What If Caring More Protects You From Burnout?

WEBVTT

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And oh, sorry,

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just behind the scenes of how today is

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going to roll, we will be recording video.

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Luckily, not me or Jimmy.

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This will be y'all,

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but we'll be using some of those video

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segments to be able to chop and change

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some social content.

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So with your permission,

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as long as that's all good, Tim,

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we intend to use those for just promotion

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of the episode.

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Got it.

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Very good.

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So just to confirm that you're in the

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background,

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Larry and I are just going to have

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a conversation and then when we're done,

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we're good.

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Okay.

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We'll be invisible.

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All right.

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The only thing I'll say is in terms

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of production,

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once we're done and I hit stop,

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just hang tight because this will finalize

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the audio.

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We've done this before.

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All right.

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Betsy, anything else?

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There you go.

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Well,

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because this is kind of a non-traditional

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format,

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would you like for us to be a

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little bit more involved with prompting

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some of the questions or you both kind

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of have briefs and just want to let

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it roll from there?

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What would you feel more comfortable with?

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I'm fine just letting it roll,

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but if there's, when it's like, hey,

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we should have asked this, you know,

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grab us at the end,

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then we'll have that conversation,

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and then you can insert it wherever.

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Yeah, we can clean that up.

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And there's also a private chat on the

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right, so if we wanted to do something,

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we can do that, Betsy.

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That's like the producer's, you know,

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earphone thing.

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Okay, wonderful.

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Jimmy and I will buzz away there.

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Let's get teed up just to hop right

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in,

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and if we're all on board with the

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brief,

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we can

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We can basically read from that, Tim,

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if that's what you feel comfortable with.

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All right, Tim,

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just wait till we're out of here.

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And to your show, my man,

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you're in charge.

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Larry, man, great to see you.

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Great to see you.

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How you been?

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I've been great, Tim.

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I understand you've taken up golf.

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What's that all about?

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Well, I mean, everybody I tell that to,

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like, Flynn, you're golfing?

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And it's like, you know,

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you get to that age,

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you're supposed to try something

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incredibly hard because of, you know,

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we'll talk about neurology and whatnot

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throughout the episode.

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It's incredibly freaking hard.

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So, yes, I have taken up golf.

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It sure is.

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It sure is, yeah.

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Indeed.

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Well, thanks for jumping on.

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This is going to be fun, Larry.

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But before we get started,

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I don't get opportunities to take a little

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memory lane journey with you.

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So I would like to, you know...

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Ask, you know,

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it's been about a quarter century and

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what's your memories of how this EIM thing

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started and the evolution?

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What's your origins to our origin story?

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Yeah, you know,

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it has been twenty plus years and,

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you know,

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founding or co-founding it together with

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with John Childs, you know, really,

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I think has had an incredible impact on

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the profession.

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I think it has moved the profession

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forward.

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I mean, people don't remember,

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but we were calling it flipped education

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back then.

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And we were sending narrated PowerPoints

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to folks and say, when you come in,

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we're going to go from two days to

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a day and a half and we're going

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to only do lab and

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You know,

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then the pandemic hit and everybody and

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their mother was calling us to see how

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you do this, because up till then,

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every every academic program said never,

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ever,

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ever over my dead body will I do

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virtual or online education.

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And so I think we had a pretty

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significant impact then.

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But I think from a, you know,

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sort of an incentive standpoint or a

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rationale of why we tried

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to what we tried to do at EIM

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was bring evidence and the evidence,

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not just on the clinical hands-on skills,

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which was largely brought by you and your

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colleagues,

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but also evidence around the soft skills

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and the non-clinical factors of clinical

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success.

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And really a good portion of that is

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what

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what began um call to care and other

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types of things and you and i go

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back to our military days and we certainly

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knew there were other factors than how

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good our hands-on skills were whether or

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not a soldier was going to go back

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to uh to the field so those are

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my best memories we also had a lot

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of good time i remember one of our

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first

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Things we gave out was underwear.

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We had ordered hundreds and hundreds of

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pair of underwear that are still sitting

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in some warehouse somewhere.

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Who knows,

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maybe they went and got shipped overseas

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or something because our message was you

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can teach and learn while you're sitting

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in your underwear.

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That's what I remember.

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I do remember, indeed.

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Well, I got to say,

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I was super excited to hear you're going

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to put out a second edition of Call

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to Care.

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And I mean, my first reaction was,

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that's amazing.

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And it's just,

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I personally feel it's so necessary.

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But what was the impetus and why now?

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you know it's it's interesting because if

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you really think about it you know your

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goals when you write a book are to

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actually try to move the needle and

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unfortunately i don't think the needle

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really moved from the first book so it's

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going to take going to take some more

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effort and it was written at the peak

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of the pandemic you know it came out

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in

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And a lot of things changed.

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And then you had this post pandemic

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hiccups.

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You know, you had shortages,

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mass shortages in PT,

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mass shortages in dental,

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mass shortages in dental hygienists,

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PT assistants.

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You had burnout and you had really the

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impacts of burnout.

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And then the evidence has moved a bit.

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You know,

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there's now different ways that people

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look at empathy that we're looking at it

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then.

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And so the publisher,

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really about a year or so ago,

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came to me and said, you know,

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this needs to be updated.

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I'm sure there's new evidence and there's

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new interventions.

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And so, yes,

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there's a lot of new psychological

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interventions.

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There's one I love called implementation

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intention,

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moral injury and how it causes burnout and

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how we look at burnout differently today

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than we did in two thousand twenty.

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various things about mindfulness as you're

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well aware of.

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And so the idea was to upgrade or

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update its current version,

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but then along the way,

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a lot of other new content.

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So it ended up being about twenty five

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percent larger book with a lot of new

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chapters.

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And then along that way,

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I was working in dental.

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And I'm like, man,

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some of my dental friends are like,

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you need to have this in a dental

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version.

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Well, that's easy.

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I'll just change the vignettes and I'll

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slap dentist and dental hygienist on it.

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And then you'd come to find out,

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my goodness,

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dentistry is massively different.

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You have this hygiene hygienist, you know,

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dentist relationship.

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Dentist only sees a patient for short

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minutes.

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They're in a power position.

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You got an operatory, you got smells,

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you got more nocebo and placebo than I've

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ever seen in any typical healthcare

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environment.

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And so I had to then sit down

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and look at the evidence around dental.

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So I was writing kind of both books

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hand in hand for a while and it

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became a lot of fun and a big

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challenge.

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And, you know,

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thank God that the hard part of all

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that's over,

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but that was one of the reasons.

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It's interesting.

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You bring it up and we'll,

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we'll talk more about, you know,

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what you're doing now, but this,

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this idea, you know,

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I was at my dentist three weeks ago

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and, you know,

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we'd moved down South from up North and

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in Fort Collins,

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we're down more Southwest of Denver,

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but it's,

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Anyway, I just really love this practice.

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And Sue goes as well.

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And we really dig this practice.

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Everybody's so positive from the moment we

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walk in the door.

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And it brings me to what you were

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so far ahead of the game back in

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front office aspects of healthcare.

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And what you know,

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I assume in the second edition,

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you still like dial up the importance of

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the environment.

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A hundred percent.

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It's more important now than it's ever

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been.

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You know,

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if you think about where we're at today,

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we're just several years ago,

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we didn't have internet.

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We didn't have text messaging.

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We didn't have social media.

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We didn't have all these noise and

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distractions.

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And so what that's done is it's sensitized

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people to experience.

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And so you better have an environment

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where you're leaving an indelible effect

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on their impression,

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their first impression,

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their ongoing impression.

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You know, Jim Nesbitt said many years ago,

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when you have high tech,

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you need high touch.

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Boy,

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can anything be more high touch now

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because of the advent of virtual and

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telehealth?

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But then AI came into the picture and

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everybody sees that as a solution.

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I go back on you and I are

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a little bit older now.

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We remember when the Internet was going to

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change health care.

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And before that,

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we when the Clinton administration was

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going to change health care.

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And before that,

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HMOs were going to change health care.

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So these are, you know,

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different different bottles of wine,

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same wine, different products.

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different cover on it.

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And it's absolutely more experiential now

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than ever.

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And healthcare has become a little bit

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more transactional.

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People do searches now.

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People run scenarios on their AI.

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They come in with the answers.

00:08:44.071 --> 00:08:47.231
They use bots to schedule for them.

00:08:48.432 --> 00:08:51.253
And so that really changes the way you

00:08:51.293 --> 00:08:52.374
have to think about it.

00:08:52.594 --> 00:08:53.693
At the same time,

00:08:54.033 --> 00:08:55.715
providers are trying to cut their costs.

00:08:56.455 --> 00:08:58.056
And so you do that through technology,

00:08:58.096 --> 00:08:58.316
right?

00:08:58.816 --> 00:09:00.277
And so as they're cutting their costs,

00:09:00.317 --> 00:09:02.217
what is left in the experience side of

00:09:02.258 --> 00:09:04.860
things and matching them up is to be

00:09:04.879 --> 00:09:06.580
the most effective is the long-term.

00:09:06.620 --> 00:09:10.001
But the great news is your number one

00:09:10.062 --> 00:09:11.842
indicator of your future patients are

00:09:11.883 --> 00:09:13.183
still your current patients.

00:09:13.663 --> 00:09:14.784
and their friends, family,

00:09:14.825 --> 00:09:15.764
and former patients.

00:09:15.804 --> 00:09:18.006
And so that relationship side of it is

00:09:18.106 --> 00:09:20.048
never more important in an environment

00:09:20.067 --> 00:09:21.509
where the transaction side,

00:09:21.889 --> 00:09:23.470
particularly in dentistry, by the way,

00:09:23.509 --> 00:09:25.431
but healthcare going that way as well.

