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Jack Chew - Live and Undressed. Part 1 · No Appointment Necessary

• 0:00
  Michael: So today we have Jack Chu, someone who I met many years ago now.
• 0:07
  Michael: I think probably five, six years ago when we first started HMDG.
• 0:11
  Michael: And I have to say, and I've said this to him personally, was instrumental in our growth, taught me an awful lot about the industry.
• 0:18
  Michael: And since then we've had many a controversial chat over a beer and come up with some silly stuff and come up with some great stuff like Therapy Live and so on.
• 0:28
  Michael: And it's a it's a real privilege to have Jack on the show because he's asked all the time to go on everything, and I'm really happy he's joined us.
• 0:34
  Michael: And today I'm gonna just throw a ton of questions at him.
• 0:38
  Michael: Things that I want to know.
• 0:39
  Michael: Um we're gonna call this episode live and undressed, I think.
• 0:42
  Michael: Uh just yeah, yeah.
• 0:44
  Michael: Just he had Jack talking and and and being a bit controversial and spewing out some opinions.
• 0:48
  Michael: I think we we generally agree on a lot of things.
• 0:51
  Michael: My job today is to stop him talking too much because he has a habit of turning a question in its own right into a four-hour podcast.
• 0:59
  Michael: So um you may hear me butting in a bit.
• 1:01
  Michael: It's not because I'm rude, it's because Jack can't keep his mouth shut.
• 1:04
  Michael: So with that, uh, I I'm not gonna do an intro with Jack because I think everyone already knows him, other than he runs physiomatters, he runs shoes health, and he's got a big mouth who uh and and has used it quite effectively over the years to call out lots of different things in the industry.
• 1:21
  Michael: I want to start on a really positive note because Jack did something incredible a couple of years ago, uh, and it's something I really rate and value, and I've really helped uh asked clinics to do more of it, which is much more of a push within the community.
• 1:35
  Michael: How can MSK clinics become influential in the community and do really great things with people?
• 1:42
  Michael: And so Jack created the Timply Trundle.
• 1:45
  Michael: So talk to me about the Trundle, Jack.
• 1:47
  SPEAKER_02: Yeah, well, thanks for having me.
• 1:49
  SPEAKER_02: I um the Trundle is uh essentially a community walking group for the elderly, namely over 60s.
• 1:54
  SPEAKER_02: We don't gatekeep that if a 58-year-old turns up now and again with it with an injury, but it's essentially a weekly walking group of which we do um each week on a Monday, and then we get together, have a coffee, sometimes we'll chat about um I do a bit of a presentation on OA or back pain or managing a frozen shoulder or uh um or uh ways in which they might manage sort of kids and grandkids and that sort of stuff, right?
• 2:18
  SPEAKER_02: So it's sort of a community-focused scheme that we uh did in partnership with uh Timpley Sports Club, which is where we're now based.
• 2:27
  SPEAKER_02: And so we sponsored a club which partly to get access and to offer discounts for lacrosse players and hockey players and cricket players and stuff at this community sports facility.
• 2:37
  SPEAKER_02: And then they invited us to come on site and set the clinic up there, partly because we'd we'd part of our sponsorship deal uh was to was to also integrate these sorts of community schemes and to engage better with our community.
• 2:49
  SPEAKER_02: Now, this is a community in which me and Charlotte also live.
• 2:51
  SPEAKER_02: We're raising a family, uh, we care deeply about it.
• 2:54
  SPEAKER_02: Um we we didn't grow up around here, but we we've we've really made it our own.
• 2:57
  SPEAKER_02: And it just seemed to be an obvious place in which we might actually then uh translate the skills of which we have to raise care standards as well as to apply rehabilitation, especially post-COVID for the elderly who are feeling increasingly isolated.
• 3:10
  SPEAKER_02: So we just get them together.
• 3:11
  SPEAKER_02: Um and so one of the things that's surprising about it is that walking groups exist all over the shop.
• 3:16
  SPEAKER_02: But what we've managed to do is it exponentially grew, went 2, 4, 6, no, we didn't, 2, 4, 8, 16, 32, and then it's not, and then it's rarely had less than 30 to 40 people, rain or shine or snow, right?
• 3:29
  SPEAKER_02: So it every week, barring bank holidays, uh, it does that.
• 3:32
  SPEAKER_02: Now, funnily enough, as I admitted to you, I'm actually a little bit all over this morning from the uh fourth annual Timpley Trundle Christmas do, right?
• 3:39
  SPEAKER_02: So um that with 50 for for Christmas dinner, right?
• 3:43
  SPEAKER_02: So it's a real interesting uh social group now.
• 3:47
  SPEAKER_02: Um also worth mentioning that every six months we do a we do a set of tests, six-minute walk tests, timed up and go, uh 30 seconds uh sit to stand.
• 3:55
  SPEAKER_02: And so you've got then got baseline health data, hand grip, balance, right?
• 4:00
  SPEAKER_02: And so they then also get this opportunity every six months to then baseline themselves against credible validated measures of frailty and things like that.
• 4:09
  SPEAKER_02: So it's um it's it's worked brilliantly for us, and it really aligns with our values for want of a better sort of corporate phrase.
• 4:16
  Michael: Yeah, I love it.
• 4:17
  Michael: I I think um because you're doing something really good, you're not charging any money for it, it's it's probably cost you money in well, it definitely costs you money in terms of time out of the clinic and so on, but then probably commercially, I imagine it's it's worked out quite nicely.
• 4:30
  Michael: But it's so nice to see um clinics in the community, and everybody I've talked to that has done it has done really well with it.
• 4:36
  Michael: I actually even talked to a a veterin practice who did the same thing.
• 4:40
  Michael: They do a like a walking doggy walking Wednesday where they get people out and about and they could get their animals checked, they get their doggies checked, and they've built a really nice community and they've ended up sending a fuckload of pet plans.
• 4:51
  Michael: Um great.
• 4:53
  SPEAKER_02: Yeah, we we've had a mixed bag from me with regards to trying to inspire other things.
• 4:57
  SPEAKER_02: I've seen it, I've seen it done well and I've seen it done badly.
• 4:59
  SPEAKER_02: If you go about it in a really complacent way, um then it is something like I saw even an NHS service that, like, oh, it hasn't really worked for us.
• 5:06
  SPEAKER_02: Our rotational band five turned up at the leisure centre each week and only a few people turned up.
• 5:10
  SPEAKER_02: I'm like, geez, like a ro rotate.
• 5:13
  SPEAKER_02: I'm not I don't know these individuals, but a rotational band five go in and just build it and they will come.
• 5:18
  SPEAKER_02: It's not like that.
• 5:19
  SPEAKER_02: It's unfortunate you're taking for granted what me and my colleague Laura, who run the trundle, have done to try and really generate that interest and properly add value to these people's lives.
• 5:27
  SPEAKER_02: Now, on a commercial level, people just bottle it.
• 5:29
  SPEAKER_02: You know, they look at what why would you and a member of staff give up two hours a week for free?
• 5:33
  SPEAKER_02: It's just like, oh, you're so short-sighted.
• 5:36
  SPEAKER_02: As I mentioned before, we live in this community.
• 5:38
  SPEAKER_02: And are you are we not the first name on people's minds when their grandchildren or their children develop a payday?
• 5:49
  SPEAKER_02: We have people regularly come in and say, like, well, you know, how did you find out about us or out like that?
• 5:54
  SPEAKER_02: Or they might even say as part of when they book online, it'd be like, Oh, you take my parents for a walk every Monday and really appreciate it, and now I've just developed a shoulder problem playing squash.
• 6:04
  SPEAKER_02: Then of course, you know, they they they're delighted to spend money with you.
• 6:07
  SPEAKER_02: Do you know what I mean?
• 6:07
  SPEAKER_02: They can't believe their luck.
• 6:08
  SPEAKER_02: They've heard uh nothing but good things about us, and and that they find out uh as part of that process about our other core MSK services.
• 6:15
  Michael: Well, I think it also uh no doubt you've introduced um things to that community that they would probably never think of.
• 6:22
  Michael: So for example, maybe um you've got a gym space, right?
• 6:26
  Michael: Strength conditioning space, so strength and conditioning for the over 60s, where they've never thought about going to a gym or that it would be good for them, but you've exposed them to that and and and probably changed a lot of people's lives that way.
• 6:37
  SPEAKER_02: That's absolutely right.
• 6:38
  SPEAKER_02: So I have this these three rings really that that what we do is you've got one-to-one patient care, of course, that's the sort of bread and butter MSK.
• 6:44
  SPEAKER_02: You've got the small group, what we call functional fitness, in the gym, where you're doing circuit training, weightlifting and stuff for anti-frailty interventions for the elderly, um, as well as then the macro intervention, which is then so you've got you've got, I'd say, more expensive on the one-to-one side, you've got cheap but not free, and then you've got a free public health intervention on the macro.
• 7:03
  SPEAKER_02: And we're gonna do that and scale that across other different interventions as well, from things like boogie walks to um some some uh even neuro-related schemes in our function room, which we need a bit more space for and stuff.
• 7:15
  SPEAKER_02: So we're gonna we're gonna scale that up because we we that's why it's it's sort of choose health, not choose MSK, really.
• 7:20
  SPEAKER_02: I've got a very MSK-centric approach to physiomatters, unapologetically so.
• 7:24
  SPEAKER_02: But with regards to our clinic, um me and Charlotte had like that to have a bit more diversity than just pain and injury eventually.
• 7:30
  Michael: Yeah, and ultimately, you know, you're doing a good thing.
• 7:32
  Michael: And I think uh I was actually talking to Adam Polter, who runs Foundation's Physio and Neuro Clinic, and he does an awful lot of stuff as well, which is it's almost uncommercial to do, but ends up being commercially correct.
• 7:43
  Michael: You do things that are just good, and from that comes good as well.
• 7:46
  Michael: I I truly believe that the more good you do, the more they're great people as well, though.
• 7:51
  SPEAKER_02: I think people underestimate this.
• 7:52
  SPEAKER_02: It's just that it's not it's not charity because it's and I always sort of tell them they're they're very thankful, especially you can imagine Christmas doing stuff.
• 7:58
  SPEAKER_02: It's one of the reasons my head's store is because they're all wanting to buy me a drink, they're very appreciative, and that's really kind.
• 8:03
  SPEAKER_02: And they think, you know, I always sort of feel a bit uncomfortable if they want to imply it's all it's all charity, or they or they're sometimes trying to uh push, you know, we should at least have a donation bucket and stuff like that, right?
