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Transcript

How Can You Improve Your Assessment? · Pelvic PT Rising

• 0:02
  Speaker 1: In the last 10 years, our field has gone from an unknown specialty to a household name.
• 0:09
  Speaker 1: This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve.
• 0:17
  Speaker 1: In order to help others get better, we need to be better.
• 0:23
  Speaker 1: This podcast will help you to become more confident with your patients, more successful in your practice or business and a leader in pelvic health, and we're going to have some fun along the way.
• 0:36
  Speaker 1: Join us as we rise together.
• 0:39
  Speaker 1: We're Jesse and Nicole Cozine, founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle, and this is Pelvic PT Rising.
• 0:54
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 2: Hey, nicole, hello.
• 1:00
  Speaker 2: Well, we just had a fantastically fun time with our rising CEO group over the last weekend.
• 1:07
  Speaker 1: We think we're actually recording this prior to that.
• 1:11
  Speaker 1: Little Jesse will go over a little behind the scenes of the Pelvic PT Rising podcast with you all here.
• 1:16
  Speaker 1: Keeping it real, we hope we had a really good time.
• 1:19
  Speaker 1: I can't imagine not having a good time with 17.
• 1:24
  Speaker 2: We had asked quarter million dollar a year.
• 1:26
  Speaker 2: Business owners who are just great people and doing some amazing things and transforming the field.
• 1:31
  Speaker 2: We went on a boat.
• 1:33
  Speaker 2: We went wine tasting.
• 1:35
  Speaker 2: We shut down a wine bar.
• 1:36
  Speaker 2: We had people over at our house.
• 1:38
  Speaker 2: We did a lot of fun things, unless it ends up raining, in which case we did none of those and we're sorry, guys.
• 1:44
  Speaker 2: We tried but then we just went to like a Irish dive bar.
• 1:48
  Speaker 1: We have done that in years past.
• 1:49
  Speaker 1: Yeah, so don't jinx it, jesse, it's going to be beautiful weather.
• 1:54
  Speaker 2: It is.
• 1:54
  Speaker 2: It's.
• 1:55
  Speaker 2: One of the funny things, though, about podcasting is that, you know, obviously sometimes we record stuff like pretty much in the moment.
• 2:01
  Speaker 2: Obviously, you guys heard us do the breaking news episode about the vaginal dilator debacle of 2024.
• 2:06
  Speaker 2: So obviously there's some that we do like right in the heat of the moment, and other times we're a little bit further ahead, especially when we've got really busy times.
• 2:14
  Speaker 2: So right now we're doing our CEO business retreat and another couple of weeks we're doing our rising mentorship business retreat.
• 2:20
  Speaker 2: So a lot of times with those we try to get a little bit further ahead on these podcasts and make sure that we're not scrambling around, you know, in the midst of all of that stuff trying to get a podcast recorded for you guys.
• 2:31
  Speaker 1: So and it's one of the reasons why I feel like correct me if I'm wrong, jesse, but there have been very, very few weeks in the more than three, almost four years now that we've been doing this podcast where we have not done two in a row.
• 2:45
  Speaker 1: Maybe we're on Christmas time a couple of times.
• 2:48
  Speaker 2: Even then, I don't think so right, I mean, this is the whole thing.
• 2:51
  Speaker 2: This is why everybody starts a podcast and why none of them ever continue.
• 2:55
  Speaker 2: Specifically speaking, I think the average length of a podcast is like seven episodes, and we're closing in on a million downloads.
• 3:01
  Speaker 2: So we appreciate all of you guys who are listening in and checking it out, because we love doing it.
• 3:06
  Speaker 2: So it's great to hear with you guys and just honestly, make this like a two way connection.
• 3:11
  Speaker 2: Right, it's not just us speaking into a microphone in our kitchen late at night, although it is kind of that too.
• 3:18
  Speaker 1: But I appreciate you guys all interacting with me on Instagram as well about the things that we talk about here on the podcast, so we hope you enjoy it.
• 3:26
  Speaker 1: You can always throw us a little star action on the reviews If you would so please.
• 3:33
  Speaker 2: Yes, that does make us feel happy, although I listen on Google podcasts, which is about to get shut down, so nobody ever cares if I do reviews.
• 3:39
  Speaker 2: But if you guys are on Apple, that's a heroin listens on Apple, like you also.
• 3:43
  Speaker 2: I'm one of like the few Android like holdouts here.
