This One Skill Predicts Success In Cash Based PT Business

Show Notes

In today's episode, we delve into the pivotal skill that can make or break your journey in the cash-based PT world: Leadership. Leadership isn't just about guiding a team; it's about confidently navigating patient care, understanding the root causes of issues, and making informed decisions even when they're tough.
This is why leadership stands out as the cornerstone of a successful cash-based PT practice. If you're looking to transform your approach and achieve unparalleled success, this is a must-watch.

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What is The Dr. JJ Thomas Podcast?

Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.

Dr. JJ Thomas: 00:00

You're gonna have to show them that this pain right here is probably a cascade of other events that led up to that point. You're gonna have to lead that treatment, and that's gonna take a lot of guts and confidence. But that is one of the first ways you're gonna have to display leadership, and that is how you're gonna exponentially grow your success in your cash boost practice. Welcome to the doctor JJ Thomas podcast. I'm doctor j j Thomas.

Dr. JJ Thomas: 00:30

Thanks for joining us today. Today's episode, we're going to discuss the single most important skill that will almost guarantee your success in a cash based practice. It's not what you think. So when we talk about a a skill that's going to boost your success in a cash based practice, you're probably thinking it's going to be a PT related skill, but it's not. It's actually a life skill.

Dr. JJ Thomas: 00:57

It's basically leadership. Having the skill to lead people to success is what's going to be the single most important factor in almost guaranteeing your success as a cash based PT. Let's talk about why. When we think about our world as cash based PTs, one of the most important things we can ask ourselves is, why does someone choose to come to a cash based PT? Right?

Dr. JJ Thomas: 01:25

Like, why choose to come to us? Why choose to pay out of their own pockets and get reimbursed, potentially, but that's a, you know, that's a risk sometimes for them? Why would they choose to do that versus go to an insurance based world? And there's 2 main reasons. There's 2 people that I find generally choose to pay for us as a cash based PT.

Dr. JJ Thomas: 01:47

The first case is the patient that has failed PT and failed treatments everywhere else. They are just so fed up. They need someone to lead them to success. They don't mind paying because they value what a cash based PT can do, potentially, because the other methods, the other models haven't worked for them. They've failed.

Dr. JJ Thomas: 02:11

The second type of person that comes and chooses to pay out of their pockets for a cash raise practice is a person that doesn't have time to mess around. They are the athlete that is a sophomore in high school, and they have all this attention potentially for recruiting in college, next year, junior years, recruitment year. They have this injury that's not allowing them to play. They are on a time budget. They don't have time to mess around.

Dr. JJ Thomas: 02:37

They're going to choose to see us because they need results fast. So what I'm going to explain is how, in that population, there's 3 main scenarios that will highlight the importance of leadership as a skill when working with these patients. The first scenario is that what you're going to have to do with these patients is you're going to have to lead them to the root cause. Chances are, if they're paying for you, as I said, they're one of those 2 types of populations. They either failed PT somewhere else or lots of other places, or they don't have time to mess around.

Dr. JJ Thomas: 03:18

So you don't have time to mess around either. You better find that root cause. And so you're gonna have to display excellent leadership in order to do that. And here's why. Most of those patients, both though both of those populations we just talked about, number 1, the ones who failed PT, and number 2, the ones that are, say, high level athletes that need to get better yesterday, both of them are going to come with an additional piece.

Dr. JJ Thomas: 03:44

In addition to their movement analysis, in addition to how their body's presenting, they're going to come with fear. They're going to come with the fear of, oh, shit. I'm paying cash for this, and I'm on a timeline, and nobody has else has been able to get me better. And what if this person can't come either? And with that fear, they've spent a lot of time, days nights, thinking, analyzing their body, trying to figure out what it is that's gonna get them better, trying to really describe, well, maybe if I can describe this pain down my arm better, if I can describe that it's burning now and tingling then or whatever, they're they're searching for the right words.

