Latest / The Heart-Led Business Show / Beyond the Scan: Rethinking Pain Diagnosis with Dr. Nelson Hendler

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Beyond the Scan: Rethinking Pain Diagnosis with Dr. Nelson Hendler · The Heart-Led Business Show

• 0:01
  Speaker: Welcome to The Heart-Led Business Show, where compassion meets commerce and leaders lead with love.
• 0:09
  Speaker: Join your host, Tom Jackobs, as he delves into the insightful conversations with visionary business leaders who defy the status quo, putting humanity first and profit second.
• 0:20
  Speaker: From heartfelt strategies to inspiring stories, this podcast is your compass in the world of conscious capitalism.
• 0:29
  Speaker: So buckle up and let your heart guide your business journey.
• 0:36
  Tom Jackobs: Gentlemen, gear up for a truly enlightening episode of The Heart-Led Business Show.
• 0:42
  Tom Jackobs: Today, we have the incredible Dr.
• 0:44
  Tom Jackobs: Nelson Hendler, a brainy beacon of hope who's not just cracked the code on complex neurophysiology, also heartily honed a business that touches lives.
• 0:55
  Tom Jackobs: With a legacy that spans medical accolades and a passion for pain management, he'll share how he intertwines compassion with commerce.
• 1:04
  Tom Jackobs: So sit back, relax, and let's dive into a conversation that promises to be an enlightening it is engaging.
• 1:12
  Tom Jackobs: Nelson, welcome to the show.
• 1:13
  Nelson Hendler: Thank you.
• 1:13
  Nelson Hendler: Thanks for having me.
• 1:14
  Tom Jackobs: Yeah, I'm really excited to have you on the show.
• 1:17
  Tom Jackobs: I think what we're gonna be talking about is gonna be pretty intriguing for a lot of people and kind of out of the ordinary as well.
• 1:24
  Tom Jackobs: So I think this is gonna be a fun episode to dive into.
• 1:29
  Tom Jackobs: But of course, the first question I always ask of guests is, what's your definition of a heart-led business?
• 1:36
  Nelson Hendler: Well, that's actually multifaceted answer.
• 1:40
  Nelson Hendler: But essentially it's something where you are committed almost to the point of it being an obsession.
• 1:47
  Nelson Hendler: You feel that what you're doing is valuable, it has application for the betterment of the good.
• 1:56
  Nelson Hendler: There's a Hebrew expression called tikkun olam, making the world a better place, and that's part of what's behind it as well.
• 2:04
  Nelson Hendler: And so that's what got me started.
• 2:06
  Tom Jackobs: I love that.
• 2:07
  Tom Jackobs: That's a great definition of leaving the world a better place and definitely having a passion around that is important'cause I'm sure having a heart-led business is not always easy.
• 2:21
  Nelson Hendler: No, it is not.
• 2:22
  Tom Jackobs: Let alone business in general is not always that, that easy.
• 2:26
  Nelson Hendler: So
• 2:26
  Tom Jackobs: tell us a little bit about your business and what got you into doing what you're doing today.
• 2:31
  Nelson Hendler: Well, as I went through medical school and residency, I noticed that patients were getting short shrift.
• 2:40
  Nelson Hendler: Doctors weren't paying attention to them, and eventually I found out that patients were misdiagnosed.
• 2:45
  Nelson Hendler: And we've published a number of articles showing that 40 to 80% of patients are misdiagnosed.
• 2:52
  Nelson Hendler: I mean, you know, and that's, you know, that's astounding.
• 2:55
  Nelson Hendler: There's an article in Wall Street Journal about that.
• 2:58
  Nelson Hendler: They reported about 56% of patients are misdiagnosed.
• 3:02
  Nelson Hendler: And the typical thing is...
• 3:04
  Tom Jackobs: In general?
• 3:04
  Tom Jackobs: Or is it...
• 3:04
  Nelson Hendler: in general.
• 3:05
  Nelson Hendler: In general.
• 3:06
  Nelson Hendler: That's general
• 3:07
  Tom Jackobs: Doesn't matter like, it could be be a, a, a hangnail or, or a cardiac incident?
• 3:11
  Nelson Hendler: Well, no, it, it's, um...
• 3:14
  Nelson Hendler: Well, it's an interesting way to look at it.
• 3:16
  Nelson Hendler: There, there are two ways that a physician will misdiagnose a patient.
• 3:21
  Nelson Hendler: This is very interesting.
• 3:22
  Nelson Hendler: These are real statistics from the medical literature.
• 3:25
  Tom Jackobs: Yeah.
• 3:25
  Nelson Hendler: The average amount of time a doctor spends with a patient is 11 minutes, during which time he speaks 7 of the 11 minutes.
• 3:35
  Nelson Hendler: You, you, you can't get a, you can't get a very careful history during that period of time.
• 3:41
  Nelson Hendler: And then typically, the doctor orders tests that have a high level of false negative results.
• 3:50
  Nelson Hendler: One classic example of this is the MRI.
• 3:53
  Nelson Hendler: People have neck problems, so they get the MRI of the neck.
• 3:57
  Nelson Hendler: It comes back normal.
• 3:59
  Nelson Hendler: Sandhu up at Cornell did a study comparing people with very symptomatic disc versus MRIs that were normal, and then he did a thing called a provocative discogram, and 77% of the time, the provocative discogram found pathology missed by the MRI.
• 4:21
  Tom Jackobs: Oh, wow.