• 3:47
  Speaker 2: This is so annoying.
• 3:48
  Speaker 2: All of us I know all of us people who have Android don't really like Android.
• 3:51
  Speaker 2: We just like pissing off everybody with an iPhone.
• 3:54
  Speaker 1: Well, and it's just so annoying when you're on like group tax and you can't do FaceTime and like you're just really like fucking up a lot of everybody's game.
• 4:01
  Speaker 2: Yeah, that sounds actually great to me.
• 4:02
  Speaker 2: I love not being on group tax and I love not FaceTiming, so I think I made the right choice.
• 4:07
  Speaker 2: I'm going to go with like an old school Nokia so I can play Snake and not FaceTime ever.
• 4:11
  Speaker 2: Great, all right guys.
• 4:14
  Speaker 2: So one of the things we've been talking about, because Nicole has been doing a lot of training of our new folks at the clinic but is thinking about what the assessment is and isn't, and this is something that is a skill, nicole, and it's actually like a pretty advanced skill, I think it is a really advanced skill.
• 4:30
  Speaker 1: I mean, it's something that no one is good at at the beginning and a lot of people aren't even good at it even though they're seasoned therapists, because a lot of times, I mean, it just takes a lot of mental bandwidth and energy to be concise and to say something meaningful in the assessment.
• 4:48
  Speaker 1: But that's really what it should be.
• 4:50
  Speaker 1: We're going to go into what it shouldn't be, what it should be, but this is just something that is just overwhelmingly difficult for everyone, no matter how long you've been practicing public health.
• 5:02
  Speaker 2: Can I throw a couple of quotes out there?
• 5:04
  Speaker 2: These are funny ones because Nicole is like I don't know what Jess is going to say right now.
• 5:07
  Speaker 2: But two of my favorite quotes Oscar Wilde Brevity is the soul of wit, and the other one is from Mark Twain.
• 5:12
  Speaker 2: He says I'm sorry for writing you a long letter.
• 5:15
  Speaker 2: I didn't have time to write you a short one, and I think that one especially really pertains to this assessment, where you know, especially if you guys are talking more than you need to be in your evaluations, if documentation time is taking a long time.
• 5:29
  Speaker 2: But the trick here is actually saying what you need to say, but in a short amount of time.
• 5:33
  Speaker 2: I'm a big believer, as another related example of this is, every email can be three sentences Right, and this is what you're going to talk about, nicole, about the assessment is right.
• 5:42
  Speaker 2: You got to strip away a lot of the nonsense and get down to like the heart of what's going on.
• 5:47
  Speaker 2: So what is the assessment not?
• 5:49
  Speaker 2: Where do people go wrong with this?
• 5:51
  Speaker 1: Well, I feel like the assessment should not be simply stating impairments Patient has left internal rotation, range of motion deficits, patients lacking strength at the pelvic floor, it's like that.
• 6:07
  Speaker 1: That doesn't mean anything in the context of this patient's story.
• 6:12
  Speaker 1: So just stating things that you found and listing off things that are wrong is not an assessment.
• 6:19
  Speaker 1: Assessment, by definition, should be relating things together and making them meaningful in a patient's story.
• 6:30
  Speaker 2: So it's not a laundry list.
• 6:31
  Speaker 2: If I come in with you and I'm like man, I've got a right out of this function.
• 6:34
  Speaker 2: You're like man patients left pinky toe is jacked up.
• 6:39
  Speaker 1: Right, I mean it just doesn't work that way, but I feel like it's actually very common to do this when you are new, or you are sort of overwhelmed with everybody, with the patient in front of you and everybody else seems to kind of get it, and you're just like, oh my gosh, I don't even really know what to say.
• 7:00
  Speaker 1: They just blabbed on for 25 minutes in the session, like I don't really get it.
• 7:06
  Speaker 1: I'm just going to list a bunch of things that I found and hope that that will make sense to me later.
• 7:11
  Speaker 2: But the opposite is also not the right answer.
• 7:13
  Speaker 2: Right is if a laundry list isn't the right answer, then just saying like one thing isn't the right thing either.
• 7:20
  Speaker 1: Yes, it's not.
• 7:21
  Speaker 1: An assessment should not also be singular, right, your pelvic floor, and one of my biggest pet peeves is oh, the pelvic floor is overactive.
• 7:28
  Speaker 1: As if that means something it's like.
• 7:30
  Speaker 1: And so why, how Like?
