Articles Of The Week May 27, 2018

Not all of our patients enjoy doing exercise, no matter how much it helps. But what if we could change the way it’s delivered, to get them to adhere to recommendations more? What if we could actually make it fun?

“Making Rehab Fun” – Jon Cain

There were a few questions floating around social media this week on plantar fasciitis. This is a great article outlining five things you can do to help patients with this.

“5 Tips For Better Self Management Of Plantar Fascitis For Athletes” – Ellie Somers

This is essentially a massive list Lars has put together of videos and interviews with some of the worlds leading pain researchers. There is a ton on this list, that could make your knowledge and learning about pain a lot easier.

“Pain Lectures With Pain Experts” – Lars Avemarie

No matter what part of the health industry you work in, there is always room for improvement. This article outlines many things I would never have thought of (but can certainly learn a lot from), and I’m sure it’s applicable no matter what part of healthcare you’re in.

“Making The Fitness Industry A Better Place”– Leigh Peele

We’ve all mismanaged time before and possibly messed up our schedule when booking patients in. As it turns out, one of the things that could prevent this from happening is taking better care of ourselves!

“Time Management And When It Goes Wrong” – Sinead Kelly-Barber

 

A Massage Therapy Discovery

 

*This post was written by an RMT who wishes to remain anonymous because it deals with legal issues. Their lawyer has advised them that while it is fine to share the information, to help us all, it is better to stay unidentified due to the legal concerns.  

 

So this is not the deep soul searching, self-reflective, becoming a better person type of discovery that I am talking about but rather an examination for discovery of the legal variety. 

That being said this legal discovery did help me discover that I dislike discoveries. I also discovered that lawyers can be pretty darn nice and helpful…at least the ones I interacted with.

Before I get into the Discovery itself I would like to say; I wish I could give the details as to what occurred but, as recommended by my lawyer, I cannot give any details which may affect client confidentiality. Due to my strong desire not to be sued, there will be no names, specific details, or any information directly related to the treatment. 

If the information was to get out and people began to talk I would then need to hire Jamie “Knuckles” Johnston for his…ahem… “silencing skills” but he is far too busy and his fees, although a great value, can add up quickly. 

What I can say is I have been an RMT for a good number of years, I had treated this patient quite a number of times over a few years, there was a long break between treatments and then there was an MVA followed by several treatments along with some underlying pathological issues on top of the typical MVA injuries.

A Legal Discovery

I think many of us have given a treatment when someone has had difficulty getting off the table, they were sorer afterwards, they were bruised, or perhaps there was a snap, crackle, or pop that occurred. On that fateful day, I gave one of those treatments and this is a bit of the process that followed.

After the treatment when the incident occurred I did a lot of thinking, rethinking, over thinking and then I thought about it some more. After all of the thinking, I felt very confident in the treatment I gave. The patient returned a few more times over the next few weeks and then life goes on and continues.

Fast forward 22 months after the incident. I received a 3rd party notice for Civil Claim from defendants of the MVA.

A claim of negligence:

  • failing to recognize the physical & medical condition of the plaintiff
  • failing to use reasonable care & skill
  • failing to properly examine, investigate, assess, test

*The clinic where I work also named in the lawsuit

I immediately contacted a lawyer, then my insurance company, and so the paper trail began. All of my notes for the treatments from the MVA and previous to the MVA were scanned and emailed.  In the first brief phone conversation with the lawyer, we discussed some of the basics from the treatments. I was told my charting was pretty good which should make things a bit easier. That was the first bit of good news I had received which helped make me slightly less stressed.

FYI: should you ever receive such a notice it states that you must respond within 21 days if you reside in Canada, 35 days if you reside in the U.S. and 49 days if you reside elsewhere.

Approximately 6 weeks after the 3rd party notice, 28 months after the incident, I received another envelope (really starting to develop a phobia of large envelopes at this point). It was a Notice of Civil Claim from my patient. Apparently, this is a normal part of the process that would allow the plaintiff to claim against me, as well as the MVA defendant.