00:09:25.812 --> 00:09:26.491
And I hate that,

00:09:26.552 --> 00:09:29.033
but the reality is those providers who set

00:09:29.073 --> 00:09:31.455
themselves up by relationship-oriented

00:09:31.495 --> 00:09:32.216
practices,

00:09:32.816 --> 00:09:34.437
not just the experience of the

00:09:34.456 --> 00:09:34.996
environment,

00:09:35.017 --> 00:09:37.698
but the experience of the care are going

00:09:37.719 --> 00:09:38.840
to be the winners long-term.

00:09:40.160 --> 00:09:40.660
Indeed.

00:09:41.201 --> 00:09:42.023
Well, you know,

00:09:42.462 --> 00:09:44.144
I'd like to pivot a little bit because

00:09:45.666 --> 00:09:47.607
this book from, you know, looking through,

00:09:47.648 --> 00:09:48.509
and by the way, it's been,

00:09:48.609 --> 00:09:51.532
it's just a pleasure to read.

00:09:52.373 --> 00:09:55.416
But it distinguishes moral injury from

00:09:55.475 --> 00:09:57.857
burnout for the first time, I think.

00:09:57.938 --> 00:10:00.740
And why does that distinction matter?

00:10:00.760 --> 00:10:02.143
And why does it really matter now?

00:10:03.774 --> 00:10:04.195
Yeah.

00:10:04.274 --> 00:10:07.515
So if you think about it burnout is

00:10:07.576 --> 00:10:10.136
sort of curdled into moral injury.

00:10:10.456 --> 00:10:12.897
And the interesting thing about, you know,

00:10:12.917 --> 00:10:16.317
the evidence is that the evidence around

00:10:16.378 --> 00:10:17.658
moral injury and I'll,

00:10:17.678 --> 00:10:18.619
I'll do a little deeper,

00:10:19.259 --> 00:10:22.840
you know dive on that in a second,

00:10:23.139 --> 00:10:24.460
but that really didn't start to,

00:10:24.480 --> 00:10:26.140
it kind of was another one of these

00:10:26.160 --> 00:10:27.400
things that kind of came out of COVID

00:10:27.421 --> 00:10:27.821
a little bit.

00:10:27.841 --> 00:10:29.442
You started reading about moral injury,

00:10:29.501 --> 00:10:30.601
maybe in the late nineties,

00:10:31.081 --> 00:10:33.443
and it became more and you know the

00:10:33.504 --> 00:10:36.284
term really came out of uh wendy dean

00:10:36.304 --> 00:10:38.287
brought this incredible book that i really

00:10:38.326 --> 00:10:40.268
highly recommend this to folks we'll put

00:10:40.307 --> 00:10:42.408
it in the show notes um then she

00:10:42.448 --> 00:10:43.750
started dealing with this i think in

00:10:43.769 --> 00:10:46.751
around but the idea behind all this is

00:10:46.831 --> 00:10:50.875
it's you carry this wound from knowing you

00:10:50.914 --> 00:10:52.255
know what you want to do for the

00:10:52.336 --> 00:10:54.037
patient but the system

00:10:55.164 --> 00:10:57.304
because of its constraints doesn't allow

00:10:57.346 --> 00:10:59.346
you to do what you want to do.

00:10:59.405 --> 00:11:00.865
It's sort of around control.

00:11:01.426 --> 00:11:02.886
And so the, so it comes with,

00:11:02.927 --> 00:11:03.167
you know,

00:11:03.527 --> 00:11:05.206
the reframe is because it moves the

00:11:05.246 --> 00:11:06.988
responsibility off of the clinician

00:11:07.008 --> 00:11:09.408
shoulders and onto a system where it

00:11:09.447 --> 00:11:10.568
frankly belongs.

00:11:11.448 --> 00:11:13.129
You can't yoga your way out of this.

00:11:13.168 --> 00:11:15.830
And so it helps us understand burnout

00:11:15.990 --> 00:11:17.470
because burnout has always been an

00:11:17.610 --> 00:11:18.289
internal thing.

00:11:18.389 --> 00:11:19.311
Oh, you're working too hard.

00:11:19.331 --> 00:11:20.591
You're not taking enough mindfulness

00:11:20.630 --> 00:11:20.990
breaths.

00:11:21.591 --> 00:11:23.371
You came into the clinic being burned out.

00:11:23.672 --> 00:11:26.312
The system depersonalized you to where,

00:11:26.553 --> 00:11:29.595
honestly, the impetus and the blame,

00:11:29.634 --> 00:11:30.855
if you will, ought to be,

00:11:30.916 --> 00:11:32.636
which is external to you.

00:11:32.736 --> 00:11:34.618
Now, the reality is to calm burnout,

00:11:34.638 --> 00:11:35.758
you have to deal with both.

00:11:36.317 --> 00:11:38.458
But you're going to continue to see and

00:11:38.499 --> 00:11:40.681
hear more about this connection and the

00:11:40.760 --> 00:11:41.100
trigger.

00:11:42.181 --> 00:11:42.821
And just remember,

00:11:42.880 --> 00:11:44.981
burnout blames the clinician,

00:11:45.022 --> 00:11:46.743
moral injury blames the system.

00:11:47.322 --> 00:11:49.604
And the reality is you have to deal

00:11:49.624 --> 00:11:50.745
with both if you're going to kind of

00:11:50.784 --> 00:11:53.025
want to weave in and out of a

00:11:53.066 --> 00:11:54.086
broken system, frankly.

00:11:55.082 --> 00:11:57.105
Well, following up on that, you know,

00:11:57.745 --> 00:11:59.446
the new research you present in this

00:11:59.706 --> 00:12:00.927
edition,

00:12:01.467 --> 00:12:05.010
it suggests empathy protects providers

00:12:05.171 --> 00:12:07.613
from burnout rather than draining them.

00:12:08.413 --> 00:12:11.095
And you talk about the, quote,

00:12:11.195 --> 00:12:13.096
exquisite empathy finding.

00:12:13.756 --> 00:12:14.638
Does that surprise you?

00:12:15.798 --> 00:12:16.960
You know, honestly, it did,

00:12:17.000 --> 00:12:19.003
because for a while, as you recall,

00:12:19.062 --> 00:12:22.046
we had a lot of teachings around empathy.

00:12:22.386 --> 00:12:24.229
And I'm real proud to say the

00:12:24.269 --> 00:12:25.590
multidimensional construct.

00:12:25.669 --> 00:12:27.773
I really was on a soapbox around this

00:12:27.812 --> 00:12:28.212
for a long,

00:12:28.253 --> 00:12:30.775
long period of time and love it and

00:12:30.816 --> 00:12:31.736
still believe in it.

00:12:32.357 --> 00:12:34.200
But there then became a little bit of

00:12:34.279 --> 00:12:34.639
evidence,

00:12:34.679 --> 00:12:36.841
but really more academia coming out and

00:12:36.861 --> 00:12:37.543
saying, well,

00:12:37.623 --> 00:12:39.804
it's those who are overly empathetic that

00:12:39.825 --> 00:12:41.966
are burning out and they're pointing to

00:12:42.287 --> 00:12:44.448
proxy and correlations rather than

00:12:44.509 --> 00:12:45.230
causality.

00:12:45.610 --> 00:12:46.812
Well, as it turns out,

00:12:48.273 --> 00:12:49.955
because I was somewhat of got a little

00:12:49.975 --> 00:12:52.856
bit absorbed in that opposite story and so

00:12:52.897 --> 00:12:53.577
did healthcare.

00:12:53.618 --> 00:12:55.620
And so we were taught compassion fatigue,

00:12:55.639 --> 00:12:56.380
that empathy is a

00:12:57.000 --> 00:12:57.182
you know,

00:12:57.201 --> 00:12:59.043
kind of a finite tank rather than a

00:12:59.104 --> 00:12:59.504
muscle.

00:13:00.004 --> 00:13:01.426
And that the more you feel with patients,

00:13:01.466 --> 00:13:02.847
the faster you'll burn out.

00:13:02.888 --> 00:13:04.929
So you protect yourself by detachment,

00:13:04.970 --> 00:13:05.169
right?

00:13:05.190 --> 00:13:06.772
Remember when we were all trying to detach

00:13:06.792 --> 00:13:07.533
from our patients.

00:13:07.972 --> 00:13:08.953
And that, as it turns out,

00:13:08.994 --> 00:13:09.634
is a joke.

00:13:09.674 --> 00:13:10.796
And then, you know,

00:13:10.816 --> 00:13:12.618
some researchers by the name of Harrison,

00:13:12.658 --> 00:13:15.221
and I think Westwood flipped it entirely,

00:13:15.260 --> 00:13:16.422
and they studied this thing.

00:13:17.043 --> 00:13:17.903
extensively,

00:13:17.964 --> 00:13:19.724
particularly about clinicians,

00:13:19.845 --> 00:13:21.085
the ones that were, you know,

00:13:21.125 --> 00:13:22.605
sort of the most emotionally,

00:13:23.326 --> 00:13:25.827
in the most emotionally demanding work,

00:13:25.947 --> 00:13:28.168
you know, which is oftentimes, you know,

00:13:28.188 --> 00:13:28.908
mental health.

00:13:29.229 --> 00:13:30.470
And they found out that they didn't burn

00:13:30.549 --> 00:13:30.669
out.

00:13:30.710 --> 00:13:32.471
And what they found wasn't distance.

00:13:32.910 --> 00:13:35.072
It was a particularly kind of engagement.

