Episode 51: Stop Guessing with Your Health: 4 Signs of High-Quality Care

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker (00:06):
Welcome to the podcast.
A podcast by healthcareon how to navigate your health
The podcast hosted by MikeBruno, a chiropractor and
athletic trainer, and me,Michael Stanton, an athletic
trainer and certified strengthconditioning specialist.
Although we are healthcareproviders, we are not your
healthcare provider.
We will discuss general healthinterventions in this podcast,

(00:26):
but you should not take that ashealth advice that works in
every situation.
Before doing anything on yourchanges, please consult with
This podcast and views from thispodcast are separate from our
full time jobs and our ownopinions.
If you're enjoying the podcast,please leave us a review on your
listening platform and orsubscribe to our podcast at
YouTube.
Thanks to our show can be foundin the show notes on any

(00:48):
platform that you are listeningto.
So today we're going to talkis, what are you looking for
provider and know if they'reRight.
That's kind of what the the listIs that a good way to go about
Yeah, yeah I would say so.
Um, and it is also a very goodthings or write them down, they

(01:16):
detector if you're with a badsomeone who can, you know, a lot
things to get you in the door.
But then, like, once they'retheir process, like putting
and like, actually like doingYeah.
And so kind of the list thatfrom an article.

(01:38):
It's a, it's a review article.
Highly, uh, established journal,British Journal of Sports
Medicine.
Um, and what they actually didwas review something called, uh,
CPGs clinical practiceguidelines.
Um, it's actually more of aSo I don't even know if you
would, you would be familiarwith them.
But essentially, what a bunch ofYeah.

(01:58):
Lose losers.
Um, we like to kind of, um.
But essentially what it is, it'sthat put together for physical
injury, for low back pain.
These are the recommendationsthat you should do treatment
wise.
So what this article did, whatwent and looked at all the CPGs

(02:21):
pertain to low back pain andAnd they took out of them what
the best what were the mostconsistent recommendations
across across the board for allof them?
Okay.
Um, it's actually kind of funnybecause in the same like breath,
they also kind of like go, ah,some of these CPGs aren't
actually very good, which isactually like kind of funny

(02:44):
reading it.
Um, but anyway, we're going toSo the first thing that you
should be patient centered.
Right?
So patient centered care meansIf you as a patient are going to
centered around you.
You should have a little bit ofin your treatment.

(03:06):
If, you know, gone or gonein and the doctor goes, alright,
going to start you on thisknow, it's like I think about
a sore throat.
I think about as a kid, you usedto walk in and it'd be like
almost no evaluation, like nostrep testing or anything like

(03:27):
that.
And they would be like, yeah,z-pack and and we'll go ahead
Right.
I think hindsight's twentytwenty on that one and be like,
oh, they're really just taking ashotgun and seeing if it will
work.
Yeah.
The two things one of myprofessors used to say, if you
had an ear infection, um, andyou went and got it treated by

(03:49):
like went to the doctor and gotmedicine, it'd be gone in a
week.
But if you waited and didnothing, it'd be gone in seven
days.
So like.
So his point being where it'ssometimes things are either like
Um, and then when we say likepatient centered care, I sit
back and I'm like, what's theother option?

(04:12):
Like, yeah, like doctor centeredLike, that part doesn't even
Um, but there are a lot of whenyou say like for profit
organizations, right?
Like, businesses are trying toSo the, the thought process is
like, hey, a doctor will takeyou on even if, like, you might
not be the best fit for theirpractice because it's not about

(04:36):
you, it's about their bottomline.
That's how I look at like theThat would be like the bad side.
Like that's how it doesn'tanymore, is what you're saying.
Right.
So like, I mean, in themore, um, like obvious that I'll

(04:59):
There are some populations whoa lot of solutions out there
So people with different typesdifferent, um, like diseases and
internal diseases and they'rewon't give them any answers.

