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Jack Chew Returns: Is MSK Heading in the Wrong Direction? · No Appointment Necessary

• 0:00
  Michael: So welcome to the latest episode of No Appointment Necessary.
• 0:03
  Michael: Today we have Jack Chu back on the show.
• 0:08
  Michael: Um three-hour diatribe this week, but uh we're gonna cover some interesting, some really interesting topics.
• 0:15
  Michael: So welcome back, Jack.
• 0:16
  Michael: Sorry, the demand was all all me insisting, wasn't it, surely?
• 0:19
  Michael: Yeah, it was.
• 0:19
  Michael: Could you tell everyone anyway?
• 0:21
  Michael: No, that's that's a joke.
• 0:22
  Michael: I want to start off by admitting I I got an email a few months ago and uh I read this thing by Jack Chu, and it was talking about his new service about this incredible new thing where you were gonna scan, get scanned to bollocks.
• 0:36
  Michael: You were gonna I mean honestly, and I was really going, oh my god, this is the worst thing in the world.
• 0:40
  Michael: Like, what is he doing?
• 0:41
  Michael: Is he completely rocker?
• 0:43
  Michael: He's obviously sold out, and then I read it quickly and it said this is a piss take.
• 0:48
  Michael: But it leads, it was very, very funny.
• 0:50
  Michael: I was I was literally sat there with Hannah going, Oh my god, what the fuck is Jack saying?
• 0:54
  Michael: Anyway, that article quickly, because I I I I think it's an interesting point to start with today.
• 1:01
  SPEAKER_00: Okay.
• 1:02
  SPEAKER_00: So yeah, I um I started writing a piece for MSK Mag.
• 1:05
  SPEAKER_00: It was it was it was the oh I'm gonna wish I'd knew the title.
• 1:09
  SPEAKER_00: I should have planned it, shouldn't I?
• 1:10
  SPEAKER_00: But it sort of the perils of perils of longevity medicine or something like that.
• 1:14
  SPEAKER_00: Oh no, it was uh beware concierge healthcare, I'd called it, right?
• 1:18
  SPEAKER_00: But it was this this idea that, of course, we've all seen it, and this idea in which get ahead of it, right?
• 1:23
  SPEAKER_00: You need to be or prevention rather than cure.
• 1:26
  SPEAKER_00: And then usually downstream of that is a series of tests for otherwise well people unearthing things that they should be worried about that they weren't yet.
• 1:35
  SPEAKER_00: I applied that as thoroughly as I could to MSK and thought, right, what would that look like?
• 1:40
  SPEAKER_00: And I it was the extreme case, it was sort of satirical because it was just an exaggerated version of it.
• 1:46
  SPEAKER_00: So what sort of scans, what postural assessments, what soft tissue analysis, what what would it look like?
• 1:55
  SPEAKER_00: Even applied technologies that all in isolation are decent.
• 1:58
  SPEAKER_00: What VLT Max testing, what dynamometry, what would you do as a part as a means of assessment for an otherwise well person as a means of a screening?
• 2:05
  SPEAKER_00: And then you'd have gold, silver, bronze packages associated to how you'd treat that.
• 2:09
  SPEAKER_00: And that'd include both medical and and physical treatments.
• 2:12
  SPEAKER_00: Um then it would be you'd you know, don't worry, we will we will rescan you quarterly, we'll do your bloods again monthly, we will then be and and of course then you'd you know just a tailored supplement regimen, meal planning, meal prep.
• 2:24
  SPEAKER_00: If you're on the gold package, of course, you'll get this as well.
• 2:26
  SPEAKER_00: And so it was it was exaggerated, of course, but fundamentally it was you're not alone in thinking that that was true because people thought I'd gone in off the deep end.
• 2:34
  SPEAKER_00: And we had to really find a way to make sure that then for those that were skimming it, kind of were alerted to the fact that it they weren't clicking on subscribe.
• 2:42
  SPEAKER_00: But similarly, that we got a lot of people that were really like good satire, really bristled some people who are getting really into that stuff, and all right, yeah, you just you st you know you're I'm disappointed with physio matters going in this direction, you used to be innovative and actually you're just gonna miss the boat on this.
• 2:57
  SPEAKER_00: This is the new frontier.
• 2:58
  SPEAKER_00: And so, but the idea really is that these things are in in isolation, both by assessment and treatment.
• 3:04
  SPEAKER_00: You know, that that's where they have their strength.
• 3:05
  SPEAKER_00: And if you've ever heard in the logical fallacies type stuff, people talk about the Mott and Bailey.
• 3:10
  SPEAKER_00: I don't know if you've I I'll I'll I'll say it for the listeners, is this idea in which the the Mott and Bailey fallacy is such that when you're trying to defend a premise, you go to um the the central thing that is easier to defend.
• 3:23
  SPEAKER_00: Um, because you know you the the fundamentals are like, oh, why are you dismissing manual therapies?
• 3:28
  SPEAKER_00: Manual therapy was one of the things that was a treatment that would be in this manual therapy's got good evidence for XYZ.
• 3:34
  SPEAKER_00: Or why would you not why would it not be smart?
• 3:36
  SPEAKER_00: For some people do benefit from a postural screen and stuff like that.
• 3:39
  SPEAKER_00: And so, but actually, that's what that's nested within a wider network of bullshit that is undefense indefensible.
• 3:46
  SPEAKER_00: And we've got to be careful not to get lured into that.
• 3:49
  SPEAKER_00: It's tempting, it's very commercially tempting.
• 3:51
  SPEAKER_00: You know, I could I could set up and sell that service.
• 3:53
  SPEAKER_00: It's amusing.
• 3:54
  SPEAKER_00: I wonder if I could have um not told everyone it was satire and see how much fun set up a fake funding round for it.
• 3:59
  SPEAKER_00: I think I'd have I'd have done really well.
• 4:02
  SPEAKER_00: So I don't know what you think about that commercially.
• 4:04
  SPEAKER_00: That's one of the things I'm interested in.
• 4:05
  SPEAKER_00: Your thoughts.
• 4:06
  Michael: I was literally just I just wrote down if someone asked me what would you do if you owned a clinic to make the most amount of money, I would set set up the most bullshitty tech enabled thing I could find.
• 4:18
  Michael: I would I would do an echo health, I would scan the bottle tout view, I would make it a subscription-based service where you have to come in every month because otherwise you might die.
• 4:26
  Michael: And I'd talk about longevity.
• 4:27
  Michael: I'd you definitely use the word longevity, I'd probably quote Joe Rogan a few times, throw in some new tropics to, you know, get your brain working properly, you know.
• 4:37
  SPEAKER_00: It'd be like nootropics.
• 4:38
  SPEAKER_00: You'd be handed a new tropic on a silver platter as you walked into the waiting room and then say, Well, we'll see you in 20 minutes.
• 4:44
  SPEAKER_00: That's not a wait time, that's for it to optimize so you can comprehend this high-level shit that's going to be given to you in your assessment.
• 4:50
  SPEAKER_00: You know, that's what you're gonna do.
• 4:51
  Michael: You're just gonna you might even throw in a bit of ayahuasca just just for a bit of fun.
• 4:56
  Michael: Definitely.
• 4:57
  Michael: But uh I I I think it's interesting because uh to some extent social media, and this leads into another topic in a way, but to some extent social media has really helped with this, right?
• 5:07
  Michael: I I can't go through TikTok or or or Instagram without seeing someone pushing some kind of new supplement with scanning or you know, some kind of new healthcare fad.
• 5:18
  Michael: You know, the longevity thing has gone absolutely bananas, and I see more and more of it happening in MSK.
• 5:23
  Michael: The amount of clinics we now have, some of them very genuinely kind of going, shit, we need to do more, we need to bring nutrition in, we need to bring extra things in, which is do you know it's fine.
• 5:33
  Michael: If you come in a hundred kilos overweight with a knee issue, it's probably you know, time to to lose some weight.
• 5:38
  Michael: And I think if you can provide a a kind of a a wider service, I I think that's wonderful.
• 5:44
  Michael: Yeah.
• 5:45
  Michael: But then see many more NSK clinics now, they've sort of forgotten the let's do cupping, and now they're moving into a load of other sort of stuff, which isn't necessarily where I know you think the MSK should be, but not even you, but but the the the people who are really interested in outcomes above money, let's let's say.
• 6:04
  SPEAKER_00: Yeah, it's it's an interesting one, and I feel sensitive even as we're talking about it, to the fact that then I really don't like the fact that I can sound really dismissive of blanket dismissal of what seems like an interest in a new innovation to some people's taste, and the fact that the premise of trying to get ahead of things and preventative is of course a lovely instinct.
• 6:24
  SPEAKER_00: But I think what the heart of it is the it's and it is an app is an opinion, I feel it's a well-defended an opinion I can defend both with logic and evidence, but it's just that as far as I'm concerned, and it would I would have to retire if it went too far in the other direction away from this, because I'm it's not how I think pain and injury works, it's not how I think that MSK rehabilitation works, it's just the the central premise of the solutions being peddled are wrong.
• 6:52
  SPEAKER_00: And therefore, of course, I could be wrong and it could be right, but at the heart of it, this idea in which you can can um you need to correct various different things that have been tested to be wrong, right?
• 7:06
  SPEAKER_00: Be that from scans, be that from blood tests, be that from postural assessment, be that a biomechanical analysis, whatever it might be, that's combination of things, though those combinations of things, the more accurate it we can be with those assessments, we can correct those faults, and then it's very much an old model that felt like it had gone away, which was based on the idea in which we're the body mechanics, right?
• 7:28
  SPEAKER_00: Us physios, we're like you take the car to a you take the car to a garage.
• 7:31
  SPEAKER_00: The key reason that that is a poor analogy and one that you should be careful to use with patients, although it's tempting, is that a vehicle is not a biologically adaptive machine, right?
• 7:42
  SPEAKER_00: And so the idea in which people can't be helping, you know, it's understandable that they want to use their brake pads as a shock absorber, it's not dissimilar to your cartilage in your knee.
• 7:50
  SPEAKER_00: And it's tempting because people patients quite like that analogy because they can comprehend it.
• 7:55
  SPEAKER_00: But your brake pads are literally not regenerative tissue in the same way that the I mean it's interesting because you meniscus and the cartilage to some extent isn't as adaptive as as I'd like it to be, but the underlying bone of which is a pain-generating centre, it can adapt under load till the day you die.
• 8:09
  SPEAKER_00: So that difference there is where I admittedly I've live and breathe a philosophy both in clinic and as an educator, and now a media enterprise that sort of perpetuates rehabilitation and functional restoration to try and decrease disability and hopefully alleviate pain.
• 8:24
  SPEAKER_00: That's my whole world.
• 8:25
  SPEAKER_00: And so then what they're suggesting feels like they're presenting something as new when I've I mean, it's not just old, it's everything I built, reputation and career moving against, right?
• 8:36
  SPEAKER_00: That was the old model.
• 8:37
  SPEAKER_00: They are there, it is a tech-optimized version of the old model.
• 8:41
  SPEAKER_00: We used to do that.
• 8:42
  SPEAKER_00: It used to be what's broken, let's fix it, and that that restoration of the of the fault is gonna then decrease pain.
• 8:48
  SPEAKER_00: We moved away from that, and I don't know how they they're rewashing it, redressing it, and uh I just feel like I smell a rat.
• 8:54
  SPEAKER_00: It feels familiar to me.
• 8:56
  Michael: Well, going back to your the car mechanic analogy, I actually I'll push against that actually, because I think as a patient Well, I think as a patient, if I'm going in for I don't know, a heart issue or any, it doesn't really matter what issue.
• 9:08
  Michael: I kind of want someone to give me an explanation that I can really easily understand.
• 9:13
  Michael: You know, brake pad, shock.
• 9:15
  Michael: Well, I'm not really a car guy, but you know, you you get the idea.
• 9:18
  Michael: And I so I don't think that it's necessarily a bad thing, even if it isn't necessarily communicating absolute truth, it's at least making sense in the patient's mind.
• 9:28
  SPEAKER_00: Well, I think this the thing is, and I really try and avoid engine analogies myself, but with the right caveats and in the right context with a patient, uh, you know, you could imagine it being explained well.
• 9:38
  SPEAKER_00: Because if you said something like that, you say, now, unlike you use the brake pad analogy and then say, but unlike a vehicle, run adaptive tissue, you you have adaptive tissue, and you and and you you could you see then you do enough caveats.
• 9:50
  SPEAKER_00: Did you need the analogy in the first place?
• 9:52
  SPEAKER_00: And and this is a really interesting thing that goes beyond MSK, by the way, right?
• 9:56
  SPEAKER_00: The analogy of the brain as a computer, it's more like a you know, your brain's more like a computer than your gallbladder's like a computer.
• 10:03
  SPEAKER_00: It's not an it's it's imprecise in some ways, but it's better than others.
• 10:07
  SPEAKER_00: So these things sometimes have their place, and you're right about an explanation needing to land with a patient.
• 10:12
  SPEAKER_00: But the the crucial thing is that with a patient, if you left it there unchanged, the idea of your brake pads are worn down, and much like in your vehicle, the mechanic needs to change your brake pads, you're not gonna pass your MOT, you're not gonna be fit for it, and you're gonna your car's gonna be dangerous.
• 10:27
  SPEAKER_00: That is a perfect way of selling stem cells, hyalonic acid, or an e-replacement, isn't it?
• 10:34
  SPEAKER_00: Because you're broken and it needs fixing, and only fixing that will improve your symptoms.
• 10:39
  SPEAKER_00: That's not how OA works.
• 10:40
  SPEAKER_00: Sometimes, of course, all those interventions might be indicated in certain cases, but that's not the fundamental reason for people's pain at low grade OA.
• 10:48
  SPEAKER_00: That's not how it works.
• 10:49
  SPEAKER_00: Or if it turns out in a few years' time that is exactly how it works, I have to retire.
• 10:54
  Michael: Yeah.
• 10:54
  Michael: Yeah, it's it's it's interesting because I suppose to some extent it also moves into another topic which is is a bit of an aside.
• 11:01
  Michael: But something that I don't see a lot of in this industry is gamifying rehab.
• 11:06
  Michael: It's something I've always been really super interested in.
• 11:08
  Michael: So everything, well, not everything I do, but much of what I do is about gamification, whether it's a tool, whether it's what whatever it is.
• 11:14
  Michael: It's getting, you know, if anyone's ever used, so for people who don't know what gamification is, join LinkedIn, you get stars every time you fill a bit uh more of your profile out, and you feel like, oh my god, I'm getting something, I'm getting an award.
• 11:26
  Michael: You're you're sort of you're gamified into completing something.
• 11:30
  Michael: And it strikes me that in this industry there is no gamification, or or what there is, there's very little of.
• 11:35
  Michael: Now you can do it a little bit with, you know, technology, I suppose.
• 11:39
  Michael: How high can you jump today versus all, you know, with a dynamometer to some extent, maybe some digital readouts, whatever.
• 11:45
  Michael: But there just doesn't seem to be a huge amount.
• 11:47
  SPEAKER_00: Why why do you think that's it's funny because there isn't, and the I I really you've I didn't know this was going to come up, but I I am so on the fence about gamification because I've seen it done really well.
• 11:57
  SPEAKER_00: Uh there's a lad called Ben Wilkins, I don't know if I've ever introduced you.
• 12:00
  SPEAKER_00: Good boost.
• 12:01
  SPEAKER_00: He's uh he's a cracking bloke, but also lovely and interesting business and projects.
