A very interesting Facbook post that I stumbled upon

[Michael McMurray]

So this person that I was following on Facebook posted a quick blurb and a video of his “low back eval”. He has a good following so I read the blurb and was caught off guard, to say the least.

He states, “How I evaluate a low back. My evals take 15 mins – 5 mins of listening to their story, 5 for hands on and 5 for explanation. I rule out red flags and check myotomes and dermatomes and do a few special tests. The reason why i don’t check all the different muscle imbalances is over my career I have identified patterns in people with each Dx and developed rehab protocols to address these and that is literally ALL I DO in my clinic. I don’t need to check because everyone with each Dx has the same imbalances, I already know it is there. It works for me over 99% of the time.

I was curious and commented on the video. There are are two different topics I posted in the comments and he “answered” me very quickly.

Here is the link to the video (my comments are on a shared version of the video):
https://www.facebook.com/WheltonMRT/videos/vb.523859327789660/671416533387476/?type=2&theater

Attached is a screenshot of the conversation.

What do you think?
(I stopped following him after seeing this post and looking back at his other stuff)

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[Kristin Kelley]

Brandon
I don’t think there is much of a learning moment on this post other than poor patient management and that he is practicing poor PT overall. It’s sad that individuals such as these can capitalize on social medial to promote their garbage. Can you (and other residents) give an example of a biopsychosocial learning moment (post from a reputable clinician or research article) that has added to your arsenal of knowledge in treating this underlying component when dealing with good patient care?

[Michael McMurray]

Dr. Kelley
Maybe I should have placed a better follow up question at the end of my post, something along the lines of:

“With a lot of clinicians using social media to promote physical therapy and their treatment philosophies/styles as well as informing people of different diagnoses, interventions, manual techniques, etc. How do you filter out those who you do not deem to be reputable and therefore find better clinicians that you would follow and possibly utilize their information?”

With that being said, I think this post does indeed have a large learning moment. When searching the literature, we have to weed out poor quality articles. In the same light, as we search for fellow clinicians who are on social media, we should weed out those who are spreading poor quality information. I believe this also shows that, like you said, there is a lot of garbage out there and we need to be vigilant in promoting quality patient management and quality physical therapy while questioning and avoiding the promotion of said garbage.

Finally, here is an article from the archives of internal Medicine called “Words That Harm, Words That Heal. The article discusses how the words that we use affect our patients. A quote that I found to be intriguing was the following:

“Being ill inherently humbles and corrodes the sense of self, making patients vulnerable to the words of their physicians. Language reinforces the tendency of the patient to yield to the authority of the physician, and it is one way that physicians inadvertently distance themselves from patients. Rather than describe the complexity of a situation, physicians may use words that generate fear, anxiety, despair, or
hopelessness, thus silencing all further discussions. As a result, patients have more difficulty making intelligent decisions and becoming active participants in their care. Such intense emotions also dissipate hope and aggravate symptoms, and may adversely affect healing.”

The article talks about frightening metaphors, misunderstood jargon and technical language, reasons why physicians use words that may harm, and also language that heals. The article proposes four possible reasons why physicians may use words to harm and they are:
1) Medicine’s inherent uncertainty may prompt the use of words that harm.
2) Time pressure may also encourage physicians to curtail patients’ questions through use of words that harm.
3) Sometimes a caring physician may reach for alarmist language in order to convey a sense of urgency, thus hoping to ensure that his or her patient will comply with lifesaving recommendations.
4) It is also likely that physicians are so close to the language of medicine, to the specific words of their subspecialty, that they may no longer really hear the words that they use.

The author describes words of healing as “clear, precise meaning and with connotations that do not evoke dread in the patient…Healing language avoids words that intensify these emotions or destroy hope and any prospect for rational self-determination…language that adapts and responds to a patient’s experience.” Reading this definition of words of healing is a nice way to create a framework and allow us to create our own words of healing for our patients.

With that being said, I am going to leave one last quote found in this article about words that heal:

The essential feature of language that heals is empathic communication, eloquently described by Coulehan et al as language that aides the process of healing by bolstering patient’s strengths, validating their perspective, and teaching them how to grow to be more self-reliant.

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[Kyle Feldman]

Hey Brandon,

I have been going back and forth with him for a few months on Linkedin because he continues to say he gets everyone one of his patients better with his self named approach. I am trying to challange him to question the mechanisms but he continues to be motivated by the “doubters”, so the more we post, the more he is going to think he has unlocked the “magic treatment”.

He is trying to build a brand and sell himself as a Guru. His whole focus is on himself and because of this it appears his clinical reasoning has become skewed.
His model is very similar to a lot of chiropractors on social media. They find there niche and try to get patients to buy in.

When you read or watch something like this, it is easy to get frustrated and find the issues. I challange you to find the positives also and then with that, find what you would do differently. You cannot stop him but you can motivate others to do the right thing and share the higher level ways to think and treat.

Positives from this video-
-patients are getting relief (even if temporary and poor education),
-he is not telling them they are weak or frail,
-he is giving them exercises,
-he is using access treat and reassess.

What I learned-
-SIJ can be a mechanism of pain and doing some distraction and PA mobs may assist with this pain.
-I want to make sure when I am doing muscle testing I block the joint above to avoid compensation
-Bias is powerful and can help get patients better (if you say to a patient this has worked 100% of the time for 10 years, they are leaving knowing they are getting better)
-adding more differentials will help me to limit having a bias and keep my options open (a zebra is always a zebra if thats the only animal I know)
-Following up treatment with specific exercises will help support my diagnosis
-Proof is in the results

The only way a guy like this would change is if he did mentoring and was forced to use a different approach and get to the same results. He is going to live and die by the sword of his protocol because he created it and truly believes it is the “holy grail”.

I challange each of you to try to put yourself in the other persons shoes when you see things like this. Think about the way you thought before you began further education. You may have had the same bias just on a smaller scale.
After that, try to find the positives and learning experiences for self growth.

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