E 166 Placebo Empathy and Kindness to Halt Physician Burnout with Larry Benz DPT

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Episode one hundred and sixty six placebo empathy and kindness. The hall physician burnout. Justin tros claire. And today we’re here. Dr larry bins perspective. Two thousand seventeen and eighteen podcast awards nominated host and bestselling author on amazon as we get a behind the curtain. Look at all types of doctor and guests specialties. Let’s hear a doctor’s perspective Welcome back everybody. Thank you again for tuning into the show. And i hope you will leave a review so that other people can know what you’re learning from it as always if you’re looking for any of the books that are you can actually find them all on amazon. The china book the acupuncture book. Or the health reboot book two of which were amazon best-sellers for a little while. If you’re looking to impress other doctors to get referrals are looking to become more attractive to businesses that you can get speaking engagement. I encourage you to visit a doctor’s perspective dot net slash one sheet. So i could create one of those four you so that you can present a concise. Pdf one pager. That highlights your awesomeness. Lastly if you like the books at the guests have recommended go to doctors. Perspective dot net slash book list. All right there right on amazon clicked the link support the show in increase. Your knowledge in many many different areas. Are today dr larry. Bins is a docker physical therapy. He’s got a masters in business. He’s got a master’s in applied positive psychology. You don’t know what that was like. I didn’t you’ll learn but he wrote a book called call to care part of his thesis that he had to write. And we’re gonna cover things but like the bio psycho social aspect of care placebo. No cbo goal setting and really just how to become more empathetic and how to approach your patients so that you can avoid burnout be. The patient feels heard and likes the care and gets better results and of course it’s also good for business. Dr bins has been around for quite a while. He has multiple businesses. You lectures does a whole bunch of things for physical therapy so so glad to have him on. You’re going to really enjoy definitely learn something so if you want to check out the show notes they’ll also have the transcripts and everything mentioned in the show that’s important at a doctor’s perspective dot net slash one six six. Let’s go hashtag behind. The curtain live from germany and louisville kentucky. Hope said that right. Today’s guest is he’s got a lot of initials d. P. t. o. Ocs an nba. a map. Somebody’s under what they are. Some of them. I don’t but i do know. He’s the co founder of health and it is a network of physical therapists and occupational health. Care and they’re doing pretty much amazing things trying to reduce healthcare costs but they’re also trying to preserve the pureness of the patient. Doctor interaction and not just have a bunch of notes. Just so you know. He went to baylor and the university of pennsylvania. He wanted a prestigious award which is pretty awesome for physical therapists. And he has a. I want to say nonprofit but pretty. Here’s a nonprofit. Sustainable physical rehab clinic in haiti and his brand new book. Twenty twenty called call to care. So please welcome to the show. Dr larry bins. We’ll thank you. It’s a pleasure to be here and look forward to the conversation. I don’t know. I guess when the somebody’s accomplished like yourself to go all the way back to when you were maybe twenty or whatever like how did you get into physical therapy might be a bit longtime ago so it might be better to say what made you take it to the next level of an nba. Writing a book and a another countries type of clinic. So i guess gives the bag runabout absolutely so you know i was one of those Probably all kids that you know from the time. I was in about middle school. I knew i wanted to become a physical therapist because this you remember when you go to college you know. You’re sitting next to person either side of you. They think they know what they wanna do. Almost nobody in pursuing that path that i pursued a path. From the time i was middle school. I wanted to be a pt as very motivated by sports medicine. I’d been an athlete again injured as an athlete and so i had a firsthand exposure to pt. Worked in the summers places that had physical therapy from everything from skilled nursing to hospital inpatient and acute care so i had kind of a range of experiences and i want to become a pt. So what’s undergraduate at bowling green state university and then graduate school at that time for physical therapy was a masters degree from baylor eventually. Got my doctorate through university of massachusetts general hospital to help promotions and then some other degrees along the way the you know. Probably the addiction. I’ve had is that i love all things physical therapy so there is virtually no parts of it. I didn’t like from patient care to administration to quality to research to academics teaching. And so i’ve literally been Smitten by this bug for so many years. And that’s what got me the position i am.

