Don’t be the patient that says these words [PODCAST]

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“Don’t be the patient that says: ‘Doc, just tell me what to do …’ Instead, you should ask for information to empower yourself to make decisions about your healing process. Framing questions around the clinician’s experience is always a good starting point; pretend to be the doctor for just a moment and consider the difference in how you might answer the following questions:

1. ‘Is there something wrong with the X-rays of my spine?’
2. ‘In your experience with patients like me, do most people get back to all normal activities following being rear-ended in an accident with findings on an X-ray like this?’

The first question does not give the clinician an opportunity to see you as an individual and truly help you on your path forward. Instead, it sets up a situation where the doctor is free to look at the X-ray in a general way and give a vague and simple answer. She might say: ‘No, everything looks fine,’ even though your back still hurts, or ‘… Well, I see you have some scoliosis here,’ without giving you any actionable steps to take moving forward. If you keep the focus on the experience of the clinician from their work treating a large number of other individuals with similar patterns of findings, it encourages both of you to keep the bigger picture in mind. But David, you might be thinking, what’s wrong with being told the findings of some specific test or measure? Simple, it’s because one specific test or measure rarely tells the full story. Imaging, for example, is just an illustration of shadows that lay beneath the skin, and has limited capability to depict underlying issues, especially when it comes to a holistic view of the body. In fact, there are specific cases when performing imaging is required by insurance before they are willing to reimburse the clinician for certain procedures to be performed. Unfortunately, this can skew their clinical decision-making. This is yet another reason why you must be the one in control, and work with people you trust.”

David Meyer is a physical therapist and author of Injured to Elite: A Guide To Empowering Yourself to Transform Your Life After Injury.

He shares his story and discusses his KevinMD article, “Don’t be the patient that says this.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have David Meyer. He is a sports performance physical therapist, and he wrote the book Injured to Elite: A Guide to Empowering Yourself to Transform Your Life After Injury. There is an excerpt from that book on KevinMD titled “Don’t be the patient that says this.” David, welcome to the show.

David Meyer: Dr. Kevin, thank you for having me on.

Kevin Pho: So we’ll get into your book and excerpt in a little bit, but first off, can you just share your story and journey to where you are today?

David Meyer: Yeah. I grew up a five-foot-five athlete. My father suffered from glomerulonephritis and had two kidney transplants, the first one from my grandmother, Pearl Meyer, the second one when I was in college at SUNY Albany, and it eventually led to a lot of immunosuppressive therapies from a rejection. He ended up developing lung cancer, and he passed away that year.

In 2006, the Mets were playing the St. Louis Cardinals in the NLCS. We grew up die-hard baseball fans; my father and I had that connection through sports. The Mets lost to the Cardinals in 2006, and my father passed away a few weeks later. I was in Columbia Press, and I was just about to graduate from SUNY Albany, pre-med. My uncle’s an orthopedic surgeon, and he said, “Don’t do it. Whatever you do, don’t do it.” I was struggling with organic chemistry anyway, and I wanted to go into a sports capacity.

So my father passes away, and I vow to my family, “I’m going to do whatever I can to make this dream a reality.” And oddly enough, nine years later, the St. Louis Cardinals hire me, five-foot-five David Meyer, who had no business being there. By the way, I was learning-disabled growing up and should have never gotten a doctorate. I went to NYU, got my DPT, lived out the dream, and realized, well, that’s not my dream exactly anymore, because the burnout that occurred in my first few years of practice was a matter of me wanting to climb the ladder really quick and not really working on my own personal development enough early in my career.

It’s been a journey since about 2017, when I left the St. Louis Cardinals, of rediscovering my passion, as Angela Duckworth calls it, great passion and perseverance, and really reconnecting with that, and realizing that it all does really connect back to mindfulness, our own mindfulness. Now I’m working on a process of integrating this for my colleagues, because physical therapists are all trying to fix pain and musculoskeletal dysfunction. It’s a misnomer. You can’t really fix the nervous system; it’s tuned that way, and I think we have it wrong.

That’s why I published that article in my book as well, being that our patients don’t know how to speak to their doctors, and of course, we can’t expect every doctor to come into that session cool, calm, collected. So we need to equip our patients with these abilities as well, and that was the metamorphosis of that.

Kevin Pho: As a primary care internal medicine physician, I think physical therapists, of course, are such a vital part of the team. I consult physical therapy all the time. Now that you have a platform, an audience of primary care clinicians, what do you think is the biggest misconception about physical therapy that you want to clear up?

