Latest / Pelvic PT Rising / Should You Be Asking Your Patient More Questions?

Transcript

Should You Be Asking Your Patient More Questions? · 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 Puddle, and this is Pelvic PT Rising.
• 0:53
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 1: Hey, nicole, hello Well this has been a hell of a week.
• 1:00
  Speaker 1: It has been a freaking crazy week.
• 1:03
  Speaker 1: So at the Pelvic Sanity Clinic we are onboarding two count them two new clinicians to Pelvic Sanity.
• 1:12
  Speaker 1: I was on the heels of coming back from CSM where I did a talk with Jessica Real of Southern Pelvic Health on interstitial cystitis what every Pelvic PT needs to know.
• 1:23
  Speaker 1: What other things have been going on?
• 1:25
  Speaker 2: We had the cohort number two of the IC course was all going on last week.
• 1:29
  Speaker 1: Oh, yeah, yeah, yeah, right that launch and then closing that and making sure everybody's all settled into their new course and everything like that.
• 1:36
  Speaker 1: And then, of course, we had a big thing that happened.
• 1:40
  Speaker 2: My word will streak ended.
• 1:42
  Speaker 1: Oh, Jesse, which one, which word did you not get?
• 1:45
  Speaker 2: I didn't get Piper 156 in.
• 1:48
  Speaker 2: That was five months?
• 1:49
  Speaker 1: Yes, five months.
• 1:50
  Speaker 1: And guess who did get the word?
• 1:52
  Speaker 1: Piper?
• 1:52
  Speaker 1: This person, if anything.
• 1:54
  Speaker 2: look dumber, though.
• 1:56
  Speaker 2: Then looking over someone's shoulder while they're playing wordle and Nicole's trying to put in like puzzle, it's like that's not the right number of letters, and I'm the same way, though.
• 2:05
  Speaker 2: It's like, oh, it's like ZZB.
• 2:07
  Speaker 2: I guess no words that start with ZZB.
• 2:11
  Speaker 2: And then I always am like I feel like that helps me, though, to like really, yeah, get the creative juices flowing, yeah, totally so yeah so that was probably the biggest thing that happened last week, and it was also a breaking news episode of the public PG rising podcast talking about the die later debacle of 2024.
• 2:29
  Speaker 1: The die debacle of 2024.
• 2:31
  Speaker 1: It surely is has been a debacle and first of all, we just want to say thanks so much for listening.
• 2:37
  Speaker 1: It surely seems that, in terms of your feedback, that it was helpful, and we always strive to be truthful and, however, I will always keep it real as well with you all.
• 2:48
  Speaker 1: So I hope that that has helped your patients.
• 2:51
  Speaker 1: I hope it's helped you if you have a business.
• 2:53
  Speaker 1: I hope it has just cleared up a lot of things.
• 2:55
  Speaker 1: So what's the TLDR version?
• 2:58
  Speaker 1: And you could definitely go back to the episode and listen to the whole thing, because I think it is really important to get the entire context.
• 3:04
  Speaker 2: But the takeaways, jesse, are Well, one is that not all diet leaders require prescription.
• 3:09
  Speaker 2: This is something that is unique to intimate rows, and that was part of the big confusion that came out with all of this stuff.
• 3:15
  Speaker 2: The other thing that we just wanted to make note of is that how a company chooses to sell really has no correlation with quality, with the material, with ethics, any of that stuff.
• 3:26
  Speaker 2: There's a lot of complexity that goes into dealing and working with the FDA and, to be honest, there's not a ton of correlation.
• 3:35
  Speaker 2: Just because you have an FDA stamp of approval does not necessarily mean your product is any better or any worse than anybody else's, and I actually have some interesting stories about this.
• 3:45
  Speaker 2: If you're OK, nicole, take a little detour into this.
• 3:48
  Speaker 1: Oh, you usually get irritated when I take detours, but I will allow it this time, Jesse.
• 3:53
  Speaker 2: Perfect.
• 3:53
  Speaker 2: Well, I mean, here's the thing about medical devices that's kind of so messed up with.
• 3:58
  Speaker 2: The way that the FDA game is played is really.
• 4:01
  Speaker 2: You're not asking the FDA is this product good or helpful or anything else.
• 4:06
  Speaker 2: All you're trying to do is say that this product is substantially equivalent.
