Are Physical Therapists Really Doctors? Unpacking the Research

WEBVTT

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Yeah.

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Lance is back on the podcast.

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Lance from High Point

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University with the branded background.

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Welcome back to the show.

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Thank you.

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Thank you.

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It's good being back.

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Before we hit record, I said, what's new?

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You said more research.

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So we're talking about research today,

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but we're going to make it applicable,

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right?

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Like,

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I think some people get turned off on

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research because it can be dense.

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But there's a new tool out there.

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I took the research that

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we're going to talk about today.

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I copied it.

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I put it into ChatGPT and I said,

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explain it to me like I'm

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in eighth grade.

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And then I understood everything.

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You have to send that to me.

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I'm excited to read it.

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It's nice and easy.

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But even better than ChatGPT,

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I got the person who's

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responsible with it.

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This wasn't just you.

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I always want to make sure

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we mention co-authors,

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people who helped before we kick it in.

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So who was with you on this

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particular piece?

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Yes.

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So the primary author is Justin Martino.

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He was a student at High

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Point while he matriculated

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under me and recently graduated.

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He's now Dr. Martino, physical therapist.

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And Dr. James Smoliga,

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who's a veterinarian,

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is working for Tufts University.

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So that's a cool mix.

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Title of the piece,

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which we're going to put a

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link in the show notes,

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Journal of Manual and

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Manipulative Therapy.

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But the title, I love it.

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I even did like a Twitter poll on it too.

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And that was one of the selections.

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You have to send me that too, yeah.

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Yeah.

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So the title is not...

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that kind of doctor an

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exploratory study on doctor

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of physical therapy patient

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introductions in the united

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states so first let's just

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start with like why'd you

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do this what was the

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there's got to be a pain

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point right there's got to

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be a question you want

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answered what was the

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instigating sort of problem

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question whatever that

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started you three from

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going down this road and

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looking into this

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Yeah.

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So I think for me personally,

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I went through the same

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journey as many other

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physical therapists.

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I now earned this degree,

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this doctorate degree.

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Am I going to use this title?

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Am I Lance?

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Am I Dr. Mabry?

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Who am I?

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And I think just like the rest of us,

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I tried different things

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out with patients to see what worked.

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And in the end, I found that

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you know,

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using the doctor title was

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actually very influential

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in helping patients be more

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adherent to their process, you know,

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less of a friction point with, you know,

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I'm just, you know, the patient saying,

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I'm just here, you know,

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treading water until I go

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back to the surgeon, you know, and

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And using that title kind of

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fixed a lot of those things

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and really helped with that

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patient experience.

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So in talking to other

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providers that have gone

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through the same journey,

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they kind of found the same thing,

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that using that doctoral

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title has been influential

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in patient care.

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So this is a question that's

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been burning inside me for years is,

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you know, very, very clearly, you know,

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in the first phase of PT literature,

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we are all comparing patients.

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you know,

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manual therapy to exercise and

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doing those kind of things.

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Now we're getting into this

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pain science contextual factors, you know,

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what we say matters to patients.

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And and my student at the time,

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Justin Martino,

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came up to me and said he had a passion.

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He wanted to do this.

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And I said, Well, let's

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let's get it done.

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This is right in my alley.

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Let's, let's figure it out.

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So, uh, you know,

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the first step we had to

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figure out before we take

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you to the clinic,

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because we do want to set

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up a clinical trial on this is, uh,

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who's even using it.

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So our physical therapist

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using the doctoral title and, and if so,

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why, and, and, you know,

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just figuring out, you know, what,

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what metrics should we

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actually use when we,

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when we hit the clinic with

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this question?

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Now,

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if you're watching this on YouTube or

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if you're listening on a podcast,

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I would love for you to chime in.

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It's easier on YouTube if

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you just drop it below.

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If you're a PT,

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do you use the title or not?

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And even if you're not a PT,

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would you expect them,

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if they're doctorally trained,

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to use it or not?

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And then we can get into

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some of the reasons,

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and let's get into the reasons.

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So, Lance,

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your research found that only

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about twenty percent of

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physical therapists are

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using the term doctor.

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during the patient introductions?

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Why do you think so many are

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hesitant to use it?

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And what are some of the top

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reasons that actually that

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you found that sway those who do?

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Well,

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I think one of the first things we

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found was setting was a factor.

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So those that are working in

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pelvic health were actually

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very likely or comparably

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more likely to use that

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title doctor than those that weren't.

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Orthopedics and sports was

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also similarly more higher

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compared to others.

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And as we would expect,

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lower areas was pediatrics, geriatrics,

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acute care, SNF,

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Actually, private practice was high.

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So the setting seemed to

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make a difference in

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whether or not people were

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using this or not.

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Because there are so many

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settings and so many patient populations,

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we didn't enter that into

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any kind of regression,

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but we did see huge

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differences in that part.

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Uh,

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therapeutic alliance is a major factor in,

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in that decision to use or not to use.

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I feel like I'm quoting Shakespeare.

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Um,

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help us understand how using or not

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using the term doctor can

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impact patient trust and communication.

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And have you seen any

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specific examples where

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this actually made a difference?

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Yeah, so we actually asked the PTs,

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both those that were using

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the title and those that weren't,

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why were they using it and

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why weren't they using it?

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So in those that were using the title,

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two of the things that

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pulled out as being

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um highly influential was

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that in that was to

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demonstrate expertise to

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their patients and also to

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advance the profession and

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that kind of ties to that

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therapeutic alliance piece

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so when you look at the

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research patients when you

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use the title doctor in

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front of patients they have

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a greater belief in the

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competence of the provider.