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I was a co founder of a private practice and eventually Co founded another one up about three hundred fifty locations now with an education company that trains. Pt’s post professionally. So i’ve never gotten this academic bug out of me and at the same time we’ve comforted those onsite work injury management. You know one of the things. That’s a really hit me. Hard was military physical therapist army physical therapist this college so i had figured out a way to pay it back in the army at a program. They’re allowed me to you. Know be pt in payback at the same time so it worked well for for my game plan and one of the things that i was really really taken back by was how psychosocial factors the way you interacted with a patient Sometimes just saying something their bid some research at the time that said if you just call injured worker and tell them you care about them they have a high statiscal odds of coming back to work. i also found with lingering patients in the military go figure I had figured out you know what were the reasons for that. And they also had camped tacoma and other kinds of hysterical paralysis and so it always occurred to me that there was more than the physical aspect of care that was going on into the clinical outcome. Vote these so-called non-traditional clinical factors now in the research they comma therapeutic alliance but another kind bedside manner. If you watch. Marcus welby growing up. What do they have any research underpinnings behind them and it occurred to me that they absolutely do. You know we talk about In chronic pain now. The treatment of the bios cycle social factors. Which is that you know as human we have not only the biological underpinning but we have you know the psychological social attributes to deal with his well and so that drew me back to the university of pennsylvania and their masters and apply positive. Psychology course headed by dr marty. Seligman the you know founder co founder of the field of positive psychology. And what you find is there’s a lot of research it can be translated in healthcare. It’s didn’t even know existed. And so the documentation of that was my journey in that graduate program culminating in a in a thesis or capstone if you will parlayed that into the book called a care which i really try to document for clinicians you. What does the research have to say about how you listen to a patient. What is empathy and compassion. Does that matter. What is a high quality connection. What type of goals should you be for a patient what does peak and effect to what is capitalization me and as it turns out. The research has a lot to say especially about things like placebo in the cbo and If you adopt as it turns out if you adopt a lot of the transportable psychological concepts into healthcare three things happen one is your own out becomes far less. Because you’re listening more to the patient you have this sorta renewal of connection with a patient. Second thing is your care is better. Your is better. We’ve done research demonstrates that the emotional intelligence if you will or the so called soft Constructs around a practitioner lead to better clinical outcomes. They got better got back to work. Got physically able to run faster. Leap tall build buildings and then the third thing as a business guy. Let’s not forget. Business guy got an mba in a president. Ceo of a investor owned company. And it helps. Business is good for business. So you can differentiate yourself in the market place by having therapists. Physicians nurses who are truly called to care who truly listened to their patients. Better who understand empathy in the multi dimensions around that Who really get compassion. And at the end of the day It’s all things good. So that’s my journey in a nutshell. Why i can tell you when. I started getting tired. Tiredness sometimes at the end of the day. Or just like oh. This patient’s coming in again. Now what’s going on like getting better. It’s just trying to refocus. It’s like asking those questions like okay activities of daily living. What’s going on. I just kind of redoing the exam and then all of a sudden. I find myself being like all right. I’m reengaged i’m focused. Now i know exactly. I think okay where i should go to now with with therapy or the rehab or whatever so there’s got to be a lot to it i think a long time ago. I don’t know if it’s called emotional interview motivational interview. That’s the one that tight end. I mean if you’ve never heard that. I would recommend it that tie into some of the things that you’re talking about been pretty much emotionally available. Yeah absolutely so. Let me give you a couple of examples. There’s the concept of burnout now. Burnout is almost like a clinical diagnosis. It means that you’ve lost the zest for what you wanna do. You don’t feel like anything you do matters to the care of your patient. You’re you’re just not receiving any joy from what you’re doing that’s a very small percentage practitioners that get it but unfortunately it’s a growing percentage of practitioners but that’s different than what we refer to as dehumanisation and so you mentioned something at the end of the day and it’s very different for each person but we learned from call center research where you’re literally calling and asking questions asking for money.