• 8:12
  SPEAKER_02: It's really you know generous.
• 8:14
  SPEAKER_02: But we we often say that um that that realistically it's what what is it what is it for?
• 8:20
  SPEAKER_02: I don't mean to be too philosophical about it, and I'm not saying it's all benevolence, but I'm just meaning like we have a skill set and facilities to, you know, what what are they for if not to actually apply them to those around you, especially those in need and those that uh that are deserving uh of a of a favour now and again.
• 8:39
  SPEAKER_02: And and and so it just seems really natural to me, and and and I don't I I'm irritated by some of the norms.
• 8:45
  SPEAKER_02: So people say, Yeah, you can say that, Jack, but it's not normal.
• 8:48
  SPEAKER_02: This is one of the old fellows said to me last night.
• 8:49
  SPEAKER_02: He said, you know, you're playing it down, but it's not normal.
• 8:51
  SPEAKER_02: No one else is doing it.
• 8:52
  SPEAKER_02: I was like, yeah, but I I don't I don't pitch myself against normal.
• 8:56
  SPEAKER_02: I don't like normal.
• 8:57
  SPEAKER_02: I don't like the fact that no one's doing it.
• 8:58
  SPEAKER_02: That's annoying.
• 8:59
  SPEAKER_02: So instead, it just you know I see it as being like a natural use of our skill set.
• 9:03
  SPEAKER_02: And so I want people to don't have to do a trumble or anything just similar like it, just what do you know that others don't?
• 9:09
  SPEAKER_02: What's your expertise, and how might you serve your community better to do so?
• 9:13
  SPEAKER_02: And if you don't want to do that, then what what sort of community do you want to live in?
• 9:16
  SPEAKER_02: You know, it just admittedly sort of suits my politics as well, right?
• 9:19
  Michael: Is it what you're building?
• 9:21
  Michael: Because you you're looking at it from a very sort of political way.
• 9:24
  Michael: I I actually look at it from a commercial marketing standpoint.
• 9:27
  Michael: And I don't think there's anything better commercially that you can do um than get involved in the community, be the first name on people's minds when they think my dad's had a fall or he's hurt himself or my mum needs some help.
• 9:39
  Michael: It's like, oh, go and see the the choose guys, right?
• 9:41
  Michael: And and I think that's almost the best marketing you can do.
• 9:44
  Michael: I can't think of better marketing, actually, um, the more you do in the community.
• 9:47
  Michael: And you see this throughout industries, other industries, you know, the more they they do in community, the the the the the better they do commercially.
• 9:54
  Michael: So I think there's a a massive monetary gain to it.
• 9:57
  Michael: And I don't want to focus on that too much because I know that isn't the the intent of what you did it for in the first place.
• 10:03
  SPEAKER_02: But we needn't we needn't ignore that as well.
• 10:04
  SPEAKER_02: I'm not gonna that's why I say is that it's not it's not uh there's no pretense for me that this is all this is all charity.
• 10:10
  SPEAKER_02: But also, I'll admit, and this is why it's really personal to me, is that me and I'm doing that on a Monday morning, somewhat instead of going to those B2B networking type things of which I'm either invited to speak at or I go and rub shoulders and shake hands and hope that the launderette will let send me a couple of their staff to look after their backs, right?
• 10:28
  SPEAKER_02: I'm not dismissing that, right?
• 10:30
  SPEAKER_02: I get that that's sort of core to building that, but because choose health is nested in my wider my wider business, I would rather do something like this, which is yeah, it's innovative in a novel, but I don't want to do those sort of more cliched networking opportunities, which you need to do to build your reputation locally.
• 10:47
  SPEAKER_02: It's kind of to a detriment to some extent.
• 10:49
  SPEAKER_02: I should be doing both, but it's just it suits me with my young family.
• 10:52
  SPEAKER_02: I'm at school pickup more because I'm not going to those things.
• 10:55
  SPEAKER_02: I'm not taking those meetings, I'm instead doing it my way, which other people should apply to their clinics more than they do.
• 11:01
  SPEAKER_02: Like they there's so many people that are just generic.
• 11:04
  SPEAKER_02: Yeah.
• 11:05
  SPEAKER_02: To my taste.
• 11:05
  SPEAKER_02: You know, that's a bit of an accusation, but I really do believe it.
• 11:08
  Michael: No, I agree.
• 11:08
  Michael: I I think um I and it's it's the the brief is the pudding.
• 11:13
  Michael: I've really pushed so many clinics to do this, and all of them have done really well with it.
• 11:16
  Michael: And it doesn't necessarily have to be a walking scheme, um, it could be some kind of viral health test.
• 11:22
  Michael: Um, I I know one clinic did a uh lie down and stand up again.
• 11:27
  Michael: Um, how fast can you do it and how many times do you groan?
• 11:30
  Michael: Really interesting test.
• 11:31
  Michael: Now, they should have fucking known better because there was a slight problem which a physio should realise, which is make sure you're able to actually lie down and stand up again um and not get stuck on the floor.
• 11:42
  Michael: So maybe for 85, don't do it sitting down and standing up, yeah.
• 11:46
  Michael: Um but it was really good, it worked incredibly well and and and um got a lot of traction in the community actually.
• 11:52
  Michael: A lot of patients coming in and saying, I want to be able to bloody lie down and stand up again without struggling and doing it within 10 minutes, you know.
• 11:59
  Michael: Um, right, let's move on to uh a bit of a controversial topic, something we've spoken about and something I've seen a lot recently, which is pushback against technology.
• 12:10
  Michael: And and sometimes I think pushback against technology is absolutely right, and we'll get on to that a bit later.
• 12:15
  Michael: But specifically on AI, I'm seeing a lot of clinicians, a lot of clinic owners specifically, who are almost dismissing AI as something that is problematic, that is a real threat.
• 12:28
  Michael: We've just done the private practice barometer, and it's really interesting.
• 12:31
  Michael: One of the top reasons for worry is the threat of AI, but at the same time, one of the top reasons for um being positive is is actually AI.
• 12:42
  Michael: Because they can I think there's there's two things there, right?
• 12:44
  Michael: It does threaten um the MSK um uh industry, but at the same time, it also potentially helps it.
• 12:51
  Michael: Um what are your thoughts on AI?
• 12:53
  Michael: What are your overall kind of views on it?
• 12:56
  SPEAKER_02: Yeah, well, I I I'll um I'll give I'll give my views, but then I also think it'd be smart for me and you to focus on maybe a few percentage points to which we disagree.
• 13:03
  SPEAKER_02: Because I think that sometimes you can't help yourself but be a bit of an evangelist in this direction because understandably, in your sector, it's something that is so obviously proliferating and radically changing what you do, and so it should.
• 13:14
  SPEAKER_02: And I think that some things apply to clinical, and sometimes it probably isn't uh Luddite-like resistance all the time that people are being a bit more reserved.
• 13:22
  SPEAKER_02: And I personally see, on a broad level, before my opinion on it, is that I am a wanky liberal enough to want to see all of those views.
• 13:30
  SPEAKER_02: I really don't mind the fact that some people are like hyper-resistant.
• 13:33
  SPEAKER_02: I don't mind it, I've never minded it.
• 13:35
  SPEAKER_02: In fact, it's helped me to come across as a heretic when I really have been saying quite basic stuff even 10 years ago, right?
• 13:40
  SPEAKER_02: I was the guy that said podcasts, podcasts might be a good education platform.
• 13:43
  SPEAKER_02: No piss off, we're doing courses instead.
• 13:45
  SPEAKER_02: And it's like, was I bothered by that?
• 13:47
  SPEAKER_02: Was I like, I can't believe you're not embracing change.
• 13:49
  SPEAKER_02: It was like, no, I'm gonna get on with it.
• 13:51
  SPEAKER_02: And some of you might follow, and some of you are probably still averse to podcasts even now.
• 13:55
  SPEAKER_02: I'm fine with that.
• 13:56
  SPEAKER_02: And so that's where I really, on a broad level, I I genuinely get surprised sometimes, yes, but I really don't mind it because I just don't think that the majority will fail to move because it rarely happens that way, especially when it's moving at this pace.
• 14:08
  SPEAKER_02: My opinion broadly, especially applied to clinical practices, I'm excited for the way in which it can assist accountability, the amount of patients that are then fact-checking programs or diagnoses of which they've been given.
• 14:19
  SPEAKER_02: Um, and that I'm not that's not to say that then they're getting a really accurate critique always perfectly by the robots, but it just means that then the uh that the holes in someone's story, the hypocrisies that come, the over-extrapolation of things biomechanically from someone like dear chat GPT, physio's said that my shoulder pain is associated to my contralateral ankle.
• 14:40
  SPEAKER_02: They wouldn't write contralateral, would they?
• 14:42
  SPEAKER_02: But my opposite ankle, and and that's why I need a carbon fiber orthotic.
• 14:46
  SPEAKER_02: Does that does that ring true?
• 14:48
  SPEAKER_02: And and ChatGPT gives them an analysis as to why that's bullshit or a version of it.
• 14:52
  SPEAKER_02: That's all for the good.
• 14:53
  SPEAKER_02: To be honest, that's that's that's what physio matters was doing on the podcast and on Twitter back in the day.
• 14:58
  SPEAKER_02: And we do it less now because we're kind of bored of it.
• 15:00
  SPEAKER_02: But fundamentally, I love the fact if I can delegate that fact check to to AI, that's all for the good to my taste.
• 15:06
  SPEAKER_02: And then on the operations side, which you know much more about, um I I see that as being just efficiency all the way down, note taking that sort of stuff.
• 15:14
  SPEAKER_02: That that's almost a given to my taste.
• 15:16
  SPEAKER_02: Uh, but on the clinical side, yeah, I'm definitely excited for the way in which patients are being emboldened to challenge a bit more.
• 15:22
  Michael: Yeah, that it's it's uh I don't know if I coin the phrase, but certainly I use the phrase AI as a new regulator a lot.
• 15:28
  Michael: Um because we we've seen recently a a big drop in chiropractic new patients, chiropractic suffering.
• 15:35
  Michael: I think one of the big reasons for that is that patients are putting in, you know, do I need 25 sessions?
• 15:40
  Michael: Should I do I need an x-ray?
• 15:42
  Michael: Do I need x and and chat GPT simply says don't see this chiro, go and see a physio.
