Interview with Todd Hargrove

Many of you may already be familiar with Todd Hargrove’s wonderful blog http://www.bettermovement.org. He is a lawyer turned certified Feldenkrais Practitioner and certified Rolfer. You can get in touch with him through his website and via twitter @ToddHargrove. I’m very excited to have had the chance to interview him and discover his perspectives on his line of work & progression over the years. Enjoy the read!

Transitioning from lawyer to Rolfer is a unique story. Not every lawyer that experiences back pain takes the same path you took. Tell us your story.

Hi Cinema, thank you very much for having me!

Yes the jump from attorney to Rolfer is pretty unusual. I wonder if there is another one?

I enjoyed many aspects of being an attorney, but the workload and the stress were too high for me. In fact, the stress probably played a role in my developing some chronic pain.

I was very motivated to get out of pain, so I tried to learn as much as possible about it. I did PT, yoga, Pilates, corrective exercise, functional training, postural training, stretching, and eventually Z-Health, Rolfing and Feldenkrais. There were many dead ends but I eventually made a lot of progress through trial and error over a few years and went from having major problems to pretty much none at all. In the process I learned that I was fascinated with chronic pain, and that there is a lot of misinformation and confusion about it.

During the same time period, I was also getting interested in the science of performance. This was partly because I was looking for an edge in my sports – competitive squash and not-so-competitive soccer. I read books by Gray Cook, Mel Siff, Mark Verstegen, Michael Boyle, and Shirley Sahrmann. I noticed a lot of interesting connections between the study of pain and motor control.

At some point in my legal career, I noticed online that there was some sort of seminar in Seattle on low back pain. I wanted to attend, but of course I couldn’t because I was a lawyer not a PT. This was just a while after I had spent a couple days bored out of my mind at a continuing legal education seminar. It occurred to me that it might be a good idea to have the kind of job where I was actually interested in the continuing education. It was a good thought!

Are there any lessons you’ve learned from your experience as a lawyer that you apply today in life & work?

I think my legal career probably doesn’t have much effect on the way I interact with my clients, but it does have an effect on the way I interpret research and write about my thoughts.

Attorneys need to cite authority in support of their legal claims. When you review an opponent’s brief, you check their citations. You discover that quite often, the citations fail to support the claims. In fact, they sometimes support the opposite claim. Most commonly, a citation can be interpreted in many ways – there are nuances, ambiguities and subtleties as to how it applies to the facts of your case.

This experience probably gave me a sense of skepticism in how I read claims made in articles and books on manual and movement therapies. As it turns out, manual therapy authors are no more trust worthy than lawyers.

Another thing about being an attorney is that when you write, you need to always be imagining every possible way that an opponent could attack your argument. I can’t help but go through a similar mental process when I write now. I think it’s probably helpful in ensuring that what I write is defensible in some way.

What differentiates what you do from an athletic trainer, massage therapist, physical therapist, etc?

Here’s what I do to help my clients. Based on my background as a Rolfer, I do manual therapy in the nature of a deep tissue massage, as well as gentler techniques like skin stretching, or what Diane Jacobs calls DNM. I do some passive mobilizations that are informed by my Feldenkrais background. I do active movements that are sometimes like Feldenkrais awareness through movement lessons, and sometimes more like corrective exercise. I also educate my clients on pain science. And I try to be a good listener and provide empathy, support and encouragement. Whatever the case, I am always looking to provide novel, interesting and non-threatening inputs that will hopefully result in improved outputs: better body awareness, better control over movement, and less perception of threat related to movement.

Unlike a personal trainer, I don’t organize a plan for strength and conditioning, although I might let people know they need more of one or the other. I’m different from a physical therapist in that I don’t have the training to diagnose sources of pain or make specific prescriptions on that basis.

Running a business and making time for family can be difficult. How do you handle this? What measures have you taken to keep this in balance?

I have two kids, ages seven and three. They are a ton of work! My wife is a psychotherapist (one word not two or three), and we work out of the same office. When one of us is working, the other is with the kids. Pretty simple. The challenge for me is to carve out some time to read and write. So I do a lot of whining about that.

What is your perspective on the “Evidence Based” trend? What are it’s limits & benefits as you see it in your practice? (I really enjoyed your post “Is Science Your Enemy?”)

Glad you liked the post! (Not everyone did.)