David Meyer: I don’t know. I might be more on your colleagues’ side. I don’t really identify too much with the title physical therapist, but I can tell you this: We’re not trying to fix anything, OK? We’re trying to, but we’ve got to change that paradigm. If the person comes in with lower back pain, right, yes, sure, we understand biopsychosocial, we understand the connection to depression, we understand that. But let’s all take a pause. It starts in your office, Doc, and I know you guys and ladies do it so well already. You have a conversation, and you try to tune down maybe some of that noise.

But then they go to the physical therapist, and all of a sudden they’re put into the system: “All right, let’s,” whether it’s putting a hot pack on it or it’s corrective exercise, whatever it is. They start to perpetuate this habit loop of chronic pain. And as we know, chronic pain and acute pain follow different pathways, the glial network in our brain. There are so many different advances in neuroscience that have shown us that chronic pain is not something that we just fix or treat with exercise and NSAIDs, all of these things.

So we have to shift this paradigm to a mindful approach. Dr. Brewer, who I’m really fortunate enough to interview next Friday, is really kind of ahead of his time with that, teaching clinicians how to address their own burnout, their own anxiety, their own issues they’re dealing with, so then they can go into that room, that session with their client, their patient, and they can really help them do the same. So I think that’s where it starts, to be honest with you. I know it’s not profound, but for me it’s where it needs to be.

Kevin Pho: So let’s talk about that excerpt from your book. Your book is titled Injured to Elite: A Guide to Empowering Yourself to Transform Your Life After Injury, and you wrote an article on KevinMD, an excerpt, “Don’t be the patient that says this.” Now, for those who didn’t get a chance to read that excerpt, can you just walk my audience through it and share the story of why you decided to share it?

David Meyer: Yeah. So my editor, Oleg Kagan, said, “You know, this is a really important chapter,” “Conversations with Professionals,” in my book. And we kind of had this conversation, like, you know, if there was anything that should be stapled to the door, glued to the door of every medical practice, it’s this chapter. Because the funny thing is, the patients would come to me, and I’d ask them, “How’d it go with the doc?” “Well, I don’t really, yeah, they said just continue PT.” “Any insights? Any learning? Did you ask any questions?” “Ah, no, I didn’t ask that question.”

And I realized that their emotional brain, their deeper brain, was really active in these sessions, and they weren’t using mindfulness, and they certainly weren’t coming in with the intention of “Hold on, let me ask you these questions.” They’re intimidated by all of you, let’s be honest. They’re intimidated by you, and I think that’s socioeconomic, that’s status-related, and these are all things we understand. When they come in, they should have a framework, just like you have a framework, because ultimately, it’s not your health, it’s their health.

So the article is essentially walking somebody through: When something sounds Latin, write it down, right? Something as simple as that. Nobody’s telling them these things. It’s really pointing out the obvious. Also, framing questions better when you’re speaking to your physician or any health care practitioner. You should be trying to understand it in their experience, because what happens is the patient comes to you and they generalize it. They do n equals a thousand, and your n equals one. I don’t care what your research is, you’re still n equals one, because you’re one practitioner.

But you have to remember, when they come in, we should also be communicating that back to them: “In my experience, with my caseload.” Because then they leave, and then they really take these generalizations to the PT, and then we’re like, “Wait, no, they didn’t say that,” right? And things get lost in translation. It’s really pointing out the obvious and us doing the fundamentals better. I think mindfulness is that, I think conversations are that, communication is that.

And I tried to do the sexy thing over the last few years of chasing, you know, creating digital courses and all these secrets, the hacks. It’s all nonsense. You don’t have to hack anything. The hack in and of itself is doing the fundamentals really well. Talk to Elon Musk. I’m sure he would tell you the same thing: “I did the basics really well,” and he’s shooting rockets into outer space. In health care, we have to remember that too, and it starts with communication.

Kevin Pho: So if a patient is in the exam room, and as you know, a lot of primary care doctors have like 10 to 15 minutes with each patient, and I’m sure a lot of patients feel the pressure of that time, that the seconds are taken away. So what’s your advice to patients who find themselves in that situation, where the doctor clearly doesn’t have enough time, the doctor has a waiting room full of patients, only has like five, 10 minutes, they could be running behind? What’s your advice to patients in that situation, in terms of how they can better frame their questions and make sure that they can, I guess, empower themselves in that short time frame?

David Meyer: In K through 12, we need to start training people on assertiveness. Assertiveness, I think, is one of the most important skills we have in life. Don’t, well, I’m not going to say not to worry about your doctor’s caseload, because you might worry about it, but you need to assert yourself. Be the annoying person if you have to be. Assert yourself, and the way you assert yourself is not aggressively saying, “Hey, Doc, why are you rushing me out?” And it’s not passive-aggressively calling the front office and, you know, making a complaint. It’s asserting yourself and saying, “Doc, I’m not quite getting that. Let’s go through that one more time.” That’s it. And then be quiet.