Our Reply was sent a couple of weeks after the 2nd notice, so it seems the time period you must respond by was not quite as much of a “MUST DO” as originally stated. My Lawyer called their Lawyer and told them of our intentions so it was all good.

And now we wait.

During this waiting period, expert witnesses are used by both parties to review my clinic notes. The expert witness used by my Lawyer was of the view that I met the standard of care in the circumstances. Not gonna lie, I was really hoping for more of a statement like “there is absolutely no chance, no way, no how that I could ever in a million years have done anything even remotely wrong,” but I will take what I can get.

42 months after the incident I learned that bad news does not have to come in a large envelope as I received an email that did not make me happy. I received a notice that I have been requested for Discovery in two and a half weeks. There were many emails back & forth to my Lawyer over these next couple weeks as I had many questions while my anxiety grew. Although I am sure panic, stress, irrational thoughts, endless questions and emails are probably fairly normal with this type of procedure I can only imagine what my poor Lawyer must have been thinking about me.

Here are some of the tips that I received from my lawyer:

  • The Supreme Court Civil Rules allow each party an opportunity to question the other parties for up to 7 hours, I anticipate that counsel will likely only take half a day to ask you questions about your knowledge of the treatment that was provided to the plaintiff.
  • Answer the question being asked and not to offer any information. The general rule is that you answer with as little information as possible to address the specific question asked, so it is very important that you understand the question.
  • This is not your opportunity to “make your case” or to convince the other side that you did nothing wrong. An examination for discovery is a hurt not help situation. I cannot use anything that you say at the examination for discovery as evidence, however, the other side can. If we went to trial then we would make sure that you provided a full explanation of your background, training, and involvement with the plaintiff.
  • You cannot be asked about your opinion regarding the plaintiff’s condition or anything else at issue in the litigation. I will be present to ensure that the questions are not objectionable. Some examples of objectionable questions are those that are ambiguous, those that seek your opinion, or those that seek information which is covered by privilege. We can also object on the grounds of relevance, although the scope of what is relevant to discovery is quite broad.
  • If I do object, then I will instruct you not to answer the question and it is very important that you follow my instructions, even if you think the answer to the question might be helpful to our case.
  • The most important advice I can give you is that you listen very closely to the question you are asked and that you answer honestly and accurately (to the best of your ability).

Requests made by Defence Counsel, I needed to provide the following information/documents:

  • Advise as to what continuing education course you last took prior to the incident
  • Provide a copy of any contract that was in place between you and the clinic you work at as of the date of the incident.

Important Advice For Every Massage Therapist

D -Day Arrives(42 1/2 months )

I met with my Lawyer one hour before Discovery to further discuss, answer questions, and calm my frazzled nerves. I am feeling pretty good, although still quite nervous.

And so it begins.

In the conference room we all gather:  court recorder for transcript & audio recorder, ICBC lawyer for the MVA defendants, Lawyer for another healthcare practitioner, Lawyer for the Plaintiff, and last but not least my Lawyer, and of course myself. I am a little disappointed that not one of them is wearing the white wig you see on Canadian TV shows.

I was questioned only by the one Lawyer.

We went over and briefly discussed EACH and EVERY treatment. There were more specific questions if/when the treatments or any other details changed, and even more discussion/questions for the day of the “incident”. I can say that I did not feel pressured, harassed or intimidated. A couple of the questions did catch me off guard and made me think a bit, but nothing that wasn’t fair. The questioning lasted approximately two hours. At the end of the Discovery, I shook hands with the opposing Lawyers and exchange pleasantries that actually felt pretty genuine. The questioning Lawyer said something along the lines of; “would have been nice to meet under different circumstances.” We left the room but the other 3 Lawyers stayed behind to discuss their next step….that hopefully did not involve me being stepped on.

Thankfully I was able to have a bit of a post-discovery debriefing with my Lawyer. I was told I represented myself and my case well. There were a couple of points that I guess I didn’t pick up on but overall I felt good and I could begin to breathe again. Sadly I had to go back to work at this time even though I would have really liked to go to a pub to celebrate.