00:13:35.153 --> 00:13:36.352
And they were the ones who really turned

00:13:36.373 --> 00:13:39.054
this idea of exquisite empathy, which is,

00:13:39.075 --> 00:13:39.254
you

00:13:39.995 --> 00:13:42.076
Being highly present, deeply attuned,

00:13:42.096 --> 00:13:44.556
that's the key word, and well-boundaried.

00:13:44.875 --> 00:13:45.416
In other words,

00:13:45.436 --> 00:13:47.096
you're not carrying this with you from

00:13:47.136 --> 00:13:49.116
patient to patient or from patient to your

00:13:49.157 --> 00:13:49.777
golf game.

00:13:50.297 --> 00:13:52.038
You deal with it as a patient

00:13:52.557 --> 00:13:53.278
individually.

00:13:53.298 --> 00:13:56.979
The clinicians don't just survive that

00:13:57.038 --> 00:13:59.038
empathy, it invigorates them.

00:13:59.198 --> 00:14:00.360
The surprise is that we had the

00:14:00.379 --> 00:14:01.360
prescription backwards.

00:14:01.840 --> 00:14:02.019
You know,

00:14:02.039 --> 00:14:03.461
we told a bunch of clinicians for a

00:14:03.500 --> 00:14:05.322
long time that caring less would save them

00:14:05.341 --> 00:14:06.523
and detachment would help them.

00:14:06.562 --> 00:14:06.702
Well,

00:14:06.743 --> 00:14:08.604
the evidence says that the right kind of

00:14:08.644 --> 00:14:09.945
caring is the protection.

00:14:10.004 --> 00:14:10.304
In fact,

00:14:10.325 --> 00:14:12.905
that's a substantive part of this book is

00:14:12.946 --> 00:14:15.167
kind of a return to teaching practitioners

00:14:15.187 --> 00:14:15.868
about empathy,

00:14:16.187 --> 00:14:18.469
because what we know that really is a

00:14:18.528 --> 00:14:20.791
muscle that you develop skills over time

00:14:21.150 --> 00:14:23.211
and that the correlation between medical

00:14:23.251 --> 00:14:24.712
school, physical therapy school,

00:14:24.793 --> 00:14:26.533
and by the time you get into practice,

00:14:26.553 --> 00:14:28.514
you've actually downgraded your empathy.

00:14:28.956 --> 00:14:30.418
Now what we do is have to teach

00:14:30.879 --> 00:14:34.226
and really impute and really encourage and

00:14:34.268 --> 00:14:35.289
empathize the opposite.

00:14:36.195 --> 00:14:36.775
Boy,

00:14:36.816 --> 00:14:39.037
you said there's like five pearls you

00:14:39.057 --> 00:14:39.498
dropped there.

00:14:40.258 --> 00:14:40.798
This one,

00:14:40.818 --> 00:14:43.541
the three key elements that you ended with

00:14:43.581 --> 00:14:45.942
that boundary around,

00:14:46.543 --> 00:14:48.345
could you just reiterate just a little bit

00:14:48.384 --> 00:14:48.985
more on that?

00:14:49.085 --> 00:14:49.346
Yeah,

00:14:49.365 --> 00:14:51.167
so when I think of exquisite empathy,

00:14:51.267 --> 00:14:53.428
I do think of it in terms of

00:14:53.889 --> 00:14:54.690
three different things.

00:14:54.950 --> 00:14:56.591
The first one is you're highly present.

00:14:57.392 --> 00:14:57.652
Well,

00:14:57.772 --> 00:15:00.234
that alone is a game changer because as

00:15:00.274 --> 00:15:00.875
you well know,

00:15:00.955 --> 00:15:02.855
our younger generation of therapists and

00:15:02.895 --> 00:15:03.437
doctors

00:15:04.481 --> 00:15:05.562
Their minds are scattered.

00:15:05.903 --> 00:15:06.464
They have this,

00:15:06.585 --> 00:15:08.167
I call it the anxiety brain,

00:15:08.187 --> 00:15:09.087
where they're worried about what the

00:15:09.128 --> 00:15:10.109
insurance will cover.

00:15:10.149 --> 00:15:11.571
They're worried about productivity.

00:15:11.890 --> 00:15:13.493
They're worried about their text message

00:15:13.513 --> 00:15:15.115
that they just got from a friend on

00:15:15.174 --> 00:15:16.496
what social thing is happening.

00:15:16.736 --> 00:15:18.359
They're worried about a like on social

00:15:18.399 --> 00:15:18.778
media.

00:15:18.840 --> 00:15:21.243
So the whole idea of being present is

00:15:21.322 --> 00:15:22.663
its own teaching point.

00:15:24.629 --> 00:15:25.530
And it's important.

00:15:25.770 --> 00:15:27.350
That's why a room is still really

00:15:27.392 --> 00:15:29.371
important to the patient element, right?

00:15:30.072 --> 00:15:31.852
The second thing is deeply attuned,

00:15:31.893 --> 00:15:34.033
which is really the idea behind empathetic

00:15:34.153 --> 00:15:36.894
listening and understanding and listening

00:15:36.934 --> 00:15:38.395
at a level where you're able to pare

00:15:38.416 --> 00:15:40.437
it back and reframe and you base it

00:15:40.496 --> 00:15:42.096
on your other experiences.

00:15:42.517 --> 00:15:44.357
And it is the softer side of the

00:15:44.398 --> 00:15:44.957
interpretive,

00:15:44.977 --> 00:15:48.980
but it also takes skills and reasoning

00:15:49.559 --> 00:15:50.860
That's the deeply in tune part.

00:15:50.880 --> 00:15:51.860
And then the third one,

00:15:51.880 --> 00:15:53.121
which is the one you asked me about,

00:15:53.182 --> 00:15:54.381
is well boundary,

00:15:54.822 --> 00:15:57.123
meaning you're not going to carry that

00:15:57.224 --> 00:15:59.825
episode of your empathy with that patient

00:16:00.264 --> 00:16:02.645
to either the next patient or at home

00:16:03.066 --> 00:16:04.466
or to your golf game.

00:16:04.846 --> 00:16:06.587
You're going to you're going to understand

00:16:06.648 --> 00:16:06.748
it.

00:16:06.988 --> 00:16:08.168
And that's when you detach.

00:16:08.469 --> 00:16:10.970
So the detachment prescription wasn't.

00:16:11.629 --> 00:16:15.251
entirely wrong it just was overemphasized

00:16:15.292 --> 00:16:17.374
as you should stay detached from the

00:16:17.413 --> 00:16:19.014
patient and not let any of that and

00:16:19.034 --> 00:16:22.177
be teflon coated as it turns out it's

00:16:22.216 --> 00:16:24.238
those three elements of it that really

00:16:24.278 --> 00:16:26.839
make for a stronger patient interaction at

00:16:26.879 --> 00:16:28.379
every level i mean some of the research

00:16:28.460 --> 00:16:30.341
even shows its influence on the clinical

00:16:30.481 --> 00:16:32.722
outcome which is uh which as you know

00:16:32.783 --> 00:16:34.583
is is something that we've we've been

00:16:34.624 --> 00:16:36.404
emphasizing through our evidence-based

00:16:36.445 --> 00:16:37.245
approach for years

00:16:38.157 --> 00:16:40.178
Boy, you know, as you're talking,

00:16:40.438 --> 00:16:40.839
literally,

00:16:40.879 --> 00:16:42.980
you've taken me back to a nineteen eighty

00:16:43.000 --> 00:16:43.701
three, eighty four,

00:16:43.740 --> 00:16:45.903
eighty five at Brook Army Medical Center.

00:16:46.442 --> 00:16:48.865
And the tremendous I mean,

00:16:48.904 --> 00:16:51.005
there was tremendous physical therapists

00:16:51.025 --> 00:16:52.466
there at the time for mentorship.

00:16:53.207 --> 00:16:56.070
And you look back and yet there are

00:16:56.370 --> 00:16:58.432
some, you know, were excellent,

00:16:58.532 --> 00:17:00.833
but they were in certain elements and they

00:17:00.874 --> 00:17:02.114
started to detach.

00:17:02.153 --> 00:17:02.634
And, you know, I

00:17:03.115 --> 00:17:04.096
And I saw it,

00:17:04.195 --> 00:17:07.499
and they would be getting burned out by

00:17:07.558 --> 00:17:08.579
the end of the day.

00:17:08.779 --> 00:17:09.680
And again,

00:17:09.720 --> 00:17:12.363
part of it was because this part of

00:17:12.383 --> 00:17:12.843
the clinic,

00:17:12.863 --> 00:17:14.443
you couldn't really have a private

00:17:14.483 --> 00:17:16.625
conversation with someone.

00:17:16.665 --> 00:17:18.267
You couldn't be there,

00:17:18.307 --> 00:17:20.828
so the presence was difficult.

00:17:20.868 --> 00:17:21.349
But boy.

00:17:21.869 --> 00:17:23.852
You know, it's these themes, you know,

00:17:23.872 --> 00:17:25.452
you look back now through a career of

00:17:25.813 --> 00:17:28.635
you've seen elements of them in the great

00:17:28.675 --> 00:17:30.457
practitioners and the ones that have

00:17:30.576 --> 00:17:32.538
struggled that were great and then quote

00:17:32.558 --> 00:17:33.859
unquote went that pathway.

00:17:33.900 --> 00:17:35.821
But boy, you know,

00:17:35.862 --> 00:17:37.403
that's that's that's excellent.