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They trust them more.

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They believe they are more

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caring and compassionate.

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The research isn't expansive in this,

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but there is this kind of

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suggestion that using your

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earned title doctor does

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positively impact that

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patient alliance through trust.

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However,

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it also popped out on those that

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don't use the title doctor.

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So those that don't use the title,

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their top reason was they

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felt that they believed it

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could confuse patients.

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And then the second one was

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therapeutic alliance.

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So both those that are using

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the title and not using

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title are both using it or not using it.

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because they believe it it

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improves therapeutic

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alliance and only one of

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those things I mean it's

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possible that both are true

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so imagine you know maybe

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in a setting like

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pediatrics not using the

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title improves that

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therapeutic alliance versus

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in I don't know sports it

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improves therapeutic

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alliance so it's possible

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that both of those things

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are true um but we just

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don't know so um that's

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going to be one of the

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things you know if we're

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hoping to get this into the

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clinic um that's going to

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be one of the things we're

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going to look into is does

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that influence trust does it influence

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therapeutic alliance.

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And hopefully if we can

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extrapolate that out and

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actually track things like

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adherence and outcomes and

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things of that matter.

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Let's zoom in a little bit too.

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Your study revealed some

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interesting demographic trends,

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such as older PTs and males

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being more likely to use

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the title and the opposite being true,

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right?

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Females and younger PTs may

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be less likely.

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Yeah.

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What do you think drive

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these differences and how

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might it influence future

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generations of PTs?

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Yeah, well, frankly,

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some of these were surprising.

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So one of the things I hear

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in chat rooms was everybody was saying,

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oh, it's easier for the younger PTs.

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It's easier for PTs now to

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use Docker than it was

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years ago when this first started.

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And if I had to guess what

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the research showed,

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is I would have guessed that

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it would have been that way,

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that newer PTs would have

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been more likely to use it

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and maybe older, comparably less so.

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When we actually looked into

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the comments from the respondents,

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one of the things we saw

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was it took PTs a while of

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practice before they felt like they,

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quote, earned it.

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That it didn't feel right

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for them at first and it

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took them a while to get there.

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And frankly, that was my...

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journey as well.

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My first few weeks, months,

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years out of school,

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I didn't use the title doctor,

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and it wasn't until it felt

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comfortable with me that I

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started using it.

00:08:21.764 --> 00:08:23.545
The other one was male gender.

00:08:23.644 --> 00:08:26.386
So there is some research coming out now.

00:08:26.925 --> 00:08:28.326
Physical therapy has been

00:08:28.505 --> 00:08:30.406
predominantly a female profession.

00:08:30.867 --> 00:08:31.927
I mean, since its inception,

00:08:32.668 --> 00:08:34.028
men weren't invited when

00:08:34.148 --> 00:08:36.308
the PT profession was first made.

00:08:38.208 --> 00:08:39.370
so now some of the research

00:08:39.389 --> 00:08:39.950
that's coming out that's

00:08:39.970 --> 00:08:42.051
showing that women are uh

00:08:42.091 --> 00:08:43.331
you know have lesser

00:08:43.511 --> 00:08:44.432
leadership titles have

00:08:44.472 --> 00:08:46.094
lesser uh pay in physical

00:08:46.114 --> 00:08:47.835
therapy it was interesting

00:08:47.855 --> 00:08:48.914
to see that they are also

00:08:49.134 --> 00:08:51.557
less likely to use this uh

00:08:51.616 --> 00:08:53.038
this title of doctor versus

00:08:53.118 --> 00:08:55.278
men aren't so I I do think

00:08:55.298 --> 00:08:56.679
that there's some uh

00:08:56.700 --> 00:08:57.960
psychological factors that

00:08:58.061 --> 00:08:59.360
that could be of value to

00:08:59.421 --> 00:09:00.802
tease out there that's

00:09:01.022 --> 00:09:02.342
probably beyond my love my

00:09:02.383 --> 00:09:03.823
skill set to tease those out but

00:09:04.104 --> 00:09:06.905
Um, but I do think that that's, uh,

00:09:07.005 --> 00:09:08.206
an interesting parallel to

00:09:08.226 --> 00:09:08.947
some of the other research

00:09:08.967 --> 00:09:09.807
we have coming out.

00:09:09.888 --> 00:09:10.269
Yeah.

00:09:10.288 --> 00:09:12.671
Uh, there's also some legal implications.

00:09:12.730 --> 00:09:13.691
People bring this up.

00:09:13.770 --> 00:09:14.751
This makes its rounds on

00:09:14.792 --> 00:09:15.613
Twitter every once in a

00:09:15.653 --> 00:09:17.193
while involving healthcare

00:09:17.214 --> 00:09:18.554
professionals and the use

00:09:18.634 --> 00:09:20.015
of this title doctor.

00:09:20.956 --> 00:09:22.038
Help us understand more about that.

00:09:22.077 --> 00:09:23.778
How might PTs navigate these

00:09:23.798 --> 00:09:25.279
challenges without causing

00:09:25.620 --> 00:09:27.142
the things that most of the

00:09:27.162 --> 00:09:27.922
clinicians are trying to

00:09:27.961 --> 00:09:29.703
avoid patient confusion or

00:09:29.783 --> 00:09:31.164
facing legal consequences?