In negotiation, it’s the same thing. When you assert yourself, you make the statement, you express your needs, you’re not being aggressive. We have to do that with our doctor: “Doc, I’m not getting that.” And then the doctor can choose to do what they want. If you need to rush out and you have your caseload, we’re not changing health care in a day, I get that. But if something there is important and the doctor doesn’t realize that, the only way we’re going to have that awareness is if we put that elephant in the room.

The same thing with the doctor: The assertiveness is not that difficult for a lot of practitioners because of the difference in status and things, but I think there has to be a change in balance of power there. So I guess, you know, look, all doctors are patients at some point or another. So I think it’s just more of an education thing for me, of getting this out prophylactically, when they go into the office. Yeah, who knows, maybe there should be some sign on the wall: “Don’t forget to ask your doctor the question you had.” Fundamentals.

Kevin Pho: Now let’s flip it. I think that from a physician standpoint, what kind of advice do you have for clinicians to make sure that we really do get all the patient’s concerns addressed during that time?

David Meyer: Well, I don’t know if you can get all their patient concerns addressed, but I think mindfulness is where it starts for you as well. So connect with that inner shadow, the inner shadow right there, the persona that Carl Jung talks about in the early 20th century. As a physician, you are feeling a stress response right there. As a matter of fact, you’re going into your emotional brain: “I’m stressed. I need to see my next patient. I need to, you know, keep my quota. I need to make sure I get through the day.”

Take a second, take a breath, let the tight feeling kind of go through your body, and then let the curiosity, the awareness: “OK, I want to at least make sure that the patient leaves knowing this,” and that’s it. It doesn’t have to be solving their problems. First of all, stop trying to solve all their problems, if that’s what you’re trying to do as primary care doctors. I get it, you have a lot of responsibilities, but as you all know, it’s probably one or two things that you could really have that maximal impact with if you use a little mindfulness for yourself, a little mindful moment, the timeout moment that Dr. Brewer trained the clinicians on over there, and I think it was in Massachusetts. The same thing for all of you. And check out his Unwinding Anxiety app if you haven’t, because it’s very, very pertinent for health care practitioners.

Kevin Pho: We’re talking to David Meyer. He’s a sports performance physical therapist, and he’s the author of the book Injured to Elite: A Guide to Empowering Yourself to Transform Your Life After Injury. David, tell us a little bit about your book.

David Meyer: So the book essentially was a challenge. My patient, who was suffering from a little meniscectomy, and he was an MMA fighter, a mixed martial artist, says, “Dave, I don’t know if you can write a book. I think you have a lot to say, though.” And being that I had a little short-man complex, like I was talking about before, I took that challenge very seriously, started writing, and it led into the 70,000-plus words or whatever it was.

But it’s basically the manuscript that anybody can read when going through any type of physical challenge, primarily because I looked out there: There was Dr. Sarno and Explain Pain, great work, inspired me, but there wasn’t this guidebook covering sleep, nutrition, covering the mental side. That’s a big focus for me, of course, the first section of my book, and you can listen for free to that section at injuredtoelite.com/listen. But it was essentially the how to go about the process, not the how-to of how to fix it, but an all-encompassing guide. I wanted people to have this.

Kevin Pho: And what would you say is the number one actionable tip that your readers should take away from it?

David Meyer: I think that we compartmentalize things. We give agency to body parts. We give agency to “my knee,” “I want to cut my leg off.” It comes from an integration, right? So to integrate, when we’re going through a physical challenge, we can’t have separation between any element, whether it’s mind, body, all that stuff. So this book really puts in the context of your life taking mental skills and applying them not only to going through the rehab process, but then what carries over to your relationships, what carries over to your career. It’s really, I call it time zero. It’s a reset point, and it’s an opportunity if you really allow it to be. And that’s really the big take-home from it.

Kevin Pho: And my final question: What is the take-home message that you want to leave with the KevinMD audience?

David Meyer: I think it’s going to come down to purpose and mindfulness. So we’re all stuck in habit loops of fixing our patients and fixing our pain and fixing our problems and social media followers. We all have to take a second, and our purpose is within us. I think we all have a good idea of it, but in order to break the loop of whatever cycle we’re stuck in, we really, truly have to be practicing what we preach, and it starts with us. It starts with the practitioner, and then we can help others out there, and not by fixing things.

Kevin Pho: And how can people reach you?

David Meyer: People can reach me on Instagram at Dave M. Meyer or email me at [email protected].

Kevin Pho: David, thank you so much for sharing your time and insight, and thanks again for being on the show.

David Meyer: My pleasure. Thank you for having me.

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