Beyond the Clinic Doors: Proactive Approaches in Pain Care

Mark Kargela: 0:00

Before we start today's episode. I just want to let you know about a special opportunity going on at modern pain care. Right now we're enrolling our first cohort of the modern pain pro community. Ram experts like Mike Stewart, Brawny Thompson, joining me to help clinicians get their confidence and success up in their pain practice. The door's closed soon. So go to modern pain care.com forward slash pro to get enrolled. Now onto this week's content.

Jerry Durham: 0:22

You go into a clinic and there's so much energy and there's. So much time and there's so much money invested in this one model that everybody's, A, they start to believe there's nothing else out there. B, they won't open up because they spent so much time, money and energy. The energy, time and money to maintain status quo insane in healthcare. why don't we flood the market with the positive instead of the negative? So instead of you creating an account and creating 100, 000 followers, because you go out and find everything that you and your tribe think is bad, why don't you just get those 100, 000 people to all share positives and show good interactions.

Mark Kargela: 1:04

Welcome back for another episode of the modern pain podcast. And this week we're gonna be talking to a good friend of mine, Jerry Durham. We're gonna talk about a lot of good topics this week. Some of them being that as clinicians, we need to look a little bit more upstream in our thinking and consider factors. That influence a patient's journey. Before they enter our clinics, We're going to talk about managing expectations and building therapeutic Alliance with patients and how that's crucial for successful outcomes. We're gonna talk about giving more than you get as it can lead to more longterm success and positive impact in healthcare. We'll speak to how moving conversations upstream and setting expectations early on in a patient's journey can be crucial for success. We're going to talk about the misalignment in organizations and how that can negatively impact patient care and Jerry's gonna give us some thoughts on how he thinks we can fix this. Enjoy the episode.

1:48

This is the Modern Pain Podcast with Mark Kargela.

Mark Kargela: 1:52

Welcome to the podcast, Jerry.

Jerry Durham: 1:53

Hello, Mark. good seeing you again. It's funny. Everything comes full circle eventually, right?

Mark Kargela: 1:58

Yes. Yes. Jerry and I have known each other for a bit. First social media. I think we talk and reflect back where I think we didn't really maybe hit it off well, initially on social media. I think we

Jerry Durham: 2:09

Dude, I didn't hit it off well with anybody on social media. Every story, dude, that's so funny you bring that. I can tell you. I'll say it right now. Todd Davenport, David Poulter, right? It started with, A little, right. Everything. the time I would consider them friends, colleagues, and friends now. It was like, tough it out. People learn how to communicate. Which was on me, but yeah,

Mark Kargela: 2:33

yeah, I learned to have some tough conversations, I think, that definitely has been my growth over time too, as far as. And we've talked about it in past episodes, just some of the times conversations came in your view, as far as questioning, maybe some of your practices, your thoughts, your beliefs and things, and how strong, how that's tough for clinicians, for anybody, just being a human, that's just stuff, just stirs your emotions up and, being able to compose yourself and recognize that, hey, you don't know nearly what you think, and that there's always different views that you should, Take into account. So I've always appreciated that about you. And yeah, from our initial, maybe a little rough intro.

Jerry Durham: 3:05

Hilarious. I laugh because there's so many stories like this and I want to, I want to just put one qualifier in there not because I don't want people to think I'm. Just a good communicator because I I wasn't and I'm still not because I'm still working on it. Here's the thing I've just been there longer than everybody else So I had a long time to fuck it up and then finally figure it out and everybody's oh, look at this Oh, yeah, look at this conversation. Oh, yeah, we're good friends and I'm like, oh no, it didn't start that way I've just been here longer and fucked it up more than everybody else

Mark Kargela: 3:37

yeah, I think we all have been there with, are looking back. I know I've had some times where man, I wish I didn't hit send on that. It did, it happened. And you learn, you grow. And I think, I agree. I think the more you're out there, just putting your voice out there and put your views out there, the more you hone your craft of being able to communicate and it is met with, failures, but that's no different than clinical practice as well. As far as,

Jerry Durham: 3:56

And there you go

Mark Kargela: 3:57

yeah, social media doesn't always portray that well, but we were just having a conversation with Mike Stewart earlier today about that and we'll save that for later. But as far as just that failures aren't even ever ones that rarely hit social media and any of that stuff. But

Jerry Durham: 4:11

Yeah

Mark Kargela: 4:11

let's talk a little bit because we had a good discussion. As always, I have good discussions with Jerry always makes me think and pushes me to consider things a little bit more big picture. But we've been talking about this thing. And I think especially when it comes to folks in pain. It's such a downstream system that we work with, especially as physical therapists, where we are often so far downstream from a lot of no SIBO laden communications and journeys that people are on. I, maybe before we even get into this downstream versus upstream talk, most folks I know who are listening to this know of you, Jerry, but if you don't mind introducing yourself, and then we'll get into some of that discussion.

