3 Lessons from my Car Mechanic.

I recently took my car into the shop for an alignment issue. Dan, the front office guy who has known me for years, greeted me. I gave him as much detailed information as I could so that he could effectively address the issue with my car. He said it would take a couple hours, gave me a rough estimate, and offered to drive me to a coffee shop or back to work so that I wouldn’t have to wait there. The shop is fairly comfortable and equipped with wifi, so I stuck around. When he motioned me over toward the desk about 2 hours later, Dan broken into a truly magical conversation that captured me as a customer. This is about that conversation.

First, in the initial greeting Dan was excited as ever to see me, and was familiar with our details, including history of our prior visits. This was remarkable considering I only see him 1-2 times per year for minor jobs. My guess is that he takes meticulous notes on his computer,  it either way – by memory or by computer notes – I was impressed by his mentioning of our previous visits.

Second, and most importantly, the words he mentioned when he motioned me back to the desk transported my experience in the mechanics shop to somewhere else… some place that made me feel like this guy has been paying attention to me since I first came to his shop. Here’s as approximation of what he said:

You know, I think you’re pretty good at your job, but I think you’re going to be much better. I can tell that you’re starting to pay attention to details more than before, and I’m sure it translates into your work as well.

What do you mean?

You gave me a pretty detailed and informative report of how the car was performing at highway speeds. It’s something you’ve never done so well in the past.

Ok, so this guy took my current experiencd, placed it within the larger arc of all my prior visits, and extracted an empowering theme with which he completely shocked me… and it makes me want to keep returning. This guy is actually paying attention to his customers as Human Beings, not simply customer #3842 with an alignment problem.

Third, he made a deeper emotional connection as we walked by a beautiful Audi:

Isn’t she pretty?

Yeah, looks nice…

Well, I wouldn’t buy it. It’s got problem after problem. Talk to me before you buy your next car. I’ll tell you what you shouldn’t be buying. And, I’ll tell you what to look for in the prospective car. This one is terrible…

Did this guy just offer me his time & experise (for free?) to help me make a smarter purchase on my next car?? He knows that it isn’t fun to keep bring your car in for major repairs/fixes. Of course he could make more money by me bringing in a terrible purchase for regular fixing, but he opted to help me get a car that wouldn’t require as much (if any) repairs or upgrades. With that, he said goodbye as I walked to my car with keys in hand.

  1. He remembered my history.
  2. He noticed positive big picture change in me and brought it to my attention. This made me feel really impressed by him.
  3. He offered something outside of the norm from a mechanic’s shop… for free, and most likely at the loss of potentially more income.

Customer service won me over, again.

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How to be a physio extremist.

How to be a physio extremist. [applies to EBP-fanatics AND physio astrologers alike]

a. BE ABSOLUTIST. Take a side and commit to it regardless of individuals involved, evidence, or circumstance.

b. FAVOR TRIBALISM. Make Physical Therapy Great Again. Only you & your friends can do it right. Everyone else is completely wrong.

c. LOOK DOWN ON OTHERS. Use words that diminish viewpoints and approaches that disagree with yours. For example, a drastic reductionist perspective is that all “Manual Therapy” is the same. Even worse, use words to demean any “Manual Therapy” such as “tickle, rub, push, poke, prod” and the like. Equally ridiculous is the reduction of the biopsychosocial model to “talk the pain out of the person”.

d. BE SENSATIONALISTIC. Get the attention you know you deserve… because you’re worth it. Use extremist headlines because you know you’re a rebel. Show your rebelliousness to the world!

e. POLISH THE PEDESTAL. Use language that is inconsistent across domains: research vocabulary and clinical practice. Even better, start using arcane and unfamiliar phrases to convey simple ideas. It makes you look so very smart.

f. CLAIM THE ETHICAL HIGH GROUND. Always bring up any and all potential ethical faults to take the conversation away from the central topic of conversation. In fact, bring up your ethical concerns the same way a vegan would, and expect the other side to see things your way. One popular word in the world of Twitter-PT is “nocebo”. It’s the equivalent of dropping “Hitler” into any conversation: an immediate conversation dilutor that re-routes the conversation away from the main topic. You are a connoisseur of conversation killers.