• 12:06
  SPEAKER_00: But basically, he he's really into gamification and has a um social enterprise that then sells rehab plans into leisure centres in the pools, like turning leisure centres into hydrotherapy, fantastic.
• 12:17
  SPEAKER_00: But also he and he wrote an MSK mag about gamification, and I'll send you the piece.
• 12:21
  SPEAKER_00: But it's just that he has been really persuasive on one hand, and I'm nearly that side of the fence, and then I've seen it done badly.
• 12:28
  SPEAKER_00: Oh, it's the most condescending, patronizing, it it babyfies, not gamifies, like it just feels really silly, like gold star for doing I've seen apps like rehab, you know, like uh like a rehab mic patient equivalent, but when you do your exercise, do do some squats in front of a camera and you'll get two thumbs up and stuff.
• 12:45
  SPEAKER_00: It just feels like ah, that would not motivate me.
• 12:48
  Michael: I think there's a bigger danger, which is your left knee's tracking 12 degrees different four right knee, let's get it to four degrees, and you go in uh for a session every two days to get that work, you know.
• 13:02
  Michael: So, or your left leg under your right if we keep adjusting you, look how much closer they get.
• 13:07
  SPEAKER_00: Well, you get have you seen that?
• 13:08
  SPEAKER_00: Have you seen the hardware that people can put on the thoracic spine?
• 13:11
  SPEAKER_00: It's like a backward necklace pendant thing which dangles over the thoracic spine and it'll vibrate if you slouch.
• 13:17
  SPEAKER_00: That premise, again, it comes that you're you're you're slouching, and therefore that's bad, and therefore it's going to remind you to do that, right?
• 13:23
  SPEAKER_00: And then they and then you get a gold star, much like your sleep tracker score on your aura ring and stuff like that.
• 13:28
  SPEAKER_00: So it's this wear, it's so postural wearable.
• 13:30
  SPEAKER_00: And and and it's I remember like it'll be like 10 years ago, it might even be 10 years ago, which is crazy.
• 13:35
  SPEAKER_00: I feel like an old man saying that.
• 13:37
  SPEAKER_00: Rob Tyre and Jack March went up to them, they were selling them, and they went to a really genuinely enthusiastic about this and said, like, like uh expo therapy expo or um whatever they were, Copushow or something like that, right?
• 13:50
  SPEAKER_00: One of these expos, and and said, underlying premise is wrong, unfortunately.
• 13:53
  SPEAKER_00: Like you don't, you know, you don't need to do that.
• 13:56
  SPEAKER_00: And um, but what you could do is if someone is really guarded and and and reluctant to flex the thoracic spine, then you could flip the incentive structure and sort of like try and get them to you know, that exercise of trying to get them to do like a cat stretch or something like that, it could vibrate for that.
• 14:12
  SPEAKER_00: And the the guy looked like he did just quickly developed a headache.
• 14:16
  SPEAKER_00: I don't think I was filming it, like that would have been cruel, but it was just this they were kind of saying, look, the product is not running the product, it's the underlying premise of this being correction, right?
• 14:24
  SPEAKER_00: It's like the uh physio version of a shock collar for dogs, right?
• 14:27
  SPEAKER_00: You've just got this idea in which that's bad and therefore we need to punish it, and that's what they were doing with these nudges.
• 14:33
  SPEAKER_00: And so this is the misapplication of technology and the incredible expense that people go to on stuff like this.
• 14:39
  SPEAKER_00: I just think it's it's funny, and that's where with gamification it's I think that it will be in our future, but done badly, it is so naff.
• 14:48
  Michael: So it can it can be the underlying reasoning behind it can actually be bullshit, but the the outcome can actually be good.
• 14:56
  Michael: So I'm wearing a wound.
• 14:57
  Michael: Now I know very well what the metabolic score on this is and it's bullshit, but I still work towards it, right?
• 15:04
  Michael: I still know it towards doing it, and I yeah, but you know what?
• 15:07
  Michael: If I sleep a bit better, if I do a few more steps, if I try and get my heart rate down, but I it's it's good.
• 15:12
  Michael: So even though the the kind of premise is a bit of bullshit, getting people to do the right things is actually a good thing, and and and Wooper's probably one of the best gamification devices I've ever seen.
• 15:24
  Michael: I mean they've done a brilliant job.
• 15:26
  Michael: But I think it's also about, you know, we all know, for example, if I come in and I'm 20 kilos overweight and I come and see a a PT, and that PT says, Well, every week we're gonna weigh you.
• 15:37
  Michael: Let's not get into arguments about whether weighing people is good or bad, but every week we're gonna measure you in some way as to whether you could run further or run faster or weigh less or whatever the case may be.
• 15:48
  Michael: After a little while, and quite quickly, actually, the patient, we'll call them the patient, really buys in and they become more motivated because they've got targets, right?
• 15:56
  Michael: And and that in itself is that sort of level of gamification.
• 15:59
  Michael: And it seems to me that physiotherapy is uniquely, in some ways, a beneficiary of exactly that of taking a patient and saying, This is because what physios do is they say, This is where you are, this is where I want to get you, but there's no way of measuring there are, but you measure it and and kind of gamify that entire process.
• 16:20
  Michael: It seems to be like such a shame.
• 16:22
  Michael: All I hear from is, oh, people leave too early and they stop coming in.
• 16:26
  SPEAKER_00: It's like, well, but that's I'm really I'm really sympathetic to that, but I it's just that quality clinicians will talk sensibly about non-scalable goals, and but that in the weight loss community, especially in and around the uh modernity of that, where it's become more medicalized, partly who has the GLP ones, and then the um consequences on bone density that means that then physios have joined that party alongside personal trainers to mean that that needs to be alongside some weight-bearing exercise in most people to do it sensibly.
• 16:58
  SPEAKER_00: So there's been conversations about it.
• 16:59
  SPEAKER_00: So non-scale goals are where you've you've got scale goals where literally the scale's changing, and then you've got non-scale goals whereby it's like I could put my shoes on without getting out of breath, right, for someone that's particularly large, or I walk the dog more comfortably and didn't then have swollen ankles, right?
• 17:13
  SPEAKER_00: So then we need to quality clinicians have been doing that and they just don't have a compliance problem.
• 17:18
  SPEAKER_00: It's it's been fantastic work that Joel Fiston's done and working with Joe Turner more recently to talk about the fact that like if you if you frame your consultations and your business writ large as a consultancy and coaching type framework, then they're participating, they're consenting to participate in something that you're not worried about them doing as they're told.
• 17:36
  SPEAKER_00: It's not a compliance issue.
• 17:37
  SPEAKER_00: It's like if their drop compliance drops off, then essentially you've their expectations are just off.
• 17:42
  SPEAKER_00: Like, why are they why are they not doing this?
• 17:44
  SPEAKER_00: And I just think that one of the things that we can do is that you can use dynamometry, you can use like, can you do more reps than last week?
• 17:50
  SPEAKER_00: You can do the scalable stuff, you can measure people's range of movement.
• 17:53
  SPEAKER_00: We're used to doing that, right?
• 17:54
  SPEAKER_00: That's our objective measures.
• 17:55
  SPEAKER_00: But unless you are in a position where you're helping them to understand how to scale their function and that some of it we can't measure, but some of it you've you you've you're kind of on a journey together on and you're trusting each other to do that, then unfortunately that's just bad therapy.
• 18:10
  SPEAKER_00: Now it might be that good therapy can't scale very well.
• 18:13
  Michael: I've got to pick you up on that because I don't I I don't think that's the case.
• 18:16
  Michael: I think that it's all well and good you, a clinician with tons of experience, with a big old mouth, who had lots of NHS experience and you've seen everything.
• 18:25
  Michael: It's kind of easy for you to say that.
• 18:27
  Michael: But when you when you're looking at the 25-year-old clinician who doesn't have the breadth, range, and breadth of experience that you have, maybe is not cut from the same mouthy cloth as you are.
• 18:38
  Michael: I think it's actually quite difficult for them actually to do exactly what you're talking about.
• 18:43
  Michael: And actually being able to lean on product, on measurement, actually makes their job an awful lot easier.
• 18:49
  Michael: So I I I think it it's right.
• 18:52
  SPEAKER_00: Two two parts to that.
• 18:53
  SPEAKER_00: You're right to challenge me on on can that's what I was just finishing with, whether how scalable is that?
• 18:58
  SPEAKER_00: And how can I say that without it coming across as really judgmental about those that are kind of coming up, right?
• 19:03
  SPEAKER_00: Is there a ladder being pulled up there by just because we've kind of come to understand what quality is, how do you get there, and then you don't feel like you can get there.
• 19:10
  SPEAKER_00: For me, one of the big one of the reasons why I say that with without much caveat this day is because of the fact that usually in my next breath, I'm talking about industry reforms at every single level of analysis that would improve that for entry-level clinicians.
• 19:24
  SPEAKER_00: I agree it's difficult.
• 19:25
  SPEAKER_00: It's annoying that the style of care that I advocate for is so far away from an algorithm that can be taught or followed that it is irritating.
• 19:33
  SPEAKER_00: Like I don't doubt that.
• 19:34
  SPEAKER_00: The resources, including free open access resources, if the technologies that exist to help you do that, the people that you can reach now on socials and influencers that aren't charging you much for insights, is enormous.
• 19:47
  SPEAKER_00: The podcast library, my own included.
• 19:49
  SPEAKER_00: So it's because there's plenty out there that means that if people want to pursue it, now it's very noisy, very difficult, but the reason to the second point you've saying about the tech, I think at the moment it's as likely to hinder as it is to help.
• 20:02
  SPEAKER_00: I think that the let's just take dynamometers for a second, just as one example of turning what seems like really difficult to scale and show and demonstrate to patients that this is worthwhile and you're making progress.
• 20:13
  SPEAKER_00: I totally agree that a clinician, and I would have my more junior therapist in my clinic measuring these things as a means of doing what you were describing.
• 20:22
  SPEAKER_00: However, there is a massive risk that the patient, and to some degree then the therapist, will overattribute the torque that someone can produce through their knee as the reason that they're making progress.
• 20:34
  SPEAKER_00: And therefore, if they then flatline that talk, which happens, right?
• 20:37
  SPEAKER_00: So they get that the patient comes in in two weeks' time and that knee extension measure isn't any better, then that becomes a problem.
• 20:44
  SPEAKER_00: And they've not really conceptualized that strength, that uh ability to generate talk through your knee in this instance for a test.
• 20:51
  SPEAKER_00: They've not put it into its appropriate context as being one of several things we're working on.
• 20:56
  SPEAKER_00: And so I see it go wrong.
• 20:57
  SPEAKER_00: Of course, that doesn't mean it shouldn't be done, but it needs to be placed sensibly.
• 21:01
  SPEAKER_00: The problem that you're describing is a problem of um of uh of of mentorship.
• 21:06
  SPEAKER_00: Well, it's a problem of leadership across the entire industry, of course, but it's a problem of a lack of mentors, it's a pro a lack of quality training posts, and some really interesting innovations where people are having to bring people in.
• 21:16
  SPEAKER_00: That there's a problem of uh of of educational standards across the undergraduate curricula, that there's a problem of um, I would argue, a c a problem of incentives across the CPD landscape that's making it really messy again.
• 21:29
  SPEAKER_00: So I'm I really do, I want to say, I admit that I agree with what you're saying about the fact that it's all well and good me saying that and it's difficult for a more entry-level junior clinician.
• 21:38
  SPEAKER_00: Totally agree.
• 21:39
  SPEAKER_00: But the reason I say it with full chest is because I also think with the work that could and should be done to improve um the uh quality across the other dimensions I've just mentioned, that means that there should be less places to hide.
• 21:54
  Michael: No, I yeah, I I I see that.
• 21:55
  Michael: And going back to the your points there, I think one of the uh big issues at the moment is commercialisation of physiotherapy.
• 22:03
  Michael: And there's a lot of young graduates getting into um physio.
• 22:06
  Michael: We all know the birth of jobs in the NHS.
• 22:09
  Michael: They're going into private practice and they're actually being ev every KPI, every single KPI is how many patients have you seen, how much money you made, what's your LTV, what's your PBA, what's your and there's very little.
• 22:21
  Michael: So if if if you give them a tool and the only thing they are being measured on is how much money you're making.
• 22:27
  Michael: Well actually having a little tool that makes a patient come back every five minutes, even if they're kind of not explaining things in the right way, makes a lot of sense to them, right?
• 22:35
  Michael: And I think you're right as well the lack of mentorship.
• 22:37
  Michael: Because I've been looking into this recently about potentially setting up some kind of mentorship programme or even if you've mentioned that.
• 22:45
  Michael: I'd really like to do it, but it's it's surprisingly difficult on both sides, both from finding mentors, but also if you do make it in any way monetized people who are who have the money to spend on even 50 quid a session or whatever with a mentor.
• 22:59
  Michael: I think it's very difficult to do.
• 23:00
  SPEAKER_00: And they don't know what and they and they don't know what they don't know.
• 23:02
  SPEAKER_00: Because you've got these intersections aren't you you've got there's like you almost want to some pe some people need just a bit more commercial now.
• 23:10
  SPEAKER_00: Some people need a sort of help with the broader almost healthcare ethics of the matter as to what it is you're in this for and there's some that there's some that need like put a couple of conversations into your mentorship with them.
• 23:22
  SPEAKER_00: Because I still do quite a lot of mentorship less than I used to but um sometimes a couple of conversations in you realise that actually like you don't send them to the job centre.
• 23:30
  SPEAKER_00: That sounds rude but they they want to retrain that their heart's not in it they made a mistake they they they sometimes did think that they were going to be a body mechanic or they were going to be the bucket and sponge man and it's just that this this job in what it's cracked up to be and and so that the the mentorship for them isn't necessarily me sort of saying this is how you do special tests for the shoulder like they don't want that.
• 23:50
  Michael: No I've heard that a lot from people who who have come out and they've said I thought I was going to be a doctor where I could fix things.
• 23:55
  Michael: And I've come out and I've realized that everything I've learned was pollocks and quite honestly like I can't fix very much at all.
• 24:02
  Michael: Yeah.
• 24:03
  Michael: For that must it is super it's super depressing.
• 24:06
  Michael: Yeah super depressing for people just just on we talked about the the uh longevity thing I do just want to quickly go back to that and because I want to be a bit sort of constructive here.
• 24:16
  Michael: So you know rather than just saying longevity medicine medicine is bullshit how would you do it effectively like if if you could create a really cool longevity medicine part of the business what would you do?
• 24:28
  SPEAKER_00: How would you how would it look I mean one of the ways I can answer that and it's not it's not perfect but I want to try and ground it I will go back to the theory if you want as to like hypothetically how would I do it.
• 24:37
  SPEAKER_00: But I want to give you a bit of a clue a project that you know about which is the trundle and I I know that that's not it's it's adjacent.
• 24:45
  SPEAKER_00: But anyway what I'm meaning is that we have this we have this elderly walking group and essentially for two hours on a Monday morning we did one this morning at 10 o'clock 10 till 12 there with us and about an hour an hour and a half of that is walking and then half an hour of that we'll sometimes do a talk about OA managing back pain learning up learning to get up and down off the floor if you fall over how to use your walking stick if you need it where to buy walking boots right and and we've got this community.