49 months after this all began I received an email that made me quite happy, it was the lawyer stating I am to be let out of legal action.  Thankfully the information gathered at my Discovery combined with my patient stating during her Discovery that during the treatment I did not do anything different than previous when “the incident” occurred allowed them to come to the conclusion I was not at fault.

What have I learned from all of this?

  1. Charting is important!!! VERY, VERY important! I was able to easily understand everything in my charts years after the treatments and the Lawyers could also understand them. Very little clarification needed.
  2. Listen to your gut. There were a couple of comments made by my patient in the treatments that immediately followed the incident that I wished I would have charted. I recall thinking that was an odd statement but then failed to put it in my notes. Chart that stuff too!!!!
  3. ALWAYS work within our scope of practice. I cannot even begin to imagine how this could have ended if I had done anything even remotely questionable.
  4. Insurance is a good thing. I know we all complain, at least sometimes, at that time of year when our fees are due. I will never complain again (at least not out loud).
  5. Lawyers are not like they are portrayed on TV….at least not all of them, BUT they are VERY expensive, so please go back and re-read point number four!
  6. Oh yes and one more thing large envelopes are very bad!!!

There are still some unanswered questions for me about this ordeal but it is not very likely that I will ever find the answers. I just have to be happy with the outcome and move on.

58 months later and I just got the official paperwork to say I am in the clear.

Articles Of The Week May 6, 2018

 

Do we need to fix our patients, or help them get a bigger cup? Listen to their stories, and ask questions like: “How can you be healthier?” and more importantly “How can I help you be healthier?”

“Do Our Patients Need Fixing?” – Greg Lehman

This is a great little summary (and video) of what happens when your brain produces pain.

“Understanding The Complexity Of Pain” – Jenn Sharman

Communication is really important when talking to our patients. While this article is directed toward doctors, there is some information we can draw from this. Take an interest in your patient, make eye contact, communicate with them!.

“When You Talk To Patients, Do You Look At Them Or At A Computer?” – Milton Packer

All of us have patients with high blood pressure (because you do check it once in a while right?). While we can’t give advice on diet, we can give some advice on exercise, and maybe give a little nudge on sharing information with them. Here’s a great article you can share with them.

“Lower Your Blood Pressure Naturally” – Julie Upton

Using best evidence in practice is crucial for our profession moving forward. So, how do we apply the best evidence to something like patients with low back pain? This article gives you a great foundation and applicable guidelines to do just that. 

“How Do You Solve A Problem Like Low Back Pain?” – Monica Noij

Articles Of The Week April 15, 2018

There was quite the buzz over the past couple of weeks about a newly discovered organ. Some groups were jumping all over it, trying to use this as a way to reinforce their modalities. But, maybe this new discovery is not quite as it seems. 

“Two ‘Newly Discovered’ Human Organs Aren’t What They Seem” – Andrew Tarantola

If it hasn’t happened to you yet, it’s going to happen eventually. There will be a point in your career, where you learn something that disrupts some of the beliefs you had in certain modalities, or concepts about manual therapy. So, you have a choice to either continue to go along with it or confront it. Here’s a good example of someone who chose to confront it.

“Confronting The Challenges Of A Major Paradigm Shift” – Whitney Lowe

Do you treat many patients who are dealing with a tendinopathy? Here’s some great info on how to progressively load tendons to rehab the injury.

“Lifters Guide To Treating Tendinopathy” – Sean Jacobs

You know how we feel about busting massage myths around here, so this article was of immediate interest. We know that when we give a massage, we aren’t flushing out toxins, but there is still some belief that you can sweat out toxins. Well, you can share this article with your patients to show them, that’s not a thing either!

“Fact Or Fiction: Can You Really Sweat Out Toxins?” – Erika Engelhaupt

Massage is awesome! In fact, it would be great if we had more confidence in it and didn’t try to use so many fancy explanations around modalities, but just use simple defensible reasoning on helping our patients.

“What’s With The Resistance?” – Taylor Laviolette

Articles Of The Week April 8, 2018

 

We can all probably look back and remember what it was that made us choose this fine profession. This post discusses what made a fellow therapist choose this, but also some great advice for practitioners, whether you’re a new grad or a seasoned vet!