• 15:47
  Michael: Um and and I think that's that's any clinic now, from a marketing perspective, and this is why it's relevant, if you are marketing something that isn't um necessarily true or clinically accurate, you have to be very, very careful because patients are going to they're gonna find out.
• 16:04
  Michael: Um, and and it it like we discussed this before, it's not just before they come in, it's once they're in.
• 16:09
  Michael: You know, you've seen them three times and you try and sell them cupping next, a session of cupping, they're gonna go home and they're gonna go, Jack says I need cupping um and uh a laser on my toe, is this relevant?
• 16:22
  SPEAKER_02: Because of it's are you is what you're saying defensible?
• 16:25
  SPEAKER_02: It's not because obviously we we apply our craft to individuals, and therefore, if ChatGPT was fact-checking our opinion against its favourite RCT or combination of research papers, then then that's that's obviously gonna be something that's frustrating.
• 16:41
  SPEAKER_02: And I think there's gonna be some of that that happens whereby the robots are being too blunt an instrument for some of the nuances that we see in clinic.
• 16:48
  SPEAKER_02: But what you've got to do is you've got to be, you've got to be able to defend your point.
• 16:51
  SPEAKER_02: So for example, cupping's a great, a great example of like, not to my taste, let's put it that way, right?
• 16:57
  SPEAKER_02: If I'm vaguely diplomatic.
• 16:59
  SPEAKER_02: But if someone was was um putting suction cups on someone, especially because I've seen it whereby people do, and I I I was sort of trained in with these sort of sort of put a vacuum cup on it, use that as a massage tool to pull rather than push.
• 17:11
  SPEAKER_02: But what you're implying there is I'm just I'm just offering some novel sensory stimulus to your tissues and stuff as a means of pain relief in a in a health spa.
• 17:18
  SPEAKER_02: It's not to my taste that it's in an MSK primary care facility, but let's just say it exists.
• 17:23
  SPEAKER_02: So I'm not all into, I'm not one of them that wants to ban it.
• 17:26
  SPEAKER_02: That is so different to saying that the the fascia in your lateral side here is affecting this other body part and stuff, and that's the bit that's going to be useful for the fact checks.
• 17:35
  Michael: Yeah, but I don't think it's necessarily uh the nuance that that is the problem.
• 17:39
  Michael: I don't I don't think there are many clinics who are using cupping in that way.
• 17:43
  Michael: We'll just I won't I want to get off cupping in in general terms, um, it's it's it's practices, whether it's the business practice of uh you need to buy a 10-session package, and you stick back to it.
• 17:55
  SPEAKER_02: Yeah, yeah, yeah, yeah.
• 17:56
  Michael: And and ChatGPT says, you better have a bloody good reason for having a 10-session package.
• 18:00
  Michael: I uh here's what to ask a clinician.
• 18:03
  Michael: And you're actually enabling patients and educating patients and giving them the ammunition to walk in and say, Why are we doing this?
• 18:10
  Michael: What is the reason for it?
• 18:12
  Michael: What and I and I think it's really important, but I think it's definitely a threat to a lot of clinics who who are maybe whether it's business practice or clinical practices that are so obviously silly.
• 18:22
  Michael: Uh and it might be uh, you know, every patient needs an x-ray.
• 18:27
  Michael: Oops, every patient needs an x-ray um before they um yeah, you know, that treatment.
• 18:35
  Michael: Um, or it might be uh I I don't know, uh I take my thing when I had my neck issue.
• 18:43
  Michael: Um I remember um and it's a it's an interesting point because I remember at the time there were people like you and Mark and a few others who who gave me very consistent information every single time.
• 18:54
  Michael: This is what it is, this is what it looks like, this is the the the pathway for it.
• 18:58
  Michael: It's it was very, very um consistent.
• 19:00
  Michael: And then I had people going, oh, you definitely need this specific type of acupuncture, or you definitely need IDD therapy to uh to uh untrap the nerve, or you definitely need to.
• 19:10
  Michael: There was one that told me to stretch in a certain way until it really, really hurt because that was going to give me the best results.
• 19:16
  Michael: And and when I put my my my um uh MRI and stuff now into Chat GPT, it it tells me exactly what you told me at the time, right?
• 19:27
  Michael: Exactly, exactly the same thing, but it doesn't say you need four massages a week to um uh release the nerve, right?
• 19:34
  SPEAKER_02: It it it doesn't say I mean that would have that would have been a cracking box office podcast clip where we got to this point and you went, so Chat GPT is calling bullshit on like most of the things you've ever said about me.
• 19:44
  SPEAKER_02: And then I'd have to I'd have to admit that I was actively trying to harm you at that time, and it would be quite fun.
• 19:49
  SPEAKER_02: Um I think we'll just on the packages thing, because you've written well on this.
• 19:52
  SPEAKER_02: Um and I think that what's tricky is people don't realize their own biases in how they will manipulate a clinical justification for something that.
• 20:00
  SPEAKER_02: That's actually an operating or business practice that they'd prefer.
• 20:02
  SPEAKER_02: And there's very little prognostic validity associated with MSK injury, right?
• 20:06
  SPEAKER_02: So outside of someone have rupturing their ACL and having it reconstructed, um, you frozen shoulder, you could make a bit of a case for it in terms of the way in which it might be a pathway.
• 20:16
  SPEAKER_02: Um, there are um a couple of others that are that are failing, uh annoying me that I can't quite bring to mind.
• 20:21
  SPEAKER_02: But they're very there are very few overt pathologies that have a prognostic value from the evidence as well as our experience that would indicate that someone might need a package of care, of which it makes sense for them to uh uh get into a discount.
• 20:33
  SPEAKER_02: Now that said, we have blocks of six S and C sessions, and we actually have a clinical membership over a six-month period for people that are likely to want to come in uh a couple of times a month, for example, and they draw down on a credit balance that of course is still refundable, but they get a better nominal value on their uh on their uh on their pricing.
• 20:50
  SPEAKER_02: But that's often for this where I'm merging MSK therapy into how health coaching and conditioning, whereby they're kind of over injury, uh their injury management is on a back burner and they're now pursuing some functional goal.
• 21:02
  SPEAKER_02: They want to climb Kilimangiro, they want to uh improve their ability and get back on the triathlon bike.
• 21:08
  SPEAKER_02: So that's slightly different.
• 21:09
  SPEAKER_02: But when it comes to the way in which someone on assessment is then making some clinical justification to say that this OA knee in this person warrants X amount of sessions, they are crystal balling to the nth degree.
• 21:22
  SPEAKER_02: It is not fair, it's not ethical, and it's something that we can completely make sense of it on a business level and as a means of boosting cash flow.
• 21:29
  SPEAKER_02: Of course we can, but do not dare bullshit us in suggesting that that is clinically justified.
• 21:35
  SPEAKER_02: It is nonsense.
• 21:36
  SPEAKER_02: And it's just not it's not fair.
• 21:38
  SPEAKER_02: It's not fair, it's not fair on all of us, and it's not fair on the reputations, and you're quite right, the robots are gonna call them out more aggressively than you and I are.
• 21:45
  Michael: They they are, and and and I I I don't I nothing's ever black and white.
• 21:50
  Michael: I could certainly see um, you know, an ACL patient who you know is gonna need more than a session, right?
• 21:57
  Michael: You know what they're gonna need.
• 21:58
  Michael: Um, and you can let them draw down on on a balance, for example.
• 22:01
  Michael: I can understand that kind of thing, but it's it's more the stuff that you're seeing every day.
• 22:05
  Michael: You know, it it was uh initially it was the chiropractor.
• 22:07
  Michael: You must have 25 sessions, 15 or but it's moved that's moved into physio.
• 22:12
  Michael: And and the point I was making earlier about the threat of AI and chiropractors, one of the reasons I think that we've seen such a steady drop in new patients is because AI is is essentially telling patients not to go see them because they're making claims that are uh ridiculous.
• 22:28
  Michael: And the more that physiotherapy clinics move into that space and and take many of those ideas because a lot of the coaches in the industry are actually taking a lot of the ideas from that kind of American Cairo model, right?
• 22:41
  Michael: Where they're they're building a clique and a cult and everything.
• 22:44
  SPEAKER_02: Yeah, you won't you only need 40 patients for you know and correct.
• 22:47
  Michael: I mean, how many ads do you see every uh every month saying um uh we'll get you 30 patients in 30 days or your money back?
• 22:53
  Michael: You know, all of that how do they do that?
• 22:55
  Michael: Well, they do that by um getting you doing free appointments, right?
• 22:59
  Michael: So you're screen appointments.
• 23:01
  Michael: And what happens when you get free appointments?
• 23:03
  Michael: Even the most ethical of physios are gonna sit sit there and go, I need to find something fucking wrong because otherwise I've just loaded, lost a ton of money.
• 23:12
  Michael: So what I'm gonna do is I'm gonna sell them into a longevity package, or I'm gonna sell them into whatever the package might be.
• 23:18
  Michael: And so you end up with those business practices impacting otherwise very cool, ethical, great physiotherapists into having to offer treatment and over-treat conditions just to make their money back.
• 23:32
  Michael: And and that is the model that we want.
• 23:35
  Michael: And certainly AI is gonna call it out.
• 23:37
  Michael: So I think from a uh and I'll say one other thing, which is uh this is another interesting threat, which I don't think people have thought about, but my guess is 80% of patients that go to most physioclinics um probably should wait a few days, they'll be fine on their own, right?
• 23:53
  Michael: Um, time is probably the biggest healer.
• 23:55
  Michael: I saw once a stat that the NHS is the the most successful MSK healing operation on the planet.
• 24:01
  Michael: Why?
• 24:02
  Michael: Because by the time they see anyone, they're all ready, right?
• 24:05
  Michael: And and I think that AI, if I now do a thing and say, I've twist my anchor, it really hurts.
• 24:10
  Michael: It says, can you walk on it?
• 24:11
  Michael: If so, do these things, go to see a physio in three or four days if it hasn't got better or if it gets worse.
• 24:16
  Michael: I think there's going to be a lot of newer patients that would have automatically have gone to a physio who won't now go because the AI will say, chill out, you don't need to get an appointment today.
• 24:28
  SPEAKER_02: Yeah, it's a cracking, it's a cra it's a cracking triage tool in that regard, um, with regards to what is urgent.
• 24:34
  SPEAKER_02: Um, and I think that that's one of the things that that is not a not a bad thing.
