Cognitive Functional Therapy and Chiropractic - can they be integrated?

It. Chris. Ed.

Hey, how you doing?

Okay. Let me just turn the volume up.

No worries. Good to almost meet you in person.

Yeah, you. It's surreal because you, you've been on this screen where I'm sitting now so many times, but I'm actually, you know, interacting with you. It's bizarre.

Yeah, it's. I find it sometimes as well, I. I'll bump into somebody at a seminar and they'll be. I've never met them and they'll be chatting me like they know me and they're like, oh, yeah, because I've been watching your videos for a bit. I was like, oh, this is a weird kind of. Yeah. One sided sort of relationship kind of thing.

So.

Interesting.

Yeah.

Thanks for taking the time to chat. Yeah. You okay if we record this, by the way?

Yeah, of course. Yeah, yeah, yeah.

I was thinking it would be really helpful because I know there's a lot of other particularly sort of new graduates and students the last few years, but even experienced cars as well, who this whole balancing manual therapy, pain science, juggling up type thing is, Is a struggle. So. Yeah, I think it'd be really valuable. So. I appreciate that. Yeah.

Screen. Am I too high, too low?

No, no, that's. That's great. Yeah, yeah, it's. So one of the things I learned after buying a decent webcam was that when it comes to online content, people don't care about video quality at all. So, yeah, it's the audio. You want to put your money in a microphone, not a webcam, apparently. So. But that's, that's fine. That's. You've got a nicer background than I do. Actually. I'm a bit jealous now. Yeah. So, yeah, like, thanks for taking the time. I thought. I've got a few kind of questions I wanted to ask, but I didn't really want to have it like a structured interview. I thought it'd be more fun to just kind of have a conversation, kind of explore, you know, your journey and how things go and see where we end up. If that's all right.

Yeah, absolutely.

So do you mind just going through just a little bit of your background? Because I know we've spoken on and off through the years, but just to kind of give a sense of. Kind of how you started as a chiropractor.

Yeah, my. I mean, I never knew what chiropractor was until I was about 21 years old and I was. I just graduated from my first degree and I was completely lost, didn't know what to do and was just searching for something that suited the way I wanted to work. And I, and I looked into all sorts of things that I look back now and think it was crazy. I wanted, I want, for some reason I thought being into weights and measures was going to be the thing. And I, I don't know why that was, was, you know, seemed appropriate, but what I've realized is that was about me wanting to be an expert in something. And it didn't matter what I was going to be an expert in. I just wanted to know an awful lot about something. And through a series of, you know, mistrials and trying certain things and applying certain things, somebody suggested me that should be an osteopath. So I looked into that. I got myself enrolled on the, the course in the British School Osteopathy. And during the open day, during the, the orientation day, we were asked, why do you want to be an osteopath so badly? What is it about being an osteopath that suits you? And people came up with these very worthy answers. And the professor said something along the lines of, look, you know, it's great, you all want to help people, you want to get into this profession, but you know, why don't you become chiropractors because you'll see 10 times as many patients. So I left that day thinking, what is a chiropractor? Yeah, I looked into it. I was lucky to find out that the, the course in the wheel could just started which was, you know, the, the difference between uprooting and living in London or a couple of hours down the road was a bit of a no brainer really. And so I don't have that kind of romantic story about, you know, being helped by a chiropractor. When I was younger, you know, being envious of a chiropractor. It was just the idea that it was a very selfish reason really. I wanted to be an expert in something and that, that fit the bill. Okay.

I think, I think if we're all honest with ourselves, I think a lot of us would say that's part of it. I think that's, that's something that, yeah, a lot of people I met, it's like they really want to be the expert. They want to be known as the specialist and something. I think sometimes as chiropractors we, we kind of carry around a little bit. Like it's that whole like, oh, but you're not a real doctor, you didn't do medicine kind of thing. There's, there's, I certainly, I've kind of felt That a bit myself of like, I've got to prove to them that I am an expert in something. Yeah, I mean I. Because I was second generation chiropractor, so I kind of grew up with it. So I had that just. Oh yeah, I was always exposed to it. I never had a, oh, what's this chiropractic thing? Moment. I looked at other stuff and realized none of it seemed as fun to me, which I'm glad my parents pushed me in other directions. But yeah, I think that wanting to be an expert, that's something that I think a lot of us do feel, maybe we don't always acknowledge it to other people there. Um, okay. So, you know, one of the things we were sort of chatting about the last few years was kind of your journey into more of the pain science around, particularly around cognitive functional therapy, Petro Sullivan's work, that sort of thing. Could you tell me a little bit more about kind of how you got into that? What you. Because that wasn't something that was taught when I was at Wheel, you know, nevermind when you were there as well. So. Yeah, how did you kind of come across that?

This is my quest to be the best and to be able to cover all angles about what I did. And that started off by looking into loads of different, you know, techniques or, you know, things like core stability. So I've got very heavily into Stu McGill's work. You know, I was looking at things like Gomstead technique and Mackenzie and all these, you know, so traditional physical models. Because I was always trying to be able to answer the questions I was trying to answer if a patient had a question for me. I felt, you know, a duty. I still do. I think it's very important, a duty to be able to give that patient a decent answer for, you know, what's going on with them or why aren't they getting better. And it occurred to me that I wasn't able to give them very good answers if it was purely based on, you know, why isn't this treatment working for me? You know, why? You know, I've had 10 or 20 adjustments and nothing's changed. Why is that? And I just, you know, I was very honest with myself and I thought, I haven't really got a good answer for that. And I just happened to be at the European Chiropractic Union Conference in Dublin and this is about 2011, I think, 2012. And I saw Don Murphy speak and he was introducing this idea of the primary spine practitioner and he was very keen on this idea of Just being very scientific with back pain, and we identified what's going on with that patient, and we match the appropriate diagnosis to their presentation. And that seems, of course, really, really simple. But it was an eye opener for me when I realized how many cases I would have missed the expression of when you're a hammer, everything looks like a nail. It really resonated with me. And I felt really excited that I'd found this. So, you know, this possibly the answer to all these questions about why don't so many really suited the way I saw things. But it was quite a shift, you know, and I just sort of had a little bit of an epiphany, really. I think it was when I saw Mike Stewart at the BCA conference. I can't remember what year that was, but that, again, was just the moment when I heard somebody say something that made me think, that's what I'm looking for. That. That that guy there seems to know have the answer to the questions I have. I'm so just. And it was. It was really. I focus on work on my own. I found it really helpful to kind of have these consistent messages from people like Mike Stewart, like Lauren Mosley, Dave Butler and Peter Sullivan. You know, that. That. That was really in. In a profession that we're in where, you know, none of us agree about anything. For every chiropractor, there's an equal and opposite chiropractor. Yeah. Which is not helpful for us as a profession. It certainly isn't helpful for, you know, people who come to see us, I don't think, because, you know, I find myself still, you know, kind of. I have to draw back from criticizing what another. What a patient has heard from another chiropractor. So I think that's. That's a total mess. But the. The Peter. Peter Sullivan just kind of encapsulates everything in a way more practical way in that when, you know, when you see. Or if you see Peter working and he does these workshops, which I know he's been on and I've been on a couple of times. When you see him work with an actual patient who's in pain, again, it's just that moment we think that that's how we should be doing it. That's my belief. That's how we should be helping people. Now, unfortunately for me, Peter doesn't do any manual therapy or didn't, you know, not in the traditional sense anyway. You know, this debate about hands on, hands off. When he see piece of work, you know, his hands are very much on. But there's no actual treatment going on. So that, that, that really, you know, through spannering, works about wanting to emulate somebody who seemed to get this so. Right. But how did that fit with, you know, a business model that relies on people having their adjustments? Yeah, that's, you know, that, that was the, the question that I still struggle with. You know, I still have this, the pendulum that swings from one way to the other and I think I'm finding the middle. But it's really difficult because that's fascinating. It's so interesting. But to fit it into your day to day work where you still have to pay the bills because people come to you, you know, expecting a very specific treatment. And I think the skill and, you know, the stuff you do really helps with this is to, is to blend, that is to have that conversation with the person to kind of really, you know, to draw out of them what their expectations are and whether those expectations are realistic and whether they're really going to be able to get what they want from you.

Yeah, to rewind a little bit. You touched on this and it resonated with me that when you first started encountering a lot of these, you know, these bigger names in the pain science world, you know, like say, Lauren Mimosis, Mike Stewart, that it was a challenge at the start because it was, you know, obviously is very different to the more structural, biomechanical approach that most of us who didn't graduate the last few years were trained in. Can you speak a little bit more about that, that challenge that. That sounds like there's a bit of a conflict there.

Oh, absolutely, yeah. I mean, the, the challenge is to try and dial down a little bit the, you know, how excited we might be about the science or the stuff we've read. And the challenge is to make that fit. And it's to respect, despite the fact that it's frustrating, it's to respect that the patient has no idea about these things. They don't need to walk around understanding pain science or any kind of science. You know, because we meet people who, you know, we meet very intelligent. You know, we. I live in a university town, so lots of my patients are professors and they have no idea about their backs or, or their spines or the anatomy or, you know, they don't know any of this. You know, to expect them to also then be able to just grasp these ideas of pain science which, you know, if it's done badly, it sounds very, very kind of alternative. And you're talking about pain being a perception and all that kind of stuff. So, yeah, the challenge was to be extremely excited about something that I felt would help loads of people, but that really wasn't what they were expecting. And to, to try and try and get that balance right is, is ongoing for me. It really is. I'm going to try and get that, you know, because it's about respecting the fact that no matter what the patient expectation is, you have to meet them where they are. Which is a phrase that I'd heard for 20 years and only recently does that phrase actually make any sense to me. Yeah, respect where they've got to in this journey. And so, yeah, so, you know, the challenge was to, or is rather, I'll be honest, the challenge is to know how, how you drip feed that information to somebody and to judge how much they really need to know here, you know, and, and to read people in a far more effective way to switch on to the fact that are they interested? Do they want to know these things? You know, are you bludgeoning them with, with information? Have they switched off?

Yeah, I can think of a very specific patient I saw actually when I see my PG cert, I wrote an assignment on this of how wrong I got it. That turns out an unsolicited 15 minute neurophysiology lecture wasn't what she needed. She'd been to see her osteopath, usually cracked her pelvis back into alignment. I think for some reason she couldn't see them. So she came to me and I was like, I've discovered this pain sightseeing recently and I'm going to show you all this stuff about how it's not going out of alignment. And yeah, I think I said to her three times, I'm not saying the pain is in your head, the pain's real. And then she left and then booked a follow up and then called up a few hours later to cancel it. And the receptionist was very good, finding out a bit more and eventually she sort of said to the receptionist like, well, I'm going to go find another osteopath. He just said the pain was all in my head. And I was like, I said three times, the pain wasn't all in your head. But I said it amongst this very complicated, unasked for lecture that just completely threw it the wrong way. And that was the thing for me to go, oh, okay, yeah, it's not as simple as, hey, I've got a load of new knowledge, I'm excited about it. Let me cram it into your brain right now. I don't know if you find this, but I often find chiropractors particularly we're guilty of really overdosing patients on education at the start. Even, even traditional chiropractic, even you know, a high volume vitalist chiropractor, they still see that report of findings as this is where we have to get them to understand everything about what we do. Yeah, and it's funny that I moved away from that and then in that pain sightseeing, I just fell into exactly the same trap of this is my one chance to cram all this knowledge you need to know into your head and expect you to A, understand it and B, thank me for it. It's a bit of a tall ask for most patients really.

Yeah, absolutely. And the thing we, we don't, you know, or we should really take on board as well is that these people are in pain. You know, it's all very well, us talking, just, you know, talking pleasantries and saying, have you been, how's your day? All this kind of stuff and there's somebody sitting there who is probably half of their brain is, is distracted on how they are feeling at that precise moment. And the way I liken it a lot of the time is to consider that person in front of you is in pain. It's like, you know, if you have road rage, you know, you're not thinking straight, you are not yourself in that, in that split second you will do things and say things and react in a way that's completely out of character for you because of just something that's happening to you in that moment. And I think that if, if we kind of appreciate that person sitting in front of you, it's got a bit of, or, you know, maybe a lot of that going on in their brain, but it's not really fair to try and get them to sit and listen and, and to, to, to process and to, you know, and also to massively change their mind about something. You know, because we're, we're, you know, highly trained chiropractors and physical therapists and physios or whatever and plenty of us don't get it, don't find this stuff fits at all with how they see things. And so how we expect, you know, Paul, Mrs. Jones to, to get it is, is, you know, it's a mistake from, you know, it's a mistake I've made, it's a mistake I probably still make. And it's the, and it's interesting for me and, and perhaps for you to kind of to be, have been around long Enough to see almost the backlash to this idea that you can paint science people out of pain. And, you know, I sort of see. I can see that. I don't think I would have. I. I would have had no time for that kind of opinion about five years ago. But now with the benefit hindsight, I do look back and say to anybody who's maybe on. On the threshold of going down this rabbit hole is just. Just hold your horses, you know, just draw back a little bit.

Yeah. I mean, it's sort of become a technique. It's a bit like if somebody goes to an SOT seminar, it's like, I'm going to. Now that's all I'm going to like. That was. That was the first technique I did out of uni. And it was, you know, of course, after my first seminar, everybody for the next month got sot, and some of them, they seem to be better. And that was really cool. But it took one of my colleagues to point out, he saw. He covered for me, and he saw one of my patients. He's like, why have you started blocking this guy? I was like, well, you know, like, I thought that's. He's like, no, no, he was getting better, and now he's not like, look at the last three visits. He hasn't gotten any better. That's exactly when he started using blocks. It's like, this guy doesn't need sot. And it was like, oh, okay. Yeah. I kind of. I got a little bit carried away running with that. And it's. I think the same thing happens with people who. I find the people are big promoters of it will go, it's not a technique. They'll really resist that idea. And I think, yeah, in its actual form, it's not, but it can often, especially when there are. There's different brands of, like, therapeutic neuroscience education. Obviously, Peter's got cognitive functional therapy. You give it a name like that, it's like, well, it kind of. It kind of does become a technique to me. And that's, I think, like you were talking about. It's then difficult to kind of blend that with other techniques you might be using. I mean, if we can rewind a little bit. So you. Your first Petro Sullivan seminar, where you saw that, what was it that you really. I mean, you obviously came away from that feeling like, wow, this is something I really want to do more of. What was it that he was doing that you didn't see in other practitioners or other approaches?

I think it was. It may have been just the. The first time that you could see it in action. So to, to kind of read, you know, Mosley and Butler stuff or to, to see clips or, you know, all that kind of stuff was, was fascinating then, but then to actually see that processed into something actually tangible in front of you, I think was, was just the light bulb moment.

Yeah. Like learning how to adjust from a textbook versus seeing one actually do it.