Jerry Durham: 4:45

This is my, excuse me, this is my 30th year and I say, I introduce myself as Jerry Durham. I've been in health care for 30 years. I've been a physio physical therapist for 30 years, but I say I've been in health care. I've been in acute care settings. I've been in a home health setting. I've been in, I've owned my own business and then at the tail end of this journey. I've been in the business side of it and so I say I've been in healthcare for 30 years. But yeah, as a physio and again, you heard my parts of the journey had my own business. Those business years were very interesting. That was a, it was an 18 year, probably million dollar MBA. It probably cost me a million dollars to get my MBA over 18 years, right? Plus my pile of books, plus the mentors and business groups I stumbled into and found. And I'm going to say, I don't say this to sound real humble because humility and me don't always line, I have, and I don't say this to get people to think, I'm smarter than them, but dude I made all the mistakes. I made all the mistakes along the way. And I didn't realize I was making the mistakes. So I make the reflection and even things I share here today. I tell people all the time that the. What I feel is over the 30 years, I gathered up all the puzzle pieces and I piled them up on the table, right? As tall as I am. And I've just been spending the last 18 years, 15 years just starting to put the pieces together. So I don't claim that I knew this journey from the beginning. I don't claim anything I share with you. I knew from day one. What I will claim is I've made every mistake that anybody could possibly make in this journey. and that I can align with you in that way and I'm just bringing now my reflection, my experiences back of trying to put those puzzle pieces together. I hope that was a good introduction, but I think it's important that people understand the context of where people are and where they were. Just dude, just like a patient interview, right? Here we go again,

Mark Kargela: 6:45

And

Jerry Durham: 6:46

go again. It's all the same.

Mark Kargela: 6:48

no, 100%. And with that journey, you speak of, we as physical therapists and not just physios, but, obviously that's our tends to be our audience along with maybe some chiropractors and other folks. But we see such a small snippet of that journey. And I think sometimes our. Considerations as clinicians is so narrow of what we just see in the four walls of our clinic and it limits our ability to help people because what influences what we see in those four walls is often what's been going on outside those four walls and what's led them to that. I'd love if you could talk a little bit about, that downstream one little narrow piece of the journey that we get into and some of the things you're doing to help us consider Sure. More upstream and maybe looking at things a little bit differently than we traditionally do as physical therapists and folks working with people in pain.

Jerry Durham: 7:33

It's interesting because I'm thinking about the My journey in getting to this point, and I am going to take credit for this. I remember sitting in PT school, by the way, I've been out 30 years. So that means 30 plus years ago, by the way, I went, I have my MPT. So it was 24 month program. I remember sitting in school going. And by the way, I claim nothing more than thinking this is why are we waiting for people to get injured? And I didn't know these terms, right? I didn't know a lot of these terms we're going to use today. And I said, why are we waiting for people to get injured? And I, and so I thought what I want to do when I get out of school is I want to help people not get injured. And so I went to some people and talk to people about, Hey, how about if I do this Safeway? I'm from California. Safeway is huge in California. There was no Costco. There was no anything, no Walmart back then, but it's the same thing, right? So I was like, how about if I went and I worked in a warehouse at Safeway and all I did all day long was give patient education around low back pain. This was 32 years ago. And it died on the vine. Why? Because everybody told me there was no money in it. Nobody wanted to do it. You can't prove it. You can't do this. And so I let it go. And that, from day one, I do remember, I was like, why are we waiting for people to get injured? Then, fast forward, over the years, anytime I heard a conversation like this, it would catch my ear or I would read it online. And there are a lot of people on this journey that I've reached out to who've shared a lot of information with me. One of the big ones is Mike Eisenhardt out of proactivity, right? People like that and really seeing the value of not waiting in the clinic for an injured person or someone who needs your services, a painful person, whatever. to call and say, I need your help. And I saw the value. Here's the cool thing. I saw the value to the person. I saw the value to your business and I saw the value to the system as a whole employers, insurance, all of it. So it was like this, right? The triple aim thing. I'd call it that, the triple aim, right? I know that's not quite the definition, this triple aim of serving, how can we impact all three of these? When we sit in the clinic and we wait after someone, a woman has had a baby to treat them postpartum and do nothing before, we're not part of the solution. Sorry, my friends. We're part of a very temporary short term impact. I'll call it an impact but the solution is to talk to the, and I'm not saying don't have babies. I'm not saying don't treat people postpartum. I'm saying you should be engaged with this person, right? Way before they step into your office. And so if we take these blinders off and get in this mindset of, okay, there is a purpose for in office visits, but that should be tertiary, right? I call it tertiary care. So again, just thinking about it that way, how what could what could I do to impact, let's just take one person, what could I do to impact this person's journey? So maybe they don't need to come into my office, which freaks everybody out from a business side, because that's the way I get paid. And that's the only world I know. But then I'm like, there's more money upstream, right? So what can I do to impact this person's world that they don't need to invest their time, money and energy? three years down, nine months down, 10 months down. And actually the dollar they spend today is way more valuable than the dollar they spend later. So that's the mindset around all this and my journey into this. It's just always questioning, why are we waiting for the phone?

Mark Kargela: 11:22

yeah, I couldn't agree with you more on that. And I always just and I've had probably had to look in the mirror on this one a little bit too, because it's so easy to sit in your clinics and, bitch and complain about all the things that are going wrong before the person comes into your office. Why don't you do something about it? And I do think there are some clinicians doing some good stuff.

Jerry Durham: 11:39

Oh yeah. Oh yeah, dude.