00:09:31.184 --> 00:09:32.385
We want to do it for the

00:09:32.426 --> 00:09:33.746
right reasons in the right way.

00:09:34.307 --> 00:09:34.547
Sure.

00:09:34.866 --> 00:09:36.967
Well, if you look at the one thing,

00:09:37.187 --> 00:09:38.087
always check with your,

00:09:38.187 --> 00:09:39.288
if you're ever worried,

00:09:39.389 --> 00:09:40.149
always look at your state

00:09:40.168 --> 00:09:41.669
board and your practice act.

00:09:41.710 --> 00:09:43.470
So one thing I'll say to PTs

00:09:43.549 --> 00:09:45.091
is what we can and can't do

00:09:45.130 --> 00:09:47.672
does not live solely in the practice act.

00:09:47.692 --> 00:09:48.412
This isn't something I

00:09:48.432 --> 00:09:49.351
realized until I actually

00:09:49.371 --> 00:09:50.253
started digging in here.

00:09:50.373 --> 00:09:51.812
A lot of the granular stuff

00:09:51.873 --> 00:09:52.894
on what we can and can't do

00:09:52.933 --> 00:09:53.874
is spelled out by board

00:09:53.913 --> 00:09:54.894
rules and board opinions.

00:09:55.114 --> 00:09:56.695
So making sure you're

00:09:56.715 --> 00:09:59.296
familiar with those is a value.

00:09:59.696 --> 00:10:01.616
uh however um those that get

00:10:01.636 --> 00:10:02.498
more detailed on this

00:10:02.557 --> 00:10:03.399
pretty much say that you

00:10:03.438 --> 00:10:05.080
have to pair the word

00:10:05.120 --> 00:10:06.059
physical therapist with

00:10:06.100 --> 00:10:07.721
doctors so uh you know when

00:10:07.760 --> 00:10:08.741
I'm meeting my patients

00:10:08.841 --> 00:10:09.962
hello I'm dr mabry I'm a

00:10:10.003 --> 00:10:12.244
physical therapist um and I

00:10:12.283 --> 00:10:13.544
haven't had any issues with

00:10:13.664 --> 00:10:14.905
patient confusion I've used

00:10:14.946 --> 00:10:15.966
it on inpatient I've used

00:10:16.006 --> 00:10:17.748
it outpatient I haven't had

00:10:17.768 --> 00:10:18.548
anybody ask me for a

00:10:18.609 --> 00:10:21.951
colonoscopy yet so um so

00:10:22.311 --> 00:10:23.272
tying that physical

00:10:23.292 --> 00:10:24.052
therapist again look at

00:10:24.072 --> 00:10:24.972
your state but tying that

00:10:25.013 --> 00:10:25.812
physical therapist to the

00:10:25.832 --> 00:10:28.936
introduction is uh is important um

00:10:29.615 --> 00:10:32.217
uh there is a case that came

00:10:32.258 --> 00:10:33.759
out recently of a doctor of

00:10:33.779 --> 00:10:35.360
nurse practitioner that got

00:10:35.461 --> 00:10:37.523
sued because she used her

00:10:37.562 --> 00:10:39.845
title her title doctor and

00:10:39.945 --> 00:10:41.066
interestingly she actually

00:10:41.206 --> 00:10:42.326
worked in a clinic that was

00:10:42.386 --> 00:10:43.347
owned by a physician and

00:10:43.368 --> 00:10:44.528
she was encouraged by the

00:10:44.649 --> 00:10:45.909
owner and the physician to

00:10:46.049 --> 00:10:47.551
use that title doctor so

00:10:48.192 --> 00:10:48.971
there was a lawsuit that

00:10:48.991 --> 00:10:50.673
came out about it my

00:10:50.693 --> 00:10:52.755
understanding is there's uh

00:10:52.775 --> 00:10:53.876
that that case might come

00:10:53.917 --> 00:10:55.038
up again that the the

00:10:55.677 --> 00:10:57.078
Final outcome of the case is

00:10:57.099 --> 00:10:57.739
still pending.

00:10:58.619 --> 00:11:00.379
I'm curious to see where this shakes out.

00:11:00.440 --> 00:11:02.640
But but I do think that

00:11:02.821 --> 00:11:03.980
ultimately that the the

00:11:04.081 --> 00:11:05.302
word doctor is going to be

00:11:05.322 --> 00:11:06.461
very difficult to defend

00:11:06.501 --> 00:11:07.902
because it's been used in

00:11:07.942 --> 00:11:10.342
academia before it was used in medicine.

00:11:10.462 --> 00:11:10.964
Yeah.

00:11:11.644 --> 00:11:14.284
As topics like this evolves,

00:11:14.365 --> 00:11:15.865
what changes would you you

00:11:15.924 --> 00:11:17.446
personally like to see in

00:11:17.466 --> 00:11:18.426
the profession regarding

00:11:18.485 --> 00:11:19.667
title usage and what role

00:11:19.687 --> 00:11:20.486
do you think it could play

00:11:20.506 --> 00:11:22.288
in advancing the profession as a whole?

00:11:23.307 --> 00:11:23.427
Well,

00:11:23.648 --> 00:11:25.090
I think the big thing is it all comes

00:11:25.110 --> 00:11:26.191
down to patients, right?

00:11:26.270 --> 00:11:28.932
So I posted this this

00:11:28.993 --> 00:11:30.474
research on online and one

00:11:30.494 --> 00:11:31.595
of the things I saw was

00:11:32.176 --> 00:11:33.256
something to the effect of this.