Yeah, yeah, yeah, yeah, I imagine, you know, I suppose a student actually. Yes. Seeing a treatment happening, the person get off the bed and go, oh, wow, that feels so much better than, as a student, go, well, great. This is absolutely what I'm going to be doing for everybody then. Yeah, we've just, it was just that. And Peter's, you know, he's a, he's an incredibly charismatic guy. He's, he's, you know, he, he lives and breathes what he does and, and that's fascinating. You know, I think everybody should be fascinated if they see somebody who's so good at what they do. You just stand back and go, wow, look at that guy. No matter, you know, talking about athletes or actors or whatever it might be, just look at somebody giving, you know, a master class and think, I want a bit of that. And also it was, you know, it's the back that by the fact that you were seeing these people with these really complicated problems who were getting better and, you know, the criticism would be, well, you know, it's a bit like face healing. You've got this massive crowd of people. Of course the person's going to stand up and say, well, thanks, Peter, great. But he'd put his money where his mouth is and say, let's get these people back in a year's time and see how they're getting on. You know, I think was warts and all. Some people were coming back saying I was a bit better for a while, but now the problem's come back, etc. Etc. You know, and he's, you know, that whole movement is, is modest enough to say, yeah, this isn't perfect, but, you know, it seems to be getting closer to what we perhaps should be doing with people. Yeah, but you know, the, the, the. I don't know, it's, it's just the. I think that's fine when perhaps. And I, you know, come back to that idea that, you know, that's fine as long as your mortgage isn't depending on seeing, you know, a bunch of people a week. It's, it's fine if you perhaps have another means of income. But, you know, I'M just going back to idea, just warning anybody who's kind of thinking, going that way. It's just, you know, use, use it carefully or, you know, you can. It becomes just the air you breathe, not the thing you do. It's involved with a bit of treatment. And the interpretation of the treatment you're giving for me has changed massively.

So, yeah, so what happened then? You, you come back from your first Peter o' Sullivan seminar and are you thinking, I'm just going to do this? Are you thinking, I'll take bits of it? Like what happened afterwards when you tried to put it into practice?

You know, I literally, I literally instructed my receptionist to get a red Biro and put a line under, you know, anybody who'd seen me, you know, before, whatever it was, you know, May 2016, put a red line under their last treatment. And I'm going to start being putriculin from this point on.

Unless it was like, okay, bang, overnight.

I'm gonna make this change, big red line. I want to see where I, you know, I was going wrong with these people. And now I'm going to implement this and now I'm going to tell people that, you know, there's, you know, the treatment is going to be this. No, I wouldn't actually tell them, you know, I, I would kind of, I would, you know, sort of mimic that.

Whole Peter o' Sullivan my way through that explanation kind of thing.

Yeah, yeah, absolutely.

And was it was the assumption you were going back to everybody and you were like, okay, everybody. I've seen pre this point, I have been treating them wrong. That was no matter where they were at or how they were doing, it's like, I've done these people a disservice. It's time to fix that.

There was, there was one particular patient and this for me was almost the validation I needed at that time. On the Thursday morning before I went to London, see the workshop the first time, I spent a big long session with the patient going all through the McGill, core stability stuff, you know, really, really, you know, that. That was how big a change I went through. So she got completely gilled on Thursday morning, Tuesday morning. Then when I was back from London, she was miserable because she was in so much pain. And she, she said, look, I came to you with a bit of a niggly back. And the stuff you gave me to do last week, I've never been in so much pain. And for me it was like, aha. I know why. I know why. Because I should never give you that stuff. Let's throw all that stuff in the bin and let's now do this. And it was, you know, I mean, I never saw her again because what the hell she thought was going on, that there's this guy who's so confident about something on Thursday, not only is talking differently, but dressed differently and you know, you know, it's a bit of hero worship at the time. Yeah, that was a complete turnaround, absolute turnaround to adjustments and course ability to cause abilities. Rubbish. I'm not going to touch you.

Yeah. Everything I've been doing until now is wrong, but now I'm definitely right and.

You should trust me now I've got it. And I, and I thought they'd all thank me and I thought they'd all be so pleased that I was saying, look, you know, I'm going to show you how to do these things yourself. And we've got it all wrong all these years and some did, but, you know, most, most didn't. Most were confused and exactly like you said, you know, people, you know, I still. My regular patient, I've got one patient who loves to tell me, oh, I saw such and such in the street. He said he never come see you again. Because she told him it's all in his head. And, you know, I've got this big whiteboard here. And there'd be times I'm literally writing in massive letters, this is not in your head. And the session would end with somebody saying, okay, I get it. It's in my head, like, well, how much this pain is not in your head. But they still get that message. So, yeah, it was, it was, it was too much. It was too much of a shift.

Yeah, it's a very, very, very black and white kind of shift. It's like, okay, come Monday morning, I'm. I'm doing this. That's it. But of course, you, you could go, what stopped you going? They didn't come back. I finally got them better. You know, that's, that's the Dunning Kruger trap. I think we all fall into at times. If they didn't come back, well, it must be because I'm so great.

Yeah, yeah.

Apart from the patient telling you it's because they think you said this. Like, what, what kind of stopped you from doing that? Because that's. It's a trap. I see a lot of people fall into, especially when we go to this sort of approach as well.

Reality, I suppose. Reality of being, you know, being really headstrong and really determined that this is going to work. And it's just about, it's just a matter of people will, people will get it, people will tell other people. And, you know, I thought there might be greater acceptance that maybe, you know, for years I've been trying to get integrated into things like local GP surgeries or the local physio department, you know, closing door, you know, nobody's interested because of the title chiropractor. You know, if I just put the groundwork in, then as time goes on, I will be accepted for doing it this way around and, you know, there'll be, there'll be success. And I suppose it's when incrementally that just became obvious that was not going to happen. And just the feel of the clinic change, you know, the feel of kind of, you know, getting to know people because they, they would have their course of treatment, then come back for their follow ups, you know, starting to think, yeah, I'm not having that anymore. I don't, I don't have that sort of, you know, nice friendly feeling of people who come and they have a chat and they have a little treatment and see you in a couple of months, you know, and it just, and let's be honest, it was my wife who kind of looks after the finances, who said, you know, what's going on? You know, people going. Because it used to be, you know, the business model was doing very well. What's changed? So, you know, it wasn't really a realization, it was more like a bit of attrition to sort of have.

Can you, can you share a bit more about. Because it's, it sounds like there's a couple of points. So there's, there's the financial aspect of like, okay, patients are not coming back, we've got less people coming through the door. But also you have this nice friendly feel. Am I? But do you felt like you lost that, that friendly atmosphere as well?

Yeah, yeah, yeah, definitely. Because it was, again, because it was about, it was by violating people's expectations and, you know, if they sort of said, oh yeah, this makes a lot of sense, thank you. But there was still a lot of doubt and there was still a lot of, you know, that it was almost like the best case scenario is that they would say that was helpful, thank you. But, you know, I'll work on what you've suggested and maybe I'll see you again. So that would be a great outcome for me if somebody seemed like they understood and then through the spectrum of people, you know, literally saying, I'm never coming back here again. So, yeah, no, the the whole, the whole thing became, you know, it became stressful again to try and, to try and retain patients or to try and get enough new patients through the door that it was okay to see them once or twice. And at the time, because I, because I'd done some training before in kind of practice building, you know, at the time it was, it was like a false economy that I was seeing loads and loads and loads of patients and loads of new patients. So I was just able to kind of, you know, go through, you know, I was able to kind of retain a big chunk of normal patients and not be too bothered about the new patients because I was so sure that they'd got the right stuff from me.

So you still had sort of a fairly solid base of patients who've known you for a long time.

Yeah.

And they, they stuck with you despite the fact overnight you were like, we're going to change your entire treatment approach.

Yeah, yeah. There was some, there were some that I'd lost, but, you know, and I, I don't know. I mean, there are, there are the, the regular patients I still have, you know, they, they've stuck through it. Even though, you know, I can think at the top of my head a few, that I'm really trying to wean them off the manual therapy with it. They stuck with this. That recommend, whatever it might be, you know, they, they stuck with it.

What was their reaction when you started trying to change this thing that they may have been very used to and comfortable with with you for quite a while?

I think, like most, you know, people who are dissatisfied, they just don't say much and wander off, you know, not, not. It takes quite a lot of guts to actually say to somebody in that context, you know, I don't, I think you're making a mistake here. I think you're going the wrong way with this. And one.

It's funny, I don't. It's a very rare patient who says, I think you're wrong. They might say, I think not sure that's me or I, you know, should we maybe do this or that? But yeah, to actually say no head. I think you're wrong.

Yeah.

Not sure they've had a patient be that direct. It's a big ask.

Yeah. I mean, yeah, absolutely. And it's, you know, I think this day and age you might get it through, you know, Google review or something like that.

But that's true. Yeah.

I think I've had, I've had, I had one. I had one patient actually, who, who said it in A nice way she said it in the. I don't know if you. Do you remember the guy called Gerald Ratner? Remember that? Do you know that name?

No, not at the moment.

No. He had a very successful jewelry company, I think it was in the 80s. And yeah, I think he was multi millionaire through this jewelry company. And he thought it was okay to tell people that the jewelry he's selling was crap. He thought it was okay to tell people that the jewelry he's selling was crap. And he thought that was funny. He thought that would be kind of people who say, oh, great, you know, that. That's. That's kind of, you know, this honest millionaire telling us how it is kind of thing. And of course, you know, nobody's heard of Gel Ratner anymore apart from people, you know, alive in the 80s. Yeah, he threw away his business based on that kind of realization that he was selling cheap stuff but making mint from it. And so the patient basically told Matt, told me that he said, don't. Don't throw away this thing that you're really good at. You know, you're downplaying this skill you have, this thing that really helps me. You seem to just be very dismissive of it. Yeah, I. I took that with a pinch of salt at the time. But she's quite right, you know, she's quite right to say, you know, I was denying her this treatment that was helpful to her. So, you know, who was I to tell her that this wasn't helpful for her when it clearly was? Yeah. That there's an instance where, yeah, she. She felt comfortable enough for me to say, I don't know why you're doing this, but, you know, stop. Stop throwing away.

But for. Yeah, for every patient who says that, there's a ton more who are like, I just don't. I'm not going to say anything, but I'm going to walk off or I'm going to hang around a bit, but one foot up the door.

Yeah. Yeah. So I don't really know why lots of patients, I thank them. Well, I do know, really, because it comes back to the stuff that you do. It's about, you know, realizing that I made a very good connection with that person. That person trusts me. Probably secondary that they. They have an opportunity every few months or a few weeks or wherever it might be to come and see me and, and, you know, chew over the problems they have. And that's more valuable than the actual treatment they get, in my opinion. But that's. That's why lots of people stuck with me is because of the, the therapeutic alliance that was built, you know, way back when.

Yeah, you put a lot of trust in the trust bank. And although in their eyes, you're spending a lot, it's like, well, we're not going to go overdrawn straight away. And it's. And when you were talking about that, that atmosphere, I had the sense of. It's almost like the, the relationship with some patients. The word combative was coming up to me and I think that's a bit strong, but I'm also not coming up with a better word. It's like you're going in, being like, I've got to change you. And it's not. I've got to do something to you you haven't done before, but it's like, I'm going to have to actually change who you are. And that's, you know, what we know about the context and healing environments is that sort of thing. It's like that's, that's making it much harder to get, not just change done, but any kind of healing done as well.

Oh, yeah, absolutely. Yeah. No, no, I do, you know, I did feel that and still do to an extent. I still, I still struggle with realistic expectations that patients have. Especially. There's a certain demographic that I imagine is common for all of us, which is, you know, men in their 20s who expect, you know, really, really quick results with very, very complicated problems. And they've got, you know, they're here today to be fixed.

Yeah, I saw the cracks on YouTube. Give me the cracks from YouTube and I'll be good. Right.

You don't need to ask me any questions. Just, you know, get on with it and I'll be on my way. So I, I still struggle with that because I, I feel as though there, there, there, there could be a way that we could manage their expectations before the appointment. I'm also aware that no matter what you, you know, what content you might give them in an email, like a welcome email or a welcome video that I do or whatever that might be, they don't, they don't read it, they don't watch it, they don't look at the website. You know, they know what they want. They don't really need background research.

It's meeting them where they're at again, isn't it? And sometimes, as I've developed in my career, I've got more. I feel like I've got better at spotting, oh, I've got to meet this person where they're at, where they're at is a place where I probably can't help them right now or I may be not the best person to do it. And even though I might know what they need, whether it's a personal thing or whether it's just their mindset, it's like that. It not right now. If I try and do it right now, I'm going to blow whatever chance I have at having a longer term relationship and I'm probably just going to put them off the idea of chiropractic whatever it is I do. So yeah, sometimes meeting them where they're at is go, oh, I see where you're at. I'm not the right person for you right now.

Yeah. And that's, that's, that's difficult to do like say when you have to, when you have to balance the books, when you're looking at somebody thinking, you know, if I just shut up and get on with it, you know, there's an extra X hundred pounds in the bank that we need. So it is, it's a luxury to be able to, it's a luxury to be able to choose your patients. And I believe that we, we should do that for their benefit. And I live in a small, you know, it's a, it's a seaside university town. This is nobody I can refer to really. You know, I, I would love to have a situation where I can say, ah, right, okay, I can see what you're saying. That's not the kind of chiropractor I am. But I'm going to give you, you know, John's number. He's around the corner. He's great. Yeah, I'll give him a ring for you and say, John, can you see this guy right now?

Yeah. Tough to be the only expert around.

Yeah, absolutely. So I suppose that that would be, you know, my advice to anybody who wants it, which is to try and, you know, to maybe, to maybe have a look around the landscape that you're in and see how that might be able to help you so that you can still seem like you're absolutely doing the right thing for that person by passing them on for the right reason. You know, it's not the hot potato case where he's thinking, I don't know what to do with this patient or send them, you know, I mean, that's.

The classic new run, isn't it? It's like, I don't know, they're not better than three visits. I'll refer back to the gp. And I always tell mine, it's like you're Never allowed to refer back to the gp. You can send them to the GP with a view to getting a onward referral or some tests or something. But if you're, you have to have an objective, you have to have an idea of what you think the GP might do. You can't just go, I don't know, over to you. Easy said than done when they're starting out. But it's, it's that idea of like, I, I don't mind being a stepping stone to something else. I just, I'd rather not be a dead end. I don't want to ever say to a patient, sorry, can't help you, don't know what to do. And that's, yeah, easy said than done with certain referrals and certain patients and things. So just going back to when you were. I've been putting this in practice and it seems like some patients, oh, it really helped. But overall I get. When did you realize, okay, this isn't really working like it should? When do you start sort of maybe having doubts or concerns around that?

That's a good question. I think it was, I mean, honestly, I think it was, it was lockdown. It was, it was 2020. It was, it was having the opportunity to stop and take a step back and think, right, where, you know, where are we going with the business, where we're going to clinic, where are we going with my career? You know, am I becoming the expert that I want to be? And I think that that was a really useful time to press pause. So, yeah, and I think, I think with lots, lots of other things, of course, I think that was a chance for me to look back and kind of think, okay, it's been four years now, from 2016 to 2020, to have gone really, you know, hardcore in on this kind of hands off, pain, sciencey, you know, has it, has it worked? And I just took a bit of time to reflect on it and do some, you know, I find expressive writing very interesting, by the way. You just write out the stuff that's in your head and. Or don't, or burn it or whatever you need to do it afterwards. I found that very useful to kind of really be honest with myself and say, is this working? You know, and the answer was, no, it's not. It really isn't.

What was your criteria for working? What was, what was the image of working or not working in your head for that?

It was about, I suppose, am I excited to go to work anymore? Am I burning out on this? And I think that the, the ability to, you know, not go to work for a few weeks and to feel so much better, you know, sort of told me a lot about, you know, the, the, the environment that I'd created within Virginic and that the, you know, the, the reason I went down that rabbit hole in the first place was because I was getting stressed with not being able to answer these questions. But then these, you know, four or five years later going, well, I mean, I'm even more stressed now because I don't even have people who ask me these questions because they fall bug it off.

To find out if it works or not. Yeah.

And like I say, to be honest, my wife, who has, you know, actually very, very top local government job, but also because I'm clueless with business and maybe that's another, you know, signpost, isn't it? Don't be useless at business and run a business. But she takes care of all that kind of stuff. So it's like having your accountant over breakfast saying, what's going on? You know, you know, we've got these bills to pay, what's going on? Where's this income? How's this dropping? So yes, there was that reflection and that kind of moment of thinking. Yeah, no, as a clinician, this isn't really working. But there's also, you know, my dear wife saying, you've got to change this now. You've got to go back, you've got to kind of, you know, give them a little bit of what they want because. Yeah, surely there's a kind of halfway house with this. Yeah.