00:17:37.816 --> 00:17:38.195
Well,

00:17:38.436 --> 00:17:39.798
I'd like to shift gears a little bit,

00:17:39.817 --> 00:17:39.958
Larry,

00:17:40.117 --> 00:17:42.900
and talk about one of the fun things

00:17:42.921 --> 00:17:44.501
that I was honored to do with you.

00:17:44.922 --> 00:17:49.786
We had an article on placebo nocebo back

00:17:49.826 --> 00:17:51.708
in JOSPT a number of years back.

00:17:51.748 --> 00:17:55.632
And I feel like it got the conversation

00:17:55.731 --> 00:17:57.933
moving in a positive way.

00:17:58.354 --> 00:18:00.015
What are your recollections and what kind

00:18:00.055 --> 00:18:01.396
of got you to, hey, Tim,

00:18:01.457 --> 00:18:02.538
what do you think of this?

00:18:03.371 --> 00:18:05.673
Yeah, I think, you know, interesting,

00:18:06.074 --> 00:18:06.253
you know,

00:18:06.493 --> 00:18:07.795
one of the one of the more best

00:18:08.816 --> 00:18:10.577
clinical advice I ever give to somebody is

00:18:10.597 --> 00:18:12.259
your language words that harm worms that

00:18:12.278 --> 00:18:12.578
heal.

00:18:13.079 --> 00:18:14.681
And that's all about the nocebo and the

00:18:14.721 --> 00:18:15.261
placebo.

00:18:15.301 --> 00:18:16.923
And the one thing that I loved working

00:18:16.942 --> 00:18:18.625
with you on is the depth that we

00:18:18.684 --> 00:18:19.244
went into.

00:18:20.486 --> 00:18:22.307
I remember even being at Menopalooza and

00:18:22.387 --> 00:18:23.188
asking the question,

00:18:23.228 --> 00:18:25.009
how many people are trying to influence

00:18:25.048 --> 00:18:26.891
placebo and mitigate nocebo?

00:18:26.911 --> 00:18:28.090
And a lot of people were like, no,

00:18:28.111 --> 00:18:29.711
we don't ever want a placebo effect in

00:18:29.751 --> 00:18:30.192
your patient.

00:18:30.212 --> 00:18:31.453
Well, that's absolutely untrue.

00:18:31.513 --> 00:18:32.713
You a hundred percent, you do.

00:18:33.315 --> 00:18:33.894
And, you know,

00:18:33.934 --> 00:18:36.416
so that was one thing is that placebo

00:18:36.497 --> 00:18:38.917
isn't bad and nocebo or isn't good and

00:18:38.958 --> 00:18:39.959
vice versa, right?

00:18:39.999 --> 00:18:41.500
That they're not twin evils of one

00:18:41.539 --> 00:18:43.500
another, that they, they both are present.

00:18:43.520 --> 00:18:44.422
We have to deal with them.

00:18:44.801 --> 00:18:47.064
The second is that it's a real measurable

00:18:47.144 --> 00:18:48.964
psychological response, right?

00:18:48.984 --> 00:18:52.166
The whole, I think it's called Nlexone,

00:18:52.446 --> 00:18:55.008
which is an opiate block that can

00:18:55.167 --> 00:18:57.348
absolutely reverse the placebo pain.

00:18:57.710 --> 00:18:59.671
That was found in the seventies, I think.

00:19:00.391 --> 00:19:02.211
And so your body does release its own

00:19:02.311 --> 00:19:02.791
opioids.

00:19:02.811 --> 00:19:04.712
You can't block something that isn't

00:19:04.752 --> 00:19:05.673
chemically real.

00:19:06.114 --> 00:19:08.075
And then I would say the other part

00:19:08.095 --> 00:19:09.776
of that physiological thing is seeing the

00:19:09.875 --> 00:19:13.557
centers light up on PET and functional MRI

00:19:13.617 --> 00:19:14.038
imaging.

00:19:14.438 --> 00:19:15.699
you know, when you say something like,

00:19:16.460 --> 00:19:18.361
you know, this might hurt, what shows up?

00:19:18.621 --> 00:19:19.281
You know, think of it,

00:19:19.321 --> 00:19:20.063
think of me now, Tim,

00:19:20.123 --> 00:19:21.604
I work in dental where how many times

00:19:21.644 --> 00:19:23.005
a day do I walk into an operatory

00:19:23.025 --> 00:19:23.744
and I hear a dentist, oh,

00:19:23.765 --> 00:19:24.685
it's going to hurt a little.

00:19:24.965 --> 00:19:25.646
Oh my goodness.

00:19:25.707 --> 00:19:25.886
You know?

00:19:26.126 --> 00:19:27.949
So even the nocebo placebo effect in

00:19:27.989 --> 00:19:29.470
dentistry is more real than it is in

00:19:29.509 --> 00:19:30.230
healthcare, I think.

00:19:30.671 --> 00:19:31.570
And so I think that, that,

00:19:32.901 --> 00:19:33.161
You know,

00:19:33.642 --> 00:19:35.644
that was what I remember best about what

00:19:36.064 --> 00:19:36.765
you and I did.

00:19:36.825 --> 00:19:39.166
And things have evolved a little bit,

00:19:39.607 --> 00:19:40.347
you know, is,

00:19:40.949 --> 00:19:42.590
and I would say the mechanism from a

00:19:42.651 --> 00:19:45.153
research standpoint, just like, you know,

00:19:45.192 --> 00:19:46.253
just like you've seen,

00:19:46.273 --> 00:19:47.776
the evidence has actually gotten better.

00:19:48.576 --> 00:19:50.638
We used to think that placebo required

00:19:50.679 --> 00:19:51.559
deception, you know,

00:19:51.700 --> 00:19:53.862
open label placebo research shows that it

00:19:53.902 --> 00:19:55.442
works even when the patients know.

00:19:56.203 --> 00:19:58.144
Like I do this times when I lecture,

00:19:58.765 --> 00:19:59.664
I say something, I'm saying,

00:19:59.704 --> 00:20:01.286
I'm going to use a placebo effect on

00:20:01.326 --> 00:20:01.546
you.

00:20:01.746 --> 00:20:03.366
The placebo effect is at the end of

00:20:03.406 --> 00:20:04.106
this lecture,

00:20:04.406 --> 00:20:07.327
you're going to have a five question test.

00:20:08.607 --> 00:20:10.229
We know the placebo impact will be,

00:20:10.288 --> 00:20:11.828
they'll pay more attention and they'll

00:20:12.028 --> 00:20:12.710
remember more.

00:20:13.750 --> 00:20:15.171
Use it to your positive effect and you

00:20:15.191 --> 00:20:15.931
can still use it.

00:20:15.971 --> 00:20:17.550
So I think, you know,

00:20:17.691 --> 00:20:19.071
since we published that article,

00:20:19.672 --> 00:20:21.133
all the evidence has done nothing but

00:20:21.173 --> 00:20:24.894
support our contention and our premise.

00:20:26.473 --> 00:20:28.414
And on the bigger issue of that,

00:20:28.474 --> 00:20:32.156
it is amazing how, I guess,

00:20:32.958 --> 00:20:34.419
for the word I'm probably searching for,

00:20:34.699 --> 00:20:38.981
more paternalistic nature of why nobody

00:20:39.041 --> 00:20:40.522
raised their hands because, well,

00:20:40.542 --> 00:20:43.104
then it wasn't me that had the effect

00:20:43.163 --> 00:20:44.265
or my hands or something.

00:20:44.305 --> 00:20:46.965
It's kind of crazy that we felt we

00:20:47.006 --> 00:20:48.446
shouldn't, you know,

00:20:49.087 --> 00:20:51.368
use effects that we didn't fully

00:20:51.429 --> 00:20:53.029
understand for the betterment of the

00:20:53.069 --> 00:20:54.070
person in front of us.

00:20:54.131 --> 00:20:54.330
Right.

00:20:54.750 --> 00:20:54.931
Again,

00:20:55.211 --> 00:20:57.833
it's kind of that I fix you mindset,

00:20:57.873 --> 00:20:58.373
if you will.

00:20:58.393 --> 00:20:59.534
It's kind of part of, I think,

00:20:59.614 --> 00:21:01.775
why people saw that as a negative,

00:21:02.095 --> 00:21:03.476
you know, where, no, we don't,

00:21:03.536 --> 00:21:04.977
we walk with, we don't fix.

00:21:05.517 --> 00:21:07.178
Yeah, it's even worse, Tim,

00:21:07.218 --> 00:21:09.358
because now even the researchers,

00:21:09.419 --> 00:21:10.460
even the academics,

00:21:10.500 --> 00:21:11.961
they've shifted a bit and they like to

00:21:12.000 --> 00:21:13.862
call it the meaning response now.

00:21:13.902 --> 00:21:13.981
Yeah.

00:21:14.362 --> 00:21:14.561
You know,

00:21:14.582 --> 00:21:16.303
the body responding to the meaning of

00:21:16.343 --> 00:21:16.603
care.

00:21:17.063 --> 00:21:18.643
I actually prefer to use placebo and

00:21:18.663 --> 00:21:21.564
nocebo because I think it incites pay

00:21:21.604 --> 00:21:22.023
attention.

00:21:22.044 --> 00:21:23.545
This is important on how you talk to

00:21:23.565 --> 00:21:25.904
patients and and it shifts it a bit.

00:21:25.924 --> 00:21:26.164
You know,

00:21:26.224 --> 00:21:28.465
meaning has the word meaning has multiple

00:21:29.246 --> 00:21:30.267
constructs as well.

00:21:30.346 --> 00:21:30.826
So, yeah,

00:21:30.866 --> 00:21:32.626
that's that's what's that's what's evolved

00:21:33.667 --> 00:21:35.067
since we published that article.