• 4:22
  Nelson Hendler: So think of-- But then another study by Jenkins in New England Journal of Medicine published one.
• 4:27
  Nelson Hendler: He looked at 98 people with no back pain whatsoever, did MRIs, and found 27% of them had positive MRIs.
• 4:39
  Nelson Hendler: So you have a test with a false negative rate of 77% and a false positive rate of 27%.
• 4:47
  Nelson Hendler: You could flip a coin and get better results.
• 4:49
  Tom Jackobs: Oh yeah.
• 4:49
  Tom Jackobs: Right.
• 4:49
  Tom Jackobs: Exactly.
• 4:50
  Nelson Hendler: The real issue here is the failure to make a distinction between anatomical test and physiological test.
• 4:59
  Nelson Hendler: I had a lot of patients involved in accidents, and so the attorney always says,"Now, explain this to the jury." I said,"Okay, well, here's the way it goes.
• 5:08
  Nelson Hendler: If I had an oven up on the wall, and I took a picture of the oven, and I handed you the picture and said,'Tom, look at the picture and tell me the oven is hot,' what could you tell me?"
• 5:17
  Tom Jackobs: Hmm.
• 5:18
  Tom Jackobs: Couldn't tell you.
• 5:20
  Nelson Hendler: But, but if I put a thermometer in the oven and I handed you, said,"375," I said,"Tom, is the oven hot?" You say,"Yeah, sure."
• 5:27
  Tom Jackobs: Yeah.
• 5:27
  Tom Jackobs: Yeah,
• 5:28
  Nelson Hendler: And that's the difference between anatomical testing and physiological testing.
• 5:33
  Tom Jackobs: So anatomical, you're just looking at a picture, you don't have any...
• 5:36
  Nelson Hendler: That's exactly right.
• 5:38
  Nelson Hendler: But pain, most of the patients I see are chronic pain and headache patients.
• 5:41
  Nelson Hendler: You can't take a picture of pain.
• 5:44
  Tom Jackobs: Right.
• 5:44
  Tom Jackobs: Yeah.
• 5:45
  Tom Jackobs: And rarely is it at the place where they say the pain is.
• 5:49
  Nelson Hendler: Well, that's another phenomenon.
• 5:50
  Nelson Hendler: That's a referred pain, things along those lines.
• 5:53
  Nelson Hendler: And then again, you have to take into account the concept of convergence and divergence, that a single medical symptom can have multiple etiologies.
• 6:05
  Tom Jackobs: Hmm.
• 6:06
  Nelson Hendler: The best way to, you know, the best analogy is a flat tire.
• 6:09
  Nelson Hendler: You got a flat tire.
• 6:10
  Nelson Hendler: Well, is, is it a leaky valve stem, a nail in the tread?
• 6:13
  Nelson Hendler: Did you hit the curb and knock the bead off the tire?
• 6:16
  Nelson Hendler: Whatever it is, you got a flat tire.
• 6:19
  Nelson Hendler: Well, now suppose you've fixed the leaky valve stem and you still have a flat tire.
• 6:26
  Nelson Hendler: Aha! It could be two things or three things.
• 6:31
  Tom Jackobs: Yeah.
• 6:32
  Nelson Hendler: And the, the old thing in medical school, they used to say you can have lice and fleas.
• 6:37
  Nelson Hendler: So you have to take into account, you have to consider when you have a single symptom, multiple etiology, but sometimes you could have two or three causes for that same single symptom.
• 6:53
  Tom Jackobs: Wow.
• 6:53
  Nelson Hendler: On the other hand, you have single causes with multiple clinical manifestations.
• 7:00
  Nelson Hendler: The best example of this would be Lyme's disease.
• 7:03
  Nelson Hendler: A little spirochete like syphilis, and in fact it is very similar to syphilis in many respects.
• 7:09
  Nelson Hendler: It's a multi-system disease.
• 7:11
  Nelson Hendler: You get neuropathy, you get arthropathies, you get your arthritis, you get vasculitis.
• 7:17
  Nelson Hendler: You get all sorts of horrible things from this one single organism which manifests in different ways.
• 7:24
  Tom Jackobs: Interesting.
• 7:25
  Nelson Hendler: So as a matter of fact, 100 years, over 100 years ago, Sir William Osler, when he was at Hopkins, said,"He who knows syphilis, knows medicine."'Cause it was such a multifactorial disease, and you really had to take all those things into account.
• 7:41
  Nelson Hendler: When you're approaching a patient, you have to take all those factors into account.
• 7:47
  Nelson Hendler: Now, the thing, I was the psychiatrist for the Department of Neurosurgery at Hopkins for 34 years.
• 7:54
  Nelson Hendler: Great guys.
• 7:55
  Nelson Hendler: I mean, couldn't ask for...
• 7:57
  Nelson Hendler: I mean, they're world-class.
• 7:58
  Nelson Hendler: World-class
• 8:00
  Tom Jackobs: Yeah.
• 8:00
  Nelson Hendler: Ben Carson, who, you know, separated the Binder twins, and also they have Don Long, who did some of the, the most remarkable surgeries in the history of medicine, chairman of neurosurgery there.
• 8:12
  Nelson Hendler: Really couldn't ask for a smarter group of guys.
• 8:16
  Nelson Hendler: But the other thing is when patients didn't get well, they operated on a patient, the patient didn't get well.
• 8:24
  Nelson Hendler: Must be the patient's fault, not my fault.
• 8:27
  Tom Jackobs: That's right.