• 4:10
  Speaker 2: That's literally what a 510K submission is.
• 4:12
  Speaker 2: Is this product substantially equivalent to another product that's been approved?
• 4:17
  Speaker 2: And so often actually, this dates back to products that were grandfathered in that were actually never evaluated by the FDA at all.
• 4:24
  Speaker 2: But if you can say my product is almost exactly the same as something that was being sold in the 1960s, then the FDA is required to allow you to sell that today.
• 4:35
  Speaker 2: So like if I had a thing for you know getting blood out of somebody's arm, I could compare it to fucking bloodletting with leeches, like that's crazy.
• 4:44
  Speaker 2: So this whole process is really just interesting, and you know when we talk about quality with that, when I was consulting with folks, we actually had a couple of times when a company had invented a better way to do something and they actually filed and ended up selling a inferior product because they wanted the material to be substantially equivalent or the same as an older product on the market and I would be responsible for that conversation.
• 5:14
  Speaker 2: I would go to them and say you know what look they're like.
• 5:16
  Speaker 2: Why can't we use this new polymer that we invented?
• 5:19
  Speaker 2: It's like 15 years ahead, it's way stronger, it's better, it doesn't break down, it's like because it's not the same and you're going to have to do way more testing and way more convincing of the FDA.
• 5:28
  Speaker 2: If you want to do that, we can do that, but it's probably going to save you $75,000 if you just use the old shit and that's how the game works.
• 5:37
  Speaker 2: Like that's how this whole FDA thing is played.
• 5:38
  Speaker 2: So we had a lot of questions from you guys and just really appreciate all of the messages and support and all of the DMs that flooded in.
• 5:45
  Speaker 2: This is probably our most common to dawn podcast we've ever done, nicole, but one of the questions we'd gotten a couple of times was you know, you said that there's really no correlation between quality and approvals and that's really unfortunately true about the way that our FDA regulatory framework works.
• 6:03
  Speaker 1: Yeah, and so and that's also where we just want to make sure that you guys know that when people are saying things about, it really all comes down to marketing at that point and what you can say in terms of claims, because that's the other reason why you would want to go through this process If something is FDA cleared for something, then you can say that it is for, in this case, vaginismus, and then that might give you an advantage or something like that.
• 6:32
  Speaker 1: So, yeah, why don't you go ahead and speak on that?
• 6:34
  Speaker 1: Just so everyone understands.
• 6:36
  Speaker 2: Yeah, that's one of the big reasons that you go through different levels of FDA clearance for medical devices or approval for drugs is so that you are allowed to make specific claims against specific diseases, conditions, whatever it is Right.
• 6:50
  Speaker 2: So basically anybody can sell willow bark tea, but if you want to go ahead and refine that and create aspirin and say that, hey, this is going to protect you against heart attacks, you need a whole different level of scrutiny before you're allowed to make that claim.
• 7:05
  Speaker 2: So a lot of times this really does come down to marketing what's allowed to be on your label, which are allowed to say that's truly what the FDA regulates.
• 7:13
  Speaker 2: It's not always about quality or anything else of the product.
• 7:17
  Speaker 2: A lot of times it's about your marketing claims and what you're actually allowed to say.
• 7:21
  Speaker 1: Right, and so then, the last thing we're going to say about this is that many of you guys are like oh well, which company should we go with?
• 7:27
  Speaker 1: And, at the end of the day, I just want to make sure that you all know that, just because something is not FDA cleared, or what did you say approved, no, not approved.
• 7:38
  Speaker 2: FDA cleared in the case of devices right.
• 7:40
  Speaker 1: Just because a device is not FDA cleared does not mean it's inferior, and so just take that for what it is.
• 7:47
  Speaker 1: We're not going to say one company is better than the other or anything like that, because there's a bunch of and that's actually what's funny about this.
• 7:53
  Speaker 1: Right, it's because the dilators are freaking dilators.
• 7:57
  Speaker 1: They look like a freaking cylindrical thing.
• 8:00
  Speaker 1: It's like they're that.
• 8:01
  Speaker 1: I mean, it's like there's not like that much differentiation between them.
• 8:05
  Speaker 2: Right.
• 8:05
  Speaker 2: So then you're looking at, you know, and FDA clearance can be a factor If that's something that you personally really care about.
• 8:12
  Speaker 2: Materials and quality can be a factor.
