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Podiatrists Eat Their Young! A Conversation with Nick Knight · No Appointment Necessary

• 0:00
  Michael: So welcome to another session of No Point Unnecessary.
• 0:03
  Michael: Today we've got Nick Knight, one of our very fine customers, who uh we've chatted a lot about all kinds of things.
• 0:10
  Michael: And I think Nick um is pretty well renowned in pedagogy circles, but we also often talk about quite a lot of controversial things.
• 0:18
  Michael: So kind of the perfect guest for uh for No Appointment Necessary.
• 0:23
  Michael: So very briefly, Nick, do you want to just quickly introduce yourself?
• 0:25
  SPEAKER_01: Yeah, no, thank you for inviting me on the podcast.
• 0:28
  SPEAKER_01: And yes, we have had many, many chats in in the past.
• 0:32
  SPEAKER_01: So my name's Nick, I'm a podiatrist based in the south of England.
• 0:36
  SPEAKER_01: I run a company called NK Active, which is a team of podiatrists and graduate sports rehabilitators.
• 0:43
  SPEAKER_01: Basically, we just sort of think of ourselves as a centre of sort of low limb excellence, as it were.
• 0:47
  Michael: So that's interesting actually, because you and I think when we met, you were originally I'd say simply, but simply a podiatrist.
• 0:55
  Michael: But actually over time, you've moved much more into rehab, and you were doing MSK podiatry, which we'll get into, but you have moved more into kind of the world of let's say general rehab physiotherapy.
• 1:09
  Michael: Yes.
• 1:09
  SPEAKER_01: We have we have done, yes.
• 1:11
  SPEAKER_01: Just because we found the need was there, and we were getting a lot of referrals from different professions, physios, sports docs, consultants, and we were seeing a lot of second opinion rehab work around and I don't know, unbiased because I treat the foot and ankle, but I always think the foot and ankle just gets forgotten about.
• 1:29
  SPEAKER_01: And I think during the rehab process is often not pushed hard enough.
• 1:34
  SPEAKER_01: And I think sometimes a rehab journey people go on isn't explained to them well enough.
• 1:41
  SPEAKER_01: So I just felt that we could do something different, and that's how we then said, right, I'm what you know me long enough now.
• 1:46
  SPEAKER_01: I'm honest people with like, if I want to try and change something, I'm like, instead of moaning about it, let's get on and try and change it.
• 1:53
  SPEAKER_01: Whether I do right or wrong, I don't know.
• 1:57
  SPEAKER_01: But I almost like because I now do it, it gives me the entitlement, then also if I want to moan about it, I can do something.
• 2:02
  SPEAKER_01: I'm actually trying to fix a problem as well.
• 2:04
  unknown: Yeah.
• 2:04
  SPEAKER_01: Rather than just sat there in my armchair just moaning about it and doing nothing.
• 2:08
  Michael: It sort of touches on a topic I was going to bring up later, but I'll I'll do it now, which is somewhat, and we'll have a few different topics around visibility of podiatry.
• 2:15
  Michael: But if I were a runner, which I'm absolutely not, but let's just say I was, um, and I had an Achilles tendinopathy, I think the only person I would come and see is you.
• 2:26
  Michael: Um it any runner with an Achilles tendinopathy, go and see Nick, he's he's he's got it.
• 2:31
  Michael: That isn't what most patients would think.
• 2:33
  Michael: I think the average patient would never even think of seeing a podiatrist and would go straight to a physio.
• 2:39
  Michael: And I think there's definitely a visibility issue, but also a marketing and education issue.
• 2:44
  Michael: Um again, I think your average patient would never dream of going to see a pod.
• 2:49
  Michael: Um, what do we do about that?
• 2:51
  SPEAKER_01: So I I think it is podiatry as a whole has a really, really poor brand.
• 2:56
  SPEAKER_01: And if we're being honest of ourselves as a profession, we've most probably only got ourselves to blame for that.
• 3:02
  SPEAKER_01: I think we've whether it's hard to say that, but at the end of the day, you've got to take responsibility for what we do as a as a profession.
• 3:10
  SPEAKER_01: There's a lot of sort of interprofessional fighting at times.
• 3:15
  SPEAKER_01: I I was speaking to an orthopedic surgeon and he sort of said, But R is a strange profession.
• 3:20
  SPEAKER_01: He said, It's the only profession I know that they're willing to eat their young.
• 3:23
  SPEAKER_01: So I think there's an element of we just need to put our differences aside and sort of like come together.
• 3:30
  SPEAKER_01: And it was almost like we were chatting before we started recording it.
• 3:34
  SPEAKER_01: A colleague of a friend of mine, Lee Amanis, posted that someone come see him left in a review, but only three weeks prior to that had no idea what a podiatrist was.
• 3:42
  SPEAKER_01: And for even my own my own personal journey, until four or five weeks before going studying podiatry, I didn't really have any clue what podiatrist was.
• 3:52
  SPEAKER_01: It's only for a certain few life circumstances that I ended up finding out what it was.
• 3:57
  SPEAKER_01: I had no idea.
• 3:58
  SPEAKER_01: I was like physio, physio, physio.
• 4:00
  SPEAKER_01: And I think it just comes about we need to do things to increase the awareness.
• 4:04
  SPEAKER_01: And it's been great working with you guys and the team at HMDG to really learn about looking at what people think.
• 4:11
  SPEAKER_01: I think we've been guilty in the past of trying to predict what people think and actually got it wrong a lot of the times, or assuming someone wants X, Y, and Z and getting hung up on things.
• 4:23
  SPEAKER_01: But at the end of the day, I think we need to be speaking more the patient's language.
• 4:27
  SPEAKER_01: We need to be telling stories more often about how we can help people.
• 4:32
  SPEAKER_01: I think we just need to try and en masse try and do it.
• 4:35
  SPEAKER_01: And it's always going to be difficult because, from an NHS England viewpoint, podiatry is an at-risk profession.
• 4:41
  SPEAKER_01: It's a profession that's actually on a decline.
• 4:43
  SPEAKER_01: So we have got a big uphill battle, but everyone that comes and sees us knows they get a good experience.
• 4:50
  Michael: So it's that I think you you bring up a a good number of issues there, and let's tackle them.
• 4:55
  Michael: So I saw the post by Liam, and yeah, it was uh uh and Liam's another customer and runs an absolute fantastic clinic around the corner from where I live.
• 5:04
  Michael: And yeah, you make the point that this this patient said an amazing review, but I've never known what a podiatrist is.
• 5:10
  Michael: I think that you actually get half the population think they know what a podiatrist is, which is they cut toenails, so really sure what it is.
• 5:18
  Michael: And then probably not even I think about 90% of the population that's how they see podiatrists, and then you've got the 10% that that actually do know, but it's very rare.
• 5:27
  Michael: And and I think there's definitely a an issue with you're right, it's the fact that podiatry as a whole has been marketing itself really terribly um in terms of getting out there and saying this is what we do and um this is how cool we are because it is actually a really cool profession.
• 5:41
  Michael: Whenever we bring um new staff in, we talk about podiatrists and they're like, Oh, they do that, like yes, they do.
• 5:49
  Michael: And it's it's interesting that there's just this real either misinformation um or lack of education.
• 5:56
  Michael: But I will also say that we work we're very lucky, I think, because we tend to only work with the really cool podiatrists that do really cool stuff.
• 6:06
  Michael: We don't see um a lot of the podiatrists, and I know there are many out there who literally don't want to get into MSK, they don't want to get into the high-end treatments or complex conditions, they are happy just being chiropadists, and I think that's that's a little bit of a problem with the profession because they're they're doing everything one way and focusing on one thing and educating people about that, but then you have and I don't know the exact I'll I'd be interested to know what your opinion is, but what percentage of podiatrists actually do really cool stuff and what percentage I'm not saying the routine is not cool, but you know what I'm saying.
• 6:36
  SPEAKER_01: Um, what percentages do routine and what percentage do high-end so I don't know the stats, but we always talk about working at the top of your license because there is a need and a demand for the non-MSK stuff, and for some people, you do that really well, that could be limb saving for people, but there's also a cohort of population that for general foot care needs, and this is this is really inter controversial, and I may get shot down for a few comics by saying this, but maybe don't actually need the skill level of a podiatrist, so that you've got foot health practitioners and sort of thinking if we're gonna get into uh FHVs later, so let's not get into that.
• 7:14
  SPEAKER_01: Okay, so it's it's one of those things that I think how many podiatrists are are using there to green knowledge and level to the top of their ability, and I don't know the exact stats on that, but I think it's if we if we think that it's part of the issue is as a podiatrist, we can do so many different things.
• 7:34
  SPEAKER_01: You can become a podiatric surgeon, you can go do pediatrics, you can go diabetes, the at-risk foot, the MSK stuff.
• 7:41
  SPEAKER_01: So that's part of the issue, such a wide variety, which makes it fantastic, but there is no dedicated training path like medicine to go down and subspecialise in anything on those lines.
• 7:52
  SPEAKER_01: So when you look at people's journeys of how they got there, a lot of people have to sort of make their own path to get where they want to, and that takes a lot of time and effort to do that.
