stresses, or stresses that are below kind of the the below the failure rate, and you're monitoring the knee for those inappropriate responses, then you can use that information to slowly progress them through a rehab safely and adequately the healing structure to then kind of into the next level of repair. The one of the tables, we talked about this, again, before we came on, was table seven, within this paper, where you have some activities where it's like this is like you said, maybe it's 1.4 times body weight, or this is 20 times body weight, or this is eight times body weight. And I think that's a really nice guide for clinicians. But I think it's also a really great educational tool for the patient. So you can show this too, because most patients get it. I think a lot of times we underestimate our patient's ability to understand. Yeah, a lot of these concepts, you know, and and so I think if we can say the patient, hey, listen, this is X amount, your body weight, this activity is less than that. And let's say you're a month out of like some sort of surgical procedure, hey, let's go with the one that's less times body weight than this. And because people say, well, what's the big deal? It seems like it would be fine. But I love that because I think it's a great way for clinicians to use the paper also is a great educational opportunity. Yeah, no, no, I think that's a that's a really valid point, is it? I think if we can educate the patients on, you know, these are the activities that you should be doing right now. And as you strong, get stronger and get better than you can move into these activities the next time, right. And so they're always asking, patients are always asking, like, what can I do now? What can I do now? And so, you know, this table can give them some insight of, okay, this is where you're at. These are the things that you start doing now. And these are the things that probably wait a little bit longer. I think that the patient will really understand the why behind, you're giving them the exercises that you're giving them. Yep. And that's really important, because if people understand the why then maybe they're more likely to do it. Yeah. And follow through. Yep. So I mean, I think it's great. I think this paper is great. Is there anything   30:00 thing that we didn't touch upon in the paper, the process of doing this paper that you would like to share before we start to wrap things up, no, you know, I'd really like to, you know, first of all, thank my co authors who were willing to, to sit down and write this, it was, it was no small feat, you know, pulling together, clinicians from around the world to, to do this. And so, you know, definitely want to, you know, think tour MacLeod, Brian higher shyt, J uebert. Tim Gavitt and Brian eckenrode, for, for agreeing to do this, you know, this, like I said, this was a paper that had been mulling around in my head, probably since I was in PT school, you know, for a long time. And, you know, this just felt like the opportune time to pull it together. And fortunately, you know, in the last several years, last 20 years or so, we have, we have the data now to support a lot of the things that we do is physical therapist that I think intuitively, we've always done. But I think now that we can, we can demonstrate a lot of what we do, and some of the value that we bring to, to rehabilitation into to patients and to clients. Yeah, and and I mean, I like this paper from a rehab standpoint, but I think it's also really great from a strength and conditioning standpoint, right? Because as physical therapists, we don't have to just be the people there when the athlete or the person is injured, we can also be the person that helps to keep them strong and kind of improve, especially in I know, in a lot of professional settings. You've got strength and conditioning coaches, and athletic trainers and pts. But for the average physical therapist, like if you're in a small town, maybe you're it. Yeah, you're doing it all. Yeah. So I think this paper is really helpful not only to progress, people after injury, but to kind of look and say, Hey, this is the load that we can place on you that will hopefully help to decrease your chances of getting injured. Yeah. So I appreciate that in this paper. And now, where can people find you? And like I said, we will have a link to the paper in the show notes. But where can people find you if they have questions of you specifically? Yeah, I'm fairly active on Twitter. And so that's primary, my primary social media outlet so you can find me It's Dave, log PT. You know, if there's any questions or anything like that, that's probably the best, best way to reach me is either directly through DMS, or, or through my Twitter feed. Perfect. And now before we wrap things up, I have one more question. And it's a question I asked everyone is knowing where you are, in your life and in your career? What advice would you give to yourself? Let's say as a new grad, right out of PT school, I would probably, I would say, at that early stage advice, actually was given to me before is don't always don't say no. Always say yes to opportunities, especially in that, that early career, that if an opportunity comes along, take it, it may or may not be the perfect opportunity. It may not be what you dreamed of, but it more likely or not, will   33:32 be the a value to you. And many times it's a huge stepping stone. I would say you know, an opportunity comes along, say yes. Especially when you're young. Yes, yes. Young and full of energy. I think that's great advice. So listen, David, thank you so much for coming on the podcast breaking down this paper. It's a great paper. So congratulations on that. So thank you for coming on. You. Thank You, anytime and everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Dr. David lager stat for coming on the program and talking all about load parameters around the knee joint and of course, a big thank you to Net Health. So again, their digital digital marketing solutions can help your clinic win by allowing you to get found get chosen and get those five star reviews on Google. They have a new offer if you sign up and complete a marketing on it to learn how digital marketing solutions can up your clinic when they'll buy lunch for your office. Head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today.   34:41 Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media
  • Healthy Wealthy & Smart podcast

    565: Dr. Jessica Schwartz: Concussion Myths and Concussion Corner Academy

    34:23

    In this episode, Founder of the Concussion Corner Academy®, Jessica Schwartz, talks about the nature of concussion treatment. Today, Jessica talks about her concussion experience and how it has shaped her work leading up to the Concussion Corner Academy®, the reality of long-term concussion symptoms, and some of the top concussion myths. Is it ever too late to have your concussion symptoms treated? Hear about treatment barriers, some of the surprising statistics in concussion and TBI research, and the importance of education, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “When you’re young, make sure you have extended disability on yourself.” “There’s no evidence-based, agreed upon international definition of concussion or traumatic brain injury.” “There’s been zero phase 3 trials on TBI and concussion in over 30 years.” “Up to 30% of folks now have persistent symptoms of concussion.” “If we can teach one, we can serve many.” “2012 was the first year the International Consensus Statement discussed the cervical spine in terms of examination treatment.” “2015 was the first academic year in which there was a formal training for both TBI and concussion if you were a neurology resident.” “2017 was the first year on the International Consensus Statement that we identified concussion as a rehabilitative injury.” “The injury of concussion is an injury of loss. It’s a loss of your ‘I am.’” “Join Twitter.”   More about Jessica Schwartz Jessica Schwartz PT, DPT, CSCS is an award-winning Physical Therapist, a national spokeswoman for the American Physical Therapy Association, host of the Concussion Corner Podcast, founder of the Concussion Corner Academy®, and a post-concussion syndrome survivor, advocate, and concussion educator. After spending a full year in rehabilitation, experiencing the profound dichotomy of being both doctor and patient, Dr. Schwartz identified the gaps in concussion treatment and management in the global healthcare community. Her role has been to identify the cognitive blind spots and facilitate collective competence for healthcare providers, physicians to athletic trainers, focusing on comprehensive targeted physical examinations, rehabilitative teams, and concussion care management.   Suggested Keywords Healthy, Wealthy, Smart, Concussion, Research, Statistics, Physiotherapy, Neurology, Concussion Corner, Myths, Healthcare, Rehabilitation, Injury, Loss,   To learn more, follow Jessica at: Website to Join the Program:          The Concussion Corner Academy® Facebook:       Concussion Corner Twitter:            @ConcussionCornr Instagram:       @ConcussionCorner LinkedIn:         Jessica Schwartz YouTube:        Concussion Corner LinkTree:         https://linktr.ee/ConcussionCorner   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full transcript here:  00:02 Hey Jess, welcome to the podcast. Finally, I'm so excited to have you on.   00:07 Thank you so much for having me. I can't believe we haven't done this yet.   00:10 I know it's like absolutely insane. And just so people know Jessica and I both live in New York City, and we actually see each other quite a bit. And this is the first time I've had you on the podcast. But I'm really excited to have you on today because we're going to be talking about concussion, persistent post concussion symptoms, and you'll talk a little bit more about that name changed in the bulk of the interview. But before we get into some common myths around concussions, I would love for you to let the listeners know a little bit more about why you decided to really specialize in this niche within medicine and rehabilitation.   00:52 Awesome. Well, I thank you for the softball pitch care know. For those that don't know, Karen used to play softball on Central Park quite a bit. But yeah, no, I mean, I thank you so much for having me on. First. I've been listening to healthy, wealthy smart forever. So just thank you again. And yeah, I mean, gosh, I think back to I was a we were one of the first six residents actually, we were the first six residents in orthopedics at NYU in 2010. When I finished up grad school and all that jazz, and we I had it, I got the dream job, right, got the dream job. I had to leave New York City for it, which sounds crazy. But I think a lot of folks can connect to that, you know, working in, you know, the old adage, Jay, we used to call mills and things like that are seeing three or four patients plus per hour. And I was like, this isn't why I went into physical therapy. This is not why I wanted to do this. And I found this great clinic out in New Jersey during residency and we saw one to two patients per hour. And we had a support staff and they were emotionally intelligent. They were physical therapy owned, and they let us grow. And keep that like use of excitement, right? I don't know about you. But I'm hopped up on caffeine and too little sleep as we launched a new business this week. But it was great. And it really it fed my soul. It was wonderful colleagues and we ended up I ended up starting kind of in the opposite end of things, a civilian prosthetics program. So I was, you know, volunteering and showing up at the Manhattan VA, which has a wonderful prosthetics program. And then we also launched a breast cancer program and be launched a concussion program. So that was kind of like my first entree into concussion about 1011 years ago. And we were the only really only office in New Jersey with that type of rehabilitative practice at approaching concussion. And so very Dunning Kruger ask, it was like, you know, you don't know what you don't know until you kind of are made self aware of it. I got hit by a car. So I was hit by a car in October 3 of 2013. And right before then, oh, actually, it wasn't even right before then care. I'm sorry about that. But it was two years before it was our last day of residency. We saw that there was a conference at NYU at the hospital. And it was on concussion and it was NY us first concussion conference. Now this was 2011. So my best friend from Italy Beatrice, you know, hi, BIA. She's in Lucca. She's a great physio, if you're out in Italy listening in. And we were like, What do you want to go and it was our first weekend off for residency. I mean, we were exhausted, excited. And we're like, let's do it. So we went to this conference, I fell in love with it. And so we were at least aware of what this program was at NYU. Fast forward two years from there. And I was actually hit by a car here in Manhattan. So that's really where it's my life's work and passion is to become because I actually live with persistent symptoms. So and went through quite a recovery. So that's kind of how it all kind of came together and coalesced.   03:49 And when you suffered a concussion, and this was in 2013 It did you did you have kind of the self awareness at that time to think, well, you know, I've been learning a lot about concussions, I think I can I can kind of help myself here and did that then really propel you to learn more and to dive in even more.   04:19 So when I was hit, I was hit by an unlicensed driver from behind and my airbags did not go off. I was in my Toyota Prius you may have even been in that car at some point. And I didn't think anything of it but I knew I when I said the story is I I got out of the car. I want to get out of the car. I got hit so hard. I was stoplight at a red light wasn't looking behind me because we were stopped. And it was the traditional traffic right care like we're just inching forward. And I was probably on that block of 12 Street between Fifth and Sixth Avenue for about two or three light cycles because of traffic. So I just got Walt from behind and so the New Yorker in May right so born and raised New Yorker You know, unbuckle the seatbelt and get out of the car to give this guy the business. And I was just so dizzy care. And I held onto the top of the hood of my roof of the car and I was like, I gotta sit down. Fast forward. I thought this was quote unquote, just going to be a concussion. And at that time, we really thought concussions were pretty much resolved spontaneously within seven to 10 days based off of the literature from 2002. From Brolio and McCrea at all from the NCAA study. But we don't have that's false. And we have so much updated information we can chat about if you'd like. So I thought it was just going to be seven to 10 days. I went back to work for for a week, I thought, you know, I would just be sore, kind of like a whiplash or like a Dom's. And now, I just kept D compensating and then from there went from 10 to 14 hours of rehab a week for 14 months.   05:53 And how did you continue to work and continue to function during all this time?   05:58 I did not. So I went off of I went out of work, mind you, I was just promoted to junior partner the week I got hit. So I remember I was like directing a prosthetics program, we had all these other programs, I just became junior partner, which would have been a profit share with a company and I loved my job, I would still send people back to that clinic, those four clinics in New Jersey in northern New Jersey. So essentially what happened was, it was a conversation that went on for months. So I was on short term disability for six months. And I say this to all physical therapists, physicians, OTs, PTs, whoever's listening to this, when you're young, make sure you have extended disability on yourself, because our bodies are so fragile at the end of the day. And again, I was an athlete, I was a cyclist I was training for, for a century bike ride and life changes in the blink of an eye. And I was underinsured with a $50,000 policy policies for car insurance to go up to 300,000 to 3 million for certain policies. And it would have been an extra $12 a month. But again, you're a new grad, you're just out of residency, just out of DPT school and you know, you're thinking about student loans and just being out of school. And so you don't really plan that far. So that's a whole other conversation we can have on another podcast. So I was on short term disability and we all know the legality of and we all have our own cognitive biases about this, right? So when people are involved in litigation, we know that their care tends to go a little bit longer. So I just I knew that. And I didn't want to, I almost didn't want to set myself up for failure, right? I just wanted to be a good soldier, show up for therapies, neuro psychology, vision therapy, talk therapy, vestibular therapy, regular musculoskeletal for the whiplash therapy, and just be a good soldier and show up as a good patient, just thinking that I would get better and slightly different than a musculoskeletal injury. The difference is with with brain injury is that there are cognitive and behavioral impairments that differentiate those from brain injury from musculoskeletal injury and rehab. On top of that, add the environmental aspect, and that's a whole other aspect of the injury. So there's no finite, you know, six to eight weeks of tissue healing or things like that, when it comes to brain brain injury, that it's a very gray area. So I was on disability for six months. And then that ended and that was petrifying. So two weeks before disability ended. I wanted to burn it down. That's when I got angry. And I think that's when I really went through that whole grief cycle, because I just kept showing up to therapy thinking I was going to get better, and then I did not. So went back after 14 months, I had the no fault car insurance, which helped pay some bills back home with mom at the time. And that was it. So after that, when I went back to work, I actually realized I had a vision handicap with overhead LED lights. So I still live with persistent symptoms, I still live with neuro fatigue, I still have an ocular motor disorder. But we learn how to manage and cope and I have wonderful support systems and definitely a grit that a lot of people don't have as well, I think I'm missing a chromosome there somewhere.   09:03 And you know, and this was eight years ago. So I think it's important for the people listening to understand that, you know, when one is diagnosed with a concussion, it's not just like you said over and seven to 10 days or maybe a week or a month or even a year, and that there are symptoms that can persist. And I think that's a great segue into what are some common myths around concussions. So I asked Jessica give me like maybe your top three common myths that surround concussion and and post concussion. So Jessica, I'll throw it over to you. So what would be Myth number one that is circulating out in whether it be layman's world or even the medical world? Well,   09:53 um, I was actually I'm going to give you something that we didn't speak about. I'll kind of combine one of them with three but One of them, actually two that we didn't speak, I'll surprise you as well. But there's actually no evidence based definition agreed upon international definition of concussion or traumatic brain injury. And that kind of will segue a little bit into two is that there's actually been zero phase three clinical trials on TBI concussion in over 30 years. So, when we're talking about research, I mean, talk about ground floor ground level, I mean, we were in the basement 10 years ago, just not having any idea what we were looking at. So I even I try to tell people like when we're talking about this, and looking at the literature, the medical legal literature got ahold of this injury 50 plus years ago, and it's been in the trapped with closed head injury and medical legal literature, but really not until 22,004. And on how we've been talking about this as a rehabilitative injury, and things like that. So, you know, historically, when we don't know what to do with someone in medicine, we tend to send them down to trajectories, we send them, we allude that they're milling, lingering, or looking for a secondary gain, or we tell them that's all in their head, and it can't be real, right. So that's what's kind of happening with these patients that we know up to 30% of folks now have persistent symptoms of concussion, they don't just spontaneously. You know, in even two weeks, we even actually, because we didn't really know what we're looking for right care. So we didn't have an agreed upon definition. So how can you know what you're looking at unless you know where you're looking for. So that's so very important to connect to is that a lot of the mismanagement of concussion was so much more prevalent in a well cared for patient.   11:38 That's wild. And so before 2004, basically, if you had persistent persistent symptoms after a concussion, it was like, good luck.   11:50 Yeah, you were allude that you're faking it. You were looking at this, that it was a psychological injury. Yeah. You know, and   11:57 that, that in and of itself is crazy making?   