I read a lot of debates about whether an evidence-based approach is superior to a science-based approach, or whether intuition, anecdote and personal experience are valid forms of evidence supporting the use of a particular technique. I think good points are made on all sides of these debates. In the end, I think manual and movement therapists should be able to give good reasons for what they do. I also think that science has already shown that many therapies either do not work, or do not work for the reasons usually offered.

I think that it is often important to understand why a therapy works, and to explain this to the client. Many therapists don’t care why a treatment works, they only care that it does work. However, there can be unintended negative consequences when a client gets the wrong idea about why they felt better after a session.

For example, I know someone who received ART to treat his neck pain. He got good results, but came away with the idea that his pain was due to scar tissue in his anterior neck, and that the therapy was working by breaking up the scar tissue (a very implausible explanation in my opinion).

Because of this misconception, he started to go about his own program of self-help in regard to his neck pain. This involved extremely aggressive interventions to break up what he thought was scar tissue. He was causing himself a ton of pain, and was probably irritating some sensitive nerves near the anterior neck. Eventually he made the whole problem worse. This wouldn’t have happened if his ART practitioner had been more curious about why his treatments work.

This problem is magnified when the therapist not only lacks curiosity about science, but denies that science is an authoritative source of knowledge at all. This type of magical thinking is quite common in massage, and is a big problem in my opinion.

Most influential book and authors? (professionally & personally)

Here are some of my favorite authors by subject.

Pain: Lorimer Moseley, David Butler, Ronald Melzack and Patrick Wall. Especially Explain Pain, Painful Yarns, The Challenge of Pain and The Sensitive Nervous System.

Manual therapy: Eyal Lederman has some good textbooks.

Somatics: Moshe Feldenkrais, Thomas Hanna, Frank Wildman, Mabel Todd and Eric Franklin.

Evolution and psychology: How the Brain Works by Steven Pinker, Darwin’s Dangerous Idea by Dan Dennett and Why Zebras Get Ulcers by Robert Sapolsky.

Motor control: On Dexterity by Nikolai Bernstein. Incredible book!

Neuroplasticity: Sandra Blakeslee and Norman Doidge.

Play: Frank Forencich and Stuart Brown.

Biomechanics and corrective exercise: Gray Cook, Shirley Sahrmann, Vladimir Janda, Craig Liebenson, Stu McGill and Pavel Kolar.

And of course, more important than all of these books put together: Game of Thrones.

While we’re on the topic, you’re in the process of writing a book! Why did you decide to write the book? And who is its audience? (You can read an excerpt of Todd’s book here: “Book Excerpt: Sensation versus Perception”)

I guess I wrote the book for the same reasons I started a blog. First, to get onto paper a lot of ideas I have running around my head. That way I don’t have to expend the mental energy to keep them organized anymore! Second, to help people with useful information. For some reason, I spend an incredible amount of time and effort thinking about pain and movement, and I think it causes me to have some insights that might help others.

Chronic pain is a huge problem. There are no easy answers on how to treat it, but we can improve our situation by eliminating the misinformation that causes confusion, anxiety and wasted resources. If someone in pain goes to seven different therapists, he might receive seven different explanations for his pain, and seven completely different treatments. And there is a good chance that the majority of these treatments will not be supported by any good science at all.

I think one common theme in this confusion is that therapists overemphasize the extent to which some alleged defect in the body is responsible for pain, and fail to appreciate the role of the nervous system. I happen to be very geeked out on pain science and neuroscience, so I’m in a good position to help remedy some of this confusion.

The book is focused on the nervous system, and is intended to be a resource for anyone who wants to move better and feel better, or help others do the same. It is especially tailored to professionals like physical therapists, massage therapists, chiropractors, personal trainers, or instructor in yoga, pilates or martial arts. But it is also written so that a person without any previous background in the subject matter can understand it.

The goal is to provide people with a concise and simple explanation of the science they need to understand pain and movement (like biomechanics, motor control, and pain science). And to boil all this down to some general principles for improving movement that will be applicable in a very broad set of contexts. The book also provides 25 movement lessons, based on the Feldenkrais Method, that represent one way to apply the principles. So it’s kind of like teaching people to fish and giving them 25 fish to get them started.

When and where will the book be available for purchase?

The book will be available for purchase on Amazon, probably by May 15.

If you could travel back in time and face yourself right after graduating college, then what advice would you give yourself?