So you've got, you know, the, the patients don't seem to be coming back and getting results. You've got, the business isn't doing as well as it was and you're just not enjoying it. So it's like, no, nobody's enjoying this, this process.

Yeah. And I think being, being a bit self centered, it was me not enjoying it. That was more because I, you know, I just fully believe that you just stick with it, plow on through and they'll come flooding back. There'll be that moment where it will turn around. So that it was, yeah, it was more to do with that, just that feeling, that feeling of, you know, am I burning out on this? And I think that's, that's, you know, that's really important because people, people might associate burnout with being, you know, just working non stop. But the burnout for me was that psychologically, you know, just thinking all the time about trying to come up with a solution, you know, trying, trying to trying to, you know, make, you know, when's it going to get better? When's this, what do I need to do? How much money do I need to spend?

You're working an 80 hour week then only just because you're only in clinic for maybe 30 or 40. It's, it's constantly going on in your brain.

Yeah, absolutely. So that, that, that, you know, that's something that I think people need to be aware of and especially the, what I found most difficult is that idea that, you know, to, to not, to not get the rewards for what I felt that I needed, you know, that I deserved, you know, how hard I'd work to build this clinic and how hard I'd work in the clinic and how much I'd, how much time and energy and, and all that kind of stuff that we actually spend on going to these courses. And you know, I felt like, you know, I'm going to be elevated to this, to the status and to not achieve that. Quite stressful. So, yeah, so very much it was just a feeling. I sort of lost that loving feeling of going to clinic and sort of just.

Yeah, I can imagine that there could almost be, you know, there's a risk of like resentment creeping in then of like, I've done all this work, I'm doing all this stuff, you know, people don't appreciate it. I'm actually now I'm not even making the same money I was before. And as much as we all say we're not motivated by the money, none of us are doing it for free either. And yet to say, okay, I'm getting, I'm doing this and supposed to be better, people appreciate me less and I'm losing income. There's like, yeah, you could very ease. And I seen a couple of colleagues actually slip into more of a resentful place of blaming everybody else. And it's very difficult place to get yourself out of and nobody else can really help at that stage. So it sounds like, you know, as much as none of us wanted 2020, that was quite an opportune time, I guess to have that pause and that reflection like you say.

Yeah, yeah. And also, I mean it was, it was unlucky for me that I developed horrendous B sciatica and you know, those biopsychosocialists amongst us would kind of go, yeah, those things are probably not, you know, unconnected. So yeah, there was me laid up, you know, for weeks with, you know, really, really disabling problem. And it was, it was just, it was, it was Great. Really. I was able to think to myself, blimey, what. What do I want right now? You know, I just want something to help you. And, you know, I just want. And I'm not going to say to you that, oh, I just want my, you know, my pedal this adjusted because it's gonna, you know, I'm not gonna. Didn't go that far back in the way, but it just really kind of brought it home to me that this is about, you know, it's a bit of hero worship at the time. Yeah, that was a complete turnaround. Absolute turnaround to adjustments and course ability to cause abilities. Rubbish. I'm not going to touch you.

Yeah, Everything I've been doing until now is wrong. But now I'm definitely right and you.

Should trust me now I've got it. And I thought they'd all thank me and I thought they'd all be so pleased that I was saying, look, you know, I'm going to show you how to do these things yourself. And we've got it all wrong all these years. And some did, but, you know, most, most didn't. Most were confused and. And exactly like you said, you know, people, you know, I still. My regular patient. I've got one patient who loves to tell me, oh, I saw such and such in the street. He said he never come see you again because she told him it's all in his head. And, you know, I've got this big whiteboard here. There'd be times when I'm literally writing in massive letters. This is not in your head. And the session would end with somebody saying, okay, I get it. It's in my head, like, well, how much this pain is not in your head. They still get that message. So, yeah, it was, it was, it was too much. It was too much of a shift.

Yeah, it's a very, very, very black and white kind of shift. It's like, okay, come Monday morning, I'm. I'm doing this. That's it. But of course you, you could go. What stopped you going? They didn't come back. I finally got them better. You know, that's. That's the Dunning Krueger trap. I think we all fall into at times. If they didn't come back, well, it must be because I'm so great.

Yeah, yeah.

Telling you it's because they think you said this. Like, what. What kind of stopped you from doing that? Because that's, that's a trap. I see a lot of people fall into, especially when we go to this sort of approach as well.

Reality, I suppose the reality of being, you know, being really headstrong and really determined that this is going to work. And it's just about. It's just a matter of people will people get it. People will tell other people. And, you know, I thought there might be a greater acceptance that maybe, you know, for years I've been trying to get integrated into things like local GP surgeries or the local physio department. It was, you know, closing door. You know, nobody's interested because the title chiropractor, you know, if I just put the groundwork in, then as time goes on, I will be accepted for doing it this way around and, you know, there'll be. There'll be success. And I suppose it's when incrementally that just became obvious that was not going to happen. And just the feel of the clinic change, you know, the feel of kind of, you know, getting to know people because they would have their hopes retrieved, then come back for their follow up, you know, starting to think, yeah, I'm not having that anymore. I don't. I don't have that sort of, you know, nice friendly feeling of people who come and they have a chat and they have a little treatment and see in a couple of months, you know, and it just. And let's be honest, it was my wife who kind of looks after the finances, who said, you know, what's going on? You know, people going. Because it used to be, you know, the business model was doing very well. What's changed? So, you know, it wasn't really a realization. It was more like a bit of attrition to sort of have a habit.

Can you, can you share a bit more about. Because it's, it sounds like there's a couple of points. So there's, there's the financial aspect of, like, okay, patients are not coming back, we've got less people coming through the door. But also you have this nice friendly feel. Am I. But do you felt like you lost that, that friendly atmosphere as well?

Yeah, yeah, yeah, definitely. Because it was, again, because it was about. It was about violating people's expectations. And, you know, if they sort of said, oh, yeah, this makes a lot of sense, thank you. But there was still a lot of doubt and there was still a lot of, you know, that it was almost like the best case scenario is that they would say, that was helpful. Thank you. But, you know, I'll work on what you've suggested and maybe I'll see you again. That would be a great outcome for me. If somebody seemed like they understood. And then through the spectrum of people, you know, literally saying, I'm never coming back here again. So, yeah, no, the, the whole, the whole thing became, you know, it became stressful again to try and, to try and retain patients or to try and get enough new patients through the door that it was okay to see them once or twice. And at the time, because I. Because I'd done some training before in kind of practice building, you know, at the time, it was, it was like a false economy that I was seeing loads and loads and loads of patients and loads of new patients. So I was just able to kind of, you know, go through, you know, I was able to kind of retain a big chunk of normal patients and not be too bothered about the new patients because I was so sure that they'd got the right stuff from me, if that makes sense.

So you still had sort of a fairly solid base of patients who've known you for a long time.

Yeah.

And they, they, they stuck with you despite the fact overnight you were like, we're going to change your entire treatment approach.

Yeah, there was some, There were some that I lost. But, you know, and I don't know, I mean, there are. The regular patient. And he thought that was funny. He thought that would be kind of. People say, oh, great, you know, that, that's, that's kind of, you know, this honest millionaire telling us how it is kind of thing. And of course, you know, nobody's heard of Gerald Ratner anymore apart from people, you know, alive in the 80s. Yeah. He threw away this thing that you're really good at. You know, you're downplaying this skill. You have this thing that really helps me. You seem to just be very dismissive of it. I mean. Yeah, so I, I took that with a pinch of salt at the time. But she's quite right, you know, she's quite right to say, you know, I was denying her this treatment that was helpful to her. So, you know, who was I to tell her that this wasn't helpful for her when it clearly was? Yeah. That there's this way. Yeah, she, she felt comfortable enough for me to say, I don't know why you're doing this, but, you know, stop. Stop throwing away.

But for, yeah, for every patient who says that, there's a ton more who are like, I just don't. I'm not going to say anything, but I'm going to walk off or I'm going to hang around a bit, but one foot up, you know.

Yeah. Yeah. So I don't really Know why lots of patients, I thank them. Well, I do know, really, because it comes back to the stuff that you do. It's about, you know, realizing that I made a very good connection with that person and that person trusts me. You know, probably secondary that they. They have an opportunity every few months or few weeks or whatever it might be to come and see me and, you know, chew over the problems they have. And that's more valuable than the actual treatment they get, in my opinion. But that's, that's why lots of people stuck with me, is because of the therapeutic alliance that was built, you know, way back when.

Yeah, you'd put a lot of trust in the trust bank. And although in their eyes, you're spending a lot, it's like, well, we're not going to go overdrawn straight away. And it's. And when you were talking about that, that atmosphere, I had the sense of. It's almost like the, the relationship with some patients. The word combative was coming up to me, and I think that's a bit strong. But I'm also not coming up with a better word. It's like, you're going in, being like, I've got to change you. And it's not, I've got to do something to you you haven't done before, but it's like, I'm going to have to actually change who you are. And that's, you know, what we know about the context and the healing environments is that sort of thing. It's like that's. That's making it much harder to get not just change done, but any kind of healing done as well.

Oh, yeah, absolutely. Yeah. No, no, I do, you know, I did feel that and still do to an extent. I still, I still struggle with realistic expectations that patients have. Especially. There's a certain demographic that I imagine is common for all of us, which is, you know, men in their 20s who expect, you know, really, really quick results with very, very complicated problems. And they've got, you know, they're here today to be fixed.

Yeah, I saw the cracks on YouTube. Give me the cracks from YouTube and I'll be good.

Right. You don't need to ask me any questions. Just, you know, get on with it and I'll be on my way. So I, I still struggle with that because I, I feel as though the, the. There could be a way that we could manage their expectations before the appointment. I'm also aware that no matter what you, you know, what content you might give them in an e, like a welcome email or A welcome video that I do, whatever, whatever that might be, they don't, they don't read it, they don't watch it, they don't look at the website, you know, they, they know what they want. They don't need background research.

It's meeting them where they're at again, isn't it? And sometimes I've, as I've developed in my career, I've got more, I feel like I've got better at spotting, oh, I got to meet this person. Where they're at, where they're at is a place where I probably can't help them right now or I'm maybe not the best person to do it. And even though I might know what they need, whether it's a personal thing or whether it's just their mindset, it's like that. It. Not right now. If I try and do it right now, I'm gonna blow whatever chance I have at having a longer term relationship and I'm probably just going to put them off the idea of chiropractic or whatever it is I do. So yeah, sometimes meeting them where they're at is going, oh, I see where you're at. I'm not the right person for you right now.

Yeah. And that's, that's, that's difficult to do like say when, when you have to, when you have to balance the books where you're looking at somebody thinking, you know, if I just shut up and get on with it, you know, there's an extra x £100 in the bank that we need. So it is, it's a luxury to be able to, it's a luxury to be able to choose your patients and I believe that we, we should do that for their benefit. And I live in a small, you know, it's a seaside university town. This is nobody I can refer to really. You know, I, I would love to have a situation where I can say, ah, right, okay, I can see what you're saying. That's not the kind of chiropractor I am. But I'm going to give you, you know, John's number. He's around the corner, he's great. Yeah, I'll give him a ring for you and say, John, can you see this guy right now?

Yeah. Tough to be the only expert around.

Yeah, absolutely. So I suppose that that would be, you know, my advice to anybody who wants it, which is to try and, you know, to maybe, to maybe have a look around the landscape that you're in and see, see how that might be able to Help you so that you can still seem like you're absolutely doing the right thing for that person by passing them on for the right reason. You know, it's not the hot potato case where he's thinking, I don't know what to do with this patient or send them.

You know, that's the classic new run, isn't it? It's like, I don't know, they're not better. In three visits, I'll refer back to the gp. And I always tell mine, it's like you're never allowed to refer back to the gp. You can send them to the GP with a view to getting a norm would referral or some tests or something. But if you're, you have to have an objective, you have to have an idea of what you think the GP might do. You can't just go, I don't know, over to you. Easier said than done when they're starting out. But it's that idea of like, I, I don't mind being a stepping stone to something else. I just, I'd rather not be a dead end. I don't want to ever say to a patient, sorry, can't help you don't know what to do. And that's, yeah, easy said than done with certain referrals and certain patients and things. So just going back to when you were. I've been putting this in practice and it seems like some patients, oh, it really helped. But overall I get. When did you realize, okay, this isn't really working like it should? When do you start sort of maybe having doubts or concerns around that?

Cool, that's a good question. I think it was, I mean, honestly, I think it was, it was lockdown. It was, it was 2020. It was, it was having the opportunity to stop and take a step back and think, right, where, you know, where are we going with the business, where we're going to clinic, where are we going with my career? You know, am I becoming the expert that I want to be? And I think that that was a really useful time to press pause. So, yeah, and I think, I think with lots, lots of other things, of course, I think that was a chance for me to look back and kind of think, okay, it's been four years now, from 2016 to 2020, to have gone really, you know, hardcore in on this kind of hands off pain, sciencey, you know, has it, has it worked? And I just took a bit of time to reflect on it and do some, you know, I find expressive writing very interesting, by the way. You just write out the stuff that's in your head and don't or burn it or whatever you need to do it afterwards. I found that very useful to kind of really be honest with myself and say, is this working? You know, and the answer was no, it's not. It really isn't.

What was your criteria for working? What was, what was the image of working or not working in your head for that?

It was about, I suppose, am I excited to go to work anymore? Am I burning out on this? And I think that the, the ability to, you know, not go to work for a few weeks and to feel so much better, you know, sort of told me a lot about, you know, the, the environment that I'd created within Pagenic and that the, you know, the, the reason I went down that rabbit hole in the first place was because I was getting stressed with not being able to answer these questions. But there's these, you know, four or five years later going, well, I'm even more stressed now because I don't even have people who ask you these questions because they fall bugging off somewhere not.

Staying long enough to find out if it works or not. Yeah.

And like I say, to be honest, my wife, who has, you know, actually very, very top local government job, but also because I'm clueless with business and maybe that's another, you know, signpost, isn't it? Don't be useless at business and run a business. But she takes care of all that kind of stuff. So it's like having your accountant over breakfast saying, what's going on? You know, you know, we've got these bills to pay, what's going on? Where's this income? How's this dropping? So yes, there was that reflection and that kind of moment of thinking. Yeah, no, as a clinician, this isn't really working. But there's also, you know, my dear wife saying, you've got to change this now. You've got to go back, you've got to kind of, you know, give them a little bit of what they want because yeah, surely there's a kind of halfway house with this.

Yeah. So you've got, you know, the patients don't seem to be coming back and getting results. You've got the business isn't doing as well as it was and you're just not enjoying it. So it's like nobody's enjoying this, this process.

Yeah. And I think being, being a bit self centered. It was me not enjoying it. That was more because I know, I just fully believe that you just stick with it. Plow on through and they'll come flooding back. There'll be that moment where it will turn around. So that it was, yeah, it was more to do with that, just that feeling, that feeling of, you know, am I burning out on this? And I think that's, that's, you know, that's really important because people, people might associate burnout with being, you know, just working non stop. But the burnout for me was that psychologically, you know, just thinking all the time about trying to come up with a solution, you know, trying, trying to, trying to, you know, make, you know, when's it going to get better? When's this, what do I need to do? How much money?

You're working an 80 hour week then, aren't you? Just because you're only in clinic for maybe 30 or 40, it's, it's constantly going on in your brain.