• 8:30
  Tom Jackobs: Exactly, yes.
• 8:31
  Nelson Hendler: And they would, they would send, send the cases to me and go,"Oh, the patient's not getting well.
• 8:35
  Nelson Hendler: Go see the shrink." Okay.
• 8:37
  Nelson Hendler: And, and I'd start talking to them, and I'd say,"Well, the reason the patient is angry and depressed is he's just not getting well.
• 8:46
  Nelson Hendler: It is, it's not the cause of his pain, it's the result of his pain." And the psychiatric literature was filled with such garbage.
• 8:55
  Nelson Hendler: It was absolute garbage.
• 8:56
  Nelson Hendler: There was a thing called depressive equivalence.
• 9:00
  Nelson Hendler: So if someone, according to some earlier psychiatrist who will go unnamed, if a patient had both pain and depression, they said it was a depressive equivalent.
• 9:10
  Nelson Hendler: The patient wasn't capable of expressing their depression, so they came up with a physical complaint of pain.
• 9:19
  Tom Jackobs: Ah.
• 9:19
  Nelson Hendler: I read that, I said,"That's the biggest bunch of horse hockey I've ever read." So but, you know, when you, when you do a, when you start out in medicine, you study anatomy before you study pathology.
• 9:36
  Nelson Hendler: 'Cause by studying anatomy, you see what normal looks like, and then you could appreciate the pathology because it's different than normal.
• 9:46
  Nelson Hendler: Okay?
• 9:46
  Nelson Hendler: Yeah.
• 9:47
  Nelson Hendler: Okay.
• 9:47
  Nelson Hendler: So with that thought in mind, I said,"Well, what's a normal patient look like when they get pain?" And the interesting thing is that they go through four stages remarkably similar to the stages described by Kubler-Ross on her book, book on death and dying.
• 10:05
  Nelson Hendler: The first stage is they, they deny it.
• 10:08
  Nelson Hendler: You know, it's gonna get well.
• 10:10
  Nelson Hendler: It's gonna get well.
• 10:11
  Nelson Hendler: And the second stage is they're sort of hopeful it's gonna get well, but they start bargaining a little bit.
• 10:17
  Nelson Hendler: "Well, if I can just get a little bit better." And then the third stage is they recognize it's not gonna get well, and they get depressed.
• 10:25
  Nelson Hendler: And that depression can last three to 12 years.
• 10:28
  Nelson Hendler: And the fourth stage is they finally accept this, this is the way it's going to be.
• 10:33
  Tom Jackobs: Yeah.
• 10:33
  Nelson Hendler: Now, the truth about this when you talk about depression, these patients kill themselves.
• 10:40
  Nelson Hendler: The suicide rate amongst chronic pain patients is two and a half to three times higher than the general population.
• 10:47
  Tom Jackobs: Totally believe that.
• 10:48
  Nelson Hendler: Yeah, it's, it's pretty devastating.
• 10:50
  Nelson Hendler: So this is what, this is what really got me interested in this whole process.
• 10:54
  Nelson Hendler: But how do we improve the accuracy of diagnosis in patients?
• 10:59
  Nelson Hendler: Well, you gotta take a careful history.
• 11:02
  Nelson Hendler: You can't take a careful history in 11 minutes.
• 11:05
  Tom Jackobs: No.
• 11:07
  Nelson Hendler: And so what is the value of a history?
• 11:11
  Nelson Hendler: So man comes into the office, he says,"I have a pain in my thumb." The doctor says,"Okay, let's take an X-ray of your thumb.
• 11:20
  Nelson Hendler: Aha! There's a vice on your thumb." Okay?
• 11:24
  Nelson Hendler: "You need a vicectomy." I'm sorry, it's a bad joke.
• 11:28
  Nelson Hendler: But anyhow,
• 11:28
  Tom Jackobs: That is a bad joke.
• 11:32
  Nelson Hendler: so he takes the vice off the thumb and that's fine.
• 11:35
  Tom Jackobs: Yeah.
• 11:35
  Nelson Hendler: Man comes in the office, he has a pain in the thumb.
• 11:38
  Nelson Hendler: Doctor takes his X-ray.
• 11:40
  Nelson Hendler: Nothing on X-ray.
• 11:41
  Nelson Hendler: I don't know what's wrong with you." What's missing from that picture?
• 11:45
  Nelson Hendler: What's missing from that picture is the doctor didn't take a careful history.
• 11:50
  Nelson Hendler: The careful history consisting of,"Well, what makes your pain worse?""Oh, when I hit my thumb with a hammer.""What makes your pain better?""When I stop hitting my thumb with the hammer." Aha! Now we know the cause of the pain and now we can provide a treatment for the pain.
• 12:09
  Nelson Hendler: And I know it's a very simple description, but that's the distinction between not taking a careful history and taking a history.
• 12:17
  Tom Jackobs: Yeah.
• 12:17
  Tom Jackobs: Well, you know I work with a lot of functional medicine doctors, and that's the whole point, is to get to the root cause of what's going on so that you can actually fix it, versus sick care model now is just put a Band-Aid on it with, you know, some medication, whatever, just, you know, and, you know, maybe it'll resolve itself.
• 12:39
  Nelson Hendler: Yeah, that's-- Well, the, the patients themselves expect that.
• 12:42
  Nelson Hendler: Everybody wants instantaneous gratification.
• 12:44
  Tom Jackobs: Right.
• 12:45
  Tom Jackobs: Yeah, exactly.
• 12:45
  Nelson Hendler: "Don't tell me what it is.