12:00 Yes, well, that's the whole thing and the chicken or the egg, right. And you can't deny psychological conversations when it comes to the brains like Hello. However, you know, it's really the chicken or the egg, you have these somatic things that we have the ability today in 2021, in a well versed clinician to validate the patient's symptom profile by doing targeted, comprehensive physical examinations as it pertains to concussion. So we actually the best thing that we can do for a patient like this, and I'm sure you've had all the chronic pain people on your podcast and things like that is validate their symptom profile. Listen, you're not crazy for seeing words coming up off the page. No, you didn't drop some LSD or an illegal drug. You have an ocelot Xia? You know, but the difference between the moderate and severe TBI is is that these folks have the self awareness to know that something's not right. But they do not have this objective language to express the what or how they feel with brain injury. So what do we do all day care? And how are you feeling? What's your pain level? What's your number? How are you feeling? But brain injury folks do not have the subjective language to express that so when they go to the mall and our fear avoidant of that, or they go to the supermarket, and they are don't like to be in a complex visual sensory environment, because the colors may blur, and things like that, that is then looked at as a fear avoidant behavior. And that's been sent to psychological counseling for decades. So how can we as physios how do we get these guys first and gals? So not to Detroit too much to keep you on track. But those are two. The first two is that there have been there are over 43 working definitions of concussion. One of them is evidence based. And to that there are zero phase three clinical trials in over 30 years for TBI concussion.   13:42 Wow. Wow. Wow, those are two biggies. Two big myth.   13:46 I would think so then I'll combine the last three because there are points. So the third one is, you know, I really, I'm really into education care. And I really believe that if we can teach one we can serve many, okay. And that's just what I've been privy to. And this implicit trust in the last, like eight to 10 years with this injury, that I've been invited to all different conferences for emergency physician athletic training, PT, you name it, because we all need to be on the same page here. So folks really need to I always say that we need to have a really humble approach when we come here because and I say this with kindness and I but I say this very firmly, is that with concussion, we have infinite ports of access to entry to care. Okay, you can go to the urgent care the emergency department, you could even be at your OB GYN appointment and you might have had this fall and a ski injury over the weekend and in your annual or biannual you know OBGYN appointment if you're a woman. And you know, you could have had you could have pre presented with signs and symptoms of concussion and not be aware of it. So I see that because there's infinite ports of entry on like cancer or unlike cardiology, you have a heart attack, where do you go care and you go to the emergency room, right? And then you see the cardiologist just right or you get diagnosed with cancer or your PCP or you start losing weight, you have some red flag showing up. Where do you go? Yeah, young colleges right to the oncologist, right. So that's a, that's a defined pathway. With concussion, we don't have a defined pathway. And that's not necessarily a bad thing. However, it's where a lot of this mismanagement has come up over the last few years and decades, and that's where patients start to suffer. And that's where it healthcare, we've actually imparted something that's called AI atherogenic suffering, which is where actually the health care system where your doctor is actually part of a way of suffering on a patient. So I bring that to our attention with these three quick facts. I'll say them quickly, and then we can chat about them. Go for one 2012. That's the number you got to know. 2012 was the first year the international consensus statement discuss the cervical spine in terms of examination treatment, that whole stick that connects the central nervous system to the peripheral nervous system and runs the autonomics up and down, right 2012. We just started talking about the cervical spine internationally. 2015 was the first academic year in which there was a formal training for both TBI and concussion, if you are a neurology resident. So if you were a brain physician in 2015, that was their first formal didactic year, they had training in concussion and brain injury. So just let that settle in there for a second because that's, that's just wow. Again, this is a place to build up, not tear down, but that was taking place within the behavioral neurology section of the American Academy of Neurology. And the third one was that 2017 was the first year on the international consensus statement that we actually identified the concussion as a rehabilitative injury. 2017. So, like, what? So if you think about it, as physical therapists, congratulations, happy 100 years care. We just had our centennial, right. So we were rehabilitation aids, literally in the trenches 100 years ago, like now, and we were treating what we were treating brain injury, what are we doing in the ICUs for treating brain injury? We're getting them up, we're getting them moving. But what do we prescribe when we don't know what to do with someone and healthcare rest? So we now know that that's not the ideal thing to do beyond the first 72 hours, but yeah, 2012, cervical spine 2015, brain physician started learning how concussion and 2017 was we call the rehabilitative so that's my third.   17:29 Wow, that's, it just seems like that cannot be possible.   17:33 Yeah. And, and it seems like that and because we know better, right? But imagine then being, you know, having deficits and having trouble thinking and processing, and what's our most valuable resource attention, but then you can't process. So it's, it's so horrible when you're a patient, and you have to negotiate the system, if you go through a no fault, or you go through a worker's comp, and there's all these other aspects, you know, of that of, of the injury. So I always say, sorry, I always say is that concussion as an injury of loss of it, I am, so you have to really pay attention to where your patients are in space and time when you when you meet them.   18:10 And it all seems to me like just not having a clear pathway. To me sounds like barriers to treatment, and barriers to to improvement. And then my question, I just one quick question. It. If you if the patient doesn't quite know who to go to, they don't know that they're they they have a concussion? Because some people like oh, you know, he got his bell rang, or whatever. And they don't even go to see a doctor, but they're having some symptoms, but they're not quite sure who to go to? Is it that the longer your symptoms go on, the less likely you are to recover?   18:50 So there's a yes or no answer to that. I don't want to say it depends. But the good news is, is that we have folks five and 10 years out who may have not sought treatment, like the patient you just alluded to, or sought treatment, then kind of plateaued, the brain wasn't ready yet. And that's totally fine. And we've got to tell patients that No, hey, maybe we need to take three to six months and just kind of let this settle. Let's reset, regroup, and then let's come back. Because the brain just may not be ready. You cannot force this. This is not about grit and resilience, in terms of being sore and pushing through. You've got to listen to the brain and I talked about it with like the knee effusion principle. You know, we have residency in orthopedic so I talk ortho all the time, although I love the neuro, neuro world these days as well. But you know, it's like the knee effusion principle, right? You do too much the knee fuses, we want to give it if it doesn't come down in two days, we did too much. Let's cut in half, right. So it's the same thing with concussion except the difference that is super frustrating to both patients and clinicians that aren't in the know is that you can have delayed symptom onset. So you can do something within the therapy office or they can do something like for example, have a vestibular migraine, where they feel good while they're walking outside and they feel okay walking But as soon as they stop their body like isn't really caught up to them yet. And then they get this distributor migraine within 20 to 60 minutes, and then they feel like garbage. But then they don't know what even to associate with. And that right there, Karen will make you feel crazy. So so it's very important to have somebody in the know, but you said something right before that question about barriers? And you're absolutely right, there are barriers, but I'll do you one better is that we're not only have barriers to accessing quality care for concussion, we also have i atherogenic, suffering, where they come and I, as a provider may not know enough about concussion to look at this from 360. So we have providers that don't know, they may be maybe in 2021, we'll be able to pull up the international consensus statement. But that's only for sport, and it's very limited. So it doesn't go through the nuance of the suffering and the delayed symptom onset and things like that. It's very white paper esque, right? So we actually then cause harm by quote unquote, just treating the neck, not looking at the vestibular system, not looking at sleep, not looking at the ocular motor system, not looking at is the the migrant or aspect of it, not, you know, all these other things and aspects that make concussion concussion. So from a symptom profile standpoint, so if you feel typically I should say,   21:15 yeah, and, and, you know, like you said earlier, you're all about education, and getting people to therapists, and whether you're a physical therapist, occupational therapist, you've been a personal trainer, physician, really understanding the ins and outs of concussion. And so I'm going to, I'm going to plug your educational entity that is that is launching, and it's concussion, corner Academy. And so now, I really like that you're coming at this from the patient and the provider standpoint. So talk a little bit more about concussion, quarter Academy, and what separates it from other educational programs. Because, you know, as you know, there's a lot out there in the world, right? So how, what, what is it about this that makes it different, and that you're really proud of as you should be?   22:08 Oh, I appreciate that care. And, golly, I mean, talk about like, your life's work, right? And I really, I just get goosebumps thinking about this. And I'm like, wow, this is this is really just a dream. And I'll be very honest with you, this is a we're in a pandemic, still, some people may not want to admit that. But we're, we're still in a pandemic. And we all kind of went through something, right, especially in New York City, we really went through it initially in the acute phase of this pandemic. And I did, I lost a good chunk of my practice, and I had to really sit with myself and I said, Gosh, just what do you want to keep doing? You know, what do you want to do with your life, I had patients no less than four years, some 11 years as patients. And I was like, I'm not doing this again, I just don't have the energy. And that was from just a like a, like, almost like a burnout aspect. I just couldn't imagine re building up my my practice again, I have no problem seeing patients, if they call me but I have no desire to market. Now. I was like, Well, my ideal life based off of my symptoms and persistent symptoms. You know, I really work every other day. So yeah, I can push through every five days and do a regular work week if needed, but I don't feel well. And then I'm not pleasant. And it's just, you know, I just know my limits. So with the neuro fatigue and the stuff that I live with, I said, Well, what's, uh, what's, what's something I can do? Well, if I could work remotely, that was kind of it. And I said, How can I help the concussion community? So we decided, and my partner is a graphic designer and in to animation and editing and all of this stuff. We said, how can we make this beautiful, and deliver it? Because the user experience was so important to us? And then how can we deliver it internationally to where it's accessible? So we're, we formed the academy, and essentially, the goal has always been to promote healing, decrease suffering, increase support, and deliver it with kindness to this mismanage patient population, but we need to have access. So I have a tremendous faculty. We're launching we are we have a nonprofit partnership. We have the faculty are actually the people on the international consensus statement. They're the people treating the the boots on the ground, their clinician scientists, and they get it, they get concussions, and they're vested in concussion. So it's going to be a 12 week online course for our first cohort. It's fixed. It's from January 16 to April 10. It's going to be two hours per week one posted for you and one live on Sunday mornings at 10am. Eastern which will allow for our European friends and our California friends as well on the West Coast. And it's going to be 24 hours of CEU activity for for for physical therapists and athletic trainers. As long as we have 10, ot speech pathologists, neuropsychologist, psychologists, social workers, we can see you them as well, but it's the first round so it's kind of a lot of investment here. So I'm just going with PT and 80 to start unless we have 10 of the others. And we're going to have a nonprofit partnership, but the the beauty of it all is already I'm actually going to have, we're going to be doing research on our students. So we're actually going to be looking to change outcomes based off of evidence based practice and education. So we're going to be able to study our students, and then link up with our nonprofits as well to support them because it's really an underfunded sector of research where cancer gets billions and trillions and and TBI and concussion tend to get hundreds of millions. So we're really going to try and support the folks you know, who are boots on the ground.   25:29 I love it. It sounds so great. Where can people find more information about it?   25:34 Sure. It's going to be it? Well, it's already at it's at concussion corner.org.org. If you follow the podcast, we tried to give things away just like you do with healthy, wealthy smart. So we've had the concussion corner podcast is 2018. I hosted the Super Bowl concussion are moderated, I should say, the Super Bowl concussion conference in Minneapolis and we launched it then it's been around in over 50 countries, it's been so well received, we have a lovely community. So we're going into education, and how can we have a supportive community with open office hours and open office hours and things like that, that will what will provide our students with, with eventually a rehabilitation video database, where that's going to be searchable for folks as well. So they can search, you know, cervical spine examination intervention, what's the referral process look like. So it'll be a robust program, but we're going to be beta in January with I just want to point out, we're going to have a referral program. And, again, I'm a person and have one right, so we're not going to have an early bird special, like we're used to at conferences. But the whole thing is to spread this word of mouth. So instead of taking $100 off, we're going to give a $75 referral. If you have seven to eight people that you refer your whole tuition is paid for Plus, you get your 24 hours of CEU. So we want to really just want this to be word of mouth, from from like grassroots, let's build it by conversation and internal marketing and get people in who are invested in wanting to learn about this injury.   27:02 Awesome, awesome. And of course, we'll have a link to it in the show notes here at podcast at healthy, wealthy, smart calm for anyone who wants to learn more about the program and about the modules and how it's set up. Or you want to just get some more information. Or if you're ready, you heard this and you're like, I see people with concussion all the time. I'm not 100% comfortable, I need to learn more, or this is something I want to learn more about, I think now you have the perfect opportunity to learn. So we'll have a link there in the podcast notes for anyone who is ready to pull the trigger and join Jessica in January. So now just is there anything that you really want the listeners to take away from this conversation around concussion and rehab of concussion?   27:58 Yeah, so I'm sure there's, there's so many things off the top of my head, really connecting to that concussion is a rehabilitative injury. And if we can connect to that the injury of concussion is an injury of loss. It's a loss of your I Am your I am funny, I am husband, I am wife, I am Doctor, I am surgeon, you're I am. So if we are sensitive to that and connect to that concussion is an event, it's not an event there, it has to be a mechanism of injury, don't get me wrong, but it's not an event, it's an actual process. And we have this neuro metabolic cascade. And then we tend to have this loss of function in our in our environment. So that is really what I want folks to connect to. Because we have to make sure we're meeting our patients where they are and their moments of recovery. So that's really the big thing to connect to is that folks tend to really connect to the event of the concussion, you know, the post traumatic amnesia, the domestic event, the loss of consciousness, and less than 10% of those folks, but they're not connecting to where those folks are in their trajectory. And how many folks have they seen before you on average, people see six to 10 providers before they walk into my door. Okay, connect to that. Do they trust healthcare providers before they've talked to you? Did they have physical therapy in a hospital gym that wasn't really, neurologically sensitive to their needs, their smell, their sound, their lights, things like that. So connect to your patients in a different way. I can guarantee you if you're a new grad, this is going to this is going to get you excited. And if you're a little more seasoned, like Karen and myself and you're feeling a little burnt out, this is a great way to look at your patients 360 We're looking at autonomics we're looking at neurology, vestibular ocular motor. The physiological aspect of its sleep, nutrition, neuro endocrine, let's talk about sexual dysfunction and concussion. That's a whole other podcast. But it really is something that you can hear my passion about, or these patients are being mismanaged much more probably than they're being well cared for. And we can change that and there's no reason that we can't change that for next day. Not Knowledge Translation in the clinic, so I challenge your listeners to that care.   30:03 Amazing, amazing. And now I have one more question to ask. And it's one that I asked everyone. And that's knowing where you are now, in your life and in your career, what advice would you give to your younger self, let's say, you know, straight out of straight out of Ithaca physical therapy school.   30:21 Um, let's see here, straight. So I've honestly joined Twitter, I have had so many, I've had so many positive experiences, the 99 that I've had positive and the one negative, you know, and you really have to conduct yourself in a certain way, of course, but I joined Twitter, I've had so many amazing opportunities. I was invited to the Super Bowl, I was asked to be one of our spokeswoman like you for American Physical Therapy Association, I've been invited to speak at conferences and, and just network with people who I would never have access or touch points to. And I really think it was the most powerful thing I've done for my education, besides, you know, maybe a residency postdoc, really. So I really do and we wouldn't have met the same way either. So I think it's been great.   31:05 All right. Well, that I think that might be the first time I've gotten that. What advice would you give to your younger self is to join, join Twitter and join social media. So thank you for that. And like you said, you have to make it your own, and you have to approach it, approach it in the right way. So I think that's great advice. And now, again, people can go to concussion corner.org. To find out more. And of course, like I said, we'll have all the links at podcast at healthy, wealthy, smart, calm. So a big thank you, Jessica, for coming on the program busting some concussion myths. So thank you so much.   31:42 Oh, thank you so much for having me and to all your listeners. Thanks so much for your time and attention. I really appreciate it.   31:47 Of course and everyone thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart
  • Healthy Wealthy & Smart podcast