00:21:35.583 --> 00:21:36.403
Yeah, that's great.

00:21:36.765 --> 00:21:37.925
I like that concept, too,

00:21:37.965 --> 00:21:39.989
because I do think on the nocebo side,

00:21:40.128 --> 00:21:41.529
it gets people to wake up while you're

00:21:41.589 --> 00:21:41.951
harming.

00:21:42.270 --> 00:21:43.452
Your outcomes are going to be worse,

00:21:44.134 --> 00:21:45.955
you know, so, you know, pay attention.

00:21:46.016 --> 00:21:47.176
So, well, very good.

00:21:47.257 --> 00:21:50.801
Well, you know, I think the...

00:21:51.903 --> 00:21:54.023
I'd like to move back to a little

00:21:54.384 --> 00:21:55.404
bigger picture here now.

00:21:55.444 --> 00:21:57.425
And, you know, I've been fortunate.

00:21:57.445 --> 00:21:59.667
I've watched your career for decades and

00:21:59.688 --> 00:22:00.607
been, you know,

00:22:01.148 --> 00:22:03.470
part of it literally since the beginning

00:22:03.529 --> 00:22:04.351
of, I think,

00:22:04.471 --> 00:22:07.051
wrestling on the floor of our house in

00:22:07.112 --> 00:22:08.692
San Antonio when you're in grad school.

00:22:08.752 --> 00:22:10.614
I think we're watching.

00:22:10.733 --> 00:22:11.634
Nineteen eighty five.

00:22:11.694 --> 00:22:12.214
Nineteen eighty five.

00:22:12.535 --> 00:22:13.175
Yeah, that's right.

00:22:13.855 --> 00:22:13.976
Yeah,

00:22:13.996 --> 00:22:15.176
I've known you longer than I've known

00:22:15.218 --> 00:22:16.638
anybody in my life, Tim, I think.

00:22:16.959 --> 00:22:18.660
Yeah, that's crazy, man.

00:22:19.000 --> 00:22:20.142
It is really wild.

00:22:20.561 --> 00:22:23.664
And I just always have felt you're always

00:22:23.684 --> 00:22:24.566
ahead of the game.

00:22:24.625 --> 00:22:25.306
And I mean,

00:22:25.926 --> 00:22:28.088
vision's thrown around way too much when

00:22:28.128 --> 00:22:31.112
it's not –

00:22:29.809 --> 00:22:32.471
appropriate um you truly have been a

00:22:32.510 --> 00:22:35.912
visionary you've always been ahead and saw

00:22:35.932 --> 00:22:38.272
around the corners and i've clearly as you

00:22:38.292 --> 00:22:40.913
know pushed back and thought and and and

00:22:40.952 --> 00:22:43.834
we would argue passionately like i thought

00:22:43.854 --> 00:22:46.275
you were wrong i'd always like damn right

00:22:46.355 --> 00:22:48.655
on this one you know and uh you

00:22:48.675 --> 00:22:50.215
know and that's what i love the the

00:22:50.236 --> 00:22:51.936
ability for you to always see down the

00:22:51.977 --> 00:22:52.416
line but

00:22:53.416 --> 00:22:54.917
What would you say is kind of the

00:22:54.998 --> 00:22:55.958
through line from your,

00:22:56.519 --> 00:22:59.160
really your back from your military days

00:22:59.200 --> 00:23:02.422
to your moving into electrodiagnostics and

00:23:02.521 --> 00:23:03.301
into, you know,

00:23:03.362 --> 00:23:05.583
building incredible private practices

00:23:05.603 --> 00:23:06.463
across the country,

00:23:07.003 --> 00:23:08.204
into evidence in motion,

00:23:08.265 --> 00:23:11.046
into more large operational confluent

00:23:11.145 --> 00:23:11.866
health lines,

00:23:11.906 --> 00:23:14.468
and now really in Dental Care Alliance

00:23:14.508 --> 00:23:14.768
team,

00:23:14.807 --> 00:23:17.068
moving into different sectors of

00:23:17.148 --> 00:23:17.730
healthcare.

00:23:18.089 --> 00:23:19.971
And what do you really see as kind

00:23:19.990 --> 00:23:21.632
of the through line through that

00:23:21.652 --> 00:23:22.271
trajectory?

00:23:22.946 --> 00:23:23.747
You know, it's interesting.

00:23:23.787 --> 00:23:25.929
I've tried to go back and see,

00:23:26.249 --> 00:23:27.009
you know,

00:23:27.048 --> 00:23:29.971
what is the underlying commonalities to

00:23:30.030 --> 00:23:30.391
all them?

00:23:30.431 --> 00:23:32.071
And I would say it divides itself into

00:23:32.092 --> 00:23:33.292
a couple of different things.

00:23:34.012 --> 00:23:36.355
I go through with my team now,

00:23:36.394 --> 00:23:37.575
my executive team,

00:23:38.056 --> 00:23:40.017
really drilling down on their why

00:23:40.757 --> 00:23:42.337
and also our company's why.

00:23:42.438 --> 00:23:43.978
And it's very different in our current

00:23:44.018 --> 00:23:45.317
company than it was in Confluent.

00:23:45.357 --> 00:23:46.818
Confluent was different than EIM,

00:23:46.898 --> 00:23:48.378
all had some commonalities to it.

00:23:48.838 --> 00:23:50.480
And so my why has always been trying

00:23:50.519 --> 00:23:53.141
to find a better way through simplifying

00:23:53.161 --> 00:23:55.500
the process and building trust in the

00:23:55.520 --> 00:23:57.221
people you work with through partnerships.

00:23:57.922 --> 00:23:59.383
And so that's been a commonality.

00:23:59.403 --> 00:24:01.202
And I think every one of these companies

00:24:01.222 --> 00:24:02.163
had the same bet.

00:24:02.182 --> 00:24:03.503
If you take care of people,

00:24:04.163 --> 00:24:05.585
who take care of patients,

00:24:06.045 --> 00:24:07.405
everything else compounds.

00:24:07.465 --> 00:24:08.445
And in the military,

00:24:08.806 --> 00:24:10.307
we learned that when we went through

00:24:10.366 --> 00:24:11.346
Officer Basic.

00:24:11.688 --> 00:24:13.888
You take care of your soldiers who take

00:24:13.929 --> 00:24:15.469
care of everything else,

00:24:15.568 --> 00:24:17.069
and things compound.

00:24:17.670 --> 00:24:18.971
And so I think that's been really,

00:24:19.010 --> 00:24:20.152
really interesting.

00:24:21.527 --> 00:24:22.929
You know, I will tell you honestly,

00:24:23.429 --> 00:24:24.871
I started my career in the military.

00:24:25.030 --> 00:24:26.352
I obviously had no ownership of the

00:24:26.372 --> 00:24:26.932
military.

00:24:27.413 --> 00:24:29.336
I will likely, maybe not, who knows,

00:24:29.796 --> 00:24:32.338
end my career as a CEO of Dental

00:24:32.378 --> 00:24:33.140
Care Alliance,

00:24:33.661 --> 00:24:35.803
a company that I didn't own, didn't start.

00:24:36.763 --> 00:24:38.585
and you want to see and during those

00:24:38.664 --> 00:24:41.046
intervening years did the playbook that

00:24:41.125 --> 00:24:43.047
you developed with your team through

00:24:43.086 --> 00:24:45.928
collaboration and through fierce argument

00:24:46.307 --> 00:24:48.990
and settling it and then instituting it

00:24:49.470 --> 00:24:51.590
like a benevolent dictator in some cases

00:24:51.871 --> 00:24:55.112
does that playbook transfer does it work

00:24:55.732 --> 00:24:58.233
and the playbook transfer issues are

00:24:58.574 --> 00:25:02.455
culture caring loving your team having a

00:25:02.556 --> 00:25:02.976
vision

00:25:03.922 --> 00:25:06.063
You know, working with people,

00:25:06.242 --> 00:25:07.884
finding out what drives them,

00:25:08.084 --> 00:25:09.944
all of those things really do make a

00:25:09.984 --> 00:25:10.444
difference.

00:25:10.525 --> 00:25:11.244
And, you know,

00:25:11.445 --> 00:25:13.606
people who are successful in business,

00:25:13.646 --> 00:25:16.048
they will themselves into success,

00:25:16.087 --> 00:25:18.568
but they also do it through three or

00:25:18.628 --> 00:25:21.130
four or five common underlying principles.

00:25:21.829 --> 00:25:23.411
And that's what it's been for me,

00:25:23.431 --> 00:25:24.672
you know, finding that better way.

00:25:25.612 --> 00:25:27.573
through simplification and building trust

00:25:27.613 --> 00:25:29.513
and caring in the process and then

00:25:29.534 --> 00:25:31.034
figuring out you know along that way what

00:25:31.074 --> 00:25:34.096
makes people tick and you know we were

00:25:34.155 --> 00:25:36.155
fortunate at confluent i think tim what we

00:25:36.175 --> 00:25:38.196
had seventy eighty physical therapists

00:25:38.237 --> 00:25:40.817
that you know joined our company and you

00:25:40.837 --> 00:25:44.319
know uh really found uh not only success

00:25:44.579 --> 00:25:46.500
in terms of their their clinical and

00:25:46.520 --> 00:25:48.561
professional but also material success and

00:25:48.582 --> 00:25:49.122
their wealth

00:25:49.622 --> 00:25:51.182
And that's something I'm incredibly proud

00:25:51.222 --> 00:25:51.303
of.