• 12:46
  Nelson Hendler: I don't want to...
• 12:47
  Nelson Hendler: Just fix it." No, it does- doesn't work that way.
• 12:50
  Nelson Hendler: I can't fix it till I know what's causing it.
• 12:53
  Nelson Hendler: I mean, if I found a guy with a broken leg and I gave him a shot of morphine, what have I done?
• 12:58
  Tom Jackobs: Yeah, nothing.
• 12:59
  Nelson Hendler: I've treated, treated them symptomatically for three hours.
• 13:03
  Tom Jackobs: Right
• 13:04
  Nelson Hendler: un- until I set the leg, we got a problem.
• 13:06
  Nelson Hendler: And but it's part and parcel of our-- it's a, a sad commentary in our society in general.
• 13:13
  Nelson Hendler: Everybody wants instantaneous gratification.
• 13:16
  Nelson Hendler: And so it's all a matter of symptomatic treatment.
• 13:19
  Nelson Hendler: Boom, boom, boom, boom.
• 13:21
  Nelson Hendler: Get out of here.
• 13:22
  Nelson Hendler: And, uh,
• 13:23
  Tom Jackobs: Yep.
• 13:24
  Nelson Hendler: You know, I think it was Pythagoras told Alexander the Great-- Alexander the Great was having trouble with geometry, and he said,"Your Highness, there's no royal road to geometry." You have to slog through, you have to take the history.
• 13:40
  Nelson Hendler: So that's why I developed these tests.
• 13:42
  Nelson Hendler: And basically, it's a question like for the pain diagnostic test.
• 13:47
  Nelson Hendler: We found, again, 40 to 80% of patients are misdiagnosed.
• 13:51
  Nelson Hendler: So the test is 72 questions, 2,008 possible answers, and asks all the questions a conscientious physician should ask if he spent an hour with a patient, but he never does.
• 14:06
  Tom Jackobs: Well, he can't afford to.
• 14:08
  Nelson Hendler: Well, well that's, well that's the other part of it.
• 14:10
  Nelson Hendler: The insurance companies have really destroyed medicine.
• 14:14
  Tom Jackobs: Yep.
• 14:14
  Tom Jackobs: 100%
• 14:14
  Nelson Hendler: And so the doctor who used to get, you know,$100 a visit is now getting$50 a visit.
• 14:21
  Nelson Hendler: So to keep the same income, what's he have to do?
• 14:24
  Nelson Hendler: He has to see twice as many patients in the same amount of time.
• 14:27
  Nelson Hendler: You know?
• 14:28
  Tom Jackobs: Yep.
• 14:28
  Nelson Hendler: And that means he's cutting the time in half with the patient.
• 14:31
  Nelson Hendler: And I know it sounds simple-minded, but that's really at that level.
• 14:36
  Tom Jackobs: Yeah, exactly.
• 14:37
  Tom Jackobs: Yeah.
• 14:38
  Tom Jackobs: And that's where we get the 7 to 11 minutes visit.
• 14:41
  Nelson Hendler: Exactly.
• 14:42
  Nelson Hendler: So the questionnaire, we score the questionnaire using Bayesian logic instead of Boolean logic and, predictive analytics and the little AI that I threw in there.
• 14:55
  Nelson Hendler: Now, people say,"Well, what's the difference between Boolean logic and Bayesian logic?" Well, Boolean logic is what computer programmers use when they program things for a computer.
• 15:05
  Nelson Hendler: On/off, yes/no, diagrams.
• 15:07
  Nelson Hendler: And Bayesian logic is what you and I use to solve everyday problems.
• 15:11
  Nelson Hendler: I'll give you an example.
• 15:12
  Nelson Hendler: On Boolean logic, I come out and I look at my car.
• 15:18
  Nelson Hendler: Does the car have a flat tire?
• 15:20
  Nelson Hendler: Yes, no.
• 15:22
  Nelson Hendler: If no, drive away.
• 15:23
  Nelson Hendler: If yes, is there a nail in the tread?
• 15:28
  Nelson Hendler: Yes, no.
• 15:29
  Nelson Hendler: If no, is there a leaky valve stem?
• 15:32
  Nelson Hendler: Yes, no.
• 15:33
  Nelson Hendler: If that, is the bead off the tire?
• 15:35
  Nelson Hendler: Yes, no.
• 15:35
  Nelson Hendler: And you see, it goes right through this branching diagram.
• 15:38
  Nelson Hendler: Two problems with Boolean logic.
• 15:40
  Nelson Hendler: Every choice is 50/50, yes or no.
• 15:43
  Tom Jackobs: Mm-hmm.
• 15:44
  Tom Jackobs: Yep.
• 15:45
  Nelson Hendler: And there's no provision for multiple problems.
• 15:49
  Tom Jackobs: Ah.
• 15:50
  Nelson Hendler: You're going in a very linear way.
• 15:53
  Nelson Hendler: That's...
• 15:53
  Nelson Hendler: And you stop when you get the one, you solve one thing, you stop because you don't keep going.
• 15:57
  Nelson Hendler: That's not how you solve...
• 15:59
  Nelson Hendler: You come out and you look at your car and you say,"Oh God, I got a flat tire." I've had 21 flat tires in my life.
• 16:06
  Nelson Hendler: 17 of them have been due to a nail in the tread.
• 16:10
  Nelson Hendler: Therefore, the first place I'm gonna look, I got a 17 out of 21 chance of having a nail in the tread.