Dr. JJ Thomas: 04:24

They're taking ownership in a way that maybe isn't that productive, but they're trying, and you have to commend them for that. But what that means for us is that they know a lot about their symptoms and their bodies. That's a good thing if you let it be, but it can be a distraction. They're going to come in with preconceptions of how and what they might need for treatment. It's gonna be up to you to not get distracted by those preconceptions.

Dr. JJ Thomas: 04:51

They're gonna come in, and they're gonna be like, I am telling you I have this pain right here. I can touch it. I can feel it. It's right there. It happens when I grip.

Dr. JJ Thomas: 04:58

I I know it. I know it so well. If you could just treat this, what you need to figure out is, has anyone else tried to treat that? Has anyone else touched it? If they have and they haven't gotten better, guess what?

Dr. JJ Thomas: 05:09

You're probably not that much better manually than the per than the other 5 people that tried to treat them in that same approach. You better start looking for other causes. So despite the fact that they can feel this pain right here, you're gonna have to show them that this pain right here is probably a cascade of other events that led up to that point. You're gonna have to lead that treatment, and that's gonna take a lot of guts and confidence. But that is one of the first ways you're gonna have to display leadership, and that is how you're gonna exponentially grow your success in your cash based practice, is having the guts and confidence to lead that patient through a movement evaluation and through a treatment session that you're directing through your professional skills and expertise that they hired you for.

Dr. JJ Thomas: 05:56

Patients come in. They think that they're trusting you, and they wanna trust you, but you have to direct them. You have to lead them to show them why it's okay for them to trust you. I'm gonna give you a patient example that I had just last week. I had a patient come in, and he's had recurring plantar fasciitis for years.

Dr. JJ Thomas: 06:16

And he says and he's, classic in the sense that I just described. He says, I've got plantar fasciitis on both feet. It's really, really bad on the left foot. He's an athlete. He's an older he's in, you know, older, like my age, but, you know, 4 upper 40s.

Dr. JJ Thomas: 06:33

But he knows his body well. He's been an athlete his entire life, and he works out hard. And he knows his body. And he says and he keeps he takes his shoe off. He's pointing to his left heel, and he's like, the pain is right here.

Dr. JJ Thomas: 06:44

And I say to him, have you had treatment for this before? Well, yes, I have. Gets better, but it comes back. Okay. Well, that's that's something we need to consider.

Dr. JJ Thomas: 06:52

Right? If it's coming back, are we really addressing the root cause? I haven't said this to him yet because he has to get there on his own. But so we're talking I'm asking him questions. Right?

Dr. JJ Thomas: 07:02

I owe it to him to lead him, but in in doing so, I need to be investigative. I need to find out exactly what we're dealing with. So other PTs, yes, they've treated the heel. It's gotten better, but it comes right back. So I say to him, describe the pain to me.

Dr. JJ Thomas: 07:15

What what makes it worse? Oh my god, JJ. He says, I can't as soon as I get out of bed in the morning, I'm afraid to put my feet down. Well, that sounds very plantar fasciitis y. Right?

Dr. JJ Thomas: 07:24

Like, that's a very classic plantar fasciitis complaint. He says, then once I get walking, it's a little better. Finally, by the time I get to the bathroom, I can walk without, like, holding my breath. Okay. Great.

Dr. JJ Thomas: 07:36

Still sounds kind of plantar fasciitis y, but I'm still wondering why has he not gotten better with the treatments that these other very competent physical therapists have done. So I started asking more questions. Well, what other things make it worse? Like, okay. You wake up in the morning.

Dr. JJ Thomas: 07:48

It's worse. Tell me what happens if you are sitting for long periods when you go to get up. Not, you know, not necessarily weight bearing, but just sitting. He says, oh, my god. How did you know?

Dr. JJ Thomas: 08:00

I get when I get up, if I sit for an hour, I go to get up. It's the same thing all over again. Well, that's very interesting because it's not like sleeping, you know, it's not like sleeping where his foot has been in a plantarflex position for hours. In sitting, he's in a neutral foot, but he's loading the spine. So now I'm starting to think, maybe there's another root cause there.