(05:21):
Um, their specialists don't haveis what it is, is what we're
They're like.
And because it's a rare disease,do much for you.
Besides, like, this is what weThese are our best practices,
be concrete because then itup the client's butt.
And those people get, you know,hold on to, like they're looking

(05:47):
And then a chiropractor would belike, I can fix it with an
adjustment.
And those people are like, oh,Yeah.
Like something.
And it's.
That's wrong.
That is just straight up wrong.
So if anybody has been in asituation like that, I would say
get your favorite pair ofsneakers.
Tie them up tight and runbecause that is that is not cool

(06:10):
during Covid.
During Covid I was like stuck inlike letters in the mail, like
Meanwhile, nothing was open,to be open.
And it was come get anAnd I was like, this is why our
profession gets viewed as ajoke, because there's those ten
percent of radical people you'remissing out.

(06:31):
Yeah.
My profession, chiropractors,making outrageous claims like
treatment for ear infections,I'm like, dude, stay in your
Yeah.

(06:51):
And so like I think what we'repatient centered like you, us as
goals as like what the patientAnd if it's not mixing, it's one
One, which is probably moreneed to like, tamper the goals

(07:13):
Right.
If it's kind of what you said,something series or lifelong
disease of some sort, it's like,hey, we can maybe make
improvements in certain areas ofyour daily life, but like, this
is something that you're goingto have to create management
strategies for, not somethingthat will be quote unquote
cured.
Um, and like, like if you havesurgeries or whatnot, it's like,

(07:37):
have a little bit of back painLike it's just managing it.
Yeah, it's expectation.
Management is the first go.
Like I had a guy who came in, hehad a stroke when he was two on
the phone.
He was like, hey, like you wouldnever be able to tell by, like,
looking at me, but like, I havesome, like, significant, like,

(07:58):
weakness on my left side andeverything.
I was like, okay, like, we'dUm, it sounded like a good fit
like, he was way more like,initially could tell.
But on the phone.
And I was like, dude, thank youBut, like, I'm not the right fit

(08:18):
Yeah.
Like us, we need to be able toall the time as an athletic
especially in the high schoolget them to the right person.
Oh, one hundred percent.
Because like, like if he waslike super on board with what I
was saying, it's like, could weget maybe some like muscle, like
some tension relief and somesymptomatic relief?

(08:40):
Sure.
But like, those weren't hisYeah, that's a stroke patient.
It becomes like, more neuroLike you should be going to a PT
straight up stroke.
Like stroke.
Yeah, right.
One million percent.
And there's not a lot of, uh,like, like protocols or anything

(09:02):
So it's like, dude, like, Idon't like I feel comfortable
doing this.
I don't feel comfortable doingRight.
You live somewhere in theI can help you do this, but this
goals that you want.
So like, you need someone whojust not me.

(09:23):
Yeah.
You pretty much took my secondpoint, which is great, which is
like, if you guys don't don'tmeld together, it's either, hey,
you need to be the bigger personand say, hey, I'm not the right
person.
Kind of what you said there.
And I'm sure, like, maybesomeone gets pissed off here or
there.
Oh my God, they wouldn't treatBut it's like that.
They respect that.

(09:43):
I think it depends.
So I'm going to be perfectlyI think it depends on the
seeing and what the like.
Yeah.
So like in our world, I thinkBut like, let's say it's like
general like injury or generalillness illnesses.
And they go, hey, I, I'm not theAnd you go up there, but this

(10:05):
But I could see, I mean, for me,in my world where it's like a
lot of out of pocket servicesand I'm like, hey, don't waste
your money or time like, thisisn't going to get you where you
want.
They're like, oh, cool.
Like, yeah, money, you know whatSo it's a little more I mean,
received that way because youcould always be like, hey, we
can give it a shot, but like, nopromises.

(10:27):
I was actually literally havingLike, you can't make any
Yeah, but the bar is so low withespecially, like,
musculoskeletal care.
Like when I talk to otherpeople, I'm like, okay, so you
had back pain and you want torun a mile, like what was the

(10:48):
plan?
And they're like, I don't know,cracked and he like massaged it
I'm like, okay.
Did he like look at running formexercises to support running
like blah blah blah blah blah.
And they're like, no, not atI'm like, yeah, someone with

(11:11):
be like, okay, before you run,Yeah.
You know what I mean?
Like, like or just like, hey, wegoing to achieve goals.
Like, put it on paper.
Yeah, let's just put it onAnd, like, the whole point of a
you know what I mean?
Like a plan sounds nice.
And then you run to your firststill the goal.