• 8:01
  Michael: You just said using what they've learned in their degree and and so on.
• 8:04
  Michael: I I'll throw a little devil's advocate in here.
• 8:08
  Michael: Um, do podiatrists really come out with all that much knowledge and expertise?
• 8:14
  SPEAKER_01: So it's like with any profession, it's like it's like passing learning to learning to drive doesn't make you a good driver, it shows you are safe to a certain level.
• 8:25
  SPEAKER_01: Becoming a graduate podiatrist physio doesn't make you a good podiatrist or physio, but it shows you will have a basic safe level of understanding.
• 8:33
  SPEAKER_01: But podiatrists as a whole, now when they graduate, have the ability to use local anesthetic, they have the ability to administer certain drugs and be able to supply certain antibiotics and do these things that not many other professions have the ability to do straight out of university.
• 8:53
  SPEAKER_01: But how many podiatrists are still actually using all of those skills that they had, or is it a case of if you don't use it, you you lose it type thing?
• 9:03
  SPEAKER_01: And I think this is where we're at a profession, is that I do think we are getting this split divide, but I also think there are a lot of podiatrists out there who want help and want to learn, but actually, because it's such a small profession and there can be a lot of interprofessional bickering, as it were, at times, are those podiatrists then sort of nervous about sort of raising their hand saying, Hey, I need some help because they don't want to be shot down type.
• 9:27
  Michael: I I think we go back to that whole point of um the profession's been terrible at marketing itself.
• 9:33
  Michael: And individual clinics actually have been really terrible at marketing themselves.
• 9:36
  Michael: You know, that's where where we've come in and helped a view.
• 9:39
  Michael: Um, and it's been really interesting because actually marketing podiatry is so bloody easy, but they've just been terrible at doing it and never thought about doing it.
• 9:46
  Michael: I guess I would throw maybe some of the blame back on, let's call them people like you, um, the more influential podiatrists who are pushing things forwards in their own businesses, but have done basically fuck all, maybe I'm wrong, but fuck all to kind of push the profession forwards.
• 10:05
  Michael: Like I've heard lots of talk about, oh, we need to really do something, we need to drive the profession forwards, we need to help other clinics, we have need to help clinicians.
• 10:13
  Michael: But I've seen very little of it actually.
• 10:15
  Michael: So, how much are you guys to blame for being very sort of insular and I'm just focusing on this and and not really caring that much about the profession and driving it forwards?
• 10:25
  SPEAKER_01: I'm not going to massively disagree with you on that.
• 10:29
  SPEAKER_01: I think it is things are changing.
• 10:32
  SPEAKER_01: There has been some of the powers that be you have hiring in the profession is hasn't maybe gone in the right way.
• 10:40
  SPEAKER_01: And has there been personal journeys that people want to embark on in the past?
• 10:44
  SPEAKER_01: Yes, but I think as a whole now we are trying as a collective to do more to try and sort of improve the awareness of podiatry.
• 10:54
  SPEAKER_01: And I think it is hard because sometimes in the past I've gone to try, or other people have gone to try and do stuff, but then you then get shot down because you're like, oh no, it's not NHS, you can't do NHS.
• 11:06
  SPEAKER_01: There's always this NHS.
• 11:07
  SPEAKER_01: So sometimes after so many times you've been shot down, you're like, you get a little frustrated with it all.
• 11:13
  SPEAKER_01: But it's one of those things.
• 11:14
  SPEAKER_01: I think if you're to take a sort of high-level overview, it's not one thing, it's most probably a catalogue of errors that haven't happened that have led us to this to this point.
• 11:24
  SPEAKER_01: And it does try and need fixing as a whole because podiatrists are definitely needed, but it's if the profession doesn't do anything, is the profession still going to be here in its entirety in 15, 20 years' time, or is it going to be broken up and piggybacked onto other professions or other aspects of healthcare later on?
• 11:46
  Michael: Yeah, I think it I don't know about it being gone, but certainly I think there needs to be some kind of concerted effort.
• 11:52
  Michael: I I would I I've spoken to a few people actually um uh about this in the past.
• 11:57
  Michael: I think you as well, we had a bit of a chat.
• 11:58
  Michael: I I would love to be involved in a project where we can really push pod dietry.
• 12:02
  Michael: Because let's be honest, like we're we're being a little bit down at the moment, but actually uh from a marketing standpoint, the dietary is a shitload of fun.
• 12:10
  Michael: Um it's actually really easy as well.
• 12:12
  Michael: Um, you are the most tech-enabled kind of MSK clinics out there, which is always fun to market when done right.
• 12:20
  Michael: There's there's a lot of innovation happening, more so than than in physiotherapy.
• 12:25
  Michael: I mean, Christ, the innovation there, it's like they actively fight against any kind of innovation.
• 12:29
  Michael: So I think podiatry is in a in actually quite a good place in many ways.
• 12:33
  Michael: I think obviously there are issues with a number of podiatrists that are coming through.
• 12:37
  Michael: I think there are issues and and this is just for my I'll be interested to get your uh take on this.
• 12:42
  Michael: I I think that that the profession is generally quite male-domin male-led, but actually most of the grads coming out now, I think, are female.
• 12:52
  Michael: And so I think that's a really interesting point as well.
• 12:55
  Michael: That there are so many females coming through and younger females, but it's still a very male-dominated and led environment.
• 13:02
  SPEAKER_01: Have you seen that?
• 13:03
  SPEAKER_01: So, from my understanding, the stats are there are more female registered podiatrists than there are male.
• 13:10
  SPEAKER_01: But if you look at the higher-end jobs, they are more male dominated than female dominated.
• 13:17
  SPEAKER_01: And yes, that that needs to we need to try and look at okay, why that is.
• 13:21
  SPEAKER_01: But also the bigger picture is actually if you look at the average age of the person who goes to start podiatry, the majority of people who become podiatrists, it's their second, third career type thing.
• 13:32
  SPEAKER_01: It was, I joined podiatry when I was 18, and there are a few, but they are the minority, not the majority.
• 13:39
  SPEAKER_01: And for me, it's actually how do you encapture that?
• 13:43
  SPEAKER_01: And essentially, how do you make podiatry sexy to an 18-year-old to say, actually, do you know what?
• 13:48
  SPEAKER_01: I want to do this.
• 13:49
  SPEAKER_01: Because I only got into it via the yellow pages, writing to a chap called Paul Haradine, and he replied, I went and spent a week with him, and I was like, Yes, I want to do that.
• 13:57
  SPEAKER_01: But if he didn't reply, I wouldn't have been here now.
• 13:59
  Michael: Yeah, but that's the thing, that's the thing, Nick.
• 14:02
  Michael: Um agreed, I think if I said to my 17-year-old son, Josh should be a podiatrist, he's gonna be like, No, Dad.
• 14:08
  Michael: But if I showed him all the cool stuff you guys do, I think that changes things.
• 14:12
  SPEAKER_01: And again, I think there was an infographic that went round and it was like what the public think I do, and it had someone cutting toenails.
• 14:19
  SPEAKER_01: Yeah, had what my friends think I do is massaging someone's leg, and then it was a picture of what I actually do, and it's that disconnect between and you see it in all jobs, don't you?
• 14:28
  SPEAKER_01: But it is you got other professions where they are big enough and large enough to ride that out and make big change, whereas podiatry we are we are small, and it's we need to do something to change because I'm really fortunate.
• 14:41
  SPEAKER_01: Like, yes, there's been a lot of down talk about podiatry so far, but I also absolutely bloody love my job.
• 14:47
  SPEAKER_01: I'm really fortunate.
• 14:48
  SPEAKER_01: I don't view, I I don't have a job, I have a hobby that I get paid to do, and I absolutely love I work about a few hours a week, and that is when I actually I'm doing notes and letters, but now with the use of AI, actually that's even less.
• 15:01
  Michael: Yeah, no, seeing patients like I love it.
• 15:03
  Michael: And and I'll tell you now, if I I've said this a million times before, if I was to open a healthcare clinic tomorrow, it would be a podiatry clinic.
• 15:10
  Michael: We have been a bit down on podiatry, but generally, like you make way more money than everyone else, you charge more money than everyone else, you're tech enabled, which again I love.
• 15:19
  Michael: I think there's a lot of innovation in the industry.
• 15:21
  Michael: Find it's very rare.
• 15:23
  Michael: I've met one, but it's very rare.
• 15:26
  Michael: I I don't meet a podiatrist that I don't really, really like.
• 15:29
  Michael: Um, uh, you know, they're generally fantastic.
• 15:32
  Michael: Yeah, I I I think it's a great industry.
• 15:34
  Michael: I think yes, there's a marketing problem, yes, there's a visibility problem, but I don't think they're that too that they're that difficult to solve.
• 15:40
  Michael: I think people just need to get together, and as you alluded to earlier, there's a little bit of toxicity within the podiatry profession, but not as much, I think, as in let's say physiotherapy, actually, or osteopathy.
• 15:53
  Michael: That's another one, right?
• 15:54
  Michael: I think there's there's more toxicity in infighting there than there is in podiatry.
• 15:58
  SPEAKER_01: Yeah.