    564: Paul Wright, Seven Critical Mistakes Which Reduce Profits, Increase Stress and Chain You to Your Health Business

    46:22

    In this episode, Creator of Practiceology, Paul Wright, talks about 7 critical mistakes that healthcare professionals can make that can hurt their bottom line and their business in general. Today, Paul talks about Perfectionist Syndrome, the implications of discretion, and doing your own PnL. What is the true role of your business? Hear about the danger of falling in love with your product, packaging an outcome-driven solution, and maintaining effective recruitment and internal systems, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “If it’s [your business] robbing you of your life, it’s not what it’s there for.” “Find the hungry market and satisfy that need.” “If you’re not embarrassed by the first launch of your product, you’ve launched too late.” “To the blind man, the one-eyed man is king.” “If you haven’t upset someone by midday every day, you haven’t said anything really important.” “One of the single biggest and most effective things you can do in your practice is to tighten up the reporter findings conversation.” “Remove discretion at the operating level of your business.” “Once you are the only person that has that program, you can’t be compared on price.” “You can’t put a monetary value on family time.” “There’s no such thing as quality time with your family. Family time is quantity time.”   More about Paul Wright Paul Wright is a Physiotherapist and former owner of multiple allied health clinics in Australia (which he rarely visited). He is the author of the Amazon Best Seller "How to Run a One Minute Practice", founder of the Practiceology™ health business freedom program, and has helped thousands of allied health business owners across 57 countries, earn more, work less, and enjoy their lives.   Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, PT, Business, Practiceology, Supply, Demand, Mistakes, Solutions, Healthcare, Entrepreneurship,   Resources: Get a hard copy of "How to Run a One Minute Practice" ($4.95AUD. Use promo codes below) Promo Codes: Non-Australian Buyers: KARENOS (Get $15 OFF) Australian Buyers: KARENAUST (Get $5 OFF) Register for the next Practiceology demonstration   To learn more, follow Paul at: Website:          PhysioProfessor.com                         HealthBusinessProfits.com                         OneMinutePractice.com LinkedIn:         Paul Wright   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript:  00:02 Hey Paul, welcome to the podcast. I'm happy to have you on.   00:06 Absolute pleasure to be here. What a boss.   00:09 I know it's so we're doing a little podcast swap here which I love. I love being able to swap podcasts with other hosts where you come on mine I come on yours and we get to know each other better. So it's been really great leading up to these podcasts. And today, you are going to talk about seven critical mistakes that healthcare practitioners can make. That can really hurt their bottom line and their business in general. But before we get to that, can you tell us your story of your career and how you ended up where you are so the listeners get a better idea of who you are?   00:52 Well, I'm I was born for a young Karen. Now I'm from from a small country town. I'm obviously Australian by my accent. I live in beautiful Newcastle but an hour north of Sydney. But I grew up in a small town about seven hours northwest of Sydney in the middle of the outback. They talk about Australia next so I'm in the outback. And what does what does a young kid do as in a small country town he Bhikkhu like sport, he becomes a physical education teacher. Because that was all I thought you could do as as a kid. I love sport. So I went to Newcastle University studied my physio, field education qualification, and then didn't even know what a physio was, but I met a physiotherapist at a party. And I liked anatomy I liked physiology. I thought, gee, that sounds cool. I don't think I could be a teacher for a long time I had an entrepreneurial streak I think so I didn't know I could work for someone else for my rest of my life. So I'll get into this physio course went to Sydney Uni did my physiotherapy degree and within two years after graduating I had started my first practice I then ended up with six of them in Sydney, one in Newcastle and five in Sydney. And I think my claim to fame Karen is I as I went through this journey I didn't go to them I was fortunate that I stumbled across the E myth by Michael Gerber very early in my business career and and I'm trading at my window counter in my practice and and looking out on the road that goes past in Sydney and there's a bus keeps going past one on the side of the bus why most small businesses fail and what to do with that is on the side of the bus and I'm getting there watching the sun come up in the morning watching the sun go down like most most help business owners and this bus kept going past and I'm getting better now I wasn't good there but I'm better now that the universe was telling me something followed up with this with this he ended up getting it to a Michael Gerber seminar read the book EMF and then I created then systematize the practice and as I said eventually had six didn't go to any of them and I then sold them which is a lesson for all of you guys the major role of a business is eventually to sell it and then started teaching other health business owners how I did it how I was able to run the remotely and how how you can still be a great health professional and have a successful business and still have a great quality of life which I think most of us miss out   03:19 yeah that's a great point talking about quality of life and I think that we'll probably get into that throughout this interview so without yeah without further ado, why don't you share with us these seven critical mistakes that can reduce your profits increase your stress and really not allow you to live your life outside of your business. So let's start with number one.   03:47 Well the first one having said I've done all of these by the way so you have earned the right to   03:52 I can't I kind of I kind of assumed that so I've done   03:57 I've done all of them but the smart people learn from other people's mistakes so hopefully you'll listen to what's happening now. That Mistake number one that I identified early is failing to understand carrying the true role of your business and if you think about what what does what does your business do for you and if it's robbing you of your life it's not what it's there for the role of your business is to serve you it's your certain needs to give you more life yet when you ask most health business owners why they started this I I wanted to be my own boss or I wanted to make my own decisions or the guy was working for before was an idiot. Whatever they like to say but is this really happening now and as Gerber talked about when I first read it you're now doing the hands on work of the practitioner plus you're also doing the business stuff the marketing the recruitment in any wonder we get overwhelmed so early. And and that's why Gerber talks about it's true. I was probably better off opening a plumbing business because I couldn't do it. plumbing work I was better off opening a business that I couldn't physically do then I could list run the business and that's the whole idea of this. My brother who's a plumber would be staggered because I'm hopeless with power tools and I he's banned me from using any sort of manual labor things but the idea of the businesses to serve you and one thing I suggest you look at guys, his his work out what I call your freedom score. And your freedom score is simply how many hours per week on average? Do you spend treating patients at your practice? How many hours per week do you spend physically treating patients and if you're telling me that we've done this in seminars, 50 6070 I've heard I've had one guy doing it five hours. And they're still trying to run the business, you just, you just can't do that. So and we talk about this thing between practice ology, right is law, which is, which is as your number of team members increases, your freedom score must decrease, you can't keep adding team members to your roster, because they time suck, they have to take energy out of you, and still see all the patients, there's going to be this balance. And that was how I was able to run it. But when that being said, you have the choice of how you run your business. Now my model was to replace myself, get therapists in do the work for me. So I had freedom of time and freedom of money. But some of our clients have a Mr. X. Mr. X is the guy that runs healthcare practice, but he runs it on his own terms or her own terms. Doesn't work, school holidays, start at nine finishes at two sets his own hours or her own hours charges, what they feel it. And guys I'm thinking about that don't even have sometimes receptionist though, sometimes if the surfs up, they don't turn up at the practice, they just gave surfing. But the patients know that's the deal. If you want to see this person, that's the model. But even in that case, Karen, the business is still serving that person. It's, it's it, you're the master, but not the other way around. And I don't know if you've ever made that. But that's understand what you want your business to do for you. And make sure it does it. Otherwise it'll suck the life out.   07:17 Yeah, and I think that's why when you look at your business, whether you're just starting, you've been in it for a couple of years, you've been in it for 20 years, if you've never written down what your goals are for your life, not what your business goals are, but you know, do you want to spend, do you want to be able to watch a movie a week workout five days a week, spend dinner with friends, pick up your kids from school, drop them off, you have to write those goals down while you're looking at your business. Because that's that's how you're going to have that freedom. And that's how you're going to have your own life outside of the business.   07:58 And the natural recourse for all health business owners is typically to see more patients, regardless of what happens in their business. Regardless, they need more money, they see more patients, team member leaves, I'll see more patients. So that that's that's the recourse their natural recourse is to go back to what they know. We teach our clients sometimes that's the worst thing you can do. You need to do something exactly the opposite. And one point also to this is that this is probably one of my worst moments. You've got understand to the concept of current bank and future neck when you think about your business. Now I had a current bank business meeting. I had one of my practices earlier was inside a fitness center. So I had a physiotherapy practice inside a fitness center in Sydney. And it was a good business. It was a cash cow. But what I didn't realize at the time was it was fragile. So it was it was making me lots of money at the time. How I knew was fragile. I got a phone call from one of my clients would have been a Thursday night. He said, Paul, I've got some news for you. The owner of the gym I've heard hasn't paid rent for three months. Okay, this is a $300,000 business like I'm running here. Oh, that's the good so I ring the owner who when you will do the gym tonight what's the deal? He said it'll be sold out Don't worry about Okay, I arrived at the practice the next day cancer that patient list hard to track proceeded to put everything inside the trap that day. So by Friday, five o'clock, I've been everything inside the event saying what are you doing wrong? What are you doing? Well, I said I'm taking everything out because I don't know what's happening here. This is all a bit unstable because I went to give the owner the gym my rent check for the month and he didn't accept it. He said hold on to that for a second. Roger, you might need it. So okay, the writing's on the wall, drove off in the truck and everyone's saying Ronnie, another another gym Chad's gonna buy this place, you'll be back open on Monday. So when I open on Monday, I'll bring the truck back and I'll check everything back in then I'll be fine. But I'll tell you, I never again set foot inside that building. It shut that day and I never will went back in there. So overnight, a business goes from 300 grand to zero. What's the lesson I had a current bank business, there was nothing. I was relying on someone else's rent someone else's tenancy. If you're leasing a space in a Medical Center in a fitness center in something else, you think you've got a business you can you can sell. There's no real future banking, that you are at the mercy of your landlords. So it's not a bad way to test the market to see if there's available market. But that's not your long term gig. Because there's a problem with it, and I've suffered badly. Anyway, yeah, yeah, start number one.   10:41 Big mistake, mistake number one. So let's talk about Mistake number two.   10:46 All right, we do this all the time. We fall in love with our product. We fall in love with the idea of being a therapist, like I fell in love with the idea of being a physio, but I didn't know was there a market for that? Was there a need for more physios, I just wanted to be one. But we do that all the time, we fall in love with our product of therapy, what we got to fall in love with is, is the market, you got to fall in love with the market once, so you might have a passion for trading on that elbow pain in one arm. Gullfoss, that might be your passion. But if there's not enough one arm golfers out there, you're not going to do any good. So the market doesn't care what you want, find what the market wants. So your job is to listen to all of your patients, listen to the doctors, listen to the community, what's missing, your job is to fill the need. And if you do that, you'll be successful in business. My favorite one, hope you guys watch Shark Tank, you guys have shark tech in the States. That's shark tank with a my favorite one is the guy that turned up with the pad for guys shirts. So now that so you put up your stick to pads on the ROM so your shirt didn't get all sweaty, there was his product. The Sharks wouldn't touch it. I said I'm not really interested. And they said how many have you sold? I've been doing it for seven years now. I've sold about 500 so in seven years, and out the back the entity in there. So what are you gonna do now he said, Our, I believe in this, I'm gonna keep going I fell in love with this product, the market had already said they didn't want to move on. So find the hungry market and satisfy that need. If you do that, you will be okay. And you see that lock county if people so they open a practice in, in a country town or regionally because they might have identified there's a market for that service. So they've done well. But the part that missing is the available labor supply. Because there's two drivers of every business available market available labor, you haven't got enough labor, you're going to be staffing that thing yourself for the rest of natural life. And that happens all the time. So be very aware, don't, don't fall in love with a product, fall in love with the market, what's the desperate need in your community? solve that and you'll be halfway there. And that's that's kind of what I did in my second my next career because I I knew help business owners struggle with business and finance and marketing and other things. And it happened to marry up with something I liked and was good at. So that was a fortunate thing. But you've got to find the hungry crowd first.   13:18 Yeah, do your research. If you don't do your research first. You're in big trouble.   13:22 I had a guy come to me once and he said, Paul, I want to open seven practices on the northern suburbs of Sydney That's what he said to me in the seminar. I said oh is there is there enough market for that automatically sell so i think so he said he just he cuz he wanted to do it. Karen he wanted to open I saw Kenya available. I was a bit tired. Can you staff those seven practices? Will you find your start? I'll just advertise. There's a guy with his head in the sand. It's not funny. But I think the key thing I want to do I want to do this. Now that's okay, if that's a passion project. But if you want to generate a revenue and a business successful and you can sell it down the track if that's what you want to do, solve solve the desperate problem. Yeah, yeah,   14:14 turn it around. It's not about you. It's about you, but it's not about you all the same time, right.   14:21 If you get married up, it's great if you can find that that thing but be careful of what you do. So make sure there's a hungry market for an audit this we found out in one of our practices, there was a real market for lymphedema treatment. So massive market lymphedema and we had a guy who knew all about it the therapist and knew all about it. So we got him doing the lymphedema program. It was great. But But don't be Dora here didn't get him to train everyone else on how to do you know what happened? The guy leaves. Three years after we're still getting phone calls from people wanting lymphedema treatment and every time they rang it killed me. So Solve the desperate problem. Yes. But then protect yourself with the viable labor supply if you're doing something like that.   15:06 Yeah, absolutely. That's a great example. Okay, what's number three. So we've got failing to understand the true role of your business falling in love with your product, your product number two, what's number three,   15:18 we'll do this falling in love or falling victim to our own perfectionist syndrome. I was probably fortunate, I had some good mentors early in my career, and they'd tell me, Roddy, it's better to be 80% and out the door than 100%. And in the drawer. And it's so true, we just worry so much about putting something out there, because it's not quite perfect yet. Reed Hoffman, I think, was the founder of LinkedIn. one of the founders, he said, if you're not embarrassed by the first version of your product, you've launched too late. If you're not embarrassed by the first version of your product, you've launched too late. Meaning put your put something out there and you see if it's got traction, is it going to get some market share? Is it going to work for me? If it does, then you can then do version two, then do version three. But so many health professionals I get so caught up in making it perfect. I just want to do this, I just want to finish this, I just want to do this. And they end up not doing it. They wait that long, and they just slowly implement. Maybe it's because we're analytical thinkers, we're sometimes slow to implement, and we just, we drag the China bit. And I like this expression to, to the blind man, the one eyed man is king. But one of my mentors said to me, Roddy, you don't have to be the best in the world. You just got to be the best in their world. Say there might be a nice specialist down the road, who's who's a superstar does all the courses and is on all the all the seminars and other things and you've got your own new program. That's great. But don't let that stop you from what you're doing. Just be the best in your clients world at it. You don't have to be as good as that guy. You just have to be the best in the client's world. And, and that also, I think, Karen, sometimes maybe it comes from our universities that that we want to be anointed or we want to be awarded, or we want to wait for someone else to recognize me. Don't Don't wait to be anointed by your profession. Don't that's too slow, anoint yourself. Someone. Someone says to me, Roddy, who's the best health business mentor in the world? Well, I want to do wait for the National Association of physical therapists to make the announcement I'm not going to wait for that I am. And I think we're going to have some balls do that. But people take you at your own appraisal aren't going away in? And if not, that's your choice. But that's it again, don't wait to be annoyed because it's just too slow to do it that way. So don't fall victim to perfectionism because it's just a curse   18:12 for us. Yeah, very, very common. Especially I think I see it more in women than men. Men will often center feel like I'm just gonna do it and see what happens and women are more like, okay, it needs to be like this, it needs to be perfect. And I think sometimes our women judged more harshly than their male counterparts for things. There aren't as many women in leadership positions so you don't have that person that looks like me in those leadership positions as a point of reference, and so I think oftentimes women tend to keep putting things off because it's got to be as almost perfect before it goes out because we don't want to get judged harshly on something. And I see that consistently. Again and again. And a lot of men will just throw shit out there and it's like, yeah, this is fine. Who cares and women are like a   19:12 you got to remember littering once I was I did electric in the fitness industry years ago and in the in the personal training space. And I remember doing anatomy lecture one day to a group of trainers and I in the audience was my anatomy tutor from uni, like a superstar like this person, you everything about everything and I'm at the front talking anatomy and and it was a pivotal moment for me because I'm so self conscious about what I'm saying in front of this, this mentor. But no one asked her any questions. They all asked me the questions. I was at the front of the room. I had the clicker. I was in charge. I was the best in their world. She was the best in mind, but I was the best. There's that's it. I'll leave all of you to make the comments about Gaza girls, I can't say that sort of stuff. So knock yourself out cam   20:05 Yeah, yeah, I'm just that's just what I've seen, you know, over and over again, is, is that women tend to be a little more hesitant at putting themselves out there. And I get it, you know, as someone who has and who does put themselves out there, the criticism is harsh people can be mean, mean spirited, especially when it comes to social media can be a little toxic and, and you are judged very harshly and people say really mean things. So you have to grow a thick skin, I think if you're going to want stepping into kind of those leadership positions   20:43 that was published one of the key things, I think my management style of the business that you had to have a thick skin to work for us. I mean, maybe I was more suited to being an owner back then that I would be now I don't think I'd be as quite as sensitive as I'd need to be now. Anyway, that's if one of my mentors said to. And I love that when I say this, if you haven't upset someone by midday every day. You haven't said anything really important. What everyone's gonna agree with you You don't you don't have different doesn't have to agree with you. You just you haven't you have the right to have your opinion in this, but I think you need to do you'd have to agree with me, that's just what it is. But if everyone's agreeing with you, are you really saying anything of any importance possum?   