Yeah, absolutely. So that, that, that, you know, that's something that I think people need to be aware of. And especially the, what I found most difficult is that idea that, you know, to, to not to not get the rewards for what I felt that I needed, you know, that I deserved, you know, how hard I'd work to build this clinic and how hard I'd work in the clinic and how much I'd, how much time and energy and all that kind of stuff that we actually spend on going to these courses. And you know, I felt like I'm going to be elevated to this, to the status and tend to not achieve that. Quite stressful. So yeah, so very much it was just a feeling. I lost that loving feeling of going to clinic and just.

Yeah, I can imagine that there could almost be, you know, there's a risk of like resentment creeping in then of like, I've done all this work, I'm doing all this stuff, you know, people don't appreciate it. I'm actually now I'm not even making the same money I was before. And as much as we all say we're not motivated by the money, none of us are doing it for free either. And yet to say, okay, I'm getting, I'm doing this and supposed to be better, people appreciate me less and I'm losing income. There's like, yeah, you could vary. And I seen a couple of colleagues actually slip into more of a resentful place of blaming everybody else and it's very difficult place to get yourself out of and nobody else can really help at that stage. So it sounds like, you know, as much as none of us wanted 2020, that was quite an opportune. Time, I guess, to have that pause and that reflection, like you say.

Yeah, yeah. And also, I mean, it was, it was unlucky for me that I developed horrendous battle sciatica. And, you know, those biopsychosocialists amongst us would kind of go, yeah, those things are probably not, you know, unconnected. So, yeah, there was me laid up, you know, for weeks with, you know, really, really disabling problem. And it was, it was just, it was, it was great, really. I was able to think to myself blindly, what, what do I want right now? You know, I just want something to help me. And, you know, I just want, and I'm not going to say to you that I just want, you know, my pelvis adjusted because it's gonna, you know, I'm not gonna. Didn't go that far back the way. But it just really kind of brought it home to me that this is about, you know, this is about helping people. This is about helping them get through something. And it just made me realize that perhaps, perhaps it really doesn't matter how that happens, you know, it's about that person. It's not about me, it's about them. So.

And if you went to see you, what were you going to do? You already had the knowledge, so if you went to see someone to help you out, it's like, well, I already know this stuff. So presumably you were thinking like, oh, but I, I'd want something else there now, being in that position.

Yeah, it was, yeah, it was about wanting, it was about wanting to be heard. It was about to be validated and to be reassured. You know, I would have loved to have been able to have somebody check me out and say, look, you're going to be okay. This, this will be okay. And so, you know, I felt all those things. It was lonely, it was confusing. You know, my mind race thinking, oh God, what could this be? You know, do I need an MRI scan? And you know, all those thoughts you think. At the end of the day, I was just a human being in pain and feeling quite scared and just wanting to reach out to somebody saying, can you help me? And you know, like I say, even if it's just like, will you listen to me if I describe this thing to you, can you tell me that it's okay? Yeah, so I think that was, that was really useful because it brought in, you know, we're talking about blending the pain science and the manual therapy. So there's kind of proof to me that that stuff, you know, don't you know, I can't throw away any of that stuff because maybe that's encapsulating what that's all about, recognizing that somebody in front of you needs your help and it's, and it's not up to you and you know, you should get over yourself into kind of saying, ah, yes, but before we get to the help, I'm going to tell you this, that and the other. And you're wrong about this because when you tell somebody that perhaps you know, you know, your pelvis isn't misaligned or whatever, you're not giving them information, they're going to go, oh, that's brilliant. You're telling them they're stupid.

Yeah, it's not helpful. They can't use that and go, okay, thank you.

Yeah, they think that you're sitting there going, you're so stupid to think that.

Of course there's a real patronizing risk with it, I think, isn't it? I see that a lot as sort of like you claim this is more patient centered and you spend your whole time telling patients they're wrong and thank God they saw you because you're so clever. Like not in those words, but that's, that's kind of the energy. And that was, that was something I struggled with when I kind of encountered painful like I, I don't know if you had this, I had like a six month existential crisis because I, I was very much in the mechanical model. I just studied like selective functional movement assessment. Like the idea that you can break the body down into these corners, core component movements, find the broken movement and fix it. And then I stumbled across this forum called SOMA simple that was full of mainly pts who were super, super pain signs, very anti manual therapy and yeah, but they were pulling out references and stories and stuff and I'm like, I can't dispute this. I think I've been mucking up all my patients for years and I've yellow flagged them all into becoming dependent maintenance patients. And it took about six months before I was like, okay, maybe, maybe I haven't marked them all up. But even then that, and that was well before I even went and actually took one of Peter's, one of his courses. So where could you speak a bit more to the, where you're at now? So what, what changes did you make after lockdown? What did you, you had this period of self reflection. You had this personal experience of sciatica. You realize you want to do something different. What did you think when you came back to seeing patients? You Thought, I'm going to do this differently.

What were the training? I think it was, I think I was able to, you know, I was able to bite my toe more. I was able to, to sit on my hands, as expression goes, that, you know, again, it was, it was just that objective.

You have to have an idea of what you think the GP might do. You can't just go, I don't know, over to you. Easier said than done when they're starting out. But it's, it's that idea of, like, I, I don't mind being a stepping stone to something else. I'd rather not be a dead end. I don't want to ever say to them with certain referrals and certain patients and things. So just going back to when you were. I've been putting this in practice and it seems like some patients, oh, it really helped. But overall, I get. When did you realize, okay, this isn't really working like it should? When do you start sort of maybe having doubts or concerns around that?

Cool. That's a good question. I think it was, I mean, honestly, I think it was, it was locked in. It was, it was 2020. It was, it was having the opportunity to stop and take a step back and think, right, where, you know, where are we going with the business, where we're going to clinic, where are we going with my career? You know, am I becoming the expert that I want to be? And I think that that was a really useful time to press pause. So, yeah, and I think, I think with a lot dose of empathy and sympathy that lots of other things, of course, but I think that was a chance for me to look back and kind of think, okay, it just, it made more sense. It just, it was, you know, I said earlier about saying, for years I've known this expression, you meet them where they are and then, and then, then it really resonates and something happens and something clicks in your brain and go, I really understand what that means now. I didn't before. I thought I did, but I didn't. So it was just that it just, it took something within me to really realize what my position should be. So the four years now, from 2016 to 2020, to have gone really, you know, hardcore in on this kind of hands off pain, sciencey, you know, has it, has it worked? It would be, you know, I just, I wouldn't dismiss the idea of using, you know, adjustments that, you know, I'm trying, whereas before I'm trying and I just took a bit of time to reflect on it and do some, you know, I find expressive writing very interesting, by the way, just to write out the stuff that's in your head and don't. Or burn it or whatever you need to do with afterwards. But I found that very useful to kind of really be honest with myself and say, is this working? You know, and the answer was, no, it's not. It really isn't.

What was your criteria for working? What was. What was the image of working or not working in your head for that?

It was about, I suppose, am I excited to go to work? I could go through a day. I was very proud of a day in clinic once where I was able to note down that I haven't performed a single adjustment in the whole day in the clinic anymore. Am I burning out on this? And I think that the ability to, you know, not go to work for a few weeks. And so I sort of flip that. I'd flip it and say, well, I just need to be sensible here and just say most patients and to feel so much better, you know, sort of told me a lot about they're going to get an adjustment unless there's a really proper reason not to, you know. And now, you know, the. The environment that I'd created within virginic and that the. And that that should. Should be the case. Anyway, got this, you know, need for an urgent referral or whatever. Always plainly obvious this person is, you know, is contraindicated to manipulate, then that should be the case. Yeah. So it was just. It was just being able to really feel that rather than kind of, you know, the. The reason I went down that rabbit hole in the first place was because I was getting stressed with not being able to say, yeah, yeah, yeah, you know, yeah, everybody gets the clicks. But to really feel like, well, that might answer these questions, but they're four or five years later going, well, I'm even more stressed as well be part of the session because. Let's see. And what's nice about that is that, you know, I will still see cases where the patient does really respond to and adjust now because I don't even have people who ask me these questions because they fall, bug it off.

Not staying long enough to find out if it works or not. Yeah.

In a way that I didn't expect they would. And then we're able to stand back and go, yeah, what's that about? That, that, you know, last week I had somebody who I'd seen before and he come in with a different presentation. He came in with tennis elbow and he said, look, oh, great, brilliant. Give me exercises and strapped his elbow, all that kind of stuff. And he said, I can't help thinking that I've got his neck problems on the left side and my tennis elbows on left side. And I said, look, because it's you and you've been very. And like I say, to be honest, my wife, who has, you know, actually very, very top local government job, but also because I'm clueless, would be kind to kind of come back and continue the treatments that I'll give you a free adjustment on your neck. So we did the session, you know, we did the kind of tennis elbow stuff. It was really painful and we were struggling with the ethnics. And maybe that's another, you know, sign probes, isn't it? Don't be used as a business and run a business. He takes care of all that kind of stuff. So it's like having size a bit perform the adjustment on the left side of his neck. And then what? He's kind of wiggling's elbow and gripping the stuff and dynamometer and all that kind of stuff. And I'm thinking, oh, that's not supposed to happen. And he's like, brilliant. I see next to me, he's like, yeah, okay, great. They have to be hungry.

I was supposed to be the ex.

In your accountant over breakfast saying, what's going on? You know, you know, we've got these bills to pay. What's going on? Where's this income? How's this dropping? So.

Yes, but not the patient.

Yeah, I think that's, that's, you know, and that's fun. I mean, that's, that's where I suppose it's about, you know, I create a good relationship with that guy. There was that reflection and that kind of moment of thinking, yeah, no, as a clinician, so we can muck about with it, you know, can have a laugh about it, can be playful, you know, and, and, and, you know, I think this, this relationship stuff, you know, used to be very didactic. It used to be that, you know, quite literally I'd be standing here, the whiteboard, you know, the person sat in front of me and I'd be drawing the brain and the outputs and always.

Kind of looking down over your glasses at them.

I cringe. I cringe. I think about how often I did that, you know, that wasn't a relationship that, that was, you know. Yeah. I say literally talking down to somebody. So, yeah, it's about having that kind of that playful relationship with the patient and then me all of a sudden going to go Joe, this is fun again, isn't it?

Yeah. Because you've introduced novelty. That's, that's not a threat now. It's not. Things aren't happening. Things, you know, something that I didn't expect happened.

This isn't really working. But there's also, you know, my dear wife saying, you've got to change this now. You've got to go back, you've got to kind of, you know, give them a little bit of what they want because.

Yeah.

Surely there's a kind of halfway house with this. Yeah.

So you've got, you know, the, the patients don't seem to be coming back and getting the results you've got. The business isn't doing as well as it was and that's a threat to my paradigm, my worldview. I don't know. Now it's like, oh, that's unusual. Let's get in and explore that a bit more.

Absolutely, yeah. And I think, and I think you can only do that.

You're just not enjoying it. So it's like nobody's enjoying this, this process.

Yeah. When you put the groundwork in, like I said about the trust on all the stuff about therapeutic line and I think being, being a bit self centered. It was me not enjoying it. That was more because I, you know, I just know that kind of stuff and it's just been, I suppose it's being true, fully believed that you just stick with it, plow on through and they'll come flooding back, they'll to yourself, isn't it? It's about being yourself with that person. And I mean that, that could be tricky because sometimes I see, I see building the therapeutic alliance in that moment where it will turn around so that it was. Yeah. It's a bit like platonic dating. You sit down with somebody the first time, you're sussing them out, they're sussing you out and you have to say the right thing and you kind of have to smile in the right place and all it was more to do with that, just that feeling, that feeling of, you know, am I burning out on that you're dating this patient.

Yeah, I've used that metaphor a lot actually. First date.

Yeah. Yes. And I think that's, that's, you know, that's really important because people, people might associate the really, it really makes sense and as long as, you know, you don't go too far with it. Then I was being, you know, just working non stop. But the burnout for me was, you know, it helps, doesn't think. Yeah. What Would you do if you think, oh God, I think this might be the one, you know, really want to make sure that I impress them and all that, you know, you wouldn't, I mean, you could, you could just say, right, I'm going to blather on about this, that and the other and sit and I don't care where you enjoying the date or not, you're not going to get very far. You will be that guy. So yeah, to kind of just, just, you know, make sure that you're, you know, that psychologically, you know, just thinking all the time about trying to come up with a solution. I need to have fun on that date.

Yeah.

It's not going to happen again. So that was the thing that made sense to me when I felt that again. I felt that moment connecting with people and having fun with people and joking with people. My approach to practice is I don't take myself seriously at all with patients. I take them very seriously. I'll take their pain very seriously. But I'm always looking, you know, trying, trying to, trying to, you know, make, you know, when's it going to get better? When's this? What do I need to do? How much money do I need to spend?

You're working an 80 hour week then, aren't you? Just because you're only in clinic for maybe 30 or 40, it's, it's constantly going on in your brain.

Yeah, absolutely. So, you know, I'm always looking to make stupid jokes or whatever it might be, you know, classic dad jokes, left, right and center. That's my practice. And I suppose it was about that, it was about realizing that when you just give that, that, that, you know, that's something that I think people need to be aware of and a little, little, you know, arm around the shoulder and that kind of stuff and give them what they want, it opens the door to that stuff. I don't know if that's answered the question or. Yeah, no, especially the. What I found most difficult is that idea that, you know, to, to not, to not get the rewards for what I felt that I needed.

You know, I love that, I love that, that it's, it's. You're having more fun, you're being more relaxed around it. I mean, that's, I, I think personally, I think that's really, really key. Not just to being an effective practitioner long term, because if you're not enjoying that, yeah. Burnout's where you end up. But also I think it's really important for patience because you enjoy.

I deserved, you know, how hard I'd work to build this clinic and how hard I'd work in the clinic and how much I'd. How much time and energy and being.

In the presence of somebody who's having a good time. And if, like you said, the vibe patients are going to get from you, if it's. Or anybody, if it's like stressed out, that almost combative kind of look, kind.

Of stuff that we actually spend on going to these courses. And you know, I felt like I'm going to be elevated.

I've got to do something here and I've got to change it and I've got to show you how you're wrong. It's. Even if, even if it's accurate and even if it's right and even if it's helped, like it's not to this.

To the status and to not achieve that, quite stressful.

People don't want to stick around that person. Eventually they'll go, okay, great, but this doesn't seem like an issue.

So, yeah, so very much it was just a feeling. I sort of lost that loving feeling of going to clinic.

And yeah, I can imagine that there could almost be, you know, there's a risk of like resentment creeping in then of like, I've done all this work, I'm doing all this stuff, you know, people don't appreciate it. I'm actually now I'm not even making the same money I was before. And as much as we all say we're not motivated by the money, none of us are doing it for free either. And yet to say, okay, I'm getting, I'm doing this thing supposed to be better. As much as we all say we're not motivated by the money, none of us are doing it for free either. And yeah, to say, okay, I'm getting, I'm doing this and supposed to be better, people appreciate me less and I'm losing income. There's like, yeah, you could varies and I, I've seen a couple of colleagues actually slip into more of a resentful place of blaming everybody else and it's, it's very difficult place to get yourself out of and nobody else. So it sounds like, you know, as much as none of us wanted 2020, that was quite an opportune time, I guess, to have that pause and that reflection like so.

Yeah, yeah. And also, I mean, it was, it was unlucky for me that I developed horrendous biopsy Attica. And you know, those biopsychosocialists amongst us would kind of go, yeah, those Things are probably not, you know, unconnected. So, yeah, there was me laid up, you know, for weeks with, you know, really, really disabling problem. And it was. It was just. It was. It was great, really. I was able to think to myself, blimey, what. What do I want right now? You know, I just want something to help me out. And, you know, I just want. And I'm not going to say to you that I just want my, you know, my pelvis adjusted because it's gonna, you know, I'm not gonna. I didn't go that far back in the way, but it just really kind of brought it home to me that this is about, you know, this is about helping people. This is about helping them get through something. And it just made me realize that perhaps, perhaps it really doesn't matter how that happens, you know, it's about that person. It's not about me. It's about them. So.