• 25:09
  SPEAKER_00: Now every six months we do a battery of tests which are validated measures right so this is where I'm getting to with the why why I'm on about that for longevity is that there's a validated set of tests that I'm doing as a screening bearing in mind that these some of these are otherwise they've most of them got aches and pains right they're all over 60s but but they it's a validated elderly person's MOT six minute walk test how far can you walk in six minutes six to stands without using your hands how many of them can you do in 30 seconds a couple of flexibility measures hand grip.
• 25:35
  SPEAKER_00: So low tech screening every six months we're doing it for four years now the Trundle and what I'm describing there across various different populations including younger otherwise uninjured people you could argue that you are testing people not necessarily for injury risk or anything like that.
• 25:51
  SPEAKER_00: You're just testing non-validated measures right so there's a way of doing it.
• 25:55
  SPEAKER_00: If you pick a set of validated measures and you're not implying that those things are faults per se, then you could create a service that is essentially a health coaching service that then helps people work on their, you know, retain their strengths and work on their weaknesses.
• 26:11
  SPEAKER_00: What do you want to achieve with their body you know how old are your grandkids would you like to play on the floor with them?
• 26:16
  SPEAKER_00: Right.
• 26:16
  SPEAKER_00: So I know that's an elderly person example, but I'm just meaning that like there is a route through we don't have to be dismissive of it writ large.
• 26:23
  SPEAKER_00: But as soon as I start talking about that and I'm not talking about supplementation and exactly what what degrees to put the ice bath in then it looks nothing like the services that we know are being commercialised now.
• 26:33
  SPEAKER_00: That's where the underlying premise is is on the solution is that you're turning a Ford Fiesta into a race car if only you get the right ingredients.
• 26:43
  SPEAKER_00: You know it's just like that's the bit that's annoying.
• 26:45
  Michael: Okay no it's a it's a good point because in in some ways it is longevity medicine.
• 26:48
  SPEAKER_00: You're just doing it slightly differently without the package and without the and doing it a bit late as well because a lot of people in longevity medicine are all talking about how they can radically decrease their biological age and um and stuff like that.
• 27:05
  SPEAKER_00: I think one of the things that's come up recently is um and and I by the way I have a c I have a clinic in clinic in in in Leafy Cheshire and occasionally I um really disgruntle people who are irritated how uninfused I am by how much time they spend in a hyperbaric chamber particularly wealthy patients who who want to come in sometimes for you know quite quickly within 10 minutes I realise that the consultation isn't really necessarily about say injury and especially those that have kind of gone down a Google or now they've asked ChatGPT like who's the who's the best physio in my area and which is hilarious because I'm not the best physio in the area but I'm just like the most Googleable physio in the area just because obviously I've got an interprofessional reputation of which doesn't really speak to my expertise but they come in and sometimes what they want me to do is validate their regimen.
• 27:49
  SPEAKER_00: You know they've they've gone down either independently under some supervision someone sold them a bill of goods and they want to come in to me and say like you know exactly what temperature should my ice bath be that I've invested in.
• 27:59
  SPEAKER_00: Would you spend more and less time in this hyperbaric chamber when I'm due to go on holiday or I'm going skiing I had one that said I'm going skiing that is technically at a slightly higher altitude than which I live.
• 28:10
  SPEAKER_00: Should I then try to acclimatize to that and this is someone that under some basic testing that I then did in the assessment is like I I think the time that you might spend thinking in that direction is just let's do a few squats because that knee's probably going to you know your skiing's going to need a bit more squatting and these weren't this weren't a particularly active person.
• 28:29
  SPEAKER_00: So it's just that the the priorities get mixed up and I suppose that's the thing that that that breaks my heart is that you're getting people going it's fads and trends again right and that happens in all industries but this is particularly fertile at the moment and it takes for physiotherapy and MSK writ large across the various different professions need to be brave and to resist the worst excesses of it.
• 28:50
  SPEAKER_00: And not to dismiss all parts of it and I'm not saying we have to miss it all and then that that this sometimes this is a market demand.
• 28:56
  SPEAKER_00: You know I've just mentioned patients coming in like I you know I'm not I'm I'm human like it'd be an easier day's work if I pandered to these people and I'd be wealthier but you've got to resist some of it and then you've got to try and then move them towards something more sensible I would argue that's kind of the the ethics of the matter to me.
• 29:10
  Michael: Okay and now a word from our sponsor.
• 29:12
  Michael: Are you a update no now is not really but you wrote the longevity article in MSK mag and I don't see I think we should quickly talk about MSK mag actually because I think it's brilliant.
• 29:23
  Michael: Oh thanks no I do and I keep talking to people they're like what's that?
• 29:27
  Michael: I'm like how are you not subscribed to the blog that's very kind you get articles like the longevity article you also get something really cool from uh HMDG which is the market update which we've started doing in there which shows you all about how the market's doing and so on and so forth.
• 29:40
  SPEAKER_00: But tell us quickly about give it give it a little go at uh yeah pushing MSK mag because I think it's before I before I do one of the ways I'm gonna just I want to ask you this because I haven't asked you this on our off air but you weren't sure were you like MSK mag when we chatted over a beer because it felt a little bit you were one of the people that felt it was a little bit weird to go old school.
• 29:59
  SPEAKER_00: We were kind of in in you know podcasts and webinars and stuff and it was like a magazine are you going to print it?
• 30:04
  SPEAKER_00: You know I and I understood so I wondered if tell me about that because I'm glad you like it but but also and I'm not calling you out on your instinct because you weren't alone on this but I just wondered if you can reflect on why you weren't sure and what's changed your mind.
• 30:15
  Michael: Yeah I think it's because the MSK market in general is so backward and I think just preceding preceding that there was Therapy Live which was it was you know just so incredibly innovative and different and new high tech took the world by storm.
• 30:29
  Michael: And you were talking at the same time about a YouTube channel as well it was like Netflix with physios or something.
• 30:36
  Michael: And then you're like oh and then then what we're doing is like a cool version of Frontline and I'm like oh fuck alright great because even I still get that bloody thing through the door and it goes straight in the booth.
• 30:46
  Michael: It's all paper now so I feel less less guilty.
• 30:49
  Michael: So but I think that the different or what I didn't expect was the not that I like them all agree with them all but you've got the really good guest writers that come in there's a very broad range of topics and you also keep it interesting.
• 31:02
  Michael: It's not just you know let's talk about the latest thing to do with the shoulder and get Joe Gibson on again.
• 31:08
  Michael: It's it's quite varied and I I I find it quite interesting and and I think that there isn't actually anything else out there like it.
• 31:15
  Michael: So it is innovative even though it's kind of a very old format.
• 31:20
  SPEAKER_00: Yeah the medium the medium is the format in the medium is is unusual.
• 31:25
  SPEAKER_00: I'm particularly chuffed with MSK Mag's progress in an age where AI generated content not dissimilar, right?
• 31:32
  Michael: They are a series of opinion pieces and blogs that are a balance of clinical pieces, business pieces as well as I think no you've hit on something really important there because I cannot get away from bullshittated content.
• 31:47
  Michael: And I think the difference that that you've got there is that this isn't AI generated nonsense.
• 31:53
  Michael: It's opinion and it's kind of interesting some of it funny and and I think that the that actually that puts it into a place and into a space where most people aren't.
• 32:28
  SPEAKER_00: Yeah and that's the thing as well is that we've it we've got a real range of viewpoints and um you know far from it being the gospel according to physiomatters you know we we have a real breadth on there and if people people need to defend their arguments and offer references and stuff like that but not they're not writing academically as well.
• 32:46
  SPEAKER_00: So what we did is we got this balance between people not just writing long tweets or like um pot shots on on a premise it needed to be an unpacked argument.
• 32:54
  SPEAKER_00: But it also didn't then the writer's guide and you've you know you've read it because you've contributed it it really makes a point of saying don't write academically we um we we don't get it right perfect all the time you know and and you've got a house style that you don't want to be restrictive so you need to have just free thinkers.
• 33:11
  SPEAKER_00: So it's working really nicely on that and I think what I would say and um why I'm particularly proud of it is my origin story on physio matter as as a podcast originally is that I was trying to bring a journalistic instinct of which I'd kind of grown up with from interest in where I do event reports for extreme sports magazines in my youth right so I ended up being an editor and we got a magazine ended up being in WH Smiths and stuff and this is my in my teens right my like work experience and some of my first jobs were were quite weird compared to I also had a paper round but we don't know this about you but you're like an Olympic longboarder right well I wish it was Olympic that would have been nice.
• 33:47
  SPEAKER_00: No but so my I I a lot of my youth was riding various different things sideways including an obscure thing called a mountain board which is like a snowboard with skateboard like a snowboard with wheels on it uh down mountain bike trails uh with no brakes on which is why one of the reasons I'm so injured and one of the reasons I met more physios than most people in my in my youth as well that rugged me yeah because of this obscure you know obscure sports quarterly um was uh was was like our magazine and and so I had this sort of journalistic interest and I was torn between being a physiotherapist and being a journalist and so I studied English language as well as media and marketing alongside biology and physio and I was like on the fence and then I became a physio and then within a few years I then thought clearly I hadn't scratched the itch I hadn't actually decided and so I invented this sort of pseudo-physio journalism on a podcast where I basically brought at least just a critical devil's advocacy approach to things.
• 34:40
  SPEAKER_00: Now I've been doing that with the podcast and then most of my work has been doing that social media meant I could be that awkward thawning people's side saying why do you think that show your evidence show your work in provide sources that sort of stuff it was basic really can't call it that clever journalism but I love the fact that with MSK Mag, especially with my tenure I'm no longer editor-in-chief we've handed that over to Felicity who's doing a fantastic job but it's just that it felt like what we're creating now with MSK Mag and the plans for it are are huge, which is that the ability to then have have staff writers to commission pieces to do investigative work to to do event reports even when this conference is happening that people would maybe on the fence about we should go next year and to have roaming reporters and to also just sort of to really represent the industry in ways that don't feel overly tainted by bias um is is just exciting and it's just really cool to be involved in we we also have I think we've found a sweet spot because we do have it has its multimedia equivalents right so it has its audio version for those that are used to us being podcasters and those are read out and and especially for our inner world where it's not just about preference it's also about people's access for neurodiversity or we lovely uh lovely outreach from blind physios recently you know just like thank you for still obviously most of your stuff remains you know we still podcast we still have our so they love that but they would like MSK Mag I love the fact that you also read it out so we try and make it as accessible as possible you can listen watch and and read all of our stuff now which is cool and the future is is really exciting for MSK Mag because of that sweets what we've found.
• 36:18
  SPEAKER_00: It's a balance of clinical content commercially interesting content as well as then professional think pieces about where we're going because it's such an interesting inflection point especially with that intersection some of the AI stuff we've talked about is like professional identity the dearth of leadership that exists in the industry the balance between sort of hot shot influences meets hard research right if you go too empirical it's boring.
• 36:43
  SPEAKER_00: If you go too much into sort of can it be done in a TikTok dance then it's just nonsense.
• 36:48
  SPEAKER_00: So there's got to be a sweet spot in between where we actually grapple with the evidence and we actually think about how that's practically applied.
• 36:53
  SPEAKER_00: And I think that's what HMDG's Market Read does which is the centerfold of every MSK mag piece now is it gives you those insights as to what might be happening in the industry that might be affecting how much your phone's ringing.
• 37:05
  SPEAKER_00: And we know that those things have as much clinical and professional relevance to your identity as sometimes your ability to treat a shoulder right so we're trying to make sure it's got that breadth and and um yeah I as I say I hope that's a pitch that doesn't sound too much like an advert but it's really cool to be working on.
• 37:21
  SPEAKER_00: What's the URL?
• 37:22
  SPEAKER_00: It is now mskmag.com our new and glorious shiny website uh because it was a a side page on uh physiomatters.com for too long now so msk mag.com go and check out the website find and read all about it and as Michael said there's too many of you that don't know about it you know even some of our members hilariously don't get their print copy and stuff like that so yeah do get involved it'll be great to hear from you and the website is is made by my useful wife who Jack saw me marry and has bankrupted me with the bar bill as well which I just got and and also because you're a sensible person right you you you don't like commandeer boats and start rowing around on a lake late at night at midnight causing havoc but anyway I wondered if you were gonna I wondered if you were gonna bravely tell your audience firstly that you uh had made the mistake of inviting me to your lovely uh wedding and then secondly what I got up to but yeah yeah it was a a wonderful day.
• 38:17
  SPEAKER_00: And I can I can also tell your listeners that believe it or not Hannah did turn up and did marry it.
• 38:22
  SPEAKER_00: And we all thought we all thought it was a bet and that she eventually would cave and just not turn up but uh no she did she followed through with it.
• 38:30
  Michael: I incentivized her was neatly on to talking about incentives which I know well done it's kind of an interesting topic.
• 38:40
  Michael: Smooth very smooth.
• 38:41
  Michael: So let's talk about incentives in the industry.
• 38:44
  Michael: One of them it's it's not exactly the incentive side but I I just as an interesting um thing because we talked a little bit a tiny bit about AI I find AI a fascinating topic and I think people are getting bored of me talking about it but I I I I genuinely believe it's going to completely change the industry, the MSK industry over the next two years and I don't think people understand how much I think there's a lot of people out there going oh you need human touch and it can't do what people honestly I I think when we see what Flock did, when we see what the UNHS app is looking like I think it's being released 20 2028 holy shit like the the that is going to make a huge huge difference to the industry.
• 39:24
  Michael: I think that a lot of easy patients are going to disappear from from private care.
• 39:29
  Michael: I think the model actually of physiotherapy is going to have to change dramatically because if you're a physio who who sees a patient sends them off with rehab my patient and some exercises and says come back next week you may as well like retire because you know I can get some pretty good exercises and rehab programs and chat GPT and so on and so forth.
• 39:47
  Michael: I know the we I don't want to get into the in-depth discussion about that but I I do think that it's going to dramatically change the industry.
• 39:53
  Michael: I think private practice is going to have to develop and I think have to be more innovative in how they deliver care but one thing just one topic I wanted to touch on because it I I've I've got some real world data on this now which is we see a lot of most clinics now implementing AI in some way or another one of those ways is patient notes.
• 40:12
  Michael: And something I've seen is that the clinics are these clinics are spending a lot of money on patient notes but at the end of the day there's nothing being reflected within their PL.
• 40:22
  Michael: So they're spending the money but there's no reflection of it at all in how much money they're making and I was I've been asking clinics I've been doing my research and you know spoken to a lot of clinic owners about this and the overwhelming message is yeah you know I've got 10 clinicians and each of them saves two hours a day because we now have patient notes whatever the the app is and so it gives us 20 hours a day and I say well great how are you using those and they say well what do you mean?
• 40:46
  Michael: Well are you reducing admin time?
• 40:48
  Michael: No no it just we're exact it's exactly the same which is unheard of in any kind of commercial environment right we've just optimized it we've saved ourselves 20 hours a day of time and we're doing nothing with it and making no extra money.
• 41:02
  Michael: And and I suppose that goes to a little bit to incentives to some extent but I just find that absolutely fascinating I wonder what your thoughts are on that.
• 41:10
  SPEAKER_00: Yeah I want to get onto the specifics of that first because I it it just it just speaks to a sluggishness always.
• 41:21
  SPEAKER_00: We know that there's a bit of an innovation lag anyway but then when people are brave in in taking something like that up because they feel like why not and then you know there's a it's certainly in in AI scribe stuff it's definitely you know it's not especially innovative now to be doing that.
• 41:35
  SPEAKER_00: In fact you'd probably be in the minority in private practice if you're not using it.