Invest in Google and Amazon. Chicken wing consumption needs to come down.

I don’t regret going to law school at all, it was one of the best times of my life. But I do regret not getting started with my current career a little earlier. Is there a difference between these two things? It feels that way to me. If I had gotten started with this career earlier maybe I would have been more involved in strength and conditioning and sports performance.

What simple/basic ideas & concepts do you believe will help practitioners become better/stronger/wiser?

That is a good question. I’m not sure I have a very good answer, and I still have a long way to go in becoming better/stronger/wiser myself. But I think you are right that good manual therapy is based on some simple basic ideas. Here are my suggestions.

Client interaction and listening skills are important.  If you are trying to treat pain, learning about pain science is important. Which technique you choose doesn’t seem to be that important, as there are many different types of techniques that get results. What seems to be important is that you execute your techniques with skill, which means practice, practice, practice.  For your practice to be productive, you need to, as much as possible, use some method to get feedback as to whether the technique is actually doing what you hope it is doing. In other words, assess, correct and reassess. And of course make sure that what ever you do can be supported by evidence and solid reasoning.

How has your practice evolved since day one?

There have been some changes along the way, but looking back, it has always involved the fundamentals described above. Hopefully I execute all of these with more skill now.

I am always studying and researching and going to seminars looking for the magic bullet or the magic technique that will help everybody. But in the end, it seems that what works according to the research and my own experience is the simple stuff – educating people about pain, providing empathy and support, and pain-free novel sensory input. And getting people to move in new ways.

Todd, thank you for the power-packed interview!

Keep up with Todd Hargrove at http://www.bettermovement.org and on twitter @ToddHargrove.

And connect with me @Cinema_Air

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The Short & Long Game

Cut & Dry Version: It’s not Process > Outcomes, it’s Process & Outcomes. There is a feedback loop between Process and Outcomes which allows Outcomes to drive the Process and vice versa. One major filter that might encourage you to focus on the outcome more than the process is the element of time. Outcomes are important for short term success, while focus on Process is requisite for long term success. You cannot arrive at the long term without surviving the short term.

The Long Sunday Afternoon Version:

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By now I’m sure you’ve read about the importance of working on your Process > Product. Just a simple google search will yield multiple hits on this very topic. A couple fantastic reads on this can be found here & here [pdf].

To the best of my understanding, in order to achieve long term success one needs more than a shiny product; they also need an iterative process that efficiently and effectively produces the desired product or outcome. This direct progression from process to product has been repeated ad nauseum, and with good reason!

So, why another article on the same beaten down topic? One reason: attempts to focus on the process while hoping to effect your desired outcome don’t always work. I will attempt to provide an understanding of two very important elements of this process that are usually left out of the equation. First, let’s quickly introduce the Principle of Reflexivity.

According to George Soros the principle of reflexivity is in effect when distorted views can influence the situation to which they relate because false views lead to inappropriate actions”. He goes on:

For instance, treating drug addicts as criminals creates criminal behavior. It misconstrues the problem and interferes with the proper treatment of addicts. As another example, declaring that government is bad tends to make for bad government.

And,

makes reflexivity a very broad phenomenon that typically takes the form of feedback loops. The participants’ views influence the course of events, and the course of events influences the participants’ views. The influence is continuous and circular; that is what turns it into a feedback loop.

[The above quotes are excerpted from Soros’ article in Financial Times. I encourage you to read his entire article “General Theory of Reflexivity”]

This same reflexive quality exists between Process & Outcomes. Not only does your process yield an outcome, but the nature of your outcomes feed back into your process by encouraging Process modification. It seems so obvious that nobody will likely deny this effect; but it gets interesting… more interesting.

Outcomes aren’t always entirely predictable in terms of their 1st order effects, let alone secondary consequences. They are usually multivariant and require a reiterative process to distill the actions needed to effect a certain outcome. Now, consider this: the outcomes may have a positive or negative effect on the reiterative process. So, which is the driver here? The Process? Or The Outcomes?

