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

Have you ever walked into a doctor's office, spent five minutes with a provider, and walked out with a prescription but no real plan? In this episode, Mike and Michael break down exactly what you should look for when choosing a healthcare provider—and how to spot the bad ones.

Basing their discussion on a review from the British Journal of Sports Medicine, the hosts outline the first four pillars of high-quality musculoskeletal care. They discuss why "patient-centered care" is more than just a buzzword, how to identify red flags, and why getting an MRI might actually cause more confusion than clarity.

In This Episode, We Cover:

• The "BS Detector": How to tell if a clinician is actually listening to you or just following a generic protocol.
• Patient-Centered Care: Why your goals should dictate the treatment plan, not the doctor's bottom line.
• Red Flags: How providers should screen for serious issues (like fractures or infections) and when they need to refer you out.
• The Psychosocial Factor: Why your stress levels, history, and fear of pain matter just as much as the physical injury.
• The MRI Myth: Why radiological imaging is often discouraged for general pain and how it can lead to unnecessary surgeries. Mike explains why "just seeing what's going on" isn't always the best approach.

Resources Mentioned:

• Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O'Sullivan PPB. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020 Jan;54(2):79-86. doi: 10.1136/bjsports-2018-099878. Epub 2019 Mar 2. PMID: 30826805.

Disclaimer: Although we are healthcare providers, we are not YOUR healthcare provider. Content is for educational purposes only. Please consult your physician before making lifestyle changes.