• 24:37
  SPEAKER_02: But it's it's gonna be it's gonna be challenging for businesses to adapt that might have been pitching themselves for, you know, don't don't ignore that niggle or whatever.
• 24:44
  SPEAKER_02: You know, sometimes you see that as a marketing act.
• 24:46
  Michael: Yeah, but it's interesting as well, and this is a real world example.
• 24:48
  Michael: I w I told you earlier, I woke up this morning, it's happened twice now in two weeks.
• 24:52
  Michael: Woke up this morning with um just awful vertigo, and that yeah, everything's spinning.
• 24:57
  Michael: Um, and I put it into Chat GPT because I wanted to see if it agreed with Mark actually, uh, because Mark said, uh, do the epile maneuver, you need someone else to do it.
• 25:05
  Michael: And it did disagree with Mark, it said you can do it on your own.
• 25:08
  Michael: But Mark said, yes, but you may not get into the position that you need to.
• 25:11
  Michael: Anyway, quite interesting.
• 25:13
  Michael: But but the fact is, ChatGPT said, This is most likely what it is, this is how you test which ear it's in, and this is how you do the epile maneuver.
• 25:22
  Michael: And actually, I uh any other time I would have gone and seen someone, I would have popped into the the local physioclinic to get it done.
• 25:28
  Michael: But the fact that Chat GPT kind of said, Well no, you don't need to, you can do this on your own or with your partner, just get them to hold your head, pretty interesting, right?
• 25:36
  Michael: I think and and I think the the more people start using whether it's GPT or perplexity or even uh Gemini and Google AI on on Google, yeah, I think the more people start using that, more the the less patience there will be to go around.
• 25:51
  Michael: I think.
• 25:51
  SPEAKER_02: Yeah, I think that there's some there's something in that.
• 25:53
  SPEAKER_02: I mean, at the at the heart of what you're describing there as well, and I feel for Kairos in this direction, because they've got a massive diversity of quality and uh evidence-informed practice across their profession, even more so sometimes than physio and osteo, which also have their challenges that are very similar, but with with Kairos, you've got a a massive culture war, arguably, within their their uh their midst, where under the same regulator and and professional council, what's it called, their um Royal College, sorry, are different overt sects and organizations that have from a really vitalistic, quite out there thing that you and I won't be big fans of through to people who you would not know at all uh the particular flavour of certificate on their wall, and that it matters that their practice is no different to mine that happens to be a physio, and so there's a and and everything in between.
• 26:46
  SPEAKER_02: And and that is that is fascinating because what we're fundamentally talking about here is is and is an opinion um about about best practice, and that there's um a number of people that are across all professions charlatans and are actively deceiving people, right?
• 27:00
  SPEAKER_02: That's fraud.
• 27:00
  SPEAKER_02: But the more the the people we're on about mainly are the people that are fundamentally just wrong.
• 27:05
  SPEAKER_02: We think they're wrong, right?
• 27:06
  SPEAKER_02: It is that they they perceive and have convinced themselves for various reasons as to the that that this style of practice, this uh biomechanical analysis, and this um set of uh conditions that they're this set of um a package of care is is warranted and justifiable by uh a set of assumptions that we think are are wrong.
• 27:25
  SPEAKER_02: Now that's what we're challenging, and it's their opinion that's different to ours, and though we should debate that.
• 27:29
  SPEAKER_02: What's interesting is the politeness culture that exists across healthcare, and particularly uh how that applies to MSK means that it's been very difficult to have that conversation in a way that doesn't play the man and instead plays the ball, right?
• 27:41
  SPEAKER_02: Even saying something like that is that oh, I disagree, I think you're wrong there.
• 27:43
  SPEAKER_02: He's like, whoa, how dare you, and you know, each to their own.
• 27:46
  Michael: I think that's been taken out of the hands to some extent.
• 27:48
  Michael: Um, because the biggest voice now, one of the biggest trends right now on on Instagram and whatever is the AI chiro chiro meme.
• 27:57
  Michael: And breathe out, yeah, yeah, yeah, yeah.
• 27:59
  Michael: And they jump on them and they breathe them.
• 28:01
  Michael: Um the biggest voices in chiropractic right now are not the Rob Vebans, right?
• 28:07
  Michael: It's not it's not the Rob Bevins, it's not the really great clinicians, it's the Aaron Kubals, the ones that are basically sat there taking the piss out of chiropractic.
• 28:15
  Michael: So you you you have the biggest voices in the industry who are now taking the piss out of it.
• 28:19
  Michael: You've got memes um uh all over the shop, you've got um the Kairos themselves doing crazy shit.
• 28:28
  Michael: Like, I I'm I'm not gonna name any, but but you go on their Instagram and you're like, it's literally laughable.
• 28:33
  Michael: You're like, are you genuinely doing I've showed this to some of the team, and and it was a I actually I'll give it away, but I I've I've been sued enough uh uh you at least by um but it's it's it's so ridiculous some of the stuff that they're doing that they're almost calling themselves out, and then on top of that, the saturation of marketing of the free appointments and the free everything it it's just uh and the x-rays and all of that stuff.
• 28:59
  Michael: I think it's it doesn't need anyone to call it out anymore.
• 29:02
  SPEAKER_02: I think it's all each it's funny how they overlap significantly, but the each each profession has sometimes got its own version of its own cliche, right?
• 29:09
  SPEAKER_02: So it so a chiropractic assessment implies that that you uh that you're uh out of uh you're out of alignment, this x-ray's shown this, and it needs these amount of manipulations at this frequency or plus maintenance to maintain your pelvic alignment, which is out helping the um all sorts of stuff they're implying from that in terms of nerve and blood flow.
• 29:27
  SPEAKER_02: And then you've got um osteopaths love a twisted pelvis, you just can't help themselves, like everything it's all to do with that, everything's downstream of that.
• 29:34
  SPEAKER_02: Again, I'm speaking to cliches here, but then the physio version of that, if we're just trying to indulge clichés, and there are several, but one of them is which is as as ridiculous as implying that your back pain is because you know T11's just uh slightly left to T12.
• 29:48
  SPEAKER_02: Um, is the um the idea that your trans abs don't quite engage properly when you pick up that pencil, and therefore you need to create some sort of um really niche um uh strategy is is the cut the it's a causal claim.
• 30:03
  SPEAKER_02: You're making a causal claim to something that you've found on assessment using non-validated measures.
• 30:07
  SPEAKER_02: So I'm just I'm just I get irritated across the piece whereby when you indulge cliche and when you look at some of the worst of it, the um implication of cause to things that we can't justify are annoying, and each profession seems to have its own favourite version of a similar thing.
• 30:22
  SPEAKER_02: And actually, what you're doing there is you're being really reductive.
• 30:25
  Michael: They they do, and and I don't want to call out just chiropractors because there's great chiropractors, right?
• 30:30
  Michael: Uh we've got someone's clients, they're they're brilliant.
• 30:33
  Michael: Um, physios, to some extent and arguably, are worse in in in some ways, and and by that I mean, you know, you've got some really egregious stuff going on.
• 30:42
  Michael: I've got, you know, you see patients being told to blow a balloon to fix a frozen shoulder or whatever it is, the balloon stuff that's going on, or you know what I'm talking about there, or um, you know, there's there's so much nonsense.
• 30:54
  Michael: Uh when I was told to to get rid of my trap nerve by having four massages a week for three months, like it just so happened after three months it'll go away, which is funny enough, what Jack said would happen anyway.
• 31:05
  Michael: And like four grand lighter.
• 31:07
  Michael: I I think where it becomes really problematic with physio is that is that people inherently trust physios because they are referred to from doctors, right?
• 31:16
  Michael: So or from a hospital or from professions that you generally trust a little bit more, if that makes sense.
• 31:25
  Michael: When my GP says you should go and do X, I'm gonna most of the time listen to them, and so physios can get away with the nonsense a little bit more because they have that inherent trust.
• 31:39
  Michael: And so I don't want to in any way say that all chiropractors are bad and all physios are good because they're not, it's pretty plenty of terrible physios.
• 31:47
  Michael: Um, but I think what's uh particularly from a marketing and business perspective, the practices employed by chiropractic are incredibly damaging to them as an industry and to their brand, and that is now moving into the physiotherapy arena, and they're being incredibly damaged by it again from the free appointments and the whatever else not as they do.
• 32:07
  Michael: The current trend is workshops.
• 32:08
  Michael: Let's do workshops for everyone, let's do a sciatica workshop.
• 32:11
  Michael: And uh, oh look, everyone happens to have sciatica, and let's now put you on a 40, you know, appointment program for fixing a sciatica or whatever.
• 32:20
  SPEAKER_02: Um it's an interesting trend though, because people in the physio game, you've got this um carriers are getting carriers are always gonna have this challenge of being over-associated to their manipulation.
• 32:31
  SPEAKER_02: They some of them call it an adjustment.
• 32:33
  SPEAKER_02: Um with physiotherapy, the the the big sort of cultural challenge at the moment is the way in which people feel dismissed with a sheet of exercises and a five-minute appointment in which I wasn't assessed properly, right?
• 32:44
  SPEAKER_02: So the the the especially that's a that's a quite NHS-shaped problem, and some of the large providers and on on cheap insurance care.
• 32:52
  SPEAKER_02: So then the the mistake that is being made, which I recognise in what you're saying, is sometimes people then thinking, right, what's the opposite of that?
• 33:00
  SPEAKER_02: And they therefore over-involve themselves and want to make implications on specificity that they can't justify.
• 33:05
  SPEAKER_02: So it's just like, right, I'm gonna be the exact opposite of that dismissive physio that just gave you a moth-eaten sheet of exercises.
• 33:12
  SPEAKER_02: I'm gonna be really tailored and really specific when they might not have needed to be.
• 33:15
  SPEAKER_02: And also that that that irritation for me clinically is that causal, they're making causal claims they can't justify, and that's where the robots will catch them out.
• 33:22
  SPEAKER_02: So it's it's an interesting one whereby the the the the why is this happening is quite complex, but the fundamentals are that I don't think it's justifiable, it's not defensible.
• 33:31
  SPEAKER_02: And also, and it's one of the reasons I still hold a clinical practice and why I still make sure I see patients, is because I don't think it's necessary.
• 33:37
  SPEAKER_02: Like so many people can't help but think that, well, that that's what patients want, it's what patients expect, and therefore I've just got to follow it.
• 33:43
  SPEAKER_02: It's like, thank goodness our GP colleagues aren't just giving people antibiotics that want them.