• 8:13
  Speaker 2: Oftentimes this stuff comes down to business considerations on how cheap are they?
• 8:18
  Speaker 2: What can you buy them for, what is the wholesale, what's the markup that you can have?
• 8:23
  Speaker 2: Do they deliver?
• 8:24
  Speaker 2: Are they have great customer service?
• 8:26
  Speaker 2: There's a lot of things that go into what you guys decide to do, but to me, like FDA clearance is pretty low on our list of things that we evaluate when we're talking about things that we carry or sell at public sanity.
• 8:37
  Speaker 1: Totally so, and just to give you one more example of that, like dilator companies that you'd like use medical grade silicone.
• 8:43
  Speaker 1: Like you can be FDA cleared and use medical grade silicone.
• 8:46
  Speaker 1: You could be not FDA cleared and use medical grade silicone.
• 8:49
  Speaker 2: And you could be FDA.
• 8:51
  Speaker 2: You have to sell with the prescription and have the exact same device that you could sell with an OTC product if you get the right clearance with that and the way that you apply.
• 8:59
  Speaker 2: So that's how this whole game works.
• 9:03
  Speaker 2: I was in this for almost a decade, this guy.
• 9:05
  Speaker 2: I'm on the creative juices flowing.
• 9:07
  Speaker 2: I feel like I've got so many ideas for Intimate Rose.
• 9:08
  Speaker 2: Intimate Rose, if you're listening, jesse.
• 9:12
  Speaker 2: Well, they listened to the last one, right?
• 9:13
  Speaker 2: I'm going to say to you guys 500 bucks an hour of consulting fees, use your own device now as a predicate device and get an OTC listing from it and all you have to do is make sure that the labeling translates well to patients.
• 9:28
  Speaker 2: Like you, run one study.
• 9:30
  Speaker 2: It's literally the same device.
• 9:32
  Speaker 2: That'll be $125.
• 9:33
  Speaker 2: Now we're rounding up to 15 minutes of advice there, but, like I've helped clients do that, where you get on as a prescription and then you use your own device.
• 9:41
  Speaker 2: Guys, this is how FDUP, the FDA process, is.
• 9:44
  Speaker 2: You use your own device as the comparison and say my device is substantially equivalent, except that it's going to be over the counter, and then all you have to do is run a labeling study to show that people aren't going to stick the dilator in the wrong hole, which in this case might be a problem, but is what it is.
• 10:03
  Speaker 1: Jesse got so excited about all these things that I was like you.
• 10:06
  Speaker 1: Better, friggin, not bail on me from pelvic sanity, pelvic PT, rising pelvic con and start to pursue some other friggin job somewhere.
• 10:13
  Speaker 1: I will not allow you to quit.
• 10:15
  Speaker 2: No, that's, that's actually true.
• 10:16
  Speaker 2: If I do quit, I leave with half, which is a great thing about a marriage contract.
• 10:20
  Speaker 2: But and FDA consulting is soulless, soulless work.
• 10:24
  Speaker 2: And you hope that you're working with somebody who has a great product or something that's new and unique, because You're basically just looking for loopholes and sticking a knife in those and like twisting it and that's.
• 10:35
  Speaker 2: It was a Interesting.
• 10:36
  Speaker 2: I wouldn't trade it for anything, but it is an interesting man.
• 10:40
  Speaker 2: If people knew, like all of the backstory that goes into approvals and clearances, it would be nuts.
• 10:46
  Speaker 2: Yeah, it would be nuts and none of us would ever take like another drug or use another device again, because it's basically the fucking wild west out there.
• 10:53
  Speaker 1: Yes, yeah, man, okay, all right enough on that.
• 10:55
  Speaker 2: speaking of here's my segue transition.
• 10:58
  Speaker 2: See how this goes.
• 10:58
  Speaker 2: Nicole, are you asking enough questions?
• 11:01
  Speaker 2: This is the reason that we ended up talking about this and breaking the story with this dilator debacle of 2024 Is we saw some things that didn't look 100% right and Needed to ask some more questions, wanted to do a little bit more digging and, nicole, I know you think this is one of the most important soft skills when it comes to being a clinician.
• 11:28
  Speaker 1: Yes, so now we're going to talk all of the things about clinical.