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Whatever case may be that after a certain point you literally stop listening to the other person at the end is though there were three dimensional character. You start to dehumanize them you start act as though they’re two dimensional and by doing that. What you’re really doing is to humanize. We call that calcification and that effect happens to all of us. You know if you saw ten patients in a row might happen on the third patient to another therapist physician nurse practitioner. Whatever it might happen at the temptation. But it’s gonna happen. And so we teach our practitioners hotter recognized the symptoms of dehumanisation. And then we tell them they need to re calcified are- humanized very different each person for some person singing a five minute breathing break for some. It’s walking outside some. It’s taking a swig literally a couple of seconds minutes or whatever away and drinking a cup of coffee. It is different and we have to do that throughout the day. So you have to humanize throughout the day or at some point you’re gonna calcified in. That patient is no longer gonna be mrs jones. It’s going to be mrs jones going to be the knee patient if you will. So we have to differentiate between those two but the interesting thing is the practitioners that make time for high quality connections empathy compassion perspective taking cognitive taking. They actually have less out. So there is an antidote. We fed up with paperwork spending way too much time on you know The the regulatory side of the business for healthcare but at the same time we can truly the antidote if you will of burn out really is empathy and compassion interesting. You were talking about this Paperwork and all that said documentation and especially when you’re doing physical therapy you know. They really wanna know everything that you’re doing but before we jump into that piece made me think of how long it takes a doctor to interrupt their patient when their initial exam. What’s wrong with you and it’s like. I think there’s a difference. We interrupting the find out more information versus all right. Shut up. i understand. You’ve got headaches. I don’t care anymore. I think that’s a big difference between wait. Hang on a second. Go back a little bit. Explain that a little bit more you know. Go into more detail but anyway the point being what have you found. How long does the patient talk before they really are. Stop talking. then you can ask what else. Yeah there are certain studies that show that it’s going to be a short thirty eight seconds. You know there are other studies. That show You know the physician seldom give good instructions to a patient if you ask a physician. How much time did you spend with that patient. They over estimated based on film studies and things that go on what we try to tell our practitioners and what we teach in what is in. The book is a concept around emotional handling so what tends to happen. Is you get a patient in physical therapy with your shoulder. Back beijing okay. Where’d you get hurt. How long did you get hurt. You know it’d be already history being hurt before it’s all these who what went away kinds of things which need of course but how often do we sit back and ask a patient. How do they feel about it. How you know what. What were they thinking when they got hurt and really not connecting them on any other level than an objective level. We have to connect with patients on both an objective and subjective level as well and You know really. The basis of empathy is recognizing that each patient has their own truth. it doesn’t have to jive with our experience. It doesn’t have to jive even with our understanding of organic. You know anatomy and physiology. What it has to do we have to recognize. It’s their truth. Net is a court empathy. On top of that we have to be able to use our experience sharing anything that has happened in our life to be able to relate to that patient. And when you get into this mode of objectify who what when where why you really shut off to very very important things with patient one. Is you shut off your ability to connect with them on us experience sharing basis in the secondly you give the principal power and when patients feel that they’re answering to a powerful character there is a complete disconnection and so the research shows that even leads to more and more cascading of lack of empathy. Lack compassion unless outcomes for everybody. So it’s not good for the system if you will this body language matter marine some books back in my earlier chiropractic years. It’s because you know you’re young. You don’t know what you’re doing. And then you’re chiropractors structural of contracts where you’re like okay. I need to build report real quick Very very good point. In fact that’s been the issue rotella during cova that’s been very challenging so three at least three things matter your tone of voice that’s pretty obvious your facial expressions that’s pretty obvious and then your body positions your movement you’re moving of your hands your posture and everything else and receptor.