21:24 Right, right? Very true. Very true. You don't want to surround yourself with Yes, people all the time, that's for sure. Because then you'll never move forward because you're never kind of grow and challenge yourself. Okay, let's, let's move on to number four.   21:40 Number four, ineffective, non existent. And unsupervised internal systems. You we've seen it, we've seen it, countless times someone goes to a seminar or they or they get an idea and they launch it into their practice. And, and they seem so excited about it. But the team have seen this before they've seen you come in with an idea and they've seen you launch it and they know you'll just it'll blow over. Once you get you'll see more patients and get busy so so that sometimes they do it for a while and you can see this owner because you'll say to them, do you have for example, you have a follow up system in your practice? I think we did here we look we did do something like that. Ryan, are we still doing that follow up system so that they haven't followed up and measured it. So one of the best things give you the tip, one of the single biggest and most effective things you could do in your practice is to tighten up the report of findings conversation. That's that's after I've done your history of January, your examination, and I'm saying what we're going to do to fix you that's the chiropractic wellness report the findings in their words, it's the action plan or it's our treatment plan, get get that script, right? Get that conversation, right? Write it down, sit the person next to you and write it down Mary to get you back running in that marathon in two weeks time. You need to see me three times a week for the next two weeks. I'll reassess you then and we'll get you ready for that race. How does that sound like that? Does that conversation that that currently is not done? Well in most practices? And and because I'm an analytical guy can often How do I measure that? How can I control that conversation. So I created an action plan a written plan. And, and the penny dropped for me when there is a number at the bottom. So the numbers at the bottom was how many how many sessions, how many times a week for how many weeks. So that's three times a week for two weeks, I had a number six, so that person needs at least six sessions before the next assessment. So I then made it mandatory that every patient would walk out at the front counter with that sheet that would give it to the admin person who and would verbally hand over that patient current to get married back to her run in two weeks time she's doing a marathon she's gonna do it really well. She needs to make three appointments for the next three weeks for the next two weeks and we'll get there admin to person books in in. And then I then got a spreadsheet that we created that has consults on plan. So that would be a six, the column next to it, consults booked. So you recommended six and how many were booked. Now if I if I then log into that spreadsheet and I see that my therapist has recommended six and a booking one so 616151 to one with it's a one on that on that booking column. I've either got a therapist problem or I've got an admin problem. Has the therapist not been good enough to get the confidence in the patient or is the admin under pressure and hasn't got time to book those sessions in advance. And you will know the dangers of a session by session appointment diary. It's just it's a recipe for disaster it's but that's that's an example of a system Karen you've got to put in to your business that you can then measure and stay on top. And you'll love this. So in true Polaroid style there was only one time in All of my practices where the therapist did not have to do one of those sheets written physical shit. And I get them all in a room and say guys, what's the only time that you can get away without doing one of these things? And they'd say, the person need to go and see a specialist or I ran at a time or whatever else that said, Now none of those things. The only reason I'll accept the no completion of this form is if the patient dies during the consultation and they've got a chuckle it's a chocolate gets a check. I want to talk about it now. But there's an element of truth to it. Everyone else gets one. Now that's that's the problem with most health businesses, we don't enforce our systems, we don't put them in and we don't make them mandatory. One of the keys to business success, remove discretion at the operating level of your business. Remove discretion, remove the chance for seminar I was going to give them a plan but I didn't think they needed it or the Garda see the surgeon or like, I want to look at the that report and say, Okay, what happened with Mrs. Johnson yesterday said news about Mrs. Johnson. She didn't make it through the consultation. And the therapists were Hi, can I get it ready? And then I can say, Man, I've noticed Mrs. Jones didn't get an action plan either. What's happening here is, is something that I'm wanting to do not sinking in, is there, imbalance here? And if it happens a third time we're gonna have a serious discussion. Now that's that may be used multiple that's hardcore. But   26:37 would you tolerate a therapist turning up without a shirt on? Would you tolerate that? horrifically bad breath? Would you tolerate them being late all the time? What are you going to tolerate? removed discretion?   26:53 Yeah, yeah, she just, Yep. Yep. That's a great system. Yeah. So really making sure that you've got systems in place that work for your practice, because every practice is different. And so you have to know what works for you. What are the KPIs that work for your business?   27:12 And quints of non compliance? What if you don't do it? Unfortunately, can we notice it now with with available library a bit short? Too many owners don't enforce this systems because they worried the therapists will leave so they're trapped they're trapped because they can't enforce this system. So what if they leave Well, what are they costing if they stay you know there's a cost for them to stay you're happy to where the cost make the decision. We've got a client in practice soldier now he's got an admin person just off sorry, a therapist, but just might want follow that action plan system to the letter, but he's got a labor supply issue. We know our numbers, we know what she's worth to the practice. We just made a decision to tolerate it for the moment that we could jump on if one day but it's not worth the fight because we're gonna have trouble with that off. Better Off fighting our battles in the right order. But it's a decision. It's a strategic decision.   28:07 Yeah, yeah. makes sense to me. Okay, let's move on to number five.   28:13 Number five, using your accountant to do your p&l for you. is a mistake because most accountants on average your account but assuming even give you a p&l, like most accountants, their job is to keep you out of out of jail and to make sure you pay enough tax and that's pretty weird. But what we want to know is, is a down and dirty profit loss for your practice. We want to know take out all the dodgy expenses take out the trip you took to the conference in New York take out all that. Even the year there was a conference there, but it's a bit dodgy like what take everything out of the car, all the other things that are legally claimable, but aren't really required for the business, get a down and dirty profit loss on a calendar month basis. Revenue we build, this is what we spent a know your numbers every month, and you shouldn't be able to wait for the end of the month to come to track your numbers. And one thing you must allocate Karen, you must have an owner consulting wage in there. Which is not the amount of money your accountant told you to take. It's not the dividend. It's a reflection of your consulting effort. So how you do that freedom school, so how many hours per week you're at the practice, multiply that by what it would cost to replace you, as a therapist, assistant your replacement costs, that money is not changing hands, by the way, the accountants looking after that. But this is we've got that in our p&l as a reflection of your consulting time. Because I can tell you now from having done this a long time, the only way sometimes you can get over practice to drop their consulting is to show them a down and dirty profit loss and show them that it hasn't changed or has improved if they dropped their consulting hours. Then you got it and you don't do that with your accountants p&l because it's a different spreadsheet, you got to deal with a down and dirty p&l. But because our natural recourse, Karen is to just consult more, whereas as a result of that we're not mentoring our team. We're not recruiting, we're not marketing. We're not with the kids, all these other things we're not doing.   30:17 Right? Yeah, no, that makes perfect sense. Yeah, I yeah, yeah, it's different. I mean, my accountant does do my p&l. But I also do monthly p&l is for myself. So on a month to month basis,   30:32 it can work if you're if you're doing a percentage of grossmith. But I just the problem with most therapists, we don't know their personal contribution to consulting and the overall scheme of things and we've show owners if you if you cut your hours, 20 hours a week, we can maintain your profit. Would you be happy to do that and see it because they're their natural recourse is to see more patients that just happens all the time. Sure. Anyway, can do it? He's know the numbers, the numbers will set them free.   30:58 Yeah, absolutely. Absolutely. No, I like that. And so when you're saying putting your consulting numbers in, you're talking about not just the time that you're with patients, but time that you're working on the business as well. Or just time when you're   31:14 just you're just you're face to face consulting time, because everything else is part of your profit margin. Right? Right. But the other thing is product and it's the other stuff is discretionary. You You can do your marketing when you want you can cancel a staff track you can you can you've got freedom to that, but your patient list. That's that's the one that use you're stuck in. So that's when you would change your business. Got it? Yeah. And, and most of ours, we try and get that down to zero. We try and get your owner consulting wage to zero maintaining your profit, then they have discretion. They can go to work if they want to say they're doing they're seeing patients because they want to not because they have to. Yeah, that's a differentiation. Not enough of us, Mike.   31:55 Got it. Okay, that makes sense. All right. So let's go on to number two to go six.   32:02 ineffective recruitment systems is a is a classic problem. And I know what it is we just we take it personally if they don't, if they leave we we don't get the right people always stuff this recruitment stuffs a nightmare. And I think it comes back a lot of it. As an owner, you have to make make a big decision regarding your team. Do you want to be liked? Or do you want to be respected, to be liked, or to be respected. I believe too many health business owners worry so much about being liked by their team, they can't have those difficult conversations, they don't have the respect of the team. And you're not always going to be like just accepted as an item of business. You know, there was going to be popular, you control the way ours you control the wages, you control everything in the business. It's important to be liked all the time. And if you're trying to be liked, it's going to be very difficult for you. Everyone is replaceable, except that and if they're not you want to make them replaceable. You need to think about the systems in a bit like my lymphedema God big mistake. I, I had an epiphany one night, I often have these epiphanies there. So there I am. And my admin, I had an admin superstar one of the practices and she knew everything. And she was so good everything she just did everything. And I had an I'm in there in bed one night, when I bought up right? What happens if something happens to Gina and I remember I couldn't sleep the rest of night. So I rang Gina, June at nine o'clock in the morning, I want you to come in, I've got someone to replace you at front desk, I've got my camera, you're going to show me everything. And we sat in the back room with the camera, show me how to do this show me how to do that show me and we just that we did that for a whole day. And I had all this stuff so if something happened you can watch the Gina file that someone can do. If you aren't doing that you are you are in all sorts of trouble. So recruitment systems, people are replaceable, except they're going to move on Don't take it personally. One of my mentors, we did a recruitment training program recently and one guy said, Just accept the fact that people are gonna, your business is like a train journey. People are gonna get onto certain station, get a bit down the track and then they get off the train. That's just that's what this journey is like they're not going to stay with you till the end of the line. Don't expect them to that's just just accept they will move on. And the final one and are running in the time, final one, not packaging your services, not packaging it into into an outcome driven solution. The bite write program for TMJ, the run marathon pain free program, whatever you do, we had a corrective orthopedic rehab program with exercise so name it something because once you are the only person that has that program, you can't be compared on price. If I'm bringing around the practices and you're charging 80 bucks and someone's charging 75 you're commoditizing yourself but If you're the only person with the x y Zed migraine program, because no one else has got that you can't put a price on that. So So you got to make sure you don't you have to package your services as a solution driven outcome, not just as a session by session deal. If you do that you're reducing the church have been caught up as a commodity. Now we've got time for one bonus mistake, I think. Yeah, all right. This is one bonus mistake. And too many owners do this. They, they think, well, they put a monetary value on their family time. They put a monetary value on their family time. Meaning I could finish at four o'clock in the afternoon. Or I could I could if I stay I'll make an extra $1,000 whenever I stopped but but I'll miss my daughter's concert. There's there's a so we put a monetary value if I do that, it'll cost me this. You just there's some things in life, you can't put a monetary value on. You just you can't put a monetary value on your family time. And people who told me that it's that it family time, I don't have much but I have quality time. And again, I don't want to guilt you into this stuff. But there's no such thing as quality time with your family. Family time is quantity time. things just happen. When you're around them. things just happen. I'm on. I'm on the back porch of my house. My second youngest daughter was about 17 on home a lot as I was on the on the back porch in she comes in she stands at the door. Not a crier young Jade. She's a very, very stout young lady. And she I said okay, down, and she dissolves like just the tears coming up. Right? a Cadillac for five minutes. Yeah, Caden are just a few things happening at school done. Um, right now, as you took off, yeah. I couldn't plan that.   36:59 I can't, you can't. You can't plan that. That just happens because you're around. And again, I'm not I'm not guilting you guys. Yes, you have bills to pay, they have other things to do. But the business is there to serve you. You do what you need to do to make sure your family is happy and fed and everything else but don't put a monetary value on it. Because it's it's a it's just not a fair comparison. You can't price it. It's just ridiculous to even think about it. Anyway. All right. Sorry to guilt everyone into something but that's the deal. Now I've lost you can you muted yourself.   37:40 There's a loud siren going by sighs just   37:44 could not go to Yes.   37:53 That was allowed one. Well, obviously edit this out. But I was like, I couldn't even I couldn't even It was so loud. Because it must have been like right in front of my apartment. So we'll edit that out. So annoying. That's that has not happened in a while that was allowed one. And didn't I don't even know what it was. Anyway. So we'll just sort of I'll do a little clap, and then we'll start. So this helps me for editing. But uh, you're killing me. I know, he's, I don't like it's fine by me. You know, I don't even realize he's there. But okay. So all right, so we went through seven mistakes, plus a bonus, which is great. And, you know, if you weren't taking notes, don't worry, we'll have all of these written out in the show notes to make it really easy for you and to follow along. But now, where can people find out more about you get some more resources so that they don't make all these mistakes.   38:59 best place to start, we do a monthly demonstration of practice ology. It's a webinar we do every month. And we'd basically show how our clients across 54 countries earning more, working less and enjoying their lives, even during a pandemic. So we talked about some of the principles to talk about today. And it's really a very interactive demonstration of how we do it. So if you go to my practice, ology.com forge forward slash Litzy li Ts Ed, why obviously. So my practice ology.com forward slash, let's see, you'll get the you can log in and register for the next next session. And if you want to get a copy of the book, I wrote a book how to run a woman a practice, as Karen explained at the start. It's not a it's not a big book, I didn't want to write it. It doesn't make sense to have a massive journal for how to run a woman in practice. It's got to be a woman's book, you should read that in less than an hour. Just covers a lot of the action plans and the bookings and there's great resources sample action plans you can get from the book If you just get to one minute practice.com forward slash book sales. So one minute practice.com forward slash book sales. And if you just put in the code, Karen Oh s for overseas. So if you're not Australian, which I don't imagine you will be if you're not Australian, do Karen r West. And it'll take 15 bucks off and you get it for $4.95 Australian which I think's about $1 us. That's a bit more than that. But it's not it's a pretty good deal. If you happen to be Australian, listen to it put in Karen, au, s t. So I'm going to practice.com forward slash Bob sales. Karen Oh s get it for if you're if you're outside Australia, or Karen a USD if you're Australian, and you get that for $4.95. And we'll post it out for you. And my social media platform is LinkedIn believer not I'm an old school, LinkedIn. So follow me on LinkedIn. Paul, right, Newcastle, I'd love to have a chat. And I hope you can join it for join us for a webinar and get some of those great resources from the book. And posted sorry, posters is a bit slow, I think we've covered but once you, once you buy the book, you do get the PDF of the book straightaway. And there is a second page, a link to all the resources and the action plans and all the scripts and stuff. So that's perfect.   41:16 And we will have links to all of that at podcast at healthy, wealthy, smart, calm. So one link will take you to the webinar to the books and to your LinkedIn page. And before we wrap things up, I'll ask you one last question. And it's one that I asked everyone knowing where you are now in your life and in your business and in your practice. What would What advice would you give to your younger self?   41:40 Oh, you love this one? Okay. I would probably be a podiatrist or an optometrist. You're sitting thinking, Okay, what are those things got in common? Well think about it. They've got a product arm. They've got a range of products, because I, I did what we talked about earlier, I became a physiotherapist because I wanted to be a physiotherapist. I didn't know I could be limited in what I can sell our products. So if I could go my time again. podiatry, I would, but I don't like feet. So maybe it's a problem. optometry, I'd be okay. Maybe orthodontics? I'd want a product range. That would be that would be why don't go and say all my diamonds done. Put a product range in your current business, if you can. That helps. But the idea of relying on your hands and trading time for dollars, I'd probably do differently.   42:38 Right? Well, great advice to your younger self, for sure. Thank you so much for Paul, for coming on and sharing seven mistakes that you've made and probably a lot of us who have been in business for more than a couple of years or more than a year have made and hopefully all the listeners out there you will not make those mistakes because we have covered them here. You've got them in your head. You'll sign up for the webinar and you won't make up and it'll be clear sailing. Fingers crossed. So thanks, Paul, for coming on and sharing all of that with us. I appreciate it.   43:14 Absolute pleasure, your superstar. Thanks for having me.   43:17 Thank you and everyone. Thanks for listening, have a great couple of days and stay healthy, wealthy and smart.
  • Healthy Wealthy & Smart podcast

    563: Luke Hollomon, SPT: How to Keep up with Research While Staying Sane

    32:23

    In this episode, Founder of PT Crab, Luke Hollomon, talks about the importance of reading, dissecting, and understanding research. Today, Luke talks about how PT Crab can help PTs, the most common research-reading pain points, why reading the abstract isn’t enough, and how to make the whole research process easier. What does it mean to keep up with the research? Hear about how to find exactly what you’re looking for, how to understand what the research says, and how to apply the research to your clinical population, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Research has shown that, in our specific field, over 90% of the abstracts are at least misleading, if not inaccurate, relative to the paper.” “It’s important, when you’re reading a paper, to read it a little bit critically.” “A lot of times, research is written for researchers. It’s really important for researchers to write for physical therapists.” “If you have a paper that doesn’t specifically address your patient population, you can translate that to your population with good communication.” “Try to make [your] favourite journal one that you have access to.” “Get focused in on something a little bit earlier.”   More about Luke Hollomon Luke Hollomon is a writer, teacher, and student from Richmond, Virginia with a special interest in sharing complex information with those who need it. Using his background in physiology and education, he started PT Crab, a newsletter that brings physical therapy clinical research, awesomely brief to the inboxes of thousands of physical therapists every week. His true passion is helping people understand and use scientific information. When not writing The Crab, he writes science and technology articles as a freelancer and is currently finishing his degree in physical therapy from Virginia Commonwealth University. Afterward, he plans to pursue a PhD in exercise physiology and study the limits of human endurance. When not doing all of that, he’s a bikepacker, rock climber, and trainer of his deaf adventure dog, Kiwi. If you’re ever in Richmond, look for her in her trailer behind Luke’s bicycle as they explore the city together.   Suggested Keywords Healthy, Wealthy, Smart, PT Crab, Physiotherapy, Research, Papers, Reading, Keywords, Critical Thinking, Science, Knowledge,   Resources: https://www.researchgate.net   To learn more, follow Luke at: Website:          PTCrab.org Facebook:       PT Crab Twitter:            @lukehollomon   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
  • Healthy Wealthy & Smart podcast