• 11:32
  Speaker 1: Now, as we were talking about this in terms of business and stuff like that and the dilator debacle, like I ended up saying, like it's just like patients, like you, just got to ask more questions and we got on this whole clinical tangent and honestly, you guys I mean I really truly believe that I am a an excellent pelvic PT, right, but if I could transfer one skill to all of you, it would be this ability and this Desire and curiosity and willingness Essentially to just continue to ask more questions of your patients.
• 12:11
  Speaker 1: If you Do this in your practice and you be and you're deliberate about this In each and every patient interaction that you come across, I guarantee you your patients will get way better than any hip mode that you do, than any connective tissue thing, than any bimanual treatment, than any, you know, helping your patient advocate themselves with their physicians, like any of the things that I talk about.
• 12:33
  Speaker 1: I'm telling you this skill right here in it and I do believe that it is a skill is hugely important to you being the best pelvic therapist that you can be.
• 12:46
  Speaker 2: And one of the things we were talking about, nicole, as we prepared this episode, is of a patient you saw recently and just as a great example.
• 12:51
  Speaker 2: So what do you mean and I think this story is going to really illustrate that when you're saying, hey, we're not asking enough questions, we're not asking enough, follow up with that, but you just had a perfect example of what that looked like in a patient thing.
• 13:05
  Speaker 2: I think would be really helpful to illustrate what's going on.
• 13:09
  Speaker 1: So I'm treating this patient and she has pretty significant period pain.
• 13:11
  Speaker 1: Quite frankly, I probably think that she has endo.
• 13:13
  Speaker 1: I'm treating her and her connective tissue and the subcutaneous peniculosis and just her overall.
• 13:23
  Speaker 1: You ever have those patients where you're just like this feels shitty, it just feels like trash.
• 13:32
  Speaker 1: It's the her, the connective tissue feels sticky, murky, it's like you're moving sludge around, it's just.
• 13:40
  Speaker 1: It's the sign of global inflammation, is what it is.
• 13:41
  Speaker 1: Can I have?
• 13:43
  Speaker 2: a 20 second time out.
• 13:43
  Speaker 2: Do you feel like everybody listening to this knows exactly what you mean when you say that, or is that something that is like a trained?
• 13:49
  Speaker 2: This is a total aside, this isn't in our notes at all, but I'm just like really curious.
• 13:53
  Speaker 2: You seem to have almost a visceral reaction when you feel that.
• 13:57
  Speaker 2: Do you feel like that's something that everybody feels?
• 13:59
  Speaker 2: Is that something that's trained?
• 14:02
  Speaker 2: Is that what you call the hands when you talk about?
• 14:03
  Speaker 2: Oh, I've got the hands.
• 14:06
  Speaker 1: It's not the hands, it's like an actual physical thing that you can, I feel like, objectively feel so.
• 14:13
  Speaker 1: I feel like I teach this.
• 14:14
  Speaker 1: I feel like not everybody that like comes into public sanity, like understands what they're feeling, I feel like you have to pay attention.
• 14:19
  Speaker 1: I don't know if that answers your question.
• 14:20
  Speaker 1: No, hopefully it does.
• 14:23
  Speaker 2: So if you guys are out there and and have never felt this with a patient, though then you're not feeling right right.
• 14:27
  Speaker 2: We need to, yeah, I mean.
• 14:30
  Speaker 1: I feel like that's your point, right, is it?
• 14:32
  Speaker 1: I believe that there is, like it's an objective thing, and I feel like the Middle of the road patient that has like a little bit of this or this in a local area is harder to feel than someone that has like global inflammation problem, where it's like everywhere you touch even someone's arm, like if you've ever felt so, because a lot of times I'll be like, oh, I'm gonna do this, I'm gonna show somebody what I'm gonna do to their public floor, or show somebody when I'm gonna touch their leg, or show somebody how I'm gonna touch their abdomen on their arm.
• 15:01
  Speaker 1: Here, let me have your arm, let me feel this.
• 15:03
  Speaker 1: Well, if you ever felt that and you're like, ah, this feels like shit too, that is an example of someone that has just like global inflammation, global fascial Issues, and may lead to more sensitized, more centrally sensitized.
• 15:21
  Speaker 1: That may lead to like a clue as to how they're eating or what they're putting in their body or something, or you know, like an autoimmune issue or something like that.
• 15:29
  Speaker 1: So it just gives you a bigger clue as to what, systemically, is going on.
