“Can you imagine ‘cramming’ on the farm? Can you imagine forgetting to plant in the spring, flaking out all summer, and hitting it hard in the fall–ripping the soil up, throwing in the seeds, watering, cultivating–and expecting to get a bountiful harvest overnight?
Cramming doesn’t work in a natural system. That’s the fundamental difference between a social and natural system. A social system is based on values; a natural system is based on principles. In the short term, cramming may appear to work in a social system. You can go for the ‘quick fixes’ and techniques with apparent success. But in the long run they just don’t work.” – Stephen Covey1
To paraphrase Jordan Harbinger, we must dig the well before we’re thirsty, not because we’re thirsty2. If we’re thirsty already, it’s too late to dig the well. We must dig the well in preparation for thirst. The coronavirus has caused healthcare to thirst tremendously and we simply cannot expect to dig a well of any worth or value while we are thirsty. Digging while we’re thirsty leads to incompetence, low quality care, troubleshooting, confusion, stress, and scrambling to stay afloat all while our patients and profession suffer. The virus has forced us to start digging for the future, and that’s why I’m here! Grab your shovels, folks…who’s with me?
Understand this…we are living through a time in history that our grandchildren will ask us about. As you know, ALL industries are being flipped on their heads. The virus has catapulted the world years into the future…teachers are being forced to learn online teaching platforms, restaurants and grocery stores are being forced to utilize delivery apps, and healthcare providers are scrambling to find ways to provide care without seeing patients in-person. Much like how after the Hunger Games everyone wanted to take up archery, this naturally leads to a booming interest in telehealth. It seems attraction and growth are outpacing competence. As Rob Vining jokingly puts it, “Telehealth is like the new toilet paper.”3
The problem is that these professions, especially physical therapy, are not ready for telehealth. It’s like throwing a kid in the deep end and expecting him/her to swim. The urgency to adopt new ways without time to adapt brings up a serious problem, which is doing something out of necessity before learning to do it well. In other words, we’re forced to change before we’re ready to change, or as Scot Morrison says, we’re “doing too much too soon after doing too little for too long.”4 We’re implementing new technologies before we know how to use them, which is detrimental to the future of those technologies.
I’m not against people implementing telehealth. The more the better and I’m here to help! We must come together to save our profession. The situation becomes problematic when individuals and companies fail to do their due diligence to become skilled at telehealth first prior to its implementation. Again, I (and others) want to help patients and providers connect during these unprecedented times to shorten the learning curve of stumbles, blunders, and stress when things malfunction.
I have been practicing telehealth through my own business and with 3DMJ for quite some time now, but it most definitely did not happen overnight as a result of a global crisis and it most certainly wasn’t easy. I am by no means an expert, but I understand that implementing telehealth in physical therapy requires a paradigm shift…and paradigm shifts don’t happen in a week, they happen in decades. If all of a sudden there was a crisis due to a massive gas shortage, I can’t suddenly embrace the technology of electric cars and try to charge up my Toyota Rav4. Why? Because it takes more than a crisis to make my car competent enough to run on electric. It was my choice not to dig the well prior and cramming during a crisis simply doesn’t work. No doubt, I can use the crisis to become more resilient moving forward, but I cannot flip a switch and go from a gas-powered car to an electric-powered car. The paradigm shift necessary for the physical therapy profession to go from in-person treatment to telehealth takes time, reflection, and hard work, not a crisis. As John Maxwell says, “reflection turns experience into insight”5 and we cannot reflect and learn without time and experiential learning.
The purpose of this article is not to focus on the shortcomings of the physical therapy profession; however, it is my opinion that physical therapists are stuck in the old ways of mechanical diagnoses, palpation, muscle energy techniques, cupping, taping, ultrasound, hypervolts, thera-guns, electric stim, crystal therapies, chakras, and manual therapy like soft tissue release, joint mobilizations, and spinal adjustments…all of which have limited evidence of efficacy AND cannot be done via telehealth. As a whole, we don’t value empathy, education, empowerment, and patient independence. We don’t understand that pain is multifactorial and rarely solely due to a mechanical “dysfunction.” Our goal should not be to find the pain trigger or what is “wrong” with our patients. Our goal should be to focus on what the patient can do. We need to focus on how the human in front of us is affected by the current situation. In addition to load, volume, RPE, range of motion, and exercise selection, we need to ask about sleep quality, stress management, hydration, recovery, and how it is affecting them both physically and emotionally. We then offer modifications to keep them functioning as close to the desired level as possible and slowly progress back to where we want to be, in a stepwise fashion. The patient is not broken and most certainly doesn’t need fixing. A quality provider is a mentor, not a mechanic. Embracing that paradigm is step one to transitioning to telehealth and without it we’re jamming a round rod into a square hole.