Clinicians (Outcomes) and Researchers (Process) – including the armchair variety – need to recognize the recursive nature of Process & Outcomes and place their communications within this context. This will also reduce an often-cited error within the medical profession; as N. N. Taleb says, “Doctors most commonly get mixed up between absence of evidence and evidence of absence.” (Emphasis mine)

Let’s contextualize this. You’re a skilled & very capable physical therapist who recognizes a pattern in the treatment of a certain classification of symptoms. Your treatment (let’s call it treatment X) yields positive results repeatedly within bounds of these classification of symptoms. While an explanation is lacking, the outcome is obvious & repeatable. What is it that informs the process in this situation? It is purely outcomes based analysis that feeds back into the treatment process.

The concept of “Phenomenology” quietly slipped into play, so let’s define it according to Taleb from Antifragile:

Phenomenology is the observation of an empirical regularity without a visible theory for it.

Phenomenology, being blatantly practical, applies to and is found in basic daily activities of life. For example, you may not be able to explain (or describe) why or how a certain spice flavors your food, but you recognize the flavor and it makes your meals so much more delightful. You know how it should taste in the end; all you do (without thinking too deeply about it) is modify & iterate your process of incorporating the spice until you know when and how much to recreate into your delicious concoction.

This feedback loop from Outcomes to Process is essential in streamlining future (and short-term) decision-making. While explanations (Process) may be lacking, the repeated positive outcomes provide validity on its own. This feedback is either dismissed via circular reasoning that exempts the potential for honest exploration, or is outright ignored on grounds of lack of evidence when the evidence of validity is present in the repeatable outcome itself.

Recognizing and applying the feedback loop from Outcomes to Process has no standard game plan to follow, no studies can capture the essence of what the outcomes could be and how they might be applied to your process. I believe this is where the “Art” resides – incorporating Outcomes to modify and drive your Process. So, the next time you hear a debate on whether “it” is an “art” or a “science”, you have a framework to see both sides of the coin and realize that they are part of the same cycle. Science is the Process, while the Art lies in incorporating Outcomes back into your Process.

Time

A major factor in the feedback loop between Process & Outcomes is the effect of time. Focusing on the process more than outcome requires the luxury of time to allow for an iterative process that gradually chips away inefficiencies. When running a business, start-up, or any venture with your reputation at stake, time is usually of the essence. Many minimize the Process to produce an Outcome to be molded by the trials of business & consumer response. A start-up without a product will likely get stranded before the running even started. A business without customers will likely fail in-spite of a fluid process. You can have an efficient process, and even correctly predict the outcome, and still be lured to shipwreck by the sirens of time. The best of the best still have to face the tyranny of Father Time.

Time is just one factor; there are likely one or two other factors (physical resources, etc) that might be equally significant in a particular situation.

Over the long run focusing on the Process is a prudent choice, however, you need to give yourself the opportunity to experience the long run by surviving the many short runs. The long run doesn’t matter if you don’t make it past the short run.

Recognizing the importance of the reciprocal (& reflexive) nature of Process & Outcomes can alleviate friction in seeing the big picture while simultaneously inviting novel approaches (& possible solutions) to old problems. Such vision and understanding requires clear and honest communication within the context of this feedback cycle filtered through the lens of time.

Outcomes are important for short term success, while focus on Process is requisite for long term success. You cannot arrive at the long term without surviving the short term.

@Cinema_Air

#FutureShock 2: Physiotherapy Outsourced??

What follows are admittedly outlandish speculations (nestled specifically within the confines of Orthopedic Outpatient Physical Therapy) intended to spark questions and explorations on the many possible futures of Physical Therapy, and retrospectively consider how you and I can prepare for and adapt to the unpredictable. There will be aspects to this post that I have either overlooked or am unaware of, so please offer your feedback.

Evidence Based Practice (EBP) is a vital component of the profession moving forward, riding waves of data-driven scientific research. The push for standardized levels and modalities of patient care via development of Clinical Prediction Rules (CPR) and Classifications of Signs/Symptoms lubricate the clinicians’ decision-making process. Again, all are important components of the profession.

What happens if we take this to levels of extreme absurdity? CPRs and Classification systems inherently implement a binary decision-making process that may not require human involvement. Imagine a world with medical technologies that employ data-driven decision-making algorithms to prescribe individualistic Plans Of Care. What are the odds of this fantastic future manifesting itself? Higher than you can imagine.

The trend is already underway. Combining the zeitgeist for “hands-off” treatments with heavy emphasis on exercise prescription and tele-health, might consummate the first (baby) steps of automated Physical Therapy. Inclusion of analytical software to analyze objective movement measurements & qualities can progress the platform, thereby reducing timeframes between time of injury and initial assessment.