• 15:33
  Speaker 1: But all that is to say is that this person that I was treating like her tissue just felt like trash and of course I would never say that to her, but it's just like, oh, wow, like I can just place my hand on your honestly on your arm and know that that's what we're gonna be dealing with.
• 15:51
  Speaker 1: And so you know, I this is all I said.
• 15:55
  Speaker 1: I just said so after we talked a little bit about what her actual symptoms were and about her period and what cycle day she was on and all of the things that we go over with our folks, like I just said, acting like it's super nonchalant, acting like it's totally out of the blue.
• 16:11
  Speaker 1: Hey, so you know.
• 16:12
  Speaker 1: So talk to me about, like, how your eating's going.
• 16:14
  Speaker 1: She, as a patient, is probably unsuspecting that I actually have a ulterior motive to this questioning, but what she said was it's going great.
• 16:23
  Speaker 1: You know, I've been trying to eat more vegetables.
• 16:26
  Speaker 1: I think that if I would have stopped there and if all of you would have stopped there and been like cool, she's really trying, she's eating better, I'll bet you she's doing right, because we usually make an assumption about what our patients are doing based on that one thing and this is my clue to you guys to ask more questions If you stop there, you're going to have a very different outcome than what I ended up gaining, right?
• 16:49
  Speaker 1: So I was like oh, awesome, so you've been trying to eat vegetables.
• 16:54
  Speaker 1: Well, have you done that, right?
• 16:56
  Speaker 1: And then I get her to talk about.
• 16:58
  Speaker 1: Well, she's like oh, she's trying to not eat out as much.
• 17:00
  Speaker 1: Hey, I'm trying to not eat out as much.
• 17:01
  Speaker 1: I used to eat out a ton and I've been really trying hard to not do that.
• 17:06
  Speaker 1: And I was like okay, super awesome.
• 17:07
  Speaker 1: Wait, you're going to say something.
• 17:09
  Speaker 2: Yeah, I mean, but that sounds like another area where you can just end it right.
• 17:12
  Speaker 2: She's like oh yeah, I'm doing better, I'm not eating out as much.
• 17:15
  Speaker 1: Right Period and I was like again yeah to Jessie's point like if I were to just stop there.
• 17:19
  Speaker 1: It's been like cool, but she's telling me all the things that I want to hear.
• 17:23
  Speaker 1: Right, she's eating more vegetables.
• 17:24
  Speaker 1: She's not eating out.
• 17:25
  Speaker 1: That probably translates to her eating more at home and maybe cooking for herself, so we could assume that she's doing great.
• 17:35
  Speaker 1: And I said you know what that's super awesome that's.
• 17:38
  Speaker 1: It's always so hard to make some comment, so talk to me about.
• 17:41
  Speaker 1: Just give me an example, though what did you eat yesterday?
• 17:44
  Speaker 1: And turns out she ate a croissant right For breakfast.
• 17:49
  Speaker 1: No, lunch snacked and had In-N-Out for dinner.
• 17:56
  Speaker 2: In-N-Out is a highly overrated, in my very biased opinion, California burger chain.
• 18:02
  Speaker 1: And Jessie and I have very different opinions on this.
• 18:05
  Speaker 1: I freaking love In-N-Out.
• 18:06
  Speaker 1: I think it's the best thing ever.
• 18:07
  Speaker 1: It really is not.
• 18:09
  Speaker 2: Oh, man but she was trying to eat more vegetables.
• 18:12
  Speaker 2: I mean, there's pickles, tomatoes.
• 18:13
  Speaker 1: Pickles, lettuce, tomatoes right?
• 18:15
  Speaker 1: Is tomato a vegetable?
• 18:15
  Speaker 1: Is that vegetables?
• 18:16
  Speaker 1: That's the thing, though.
• 18:18
  Speaker 1: When you question more and just have genuine curiosity about your patient's responses, you get down to this person as an example day of eating, didn't eat lunch, had a shit for dinner and shit for breakfast, and like we're wondering why her connector tissue feels like trash.
• 18:44
  Speaker 1: Right, if we just took her at face value and said, oh, she's eating more vegetables and she's trying not to eat out, I would have been like cool, this is great, keep doing that thing.
• 18:53
  Speaker 1: And then we would have never talked about it again.
• 18:56
  Speaker 1: And now I have 10,000 more questions about this situation.
• 19:02
  Speaker 1: Do you even know what to eat?