g. LET SELF-PRESERVATION BE YOUR GUIDING LIGHT. A crowd of similar beliefs & opinions offer warm comfort – who cares if those beliefs &/ opinions are weaponized?! Stay warm in your crowd. Never mind the existence of the other crowds who may hold different perspectives than yours – they are wrong. They always have been, and always will be. Enjoy the warmth of your echo chamber.

h. EVIDENCE SCHMEVIDENCE. Arm yourself with a quiver of research papers that you can quote/link in your Twitter arguments… I mean “discussions”. After all, arguing is supposedly nothing but constructive & positive… right? So, why not come prepared. Come prepared to win, not to learn. While you’re at it, feel free to take 1 of 2 opposing sides; either you are a qualified physio who functions in a world of religiously peer-reviewed and statistically approved physical therapy where nothing you do in the clinic is without the complete blessing of the research gods, OR you choose to believe that all research is inherently flawed from beginning to end… and you no longer hold any faith in the existence of math. Go ahead, choose your side and guard it with every fiber of your being whether you’re ultimately right or wrong. And by all means, never ever look up the word falsifiability.

i. ABOVE ALL, FORGET THE MAIN THING: THE PATIENTS. It’s about you being right, not about you being right for the patient in front of you.

Now that you’ve chosen your side, remember: there is no middle ground in the world of an extremist. You’re either with “us” or against “us”.

Approaching multiple climaxes in PT.

What are the odds that we are reaching multiple climaxes in the world of PT? Student loans, declining reimbursement, more PT students graduating every year, combined with a weak professional moat and big data all point toward a significant shift in the industry.

Add venture capital into this already volatile mix, and there’s now more fuel to combust. The entry and increase in PT venture money is somewhat surprising given the trends in industry reimbursement dynamics. Not only does it expose physio’s to unseen financial risk, but it also fuels an insidious race to a commoditization of our profession.

In an effort to battle this ongoing commoditization, some adventurous physio’s are branching into niches that weren’t on the radar 15-20 years ago. PT business models are adapting into new environments focusing on specific clienteles based on their needs, as well as the ever-growing number of physio’s specialties. 

Catering to these changing dynamics, some physio’s have even built enterprises with the intent to educate other physio’s. As a result, the realm of Continuing Education has transformed into an immense mess of a financial boon.

PT ain’t what PT was. The internal dynamics are shifting, and have been shifting more intensely for the last decade.

I wonder when it will reach critical mass. Even more so, I wonder what’s on the other side of this critical mass.

When do you think this’ll happen?

What shifts in the industry have you noticed? What shifts are you expecting in the near & far future?

How are you adapting? What prophylactic measures are you taking?

How is it affecting You?

I’d love to know.

Our Inner Tribesman (or Tribeswoman!)

It’s hard to challenge what have become your core beliefs. You’ve made a stance in the past and don’t want to look like someone who wasn’t right from the start.

Good news: most of the greats weren’t right from the start. The adapted themselves and their ideas to the world around them. They let go of crowded thinking and mob mentality to forge a future only they could foresee.

Tribalism puts blinders on your ability to adapt. You feel caught in the spirit of the times, cementing a sense of certainty, and discounting the costs & consequences of being wrong. We do this by ignoring signs, ignoring opposing evidence, continuing to invest in sunk costs, and downplaying any counter-arguments with cries of biases and clever belittlement.

Let go of your inner tribesman. It hampers your adaptability & hijacks your future. 

Our hidden biases betray our true incentives. Uncover your hidden biases; the ones that you dare not admit to the world. Ask yourself: “what is something I believe that most of my tribe would have strong disagreements with?” Why do you have these differences? Are you trying to feel the warmth of an agreeable crowd or are you thinking for yourself? [hint: neither option is ideal. You ought to be serving something greater than yourself. If not, then you may be lying to yourself about your hidden biases and true incentives.]

Find your hidden fears. What negative impacts would you suffer if you were wrong? Explore these fears. Test these fears of being wrong. These fears are very likely tribal & misguided… weighed down by the distant and recent past.

Don’t pin yourself to the past. Don’t hang your hopes on a confirming future. Free yourself from tribalism and allow yourself to adapt to the changing terrain of the present.