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The patient picks up on all of those. When you’re on a telehealth is it or a television. I’m sorry telephone type of a visit or texting type of visit. You lose at least two if not all three of those and what we know from texting and communicating and email. That you is that not only do you lose the tone of voice you infer you make up stories around it. And that’s even bad further back from everybody but you’re absolutely right and so what we have to do is when when you have to virtually visit because a covert or other kinds of things be sensitive tuned to the fact that your body posture. Your tone of voice in your facial expressions. Make a huge difference. Okay everyone’s wearing a mask at the clinic in that kind of switched over to like the plastic visor and for me. It made a big difference. Because i’m trying to crack a joke. They’re already nervous and they can’t even tell that i’m smiling or whatever. I’m just like situated the motions and the eyebrows but once switched. I like okay. Everybody kind of more calm and more trusting relaxed and able to understand no isn’t a serious condition but at the same time like cancer. You’re not gonna die. You don’t need chemo but we can. We can help your back pain this absolutely okay. Excessive documentation our electric records really helping speed things along so we’re not so much time on it. Or what all these process improvement measures Having the document more really demonstrate that they rob the patient of the time with the practitioner. That’s that’s the number one point is you are not substituting time for time. You’re taking time away from a patient. You know in the us government funded insurance. Vis-a-vis medicare medicaid. The regulations are so who’s ing that it takes fifteen to twenty minutes more paperwork and Those patients and they get robbed than process so yes. It does. Initially every visit on the initial visit in particular. Take fifteen to twenty five extra minutes and then on subsequent Visits they still take longer than a conventional visit but the the real question is do they really add any value to the interaction. Answer is now and so you know everything from coding. To documenting to gaming the system again is bad for everybody most notably the patient so yes excessive paperwork documentation time is not good for the patient and unfortunately it’s not good for the practitioner. It is the number one reason cited for burnt out by foundation Study on physicians in practice that excessive paperwork documentation time is really really a a bad ward for the american health system. That’s for sure. Do you think has something to do with. Maybe they’re older. Docs in the mercedes eighties. When you can get paid twenty bucks to put an ice pack on somebody and as the years go by. they’re getting more and more disgruntled and getting paid less than i gotta do more paperwork and maybe they just haven’t taken a good documentation seminar to know how to meet the prt instead of their paperwork so it could still be click buttons of five things to do with a symmetry or range of motion. So it’s just quicker easier. He don’t get audited. Our failure audit one day. Yeah i i’m sure. There’s some component that efficiency forcing everybody to any of them. Are you know the flip side of that. Is that every insurance has these various requirements that are superimposed. On things that you’re already doing so for meditation. I need to do this for blue. Cross bache any. Do this for workers compensation patient. I need to do this. We have what. I refer to as a golf shirt problem. I have a rule that says. If i buy golf shirt or get win at a tournament i have to replace it with another golf shirt in other words. Have to throw one away or donate will but what we do in healthcare as we add golf shirts but we don’t take any way and so it really is the compound or the accretive effects of all of these things interacting which is Which which which can lead to burn out. I mean you you raise a very good point as practitioners we need to be better trained and be taught a little bit more efficiency and balance that out but at the same time medical providers. You don’t go to school. Become the best at compliance the best documentation the paperwork. You work with patients alpine up. I don’t want to be the best. Getting fined who the last five hundred visits were wrong and now oh money even though we both know. The care was still valid in chiropractic lane. You’ve got people that are trying to thirty visits and things like that and you don’t even have the documentation to prove twelve. That’s a problem in lots of different matters. So i could see why they would want the documentations. That’s the only proof they have that something happened didn’t happen etc. What are your thoughts on. Assessments like the roland morris. Born mouth with your thoughts. So i assume you’re speaking of sort of validation instruments.

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Then you know oswestry for the best exactly morris on. I think they’re great. You know what we’ve learned about outcome studies at least in different dimension. So i’ll give you an example. So for many years we were trying to use a standardized health outcome measure like the sf twelve. Thirty six. Basically said you have all these factors that lead into your health outcome and so you looked at all. The health related outcome quality life scores as it turns out at least physical therapy and chiropractic and others is that you know we make these impairments better. So the impairment rating impairment assessment tools. You know like oswestry neck. Index lysol rollers. Those stood up the time much greater than the health related. Hr q. l. instruments. Thank goodness for that. Because they’re more intuitive practitioner. They can explain it better to the patient and That’s what we do. You know the number of visits that we see patients we don’t we don’t You know as a t. i don’t solve their diabetes. I help them with their low back pain. So you’ve fundamentally believe