Mark Kargela: 11:41

We have the beauty of YouTube and things like that where, Hey, we can give people resources and things to hopefully better navigate some challenges. Obviously there's some limitations of that, but I do think there's such avenues and like Mike Eisenhardt and his group are a great example of some folks that are swimming upstream and doing some things to not wait till the wheels fall off before they're going to try to help somebody. And I think there's this weird mindset is in physical therapy and I don't know others that as much have it, but this whole, episode of care is the only place we interact with the human and once they're discharged, like we lose complete touch with this person and like they are no longer part of our world. I think we can serve people so much better if we could just see beyond the clinic. And I think there's got to be some clinicians some practices that are like, wow, that would open up a whole new revenue stream for us. Because I know that often becomes the discussion. I get it. We can't just do things for the sake of doing them without having some sort of ability to keep benefits and keep lights on and all that stuff. I get it. But just what do you think is behind our limitation to see you talk to people probably more than anybody I know of who struggled to see beyond the clinic and beyond this journey downstream, like what are the big barriers you're seeing out there that really influenced that? No,

Jerry Durham: 13:02

I just want to figure out the best way to go at this without going down a rabbit hole and going, wait, where'd we start? There's a couple components and bear with me on this. I, right? It's I'm in outpatient clinics. I'm in network clinics. I'm in out of network clinics. I'm in cash paid clinics. I'm in peds clinics. I'm in women's health clinics. I'm in musculoskeletal clinics. I'm in neuro clinics, right? Been in a couple hospitals recently. The pain we know today, right? Is that pain will choose if there's a possibility of shifting to something and getting out of pain. but it may not work. I'll stick with my pain today. And we all know these studies, my friends, it's been proven over and over. And we could go back to what I like to say is our embracement of the status quo, because it's the only thing we know. And it's the pain we know. And I've learned a lot about this year, even from a financial side, I've seen it put a number in front of somebody about how much money they're losing out of their business monthly. And then they decide to do nothing. And I've spent a lot of time examining why would someone do that right from a psychology side and it's no different, absolutely zero difference than the patients we treat. So this pain we know is far better than the unknown is far better than the change. So I'll stick with this machine shocking me every five minutes because I don't know what's on the other side of this. So right, so I'll give you an example, right? You go into a clinic and there's so much energy and there's. So much time and there's so much money invested in this one model that everybody's, A, they start to believe there's nothing else out there. B, they won't open up because they spent so much time, money and energy. The energy, time and money to maintain status quo is insane in healthcare. And so back to your point. I don't go in and tell people to blow up your business. I say, how can we incorporate exactly what you just said, Mark? How can we incorporate this into your current model? And really where I have to start with them is showing them the finances of it, right? And the opportunity actually better than opportunity. I like this word potential, right? What is the potential of this work? What will the impact be? And what is the risk to you? Because this change thing has to do with all those. And I think. I think a big thing with change is people don't look at the risk, right? And so what is the, what's the potential here? If we do this right, like I've talked to Dr. Katie O'Brien, I've talked to Rebecca Gras, I've talked to Rebe, Dr. Rebecca Griffith. They're all further upstream and they ain't that far upstream. Lemme tell you people, they're a step or two. And they're training people. And one of the things they're doing, and very wisely, is they're coming in and showing people how to bring primary care, how to do ER from your current model. sO this idea of, and this resistance to change is just so much time, money, and energy in the status quo, and then the psychology that goes behind that. And understanding that, look you can have this here because I see the current model mostly as a tertiary care. So you should be asking yourself, what one layer can we add above that? What one layer can we add above that in our current model? Because I'm not telling anybody to blow their business up. So hopefully that answered the question.

Mark Kargela: 16:27

100%. I think it's interesting. Yeah, I do agree. There's a lot of. of gripping of the status quo and the pain, like you said, as much more of at least it's predictable. There's a sense

Jerry Durham: 16:38

All of it,

Mark Kargela: 16:39

the knowing versus the unknowing and yeah, it's a tough thing

Jerry Durham: 16:43

No different than sitting across from not talking to a patient, man, going through the same thing.

Mark Kargela: 16:47

No, a hundred percent.

Jerry Durham: 16:48

I change? Why should I change? If

Mark Kargela: 16:50

a patient right now who's just struggling to make that change as far as, sitting, laying bedridden for the most of the day versus cause she knows she has a schedule that she lives by. With their pain laying in bed, but getting out of that is just an unknown of not knowing what's going to happen and a major challenge for her. So yeah, definitely some parallels between apparently we're all humans. Crazy to think. But

Jerry Durham: 17:11

if I type that into Twitter 30 times a week, man, I go humans. I'll just reply people humans. What do you expect? And that's the sad part. We expect differently and I think it's because there's another thing. Expectations aren't aligned properly.

Mark Kargela: 17:27

Yeah, I'd love if you could unpack that a little bit about expectations and where you, because you do some great work. I know with Maxi Michak and other folks who are really looking at, therapeutic alliance, patient expectations, all those things. I know you have some projects in the hop or two on that, but where do you see that? Not only because you work beyond just the clinical side, you work on the whole business side of that.