00:11:33.397 --> 00:11:36.399
This this is not a clinical question.

00:11:36.438 --> 00:11:38.421
And frankly, to me, I am a clinician.

00:11:38.942 --> 00:11:38.961
I

00:11:40.302 --> 00:11:41.724
I have more than a decade in the clinic.

00:11:41.803 --> 00:11:42.683
I still see patients.

00:11:43.945 --> 00:11:44.205
And to me,

00:11:44.225 --> 00:11:46.106
it's a hugely clinical question.

00:11:46.126 --> 00:11:48.128
That contextual factor and

00:11:48.307 --> 00:11:50.590
how that influences

00:11:50.629 --> 00:11:51.730
patients and their outcomes

00:11:52.091 --> 00:11:53.471
is hugely important.

00:11:54.913 --> 00:11:56.413
So where I would like to see this going is,

00:11:56.533 --> 00:11:57.274
one, we have to figure out,

00:11:58.014 --> 00:11:59.355
is this a net positive for

00:11:59.395 --> 00:12:00.197
patients overall?

00:12:00.216 --> 00:12:03.239
Does that vary by population?

00:12:03.259 --> 00:12:04.299
Does that vary by age?

00:12:04.320 --> 00:12:05.500
Does that vary by demographic?

00:12:05.961 --> 00:12:07.381
Not just in the PTs,

00:12:07.402 --> 00:12:08.503
but also in their patients.

00:12:09.364 --> 00:12:10.505
And then how can that help

00:12:10.546 --> 00:12:11.888
guide our care and help

00:12:11.967 --> 00:12:12.950
influence our care?

00:12:13.029 --> 00:12:16.615
So if it does in fact match

00:12:16.655 --> 00:12:17.538
what the other research and

00:12:17.557 --> 00:12:18.519
other professions show,

00:12:19.408 --> 00:12:20.869
that using the title doctor

00:12:20.928 --> 00:12:22.870
does positively influence

00:12:22.929 --> 00:12:25.169
trust or belief in trust,

00:12:25.210 --> 00:12:27.990
belief in caring, belief in competence,

00:12:28.750 --> 00:12:29.791
then I think we should

00:12:29.831 --> 00:12:31.731
probably start being that

00:12:31.772 --> 00:12:32.731
change in our profession.

00:12:32.792 --> 00:12:34.552
And one of the things I see, you know,

00:12:34.652 --> 00:12:36.033
you and I are both on social media.

00:12:36.732 --> 00:12:38.133
One of the things I see is a lot of people,

00:12:38.592 --> 00:12:38.793
you know,

00:12:38.832 --> 00:12:40.094
complain about the profession

00:12:40.134 --> 00:12:41.173
and complain about changes

00:12:41.193 --> 00:12:42.234
they want to see in the profession.

00:12:43.313 --> 00:12:44.355
But the same people that are

00:12:44.375 --> 00:12:45.674
complaining aren't willing to actually

00:12:46.315 --> 00:12:46.975
Make the changes.

00:12:47.076 --> 00:12:48.677
So let's make the changes.

00:12:48.756 --> 00:12:49.017
Right.

00:12:49.177 --> 00:12:49.817
So if I mean,

00:12:50.837 --> 00:12:52.298
if we are going to diminish

00:12:52.399 --> 00:12:53.820
ourselves as a profession,

00:12:53.879 --> 00:12:55.039
then we're going to be if

00:12:55.080 --> 00:12:56.360
we're if we're less in the

00:12:56.441 --> 00:12:57.261
eyes of ourselves,

00:12:57.282 --> 00:12:58.503
then we're certainly going

00:12:58.523 --> 00:12:59.942
to be less in the eyes of others.

00:13:00.023 --> 00:13:00.543
Yeah.

00:13:00.624 --> 00:13:00.764
Yeah.

00:13:01.936 --> 00:13:03.277
Uh, no one questions Dr. Seuss.

00:13:03.356 --> 00:13:04.476
No one's ever asked him for

00:13:04.517 --> 00:13:05.236
his credentials,

00:13:05.456 --> 00:13:06.618
but we just truck that Dr.

00:13:06.658 --> 00:13:08.717
Seuss is in fact a full doctor,

00:13:08.837 --> 00:13:09.778
not that kind of doctor and

00:13:09.798 --> 00:13:10.899
exploratory study on doctor

00:13:10.918 --> 00:13:11.639
of physical therapy,

00:13:12.058 --> 00:13:13.320
patient introductions in

00:13:13.340 --> 00:13:14.200
the United States.

00:13:14.220 --> 00:13:14.820
Uh, again,

00:13:14.860 --> 00:13:16.260
we'll share that link in the

00:13:16.301 --> 00:13:16.860
show notes in the

00:13:16.900 --> 00:13:18.100
description below some

00:13:18.140 --> 00:13:19.142
other findings on top of,

00:13:19.182 --> 00:13:20.662
we said at the top of the show,

00:13:20.741 --> 00:13:22.062
only one in five PTs use

00:13:22.102 --> 00:13:23.503
doctor title around around

00:13:23.582 --> 00:13:24.263
twenty percent.

00:13:25.063 --> 00:13:25.124
Uh,

00:13:25.283 --> 00:13:28.404
older PTs and male PTs are more likely

00:13:28.445 --> 00:13:29.345
to use the title.

00:13:30.326 --> 00:13:30.566
Also,

00:13:30.625 --> 00:13:32.927
experience matters to PTs who

00:13:32.967 --> 00:13:34.068
completed extra training

00:13:34.109 --> 00:13:35.389
like a residency program

00:13:35.409 --> 00:13:36.730
were more likely to use the title.