Proliferation of telehealth could outsource a surprising share of the profession. When the average PT (of course not you) makes decisions based on binary input and predictable decision trees, what prevents such a process from being automated? I would conjecture that no less than 30% of all PT cases could be exported via virtual sessions.

Early inklings of this reality are likely embedded into your EMR software. Classification systems based on signs & symptoms are associated with particular sets of treatment recommendations. Of course, you can exercise clinical reasoning to alter or turn down any or all recommended interventions, but a suggested framework is pre-set based on your data input. Research-based data is implemented into the software under the canopy of “Evidence-Based Practice”.

Telehealth provides venues of access and care that prior generations could not have imagined. Not only is it an element of the future of Physical Therapy, but is already a small and growing reality in the present. A transition from this point onward is mere logistics; moving “Physical Therapy” consultations offshore followed by software supplanting these telehealth PTs. Offshore? Yes. The future of telehealth consultations will cross geographic lines. There already exists a need for dissolution of arbitrary geographic divisions implemented by insurance companies; technology will likely force and accelerate the transition. Once patients habituate to distal care-givers, responsive and adaptive software will flag its allure via claims of greater efficiency and further streamlined costs.

Too far-fetched? Think again. Vinod Khosla, co-founder of Sun Microsystems and accomplished Silicon Valley investor, says that “Technology will replace 80% of what doctors do” and he put his money where his mouth is by investing in companies driven toward this eventuality. It might be worth your time to read his two-part series titled “The Surprising Path of Artificial Intelligence” and “Do We Need Doctors or Algorithms?” I love his closing lines in part two:

“The best way to predict this future is not to extrapolate the past and what has or has not worked, but to invent the future we want, the one we believe is possible!”

I can hear it already: “What about the complexities of the human body? Or the psychological and social influences? Or…etc” What about it? Tell me why this too cannot be automated. And, if the veneer of humanity can be replicated into cybernetic algorithms, then this trend could accelerate much faster than any of us can imagine; thereby capturing 30% of all orthopedic outpatient cases.

My advice? Be irreplaceable; that might involve unconventionality and a certain amount of “going against the grain”. Go on – invent your future.

What you just read are speculations intended to spark questions and explorations on the many possible futures of Physical Therapy to retrospectively contemplate how you and I can prepare for and adapt to the unpredictable. Again, there will be aspects to this post that I have either overlooked or am unaware of, so please offer your feedback.

More #FutureShock speculations to come…

I am @Cinema_Air

Interview with Jerry Durham, PT

I was fortunate enough to interview Jerry Durham, PT and Principal of San Francisco Sports and Spine Physical Therapy (also on twitter: @SFsportspinePT) with 3 locations in the San Francisco area. Check out his blog, Rockit Conversion, for a good view into his business & management insights and applications for your clinic. Also, if you aren’t following him on twitter @Jerry_DurhamPT (who isn’t?), then you should. I’ve picked up some valuable lessons from Jerry and I’m sure you will too; and if you’re also into baseball & bourbon, then you’ve hit gold. Here’s a youtube video of Jerry speaking to the Value of Twitter as it pertains to Physical Therapy:

 

Finally, make sure you check out his conversation with Karen Litzy, MS, PT and Dr. Jared Carter, DPT, MTC about Cash-Based PT at Medbridge.

I gleaned quite a bit from this interview. I hope you find it as invaluable as I have. Enjoy!

Tell us about your career trajectory. What got you first interested in Physical Therapy? And the evolution you went through to be where you are today?

What got me interested was a combination of not knowing what I wanted to do and a great relationship with Ed, the Trainer for our High School football team who was also a Physical Therapist.  After my first semester of undergrad I had no idea what I wanted to study or do. I contacted Ed and after a few lengthy discussions I began taking the PT prereqs and started spending time volunteering in numerous PT settings.  And I guess you can figure how that worked out.

For the rest of it, If I could actually remember the majority of that story I would share it. Just know I worked in literally every possible setting except Peds and Neuro Rehab…my 2 worst classes in school.  I do know I kept switching jobs because “my bosses were stupid, bad, etc”.  Then finally after 7 years of hearing this my wife politely pointed out to me that, “the only constant in all those jobs is…….YOU Jerry!  Its not your bosses, YOU need to start your own business”  (That is verbatim a direct quote.  I will never forget that day over 14 years ago).  That!!!!…… is where all this began.   I immediately told her there was NO way I was starting my own business!