Jerry Durham: 17:48

Yeah, and really, it's funny, it's interesting. I've really tried really hard to get in on the clinical side. No one wants to conversation, dude. So I have. I have what I call, I have the rules of engagement for a successful course of care. I have the SOPs written out. From first phone call, managed all the way to arrival, to first visit, the evaluation. By the way, I never tell anybody how to treat. I never tell anybody how to, how many visits. I never tell anybody what to charge. I tell everybody how to talk, right? How do we manage this person through this journey? So that we can keep fear, doubt, and uncertainty low, and we can keep expectations managed and set, and when all that happens, we're going to build more trust, we're going to build more alliance, and we're more than likely going to get the result we desire, low risk, and we're, people are going to not no show, or sorry, people are going to cancel less, hopefully not no show, and not drop off. That's it. I've got the whole system. Nobody wants to dance, right? Oh no. We got this. So what has happened and what I love is right here we go. Going upstream. Your front desk is upstream, right? Your marketing is upstream and people want to engage in that. That's where I start this whole journey. And it's interesting because I want people to understand because I know this is a lot of clinical stuff here. My, Okay. My work in Expectations Upstream, my work in Alliance, I refuse to say Therapeutic Alliance anymore. And I'll, if you want to go down that rabbit hole of how ego driven Therapeutic Alliance is, and that one moment, that fucking 15 minutes of time, and we're supposed to read all this research and learn how to build a Therapeutic Alliance with someone we're going to spend 30 minutes with, I'm like, this is absurd. It's all it's almost laughable, man. So I call it Alliance. Because it can be built. And I'm doing some work on this right now as I shared with you. The work I do upstream came out of J O S P T, dude. Bishop, we've had this conversation. Bishop, Belosky, and Klielander, right? Their work on expectations. I remember first reading that as a clinician. And thinking, how can I apply this? How can I use it? Then when I went upstream, I'm like, wait a minute. Why aren't we doing this before they get here? Anybody who's ever read an article on expectations, why do, and then the research is always about, okay, so when they get in the office, I'm like I think you're missing the point. This thing about expectations and managing expectations, I teach front desk people how to differentiate past experiences from current expectations. And, I do secret callers into clinics, right? Where I say, Hi, I'm Jerry. I have low back pain. I want to get scheduled for physical therapy. In five years, six years, seven years of doing secret callers, I've been asked my expectations zero amount of time. Expectations correlate with outcomes greater than anything else in our research. And I'm like, by the way, you owe the person you're talking to, to get their expectations. Because if you can't deliver it, you should not put them on the schedule. I think I went a little tangential there, but I think that's the expectation part that we

Mark Kargela: 21:17

A couple of things I'd love to unpack there because it's no different than going to a restaurant and you as the restauranteur, I'm going to give you the food I think you need because, heaven forbid, I

Jerry Durham: 21:27

By the way, that's one of my favorite examples, dude. I'm like, when's the last time you went to a restaurant and had no idea? Oh, we won't tell you till you get here. You how quickly would that place close down, dude?

Mark Kargela: 21:38

They don't even get the menu that patients don't even get the menu. It's

Jerry Durham: 21:41

No, you're told.

Mark Kargela: 21:42

like you are told what you're gonna eat. And and we, heaven forbid we prepare meals that are in line with your tastes and what you like, we're just gonna, heaven forbid you choose a restaurant that fits your expectations even.

Jerry Durham: 21:52

Heaven forbid. Here let's do. You call. Do you have Italian food? No. Oh, I'm looking for Italian food. Oh, you know what? There's a great Italian restaurant about half the way down the street. You should give them a call. Here's their phone number. Thank you. You're welcome. Click. Tell that to a business owner, dude,

Mark Kargela: 22:13

yeah, no, they, yeah their head would explode. I can imagine.

Jerry Durham: 22:17

I train front desk people to do that. Sometimes I don't even tell, and I'll say it here, sometimes I won't even tell the business owner that's what we're doing.

Mark Kargela: 22:25

well

Jerry Durham: 22:25

oh, by the way, you're going to recommend when they say no, right? Everybody comes to me and wants, hey, Jerry, how can we manage these objections? I'm like, don't get them. Bring them up first.

Mark Kargela: 22:36

Yeah, knock him down before. And then, when you're not a good fit, don't try to fit a round peg in a square hole. It's

Jerry Durham: 22:42

There's healthcare, dude. There's healthcare.

Mark Kargela: 22:44

Yeah.

Jerry Durham: 22:45

Here's these, here we go again, man, here are these people that are raising their hand by calling your clinic by saying, I need your help. I need your help. Cool. What's going on? Got back pain. Great. What's your insurance? Blue Cross. We don't take that. Okay. Click.

Mark Kargela: 23:09

Yeah. Yeah, it is depressing.

Jerry Durham: 23:13

Oh, real quick. Let's go back to expectations. They hang up. I say what they want. They wanted to know if we took our, their insurance. I'm like, timeout. They called here and told you had back pain. Yeah, but they wanted to know if we took their insurance and I told them, no, I'm like, so what they want from us, they want to know if we took their insurance. I said, you don't call a physical therapy office to find out your insurance benefits. They called you because they have a problem that needs to be solved and you didn't even have the courtesy to talk to them about what that problem is to even see if you're a fit. No. So you just told them, here we go. You want to talk about status quo and the change in the current system? This is why your first question I was like, which way are we going to go? So you just told that person, and then here's what else I get, dude, all these years of this. The front desk person, by the way, I blame the owner, not the front desk person, whoever the fuck trained this person, did them a disservice, left them hanging out there, and they are going to do what they believe is best, and it is not on them, it's on you, so when you hear me talking like I'm bashing on the front desk, no I'm not, I'm bashing on the person who hired them and did not train them. That front desk person will tell me all people care about is their insurance. So what'd they ask you? They asked if we took their insurance. I said, why'd they ask you that? They don't know. I'm like, so you told them it's about their insurance. I said, you realize you're facilitating, you're perpetrating the fucking fraud that you believe that they, all they care about is insurance because everybody they call goes, what's your insurance? What's your insurance? What's your insurance? I said, that's you. That's not them.