• 15:58
  SPEAKER_01: Oh yeah, my dad, I I I will be sort of blindsided to a degree because I I see my own profession, I see the Facebook groups and everything that goes on.
• 16:07
  SPEAKER_01: I don't see the physiotherapy in other way.
• 16:09
  SPEAKER_01: You'll be in that fortunate position where you'll have a wider scope of the sort of the AHP land, as it were.
• 16:15
  Michael: I I would say there is more um communication and friendliness and networking within the podiatry community than there is now there in other days.
• 16:26
  Michael: Whenever I speak to any podiatrist, I'll mention 30 of our other pod clinics.
• 16:30
  Michael: They're like, oh yeah, I know him really well.
• 16:32
  Michael: Oh yeah, we went to dinner, oh we went for drinks.
• 16:34
  Michael: You don't get that in other professionals.
• 16:36
  Michael: I and I think you are also way more open to sharing advice.
• 16:40
  Michael: I I remember Rachel Green's one of our customers who's one of my favourites, other than you, of course.
• 16:45
  Michael: Rachel Green's an up there, and she's gonna be doing a pod in in the next few weeks.
• 16:54
  Michael: Yeah.
• 16:55
  SPEAKER_01: Hey Shara, she's there.
• 16:57
  Michael: But I remember we had another client and it's it escapes me now, but just opening a brand new clinic, and I put them in touch, and Rachel was more than happy to go for a cup of coffee and help out and give advice.
• 17:08
  Michael: The amount of of that that I see is really impressive in the pediatrician industry.
• 17:13
  Michael: And conversely, the amount of physios that I and I don't want to pick just on physios, uh just using that as more of a general term, the amount of physios I see who say, Don't tell anyone else what I'm doing.
• 17:24
  Michael: I just literally the other day I was asked to sign an NDA because they didn't want anyone to know their secrets.
• 17:29
  Michael: You know what the secret was?
• 17:30
  Michael: Shockway for runners.
• 17:32
  Michael: Anyway, it's like um about five years too late, my friend.
• 17:35
  Michael: Okay.
• 17:35
  Michael: But um, but in any case, it it is interesting to see that you do have a really nice community.
• 17:40
  Michael: You do all um often, not all, but many of you do work together and chat and you are pushing for the same things.
• 17:46
  SPEAKER_01: Maybe you're just all too bloody busy so you don't get together properly and kind of Yeah, it you're right, because before I had kids, I used to run like a I used to be on like the chair of the committee of the local podiatry branch, and I used to run like an MSK UK thing, and we used to get together and have like week, monthly, quarterly meetings, and and even now, I'll still get messages from people asking for tips and advice on things, and I'll still just open up until I'm a very open book kind of chap.
• 18:18
  SPEAKER_01: I will still because I I view it as that people turn around and say, Oh, you're giving your competitors an edge.
• 18:22
  SPEAKER_01: No, I'm not, you're helping grow the profession because we need more awareness out there.
• 18:27
  SPEAKER_01: There's enough bloody feet out there to go around for all of us.
• 18:29
  Michael: It doesn't I I wish I wish other clinics saw the same thing.
• 18:33
  Michael: I I had someone the other day say, Oh, I don't want you working with with anyone else within 30 miles of me or 50 miles.
• 18:39
  Michael: And I'm like, listen, there are enough patients to go around, and quite honestly, we don't take on clients who are like that.
• 18:44
  Michael: I want people who are collaborative.
• 18:46
  Michael: You know, I want someone that was up in Scotland moaning about the you know, they didn't want any someone in Southampton knowing what they're up to.
• 18:52
  Michael: And I'm like, that's not how this should be working.
• 18:54
  Michael: Like, if you don't think the the chairman of Vodafone and BT don't sit together for lunch and discuss things, you're wrong.
• 19:00
  Michael: They do.
• 19:01
  Michael: And I think it's really important.
• 19:02
  Michael: Great, it's great that it actually does happen in this industry.
• 19:05
  Michael: And and I think I wish more clinic owners in other sort of disciplines could learn from pediatric clinic owners because I think the information that you can share is so valuable and so important.
• 19:16
  Michael: I always talk about in many sort of disciplines in the sector, it's very difficult to benchmark, it's very difficult to know how others are doing.
• 19:22
  Michael: So you are almost like a little island and you're always prepping yourself, oh my god, my business is falling over because you've had a bad month, or you know, I I don't know what to do here.
• 19:30
  Michael: But in in your area, I think there's always someone to pick the phone up to or ask, right?
• 19:35
  Michael: There's always someone where you can say, What do you think?
• 19:37
  Michael: I'm having a problem with this, I'm having a problem with that.
• 19:39
  Michael: And I think that's that's super important.
• 19:41
  Michael: A massive credit to the people, at least who I know and have experienced, who are podiatry clinicans.
• 19:47
  SPEAKER_01: Yeah, I know I have now got some very good friends that are podiatrists.
• 19:50
  SPEAKER_01: Someone's help some have helped mentor me, some have been there when I've had an issue to pick up the phone to.
• 19:56
  SPEAKER_01: There's always a good list of people I know that I could phone.
• 20:00
  SPEAKER_01: And they'll either pick up the phone or ring me back within a day saying, Hey Nick, what's up?
• 20:04
  SPEAKER_01: And I can talk stuff for you, use my soundboard, and we can bash something out.
• 20:08
  SPEAKER_01: And and it's great just to have that ability to do that.
• 20:11
  SPEAKER_01: So that is again one of the beautiful things of that, of the profession, is that we we are all we've got this common goal of just want to help people get better.
• 20:21
  SPEAKER_01: And I think if you speak to most podiatrists, it's a case of we want the profession to thrive, but we're not quite sure what's the best way to go about it.
• 20:30
  SPEAKER_01: And I think I've been guilty in the past of not reaching out and realizing, I want to try and do this, I want to try and do my marketing for an kayactive.
• 20:38
  SPEAKER_01: Realize, do you know what?
• 20:39
  SPEAKER_01: It's not my forte.
• 20:40
  SPEAKER_01: I'm not great at it.
• 20:41
  SPEAKER_01: Tried a few other things, and then found HMDG, and it has been transformational for us because that's what you guys do.
• 20:48
  SPEAKER_01: So it's collaborating and it's finding those different people with different skill sets.
• 20:52
  SPEAKER_01: So you basically got the right bum on the right seat at the right time.
• 20:55
  SPEAKER_01: It's almost like rule one-on-one of running a business, isn't it?
• 20:57
  SPEAKER_01: I'm just like, and if you can do that, things will fly.
• 21:00
  Michael: I always say this is why I I never did my own accounts.
• 21:03
  Michael: Like I can work a spectrum just but let an expert do it.
• 21:06
  SPEAKER_01: But it's if you had to do mine during the pandemic, and my practice manager, I reckon she would have just shot me because she sort of said, Nick, every every time you're on payroll, it was like a few pence out.
• 21:15
  SPEAKER_01: And she said, It's fine, no one really noticed, but it creates a havoc on the accounts on the back end.
• 21:20
  SPEAKER_01: So I'm banned from doing I'm banned from doing admin, I'm banned for doing accounts.
• 21:24
  SPEAKER_01: So it's not good enough.
• 21:25
  Michael: When you first started with us, and I and obviously we got very close over the years, and uh, so I know all those numbers.
• 21:30
  Michael: It wasn't that you were doing necessarily badly, um, but it was again just a visibility problem.
• 21:36
  Michael: You had this incredible business, incredible people, you and and so on and so forth.
• 21:40
  Michael: But it was just it was that visibility again, right?
• 21:43
  Michael: It was that education, it was getting out there in front of people, letting people know what you do.
• 21:47
  Michael: So yeah, I won't get into it too much, but there are a few uh sort of early discussions where you're like, oh, this is really fucking not bad, but oh, I just want to grow a bit more, I want to let more people know about us.
• 21:59
  Michael: And and it wasn't that difficult, was it?
• 22:01
  Michael: It took a little while, but yeah, it's been it's been really interesting.
• 22:06
  Michael: And I think it's very easy if if there's pods listening who do routine and they're like, I don't understand, we're really, really busy.
• 22:13
  Michael: You can get very busy on routine pediatry.
• 22:16
  Michael: That's easy.
• 22:17
  Michael: It's getting busy on the on the fun stuff, on the more complex stuff.
• 22:20
  Michael: Um, because again, I think the majority of people just end up at the physio and not really know what a pod does.
• 22:25
  Michael: Let's talk about tech and go on to something controversial here because I love a bit of tech.
• 22:29
  Michael: I I I really do, and I think that tech is underused in in much of healthcare.
• 22:36
  Michael: I I can't believe that you you don't have at this point in every GP surgery an AI that tells you to bugger off and Timmy's got a cold rather than coming in for an appointment.
• 22:46
  Michael: I think there should be full AI triage and doctor support and doctor surgeries and so on.
• 22:50
  Michael: But but Dietry has been very good at adopting um new technologies, and there's also some really great businesses out there.
• 22:58
  Michael: Um I was just at the Gate Emotion event and and the guys there, they're fantastic, really, really enjoyed that event.
• 23:04
  Michael: You know, they've done a lot, I think, to to to push a lot of technology.