• 33:47
  SPEAKER_02: And they recognise that fundamentally the patient is not always right in healthcare, they're not always right in most markets, but particularly in healthcare, their instincts might be off, and it's up to you as a credible professional to put that right in a caring way, in their best interests, but not to just succumb to what they want.
• 34:03
  SPEAKER_02: You are not a shopkeeper, you are not a hairdresser, grow up.
• 34:07
  Michael: So let's let's it get us into another topic quite honestly, which is evidence-based practice.
• 34:13
  Michael: Um I I see I'm seeing a massive backlash again to evidence-based practice, people saying, I, I, I, uh, we need to ignore all this stuff because I've done this for the last 20 years and I know it works because patients tell me.
• 34:28
  Michael: Um and and this is something that you've been really strong on, right?
• 34:31
  Michael: You you I think you would be um quite tied in with the words evidence-based practice, all right?
• 34:36
  Michael: You and so.
• 34:38
  Michael: What do you what do you think about that?
• 34:40
  Michael: Um, do you think that there is room for people to kind of push it to one side and say, you know what, I I I I know that um it's not quite right, and and I know that what I do is maybe not evidence-based, but is is impactful and I have some s I'm gonna give the devil his due for a minute.
• 34:57
  SPEAKER_02: I have some sympathy for when people um are quite clumsily um going after evidence-based practice and they're painting with a really broad brush, when actually you read between the lines and you try and give them the the due, um, which is which is ambitious sometimes because it's sometimes it's clear what they're doing there, is it's how can I make an argument that dismisses the things that are inconvenient to me, my business practices, and my preferred style of practice, independent of business, really.
• 35:21
  SPEAKER_02: You can see this in NHS clinicians, too.
• 35:24
  SPEAKER_02: So the reason I'm starting with that is because I know that if you had a really narrow research-based practice, right, if you were thinking that everything is downstream from the NICE guidelines or that that everything needs an RCT for you to know exactly where to intervene, then that is an over-academic and irrelevant method of practice.
• 35:44
  SPEAKER_02: Now, fortunately, there's very few people that practice that way, because it's it's nonsense.
• 35:48
  SPEAKER_02: It is not, it's not, you know, we we l we're in a very applied science, right, in medicine, in healthcare.
• 35:52
  SPEAKER_02: And so it's a nonsense to think that the computer says no and you've just got you've got this algorithm running that means that what is evidence-based, what is what is gold standard.
• 36:00
  SPEAKER_02: However, for your practice to not be influenced by um a more contemporary understanding of mechanisms of effect, to not realise that, you know, these are all um certain treatments and and and diagnoses, we've come to be quite humbled by our greater understanding scientifically of what we do and what we don't do, then that just seems really, really crazy to me.
• 36:21
  SPEAKER_02: So again, I have some sympathy in a direction where people see evidence-based practice and the phrase evidence-based practice as being when they were beaten over the head with an ice guideline for touching someone's calf.
• 36:32
  SPEAKER_02: You know, I can I can understand why they're really prickly.
• 36:34
  SPEAKER_02: I I would say that's a misconception.
• 36:35
  SPEAKER_02: I think it's a misleading framing, and it's also a very convenient framing for some people that want to practice anecdote-based practice and what they consider practice-based evidence.
• 36:45
  SPEAKER_02: My years of experience is never going to be thwarted by an RCT that is constructed of clinic uh of patients that aren't representative of the group in which I see, right?
• 36:53
  SPEAKER_02: That that that's not who I see.
• 36:55
  SPEAKER_02: Therefore, um I can I can just do what I've always done, and and it's just a convenient way in which they justify it uh in their own rhetoric as well as help them sleep at night.
• 37:03
  SPEAKER_02: It's annoying.
• 37:04
  SPEAKER_02: Now, I but what what I think is the the better way forward and what I've tried to do with physiomatters, as well as then actually hopefully practice what we preach in in clinic, is to say that this these things are integrated.
• 37:14
  SPEAKER_02: These are all part of what informs your clinical reasoning.
• 37:16
  SPEAKER_02: And there are certain ways in which, of course, you are personalising care to that individual.
• 37:20
  SPEAKER_02: But that individual, unless they're unless they're somehow uh Superman, they are gonna be uh still adhering to the laws of physics as we understand them.
• 37:27
  SPEAKER_02: Their biology is not gonna be so radically different than other humans unless you're gonna prove otherwise.
• 37:31
  SPEAKER_02: And so there are certain things that you do have as a condition, you've got diagnostic categories that have their challenges, but fundamentally that there is best practice associated to different conditions, and that you can't then say that because I'm just I'm gonna ignore um what we understand about tank segrety of the ITB, and I'm gonna be because I love I love foam rollers and I've sold them for years, and I'm gonna use my forearm to lengthen that ITB, which is gonna really positively affect their ankle biomechanics, and that's what I've always done.
• 38:01
  SPEAKER_02: You can't then just put your fingers in your ears and hide from the fact that we can't influence tissue in the ways of which we once thought, and that yes, you might have got results there, but the reason for those results might be different.
• 38:11
  SPEAKER_02: And so you've got to you've got to update and modify and and modernize your practice.
• 38:15
  SPEAKER_02: And and again, it's just it's tough shit.
• 38:17
  SPEAKER_02: Do you think do you think there's enough of that?
• 38:19
  Michael: I I I I know, and we both know during COVID there was a massive outbreak of um CPD, right?
• 38:26
  Michael: I mean, it's what happened with both life, how that worked.
• 38:29
  Michael: I still remember the the that first day where we were like, we're gonna get a thousand people, and it's gonna be massive, and then 10 weeks later we got 22,000 people.
• 38:37
  Michael: And everyone loved CPD, and and the people we got on were fantastic, or that you got on on there, um, were fantastic.
• 38:44
  Michael: Do you think there's still enough continuous learning and and and changing within clinics?
• 38:50
  Michael: Do you think they do enough there?
• 38:52
  SPEAKER_02: Yeah, it's interesting.
• 38:53
  SPEAKER_02: I don't know.
• 38:54
  SPEAKER_02: I see I think we we all we call all kind of overindulged on webinars, didn't we?
• 38:58
  SPEAKER_02: And we were we were uh guilty of of some argues saturating the market there.
• 39:03
  SPEAKER_02: Um, but also it was a tough time to be in clinical practice and a good time to be in digital education.
• 39:08
  SPEAKER_02: So we were well placed to pivot there and we did it, and then others have come and done other things.
• 39:12
  SPEAKER_02: I think people have ended up being able to, because there's now content for everyone of all different kinds, we've got less of a communal hub now.
• 39:18
  SPEAKER_02: And I think people, if they want to, if they're if they're big into um the uh really specific manipulation of fascia, uh, then they can they can find their tribe.
• 39:26
  SPEAKER_02: And in their heads, they're doing loads of CPD, they're doing more CPD than than than everyone else, right?
• 39:30
  SPEAKER_02: So they they're learning, but they're learning in their own little clique, and it's not really you know defensible argument.
• 39:35
  SPEAKER_02: I think one of the things that's unfortunate is I was a bit naive in thinking that we had this democratization of opinion that occurred on social media, but it ended up being a bit of a uh the way that that integrated into other cultural conversations means that that's then ended up degrading.
• 39:48
  SPEAKER_02: So a general civic discourse across culture is is poor right now.
• 39:52
  SPEAKER_02: Our physio and MSK version of that is also poor.
• 39:56
  SPEAKER_02: So there's lots of CPD going on, remembering that we've got a lot.
• 40:00
  SPEAKER_02: Of clinicians uh are really trying to do their best, but fundamentally they're in it, they're it they're isolated, they're in silos, they don't know what they don't know, and also there's this continued aversion to challenge, or it seems so impolite to say, I think you're wrong there, no matter how it's said, no matter what platform, what context, it's not a particularly aggressive way in which someone's challenged, but that confrontation is seen as being so uncouth that that people are hiding still, and that is a shame.
• 40:28
  SPEAKER_02: Whether there's enough of it, too much of it, I don't know.
• 40:30
  SPEAKER_02: I think that some of the debunking, including from myself and our team, has been uh been been a bit imprecise at times over the in the past, but generally speaking, I I I'm still irritated at how many corners in which people can hide.
• 40:41
  SPEAKER_02: It's not even corners, like this this place, it's too easy to be it's too easy to be crap, uh to my taste.
• 40:47
  Michael: Let's jump on that in a second.
• 40:48
  Michael: But something I've noticed is that particularly when we were doing lots with physiomatics and therapy live, clinic owners would buy CPD themselves.
• 40:58
  Michael: But it was very rare that they took a package of CPD for their clinicians.
• 41:04
  Michael: Yeah.
• 41:04
  Michael: And and knowing many of the providers of CPD out there, I it's interesting that clinics themselves don't do as much CPD or at least pay for CPD as you would imagine that they would.
• 41:21
  Michael: Yeah.
• 41:21
  Michael: Um, and I wonder why that is.
• 41:23
  Michael: I wonder if that's partly the the contractor model and why you're spending money on people that are dispensing.
• 41:29
  SPEAKER_00: That's not my job.
• 41:30
  SPEAKER_00: Yeah.
• 41:30
  SPEAKER_02: Um I'm I'm similar, I'm similarly surprised uh because it seems like that would be so yeah, having well, I I call it content in common.
• 41:38
  SPEAKER_02: It's one of the things that inspired MSK Mag because of the way in which the natural proliferation of compet content and also rival companies of ours meant that that was fine, but it means that when we were the only radio show in town, and the and the staff room was talking about the podcast that came out last week because it's why not listen to it?
• 41:54
  SPEAKER_02: We we feel like we've managed to achieve some of that with MSK Mag again, which is great.
• 41:57
  SPEAKER_02: Because it means that then you don't have to agree with it all, but it means you've all kind of engaged with it.
• 42:01
  SPEAKER_02: Um and I think that that's what's a shame because you'd think that clinics and companies would would would find that useful to have that in common.
• 42:07
  SPEAKER_02: At least you'd have to all agree with it.
• 42:09
  SPEAKER_02: Don't mean that that then adjusts everyone's practice, but it just means that you've got that that that that phenomena where you've got something in common.
• 42:14
  SPEAKER_02: I think one of the reasons that's really challenging as well is that we can't overrepresent it.
• 42:18
  SPEAKER_02: Might well be that there are more clinics doing that, but don't have clinic licenses with physiomatter as an equivalent.