Dr. JJ Thomas: 08:18

So, okay, that's interesting. I do tell him now. Now I'm starting to lead him a little bit more. That's interesting. It's worse when you're sitting, and I give him my rationale.

Dr. JJ Thomas: 08:26

Your foot isn't really shortened there, but your back is loaded. Any history of back injury? He says, oh, my god. Yeah. I should have told you.

Dr. JJ Thomas: 08:34

5 years ago, I had a debilitating back injury. He says, I don't know what happened. I I went to pick something up. My back seized. He said, I dropped to the ground.

Dr. JJ Thomas: 08:44

I was home alone. I literally had to call my wife to come help me because and he said, and I had to crawl to the phone to get her because I was in so much pain. I said, what'd you do for that? He said, well, actually, I just kinda rested, and, I did go to the the doc. They gave me some medication.

Dr. JJ Thomas: 08:58

It felt better. Eventually, it just went away. Things don't just go away. Right? I didn't say that to him because, again, I don't wanna be condescending.

Dr. JJ Thomas: 09:06

But in my mind, I'm like, he has this history of back. That was 5 years ago. So I said, well, how's the back been since then? He said, actually, now that you mention it, I get these episodes almost once, twice a year. And it and it kind of goes out, and then it settles.

Dr. JJ Thomas: 09:20

So it's similar to the plantar fasciitis. Right? All of this stuff, I'm leading him to get to the answer on his own. Right? I'm not saying I'm not jumping the gun and saying, oh my god.

Dr. JJ Thomas: 09:30

You have a back injury. We have to treat your back. I'm saying I'm letting him get there on his own. We're leading him with questions, similar to what you see on on, you know, the TV shows where the attorneys are leading the witness, right? We're leading the patient to potential sources to potential other sources that are maybe the underlying causes of a symptom that hasn't been treated successfully anywhere else.

Dr. JJ Thomas: 09:54

So then we take it another step, and I say, you know what? I'm thinking there may be a back component. Let's do a test to see. So I put him in a slump posture, right, slump neural tension testing, and I I start with his right leg because his left leg's worse. We do the test.

Dr. JJ Thomas: 10:11

When he lifts his head, as you do with the slump testing, symptoms change in his lower extremities. He says, wow. When I lift my head up, that makes it better. Okay. I explained to him, you know what?

Dr. JJ Thomas: 10:21

That means there is some underlying low back issue. It may or may not be related. We're gonna do some more tests. We go to the left side. Left side is so much more limited.

Dr. JJ Thomas: 10:31

I mean, I go to bring that leg up. It barely goes. Head is down. I ask him to lift his head. He lifts his head.

Dr. JJ Thomas: 10:36

Same thing. Wow. That significantly changes my stretch on my leg. Okay. So I tell him, you have a you have an irritability in your nerve.

Dr. JJ Thomas: 10:45

It's likely related to your foot. Let's do some other testing. So now I'm gonna stand him up. I'm gonna go to the low back, and I'm gonna see what I find there. Wouldn't you know when we look at his low back, he has limited left side bend, and there's an apex, so left lumbar is not closing at all.

Dr. JJ Thomas: 11:02

He has limited left extension quadrant. And when we test multisimodal rotation, left doesn't move at all either, so that left lumbar is completely locked up from movement testing. He feels it. I say to him, how does that feel? Wow.

Dr. JJ Thomas: 11:15

That feels really limited. Interesting. That's your left side, same side that's worse on the foot. Right? Yes, it is.

Dr. JJ Thomas: 11:22

Okay. So he's getting there on his own. So here's where the real guts comes in. Here's where the leadership comes in. If you think there's a definitive relationship related.

Dr. JJ Thomas: 11:31

And you know how you're gonna do that? You're not gonna touch the spot that they feel pain. You owe it to them to show them that that's related. And you know how you're gonna do that? You're not gonna touch the spot that they feel pain.