• 41:39
  SPEAKER_00: But then when when those productivity gains come where does that fall and really that needs to be a balance of the business writ large and then the sanity of the clinicians if you swung it too far the other way well let's say the one the way that you're describing it is just bizarre like why is the unless there was a a a plan for how to use that time if you weren't to be seeing patients with it then that is strange and wasteful.
• 42:05
  SPEAKER_00: And then if you swung it too far the other way and said well that's why you should see 20 patients instead of 15 patients, especially on a salaried member of staff of which is not incentivized to do so, then that would be clumsy especially if those patients were no less complex and were then just going to be a recipe for burnout in in a a um especially in a generation younger than me that we know increasingly are at risk of that partly through to some of the undereducement I alluded to earlier.
• 42:31
  SPEAKER_00: So it's got to be a bit of a balance of the gains falling across the board because of course we know that the clinic owners gain is also the safety and sanity of the clinicians that they want to retain as well as the motivation for them to deliver good care and to not be completely worn out going back to back all the time.
• 42:48
  SPEAKER_00: So I would say that that some of that time needs to be spent in some of the service development and innovations that could mean that there's community outreach going on right some of your some of you people that are really interested in adolescent care that haven't had time to you know if someone said wouldn't it be cool you know so and so's one of my patients is a school governor she'd love to have one of you come in and talk at an assembly and then your adolescent specialist is like well I'd love to do that but I'm back to back you've freed up some time because you know you've got some actual breakthrough innovation where you've got a digital scribe then some of that time could be to start doing some community outreach and then you can imagine the way that that reshapes the perception of physiotherapy and MS care services within your community.
• 43:23
  SPEAKER_00: Only one example but it's a great one where that would then generate new business but also help someone to subspecialise in something that they're interested in.
• 43:30
  SPEAKER_00: They're going to see more Oscar Schlatters they're going to see more adolescent backs in sport that they might be more interested in.
• 43:36
  SPEAKER_00: They're then motivated they can of course then charge a premium on that reputation and obviously in doing so be that we salaried or associate rates then of course the the incentives feel like they're well balanced where the clinic is winning, the therapist is winning then of course the patients are winning because you've got this specialist who's absolutely loving what they do.
• 43:54
  Michael: It still seems bananas to me and completely bonkers.
• 43:56
  Michael: If if I saved my team who are also I'd say my team the HMDG team two hours a day, each of them, and then said, Yeah, just chill out.
• 44:04
  Michael: I don't want you know no burnout.
• 44:06
  Michael: I that's banal like I I I honestly you have to find even if it's not directly revenuable revenue attribu attributable like multiens, like you say, we've got to do something with that time.
• 44:20
  Michael: The business has to benefit.
• 44:21
  Michael: Otherwise why get notes at all and spend money on it.
• 44:23
  Michael: Yeah.
• 44:24
  SPEAKER_00: And I I of course I agree, but then also like we can't pretend that that's not controversial to some degree anyway.
• 44:30
  SPEAKER_00: There's some people that have a of an ideological persuasion that just feel like there's not that much only a hair's breadth between work and slavery.
• 44:37
  SPEAKER_00: Really it's just all irritating.
• 44:39
  SPEAKER_00: It's just obligating people into actually selling their labour.
• 44:42
  SPEAKER_00: There's some people that are that far out on their own instincts uh that they they don't you know they they they are that radical and it's and it's strange and especially in in unfortunately in in healthcare that you see some of that more.
• 44:54
  SPEAKER_00: There's a strong public sector in health and education that means that then people can kind of have a it's not only that they're not commercially savvy like we sometimes talk about you've got people that have absolutely no concept of market economics in any which way and no sh nor need they, right?
• 45:08
  SPEAKER_00: Because they can live their live their life that way.
• 45:11
  SPEAKER_00: And of course which is their right but it just means that sometimes in conversation then people will sometimes moralize as if to suggest that that conversation we just had about productivity falling productivity gains falling to the owner as well as the the staff member they think they hear that as being somehow lacking empathy and and compassion for the clinician when of course we recognise that that we as soon as we'd say yeah but what about the the owner that's taken up so much of that risk then it depending on someone's ideological persuasion they'd go oh what woe is me for the for the naughty capitalist owner who wants to then slave drive his his clinicians and stuff right there's a lot of that really there is but then you the counter argument is the owner owns fuck all and it's is is taking on a huge blast strip those are the insights that we have that would would be underneath what we're saying and that unfortunately the the stereotypes that play there aren't aren't aren't fair and we and we do know that and that's one of the things that fair play to you guys for the barometer for for really something we've known for a while behind the scenes we kind of now have the data to say that you've got some some of the lowest some of the lowest paying some of the lowest paid senior senior clinicians in in the MSK game of all stripes and persuasions are the owners of these clinics.
• 46:25
  SPEAKER_00: And so that which is the Scrooge McDuck swimming in his pool of gold because of the because they're selling loads of MSK care and having loads of staff and loads of clinics is is such a nonsense and always has been.
• 46:36
  Michael: If you thought the barometer was good I can't now wait till you I I was just for this call I was laxing laxing waxing lyrical about this this new thing we're doing.
• 46:47
  Michael: It's absolute and you don't even know what it is yet but oh but this I'm I'm I'm I'm excited for this podcast to wrap up because you promised you'd tell me we are doing something insane so watch this space by the end of this year we should have something like the barometers still I don't want to say forget the barometer but this is amazing.
• 47:04
  SPEAKER_00: Right incentives talk to me I I know I answered really specifically about incentives but I I think that what what we've just described and a lot of the conversation we've had already is I find that one of the the only way the only way and I overuse this phrase on and off a hair right I sometimes will say that the only way is through right there's certain problems that we can't go round them we can't go under them we have to go through them.
• 47:28
  SPEAKER_00: And in this instance if we're gonna as a community of practice anyone associated and interested in the care of people with pain and injury particularly we're talking fairly UK centrically for a second but it does travel well across borders is that we need to reform and reframe our role we need a societal shift in our per how people perceive us we need to be noticed to be adding value.
• 47:49
  SPEAKER_00: We have a really unique circumstance whereby we use our hands in a really interesting way compared to say most healthcare professionals.
• 47:57
  SPEAKER_00: And so we've just got so many ways in which things should be falling in our favour.
• 48:01
  SPEAKER_00: And if we are to take that opportunity as well as to decrease the threat minimize the threats that are coming from the technologies of which we've talked about of which I I do agree with you is a very interesting thing then we have to find a mechanism in which we can actually operate as a community of practice and have some sorts of fora that would actually benefit that.
• 48:22
  SPEAKER_00: And so I think that the incentive structures around it so the ability to reward individuals services projects businesses innovators of all stripes the way in which that is rewarded and celebrated within the industry is absolutely absent lacking is there's just just the showcasing of talent the way in which that can be what are what are the rising what is the incentive for the rising starter to keep rising to be honest you know and how do we not lose incredible clinicians and researchers and innovative entrepreneurs in our sector how do we encourage money to come into our sector if indeed it's not going to be appropriately championed and celebrated I think that's absolutely absolutely well also and I'll I'll uh I'll sort of take a it's the same thing but almost the reverse how do we not cut off people for being innovative and doing something different and and you know I I still um sore on this one but you do something like the barometer and you get criticised left right and centre because for whatever reason because you you've done something really really cool that's free.
• 49:21
  Michael: Yeah yeah I I I think there's there's uh a kind of a a lack of entrepreneurialism in the industry and a lack of that kind of as you say community and I I wonder whether that's partly because the community has been quite toxic over the last since I've been in it.
• 49:36
  Michael: Less toxic today and I think that's because of the demise of Twitter maybe but certainly it's been it's been toxic over the years.
• 49:42
  Michael: Yeah do you think that's one of the reasons that's that's happened?
• 49:45
  SPEAKER_00: Yeah look I it's interesting because you like anything when you when you're analyzing history it depends where you start the clock as to what the reaction and the counter reaction was so people would always dispute this but I think one of the things that's definitely happened is that in it's a very British thing and it's a very healthcare in Britain thing that you've got a version of Toll Poppy syndrome or use other expressions if you like people don't put their head above the parapet it'll get shot at and things like that.
• 50:08
  SPEAKER_00: So there's a compliance thing and especially when it comes to in uh innovation and entrepreneurship it's a lot of ink's been spilt comparing the UK to the US in that way and and the sort of mindset and cultural differences there.
• 50:19
  SPEAKER_00: So we have our version of that thing.
• 50:21
  SPEAKER_00: And then in healthcare especially when it comes to healthcare in an increasingly mixed economy which we're not used to as well right so that's an that's an interesting thing that's happening.
• 50:29
  SPEAKER_00: Now I argue that it's hilarious when people talk about two tier healthcare in the UK that is nonsense.
• 50:34
  SPEAKER_00: There is at least three tiers you've now got the NHS you've got private medically insured patients and then you've got cash payers that are then able to access a full suite of services many of which now obviously don't actually take your your classic private medical insurers outside of London anyway.
• 50:48
  Michael: Also that's at least you've got that level almost above that I don't know if you count that as cash payers but that concierge level of service right where uh and I got one a completely private doctor.
• 50:58
  SPEAKER_00: Oh that's right.
• 51:00
  SPEAKER_00: Yeah then my that cash pa that cash paying is a hell of a layer that has you know you you could split it further but I'm I supposing just in terms of in terms of state pays euro pays cash pays as as as three crude levels even though you could sub you know you could split them up because you've got the independent sector that's technically not state it's state funded but not a state provider.
• 51:19
  SPEAKER_00: So they weren't it's messy but just on that it's that you you're kind of um you're kind of in a situation where people's ability to sort of say something different or be different or create something different you're quite right you've got the balance of of making sure that then people just is it worth their hassle right and and so why do people get shot at and stuff like that?
• 51:39
  SPEAKER_00: Sometimes it's that in healthcare I think there's a really healthy instinct to make sure that this is somewhere that unlike in apte right in aptech the market can you can really rely on the market to do some of that work.
• 51:55
  SPEAKER_00: Someone creates something that's that's that's crap and also there's a there's a there's an it would take for something really extreme for it to be really dangerous.
• 52:04
  SPEAKER_00: Whereas in healthcare that has to meet a threshold for it to not be really dangerous right you can't let the pharmaceutical industry to use an extreme example operate the same as the app industry right on your iPhone.
• 52:17
  SPEAKER_00: So that's healthy but then people get carried away on that and especially those that are uh are of a persuasion that are disinterested in innovation you've got people that are um are um of a of a persuasion that really would rather that doesn't exist or or they're frustrated at the the rate of of change in that direction they can't help themselves but to shoot at things because that's that's just their their nature so you've you've kind of got this balance of various different things that are sometimes thought in innovation and as I mentioned before if you then don't have your incentives right you know I'm I'm gonna be people are going to get bored of me over using this analogy but I say that MSK's got its carrots and sticks mixed up and we just don't have either any consequence for poor practice or any incentives to it to accelerate and and celebrate good practice um it amazes me.
• 53:06
  SPEAKER_00: And we never really had a time where it was great but it wasn't many years back that we seemed to be creating something where you had this network in which people were able to celebrate some of the good ideas, translate them into various different geographies and postcodes try them, learn from them.
• 53:27
  SPEAKER_00: People were a little less sensitive to everything at the time very briefly and then you also had robust debate about the mechanisms underneath certain clinical treatments or that what seemed like something was a really nice commercial idea might have some perverse incentives baked into it and stuff.
• 53:45
  SPEAKER_00: And so it was I think we need to try and at least find a way to get back that because as I mentioned before the only way is through we kind of we have to come together because if not unfortunately we you know we're not as a as a as a as an industry as a cohesive sort of network of professions called the MSK industry and its associated businesses I think is not long for the world.
• 54:07
  SPEAKER_00: I don't think it's many years unless we can get our shit together.
• 54:09
  Michael: No I agree do you do you think some of that's down to just the the the massive infighting over different ways of treating you know the the the anti-manual crew as I call them versus the the you must touch everything, the the the shockwave and do you think that I think it would yeah I I call that I call that styles of practice just broadly and I think that historically that has been I think weirdly it's not as important now as it used to be I think because there's various intersections to that now in public versus private versus uh charitable sector versus independent sector.
• 54:46
  SPEAKER_00: So that those things have ended up being so this turf wars almost wherever you look but when it comes to people's style of practice I think what's a shame and and the bits of progress that I mentioned before from a few years ago actually were that that people people were really into a certain modality right I'm a manual therapist I'm an acupuncturist I'm really into coloured tape I'm really into rehabilitation I'm a Pilates instructor and a physiotherapist I'm really into my psychosocial intervention.
• 55:12
  SPEAKER_00: People got really into that that doesn't matter necessarily right I love the fact that we've got that diversity of interest it's not a problem really right there's some extremes of that that I think we need to gatekeep I'm a homeopathic physiotherapist like no I'm happy to gate we need to gatekeep our license to keep that sort of nonsense out right there's got to be I'm really into astrology physiotherapy right it's odd but outside of that within the grounds of what I said before those nonsense examples I'm into that diversity.
• 55:39
  SPEAKER_00: I think what's the problem is is that if people then attach that so centrally to their character that they can't hear a a hear a critique of acupuncture manual therapy Pilates without then thinking that that's an affront to them because they've attached it to themselves, right?
• 55:54
  SPEAKER_00: If your acupuncture identity and you're really into using acupuncture for pain, if that becomes to you as important as your left arm, that when someone criticizes acupuncture or Pilates, you feel like they're trying to chop your arm off your defensive reaction to it is so visceral that you can't be reasoned with.
• 56:13
  SPEAKER_00: And that to me I mean it's just by temperament that is just not just irritating to me like I can't I can't really understand that.
• 56:20
  SPEAKER_00: It's so different to how I think about things and it's also so to me so obviously unhealthy to be that that confused.
• 56:28
  SPEAKER_00: It's very human by the way I mean I've studied it enough to know that I'm a bit odd really on that.
• 56:33
  SPEAKER_00: But as far as how can we move forward and you ask the question is this because of styles of practice disputes partly but honestly if we as an industry and more in if more individuals can't gr outgrow that ASAP then we're screwed.
• 56:47
  SPEAKER_00: If everyone feels like actually no those tribal turf wars over styles of practice are actually a central thing we need to continue to fight about forever I won't be it won't not only will the industry not be long for it but I will be long out of it.
• 56:58
  Michael: You know it's interesting because I think that the the tox I don't want to call it toxicity the argumentative nature of certain people you included has actually reduced over the years.
• 57:11
  Michael: You used to get way more wound up by bullshit than you do today.
• 57:15
  Michael: Lots of people maybe not Meekins I think he's still wound up by everything but I think people are just less they're more accepting I do wonder whether that's because you know you can only call out so much bullshit and I think the MSK industry has has really embraced the bullshit like more than I've ever seen and and and and I think that you know in the past when it was like oh I'll I'll criticise one in every 10 clinicians or one in every hundred clinicians now you stick a pin in it and you're criticizing one in every three for being shit by you know saying if that makes sense.
• 57:44
  SPEAKER_00: Yeah I think that's a really it's a really good point.
• 57:46
  SPEAKER_00: I mean I one of the things that I've thought about recently is that on the wider I don't much like I don't like car mechanic analogies for for human bodies I also don't like battle and war analogies necessarily for wider career activism.
• 58:02
  SPEAKER_00: However I will use one now is that I won a couple of battles but we lost the war.