• 42:23
  SPEAKER_02: It's because essentially we we know because we see we follow the IP addresses, is that people are just sharing passwords.
• 42:28
  SPEAKER_02: It's just absolutely painful, you know.
• 42:30
  SPEAKER_02: And that's really one of the things that's hardest about uh our business model is that essentially it's low-grade fraud, whereby people have got a um that the owner's got a license at£10 a month and he's then sharing it across 20 clinicians.
• 42:42
  SPEAKER_02: And it's it's it's upsetting when they clearly they clearly value the content enough, but they're willing to defraud me of hundreds of pounds.
• 42:47
  SPEAKER_02: It's upsetting, but you know, it we know it happens.
• 42:49
  Michael: I think just as many people are using their Netflix across their mates account as anything to that.
• 42:56
  Michael: I would have thought still though, it would be more because you can see who's doing it.
• 43:00
  Michael: They probably don't know that you know that they're doing it, but but um but we do.
• 43:04
  SPEAKER_02: But um just on that, do you do you think it just could maybe I I didn't mean to get a tiny violin out there for myself, but just out of interest and because I've now said it, it is like Netflix, but I'm not like Netflix, right?
• 43:13
  SPEAKER_02: So you you know, I can't help what people think.
• 43:15
  SPEAKER_02: Well, you know, and to be honest, like I'm I'm not gonna pretend I've not done it before with Netflix, but I'm not Netflix.
• 43:20
  SPEAKER_02: So I just think that that's one of the things that kind of I do feel a little bit sorry for myself sometimes.
• 43:24
  Michael: No, but you are.
• 43:25
  Michael: It's like I I I I I was criticized recently about some stuff, and I'm like, we're not private equity.
• 43:31
  Michael: Like, what are you talking about?
• 43:33
  Michael: Like, you know, we're not some giant congom conglomerate and blah blah.
• 43:37
  Michael: But in people's minds, you are, right?
• 43:39
  Michael: You're running a business, you're making loads of money, Jack.
• 43:41
  Michael: Physiometic money did you make out of therapy live?
• 43:44
  Michael: Oh my god, you must be uh why don't you have a yacht and you're like all right, can barely afford a fucking cigar.
• 43:50
  SPEAKER_02: But well, we know we know the only person that made money out of therapy live and it wasn't us, which is very upsetting.
• 43:56
  Michael: No, well, at least the first one, at least the first one.
• 43:58
  Michael: Let's not get into that.
• 43:59
  Michael: But um, no, I I I think people still they they imagine that you must be rich.
• 44:04
  Michael: You know, you see it with the PCP as well, like, oh my god, they're so fucking low-with Adam's so rich, and it's like he still works in the bloody when he's allowed to.
• 44:12
  Michael: Um, but um, but you know, I I I so I think that um people see you the same way as they see Netflix and they see you the same way as they see other things as well.
• 44:22
  Michael: So um I don't blame people too much.
• 44:24
  Michael: I I where it's uh another thing actually, just as a complete adjunct, what's really interesting was do you remember we did a an offer to new grads for you they could have like uh all the physio matters content for like a quid a month or something?
• 44:39
  Michael: Yeah, we had like one person take it up, and that was another surprising thing was that they're just those those students, they weren't like, oh my god, I can get this for a quid a month, yeah, and it'll be super cheap.
• 44:51
  Michael: Or even uh do you remember there were you've got you can always get workplacement um kind of finding your grads in, don't you?
• 44:57
  Michael: And I remember asking them having conversation, I was like, why don't you buy this content?
• 45:00
  Michael: And they're like, Well, because and I remember one of them in particular, he's a really good guy, I still know, but he he said in particular, um, it's actually quite different to what we're being taught.
• 45:12
  Michael: Like we're being taught like old stuff that is not very good, and this stuff we wouldn't pass exams on because it's a little bit too modern, which I remember being like, holy shit, really?
• 45:22
  SPEAKER_02: Yeah, oh my god, that's that's really and it's also it's interesting because they also don't know what they need, or it's not suggested that they can help.
• 45:30
  SPEAKER_02: Um it's like will that assist my practice?
• 45:34
  SPEAKER_02: Will it and also sometimes the the lecturers it's we've got to remember as well that one of the things that's interesting about physiomatters is it really disrupted the um the it disrupted higher education.
• 45:45
  SPEAKER_02: And and so you got you have got some some lecturers that are really frustrated at the fact that that then debunked some of their sacred cows, but also it it really disrupted their method of having a bit of a monopoly on on education.
• 45:58
  SPEAKER_02: And that means that when when someone said, Josh, uh should I listen to this, there were a number of years whereby people would present and love nothing more than to share evidence with us of them saying no, and this is why they're crap, and that's why he's full of shit and stuff.
• 46:11
  SPEAKER_02: And it's just you know, it's petty, but it's also you know, I I do understand that there's a bit of defensiveness there because we disrupted an industry.
• 46:18
  Michael: Yeah, there was a funny, I don't remember, uh, there was a lady who was often on television as the top physician in the country, and I think she was on this uh on This Morning or Good Morning or Britain or whatever it's called, and she said the disc is just like a donut.
• 46:32
  Michael: And do you remember this?
• 46:33
  Michael: And there was a huge pushback, and you were all over it, and it was really, really funny.
• 46:37
  Michael: And calling out, like, this is really terrible.
• 46:39
  Michael: And I think, did you get a letter from the CSP, or maybe she did, I can't remember.
• 46:43
  Michael: Um, but when people looked, it was traced back to a textbook that is still being used today, or at least two or three years ago.
• 46:52
  SPEAKER_02: Yeah, well, it's just that you know, it's people, especially, you know, people are super isolated, so people are always fascinated.
• 46:59
  SPEAKER_02: Like, how can someone that's so obviously wrong on something like that, right?
• 47:03
  SPEAKER_02: Because people can use analogies and stuff.
• 47:04
  SPEAKER_02: Of course, I'm not saying it's exactly like a donut, but it's just that people don't realise how damaging an analogy that can be, and they therefore end up getting escalated to being spokesperson for an organization supposedly credible.
• 47:15
  SPEAKER_02: Um, is is is funny.
• 47:17
  SPEAKER_02: So people just can't believe that these things can can happen.
• 47:21
  SPEAKER_02: Um, but I think one of the reasons, and I come back to it, I'm saying it a third time on the show now because I'm I'm so repetitive with this, is that it's that culture of sort of supposed politeness that people therefore just aren't aren't comfortable calling stuff out, and that's how it proliferates, is because what we're saying is we think she's wrong.
• 47:38
  SPEAKER_02: But the act of saying we think she's wrong is seen as being somehow really offensive.
• 47:43
  Michael: Yeah, so let's get on to that because I think it's really important.
• 47:46
  Michael: Um on the commercial side, I and I had this chat with um Casey Napton, and I don't want to get into physio first too much here, but I had this discussion with Katie Napton.
• 47:55
  Michael: It seems like I'm the only one, this isn't an egotistical thing here, I'm literally the only person calling out real nonsense within the business world of and and the marketing world of of MSK.
• 48:06
  Michael: And there are very few people like you.
• 48:08
  Michael: There's you, there's Meekins, there's Cormac, um few others, maybe doing it in a slightly less aggressive way, um, calling out bad practice.
• 48:16
  Michael: Why why is the industry so allergic to it?
• 48:19
  Michael: Why aren't people out there really making a lot of noise?
• 48:21
  Michael: Because you get it in other industries, but for some reason, this industry, there's very few people calling anything out nowadays.
• 48:28
  SPEAKER_02: Well, my to my taste, because there's some some people will just spit feathers at even that suggestion.
• 48:34
  SPEAKER_02: There's a lot of people that feel like actually the biggest degradation to uh our culture in OSK is that uh is that people are calling stuff out too much, debunking stuff too aggressively.
• 48:46
  SPEAKER_02: And so um, you know, it's it's it's not even a given that people would agree with that premise.
• 48:50
  SPEAKER_02: But I I certainly do, I and and and I'm happy to talk to it.
• 48:54
  SPEAKER_02: I I I think that fundamentally, people that choose to go into healthcare are naturally agreeable in such a way and and they have a personality disposition that makes them empathetic and caring in such a way that it it feels it feels unpleasant to confront a difference, and particularly when it comes to something that is well, it's it you we're making arguments and we're making uh weaving together opinions rather than it being like an overt fact check.
• 49:25
  SPEAKER_02: It's not we're not we're not in it's not like someone's denying gravity and that you're or a flat earth thing.
• 49:30
  SPEAKER_02: It's not quite as overt as that.
• 49:31
  SPEAKER_02: And so instead, we're making arguments for and arguments against.
• 49:35
  SPEAKER_02: And therefore, the act of just saying, like, oh look, I don't agree with 20% of that, but the majority's good.
• 49:41
  SPEAKER_02: Or the big one over the years has been like someone that is like our what would be an educational nemesis uh of mine in terms of what you'd expect to be um saying something that's radically different to what I think is the is best practice MSK.
• 49:56
  SPEAKER_02: The amount of times that you'd offer a quite uh specific critique of something they've said that's not not spinning it, it's not misrepresenting it, it's just you know reporting what they've said and saying this is why I disagree with it.
• 50:08
  SPEAKER_02: The amount of people would say, look, they're just trying to get people moving the same as you, you know, as if there's this massive cover that's provided by saying, look, we're all meaning, we're all meaning well, we're all trying to get people moving more.
• 50:19
  SPEAKER_02: It's like, well, their their suggestion that it's actually unsafe to run on arthritic knees, for example, was one example, means that they are not necessarily helping people get moving more.
• 50:31
  SPEAKER_02: Or the fact that they're suggesting this is the programme you need to do before you go running again, right?
• 50:35
  SPEAKER_02: Do you not see what they're doing there?
• 50:36
  SPEAKER_02: And it's just that it just feels it feels so unpleasant to people and they don't realise, and I think it just cor it correlates with a cultural degrading of conversation whereby people can't help but attach uh individual ideas so much to themselves that when those ideas are critiqued, they feel like it's a personal attack, right?
• 50:55
  SPEAKER_02: It's just that these these things become and people we we see this across the board, so uh obviously super contentious, so we won't get into the detail.
• 51:02
  SPEAKER_02: But if people are really have a massive affinity to their religion, it's so important to them that they can't hear a critique or ridicule of said religion without them feeling and being personally wounded by that.