that. The impairment based Once for those who are in sort of the physical medicine areas of healthcare are have been proven out by the research and thank goodness. It makes sense. What about placebo. How can we use it unethical way but in a way that it can benefit the patient until they get better results are like. What are you finding with placebo because it has a place. It absolutely does so. Let’s examine it a little bit. And the first miss about placebos you know people say well you know it’s all in your head. It’s not a physiological thing. Well it’s absolutely not true. They’ve demonstrated over and over again that the placebo effect is a real effect. And we use it every day of our life when we tell a young kid that he just it’s menu great. Keep it up keep it up. We are in effect trying to influence a placebo effect. One of the one of the ways. I do it is when i teach a class. There be a certain number of students. I’ll say i do watch you know at the end of this class. We’re going to have a quiz for those who get the top five online. They’re going to get a prize right as it turns out that was all. Bs there’s no prize. There’s no quiz but we know that those students will retain more and more information in fact. Placebo is so powerful. Could you tell them. It’s a placebo. Mill still work like for example. I could say we’re gonna have a cuisine prize and by the way. This is a placebo. When i say all this do all this you will. You will actually retain more so you can even tell patients at times that it’s the cbo networks so i i like to say it. Placebo is part of life. We use it in all other aspects of it. Why would we tried to influence it in healthcare not to the detriment of other evidence based interventions that work but to the benefit of it and so words of encouragement words mean things how we influence As a big big part of the so-called placebo effect Don’t advocate for giving patients medication. That is not a real fat but in terms of our words of encouragement and how we go about setting patients. It’s absolutely indicated that we we try to mitigate a no siebel effects and we try to influence a placebo effect. And it’s just as important mitigated no cbo fact if you tell patients how something’s going to hurt we know it’s going to hurt more if we tell them. Adverse effects of a certain intervention or a pharmacological agent a statistical number of them will exhibit those. You know sort of Without having if you hadn’t used those words or those those terms of influence that good or bad well one of the examples we like. I think germany actually where you do not have the patience given the option of knowing what the adverse effects are they can sign a release waiver because again the no cbo fact certain numbers of them are going to have the have these adverse effects even if only because you told them about him as it happens dry needling you know we use dry. Needling and trigger point injections and things like that and the way you speak to a patient about that procedure has a lot to do with how they experience it so you have to be careful about it. So yeah a basic underlying Foundation of no siebel is key for any health care practitioner. We’ll before we move on. Is there anything else that you would. I have a couple of standard questions before we interview. Is there anything that we missed that you would want to chat about. We haven’t chatted yet. Yeah the only thing i would say is that when we use the words empathy and compassion. We have to be very very careful. Because empathy is a multidimensional construct. It’s got about four aspects to it. You have perspective taking which is so called cognitive aspect. You know walking in somebody’s shoes. That’s that’s perspective taking. You have sort of the emotional. The affect of part of of empathy.

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And that’s the emotional sharing in relying on your experience but then there are other components like one for example that were very good at it in healthcare is pro social concern meaning. We’re motivated to get a patient better. Unfortunately sometimes our empathy is only around pro social concern. We wanna help somebody so we hurry that we have to have the other components of empathy is well then lastly as the whole notion of non judgment so without all four of them compassion rightly so gets a lot of attention but compassion is one of the subsets of empathy. You’re motivated. You’re inspired to help the patient. So you can’t really divorce empathy from compassion because compassion is all compassionate empathy. But not all empathy is compassion. So i’ll do differentiate for for folks those concepts so glad you ask thank you now you bet so your helper since you the link of questions but here it is very simple. A lot of people have multiple businesses like yourself and then are on their second marriages third. Or whatever. So i always ask. Is there any hints to keep the love alive in a relationship so that you stay happy in that room of life well know. I’m a big believer in novelty. And i’m a big believer in newness and keeping things fresh and being a envir- of that my muscle big believer that you have to watch your own cognitive biases and many of them are the stories. You tell yourself about things the email that you read or the message you re were you interpret for yourself and you make all these counterfactual all of these things up and so the only antidote. I know that curiosity and curiosity really really. In fact people don’t like the word empathy. I tell them be curious and always curious to a point of your questioning things and really trying to keep non judgement away. you know. Judgement is the most addictive drug that we ever have created. And and for good thing you know we we rely on judgment when we have to make assessments. We have to think things through but it also can harm us if constantly were making judgments about somebody or something when we don’t need to in part of apathy is trying to turn off the judgement so part of who we tend to judge. The most as we get older is those who are