Mark Kargela: 25:04

yeah, it is head scratching from time to time. I know you've dealt with these discussions and these frustrations.

Jerry Durham: 25:11

I listen to these calls every day. Okay. The single most valuable thing I've done in these 30 years is listen to new patient phone calls, right? Potential new patients. Sorry, because they don't all schedule, right?

Mark Kargela: 25:27

yeah, and it is just the thought process that I've seen out there is just, get everybody in.

Jerry Durham: 25:34

Yeah. Yeah, right? So it's funny get everybody in but don't not the people wait I'm like wait, do we get everybody in or do we how you know, it's weird in sales lingo. It's called qualifying a lead I'm like you're qualifying a lead by how they're going to pay So here's another thing, right? The restaurant thing. Hey hey Mark yeah, I was wondering if I could get a reservation at 630. Yeah, how are you going to pay? I was thinking about using my credit card. No, sorry, we don't take credit cards. Click. It's would they have paid out of pocket? Were they going to, do they have a check? Could they Venmo you? What?

Mark Kargela: 26:12

yeah. We could go down this rabbit hole for,

Jerry Durham: 26:15

Yeah, that's why I'm going to sit back and be quiet here for

Mark Kargela: 26:18

A few podcasts for sure. I'd love if you could touch upon a little bit about your view on where patients sit and all this thing because they're obviously the consumer. And I know you're doing some consumer facing things to to open the eyes when you discussed like how clinicians are so resistant to, to, to you coming in and, because the magic has to happen in that little treatment room. None of this stuff matters outside of my treatment. What's my magical approach and or letters after my name versus. Again, I think we do such a better service as you've already pointed

Jerry Durham: 26:51

You'd be surprised some of the things I've heard from clinicians coming in saying, I'm going to help you. I'm going to help you be able to facilitate a conversation and move forward. and get agreement on the plan of care that you are going to give them. I'm not telling you a plan of care. I'm just saying have the conversation in this manner.

Mark Kargela: 27:09

Yeah. And I can only imagine because I know my, when I, parts of my career, probably I would struggle with anybody telling me how I'm going to, communicate or do any of that stuff. And yeah, we've all probably been there when we're a little insecure clinically, but yeah, as hopefully if you've listened to this podcast, even a little bit, you've recognized that how we communicate and the relationship we establish with a patient of trust. Of and belief and seeing that

Jerry Durham: 27:33

And Alliance. I think Alliance is a great word. I'll use Alliance. And the research. Here's what's interesting about Alliance research. It exists way outside of healthcare, way before healthcare ever came up with it. That's another big issue. I will say this and stop. It's another big issue in healthcare. We believe the only solutions are in healthcare.

Mark Kargela: 27:54

Yeah.

Jerry Durham: 27:55

I have learned more. on how to facilitate a successful patient journey from a sales handbook than any single healthcare article I've ever read in my life.

Mark Kargela: 28:09

Yeah. You look at how healthcare forms policy it's minimally about the consumer. It's about again, just the whole thing of

Jerry Durham: 28:16

There you go. There's no other industry that, that downplays the actual consumer buyer, whoever, right? That this consumer buyer, client, patient in healthcare, man.

Mark Kargela: 28:30

Yeah. It's we're going to shove our menu at you relentlessly without your input on what the dishes are, what the appetizers are, what you might drink. It's

Jerry Durham: 28:38

And ultimately you're paying, we're back to the consumer here, right? Patient. Ultimately, you're paying

Mark Kargela: 28:43

Yeah.

Jerry Durham: 28:45

employee benefits. That's what I always love. Oh, I hate cash PT. I'm like, where the fuck? So what do you have? Oh I'm all contracted, fuck the cash PTs. I'm like, where do you think the people's benefits are getting paid for out of their fucking paycheck, man? Employer, by the way, out of their wages, we had this conversation online, right? It's healthcare costs and your benefit costs that are keeping you from getting a bigger raise.

Mark Kargela: 29:10

Yeah.

Jerry Durham: 29:12

So tell me who pays most for this. And every I, There was a post the other day about end of year and deductibles resetting and everybody's showing up and right, blah, blah, blah. And I recommend everybody show up and get everything they can out of their insurance. And I went, I sat in that for a bit before I responded. I said said, interesting take. I said, we definitely learn a lot about people at this point in time in the year. And their response was insurance related and getting the most out of it. I said. I was taught something a while back, this term agency effect, and we use it in healthcare. But I'm like, you realize we give up agency when we engage and take insurance. We've separated ourselves from the decision and the financial impact and said, you take care of that. I'm like, we facilitate that on our side, on the healthcare side. When you ask people about their insurance, you're taking away their agency. It's about their insurance. That agency effect was huge. I forget who first presented that to me. That was about six, seven years ago.