How did you know you were (& are) in the right field of work?

1….. I get to interact with people all day, everyday

2……I am helping people (patients, employees and other PTs) achieve THEIR goals

3……I get paid doing 1 and 2…..

Oversimplified?, No….

Tell us about one of your more difficult decisions (professionally) and your process of coming to a conclusion. Did it work out? Why or why not?

The day I went to my business partner and told him I wanted out…. In hindsight it was a decision made on confusion and misunderstanding of MYSELF.  When we started the business we defined our roles and I believed that I was going want to treat patients until to the very end.  Then about 5 years ago I faced a personal battle when I became burned out with treating patients everyday.

Decision making. What are your filters for decision-making while at work?

Overall it is the company Core Values.  So many times it sounds like a cliche yet I default to them frequently.  We put a lot of time, energy and research into our Core Values.  We actually didn’t come to our current list until about 3 years ago, which is 10yrs into the business.  Prior to that we had a “code”.   The code didn’t carry the same effect, they presented more as rules.  True Core Values are guiding principles, not rules.  One of the Company’s core values is “Put Patients First”.  Yes it’s that simple.  The patients are why we exist.   Whether we are discussing how to schedule, hours of service, what Providers to work with, etc it is “Patient first.”  It’s a great list and really is the guide to functioning properly.  I have adapted a personal list of  Core Values and there is some crossover between the business and my list (my list came after).

Tell us about balancing work & life. Where can couples or individuals go wrong? And how do you approach this?

My business partner was the first one I heard say that “balance” means there has to be a negative. So, to ask about “Work/Life Balance” is implying that there is always a negative occurring. I dont want to approach it as a Negative/Positive. I like to approach it as ‘How do you prioritize your work and Life activities on a regular basis, Daily, weekly, monthly… So, this is where I start the discussions with myself, my wife and with my biz partner.  The question to them is “What do YOU need from me?” Obviously I already know what is expected or I’ve already had the discussion of what I can deliver. I can then make decisions based on my priorities and let people know when and if I can follow through. So, no surprises for anyone. Where people go wrong?, they don’t have frequent conversations with their spouse/partner/significant other to be discussing these weekly at a minimum. Priorities shift daily, weekly, monthly those affected HAVE to be kept in the open conversation. DON’T assume anything.  20 yrs married, 13 years business partner this still holds true

Whether we realize it or not, almost all of us have morning routines. What is your weekday morning routine?

I Love to get up early. I like to be out and about when its dark and/or before others are up. I like to workout early, whether a bike ride mostly on weekends or my gym classes throughout the week. I like to be in the office early before others. I like to get my stuff together and be READY before a patient, meeting or otherwise. I love my music in the morning. When going to gym, working out or riding BART to work its all about my music. I love my espresso in the morning at home and then again at Coffee Cultures in SF.

“Time” for my usual time travel question: Imagine you’ve travelled back in time right after your graduation from PT school and are face-to-face with yourself. What advice would you give the young Jerry Durham?

I would beat the following statements into my Younger head….

-Believe in yourself, your ideas and what you bring.

-Understand that YOU being YOU is the most Valuable thing you can do (Fuck others who say dont be YOU)

-Present SOLUTIONS not just COMPLAINTS

-Don’t be afraid NOT to be the smartest guy in the room…You can learn from Everybody

-Find a Business Mentor TODAY (this woulda helped on multiple fronts, not just starting my biz)

-Set up a financial plan and follow it..

-Your parents are right!!…(almost all of the time).

All of those played a huge role in my personal and professional development.  A couple of those came way later than others.  If those were beat into my head 20 years ago, my learning curve would have been far shorter!

(I would also mention to hold that Apple stock I bought at $14 a share…no joke.  But thats for another day)

Just 30-35% of Physical Therapists are APTA Members. Why is this? And how can we get more Physical Therapists on board?

I am a 22 year member of the APTA.  Ive been a PT for 20 years.  I had no idea the first 5 years what the APTA was doing for me, I just knew I needed to be a Member of my Professional Association, I knew it was important to be a part of a whole…..