• 19:04
  Speaker 1: Has anyone taught you anything?
• 19:06
  Speaker 1: What do you like?
• 19:07
  Speaker 1: Do you have symptoms?
• 19:10
  Speaker 1: More?
• 19:10
  Speaker 1: What's your mental health status like?
• 19:13
  Speaker 1: Was, why didn't you eat lunch when she?
• 19:16
  Speaker 1: You know?
• 19:17
  Speaker 1: Like there's a lot of things about that.
• 19:19
  Speaker 1: Did your boss not let you eat?
• 19:21
  Speaker 1: Like what is happening?
• 19:22
  Speaker 1: Where do you work?
• 19:23
  Speaker 1: What were you doing that day?
• 19:25
  Speaker 1: It depends on whether or not it was a weekend or a weekday, like I have 10,000 more questions when we get down to that.
• 19:33
  Speaker 2: And I think the interesting thing here, nicole, to me in hearing this from you, is that that actually very much affects how you proceed with that person, what you prioritize, what your conversations are with her, and I think that's so interesting that that can totally alter the trajectory of your treatment plan for this person 1000%.
• 19:57
  Speaker 1: And the thing is, is that really?
• 19:59
  Speaker 1: What I'm trying to get down to is like where are you at?
• 20:02
  Speaker 1: What are you physically doing?
• 20:04
  Speaker 1: And in this case we're talking about nutrition.
• 20:06
  Speaker 1: But it could be for anything, it could be for exercise, it could be for anything, but in this case we're talking about nutrition and how it specifically relates to inflammation.
• 20:14
  Speaker 1: So I need to know where you at.
• 20:19
  Speaker 1: What I'm really trying to get to is what's your knowledge base?
• 20:22
  Speaker 1: How much education are we going to have to do?
• 20:23
  Speaker 1: Are you willing to change?
• 20:26
  Speaker 1: How hard is it going to be for you to change?
• 20:27
  Speaker 1: What are the barriers to changing?
• 20:30
  Speaker 1: I'm asking things about.
• 20:31
  Speaker 1: They're going to in and out.
• 20:33
  Speaker 1: Does your partner like in and out?
• 20:34
  Speaker 1: Did you go by yourself?
• 20:35
  Speaker 1: Are you like eating two dinners?
• 20:37
  Speaker 1: What is happening?
• 20:38
  Speaker 1: You know so it's like, but I want you all to understand the power of continuing to ask more questions with genuine curiosity and trying to paint the picture of what their life looks like, because that, ultimately, is where we need to meet people, is where their life is at right now and there's a capacity for them to actually change, and that is where our intervention starts.
• 21:11
  Speaker 2: I think the other thing that you've done with me before, nicole, and I think that you do this really well with patients too.
• 21:16
  Speaker 2: But those questions lead to a self-realization from the patient, right?
• 21:21
  Speaker 2: Because her initial story and I see this a little bit on the business coaching side, but you do this with patients all the time her initial story is I'm doing better, I'm not eating out as often and I'm eating more vegetables, and that is all probably true in some context, but that's her top level story.
• 21:40
  Speaker 2: But when you asked her, what did you eat yesterday?
• 21:44
  Speaker 2: And there had to have been some kind of sheepish look on her face.
• 21:48
  Speaker 1: Totally.
• 21:48
  Speaker 1: She got super embarrassed and then totally, and that's a thing it's like, just by asking the questions it can be an intervention in and of itself, because you're not telling them that she should be eating more vegetables, that she shouldn't be eating more in and out, that she should be eating lunch, that she shouldn't have a croissant for breakfast, like you could tell her all of that.
• 22:10
  Speaker 1: She's an intelligent person, she knows that.
• 22:14
  Speaker 1: But having to articulate that to me is a self-realization and, honestly, an intervention in and of itself, because it humbles people.
• 22:23
  Speaker 1: It helps them to see for themselves where they're at.
• 22:29
  Speaker 1: It puts us on an honest conversation level.
• 22:33
  Speaker 1: That just really levels the playing field.
• 22:35
  Speaker 1: It's not practitioner-patient anymore.
• 22:38
  Speaker 1: As the patient I'm telling you what you I know you want to hear.
• 22:43
  Speaker 1: It's basically bringing it down to human level.
• 22:46
  Speaker 1: It's OK and they just essentially confessed something to us.