(11:33):
Pivot, pivot, pivot.
Yeah.
And you get there.
But that's why I called myBecause it's a navigation
So you're driving the car.
You're making all the majorBut if you make a detour and you
go this way, I'm like, let'slike get let's get back to the
point here and helping you getto your destination a lot faster

(11:53):
and safer.
Yeah, it's funny you broughtI was just talking to my little
had, like, no clue.
It's like where you're justShe just like, I don't know how
much or how little I should bedoing now.
It's just like a but I just wantto be a generally healthy
person.
So I legitimately just helpedwas like, well, I want to do

(12:14):
class, is it enough?
Is it not?
So we just kind of like, allgoing to do you're going to do
You're going to do that groupstrength training class one day
a week.
You're going to do your ownstrength training one day a
week, and then you can run twotimes a week, thirty minutes
each.
And then we'll kind of adjust asAnd that's how she'll hit all of
You know, all the recommendedone hundred and fifty minutes of

(12:40):
Um, and I was like, honestly,that's all you need to do and
you'll be in a good spot withthat.
And like, to be honest, if sheshe'd probably still be fine.
That's great.
Yeah.
So, yeah.
Number two.
Screen patients to identifyof serious pathology.
Slash red flag conditions.

(13:01):
Um, so this kind of goes off alittle bit off on the previous
one.
Like.
And the biggest things for us,And I'm trying to think, you
guess for low back we'll go toUm, if, if it's like numbness

(13:22):
all the way to like the bottomAnd you could answer this better
was like, if it doesn't go pastlike, yeah, whatever.
Like we'll we'll do someLike there's no real
it actually goes all the waya Dermatome or myotome.

(13:44):
So like specific areas of yourfoot are numb compared to the
other side.
You're probably going to bethis first, right?
Or like that's a red flag.
Maybe we'll hold off on Yeah.
The basically what a red flag isto me is, hey, these are strikes
in the I'm not going to treatyou column.

(14:05):
So if it's something that looksNot going to treat you.
Um, if it's something internal.
So it looks like like bowel orbladder stuff like things like
that.
Heart lung.
So we went through a lot ofdiagnostic courses for all that

(14:27):
stuff.
I learned how to do a heart examexam, all that.
But the whole point of that isnormal sounds like.
This doesn't sound normal.
Go see somebody.
It's it's recognize and refer atAnd I think a lot of times

(14:48):
We're like, oh I learned this.
So like, let me just adjust myAnd it's oh God, it's not a good
It's funny because and like welittle bit more with like acute
Like, what are my red flags forAnd like, you know, if they have
doesn't look right.
Yeah.
Yeah.
You know.

(15:09):
Yeah.
Yeah.
Exactly.
Yeah.
Um, another one, I had a, I hada kid get hit in the ribs and
like initially he saw me andlike, he was just dealing with
pain.
Like it just hurts.
They're like kind of discomfortAnd to be honest, I've seen so
It was.
I was like, hey, I'm not worriedNow let's say it becomes
or you start spitting up bloodDidn't see didn't see the kid

(15:33):
See him back.
It's like, hey, man, like, whereHe goes, oh, I started spitting
Ah, yes.
It's like, thanks for tellingYeah.
Ended up.
Yeah.
Kind of crazy.
Didn't have a rib fracture.
Just had a lung contusion.
Um, just a lung contusion.
Dude, there is a kid I went toHis lung collapsed, like, after
No, he was like a just.

(15:55):
It was just like a randomHe was a singer or something
like it just spontaneously,like.
Well, I don't know if you saw.
Sorry.
Really.
Sidetracked.
Uh, TJ, what had, uh, dry duringHis lung collapsed.
Yeah, it is one of my had to getYeah, yeah.
Jeez.
Craziness.