And if you went to see you, what were you going to do? You already had the knowledge, so if you want to see someone to help you, it's like, well, I already know this stuff. So presumably you were thinking, like, oh, but I'd want something else there now, being in that position.

Yeah, it was. Yeah, it was about wanting. It was about wanting to be heard is not to be validated and to be reassured. You know, I would have loved to have been able to have somebody check me out and say, look, you're going to be okay. This. This will be okay. And so, you know, I felt all those things. It was lonely, it was confusing. You know, my mind would race thinking, oh, God, what could this be? You know, do I need an MRI scan? And, you know, all those thoughts you think. At the end of the day, I was just a human being in pain and feeling quite scared and just wanting to reach out to somebody and saying, can you help me? And, you know, like I say, even if it's just like, will you listen to me if I describe this thing to you, can you tell me that it's okay?

Yeah.

So I think that was. That was really useful because it brought in, you know, we're talking about blending the pain science and the manual therapy. So there's kind of proved to me that that stuff, you know, don't, you know, I can't throw away any of that stuff because maybe that's encapsulating what that's all about, recognizing that somebody in front of you needs your help, and it's. And it's not up to you. And, you know, you should get over yourself into kind of saying, ah, yes, but before we get to the help, I'm going to tell you this, that and the other. And you're wrong about this because when you tell somebody that perhaps you know, you know, your pelvis isn't misaligned or whatever, you're not giving them information, they're gonna go, oh, that's brilliant. You're telling them they're stupid.

Yeah, it's not helpful. They can't use that and go, okay, thank you.

Yeah, they think that you're sitting there going, you're so stupid to think that.

Of course there's a real patronizing risk with it I think, isn't it? I see that a lot. It's sort of like you claim this is more patient centered and you spend your whole time telling patients they're wrong and thank God they saw you because you're so clever. Like not in those words, but that's, that's kind of the energy. And that was, that was something I struggled with when I kind of encountered pain slot. Like I, I don't know if you had this. I had like a six month existential crisis because I, I was very much in the mechanical model. I just studied like selective functional movement assessment, like the idea that you can break the body down into these core component movements, find the broken movement and fix it. And then I stumbled across this forum called SOMA simple that was full of mainly pts who were super, super pain signs, very anti manual therapy and yeah, but they were pulling out references and stories and stuff and I'm like, I can't dispute this. I think I've been mucking up all my patients for years. A six month existential crisis because I, I was very much in the mechanical model. I just studied like selective functional movement assessment, like the idea that you can break the body down into these core component movements, find the broken movement and fix it. And then I stumbled across this forum called SOMA simple that was full of mainly pts who were super, super pain sized, very anti manual therapy. And yeah, but they were pulling out references and stories and stuff and I'm like, I can't dispute this. I think I've been mucking up all my patients for years and I've yellow flagged them all into becoming dependent maintenance patients. And it took about six months before I was like, okay, maybe, maybe I haven't mucked them all up. But even then that, and that was well before I even went and actually took one of Peter's, one of his courses. So where could you speak a bit More to the where you're at now. So what, what changes did you make after lockdown? What did you. You had this period of self reflection. You had this personal experience of sciatica. You realized you want to do something different. What did you think when you came back to seeing patients? You thought, I'm going to do this differently.

What were the changes? I think it was, I think I was able to, you know, I was able to bite my tongue more. I was able to sit on my hands, as expression goes, that, you know, again, it was, it was just that massive dose of empathy and sympathy that, you know, it just, it made more sense. It just, it was, you know, I said earlier about saying, for years I've known this expression, you meet them where they are and then, and then, then it really resonates and something happens and something clicks in your brain. You go, I really understand what that means now. I didn't before. I thought I did. I didn't. So it was just that. It just, it took something within me to really realize what my position should be. So it would be, you know, I just, I wouldn't dismiss the idea of using, you know, adjustments that, you know, I'm trying, whereas before I'm trying, I could go through a day. I was very proud of the day in clinic once where I was able to note down that I haven't performed a single adjustment in the whole day of clinic. And so I sort of flipped that. I'd flip it and say, well, I just need to be sensible here and just say, most patients are going to get an adjustment unless there's a really proper reason not to, you know, and, and that, that should, should be the case. Anyway, got this, you know, need for an urgent referral or whatever. Always plainly obvious this person is, you know, contraindicated, indicated to manipulate, then that should be the case. Yeah. So it was just, it was just being able to really feel that rather than kind of say, yeah, yeah, yeah, you know, yeah, everybody gets the clicks. But to really feel like, well, that might as well be part of the session because, let's see. And what's nice about that is that, you know, I will still see cases where the patient does really respond to an adjustment in a way that I didn't expect they would. And then we're able to stand back and go, yeah, what's that about that, you know, last week I had somebody who I'd seen before and he'd come in with a different presentation. He came in with tennis elbow and he said, look, oh, great, brilliant. Give me exercises and strapped his elbow and all that kind of stuff. And he said, but I can't help thinking that I've got this neck problem that's on the left side and my tennis elbows on that side. And I said, look, because it's you, and you've been very kind to kind of come back and continue the treatment, et cetera, I'll give you a free adjustment on your neck. So we did the session, you know, we did the kind of tense elbow stuff. It was really painful, and we were struggling with the exercise a bit. Performed the adjustment on the left side of his neck. And then what? He's kind of wiggling his elbow and gripping the stuff and dynamometer and all that kind of stuff. And I'm thinking, no, that's not supposed to happen. And he's like, brilliant. Go see next to me, like, yeah, okay, great.

I was supposed to be the expert, not the patient.

Yeah, I think that's. That's, you know, and that's fun. I mean, that's. That's where I suppose it's about, you know, I create a good relationship with that guy, so we can muck about with it. You can have a laugh about it, can be playful, you know, and. And. And, you know, I think this. This relationship stuff, you know, used to be very didactic. It used to be that, you know, quite literally, I'd be standing here, the whiteboard, you know, the person sat in front of me, and I'd be drawing the brain and the outputs and all.

This kind of looking down over your glasses at them.

I cringe. I cringe. And I think about how often I did that. You know, that wasn't a relationship. That was, you know. Yeah. I say, literally talking down to somebody. So, yeah, it's about having that kind of that playful relationship with the patient. And then me all of a sudden, gonna go, sure. This is fun again, isn't it?

Yeah. Well, because you've introduced novelty. That's. That's not a threat now. It's not. Things aren't happening. Things, you know, something that I didn't expect happened. That's a threat to my paradigm, my worldview. I don't know. Now it's like, oh, that's unusual. Let's get in and explore that a bit more.

Absolutely, yeah. And I think. And I think you can only do that when you put the groundwork in, like I said, about the trust bank and all the stuff about Therapeutic alliance and all that kind of stuff. And it's just been. I suppose it's Being true to yourself, isn't it? It's about being yourself with that person. And I mean, that. That could be tricky because sometimes I see, I see building the therapeutic alliance a bit like. It's a bit like platonic dating. You sit down with somebody the first time, you sussing them out there, sussing you out, and you have to say the right thing and you kind of have to smile in the right place and all that kind of stuff. You're dating this patient.

Yeah, I've used that metaphor a lot, actually. First dates.

Yeah, it really makes sense. And as long as, you know, you don't go too far with it, then, you know, it helps. Doesn't think. Yeah. What would you do if you think, oh, I think this might be the one. You know, really want to make sure that I impress them and all that kind of, you know, you wouldn't. I mean, you could, you could just say, right, I'm going to blather on about this, that and the other, and sitting. I don't care whether you're enjoying the date or not, you're not going to get very far. You will be that guy. So, yeah, to kind of just, Just, you know, make sure that you're, you know, you need to have fun on that date.

Yeah.

Happen again. So that was the thing that made sense to me when I felt that again. I felt that moment connecting with people and having fun with people and joking with people. My approach to practice is I don't take myself seriously at all with patients. I take them very seriously. I'll take their pain very seriously. But I'm always looking, you know, I'm always looking to make stupid jokes or whatever it might be, you know, classic dad jokes, left, right and center. That's my practice. And I suppose it was about that. It was about realizing that when you just give them a little, little, you know, arm around the shoulder and that kind of stuff and give them what they want, it opens the door to that stuff. I don't know if that's answered the question.

Yeah, no, definitely. I love that. I love that, that it's, it's. You're having more fun, you're being more relaxed around it. I mean, that's. I, I think, personally, I think that's really, really key, not just to being an effective practitioner long term, because if you're not enjoying that, burnout's where you end up. But also, I think it's really important for patients because you enjoy being in the presence of somebody who's having a good time. And if like you said, the vibe patients are going to get from you if it's, or anybody, if it's like stressed out, that almost combative kind of look, I've got to do something here and I've got to change it and I've got to show you how you're wrong. It's. Even if, even if it's accurate and even if it's right and even if it's helped, like it's not enjoyable place to be. The emotional experience here isn't positive. You know, it's like the total opposite, the ScareCare High Volume X ray. Everybody, everybody. Oh my God, you've got phase three degeneration. Thank God you came, otherwise you could have had cancer in five years. Those places, even when somebody's like, oh my God, I didn't know all this stuff, yes, here's my payment for 36 plans up front. They do, they do that and they're like, thank God I came now. Like this could have been so bad. They don't refer, they actually don't refer because they do not want anyone else they know to have that negative emotional experience. Yeah, it's, it's the same kind of thing that even if it works and even if they're like, oh, you're right. Thank you. If, if you're not having fun in peers and I've yellow flagged them all into becoming dependent maintenance patients and it's practice, it's really hard to build that long term.

Also, I think, if you don't mind me saying, there was the, there's something that I think was important too that you said about not referring. I think that here's a criticism that people say if you introduce this idea of pain science and you'll say, well, you know, I'm not a psychologist, well, I'm not a counsellor, you know, I'm a manual therapist or people will say something like what an expect I'll get a bit of counseling today. Now, counseling for most people these days is quite a private thing. There's still a stigma attached. So if you're, and this is my advice again to anybody wants it, that you know, be careful about going down that route of, you know, leaning too much into stress, anxiety and relationships, that kind of thing because number one, it's not what the patient expecting, that's fine. Number two, you have to build up quite a lot of trust before, you know, you expect somebody to tell you how they're getting on with their wife or whatever it might be. Also that's private to them so they're unlikely to go and tell their friends that you should go and see that guy because they just need for an urgent referral or whatever. Always plainly obvious, this person is sort of have to admit that they're having a bit of therapy from you.

Yeah. If their friend goes in and they're like, wow, that chiropractor is almost like therapy, then. Oh, that's what you had.

That's why you reckon, you know, indicated to manipulate, then that should be the case. Yeah. Yeah. Well, like I say, you know, you just, you wouldn't, I don't think you'd say, oh, wow, great. Hey, everybody. I'm really struggling with depression. I've been seeing this great counselor, you know, in this day and age. So it was just, it was just being able to really feel that rather than kind of say, yeah, yeah, yeah, you know, yeah, everybody gets the clicks. But to really feel like, well, that might as well be part of the session because, let's see. And what's nice about that is that, you know, I will still see cases where the patient does really respond to an adjustment in a way that I didn't expect they would. And then we're able to stand back and go, yeah, what's that about that, you know, last week I had somebody who I'd seen don't do that too much as that person, then you might find your people's little secret, you know.

That's a good point, actually. Yeah. Because it's the thing you come in.

With a different presentation. He came in with tennis elbow and he said, look, oh, great, brilliant, interesting.

The last few years, because my wife qualified as a counselor last year and it's been really interesting. She's been training us, having chats about the things she's learning, the communicating, the.

Exercises and the strapped his elbow and all that kind of stuff. And he said, I can't help thinking that I've got his neck problems on the left side and my tennis elbows on left side. And I said, look, because it's you and you've been very kind to kind of come back and continue the treatments that I'll give you a free adjustment.

On your neck vacation approaches and stuff like that. And it's. So I've learned a huge amount from counseling and psychotherapy.

So we did the session, you know, we did the kind of tennis elbow stuff. It was really painful and we were struggling.

Therapy and the literature and the research that to me, they've been doing this patient centered thing for years, like, like decades, because that's all they have is a therapeutic alliance, and it's really informed a lot of my approach to communication. It needs adapting. And obviously, you don't delve into.

Perform the adjustment on the left side of his neck and then what. He's kind of wiggling elbow and gripping the stuff and dynamometer and all that kind of stuff. And I'm thinking, oh, that's not supposed to happen. And he's like, brilliant. Go see next to me, like, yeah, okay, great. They have to be humble.

I was supposed to be the expert. And it's really informed a lot of my approach to communication. It needs adapting, and obviously, you don't delve into things in the same way, but there is. There is definitely. I noticed when I was getting more into that, there's a part of me that wanted to, like, almost be a counselor to patients because. And it was my wanting to be an expert again. I wanted to be better than every other chiropractor because I dealt with not the patient.

Yeah, I think that's. That's, you know, that's fun. I mean, that's.

That's with this stuff. And I did have to watch that and go, okay, hang on a minute. Things in the same way. But there is. There is definitely.

I. I suppose it's about, you know, I create a good relationship with that guy.

Hey, I'm not trained to do that. That's. It's very, very risky because if it goes wrong, it goes badly wrong.

Wrong.

And b. Yeah, they don't want this. Like, some do. And, yeah, over time, I've got some. I. Literally one patient that we. She was like, sorry, this is a bit more like a therapy session today.

So we can muck about with it. We can have a laugh about it can be playful. You know, I was like, yeah.

And that's what she needed. But we've known each other for a while. I've earned that trust. And.

And. And. And, you know, I think this. This relationship stuff, you know, it used to be very didactic. It used to be that, you know, quite literally, I'd be standing here, the White House board. You know, the person sat in front.

Of me, she's felt she could do that. I've had patients I've known far longer who just would not tell me about whatever's going on because that's. Yeah, that's private and that's personal, and I'm a chiropractor. And I did just want to ask briefly as well, you. Because obviously we're speaking about this as chiropractors, and I think that Presents some unique challenges. When we were chatting a little while ago, you, if I remember right, you were talking about maybe not using the title when you were very much into the, the cognitive functional therapy. Peter o' Sullivan's approach.

Yeah, absolutely. I, that's something I picked up from Don Murphy, which he. Drawing the brain and the outputs and.

All this kind of looking down over your glasses at them.

I cringe, I cringe when I think about how often I did that. You know, that wasn't a relationship. That was, you know. Yeah. I say literally talking down to somebody. So, yeah, it's about having that kind of that playful relationship with the patient. And then me all of a sudden kind of go, he's a great speaker. The way he would draw your attention, you know, catch your attention on his features. He'd come out and say, right. You know, this is a room of chiropractors. I got something to tell you. People hate you. People hate chiropractors. So why did you call yourself chiropractors? Wow. Okay, that's. That's, you know, brought me up. Quite sure. This is fun again, isn't it?

Yeah. Because you've introduced novelty. That's, that's not.

And his approach would be that, you know, you, you just don't push yourself as a chiropractor. You don't deny that you're a chiropractor. But, you know, you, you, you sell.

What a threat. Now it's not. Things aren't happening. Things, you know, something that I didn't expect happened, that's a threat to my paradigm, my worldview. I don't know. Now it's like, oh, that's unusual. Let's get in and explore that a bit more.