Transcript

Speaker: 0:06

Welcome to the podcast. A podcast by healthcare on how to navigate your health The podcast hosted by Mike Bruno, a chiropractor and athletic trainer, and me, Michael Stanton, an athletic trainer and certified strength conditioning specialist. Although we are healthcare providers, we are not your healthcare provider. We will discuss general health interventions in this podcast, but you should not take that as health advice that works in every situation. Before doing anything on your changes, please consult with This podcast and views from this podcast are separate from our full time jobs and our own opinions. If you're enjoying the podcast, please leave us a review on your listening platform and or subscribe to our podcast at YouTube. Thanks to our show can be found in the show notes on any platform that you are listening to. So today we're going to talk is, what are you looking for provider and know if they're Right. That's kind of what the the list Is that a good way to go about Yeah, yeah I would say so. Um, and it is also a very good things or write them down, they detector if you're with a bad someone who can, you know, a lot things to get you in the door. But then, like, once they're their process, like putting and like, actually like doing Yeah. And so kind of the list that from an article. It's a, it's a review article. Highly, uh, established journal, British Journal of Sports Medicine. Um, and what they actually did was review something called, uh, CPGs clinical practice guidelines. Um, it's actually more of a So I don't even know if you would, you would be familiar with them. But essentially, what a bunch of Yeah. Lose losers. Um, we like to kind of, um. But essentially what it is, it's that put together for physical injury, for low back pain. These are the recommendations that you should do treatment wise. So what this article did, what went and looked at all the CPGs pertain to low back pain and And they took out of them what the best what were the most consistent recommendations across across the board for all of them? Okay. Um, it's actually kind of funny because in the same like breath, they also kind of like go, ah, some of these CPGs aren't actually very good, which is actually like kind of funny reading it. Um, but anyway, we're going to So the first thing that you should be patient centered. Right? So patient centered care means If you as a patient are going to centered around you. You should have a little bit of in your treatment. If, you know, gone or gone in and the doctor goes, alright, going to start you on this know, it's like I think about a sore throat. I think about as a kid, you used to walk in and it'd be like almost no evaluation, like no strep testing or anything like that. And they would be like, yeah, z-pack and and we'll go ahead Right. I think hindsight's twenty twenty on that one and be like, oh, they're really just taking a shotgun and seeing if it will work. Yeah. The two things one of my professors used to say, if you had an ear infection, um, and you went and got it treated by like went to the doctor and got medicine, it'd be gone in a week. But if you waited and did nothing, it'd be gone in seven days. So like. So his point being where it's sometimes things are either like Um, and then when we say like patient centered care, I sit back and I'm like, what's the other option? Like, yeah, like doctor centered Like, that part doesn't even Um, but there are a lot of when you say like for profit organizations, right? Like, businesses are trying to So the, the thought process is like, hey, a doctor will take you on even if, like, you might not be the best fit for their practice because it's not about you, it's about their bottom line. That's how I look at like the That would be like the bad side. Like that's how it doesn't anymore, is what you're saying. Right. So like, I mean, in the more, um, like obvious that I'll There are some populations who a lot of solutions out there So people with different types different, um, like diseases and internal diseases and they're won't give them any answers. Um, their specialists don't have is what it is, is what we're They're like. And because it's a rare disease, do much for you. Besides, like, this is what we These are our best practices, be concrete because then it up the client's butt. And those people get, you know, hold on to, like they're looking And then a chiropractor would be like, I can fix it with an adjustment. And those people are like, oh, Yeah. Like something. And it's. That's wrong. That is just straight up wrong. So if anybody has been in a situation like that, I would say get your favorite pair of sneakers. Tie them up tight and run because that is that is not cool during Covid. During Covid I was like stuck in like letters in the mail, like Meanwhile, nothing was open, to be open. And it was come get an And I was like, this is why our profession gets viewed as a joke, because there's those ten percent of radical people you're missing out. Yeah. My profession, chiropractors, making outrageous claims like treatment for ear infections, I'm like, dude, stay in your Yeah. And so like I think what we're patient centered like you, us as goals as like what the patient And if it's not mixing, it's one One, which is probably more need to like, tamper the goals Right. If it's kind of what you said, something series or lifelong disease of some sort, it's like, hey, we can maybe make improvements in certain areas of your daily life, but like, this is something that you're going to have to create management strategies for, not something that will be quote unquote cured. Um, and like, like if you have surgeries or whatnot, it's like, have a little bit of back pain Like it's just managing it. Yeah, it's expectation. Management is the first go. Like I had a guy who came in, he had a stroke when he was two on the phone. He was like, hey, like you would never be able to tell by, like, looking at me, but like, I have some, like, significant, like, weakness on my left side and everything. I was like, okay, like, we'd Um, it sounded like a good fit like, he was way more like, initially could tell. But on the phone. And I was like, dude, thank you But, like, I'm not the right fit Yeah. Like us, we need to be able to all the time as an athletic especially in the high school get them to the right person. Oh, one hundred percent. Because like, like if he was like super on board with what I was saying, it's like, could we get maybe some like muscle, like some tension relief and some symptomatic relief? Sure. But like, those weren't his Yeah, that's a stroke patient. It becomes like, more neuro Like you should be going to a PT straight up stroke. Like stroke. Yeah, right. One million percent. And there's not a lot of, uh, like, like protocols or anything So it's