(16:15):
Any Hoosier?
What's the next one?
Three.
Assess psychosocial factors.
I think this is this is biglike I think about when you're
know, you always go to a doctor.
They have those intake forms.
They probably don't get readBut it's like that's why you
Like you're probably better offand having some of those

(16:40):
kind of assess theirhandling the pain?
Is there stuff going on outsidewhy their pain is getting better
So I think it's something thatis still missed a lot of the
time.
So I would say for a lot.
So this is actually a personalI went to the doctor, um, like

(17:06):
my general yearly physical andthe there are questions in their
intake forms that are meant forthis purpose.
And like just the way that theychange, like the interpretation,
asking and interpreting.
So the medical assistant comeslike a smoker or drug user?

(17:29):
Like, no. She's like, oh no,No. Are you smoker?
I was like, no. She's like, soyour whole life?
And I was like, I have like acigar at a wedding every like
two or three times a year orwhatever.
And she's like, oh, okay, blah,blah, blah, get moved to the
medical room.
Um, and the, uh, the doctor'slike, okay, so I see you're a

(17:52):
smoker.
When did you quit?
And I was like, well, what doesYeah, I got a similar story for
Yeah.
And I was like, that's crazy.
Because, like, you know, all,you know, defend myself or
whatever you want to call it,like, I'll like, correct her and
stuff, but like, potentially ifI sat there quietly and I was

(18:15):
like, didn't say anything likethat could completely change the
whole doctor's entire line ofthinking.
Because if I now tell her, like,hey, like, I have like chest
tightness and stuff, like herwhole like, diagnostic mentality
has shifted towards like, hey,this kid's been smoking forever
or however long versus like, oh,it might be something completely

(18:37):
unrelated.
So like it changes the thedrastically change the outcome.
The question is well intended,but like the way that you ask it
and the way that it getsinterpreted is going to make all
the difference.
Yeah.
And so maybe not so much on thisthird bullet point of
psychosocial.
But I went to a primary carevisit one time and I went
through it.

(18:58):
A couple things happened.
One, it was like the nurse, theyactivity level was at all
And so, so which is like really.
And so the nurse, like, I'm arate is really low.
And yeah, my heart rate's likein the low forties because I
exercise and you're going likethis.
Yeah I was like yeah don't worryLike that's normal.

(19:21):
All right.
Whatever.
And so then you said that I toldLike, don't worry, lady, you
don't know what you're talkingabout.
Yeah, yeah, I kind of startUm, which then later on, like
I was like, I was like, okay,I said, yeah, all right, can I
I want a complete metabolicwhat's going on.

(19:42):
She's like, all right, sure.
And so get it.
It comes back.
My ldls are actually a littleYeah.
And so they get on the phone andare high, so you should probably
I had a client that told me theI was like, it's apparent.

(20:02):
And we're we're not nutritionBut I started looking into it.
And because first of all, mytriglycerides, which is like the
free floating fat masses, it waslike twenty.
That number is like almostthere's no fat flowing through
my blood.
So like the LDL number doesn'tAnd apparently when that number
is so low, your ldls will comeout high.
Um, and I don't know if I wouldhave to research it more, but

(20:26):
you're you're telling a personwho at the time was running
thirty miles a week and liftingfive days a week to exercise
more, that mentally would have,could have thrown me into a
tailspin.
Instead, I just said, you don'tand moved on.
But like, you know that thatgoes back to like, you're trying
to you need to find like aprovider.
I'll be honest, I haven't gone.
And this is bad.

(20:46):
I haven't gone for a regularyears because that experience
So I really do need to findunderstanding of what my goals
one hundred percent.
There's and like the thewhen it comes to pain if people

(21:08):
So if we define that as overYeah, like some people have been
And I'm like, that's miserable.
And like it changes your brainyou're like people say like, oh,
But like, I got used to it.
Like, that's not normal.
Like, no, you you like livingSo it's like, okay, well, what

(21:35):
What do you want to what do youAnd they're like, oh, I can just
It's like, okay, that's aBut I just want you to know it's
And they're like, well, I'veSo like like and their, their
because to be fair, like theygotten a lot of results.