Mark Kargela: 30:16

Yeah, the agency of a patient has been stripped so much from that whole situation and also, like you said, practitioner when we put it in insurance company's hands and all these different things, which I don't think anybody listening will argue that our system is quite jacked up and in need of

Jerry Durham: 30:33

And then we so what I want to say is because everybody will tell us the system's jacked up. Cool. Good. Good starting point. We facilitate greater than 51 percent of the fucked upness of the system.

Mark Kargela: 30:43

Yeah, and this might be a good jumping off point to and you mentioned this of we just wanted Yeah, What about keeping people out of health care? What about services to, to get them to where they don't There's this, let's wait till the wheels fall off illness care system. I even hesitate to call our system a health care system, because it's, we're going to wait till you're in trouble before we do anything, and then it's going to be probably more revenue based care versus anything that's semblance of patient centered or evidence based or evidence informed, any of that stuff. What are your thoughts on opportunities for us to instead of just waiting? Especially with people in pain.'cause oftentimes I got patients right now who are asking me, what's, do you have a recommendation with a for a pain doctor? How many have you seen so far? 14. I'm like, and it's this continued journey of like constant, like if we could just get in their lives earlier before this 14 pain docs happened. And I know there's some options like YouTube and different things, and that's where we're looking to start creating some patient facing. Resources because I'm not wait, I'm definitely not gonna wait

Jerry Durham: 31:44

Yeah. We got to go. If we want to be honest, dude, we got to go way upstream, right? Even in the model that I was talking about, because I still think about, primary care, ER care, ER is who? I don't know yards tertiary, maybe whatever the word for fourth level care. But Rebecca Griffith, I got to give her a shout out because she said one of the most, she said she had a business model for current business owners in communities with a hospital. She said, go set up a tent in the parking lot in the ER. You do not know how much business you could get running a PT clinic. out of a tent in an ER parking lot and screening the people going in, what do you have? I have low back pain. So stop here, right? Meaning people you can serve and help at that moment in time. So think about that for a second. Everybody's so resistant to change and she's saying, if you dropped a tent in the parking lot at an ER, right? And everybody everybody would go, how am I going to get paid? And I'm like, yeah, sure. But yeah, we need to go further upstream and, again, I've been around for a while and in a good way. I say this in a positive way. I was around before. When I went to PT school, dude, I was in the library doing research, right? With my copy card. Internet was just new. I had to flip phone. You didn't use your phone unless it was an emergency and obviously no social media. So now with the advent of social media and social media, every day it peaks, right? Meaning every day is a new day for something. There is, now you get to see real humans. See, I say, people are like, social media created something. I'm like, no, just give people a megaphone. Because if you look at the psychology of it all, it was no different. It was just in our communities. It's just now on a bigger scale. I don't think anything's new and people want maybe staring down at your phone. We can talk about that. But the way people interact. No, it's no different. I'm sorry. And I've had this conversation with people just a megaphone. So instead of pushing back and going, wow, it's created this horrible people don't know how to communicate. I'm like, Fuck, you think they knew how to communicate before there was Facebook? They didn't know how to communicate. So getting back to your question is we see social media where people, some people like to spend all their time, money and energy bashing other things. And they'll tell you, we have to get this word out. We have to tell you why this is bad. I'm like, why don't we flood the market with the positive instead of the negative? So instead of you creating an account and creating 100, 000 followers, because you go out and find everything that you and your tribe think is bad, why don't you just get those 100, 000 people to all share positives and show good interactions. And so again, the value of YouTube, the value of any social media platform to get a message out to the consumer side is so undervalued and so misunderstood. That there are people, Anthony Moritato does this he teaches people how to get on social media and how to get leveraged through that channel to get their exercises out, to get their education tools out. But no one's doing that because. Because it takes some work because it's not the status quo. So really that's where we need to be is consumer facing. And here's my other favorite one. The APTA should do this. I'm like, what are you doing? What are you doing? What are you doing? I'm sitting in my clinic treating 20 people a day. I'm like, good on you. We can go upstream the marketing side, the consumer facing side. There are so many people out there want the information that need our help. The pain people that you can get the eyeballs if you're not trying to piss everybody off every minute of every day and then having resources, every YouTube page should have resources for people, right? Right? Not just the PT part, maybe YouTube page. I love this integrated model, right? Integrated health model of bringing different people in the nutritionist, personal trainer, Cairo, PT MD, right? And everybody's aligned in this. My wife belongs to one of these systems. She pays a fair amount of money. And it's nice because everybody is aligned in the conversation. So no matter who she sees, the conversation is the same. Do I agree with all of it? No. But is it fucking off the rails shit? Fuck no. Is it a solution to a problem? Hell yeah. because guess what? My wife's healthier. She exercises more. She does all these things. So I'm like, how is this bad?

Mark Kargela: 36:20

Yeah.

Jerry Durham: 36:21

And so that's where we have to go. And I like this integrated model a lot, right? And by the way, and so the integrated systems and I'm just going to use my wife's group as the example, you go to their social media, they're sharing nutrition, they're sharing exercise, they're sharing physical therapy, they're sharing the doctor talking, right? So someone who needs that group. understands that, hey, maybe this is right for me, right? And by the way, they put out a lot of good educational stuff too. That to me is, so you have the center but you have to be willing to give to get right. So you got to put more stuff upstream and allow people. Who may never, ever spend a dollar with you to benefit from what you do.