• 16:18
  Nelson Hendler: Ah, but two were due to a leaky valve stem.
• 16:22
  Nelson Hendler: Ah, now I got a two out of 21 chance.
• 16:25
  Nelson Hendler: Uh, oh, wait, but once I knocked the tire against the curb and took the bead off one time out of 21.
• 16:31
  Nelson Hendler: So now you have a whole list of diagnoses and differential diagnoses rank ordered from most likely to least likely.
• 16:40
  Nelson Hendler: But with the Bayesian analytic tool, you never miss a diagnosis.
• 16:44
  Nelson Hendler: No matter how remote it is, it's still in the consideration, maybe down at the bottom.
• 16:50
  Nelson Hendler: But after you've exhausted the other two or three choices, you still have that other option.
• 16:54
  Tom Jackobs: Well, that, that's your diagnostic tool.
• 16:56
  Tom Jackobs: And, and so that's the business that you're in right now.
• 16:59
  Nelson Hendler: Precisely it.
• 17:01
  Nelson Hendler: Yeah.
• 17:01
  Nelson Hendler: Now the CEO of my company is a former New York Stock Exchange CEO, Ron Riewald.
• 17:06
  Nelson Hendler: He headed the largest pain treatment center company in the country, was doing 80 million a year EBITDA.
• 17:11
  Nelson Hendler: It was on the New York Stock Exchange.
• 17:13
  Nelson Hendler: And I'm, I'm having trouble selling the test.
• 17:15
  Nelson Hendler: He says,"You know what it is?
• 17:17
  Nelson Hendler: Your results are too good." I said,"What do you mean, Ron?" He says,"First off, you can't come into a doctor's office and say you're misdiagnosing the patients 40% to 80% of the time.
• 17:27
  Nelson Hendler: That's a non-starter."
• 17:30
  Tom Jackobs: Exactly.
• 17:31
  Tom Jackobs: Doesn't bode well for the physician.
• 17:34
  Tom Jackobs: You know, it's like,"What?"
• 17:35
  Nelson Hendler: Get, get out of here.
• 17:37
  Nelson Hendler: Right.
• 17:37
  Tom Jackobs: Right.
• 17:38
  Nelson Hendler: And the second thing is, and the study we did with Don Long, who was chairman of neurosurgery at Hopkins, a great guy.
• 17:43
  Nelson Hendler: We've written articles together, books together, my old hunting buddy for 35 years, great guy.
• 17:50
  Nelson Hendler: And we looked at 70 patients who had been in auto accidents, who had normal MRIs, normal CT scans, and normal X-rays, and were called whiplash because all the tests were normal.
• 18:04
  Tom Jackobs: Huh.
• 18:05
  Nelson Hendler: Right?
• 18:05
  Tom Jackobs: But they still had pain or they still had something...
• 18:08
  Nelson Hendler: the doctors were diagnosing the tests, not the patient.
• 18:11
  Nelson Hendler: So we did the diagnostic paradigm.
• 18:13
  Nelson Hendler: We found out there were a lot of things what made the pain worse, what made the pain better, sort of like the guy with the hammer.
• 18:19
  Nelson Hendler: And we said,"Oh, okay." Now these guys, we found that 95% of these patients needed physiological tests like root blocks, facet blocks, provocative discograms.
• 18:30
  Nelson Hendler: And when we did those blocks, we found that 63% of these 70 patients previously called whiplash, 63% required cervical fusions.
• 18:44
  Tom Jackobs: Ooh.
• 18:44
  Nelson Hendler: Ooh, think about that.
• 18:46
  Tom Jackobs: Yeah.
• 18:48
  Tom Jackobs: Well, that's rough.
• 18:49
  Nelson Hendler: And this is from the chairman of neurosurgery at Hopkins.
• 18:51
  Nelson Hendler: This is not some meatball surgeon who's operating because he, he needs a new car.
• 18:56
  Nelson Hendler: These were well, well-documented, rational selection processes saying this guy needs a fusion.
• 19:04
  Tom Jackobs: Wow.
• 19:05
  Nelson Hendler: That's a very interesting insight.
• 19:06
  Tom Jackobs: Yeah.
• 19:07
  Tom Jackobs: So tell me about the business and what makes it heart-led for you.
• 19:11
  Nelson Hendler: It's heart-led because, you know, for the reasons I told you.
• 19:15
  Nelson Hendler: I go into the doctor's office and, and he says,"Nah, I don't, I don't need this." You know?
• 19:20
  Tom Jackobs: Right.
• 19:20
  Nelson Hendler: You know, I c- I can make my own diag-
• 19:22
  Tom Jackobs: So how do you help them, you know, or how do you convince them that they actually need it or should want it?
• 19:27
  Nelson Hendler: Well, I try to understand where their pain points are, if you'll excuse the,
• 19:33
  Tom Jackobs: Yeah.
• 19:34
  Nelson Hendler: And usually it's, I hate typing and dictation.
• 19:37
  Nelson Hendler: I don't know if you've ever seen that, you know, doctors will go into an office and talk with a patient and go out, and then goes into the next office, talk to another patient, talk to another patient.
• 19:47
  Nelson Hendler: At the end of the day, he's got seven or eight charts to dictate.
• 19:52
  Nelson Hendler: And he's got all those charts and he has to dictate them.
• 19:55
  Nelson Hendler: Now he's sitting there and,"Mrs.
• 19:56
  Nelson Hendler: Smith, was her pain in the left arm or the right arm?" You know, he, and you know, he's...