• 7:33
  Speaker 1: What is going on?
• 7:34
  Speaker 1: That's not enough to just say that your pelvic floor muscles are overactive.
• 7:38
  Speaker 1: Which ones?
• 7:40
  Speaker 1: Where Right greater than left, superficial more greater than deep, like?
• 7:43
  Speaker 1: I need to know way more things than just one singular statement about one part of the body.
• 7:52
  Speaker 2: Which also goes the opposite direction too.
• 7:53
  Speaker 2: Right, oh, the pelvic floor is weak.
• 7:55
  Speaker 2: If you're having incontinence symptoms or prolapse symptoms or something like that, it's like what are we even talking about there?
• 8:01
  Speaker 2: I like this next one that you have on our list and we've actually had some experience with this with our own clinicians but where it's so vague as to be meaningless or so buzzwordy, maybe is right the right way to say that.
• 8:14
  Speaker 2: Where it's like you're saying words.
• 8:15
  Speaker 1: Saying words.
• 8:16
  Speaker 1: A good, really good example of this is patient lacks motor control Period, as if that's a full sentence.
• 8:22
  Speaker 1: First of all, it's not a full sentence Like motor control of what?
• 8:26
  Speaker 1: And it doesn't really tell me what you think about that person's integrative system if you just say they have motor control deficits, like it doesn't mean anything.
• 8:40
  Speaker 1: It's so broad to be meaningless.
• 8:43
  Speaker 2: And then the last one on here.
• 8:44
  Speaker 2: I know gets your blood boiling, nicole, but the idea where your assessment is almost like accusatory, or listing things that are beyond the patient's control, or Talk to me about some of those examples, I know this is always a big frustration point for you.
• 9:01
  Speaker 1: Yeah, I think sometimes this comes out a little bit more in your assessment if you're verbalizing to somebody but I will see this written as well Patient resistant to medication, nerve pain medication or something like that as if that it's relevant to the patient's story.
• 9:20
  Speaker 1: But is that really something that is going to dictate me treating that patient?
• 9:26
  Speaker 1: If I walked in to the next visit and read that, I'd be like, okay, and why does that matter?
• 9:33
  Speaker 1: And so it has an accusatory tone towards it that I'm not loving.
• 9:40
  Speaker 1: It also is the kind of thing, too, where, if someone can't control something like, oh, patient under a lot of stress at work, it's like, well, yeah, he's a fucking lawyer and he went to school for a long time to do this thing and he's not going to not be a lawyer right now, like you're not going to change his job.
• 9:56
  Speaker 1: So why is that?
• 9:57
  Speaker 1: Even in the assessment?
• 9:59
  Speaker 2: Right, it's almost like an excuse for you as to why things aren't getting better, or accusatory to the patient on what that is.
• 10:05
  Speaker 2: And so this is like the bane of writing.
• 10:09
  Speaker 2: Right Is like the editing part.
• 10:11
  Speaker 2: It's like that, all stuff that matters.
• 10:13
  Speaker 2: I hear you saying, right, you're thinking about that when you're dealing with a person, but when you're really thinking about assessing, it's almost more about the editing.
• 10:21
  Speaker 2: It's like stripping away the stuff that doesn't matter and honing it on the stuff that does and clarifying your own cognitive process.
• 10:30
  Speaker 2: There's such a value in that, and we're going to talk about that again in like future episodes on why, how this like starts to guide your treatment.
• 10:38
  Speaker 2: But just to think about that, nicole, on the assessment side, where do we go then?
• 10:42
  Speaker 2: So, if it's not listing impairments, if it's not just saying a single simplified phrase like oh man, the pelvic floor is overactive, if it's not being so vague and just throwing out buzzwords, and it's not just listing things that are maybe either accusatory or beyond their control or patient doesn't deal with stress, well then, what is the assessment?
• 11:05
  Speaker 2: What should it be?
• 11:06
  Speaker 1: So we did a podcast episode about this a little bit before too, so we're going to bring it into this one as well.
• 11:13
  Speaker 1: But it should be commenting on why, and there's really four areas of why we should be commenting on.
• 11:21
  Speaker 1: We should be commenting on the pelvic floor reason.
• 11:22
  Speaker 1: We should be commenting on an orthopedic reason.
• 11:24
  Speaker 1: We should be commenting on some sort of usually neuro reason and then something like a big picture reason like how does this work in the context of this patient's story?