• 58:06
  SPEAKER_00: However in winning a couple of battles we then at least created a network of there was enough there's enough landscape for us to control control's not the right word but we but have some jurisdiction on or have some that there are now you know people used to accuse me of that that landscape being an echo chamber I say well it's fine it could it could be there's a risk of me being speaking into an echo chamber but if the echo chamber's big enough how many how many tens of thousands of people do we need to have reading MSK mag um or interacting with our stuff or coming to our events before then you know that accusation of an echo chamber if it's in north of 60-70% of what we estimate the MSK industry in the UK to be you know so I get a bit frustrated when it's overminimized but to some extent the point about losing the war is that the war was what MSK reform was trying to fight right it was the this wider thing of like could we radically change the game and the answer was no for various reasons and so yes the industry has there are much more places to hide now for bullshit and that there hasn't been a lot of embracing of bullshit it hasn't gone in an evidence based direction across the board but the enclaves that do are far better than they were and that gives me some hope and I feel like I'm not having to repeat myself as much as I used to.
• 59:20
  Michael: Yeah and but what sort of in it annoys me and I said this to you not so long ago that I I sometimes ugh it's gonna sound a bit egotistical but I sometimes feel like I'm the only person on the business side of the industry that's calling out the book that I see.
• 59:34
  Michael: And and it's such a shame there aren't more people stopping clinic owners from being fucked over by unscrupulous and and stupid shit that you see.
• 59:44
  Michael: I just think this is a topic in its own self but it's almost like social media has led to really structurally just bad healthcare because the things that the that get traction on social media are the things that are just nonsense, right?
• 59:58
  Michael: And you get all these coaches now pushing towards nonsense some of it being longevity medicine but pushing towards the nonsense on on social media.
• 1:00:05
  Michael: You know I I I could probably call out 20 people now who are in this industry who are just pushing really like just not okay things in the industry.
• 1:00:14
  Michael: And what frustrates me on your side is that you don't have anyone and didn't have anyone back in the day supporting you.
• 1:00:21
  Michael: No physiophilist at the time and I know physiophilists change and whatever physiophil support there was no CSP support there's no regulator support and they're more interested in whether Meekins swore in a tweet or not and it's like where is where is the support?
• 1:00:37
  SPEAKER_00: Where are the other people calling out back so that's true.
• 1:00:41
  SPEAKER_00: I've become more more philosophic I have a it gets to be I'll I'll I'll stop myself because it gets a bit this is your life and it's definitely not interesting.
• 1:00:49
  SPEAKER_00: But I look back over my career and think about those times where I used to be more irritated and more irritable about about bullshit and stuff and and and it's hard to tell how much I'm war weary and how much it's just the philosophy of of what you go about how you go about things is different when you've got different priorities right that was you know it's like oh you you're a bit different now to were 10 years ago oh yeah a little bit so when I started physiomatters as a as a 24 year old yes I was different my life was different you know my children's far from existing at that point and I had a bit of maturing to do.
• 1:01:19
  SPEAKER_00: Now I wasn't necessarily wrong about everything but I was aggro and I was naive about the fact that how I was putting my message across was Marmite right now I can't regret it can I look it's gone well but fundamentally I put people off that that are coming back to us now that then say oh you've changed your tune I'm glad you have now also the problem is that when you're on an evidence based Vanguard then you look like a maniac.
• 1:01:40
  SPEAKER_00: You know it sometimes takes people years to realize that what looked completely mental about biomechanics that they were really into eventually they kind of come around to some of it and they you look less mental, right?
• 1:01:52
  SPEAKER_00: That's one of the things that happens.
• 1:01:53
  SPEAKER_00: Now to link that to your commercial point I just think that you on and off air love to probably every third week call you a weirdo and you've got to know that to be the case that your incentive structures to talk about that because we're talking about it in this podcast are are quite bizarre is that you have become rather taken by the industry.
• 1:02:14
  SPEAKER_00: I like to think I've done some persuading in that direction you know and I love to point out where I think sometimes your instincts are off but generally speaking you really care about the clinicians within it you care about the patients within it you don't like people being exploited and it and it you've got you your your fairness bristles have gone up a number of times.
• 1:02:31
  SPEAKER_00: That is weird for someone that's a non-clinician you and then you've been weird in the position you've ended up in in HMDG even more so since selling it to then be in a position to sort of be willing to call those things out and not be worr worried about the social consequences or business consequences of that.
• 1:02:46
  SPEAKER_00: That's odd.
• 1:02:47
  SPEAKER_00: Now it's a shame that it takes for an incredibly unique circumstance in a per in a unique person to do that but it kind of does.
• 1:02:55
  SPEAKER_00: And we've talked about it I think on air before about the fact that I mean even now you say I'm I'm far less outspoken now but given the chance to I mean I don't I don't self-volunteer into aggro as much as I used to but when invited to I absolutely I'm not pulling I never pull punches do I if you ask F the question um I'll I'll answer it.
• 1:03:13
  SPEAKER_00: But the difference now is that of course my independence is incredibly relevant.
• 1:03:18
  SPEAKER_00: If I had a boss's boss's boss that was trying to trying to commercialise me right if I didn't manage to retain well it was close a couple of times as you know retain ownership of physio matters then I wouldn't be in a position where I could probably be as brave now it shouldn't take bravery and I don't really think what I do is brave really but I'm just meaning like people aren't that outspoken in various ways because it's bloody awkward it's just it's easier to not be it's easier to be compliant it's easier to be a top eat a poppy in the field right yeah it is but you know I don't know for me I don't I don't think it's strange or unique I I I I speak to clinic owners every day and I and I think you know you you look at who they are they aren't multi-millionaire business owners with big houses right they are vulnerable people who are who got into this to help other people and I just hate seeing them being taken advantage of by bullshit.
• 1:04:07
  Michael: I hate it and and it doesn't matter whether a clinic owner or anyone else I was always the kid that used to s stand up for the against the bullies for other kids at school.
• 1:04:15
  Michael: I just feel like you know you you you have a bit of a yeah you you should stand up for things that you think are right.
• 1:04:22
  Michael: And and on the patient side yeah I don't I I do still have to be a little bit careful what I say because I am yeah but there are certain things where I I I see and I just think imagine if I was that patient or imagine if my mum was that patient.
• 1:04:35
  Michael: I don't I don't want to see that bullshit.
• 1:04:37
  Michael: I don't want to again I think one of the issues is particularly in this industry is you see people who are incredibly vulnerable and when someone is vulnerable and this is how loan sharks work right when you get people completely vulnerable you can get anything out of them.
• 1:04:53
  Michael: I remember when I had my issue I remember sending a WhatsApp to a little group saying is IDD a thing is it really gonna release my nerve and make me fine again and everyone was like fuck off and bullshit it's stupid and the thing is as a somewhat intelligent person I was ready to drop 10 grand on it or whatever it was because I just wanted to get rid of the pain.
• 1:05:13
  Michael: And and I think when you see and I'm not talking necessarily about ID here but when you see people being taken advantage of I think we have a responsibility and I know clinicians by the way who have seen a patient I know one I've got to be careful what I say here but one story of a patient that came to them after seeing another clinic and their first thing was their first bit of advice is I need to refer you to an oncologist after seeing this other clinic for 14 weeks whilst you underwent you know 20% of your weight loss and you you know radiating back stuff.
• 1:05:43
  Michael: And so I think that it's just a shame that there aren't first of all enough people but beyond that what about the institutions?
• 1:05:49
  Michael: What about the CSP?
• 1:05:50
  SPEAKER_00: Sure I I I think what what's interesting is a lot of my a lot of my sort of strident I think stridentness that's definitely not Strident nature over some of some of these things is partly informed by the fact that I see a lot of second opinion work.
• 1:06:07
  SPEAKER_00: And so I know that that sometimes skews me.
• 1:06:09
  SPEAKER_00: And so I, you know, unfortunately do need to sort of see that I see the I see the people that have been having their hamstrings tortured for a tear that's not healing when it's sciatica on the low on the on the entry level side.
• 1:06:20
  SPEAKER_00: And I see that I see the back pains in in uh in children that have been given some tummy-tuck Pilates type stuff and they've been massaged and stuff and they needed a an MRI because they've got a stress fracture.
• 1:06:31
  SPEAKER_00: And so I see more of that than most people would.
• 1:06:33
  SPEAKER_00: And so that does deject me a little bit and make me a bit cynical.
• 1:06:37
  SPEAKER_00: However, the big risk in all of this is that we've got to try and develop more consistency in care standards.
• 1:06:45
  SPEAKER_00: And as soon as you're trying to do that, you have to acknowledge that this isn't just a quantity thing, it's a quality thing.
• 1:06:50
  SPEAKER_00: So someone like the CSP, which has its internal conflict of interest by being a trade union and a professional body, is completely conflicted because essentially what they need to try and keep the message discipline, especially including with civil servants and politicians, to say we need more physiotherapists and we need better pay for physiotherapists, and we need the minute that anyone, including myself, maybe even from inside the tent, will say, like, we also need better physiotherapists.
• 1:07:14
  SPEAKER_00: It's like it's implied that there is a range then of quality, right?
• 1:07:18
  SPEAKER_00: There isn't this well-guarded competency standard, and obviously no one's naive enough to think there won't be some variation, but there's a there's a flaw to it, right?
• 1:07:25
  SPEAKER_00: There's no such thing as a bad such thing as a bad physiotherapist to be regulated as a CSP member in this country.
• 1:07:30
  SPEAKER_00: It's like, well, we'll unfortunately there is, because outside of your bachelor's and signing a register, you're just unchecked and ungoverned, and you've just not got any career pathways that are credible, right?
• 1:07:40
  SPEAKER_00: Which is a best kept secret in just physiotherapy, and the other MSK professions are no better.
• 1:07:44
  SPEAKER_00: But I just think that then that like you're asking a question about the institutions, is that they they're just not even at the races.
• 1:07:50
  SPEAKER_00: It's not these days.
• 1:07:51
  SPEAKER_00: I don't it's funny, I don't I don't think that they're not doing they're not doing anything.
• 1:07:54
  SPEAKER_00: The thing that they're doing most wrong is the things that they're just not doing they should be, right?
• 1:07:58
  SPEAKER_00: And it's just hilarious because but these are often, and this is what's embarrassing for us, is that these are member institutions, you know.
• 1:08:03
  SPEAKER_00: These are these are there are technically levers that we could pull if we could get together that you could you could influence.
• 1:08:09
  SPEAKER_00: Amusingly, of course, and I know more than most how impenetrable these sorts of things are if you wanted to try and reform them from without and from within.
• 1:08:17
  SPEAKER_00: But it's just that they they technically part of the apathy we were talking about earlier, part of the lack of um incentive structures that exist to even help us be cohesive together.
• 1:08:27
  SPEAKER_00: The challenges that we've had over the timing of some of the more insurgent movements, uh my own included, being thwarted by timing over uh combinations of of COVID and other political factors, um, make it challenging.
• 1:08:40
  SPEAKER_00: You know, I one of the things you you know I've said before, which is amusing, and people ask me um all the time about why I bother, is that um, you know, I've I'm fortunate that I got into this as a a young SADO and I'm not that old yet.
• 1:08:52
  SPEAKER_00: And so, you know, this is an important thing to me.
• 1:08:54
  SPEAKER_00: I just like trying to move the needle across the course of my career to improve care standards for people with pain and injury.
• 1:09:00
  SPEAKER_00: And I think that the way that that intersects with policy, commercial factors, professional analysis that transcends sore knees and backs and hips, um, it transcends sectors.
• 1:09:10
  SPEAKER_00: You know, I'm I'm no more bothered by independent private practice than I am about the way in which the standards of care in the NHS are delivered, in part because the majority of MS care care in the UK is delivered in the NHS, and so we need to try and make sure that those clinicians are looked after and that aren't allowed to that aren't capped at four sessions or that they can't get a follow-up for six weeks.
• 1:09:30
  SPEAKER_00: And so the style of care that they can deliver is incredibly restrictive, not least that they can't get a dynamometer to rub together between three departments, or they're passing it around between cubicles.
• 1:09:39
  SPEAKER_00: You know, it's just it's just embarrassing.
• 1:09:41
  SPEAKER_00: And we know um that those conversations are why I end up having almost this hobby horses grow, or it becomes one massive hobby horse.
• 1:09:49
  SPEAKER_00: Um, one thing I want to just make sure I state is that uh for those that are listening that do cringe at the fact that me and you have just gone, uh aren't we all aren't we very brave innovators, me and Michael.
• 1:09:57
  SPEAKER_00: I'm glad we're speaking up.
• 1:09:58
  SPEAKER_00: Uh check us out.
• 1:10:00
  SPEAKER_00: It's it's more that um and I hope we can reference previous conversations that give context a little bit to some of the stuff we've done both together and apart, where unfortunately we have had experiences where it isn't just uh a few people that want to disagree with us, you know, it's just that people get get nasty enough to try to literally come for your right to say it, you know.
• 1:10:19
  SPEAKER_00: So so we that's why we are sometimes come across maybe a little sensitive in that direction, is because we've had phases in our lives and careers whereby people have uh have really tried to be nasty is the way that they disrupt uh our ability to actually make a living.
• 1:10:34
  Michael: Yeah, I mean well they tried, but uh yeah.
• 1:10:38
  Michael: Good luck to them.
• 1:10:39
  Michael: Cancelled now, motherfuckers.
• 1:10:41
  Michael: But uh no, but you know, we i i i it is in it has been difficult at times with with various projects that we've done and uh but on the plus side we're still going.
• 1:10:50
  Michael: Uh uh we're about to announce Clinic Signal as HMDG, which is well our customers already know about it.
• 1:10:56
  Michael: Yeah, absolutely.hmdg.co.uk.
• 1:11:00
  Michael: I think it's clinicsignal.
• 1:11:04
  Michael: Signal.hmdg.co.uk.
• 1:11:06
  Michael: I'm gonna do a podcast on it at some point.
• 1:11:08
  Michael: Um we've got uh I mean we've got something else insanely special coming.
• 1:11:11
  Michael: And let's talk about uh incentives and what you've got coming up because we're sponsoring something else.
• 1:11:16
  SPEAKER_00: Yeah, so I talked a bit there tonight about how really we need we we need to find a mechanism of doing the having a town square um really again and and creating decent interprofessional debates.
• 1:11:26
  SPEAKER_00: One of the things that we've done a lot of is that we've kind of had various different multimedia commentary, but what I think we have not done, and and I I I I've slept on this and realized how we've been a bit delayed in sorting this out, is that when I was speaking to an increasingly reforming and improving physio first, is that they recognized this incentive problem and thought, I said, what if we just had this really independent opportunity to celebrate excellence, to actually have an awards industry uh awards network and nomination process and celebration and ceremony where we can champion um great people, great services, great projects, great businesses that are contributing to the improvements in care for MSK patients.
• 1:12:10
  SPEAKER_00: Um and so fair play to them, they they took that on and and we're co-hosting the first annual MSK Awards on the 27th of November.
• 1:12:17
  SPEAKER_00: And we have eight categories, um, including the HMDG Service of the Year, or is it Clinician of the Year?
• 1:12:24
  SPEAKER_00: I can't remember which one of it is you guys have sponsored, but we have eight categories in which people can nominate the best and brightest in the game, especially those unsung heroes.
• 1:12:34
  SPEAKER_00: And also, if you think about someone that you know you know would qualify well for one of these awards, but you know they're the sort of person that wouldn't for the reasons some of the reasons we talked about before wouldn't blow their own trumpet, then nominate them, right?