    562: Dr. C. Adam Callery: Post Covid-19, Resetting Business for Continuity

    37:19

    In this episode, Managing Director of Sagesse Lumiere, Dr. C. Adam Callery, talks about small In businesses in the wake of the Covid-19 pandemic. Today, Dr. Callery talks about the implications of the pandemic on future business strategies, the importance of agility, and understanding cashflow. How often should a business of any size check their financial status? Hear about some emerging trends, three critical activities for success, how Dr. Callery helps other entrepreneurs, and get his valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Never confuse faith that you will prevail in the end.” “If you want to be successful moving forward, you have to be ready for these unexpected changes.” “You can’t be afraid to act fast, but you don’t want to be reckless.” “You have to take a step back sometimes and attack a problem formally.” “I cannot just assume that because my bank account has money in it that I’m actually in a good position.” “You have to position yourself, or maybe carve out specific time, for you to really learn your industry.” “You have to be close enough to the operations to know what’s going on.” “It is extremely important, whether you’re an existing business owner or a new business owner, to truly understand what cashflow means.” “You can do it. You can actually be an entrepreneur. Just go out and do it.” “Bring people around you who have the knowledge that you need, because you’re not going to know everything, and if you adapt that knowledge, you’ll be successful.”   More about Dr. Callery Dr. Callery is an entrepreneur and higher education educator. For the past eleven (11) years, Dr. Callery has worked directly with the start-up and emerging business communities at a national level. For ten of the eleven years, Dr. Callery has held the roles as facilitator and trainer for two (2) nationally recognized small business growth programs, the US Small Business Administration’s Streetwise MBA Program in Chicago and the Goldman Sachs 10,000 Small Businesses Program. His company, Sagesse Lumiere, a small business coaching and consulting firm, was established seven years ago to complement the work he was doing in these programs. To date, Dr. Callery has advised over one thousand small business founders while participating within the national programs cited above. Dr. Callery, as a coach and consultant, works with small business owners on approaches to effectively build value by deploying new business practices and processes to improve financial performance and operational efficiency. Prior to working with small business owners as a business coach, Dr. Callery worked for several Fortune 1000 companies such as IBM, Dow/Dupont, Pepsi, United Airlines, and First National Bank of Chicago. His broad industry experience has prepared him to be a capable business consultant. Since leaving the corporate arena, he has become a trusted advisor for many small business founders. As a higher education educator, he has served as an Associate Dean for workforce development programs and currently works as a tenured faculty member for Harold Washington College, one of the City Colleges of Chicago. Dr. Callery has earned a Bachelor’s in Chemical Engineering from Illinois Institute of Technology; a Master of Business Administration from University of North Carolina, Chapel Hill; and a Doctorate in Higher Education from National Louis University, Chicago.   Suggested Keywords Healthy, Wealthy, Smart, Small Business, COVID-19, Research, Success, Cashflow, Entrepreneurship, Mentorship, Finance   Resources: The Goldman Sachs 10,000 Small Businesses Program WSC1998: AVOIDING THE BLUES FOR AIRLINE TRAVELERS   To learn more, follow Dr. Callery at: Website:          https://sagesselumiere.com Twitter:            @callerysagesse Instagram:       @callery_sagesselumiere LinkedIn:         Dr. C. Adam Callery   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:03 Hi, Dr. Callery. Welcome to the podcast. It's an honor to have you on. So thanks so much for joining me.   00:10 I'm so happy to be here. And so glad you invited me to attend your podcast.   00:14 Oh, this is great. And you know, like I said in the, in the intro, you were our lead instructor for the Goldman Sachs 10,000 Small Business program. So I owe a lot of my being a therapist and having to be a business owner to now being a business owner who happens to be a therapist to you and the rest of the staff and business advisors. It was really life changing. So thank you so much.   00:40 Well, I think I thank you for being a participant in the program. It's a hard program, we asked a lot of you for an extended period of time. And I have to say, I cannot do it solely by myself. It really is just a good strong team that covers so many different areas of business management that's needed for most small business owners. So I'm just having to have good people around me, that helps make the process very smooth.   01:05 Yeah, absolutely. And today, we are going to talk about sort of small business owners, and the effects of COVID-19, which we have been in for the last 18 months and doesn't look like it's ending anytime soon. But we are back to work. There are mitigation factors in place. But now, how do we position ourselves for the long term in this new world? So my question is, what are some of the lessons you have learned over the past 18 months? And what are the implications for your future business strategies?   01:50 Well, I think that's a great question. Because myself, I'm also a business owner, I am a small business coach. And I would have to say for the last 18 months, that's been a question that's been raised many times, I can think back to March, when we first moved into COVID. Everything shut down. And to be honest, it seemed very dark at that time. And then for the next three to four months, I was working with a lot of small business owners, and we were having those discussions, what are what's next, you know, how do I get out of this. And in fact, if you started to look at the newspaper, you'll see headlines saying this is the worst crisis since the depression or behind closed doors, there's calamity. And when you read those phrases, it actually diminishes your ability to be a leader, and organizer of your business. And so what I had to do as a coach started having different discussions and say, we must look forward. And the way I did that was having a time with individuals to stop and say, Hey, if we take a look at the Great Depression, or the great recession of 2008, those same phrases were being said then, yet, we were still standing in 2020. So we have to believe that we're going to pass through this period as well. And so the discussion became, how do we do that, and in most cases, and then bring back or I should say, shorten your horizon from looking out two to three years, to just make it now bring it down to three months down the six months, make it manageable, it was easier for you to see out three months, it's easier for to see how six months, and then just be very tactical. And so during that last quarter of 2020, through the beginning of the initiation of 2021, many of the conversations with business owners have centered on that, how can we focus on some short tactical goals that keep the lights on, they keep my current employees satisfied, so they stay with me to make sure the customers I do have still like the services are providing or the product that they're buying from us. Therefore, we have to maintain the same level of quality. So just being very tactical that way. And then hopefully, when we're on the other side, we can then return to a posture where we're thinking longer term.   04:06 And all that, to me just sounds like a small business owners that we have to be really agile, and we have to be able to pivot. And so can you speak to a little bit more about agility as a business owner, and how we can foster that if it's something that we're not used to?   04:28 Well, agility, you know, it's a strong word, right? So it means that we're flexible. But again, coming through this COVID period, it didn't seem like flexibility existed. Everywhere I turned, something was shutting down. So I've seen closer to the end, then something that was gonna be an opportunity in the future. And I came across a quote, it came out of the book called Good to Great. That was written in 2001. And I wrote it down someone just read it verbatim because it's a unique quote, but I think it addresses issue. It says never confused. That you will prevail in the end. So that saying this thing of, I have faith that I'm going to win, I have faith that my business is going to win, it's going to be successful, and I'm gonna make a lot of money from it, or I'm going to be fame, I'm going to become famous from it, you have this faith, you got to have this confidence, that's probably a better word, I got to have the confidence that I will make it through. But here's what the rest of the quote says it says, I can never lose that confidence. However, I must have the discipline to confront the most brutal acts of your current reality. So the current reality of 2020 was, everybody's impacted at the same time, my competitors, my peers, people across the ocean, everyone is getting hit with this calamity. So now I have to think out of the box, and I also have to think very practically, so that's where the agility comes in, I didn't have a lot of time to wait six months to see if it's gonna work, because I may not be here. So I may have to take some cost cutting measures that are going to be very draconian, but necessary, I may have to talk to my staff and negotiate with them, and maybe get them to take a cut and pay, letting them know I'm trying to keep everyone alive here, I may have to talk to my customers in a different way and find out, are you still here? You know, are you still viable, because my customer is also impacted by this. So then I can sort of forecast what my sales potential could be. Because many of the customers went out of business for many of my clients. So agility means that you are being sorry, that you're focusing on today. And you're being very practical, very tactical, you're using your experiences, from your I should say, your past experiences as a business leader, and a business owner. But you also are willing, and here's the key, you are willing to take in advice from subject matter experts who are in your industry, and also outside your industry to help you navigate this because this was so unknown, a lot of unknown territory that we were crossing through.   06:55 Absolutely. And I would also think that in that time, I'll use the example of the physical therapy profession, but kind of acknowledge acknowledging emerging trends during this time. So for the physical therapy world, certainly here in New York City, we were close, literally shut down ghost town from March to almost June or July of 2020. So what do you have to do to keep things going? So the emerging trend was telehealth? Yeah, telehealth has been a trend and it has been coming up and coming up. But I think as a PT, if you didn't acknowledge that that trend existed, and didn't hug that trend, like it's your best friend, you you were in trouble, right? So what other kinds of trends Did you see within the small business world that people had to acknowledge and embrace in order to not only bring them through 2020. But I'm sure a lot of those trends have continued well into this year.   07:56 I agree 100%, the hardest trend, and I don't know if I can call it a trend, that's probably more of an action, the action that I may have to return to what I was before. And what I mean by that is, maybe we're a sizable business, you had 50 employees, or maybe employees and contractors working for you that accounted for about 50 people that you're responsible for, had a fairly good customer base that you're working with COVID hits and everything shuts down. Now, you may have to go back to what you were three years earlier, that's when you started the business where you were a smaller company, not as nimble because you were smaller, but you were very focused and very targeted. And that was the trend, I was saying that people say I'm at the roll back to where I was before. And that by rolling back doesn't mean I'm failed, which is another trend element. It doesn't mean I'm failing, it means I had to adjust, you know. So it's realizing that businesses aren't always going to go up with hockey stick and grow, grow, grow, grow without interruption, that there will be these troughs. And if I hit a trough, I may have to back up a little bit. In this case, people have to back up a lot. A great example of that would be the restaurant community. Here in Chicago, I've seen it all over where people physically had to change the menu, they may have 30 items on the menu. And they just took duct tape and started covering over things and reduce the menu down to something that they could manage based on staff based on a cost of the ingredients based on just pure demand, because now they're doing just takeout services, no longer doing to sit in services. why they do that, because I have to still pay the rent, I still have to pay some utilities, I still have to pay something. So I have to have some money coming in. And I want to be here for the next day. So I may have to swallow deeply. And Take another deep breath and say I have to go back to where I was maybe when I started the business so I can survive this period not knowing if you remember not knowing back in April, how long is this going to go? Because the predictions were two months, six months, two years, five years. Nobody knew. So You had to be very specific and very intentional about how far you will go back in time in order to survive and be here for the future.   10:09 Yeah, I mean, gosh, back in March, when New York City shut down, I was like, ah, six or eight weeks, we'll   10:15 be back up and running. Let's see, 18 months later,   10:21 not quite back to where we were. But getting closer. But to your point, yeah, I thought it would just be like six or eight weeks. And this will be a little adjustment that I'd have to make in my business. But it, it actually turned into a long term adjustment that I love. And I'm glad now that it's part of my business. So that ability to pivot quickly actually turned into a big positive for my company, because now I can actually see more people because I don't have to see them in person.   10:51 I agree. I agree. And I stole something else out to you. It's not so much of a trend, but it's probably a revelation. So we know a lot of business owners have different backgrounds, and they come from different walks of life. And so if we put an academic hat on, we have individuals coming out of MBA programs, and they have knowledge around business. The key is what does an MBA program teach? What MBA program teaches is that you need to go out and look at the environment that you're in. So that means you research on what some of these latest trends are. When we have a situation like COVID, I know many business owners typically don't worry about what the trends are, they worry more about what's going on in their daily environment in their community, and their marketplace, and they're just focused on can I sell something tomorrow, I think COVID has opened up a new reality that if you want to be successful moving forward, you have to be ready for these unexpected change as well. How can I reduce the number of unexpected changes, I start to do some research, I start to do some reading in my industry and also outside of my industry. So I can see those trends that you were talking about earlier. So telemarketing has been or tele health rather, has been around for a long time. People talk about it, but it wasn't economically feasible. Then when I need it, those who knew about it jumped on it. So but I had to know about it, I needed to have that information. So this is an important time as business leaders now to say, what else do I need to know? Do I need to join my industry associations? Do I need to go out and and go to conferences, go to particular training programs, where I can start to learn about what is going on around me so I can be better equipped for the next situation may not be a pandemic? Or it could be droughts, if you're out west? Who knows? It's going to be something so how can I be prepared for the next something?   12:39 Yeah, because you know, something that you had brought that you brought up in our kind of communication before we recorded this is and I like this phrase you put in quotations, you can't be afraid to act fast. But you don't want to be reckless. Yes, yeah, right. And so by doing the research, you can act quickly, and not in a reckless manner. Because you know where you are, you know, what the industry is holding, and you've got that research. So you can act quickly with authority. And with some sense of operation.   13:15 I agree. And ask where, you know, we want to say, you want to be intentional. And that's what that word really means. And especially when we're in our programs, we use that word a lot. But it's good to unpack it. So you just mentioned and that reckless, and I'm not trying to be strong willed. So when I'm talking to my employees, I'm trying to hit them over here with a club, but I'm intentional. So I have I know where I want to go, I've taken the time to do some research. So I've set a goal in mind, I've also decided on a path that we can take, but I'm also willing to ask around to see if that's the best path. So that's where I'm not being reckless, I'll go ahead and qualify it by talking to other subject matter experts, talk to other people in the industry and say, This is what I want to do based on my capabilities. What do you guys think? What do you people think? And that can help me then to minimize risk? Because we'll never eliminate it. We're just trying to minimize risk. So we can be successful.   14:10 Absolutely. And so now, we've we've sort of identified research we have we spoke to people, we got advice. Now we want to move forward. So we need some sort of formal operations. So these operations, as you said, they kind of revolve around three critical activities. So can you share with the listeners what those critical activities are, to make that those formal operations successful?   14:38 So I can that'd be beautiful. We've met through the Goldman Sachs program and what I've learned over the last 10 years in that program, is that you have to take a step back sometimes and attack a problem formally. And so we start off with the purpose, what is your business purpose? And what that means, of course, is what do you think? to do in your marketplace, who you're trying to sell to, why you're doing it, why are you actually involved in this work? The second thing we try to do is examine how we actually do the work. And this is the operational piece. So how do we actually do the work? How do we earn our revenues? How do we manage our team? How do we actually produce the product or service? Are we doing it efficiently? And then the last piece I call her reflection, but that's the research piece. I've been doing this for five years, I've been doing it for 10 years, is this the best way to do it now, based on the changes in the business environment, changes in government regulations, changes in social trends, changes in the number of competitors, or the type of competitors that so the three pieces are looking at my purpose? Why did I get into this business? Why do I want to do this or continue to do this kind of work, I look at my model my business model in general, and think about how I currently conduct business and see there's a better way I can do it more efficiently, more effectively. And then last but not least, I have this reflection or research activity that I do continuously continuous learning to make sure I understand my marketplace, understand my industry, understand what's happening with competitors around me also start to probe and find out are my customers still satisfied with what I'm doing? And if not, what do I need to do to reach them?   16:21 Yeah, and I'm glad that you said that you're continuously looking at this, because this isn't something that you do when you start your business, you assess your purpose, your model and solutions and reflect. It's not like you just do it once. Yes. Like how often would you say do you recommend even the business owners that you work with, kind of go through these three critical activities?   16:47 Well, I think we can take the model from the corporates. Now you understand corporations are huge, billion dollar places, but they are billion dollar places for a reason. And that is because they do take the time to annually look at what they do, and assess whether or not is making sense. So if I was any business owner, I don't care what size you are, I would make it a point to say maybe in the fall, that November period, Christmas period, when it's kind of quiet, people focused on vacation or focus on the holidays, you take that time, sit down with your management team and say, hey, let's think about how our last year went. Is there something that we want to do better, right doesn't mean that you did anything wrong? Is there something that I can improve upon? Or are there some new things coming down the pipeline that I need to be aware of, or we'd need to be aware of, that we need to plan for starting in January. So doing an annually isn't a bad practice. And if you do it formally, and you do it every year, it just becomes part of your routine. And you'll start to think about the questions you want to ask each other during those sessions. And you'll be able to flesh out what is happening with the business. In fact, you probably want to go ahead and bring in some of your key employees that sit them around a table, get some insight from them on what they're experiencing, when you're engaging your clients, when they're engaging your suppliers, or if what they see, in general, they may see some things in the market that you have missed. And it's a good time to sit back and get their feedback as well.   18:16 And how often would you say suggest to a business owner small of any size, but let's say a small business owner, to really look at the financials of their business once a quarter every month, every week, every night before you go to bed? Like is there overkill? Or? Or what? What are your thoughts on that?   18:40 That's a tough question is a tough question, right? Because Is there any should you have any limit on when you look at your numbers, because for instance, everybody will tell you, you need to know your numbers. So if I'm sitting in front of an investor, or a banker, they're going to say you need to know your numbers. But I guess the question is, what are they really asking me? They're probably just asking, do you know enough about your numbers to tell me whether or not you're profitable? That's really the question they want to know. And they want you to be able to tell them that, tell them you're profitable in a confident manner. And they can easily see if you're sort of dancing around the question, right? Because you really don't know your numbers today. They can sense that in the way you respond, your eye contact, and so on. So to your direct question, how often should I look, if I put on my accounting hat, we typically look once a month. So every month we take a step back, and we see how the business is performing financially. In order to do that, we probably need to have some type of system in place. That could be a QuickBooks system, or it could be a cell spreadsheet. It depends on the complexity of your business. And that's when we have to define a small business. So small business can be defined as any business with less than 500 employees. That's a big business. But let's say I'm a mom and pop I have less than 10 employees. In fact, I am the key employee and everyone else is a contractor. If I'm that size, once a month is probably still appropriate, I need to take the time to stop. And look, I cannot just assume that because my bank account has money in it, that I'm actually in a good position. So if I take the time, look at it once a month, that's probably enough. The furthest I would like to go out is probably three months, you know, quarterly, but want to go beyond that. Because a lot can happen to a business in two days, let alone in 90 days. And if I'm not keeping track of my numbers, I may find myself in a very dire cashflow position, and maybe find myself going out of business fairly quickly.   20:42 Yeah, excellent advice. Excellent advice. Thank you for that. And you know, as we start to wrap things up, what would be if you could give one or two pieces of advice to let's say, a new small business owner, so their business is less than a year old? What is your best advice for those business owners?   21:04 I think it's extremely important for the person just getting started to do some of the things we're talking about earlier, you have to position yourself or maybe carve out specific time for you to really learn your industry. So that could mean joining an industry association, going to those industry association meetings. So that's gonna take time, read some of their white papers that they generate about your industry. So for instance, I was at one time I was looking at buying a limo service, I love this guy service used to take me to the airport all the time, all his drivers were professional, his cars were clean, well maintained. And all I knew about the business at the time was the fact he took me in a limo to the airport. But that's not knowing the business. So I went ahead, I contacted limo Association, they sent out to me information on the business, you know, on the industry, the cost factors, the maintenance issues, some of the trends in the industry. After reading all those materials, and learning that it was a very highly capitalized business, I realized that it wasn't for me, at that time, still like the business. But I knew I was not in a position where I had enough capital to keep the cars up to spec to meet the requirements of running a limo business. So if I'm starting a business, whatever it is, I need to know as much as possible about that industry and the business model itself. How's the business make money? What are the cost factors? What are the what are the cost influencers, I need to know that like the back of my hand, then when I'm running the business on a day to day, I need to be in the business to see how it really operates. I've met some people that have started a business. And I've started another one that started know when I started another one. And I now ask them I said, Well, how do you possibly run three businesses at the same time? Well, I got people working for me. And what comes to mind is something someone told me many years ago, is that you have to smell the people. And what this is gain from Business School, and the professor was saying, you have to be close enough to the operations to know what's going on. And if you're too far away from it, there's too many things that can happen to the operations that will shut you down. And so if you're just getting started, your focus needs to be in the business and getting the business to a place where it's stable, and is sustainable. That usually means creating cash reserves, that usually means bringing in solid employees, it usually means having a great understanding of your customers so that you know you have returning customers that'll help keep the business afloat.   23:42 Excellent. Thank you so much. I know a lot of people that listen to this podcast or maybe budding entrepreneurs, they've been in business for maybe a year or two. So I think that advice is really great for that group. Now, is there anything have we not covered something that you were like, I want to hit this point during this podcast?   24:02 I think it's important, we haven't used that key phrase. And that's cash flow. It is extremely important whether you are a existing business owner, or a new business owner to truly understand what cash flow means. And so when we talk about cash flow, what it means in general, is that we're talking about the money that's coming in. And that's where most people focus is, Hey, I'm making revenues, things are going well. But you can't just stop there, you got to think about the cash outflow. And people say I write the checks every day, I know how much money is going out. The third piece is timing. You have to think about when the money has to be paid out. When does that liability has to be paid out, and whether or not I'm going to have enough cash on hand to pay it on time. Because once I default on that payment, I'm now in trouble. The bank is knocking at the door. My creditors are knocking at the door, my investors are knocking at the door and I'm going to have problems paying my employees so on and so on. So cash flow is very important. And it's important from the standpoint of you have to truly understand the definition of it. And what it means is inflow is outflow. And it's also timing. When is the money coming in to pay those current debts that I have? Will I run into a situation where I don't have enough coming in to pay those debts? And if I do, what am I going to do about it? Am I going to reach into my personal account and pay it? Am I going to run down to the bank and ask for a line of credit? Do I need to run out and find investors? Who can give me additional cash to help me close that gap? So cash flow is critical?   25:36 Yeah. And I think, as you were saying that the thing that popped into my mind is, ooh, this is why Ponzi schemes ultimately fail.   25:44 Yes, yes. Because the money stops coming in. And their commitments outweigh our Yeah, extend beyond the, the amount of money that's coming in.   25:54 Right. Right. Yeah, that is why a Ponzi scheme fails. And, and I agree that cash flow is so important. And it's something that I didn't really wrap my head around fully until the Goldman Sachs program. You know, I knew like, yeah, money's coming in. But once I started doing cash flow statements, I was like, Ah, okay, yeah. Now I got it. No, I know, I can now I understand this as, as one of the three sisters, you know, your cash flow statement, your balance sheet, and your income statement.   26:32 Exactly, exactly. And it's the cash flow statement, and we never talk about, you talk about it. If you again, be school, we talk about all the time, but most people just stop at the income statement. In particular, they stop at the income side, then when you introduce the balance sheet, I don't see why I really need it. I don't have any assets. But they don't combine the two to come up with the cash flow. And that's what you really want.   26:53 Yeah, yeah. Excellent. All right. Now, where can actually let's talk before we before I asked, Where can people find you? Why don't you talk a little bit more about your business? And how you help other entrepreneurs, your coaching business and what you do to help entrepreneurs?   27:12 Well, what I do is I focus in the business development area, as well as the operations or organizational development area. And what does that mean? So I come in as a business coach, not as a consultant, I sit down with my clients, and we have discussion. So it's like we're doing now and we focus on the issues that are facing them. So in a business development side, for instance, such as a marketing issue, we're not talking about social media, what we're talking about is more around a target market. Have they identified the right persons, or the right audience? When it comes to marketing? Also, you got to think about the delivery of the product and service. Are there some challenges in terms of quality, some challenges in terms of delivery, that they're facing? And then we start to peel back a little bit? And this is where we get into the operations? Why are you having those challenges? Is it a capability issue is a capacity issue, these things have to be fixed, or the marketing, social media really won't matter? So I focus on a business development sort of working backwards? What are you trying to sell? What are you servicing? How are you working with your clients? And what are your business capabilities, what is what is your business capacity, in order to essentially achieve the goals that you've set for the business or to meet your current demand for your customers, those are all very important pieces, because most businesses will suffer or in a trough when they get to that third and fifth year when they try to scale up. And they always find, hey, I have this resource deficit. And I usually think it's money but it's not so much money, it's really capacity and capability, they may not have the right people on hand, they may not have the skill themselves in order to scale up and they need to go back, build up those skills so that they can grow. And that's where the coaching comes in and sort of help the build up those skills.   28:57 Awesome. Now where can people find you?   29:00 Well, they can find me right on the internet. I have a website out there, my, my company has a very unique names, it's called suggests luminaire and will suggest and stores wisdom, and then luminaires light. And so right out there on the internet, I have a web page where you can contact me through that or you can come back contact me through LinkedIn. So I do have a LinkedIn profile out there. That's probably the best way most people will contact me through LinkedIn. And then we'll set up an appointment and we go from there.   29:29 Perfect and we will have direct links to all of that at podcast at healthy wealthy, smart, calm and the Show Notes for this episode, so don't worry if you didn't have a pen you can take it down. totally get it we will have one click direct links to all of that. And now, Dr. calorie for the last question, which is a question I asked everyone, knowing where you are now in your life and in your business, what advice would you give to your younger self   29:57 so what I would tell my younger self I'm fully invested in entrepreneurship, I would tell my younger self is that you can do it, you can actually be an entrepreneur. To be honest, when I came out of school or coming came out of undergraduate, my mind wasn't there, my mind was I had to go through this career track, because that's the only possibility that entrepreneur thing, or that small business thing was just too far out there. You have to literally be born into it. It has to be a legacy relationship in order to start a business. Today, I recognize after meeting so many people in this space, that's really not it is really tied to have any interest. People use the word passion, but I go beyond the same passion, you really have that ambition that you're willing to give all in order to accomplish this. And so I would tell my younger self, that you do have that ability, you do have that ambition, just go out and do it. Bring people around you who have the knowledge that you need, because you're not gonna know everything. And if you adapt that knowledge, you'll be successful.   31:03 And I think that's great advice. And especially for a lot of the physical therapists who listen to this podcast, because so often we graduate, and we think, well, I'll work at a clinic, I'll work at a hospital, I'll do that for 40 years, and then I'll retire. You know, it's like, it's never it. Because in school, we're not really given any entrepreneurial mentorship or classes, you really have to seek it out on your own. And so I think that's great advice for any students listening or newer graduates, who think, Well, my mom wasn't wasn't an entrepreneur, my dad or I don't, I don't have any real role models in my immediate family, but that you can do it if you surround yourself with the right people, and you have the ambition and passion to do it. So I think that is excellent advice. So thank you for that. Well, and thank you again, for coming on the podcast and for being a great instructor in the Goldman Sachs 10,000 Small Business program, I can put a link up to that too, if people are interested in learning more about the program because it is a life changing program. It was for me and I'm sure as an instructor, it must have been for you as well.   32:13 Oh, it hasn't. It hasn't, I have to say, I never, I never thought I'd have this experience. It's been now going into my 11th year and I've actually set before 1000 business owners never thought that could happen in my wildest dreams and having the ability to have conversations like we're having now. Again, it's opened up my mind to say the The possibilities are limitless in this country when it comes to being able to create something that you want to create. And that's the beauty of it. So it's it's a fantastic opportunity. Fantastic country fantastic. Time, even though it's difficult time, it's a fantastic time to to do something that you want to do.   32:57 Excellent. And on that note, I will wrap things up by saying thank you again and thank you to all of the listeners for tuning in today. Have a great couple of days and stay healthy, wealthy and smart.
  • Healthy Wealthy & Smart podcast