• 11:35
  Speaker 1: So the assessment is commenting on why, and the assessment is also layers of why.
• 11:42
  Speaker 1: Why is this happening?
• 11:45
  Speaker 1: So, again, you can't just say pelvic floor is overactive.
• 11:48
  Speaker 1: We want to know why.
• 11:49
  Speaker 1: And if it says something to do with the hip, why is that happening?
• 11:52
  Speaker 1: And I want you to be thinking about layers and layers of why, and the key here is then combining that into a succinct sentence or a succinct way of describing that, so that someone doesn't have to read a dissertation on this patient if they're going to go in and treat the patient next.
• 12:12
  Speaker 2: So I guess that would probably be then like the simplest explanation, then, of what a great assessment is.
• 12:20
  Speaker 2: Is it a relatively brief, what do you think?
• 12:23
  Speaker 2: Four or five sentences are we talking?
• 12:25
  Speaker 1: Yeah, four to five sentences probably is like a good rule of thumb, for sure, like some can be shorter and if there are some people that are complex enough that you need to say more things about their situation.
• 12:37
  Speaker 2: So, but it's basically a normal sized human paragraph that somebody else would be able to read and be able to guide the care that they give at the next appointment.
• 12:49
  Speaker 2: So like if you just disappeared and you walked off into the sunset and said you know what Jesse, like I'm out of here, you've got clay, I'm going to Tahiti for three months.
• 12:59
  Speaker 2: And somebody was reading your assessments at pelvic sanity.
• 13:03
  Speaker 2: They should be able to read those four sentences and have a really damn good idea of what you've been thinking, what you think, the why is and where they should start with that person that they're working with.
• 13:13
  Speaker 1: Yeah, and this is where I think too.
• 13:15
  Speaker 1: I think sometimes we write we, as in the pelvic rehab, we write the assessment as if we're writing it to a physician or we're writing to somebody that's like different than we are and really remember you guys, this is your rehab assessment, this is your physical therapy assessment, this is the assessment that we should be able to understand, that doesn't have to be understood by every other discipline that exists in this person's.
• 13:47
  Speaker 2: They're like medical management side medical management team.
• 13:49
  Speaker 1: They had their whole like medical team and not everybody has to like understand it's like we do and it should be a huge piece of communication to yourself and to your people that are in your office if you guys share patients or if someone would happen to have to step in and treat a patient of yours if you're sick or whatever.
• 14:09
  Speaker 1: But it should be like where your brain's going on what this person is dealing with and why.
• 14:18
  Speaker 2: I always love clarifying the audience with that too.
• 14:20
  Speaker 2: Right, it's like the audience is not some like physician who's going to be reading your note and like judging you for how you wrote it.
• 14:28
  Speaker 2: Your audience is either you or your colleagues to know where your head is at.
• 14:34
  Speaker 2: Can I ask the cold?
• 14:35
  Speaker 2: Does that change if you're at a more insurance based practice?
• 14:38
  Speaker 2: Like this is matter.
• 14:39
  Speaker 2: Like would you be giving different advice to somebody who is like in an insurance practice and worried about getting all this stuff kicked back for denials if they don't write the assessment correctly?
• 14:48
  Speaker 1: Probably.
• 14:49
  Speaker 1: Here's what I would say about this.
• 14:51
  Speaker 1: If you are in a heavily insurance based world, then I actually don't think that, from a fundamental standpoint, your assessment changes.
• 15:03
  Speaker 1: How you communicate that assessment or what you put additionally there for the insurance company may have to change, but this is still a fundamental way to think about your patient and think about why they have these symptoms.
• 15:19
  Speaker 1: I don't want anybody to lose sight of that just because of the setting that they chose to practice in.
• 15:26
  Speaker 2: Right.
• 15:26
  Speaker 2: So don't start like bowling down to insurance companies and writing it for them when in reality, this is a document for you to know what you're thinking about the patient and where you're going with their treatment.
• 15:37
  Speaker 2: And, nicole, I know I want to hit the where the rubber meets the road here.
• 15:41
  Speaker 2: So we've talked about what it should be is it should be examining the why, looking at those layers of the why.
• 15:47
  Speaker 2: It should be short, concise, able to guide care.
• 15:50
  Speaker 2: Can we get a couple of examples?
• 15:54
  Speaker 1: Oh sure, jesse, I do have some written down here for you.
• 15:57
  Speaker 1: I do have a few written down.
• 15:59
  Speaker 1: These are from real patients that I've treated with.