• 23:08
  Michael: But something that is often true is the first thing is you can spend a lot on the technology and the ROI isn't always there.
• 23:17
  Michael: And I think a lot of people lose money.
• 23:19
  Michael: Um, and then I think also beyond that, well, let me ask you a question without slamming any particular business or whatever, how much of the tech out there is just absolute fluff and nonsense?
• 23:31
  Michael: And how much of it is useful?
• 23:33
  Michael: And and I guess another way of asking that question would be what could you not do without in terms of running your business and your clinic?
• 23:40
  SPEAKER_01: Okay, so we purely look from a tech perspective, and yeah, I'm not it's one of those things, doesn't it?
• 23:48
  SPEAKER_01: Do we need to look at it a slightly different way?
• 23:50
  SPEAKER_01: Aiva is that all I think tech has a place, but it's truly understanding what that tech does and using the tech in the right way.
• 23:58
  SPEAKER_01: I think there are many people guilty of having tech and saying it will do something, but that what it wasn't designed to do the thing they're asking a question for.
• 24:10
  SPEAKER_01: So it's not the tech issue, it's the person using the tech in the wrong way.
• 24:15
  SPEAKER_01: I think there is lots of stuff, there are lots of different types of case analysis kit out there.
• 24:20
  SPEAKER_01: I don't think none of them are inherently bad or or wrong, but I think how sometimes we use data to then try and then sell something.
• 24:32
  SPEAKER_01: It's a case of, well, you're saying, oh no, so you take 2D gate analysis, for example.
• 24:36
  SPEAKER_01: And 2D gate analysis, people are asking, okay, what's the best tech to use for a 2D gate?
• 24:41
  SPEAKER_01: And I'm like, personally, just use your bloody iPhone now.
• 24:44
  SPEAKER_01: Actually, you don't need anything more, it's got slow motion settings, slow down on them, but then I get frustrated when people then start drawing angles on there because you can't determine sort of rotation on a 2D camera.
• 24:56
  SPEAKER_01: You're just guessing, you can't you can't do that.
• 24:58
  SPEAKER_01: So, yes, use a tech, but you've got to understand the limitations of the tech and what it can and can't do.
• 25:03
  SPEAKER_01: I think there are some times where actually tech may get fluffed up where actually just go back to using something completely basic.
• 25:09
  SPEAKER_01: You don't need to do stuff.
• 25:11
  Michael: I I suppose it sort of allows I I think one of the issues with any tech in any industry really, but particularly in in this, is is the you can use the tech to then generate revenue.
• 25:24
  Michael: So I remember many years ago, yes, uh, I was my my ex-girlfriend at uh girlfriend at the time, she was doing the marathons, so she wanted to buy some new trainers from the Nike store in Oxford Street.
• 25:33
  Michael: So we went up to the top where they had all these bloody expensive shows, and they had like a gate analysis thing set up, and they made a run on it and they started drawing all these angles, and they were like, right, this is the shoe that you need.
• 25:43
  Michael: And I was a little bit dubious at the time, it was like a 400-pound shoe, but it was really interesting because everyone was queuing up for this thing to just understand what was the best shoe.
• 25:51
  Michael: And of course, they had no idea, they were just kind of pointing at shoes.
• 25:54
  Michael: But you can use technology a lot to oversell.
• 25:56
  Michael: And I guess you run into that or podiatry clinics could run into that same problem that chiropractic clinics often have, which is we've got an x-ray.
• 26:04
  Michael: Look, now you need 25 treatments to solve a non-existent problem.
• 26:10
  Michael: Um, I think there's a lot of that going on at the moment.
• 26:13
  SPEAKER_01: I think there is a lot of that going on at the moment.
• 26:16
  SPEAKER_01: It's just it's just me, I think, being true to yourself with the tech and really understanding, asking the question, okay.
• 26:21
  SPEAKER_01: So we've got a lot of tech in clinic.
• 26:23
  SPEAKER_01: We've got 3D gate systems, we've got strengths by numbers, fourth platforms and dynamometers, we've got an anti-gravity treadmill, we've got our own 3D printer, we've got lots of stuff in clinic, but it's understanding a what's the right time to use it for the right person.
• 26:38
  SPEAKER_01: And I think it's always asking the question before I do any 3D gate on someone is what's the question I want to answer?
• 26:44
  SPEAKER_01: If I can't answer that, then it's not the right time to use that bit of tech because with any form of gait analysis, you could pick holes in anyone's gate, but it doesn't actually mean it's going to be a problem for them.
• 26:56
  SPEAKER_01: It's actually making it relevant to the problem, or is it going to actually change or impact the treatment plan?
• 27:02
  SPEAKER_01: This is why we don't let people book in for a gait analysis, they've got an injury straight off the bat.
• 27:07
  SPEAKER_01: A lot of patients come and say, I've been told I need a gate.
• 27:10
  SPEAKER_01: Well, actually, if you come and you've got an Achilles problem, you've gone from no running to running 100 miles a week, you don't need a gate.
• 27:16
  SPEAKER_01: You just need a bit of education about load management.
• 27:18
  SPEAKER_01: Your gate's not the issue, it's the fact you went from zero to a hundred in the course of a really short period of time.
• 27:26
  SPEAKER_01: Your gate's almost irrelevant.
• 27:28
  SPEAKER_01: So it's understanding when to use the tech.
• 27:32
  SPEAKER_01: We don't necessarily on every initial appointment, we don't do a 3D gate or a pressure analysis on every single patient that comes through the door because not every patient actually needs it.
• 27:43
  SPEAKER_01: So it's like you just then, in my mind, is you just use a tech for the patients needed at the right time.
• 27:49
  SPEAKER_01: But it's also you you've got to be true to yourself because it is very easy to try and say, I've got this thing that gives me lots of flashy images and it looks very pretty and great, and charge a little bit extra and actually see all these people coming in.
• 28:02
  SPEAKER_01: But actually, how many people need all of that?
• 28:04
  SPEAKER_01: That's it.
• 28:05
  Michael: It's always this this is uh it's a never-ending question, is it it's that balance between generating revenue and treating the patient at the right level for the best outcome?
• 28:15
  Michael: And I think everyone has this issue, everyone has this this problem.
• 28:18
  Michael: You know, you just bought bought yourself a laser.
• 28:21
  Michael: There's a lot of clinics, they they need to pay for it, so they laser the shit out of everybody for everything, right?
• 28:26
  Michael: It's it's one of those things, but there is always that balance, and I think it's sometimes quite difficult to strike, particularly, you know, we're we're talking here of uh businesses where the margins are not massive, right?
• 28:36
  Michael: It's it's not like you're making a thousand pounds lifetime value of a patient.
• 28:40
  Michael: Well, maybe sometimes be, but it is a difficult one, and you you need to monetize it, right?
• 28:44
  SPEAKER_01: You need to get an ROI on the kit that you've you've but it is it's that's the risk when you buy tech.
• 28:49
  SPEAKER_01: It's like if you give someone a hammer, everything becomes a nail.
• 28:52
  SPEAKER_01: As soon as you buy a bit of tech, you are already financially invested in actually, are you more likely to recommend it because you've brought it and you think, shit, I've got to make all this money back and everything on those lines.
• 29:04
  SPEAKER_01: But to go back to your question, one bit of tech I couldn't be without, it would be our dynamometers and force plates, but not for the reason that people think.
• 29:13
  SPEAKER_01: And I think a lot of tech, we think about it in the wrong way.
• 29:17
  SPEAKER_01: What I absolutely love about dynamometers and force platforms is the ability to help educate the patient.
• 29:24
  SPEAKER_01: So if we are someone's coming with an Achilles problem, we're saying, like, right, we need to go through a rehab plan and actually we need to focus on some strength around the hips, they're like, why do I need to do that?
• 29:34
  SPEAKER_01: Well, actually, if we can use some data to show them, like, actually, yeah, I get it.
• 29:38
  SPEAKER_01: And they then get they get what I call emotionally brought into the program, and you need them to do it because they're the ones doing the work.
• 29:44
  SPEAKER_01: I don't fix people, people fix themselves, I just take them on a road of discovery.
• 29:49
  Michael: This is absolutely crucial, actually, because um this has come up a lot recently where I keep getting asked, and we keep getting asked about retention.
• 29:56
  Michael: Retention, retention, retention.
• 29:57
  Michael: It pisses me off because if you are doing a great job, and we all have this, right?
• 30:02
  Michael: We we we have companies or whatever businesses that we love.
• 30:06
  Michael: We don't need to be retained.
• 30:07
  Michael: I'm sure there's plenty of people that have a hairdresser.
• 30:09
  Michael: They don't need to be retained, they just go back because it's a great service to so on.
• 30:12
  Michael: And I think one of the most important parts of retention and and getting the patient back is getting them to buy in and educating them.
• 30:20
  Michael: Because once you've done that, it doesn't become a problem, right?
• 30:22
  Michael: Because you get them to buy in exactly what you educate them, knowledge is power, and then they buy in pretty easily to what you're what you're suggesting that they do.
• 30:31
  Michael: And I think a lot of clinics and clinic owners forget this, they focus too much on my clinician isn't retaining, I need to do more retention and have retention strategies.