00:13:37.091 --> 00:13:37.390
However,

00:13:37.431 --> 00:13:39.452
PTs who serve as clinical

00:13:39.493 --> 00:13:40.933
instructors or CIs who

00:13:40.974 --> 00:13:43.115
train student PTs were less

00:13:43.216 --> 00:13:44.777
likely to use the title.

00:13:45.256 --> 00:13:46.477
So imagine you're a student.

00:13:47.539 --> 00:13:48.682
you'd be very confused.

00:13:48.701 --> 00:13:49.583
Of course, you're going to come out very,

00:13:49.604 --> 00:13:50.485
you know, you've got, you've got,

00:13:51.086 --> 00:13:51.306
you know,

00:13:51.366 --> 00:13:53.089
professors in class telling you

00:13:53.110 --> 00:13:54.130
maybe instructing one thing,

00:13:54.171 --> 00:13:55.212
then you go to a CI,

00:13:55.253 --> 00:13:55.953
it's a different thing.

00:13:55.974 --> 00:13:56.495
You're watching what

00:13:56.534 --> 00:13:57.397
everyone else is doing.

00:13:57.957 --> 00:13:58.859
No wonder students might,

00:13:58.999 --> 00:14:00.461
and younger physical therapists would,

00:14:00.581 --> 00:14:01.423
would be confused.

00:14:02.533 --> 00:14:03.274
I think everybody's kind of

00:14:03.293 --> 00:14:04.053
going through this journey.

00:14:04.654 --> 00:14:05.916
Are we going to use this?

00:14:05.936 --> 00:14:06.796
Are we not going to use this?

00:14:06.836 --> 00:14:07.756
I think everybody at some

00:14:07.817 --> 00:14:09.518
point asks themselves this question.

00:14:09.577 --> 00:14:13.020
And when we do control for

00:14:13.061 --> 00:14:14.261
the other two major factors,

00:14:14.642 --> 00:14:15.643
age and gender,

00:14:16.763 --> 00:14:17.604
those that completed the

00:14:17.624 --> 00:14:19.105
residency program more likely.

00:14:19.764 --> 00:14:20.546
But as you said,

00:14:21.005 --> 00:14:22.687
those that serve as CIs

00:14:22.727 --> 00:14:23.927
were less likely to use the

00:14:23.967 --> 00:14:24.928
term a doctor.

00:14:24.948 --> 00:14:26.909
So this was very much an

00:14:26.950 --> 00:14:27.890
exploratory study.

00:14:28.091 --> 00:14:28.991
That's in the title that

00:14:29.032 --> 00:14:30.092
it's an exploratory study.

00:14:30.592 --> 00:14:31.354
And as we

00:14:32.014 --> 00:14:33.634
dug into this, there were things that,

00:14:34.075 --> 00:14:35.255
you know, usually as a researcher,

00:14:35.316 --> 00:14:36.897
you build a study and you

00:14:36.917 --> 00:14:37.477
kind of know what the

00:14:37.538 --> 00:14:38.118
outcome is going to be

00:14:38.138 --> 00:14:39.499
before you even do the study.

00:14:40.340 --> 00:14:41.039
There were things that shook

00:14:41.100 --> 00:14:42.400
out about this that surprised me.

00:14:42.520 --> 00:14:45.744
Why are CIs less likely to

00:14:45.884 --> 00:14:47.345
use their title doctor?

00:14:47.365 --> 00:14:49.206
Is it, you know,

00:14:49.905 --> 00:14:52.067
does it kind of predispose

00:14:52.187 --> 00:14:53.509
which people choose to be

00:14:53.568 --> 00:14:56.071
CIs or which clinics are minimal to CIs?

00:14:57.971 --> 00:14:58.832
That was something that

00:14:58.913 --> 00:15:00.553
shook out that we just did not expect.

00:15:01.259 --> 00:15:03.520
Yeah, some other information,

00:15:03.581 --> 00:15:05.301
reasons for using or not using the title.

00:15:05.321 --> 00:15:06.260
We mentioned some of those before,

00:15:06.321 --> 00:15:07.880
why some PTs use the doctor

00:15:07.900 --> 00:15:09.142
title to show expertise

00:15:09.522 --> 00:15:10.121
because they feel like

00:15:10.142 --> 00:15:11.522
they've earned the title, which they have,

00:15:11.922 --> 00:15:12.743
and to help advance the

00:15:12.783 --> 00:15:14.003
profession of physical therapy.

00:15:14.043 --> 00:15:14.962
If we all do this,

00:15:15.062 --> 00:15:16.102
it will change perception

00:15:16.143 --> 00:15:17.043
and perception could be

00:15:17.102 --> 00:15:19.244
reality and why others might avoid it.

00:15:19.283 --> 00:15:20.884
Concerns about confusing patients,

00:15:20.903 --> 00:15:22.524
which I can empathize with,

00:15:23.004 --> 00:15:24.105
or worrying that using the

00:15:24.144 --> 00:15:24.825
title might hurt their

00:15:24.845 --> 00:15:25.865
relationship with patients,

00:15:25.884 --> 00:15:28.206
that therapeutic alliance.

00:15:28.846 --> 00:15:29.846
Anything I didn't ask about

00:15:29.886 --> 00:15:31.388
this or that came up that

00:15:31.408 --> 00:15:32.990
surprised you in a good or

00:15:33.049 --> 00:15:33.529
interesting way?