(21:56):
So you know, it's it's aAnd usually that's because one
they tried was focused on theIf it was focused on the right
thing, the timeline wasn'tright.
So it's like, hey, I did it fora day when you needed to do it

(22:17):
for a month, you know what Imean?
And but even going off that,it's like the psychosocial
aspect of like talking about,like you just having that
conversation of like, you're notsupposed to be in pain based on,
like, what your diagnosis is andall that.
Like, this is something that weAnd I think rewiring happens and
Maybe I can actually get there.

(22:38):
And like, you know, part of it'ssome stuff and getting them out
Like that's kind of where itYeah, one hundred percent.
And the conversation like thatwhole like, hey, this like the
reason all the other stuffdidn't work before is like
either wrong time or wrongplace.
And it's like, okay, you triedgoing to do A, B and C, and then

(23:05):
We do A, B and C and they'reLike I notice a significant
That's a really good sign thatSo now we have the wrong or the
Right.
Knowing that and knowing yourhistory, we get to talk through
a plan and come up with theright time.
And those two things togethersuccess rate than the, uh, like

(23:32):
What's it say?
What did I say?
Pray.
Spray and pray.
Whereas, yeah, yeah, you're onLike, let me do that one.
Yeah, yeah.
That just sets you up forLiterally talking to a guy
yesterday, he's like, dude, likeI have this like sharp shoulder
pain.
I know I should be stretchingLike I know the things that I

(23:53):
YouTube and I just get likemany different opinions.
This guy is trash talking.
This guy who's trash talking,where to start.
Yeah.
And I was like, well, that's ayou know, the navigation system.
Yeah, super, super helpfulbecause it shrinks that time,
right?

(24:13):
It's like it takes you sixmonths to figure it out on
YouTube.
We can figure it out in sixYeah, exactly.
Um, I think that's good.
So we're going to move on to ourSo the fourth point is that
radiological imaging isdiscouraged.
And there's a couple of reasonsMaybe it's not.
It's if you suspect a seriousUh, fractures, grade three

(24:37):
ligament sprains, as in, like,stuff completely pop. Things
like that.
Um. Or there's beenunsatisfactory response to
conservative care.
Um, that's like.
Like for you be like, youtreated someone for, like, five
months and there's noprogression.
You're going to say, hey, youHey, an MRI might actually,
like, be beneficial in yourcase.
Um, so it's really those twomain points and then three, it's

(25:00):
like it's likely to changemanagement which like hey, you
might actually have, uh,displaced, uh, fracture in your
back.
You might actually need surgeryLike that will change your
That that would be that's howBut yeah.
So right.
Radiological imaging is oftenAnd I know you're big on this
because like for low back pain,it's like the general

(25:21):
recommendation is never get an xray.
But also in the chiropracticconvince people, hey, this is
We'll fix it.
Alrighty.
Here we go.
This is one of my favoriteSo with X-rays and MRIs.
If it's to your point, if it'sto do in the office necessary if

(25:46):
scary tumor like big scary stuffuh, imaging necessary outside of
I tell people all the time,is, uh oh, I just want to see
It's like, okay, your health,Once you do see it.

(26:07):
Right, let's go down that rabbitOnce you do see it, then what
It's like, oh, then like, we canjust, like, do what we've been
doing, right?
It feels like an unnecessaryA lot of the times, um, usually
psychosocial and like, the trustis something that's such a hard

(26:31):
Because if you take fifty fiftythem probably have some form of
significant findings on the MRIThe other half probably has no
findings on an MRI, and they dohave pain.

(26:54):
So what you see on an image doesnot explain your pain usually,
which is why the like thisexists now.
It's like, hey, it's probablygoing to cause you like people
get imaging for clear answers,but it actually adds a layer of
confusion because they're like,hey, I'm in pain, but my MRI is

(27:14):
clean.
Now, more confused or the flip?
It's like I thought I was fine,but I get this imaging and I
have all this stuff wrong withme.
It's like, no, I'm scared.
Not helpful in ninety plusNo, it's funny because obviously
back stuff and in the shoulder,like slap tear.