00:25:51.323 --> 00:25:53.743
But I'm also proud of, you know,

00:25:53.804 --> 00:25:55.505
seeing I just had like thirty some

00:25:55.565 --> 00:25:57.885
dentists in the last four months through a

00:25:57.965 --> 00:26:00.146
strategy we put together called Pathway to

00:26:00.207 --> 00:26:02.548
Partnership own a piece of their clinic.

00:26:03.068 --> 00:26:04.910
And so when they're doing everything from

00:26:04.950 --> 00:26:07.030
a restoration to a cleaning to a

00:26:07.090 --> 00:26:08.832
consultation, you know,

00:26:08.971 --> 00:26:11.653
I've just found that those who own a

00:26:11.712 --> 00:26:13.013
piece of the rock manage

00:26:13.394 --> 00:26:15.238
best and the managed best managers,

00:26:15.258 --> 00:26:16.480
the ones who manage least.

00:26:16.539 --> 00:26:18.082
And so that's been a commonality too.

00:26:18.102 --> 00:26:19.263
And that's a long winded answer,

00:26:19.305 --> 00:26:21.248
but I had to give that some thought

00:26:21.307 --> 00:26:23.030
and some ideas triggered along the way.

00:26:23.936 --> 00:26:26.577
No, that is excellent.

00:26:26.657 --> 00:26:32.461
And as you alluded to this, is there,

00:26:32.862 --> 00:26:34.662
when it comes to effective clinical

00:26:34.721 --> 00:26:37.263
leadership in these various sectors,

00:26:37.304 --> 00:26:39.644
now you've moved from a physical therapy

00:26:39.684 --> 00:26:41.145
world into a dental world,

00:26:41.465 --> 00:26:44.067
do you see the same commonalities there in

00:26:44.106 --> 00:26:46.167
terms of effective clinical leadership

00:26:46.228 --> 00:26:48.088
across industries?

00:26:48.469 --> 00:26:49.029
Yeah,

00:26:49.190 --> 00:26:51.310
I talk about this actually quite a bit.

00:26:52.377 --> 00:26:53.939
And I have a chapter in the book

00:26:53.959 --> 00:26:55.500
called High Quality Connections,

00:26:55.560 --> 00:26:58.403
which is the literature basis in Shelley

00:26:58.442 --> 00:27:01.565
Gable's work and Marty Seligman's work and

00:27:01.625 --> 00:27:03.446
Angela Duckworth's work and all these

00:27:03.547 --> 00:27:04.227
luminaries.

00:27:04.728 --> 00:27:06.288
But the idea is really pretty simple.

00:27:06.308 --> 00:27:07.809
And that is that the first sixty to

00:27:07.890 --> 00:27:10.132
ninety seconds are a clinical

00:27:10.152 --> 00:27:11.692
intervention, not small talk.

00:27:12.314 --> 00:27:12.894
And, you know,

00:27:12.913 --> 00:27:14.454
like I like to say to the dentist

00:27:14.474 --> 00:27:15.836
is connection is dosage.

00:27:16.696 --> 00:27:18.739
And your desire is to give as much

00:27:18.838 --> 00:27:21.201
dose in connection as you can.

00:27:22.684 --> 00:27:26.188
And it really resonates with them because

00:27:26.248 --> 00:27:28.230
now I see the dentist in between patients

00:27:28.269 --> 00:27:29.691
doing five mindfulness breath.

00:27:29.730 --> 00:27:31.991
I see them coming back and understanding

00:27:32.011 --> 00:27:33.933
that connection is therapy,

00:27:34.094 --> 00:27:35.055
is the intervention.

00:27:35.214 --> 00:27:38.317
It isn't just their intraoral skills,

00:27:38.436 --> 00:27:40.178
it's their oratory skills.

00:27:40.519 --> 00:27:41.579
And I would say the same thing to

00:27:41.599 --> 00:27:43.141
physical therapists or to doctors.

00:27:43.601 --> 00:27:46.765
We overemphasize hands-on clinical skills

00:27:46.805 --> 00:27:49.548
to the detriment of non-clinical skills.

00:27:49.588 --> 00:27:51.010
And that's really hard for somebody who's

00:27:51.030 --> 00:27:51.811
in, you know,

00:27:51.852 --> 00:27:52.933
you and I are kind of have a

00:27:53.193 --> 00:27:54.615
left brain academic approach,

00:27:54.675 --> 00:27:55.436
research approach.

00:27:55.477 --> 00:27:57.740
But the reality is the soft skills are

00:27:57.759 --> 00:27:58.520
every bit as important.

00:27:59.644 --> 00:28:02.685
And I've always wondered,

00:28:02.726 --> 00:28:05.286
and you triggered me, Larry, sorry,

00:28:05.486 --> 00:28:07.507
that when we use terms such as soft

00:28:07.527 --> 00:28:09.406
skills, those are freaking hard skills.

00:28:10.587 --> 00:28:12.188
Where did that word ever come, right?

00:28:12.508 --> 00:28:15.368
This idea of those skills were, to me,

00:28:15.409 --> 00:28:17.388
they sound secondary, right?

00:28:17.429 --> 00:28:18.028
When in fact,

00:28:18.088 --> 00:28:20.289
as your work shows that actually these are

00:28:20.309 --> 00:28:22.410
the primary skills first,

00:28:22.769 --> 00:28:24.631
and then we can teach you technical

00:28:24.671 --> 00:28:24.990
skills.

00:28:25.270 --> 00:28:26.511
And you said that way back when,

00:28:27.112 --> 00:28:27.592
I mean,

00:28:27.612 --> 00:28:29.893
this is over two decades ago where I

00:28:29.913 --> 00:28:31.114
was really, you know,

00:28:31.134 --> 00:28:34.035
I still consider science an expert manual

00:28:34.075 --> 00:28:36.016
therapist and believe passionately about

00:28:36.056 --> 00:28:37.636
the laying on of hands.

00:28:37.696 --> 00:28:40.198
But, you know, it's like, well, hey,

00:28:40.458 --> 00:28:43.619
if you have a good skill set of

00:28:43.960 --> 00:28:44.861
communication,

00:28:45.121 --> 00:28:46.381
those hand skills are a lot less

00:28:47.461 --> 00:28:47.922
important.

00:28:47.942 --> 00:28:50.042
Yeah, no, it's fascinating, Tim.

00:28:50.143 --> 00:28:50.522
Actually,

00:28:50.563 --> 00:28:52.023
that's the area where I think healthcare

00:28:52.084 --> 00:28:53.125
has gotten a lot worse.

00:28:53.964 --> 00:28:55.826
Because what I see practitioners do and

00:28:55.866 --> 00:28:58.868
physicians do and therapists do is they've

00:28:58.929 --> 00:29:00.630
moved the treatment intervention.

00:29:00.849 --> 00:29:01.830
They've outsourced it.

00:29:01.871 --> 00:29:03.412
Dentists do it as a matter of routine.

00:29:03.432 --> 00:29:05.073
And what I mean by that is the

00:29:05.093 --> 00:29:05.834
whole time they're thinking,

00:29:05.854 --> 00:29:07.795
does insurance cover this?

00:29:07.895 --> 00:29:09.596
What is going to happen if I say

00:29:09.616 --> 00:29:10.076
to the patient?

00:29:10.336 --> 00:29:12.538
So what I've seen surgeons do and others

00:29:12.558 --> 00:29:13.240
do is they'll say,

00:29:13.579 --> 00:29:15.520
we want to do this shoulder surgery.

00:29:15.882 --> 00:29:17.262
I'm going to bring somebody in here who's

00:29:17.282 --> 00:29:19.604
going to walk you through what the

00:29:19.644 --> 00:29:21.365
insurance cover, what they won't cover.

00:29:21.865 --> 00:29:23.405
And they're effectively outsourcing the

00:29:23.425 --> 00:29:25.386
entire conversation to a non-clinician.

00:29:25.646 --> 00:29:26.987
And I see this so routinely,

00:29:27.007 --> 00:29:27.487
and I just,

00:29:27.747 --> 00:29:29.567
if that ever happens to me, I'm running,

00:29:29.768 --> 00:29:29.847
man.

00:29:29.907 --> 00:29:30.928
I'm not just walking.

00:29:31.127 --> 00:29:31.847
I am running.

00:29:32.409 --> 00:29:32.669
You know,

00:29:32.868 --> 00:29:35.209
I want the orthopedic surgeon or the brain

00:29:35.249 --> 00:29:38.990
surgeon to explain absolutely what needs

00:29:39.009 --> 00:29:39.910
to be done and why,

00:29:40.089 --> 00:29:42.030
irregardless of what the insurance covers,

00:29:42.270 --> 00:29:43.171
irregardless of that.

00:29:43.611 --> 00:29:45.711
And that's what's this revenue anxiety,

00:29:45.751 --> 00:29:47.491
Jimmy McCain, I talk about sometimes.

00:29:48.031 --> 00:29:49.833
It's that voice in the head that's going

00:29:49.992 --> 00:29:50.472
on there.

00:29:50.492 --> 00:29:51.173
And I hopefully...

00:29:51.653 --> 00:29:53.974
AI agents and other things have an ability

00:29:53.994 --> 00:29:55.055
to mitigate this a bit.

00:29:55.516 --> 00:29:57.156
But that's where I see healthcare gotten

00:29:57.176 --> 00:29:57.477
worse.

00:29:58.238 --> 00:29:59.919
It's again, this moral injury effect.

00:30:00.019 --> 00:30:02.740
We've effectively given it up.

00:30:05.019 --> 00:30:06.240
And poor Medicare patients,

00:30:06.280 --> 00:30:07.201
they have it the worst.