• 1:12:46
  SPEAKER_00: Like we've got to we've got to get them nominated because we've got some incredible uh nominations coming in with now, which is which is fantastic.
• 1:12:52
  SPEAKER_00: But just think about what we've talked about there, is that there are increasingly uh uh there's increasingly a lack of lack of way in which we can celebrate and then translate some of the best ideas in our industry.
• 1:13:04
  SPEAKER_00: And if you think about what that means for people that have got really interesting projects or services, or you've got a rising star that's got this balance of clinical work as well as in-practice research, that really that should be inspiring someone who's only a few postcodes away, or even the other side of the country, to do something at least similar, if not taking that template, but they don't know about them and they don't know about them partly because of the institutions that we're talking about that aren't doing a good job of it, or the influencer network that even we're part of is not necessarily that cohesive and we don't communicate as easily.
• 1:13:32
  SPEAKER_00: And so that's why I think that the MSK Awards could really help to, it's only a small part, it doesn't solve the incentive problem for MSK at all, but it's a part of what I think could really at least give us if we think about carrots and sticks, right?
• 1:13:46
  SPEAKER_00: You think about rewards and and then sticks being the consequences on the carrots side, I think we're going to be able to create an incredible and fun party at the awards ceremony, as well as a credible process with some of the best minds being judges on that panel that will mean that then we can actually then celebrate that on an annual basis, and that having an MSK award and being in that nomination process being commended, being uh one of the runners up, even the winner of an MSK award being something that we can use as a template and a model to then translate that across the country.
• 1:14:18
  Michael: Yeah, you know, I don't even care about that.
• 1:14:20
  Michael: I I I gotta say, I just I like the fact that we've got something positive.
• 1:14:24
  Michael: Not not a paid-for award where you stick it up on your website and go, we're the best whatever, but just something a bit positive, a bit of fun, you know, something that's a little bit different.
• 1:14:33
  Michael: Because uh again, we talked about innovation enough times since knowing each other, and it's nice to do something that's just a little bit different, a bit positive, saying nice things about people, not just because they pay you a load of money.
• 1:14:44
  Michael: And yeah, and maybe just recognizing people that that that need a bit of recognition that other would otherwise not get it.
• 1:14:50
  Michael: And I think it it it takes us from that kind of toxicity that we had uh six years ago into something that's just a little bit lighter and a bit more fun, you know.
• 1:14:59
  SPEAKER_00: And I think this is at the very least it's gonna be a cracking party.
• 1:15:04
  SPEAKER_00: Like that's one of the things is that that we've got I have got some somewhat romantic and highfalutin goals for what it can achieve and how it might help to shift the balance on incentives.
• 1:15:13
  SPEAKER_00: I am that sadho.
• 1:15:14
  SPEAKER_00: However, as an evening on the 27th of November in the Sky Gallery in Birmingham, there's the plug, to go to mskawards.com for your tickets now.
• 1:15:22
  SPEAKER_00: That is gonna be, even if you're not bothered about about the nominees or about listening to the projects and services that are people that have been celebrated, it's gonna be a really good dinner, it's gonna be a really good dance, really good party.
• 1:15:35
  SPEAKER_00: We've got Alistair Brownlee as a as our guest speaker, talking about some of the challenges he had with injuries between his two Olympic gold medals, and also he's got some really hot takes on the fact that in MSK you've got he's seen the good, the bad, and the ugly, even as one of the best in the world at uh what he did, uh the best, arguably, an Olympic triathlon.
• 1:15:54
  SPEAKER_00: He knows that that nearly scuppered his career to then see people giving him poor advice over some stress fracture management between gold medals, right?
• 1:16:01
  SPEAKER_00: So so it it's we've got something that's like a highly relevant MSK entertainment, but at the heart of it, it's just gonna be dead fun.
• 1:16:10
  SPEAKER_00: And that's one of the things that we've we create events all the time, including with yourselves, but we've never had a chance to do one that doesn't have to worry itself about education.
• 1:16:18
  Michael: We're just doing a really good party.
• 1:16:20
  Michael: Exactly, and that's what's so different about it, right?
• 1:16:21
  Michael: It's it's not about education, it's a bit a bit of fun.
• 1:16:24
  Michael: It's a day after uh is it the day after therapy expo or whatever they've called it now.
• 1:16:27
  SPEAKER_00: Yeah, there was a there was a risk, there was a risk because we were originally in London and there was a risk that that was going to be a bit of a collision, and so we're in on great terms with the therapy show, it's called now.
• 1:16:37
  SPEAKER_00: So we're gonna be as the media partner at therapy show, we then instead of risking dragging the people away, including us, down to London, we were going to have to split the team or not go to therapy show.
• 1:16:47
  SPEAKER_00: It's now the day after therapy show on the Friday night.
• 1:16:50
  SPEAKER_00: So it's the last Friday, and one of the things that I want to, if people hadn't realized what that date means, right, is that's the last Friday in November.
• 1:16:55
  SPEAKER_00: It's it'll be like we all go on Christmas do's, right?
• 1:16:58
  SPEAKER_00: And sometimes you and your team will pay silly money to go in a tent somewhere for a Christmas do um with your team where you you know at least this would be relevant, right?
• 1:17:06
  SPEAKER_00: This will be a it'll be a cracking party in the ways I've just described it.
• 1:17:09
  SPEAKER_00: But this would be I think it's a perfect Christmas do, in it, for a clinic.
• 1:17:13
  SPEAKER_00: I don't know, maybe I'm biased, obviously, but I think that'd be a really relevant thing to do, but still really fun, and and obviously, and also yourself included has been one of the sponsors that's throwing in good money, so we'll be getting uh plenty of booze going around.
• 1:17:24
  SPEAKER_00: Well, yeah, and I'll be there as well.
• 1:17:26
  SPEAKER_00: That's an incentive.
• 1:17:27
  Michael: That's oh you I weren't gonna tell them that.
• 1:17:29
  Michael: That's gonna cut them off.
• 1:17:30
  Michael: I wasn't gonna go to the therapy show.
• 1:17:31
  Michael: I didn't know if I could take another 23 taped vendors and 24 shockwave vendors, and then being people selling something that vibrates a lot, but maybe it's a better show this year.
• 1:17:42
  SPEAKER_00: Well, never know.
• 1:17:43
  SPEAKER_00: I mean, hopefully it's so.
• 1:17:44
  SPEAKER_00: I tell you what, I've been impressed with with them is the um the willingness to collaborate with us, which I know sounds funny, but you know, we we we've sometimes been in collision with them at times, gently and and cordially, but they we're working with them as a media partner because we see that they are not just changing the colour of their logo and their name, they're really trying to turn that into something that is a showcase, an educational event, not just an expo, and so that's good.
• 1:18:08
  SPEAKER_00: And then the second thing is that they've recognised they've that um that that's something that working with us on it and uh and sponsoring, they're sponsoring the party, they're sponsoring the band, you know, they kind of recognise that sometimes we need to just make things a bit more fun and a bit less stiff.
• 1:18:20
  SPEAKER_00: And so I've been I've been impressed with them, closer still, who run Very show, and I'm giving them a chance, I'm giving them a real good chance.
• 1:18:26
  Michael: Well, what I would say is I'll give them a a little bit of a pass if you're saying good things, but to be an educational show, you need speakers who are educators and not dickheads, which the speakers, and also maybe get people on that aren't not just people who are paying to do a talk, but maybe people that are good that are there because they are good, not just because they want to spend what do they want from me two grand or something to for a half-hour slot?
• 1:18:53
  Michael: It's alright, you know.
• 1:18:54
  SPEAKER_00: Well, pay to pay to play is a massive problem in education, and we know that because of the people that that will sometimes and it's tempting sometimes, but you know, people offer good money to come on the podcast and stuff like that.
• 1:19:03
  SPEAKER_00: So we know that, and and and and there are times and they will admit um that there have been times over the years that they uh have gone too far in that direction.
• 1:19:12
  SPEAKER_00: I think one of the things that uh I'm pretty sure they won't mind me saying is that um we were op we were open both publicly and privately, challenging them on some of that, and that that was the way in which the leopard needed to change its spots for it to be uh a credible and meaningful show in the MSK calendar compared to what it had had become at times, and um and they have listened.
• 1:19:32
  SPEAKER_00: Now, I don't, you know, I you can only judge it by its first show in the new colours, right?
• 1:19:38
  SPEAKER_00: So that's one of the things that's interesting, and I don't know.
• 1:19:40
  SPEAKER_00: But one of the things that I've been really impressed with, and you're mentioning it as being like the MSK Awards is is um it's affiliated in some ways by the fact that they're kindly one of our one of our sponsors for the party, um which is really good of them, but as a general rule, it seemed like an unnecessary um an accidental confrontation if we ran it in London the next day, in such that people would decide to go to one or the other, wouldn't they?
• 1:20:01
  SPEAKER_00: Then that seemed that would that would seem that would seem unnecessarily aggro from us, even though it would have been an accident.
• 1:20:07
  SPEAKER_00: And so instead, in the spirit of what I was saying before, where as a community of practice in MSK, if people are bothered about raising standards, even where they might disagree with certain style or uh having how much diversity we should have in those styles of practice in MSK, I think it seems smart for us to to come together, and I think it sort of hopefully makes it more logistically convenient as well for people that might be going to the therapy show to stay around for another day, come to the MSK Awards and have a party with us on that last day, because that's one something that they do know that it lacks sometimes, is that uh it's ended up not having that opportunity for us to have a good a good uh dance and sing song and have a good piss-up at the end of uh of a good conference.
• 1:20:44
  SPEAKER_00: And so we've now got this opportunity on the Friday.
• 1:20:47
  Michael: Last year, not we me and Ben ended up in a casino with uh a client and I'm sure C.
• 1:20:53
  Michael: Lou Champ wouldn't I mean saying in a casino getting absolutely smashed and losing money.
• 1:20:59
  Michael: Hey, what is the URL again for the show?
• 1:21:02
  SPEAKER_00: Tom has all the information that you need.
• 1:21:05
  SPEAKER_00: And the main thing really that I want to encourage anyone that's listening to, especially suppose it's like if if you're persuaded that that we need to improve the incentive structures or you've recognised that then something a bit more lighthearted and fun, as you mentioned, is is necessary, then you might not fancy coming along, you might not be available, it might not be your your style of Christmas do.
• 1:21:24
  SPEAKER_00: But if you know of someone that is doing really interesting work, if you know of a service that deserves some recognition, then get your nominations in, right?
• 1:21:32
  SPEAKER_00: It's just engaging with that process and watching some of the nominations come in.
• 1:21:36
  SPEAKER_00: It's it's everything that I dreamt of when we kind of conceived of it, and it falls down if we don't create not just a credible process for managing those nominations, but also that we get that talent that we can showcase.
• 1:21:48
  SPEAKER_00: And so I do encourage the listeners to really just have a look on the website, go into the nomination process, and do send us your talent.
• 1:21:55
  SPEAKER_00: Yeah, send it.
• 1:21:56
  Michael: On that note, two questions for you, and then we'll finish up.
• 1:21:59
  Michael: First is other than HMDG, who's the coolest company in in MSK right now doing kind of really cool things in your mind?
• 1:22:06
  Michael: Who would you nominate?
• 1:22:07
  SPEAKER_00: Well, it's funny that um controversial take from me if I take it across the board, so not just B2B, but B2C.
• 1:22:14
  SPEAKER_00: I think the I think Flock is is is cool.
• 1:22:17
  SPEAKER_00: It's it's funny because it's not typically cool, in traditionally cool, but as someone that's just like, I think it's got a risk of not being, but I think it's a disruption in in all the right ways.
• 1:22:26
  SPEAKER_00: And so yeah, that's my sort of instinctive answer across the board.
• 1:22:30
  SPEAKER_00: I think that if I tried to if I tried to say more on a more on a B2B or like two to professionals, then I've been really impressed with a project by a little known company called Physio Matters.
• 1:22:43
  SPEAKER_00: They've got a mag out, they do an MSK mag and uh and and they uh they are doing some exciting work.
• 1:22:49
  SPEAKER_00: No, I I just but I don't actually have a good answer to the uh to the other.
• 1:22:52
  SPEAKER_00: Do you have someone in mind?
• 1:22:54
  Michael: So I uh the more I've been getting into this new NHS app that and the things that I never thought I'd be like the NHS are doing something really cool and innovative, but I really feel like if they get that right, that's gonna be quite impressive.
• 1:23:07
  SPEAKER_00: You know who uh I like I like um I've just remembered.
• 1:23:11
  SPEAKER_00: I like uh I like what Preev have have have created.
• 1:23:14
  SPEAKER_00: Yeah.
• 1:23:15
  SPEAKER_00: Yeah, you mentioned that before, Preevs.
• 1:23:17
  SPEAKER_00: Yeah, that that's that they that that's that's uh and it's really thoughtful how it's come about.
• 1:23:22
  SPEAKER_00: I don't know if you listen to podcasts I did with their founder recently and stuff, and you can see the thought process as to how they were solving it in real time.
• 1:23:29
  SPEAKER_00: Um and so yeah, that's been nice because I've been inundated with what feel like the same sorts of products for a while, and then that felt like it cut through the noise, uh, which was which was good.
• 1:23:39
  Michael: I I what one this is gonna sound so fucking boring and people keep accusing me of being paid and I'm not, but something that's really holding its own again is Clinico because what what not that they've created anything new, but what's really fascinating about them is that because they've for years had this open API and just said, listen, we do what we're good at and you lot build whatever you like, it means that there are so many cool vendors out there that are plugging into that system and creating exceptional things, whether it's it's us with Clinic Signal and or other people.
• 1:24:13
  Michael: And I think again, like that open API argument, which so many tools still to this day don't have TM3 and Jay and everyone else, it's so cool.
• 1:24:21
  SPEAKER_00: Oh another one had him on the podcast, uh Ephra, another absolute fantastic that's one of the um reception AI receptionist things, isn't it?
• 1:24:29
  Michael: Yeah, yeah.
• 1:24:30
  SPEAKER_00: I haven't tested those out.
• 1:24:32
  Michael: No, no, no, it's not a receptionist, it's uh think of it oh I shouldn't really say it in this way, but think of it as like a a health code type product, but it's like an amazing invoicing solution, money collection solution.
• 1:24:46
  Michael: Um the guys are originally uh Go Carter's guys.
• 1:24:48
  Michael: Sorry, no, I do.
• 1:24:49
  SPEAKER_00: Uh yeah, no, I've I I remember now.
• 1:24:51
  SPEAKER_00: Um I haven't used it, but no, you you told me about it, and uh I have followed some of their stuff.
• 1:24:55
  SPEAKER_00: I'm mixing them up with I think Avo, which was what I was thinking of, which is like uh one of these AI receptionist things.
• 1:25:02
  SPEAKER_00: Don't know much about those guys, uh and I've got to hold off some of the one of the things that um is interesting for me is um on the on the hardware side, and they have their challenges in certain ways, but as far as just quality hardware health tech, then Kimvent's dynamometers are really accurate and really user-friendly.
• 1:25:22
  SPEAKER_00: That's been that's been really interesting to use, and and also I can vouch for their robustness and and longevity, the reliability and stuff like that's been really impressive.