    561: Schellie Percudani & Rebecca Rakoski: The Importance of Cybersecurity

    37:13

    In this episode, Managing Partner of XPAN Law Partners, Rebecca Rakoski, and Senior Account Manager at Contango IT, Schellie Percudani, talk about cybersecurity, especially for small businesses. Today, Rebecca and Schellie talk about business privacy and security practices, cost-effective steps that you can take to protect your business, and the importance of cybersecurity insurance. Why do small businesses have to worry about cybersecurity? Hear about ransomware attacks and how to react to them, data privacy laws and how they impact your business, and the value of hiring lawyers, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “What we all have in common between the small businesses and the large businesses is we’re all human.” “You’re only as good as your last backup.” “You can’t have privacy without security.” “You definitely don’t want to be fudging any kind of information. You definitely want transparency.” There are four basic things that you can do as a business owner: enable multi-factor authentication, provide security awareness training, monitor and patch your systems, and enable software and hardware encryption. “Encryption is your Get Out Of Jail Free card in most jurisdictions.” “60% of small businesses will go out of business within 6 months of a data breach without liability insurance.” “The first thing that businesses need to do is take a proactive posture.” “If you look at data breaches, if it’s not caused by an employee in the company, it’s caused by an employee at one of their vendors.” “Make sure you put yourself in a legally defensible position.”   More About Schellie Percudani Schellie is a Senior Account Manager at Contango IT located in Midtown, Manhattan. With 75 people, Contango IT services their clients through 4 key areas of technology. IT Service/Support - We offer unlimited onsite and remote support for all covered users and devices with up to 60-90 second response time. In that same fixed monthly price, we also include asset management, budgeting breakdowns, disaster recovery planning, compliance requirement review and planning, technology road mapping, and a lot more. IT Infrastructure / Cabling - Moving offices? Contango IT handles the technology side of the move through Cabling and IT setup. Cybersecurity - 45 people strictly in Cybersecurity keeps Contango IT on top of the biggest buzz In technology. Risk? Compliance? Reach out, looking to help in any way possible. Even if it is just second opinion or advice. Custom Programming - Front-end or Back-end development, Android, iOS, Web-based and much more. Winners of the Microsoft Best Use of Technology Award and the NYU Stern New Venture Competition Any technology questions, reach out! With hundreds of clients over 4 services, Contango IT has seen it before.   More About Rebecca Rakoski Rebecca L. Rakoski is the managing partner at XPAN Law Partners. Rebecca counsels and defends public and private corporations, and their boards, during data breaches and responds to state/federal regulatory compliance and enforcement actions. As an experienced litigator, Rebecca has handled hundreds of matters in state and federal courts. Rebecca skilfully manages the intersection of state, federal, and international regulations that affect the transfer, storage, and collection of data to aggressively mitigate her client's litigation risks. Rebecca is on the Board of Governors for Temple University Health Systems, and an adjunct professor at Drexel University’s Thomas R. Kline School of Law and Rowan University.   Suggested Keywords Healthy, Wealthy, Smart, Cybersecurity, Small Business, Privacy, Security, IT, Insurance, Legal, Hacking, Ransomware, Malware, Data, Technology, Data Breaches, Encryption   To learn more, follow Schellie and Rebecca at: Website:          https://www.contangoit.com                         https://xpanlawpartners.com Twitter:            @XPANLawPartners                         @RRakoskiesq Instagram:       @schellie00 LinkedIn:         Schellie Percudani                         Rebecca Rakoski, Esq.   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hello, Rebecca and Shelly, welcome to the podcast. I'm very excited to have you on to talk all about cybersecurity. So welcome, welcome.   00:13 Thank you for having us.   00:14 Yes, thank you. And   00:16 so this cybersecurity this for me as a small business owner, is brand new to me. Although it probably shouldn't be, but it is, but that's why we're talking about it today. But before we get into it, can you guys give a little bit more detail about yourself and what you do so if the listeners understand why I'm talking to you guys today?   00:41 So I, Rebecca McCroskey, I'm a co founder and managing partner of x Pam law partners, we're a boutique cybersecurity and domestic and international data privacy law firm, which is a really fancy way of saying we help organizations with their cybersecurity, and data privacy needs, right? I have been a practicing attorney for almost four years. I hate to admit that sometimes I'm like, I'm dating myself. But what's great is we really help businesses, small startups, all the way that big multinational corporations because right now businesses are it's, it's really a brave new world that we're facing today. And businesses are getting attacked literally from all different sides. And so we started x pant to really help businesses understand what their legal obligations are, and what their legal liabilities are. And I tell my clients, my job is to avoid those problems for you, or do my best or put you in the best position to address them if and when it becomes an issue. So that's   01:48 what I do in a nutshell. Great, thanks, Shelly. How about you?   01:53 Yes, my name is Shelly perky. Donnie, I am an account manager with contango it and we help businesses and our end organizations if I could speak, we help them manage their day to day it to help build a strong security posture. We also help them with cybersecurity, we have 45 people strictly in cybersecurity, we have 25 penetration testers, eight ethical hackers. So we have a strong, you know, posture to help businesses build a posture so that they at the end, I wouldn't say that they're not going to be attacked, but they are prepared for anything that could happen. And so we help them with that. Got it.   02:43 Well, thank you both for being here to talk about this, because we are seeing more and more things in the news lately about ransomware and cyber attacks. And so oftentimes, we think of that as only happening to the big businesses, right? So why should small businesses, which a lot of listeners that listen to this podcast, are entrepreneurs or small business owners? Why should we have to worry about this?   03:10 So, you know, from a legal perspective, obviously, anybody who's ever come into contact with the legal system knows, it's not just for large businesses. So from a legal perspective, you're going to be subjected to liability from your people who whose information you're collecting, call them data subjects, you can, you're going to have contractual obligations with your vendors and third parties that you use and share data with. So put that and then just put that aside for a moment, then you also have small businesses have a reputation. And in the small business community, I am myself a small business, I'm a small law firm, Chief law firm. And you know, your reputation is everything. And so part of your reputation nowadays is how you're handling security and privacy. What are you doing the data. And so it's really important for small businesses to realize it's not just the big guys, we hear about them in the news, the colonial pipelines and the JPS foods and the Equifax is of the world. What you don't know is that every single day law firms like mine are getting a call from small businesses going help. We just clicked on a bad link, we just got ransomware, what do we do? And that happens all the time. It really you hear about the big guys, but it's the little guys that are really, you know, bearing the brunt of it, I think.   04:32 Now, I would agree. And what we all have in common between the small businesses and the large businesses is we're all human. And like Rebecca said, it's human error. Somebody clicked on an email, and they didn't know you know, they weren't trained. Hey, this is a spoofing and phishing email. This is what they look like, this is what you need to look for. And so that's where we come in, and it's we're all human and we all make mistakes. It's just no Like, you know, you this is what to look out for.   05:04 Got it. And so what are some of the issues facing businesses today, when it comes to cybersecurity?   05:12 What ransomware is obviously one of the biggest issues, right. And for your listeners who don't know what ransomware is, it is, what happens is somebody clicks on a bad link, download the bad, you know, attachment to a file, and the ransomware is downloaded to the system. Depending on how sophisticated the hackers are, they can either deploy it immediately, which means your system starts to, they start to encrypt your files, or it can be that they sit in there and wait for Oh, I don't know, the most inopportune moment that your business has. And then they deploy the ransomware. I've had clients where they deploy ransomware, or they first delete backups before they deploy the ransomware to really add insult to injury there. So but so that's one of the big things and then the your entire system gets encrypted and you can't unencrypted it without the encryption key which you then have to pay for the ransom part of it. And, you know, we hear about the big ransoms, again, the 4.4 million from colonial the 11 million from JBS. But you know, I was speaking with a colleague the other day, and a law firm got ransomware for $50,000. Now, that's a lot to a small business, it's a lot to any business, but they try to make it it's almost like it's commercials with what they think that they can afford and pay and so that they'll pay because they want you to pay the ransom. So that's I think, I think that's probably the   06:35 number one I would say so too. And then you now you're on their list, because you've paid your   06:41 SIR now. Wow, they paid   06:44 from now you're on a list of this hacker of like, Well, you know, was easy to get in before. Yeah. So let's see how we can get in again.   06:55 Right? Oh, my goodness. Hang in and you know Rebecca's right.   06:59 And that's where you know, also patching and monitoring your systems having a good strong it. posture is important. Because they see that stuff, they see little inklings of, Oh, well, something's going on here. somebody's trying to get in, you know, so they can see that. And you know, you're only as good as your last backup, and where is your backup being stored? And you know, is that in a secure location? Because if not, guess what? It doesn't matter. Because your information is gone.   07:33 Oh, my gosh, yeah, that makes so much more sense. Now, even just explaining what ransomware is. I didn't realize so they hold the encryption key ransom. And that's what you're paying for.   07:46 Correct you in order to get your data back, you have to pay to get the encryption key. And people think Well, okay, so I'll pay the ransom. And I'll get the encryption. I'll get the encryption key. And it's like, like magic? Yeah. You do, to some extent, although there used to be honor amongst thieves. It's not always the case anymore. No. But the other thing is to keep in mind encryption is not perfect. So you're not going to get it back exactly the way it was before. And a lot of laws have been changed now. So the fact that you were ransomware, it is in and of itself, a reportable event for a data breach. So that's another aspect to it. I mean, we're talking more about the technical aspects with the ransomware. But this is the other part where you know, I always say like, ransomware is like three explosions. The first one, oh, my God, my computer has exploded, but yeah, my computer's, what do I do? And then the second one, which is how are we going to, you know, get back up and running. And then the third is really the legal liability that flows from it and holding it together.   08:55 Also to I mean, Rebecca, are you finding that now, too, they're not only holding it, they're selling the data? Yeah. So they're still older data copied it, they're giving you back access to it, but now they're gonna sell it?   09:12 Yes. So what it comes down to is yes,   09:15 there's a lot to do. At that point to now you've got to tell your clients, hey, I've been   09:23 hacked. And that's where that whole reputation part comes in, you know, where you're, you know, these are people who are interesting information to you data. You know, I mean, as a law firm, we obviously hold our clients data. But you know, if you're a business, you could be holding personal information of your clients and business partners. You could be holding sensitive data on your employees or social security, financial information, information about their beneficiaries, which could be kids and things like that. So it really is a problem that just expands exponentially. It's a rabbit Well, I guess you're falling down that rabbit hole for a while.   10:04 You're like Alice in Wonderland.   10:07 Right? Oh, my gosh. Well, now you mentioned Rebecca about laws? And does that? Could you talk a little bit more about like certain data privacy laws and how that works? And if you're a small business, what does that mean?   10:24 Sure, so different. So there are two sets of laws that you need to really be businesses need to be concerned about, right. So one of them are your your data breach notification laws, which won't really be triggered unless and until there is a data breach, there are 50 states, there are 50 different laws, it's super fun for businesses who have to deal with us, then you have data privacy laws, and because nobody can seem to get their act together to come up with a federal law, we are stuck with, again, a patchwork of laws. So different states have passed different laws. And that is in and around a data subjects rights, about the data that's being collected about from them. So for example, California has a law, Virginia passed the law, Colorado passed a law recently, I know there's a proposed one in New Jersey in New York, Pennsylvania, Texas. So you name the state, and it's probably considering Washington State has tried to have made several passes into data privacy law. And what's interesting about this privacy laws is it they're usually, there's usually a threshold, sometimes small businesses will meet that threshold, but you need to understand that and it's all about the data that you're collecting. So the data you're collecting is going to trigger or not trigger requirements under some of these laws. That same data is the attractive nuisance, if you will, to the hacker they want to, they want to so you know, I always say you can't have privacy without security. So they really do go hand in glove.   12:00 What would be like an app if you know this at the top of your head, but an example of data privacy law from one of those states that has them on the books like what would be an example.   12:13 So California has the California consumer Privacy Act, the ccpa, which was amended in November, when the good citizens of California had a ballot initiative to pass the California Privacy Rights Act or the cpra. And those types of so in and around that you have different rights, the right to deletion, the right to correction, or right to a ratio of three, you know, the right to be forgotten is what's commonly known as, or just some of the rights that you're entitled to. And so businesses that fall under the within the purview of the ccpa, which is in effect right now, the cpra, which will go into effect in 2023. And so if you are a data subject, and the business is is under those laws, you can, you know, say to the pay, I want to know what you're doing with my data, hey, I need you to correct or delete my data. And the business has a set statutory period of time to respond to that data subject Access Request. It's about transparency. So anybody who saw all those updated privacy policies online, that's all driven by privacy laws, there's one in Europe called the GDPR, the general data protection regulation. And it really is in and around transparency, and data collection, storage and sharing practices. So that's, I could go much deeper, but I don't want to put anyone to sleep as I talk about loss.   13:42 I think I think that's really helpful just so that people get an idea of like, well, I don't even know what that is, you know, and if you're a small business owner, you've got a million other things on your plate, because you probably don't have a dedicated IT department, you don't have a dedicated cybersecurity department, oftentimes, you're a solopreneur. Or maybe you have less than 10 employees, you know, so all of a sudden, all of this stuff has to come on to somebody. So I think just getting an awareness out there that it exists, is really important so that you can maybe look it up in your own individual state.   14:20 Yeah, and one thing I would say and I know that this is a problem amongst entrepreneurs and startup is within the startup community is that they think well, we can do this ourselves. We can like cut and paste the privacy policy online and somebody Shelley's laughing at me over here. But you know, the purpose of these laws is to provide information about what that business is doing with data. So if you're borrowing it from somebody else, you could be in trouble twice because you're now you're not accurately reflecting what your laws are, what you're doing with the data. And you've basically taken this information and maybe obligating yourself under other laws of regular So for people who are listening, I know nobody likes talking to lawyers. I swear we're not that bad. But hiring a dedicated privacy or security attorney who understands this is really important because you told what to, you know, have an Ono moment on top of it. Oh, no moment when you're you know,   15:19 exactly. You definitely were Rebecca Sade is absolutely correct. There are people that do that they try to manipulate it and do it themselves. What they don't realize is once you're hacked, it's not just, Oh, no, they've got my information. Now I have to pay this ransomware. But guess what, oh, if you weren't following those privacy acts, you're also gonna get fined on that data, too. So you definitely don't want to be fudging any kind of information. You definitely want transparency.   15:47 Yeah. So hire lawyer. I'm a big fan of lawyers. I hire lawyers for for everything, because I don't I'm not a lawyer. I don't know how to do any of it. And I want to make sure that I am protected. So I 100% get it. Now, what? So we're talking about the pitfalls of what could happen if you have a breach, or issues facing businesses. So what can businesses do to help with cyber security? What are some things we can have in place to give us some protection and peace of mind?   16:20 Well, I would like to answer that this is Shelley, I'm someone who's there for simple and very effective basics that you could do as a business owner. And they're very cost effective. In fact, you know, you already have some of them in hand, as far as like Microsoft Office 365, all you have to do is enable your multiple factor authentication, that's a huge one, it's like leaving your light on in your house, if you're going out to dinner, they're gonna move on to the next house, because you have that layer of protection. And then, you know, security awareness training, educating your employees, educating yourself a lot of spoofing and phishing email looks like, that's huge that you know, it, it makes them aware. And that also, you know, it shows your employees that you're protecting them, you're protecting your clients, you know, it shows stability. And then also, you know, monitoring and patching your systems, you know, making sure that someone has an eye on what's going on. I'm looking for those little ticks that someone may be trying to get into your system, because a lot of people that you can have websites, you can tell by is your website going slower, that's usually a sign that someone might be trying to hack into your system. You know, so it's little things like that. And then also, you know, software and hardware encryption, that's a huge one. A lot of people, I know we have all our devices, it's our fingerprint or face that opens it. But if your hardware is not encrypted, they could just steal your laptop, pull out the hard drive, plug it in somewhere else, and guess what the data is theirs. And it's just the simple things that can help a business.   18:10 Yeah, so So to recap, the multiple factor identification that I get, and I do security awareness training, what what are these emails look like? What not to click on? monitoring and patching systems? So when you say patching systems, what exactly does that mean?   18:27 Well, that's where someone is patching in and they're, you know, they're making sure that your system is secure. And it's going somewhere in that secure like firewall, everything like that. So that is exactly   18:39 the basic there. There are systems like so for example, the Equifax data breach was a vulnerability in an Apache struts operating system. And when they found this vulnerability, it was it was a problem. People write code, people make mistakes, you need to fix it. Once they discovered the problem. They went, they were like, Oh, you need to apply this patch. It basically fixes the code. Well, if you don't apply the patch, if you don't have somebody who can help you do that you're not you're leaving your back door   19:11 open or even Yeah, or even like software, like it needs to be updated. So they're patching and updating, they're constantly monitoring, updating any software so like have you ever had where your phone doesn't work and because you haven't upgraded your system? Well that's kind of like it is for monitoring and patching. They make sure that everything is up to date everything is to code   19:34 right because if you're not patching and updating like Shelly said, you can actually leave a hole Yeah, and you're not the it's a lot easier for them to get in because you would not that system isn't being supported anymore by the Microsoft's or the Googles because they've moved on. You got to move on with them. Otherwise, you're you're gonna have a problem.   19:52 Got it. Got it. Okay, that makes a lot more sense.   19:55 They could do that themselves. Like oh, I can do this. I can do this. But as they're growing Their business, they don't have time to focus on that. And that's how little cracks happen.   20:04 Got it? Okay, that makes a lot of sense. And number four was making sure that your software and your hardware was encrypted. Right? And does that. I mean, this might be a stupid question. But does it come that way?   20:19 No, that's not a stupid question. I mean, a lot of us think that because, you know, I mean, we're on a computer right now that if I shut it and locked it, I opened it again, I could put my finger on it, it would open it, I wouldn't have to type my password in. But if my hard drive wasn't encrypted, didn't have that same protection on it, where someone could steal it, and then just pull out the hard drive, because these people are very talented, plug in the hard drive. So you need to make sure that your hard drive has that same protection with your fingerprint of code that, you know that if they would have to, they wouldn't plug it in somewhere else, they're gonna have to know that code, because it's not going to work.   21:06 Keep in mind, too, that encryption, like we're always talking about is, in most jurisdictions, if you have an encrypted hard drive, if even if they get it, they can't access it. It's not a data breach. So I like to say encryption is your get out of jail free card in most jurisdictions, okay. There are 50 of them. There's a lot, but in most of them, that's your get out of jail free card. So it's one of the biggest, that multifactor I guess, are probably two of the biggest bang for your buck. There they are. And how do you   21:37 know if your software and hardware is in is encrypted? Again, perhaps another silly question, but I just don't know.   21:43 So first of all, I don't encrypt my own hard drive. I know a lot about technology. But I, you know, I don't go to my dentist for brain surgery. professionals, who are IT professionals, like Shelley's company, and I say, here, encrypt my hard drive, and they take care of it for you. So having it's really important   22:06 night. Yeah, I can. And does that literally mean you hand your computer over to someone and say, encrypt my hard drive? Not necessarily No, no, okay.   22:16 No, no, no, a lot of times what you know, like our text can do, they can come in, they can work in remotely in and you know, just like when they have when we monitor and patch, they do it remotely. You know, if you don't even know what's going on. It's just and it shouldn't, it shouldn't interrupt your day, it should then to wreck your workflow. It should be seamless. And usually, you know, it's something that, you know, our techs are very, you know, highly educated, I love text, I always think, Oh, my gosh, what they do is so cool, because they can just, they can fix everything, and they just go in and they're they're magicians.   22:56 Got it? Got it. Okay, how it should be you.   22:59 I mean, a lot of times, and this is true, too. I think Rebecca, a lot of rules now are making sure that you actually have a credible IT team. Because if you don't, you can now get fined. Or   23:14 Yeah, there are different laws where you can if you're not doing the things you're supposed to be doing, if you're not monitoring if you don't have your asset, you know, management, those kinds of things. I mean, one of the classic examples of that is is HIPAA. Now they don't say you have to have it on teaching but they do say you have to encrypt your heart you know, encryption, or they say you show it or they say you have to monitor monitor your devices and let's face facts, do you want to be I don't want to be monitoring my devices, I want my IT guys or gals to be monitoring my devices, I want to be practicing law. So that's the beauty of it is that it's it's Charlie says it's running seamlessly in the background, and you're doing what you should be doing much with running   23:55 your business. Got it? All right. Now let's move on to so let's say you have all of this in place. You've done your basics for cybersecurity. Do you have to have cyber security insurance? Or can you just say, Well, I did all this. So what do I need the insurance for? No,   24:15 that's like driving around without your seatbelt on. Like, you know, I, I frequently wanted to ram the car in front of me, but I don't I don't do that. So cyber insurance. When I will tell you this as when I started my own law firm. The first thing I bought was malpractice insurance. The second thing I bought was cyber liability, a separate standalone cyber liability policy. They are getting more expensive, but for a small business depending on the data you're collecting, they can be very reasonable. But I sleep at night because I know that if something goes horribly wrong, it's there. All of the things you're doing. me that all The good cyber practices that Shelly and I have been talking about that just means they're going to cover you when the when the stuff hits the fan. Because if you're not doing all of that, you've probably told they've sent you a questionnaire with your cyber liability policy and you filled it out and you're like, Oh, do I have multi factor authentication? Oh sure. I encrypt my hard drive. If you lie to them, they don't cover you. But if you're doing all these good cyber practices, and you have insurance, it's you know that every single one of my clients first thing I ask, Where is your data? What is it doing? Where is your cyber liability policy? Those are the   25:35 those are the big three Yeah. Okay. To help you too, because how are you going to get that money out? Right, how do you get that money back? How do you recoup your business? I mean $50,000 is a lot Oh yeah. And you know, you're a small business and yeah, you you could take a hit you can take a loan but wouldn't it be better if somebody covered it for you it's kind of like you You get a car accident you know, it was like that rental car where your car is getting fixed. You would like to get a new car that new car smell   26:11 Yeah, cyber liability insurance is absolutely critical for small business every this statistic might be a little bit old, but I will pull it out anyway for just as an example 60% of small businesses will go out of business within six months of a data breach without live liability insurance. So that's an I know that statistic has gone up it's a it's a little stale, but I think that's about a year old and every year they put out new stats I just haven't brushed up on my statistics today. But   26:41 well that is true because as many business owners as I talked to in everything, you would not believe how many of them I've had friends that had successful businesses and everything was going great. They got hacked, and they just couldn't recoup the money that they need it breaks my heart because they never thought it would happen to them because they weren't trading money they weren't doing anything like that. It was just common goods like e commerce that they were just like, yeah, and then something happened.   27:09 I mean, I get a call at least once a week from a crime business person literally tears I don't know what am I going to do? I have a little bit of a policy or something. It's like a rider on my my general liability policy, but now it's going out because it runs out like that and so quick, and they're like now what do I do? I don't I don't have an answer for them. They're gonna have to you know, they have to pay for it out of pocket. A lot of them can't It is really heartbreaking.   27:37 Yeah. Oh my goodness. Well, so you know, we talked about some issues facing businesses today. basics for cybersecurity, the need for cybersecurity liability, which I am in the process of getting after speaking with Celli a couple of weeks ago, so I'm there I'm doing it I'm in. You don't have to I You don't have to tell me twice when it comes to important insurances, I will get it. So is there anything else that you guys wanted to let the listeners know when it comes to cybersecurity for their businesses?   28:14 Um, I think the first thing that businesses need to do is take a proactive posture. So doing the technical things that Shelley's talking about, shoring up some of their legal obligations, like I'm talking about with, you know, appropriate privacy policies, contract language and things like that. The other thing is, they have to also be aware of their vendors, which I think is another big issue facing organizations if you look at data breaches, it's not caused by an employee in the company it's caused by an employee at one of their vendors. And so you know, it's a big issue and so I would say that for all small businesses, all of the technical aspects and then make sure your your legal, you put yourself in a legally defensible position because unfortunately, these things are going to happen. And you want to make sure that you not just survive but thrive after after an event like this.   29:09 Yeah, and I agree with Rebecca, those are the key things that you need to do as a business owner, but it's also helping yourself to educate been growing your business and I know at times it can be scary because like, Oh my goodness, I got to talk to a lawyer. That's more money. Oh, I gotta have someone you know, outsource it person. When I've had my cousin, he knows computers, he knows everything. You know, everything's going but if you're looking to move your business to that next level, and you're looking to flourish, you really just like anything else, you need to make sure you understand and you are doing what is required of you to do to help your business flourish.   29:53 Got it. Well, this was great. I mean, hopefully people listening to this, it will set a match under them. To get them to really take a look at this in their business because like you said when you're a small business owner you've got a million things going on. But this is super important and I think something that people really need to focus on so I thank you for bringing this topic to me Shelly and for bringing Rebecca on because I think this is really great and I do hope that all the listeners out there will now start to take a better look at their businesses and are they protected Do they have the right things in place so thank you thank you now where can people find you? if they have questions? If God forbid they have a breach and they need a lawyer or they need someone to help do an IT assessment of their business so where can people find you? So   30:47 I obviously have a website expand law partners com Also you can follow us on Twitter and on LinkedIn please connect you can connect connect with me personally and my business we put out for small businesses out there who have a lot of questions we are constantly pushing out different topics raising issues bringing attention to different ones so please act x Pam law partners connect with us and hopefully will will provide you with some of that information that Shelley was talking about   31:23 excellent Shelly Go ahead.   31:24 You can reach me at contango it calm is our website I can also link in with me you know I love to meet new people and I always like to offer any kind of advice or second opinions I can help with if I if there's anyone I can point you into the direction to you know help your business I would love to do that.   31:46 Excellent. Shelley is a great super connector for sure. So definitely reach out to them now ladies one last question and I asked everyone this is knowing where you are now in your life in your career. What advice would you give to your younger self?   32:01 see somebody asked me this I'm gonna have to steal from my prior answer was start my law firm earlier. I wish I had done it earlier. I cherish the time I spent at a large law firm but I love what I do now. I love helping businesses so this I would do it earlier. So amazing. I would become an ethical hacker. Love that. I want to change my answer. That's a great answer. I love it.   32:35 I love it. Well, ladies, thank you so much for coming on the podcast sharing all this vitally important information. I do appreciate it. Thank you so much for having us. Pleasure and everyone. Thank you for listening. Reach out to these ladies if you are a small business because you may need some cyber help. Thank you for listening, have a great couple of days and stay healthy, wealthy and smart.
  • Healthy Wealthy & Smart podcast