Dr. JJ Thomas: 11:36

And you know how you're gonna do that? You're not gonna touch the spot that they feel pain. You know how you're gonna do that? You're not gonna touch the spot that they feel pain in. What you're gonna do instead is you're going to treat, like what we did in this session, we treated the lumbar spine that day.

Dr. JJ Thomas: 11:54

I took them, and I do dry needling. So the benefits of dry needling are that it gives a pretty dramatic result right away. So we dry needled his lumbar spine, and I did extra focus on his left lumbar because it was so locked up. He sat up, and he had a I should have said earlier. He had a standing level of, like, a low level, even without any movement, without weight bearing on his on his foot.

Dr. JJ Thomas: 12:17

He said in standing, he, he had a 3 out of 10 symptom. Right? So I treat his left lumbar with dry needling. He gets up. As soon as he gets up, before I even get to do motion testing, he says, oh my god.

Dr. JJ Thomas: 12:30

My foot feels better. That's leading a patient to show them why they come to us, why they pay for us, why they choose to come to us versus an insurance based practice where maybe they don't have time to find these relationships. That's the first way you're gonna lead someone down a path that you're not going to be able to do in an insurance based practice. And if you don't have the guts to do that, if you fall into the pattern that so many people do, even in the cash based world, because they're afraid to not give the patients what they want, then if you touch that foot if you even touch that foot in that same treatment, they're gonna think that they got better because you touched that foot even though they went to all these other therapists and they touched the foot and it didn't change long term. So if you can find an opportunity to show them that treating something remote, an underlying cause, how it's related, how their body's interconnected, if you can find that, you're going to successfully build your practice on so many levels.

Dr. JJ Thomas: 13:31

You're gonna get results that your patients can are gonna wanna holler at rooftops about, and your reputation is that, oh, she's relentless in finding the answer. He's relentless in finding the answer. That's the type of brand you want to build for yourself, and only a skill like leadership is going to allow you to do that. There's a second scenario here where leadership is going to be key in your practice. That scenario is similar to this one, and we mentioned it throughout the themes of that first example, but what that second scenario is is you're going to use leadership to get buy in in your patients, and that's exactly what I was talking about just at the end of that first scenario where, excuse me, where the patient has to understand, fully wrap their head around what you're doing with them, where your treatment is progressing, and why you're choosing to do the things you're doing.

Dr. JJ Thomas: 14:26

When you have buy in with a patient, when they fully understand, not here, but, like, here, they understand the path that you're taking them through, they're gonna get better faster because they know they know and trust you. So the cerebral part of that is really important, the the buy in mental confidence in you. Number 2, they're gonna they're gonna actually do what you say. Like, this patient, back to the previous example, the plantar fasciitis example, I gave him 2 exercises. I gave him you may not know the exercises, but, essentially, they were spinal stability exercises.

Dr. JJ Thomas: 15:03

1 was in a flex spine, 1 was in a neutral spine. They were basically spinal exercises. Now those particular exercises I gave him are also gonna have a flexibility role in his lower extremities, including his ankles, and I explained that to him. But I also made sure to tell him the primary reason I'm giving you these is because they're going to improve your spinal stability, which is gonna give you better outcomes for the treating the root cause. So I left him with that, and you know what?

Dr. JJ Thomas: 15:32

He's gonna do it because he has buy in. And I make it very manageable for him. They also they need to be manageable. Like, I said to him, look. I'm giving you 2 exercises.

Dr. JJ Thomas: 15:41

I want you to do 1 minute of each of these 2 exercises once or twice a day, 3 to 6 minutes. Break it out like that. Simple as can be. They know the time commitment, and then when you can foster that, that, compliance with an exercise that's gonna support your goals together, then they're going to be productive. They're going to have results, and it's gonna feed that buy in even more.