• 1:25:31
  SPEAKER_00: So there are some, and also I I've said this before that we need to another reason for the MSK awards and for some of the stuff that yeah, I might I might I might particularly leak leak some news about uh hybrid therapy live as well in a sec the stuff like that needs to be we've got to find mechanisms to incentivize people to invest in MSK and to create a network and community of practice.
• 1:25:53
  SPEAKER_00: I'm over using that phrase, but like having something of which people feel like has a decent feedback loops and there's a network effect that people can actually want to invest in.
• 1:26:03
  SPEAKER_00: And so otherwise there won't be innovation, or if they do, it'll feel like there's one innovation every 50.
• 1:26:08
  Michael: You know, you know what's something that's interesting is is that the the amount of money that can be made in MSK is so tiny that there's very little point in investing.
• 1:26:18
  Michael: Like I I once looked at building a a PMS and it was gonna cost about a million quid or whatever.
• 1:26:24
  Michael: I was looking at putting it all together, and I just thought it's just not enough money in it, it just doesn't make sense.
• 1:26:28
  Michael: And I think where there's a a big gap here is the MSK community getting together and doing almost like a a Kickstarter grassroots type collection of products almost, you know.
• 1:26:39
  Michael: Um I don't know what that looks like quite necessarily, but I think there is room because there's you know the big vendors are not coming into this space because they're you know what what's the growth trajectory?
• 1:26:49
  Michael: You've got maybe six thousand clinics that are gonna buy something from you.
• 1:26:53
  Michael: But six thousand clinics isn't enough.
• 1:26:55
  SPEAKER_00: But that's one of the reasons why, and I'm glad you mentioned them, because I I really do have such a I have such a soft spot for some of the early innovators that then obviously are in a position where they're then refining product rather than reinventing the wheel.
• 1:27:09
  SPEAKER_00: But Clinico and Rehab My Patient are doing some incredible work to just refine what has existed, but they innovated in the first instance.
• 1:27:17
  SPEAKER_00: And so as someone that really likes the reinvention of the wheel when the wheel needs reinventing, it's also worth recognizing that one of the things that holds the whole thing up is someone to be brave enough to have an open API in a time where that wasn't trendy and to recognize that we're not going to build something that does everything, but we can invite you to bolt slove onto it and stuff, and that's great.
• 1:27:38
  SPEAKER_00: And then similarly, you know, I was saying before about with um we have my patient being someone that you know it's it's such an existing large library that when you then start to have AI integrations within it, then that can be a disruption that that they could easily have just avoided, right?
• 1:27:53
  SPEAKER_00: Especially with a large NHS user base and stuff.
• 1:27:56
  SPEAKER_00: It was something that they didn't mess with, but again, they just he cracked his knuckle.
• 1:28:00
  SPEAKER_00: And fancied it.
• 1:28:01
  SPEAKER_00: And so sometimes I I sometimes forget to also celebrate some of the internal innovation that can exist within legacy software, I suppose is the way to put that.
• 1:28:09
  SPEAKER_00: And I think that those are two companies, of course, that we work with that you know, that's a bias of the sorts, but it's not something I'm paid to say, it's something that I have been always impressed when I peek behind the hoods of those companies and get to know them internally about what they've got next in their iteration, is that it's always impressive and thoughtful compared to other companies who you know, some of which it would be rude to name, but once they then have a bit of breakout success and feel like they've got a sticky product, they make it even stickier, and then they just do not iterate at all.
• 1:28:40
  SPEAKER_00: They don't listen to the there's no feedback loops.
• 1:28:43
  SPEAKER_00: And and that is sort of not fair on the carrots and stick argument to not sometimes celebrate some of the companies that really do go into bat for their customers on a regular basis.
• 1:28:52
  Michael: Yeah, I think it's important.
• 1:28:53
  Michael: And then also on the on the I don't know if you have this award, but a kind of a clinic of the year.
• 1:28:57
  Michael: Because uh, you know, I know so many clinics.
• 1:28:59
  SPEAKER_00: We've got a service of the year, clinic clinic would be service of the year, so it's across it across the industry.
• 1:29:05
  SPEAKER_00: But yeah, absolutely, we have a we have a clinic of the year, service of the year.
• 1:29:08
  Michael: And there's so many small clinics that are, you know, they're not making the the millions and the millions of pounds, but they're doing such a great job.
• 1:29:14
  Michael: And and some of them with with certain things happening in their personal lives which are not particularly great, but they're still there for the patients, they're still putting out of service, you know, they're they're struggling along, you know, delivering really great service and really trying to do to do great things.
• 1:29:28
  Michael: And I think that's that's one really incredibly posit positive thing actually about this industry is is the number of of clinics that continue to even though they they uh are not really the clinic that ever wants to earn the the 10 million pounds and become the the the ascentee, no jokes, uh but that you know they they just want to do great work and they want to do good things for patients, and it's not about the money, it's about delivering great outcomes and and doing things the right way and and helping young clinicians.
• 1:29:56
  Michael: Like you you you you might well you probably wouldn't, but the amount of investment I see in CPD, the amount of absolutely terribly uncommercial decisions, like let's put these people through tons and tons training, but not having a contract that they'll save for it, like it it it's so good.
• 1:30:12
  SPEAKER_00: And and I've got to say there is some there is some unsung generosity, isn't there, across the board.
• 1:30:18
  Michael: It's it's rare that you see in any industry quite so many businesses that are doing things not just for the money, but because they really do want to make a difference, they really do want to help people.
• 1:30:27
  Michael: The amount of free things that people are giving, and it it it's it's just crazy.
• 1:30:32
  Michael: So, you know, we have a lot of dickheads in the industry and a lot of dickhead clinics, but at the same time, a lot of really genuine people who, you know, some of whom I invited not you, but some of whom are invited to my wedding, who who I consider friends now, who you know, it you you it it it's it just it still amazes me, actually.
• 1:30:50
  SPEAKER_00: And and so but this is what the I mean you've nailed it, and it's really interesting that you you observed that from such a different vantage point in some ways, well, with different background into the industry or whatever, is that we need to find ways in which we can differentiate those two categories.
• 1:31:05
  SPEAKER_00: I mean, it's not a they're not crisp categories, of course.
• 1:31:07
  SPEAKER_00: Those unsung heroes, we don't have an unsung hero award, but we're kind of recognizing that some of the time, and me and Laura did a chewing it over about the MSK awards, and we were realizing that as we went through the categories, most unsung heroes, those that wouldn't normally put themselves forward and stuff are exactly the sorts of people we want to celebrate, is that there's some people doing some cracking work and some services bringing things together in really innovative ways that just need to be celebrated.
• 1:31:29
  SPEAKER_00: We need to differentiate them from the people that are mailing it in, and the people that are sometimes taking advantage of all of our better nature as well as the vulnerability of patients.
• 1:31:37
  SPEAKER_00: And I don't mean necessarily those that are absolute charlatans that are that are criminal, even I'm talking about those that are through a degree of complacency as well as the lack of appropriate incentive structure, and there's a lot of places to hide, mean that then they are mailing it in.
• 1:31:52
  SPEAKER_00: And so when you've got services that against some of the better judgments sometimes for the betterment of those they work with, those that that they employ, that's um those that are in there under their care and management for or in service of the patients of which they serve in their community are going above and beyond.
• 1:32:10
  SPEAKER_00: That's what we need to differentiate, and that's why it felt like the EmScare Awards is one way to do that.
• 1:32:15
  Michael: Yeah, you know, there's there's a lot of um, and and I saw this in the in the barometer where you know it's all about the million-pound clinic and the clinic making a big IBITR and the clinic that's sold for lots of money.
• 1:32:26
  Michael: But actually, I'm almost more interested in in those clinics that are just about getting by, but delivering brilliantly and and trying to help those guys.
• 1:32:36
  SPEAKER_00: Well, yeah.
• 1:32:38
  SPEAKER_00: I liked it in a number of ways, but one of the one of the big ones was that like it really helped me to have some questions, post some questions to people in like a mentoring context, or just sometimes friends, where it's like the reason that the services that you're on about there are particularly interesting is because what are they doing it for, or what's it in service of, right?
• 1:32:56
  SPEAKER_00: So if they're doing great work as a means of then paying themselves an appropriate salary so they can spend more time with the children, or to care for their elderly relatives, or to pursue their dream of uh, you know, I had one that of course was relevant to me because I love my camper van as well, but they were building a camper van.
• 1:33:11
  SPEAKER_00: Their spare time was doing that, and they wanted to work two days less, and so they had this spoo tea clinic in order to do that, and we're doing some really interesting projects off it and doing a lot more home care and community care, working in farmyards and stuff like that.
• 1:33:23
  SPEAKER_00: And it but it was in service of a specific goal.
• 1:33:25
  SPEAKER_00: They were talented people that no doubt could apply themselves six days a week and try and create a commercial enterprise, but in that moment, that's not what they were wanting to do.
• 1:33:33
  SPEAKER_00: So it would be really clumsy for us to not recognise the context and the goals that each person has, and other people that you've you've you've kind of uh you might not be alluding to the same people, but those that have their own, say health challenges that mean that then why would that context not be recognizable in their business?
• 1:33:51
  SPEAKER_00: And the fact that they get their business and their service and their team to work within that that contextual, those parameters are relevant.
• 1:33:58
  SPEAKER_00: Measuring measuring the success of those outcomes on eBitDar is hilarious.
• 1:34:02
  SPEAKER_00: Like what a nonsense compared to the outcomes and the happiness and fulfillment of the owner and its staff.
• 1:34:08
  SPEAKER_00: So exactly the sorts of things we need.
• 1:34:10
  SPEAKER_00: How are we going to find out about those?
• 1:34:12
  SPEAKER_00: Me and you get unusual contact with those stories, don't we?
• 1:34:15
  SPEAKER_00: Yeah.
• 1:34:16
  SPEAKER_00: Compared to most people.
• 1:34:17
  SPEAKER_00: But we need to have a way in which we can celebrate those beyond our phone calls.
• 1:34:21
  Michael: Yeah.
• 1:34:21
  Michael: But let's think about that.
• 1:34:22
  Michael: Because I another thing I'm prompted was there were so many women who felt really and I and I wish we'd have put more about this in, and I I I I may tackle this separately, but a lot of women who felt a little bit disparaged, a little bit sad because it was the it was the by and large, it was the men with the big clinics, the men that made loads of money.
• 1:34:39
  Michael: And and and then you talk to those women and you're like, hold on a second, you've got three kids.
• 1:34:43
  Michael: You're a single mum, or your child has learning difficulties, or whatever, and you've still got a really fucking great clinic, you're still making loads of money, you just happen not to have wanted to go that next step and build something massive because you cared more about looking after your kids and having a good work-life balance, whatever they not that I like that word, but whatever it is you were aiming for.
• 1:35:04
  Michael: And those people need to be celebrated.
• 1:35:06
  Michael: There's a lot of women in this industry, you know, uh as much as it is it is way easier being a man running a clinic than in in general, not not for all, than it is for a woman who's who's got children.
• 1:35:17
  Michael: You know, we we're both fathers, and we still know the as good as dads as we are, and as much effort as we put in, there's still one person that's doing the uh sorting out the school dinners or sorting out the school uniform or sort do you know what I mean?
• 1:35:30
  Michael: You're probably gonna say you do that now, but I bet Charles does it.
• 1:35:33
  SPEAKER_00: No, well, no, of course it's there's there's there's levels to that game, and she is she is next level.
• 1:35:38
  SPEAKER_00: I think one of the things that's amusing is I think we've just done of the of this long podcast, the last 20 minutes have been probably a little bit too safe for you, and so you dragged us into the sort of sociology and gender debate by talking about which is hilarious.
• 1:35:52
  SPEAKER_00: Because of course, I'm not disputing what you're saying, I'm not saying you shouldn't have done, but I'm just uh amused at the fact that of course we uh we uh the at this stage of being tired nearly two hours into a podcast, we could easily take over some tripwires, couldn't we?
• 1:36:04
  SPEAKER_00: But no, in the barometer, barometer, I think, did uh in the spirit of uh you know, I'm not just being cheeky with that answer because i I know exactly, you know, it's relevant, relevant conversation, but it's just that for those that haven't read the barometer, they should, because I think one of the things it tackled really sensitively and fairly was um was the interest in gender data that we had, and that without speaking to the goals and context and then the uh the uh more controversial stuff, it's like what might be dispositional differences between men and women as a on the mean rather than or as a group, that that's where it's interesting because that's where unfortunately we see that data play out across other industries.
• 1:36:44
  SPEAKER_00: And so seeing it applied to ours in a way that was precise and was based based on something was was interesting and should inform debate in ways that unfortunately people haven't been as forthcoming sometimes.
• 1:36:56
  SPEAKER_00: It's a bit of a third wheel still, isn't it?
• 1:36:58
  Michael: Where I'm deriving some of my opinions just then is is just speaking to more than 300 female clinic owners who all say the same, well not all, the the the vast majority say the same things.
• 1:37:09
  Michael: And we can actually even go into perimenopause and menopause and and the impact that that has.
• 1:37:14
  Michael: Because you know what it's like running a clinic.
• 1:37:16
  Michael: It's it isn't a I'll come in the morning for an hour, check how things are going, and then go home, right?
• 1:37:21
  Michael: It is an it's a 24-hour job, just like running most businesses, to be honest, and and that's fucking hard.
• 1:37:28
  Michael: And so what what I I really am happy about is that there are not people out there punishing themselves because they just haven't done as well as the top 10th percentile when actually that isn't their goal.
• 1:37:40
  Michael: You know, I I had a LinkedIn post from someone going, oh, unless you have three clinics, the three physioclinics and turning over this much money, you're a failure as a physio.
• 1:37:48
  Michael: I was like, the fuck are you talking about?
• 1:37:50
  Michael: Maybe someone doesn't want three physio clinics, maybe they don't want like it's it's just insane.
• 1:37:55
  Michael: And it's almost like there's so much of a push nowadays, and this is my point about recognizing smaller clinics and and and I don't really probably more ethical and better clinics, but recognizing those guys rather than just the ones that have got commercial success.
• 1:38:08
  Michael: Because I think it's those smaller community-focused clinics that are actually doing an incredible job.
• 1:38:13
  SPEAKER_00: Well, yeah, I mean it's the thing is it's serve service of the year.
• 1:38:16
  SPEAKER_00: You can imagine I'm not gonna influence the judging process of which people like Joe Gibson, Mike Stewart, D.
• 1:38:21
  SPEAKER_00: Vogel, Cashio, and um and Flick, and just what a panel that's gonna be.
• 1:38:26
  SPEAKER_00: So I'm not gonna influence or put my thumb on the scales of that at all.
• 1:38:29
  SPEAKER_00: So I have no idea if what type of service or clinic is gonna win that award.
• 1:38:33
  SPEAKER_00: But what I know for sure is that that the criteria on that is not gonna be them submitting a spreadsheet of financials, or we're looking at margin.
• 1:38:41
  SPEAKER_00: Like it because because, of course, not to disparage or or imply that that's not relevant, of course, to be profitable.
• 1:38:48
  SPEAKER_00: And no one should be ashamed of that, to my taste.
• 1:38:50
  SPEAKER_00: But it's more that we know that a a service to be celebrated is is one of which is gonna be in various different circumstances, right?
• 1:38:59
  SPEAKER_00: The all the factors that we've talked about should be being considered.