• 30:41
  Michael: Where in actual fact, if they kind of went back to the start and said, okay, let's look at the training element of this, are clinicians getting proper buying and are they educating enough?
• 30:50
  Michael: I think they would have far less of a problem.
• 30:52
  SPEAKER_01: Yeah.
• 30:53
  SPEAKER_01: Because the majority of our workload is MSK-based, I don't actually, as a metric, measure rebook rate past the first appointment because I'm like, in my our eyes, it's like well, I want to effectively discharge every patient we see.
• 31:07
  SPEAKER_01: And I've got a patient a couple of weeks back I hadn't seen for like 10 years come back because they had a different problem and they knew that.
• 31:14
  SPEAKER_01: So I'm like, well, if you offer like good service, we haven't got to worry about getting people through the door constantly.
• 31:19
  SPEAKER_01: And I'd also argue, so we have a rule, and it's something I actually stole from Dr.
• 31:23
  SPEAKER_01: Andrew Franken Miller, is that when we do a rehab plan, as it were, it's five sessions, after that five sessions, there's a break and a stop point.
• 31:30
  SPEAKER_01: Because by that time, we should either be seeing significant progress or they should be back to where they want to be.
• 31:37
  SPEAKER_01: If they're not, we need to sit there and ask, is the plan right?
• 31:40
  SPEAKER_01: Is the diagnosis right?
• 31:42
  SPEAKER_01: Are we the right people?
• 31:43
  SPEAKER_01: Do we need to refer on?
• 31:44
  SPEAKER_01: So you don't run in this cycle of actually having to sign up for 50 sessions and come in every week for the next year type thing, because that is just it's just criminal in my eyes.
• 31:56
  SPEAKER_01: Like in something with Moscow's collegial-based injuries, we know that actually you shouldn't be needing that number of sessions on a regular basis.
• 32:06
  SPEAKER_01: It's something that we have a duty of care of not overselling and fleecing someone, and that's when I get really irritated about practice.
• 32:14
  SPEAKER_01: I've got no I've got no issue of selling packages.
• 32:17
  SPEAKER_01: We sell packages of care, but there's a definitive start and stop, and there's a definitive plan of what we're going to do, and then after that, it is reviewed.
• 32:26
  SPEAKER_01: It's not just, oh, let's just keep this going on because I know I can get an extra few sessions.
• 32:31
  SPEAKER_01: And sorry, I'm ranting because it really annoys me.
• 32:33
  Michael: Well, within the next 24 hours, we're going to release something on packages, and we're going to slate anybody that uses them.
• 32:38
  Michael: I know you use them.
• 32:40
  Michael: Um you do use them slightly differently, though.
• 32:42
  Michael: But um, yeah, no, I I do agree.
• 32:45
  Michael: I think though, that again, there's always this sort of balance, and I look at this slightly more from a patient position.
• 32:51
  Michael: Um, and I'll give you a real example.
• 32:53
  Michael: And I was talking to Mark about this this morning where I had a neck issue.
• 32:57
  Michael: Uh, this is for Mark.
• 32:58
  Michael: Mark Mark's a physio that now works for us, but uh at the time he was my physio uh for this neck condition, and uh it was a three-month condition, I was gonna be fine.
• 33:08
  Michael: And he ethically could have said, Michael, one appointment per month, three three appointments, that's all you need.
• 33:14
  Michael: And that would have been very ethical, and that would have been the way to do it, and that's all I needed from his perspective.
• 33:20
  Michael: However, from my perspective, I was in real pain.
• 33:23
  Michael: I was worried, became very stupid as you do when you're in pain.
• 33:27
  Michael: And I remember once having a session with him where I just said, Mark, um, every time I sit like this, it really hurts.
• 33:33
  Michael: And he went, Don't fucking sit like that then.
• 33:35
  Michael: And and obviously to most people listening, they're like, Yeah, it's obvious advice.
• 33:38
  Michael: But for me, it wasn't.
• 33:39
  Michael: I was like, I was in pain.
• 33:41
  Michael: And so I do think that sometimes clinicians can forget that patients may want something that they don't necessarily need.
• 33:49
  Michael: And I don't mean when a patient says, I need 200 massages to release my trap.
• 33:53
  Michael: Nerve, that's fucking stupid, and no, you've got to educate them.
• 33:56
  Michael: Sometimes patients do want a little bit more help or reassurance or whatever.
• 34:02
  Michael: I do think that there is sometimes a tendency to be too ethical, too black and white, and say, no, that's all you need.
• 34:09
  Michael: You don't need to come back, bugger off.
• 34:10
  SPEAKER_01: Yeah.
• 34:11
  SPEAKER_01: I think it's all about giving patients being clear and giving patients choice and options.
• 34:15
  SPEAKER_01: So we will do packages and we'll have our rehab accuracy five sessions over three to four months, and that only come out from our own audit data which works for our population of data that we see.
• 34:26
  SPEAKER_01: We'll offer patients that, but we'll also say, if that's not right for you, you can just do it session by session basis.
• 34:33
  SPEAKER_01: We'll give them options.
• 34:34
  SPEAKER_01: I won't let them make a decision that I think is detrimental to them.
• 34:38
  SPEAKER_01: And you get some patients who are like, need a bit of hand holding.
• 34:41
  SPEAKER_01: You've got some patients who are like, actually, we'll do the strength test and we'll give them a program and they'll fly that and we don't need to see them again.
• 34:48
  SPEAKER_01: It's just giving those, it's understanding.
• 34:50
  SPEAKER_01: We're as human beings, we all have different needs.
• 34:52
  SPEAKER_01: We all I'm someone, even though I know what I'm doing, if I've got an injury, the team had to write me a bloody programme, even though they because if I haven't got a program, I just won't do it.
• 35:00
  SPEAKER_01: I'm just that type of person.
• 35:02
  SPEAKER_01: So I'm that person and I need that rigidity.
• 35:04
  SPEAKER_01: You get some patients who are much better and don't need that.
• 35:07
  SPEAKER_01: You've got some who are a little more nervous.
• 35:09
  SPEAKER_01: And I think we we do have to be aware that there's almost not vulnerability, but you're getting patients coming who've got pain, they've got a problem, or they can't do the sport, or they can't do the exercise leather they want.
• 35:21
  SPEAKER_01: So it's almost like their guard is down slightly, and I think we've got to be careful that we don't scaremonger into people doing stuff they don't need to be doing as well.
• 35:32
  Michael: Agreed.
• 35:32
  Michael: I just sort of as a side note, something we've been seeing a lot more of recently is patients turning up in clinic incredibly well educated with a rehab program in hand because they asked their best made chat GPT.
• 35:45
  Michael: How much of that are you seeing?
• 35:46
  SPEAKER_01: We're starting to see more of it, but actually I love it because it is when I start discussing to them about different treatment options, is they've got a bit of understanding, it's not a complete shock to them.
• 36:00
  SPEAKER_01: And actually, for us, the use of AI is helping us solve some of our visibility issues.
• 36:06
  Michael: You know what?
• 36:06
  Michael: I just want to jump in because that that's I love hearing that, and I love that attitude because it's fucking pissing me off right now.
• 36:13
  Michael: AI is being battled against by so many clinic homers, it's such a pushback against it, and and oh, it's never gonna help us, it's never gonna, it's never gonna take over from us because we're too good and nothing will diagnose as well as we have.
• 36:26
  Michael: We we have the human pisses me off because it's bullshit.
• 36:29
  Michael: What I've seen is really interesting is that there are a number of people who are just so anti-kind of innovation and AI and so on, and then people like you who are like, I love it.
• 36:40
  Michael: There is an opportunity, we can utilize it, whether it's in clinic or with patients or whatever.
• 36:46
  Michael: And I think that's it's just so refreshing to hear someone say, I love it, and and and we can really utilize it.
• 36:53
  Michael: And it'll be really interesting.
• 36:54
  Michael: We're gonna be doing some some stuff with our innovation lab, which we're gonna announce at some point in Jan.
• 36:59
  Michael: I'll I'll talk to you that about that privately.
• 37:01
  Michael: Uh, I can't launch anything here live, but where we really want to start looking at the exploitation of using various things to really enable um uh again, a drive forward within the industry.
• 37:14
  Michael: I just think there's I don't I don't think there are enough people who see things as opportunities in this industry.
• 37:19
  SPEAKER_01: Oh, and I think if we go back our earlier thing about how do we help promote a podiatry as a profession, I think AI could just accelerate that massively.
• 37:30
  SPEAKER_01: I've even tried it myself of like, right, I've got a foot and ankle problem, frame ankle playing football, I'm in the Romsey Southampton area, who do I go and see?
• 37:38
  SPEAKER_01: And NKECTIVE was one of the recommended things.
• 37:40
  SPEAKER_01: And I said, hang on, you've recommended a podiatrist, don't I traditionally need a physio?
• 37:46
  SPEAKER_01: And this is nothing against physio, this is what the public normally perceive.
• 37:50
  SPEAKER_01: And they said, Yes, we think that, but actually NKActive is a specialist foot and ankle clinic, and this is their rehab approach, and they take a real personalised approach where actually we think they're possibly a better outfit for what you want for you.