• 16:02
  Speaker 1: Obviously, some things changed a little bit a long way to protect privacy and such.
• 16:07
  Speaker 1: But I do want to say one other thing about this insurance situation is that I really want you guys to be thinking about what do you actually need to write down in these situations, and not what you assume you need to write.
• 16:21
  Speaker 1: Remember, from a strictly legal standpoint, documentation is what you need to write down for legal aspects and what you need to do for communication aspects of between either yourself or your other colleagues.
• 16:35
  Speaker 2: And by legal we mean your actual practice act, which is almost always incredibly vague.
• 16:42
  Speaker 1: Yes.
• 16:42
  Speaker 2: Like no one has ever gone to documentation jail that we know of for not documenting according to their practice act, it's usually like you have to say the name of the patient and when they came in and what you did.
• 16:56
  Speaker 1: Right, totally.
• 16:56
  Speaker 1: So that is all, and we did a whole documentation podcast which is super game changing for anybody, so you can go back and listen to that as well.
• 17:05
  Speaker 1: But the thing is is that if you do practice in a setting where you do need quote, unquote, to write more in this section, then I want you to go and ask and figure out exactly what and don't write any more than that.
• 17:20
  Speaker 1: So you're going to write this plus the absolute minimum that you need to write in order to meet any other requirements that you have, and a lot of times it can go down in the objective portion.
• 17:31
  Speaker 1: He doesn't have to be right in the assessment piece, like there's a lot of things that I've worked in an insurance model before and so I do understand.
• 17:38
  Speaker 1: But I you know all you know.
• 17:40
  Speaker 1: We're transparent here.
• 17:41
  Speaker 1: I haven't worked in an insurance clinic in a while.
• 17:44
  Speaker 1: I just want you to make sure that you don't lose this part just because you're in an insurance based place.
• 17:51
  Speaker 2: Right, don't throw the benefit of the assessment out in order to appease an insurance company.
• 17:57
  Speaker 2: Is what you're saying.
• 17:58
  Speaker 1: Yes.
• 17:58
  Speaker 2: Okay, so can we get some examples from the mind and brain of the Dr Nicole?
• 18:05
  Speaker 1: Cussey no, it's not that big of a deal, right, but you should actually be able to.
• 18:09
  Speaker 1: You should have a snapshot of this person by these sentences.
• 18:16
  Speaker 2: And 20 second time out.
• 18:17
  Speaker 2: This is one of the reasons that you're always so frustrated by like case reports, because they drag on, and I mean this is like if one of your employees and staff clinicians wants to come to you and have questions about things, like, you should have this dialed in like hey, basically here's my assessment.
• 18:35
  Speaker 2: Where do I go from there?
• 18:37
  Speaker 2: Like, being able to do this is a massive skill and it really is like honing in on what's really the most important thing.
• 18:44
  Speaker 1: Yes.
• 18:45
  Speaker 2: Okay, 1000%.
• 18:47
  Speaker 1: So here's just one example All right, it's of somebody that has erectile dysfunction.
• 18:51
  Speaker 1: So I would just say something like patient presents with symptoms of erectile dysfunction and painful ejaculation due to right greater than left overactive pelvic floor muscles.
• 19:03
  Speaker 1: And if you wanted to, you could put in parentheses which ones history of right L23 injury leading to right hip stiffness and decreased range of motion, especially in transverse plane.
• 19:16
  Speaker 1: Irritation of genital femoral nerve is exacerbated by sympathetic nervous system up regulation and overcompensation of right abdominal wall musculature during lifting with rotation.
• 19:31
  Speaker 2: Awesome.
• 19:31
  Speaker 2: So then tell me, nicole, because I don't understand this.
• 19:34
  Speaker 2: I'm sure most of you guys listening to this absolutely do.
• 19:37
  Speaker 2: But that guides care, right?
• 19:40
  Speaker 2: If you wrote that to one of our staff clinicians and transferred this person to their care, they would read that and presumably have some clue of what to do.
• 19:50
  Speaker 1: Yeah, I mean you could read that and know that I'm focusing on the right side of that person's pelvic floor.
• 19:57
  Speaker 1: We definitely need to be looking up into the thoracolumbar junction right, l23.