Absolutely. Yeah. And I think, and I think you can only do the benefits of what you do. You don't, you don't sell the word chiropractic. And so, for instance, the clinic here, it's only. I would have been very proud to say this about six months ago. It doesn't have the word chiropractic anyway. It doesn't say chiropractor. No, it says, you know, expert diagnosis of disc or whatever it says on the front of my building, it says, you know, disc pain, joint pain, muscle pain, whatever pain. When you put the groundwork in, like I said, about the trauma, on all the stuff about therapeutic alliance. And so one of my patients said, you know, you're trying to tell people about not using this word pain. And the front of your clinic placidly word pain. Like, yeah, I Thought that, but it didn't say chiropractic and tilts and all that kind of stuff. And it's just being. I suppose it's being true to yourself, isn't it? It's about being yourself with that person. And I mean, that. That could be tricky because sometimes I see. I see building the therapeutic alliance a bit like. It's a bit like platonic dating. You sit down with somebody the first time, you're sussing them out, they're sussing you out, and you have to say the right thing and you kind of have to, you know, smile in the right place and all that kind of stuff. You're dating this patient.

Yeah, I've used that metaphor a lot, actually. First dates.

Yeah, it really makes sense. And as long as, you know, you don't go too far with it, then, you know, it helps. Doesn't think. Yeah. What would you do if you think, oh, I think this might be the one. You know, I really want to make sure that I impress them and all that kind of, you know, you wouldn't. I mean, you could, you could just say, right, I'm going to blather on about this, that and the other, and sitting. I don't care whether you're enjoying the date or not, you're not going to get very far. You will be that guy. So, yeah, to kind of just, Just, you know, make sure that you're, you know, you need to have fun on that date.

Yeah.

So that was the thing that made sense to me when I felt that again. I felt that moment connecting with people and having fun with people. People and joking with people. My approach to practice is I don't take myself seriously at all with patients. I take them very seriously. I'll take their pain very seriously. But I'm always looking, you know, I'm always looking to make stupid jokes or whatever it might be. You know, classic dad jokes. Left, right and center. That's my back. And I suppose it was about that. It was about realizing that when you just give them a little, little, you know, arm around the shoulder and that kind of stuff and give them what they want, it opens the door to that stuff. I don't know if that's answered the question.

Yeah, no, definitely. I love that. I love that, that it's, it's. You're having more fun, you're being more relaxed around it. I mean, that's. I, I think personally, I think that's really, really key, not just to being an effective practitioner long term, because if you're not enjoying that burnout's where you end up. But also I think it's really important for patients because you enjoy being in the presence of somebody who's having a good time. And if, like you said, the vibe patients are going to get from you, if it's, or anybody, if it's like stressed out, that almost combative kind of look, I've got to do something here and I've got to change it and I've got to show you how you're wrong. It's even if, even if it's accurate and even if it's right and even if it's helped, like it's not, people don't want to stick around that person. Eventually they'll go, okay, great, but this doesn't seem like an enjoyable place to be. The emotional experience here isn't, you know, it's like the, the total opposite, the ScareCare High Volume X ray, everybody. Oh my God, you've got phase three degeneration. Thank God you came, otherwise you could have had cancer in five years. Those places, even when somebody is like, oh my God, I didn't know all this stuff. Yes, here's my payment for 36 a few months ago.

You know, this is part of me kind of finding the middle ground going, okay, no, do you, I need to.

Plans up front. They do, they do that and they're like, thank God I came now. This could have been so bad.

They put the word chiropractic somewhere on the front of the building. Oh. So, yeah, so the, the, the point.

They don't refer. No, they actually don't refer because they do not want anything that, Yes, I.

I very much saw that. I, I, I saw the, the benefit in the idea of, you know, people don't know what kind of practice I like I said, you know, however, anyone.

Else they know to have that negative emotional experience. It's the same kind of thing that even if it works and even if they're like, oh, you're right. Thank you. If you're not having fun in practice, it's really hard to build that long term.

Also, I think, don't mind me saying, there was the mongo. I didn't know what a chiropractor was and then I became a chiropractor and there's lots of misconceptions and lots of confusion about what chiropractic or chiropractor is. And again, especially perhaps a little town where I am, I'm the only chiropractor. So I thought, yeah, that would probably make a lot of sense. To replace chiropractor with something else. And so there's something that I think was important too that you said about not referring. I think that here's a criticism that people say if you introduce this idea, I call myself pain recovery coach, which makes sense. The thing is a bit, I now think of pain science and you'll say, well, you know, I'm not a psychologist. Well, I'm not a counselor, you know, a man who's a bit woolly. I don't think it's very striking. But I still, I still think that there is benefit to, in putting your professional therapist. Or people will say something like what an expect I'll get a bit of counseling today. Putting your qualification in the background. You know, it's about you and it's about what that person wants and it's about the goals that they have. And so if you're going to put all your eggs in the basket of promoting yourself as the chiropractor or a chiropractic clinic, I'm not sure that's helpful. I think, you know, it's about saying, what are the things in life that you're missing out on and can we help you get there? Yeah, that's a useful way to look at maybe, you know, like the Simon now counseling for most people these days is quite a private thing. There's still a stigma at sign that the, the, the, the why question, you know, why am I doing this? You know, it's not about the what, you know, I'm a chiropractor. Why am I, why am I chiropractor attached? So if you're, and this is my advice again to anybody wants it that, you know, be careful about going down that route of, you know, leaning too much into stress, anxiety in relationships, that kind of thing. Because number one, it's not what the patient expecting, that's fine. Number two, you have to build up quite a lot of trust before, you know, you expect somebody to tell you how they're getting on with their wife or whatever it might be. But also that's private to them. So they're unlikely to go and tell their friends that you should go and see that guy because they have to help people get to that end goal. And so, yeah, it doesn't make any sense to use this word when you can just use a, you know, an image or, you know, a vision of where they can get with you. So, yeah, so I mean, so I kind of, you know, changed my website to Pain Recovery Coach and you know, removes all rest sort of have to admit that they're having a bit of therapy from you.

Yeah. If their friend goes in and they're like, wow, that chiropractor is almost like therapy, then. Oh, that's what you had.

That's why you recommend to chiropractic. And again, I think, I suppose just in practice it became a little bit. People, People weren't sure one way.

Yeah, I don't. If I said, oh, I saw this pain recovery coach the other day, I feel like people go, oh, what, what do they do? It's like with a chiropractor, they're like, oh, at least I know that's the thing. I might think all they do is, you know, crack backs. But I'm recommending.

Yeah. Well, like I say, you know, you just, you wouldn't, I don't think you'd say, oh, wow, great hand. But I'm really struggling with depression seeing this great counselor, you know, in this day and age, we don't do that too much as that person, then you might find your people's little secret, you know.

Now it's a good point actually. Yeah. Because it's the thing. Oh, okay. That's the thing I've heard.

Yeah, yeah, yeah. So it's, it's about, it's about, you know, I suppose got the luxury of having the opportunity to try a few things and for stuff to go wrong. But we're still here. I mean, and I think that that speaks to how successful the business has been.

Interesting the last few years because my wife qualified as a counselor last year and it's been really interesting as she's been training us, having chats about the things she's learning, the communication approaches and stuff like that. And it's. So I've learned a huge amount from.

Counseling and psychotherapy in that, you know, I can basically throw a business away and six years later I'm still happy.

And the literature and the research that to me they've been doing this patient.

Centered thing for here or seven years later, until here as a chiropractor, you know, and I think it's very tempting, it's very tempting to go down that route of high volume practice. It's very difficult to have a sample of that and, and benefit years like.

Like decades, because that's all they have is a therapeutic alliance. And it's really informed a lot of my approach to communication. It needs adapting and obviously you don't delve into things in the same way. But there is, there is definitely. I, I noticed when I was getting more into that there's a part of me that wanted to, like, almost be a counselor to patients because. And it was my wanting to be an expert again. I wanted to be better than every other chiropractor because I dealt with this stuff and I did have to watch that and go, okay, hang on a minute. A, I'm not trained to do that. That's. It's very, very risky because if it goes wrong, it goes badly wrong. And B, yeah, they don't want this. Like some do. And, yeah, over time, I've got some pain. I literally one patient then we. She was like, sorry, this is a bit more like a therapy session today.

To go with seeing loads and loads of patients, and then says, think, oh, do you want to step back and do this?

And I was like, yeah. And that's what she needed. But we've known each other for a while. I've earned that trust and differently.

Oh, don't do that. Really? Well, again, I'm not sure if I'm answering the question at all.

No, no, this is good. This is. This is really, really useful. I mean, so if we were to compare, let's say I'm a fly on the wall. I'm observing you in clinic today, and I'm comparing that to observing you in clinic. Say she's felt she could do that. I've had patients I've known far longer who just would not tell me about whatever stuff going on because that's. Yeah, that's private and that's personal. And I'm a chiropractor. Ten years ago, before you'd even come across Peter Osalum, this type of thing. What. What am I seeing that's different? What would I see in the room? When you're with a patient, you'd see.

Me in very formal dress. You'd see me maybe in a white tube.

And I did just want to ask briefly as well, you. Because obviously we're speaking about this as chiropractors, and I think that presents some unique challenges when we were chatting a little while.

But you certainly see me with a shirt. In time, you'd see me standing up a lot. Or you might not see me at all, because I came up with this fantastic idea when I had. At the height of my practice, I would work between two identical treatment rooms and you'd have the patient changing in one room while you were.

Just while ago, you. If I remember right, you were talking about maybe not using the title when you were very much into the cognitive functional therapy. Peter Sullivan approach.

Yeah.

Even when somebody Is like, oh, my God, I didn't know all this stuff. Yes, here's my payment for 36.

Absolutely. That's something I picked up from Don Murphy, which he plans up front.

They do, they do that. And they're like, thank God I came now. This could have been so bad. They don't refer. They actually don't refer because they do not want anyone else they know to have that negative emotional experience. Yeah, it's. It's the same kind of thing in the other room.

And you could just swap and you could see people, you know, really, really quickly. And I came up with this great idea, and I'd ask my receptionist, who's been with me since the start, I said, actually, do you know what you can do? Can you bring them into the room and have them lying face down so I don't have to talk to them? I can just get on with. He's a great speaker. The way he would draw your attention, you know, catch your attention. And his speech. He's, you know, being a back mechanic. And again, that was one of the instances where she had the command, say, right, you know, this is a room of chiropractic. I got something to tell you. People hate you. People hate chiropractors. So why did you call yourself chiropractors? Wow. Okay, that's. That's, you know, brought me up. Quite sure I was gonna say nerve. That's not the right word. But she, you know, she.

Even if it works, and even if they're like, oh, you're right. Thank you. If you're not having fun in practice, it's really hard to build that long term.

Also, I think, don't mind me saying, there was the. There's something that I think was important to be said about not referring to. Stood up for the situation and said, I don't think people are going to like that. Yeah, you might be right. So, yeah, you know, I was so, so fascinated. I'm so, you know, obsessed with just manipulating. I didn't think I even had time to talk to people. I think that here's a criticism that people say, if you introduce this idea, and his approach would be that, you know, you just don't push yourself as a current chiropractor. You don't deny that you're a chiropractor. But, you know, you, you, you sell the benefits of what you do. You don't. You don't sell the word chiropractic. And so, for instance, the clinic here, it's only. Well, I would have been very proud to say this. That's it.

Yeah, they're here to have their back cracked. Like, what is the talking matter?

Yeah, yeah. How the adjustment is all months ago. It doesn't have the word chiropractic anyway. It doesn't say chiropractor. No, it says, you know, expert dia, pain science experiments. And you'll say, well, you know, I'm not a psychologist. Well, I'm not a counselor, you know, a manual. So, you know, come in, get it done. And, you know, it's up to you whether the therapist or people will say something like, what in expect. I'll get a bit of counseling today. Now, counseling for most people these days is quite a private thing. There's still a stigma, you know, you get better or not kind of thing. So, yeah, you'd see me rushing between one room and the other. You'd see me very formal, you know, not. Not much time for the patient. You know, I've got my form attached. So if you're. And this is my advice again, if anybody wants it, that, you know, whatever it says on the front of my building, it says, you know, disc pain, joint pain, muscle pain, whatever pain, I'm just gonna do the adjustment and get on to the next one. So, yeah, very different. So now what you're going to see is, you know, you probably see in the background, I've gone for a much more homely feel. You know, the lighting, the little. Two little sofas here that we sit and chat and so on. On. The patient said, you know, you're trying to tell people about not using this word pain. And the front. Be careful about going down that route of, you know, leaning too much into stress, anxiety, relationships, that kind of thing. Because, number one, it's not what the patient expecting. That's fine. Number two, you have to build up quite a lot of trust before, you know, you expect somebody to tell you how they got.

I didn't twig this as your clinic, by the way, until I saw the models up on the shelf.

And I thought, pretty sure with their wife or whatever it might be. But also that's private to them. Placidly with pain. Like. Yeah, I thought that, but it didn't say chiropractic until a few months ago. You know, this is part of me kind of finding the middle ground, going, okay, no, do you want.

I need to look at my wife. Wouldn't be all right with anatomy models in our living room. But it has that. That really nice feel there.

Yeah, yeah, absolutely. Absolutely the feel I wanted. So that. Yeah, so that that would be very different as well. So put the word chiropractic somewhere on the front of the building. Oh. So yeah. So the, the point. Back in the old clinic we moved clinics. Well which kind of didn't really matter, but the old clinic being that yes, I, I very much saw that. I, I saw the, the benefit and idea of, you know, you, you people don't know what chiropractic is. I like I said, you know, however long ago I didn't know of chiropractor was and I became a chiropractor and there's lots of misconception so they're unlikely to go and tell their friends that you should go and see that guy because they, it was, you know, I wanted to look like almost like a surgical room. You know, sort of have to admit that they're having a bit of therapy from you.

Yeah. If their friend goes in and they're like, wow, that chiropractor is almost like therapy, then. Oh, that's what you had. That's why you recommended.

Yeah, yeah. Talking about. Or like I say, you know, you just, you wouldn't. I don't think you'd say, oh wow, great actions and lots of confusion about what chiropractic or chiropractor is. And again, especially perhaps a little town.

Expert doctor of chiropractic.

Yeah, yeah, absolutely. Absolutely. And then yeah, it's soft. It's soft. You know, dress differently. I, you know, haircut that's a little bit more severe than I'm used to. But usually a be where I am the only type of person practice. So I, I thought yeah that that would probably make anybody. I'm really struggling with depression see this great counselor. You know, you, you. In this day and age we bit more unkempt and that kind of stuff. So yeah, you, you, you, you, you know, there'd be a very lot of sense to, to replace chiropractor with something else. And so I called myself pain recovery coach. Which kind of makes sense. I think it's a bit. I now don't position yourself too much as that person. Then you might find you a different vibe.

And then what would you be doing with the patients now that you.

Put your people's little secret.

Yeah, now that's a good point actually. Yeah. Because it's the, it's interesting the last few years because my wife qualified as a counselor last year and it's a bit woolly.

I don't think it's very striking.

But I still weren't doing back then.

There'd Be, I mean lots, lots more talking, you know, a lot more. The history for me is key. Taking the history or receiving the history, you should say that for me is fascinating.

It's been really interesting. She's been training us, having chats about the things she's learning, the, the community.

I still think that there is benefit in putting your professional, putting your qualification in the background. You know, it's about you and it's about what that person. I'm fascinated, you know. You know, I feel like it's, I feel perhaps this, this wants and it's about the goals that they have. And so if you're going to put all your eggs in education approaches and.

Stuff like that and it's so I've learned a huge amount from counseling and psychotherapy.

A selling point for people is to be, you know, like where, you know, you're interviewing me now and I listen.