• 38:02
  SPEAKER_01: And I was like, This is gonna be so so helpful to like help that education and awareness.
• 38:10
  Michael: We do your AI SEO.
• 38:12
  Michael: You do.
• 38:12
  Michael: Ah, so something we've seen a lot of, and the reason we we're doing AI SEO, it's it's it's a bit of a sidetrack, but it is important.
• 38:20
  Michael: But patients are starting to there's this big behavioral change in what patients are asking.
• 38:26
  Michael: And we do it ourselves, right?
• 38:28
  Michael: We well it you know, a few years ago you you might say, I want a kettle, um, and do a search for that.
• 38:33
  Michael: Now you're searching, I'd like a kettle, I've got black worktops, my kitchen's green, what's what would fit best into an interior design, blah, blah, blah.
• 38:41
  Michael: I want something as economical, yaddy, whatever the question is.
• 38:44
  Michael: And what we've seen in in healthcare is patients asking an initially simplish question and then asking more sort of complex questions because they're being pushed to it by by the AI, and then ultimately asking really interesting questions where AI gives them answers like yes, go and see NICA NKActive because XYZ, and and would you like me to tell you what you might expect and what the rehab program might look like?
• 39:12
  Michael: And so patients are you know coming through, and and by the way, I did it recently with a a plumber um with our heating and and nest and whatever.
• 39:20
  Michael: And I was like, I want to know what's what's coming my way, I want to be informed before they turn up.
• 39:24
  Michael: So when they try and charge me a grand, I know to start off.
• 39:27
  Michael: So it is an it it is really interesting.
• 39:29
  Michael: I think again, another massive opportunity.
• 39:32
  Michael: Um, because I think, although also a danger, because this is interesting, again a side point, but I think my opinion is particularly when it comes to general MSK, 80% of patients who go and see a physio probably don't need to go and see a physio at that point.
• 39:50
  Michael: Probably 90% of that 80% are better on their own within a week, or at least starting to progress, right?
• 39:57
  Michael: So, what happens when you say, I've just fallen over, I've tripped Over, my ankle's a bit um blue.
• 40:03
  Michael: Should I go and see a physio?
• 40:04
  Michael: And AI says, not yet.
• 40:06
  Michael: Don't worry about it.
• 40:06
  Michael: Can you walk four steps?
• 40:08
  Michael: Yes, I can.
• 40:08
  Michael: Or no, I can't.
• 40:09
  Michael: Don't worry about physio.
• 40:10
  Michael: Go to any.
• 40:11
  Michael: I think AI is now dissuading a lot of patients to use MSK services and saying, wait a little bit.
• 40:16
  Michael: Because that's also interesting.
• 40:18
  Michael: I think that's going to have a bit of an impact.
• 40:20
  SPEAKER_01: I think that is interesting.
• 40:21
  SPEAKER_01: Luckily, well, we currently don't have that issue in podiatry because pediatrics is normally the last profession people go to.
• 40:26
  SPEAKER_01: They've normally been to see everyone else first.
• 40:29
  SPEAKER_01: So by the time they phone us up, yes, you do need to see us because this is now a chronic type thing.
• 40:34
  SPEAKER_01: Um, but I still get some patients message us saying, Oh, I've just tweaked my calf muscle on even point.
• 40:39
  SPEAKER_01: I'm like, no, you don't.
• 40:40
  SPEAKER_01: Give it a couple of weeks.
• 40:41
  SPEAKER_01: If you still want an issue in a couple of weeks' time, or they'll turn and say, Oh, I went out for a run, my legs hurt, and I was like, You just got DOMs.
• 40:48
  Michael: Nick, you are the least businessy businessman I've ever met.
• 40:50
  Michael: Bloody hell.
• 40:51
  Michael: I know you need to pay me 500 pounds for an assessment.
• 40:55
  SPEAKER_01: But I'm just not like that.
• 40:57
  SPEAKER_01: This is why this is why I'll never be a sort of retiring in Barbados with multiple mansions type things because I just if it keeps going as it is.
• 41:06
  SPEAKER_01: Yeah, so so it's definitely um there are lots of things I think AI is going to be really helpful for, and I think the awareness is I think gonna be great for podiatry.
• 41:16
  SPEAKER_01: I think also though, is that if you're not operating at the top of your license, like I said earlier, I think AI may find you out.
• 41:25
  SPEAKER_01: Because if a patient comes in with an expectation and you try to offer them something non-evidence informed and non-evidence-based, I think patients are gonna sort of question you about that.
• 41:36
  Michael: Yeah.
• 41:36
  Michael: Did you read my last newsletter about that?
• 41:39
  SPEAKER_01: I did, yeah.
• 41:40
  Michael: There's it's really interesting.
• 41:41
  Michael: There's a lot of clinics, I think, that are gonna have to start removing some of what they say and not offering certain things for certain things they've been offering it for.
• 41:50
  Michael: And we're seeing it more and more.
• 41:51
  Michael: And you can test it yourself.
• 41:52
  Michael: Um, you know, should I go?
• 41:54
  Michael: My physio says I need cupping to solve my chronic lower back pain, get a new physio.
• 42:01
  Michael: You you it it is really interesting because obviously um GPT is plugged into NICE, it is plugged into the Cochrane Research PubMed and so on.
• 42:10
  Michael: So you've got to be careful what you're offering.
• 42:12
  Michael: And if you do get a client into the clinic, and and we have this as well ourselves, right?
• 42:16
  Michael: If it and we've seen clients do more and more of this, they're putting their stuff through or saying, Michael said this, or Gabby said this, is this you know, is this legitimate advice?
• 42:25
  Michael: And GPT, uh hopefully always says, in fact, we keep getting reports by going, GPT says you're doing really great stuff.
• 42:30
  Michael: I'm like, thank you.
• 42:32
  Michael: We know, but it is interesting because if we started saying Nick, you need to start paying£3,000 a month for this crazy new thing, you put it into GPT and you'd find us out pretty quickly.
• 42:41
  SPEAKER_01: Yeah, you would do.
• 42:43
  SPEAKER_01: And it is, I think it is interesting that it will it will help accelerate people's learning and understanding of things.
• 42:50
  SPEAKER_01: I think the only thing is healthcare we've got to be wary of is having that critical appraisal mindset of just making double checking the information it's giving is true.
• 43:01
  SPEAKER_01: But I think as AI develops, that will get better and better.
• 43:04
  SPEAKER_01: It will learn to weed out the crap basically over time.
• 43:08
  Michael: So I think so, and and I still check, I use GPT for pretty much everything in my life now.
• 43:12
  SPEAKER_01: But even people say I don't use it, but actually now it's integrated into Google's main search.
• 43:18
  SPEAKER_01: It is there.
• 43:19
  SPEAKER_01: Yeah, yeah.
• 43:20
  SPEAKER_01: You may not use GBT, but Google integrates it on the search bar, it will give you AI response, and then you've got that little AI D perview button or whatever it's called.
• 43:29
  Michael: Yeah, it it's it's it's everywhere.
• 43:31
  Michael: And I was chatting to uh my financial person, whatever.
• 43:34
  Michael: I just do all my financial investment stuff myself now.
• 43:37
  Michael: And he said, Yeah, do it, you're gonna get better results than we are, and what half percent fees.
• 43:42
  Michael: It's happening in every profession, but quite honestly, and I know that there's this, I heard this thing the other day from a physio saying, Ah, but it it's not gonna be accurate, it's not gonna be it, it's gonna sometimes be inaccurate and give you bad advice.
• 43:54
  Michael: I would personally pit GPT against any 5,000 physios, random 5,000 physios.
• 44:00
  Michael: I keep using the term physio, I'm gonna say a mistake clinician said, um, and I would bet that GPT wins overall in terms of applications.
• 44:06
  SPEAKER_01: Well, wasn't I think there was a study done where they pick some images of X-rays or MRIs and they they put that against radiologists, and AI wasn't too far off in picking up the same diagnosis.
• 44:19
  SPEAKER_01: And and I think, but it's human nature, we're scared of change, isn't it?
• 44:22
  SPEAKER_01: I think if we were had the ability to do this during the Industrial Revolution, or when computers first come out, or when the internet was first introduced, everyone was like, Oh, it's not gonna take off.
• 44:32
  SPEAKER_01: Blockbusters made a mistake of not buying Netflix, oh that's never gonna work.
• 44:36
  SPEAKER_01: Well, look at it now, type thing.
• 44:37
  SPEAKER_01: It's sort of like it's one of those things that I've just learned over time that there is nothing we can do to stop this AI train whatsoever.
• 44:45
  SPEAKER_01: It is coming along, so you've either got to jump on board and learn how to work with it or get left behind.
• 44:50
  SPEAKER_01: And going back to your comment of people coming in with rehab plans, that doesn't phase me whatsoever because it's not, and the thing that AI can't do is the intricacy of learning about that individual human being.
• 45:02
  SPEAKER_01: I say we we published some of our data, we've done a little poster presentation, a conference about it.
• 45:07
  SPEAKER_01: And when you talk about rehab, the actual physical exercise or the technique doing that exercise is most probably the least important thing.