Now more than ever we need to promote quality online care. It’s not just physical therapy either. It’s online personal training and coaching as well. With less people going to commercial gyms, every Joe Blow personal trainer will be opening online coaching platforms. Everyone is trying to get their “skin in the game” out of necessity, but what they do not understand is that this isn’t a game. Online care is not something that you just start doing to get your “seat at the table.” I don’t go buy some land and a tractor and tell people that I am a farmer. That does a disservice to the people relying on my crops as well as farmers in general. Similarly, I wouldn’t open a clinic that treats babies with cerebral palsy just because there is some sort of boom in babies with CP (God forbid…). I can absolutely do my due diligence and educate myself on that patient population, but until then I have no business starting to treat those patients just to get some skin in the game. As Neil Degrasse Tyson puts it, “One of the great challenges in this world is knowing enough about a subject to think you’re right, but not enough about the subject to know you’re wrong.”6 We have an ethical responsibility. We have an oath to serve in an ethical way. Remember that.
The truth is, those who are jumping into online care just because it is the trendy thing to do are not ready and will end up tarnishing the reputation of telehealth and online coaching unless we are able to recognize the “ice cream from the poop,”7 to quote Alberto Nunez. As Michael Caine puts it, “rehearsal is the work; performance is the relaxation.”8 You simply cannot expect to perform without proper rehearsal.
While I do believe that I can provide education, guidance, and mentorship when it comes to treating via telehealth, I’m not saying that I am the person to go to by any means. I do not have all the answers and I’m certainly not a leading expert in the field. There are others out there who are much better than I and from whom I’ve learned a ton. What I am saying is that if you take the leap into online care, take the responsibility to learn from a qualified expert with experience before diving in. If not, you’ll ruin it for patients and providers of the future. Make no mistake; the purpose of this article is to help. Patients and providers, please reach out to me and I will do my best to help in any way possible. These are scary times. Again, I am not an expert, but I do have experience and can guide you to some of the best resources out there. Who’s with me?!?!
My Top Telehealth Resources for Healthcare Providers
I am many things, but a complainer I am not! Momma didn’t raise no fool and I have a few simple rules in life: never curl in the squat rack, always listen to Albus Dumbledore, and don’t complain without trying to do something about it. I am here to help! I want telehealth to grow, but the growth must never out-pace the quality. BEFORE IMPLEMENTING TELEHEALTH, I highly encourage you to check out my website, www.strengthtogetheronline.com as well as these resources:
Telehealth: Building Your Digital Practice (online course):
Telehealth 20 Podcast:
(Sound Cloud) https://soundcloud.com/telehealth20
1Stephen Covey, A. Roger Merrill, and Rebecca R. Merrill, First Things First: To Live, to Love, to Learn, to Leave a Legacy. New York: Simon and Schuster, 1994.
2 Bilyeu, T. (2018, May 29). The Secret to Making Powerful Friends | Jordan Harbinger on Impact Theory. Retrieved from https://www.youtube.com/watch?v=Rx-TNupNU8Q.
3 Carter, Jarod & Vining, Rob. (2020, March 16). The QUICK START GUIDE to getting Telehealth going in your practice THIS WEEK!! Retrieved from https://www.facebook.com/groups/TelehealthPTs/search/?query=The%20QUICK%20START%20GUIDE%20to%20getting%20Telehealth%20going%20in%20your%20practice%20THIS%20WEEK!!&epa=SEARCH_BOX.
4 Clinical Athlete (2018, May 26). Podcast Episode 9 – Practical Periodization w/Scot Morrison. Retrieved from https://www.youtube.com/watch?v=n2LBkOhUsqE&t=123s.
5 Bilyeu, T. (2020, February 4). How to Jumpstart Your Personal Growth with High Level Leadership | John Maxwell on Impact Theory. Retrieved from https://www.youtube.com/watch?v=T9WIWz5PEQk.
6 Master Class (2019, December 19). Neil deGrasse Tyson Teaches Scientific Thinking and Communication | Official Trailer | MasterClass. Retrieved from https://www.youtube.com/watch?v=0kPINNhHGNw&t=63s.
7 Do I really need to cite this one?
8 Carlson, Tony. (2005). The How of Wow: A Guide to Giving a Speech That Will Positively Blow ‘Em Away. American Management Association.