“Why I Became A Massage Therapist” – Taylor Laviolette

This seems to be a recurring theme. Doctors prescribing opioids and other treatments that don’t really work for low back pain, when looking at social, psychological and other factors do. Great to see more mainstream media spreading the word.

“Ineffective Treatment Often Prescribed For Lower Back Pain” – Rina Shaikh-Lesko.

“It may not be surprising that people with chronic pain don’t necessarily like the idea of accepting it.” But this article shows some research where this could be a valid approach.

“Is Chronic Pain Something More People Should Accept?” – Clare Foran

Ever recommend foam rolling to your athletes as part of their warmup routine? Will it actually make a difference? Well, maybe for a short time, but foam rolling might be better used at other times.

“Foam Rolling May Increase Range Of Motion In The Legs, But For A Very Short Time” – Nick Ng

It’s great to see that some massage therapy associations are getting in on the act of spreading evidence-based information. The AMT (Association of Massage Therapists in Australia) does a great job dispelling the myths around pregnancy massage with this post.

“10 Pregnancy Massage Mythconceptions” – Sharon Livingstone

 

The #1 Secret And A Jedi Mind Trick To Make Planning Not Suck

“If you fail to plan, you are planning to fail” – Benjamin Franklin

Why am I so resistant to planning?!

I suppose, like most people, I’d rather be “doing” than planning. All that thinking. It doesn’t feel as rewarding as the instant satisfaction that comes from action: even if it’s answering and erasing emails.

And, yes, planning can be hard to do – documenting and prioritizing ideas. Estimating (aka guessing) how much time I need, versus how much time I have, to get work done can be tedious.

And, true confession time, because I see myself as a sort of free-wheeling over-achiever, writing down goals and planning them out, kills the spontaneity and introduces a level of accountability that can be anxiety making. It feels like a set-up for an annual performance review.

The worst – when I do put together a plan I feel good about, it’s out-of-date almost immediately. The sad truth:  plans are just that – plans. And, like life, they change. It’s the nature of the beast.

So… why do I persist?

Well, when I first started my coaching practice, I didn’t plan. And, a big product launch for my first group program, in plain language, tanked. It bombed. No registrations. Nada. Crickets.

As the launch was circling the drain, I realized what I’d done wrong. I hadn’t planned. Oh, I was smart enough to plan the daily tasks – the tactics. I engaged a great team, but, I hadn’t adequately thought through the bigger picture, strategic chunks of work. I missed accommodating for a big risk:  I’m not that well-known.

As a result, I hadn’t engaged people around me who are considerably better known, liked, and trusted than I am with (much) larger email lists who could have reached out to their audiences to vouch for and promote me. Now, facing disaster, it was too late in the timeline for them to effectively step in and bail me out.

Based on this experience, I realized planning and I had to come to terms – I had to find a way to get over my entrepreneurial ego and accountability anxiety.

My First Exercise In Planning

Here’s my secret (the jedi mind trick).

I sat quietly, closed my eyes, and pretended it was one year from today. I cast myself into the future and imagined I was having dinner with my best friend to celebrate my successes. I thought about what I’d tell her about my accomplishments. What had I achieved?  How did it feel?  What did I learn?  What changes did I make to get the amazing results I was so proud of?

When I opened my eyes, I had more clarity and excitement about my goals for the coming year and the process for achieving them.

But that wasn’t my only discovery.

The imagining exercise changed the story I tell myself about the planning process. I stopped thinking, “Ugh – planning, shoot me now.” Instead, I began asking myself, “How can I make the planning process easy and fun?”

For me, easy and fun means focus.

First, and this step is super important, I describe the qualities of my ideal client.  These are the only people I want to serve because they love what I do and I love working with them.  It’s not to say, I don’t work with other people, but these are the people I actively seek out.

The 4-Step formula I use to describe my ideal clients works like this: “I help people who are [characteristic #1] and [characteristic #2] to achieve [immediate outcome #1] so that they can achieve [big outcome].