00:15:33.990 --> 00:15:34.250
Yeah.

00:15:34.551 --> 00:15:35.131
So you mentioned about

00:15:35.152 --> 00:15:36.111
advancing the profession.

00:15:36.192 --> 00:15:39.274
So when you look at some of

00:15:39.294 --> 00:15:40.015
the research that we found

00:15:40.035 --> 00:15:41.356
on this is from optometry.

00:15:41.437 --> 00:15:43.619
So optometry has the same question.

00:15:43.859 --> 00:15:45.740
If optometrists, which are now doctors,

00:15:47.481 --> 00:15:48.743
the research suggests, hey,

00:15:48.783 --> 00:15:49.663
we should be using this

00:15:49.984 --> 00:15:51.485
title to advance our profession.

00:15:52.186 --> 00:15:53.726
um interestingly one of our

00:15:53.767 --> 00:15:55.687
co-authors on this james dr

00:15:55.727 --> 00:15:56.969
james malaga is a

00:15:57.028 --> 00:15:59.309
veterinarian and uh he said

00:15:59.330 --> 00:16:00.730
that veterinarians were the

00:16:01.030 --> 00:16:02.591
uh were the original not

00:16:02.652 --> 00:16:03.952
that kind of doctors that

00:16:04.153 --> 00:16:05.352
veterinarians went through

00:16:05.373 --> 00:16:07.533
this same journey of are we

00:16:07.654 --> 00:16:08.695
are we doctors are we not

00:16:08.735 --> 00:16:09.796
doctors should we you know

00:16:09.836 --> 00:16:10.596
are we doctors with our

00:16:10.635 --> 00:16:12.177
patients and you know

00:16:12.197 --> 00:16:12.917
they've kind of gotten to

00:16:12.956 --> 00:16:14.138
the other other end of that

00:16:14.197 --> 00:16:15.578
and yes they are and

00:16:16.078 --> 00:16:16.298
you know,

00:16:16.438 --> 00:16:18.020
looking at podiatrists kind of

00:16:18.041 --> 00:16:19.162
going through the same journey.

00:16:19.241 --> 00:16:19.422
You know,

00:16:19.642 --> 00:16:21.263
there's there are now surgical

00:16:21.302 --> 00:16:22.663
and non-surgical podiatrists.

00:16:22.725 --> 00:16:24.025
Podiatrists years ago were

00:16:24.046 --> 00:16:25.246
doing a lot with, you know,

00:16:25.366 --> 00:16:26.847
inserts and lifts and

00:16:26.888 --> 00:16:27.788
various other things.

00:16:27.828 --> 00:16:29.690
But now podiatrists are in

00:16:29.730 --> 00:16:30.630
the operating room and

00:16:30.650 --> 00:16:31.672
they're performing surgery.

00:16:32.832 --> 00:16:33.894
They don't have an MD.

00:16:33.913 --> 00:16:34.693
They don't have a DO.

00:16:34.734 --> 00:16:35.914
They have a DPM,

00:16:35.934 --> 00:16:37.777
a doctor of podiatric medicine.

00:16:38.496 --> 00:16:39.597
um they have come out on the

00:16:39.638 --> 00:16:40.697
other end and nobody

00:16:40.738 --> 00:16:42.719
questions when they use the

00:16:42.759 --> 00:16:44.720
the title doctor uh or not

00:16:44.740 --> 00:16:46.580
that I've seen so I think

00:16:46.600 --> 00:16:47.400
our journey is going the

00:16:47.441 --> 00:16:48.841
same way um I think we are

00:16:48.860 --> 00:16:49.520
going to come out on the

00:16:49.542 --> 00:16:50.542
other side where we're

00:16:50.581 --> 00:16:51.381
probably using it more than

00:16:51.422 --> 00:16:54.182
not um uh so just one

00:16:54.222 --> 00:16:55.323
clarifying point so it's

00:16:55.364 --> 00:16:56.583
not twenty percent of pts

00:16:56.604 --> 00:16:57.384
but it's twenty percent of

00:16:57.424 --> 00:16:58.825
doctorally trained pts

00:16:59.085 --> 00:17:00.885
understood um because uh

00:17:00.946 --> 00:17:01.806
obviously masters and

00:17:01.846 --> 00:17:02.826
bachelors trained pts

00:17:03.606 --> 00:17:04.446
probably can't use that

00:17:04.507 --> 00:17:06.268
title but um but when you

00:17:06.288 --> 00:17:07.388
look at them when you look

00:17:07.409 --> 00:17:08.548
at the curve of innovations

00:17:09.068 --> 00:17:10.430
uh there's the uh the early

00:17:10.470 --> 00:17:11.630
adapters and then once you

00:17:11.650 --> 00:17:12.770
hit a certain threshold

00:17:12.810 --> 00:17:13.671
then things kind of really

00:17:13.711 --> 00:17:15.372
take off um when you look

00:17:15.392 --> 00:17:16.372
at where we are with twenty

00:17:16.392 --> 00:17:18.472
percent of dpts uh using it

00:17:19.113 --> 00:17:20.153
um I think we're kind of

00:17:20.273 --> 00:17:21.473
really close to that

00:17:21.535 --> 00:17:22.555
threshold where you're

00:17:22.575 --> 00:17:24.276
gonna see this uh you're

00:17:24.296 --> 00:17:25.215
gonna see this change and

00:17:25.236 --> 00:17:26.336
it's gonna be it's gonna be

00:17:26.356 --> 00:17:27.297
a fast change I believe

00:17:27.676 --> 00:17:27.896
Right.