• 45:15
  SPEAKER_01: The important thing is actually just bloody doing things on a consistent basis, and the important thing in doing that is actually getting to know the human being attached to it.
• 45:23
  SPEAKER_01: So you actually, yes, you've got a program.
• 45:25
  SPEAKER_01: Anyone can go on YouTube and get a program, but actually, there's one thing getting the program, doing it is so when I do any stuff, when people say to me, Oh Nick, what's the best exercise for X?
• 45:36
  SPEAKER_01: And I'm like, that's the wrong question.
• 45:38
  SPEAKER_01: Get to know the human being first, find out what their barriers are, and then you can implement that plan and tell them how to how to do it.
• 45:46
  Michael: I I think that that there are those nuances, and I think there is that that understanding and knowledge of the person.
• 45:52
  Michael: I I have a private doctor, and I said, uh, I sent them a WhatsApp and I said, Um uh I'm worried about my younger son, uh James, and she said, Go to A and E.
• 46:01
  Michael: And I was like, What?
• 46:02
  Michael: She said, Michael, you never worry about anything.
• 46:04
  Michael: If you're contacting me worried, it's a problem, go.
• 46:07
  Michael: And she was right.
• 46:08
  Michael: It was fine, there's nothing wrong with him in the end.
• 46:10
  Michael: But it's it's it it was really incredible that she knew who I was, and and and to be able to not have to even think and just go, right, this is what you need to do.
• 46:19
  Michael: And I think that's what AI can't yet do.
• 46:21
  Michael: I think it will look in.
• 46:23
  SPEAKER_01: But yeah, and but it's like even during consultations with patients, I used to sit there with a notepad and pen and write notes as I went.
• 46:30
  SPEAKER_01: Now it's like I don't, I can sit there and just listen.
• 46:33
  SPEAKER_01: And patients love it because I can just pay more attention to them and listen to them.
• 46:39
  SPEAKER_01: And I think if you want to get better at MSK stuff, it is yeah, learn to use your ears more, yeah, because and ask the right questions.
• 46:45
  SPEAKER_01: And that's as complex as it is.
• 46:47
  SPEAKER_01: You can look at all your fancy tests and everything, but until you learn to take a good history and and listen, you'd you're never really going to succeed how you want.
• 46:56
  SPEAKER_01: And AI allows me just to be more present with with the patient and not worry about the stuff afterwards.
• 47:02
  SPEAKER_01: And it's almost like you know, it's like if you're in a busy day in clinic and like you've made notes throughout the end of the day, and then you do your notes and letters, and like you try and do them as you go, but something cropped up, you need dilute, coffee or whatnot.
• 47:13
  SPEAKER_01: You get to the end of the day, you've got six, seven sets of notes to do.
• 47:16
  SPEAKER_01: Actually, how many errors was were you making while they were actually patient presented to their left hip pain when actually it was their right hip pain and stuff along those lines?
• 47:25
  Michael: Now AI just and we well, no, we use Fathom for all of our client calls now.
• 47:32
  Michael: So everything beautifully recorded, it's all there.
• 47:35
  Michael: It's it's changed our world, and and we're using so much way.
• 47:39
  Michael: We will do um we will be doing something really special on AI and the use of AI in businesses.
• 47:44
  Michael: So we'll we'll get into that another point.
• 47:46
  Michael: We I don't want to make this podcast too long because we can matter for hours, but there's a few topics I just want to cover and quickly.
• 47:54
  Michael: Yeah.
• 47:55
  Michael: One is let's talk orthotics, orthoses, and ethics.
• 47:59
  SPEAKER_01: Okay.
• 47:59
  SPEAKER_01: So I think foot orthoses are the most underused and overused products within a podiatrist treatment arm.
• 48:09
  SPEAKER_01: I think there's a lot of the time they're not used in the right times, but a lot of the time they're not used, that they're just overused too much.
• 48:17
  SPEAKER_01: I think it's and that comes down to again, like the tech question, it's not the orthosis fault.
• 48:24
  SPEAKER_01: It's actually the clinician not really understanding, okay, what is it that I want to achieve from this?
• 48:30
  SPEAKER_01: And it goes back to patients you saying, coming in and saying, Oh, I got a flat foot, I need orthoses to straighten you up because that's what Instagram stories told me.
• 48:37
  SPEAKER_01: And I'm like, Well, that's just utter trash.
• 48:39
  SPEAKER_01: That's not that's but it's one of those things it really grates me, and sometimes there's that relief with some patients, like, Nick, you're not going to offer me insoles.
• 48:48
  SPEAKER_01: No, you don't need insoles.
• 48:50
  SPEAKER_01: We got some data here that shows this is most likely a strength issue.
• 48:53
  SPEAKER_01: Insoles may be needed, but if we're playing an odds game, most probably 70% of your issue is strength and training related.
• 48:59
  SPEAKER_01: So let's focus on the big bit.
• 49:00
  SPEAKER_01: We may go to all thirties at our later stage if needed, but why jump for the 30%?
• 49:05
  SPEAKER_01: Let's start at the 70% because that's got higher odds of winning for you.
• 49:08
  Michael: I have a personal story on that.
• 49:09
  Michael: My eldest son, he's had flat feet from the age of like whatever, nine or ten or whatever, and his mum all the time constantly harassing me.
• 49:16
  Michael: We need to go and get an appointment.
• 49:18
  Michael: He's got inverted ankles.
• 49:19
  Michael: I don't know what inverted ankles are.
• 49:21
  Michael: Um, she's just read all this stuff, and every pod, I think it may be you, every pod was like, Does it hurt?
• 49:26
  Michael: No, then leave it the fuck alive.
• 49:28
  Michael: Like, just leave it.
• 49:30
  Michael: Eventually, it did hurt, and he got some knee pain, a bit of hip pain.
• 49:33
  Michael: So we went in and saw um Suzy Spears, who's really lovely kind of fantastic pod.
• 49:37
  Michael: Fantastic.
• 49:39
  Michael: Um, yeah, we went in and saw Susie, and yeah, we got some nice orthotics at that time, and it was great, and it solved everything.
• 49:46
  Michael: And but it was really interesting that there are so many people who just immediately think I need to go and buy some orthotics.
• 49:52
  Michael: And in fact, one of the biggest searches actually around podiatry is uh flat feet and orthotics, and that's why Amazon gets so much business selling itself and it actually just on that it does make me wonder why so few podiatry clinics market a peds or flat foot service because the the searches are there, and I think it's a massive moneymaker, even if it is a you don't need this, come back when this happens.
• 50:20
  Michael: I I think number one, you'd be doing a great job and saving parents a lot of money buying some really weird stuff and probably causing more issues than they're solving.
• 50:26
  Michael: Um, but number two, there will be some that will need um the service and you'll make a lot of money.
• 50:31
  Michael: So I do I I don't do you know why so few clinics are offering that or or marketing?
• 50:35
  SPEAKER_01: I I think it's just because if you look at the majority of the evidence out there, it is from purely from an evidence viewpoint is that most kids with flat feet don't need any intervention whatsoever.
• 50:47
  SPEAKER_01: But there's also, and that's what the the research says, there's also an element though of actually sometimes it's like you say with your your neck, don't don't sit in that angle.
• 50:56
  SPEAKER_01: You think it's bloody obvious, we think it's bloody obvious they don't need it, but actually patients and their parents sometimes don't need that, sometimes just that bit of reassurance is really helpful.
• 51:04
  SPEAKER_01: What I think is really, really simple to them is just like actually they just need that bit of reassurance.
• 51:10
  SPEAKER_01: That's my question.
• 51:11
  SPEAKER_01: And I think that's my question.
• 51:13
  Michael: So, for example, you've got all these chiropractors with the free spinal checks, complete nonsense.
• 51:17
  Michael: But I encourage physioclinics to offer spinal checks, not because they're in any way useful or doing them, because it gets patients in and they can say, Yeah, forget that, ignore it, what is the actual problem?
• 51:31
  Michael: And you then examine them and you keep people away from the dodgy chiropractor who's about to sell them 300 sessions.
• 51:37
  Michael: So even if it isn't needed, it's still a service that people would pay for and somewhere where you can do a lot of good and say, You don't need this, don't worry about it.
• 51:45
  SPEAKER_01: Yeah.
• 51:46
  SPEAKER_01: But I think a lot of the barriers come from our perception in the UK of charging for for healthcare.
• 51:53
  SPEAKER_01: I still think there's a barrier of some condition to like not we've got the NHS and we shouldn't be able to charge for this.
• 51:58
  SPEAKER_01: But I always look at and say, Well, it's not our job to decide what someone wants to pay or not pay for.
• 52:04
  SPEAKER_01: It's one of those things that you got a service, the patient will decide whether they value that to pay the set feel on that service, as long as you're not selling someone that someone someone doesn't actually need, so you're not giving every kid a set of phothosis.
• 52:18
  SPEAKER_01: But if that patient comes in and they have a checkup and you say to them, look, do you know what?
• 52:22
  SPEAKER_01: Yes, you got flat feet, but you're doing all the sport, all the exercise, you've got no issues.
• 52:26
  SPEAKER_01: I don't need to see you again.