• 20:02
  Nelson Hendler: Right?
• 20:04
  Tom Jackobs: Yep.
• 20:04
  Nelson Hendler: Yeah.
• 20:04
  Nelson Hendler: Or, or he's...
• 20:05
  Nelson Hendler: And he's trying to either type contemporaneously, and then he's not listening to the patient.
• 20:10
  Nelson Hendler: So the testing eliminates typing and dictation, and never misses a symptom.
• 20:15
  Tom Jackobs: Nice,
• 20:18
  Nelson Hendler: And it never forgets...
• 20:19
  Tom Jackobs: something that, they well, so- You can give it to them before they even go to the office.
• 20:23
  Nelson Hendler: That's exactly it, Tom.
• 20:24
  Nelson Hendler: That's exactly it.
• 20:25
  Nelson Hendler: You give it to the patient before he sees the doctor.
• 20:27
  Nelson Hendler: Results are available in three seconds before the patient sees the doctor.
• 20:32
  Nelson Hendler: He reads through.
• 20:33
  Nelson Hendler: He's got chief complaint, history of present illness, past history, diagnosis, differential diagnosis, diagnosis with a 96% correlation with diagnosis of Johns Hopkins Hospital doctors.
• 20:45
  Nelson Hendler: And then based on the correct diagnosis, or we assume it's correct because it correlates with Hopkins doctor's diagnosis, it recommends the correct medical test to use.
• 20:55
  Nelson Hendler: Not just MRIs, not just CT scan, not just X-rays.
• 21:00
  Nelson Hendler: You know, though we talked about the MRI missing pathology.
• 21:04
  Nelson Hendler: The CT scan misses 56% of the pathology compared to a 3D CT scan.
• 21:10
  Nelson Hendler: And then my favorite is the X-ray.
• 21:13
  Nelson Hendler: Patient's injured in an X-ray, the doctor takes an X-ray.
• 21:18
  Nelson Hendler: So I say to the patient,
• 21:21
  Tom Jackobs: One view.
• 21:22
  Nelson Hendler: No, no.
• 21:23
  Nelson Hendler: What makes your pain worse?""Oh, doc, when I lean forward or lean backwards.""Okay.
• 21:28
  Nelson Hendler: How about when you hold your head upright?""No, that doesn't hurt.
• 21:30
  Nelson Hendler: Only when I lean forward, lean back.""Well, let me see your X-ray." I'm not making this up.
• 21:36
  Nelson Hendler: More than 95% of the time, Tom, all those X-rays are upright.
• 21:41
  Nelson Hendler: Yeah.
• 21:42
  Tom Jackobs: Yeah, of course.
• 21:42
  Nelson Hendler: We're not talking medicine here.
• 21:44
  Nelson Hendler: We're talking common sense.
• 21:46
  Nelson Hendler: If it hurts when you lean forward, don't you think it'd be a good idea to take a picture when you're leaning forward?
• 21:53
  Tom Jackobs: Right.
• 21:54
  Tom Jackobs: Yeah.
• 21:54
  Nelson Hendler: And that's, that's what I'm up against.
• 21:57
  Nelson Hendler: And then on the other side, we also have a business to consumer website for patients who are injured and they're not getting well and the doctor says,"Well, I don't know what's wrong with you.
• 22:06
  Nelson Hendler: It's all in your head," or, you know,"It's, it's just a sprain or it's just whiplash." And so the consumer can go on and take the test himself and take it into the doctor and say,"Here's what this test from Hopkins says." And the doctor will say,"Ah, you're on the...
• 22:20
  Nelson Hendler: I don't believe anything on the internet." And that's the end of that.
• 22:23
  Nelson Hendler: But you can see how that...
• 22:26
  Tom Jackobs: Yeah.
• 22:26
  Tom Jackobs: Yeah.
• 22:27
  Tom Jackobs: And I think that's probably, the avenue of least resistance is going to the consumer, and it's the, the consumer that pushes to have these available.
• 22:38
  Tom Jackobs: And, you know, it's the same that the pharmaceutical companies do in terms of advertising,
• 22:42
  Nelson Hendler: The ad- ads
• 22:44
  Tom Jackobs: and
• 22:44
  Nelson Hendler: on TV.
• 22:44
  Nelson Hendler: You're right.
• 22:46
  Tom Jackobs: It's crazy.
• 22:46
  Nelson Hendler: Hey doc, how about prescribing me this?" Right.
• 22:49
  Nelson Hendler: Yeah.
• 22:49
  Tom Jackobs: Yeah.
• 22:50
  Tom Jackobs: "Hey, hey doc, I, I have restless leg syndrome," whatever that is.
• 22:54
  Nelson Hendler: Right.
• 22:55
  Tom Jackobs: "I think I need that purple pill that they're advertising on TV.
• 23:00
  Tom Jackobs: Can you prescribe that to me?
• 23:00
  Nelson Hendler: Is that right?
• 23:01
  Nelson Hendler: You try that too?
• 23:02
  Nelson Hendler: Yeah, that's it.
• 23:03
  Nelson Hendler: Sure.
• 23:03
  Nelson Hendler: Okay.
• 23:05
  Tom Jackobs: Yeah, that's crazy.
• 23:05
  Nelson Hendler: And that's it.
• 23:06
  Nelson Hendler: And, and of course the patients want instantaneous relief.
• 23:09
  Tom Jackobs: Yeah.
• 23:11
  Nelson Hendler: And they want relief.