Mark Kargela: 37:02

Yeah. There's a scarcity mindset of clinic. I just, people can't see that, that sharing that value. And putting that value out in the world will be, we'll come back in droves if you just, but yeah, will it have some people that you just give a lot of free stuff away that helps a lot of people. Yeah. To me, that's great. And then the people that need more, handholding or more guidance or more things you've established

Jerry Durham: 37:25

now we're talking about those levels, right? So really, there's that tertiary, there's that secondary, there's that primary, but there's the one before, right? And it's what you're talking about. Yeah, that's perfect. I never thought about it that way. But yeah, that's exactly what we're talking about. Give to get. I say that twice a week.

Mark Kargela: 37:41

Yeah. And it's just interesting where we're so resistant to it. It's everything has got to have. And again, it's just, if you're willing to give away a lot of, goodwill into the world, it will come back. I,

Jerry Durham: 37:54

One of my favorite, and because I think this builds into what we're talking about. Naveen Jane, N-A-V-E-E-N-J-A-I-N. I first heard him on the Impact Tom Biu podcast, and it was still, it is so burned in my head. I don't remember people's names I met yesterday, but Naveen Jane is literally that story, right? Family packs'em up, was living in a home with a mud floor, right? A dirt floor family packs him up from India. He literally, as a little kid, had 25 cents in his pocket. His parents had nothing. hE's a, he's an entrepreneur, right? He's very successful. Now, Naveen Jain said, probably the most, and I'm probably going to get this tattoo. One of the, probably one of the most inspirational things I ever heard that impacts this conversation, that impacts the work I want to do with Rebecca Seagraves, that impacts the work I want to do with my clinics. If you want to make a billion dollars, find a problem that 1 billion people have and charge them all 1. 1. When he said that, dude I will guarantee you, I literally fell the fuck out of my chair because I was like, I have never ever, it's always how much can I charge? What's the maximum I can charge for everybody? That's always been my mindset, right?

Mark Kargela: 39:20

I think it's tradition. Most folks mindset is like wanting to really look that route. But yeah, no, it's been interesting. Just as I've trying to look at ways to provide value to people without. How do we reach as many people as possible? I think that approach of being able to give more than you get and it will definitely, it's not a, it's a long term play a little bit, but if you put the work in and you put the resources out

Jerry Durham: 39:42

If we talk about this potential impact and risk model again, I tell you what, set up a business. And start with this. Start with the fact that I'm only going to charge people a dollar. Now the work's on you, right? And this is what's interesting. And this is what I don't like about some of the healthcare coaching groups out there. The solution to everything is raise your prices.

Mark Kargela: 40:04

Yeah,

Jerry Durham: 40:05

how can that be the, I can tell you what healthcare people devalue what they do and they, the majority starting out under charge. I get it. But come to a level where it's right, where it's appropriate, whatever that term means. And then but start, this consumer facing business that I want to start, my, the challenge to myself is. is to not charge the consumer at all. So then the work is on me to find ways and people and beneficial things that can benefit that consumer and I will charge them. But again, maybe we charge them 99 cents a month, right? Yet I would do that just as a kind of skin in the game type thing. I don't know, but then the challenge is on me. The work is on me. If I'm like, oh, I'm going to charge 250 bucks. It's like when people tell me they're raising their prices again, there's another issue in the business.

Mark Kargela: 41:03

Yeah definitely. Jerry, we could talk about this stuff for hours and we have we've pondered this over bourbon and whiskey and other beverages in the past. But what are some things we, you're up to that you, I'd love to highlight some of the things you're up to and where can folks get to contact with you?

Jerry Durham: 41:21

My website is client experience company. It needs to be updated, but I think if you go there, you'll see some of the work I've done. What you'll see is the work. I think, because the testimonials I put on there try to reflect what we talked about. How does doing work upstream your front desk, right? Integrating the nonclinical members into your business as a team, true team and look at the. Look at the patient results, look at the client results and then look at the business results from that. And that's what the client experience company is about is how do we take this expectations work? How do we take this fear of the status quo? How do we take managing and setting expectations? How do we take? All this work and move it upstream and then facilitate moving that conversation with the person. So when mark calls the office and says this is the problem, low back pain is not a problem to be solved. Mark can't go to work. Mark can't pick up his grandkid. Mark can't go to the gym. That's a problem to be solved. Once I have that information has to travel with Mark. So when Mark comes in to see his expert, Dr. Jane Doe, that he got set up with, that helps people just like him get back to the gym pain free, Mark walks in the door, Mark's greeted. by his name and his goals. Mark doesn't have to repeat himself. And doc, this is what I scripted out. Stuff like clarifying, redefining expectations at the beginning of the visit, because they were set. So Mark, I know you spoke to our front desk team. I know they took information from you. By the way, if you have to repeat yourself. Just know I want to, I need to go deeper into the information, right? What's that take me? 20 seconds to say that? The value of that statement right there? Dude, if I tell you the feedback I've gotten from my clients who took this downstream of someone at the beginning going Mark, I know you're here for A, B, and C. And I know that you're expecting this. Is this correct? And the guy might, I'll never forget the PT who told me the first time he did that. And the guy stopped the patient. So he said that to the patient. I know you're here for these three things and I know this is what you're expecting. Is this correct? And the person sitting there paused and said, wait a minute. Where'd you get that information from? And he said, when you spoke to Becky at the front desk, you shared that with her and she gave that to me. So I'd know right where we were starting today. sO you guys communicate. You guys talk to each other here. Yeah, we do that. Oh, cool. I'm like, dude, that's 30 seconds into an hour long about. I'm like, we're done. He'll fucking sign any plan of care you give just bear with me on this, right? But we're done.