• 52:28
  SPEAKER_01: Come back if you get an issue.
• 52:29
  SPEAKER_01: Patients are like, Thank you very much.
• 52:31
  SPEAKER_01: And so many people are grateful for that when I do that with them because they're like, I've had that bit of reassurance, I've had the checkup done.
• 52:37
  SPEAKER_01: It's like going to the dentist on a regular basis, isn't it?
• 52:40
  SPEAKER_01: You don't go to the dentist looking for a problem, you go to the dentist hoping to say you've got the AOK.
• 52:45
  SPEAKER_01: But if you haven't, you can act on anything that comes from it.
• 52:48
  Michael: Clinic owners all the time, and they're they're always judging what someone should be paying, how much it is it used to.
• 52:53
  Michael: Imagine if Ferrari said, you know what, let's not let's not do Ferraris anymore.
• 52:56
  Michael: You can buy a perfectly good feature over there, don't worry about it.
• 52:59
  Michael: It's it it's as long as you are not overselling, as we say.
• 53:02
  Michael: And I think it's a great service.
• 53:04
  Michael: For example, I was very lucky because I know about a billion pods who told me not to do anything with with Tom.
• 53:10
  Michael: But imagine if his mum had gone and you know, just bought those orthotics and seen specialists.
• 53:16
  Michael: It would have been great for her to go in and see someone and for them to say, no, you don't need it.
• 53:21
  Michael: And here's why.
• 53:21
  Michael: And you could cause more problems by doing something about it.
• 53:24
  SPEAKER_01: If people rock up with a bag of foot orthoses, I'm like, the last thing you need is another insult because the odds of all of them not being one of them being right for you is quite slim.
• 53:34
  SPEAKER_01: And but it's also actually asking what the patients want.
• 53:37
  SPEAKER_01: I've got some patients where I'm like, Do you I think foot orthoses would be helpful, but they're like, Nick, I just don't want to wear them.
• 53:42
  SPEAKER_01: I'm like, fine, let's not let's change tax and look at something else then because it's about asking the patient, are they comfortable having them?
• 53:49
  SPEAKER_01: Some patients have views on them and they don't want to change their views, which is completely okay.
• 53:54
  SPEAKER_01: It's their their choice, their decision.
• 53:56
  SPEAKER_01: So it's one of those things that, in my eyes, it is just another tool in the treatment box to help facilitate someone doing an activity they want to do.
• 54:04
  SPEAKER_01: Nothing more, nothing less.
• 54:05
  SPEAKER_01: It's the same with taping or different shoes, or there are many ways to skin a cat.
• 54:10
  SPEAKER_01: It's about trying to build the right plan at the right time for the right person.
• 54:14
  SPEAKER_01: But not every person who comes into clinic with a foot or a knee issue actually needs foot orthosis.
• 54:19
  Michael: Okay, last topic.
• 54:21
  Michael: Yeah.
• 54:22
  Michael: Foot health practitioners, a threat, awful, terrible thing, FHBs, or useful and good?
• 54:28
  Michael: Useful.
• 54:29
  Michael: I think amazingly useful.
• 54:31
  SPEAKER_01: Um, because if we're sort of thinking about what a podiatrist is and does, you've got this degree-level educated clinician that has this fantastic skill set.
• 54:42
  SPEAKER_01: And with the demands of the population out there, if you've got someone that needs general foot care health and advice, who has no medical issues, no complications, no concerns, you don't need a podiatrist.
• 54:56
  SPEAKER_01: The way I think of it is like hygienists and dentists.
• 54:59
  SPEAKER_01: It's sort of like if I've got a routine sort of clean or something needs my feet and I'm in good health, I don't need a dentist.
• 55:06
  SPEAKER_01: I don't need to pay, take the dentist's time, I don't need to pay a dentist fee, I can go see the hygienist.
• 55:12
  SPEAKER_01: And then the hygienist can then flag for the dentist if there's an issue.
• 55:16
  SPEAKER_01: I think though there's a lot of the podiatry profession that are threatened by FHP, but is that because are some of those podiatrists offering an FHP-based service?
• 55:26
  Michael: Um true, but let's take the hygienist analogy, let's say the hygienist sets up and starts doing fillings.
• 55:33
  SPEAKER_01: Ah, so I think that's not you can't blame a whole profession on that.
• 55:39
  SPEAKER_01: You can't blame if an FHP goes rogue, you can't say all FHPs are bad, like it's the same with So let me ask that question.
• 55:47
  Michael: Do you think it's because rogue implies very few, one or two?
• 55:52
  Michael: Do you think it's more of a trend within the FHE community that many of them are overstepping boundaries and doing things they really ought not?
• 56:00
  SPEAKER_01: So are they overstepping boundaries or are they trying to push because there's it there is no regulation and process?
• 56:07
  SPEAKER_01: I think that's when you get down to it, that's the big issue that most pods really have is the lack of boundaries and regulation for patients, uh public health and safety and awareness type thing of saying, right, an FHP can do this, this, and this.
• 56:22
  SPEAKER_01: And FHPs are doing more and more, but there's no regulations in there to suffer.
• 56:26
  SPEAKER_01: They're not governed by the HCPC, they don't actually have anyone to say, no, you can't do this.
• 56:32
  SPEAKER_01: It's like it's like facial fill isn't like that.
• 56:34
  SPEAKER_01: If you're a doctor or a nurse, you have to be registered with the CQC, but you could do a weekend course and not actually have to be registered with the CQC, and your CQC can't do anything protective.
• 56:44
  SPEAKER_01: So I think it's a wider public um safety awareness type thing, and then you need better sort of restrictions in place and clear guidelines on what people can do.
• 56:55
  SPEAKER_01: I would love FHP to be taken under the HCPC wing to be able to then turn around and say, actually, this is where they sit and the and people educators around it.
• 57:05
  SPEAKER_01: But I think you're also saying that you're going to get other podiatrists that branch off and do things that aren't podiatry related or physios trying to do stuff.
• 57:14
  SPEAKER_01: And unlike sometimes, just stay in your bloody lane, focus on what you're good at, maybe spend more time doing the stuff that you should be doing, get better at doing that rather than worrying about other things as it were.
• 57:24
  SPEAKER_01: So I've got no issue with them, but I do think there is a need for better regulation out there just so you can help offer clarity to people.
• 57:33
  SPEAKER_01: But the majority of FHPs that I know were well within their scope of practice, I trust what they do and they refer on as and when needs.
• 57:41
  Michael: I and I think clinics should certainly be hiring FHPs.
• 57:44
  Michael: I think it makes a lot of sense.
• 57:45
  Michael: What I'm seeing a bit of a trend of is other disciplinary clinics, let's say physios again, hiring FHPs and then claiming they have a podiatry service.
• 57:58
  Michael: They can't find a podiatrist, so they move to the FHP and then they say, Oh, yeah, we do podiatry.
• 58:03
  Michael: Um now they may not say it publicly, but certainly internally, oh, we now do podiatry.
• 58:06
  Michael: And it's like, I think that's where it becomes a little bit of a problem.
• 58:09
  SPEAKER_01: I think, yeah, that becomes an issue, but it's sort of technically where are they actually breaking any rules?
• 58:17
  SPEAKER_01: And it's not so much that I'm thinking more than it's more the deception that I don't like with that.
• 58:23
  Michael: It's from the patient perspective.
• 58:24
  Michael: So I I spoke to a clinic not so long ago who said, Oh, we've just got a health practitioner, so we want to run some podiatry ads.
• 58:30
  Michael: And so, well, we're not going to run podiatry ads because they're not podiatrists.
• 58:34
  Michael: And they said, It's the same thing.
• 58:36
  Michael: I'm like, I'm not sure I agree, and I'm not sure many pods would agree.
• 58:40
  SPEAKER_01: It's not it's not the same thing.
• 58:42
  SPEAKER_01: It's like we don't we we uh don't employ physiotherapists, we have GSRs, and we've had many conversations about that how much easier it would be to market the word physiotherapist than it is sports rehab.
• 58:54
  SPEAKER_01: But we we've been very clear in that we don't mention any of the words because we're not a physiotherapist.
• 59:00
  SPEAKER_01: Now, don't get me wrong, patients will come and say, Yeah, I'm here to see Nick and the team to do my physio-based stuff, and we'll correct them.
• 59:06
  SPEAKER_01: It's one thing patients saying it, but it's the other thing if you're actually putting it out there as a company and you know that information is is wrong.
• 59:14
  SPEAKER_01: And I think that is where people should have their wrists slapped to saying, Come on, you know this isn't true, and you're just trying to do it to try and because it's an easier way to market something and and whatnot.
• 59:26
  SPEAKER_01: And I don't think that's right, I think that's a little unfair.
• 59:29
  Michael: All right, listen, that's been a brilliant podcast.
• 59:31
  Michael: We've been on for an hour and five.
• 59:33
  Michael: It's supposed to be like 30 to 40 minutes, but being lovely as always.
• 59:37
  Michael: Um thank you for having me.
• 59:38
  Michael: Yeah, thank you very much, and um yeah, we'll see you again soon.
• 59:42
  Michael: Shade me.