• 23:12
  Nelson Hendler: They don't want testing.
• 23:13
  Tom Jackobs: Wow.
• 23:14
  Tom Jackobs: Well, but-- And yeah.
• 23:17
  Tom Jackobs: And then that, I think that would, that would be part of the education then in terms of the consumer education is, you know, this is step one, step two is the diagnostic, the real diagnostic, and then step three is the result or the,
• 23:31
  Nelson Hendler: Yeah.
• 23:32
  Tom Jackobs: The management of the pain.
• 23:33
  Nelson Hendler: Let me give you a thought.
• 23:35
  Tom Jackobs: Yep.
• 23:35
  Nelson Hendler: There are two types of medical errors.
• 23:39
  Nelson Hendler: There are errors of omission and errors of commission.
• 23:43
  Nelson Hendler: The error of omission is okay.
• 23:45
  Nelson Hendler: The doctor does the test and he says,"I don't know what you have." I can live with that.
• 23:51
  Nelson Hendler: That's an honest answer.
• 23:52
  Nelson Hendler: I did all the tests.
• 23:53
  Nelson Hendler: You know, the worst is when he does the test, he does the wrong test, and he says,"Aha, here's the diagnosis," and he goes down the wrong path, which prevents the patient from getting the correct diagnosis and the correct testing.
• 24:08
  Nelson Hendler: And that's the error of commission, and that's the worst that there is.
• 24:12
  Nelson Hendler: We saw that.
• 24:12
  Nelson Hendler: I was president of the American Academy of Pain Management, but I was also president of the Reflex Sympathetic Dystrophy Syndrome Association of America.
• 24:22
  Nelson Hendler: A horrible disease.
• 24:23
  Nelson Hendler: You know, a very, very, not
• 24:25
  Tom Jackobs: That's a long...
• 24:26
  Nelson Hendler: pleasant, not a pleasant disease.
• 24:28
  Nelson Hendler: And we found that 77% of patients told that they had RSD actually had nerve entrapment.
• 24:38
  Tom Jackobs: Hmm.
• 24:38
  Nelson Hendler: 71-- I found 71%.
• 24:41
  Nelson Hendler: My buddy Lee Dillman found 80%.
• 24:43
  Nelson Hendler: So they had been going down this garden path getting all sorts of blocks, you know, stellate ganglion blocks and all sorts of medications.
• 24:51
  Nelson Hendler: They weren't getting well.
• 24:53
  Nelson Hendler: But they weren't getting well because they were treated for the wrong disorder because they had the wrong diagnosis.
• 25:00
  Tom Jackobs: Yeah.
• 25:01
  Nelson Hendler: And it's-- So you asked me what makes me passionate about my work.
• 25:06
  Nelson Hendler: What makes me passionate, I see someone in my office in tears.
• 25:11
  Nelson Hendler: And, and I used to, I, I'm retired now.
• 25:13
  Nelson Hendler: I'm 82, so I'm not seeing patients anymore.
• 25:16
  Nelson Hendler: But you know, they were in tears.
• 25:17
  Nelson Hendler: "I'm not getting well.
• 25:18
  Nelson Hendler: The doctor's not listening to me.
• 25:20
  Nelson Hendler: The tests are normal.
• 25:21
  Nelson Hendler: What do I do?"
• 25:22
  Tom Jackobs: That's sad.
• 25:23
  Tom Jackobs: Yeah.
• 25:24
  Tom Jackobs: So tell us, you know, this has been absolutely fascinating conversation, by the way.
• 25:29
  Tom Jackobs: I always like to geek out on these medical stuff.
• 25:32
  Tom Jackobs: But how can people learn more about this test and you and the work that you're doing?
• 25:36
  Nelson Hendler: Well, there are two websites, but I think, I think you hit it, put your finger right on the bad, the issue, is that we really require some consumer education.
• 25:46
  Nelson Hendler: So I created...
• 25:47
  Nelson Hendler: There's one website, www.diagnosemypains, plural, diagnosmypains.com, and it has information on the website.
• 25:58
  Nelson Hendler: It has information about symptoms.
• 26:00
  Nelson Hendler: And then if you say,"Oh, that sounds like what I have.
• 26:05
  Nelson Hendler: I ought to take the test and find out if I'm correct," that's good.
• 26:08
  Nelson Hendler: So, you know, sort of like the Vogue magazine, questionnaire, do I have PMS?
• 26:13
  Nelson Hendler: Okay, check, check, check.
• 26:19
  Tom Jackobs: Right, that's great.
• 26:20
  Tom Jackobs: So, we'll put that link in the show notes so people can go check diagnosemypains.com.
• 26:26
  Tom Jackobs: And now here's, I know you won't believe this.
• 26:29
  Tom Jackobs: A couple of my buddies I have a, a Princeton luncheon group I go to every month for 60 years.
• 26:37
  Tom Jackobs: All my buddies in the DC area from Princeton have lunch together.
• 26:41
  Tom Jackobs: Okay?
• 26:42
  Tom Jackobs: So, so they Oh, wow.
• 26:43
  Tom Jackobs: Yeah, nice.
• 26:46
  Nelson Hendler: And the, and as we get older, the group has progressed from discussions about work, wife, the wife and the marriage and the children to grandchildren, and now it's about what surgery did you have?
• 26:58
  Nelson Hendler: One of, one of my friends said,"This is not a meeting, it's an organ recital." And so I, I, I...
• 27:05
  Nelson Hendler: A couple who's, a couple of the people were complaining about stuff.