Mark Kargela: 44:15

yeah. Such a sad reflection of the status quo in our profession

Jerry Durham: 44:18

So that's the work I do, right? That's the work of the client. Client experience company is making sure we have the right people upstream at the front desk to manage this journey to make sure you have the systems and then we connect them. I talked about these rules of engagement. I have S. O. P. S. For pre arrival. I have S. O. P. S. For the evaluation. And I have, by the way, I have one S. O. P. For follow up because every visit should be managed outside of the clinical part, right? Remember, I'm not telling you how to manage clinically, it should be managed the same exact way. It's so funny, the pre arrival SOP takes weeks, maybe months to put together. The fucking course of care SOP took 15 minutes to put together. And by the way, you and I would talk about it for maybe 20 minutes and we'd be done.

Mark Kargela: 45:05

Yep.

Jerry Durham: 45:05

The impact is upstream. So this is the work I do with my client experience company. This is the work I love doing with people. I'm going to tell you right now, the results will be increased patient success. So Less cancels, less no shows, less drop offs, more completed plans of care, which if you're a business owner, let's make the next jump. That's more money for the business. That's more client satisfaction. That's more employee satisfaction. That's less chaos downstream, right? That's more people on the schedule who arrive, pay and stay. That's the work I do. The other thing I'm currently working on is, is working on a paper with some other people and we're looking at it. The research and the proof of the right, the proof behind this work of how to get organizations are organizations misaligned. And how is it impacting the patients we serve? And I got to tell you, the research is out there, my friends, that shows that there's a misalignment between management, clinical and the patient. And I'm like, cool, I'm the solution.

Mark Kargela: 46:05

Yep. Yep. It's interesting how, again, it goes back to the restaurant analogy of how absolutely

Jerry Durham: 46:13

it is. And by the way, if and when we do work together, you're going to go, that's it. And I'm going to go now. You just got to fucking do it. A hundred percent of the fucking and my clients who do it. I got a group right now. tHey, oh man, I'm bringing the knowledge without the action is right. It's like a

Mark Kargela: 46:33

Yeah. Useless.

Jerry Durham: 46:34

I got a group now in 9 months. They got 4 offices dude. So I'll let you all do the math right there. Their cancel rate is just gone from 21 to 17 to 14 to 12. Now that's monthly. So that means every month, 9 percent of their visits on the schedule are keeping the schedule and staying there. I'll let you do the math on that, everybody. It is over, it's over 10 percent of their margin, or sorry, over 10 percent of their revenue. That goes straight to the bottom line. They didn't have to hire people. They didn't, there, there was no software purchased, no hires made, no nothing. They just, they built the system. the connectedness in this business. And guess what? Patients show up. Is that good for them? You tell me. goOd for the patients, right?

Mark Kargela: 47:27

Love the work you're doing, my friend. And it seems if clinicians can just get out of their own head of this magical

Jerry Durham: 47:33

the owners don't forget this. This is well, I'm going to challenge and say, it's got to start up here in

Mark Kargela: 47:39

Oh yeah. A hundred percent owners have to understand

Jerry Durham: 47:41

just want to make sure I say that because I'll bash on everybody. That I always have to clarify at the beginning. I'm going to bash on everybody, but just bear with me.

Mark Kargela: 47:49

They think the value only lies in the treatment room, and

Jerry Durham: 47:52

Yeah, so so I will give you that it's this right? And that idea of, yeah, the pushback I got to share this with the pushback I've gotten from a couple of clinicians going the front desk can't do that. That's my job. I'm like. And you're going to be the one burning out of the system in five years and saying, fuck this system and fuck this and how everybody fucked you over. And I'm showing you how I'm going to make your life easier. Yeah literally front desk. Can't do that. That's my job.

Mark Kargela: 48:21

Yeah. Yeah. It's interesting. Frustrating. Yet interesting at the same time. Hey, I wanted to thank you for your time today, Jerry. I always have a good conversation with you and those of you who are trying to maybe think a little upstream in your own practices, you need to give this gentleman a call or contact him via his website. We'll link it all in the show notes. For those of you who are listening on your podcast provider, we'd love if you could subscribe, even leave a review that helps us get more exposure and get more of the good message out to help more folks in pain. If you're watching on YouTube, we'd love to have you subscribe there as well. But we'll leave it there at this. We'll leave it there this week. Hope you all have a good rest of your week. Have a good holiday season. It's that time of year, at least at the time of recording. We'll talk to you all next week.

Jerry Durham: 48:57

Thank you, Mark.

48:58

This has been another episode of the Modern Pain Podcast with Dr. Mark Cargilla. Join us next time as we continue our journey to help change the story around pain. For more information on the show, visit modernpaincare. com. This podcast is for educational and informational purposes only. It is not a substitute for medical advice or treatment. Please consult a licensed professional for your specific medical needs. Changing the story around pain. This is the Modern Pain Podcast.