Dr. JJ Thomas: 16:07

So when he comes back next week because I see most of my patients once a week when he comes back next week after a week of doing those exercises and after a really helpful treatment that targeted the root cause, he's going to be so much better. He's going to have that buy in. He's going to say, give me more. He's going to say, you know what? I'll spend 15 minutes now if I have to.

Dr. JJ Thomas: 16:25

Whatever you tell me, JJ, I will do because I now see that you're not going to chase my pain. You're not going to just give me palliative care where you're just rubbing my foot because you learned that that didn't work, and you took the chance of maybe doing something that I didn't believe in at first and showing me how it worked. That's the buy in. That's the beauty of buy in. I want to give another patient example, just because I think this is so important, and and we see it literally daily.

Dr. JJ Thomas: 16:57

I mean, repeated times daily in our practice because we instill this pattern in all of our clinicians. Like, don't waste anyone's time chasing the pain. We have to, right off this right off the bat, start by finding that root cause. And so another patient of mine, I met with maybe 2 weeks ago, He said, he said, You know what, JJ? I have this, like, left upper trap achiness here.

Dr. JJ Thomas: 17:24

It's pretty much always there, but it's really bad lately, and I can't turn my head to the left very well. So I said, okay. Well, let we're gonna work on it. He said, yeah. I he I could tell, like, absolutely tell that he really wanted me to rub that spot.

Dr. JJ Thomas: 17:37

Like, he's like, I I it's just right here. Like, he's pointed to me multiple times. Like, he wanted to make sure I I knew exactly where his fingers were. Like, it's right here. If you could just treat it right here.

Dr. JJ Thomas: 17:47

Right? I said, that's great. I'm gonna touch it in a second. I promise. But let's do some movement testing and make sure that we're gonna we're gonna treat the right area.

Dr. JJ Thomas: 17:55

Okay? So I look at him in standing. He turns his head to the left. It's very limited. He goes about 30 degrees.

Dr. JJ Thomas: 18:02

He's I said, you feel that? Yeah. I feel it. It's right there, JJ. He's showing me again.

Dr. JJ Thomas: 18:07

I say, okay. Bear with me a second. I want you to sit down. I want you to sit with your So I have him sit all the way back, so his hips are flexed to 90 degrees now. Now turn your head to the left.

Dr. JJ Thomas: 18:17

He turns his head. Goes pretty far, actually. He's like, well, that's crazy. I tell him it is crazy. Do you know why it's crazy?

Dr. JJ Thomas: 18:25

Because that highlights a deficit that's different than what you expected. What it highlighted is when we shorten the anterior chain for him, we allow the neck to move. We take some tension off that upper trap now. So I can use that test to show him, to get that buy in, and say, hey. Listen.

Dr. JJ Thomas: 18:47

I know you feel it right here. I, a 100% understand you, hear you, believe you. But this test shows us that when we soften the anterior chain, hip flexors, abdominals, maybe even pec muscles, when we soften that, we'll your neck moves further, and it feels better. Right? He says, yeah.

Dr. JJ Thomas: 19:07

It does. I said, alright. Let's test it. So what we did treatment wise that day, we massaged abdominals. We treated the anterior hips.

Dr. JJ Thomas: 19:15

I did some other movement testing to prioritize our time, like left hip versus right hip, left shoulder, is it pec related, things like that. So you're gonna hone in on your skills. Right? But all this comes back to leadership. I can't just, like, be like, yeah, buddy.

Dr. JJ Thomas: 19:30

I know your left upper trap hurts. I need to rub your stomach. I need to lead him there. I need to show him why we're going to treat the anterior chain through the abdominals, hip flexors, and maybe the pec, and then retest him. So that's what we did.

Dr. JJ Thomas: 19:45

We we massaged abdominals. We treated left hip. We treated left pec. We retested him. Immediately, left neck turned so much better.

Dr. JJ Thomas: 19:54

Like, he went from 30 degrees to 60 degrees easily, and he's like, oh my god. I feel so much better. So when you get results like that and you resist the urge to follow the fear that the patients have of not getting better, Like, I completely sympathize with patients when they they come in. I I know the face. They're like, it's right here.