00:17:28.057 --> 00:17:28.757
Yeah.

00:17:28.797 --> 00:17:32.638
Mentioning veterinarians and podiatrists,

00:17:32.679 --> 00:17:34.499
veterinarians being the, you know,

00:17:34.538 --> 00:17:35.239
the guinea pig.

00:17:35.720 --> 00:17:36.259
See what I did there.

00:17:36.799 --> 00:17:38.200
And then podiatrists, right.

00:17:38.220 --> 00:17:39.221
Blazing the trails.

00:17:40.020 --> 00:17:41.260
You know, Dr. Scholl's, you know,

00:17:41.280 --> 00:17:42.221
teaching us the way of

00:17:42.521 --> 00:17:43.461
making sure we understand

00:17:43.481 --> 00:17:44.942
who those who those professionals are.

00:17:45.823 --> 00:17:47.343
Lance, last thing we do on the show,

00:17:47.383 --> 00:17:49.023
as you are aware, is the parting shot.

00:17:49.044 --> 00:17:49.683
What would you want to leave

00:17:49.703 --> 00:17:50.324
with the audience about

00:17:50.344 --> 00:17:51.565
what you learned with your

00:17:51.585 --> 00:17:52.444
co-authors on this?

00:17:53.419 --> 00:17:54.099
Oh, man.

00:17:54.119 --> 00:17:59.083
So I think the big thing is, for me,

00:17:59.262 --> 00:18:00.584
is embrace the change.

00:18:00.844 --> 00:18:02.885
So when we started digging

00:18:02.965 --> 00:18:04.446
into the background on this,

00:18:05.166 --> 00:18:06.587
I didn't expect to find so

00:18:06.607 --> 00:18:09.130
much research on using the

00:18:09.150 --> 00:18:10.171
title Docker and that it

00:18:10.191 --> 00:18:10.971
would be positive.

00:18:12.211 --> 00:18:12.392
You know,

00:18:12.653 --> 00:18:13.673
I grew up with you don't wear a

00:18:13.752 --> 00:18:15.493
white coat because it makes

00:18:15.673 --> 00:18:16.815
people's blood pressures high,

00:18:16.835 --> 00:18:17.836
the white coat syndrome.

00:18:18.675 --> 00:18:19.916
That's what I expected to

00:18:19.977 --> 00:18:21.258
see when I when I dug in

00:18:21.278 --> 00:18:22.759
the research on this to

00:18:22.778 --> 00:18:23.618
write the introduction.

00:18:23.660 --> 00:18:24.980
And as we started digging in

00:18:25.160 --> 00:18:26.141
more and more now, again,

00:18:26.161 --> 00:18:27.321
there's not abundant research

00:18:27.882 --> 00:18:29.282
But the research seemed

00:18:29.383 --> 00:18:30.703
overwhelmingly positive in

00:18:30.844 --> 00:18:33.546
favor of using the title doctor,

00:18:33.605 --> 00:18:35.247
which which surprised me.

00:18:35.366 --> 00:18:36.989
So so ultimately,

00:18:37.009 --> 00:18:38.589
I would say for those that

00:18:38.630 --> 00:18:39.529
are that are running in the

00:18:39.589 --> 00:18:40.431
opposite direction and

00:18:41.151 --> 00:18:42.551
saying it's for therapeutic

00:18:42.571 --> 00:18:44.253
alliance or the other thing I see is,

00:18:45.173 --> 00:18:45.413
you know,

00:18:45.493 --> 00:18:46.714
those that use the title doctor

00:18:46.734 --> 00:18:47.476
are just arrogant.

00:18:47.996 --> 00:18:49.537
And that's not what I'm seeing at all.

00:18:49.576 --> 00:18:50.157
You know, the top.

00:18:50.617 --> 00:18:51.577
know two of the top three

00:18:51.617 --> 00:18:52.778
reasons is you know kind of

00:18:52.798 --> 00:18:53.878
that build that trust with

00:18:53.939 --> 00:18:55.200
patients through expertise

00:18:55.220 --> 00:18:56.421
that therapeutic alliance

00:18:56.760 --> 00:18:57.340
and advancing the

00:18:57.361 --> 00:18:59.021
professions this is all

00:18:59.061 --> 00:19:01.282
very altruistic stuff so I

00:19:01.303 --> 00:19:02.742
think we need to to lower

00:19:02.782 --> 00:19:04.483
our swords a little bit and

00:19:04.624 --> 00:19:05.625
and start listening to both

00:19:05.664 --> 00:19:06.865
sides and see where we are

00:19:06.904 --> 00:19:09.046
and and and and then again

00:19:09.086 --> 00:19:10.166
just taking that next step

00:19:10.267 --> 00:19:11.507
the next step is let's take

00:19:11.606 --> 00:19:12.867
this clinic let's take it

00:19:12.887 --> 00:19:13.708
to the clinic and let's

00:19:14.107 --> 00:19:15.368
let's see what shakes out with patients

00:19:16.356 --> 00:19:17.377
I'm the kind of research guy

00:19:17.397 --> 00:19:18.239
that I love it goes on,

00:19:18.259 --> 00:19:18.960
but I'm probably not going

00:19:18.980 --> 00:19:19.861
to do it anytime soon.

00:19:19.921 --> 00:19:21.501
But there's probably room for this.