For example, in a massage therapy practice, this formula could become: “I help people who are [active in sports] and [have sustained a sports-related injury] to [return to health] so that they can [play competitive hockey again].” Another example could be: “I help women who are [35-45] with [chronic back pain] to [provide stretching/strengthening exercises] so that [they can enjoy the freedom that comes with living pain-free].”

Once I’ve defined who I’d love to work with, I think about what I need from them.  For example, I love to work with people who are committed to doing the exercises I suggest, show up on time, happily pay my fee, and provide referrals.

Next, having identified my ideal client, I think about ways to reach out to them. And, of all the ways I identify, I focus on only 2-3 (instead of 5-6) Big Hairy Audacious Goals or opportunities that are exciting, inspiring, and challenging enough to carry me through the year.

If you love sports and you’d love to work with athletes who are challenged by sports injuries, you’re going to want to build relationships with people who work with them: coaches, trainers, and sport med doctors to establish your reputation and obtain referrals. You may even want to volunteer with sports teams to help players recover from, or mitigate injuries.

On the other hand, if your ideal clients are office workers who suffer from neck and lower back pain because they sit at desks all day working on computers, you may want to build relationships with corporate health and wellness coordinators and offer “lunch and learn” sessions or chair massages to build relationships with prospective clients.

Then, I identify what Brendon Burchard, a leading high-performance coach and best-selling author, calls the “needle movers” – the five big steps needed to move each goal forward. These five big moves, or chunks, can include many activities but they keep me from getting too lost in the details.

Photo by: image4you

Making Big Moves

If one of the opportunities I identified was “relationship building”, my five steps might be: identify relationships (successful massage therapists, doctors/chiropractors, team coaches, corporate health and wellness coordinators); speak with key people; identify opportunities (volunteering or speaking engagements); create an offer (e.g. a free consultation); and, develop support materials (e.g. a website or a Facebook page where people could learn more about the benefits of massage therapy, how to select a reputable massage therapist, and get to know, like, and trust me).

For example, when Burchard wanted to produce a best-selling book, he chunked the project down into five steps:  finish the book; cultivate an audience; get an agent; create an offer (e.g. an online promotion that could include a free webinar); and, develop a partnership-focused launch (i.e. engage people who are influencers with email lists to promote the book).

Planning Hack Alert!  Research.

In Burchard’s case, he researched and interviewed authors to learn the process they followed to attain best-seller status for their books. As you can imagine, this helped him benefit from their learnings, avoid mistakes, and build his network. In my case, I find ways to research the level of interest my clients have in the product(s) I’m considering launching to support each Big. Hairy. Audacious. Goal.

Flexibility is the last thing I now build into my planning process because… life happens. Once I decide on my chunks or my “needle-moving” five steps, I plan the first 3 months of my year carefully and I review how I’m doing each week so I can make adjustments. The rest of the year is loosely planned. I know what “chunk” – or big accomplishment – I want to focus on or complete every 3 months but the daily and weekly tasks remain to be fleshed out.

This level of flexibility is important.

I think many people get frustrated with planning because they try to get too detailed too quickly. They spend a lot of time – and do an amazing job – plotting out every little task. Then, circumstances change. They get overwhelmed at work, a task takes longer than anticipated and they get discouraged.

I leave room in my plan to “breathe”.

For example, Mondays are research and writing days. I set aside Friday or Sunday afternoons to reflect and readjust. I’ve learned to accept that planning is a fluid, ongoing process. Once you decide where you’re going, it requires a series of adjustments to stay on track – and that’s ok.

A final big change – I don’t check email (or Facebook) first thing in the morning anymore. Instead, I take a close look at my day and take Burchard’s “needle-moving” approach one step further by identifying the “needle-moving” activities that need to happen. Is there someone I need to call?  An article I must complete? In this way, my annual Big Hairy Audacious Goals get “baked in” to daily tasks, reviewed weekly, and assessed quarterly. Planning has become an ongoing review rather than a one-shot horror show that only takes place once a year – or under duress. And, it’s more engaging because it’s designed to be easy and fun.