Dr. JJ Thomas: 20:18

I'm like, I know. I promise if we do this and it doesn't work, I'll address that spot differently. But we have to do this first. If I went in and I treated that upper trap right away, guess what? It would be better temporarily, but it wouldn't stay and the motion wouldn't be better.

Dr. JJ Thomas: 20:32

So by making a motion change, we're proving to them. We're getting that buy in. We're leading them and showing them why we're worth paying cash for. So the buy in is that number 2 leadership, skill that number 2 highlight of when that skill of leadership is critical in your cash based practice. Now there's a third scenario that is critical to exercise your skills and leadership as a as a physical therapist in a cash based practice.

Dr. JJ Thomas: 21:01

And this one is is really hard, but it's I'd say it might be one of the most important times that you're gonna exercise this skill of leadership. It doesn't happen very often, thankfully, But what what it is is choosing to make the hard decisions when you need to, and that might be the hard decisions for your patients. So being a leader, we all know, in every in every type of the of the name, of the word, of leadership, right, we know that, military personnel have to make hard decisions. Parents have to make hard decisions. Everyone in a presidents, have to make hard decisions.

Dr. JJ Thomas: 21:44

Everyone in a leadership role at times has to decide to make hard decisions that are for the good of the people that they're leading. So for our patients, what that means is there are going to be times where you can't necessarily lead them the way you know they need to be led. So either they don't understand the path that you're the plan of care that you've decided is the right one for them, or they don't have the buy in. Like, maybe you went through the movement testing as we described, and it seems very clear to you, but they just can't get there and they don't have that buy in, you're gonna have to let that patient go. You're gonna have to say I mean, I'm not saying right away.

Dr. JJ Thomas: 22:29

Like, give it time. Try to try to meet them there. Try to help them understand what you're seeing and how what you're seeing is going to get them better faster. But you can't let them you cannot sacrifice your, professional experience and let them drive the decisions and drive the path, the plan of care, just because they don't have the buy in. I'm gonna give an example of a patient I This patient I saw gosh.

Dr. JJ Thomas: 22:58

It was probably 8 years ago. It was a long time ago, I still remember her because it was a hard decision. She was an athlete, a young athlete, like, college age. And she was a competitive athlete. And she had chronic pain.

Dr. JJ Thomas: 23:12

I mean, I was maybe the 10th provider she'd seen. She didn't respond per you know, through her report. She didn't respond to the other treatments and sessions she's had with other therapists, other clinicians. And so we did our eval, and I found some things that I thought were going to help her. And, you know, she entertained me in the beginning.

Dr. JJ Thomas: 23:34

Like, I feel like she was she was actually classic with, like, it was hip it was hip dysfunction. And there was a spot she always wanted me to treat. And I was like, look. Same thing I just said. Like, we're going to we're going to address that, but I have to address these other things first to really see the and identify the relationships.

Dr. JJ Thomas: 23:51

So she let me, the first couple sessions, do that. But what happened is after about 3 sessions, she's that fear started increasing more in her, and I don't think I had the buy in. Like, she wasn't really doing the exercises that I knew she needed to do. I just we were not connecting. We were not jiving for whatever reason.

Dr. JJ Thomas: 24:10

And then around the 3rd, 4th session, I actually started hearing her say things that made me realize there was a whole another psychological component to to her injury that had not been addressed. So now my line of questioning started changing a little bit. Like, okay. And I I had to talk about the elephant in the room. I had to say to her, okay.

Dr. JJ Thomas: 24:30

Listen. I'm hearing some things that are outside of my scope as a PT. I I really think you need some professional help with, either a psychologist or a psychiatrist to to work through this with you. I said, are you working with someone for this? She said, no.

Dr. JJ Thomas: 24:43

I'm not. I I went to 1, but I didn't stay. I didn't like them, whatever. I said, listen. I'm gonna have to I'm gonna have to draw a line here.