To loads of therapy and the literature and the research that to me they've been doing this patient centered thing for years, like, like decades because that's all they have is a therapeutic alliance podcast.

And I sort of identify with the interview and think, oh, they're really good at getting that information accidentally basket of promoting yourself as the chiropractor or chiropractic clinic. I'm not sure that help and I think to myself, God, what a treat, what an absolute treat to be interviewed and for somebody to listen to.

And it's really informed a lot of my approach to communication. It needs adapting and obviously you don't delve into.

I think, you know, it's about saying what are the things in life that you're missing out on and can we help you get you. And so you know, I, I put a lot of, of, of importance in that and saying to the patient, as you said, you know, I'm going to listen to everything that you, you have to say, tell me everything there. Yeah, that's a useful way to look at maybe you know, like the Simon Sinek the, the, the why question, you know, why am I doing this things.

In the same way. But there is, there is definitely. I, I noticed when I was getting more into that there's a part of me that wanted to like almost be a counselor to patients because. And it was my wanting to be an expert again. I wanted to be better than every other chiropractic as I dealt.

Tell me all about it, tell me everything and listen to everything you say and really hope that the patient goes oh wow, brilliant. For me before this is, this is great. And it's not about the. What. You know, I'm a chiropractor. Why am I. Why am I chiropractor, enjoying just talking. So, you know, really amplifying that and. And reassuring with this stuff.

And I did have to watch that and go, okay, hang on a minute.

The patient, you know, they kind of say some, you know, they'll give you a very potted history and kind of say, you know, I don't know what else you want to know. That's fine. You know, honestly, this is what we're here to do. Just.

Just, you know, hey, I'm not trained to do that. That's. It's very, very risky because if it goes wrong, it goes badly, you know.

To help people get to that end goal. And so, yeah, it doesn't make any sense to use this word when you can just use a, you know, an image or, you know, keep talking, keep telling me. Keep describing that.

Oh, sorry, this isn't relevant. You don't need to know that.

Of where they can get with you. Yeah. So, I mean, so.

And b. Yeah, they don't want this. Like, some do. And yeah, over time, I've got some pa. I Literally one patient that we. She was like, sorry, this is a bit more like a therapy session today. Going off on a tangent. Yeah, yeah.

Imagine this is like a really complicated movie and I've come in halfway through, so don't worry. I want. You know.

But I was like, yeah, and that's what she needed. But we've known each other for a while. I've earned that trust.

And tell me all about it. Describe everything that's happening, every scene. I want to know. Absolutely. What's. What's going on. I'm going to watch the rest of it with you. All right. I see. So you do have to know she's.

Felt she could do that. I've had patients I've known far longer who just would not tell me about whatever's going on because that's.

Yeah.

That's private and that's personal and I'm a chiropractor. And I did just want to ask briefly as well, you. Because obviously with, you know, what was.

Happening with time, how I feel about it and what. You know, it's just replaying those scenes again.

I really like that metaphor that. Yeah, I might pinch that one.

Yeah.

For me, speaking about this as chiropractors, and I think that presents some unique challenges. We. When we were chatting a little while.

Makes sense. It's them to kind of slow down a bit and just don't say, oh, yeah, that guy shot that guy and I was chasing that guy. That doesn't help me. Just who is that guy?

While ago, you, if I remember right, you were talking about maybe not using the title when you were very much into the, the cognitive functional therapy, Peter o' Sullivan's approach.

Yeah, absolutely. That's something I picked up from Don Murphy, which he, yeah, that tends to help. You know, it's just about telling them, just calm down a bit, take a breath. Let's, you know, let's, let's get stuck into this. Yeah. Again, you know, that, that you have to adapt, that he's a great speaker, the way he would draw your attention, you know, catch your attention. And his speeches, we come out and say, right, you know, this is a room of chiropractors. I got something to tell you. People hate you. People hate chiropractors. So why did you call yourself chiropractors? Wow. Okay, that's, that's, you know, brought me up quite short. And that's helpful with, with the social styles model is recognizing where somebody just, that's just not going to work for them. They don't want to do that. They want to tell you, yeah, driver.

In, out, here's the facts, give me the solution. Off we go.

And that's fine because, because then, you know that that's helpful or all round, you, you're going to, you're both going to get what you need for that encounter. And his approach would be that, you know, you, you just don't push yourself as a chiropractor. You don't deny that you're a chiropractor. But, you know, you, you, you sell. But I also, I do wonder whether, you know, if, if they are, if they're, you know, if they know that that's an opportunity for them to just, you know, sit down and let it all out. But I wonder what would happen to a driver if they knew, they interviewed. And you're going to hang on every single word how to say so the benefits of what you do, you don't, you don't sell the word chiropractic. And so, for instance, the clinic here, it's only. Well, I would have been very proud to say this about six months ago. It doesn't have the word chiropractic anyway. It doesn't say chiropractor. No, it says expert diagnosis of disc or whatever it says on the front of my building. That's, that's, you know, the structure of the, the first algorithm is, is for me Very, very much about. We are going to talk about this and we're gonna, you know, explore and you know, and maybe we'll get to, maybe we'll get to treatment at the end, you know, and that, that's helpful with you saying about the, the session and a half kind of idea. It says, you know, disc pain, joint pain, muscle pain, whatever pain. And so one of my patients said, you know, you're trying to tell people about not using this word pain and the front of your clinically placidly with pain. Like. Yeah, I thought that it didn't say chiropractic until. Try and get a bit of treatment just to see how, you know, you kind of. It's a sample. You can kind of see how I work and then if that seems useful, then we'll use that next time. So that's been very helpful A few months ago. You know, this is part of me kind of finding the middle ground going okay, no, do you need to. But yeah, and it's, and it's more, it's more movement, it's more mucking about. It's more, you know, playful stuff and I might be doing stuff with. I've got a bruised. Put the word chiropractic somewhere on the front of the building. Oh. So yeah, so the, the point being that yes, I very much saw that. I, I saw the, the benefit in the idea of, you know, people don't know what chiropractic is. I like I said, you know, however long ago I didn't know what a chiropractor was and then I became a chiropractor practice and there's lots of misconstic which I tell them is a Chinese fighting stick and they're not to be concerned. I bring it into the elections and lots of confusion about what chiropractic or chiropractor is. And again, especially perhaps a little town position, I come with this broomstick and you know, that's, that's how I kind of approach it a little bit. D. You know, things like juggling and throwing ball. You know, the rehab is where I am. I'm the only chiropractor. So I, I thought yeah, that would, that would probably make through the back door, you know, playing ping pong or whatever. You know, that that's something I would never a lot of sense to. To replace chiropractor with something else. And so I called myself pain recovery coach, which kind of makes sense. I think it's a bit, I don't think ever have considered back in the day, you know, it's a bit woolly. I don't think it's very striking. But I still, you know, we're going to do some fake kind of karate moves or whatever it might be. But it's, it, you know, it's fun. It's. It's a lot of fun.

Yeah, it's, it's really, it's bringing that fun back in from what you're saying. Yeah, yeah.

I still think that there is benefit in putting your professional. Yeah. And then. And there's a bit of treatment and I found that what's useful, putting your qualification in the background, you know, it's about you and it's about what that person wants and it's about the goals that they have. And so if you're going to put all your eggs in the floor as well, this is, this is a Laura Mosley kind of thing, which is that you just ask. Would they like to ask you, promoting yourself as the chiropractor or a chiropractic clinic? I'm not sure that helps. No more about that. You know, if you do report a findings and you kind of, you know, use the model or the pictures or whatever it might be, I find the best things to say. Do you want to know more about that? Do you want me to explain that in a different way or is that, is that okay? You know, it's okay that then the two. I think, you know, it's about saying, what are the things in life that you're missing out on and can we help them get there? Yeah, that's a useful way to look at maybe, you know, like the Simon Sinek, the why question, you know, why am I doing this? The decision is there.

It's a patient centered approach to communication.

No, I get it or I don't get it or I'm not sure, you know, Brilliant. Well, I know where you're at. Where you're at. It's not about your. What, you know, I'm a chiropractor. Why am I. Why am I chiropractor? You know, it comes to treatment recommendation as well and it's. I think that's, I suppose it ties in inadvertently with patients being able to, you know, to help people get to that end goal. And so, yeah, it doesn't make any sense to use this word when you can just use a, you know, an image or, you know, a vision of where they can get with you. So, yeah, so, I mean, so I want to be brave enough to tell you what, what they think. It's. I'm Kind of, you know, changed my website to Pain Recovery Coach and you know, removes all that. You know, it takes quite a bit of guts to kind of remove your own ego from the situation and say, what do you, what do you think? You know, I'll give you, giving you my idea. What do you think? You know, what do you really think? Is that going to be okay? Can you afford it? Reference to chiropractic. And again, I think, I suppose just in practice it became a little bit people, people weren't sure one way.

Yeah, I don't. If I said, oh, I saw this pain recovery coach the other day, I feel like people go, oh, what, what do they do? It's like with a chiropractor, they're like, yeah, it's an invitation for them to go, well, I'm not so sure about this. You know, you've got to be able to sit with your own self confidence to the degree that, yeah. Open yourself up to a challenge and not worry about what if they say they're not happy or what if they say they don't get it.

Yeah, yeah.

But it's a, my experience, it's a much nicer place to be. It's like, oh, great, pressure's off me. I don't have to be the expert. At least I know that's the thing. I might think all they do is, you know, crack backs, but I'm like, oh, okay, that's the thing. I've heard of.

Yeah, yeah, yeah. So it's, it's about, it's about but with the answers.

And you know, I, I, I say this all the time now. I don't ever, I suppose I've got.

The luxury of having the opportunity to try a few things and for stuff to go wrong. But we're still here. I mean, and I think that I.

Can'T think the last time I tried to persuade a patient to do something, like I might try and inspire them if I think it's leading towards where they want to be. But to like persuade something to do something they don't want to do, like, it almost never works. And when it does, it works by.

That speaks to how successful the business has been in that, you know, I can basically throw a business away and six years later I'm still producing a.

Bit of resentment and then they just, they stop doing it as soon as they can get away with it. Yeah. So having that, that exploratory sense, I think is, is really valuable. I'm just, I'm aware of the time. There's a Couple of the quick questions I wanted to. To ask you before we go, if.

That'S all right here or seven years later until here as a chiropractor, you know, and I think it's very tempting, it's very tempting to go down that route of high.

Firstly, if you. What advice would you give to volume practice?

It's very difficult to have a sample of that and benefit, say, somebody who's.

A fairly new graduate. They've come out the last couple of years and they're aware there's this whole.

Go with seeing loads and loads of patients and then so think, oh, do you know, I'm going to step back and do this.

Oh, this false dichotomy or whatever you want to call it. But there's this kind of like manual therapy versus rehab pain science approach and they're all kind of differently.

Oh, don't do that. You're doing really well.

I find it quite confusing. You know, they've had confusing messages at uni. They've had confusing messages after they graduate again.

I'm not sure if I'm answering the question at all.

No, no, this is good. This is, this is really, really useful.

I mean.

So if we were to compare, let's. What kind of advice would you give someone like that?

I would say, I mean, I would say that you, if you possibly can, is to. Is to accept that this.

I'm a fly on the wall. I'm observing you in clinic today and I'm comparing that to observing you in clinics.

Say stuff will. It can. It can permeate. If you allow it to. It can permeate into how you think.

10 years ago, before you'd even come across petrosalam, this type of thing.

What.

What am I seeing that's different? What would I see in the room?

When you're with a patient, how you do stuff, how you are with patients. You just have to let you see me in very formal dress. You'd see me maybe in a white tune, kind of settle. You have to let it kind of, you know, just, just blend in. If you, if you can, if you can just, just stop yourself from jumping too hard into it, that it will be useful. You won't forget it. You won't be, you know, it's Nick. But you certainly see me with a shirt and tie. You'd see me standing up a lot. Or you might not see me at all because I came up. I suppose it's not like learning a technique on a weekend course and then thinking, well, I have to remember how to do that bit. It was a fantastic idea. When I, when I had, when I. At the height of my practice, I would work between two identical treatment rooms and you'd have the patient changing one room while you were adjusting them and showed me how to put my hand there. You know, it's not like that this can be absorbed into the way you are. Like I said earlier, it's kind of, it's, it's, it's, it's the air you breathe. It's not the thing that you do in the other room. And you could just swap and you could see people, you know, really, really quickly. And I think that it's important to, you know, it's important to. And I came up with this great idea and I'd ask my receptionist, who've been with me since the start, I said, actually, do you know what you can do? Can you bring them into the room and have them lying face down so I don't have to talk to them? I can just get on with, you know, being a back mechanic. And again, that was one of the instances where she had, you know, I, I suppose I'm hesitating. I'm thinking, you know, we're talking about somebody like me who's on my own and doesn't have anybody to reflect on, you know, you know, be able to say, you know, if I had, if I was the associate for my boss and he might say, hang on, you think is, you know, the. I was gonna say nerve. That's not the right word. But she, you know, she's down in the toilet, what's going on, you know, that, that would have been very useful, I suppose. Stood up for the situation and said, I don't think people are going to like that. Yeah, you might be right. So, yeah, you know, I was so, so fascinated. And so I think, yeah, I think it's about just, just hang on, hang on to it, hang on to it and understand that there is a middle ground, you know, there is a middle ground to put your hands on people and manipulate. You know, obsessed with just manipulating. I didn't think I even had time to talk to people. People and seeing them improvement for that kind of thing. And that's all part of it. That is all part of.

Yeah, they're here to have their back cracks. Like, what does the talking matter?

Yeah, yeah. Power, the adjustment is all completely evidence based, acceptable, appropriate way of so, you know, come in, get it done and, you know, it's up to you whether you, you know, you get better or not. Kind of Thing. So, yeah, you'd see me rushing between one room and the other, treating people and that you perhaps don't have to worry too much. I mean, I had this kind of paranoia that, you know, what if you'd seen me very formal, you know, not, not much time for the patient, you know, I've got my form. What if Peter Sullivan came and watched me work, you know, had all these names that, you know.

Yeah, yeah.

What other Negans think, you know, such a, you know, manual therapy sucks feeler. I'm just gonna do the adjustment and get on to the next one. So, yeah, very different. So now what you're going to see is, you know, you probably see in the background I've gone for a much more homely feel. You know, the lighting, the little, two little sofas here that we sit and chat on. What would he think if I saw you dare to actually do a treatment on somebody? You know, it's quite, it's quite paralyzing.

Yeah, I'd be one of those chiropractors who's rubbishing on Instagram and stuff. That could be me.

Yeah, yeah, yeah, absolutely. So it can paralyze you.

I didn't twig this was your clinic, by the way, until I saw the models up on the shelf and I.

Thought pretty sure to, you know, just stocking everything, I probably did mean. So yeah, it's about, it's about knowing that it will, it will, it can settle. It can absolutely settle.

My wife wouldn't be all right with anatomy models in our living room. But it has that, that really nice feel there. Yeah.

In that middle. And you don't have to justify, you know, put your hands on people. You don't have to. Yeah, absolutely, absolutely. The feel I wanted. So that, yeah, so that, that would have been very different as well. So back in the old clinic we moved clinic as well, which kind of doesn't really matter. But the old clinic justify any of that to anybody. It just has to be a grown up relationship between you and the person in front of you is in pain and you. And you know, I can't because, you know, I want to look like almost like a surgical room, you know, do it now because the camera's too small. But this idea of, you know, you're not face to face with somebody.

It's one of your little expert doctor of chiropractic.

Yeah, yeah, absolutely, absolutely. Isn't it? You're not kind of face to face with this person. You should be side by side with them with your arm around to Say, well, let's, let's look out here and see where can we go with this.

Yeah.