• 22:50
  Speaker 1: And then now we just get to proceed with absolutely no judgment and it's fun, and we get to joke about it a little bit, and then we get to build from where she is.
• 23:02
  Speaker 1: But if we try to build a plan for where she thinks she is, then we're going to shoot both of ourselves in the foot.
• 23:07
  Speaker 2: And this is where you talk about, with our staff just asking more questions.
• 23:11
  Speaker 2: I mean, you talk about this like an 80-20 rule in the cold, but the patient should be talking 80% of the time.
• 23:17
  Speaker 1: I know, sometimes when I literally sometimes this is probably I shouldn't admit this on air, but I'm going to so I will eavesdrop on my people Because I can hear through the door.
• 23:27
  Speaker 1: If you get really close and I look like kind of a crazy person, I make sure no one's seeing me and all the things.
• 23:32
  Speaker 1: But it's just like if I hear my therapist talking in the amount of time that I'm sitting at the door, listening problem, immediate problem.
• 23:44
  Speaker 1: If I'm going to eavesdrop in on your conversation.
• 23:48
  Speaker 1: If you listen to this podcast, if I were to eavesdrop in on your conversation, what would I hear?
• 23:54
  Speaker 1: I better freaking, not hear you talking that much.
• 23:57
  Speaker 1: They should be literally answering all of your questions.
• 24:00
  Speaker 1: They should be the ones talking.
• 24:01
  Speaker 1: Your patient should be the one doing the majority of the talking.
• 24:05
  Speaker 1: And I know for all you freaking PTs, n-o-t's that are chatty cathes, that are on that friend level with your patient, and you guys are talking about your lives and you're talking about who's boyfriend is what You're talking about.
• 24:17
  Speaker 1: Who's on swiping, on Tinder and all this bullshit.
• 24:21
  Speaker 1: It's like you need to be asking more questions about what is going on and, honestly, even if you're asking them about their Tinder date, you need to be asking them questions that are relevant to what you're going to be finding out.
• 24:33
  Speaker 1: Did you like him?
• 24:35
  Speaker 1: Did you get aroused?
• 24:36
  Speaker 1: What's happening?
• 24:38
  Speaker 1: Like did you tell your parents about this?
• 24:40
  Speaker 1: Does your sister know?
• 24:42
  Speaker 1: Like tells me about their family?
• 24:44
  Speaker 1: That tells me about their relationship with their parents?
• 24:46
  Speaker 1: Have they always liked your boyfriends?
• 24:49
  Speaker 1: Like all of the things, this is all relevant information to what might be causing their nervous system up regulation, why they might be having a problem with painful intercourse.
• 24:59
  Speaker 1: Like all of it is relevant and the more that they talk, the more that you're going to understand that the more that you talk, the more you don't understand shit about your patient.
• 25:08
  Speaker 2: That is all true.
• 25:09
  Speaker 2: I do want to just point out, Nicole, that not everybody younger than you is on Tinder all the time.
• 25:15
  Speaker 1: Are you sure?
• 25:15
  Speaker 1: I talk to a lot of people.
• 25:17
  Speaker 1: I think everyone is.
• 25:19
  Speaker 2: I don't know man.
• 25:20
  Speaker 1: You fucking don't know either.
• 25:21
  Speaker 2: I don't know either Anybody who's under the age of whatever man we don't even know.
• 25:25
  Speaker 2: Just get out of here.
• 25:25
  Speaker 1: Anyways, but my point is well taken, right, you could be asking more questions about, I mean, one of the things that I ask, even someone that's older than me, right?
• 25:34
  Speaker 1: It's like, oh, my daughter is getting married.
• 25:37
  Speaker 1: It's like cool.
• 25:37
  Speaker 1: Do you like the guy If it's a heterosexual person?
• 25:40
  Speaker 1: Like, do you like them?
• 25:41
  Speaker 1: Do you like the partner?
• 25:43
  Speaker 1: Like what's happening, like I want to know that.
• 25:46
  Speaker 1: Is it a source of stress for you?
• 25:48
  Speaker 1: What do you do for your job?
• 25:49
  Speaker 1: Do you like your boss?
• 25:51
  Speaker 1: Like, all of those things are questions and I make them tell me shit, make your patients tell you shit.
• 25:57
  Speaker 2: Right, and so this is, I thought was a great example in the call that you shared when we were talking about this.