Dr. JJ Thomas: 24:51

I know I cannot get you better unless I co treat you with someone who's able, who's capable of treating the psychological component to this injury. I said, I'm going to have to require you to go see a psychologist or psychiatrist in conjunction with me. I'm I see movement deficits in you that I know we can treat and we can get better, but I also know that the brain is a really powerful thing. And if we don't address these the mental side of things in addition, I'm never gonna be able to get you better. She was really resistant.

Dr. JJ Thomas: 25:24

I said, listen. I don't wanna shove this down your throat. Go think about this. I'll see you next visit. She came back next visit.

Dr. JJ Thomas: 25:31

And when she came back, it was as if she didn't want to talk about it. She was kind of blowing it off, trying to sweep it under the rug. But I I had to lead her. I had to go I had to follow my instincts and my professional experience, and I had to go back to that. And I said, listen, how'd you do?

Dr. JJ Thomas: 25:47

How are you feeling about seeing the psychologist? She said, you know what, I'm just not there. I can't afford it. I said, look, you can't afford not to. Like, I will work with you on how our charges are here, but this is I cannot get you better unless we do this.

Dr. JJ Thomas: 26:00

She continued to resist, so much so that I finally said to her that day, Listen. I am I am not going to treat you until we do this in collaboration with a with a therapist, with a psychologist or psychiatrist. I said, please don't come back until you've already scheduled an appointment with 1. She was very upset. She begged and pleaded me.

Dr. JJ Thomas: 26:20

I said, listen, I have to follow my you you have to respect you came to me because you respect my professional experience and expertise. Now you have to respect my opinion as a professional. So she eventually left begrudgingly. About 5 weeks later, she showed back up on my schedule. And I remember seeing her sitting in the waiting room, and I remember thinking, Oh, man.

Dr. JJ Thomas: 26:43

This is gonna be another hard conversation. We're gonna have to do this. So before I even brought her back to the table, I went over to her in the waiting room, and I quietly said to her, how are you doing? I'm okay. I'm not any better.

Dr. JJ Thomas: 26:54

I said, okay. How's it going with your psychologist? She said, I didn't see anyone yet. I said, I was not unclear. I cannot see you.

Dr. JJ Thomas: 27:02

I cannot get you better until I have someone else treating you in conjunction with me for that side of things. So she left, unhappy. But that's the thing. As a leader, you're not going to make everybody happy, but you have to follow your professional, experience and instincts in a way that supports your values and goals, in a way that supports your mission, so to speak, right? So my mission is to get people better, and if they're getting in my own way, if they're getting in our way as a team, I have to let them go.

Dr. JJ Thomas: 27:38

Now I don't have to just say, like, kick it to the curb. You suck. I can't get you better. But what I can say is, look. For whatever reason, you're not valuing my opinion here, and I'm not willing to sacrifice what I see is the need for you.

Dr. JJ Thomas: 27:52

Maybe I can find another therapist that you can work with. You know, I know tons of therapists. Maybe I can find someone that will get through to her better. And so that's what we did. She moved on.

Dr. JJ Thomas: 28:04

I I actually never got a follow-up. But in my heart, I know that if I continued to treat her, I wasn't going to get her better. I was going to waste her money. I was going to waste her time. I was going to waste a spot on my schedule that I could get someone else better.

Dr. JJ Thomas: 28:19

So the right thing to do is not to hold on to those people. So as a leader, there are going to be times you need to let people go, and you need to say, you know what? As a leader, I wasn't able to find the root cause, or I wasn't able to get the buy in, or I wasn't able to get them where they needed to be, and so I had to make this hard decision. Being a leader isn't always fun, but when you are a leader and you stick to your standards and you stick to your own expectations, the benefits are boundless. When you follow your own path and you follow your direction and you, as I said, are true to your own standards, what happens is people see that you have the confidence and the experience to get them better in a way that maybe someone else can't, and they also can be comforted in knowing that your reputation is such that if you can't get them better, you're going to find someone else that can.