closest to us which is kinda sad when you think about it and we usually have a negative view into. Yeah exactly so noon. It i think the only antidotes to that are newness curiosity in to try as best. You can to shut the judgment Train on off. And if you can’t take a few deep breaths and you’ll get over it All right how. How do we unplug so we can take more vacation Well i call it being purposely irresponsible. I consider that skill like anything else. And you have to develop a skill to just be irresponsible and a purposeful way toward your on leisure. Time your own health. Your own emotional fitness absolutely a big believer in it practice. Good lastly in your own book definitely pitch. That gives us a web. Page any books or podcasts. that you’re consistently are recommending. Always recommend malcolm glad wells podcast. Because i learned tremendous amount. Just absolutely love it. I read the book bias earlier this year. I thought it was a tremendous. Helen reese has written a book about empathy that i thought was also extremely good. Just got done reading a book. This morning actually called them always take never take yes for an answer Which i thought was more of a busy kind of a book by a very profound business guy who has a acronym called. Aw authenticity i think. Warm energy and and So it’s a very very good one is well. I tried to do two books. A amount through a combination of direct reading and listening on all the different accoutrements of it. But i tend to lean more towards the sciences and really more towards the psychological literature. The new smart behaviors for example is a tremendous book. Read a couple of years ago So yeah those are those are the ones that come to mind that i think malcolm he a run a first name basis with me malcolm where a lot of talk about his book you know ten thousand hours and this and that and they always leave out the last piece it’s with a mentor with coach someone to correct you in those ten thousand hours and people don’t hear about that a lot of times and it’s so important i talk about that a little bit in the book under us ericsson’s deliberate practice deliberate practice which is wet malcolm was writing about ’cause you know on a first name basis with a to obviously the part that’s really critical about that as you say is feedback trusted feedback failing often to go further is really really critical and i related to the very skills that we’ve talked about in this podcast all these cognitive skills emotional intelligence how you manage yourself and others empathy compassion high quality connections empathetic listening.

00:30:05 – 00:33:53

All of those are skills that you can only develop through deliberate practice which means you have to have either a mentor or a trusted ally. It’s giving you feedback in those skills are a lot harder to learn than our hands on skills whether you’re doing a manipulation or some type of test. Those hand skills are really really difficult but you know what they’re not as difficult as the cognitive skills so approach him in a very similar way. Love it And how can people contact you or what web pages do you want to promote. So we have a webpage called to care. Book dot com. That’s called a cure. Book dot com. I’m physical therapy on twitter And the name of our company’s website is go can fluent dot com. And i’m larry at physical therapist dot com very easy to Remember so they can get to me in any one of those Either one of those ways all be in the show notes as well are the transcript. Both of those actually really. Thank you for being on the show and it’s been great. I’m to edit and put this podcast out. Awesome always always enjoyed talking. All things called icare so thank you very much for having me. Another great interview has ended. While you’re on your phone. Click that review but right up a nice review for me five stars if you could as everyone says industry. It’ll help other people find us when we have enough rankings not to mention i’ll mention you and your review on upcoming episode if you follow me on instagram you only get one link. So i use a link tree and so it’s a doctor’s perspective dot net slash links with an s. And that’s going give you everything you need to know. The top episodes twenty seventeen in two thousand eighteen. The podiatrist series dinner acupuncture series holiday. Twenty seventeen financial series. How to write a review how to support the show like buying a cup of coffee getting swag like shirts. The today’s choices tomorrow’s health book. That’s the blueprints for better health. Exercise picking food correctly and financial. And then of course bundle packs which can get you know. Acupuncture book forty common conditions including the electric puncture pin at great deal. The resources page has some of the products that i like. It’s a phillies style. So if you buy something from them. I get a piece of that just like on the pages if you buy a book from clicking that link i get a small piece of that as well so i really appreciate that things like screen castle matic pure. Vpn missing ladder j. lab speakers pro alone edge or hog grips once again. If you do need any coaching on how to improve your bloodwork drop weight and the pro loan diet fast mimicking diet five they plan. Let me know as well as if you just need some coaching whether it’s health whether it’s marketing whether you need some practice growth etc reach out facebook. Justin tros claire emcee of course at a doctor’s perspective dot net on the top right. You got all the social media icons that you can imagine. Click your favorite and reach out. Thank you so much for tuning in. Please tell a friend pass it along. You can go to dot net slash. Listen it’s just that easy it will open up right in your app. And don’t forget i appreciate you. Listen critically think and integrate see on the minnie’s odes on thursdays and saturdays. Hope you’re enjoying those. I’m definitely having fun. Summarizing the podcast and less than ten minutes for you. You get the nuggets without having to waste your time. Have a great week. Audibles day shots and sit down.