00:30:08.262 --> 00:30:10.184
Offices are now built on what Medicare

00:30:10.204 --> 00:30:11.665
will accept and what they won't accept,

00:30:11.766 --> 00:30:13.366
and they're not built around talking to

00:30:13.386 --> 00:30:13.907
the patient.

00:30:14.248 --> 00:30:15.528
Our elderly are getting,

00:30:15.749 --> 00:30:17.230
and as I'm approaching the elderly,

00:30:17.971 --> 00:30:19.492
we're getting the worst, you know,

00:30:19.553 --> 00:30:20.634
I'm not Medicare yet,

00:30:20.673 --> 00:30:22.655
but we will be getting the worst of

00:30:22.695 --> 00:30:24.037
the treatment and the worst of the

00:30:24.076 --> 00:30:25.897
coverage because everything has been

00:30:26.078 --> 00:30:27.519
administratively outsourced.

00:30:28.079 --> 00:30:30.402
The conversation there is no longer part

00:30:30.442 --> 00:30:30.962
of the treatment.

00:30:33.193 --> 00:30:35.015
You look about how we went.

00:30:35.275 --> 00:30:37.135
I mean, again, well,

00:30:37.155 --> 00:30:39.116
let's step back to the EMR revolution,

00:30:39.156 --> 00:30:39.396
right?

00:30:39.457 --> 00:30:41.178
When it was first going to change our

00:30:41.198 --> 00:30:41.498
life,

00:30:41.837 --> 00:30:44.118
where we went for literally the note cords

00:30:44.179 --> 00:30:45.420
at the troop medical clinic was like,

00:30:45.440 --> 00:30:47.381
you know, like, you know,

00:30:47.401 --> 00:30:48.300
literally ten words.

00:30:48.340 --> 00:30:50.082
But man, you knew who you saw this,

00:30:50.122 --> 00:30:50.902
what their problem was,

00:30:50.922 --> 00:30:52.403
and you'd see them throughout, you know,

00:30:52.442 --> 00:30:53.523
to this, you know,

00:30:53.564 --> 00:30:55.484
spend and the amount of time you could

00:30:55.525 --> 00:30:57.486
spend and the amount of people you could

00:30:57.566 --> 00:31:00.666
see because you were spending your time

00:31:00.747 --> 00:31:02.307
doing what you were trained to do.

00:31:02.887 --> 00:31:05.329
And not trying to, and boy, what a,

00:31:05.750 --> 00:31:08.010
what a crazy way we've, we've become.

00:31:08.090 --> 00:31:10.593
So, well, as you know, as,

00:31:10.772 --> 00:31:12.114
as we come to a wrap here,

00:31:12.933 --> 00:31:15.435
is there anything that you'd like to, to,

00:31:15.496 --> 00:31:17.057
to mention Larry that we haven't,

00:31:17.416 --> 00:31:19.357
we haven't covered here or any closing

00:31:19.398 --> 00:31:19.798
thoughts?

00:31:20.730 --> 00:31:21.451
No, I don't think so.

00:31:21.511 --> 00:31:22.032
I think, you know,

00:31:22.053 --> 00:31:23.213
one of the things that we hope to

00:31:23.253 --> 00:31:25.416
cover in, you know,

00:31:25.457 --> 00:31:27.660
some podcasts and special guests,

00:31:27.760 --> 00:31:29.122
we did this last time, the book,

00:31:29.162 --> 00:31:30.884
but now we've got some topics that I

00:31:30.904 --> 00:31:32.487
think will move some really cool,

00:31:32.626 --> 00:31:33.868
you know, conversation.

00:31:33.888 --> 00:31:35.171
We've already talked about burnout and

00:31:35.191 --> 00:31:36.031
sort of moral injury,

00:31:36.071 --> 00:31:37.252
but AI and connection.

00:31:37.773 --> 00:31:38.855
I think is a big one.

00:31:40.057 --> 00:31:42.038
What does it mean across it?

00:31:42.078 --> 00:31:43.480
I'm currently running a series on

00:31:43.579 --> 00:31:44.221
Substack,

00:31:44.560 --> 00:31:45.823
and you helped with some of this writing

00:31:45.843 --> 00:31:46.303
as well, Tim,

00:31:46.343 --> 00:31:48.345
about AI agents and their ability to

00:31:48.385 --> 00:31:49.987
mitigate these voices in the head and

00:31:50.027 --> 00:31:51.229
other kind of things that might have a

00:31:51.288 --> 00:31:51.709
chance.

00:31:52.190 --> 00:31:55.133
The placebo and nocebo obviously has a

00:31:55.173 --> 00:31:55.874
highlight there.

00:31:56.394 --> 00:31:58.055
Can't ever leave out the peak end rule.

00:31:58.075 --> 00:32:00.056
That's just such a, you know,

00:32:00.435 --> 00:32:02.217
a good starter for those high quality

00:32:02.257 --> 00:32:03.757
connections and things that go with it.

00:32:04.258 --> 00:32:05.417
I also like this, you know,

00:32:05.438 --> 00:32:06.558
some of my favorite chapters,

00:32:06.618 --> 00:32:07.239
ironically enough,

00:32:07.298 --> 00:32:09.440
around goal setting and how using

00:32:09.480 --> 00:32:11.621
implementation intentions and other kind

00:32:11.661 --> 00:32:15.482
of newer age research backed interventions

00:32:15.522 --> 00:32:16.442
are really, really helpful.

00:32:16.482 --> 00:32:18.144
So it's going to be a lot of

00:32:18.163 --> 00:32:18.263
fun.

00:32:18.846 --> 00:32:20.948
that sounds great that sounds great well

00:32:21.548 --> 00:32:25.171
as we close with that you spoke briefly

00:32:25.191 --> 00:32:27.673
about this dental edition uh can you like

00:32:27.712 --> 00:32:30.275
throw anything little uh hints out there

00:32:30.315 --> 00:32:33.396
and how that will be i'm fascinated by

00:32:33.636 --> 00:32:35.318
how the market might take it up on

00:32:35.338 --> 00:32:37.079
the dental side yeah i've been having the

00:32:37.119 --> 00:32:39.321
book reviewed by lots of dentists and lots

00:32:39.342 --> 00:32:40.623
of hygienists right now it has been

00:32:40.643 --> 00:32:42.804
approved for for publication it's in that

00:32:42.884 --> 00:32:43.404
stage

00:32:43.865 --> 00:32:44.045
you know,

00:32:44.065 --> 00:32:45.945
the painstaking proofreading stage.

00:32:46.526 --> 00:32:47.707
And it'll be same, you know,

00:32:47.807 --> 00:32:48.586
out the later this year,

00:32:48.606 --> 00:32:50.667
same framework rebuilt for dentists,

00:32:51.068 --> 00:32:52.148
dentistry realities,

00:32:52.169 --> 00:32:53.089
which are a lot different.

00:32:53.690 --> 00:32:55.590
Like I said, the relationship,

00:32:56.270 --> 00:32:58.051
the hygienist spends a lot more time with

00:32:58.071 --> 00:32:59.133
the patient than the dentist.

00:32:59.153 --> 00:33:00.733
So there's a lot of choreography there,

00:33:00.794 --> 00:33:02.453
the operatory and the meaning effect,

00:33:02.513 --> 00:33:03.494
placebo, nocebo.

00:33:04.576 --> 00:33:05.576
You know, in some cases,

00:33:05.615 --> 00:33:07.396
thirty to seventy percent of the patients

00:33:07.877 --> 00:33:09.818
come in with anxiety to see the dentist

00:33:09.999 --> 00:33:10.819
and a lot of shame,

00:33:10.839 --> 00:33:11.460
a lot of guilt.

00:33:11.480 --> 00:33:12.661
And then the dentist puts them in a

00:33:12.701 --> 00:33:14.001
position where they're laid back like

00:33:14.041 --> 00:33:15.803
this, Tim, and they're standing over them.

00:33:15.823 --> 00:33:17.223
And it's this power position.

00:33:17.284 --> 00:33:18.785
And by the way, the patient can't talk.

00:33:18.805 --> 00:33:19.905
Yeah.

00:33:19.986 --> 00:33:22.386
And then you have DSOs is kind of

00:33:22.406 --> 00:33:24.087
the private equity back to how to call

00:33:24.127 --> 00:33:24.969
two hundred plus.

00:33:25.388 --> 00:33:26.630
And there's a corporate practice of

00:33:26.670 --> 00:33:28.270
medicine issues and things around it.

00:33:28.290 --> 00:33:29.352
And so, yeah.

00:33:30.451 --> 00:33:31.032
Yeah,

00:33:31.212 --> 00:33:32.814
I think the principles are somewhat

00:33:32.894 --> 00:33:33.334
universal,

00:33:33.354 --> 00:33:34.615
but operatories are a different

00:33:34.654 --> 00:33:35.234
environment.

00:33:35.295 --> 00:33:36.935
And so I've had an enormous amount of

00:33:36.976 --> 00:33:37.276
fun.

00:33:37.316 --> 00:33:38.916
And I did differently this time as I

00:33:38.957 --> 00:33:41.198
took two or three characters in clinical

00:33:41.218 --> 00:33:41.739
vignettes.

00:33:42.699 --> 00:33:44.559
And I kept them the same characters

00:33:44.579 --> 00:33:45.361
throughout the book.

00:33:46.480 --> 00:33:47.821
as we do the interventions.

00:33:47.902 --> 00:33:51.063
And so I've made the assumption that

00:33:51.103 --> 00:33:52.403
physical therapists are maybe a little

00:33:52.442 --> 00:33:54.023
smarter and don't need it and dentists do,

00:33:54.044 --> 00:33:54.903
but no, I'm just kidding.