So to answer your question Why only 35%?…..its poor Value sharing of the benefits of membership.           “Your Customers Don’t Know The Product”

This is happening on at least 2 fronts……

1…. I believe The APTA has done a poor job sharing the Value of Membership (aka Marketing themselves)..  Go to the website,  if I’m a “maybe member” why am I gonna join?  There is absolutely no Value Proposition until I clicked 3 times..  Then the reasons were canned reasons EVERY association uses.  The SOLUTION?… their needs to be stories by members from multiple sections across multiple States SHOUTING the individual value they receive!  You have to have multiple stories so all kinds of “maybe members” can place themselves in the story.  Have acute care, peds, home health, private practice, neuro, research and student PTs sharing stories.  APTA did a great job at CSM doing this with their videos reports from CSM.  Post those front and center on the website!

Remember the question above when I said look at other industries?  Well APTA has to look at other successful Associations, god forbid maybe even the Chiros!   With so many prospective members stuck on the “cost”, you only get stuck on cost when you have trouble finding the benefit.  I know they are looking at reduced cost options, why?  Quickest path to reducing value in your product is cutting cost,  thats the kiss of death. It then just becomes a commodity game.  I propose focusing on SHOWING the “maybe member” the Value of membership on multiple fronts and in multiple ways so the cost becomes a smaller and smaller issue.

2……Poor job by the PT Schools instilling a sense of Professionalism and again the Value of an Association in a Profession..  They have a captive audience of the future of our Profession for 3 years.  How the hell are these future DPTs not bought in by Graduation Day?  Now, with that said I can speak to schools like Pitt that I know first hand participate on many levels building the Value of membership with their faculty and Students.  I also know of individuals, like Eric Chaconas at USA, and at other programs both students and faculty doing the same but nothing as deep as Pitt.  (there may be more out there, I just don’t know them).  Unfortunately, they are the exception.  I have contacted multiple schools over the years in CA offering my time (read FREE) to share the value I have received as a Member of the CPTA, APTA and PAC board Trustee,  I have been turned down far more times than I have been invited.  I have had polite rejections with multiple excuses that range from “political” right down to lame ass!… The SOLUTION?….have the faculty engaging and pushing the mindset of our future professionals towards joining the Association.  The students have to be given the week of CSM OFF from school.  All programs need to participate in their State Legislative days.  The Students need to be made to attend the State conferences.  All this HAS to occur so that the students are exposed to the multiple benefits of membership in a Professional Association.  Solution 2?…..as above multiple outside speakers sharing their stories about Value of Membership (see above)…..If schools can still teach Ultrasound, they can do these things!

The solutions are easy, they MUST be executed frequently, and then again and again….

Social media do’s & dont’s?

There are so many rules right now.  The only truism to Social Media is: THERE ARE NO RULES.  Whatever you believe to be the rules, is something that you believe.  Thats fine, just understand its your rule, not a universal.  So again there are no set rules.  All and All, thats a good thing.  I found this great quote recently while preparing for a Twitter talk.  Its by Thomas Edison  “ Hell, there are no rules here, we are trying to accomplish something”!…… #KABOOM        So guess what,  You get to define what you want to do.  There is no equation to success.  The only real question to answer is, What are your goals?

So are far as Dos and DONTs……

DOs:  Be whoever you want to be and own it.  If you just want your Professional side.  If you just want your personal side.   If you just want to talk SF Giants and Beastie Boys! Those are all fine…. its your choice.  Again ask yourself, What are your goals?

DON’T:  If you choose to be there representing YOUR Profession, DON’T forget YOU ….ARE……REPRESENTING……YOUR……..PROFESSION.   With that said, if you want to be an Ass and argue just know that you are being an Ass!

Yes its All that simple…

If there were 2 or 3 things every Physical Therapist could do to get better, then what would they be?  

1…….”Get Inside your own head so that you can get the Hell out of it.”  Do what YOU need to do to grow your Self Awareness.  (Read more, visit a psych, etc)…Find your Strengths and find your weaknesses.  Once you find them decide what YOU want to do with them.  Just acknowledging your weaknesses is 99% of the solution…… change them or don’t, its up to YOU.  And by the way, ITS NOT ABOUT CHANGING, Just own them.  Don’t let ANYONE tell you that you need to change, as long as you are aware, thats the solution.