• 51:13
  SPEAKER_02: And I understand that phenomenon because we all have our own favourite things, but when it comes to clinical practice or modalities, or the fact that like you became known in your friends, family, it's really part of your core identity, that you are not just a physio but also an acupuncturist, or you are really good at that technique.
• 51:30
  SPEAKER_02: The the critic critique of that technique, I understand why it would would potentially also hit you and hurt you, but that doesn't mean that it's illegitimate to think carefully about the the legitimacy of those techniques.
• 51:43
  SPEAKER_02: And to me, that's just good reasoning, but to others, it's it's just they err on the side of caution as a means of not offending, they therefore just don't speak.
• 51:52
  Michael: But shouldn't and here's my problem, because I get the religion thing, five, don't care.
• 51:57
  Michael: Um, I get the trans thing, don't care.
• 52:00
  Michael: We genuinely don't care about any of that stuff.
• 52:02
  Michael: What I do care about is that you're supposed to be in medicine.
• 52:05
  Michael: And when you're in in the world of medicine, you should be updating your opinions.
• 52:11
  Michael: Imagine if if the if if surgeons still thought like they did 60 years ago um and still go operations the same way.
• 52:18
  Michael: Um and they said, Well, well, you know, don't criticize me because I I I just think uh the very nature of being a physiotherapist is that you should be science-based, you should be um addressing um uh critiques to to what you do.
• 52:32
  Michael: I I I had someone um criticize me about uh something we did on a Facebook campaign recently, and I'm like, shit, I didn't know that.
• 52:39
  Michael: I will not do that the same way again.
• 52:41
  Michael: You're absolutely right.
• 52:42
  Michael: We now run run things at a campaign level in a slightly different way because someone showed me that there was something I was doing that was wrong.
• 52:48
  Michael: I'm not a pet enough of a pussy to go, oh don't don't be don't be mean to me.
• 52:52
  Michael: When when we had the um issues of private classroom and someone said that was stupid, I change it, we changed it, right?
• 52:58
  Michael: And I think that the uh it seems like for whatever reason uh there's just uh people are so uh embedded with these ideas of what they do and they don't like to be criticized, which then leads to other people um either being seen as uh evil who do call things out.
• 53:15
  Michael: Meekins again is a really good example of that.
• 53:17
  Michael: The amount of you know, it's very marmite, 50% of people, maybe more, think he's just an awful human being.
• 53:23
  Michael: Uh I know you know he's trying to do things that are good.
• 53:26
  Michael: I I don't think he always necessarily does it the best way, and you know, whatever, we can argue about that.
• 53:32
  Michael: Um, and the same with you, with the podcast and calling out certain things in the past.
• 53:36
  Michael: I think these things are really, really important, and it just seems it's it's a shame that not more people are doing that.
• 53:42
  SPEAKER_02: Yeah, well, you know though, I was saying I was speaking to those temperamental differences that might then predispose someone to a career or not, is that you know, you it it's one of the things for for you to reflect on, is that you you wouldn't have you it's unlikely for you to have then gone into healthcare um for some of those reasons, right?
• 53:58
  SPEAKER_02: It's just seems that and and what what's what's weird about Meekins is how how instinctively impolite he is as a as a person, even though of course it we as we say that his we we know his motivations better than most do, and and he's certainly not malicious as he's sometimes maligned as being.
• 54:15
  SPEAKER_02: But it's just that that's what makes him so novel.
• 54:18
  SPEAKER_02: Like it is he's uh an unusual character in healthcare that makes them um people, even though he would um come if you lined him up uh with with everyone, then he's not gonna be anywhere near the top 40% of impolite people.
• 54:34
  SPEAKER_02: He's in the top five percent of impolite physios, right?
• 54:37
  SPEAKER_02: So it just means that you get that you get that extreme, it is seen as extreme, uh partly because it's all relative to the industry that I was talking about being very polite, right?
• 54:46
  SPEAKER_02: And I think that that's what's strange.
• 54:47
  SPEAKER_02: Now, I just want to just one point before I go and forget, right?
• 54:50
  SPEAKER_02: You're quite right that it's different when it comes to when it's applied to healthcare, and I agree that the healthcare ethics should be treated not as a perfectly separate category, it shouldn't have allowances for hypocrisy or anything like that.
• 55:01
  SPEAKER_02: But I'm just meaning that where it is different, and I use this as a as a thought experiment sometimes or an analogy that I try and use, is that the extreme version of bad practice and bad education and bad ideas proliferating in healthcare is homeopathy instead of chemotherapy for childhood cancer, right?
• 55:20
  SPEAKER_02: Your child gets leukemia, and and and modern medicine evidence-based practice suggests chemotherapy, and someone else proliferates the idea instead of is homeopathy.
• 55:30
  SPEAKER_02: You've got the opportunity cost of them not getting the care they need.
• 55:33
  SPEAKER_02: And so the idea of saying, well, homeopathy, it's just it's just water.
• 55:38
  SPEAKER_02: It's not going to be any harm.
• 55:39
  SPEAKER_02: The harm is in what you're avoiding, right?
• 55:42
  SPEAKER_02: And so people underestimate that.
• 55:43
  SPEAKER_02: So you get these supposedly benign um, you know, people are wrong about something, right?
• 55:49
  SPEAKER_02: Or they've suggested they should do something.
• 55:52
  SPEAKER_02: At worst, in MSK, they don't get better, right?
• 55:56
  SPEAKER_02: And so there's often this hiding behind uh worth a try, not going to do any harm.
• 56:01
  SPEAKER_02: Why not?
• 56:02
  SPEAKER_02: And fundamentally, the failure to recognise the opportunity cost, or the place in which that was a moment in time, or that that was their moment in which they might have trusted physiotherapy, chiropractic, osteopathy, sports therapy, sports medicine, they trusted that they got given advice of a particular flavour that wasn't defensible, wasn't justified, and that person's not kept in touch with a sensible, reasoned, evidence-informed approach.
• 56:27
  SPEAKER_02: It's not that they then go, okay, what's next?
• 56:29
  SPEAKER_02: And plan B is then good therapy.
• 56:31
  SPEAKER_02: Plan B could often be the dismissal of all things MSK.
• 56:34
  SPEAKER_02: And so whilst it's an extreme example with homeopathy, I use it as a means of saying, of course, those that are suggesting some of the stuff I've mentioned before, some of the things that I'd be against in terms of their care.
• 56:44
  SPEAKER_02: It's it's the opportunity cost that gets undervalued in that analysis, and it drives me crazy because it is so unethical.
• 56:50
  SPEAKER_02: It's not, it's not like other industries whereby it's like, well, you know, people have got different favourites and different flavours, and you know, you like that vape shop and I like this vape shop.
• 56:59
  SPEAKER_02: It's not that, is it?
• 57:00
  SPEAKER_02: It's it's this is something much more fundamental to humans.
• 57:04
  Michael: It's not, and I think one of the problems that that you have in this industry is that much of um many of the issues that people have are solved by nothing but time, elapsed time, right?
• 57:19
  Michael: So you get uh and I'll talk about MBST because I had a uh fun run-in with their managing director at Therapy Expo, and I'm gonna get her in on the podcast because she's very lovely.
• 57:29
  Michael: But one of the things about MBST is that you're charging a patient thousands of pounds to let's not get into the the the technical aspects of it, but you're charging a patient thousands of pounds and to fix an injury or whatever it might be.
• 57:44
  Michael: Now that's good for the clinic.
• 57:48
  Michael: And if the patient's fucking loaded to some extent, you go, well, who cares?
• 57:53
  Michael: And people have got better using it.
• 57:56
  Michael: Is that because of uh the intervention or is that because well it the program is six weeks and most minor issues are gonna be dead gone within six weeks, right?
• 58:04
  Michael: Um but it is it i it it's an interesting one because on one hand you're absolutely right.
• 58:10
  Michael: On the other, from a commercial perspective, if something isn't invasive, if something isn't uh actually causing harm the placebo, if you like, is it such a bad thing if you're charging money to people who can afford it?
• 58:25
  Michael: Let's just assume people can afford it.
• 58:27
  Michael: Is it such a bad thing?
• 58:29
  SPEAKER_02: Yeah, well I mean it's um that that starts to become sometimes people don't realise how profoundly philosophical these conversations are and should be, because I really personally care about the truth.
• 58:42
  SPEAKER_02: And and I think there's something to be said about human to human, is what I'm saying defensible and justifiable based on what we know and what we should know.
• 58:51
  SPEAKER_02: And the argument that there's lots of patients that I see that I could say, I could, I could, I could put a probe uh of a scanner on them and go, aha, right, okay, yeah, this is often missed.
• 59:02
  SPEAKER_02: Um you've got this, you've got this lesion.
• 59:04
  SPEAKER_02: Uh I don't need to go into exactly what it is, but this injection will sort it.
• 59:10
  SPEAKER_02: Don't worry about it.
• 59:11
  SPEAKER_02: You also need to just do a couple of these exercises just as a means of maintenance and and and a bit of time needs to pass.
• 59:16
  SPEAKER_02: I could inject them with saline, sterile, I'm not doing anything dangerous, okay?
• 59:20
  SPEAKER_02: Um, make sure it's clear.
• 59:21
  SPEAKER_02: Imagine, for the sake of this argument, that there's just a 0% chance of infection, right?
• 59:25
  SPEAKER_02: So I've picked something invasive there, which was a bit clumsy of me, really.
• 59:28
  SPEAKER_02: But let's just say that you're injecting something inert, right, as a placebo.
• 59:31
  SPEAKER_02: You've been very convincing, all the illusion in the theatre is is really waiting in favour of it working.
• 59:37
  SPEAKER_02: You've then allowed time to pass and maybe given them a bit of rehab exercises for something, let's say this is something that was going to settle down in your opinion, anyway.
• 59:43
  SPEAKER_02: So again, I'm I'm making something up whereby I'm I'm being a charlatan there, but fundamentally, you you that the what is wrong with that, what's wrong with it is it's dishonest.
• 59:54
  SPEAKER_02: And so the the Andrew's.
• 59:56
  SPEAKER_02: Let me sort you there.
• 59:57
  Michael: Out of interest, have you ever.
• 1:00:00
  Michael: Lie to a patient to do good.
• 1:00:06
  Michael: Or or or just gone, yeah, that's right, even though they've explained something really badly and and and you pick your moments.
• 1:00:15
  SPEAKER_02: There'll be times there'll be times where I've forgotten to come back to it or run out of time to come back to it.