(27:37):
So like tears in overheadUh, like, within their labrum,
actually don't don't get imagingRehab it for three months and
Um, there's also a really coolwhere they just healthy baseball
They just took MRIs of all theirHalf of them had labrum tears

(28:00):
recommended to have surgery onUm, so yeah, yeah, yeah.
If I could say like to someonelike, it's like, you know, you
want to have good bedside mannerand like, but like the people
who I've been working with for awhile and, like, they get my
sense of humor and they trust meand everything.
Um, if they ever, like, came tome and was like, I think I

(28:21):
should get an MRI, I'm like,okay, why?
lot.
Like, I just want to see what'sIt's like, okay, let's say we
And it's like, uh, like they getYeah.
For what you're dealing with,it's they're not going to
magically all of a sudden getsurgery.
They might get a cortisoneinjection and like that would be
it.

(28:42):
Most people are working with meto avoid surgery in the first
place.
Yeah.
Like like if you if you go talkto a surgeon, like, surgery is
probably going to be a much morelikely outcome than talking to
me.
Yeah.
Like, you know what I mean?
So it's you have to know whoIf you're going to a butcher,

(29:04):
You know, if you go to the it'slike who you your first point of
contact.
I forget what the exact studyWe'll have to look this up.
If you go talk to a surgeon asyour first point of contact,
your chances of getting surgeryFor back pain is like ten x,

(29:25):
right?
Yeah.
If you need it or not.
Right.
Like so there, there is so muchsurgery where people are getting
That is not necessary.
And like that low back.
That's pretty extreme.
But like that happens all theLike I had someone go and
they're like, yeah, we didn'treally see much on the MRI, but

(29:45):
we're just going to scope yourknee anyway.
Yeah, I didn't see much.
Let's scope it.
Then I'm like, why are wegetting everything in the first
place?
It's like, let me just like, letsome stuff up.
Like, I don't know, that'sAnd we can kind of wrap up on
with the imaging.
So, um, so there's a study.
It was in Finland, no clue howthis study got approved, to be

(30:07):
perfectly honest.
But like it was, you know, whenyou're talking the shoulder pain
and doing so like they had twogroups, one like they both had
shoulder pain.
And the what you're supposed toSo you're supposed to go in and
shoulder to relieve some space.
Well, in half of them they wentAnd the other half, they just

(30:28):
Did nothing.
They just cut the skin, right?
Yep.
And they had the same exactI want to say I don't.
There may have been a separateThe same study.
They also had a study that justdid conservative treatment the
entire time.
And I think they all just over ayear, they all did exactly the
same thing.
They were all they all did theYeah.
Time.
Time is a very good healer.

(30:49):
It's if you get stuck in, like,a wheel, like of, hey, I need to
stretch or hey, I need to dowhatever.
Like, what do they say?
They say, uh, what's theInsanity is like doing the same
Different results.
Yep.
So, hey, I just need to stretchIt's like, hey, how long does

(31:12):
You know, twenty minutes an hourIt's like, okay.
So you can either like that canLike you can do that every day.
And like, you have to, like,single day because like that's
Or you can go and like actuallyto feel like it needs to be

(31:34):
that you don't have to go doRight.
Both are options you pick.
Yeah.
So now I think that that wrapsthis episode up, I think pretty
well.
Um, we'll get six more seven,six to seven more points next
episode.
Um, yeah.
Yeah.

(31:55):
Cliffhangers.
A lot of stuff.
Unless.
Unless you're into the researchAnd go find the article.
Um, really?
Yeah.
Probably not.
Probably not.
That's what we're here for.
To sift through all of it soGo fix yourself.

All Episodes

Episode Transcript

Popular Podcasts

Stuff You Should Know

Dateline NBC

The Burden

.css-15opob5{left:0;position:absolute;top:0.8rem;} All Episodes

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Episode 51: Stop Guessing with Your Health: 4 Signs of High-Quality Care

Episode Transcript

Popular Podcasts

.css-r6mb8g{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:1;overflow:hidden;}Stuff You Should Know

Dateline NBC

The Burden

All Episodes

Episode 51: Stop Guessing with Your Health: 4 Signs of High-Quality Care

Stuff You Should Know