    560: Dr. F Scot Feil: Eliminating Student Loan Debt with Multiple Revenue Streams

    39:50

    In this episode, Physical Therapist and Educator, F Scot Feil, talks about understanding and eliminating student loan debt. Today, F Scot talks about the different kinds of student loans, his different revenue streams, and the value of having a diverse set of skills. How does the debt-to-income ratio affect student loans? Hear about eliminating student loans, managing multiple revenue streams, and get F Scot’s most important piece of advice for students with debt, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “The debt-to-income ratio is the amount of student loan debt you have over your current income.” “The best way to learn about this stuff, and what’s right for you, is to talk to a certified financial planner that knows about student loans.” “The biggest thing to try to do, if possible, is not to privatise your loans. Try to keep as many of your loans federal as possible.” “You make your own luck. You have to work hard, and you have to network and leverage with the right people at the right times about the right things, and then you’ll start to see those opportunities open up.” “The one key takeaway that I’ve had with all these revenue streams is you’ve got to do one at a time, and you’ve got to get it flowing, and then you can step on to the next stream of revenue.” “The money is nice, but the time-freedom is really what you’re looking for.” “You don’t have to work as hard, you can scale back, charge what you’re worth, and make a lot more money in a lot less time.” “Your career just has to be the tip of your iceberg.” “There’s a whole lot more out there than just going to an outpatient clinic every day and seeing your patients.” “Don’t worry as much. Just leverage the heck out of your career and your degrees. Use them to do what you want to do and what you enjoy doing.”   More about F. Scot Feil Dr F Scott Feil is a husband, a father, a physical therapist, a professor, and, most recently, an amazon best-selling author. F Scott is also a business coach and mentor, despite starting his journey as an English major before landing as a Physical Therapist. He is one of three co-hosts of the Healthcare Education Transformation Podcast, which aims at breaking down the silos between healthcare professions and trying to find best practices in teaching and learning throughout healthcare academia. His goal is to help at least 222 professors (one from every PT School at the time of publication of his book) and clinicians pay off their student loans quicker by using multiple revenue streams. If he helps some others with terminal degrees, or other healthcare clinicians, along the way, then it’s a bonus!   Suggested Keywords Student Loans, Student Debt, Financial Planning, Education, Skills, Income, Revenue, Profit, Opportunities, Physiotherapy, Healthy, Wealthy, Smart   Resources: FREE PT Educator’s Revenue Idea Generator Professors Of Profit Facebook Group PT Educator's Student Debt Eliminator: Multiple Streams of Revenue for Healthcare Clinicians and Academicians   To learn more, follow F. Scot at: Website:          https://pteducator.com Podcast:          Healthcare Education Transformation Podcast Facebook:       PT Educator Twitter:            @FScottFeil_DPT Instagram:       @PTEducator LinkedIn:         F Scott Feil YouTube:        PT Educator   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full Transcript Here:  00:02 Hey, Scott, welcome to the podcast. I'm happy to have you on. It's great to see you and to speak with you.   00:09 Yeah, Karen, thank you so much for having me. I'm a longtime listener, first time caller here. So this is exciting. I've been waiting to do this for quite some time now.   00:17 Yeah. And I'm happy to have you on. And today we're talking about a topic that is near and dear to many, many physical therapists. And that is we're talking about student loan debt, and not only talking about it, but how to maybe understand it a little bit better, and how to eliminate it. So let's start with some definitions. And what is the debt to income ratio? And how does that affect your student loans.   00:50 So, you know, I'm not a student loan expert, by any means. I'm more of an elimination expert. That's that's where, you know, my specialty comes in. So I've had to learn this stuff, too. And, you know, one of the best ways that I've gone about doing this is going to certified financial planners, especially once you understand student loans, and talking through, you know, where I'm at what what plan looks like, it's going to work for me, what are my plans in the future? What is, you know, my vision look like? You know, do I want to start a family, buy a house, buy a car, all those things kind of factor in to your big plan. And then from there, you've got to come up with a foundational blueprint or a roadmap that you're going to follow based on what your student loans are. So the debt to income ratio is very simple, you know, it's the amount of student loan debt that you have, right? over your current income, and you just, you know, do the math and divide, right? So, realistically, the highest that you would want your debt to income ratio to be is approximately 1.01. To one, right. So if you had $100,000 worth of student loan debt, you're making $100,000 salary. That's not a terrible debt to income ratio, right? Unfortunately, especially in the field of physical therapy, we're finding that students are graduating with 150 175 200,000 plus worth of student loans, and they're coming out and they're getting jobs at 65 75,000 a year. And those are some pretty risky debt to income ratios, right? those, those get a little heavy, because, you know, if you don't know anything about it, and you you have all this debt, and you've accrued this debt, that's just massive, your payments are going to be massive, right, your student loan payments, if you just do the standard repayment, mine started out at 1700 a month, right. And I only had 140,000, when I graduated, that was with two doctoral degrees. So you know, it was one of those things where I got a little nervous at one point, because I didn't even know that I wanted to use the doctoral degrees, the way they were kind of meant to be used. But then I kind of settled down talk to a couple people both both on the business side of things, and on the Certified Financial Planner side of things, and created that roadmap, I went from the generic, you know, repayment plan at 1700 a month down to the income driven repayment plan, which for me, looked like about 700 a month. And then again, after really doing a deeper dive with the Certified Financial Planner, where I was at in my life and how I was planning on attacking my student loans, we've finally got it down on the repay plan or the revised Pay As You earn plan. And that's about $135 a month. And that stretches it out over 20 years now. So the difference that I'm making between the, you know, 135 a month and the 700, I was paying, I can now take that and have more liquid assets to do something with right I can have more cash in hand to invest or to start a new project or, you know, to make payments on other stuff, you know, so it's taken me some time to kind of learn this stuff. And again, like I said, I'm by no means a student loan expert, but I am learning through the bumps and the bruises and going through it and being in the thick of things there. And realistically, like I said, the best way to learn about this stuff and what's right for you, because it's going to be different for everybody is to talk to a certified financial planner that knows about student loans. So that would be my first recommendation.   04:15 Yeah, and that is great advice. Great advice. I've been working with a certified financial planner myself. And it really, it's really great to have an outside view of your finances and everything that surrounds them by a professional who can go in and not be emotional about it, and not have biases built in because we all have emotions around our money and around our debt and our loans. And so it's great to have that outside perspective. Yeah, you   04:45 hit the nail on the head there, you know, especially when it comes to business and money. We tend to be very emotional beings and you really have to be objective when it comes to that. And that was that was you know, a big takeaway that I found when when starting up businesses and you know, figuring things out. I've had a bunch of deals in the last couple months kind of crumble and fall through and it's like, Man, that's a bummer. But at the end of the day, you realize it's just business like, it's not a big deal. Not personal, that, you know, can't get emotional beat up over, you just got to move on it's business, you know?   05:15 Absolutely. It's it. But I mean, it does suck.   05:20 It does. It does. And it's okay to kind of recognize that, you know, you know, exactly, but at the end of the day, okay, it's business. What's my next step? How do I pivot? How do I recover? What comes next? You know, I think that's really what entrepreneurs are doing these days is trying to figure it out, you know, just keep rolling with the punches until they, they get it right. Yeah,   05:38 absolutely. And now, you spoke a little bit about those different kinds of student loans. And so I'm assuming there are different approaches one can take, can you speak to that?   05:50 Yeah. So you know, again, like I said, I'm not exactly a student loan expert, there's several different kinds of student loans out there, the biggest thing to try to do, if possible, is not to privatized your loans, right, try to keep as many of your loans federal as possible, because the federal plans are the ones that work with you a little bit more, there's a little bit more give to them, right? You can restructure them a little bit. Like I said, I went from just basic repayment plan to income driven repayment plan, which is based on, you know, the amount of income that I would make as a new grad, down into the revised Pay As You earn plan, which, like I said, that one kind of starts you at a lower bracket. And year over year, as you make a little bit more, it creeps up a little bit, you know, but it also, again, it stretches it out over a longer period of time. So you know, they're their differences are time dependence, you know, how quick you have to pay him back. But you know, things happen, like COVID, right, and all of a sudden, the Federal plans have all kind of stopped, they put a, you know, a pause on them until the new year. So, you know, that's one of the ways that they can give you grace, you can go into a deferment plan, if you need a month or two, you know, though, they'll work it out with you, and they'll tack it on to the end or whatever, you know, there's just a lot of forgiveness. And then at the end, there's a big forgiveness. But with federal loans, you just have a lot more grace, right? Once you privatized the loans, you're stuck, that's it, they are what they are, and you've got to pay him back, there's, there's no getting rid of them, right. Because, you know, student loans are loans that we just, we can't go bankrupt on we can't, you know, get out of there just gonna be there forever until you pay them off. So, you know, it's super important to recognize the difference between a private loan and you know, a federal loan. So big takeaway there is try to keep as many of your loans federal as possible for as long as possible, because those will have the most options for payoff and forgiveness and forgetting, you know, you know, any sort of programs that are available that may come and go, right, there's the one program where if you work for a nonprofit for 10 years, right, X amount is forgiven. Now, there's been kickback on that saying that, like 99% of people don't get approved for it at the end, they cross the finish line, then all of a sudden, the finish lines moved, right. So you know, there's some fine, fine print, you've got to read there with all these. But you know, at the end of the day, most of the federal loans will give you a certain time period. And as long as you make your payments all along that time period, at the very end, there will be some form of forgiveness. Now, the only caveat with that is the way you're forgiving those loans is you get taxed on the amount of forgiveness as if you made that income that year. So, you know, for me, it'll probably be a 20 year repayment plan, at the end of those 20 years, I'll have $100,000 left, it'll be forgiven. And then it'll be like I made that extra 100,000 on my salary that year, so I get taxed on it. So in those 20 years, I have to come up with some sort of plan to save up and to make money to repay that one year, when I have that influx in salary, even though it wasn't there. It was a loan forgiveness. So just something to think about there, too, when you're planning out your loans and your repayment plan.   09:04 Yeah, yeah, I don't think people realize that you have to pay taxes on that loan that is left. So each year, you want to make sure that you're putting money aside and putting money aside so that you're in an account that maybe you can't touch so that when it comes you're not like, Oh my gosh, where am I gonna get this money from, but you're like, Oh, I know exactly where I'm gonna get it from. Because I have this account of money I haven't touched for 20 years, you can pull it out from there. And that can be like, it doesn't have to be a savings account at the bank. Exactly. That could be an account that is actually generating, maybe, you know, 4% or something like that, right? So you're making money on it, especially if your loan is only like 2.3%. So you could take that money that you would be paying toward that loan, put it into an account that's maybe making even if you're making 4% You're still making money on on that money in there so that when the time comes to pull it out to pay your taxes, is number one, you're not penalized. So it's not like you're putting into a 401k plan or an IRA or something like that, but just putting it into some sort of an account that can make you some money on the way.   10:12 Exactly. And that's where a certified financial planner comes in, because they can set you up with a savings plan over those 20 years that can get 810 12%. So you're actually saving a ton more money, and you're paying way less when it comes to it. And the you know, the rate the APR is, is even lower. So I don't, I don't want to throw out a bunch of like, you know, terms and, you know, definitions and stuff that are just kind of boring and not very sexy, to be honest with you. But we do have to kind of know a little bit about this stuff. You don't have to be an expert. Again, I'm not. But I know enough. Now I'm educated enough, because I took the time to talk to that certified financial planner and figure this out and sit there, it only took maybe an hour or two, to sit there with them and go through the plan and look at it and say, Alright, here's where I am. Here's my goals and plans. Which program is best for me. Okay, great. Let's get on that program. And then you know what, now let's figure out how we're going to pay it out. You know, and there's several different ways to do that, too. Right? You just have to come up with that number at the end of those 20 years. So how do you want to do that? And, you know, that's where my expertise kind of comes in? Is the elimination part of it? Yeah.   11:17 Yep. So let's talk about that. Let's talk about how do you eliminate that debt. And I know one thing that you speak about is having multiple income streams, I'm sure that's part of this conversation, but I'll throw the mic over to you. So you can talk about the elimination part. What does that mean? Yeah, so   11:33 originally, when I wrote my book, right, peak educator, student debt eliminator, I thought I could just start a side business or to write and make a bunch of money, and then throw all that money that I made toward the student loans and pay them off in a year or two and be done. That was my plan. And realistically, I probably could have done that, I probably could have knocked them out in about three to five years total, and been done. But that's kind of what the banks want you to do. Right? That's what these loans, processors wants you to do. They want you to pay all your loan off as quick as possible. So they get all the money and make all the interest, right? Well, after talking to the Certified Financial Planner, I said, Okay, well, if my loans are gonna go down from you know, 700 a month and 135 a month, that leaves me a good extra chunk of money that I can do stuff with, right? And he's like, Yeah, absolutely. He's like, in truth be told, as long as you're putting your a lot of money every month into your savings plan, or whatever, you know, investment plan, if you will, to pay off that 20th year, you can do anything with the money, right? So I figured, okay, well, could I invest it in stocks? And he's like, yeah, you could do that. I said, What about crypto? And he said, you could do that? What about real estate? Can I do that? Yeah, absolutely. So that's been kind of my plan is like, Okay, let me start a couple of side businesses that generate income and revenue for now. So that I can put it toward investments that don't kind of take me on the long term. Right. And I think realistically, you know, I think almost every millionaire has several different streams of revenue, right. And I think that we need to start thinking about that, as soon as we either enter grad school, or immediately after we finish grad school, you know, what is our plan for long term wealth? Right? How are we going to take care of ourselves, as well as our family, you know, that might not even exist yet. As well, as, you know, future generations, you know, we're talking generational wealth here. And it's not like, you've got to be a millionaire, right? But you know, a couple of six figure incomes, that can help a lot of people, right? I mean, you can take care of a family, or two or three down the line, even, you know, making several six figures over the course of many, many years, you know, and then if you invest it, right, you can put it in places, like we talked about, like rental properties, or something like that, where, you know, once those pay off, the mortgages are done on those in 15 or 20 years? Well, now you're going from making two or $300 a month in rent, up to, you know, 18 or 2000 a month, per per house, right? And that's where you get into that generational wealth. So, you know, for me, it started out as a simple mobile PT practice, right? I was by myself in a car with a table and some sheets and a bag with some equipment in it. And I was just driving around, you know, Waco, Texas, just kind of helping people in their homes or their offices or the gyms. Because I knew I could do that. I knew I could start that business, right? I had enough expertise in the physical therapy world to be able to run a small practice on my own. And I didn't really want to be tied down to the brick and mortar. I didn't want to have a high overhead. I didn't want to do any of that, you know, so I just started my own little business. And it started out with a crossfitter, too, you know, and that was not my demographic. It was just people in the community that I knew that asked if I can help, and so I did. And then Luckily, one of the women that I worked with, her husband had some shoulder and elbow issues and he was a big tennis player. So she said, You treat the arm in the elbow and choice it. Yeah, absolutely, I can do that. So once I started talking with him, he's a CEO of a small business in Waco there. We got him better, we got him back in the tennis court, he was feeling great. And so then he started referring me to all his other CEO buddies, and the CEO buddies and C suite level execs, right, and all these busy businessmen and business women. And it was great because I was I was selling them time, right, it wasn't so much about the physical therapy, or whatever it was, it was, I was buying them back time because I could come to their home or their office or their gym, and they love that. So it was just the right niche for me in the right, you know, they had expendable income, most of them because they were, you know, own their own business. So it was a really good group to get into, and a really good niche to break into. And, you know, word of mouth spread. And that kind of took off? Well, once that kind of happened, I really started having to figure out how to like market myself better, and how to do some, like digital marketing, you know, Facebook ads, Google ads, stuff like that. And I just didn't know that I didn't have that skill set, you know. And so I had to take a course in that and learn from it and kind of invest in myself. But once I did get better at that, you know, I even took a copywriting course and read a bunch of copywriting books as well. And once I started getting better at that a bunch of my buddies that I graduated PT school with saw what I was doing with Facebook ads, and they said, Hey, could you do that for our business? And I was like, yeah, I'm sure I could probably figure it out. They said, We'll pay you and I was like, Okay, great. That sounds awesome. You know, and that's where my agency kind of started, right. But one of the second pillars of revenue for me. You know, I kind of started a little bit of a digital marketing agency unintentionally. And so I did that for you know, that a year or so. And that even brought me outside of the field of physical therapy as well. I did it for a couple local businesses, some home renovations, some roofers, pool builders, stuff like that. And it was really working pretty well.   16:58 And then, you know, COVID, started hitting and things kind of got a little crazy. And I was still working full time in the clinic, too. And so with my wife being a type one diabetic, and already being immunocompromised, I had to kind of step back from that a little. And I stepped away from the clinical side of things. And that same week, the head of the program at university, St. Augustine emailed me and said, Hey, are you still interested in teaching because I spoken to him at the ETD graduation in 2018. And, you know, I said I wasn't, but now it's actually looking like a pretty good option. So I stepped out of clinical work, I headed into academia. And while I was doing that, you know, it really became a good fit for me, because, you know, I talked online most of the time, and then I had to go up and be there for labs. But it also gave me a lot of free time to work on my side hustles, and my side businesses, you know, and that's kind of how I fell into the consulting gig as well, like, that wasn't something I ever thought I'd be doing either. But I worked for workman's comp company as well up there in Waco. And I said, Hey, we should be educating these businesses to injury prevention and wellness and how to properly lift and ergonomics and all that. They said, Oh, no, we're not going to do that, you know, that's gonna eat into our PT numbers. And I said, No, it won't. Because I can't stop somebody from running over someone's foot with a forklift, it's gonna happen, accidents are gonna happen, you know? And they said, Well, no, we're not going to do that. So I said, Alright, fine. I'll do it myself, you know. And so I just went around to all the companies locally there that were sending us workman's comp people. And I said, Hey, would you like to lower your workman's comp numbers? And they were like, Yeah, sure. And so I go in, and I educate the workforce. And, you know, you can charge good money for consulting. I mean, I was able to charge you know, 1000 bucks to 1500 bucks an hour for two hours worth of work. So now it becomes a matter of, Okay, do I want to see patients at $200 an hour, which is a pretty fair rate for physical therapy, right? Cash pay at a network? Or do I want to work two hours and just, you know, educate these people and use my add my education background combined with my PT background, to kind of help them with injury prevention and wellness. Right. So again, it just kind of one of those things that fell into my lap, that wasn't ever something I thought I would do it just the opportunities were there. And I just kind of sees, you know, it was like, seeing like these opportunities out there and just realizing that holy cow, this is where I knew I was fine. Having a PT, you know, DPT and an add, not necessarily wanting to use them even though now I am, you know, more traditionally. But being able to leverage those degrees into other opportunities. You know, I'm not a huge believer in luck, I kind of feel like you make your own luck, you have to work hard and you have to network and leverage, you know, with the right people at the right times about the right things. And then you'll start seeing those opportunities, you know, kind of open up and you have to be ready to jump on those opportunities when they present themselves. So, you know, that's, that's kind of where a lot of these streams of revenue started from. It just kind of happened, you know, and I fell into them and I got better and better and better at it. I went, and then I was able to help more people with them as well.   20:04 Yeah, it sounds like you've gone from one to the next to the next to the next, which is, which is good. You're sort of keeping yourself open and you're learning and, and understanding like, Hey, I don't know how to do this. So I'm going to educate myself and learn a little bit more, and be able to do things that may not be at face value, what you went to, quote unquote, school for, but yet they are.   20:32 Yeah, I mean, we learn so many amazing skill sets throughout grad school, you know, whether it be the DPT program, or the ed d program, systems, right processes, standard operating procedures, things like that, like clinical development, and, you know, clinical thinking skills, critical thinking skills, all these things that we learn, are a lot higher level than a lot of the general public already know and deal with. So we can help by kind of bringing those things down and simplifying them, just like we would talk to a patient, right, if you're using layman's terms, you know, and I think the key here is to realize that we have a lot of these skills already, you can keep one foot in the healthcare boat already. Or you can diverged and go a different route. And you know, some of these skill sets, you're gonna have to learn because not everybody's, you know, born a natural with a lot of these skill sets. And that's okay, I've done that. But it's a good combination of taking as much as you already know, and pushing in on that. And then adding and supplementing a little bit here and there, when you find that you need it. You know, and that's where I think taking courses and paying for mentors, and doing all that stuff speeds up your timeline a little bit. You know, and that's why I'm a big believer in that I've had many coaches, many mentors over the last couple years, and they've totally sped up my timeline and showed me mistakes that they made and made sure I didn't make the right, you're still gonna make your own mistakes, there are a lot of them are going to be different than what your mentors went through, right? That's totally normal. But it's, it's realizing that they're not failures, they're just learning opportunities, you know, and I think we as pts are really good at being lifelong learners. And so it really shouldn't be a problem to dive into a skill set you're not familiar with, and just, you know, put your ego aside and being like, Alright, I don't know this, I need to learn it, here's a good resource, here we go, you know, just keep kind of attacking it until you get it right. You know, and I think at the end of the day, these multiple revenue streams now that are kind of growing are great, I love them, I'm very passionate and energized about them. They're definitely like passion projects for me, you know, and zones of genius for me, but it's a good way for me to get an outlet of creativity, I think, because I was an English major before I was a PT, right. So, you know, that to me was was a big transition in itself. But that's also helped me monetize blogs, monetize my book, right? monetize, SEO, and email sequences and copywriting. So, you know, again, all those things kind of fall into that consulting, revenue stream. But, you know, I had to learn how to adapt that English major into copywriting or into email marketing, or whatever it may be, you know, and I think the one key takeaway that I've had with all these revenue streams, is you've got to do one at a time, and you've got to get it flowing. And then you can step on to the next stream of revenue, then get that up and running, then get that flowing. And then step onto the next one. And again, you know, if you don't do that, you're going to fall for that shiny object syndrome, right, and you're going to be kind of chasing around, Ooh, that looks cool, that looks cool. I could do that, oh, I could do that, oh, that person's doing that, Oh, that looks really good. They all work. And you can do all of them, for sure. But you've got to get one down first, and then move on to the next and there's going to be you know, arguments and debates over what number is the right number to walk away from the first one and go on to the second one. I don't think it matters, I really don't just get it up and running, make sure it's making you some money, make sure it's profitable. And then when you're ready to step on to the next project, you're still gonna go back to the first one, you know, you're still who knows, you may even hire somebody to take over that portion for you. You know, but just knowing that there's multiple opportunities out there for physical therapists for healthcare providers, I think it's a great stepping stone for you to kind of open your mind a little and get out of that nine to five clock in clock out clinician mindset, you know,   24:15 and where are you now with? How many streams of revenue Do you have at the moment? And if you could put it in a pie chart, what is what makes up what? Because I think people would really be curious as Jeff, you mentioned a whole bunch. So where are you now? And what does it look like?   24:32 So I essentially what I teach, you know, all my students, I have what's called the feelgood method, right? Which is not just a clever play on my last name. It's also you know, how I make my students feel good about staying organized with their streams of revenue, right. So there's an umbrella on top and that's your holding company, right? For me, it's feelgood industries. pllc. Texas recommends if you have a professional license that you get a pllc it's different for every state. But, you know, doctors, lawyers, dentists, they all have pllc Alright, so since I started as a mobile clinic, I started as a pllc. then underneath that I had about four or five different revenue streams or tubes of revenue, that each of those was a DBA, or doing business as underneath the pllc. Eventually, I'm probably gonna have to turn some of those into their own individual LLC and make the pllc an actual holding company, but I'm not there yet. So, you know, with each stream of revenue, like I said, I have a couple little numbers next to each stream. And those are the checklists, things that you have to get done in order for that stream to start running. So I made a shift recently, because of my changing career, you know, like I said, the goal is to try to, you know, kick the bucket of the nine to five and do your own thing, you know, and go all in on entrepreneurship and your own business eventually, right? That's the hope. For me, my story's a little bit different, because my wife is a type one diabetic. And we need not just medical benefits, but good medical benefits, right? My nine to five might always be there. And I'm okay with that. I've learned how to kind of find the best possible job with the best possible benefits. and academia has afforded me that right now. So I'm able to do that, you know, at a little bit lower rate of like 32 hours a week instead of maybe 40. And that gives me more time then to work on the businesses. So while I was doing a lot of the mobile PT at first, that's kind of decrease now, because like I said, it's like, do I want to treat patients for $200 an hour do I want to do consulting at 1500? An hour, right. So I would say overall, you know, I've got the mobile business, I've got my online business and PT educator Comm. And then I've got my consulting, business, FTI consulting, and those are kind of the three main revenue streams. Now in those revenue streams. There's probably, I don't know, three or four different services, if you will, that are offered. You know, the consulting can be anything like injury prevention and wellness, because I've got that systemized. And I've got templates for that now where I can just come in, do the tour, see what's what, and then put together a presentation overnight. And then that also will have my copywriting little digital marketing. It'll have you know, Facebook ads, Google ads, it'll have copywriting, email, all that stuff underneath the consulting. And those I can charge, you know, for just one little piece, or put together a package where I'm like, Hey, here's what you need, here's what I recommend, you can go ahead and do it based on my outline, or if you need my help, here's my price, right, my fees. And then PT educator comm is just like I said, my online site where I do a lot of my blogs, I have a lot of the courses for sale and stuff like that. And that's just really to kind of keep me up to date on my writing. And, you know, my blogging skills and stuff like that just recently passed them the mark for 1000 subscribers and 4000, watch hours for YouTube. So I cannot monetize that as well. So the vlog cast, which I do one episode a week of an interview with somebody who's done that particular side, hustler side gig, starts out on YouTube, and then eventually makes it to the podcast in audio form. And that actually, the podcast hasn't even come out, that'll start September 1. With the first few episodes, I'll probably release three or four and the first one, and then do one a week after that. So if you want the new fresh content, you go to YouTube and watch the video if you want to catch up, you go to the podcasts. But if we're if we're giving it a breakdown, you know, I would say we're probably at about 60% of consulting at this point. And coaching, I kind of put coaching underneath that as well. And then I would say, you know, the the online business is probably about 30% at this point. And then treatment is just at this point, word of mouth, close family and friends here in the Wimberley area, you know, 10%? If that?   28:54 Yeah, got it? Yeah, I think that's really helpful for people to hear so that they're like, wait, I don't understand how, how is someone doing all of this at one time? Do you know what I mean?   29:03 Yeah, and let me make this clear, too. So 32 hours a week is still dedicated to my full time job and Right, right. So that gives me maybe eight hours extra to get to a 40 hour week, and then I work 50 or 60 hours a week, there's you know, I love that stuff, though. I would do that for free if I could all day every day, because that's what gets me excited, you know, the passion projects, helping people figure out a business model. So you're, you know, figure out what they can do for side hustles and side gigs. Even if it's just making an extra 500 bucks, you know, a week or something like that, you know that that could be huge for somebody who's having to pay 2000 bucks a month for student loans, right or 1500 bucks a month for student loans. So if we can figure out a side hustle or side business to get you started, at least, maybe you grow it big enough to the point where you can walk away from that nine to five and that's great if that's what you want to do. You know, but but I'm also to the point where I was working 60 or 70 hours a week for someone else and trading time for money and just wasn't cutting it. So I've scaled back, I've been able to, you know, increase my value on certain things and, you know, raise the prices on things enough to where I'm working less time and making more money. So it's like PRN rates don't even, you know, don't even cut it for me anymore. It's not even something I would look at. It's just not worth my time, because the money's nice, right. But the time freedom is really what you're looking for, I think, you know, I think people are, are looking to claim back a lot of that time with their family, not having to work weekends, not having to stay, you know, all hours at night at an outpatient clinic, doing notes and trying to, you know, stay on top of things. So, I know I've been there, man, it's a grind. And, you know, it's nice to be able to use my add and teach and to use my DPT and use that knowledge toward you know, something as trivial as a fantasy football injury course, right? That was one of the first courses I ever made. And then, you know, video gamers eSports, I did an Esports ebook on injury prevention for gamers, right? Like, that stuff is just fun to me, you know, I love that stuff. And we can use our knowledge to help those people and solve those problems. So why not do that? Right? Why not find a hobby or something you like? And just go all in on it, you know, and use your knowledge to help people. You know, so that's been a big a big finding for me over the last year or two, it's just that, you know, you don't have to work as hard. You know, you can scale back, you know, charge what you're worth, and make a lot more money in a lot less time. You know?   31:29 Yeah, that all makes sense to me. And what would be your says, we kind of come come to a close here, what, what is your biggest, your most important piece of advice for people listening, if they could take one, if you were like, oh, man, if you just took one thing away from this talk, this would be it.   31:51 Yeah, I think physical therapy or your profession, your career just has to be the tip of your iceberg, right? I mean, again, like I said, we as physical therapists can do so many things, we can help so many people, and it's like, if I go and treat a patient, you know, one on one, that's great, that one person gets better in that hour, maybe times eight hours a day, there's eight people, right? If you want to have a bigger impact, and you want to affect more people, right? Then maybe you coach somebody or teach somebody, you know how to start their own business. And now that person's treating, you know, 50 people a week. So now you're impacting 50 there, and the few that you were teaching, then you coach somebody else on something else, and they're helping, you know, 20 businesses, you know, with their patient intake model, and they're, you know, they're doing things, you know, at a higher rate. So now you're helping 20 businesses with 50 patients each, right. And so I think more impact can come if we realize that we're more than just a physical therapist that goes in and treats eight people a day, or 20 people a day, or 30 people a day, or whatever you're treating, right? Like we can do so much more. And we just need to think outside the box a little bit, you know, and be a little bit more than that nine to five clinician that clock in and clock out, you know, and then again, by having a bigger impact by helping more people, right, and then coming at it with a servant's heart. Money is just a byproduct, you can then take that money and pay off your student loans quicker if you want or invest in things that are going to make you more money down the line so that you can pay off the student loans, should you want to do it over a longer period of time. Either way, you know, it's just about opening your eyes and seeing that there's a whole lot more out there than just you know, going to outpatient clinic every day and seeing your patients.   33:29 Excellent, excellent advice and great takeaway. Now, where can people find you if they want to learn more about you what you're doing and how to get in touch with you?   33:37 Yeah, sure. So all of my tags are pretty much at p key educator on all the social medias. And then the book is on Amazon. It's available in softcover. And in Kindle, it's called PT educator, student debt eliminator, multiple streams of revenue for healthcare, academicians and clinicians. definitely have a second edition coming out pretty soon. So check it out, out while you can. You know, I'd love to see people hop on the second edition as well, because there are a couple of key changes with all the stuff that's going on nowadays, with cryptocurrencies and, you know, all sorts of investing strategies and stuff like that. So I'm still learning, you know, lifelong learner for sure.   34:13 Absolutely. And last question, what advice would you give to your younger self, knowing where you are now in your life and in your career? Yeah.   34:22 Don't Don't worry, as much, you know, just leverage the heck out of your, your career and your degrees. You know, use them to do what you want to do and what you enjoy doing, you know, leverage the heck out of it, you'll be fine.   34:37 Excellent, great advice. I've heard that many times on this show. So, Scott, thanks so much for coming on. This was great. I think you really gave people a lot to think about and some inspiration on maybe how they can use their passions and and think outside the box a little bit. So thanks for coming on.   34:57 Absolutely. Thank you, Karen. It's been a pleasure.   35:00 Absolutely and everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
  • Healthy Wealthy & Smart podcast

    559: Dr. Lisa Folden: Diet Culture and Fat Phobia in Healthcare & Physical Therapy