• 1:00:19
  SPEAKER_02: Because you you pick your moments sometimes.
• 1:00:21
  SPEAKER_02: So um what you've got to do is you've got to try, and it's an interesting, definitely beyond the scope of what we've time for now, because I do need to go in a couple of minutes, but um we I I there will have been times whereby if you were a fly on the wall, you'd have been surprised at me not challenging something in the moment that I've then forgotten to get back to.
• 1:00:37
  SPEAKER_02: You also got this balance of when someone's got a sense of of themselves or their condition that is not accurate.
• 1:00:42
  SPEAKER_02: You you you've got to try and work out to move them from A to B if you feel that B is a more sensible place.
• 1:00:47
  SPEAKER_02: And and that's an art as well, which is interesting, where you don't want to just aggressively debunk their sense of self, right?
• 1:00:52
  SPEAKER_02: If they're wrong, they're wrong by accident.
• 1:00:53
  SPEAKER_02: I often say that about my colleagues as well as patients, right?
• 1:00:56
  SPEAKER_02: They're not doing it on purpose, they've just got a misconception.
• 1:00:58
  SPEAKER_02: And the body's a weird thing.
• 1:00:59
  SPEAKER_02: Um, you know, back pain, including my own back pain, can sometimes feel much more fragile uh in all sorts of ways than it actually is, and that's not them being wrong and stupid, that's just how it feels.
• 1:01:10
  SPEAKER_02: And so explaining to them that your back's not quite as fragile as it might feel right now is something that you've got to pick your moments for without it sounding like you're being dismissive of the fact that it feels fragile.
• 1:01:19
  SPEAKER_02: So I hope that answers your question.
• 1:01:20
  SPEAKER_02: I think on the on the wider sort of modalities and stuff, um, there is a way in which you interact in clinic that can amplify and accentuate the effectiveness of your stuff of your of your care.
• 1:01:31
  SPEAKER_02: But the fundamentals of it for me need to be that you're aspiring someone to be better uh than they were when they came in by way of functional rehabilitation, right?
• 1:01:39
  SPEAKER_02: Everything drives back to them exposing themselves to a version of what they're struggling to do at the moment that means that they can do things that they couldn't do before, or for us to aspire to correcting some of the things that we wanted to uh wanted to correct based on a shared decision of what is wrong.
• 1:01:52
  SPEAKER_02: And and that is interesting because of course it means in any given sentence there might be things that could have been said better, but over the course of a care or over the course of an appointment, you would hope that what you're saying isn't deceptive and what you're saying isn't uh isn't a lie.
• 1:02:07
  SPEAKER_02: You might not counter some of their misconceptions in one session, all of them in one session, but it's the difference between what you're saying being defensible.
• 1:02:16
  SPEAKER_02: If in any given moment you uh there was a way in which someone could could press Bernard's watch and just stop you and say, right, well, you just said that there, how would you defend that?
• 1:02:24
  SPEAKER_02: Are you in a position where now and again you might be like, yeah, good point, I could have said that better.
• 1:02:28
  SPEAKER_02: Or is it that if a colleague caught you out and said, Can you defend that?
• 1:02:32
  SPEAKER_02: You would then be in a position to say, Well, of course that's not strictly true, but sod it, it'll trend positive.
• 1:02:37
  SPEAKER_02: And if it motivates them to do that, then you know, sod it.
• 1:02:41
  SPEAKER_02: I personally don't like that, and I don't like it.
• 1:02:44
  SPEAKER_02: The ends justifies the means, right?
• 1:02:45
  SPEAKER_02: That's what that argument is.
• 1:02:47
  SPEAKER_02: And people make that argument in all sorts of ways across the world.
• 1:02:50
  SPEAKER_02: I don't like it applied to healthcare, but that's partly because personally I don't like that justification anyway.
• 1:02:55
  SPEAKER_02: I don't like misleading things, I don't like nudge theory for those that know it.
• 1:03:00
  SPEAKER_02: Yeah, I didn't like it in the pandemic with public health.
• 1:03:02
  SPEAKER_02: I'm fairly consistent with this, but I know that not everyone feels that way.
• 1:03:05
  SPEAKER_02: So if something's trending positive, sometimes people give it a bit more leeway.
• 1:03:10
  SPEAKER_02: Personally, I like consistency, I like it intellectually, and I like it in clinics.
• 1:03:14
  SPEAKER_02: So you need to go.
• 1:03:15
  Michael: Uh and I'm gonna convince you to do a part two because I've got about a hundred questions that I've not asked.
• 1:03:19
  SPEAKER_02: Yeah, okay.
• 1:03:19
  SPEAKER_02: Well, I'm I'm happy to.
• 1:03:20
  SPEAKER_02: Well, obviously, don't do a part two if this goes down like a sack of shit.
• 1:03:23
  SPEAKER_02: Like me and you can chat about this off air.
• 1:03:26
  Michael: I know we can, but just finally on that last point, so we will do a part two, I'll convince you.
• 1:03:30
  Michael: But on that last point, talking about um Whoop the other day, and because I've got a well, I don't have it on, but uh I have a Whoop, and it's fascinating because it kind of gamifies health, right?
• 1:03:41
  Michael: So it it pushes you into doing things that are good for you.
• 1:03:46
  Michael: Now, most of it, I think, is probably kind of rubbish, right?
• 1:03:50
  Michael: Um, a lot of it is is overstating things and the algorithms are probably kind of wrong, and it's just a lot of nonsense in there.
• 1:03:58
  Michael: But when you combine it all, it does push people into doing better things, it does make me have more steps, even if the my whoop health span age of 55.8 is kind of bullshit.
• 1:04:12
  Michael: I like seeing it go to 54, right?
• 1:04:14
  Michael: Or 53 or 52.
• 1:04:16
  Michael: It's encouraging me to try and sleep more or to be more consistent with my sleep or whatever the case may be.
• 1:04:22
  Michael: And so I think there are um, and this will lead into further questions later on in part two about the use of health tech within clinics to make money for commercial gain that may not necessarily be clinically impactful or effective in their own right, but can motivate uh people to maybe do better things.
• 1:04:45
  Michael: Um, an example might be VO2 Max in its own right.
• 1:04:48
  Michael: Well, you know, come on, but it can lead people to um change their lifestyles and so on.
• 1:04:54
  Michael: So we'll leave that for another day.
• 1:04:55
  Michael: But I just thought the Whoop example is quite interesting.
• 1:04:57
  Michael: Because gamification in healthcare is so important that very few physioclinics or we'll say MSK clinics actually gamify rehab in any way.
• 1:05:09
  SPEAKER_02: Um and I think Yeah, yeah.
• 1:05:10
  SPEAKER_02: No, I and that's why I I don't I definitely don't want to be such a um so cynical that people aren't being able to be creative with things and and ways in which they deliver things that uh that that that then might not move us all by that innovation.
• 1:05:25
  SPEAKER_02: Because I do want that innovation.
• 1:05:26
  SPEAKER_02: I think sometimes we're too static, too, too complacent.
• 1:05:29
  SPEAKER_02: So I'm not saying that people need to tread a really fine line all the time.
• 1:05:32
  SPEAKER_02: But I think that what's interesting, and and there's a lot of conversation, and and Greg Lehman came after me and others about dynamometry in a similar way.
• 1:05:39
  SPEAKER_02: Like, what does it do to, you know, we know that yeah, it might motivate patients, but that's not a good enough justification if you're implying that that level of strength that it's showing there is the reason you're in pain, you can't make that claim.
• 1:05:49
  SPEAKER_02: And so it's all about the language of how you explain that to a patient to make that ethical.
• 1:05:52
  SPEAKER_02: It's not the technology that's inethical, it's the way in which it can be sometimes implying something that's more than what you can justify.
• 1:05:58
  SPEAKER_02: Um, and I think what what I'd I'd say about Whoop is that what you're describing there, if it became more and more precise or that data was informing things in a more evidence-based way over time, then that would only be better.
• 1:06:12
  SPEAKER_02: The fact that it happened to be moving in the right direction, yeah, is it better than nothing?
• 1:06:15
  SPEAKER_02: Perhaps it can also go the other way, and I see this all the time, is that people are worried about the the data that it's giving them, and they think that that's somehow got uh it's making somewhat causal claims on their own health, and they're feeling uh like it's uh it's not just the trend that they're bothered about.
• 1:06:29
  SPEAKER_02: And so it has its upsides, it has its downsides.
• 1:06:31
  SPEAKER_02: But to me, the more precise we can be, the more that that data is nested within a sensible reasoning framework and a combination of technologies and humans can get us there.
• 1:06:39
  SPEAKER_02: And I'm excited for that future, but that hybrid needs to be had maturely rather than it being, like I said, Ludheights versus Evangelis.
• 1:06:46
  Michael: Well, yeah, and you you're Manchester Way, right?
• 1:06:49
  Michael: So uh Necho Health.
• 1:06:51
  Michael: I don't know if we we've not spoken about it.
• 1:06:52
  Michael: I don't know if you've come across Neco Health, but basically they're doing the sort of everything scan, aren't they?
• 1:06:58
  SPEAKER_02: The everything scan, you scan everything going.
• 1:07:00
  SPEAKER_02: They got like a two-year waiting list.
• 1:07:03
  SPEAKER_02: Yeah, it's annoying because I was gonna do a I was gonna do a little physiomatters TV thing on it and I got an appointment, but I couldn't make it down to London in time for it.
• 1:07:09
  SPEAKER_02: But I it's annoying because I got offered one and I was gonna do a piece on it.
• 1:07:12
  SPEAKER_02: So I'll try and get back round to that because it was just annoying that I couldn't I couldn't maybe maybe I should have got sent someone else, but I I got my money back.
• 1:07:19
  Michael: But but with uh what is it, thirty percent false positive rate?
• 1:07:22
  Michael: I d I don't know.
• 1:07:23
  Michael: I'd probably crap.
• 1:07:24
  Michael: Oh yeah, exactly.
• 1:07:25
  Michael: Exactly.
• 1:07:26
  Michael: Well that's definitely one for another day, mate.
• 1:07:27
  Michael: I'm sorry I've got to go.
• 1:07:28
  Michael: We will do it again, I promise.
• 1:07:30
  Michael: We'll do a part two.
• 1:07:30
  Michael: Thank you so much, and um yeah, we'll chat soon.
• 1:07:34
  SPEAKER_02: Yeah, thanks, but it