And now. Yeah, it's soft. It's, you know, soft. You know, it's so, you know, dressed differently. I, you know, haircut is a little bit more severe than I'm used to, but usually a bit. Yeah. Yeah.

I think, you know, patience is what's coming to incident. It's like not trying to go, I've got to take this stuff and do it all right on Monday morning and I've got to change, you know, a.

Bit more unkempt and that kind of stuff. So, yeah, you, you, you know, there'd be a very, very different vibe.

And then what would you be doing with the patients now that you like?

You.

You have that sort of weekend epiphany of I'm going to change everything More a case of think about it, keep it on your mind, but don't rush into changing a lot of stuff. Don't weren't doing back then.

There'd be, I mean, lots, lots more talking, you know, a lot more. The history for me is key. Taking the history.

Don't feel like you need to be the expert straight away way, I guess.

Is that fair? Yeah, absolutely. And. And you can't be. And, you know, I do sort of, you know, have a little kind of treat or receiving the history. You should say that for me is fascinating being my bonnet about how, you know, when, when I look back and go to be in my bonnet about how, you know, when, when I look back and go to things like Peter and Lauren Bosley and all these kinds of. Of things, you know, I sort of. I'm waiting, I'm fascinated, you know. You know, I feel like it's. I feel perhaps this, this that they could have said, listen, guys, this stuff is really amazing, but don't go mad on it. We're not quite sure where this fits. You know, most of your physios and your cars and the osteos, whatever it might be, could be a selling point for people is to be, you know, like where, you know, you're interviewing me now and I listen to loads of podcasts and I sort of identify with the interview and think, oh, they're really good at getting that information accidentally. Here's some information that we want you to kind of take on board and think about and ponder and maybe come back to, you know, don't go mad, don't Monday morning the hell out of this. And the last time I saw Speak, he. He said something along the lines of, look, we can't tell you what to do with this information. You know, we're not taking responsibility for what you do with information. And I think to myself, God, what a treat. What an absolute treat to be interviewed and for somebody to listen to it off of that. Because I was like, hang on, hang on, mate. You, you know, you basically, you have completely revolutionized what I do. But now here's you literally saying, this is nothing to do with me. Yeah, you know, I can see that kind of backlash, you know, I said earlier about saying the backlash to all this stuff and me thinking that, because I felt quite let down by that, you know, this kind of explained pain movement and then to say, yeah, but we're not, you know, do what you like with it.

Doesn't work. It's nothing to do with us kind of thing.

Yeah, yeah, a little bit. A little bit. So I suppose, I suppose there's that kind of advice is to, you use it, use it carefully. Use it, use it judiciously. Use it. Like you said, it's like, it's like a treatment method that you've learned. And so, you know, I put a lot of importance in that and saying for the patient, as you say, you know, I'm going to listen to everything that you, you have have to say, tell me everything, tell me all about it, tell me everything, and listen to everything you say and really hope that the patient, not everybody can have that treatment on Monday morning. My belief is that it should, it should permeate everything that you do. And it's not, you know, it's not good enough to kind of ignore it or just to say, well, that doesn't apply to me because I get these great results with all my patients by ingesting the hell out of them. Yeah, it has, it has to be part. You have to, you have to know who these people are, in my opinion. You have to know. And that. That's disappointing. If you say to, you know, mention name Laura Mosi or whatever and you get a blank look, you think, Yeah, I think, I think we should know who these people are.

Yeah.

Can't be so into chiropractic that nobody else counts.

Yeah, that kind of leads into like.

I guess goes, oh, wow, brilliant. I've never done that for me before. This is, this is great.

Another question I was going to ask, and this is. It's a bit of a selfish question because I'm actually taking two of our associates to the Peter o' Sullivan seminar next month. Should we be going to see Peter o' Sullivan, should we be going? Would you recommend that to colleagues to go to this seminar?

Absolutely, yeah. Enjoying just talking. So, you know, really amplifying that and reassuring the patient, you know, they kind of say something, you know, they'll, they'll give you a very potted history and kind of say, you know, 100, 100. I mean, I think that especially, you know, we talked about like expectations and, and setting people up and that kind of thing. So to have the, have the ability to say to them, look, what you're about to see might blow your mind. It might be absolutely mind boggling for you to see this happening. Or you might, I don't know what else you want to know. That's fine. Honestly. This is what we're here to do. Just, just, you know, I just kind of go or whatever. But to be able to say to them, you know, just, just bear in mind that you, you kind of have to fit this into your practice, but it can't, it can't be, you know, it can't be your practice.

Yeah.

And, you know, so, yeah, I would say absolutely, you need to see, you know, keep talking, keep telling me, keep describing that whole.

Sorry, this isn't relevant. You don't need to, to know that.

If you want to be the complete expert, you, you as a chiropractor, osteopath or whatever we're talking about, you know, you owe it to yourself to dip into these different ways of, you know, treating and learning. And then when you, when you see, you know, the kind of research that Peter's coming up with and his team, you know, we need to go off on a tangent.

Yeah, yeah.

Imagine this is like a. No, that's stuff. You know, he's talking specifically about how best to treat disabling, you know, pacific complicated movie. And I've come in halfway through, so don't worry. I want, you know, low back pain. How are we not in on that? How do we not know that stuff inside out that, that perhaps should be us driving that. Oh, yeah, absolutely. To, to, you know, to be the completist. Then you have to, you tell me all about it. Describe everything that's happening. Every single. I want to know absolutely what's going on. I'm gonna have to know Peter Sullivan stuff.

Yeah, I think I know because I, I went a few years ago. The, the couple of reasons that I'd go about this time. One was I thought, I know, it's like they're both fairly new graduates. This stuff can be. It was overwhelming for me and I've been out several years. So I thought, I want to make sure I'm kind of there with them in case they've got questions and things like that. But also I'm going to watch the.

Rest of it with you. All right. See, so you do have to know.

Not second time through. I'm not going to go to day one because for those who don't know, day one is very much the theory. And then days two and three, it's just watching him work live with people. I would say watching him work live, I, I didn't really take a lot from the theory. There was Morton Ho, who's a big chronic pain physio over in Denmark.

He's there, you know, what was happening with time, how I feel about it and what, you know, it's just replaying those scenes. Scenes again.

I really like that metaphor that. Yeah, I might pinch that one. He's the head of one of their big academies or something. We're chatting to him about this and he's like, yeah, he's like, but all that, he's like cognitive functional therapy is like all that bit. That's just bs like chronic central sensitization. That's all bs. Like all this stuff, it's just BS that we've just made. Its theory doesn't really mean anything. It's like, go see them do it live. Like, watch Peter.

Makes sense. It's them to kind of slow down a bit and just don't say, oh yeah, that guy shot that guy and I was chasing that guy. Doesn't help me just that guy work.

With somebody like that. You'll learn a ton from the actual theory. He's like, yeah, it's interesting, but it's, it's made up stuff because we don't really know. And that's kind of true of all the. Doesn't mean it's not valid, but yeah, even the idea of central sensitization is like, we made that up. That's a model we don't know that's happening inside the patient. So maybe don't get too hung up on.

Yeah, that tends to help. You know, it's just about telling them, just calm down a bit, take a breath. Let's, you know, let's get stuck into this. Yeah. Again, you know that, that, that you have to adapt that.

Just look at what they do and how they get people better.

The other advice I would give anybody going for the first time is I can't remember the name of the place, but there's that pub. That's right Next door to the Royalty Hospital. And if you're lucky, everybody who's anybody on the course is in the pub afterwards, you know, sinking a few pints. And that was probably one of the highlight that's helpful with the social styles model is recognizing where somebody just. That's just not going to work for them. They don't want to do that.

They want to tell you, yeah, driver in, out.

Here's the lights of my professional career is being. They go, oh, wow, that's. Oh, wow, wow. Oh, no, I'm drinking them. Oh, that's brilliant. So, yeah, find that pub, I think it might be called the Queen's Head or something. Anyway, it's nice because I did not.

Know that last time.

Yeah, it was great. It was a great few nights out. Brilliant.

All right, lovely. Well, thanks again for your time. Head. We've got to wrap things up there, but really appreciate that. I think, like I said, it's really valuable for people to hear your experience having gone from that traditional chiro background right through to trying to emulate, you know, Peter said on these people, to finding that middle ground. I hope more and more of us can do that because I completely agree. We need to know this stuff. It's not enough to go, oh, that's, that's a weird physio thing. I'm going to leave that. But equally that the risk of overdosing, I think is quite a real one as well. But yeah, thanks again for your time. I'd love to follow up. And there's probably about 50 other things I wanted to ask you that I'll think of afterwards, but maybe we can.

Check in something my perspective, Chris, I think, you know, the stuff that you do is great and I think that it's facts.

Give me the solution. Off we go.

And that's fine because. Because then, you know, that that's helpful all round. You, you, you're going to, you're both going to get what you need for that encounter. But I also, I do wonder whether, you know, if, if they are, if they're, you know, if they know that that's an opportunity for them to just, you know, sit down and. Being really useful for me, having kind of come through that period of going, I don't know, almost like, how do I integrate myself back into being a chiropractor? And the stuff that you're doing is, is, you know, absolutely, you know, so helpful. It was really helpful, you know, continues to be really helpful for me. So that's, you know, that's my moment to repay the let it all out. But I, I wonder what would happen to a drive if they knew. Compliment.

My pleasure. Sorry to hear. All right, well, thanks again. Head and we'll, yeah, we'll chat soon.

Good. Yeah, thanks, Chris. Enjoyed that.

Yeah, it's me too.

Interviewed and you're going to hang on every single word they have to say. So that, that's, that's, you know, the structure of the, the first algorithm is, is for me very, very much about. We are going to talk about this and we're gonna ex, you know, explore and you know, and maybe we'll get to, maybe we'll get to treatment at the end, you know, and that, that's helpful with you saying about the, the session and a half kind of idea. We'll try and get a bit of treatment just to sort of see how, you know, you kind of. It's a sample. You can kind of see how I work and then if that seems useful, then we'll use that next time. So that's been very helpful. But yeah, and it's, and it's more, it's more movement, it's more mucking about, it's more, you know, playful stuff. And I might be doing stuff with. I've got a broomstick, which I tell them is a Chinese hiding stick. And they're not to be concerned. I bring it into the room position. I come with this broomstick and you know, that's, that's how I kind of approach it a little bit dapper. You know, things like juggling and throwing ball. You know, the rehab is through the back door. You know, playing ping pong or whatever. You know, that's something I would never ever have considered back in the day. You know, we're going to do some fake kind of karate moves or whatever it might be, but it's, it, you know, it's fun. It's a lot of fun.

Yeah, it's, it's really, it's bringing that fun back in from what you're saying.

Yeah, yeah, yeah. And then, and there's a bit of treatment and I found that what's useful as well, this is, this is a Laura Mosley kind of thing, which is that you just ask would they like to know more about that? You know, if you do reporter findings and you kind of, you know, use the model or the pictures or whatever it might be, I find the best things to do. Say, do you want to know more about that? Do you want me to explain that in a different way? Was that, is that okay? You know, it's okay. Then the decision is there.

It's a patient centered approach to communication.

No, I get it or I don't get it or I'm not sure, you know, Brilliant. Well know where you are, where you're at. You know, it comes to treatment recommendation as well. And it's, I think that's, I suppose it ties in inadvertently with patients being able to be able to be brave enough to tell you what, what they think. It's, you know, it takes quite a bit of guts to kind of remove your own ego from the situation and say, what, what do you think? I'll give you, giving you my idea. What do you think? You know, what do you really think? Is that going to be okay? Can you afford it?

Yeah. It's an invitation for them to go. I'm not so sure about this. You've got to be able to sit with your own self confidence to a degree that, yeah. Open yourself up to a challenge and not worry about what if they say they're not happy or what if they say they don't get it?

Yeah, yeah.

My experience, it's a much nicer place to be. It's like, oh, great pressures off me. I don't have to be the expert with the answers. And you know, I, I, I say this all the time. I don't ever think, I can't think. The last time I tried to persuade a patient to do something, like I might try and inspire them if I think it's leading towards where they want to be. But to like persuade something to do something they don't want to do, like, it almost never works. And when it does, it works by introducing a bit of resentment and then they just, they stop doing it as soon as they can get away with it. Yeah. So having that, that exploratory sense I think is, is really valuable. I'm just, I'm aware of the time. There's a couple of the quick questions I wanted to, to ask you before we go, if that's all right. Firstly, if you, what advice would you give to say, somebody who's a fairly new graduate, they've come out the last couple of years and they're aware there's this whole, this false dichotomy or whatever want to call it, but there's this kind of like manual therapy versus rehab pain science approach and they all kind of find it quite confusing. You know, they've had confusing messages at uni. They've had confusing messages after they graduated. What kind of advice would you give someone like that?

I would say I Mean, I would say that you. If you possibly can, is to. Is to accept that this stuff will. It can. It can permeate. If you allow it to. It can permeate into how you think, how you do stuff, how you are with patients. You just have to let it kind of settle. You have to let it kind of, you know, just. Just blend in. If you. If you can. If you can just. Just stop yourself from jumping too hard into it, that it will be useful. You won't forget it. You won't be. You know, I suppose it's not like learning a technique on a weekend course and then thinking, well, I have to remember how to do that. Then you showed me how to put my hand there. You know, it's not like that this can be absorbed into the way you are. Like I said earlier, it's kind of. It's. It's. It's. It's the air you breathe. It's not the thing that you do. And I think that it's important to, you know, it's important to, you know, I suppose I'm hesitating. I'm thinking, you know, we're talking about somebody like me who's on my own and doesn't have anybody to reflect or, you know, you know, be able to say, you know, if I had, if I was the associate for my boss, and he might say, hang on, you think, is, you know, down in the toilet, what's going on, you know, that. That would have been very useful, I suppose. And so I think, yeah, I think it's about just. Just hang on, hang on to it. Hang on to it and understand that there is a middle ground, you know, There is a middle ground to put your hands on people and manipulating people and seeing them improvement for that kind of thing. And that's all part of it. That is all part of a completely evidence based, acceptable, appropriate way of treating people and that you perhaps don't have to worry too much. I mean, I had this kind of paranoia that, you know, what if Peter Sutherland came and watched me work? You know, had all these names that, you know. Yeah, yeah, whatever. Negan's thing. You know, such a, you know, manual therapy sucks guy. What would he think if I saw you dare to actually do a treatment on somebody? You know, it's quite. It's quite paralyzing.

Yeah, I'd be one of those chiropractors he was rubbishing on Instagram and stuff. That could be me.

Yeah, yeah, yeah, absolutely. So it can paralyze you to, you know, just stocking Everything I probably did mean. So, yeah, it's about, it's about knowing that it will, it will, it can settle, it can absolutely settle in that middle. And you don't have to justify, you know, put your hands on people. You don't have to justify any of that to anybody. It just has to be a grown up relationship between you and the person in front of you is in pain and you, and you know, I can't do it now because the camera's too small. But this idea of, you know, you're not face to face with somebody, it's one of your little doodles, isn't it? You're not kind of face to face with this person. You should be side by side with them in your arm round to say, well, let's look out here and see where can we go with this?

Yeah.

Yeah.

I think, you know, patience is what's coming to incident. It's like not trying to go, I've got to take this stuff and do it all right on Monday morning and I've got to change, you know, like you, you have that sort of weekend epiphany of I'm going to change everything. More a case of think about it, keep it on your mind, but don't rush into changing a lot of stuff. Don't, don't feel like you need to be the expert straight away, I guess. Is that fair?

Yeah, absolutely. And, and you can't be. And you know, I do sort of, you know, I have a little kind of be in my bonnet about how, you know, when, when I look back and go to things.