    38:17

    In this episode, Physical Therapist and Owner of Healthy Phit Therapy & Wellness Consultants, Dr. Lisa Folden, talks about diet culture. Today, Lisa talks about the pervasive nature of diet culture, how to reconcile diet culture with physical therapy recommendations, and how to support patients who are on their weight loss journey. What is diet culture? Hear about weight biases and phobias and how to deal with them, the Health At Every Size movement, and get Lisa’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaway “Diet culture is this pervasive thought process that we’re born into, that fosters the belief that we’re never enough – we’re never thin enough, we’re never healthy enough, we never got it right.” “Diet culture is the constant reminder that something’s wrong - you need to fix it all the time.” “Even if weight is causing some of the issue, the reality is, the research shows that weight loss doesn’t really work for most people. 95% of people who lose weight gain it all, plus more, back.” “Weight loss is a by-product that some people will experience, and other people will not.” “We think in our society that no one should be fat, and if they are fat, it’s because of poor health choices.” How to challenge the weight bias: Unlearn the idea that people in larger bodies are inherently unhealthy. It’s not going to help you make them feel better, and it’s not true for many people. Think about accessibility. Considerations are made for people with various degrees of mobility, so ensuring that there’s appropriate furniture is a consideration for those with larger bodies. Reassure patients. Especially when dealing with patients who have dealt with the weight stigma, it’s important to reassure patients that size variation isn’t a problem. “I assume that their condition is caused by something other than their weight, and I treat them based on that.” “We’re supposed to be different sizes, and we don’t have to lose weight to be healthy. You can be healthy at any size.” “Stop telling your patients to lose weight, offer people in larger bodies the same treatment options you offer people in smaller bodies, and don’t shy away from manually and physically examining them because of their body weight.” “It’s going to be okay.”   More about Lisa Folden Dr. Lisa N. Folden is a licensed physical therapist, mom-focused lifestyle coach, and the owner of Healthy Phit Physical Therapy & Wellness Consultants in Charlotte, NC. As a body positive women’s health expert and health at every size (HAES) ambassador, Dr. Folden assists women seeking a healthier lifestyle by guiding their wellness choices through organization, planning strategies, and holistic goal setting. Dr. Folden is a mom of three, published author, and speaker who understands the complex needs of the modern busy woman. Therefore, she considers helping busy moms find their ‘healthy’ as one of her of top priorities. Dr. Lisa is a regular contributor to articles on topics related to physical therapy, health, wellness, self-care, motherhood, body positivity, and pregnancy, and has had the distinct honor of being featured in Oprah Magazine, Shape Magazine, Livestrong, Bustle, and several other local & national publications. Additionally, she is a member of the National Association of Black Physical Therapists, the Association of Size Diversity & Health, The Know Women, Alpha Kappa Alpha Sorority, Inc., and serves as an expert panelist for H.E.R. Health Collective (2021).   Suggested Keywords Diet Culture, Weight Loss, Body Positivity, Acceptance, Stigma, Body Size, Fitness, PT, Physiotherapy, Symptoms, Healthy, Wealthy, Smart   Resources: Health At Every Size Community   To learn more, follow Lisa at: Website:          https://www.healthyphit.com Facebook:       Healthy Phit Twitter:            @HealthyPhitPT Instagram:       @healthyphit Pinterest:         @HealthyPhit YouTube:        HealthyPhit PT   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full Transcript Here:  00:02 Hey, Lisa, welcome to the podcast. I'm happy to have you on today.   00:07 Thank you so much for having me. I'm so excited to be here.   00:11 Yeah. And today we're going to be talking about diet culture, in health care, and specifically in physical therapy, which is not something that I've ever spoken about on this podcast. And so I'm really happy to have you on to talk about this. And I remember speaking with Dr. Lisa van who's, and we were talking about biases in health care. And she said, one of the more accepted biases in health care is against overweight people. Yes. And so I'm happy to have you on and dive into that a little bit deeper. And so let's, let's talk about first diet, diet culture, you know, its impact on our not just our physical health, but also our mental health as well. So why don't we first start with what do you feel diet culture is? Let's define that.   01:13 Sure. So it's nuanced, of course, but essentially, diet culture is it's this pervasive thought process that we're kind of born into, that fosters the belief that we're never like enough, we're never thin enough, we're never healthy enough, you know, we've never gotten it right. And so it feeds into, you know, this multibillion dollar industry that says, you know, buy this tea, by this waist trainer, by this weight loss program by this because you always need to be getting smaller, shrinking yourself, doing something to change yourself, because, you know, you couldn't be healthy, you know, there's no way you're healthy, especially if you happen to be someone who was born into or developed into a larger body, there's no way you're healthy. So diet culture is sort of the constant reminder to you that something's wrong. You need to fix it all the time. And it's a deep part of our healthcare system. It's a deep part of, you know, like Hollywood and television, things we watch every day. So it's it seeps in without anybody really knowing that it's happening. And it's so common and so accepted, that we just look at it as you know, health, like a lot of things that are really diet culture, a lot of us would just look at as Oh, that's health, that's fitness. And it's and it's not, because it's actually corruptive. And it, it breaks us down. And it's not good for our mental health or for our physical health. It results in a lot of weight cycling and bingeing and restrictive in disordered eating. And so, you know, it's really bad. I mean, that I don't call a whole lot of things good or bad, but diet culture is one that I kind of just categorize is bad and unnecessary,   02:53 really. And so looking at that through the lens of a physical therapist, how do you reconcile that culture with what we do as physical therapists, because so often, if someone is, let's say, an example, someone is coming to us with osteoarthritis hips, knees, one of the recommendations is weight, weight loss of whatever that weight loss is, I don't think the recommendation is to be a size zero or two. But that recommendation is weight loss. So how do you? How do you kind of blend these two this diet culture, which knows very bad, but yet, in certain populations, it can be helpful to take off some weight to unload those joints. So how do you reconcile with that as a PT?   03:40 Yeah, that's a great question. And it's obviously something I've had to kind of deal with head on as a physical therapist still treating in the clinic. You know, like I said, in the standard outpatient practice. So here's the thing, there's physics, right? physics exists, when there's more pressure, you know, from gravity and weight, you can feel more pain. Like that's, that's a fact. But there's also, you know, this idea that we all have different sort of thresholds for our pain. And, you know, you know, like, I know, you can look at someone's, you know, x rays to people, and they can have identical things happening there, you know, at the structural level, and have completely opposite symptoms, one with severe symptoms and one with none. So, when I address the issues of pain that could be could be contributed to from weight, I just, I approach my patients from the lens that even if weight is causing some of the issue, the reality is the research shows that what weight loss doesn't really work for most people. 95% of people who lose weight, gained it all plus more back within one to two to three years, and they don't really have research beyond the five year point because nobody typically makes retains it. So the reality is, even if if you know if that is the suggestion, that's kind of what we've been taught as physical therapists, I know that it doesn't work. So I'm not helping my patients by saying, hey, you really should lose some weight. So I approach it from the lens of I'm going to treat them as if this osteoarthritis, this this issue, whatever they're dealing with, has nothing to do with their weight, and everything to do with all of the other possibilities in my toolbox as a physical therapist. So are we dealing with, you know, restricted, you know, soft tissue, tight muscles, you know, imbalances, muscle imbalances, are we dealing with, you know, just lack of flexibility and other things, can I do some manual therapy that can help, like, what other things can I do, because even if weight is a contributing factor, me telling them to lose weight is in the long run, not going to help them because for like I said, most people aren't going to maintain that weight loss any way, or if they ever achieve it in the first place. And it can be so daunting, when people in larger bodies go to health care professionals, and no matter what is going on with them, if they are in a larger body. The suggestion is weight loss literally across the board, not just you know, in our profession with, you know, things regarding the joints and osteoarthritis, you know, other things like that. It's literally everything, I'm having stomach pain, lose weight, I'm, you know, they literally here for everything. And so I just don't want to be a part of that. And I don't think I don't think that it helps our clients to get better in the long run.   06:28 Yeah, and it, might it add one more thing to this person's plate, so to speak to maybe, then they will say, Well, I'm not even gonna go back to this PT. Yeah, is there a way to meet people where they're at, and through exercise and other modalities, if they were to lose some weight great, not make that the singular focus?   06:54 Absolutely. And that and that's just what it is. Because, you know, adopting new health behaviors is good for everybody, whether you lose weight or not. And you know, just just just increasing the synovial fluid in the joint from, you know, more activity can be great, you know, so weight loss really is a byproduct that some people will experience and other people will not. And, and coming to terms with that has been a journey for me as a professional, and then in my own personal life and my own, you know, struggles from the past with weight loss and diet culture, but it's really freeing, and it helps people eat, I can just this year alone, I've had at least four clients, all of them were women, but they all had the same story, like severe trauma, from interacting with other healthcare professionals, like figuring out something's going on with them, and then being told, like, Oh, yeah, you just got to get that weight off, you just got to keep that weight up, and just kind of hearing it over and over again. And so coming to me was like a, sort of a breath of fresh air for them. It's like, you're the first person, it's like, not telling me I need to lose weight. And it's like cash. Like, I couldn't imagine that being the discussion. Every time I go to the doctor, every time something's bothering me, you know, as if to say, thin people, and people in larger bodies don't experience some of the exact same diagnoses and issues, you know, if weight were the problem, then that would be the situation then people and, and fat people would not have the same diagnosis. And we know that's not true. So yeah, you're right, it adds a whole nother layer of trauma that they have to deal with.   08:28 Yeah. And, and sticking with that theme, let's go into some of the the biases. So the weight bias, fat phobia and healthcare, we could talk about PT in general, like I said, and speaking with Dr. van Who's she sort of said, Hey, listen, this is apparently one of the accepted biases that you can have, you know, so let's talk more about that. Go ahead. I'll give the mic over to you and just kind of what's the situation on the ground here?   08:58 Yeah. And, and she's, she's right with that. It's like, it's like the legal bias. It's like it's okay. And, and even people, what's disheartening to me is interacting with people in larger bodies, they often will just accept it, because it is the norm. And they begin to believe that inherently something is wrong with them. They haven't figured out the magic formula, they're not doing something right. And so there's something wrong with their body. And they're almost Okay, in a sense being discriminated against or dealing with the biases because it's just so much a part of what we do. So it you know, it shows up in everything, like literally from the time you're born. You know, I had a great discussion on my Instagram with some people we were talking about, I did a summer body challenge. So I had everyone like, put on a sports bra and black bottoms and just show it and be proud of your body and we said it was the Being confident and proud of my body this summer and always, you know, not feeling like I gotta lose weight, two summers coming, you know, warmer weather doesn't mean I have to get to the gym and lose some weight or cut back on my calories. And a recurring theme in those conversations was just this idea that like, it starts at home, like my mom, you know, said, Oh, you're putting on a little weight, or you're getting a little chubby, or it's, it's this pass down fat phobia, it's like, do whatever you do, don't get fat. And it's like, oh, my gosh, we, we think we literally think in our society that no one should be fat. And if they are fat, it is because of poor health choices. So we create this hierarchy, where I'm better than you, I must make better health choices in you, because I am thinner, and you are fatter. And it just couldn't be farther from the truth. Because, you know, we, a lot of us like to believe we have a whole lot of control over the size, shape and weight of our bodies. But so much of that is genetic, you know, so much of that has a genetic component, we only have so much control. And even within the window of our control, without going into disordered eating patterns, it's still a very small, you know, amount of change that you can expect to see. So, you know, we hear it from our parents, we hear it at home, we see it on television, you know, when you get on a plane, and the seats are barely big enough for an average adult, you know what I mean? Like, barely, like we're squeezed in there. So imagine that humiliation, you know, as someone in a larger body having to either buy two seats or figure out how to squeeze into that seat. You see it in doctors offices, there's small seats and doctor's offices, even though we treat a huge variation of people in their body sizes, the lobby looks like everybody should be the same, you know. And so those are, you know, things that I want to see changed and considerations I want to see being made, especially in healthcare, because, you know, we we have the privilege of working with people, you know, from largely diverse communities, especially as it relates to their size. So, at the very least, that should be a comfortable experience, you know, you're going to your doctor should be a comfortable experience, you're going to your physical therapist, it should be a comfortable experience. So yeah, there's more I could say, but   12:36 I have a question for you that. So as a physical therapist, so let's say you're talking to you're talking to a group of pts about this, what advice do you have, that they can put into action to challenge these biases, and to make their spaces more inclusive?   12:55 Yes, that's a great question. So the first thing is to start within, and just avoid all of those assumptions that we like to make. So just you know, unlearning, that's where it starts like unlearning this idea that people in larger bodies are inherently unhealthy, or have inherently made bad decisions. Because one, it's not going to help you get them better, or make them feel better. And to it's not true for a lot of people. So getting rid of those, those preconceived notions about what someone in a larger body, you know, has going on, or what kind of health status they have. Also, if you're in a setting, where you have the privilege of sort of, you know, making decisions about the clinic setup, you know, thinking about the furniture, thinking about, you know, having things that are accessible, we think about this, and we're talking about people, you know, with varying levels of ability, if they're in a wheelchair or on crutches, you know, we think about making sure the doorways are wide and this and that, and height, adjustable seating and things of that nature, we should do the same thing for people in larger bodies, people come in different shapes and sizes, and we should do as much as we can within our power, you know, to accommodate them. The other thing is, especially when we're dealing with people who have dealt with the weight, stigma and all that trauma, we need to reassure them, we need to let them know like my patients are literally floored when I tell them like there's nothing wrong with you. You know what I mean? Like we have to abandon this thin ideal, like everybody is not gonna be thin, no matter how hard we work, no matter how hard they work, no matter how many calories we cut, everyone in the world will never be thin, nor do we need to be. It's okay to have variations in size. I truly believe in the concept of Health at Every Size, which is an excellent book by Dr. Linda bacon. But you know those things so I'm learning, reassuring your clients, you know, avoiding the assumptions. You know, there are people in large bodies that can do just as much as you can do or more, you know, but then when you do encounter someone in a larger body that is having trouble because of You know, their mobility issues or their body size, you need to be quick with the modifications, you know, we're good at that, like that. That's what pts do. So you know, give them the opportunity to try it full out. And if they can't, or you see them struggling, jump right in with a modification and you reassure them and you let them know there's nothing wrong with this, like exercise movement is for every body. And if you can't do it this way, well, guess what? I got another way you can do it, oh, that didn't work, I got another way you can do it. Or let's try this one. instead. It's, it's okay. And people need that reassurance. Because in the healthcare setting, especially if they've had that trauma, they're so nervous and so uncomfortable. And again, they feel like there's something wrong, you know, with them. And so, you know, we learn this in PT school, we treat the whole person, you know, we don't see a person and this is a knee, no, we're treating the entire person and all of that all of their preconceived notions, all of their trauma, all of their hardships that comes with them into the clinic. And so we have to figure out a way to work with them, ease their you know, their minds and give them the tools that they need to get better. And so I typically, I take weight out of the equation, I just, I assume that their condition is being caused by something other than their weight, and I treat them based on that   16:14 period. Now, here's the question, how about if you have a patient or client coming to you, who they want to lose weight, or they're in the middle of this weight loss journey, and they're committed to it, because they want to feel better? for themselves? Not for anything else. But you know, we're coming off of a really difficult year where a lot of people might have gained weight over COVID. And so how do you or how would you suggest PT support the patients that are coming to you, they're saying, Hey, listen, I, I'm on this journey, this is what I'm doing. I'm moving, I'm exercising, I'm eating better? How can you give them a little extra support? With out perhaps leading them into an extreme version of that?   17:04 Yeah, what I find in those cases, your role is more of a, I don't want to say a silent partner, but you're there for the supporting piece of it. But the goal is to not. Okay, I'll say it this way, I respect body autonomy. So essentially, I know the research, I don't think that, you know, chasing weight loss is a great idea, really, for anyone, despite COVID I know, people are like I gave the quarantine 15. I'm like, Listen, you're alive. That is such a blessing with the year we've had, you know, the year plus we've had at this point, so but I respect body autonomy. So if you believe like, this is not a weight I'm comfortable with I'm not, I don't feel good, I don't think I look good, I want to do something different, then by all means, go about, you know, the process that you feel comfortable doing, I am going to be here to support you by way of giving you evidence based solutions. So if you tell me, Hey, I'm doing this, you know, 30 day detox, I'm only going to be drinking lemon water. And shakes, I'm going to tell you, I don't think that's a great idea. And here's why. But ultimately, you are an adult. So you get to make all of these choices for yourself. Before I became you know, haze or Health at Every Size aligned and anti diet, I did, I did all kinds of things. And I would not have taken kindly to someone telling me, oh, you're wrong, you need to stop it. So people need to have the freedom to do what they want. And I just as a therapist, I just want to be there. And in my role as a health coach, I want to be there to support them, but provide them with the evidence that's out there. And then, you know, as they go through their process, I'm happy to fine tune, I love to give people workouts, you know, that's, that's what we do is PT. So yeah, I can give you some workouts. If you talk to me about like, I feel really weak in my glutes, I want to be able to do this or I want to be able to benchpress or daily, oh, I've got you, I can give you a great program, you can work on it, you know, we can follow up with me. But whenever you're talking about extreme dieting, and crazy restrictions and weighing yourself incessantly and you know, tracking your movement on your Fitbit all day, I'm gonna kind of bow out and give you the, you know, the freedom to do what you choose. But just let you know that I don't think that's going to really support your goals   19:26 overall. Yeah, and, you know, it's the same as as if we would talk about a return to sport after an injury. So we can help guide the patient through their rehab process. And when we get to that decision making point, it's a shared decision making point where it's you, the client, maybe it's a spouse, a child, a partner, the doctor, whomever might also be within that decision making framework, and exactly what you just said, You're giving the best evidence based information. You can to that patient, and then that patient can make an informed decision on what they can do next, or what feels good, what is the best decision for them? So I just want the PTS out there listening to understand that this is not unlike any other shared decision making that we would do. And it's not a you do what I tell you to do. Because we're biased against people who are fat. Yeah. Because you're overweight, you clearly can't make a good decision. Right? which is not the case. And it's maybe they need information to make a better informed decision, just like someone coming in after an ankle sprain or an injury or low back pain.   20:43 Yeah. And you know, and that that's a great point that you bring up because you're right, it comes up with injuries, people will Google it. And listen, I love Google, no disrespect to Google, I google things all the time. Know when somebody is coming in, and they're dealing with some type of injury or medical condition. And they're going solely based off Google. It's like, Yes, we have a responsibility as a trained professional to say, Hey, here's what I think you should really know. But ultimately, you're right, they they're going to have to make the call. You can't you know, get someone better in physical therapy, just you know, when they come to you, it has to be their follow through at home and their decision making. So that you're absolutely right. That's a great analogy, for sure.   21:27 Yeah. And now, you said this a couple times. But I just want you to talk a little bit more about the Health at Every Size movement. You mentioned it a few times tell the listeners exactly what that is, and what its significance is to diet culture.   21:43 So the health and every size movement is it was sort of tagged by Dr. Linda bacon. I don't really know the lifespan, how long it's been around, I don't think it's been before, like the 90s. But it's essentially a movement that believes in body respect, and body positivity or best body neutrality, and respecting and understanding that we're supposed to be different sizes. And we don't have to lose weight to be healthy, you can literally be healthy at any size. So it's it's really the antithesis to diet culture. It's everything that diet culture is not it's not a movement that is rooted in, you know, being sedentary and eating McDonald's every day. But it is a movement that's rooted in people making their own individual health choices, and and creating health habits that improve their health without any focus on weight loss. So the Health at Every Size movement sort of omits the idea of like, let me check my way, let me weigh in this week. Let me let me measure this week, let me see where I am. It's it kind of throws all of that out of the window. And so the book is actually Health at Every Size by Dr. Linda bacon, that was sort of my introduction to it. And it's been life changing for me again, personally and professionally. So I recommend it to essentially everyone.   23:03 Nice. And because I think oftentimes when people look at someone who's overweight, they think, oh, they must have heart disease. They must be a diabetic, they must have this, but you can have normal labs and be overweight. Yeah, yeah. So and I think that is one of the biggest biases not just in healthcare, but in society in general.   23:27 It is it is. And that is the premise behind Health at Every Size is recognizing that you can't look at someone's physical body and know what their health status is. And we're just so used to making those assumptions and it's so counterproductive to true health and it's so damaging, you know, to people, you know, I personally know people and my own personal story. I'm only 411 I know we've never met in person, but I'm very short.   23:55 A short and you come across way taller.   24:02 It's the hair.   24:04 The hair gives you an added oranges.   24:07 I am short. I've always been short. But genetically, my family my mom's side of the family, they're more like apples shape. So they carry weight in the stomach. They're usually just you know, they got big solid legs. My dad's family was a little bit more Hourglass OR pear shaped so very lower, larger lower bodies. And so literally my entire life here and I have never, ever, ever ever not been overweight. Ever according to BMI which is a whole nother topic but I believe it's trash. So I have always my entire life they considered in an overweight category. I have never had high blood pressure, high cholesterol. AB issues doing any physical activity I used to run once upon a time I ran 25 K's I've never had an actual health issue, but I have always been considered over weight, and that stigma because that you know, value was created by a mathematician, you know, that really even said that it wasn't supposed to be used to like actually measure health into BMI, the BMI. But because of that, being sort of what our healthcare system is run on in our insurance markets, kind of, you know, utilize for everything. I have never, for my whole life, I felt like something was wrong. It's like, I'm not running enough, I must be eating too much. Let me stop having carbs. Let me switch to this diet. Let me and that is it. You know, it's not just my story. That's a lot of people's stories, especially here in this country. And it's like, if we could just stop for one minute, and ignore the weight and ignore the BMI, and just focus on health activities, health behaviors that make you feel good. If it's walking for you, if it's running, if it's skating, if it's dancing, if it's height, whatever it is, for you know, joyful movement, that's kind of you know, that's a part of the Health at Every Size, mantra, it's like joyful movement. Eating when you're full stop eating when you're hungry, stopping when you're full, trying different foods and just living a life and, and managing the other aspects of your health, like your mental health, your emotional health, your spiritual health, if we could just focus on that, instead of the scale, or the measuring tape, BMI, we will be so much healthier. So so so much healthier. So yeah, I, like I said, I could talk about BMI forever, but I just I really, I love what health and every size stands for because it, it's really about valuing body diversity, that's what it is. Because the bottom line is, we're not all going to be the same size, we're not all going to be thin, we're all going to have different dimensions, and our bodies will change over the course of our lives, age, stress, hormonal things, pregnancy, you know, all kinds of stuff. And so we have to get more comfortable with that fact. And not try to create this, you know, there's the whole snap back movement with pregnancy, like, have a baby lose the weight. It's like, wait a minute, let's just be you know, let's adjust to motherhood and whatnot. Um, so yeah,   27:08 yeah, it's it. I can't even get into the BMI. Because I cringe when I when people start talking about their BMI is and what it should be. I mean, for my height for BMI. I am right now, like a tick away from being overweight. And I would if you saw me, you wouldn't think oh, she's overweight. But according to the BMI, I'm like, a tick away. And for me to be in that sweet spot. I would look emaciated. Yeah, exactly. You know, so, like, 100 pounds. Let's like, stop with the BMI stuff. You know, and, and I just had all my labs and I could not be healthier. Absolutely. So there you go. But yeah, I'm with you on the BMI. We could talk. We can go on about that for a while, but we won't. So let's talk about, you know, we talked a little bit about what, what can physical therapists do to look at their own bias and fat phobia in health care? Is there any Do you have any other tips for health care providers out there, when it comes to their bias and phobias?   28:30 Yeah, I would say, you know, in addition to what we talked about earlier, and then on learning practice, you know, we have to just stop telling people to lose weight, it's counterproductive, it's not effective. And again, most people aren't able to even do that consistently and maintain it. And then we have to offer the same treatment options we would offer offer someone who was thin, like it, you know, we just have to treat them with some, you know, equality or you know, equitably, and giving them the same options. And then I know in physical therapy, this has come up before and that's one of the sort of issues that the fat acceptance community has expressed in dealing with with healthcare professionals, is they are less likely to be examined to be physically examined, because of their body fat. And I get that, you know, when you go to physical therapy school, and we learn all these manual techniques, oh, it's much harder to try to palpate things, you know, when there's more adipose tissue, of course, but that doesn't mean you don't do it. You know, so my advice is to do it, it might be uncomfortable, it might be awkward, it might be challenging, but guess what, you grow as a professional and then you at the very least give that patient the the decency and the respect of trying what you know best to do, you know, in that you know, situation. So, um, you know, just being being supportive and not being demeaning that playing into the weight biases. And first really acknowledging that you have them that that's that's the first part because a lot of people don't think that they have until they're put in a situation where they have to face them head on. So recognize them. And then stop telling your patients to lose weight offer people in larger bodies, the same treatment options. You offer people in smaller bodies, and then don't shy away from manually and physically examining them because of their body weight.   30:19 Yeah, great advice. And hopefully people listening to this podcast will take that advice to heart. Now, where can people find you on social media websites? All the good stuff? If they want to reach out to you they want to work with you. Where can they find you?   30:37 Yes, well, my favorite social media is Instagram. I'm pretty much on everything. But if you really want to reach me, you can find me on Instagram and I'm at healthy fit. And that's h EA l th y pH it. I'm also again on YouTube and everything else. But I live there. I'm on the peanut app, which is kind of new. If you're a mom, and you want to have talks about body positivity and changes to your body through motherhood. I'm on that app. You can find me there Dr. Lisa folden. And then my website is www dot healthy fit that calm.   31:10 Awesome. What is this the peanut app? Yeah, this   31:15 is really cool. It's like club friends, but it's for moms. And so they have tons of discussions on there. But um, I was requested by the I think the creators to serve as like a professional and do talks on things in the health realm. So yeah, so I go on there every, every other Friday, and I host talks on things related to body positivity, Fitness, Health, Exercise, things like that.   31:38 Fabulous. Congratulations. It's awesome. Thank you. Now last question. It's out when I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self? Maybe like fresh out of PT school?   31:53 Oh, yes. Oh, fresh out of PT school that changes things, let's see, or high school or undergrad or whatever you want somewhere in there. I think you know what I think the best advice I would give to myself is it's going to be okay. That's really it. Because I was one of those like type A planners, like let me figure everything out. And I just remember being stressed all the time, like wanting my life to work out a certain way. And so it would have been nice. If you know, my older self this Lisa could reach back to that Lisa and just pat her on the back and say it's gonna be okay, honey, you're going to be fine. You can calm down. I just Yeah, that would that probably would have helped me relax a bit more during that process, you know, going through PT school and like, I felt, I just felt this heavy, you know, weight on my shoulders to like, get through and pull through and be great. And so if I could say anything to myself, it would be to just you know, relax. It's going to be okay. Enjoy the ride. You know, for sure.   32:51 Yeah. It's a very common piece of advice from a lot of people on this podcast. Obviously not hard to believe. Right. Right. Right. Lisa, thank you so much for coming on the podcast. It was a great discussion. And, you know, my hope is that people will take away from this all of the great tips to really examine your biases, and just start treating everybody like the people they are. Absolutely. Thank   33:18 you so much for having me.   33:20 Anytime. Anytime. You want to come back. You are welcome. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

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