• 26:02
  Speaker 2: But if you guys are thinking, oh, I do that already, here was one that might stop you in your tracks.
• 26:08
  Speaker 2: You had a patient tell you that they drink 24 ounces of water per day and I want you guys out there thinking, listening to this podcast, what would you say to that?
• 26:18
  Speaker 2: Oh yeah, my name is Jesse.
• 26:20
  Speaker 2: I drink 24 ounces of water a day.
• 26:22
  Speaker 2: My urine looks like it is like Kool-Aid, like.
• 26:27
  Speaker 1: Hopefully not Kool-Aid.
• 26:28
  Speaker 2: Oh yeah, right.
• 26:30
  Speaker 2: I bet that a lot of people's initial thing is wow, you need to drink more water.
• 26:36
  Speaker 2: Like water is important for life.
• 26:38
  Speaker 2: Your body is made up of 70% water.
• 26:41
  Speaker 2: All of the great when you guys say education Right.
• 26:44
  Speaker 1: And then we go into bladder irritants.
• 26:46
  Speaker 1: We're like, oh, did you know that?
• 26:48
  Speaker 1: If you dilute your bladder irritant, then I mean, it's just we have.
• 26:52
  Speaker 1: So we want to continue talking about how much we know and it's hard.
• 26:58
  Speaker 1: It's hard not to do that because we know a lot of cool shit, but at the end of the day, what we really need to know about that person?
• 27:05
  Speaker 1: I have a million questions about why they're only drinking 24 ounces of water.
• 27:10
  Speaker 1: Do they know what the average amount of water you should be drinking?
• 27:14
  Speaker 1: Do they think that's a lot?
• 27:15
  Speaker 2: Do they think that's great they?
• 27:16
  Speaker 1: might think it's a lot.
• 27:17
  Speaker 1: You know what happens when you drink water.
• 27:19
  Speaker 1: Does it make your symptoms worse?
• 27:20
  Speaker 1: Are you able to drink water at work?
• 27:23
  Speaker 1: Did your Stanley Cup break Like I don't know why?
• 27:28
  Speaker 1: 24 ounces is what you're drinking, but I need to know that in order to give you the proper advice on what you need to be working on in that realm.
• 27:38
  Speaker 1: So it's not just like you ask a question and then it's like cool, now I get to talk about how much I know it's.
• 27:46
  Speaker 1: Wow, that's interesting.
• 27:48
  Speaker 1: What about that?
• 27:50
  Speaker 1: Can I ask more questions on?
• 27:52
  Speaker 1: And you can?
• 27:53
  Speaker 1: I want to challenge you all that's listening to this podcast right now.
• 27:57
  Speaker 1: I want to challenge you all to go through an entire treatment session and besides the last five, which you know I'm a big fan of where you are the ones.
• 28:09
  Speaker 1: That is like telling patients what to do.
• 28:11
  Speaker 1: I'll see you next time.
• 28:12
  Speaker 1: This is what your homework is, but from the if you, hopefully you have an hour with your patient.
• 28:17
  Speaker 1: So if your patient comes in at 11 from 11 to 1150 or 1155, I want you to only communicate to your patient with questions.
• 28:28
  Speaker 1: Do you think that's possible?
• 28:30
  Speaker 1: I, 100% is possible, are you sure?
• 28:32
  Speaker 1: Jesse, you almost got me.
• 28:34
  Speaker 1: I'm a freaking dick.
• 28:37
  Speaker 2: So you guys have a challenge, but that's why we titled this episode the way we did.
• 28:43
  Speaker 2: Are you asking enough questions?
• 28:45
  Speaker 2: Yes, the answer is probably not question mark, so I hope this has been really helpful for you guys.
• 28:52
  Speaker 2: Thank you guys, so much for listening.
• 28:53
  Speaker 2: Let us know how this goes.
• 28:54
  Speaker 2: Honestly, try this, go that direction, see what happens and let us know.
• 29:00
  Speaker 2: Right.
• 29:00
  Speaker 2: Nicole, senator DM, tell her that man you cracked at 1127 when you couldn't help but just jumping in with something because we want to hear from you guys.
• 29:09
  Speaker 2: We want to hear that.
• 29:10
  Speaker 2: So, thank you guys so much for listening.
• 29:11
  Speaker 2: As always, we want to keep this conversation going and let's continue to rise.