• 27:08
  Nelson Hendler: I said,"Well, here, take this diagnostic test.
• 27:12
  Nelson Hendler: And then, you know, I'll be happy to tell you what we should do." These are bright guys, capable guys.
• 27:20
  Nelson Hendler: They didn't want to spend a half hour to an hour taking the test.
• 27:24
  Tom Jackobs: Really?
• 27:25
  Nelson Hendler: Really.
• 27:28
  Tom Jackobs: That's crazy.
• 27:29
  Nelson Hendler: Instantaneous gratification.
• 27:31
  Nelson Hendler: Instantaneous.
• 27:32
  Tom Jackobs: That's right.
• 27:32
  Nelson Hendler: It's too long.
• 27:34
  Nelson Hendler: I did it for about 10 minutes.
• 27:35
  Nelson Hendler: That was enough.
• 27:36
  Nelson Hendler: I didn't want to do it anymore.
• 27:39
  Nelson Hendler: But, you know, I don't know, I don't know what's wrong with you.
• 27:41
  Nelson Hendler: I don't want to spend an hour on the phone with you asking these questions.
• 27:45
  Nelson Hendler: They're all there.
• 27:46
  Nelson Hendler: Just answer the questions.
• 27:48
  Nelson Hendler: Nah.
• 27:48
  Nelson Hendler: So that's part of it.
• 27:50
  Nelson Hendler: So when the consumer goes to the website, they should be prepared to spend a half hour to an hour answering all the questions.
• 28:00
  Nelson Hendler: And by answering all the questions, we'll have all the information we need to make the diagnosis.
• 28:06
  Tom Jackobs: Nice.
• 28:07
  Nelson Hendler: But don't expect an instantaneous answer.
• 28:10
  Nelson Hendler: Don't expect immediate gratification.
• 28:13
  Nelson Hendler: You have to know what you're treating.
• 28:14
  Tom Jackobs: Yeah.
• 28:15
  Nelson Hendler: And that's the greatest resistance that I've encountered.
• 28:20
  Tom Jackobs: Got it.
• 28:20
  Tom Jackobs: Yeah.
• 28:21
  Nelson Hendler: Does that make sense?
• 28:22
  Tom Jackobs: Absolutely.
• 28:22
  Tom Jackobs: And I think that's universal.
• 28:25
  Tom Jackobs: I think lot of people in the medical field are, are experiencing that as well.
• 28:29
  Tom Jackobs: And that's, you know, I think especially with functional medicine and, and some of the, more holistic approaches, it takes a lot of time, and people just don't want to spend that time or spend the effort.
• 28:42
  Tom Jackobs: But I gotta tell you, just going through my own journey with functional medicine, it's worth it to go through that time that you're not just always covering up something, but you're actually getting to the root cause and understanding what the problem is so that you can avoid having the pains or the problems in the future.
• 28:59
  Nelson Hendler: I was, on a radio show much like this out in Palm Springs with a very attractive, hostess.
• 29:05
  Nelson Hendler: And I said,"Well, listen, you know, you really need to take a lot of time to make a diagnosis.
• 29:10
  Nelson Hendler: When was the last time a doctor spent an hour with you?" And she said,"When he took me to dinner." That was
• 29:22
  Tom Jackobs: Well
• 29:22
  Nelson Hendler: the best, best answer I ever...
• 29:25
  Tom Jackobs: Yeah.
• 29:26
  Tom Jackobs: Hopefully not her primary care physician,
• 29:28
  Nelson Hendler: Right, right.
• 29:29
  Nelson Hendler: So
• 29:30
  Tom Jackobs: Yeah.
• 29:31
  Tom Jackobs: Interesting.
• 29:31
  Tom Jackobs: That's funny.
• 29:31
  Nelson Hendler: But yeah.
• 29:33
  Tom Jackobs: Well, that's, that's awesome.
• 29:34
  Tom Jackobs: Well, Nelson thank you so much for coming onto the show and sharing your wisdom with the audience and sharing this, the diagnostic tool as well.
• 29:42
  Tom Jackobs: I think it's definitely needed and I wish more people would want it, right?
• 29:47
  Tom Jackobs: So they could get
• 29:48
  Nelson Hendler: Yeah.
• 29:48
  Tom Jackobs: to the root cause of their issues.
• 29:50
  Nelson Hendler: I appreciate, really appreciate you asking me to be on your show.
• 29:53
  Nelson Hendler: Thank you.
• 29:54
  Tom Jackobs: Yeah.
• 29:54
  Tom Jackobs: No worries.
• 29:55
  Tom Jackobs: Yeah.
• 29:55
  Tom Jackobs: And thank you audience for tuning in for today's show.
• 29:59
  Tom Jackobs: We really do appreciate it.
• 30:00
  Tom Jackobs: Make sure that you're checking out everything that Nelson's doing, and we're gonna put all those links down into the show notes, so make sure you're down there and checking that out.
• 30:07
  Tom Jackobs: And also while you're down there, if you don't mind, if you could give the show a rating and review, I would certainly enjoy that.
• 30:14
  Tom Jackobs: And it also helps others find the show and get the help that they need in terms of building a heart-led business and helping more people from the heart.
• 30:24
  Tom Jackobs: So until next time, lead with your heart.
• 30:28
  Speaker 2: You've been listening to The Heart-Led Business Show, hosted by Tom Jackobs.
• 30:33
  Speaker 2: Join us next time for another inspiring journey into the heart of business.