• 20:03
  Speaker 1: I am thinking in this initial assessment that it's probably genitofemoral nerve irritation and we know that there's some sort of sympathetic nervous system overdrive which means that it's been chronic for a while and there he is a lifter right and so we have some overcompensations of the way he's recruiting his abdominal wall musculature which can contribute to that genitofemoral irritation and potentially cause that painful ejaculation and erectile dysfunction.
• 20:33
  Speaker 1: Like you have a lot of areas to go and treat.
• 20:36
  Speaker 1: You have hip stuff to look at, you have got back stuff to look at.
• 20:39
  Speaker 1: By extension, you have things up into the thorax to look at.
• 20:42
  Speaker 1: You have vagus, nerve and sympathetic nervous system things to look at, and then you have all of the pelvic floor stuff to look at as well.
• 20:49
  Speaker 1: Like you have a really pretty good snapshot of what this person might be looking like.
• 20:54
  Speaker 1: You know he's lifts right, you know he's a lifter right.
• 20:57
  Speaker 1: So now we are going to do that, we're going to talk about that, and so I feel like that's a pretty good little assessment you should have a pretty good snapshot.
• 21:06
  Speaker 2: Three to four sentences.
• 21:07
  Speaker 2: Three to four sentences.
• 21:07
  Speaker 2: Right, that was it.
• 21:08
  Speaker 2: So can you hit us with another example?
• 21:11
  Speaker 1: Right, you guys know I treat a lot of IC patients, so you could say something like patient presents with symptoms of severe urgency frequency consistent with IC slash BPS with global moderate to severe pelvic floor muscle overactivity, with significant hypersensitivity of periurethral muscles, significant right greater than left pedental nerve irritation at Alkox canal, initial spine, likely contributing to perpetuation of visceral somatic reflex.
• 21:40
  Speaker 1: Patient has history of sexual trauma in teens and not feeling safe at home, which has set the stage for sympathetic nervous system overdrive.
• 21:52
  Speaker 1: Patient also has history of childhood constipation and straining that contributes to pressure management issues and bladder hypersensitivity.
• 22:06
  Speaker 2: Oh, so even I know some things to be working on here.
• 22:08
  Speaker 2: Right Is like now you're talking about constipation.
• 22:10
  Speaker 2: Well, you've got all of the different things and eating right and movement and water and things like that.
• 22:17
  Speaker 2: I totally get how that guides treatment and Alkox, you know you got to go in and fucking handle that shit.
• 22:23
  Speaker 1: Yes, Jesse.
• 22:24
  Speaker 1: Now here's the thing.
• 22:25
  Speaker 1: Here's what I want to point out to If in this person could they also have, and could I have documented in the objective portion the fact that they do have a limited hip internal rotation range of motion, a SI joint issue, weaknesses in some sort of core musculature, functional core strength, like active straight leg raise test, something like that?
• 22:50
  Speaker 1: Sure, but do you, as the therapist coming in to treat this patient, do you need to know, really know, that?
• 23:00
  Speaker 1: I mean, I feel like the things that I chose to put in this assessment are things that are certainly more going to guide your treatment than oh, this than oh.
• 23:10
  Speaker 1: This person has a weak core.
• 23:13
  Speaker 1: You know what I mean.
• 23:14
  Speaker 1: I feel like that is a much more descriptive thing of this patient than pelvic floor muscle overactivity due to weak core and poor hip strength.
• 23:28
  Speaker 1: The thing I just described is the assessment that I just gave is so much more descriptive and it gives you a snapshot of what this person is like and what her body's been through and why she might be in this severe state of interstitial cystitis.
• 23:48
  Speaker 2: So I hope that gives you guys an idea of where this goes.
• 23:52
  Speaker 2: Do you wanna do Nicole one more?
• 23:54
  Speaker 1: I will do one more, as many of you are in like a postpartum place to work, so I'm going to say that this is another one that could be in your place.
• 24:06
  Speaker 1: So patient is a G2P2 female with history of V-Back that presents with stress, urinary incontinence with running and lifting.
• 24:15
  Speaker 1: She presents with left greater than right PC and IC overactivity due to left hip weakness in the sagittal and transverse plane.
• 24:23
  Speaker 1: She has poor shock absorption and at the foot and mechanics at the torso which contribute to left hip compensations.
• 24:30
  Speaker 1: Patient has history of grade three perineal tear with scar tissue adhesions contributing to decreased ability of pelvic floor muscles to meet demand with exercise.
• 24:41
  Speaker 1: Patient presents with poor C-section scar mobility limiting proper core muscle recruitment during high impact of running.