I know I’m Loud…Deal with it!  I know I talk to much…..I’m working on it.  I know when I’m right and I know when I’m wrong……

2….Start reading about, learning about and looking towards other industries for Healthcare solutions.  I’m a big believer in the quote from 1899 by the head of the US Patent Office, “Everything that can be invented, has been invented”.  I see that as don’t reinvent the wheel.  Use the wheel and make it better, lighter, more long lasting etc.  So, look for the similarities and differences in other industries that you believe applies towards Healthcare. Think Disneyland, In-n-Out Burger and any company filling a niche you didn’t believe existed.  Look to the Leaders in those Industries.  Read about them, their History their successes and failures. A great example of this is Corner office.  A book which is a compilation of interviews with multiple CEOs across multiple industries.   Use the ideas and thoughts and proven systems to drive your growth and to grow the Profession.  Why reinvent the wheel?  I’m having conversations with people now I would have never imagined talking to 3, 4,5 years ago!  I talk to them because I have questions and I want to learn what they know.  People are always happy to share their knowledge, just ask.

3….Look for a Mentor NOW…. whatever your interest, find a Mentor.  Interview them and see if they fit your goals then set up regular scheduled meetings. Nothing will improve you faster.  I recommend 2 mentors,  1 who is a PT and one who is outside of Healthcare.  This someone should help guide and coach you in life/world/business.  A great Mentor makes you think, they don’t feed you information…  They will answer YOUR question with a question.  Ultimately you will be far ahead of those without mentors….which is most people!

Books – your favorite ones & how they’ve impacted you? What are you reading right now?

Biggest Impact:    Start with WHY  Simon Sinek      made me dig deep to consider WHY Im doing what Im doing instead of always focusing on WHAT and HOW I do.  Then using that WHY to connect with others both professionally and in the business.  He uses contemporary examples like MLK, Steve Jobs and Herb Kelleher.  He also uses current and past companies to show the true effects of using your WHY.  This is a great personal and professional development guide….Its not a spirtual book.

2nd Biggest Impact:    To Sell Is Human    Daniel Pink        He nails the fact that everything we do involves selling.  From a job interview to deciding on where to go to dinner tonight with a significant other….Its ALL “Non sell Selling”.  He hits on 3 major points that we must all be aware of while in a conversation.  He even uses PT as an example in the book.  This is a MUST read by all in Healthcare.  This thinking is necessary to move yourself forward personally and professionally.

A favorite Book is also “Barking Up A Dead Horse”   Tom Batchelder     he does an excellent job exploring the egos role in selling and why this awareness is key in successful sells (which is EVERYTHING!…. as noted above)

As far as what I’m currently reading, I tend to pick up 2-3 books at a time.  I love to take notes and highlight so when I do it takes me awhile to get through all the books. Currently, Compelling People, The New Elevator Pitch, Confessions of a Sociopath and Letters from Seneca. As you probably notice 3 of those books come from the Farnam Street Blog of recommended reading that Mr Cinema Air turned me onto. The Farnam Street Blog site is an awesome Sunday morning read that can get you thinking in ways you never imagined.  I recommend everyone go there on Sunday and take a pass through…. It is awesome brain exercising.

Life is full of amazing and memorable experiences. Tell us about one of them.

Your interview, my answers.  Im going to share 2……

1….The first 5 yrs of my PT career I worked Per Diem in the Acute Care setting in Napa CA.  The Hospital there had a contract with the Veterans Home in Yountville CA.  The Veterans home is the largest in the US housing over 1,000 US War Veterans.  My memorable experience is the number of incredible people I met who served for our Country.  Their stories were amazing and they were some of the most humble people I have ever met.  I met one gentleman who served and fought in 3 wars.  This was the early 90s….. he served in WW I, WWII and the Korean war.  I met a gentleman who served in the mounted Infintry for the US Army.   I met a man who served in the landing party on D Day.  I met women too who served.  These stories and these people will live with me forever.  That simple little acute care job effected me forever.

2…… I HATE HEIGHTS….

so last year on little notice I went tandem hang gliding!  This experience was incredible. We went off Mt Tamalpais in Marin over huge redwoods and even ended up out over the ocean. This was a once in a lifetime thing for me….

Jerry, thank you for this interview! There’s much to be learned from it, and definitely worth revisiting periodically.

Find Jerry Durham, PT on twitter @Jerry_DurhamPT.

And connect with me @Cinema_Air