00:33:54.943 --> 00:33:57.104
My dental friends, we go back and forth,

00:33:57.144 --> 00:33:58.265
but at the end of the day,

00:33:58.325 --> 00:34:00.326
physical therapists and dentists are twin

00:34:00.385 --> 00:34:04.106
sisters of different mothers of the same

00:34:04.386 --> 00:34:04.866
mother for twins.

00:34:04.886 --> 00:34:05.987
And so there's a lot of common,

00:34:06.007 --> 00:34:07.428
they're doing the profession for the right

00:34:07.468 --> 00:34:07.788
reason.

00:34:08.367 --> 00:34:09.248
That's why I'm really,

00:34:09.309 --> 00:34:11.550
really wanting to spend a lot more time

00:34:11.610 --> 00:34:13.672
on convincing payers and others on the

00:34:13.733 --> 00:34:14.875
damaging effects.

00:34:14.914 --> 00:34:16.817
There's the intended consequences and the

00:34:16.876 --> 00:34:18.538
unintended consequences of what they're

00:34:18.938 --> 00:34:19.960
doing to health care.

00:34:20.539 --> 00:34:23.202
And I will spend my waning days,

00:34:23.262 --> 00:34:25.284
even after I'm done being in leading

00:34:25.344 --> 00:34:25.844
companies,

00:34:26.485 --> 00:34:28.527
spending time on the bully pulpit,

00:34:28.867 --> 00:34:29.929
really going after that.

00:34:29.989 --> 00:34:31.331
That's my mission in life, I think.

00:34:31.900 --> 00:34:32.159
Well,

00:34:32.280 --> 00:34:34.001
it gets me excited as you talk about

00:34:34.041 --> 00:34:35.240
this because, as you know, I mean,

00:34:35.260 --> 00:34:37.943
the oral hygiene and health,

00:34:37.983 --> 00:34:40.344
cardiac health, brain health, I mean,

00:34:41.164 --> 00:34:42.423
it's huge, right?

00:34:43.625 --> 00:34:46.206
But also, I'm wondering,

00:34:46.706 --> 00:34:49.608
are there many studies like just what you

00:34:49.807 --> 00:34:50.688
threw out there saying,

00:34:50.788 --> 00:34:51.688
This may hurt a little.

00:34:51.789 --> 00:34:51.969
I mean,

00:34:52.228 --> 00:34:54.389
have they gone through like RCTs

00:34:54.429 --> 00:34:54.829
comparing?

00:34:55.050 --> 00:34:55.971
This may hurt a little bit.

00:34:56.251 --> 00:34:58.351
Oh, I'm going to do this, you know.

00:34:58.492 --> 00:34:59.572
Are there some studies?

00:34:59.632 --> 00:35:00.693
Oh, yeah, there are definitely some.

00:35:00.713 --> 00:35:00.793
Well,

00:35:00.813 --> 00:35:02.474
there's definitely some placebo research

00:35:02.514 --> 00:35:02.755
on that.

00:35:02.795 --> 00:35:03.934
But the last thing you mentioned,

00:35:04.014 --> 00:35:06.657
I spoke at the largest dental conference

00:35:06.697 --> 00:35:07.117
in the U.S.

00:35:07.137 --> 00:35:08.237
just last weekend in Denver.

00:35:08.657 --> 00:35:10.958
And one of my take-home points was the

00:35:10.998 --> 00:35:13.501
biggest opportunity in dentistry is the

00:35:13.661 --> 00:35:15.121
oral health combination.

00:35:15.842 --> 00:35:17.804
The fact that every patient doesn't come

00:35:17.884 --> 00:35:19.606
in and get a saliva test to tells

00:35:19.646 --> 00:35:21.248
them how many cleanings they need a year.

00:35:21.288 --> 00:35:23.050
What are some underlying diagnosis that

00:35:23.070 --> 00:35:23.971
needs to be dealt with?

00:35:24.311 --> 00:35:24.512
You know,

00:35:24.532 --> 00:35:26.132
generally patients only need dentistry

00:35:26.152 --> 00:35:27.235
when they're young, when they're old,

00:35:27.255 --> 00:35:27.775
and when they're old,

00:35:27.815 --> 00:35:29.436
you have a lot of comorbidities and such.

00:35:29.965 --> 00:35:32.447
And all the areas around cardiac disease

00:35:32.467 --> 00:35:34.467
and everything else stems from a lot of

00:35:34.568 --> 00:35:37.208
oral health issues and just the ability to

00:35:37.248 --> 00:35:39.269
diagnose things alone and to really be

00:35:39.309 --> 00:35:41.230
more prescriptive about it through a

00:35:41.530 --> 00:35:42.971
twenty cent saliva test.

00:35:43.010 --> 00:35:44.652
And there are some DSOs and others that

00:35:44.952 --> 00:35:46.192
are routinely doing this.

00:35:46.431 --> 00:35:48.092
The technology is also amazing.

00:35:48.132 --> 00:35:50.514
The AI underwriting of imaging

00:35:51.534 --> 00:35:53.016
I could take five pictures of your mouth

00:35:53.036 --> 00:35:54.097
with the iPhone, Tim,

00:35:54.378 --> 00:35:56.000
throw it to an incredible scanner.

00:35:56.701 --> 00:35:58.222
You and I have worked in a world

00:35:58.262 --> 00:35:59.143
of healthcare where it's been

00:35:59.204 --> 00:36:01.186
over-diagnosed and over-medicalized and

00:36:02.106 --> 00:36:02.927
way over-treated.

00:36:02.987 --> 00:36:04.068
Dentistry is the opposite.

00:36:04.088 --> 00:36:05.550
It's the most under-diagnosed and

00:36:05.590 --> 00:36:07.132
under-appreciated from an oral health

00:36:07.172 --> 00:36:07.733
perspective.

00:36:08.673 --> 00:36:10.094
I used to think it was a prevention,

00:36:10.235 --> 00:36:11.215
you know, profession.

00:36:11.375 --> 00:36:12.335
I no longer think that.

00:36:12.396 --> 00:36:13.536
I think it's a profession that is

00:36:13.556 --> 00:36:14.896
preventing conversations with their

00:36:14.936 --> 00:36:15.376
patients.

00:36:15.657 --> 00:36:15.836
You know,

00:36:15.856 --> 00:36:17.157
let's wait on that tooth and see what

00:36:17.197 --> 00:36:17.518
happens.

00:36:17.538 --> 00:36:18.378
That's not prevention.

00:36:18.577 --> 00:36:20.259
That's elimination of a conversation.

00:36:20.659 --> 00:36:22.059
And so I have found a lot of

00:36:22.079 --> 00:36:23.179
things in dentistry you get real

00:36:23.219 --> 00:36:24.000
passionate about,

00:36:24.239 --> 00:36:26.340
but so much of it relates to the

00:36:26.380 --> 00:36:27.742
world we've lived in for the last forty

00:36:27.782 --> 00:36:28.001
years.

00:36:28.681 --> 00:36:29.561
Outstanding.

00:36:30.001 --> 00:36:30.702
Outstanding.

00:36:30.983 --> 00:36:32.242
I look forward to reading that one as

00:36:32.282 --> 00:36:33.623
well because you, like me,

00:36:33.702 --> 00:36:34.882
I'm just interested.

00:36:34.983 --> 00:36:35.764
I spend my time.

00:36:35.824 --> 00:36:38.643
I'm interested in making health care

00:36:38.704 --> 00:36:39.063
better.

00:36:39.224 --> 00:36:40.605
Well, we're sick care.

00:36:40.644 --> 00:36:42.244
We're in the actual health care world.

00:36:42.304 --> 00:36:46.405
And there's so much opportunity with small

00:36:46.445 --> 00:36:47.925
nudges to make a difference.

00:36:48.045 --> 00:36:49.907
And you have a big nudge with this

00:36:49.967 --> 00:36:51.987
book and it coming out.

00:36:52.047 --> 00:36:53.626
And like I say,

00:36:53.666 --> 00:36:55.047
it's just been a pleasure to speak with

00:36:55.068 --> 00:36:56.688
you today and really look forward to

00:36:57.867 --> 00:37:00.369
getting the bound cover and seeing that in

00:37:00.668 --> 00:37:00.989
print.

00:37:01.809 --> 00:37:02.869
Yeah, well, Tim, thanks.

00:37:02.929 --> 00:37:03.750
And I can't wait to get you on

00:37:03.789 --> 00:37:04.949
a golf course and find out how many

00:37:04.989 --> 00:37:06.090
strokes that you want me to give you.

00:37:06.110 --> 00:37:07.851
That's going to be the conversation.

00:37:07.871 --> 00:37:08.391
It'll still be a lot.

00:37:08.411 --> 00:37:08.590
All right.

00:37:08.610 --> 00:37:12.293
Take care.

00:37:12.592 --> 00:37:13.233
Awesome.

00:37:13.253 --> 00:37:13.753
All right, buddy.

00:37:13.952 --> 00:37:14.432
Thanks, Al.

00:37:14.492 --> 00:37:15.233
We'll talk to you soon.

00:37:15.534 --> 00:37:16.653
Leave that tab open, Tim,

00:37:16.673 --> 00:37:18.293
because Jim's got this whole thing on

00:37:18.313 --> 00:37:18.454
there.

00:37:22.056 --> 00:37:22.976
How'd we do, Betsy?

00:37:23.175 --> 00:37:23.896
You're the judge.

00:37:25.155 --> 00:37:26.157
Well, you're doing great.

00:37:26.197 --> 00:37:26.856
Jimmy and I are in a