• 1:39:03
  SPEAKER_00: And I think one of the things that does is interesting when it comes to say the more uh the size of the clinic and the amount of or the size of the business by revenue turnover, or even as we talked about the intersection there with say the gender of the owner and founder, is that you do end up having people with different temperaments and different circumstances that can mean that their goals are gonna affect the rate of change, the size of the business at at any given moment, the you know, like you've said, when we're talking or mentoring with or reassuring people in the industry and stuff, and they'll think that you're gonna be asking them really niche, niche, nitty-gritty details about their revenue split, and instead you say, How old are your kids?
• 1:39:45
  SPEAKER_00: How much time are you wanting to spend more time with them or less?
• 1:39:51
  SPEAKER_00: You know.
• 1:39:52
  SPEAKER_00: Um of course mums and mums and dads that, but it's kind of like the big one is what are you doing this for?
• 1:39:59
  SPEAKER_00: You know, it is this you know, I and I have I have to ask that question to people in part because uh of course I know that I am very fortunate that most of my, if not all of my work, or 90% of it, apart from some of the boring admin that's inevitable that creeps in, is that it is a massive passion project.
• 1:40:16
  SPEAKER_00: I mean, you know this, having worked with me for a number of years and stuff, so much to my much to my detriment and also uh against commercial sanity, I can sometimes be blinded by uh it being a passion project, but I really care about it.
• 1:40:29
  SPEAKER_00: And so I can't pretend that that's something that should and does motivate everyone in every decision like it does me.
• 1:40:34
  SPEAKER_00: But when it comes to what is it you're doing this for, how would that not be one of the crucial questions as to whether you should have one clinical three?
• 1:40:41
  SPEAKER_00: It's like, you know, well rather than like some sort of weird obligation to, you know, who or what are you chasing?
• 1:40:46
  SPEAKER_00: And unfortunately, and this I'm very lucky, of course, to have worked with Joe Turner now for a number of years to realize that sometimes underneath that is some really challenging issues in and around you know who you're doing this for, not not why you're doing this.
• 1:40:58
  SPEAKER_00: It's like what what what is it you're chasing?
• 1:40:59
  SPEAKER_00: What might there be some some demons there that you need to make sure you shake off so you don't feel obliged to just do stuff because other people do it or because people expect it, or because some dickhead on LinkedIn said it, or your business coach suggested it, or whatever.
• 1:41:12
  Michael: That gets me because I think there's the there's so many more people now, clinic owners on on LinkedIn, that all you hear is about my big clinic and look what I've achieved and look how wonderful I am and look at my new tech and my new kit.
• 1:41:25
  Michael: And it's almost like this this like new push to be incredibly successful, and success it for them is it's just money, it's just this is what I think.
• 1:41:36
  SPEAKER_00: Some people that's it's that and that's where another area in which I struggle to empathize in part because I uh you just just you know i i'm I'm I'm odd in in how unmaterial I am with stuff like that.
• 1:41:47
  SPEAKER_00: It's not I'm not trying to say that that's a uh it's a flaw as much as it is anything, it's quite odd.
• 1:41:51
  SPEAKER_00: I I struggle with that.
• 1:41:53
  SPEAKER_00: Um there was a time where people were it's almost gone a bit far in that direction, of course, and it's not to my taste, but equally there was a time where there was people weren't talking about commercial elements.
• 1:42:03
  SPEAKER_00: Remember when me and you started working together, it was kind of really refreshing that we were trying to get people to to speak well to that.
• 1:42:09
  SPEAKER_00: Celia did a good job of that early, you know, and and Andy Hosgood did a good job about that, just trying to say, let's not talk about money as if it's dirty and stuff.
• 1:42:16
  SPEAKER_00: And so I think that did improve things, but unfortunately, it did mean that then you've got this Andrew Andrew Tates of of physiotherapy wanting to think it's a flex to hire a a private jet to go to Jersey.
• 1:42:26
  SPEAKER_00: And and it's just like you know, that's that's that's weird, and it's a shame, but also, you know, we've got to try and make sure we right size this stuff, don't we?
• 1:42:33
  SPEAKER_00: Is that there's there's good, bad, and ugly across the entire spectrum.
• 1:42:37
  Michael: If I see another fucking picture on LinkedIn from some physio who once took a business class flight and is now reposted it 15 different times in 15 different ways to show how successful holy shit, like honestly, it it's it's it's mind-numbing.
• 1:42:52
  Michael: And and there's just so much of it going on, this whole, you know, look at me and look how successful successful I am, and then a lot of it is oh by the way, I'm an hour I sell a course too.
• 1:43:01
  Michael: You know, it's it's come and join my club or come to buy my course or whatever case it may be.
• 1:43:06
  SPEAKER_00: Something that joins all of these things up and also is the you know uh the perfect marriage to me between HMDG, excuse me, H and D G and Physiomatters these days, because we've got such an interesting and colourful history of things we've done, products we've built together.
• 1:43:20
  SPEAKER_00: But what I'm excited about for the future together in partnership and friendship is that my passion for clinical standards and your passion for commercial sanity and uh not being pulled in the wrong directions and being exploited by others, as well as then creating efficient services and products that can be to the assistance of clinics, the center of the bullseye for both of those things is to optimize experience, particularly customer experience, and that customer experience applies both B2B and B2C, and that the idea of improving that journey for people and recognizing the upsides of efficiency that come with that, and that everything from technology to uh the phone answer is script should be in service of that, and that is also part of your brand and and that consultation process of which your products and your marketing and media, including your podcast, now that does that, that's really cool.
• 1:44:09
  SPEAKER_00: Like I think I think that what physiomatters and HMDG are doing are not the only ones, of course, but I mean our partnership feels to me to be shaped by this passion for improvements in experience and also some of the stuff we've just been riffing on where we're not indulging one part of it, we're kind of recognizing that the individual circumstance and context in which people find themselves is going to influence what their goals need to be.
• 1:44:30
  SPEAKER_00: And it's a tailored version of that.
• 1:44:32
  SPEAKER_00: Now, I sound like a clinician again, right?
• 1:44:34
  SPEAKER_00: You do a thorough analysis and you tailor to that patient's needs as aspiring to their functional goals.
• 1:44:39
  SPEAKER_00: I'll go back to lifting the grandkids up and all the stuff I said at the early parts of the podcast.
• 1:44:43
  SPEAKER_00: Your version of that, or our shared commercial version of that, is recognizing that a clinic owner is in a circumstance where it needs to serve them and their needs rather than aspiring to some nebulous or abstract concept or a flowchart or algorithm that wouldn't apply clinically and doesn't apply to your business.
• 1:44:59
  Michael: And sort of fits is is for me like it it it doesn't bother me if you want to stick at your 200 grand a year or 100, whatever it is.
• 1:45:07
  Michael: But what I don't want to see is you wasting money by doing the wrong things or or having bad processes or not understanding how to email a patient and set up an automation or whatever the case may be.
• 1:45:18
  Michael: Like you can still be commercial and do the right things even at a small level.
• 1:45:23
  Michael: And to some extent, it's more important because you really have very small margins.
• 1:45:28
  Michael: And if you can just change those margins by 5%, it makes all the difference.
• 1:45:31
  Michael: And what certainly doesn't interest me is you know, I could probably, quite honestly, I could probably make a million quid in the next year if I created the shoe match of MSK funnel and created some bullshit to pull out and wrote a book through ChatGPT and went, hey, big become a billionaire and blah blah blah and buy, you know.
• 1:45:49
  Michael: But that doesn't interest me because that isn't, I think, what the market needs or what the industry needs.
• 1:45:53
  Michael: I think it needs a lot of clinic owners who, by and large, own small businesses, right?
• 1:45:59
  Michael: Who need help running their businesses properly, understanding what a a well-run business looks like, because they don't need help on making sure their staff are fine.
• 1:46:07
  Michael: They don't need help in support and all of those sorts of things, because they're doing really well there.
• 1:46:12
  Michael: Um but at the same time, I think they also need support from outside, right?
• 1:46:15
  Michael: From people like you to enable.
• 1:46:20
  SPEAKER_00: One of the things that's interesting as well is if we go back to where we started with this, is that you could write a business blueprint 101 for MSK Clinics, insights from the industry.
• 1:46:31
  SPEAKER_00: You should write the satire, you know, like my beware concierge healthcare thing that you started with.
• 1:46:36
  SPEAKER_00: You could write the uh satire version of that.
• 1:46:39
  SPEAKER_00: So maybe that should be your next MSK my piece.
• 1:46:41
  SPEAKER_00: Right.
• 1:46:42
  SPEAKER_00: Roping you into some content.
• 1:46:44
  SPEAKER_00: So if anyone wants to laugh, go to fake-guru.co.uk.
• 1:46:48
  Michael: I created a very cool kind of uh template of how a guru is built.
• 1:46:53
  Michael: And you'll recognise this in all the gurus in this industry that you see.
• 1:46:57
  Michael: You can actually build a guru on the top right, and it will create a brand new guru with new images and a new kind of thing.
• 1:47:04
  Michael: You know, the the first one that's just open, the proven system that elite clinic owners use to escape the diary trap, double their value, and find building ones without them, right?
• 1:47:12
  SPEAKER_00: The whole thing is just like we should get you 50 new patients tomorrow.
• 1:47:16
  SPEAKER_00: Exactly.
• 1:47:17
  SPEAKER_00: Did you ever see Mike Winnett's contrapreneur formula?
• 1:47:20
  SPEAKER_00: Did you ever see that?
• 1:47:21
  SPEAKER_00: You're going for a treat, mate.
• 1:47:22
  SPEAKER_00: No, it's not MSK specific, of course, but it's kind of like lampooning Grant Cardone and the worst of that industry, right?
• 1:47:29
  SPEAKER_00: Contrapreneur formula, he called it.
• 1:47:31
  SPEAKER_00: And he was uh sort of you'll love it on YouTube.
• 1:47:34
  SPEAKER_00: It's a bit old now, but yeah, you'll enjoy that.
• 1:47:36
  SPEAKER_00: But it really is, you know, if you I didn't realise that you were bringing some uh some satire, MSK specific uh satire of that persuasion, which I think would be great.
• 1:47:45
  Michael: What what I once thought of doing, and I still want to do it, I found a place in Kent where you can rent a private jet set and you can uh rent a Lamborghini.
• 1:47:55
  Michael: So it doesn't take off or anything, it's just like a photo shoot.
• 1:47:58
  Michael: It's where all the influencers they they they take their pictures of the plane, they've got like a video so it looks like you're flying.
• 1:48:03
  Michael: And what I was gonna do was like really satirical, like walk in and like be a millionaire just like me, and like have one of the teams throw money around and like find my clinic blueprint on how to make money.
• 1:48:15
  Michael: I was gonna do like a proper, really well-produced video on it.
• 1:48:18
  Michael: I I've been busy doing it.
• 1:48:20
  SPEAKER_00: Well, you shouldn't have given it if you you've been busy, but yeah, you shouldn't have given it away on this.
• 1:48:23
  SPEAKER_00: Um, I may still do that would be fun.
• 1:48:26
  SPEAKER_00: One of the things that I'm amusing that uh I have to give you one final compliment and then I need to go amusingly to go and pick the kids up is to uh is to say that you have picked your topics today.
• 1:48:37
  SPEAKER_00: We we usually disagree at least every third thing we talk about.
• 1:48:40
  SPEAKER_00: And so today this has been hilariously cordial.
• 1:48:42
  SPEAKER_00: I've never known us agree for two hours about anything ever.
• 1:48:45
  SPEAKER_00: So we've been accidentally.
• 1:48:47
  SPEAKER_00: I apologize to the listeners that wanted this to be spasier, at least between us, because we rarely do this, it's been a bit of a circle joke.
• 1:48:53
  SPEAKER_00: And next time, if there is a hat-trick, if you guys want a trilogy of me coming on this podcast, I'm just gonna pick fights with him, just constantly pick holes in where we differ.
• 1:49:02
  Michael: Well, we could always talk finally about how wonderful Brexit's been and the aimful results of voting Brexit, but uh it's not the one for next time.
• 1:49:12
  SPEAKER_00: Well, I love that you say you you have to say that as I leave, don't you?
• 1:49:15
  SPEAKER_00: Because I've got to go.
• 1:49:16
  SPEAKER_00: I do.
• 1:49:17
  SPEAKER_00: I'll tell you what I did prepare.
• 1:49:18
  Michael: One final question.
• 1:49:19
  Michael: Go on.
• 1:49:20
  Michael: What do you believe today?
• 1:49:21
  Michael: This is my my question I came up with earlier.
• 1:49:24
  Michael: What do you believe today that Jack Chu from 2015 would have called bullshit on?
• 1:49:29
  Michael: Where were you wrong?
• 1:49:30
  SPEAKER_00: 2015.
• 1:49:32
  SPEAKER_00: Ten years ago.
• 1:49:33
  SPEAKER_00: I think Jack Chew of 2015 was incredibly skeptical of the I didn't think that human touch was crucial in MSK.
• 1:49:45
  SPEAKER_00: I thought that it was important but not crucial, and I thought that then we would just naturally over the last over the 10 years would evolve increasingly away from it and that would be healthy.
• 1:49:53
  SPEAKER_00: And I think that that was clumsy, and that some of my instincts were fair there in terms of the specificity of it, but I think that and what that I think it was almost COVID that did that, that the literal not touching each other, and that the way in which how reassuring touch can be, how professionalized touch is so different uh to spa massages, and and so that was definitely quite a radicalizing thing for me.
• 1:50:17
  SPEAKER_00: And I think that where my practice is now is that I'm far from manual therapist, but when if someone shadows me, they're sometimes surprised how much I might facilitate movement in rehabilitation or use touch in a reassuring manner, or uh the ways in which my practice is is more hands-on than people expect, even though I'm technically in the gym rehabbing people.
• 1:50:34
  SPEAKER_00: So I think that's the biggest one on a clinical level, definitely.
• 1:50:37
  Michael: Well, in that case, thank you, Jack Chu, manual therapist, for coming on today.
• 1:50:41
  Michael: And oh god, the if you're watching the video, this is a picture of Jack towering over.
• 1:50:48
  SPEAKER_00: You need to get you need to get your video out.
• 1:50:50
  SPEAKER_00: I'm putting this lovely picture of me and my wife with uh now Michael and his wife at their wedding, and we were talking about the uses and uh important uses of AI, weren't we?
• 1:51:01
  SPEAKER_00: And so that was why I uh I thought that of course the most important uses of AI are editing videos ridiculously.
• 1:51:08
  SPEAKER_00: And I thought that the best edit that exists for for AI is is this, which is uh which is real and which is fake is difficult to deduce.
• 1:51:16
  Michael: But uh anyone that does that's a little treat for the stuff watching the video.
• 1:51:20
  Michael: For anyone that doesn't know Jack Chew is like eight foot tall.
• 1:51:22
  Michael: Right.
• 1:51:23
  SPEAKER_00: So very quickly, MSK Mag URL is MSKMag.com, MSKAwards.com, and then I I shouldn't be mentioning it yet, but uh therapyhalf and live.co.uk might be uh have some interesting news on it soon.
• 1:51:35
  SPEAKER_00: There's maybe something happening soon with therapy live.
• 1:51:38
  SPEAKER_00: Very exactly exactly.
• 1:51:39
  SPEAKER_00: Thanks so much, mate.
• 1:51:40
  SPEAKER_00: That's been that's been a surprising pleasure.
• 1:51:42
  SPEAKER_00: Brilliant.
• 1:51:43
  SPEAKER_00: Cheers.
• 1:51:43
  SPEAKER_00: Take care, mate.
• 1:51:44
  SPEAKER_00: Bye bye.