• 24:49
  Speaker 1: Awesome.
• 24:50
  Speaker 2: So let me ask one more practical question, nicole, before we close that out with those examples.
• 24:55
  Speaker 2: If this is a challenge for you, right?
• 24:57
  Speaker 2: Because all of those were between three and five sentences and I think all of them were super descriptive and I'm sure all of you guys listening can understand exactly what you would go ahead and do based on that assessment If this is something to call that is a real challenge for you is man, you're writing too much.
• 25:15
  Speaker 2: You've got so many things.
• 25:17
  Speaker 2: You're tempted to do that laundry list.
• 25:19
  Speaker 2: How do you pare it down to the most important stuff?
• 25:24
  Speaker 2: Is that something where you recommend, like, actually writing it all out and then cutting it?
• 25:29
  Speaker 2: Is it something where you just really ask yourself what is the most important thing?
• 25:37
  Speaker 2: Or what are the three most important things?
• 25:39
  Speaker 2: Like when you train the staff at public sanity, how do you help them with the brevity side of this?
• 25:45
  Speaker 2: So it's not a five paragraph essay, it's a four sentence concise summary of what's going on with the person.
• 25:54
  Speaker 1: I would say that if you're having a hard time with this, I would start with one piece.
• 26:00
  Speaker 1: So I would start with probably the pelvic floor piece and just say what, from a pelvic floor standpoint, is contributing to this patient's symptoms.
• 26:12
  Speaker 1: And most of us can discern what is going on at the pelvic floor.
• 26:17
  Speaker 1: Is it right versus left, is it superficial versus deep, is it global?
• 26:22
  Speaker 1: So I gave you guys examples of that stuff in there and once you have that, I would just start layering on one thing at a time so that you can start to kind of layer on those whys.
• 26:34
  Speaker 1: It's going to take time to build this skill.
• 26:37
  Speaker 1: I hesitate to have people just write everything out because I don't feel like that's helpful to give yourself a laundry list of stuff when we're trying to not do a laundry list of stuff Right.
• 26:49
  Speaker 1: So I think to the next question, you can ask yourself to sort of decide what's the most important thing.
• 26:57
  Speaker 1: Is that, if I were to not be able to treat this person next time, what would be damaging or what would make the patient experience not great if your colleague didn't know something?
• 27:13
  Speaker 1: It's like going back to that very first person.
• 27:16
  Speaker 2: It was a big deal that that person was a lifter, yeah Right.
• 27:21
  Speaker 1: And if that was?
• 27:22
  Speaker 2: exacerbating symptoms and that person walks in and you couldn't be just like so do you exercise?
• 27:27
  Speaker 2: Yeah?
• 27:29
  Speaker 1: Or that's why we said don't put things in there that are accusatory.
• 27:32
  Speaker 1: But in that second example we said that somebody had a history of sexual trauma in their teens and doesn't feel safe at home currently.
• 27:39
  Speaker 1: So we can go into the session understanding a little bit of the story of what got them to this place, and so I think that answering that question helps you to decide what to put in there.
• 27:54
  Speaker 1: And suddenly, when you have to think about it that way, then you're like does it really matter that this person's midfoot is not working?
• 28:06
  Speaker 1: Great, because, remember, they can still have impairments that you are going to a thousand percent do in the session.
• 28:12
  Speaker 1: But this is all about what's the most important thing.
• 28:15
  Speaker 1: What's the most important thing for this person and what would be the most important thing for you to remember, because you're a lifter To remember, because you're going to carry this forward through every single one of your notes what would be the most important thing for you to remember with this patient?
• 28:34
  Speaker 2: Awesome.
• 28:34
  Speaker 2: So, nicole, I hope this helps everybody out there listening to prioritize, to be able to consolidate this because you feel very much that the average is to go way too long on this and to listen more than is needed, and there is a magic in stripping away the stuff that's not essential and really focusing in on the stuff that is.
• 28:56
  Speaker 2: So I hope this has given you guys some really good examples, my ideas about what this can be.
• 29:00
  Speaker 2: As always, we love hearing from you guys and if you want to reach out, you can always DM Nicole.
• 29:06
  Speaker 2: You can shoot us an email.
• 29:07
  Speaker 2: If you have questions about this, please reach out.
• 29:10
  Speaker 2: We love hearing from you guys.
• 29:11
  Speaker 2: Let's keep this conversation going.
• 29:13
  Speaker 1: And let's continue to rise.