00:19:21.563 --> 00:19:21.823
Again,

00:19:21.843 --> 00:19:23.344
this is a non-research guy asking a

00:19:23.384 --> 00:19:23.944
research guy.

00:19:24.726 --> 00:19:25.567
There's probably room for this.

00:19:25.606 --> 00:19:27.167
We probably should ask patients, right?

00:19:27.209 --> 00:19:27.828
There's someone should be

00:19:27.868 --> 00:19:28.710
doing some research where

00:19:28.730 --> 00:19:30.352
they ask patients their perceptions.

00:19:30.652 --> 00:19:31.692
So we're not guessing at

00:19:31.752 --> 00:19:33.355
what the other half of this

00:19:33.776 --> 00:19:34.876
therapeutic alliance is

00:19:34.916 --> 00:19:35.678
thinking or feeling.

00:19:36.218 --> 00:19:36.898
Yeah, no.

00:19:36.919 --> 00:19:37.999
And that's what we're hoping to do next.

00:19:38.059 --> 00:19:39.721
So what I'd like to see next,

00:19:39.740 --> 00:19:41.241
we haven't we haven't set up the study.

00:19:41.261 --> 00:19:42.282
We haven't called an IRB.

00:19:42.903 --> 00:19:44.565
What I'd like to do next is

00:19:45.305 --> 00:19:47.446
take it to a patient and dichotomize,

00:19:48.147 --> 00:19:49.127
randomize what the

00:19:49.167 --> 00:19:50.809
therapist is introducing themselves as.

00:19:50.829 --> 00:19:51.470
Are they introducing

00:19:51.509 --> 00:19:53.070
themselves as Lance or are

00:19:53.090 --> 00:19:54.172
they introducing themselves

00:19:54.251 --> 00:19:55.252
as Dr. Lance Mabry,

00:19:55.292 --> 00:19:56.153
your physical therapist?

00:19:56.753 --> 00:19:58.096
And then afterwards,

00:19:58.476 --> 00:19:59.237
seeing what shakes out.

00:19:59.336 --> 00:20:01.699
Does that change trust?

00:20:01.818 --> 00:20:04.320
Does that change adherence?

00:20:04.361 --> 00:20:05.521
Does that change outcomes?

00:20:06.742 --> 00:20:07.924
That's where I'd love to see that go.

00:20:07.944 --> 00:20:08.605
That's obviously going to

00:20:08.625 --> 00:20:09.645
take a lot more manpower

00:20:09.685 --> 00:20:11.708
and a lot more time and effort.

00:20:12.348 --> 00:20:13.369
There are also some smaller

00:20:13.410 --> 00:20:14.711
stuff that can be done as well.

00:20:14.770 --> 00:20:16.432
I just posted a picture that

00:20:16.451 --> 00:20:17.993
was done by Devlin et al back in

00:20:18.875 --> 00:20:21.438
They actually took snapshots

00:20:21.938 --> 00:20:24.240
of offices and put diplomas

00:20:24.280 --> 00:20:25.383
in some offices and no

00:20:25.423 --> 00:20:26.324
diplomas in others.

00:20:27.005 --> 00:20:28.546
And they asked patients what they thought.

00:20:28.666 --> 00:20:30.729
And patients thought those

00:20:30.749 --> 00:20:31.549
that had diplomas on the

00:20:31.569 --> 00:20:33.712
wall were more qualified, more energetic.

00:20:34.573 --> 00:20:35.713
And those that had diplomas

00:20:35.753 --> 00:20:37.575
were also more qualified and energetic,

00:20:37.615 --> 00:20:38.375
but that was heightened

00:20:38.395 --> 00:20:40.718
when you added family photos in there.

00:20:40.817 --> 00:20:42.659
So very,

00:20:42.699 --> 00:20:45.180
very minor tweaks that we can do

00:20:46.201 --> 00:20:47.602
to influence all the great

00:20:47.642 --> 00:20:48.242
stuff we already do.

00:20:48.262 --> 00:20:49.383
We're already great at exercise.

00:20:49.403 --> 00:20:49.903
We're already great at

00:20:49.923 --> 00:20:50.723
manual therapy or dry

00:20:50.743 --> 00:20:52.325
needling or whatever our skillset is.

00:20:52.365 --> 00:20:53.586
We're already great with that.

00:20:53.945 --> 00:20:55.988
This is just doing one extra little thing.

00:20:56.048 --> 00:20:56.768
Put up a picture of your

00:20:56.807 --> 00:20:58.068
family in your clinic.

00:20:58.108 --> 00:20:59.490
Put up your diploma on the

00:20:59.529 --> 00:21:02.211
wall and see how that

00:21:02.652 --> 00:21:03.492
influences patients.

00:21:04.173 --> 00:21:05.413
Well done.

00:21:05.493 --> 00:21:05.874
One more time,

00:21:06.394 --> 00:21:07.614
not that kind of doctor and

00:21:07.653 --> 00:21:08.375
exploratory study.

00:21:08.394 --> 00:21:09.454
I'm a doctor of physical therapy,

00:21:09.474 --> 00:21:10.394
patient introductions in

00:21:10.414 --> 00:21:11.175
the United States.

00:21:12.135 --> 00:21:12.336
Lance,

00:21:12.395 --> 00:21:14.196
thanks for stopping by to help us

00:21:14.237 --> 00:21:15.477
understand a little more about research.

00:21:15.836 --> 00:21:16.377
Thank you much.

00:21:16.498 --> 00:21:17.198
I appreciate you having me.