Dr. JJ Thomas: 29:20

That is, like, priceless. Right? I actually tell patients, oftentimes, you know, people know that when they say, how long is this going to take, you can't give them an answer on day 1. Right? Usually, what I say to them is, listen.

Dr. JJ Thomas: 29:35

Let me day 1, they're like, how long do you think? I'm like, listen. Let's do an evaluation. Let's see what we think we're dealing with. Even after day 1, I'm going to need to see how you respond after day 1 to really get a better sense of how you're going to respond to treatment with us.

Dr. JJ Thomas: 29:50

I can tell you that in 4 to 6 sessions, if we don't see a significant change, that we're moving in the right direction, we're either going to change our plan, or I'm gonna find someone else who might be more appropriate to treat you. That is, like, a really important thing, but that's what a leader does. They establish the rules, right, and they expect people to follow by the rules. And if they don't follow by those rules, then they they don't need to come. You're better off spending your time with people that are going to be on the same page as you, so try to get them there on your own, and if you can't, recognize that you're just not jiving.

Dr. JJ Thomas: 30:27

It's fine. Find someone else that can get them better. Do the world do the world a good thing, right, and it'll come back to you. So all of these topics that we talk about when we talk about being a leader for your patients and being a leader, in your in your practice and how what this is really going to do is almost guarantee your success as a cash based therapist, right? When we talk about this, there's an underlying skill set that I do want to mention, and I've mentioned it throughout this episode.

Dr. JJ Thomas: 30:54

It's essentially having confidence in what you do. And so I think that's one of the biggest barriers I see newer PTs in the cash based world run into, is that they're afraid to almost stand by their own values because they feel like, oh, they're paying me cash. I better give them what they want. What they want is to get better, and so what they need is for you to figure out the best plan to get them better, and that's gonna give them what they want, if that makes sense. But you have to have the confidence to do that.

Dr. JJ Thomas: 31:25

So the other thing I wanted to make sure I took the time for on this episode is is to recognize that if, for some reason, you don't feel that confident to do this, you need to work on yourself in a way that's gonna build that confidence. For most PTs, that means maybe you're gonna put more time into continuing education. Right? Maybe you're gonna find a evaluative method that is gonna help you establish that patterning that I was talking about earlier to show your patients the buy in. If you tell a patient something's related, they're never going to really believe you if it seems remote and hard to see, hard to recognize.

Dr. JJ Thomas: 32:02

But if you show them, it's undeniable. If you repeatedly show them these correlations in the body, it's undeniable. So there are tons of, continuing education methods out there that will help breed that. My suggestion would be I'm happy to suggest a few. Feel free to DM me anytime, and I'm happy to recommend the ones that I took and other ones that I've heard about that are great.

Dr. JJ Thomas: 32:24

We are also launching our Primal University, series starting in January 2024, so that will help, again, show you the methods, give you the confidence to be able to get that buy in, to be able to lead your patients in a way that helps you show and demonstrate and go after that root cause. But, ultimately, what all of this does is it sets us apart as individual clinicians. So when you lead your patients in this way, it sets us apart. It shows that we're not going to fall into the fear factor and just chase the pain. It also shows them we're not an a la carte profession.

Dr. JJ Thomas: 33:03

If if we fall into that fear and we just massage out an area that's symptomatic, why how does that make us different from any other from a massage therapist that maybe isn't chasing isn't is chasing the pain and not looking for the root cause? So being a leader and helping a patient direct their care in a way that's actually productive for them rather than following what you think they want and chasing their pain. It's going to set us apart, and it's going to, give results that will really compound your success as a clinician and, ultimately, your sex success in your practice. Thanks so much for listening. I hope this was helpful.

Dr. JJ Thomas: 33:46

Anytime you want to hear more about something in our Cashbase world, learn from our experiences, please reach out, DM me, leave a message in the comments below, and you can check out our website, primalhq.com for more information on Primal University and our ebook on cash based practice success.