like, dude, like, I don't like I feel comfortable doing this. I don't feel comfortable doing Right. You live somewhere in the I can help you do this, but this goals that you want. So like, you need someone who just not me. Yeah. You pretty much took my second point, which is great, which is like, if you guys don't don't meld together, it's either, hey, you need to be the bigger person and say, hey, I'm not the right person. Kind of what you said there. And I'm sure, like, maybe someone gets pissed off here or there. Oh my God, they wouldn't treat But it's like that. They respect that. I think it depends. So I'm going to be perfectly I think it depends on the seeing and what the like. Yeah. So like in our world, I think But like, let's say it's like general like injury or general illness illnesses. And they go, hey, I, I'm not the And you go up there, but this But I could see, I mean, for me, in my world where it's like a lot of out of pocket services and I'm like, hey, don't waste your money or time like, this isn't going to get you where you want. They're like, oh, cool. Like, yeah, money, you know what So it's a little more I mean, received that way because you could always be like, hey, we can give it a shot, but like, no promises. I was actually literally having Like, you can't make any Yeah, but the bar is so low with especially, like, musculoskeletal care. Like when I talk to other people, I'm like, okay, so you had back pain and you want to run a mile, like what was the plan? And they're like, I don't know, cracked and he like massaged it I'm like, okay. Did he like look at running form exercises to support running like blah blah blah blah blah. And they're like, no, not at I'm like, yeah, someone with be like, okay, before you run, Yeah. You know what I mean? Like, like or just like, hey, we going to achieve goals. Like, put it on paper. Yeah, let's just put it on And, like, the whole point of a you know what I mean? Like a plan sounds nice. And then you run to your first still the goal. Pivot, pivot, pivot. Yeah. And you get there. But that's why I called my Because it's a navigation So you're driving the car. You're making all the major But if you make a detour and you go this way, I'm like, let's like get let's get back to the point here and helping you get to your destination a lot faster and safer. Yeah, it's funny you brought I was just talking to my little had, like, no clue. It's like where you're just She just like, I don't know how much or how little I should be doing now. It's just like a but I just want to be a generally healthy person. So I legitimately just helped was like, well, I want to do class, is it enough? Is it not? So we just kind of like, all going to do you're going to do You're going to do that group strength training class one day a week. You're going to do your own strength training one day a week, and then you can run two times a week, thirty minutes each. And then we'll kind of adjust as And that's how she'll hit all of You know, all the recommended one hundred and fifty minutes of Um, and I was like, honestly, that's all you need to do and you'll be in a good spot with that. And like, to be honest, if she she'd probably still be fine. That's great. Yeah. So, yeah. Number two. Screen patients to identify of serious pathology. Slash red flag conditions. Um, so this kind of goes off a little bit off on the previous one. Like. And the biggest things for us, And I'm trying to think, you guess for low back we'll go to Um, if, if it's like numbness all the way to like the bottom And you could answer this better was like, if it doesn't go past like, yeah, whatever. Like we'll we'll do some Like there's no real it actually goes all the way a Dermatome or myotome. So like specific areas of your foot are numb compared to the other side. You're probably going to be this first, right? Or like that's a red flag. Maybe we'll hold off on Yeah. The basically what a red flag is to me is, hey, these are strikes in the I'm not going to treat you column. So if it's something that looks Not going to treat you. Um, if it's something internal. So it looks like like bowel or bladder stuff like things like that. Heart lung. So we went through a lot of diagnostic courses for all that stuff. I learned how to do a heart exam exam, all that. But the whole point of that is normal sounds like. This doesn't sound normal. Go see somebody. It's it's recognize and refer at And I think a lot of times We're like, oh I learned this. So like, let me just adjust my And it's oh God, it's not a good It's funny because and like we little bit more with like acute Like, what are my red flags for And like, you know, if they have doesn't look right. Yeah. Yeah. You know. Yeah. Yeah. Exactly. Yeah. Um, another one, I had a, I had a kid get hit in the ribs and like initially he saw me and like, he was just dealing with pain. Like it just hurts. They're like kind of discomfort And to be honest, I've seen so It was. I was like, hey, I'm not worried Now let's say it becomes or you start spitting up blood Didn't see didn't see the kid See him back. It's like, hey, man, like, where He goes, oh, I started spitting Ah, yes. It's like, thanks for telling Yeah. Ended up. Yeah. Kind of crazy. Didn't have a rib fracture. Just had a lung contusion. Um, just a lung contusion. Dude, there is a kid I went to His lung collapsed, like, after No, he was like a just. It was just like a random He was a singer or something like it just spontaneously, like. Well, I don't know if you saw. Sorry. Really. Sidetracked. Uh, TJ, what had, uh, dry during His lung collapsed. Yeah, it is one of my had to get Yeah, yeah. Jeez. Craziness. Any Hoosier? What's the next one? Three. Assess psychosocial factors. I think this is this is big like I think about when you're know, you always go to a doctor. They have those intake forms. They probably don't get read But it's like that's why you Like you're probably better off and having some of those kind of assess their handling the pain? Is there stuff going on outside why their pain is getting better So I think it's something that is still missed a lot of the time. So I would say for a lot. So this is actually a personal I went to the doctor, um, like my general yearly physical and the there are questions in their intake forms that are meant for this purpose. And like just the way that they change, like the interpretation, asking and interpreting. So the medical assistant comes like a smoker or drug user? Like, no. She's like, oh no, No. Are you smoker? I was like, no. She's like, so your whole life? And I was like, I have like a cigar at a wedding every like two or three times a year or whatever. And she's like, oh, okay, blah, blah, blah, get moved to the medical room. Um, and the, uh, the doctor's like, okay, so I see you're a smoker. When did you quit? And I was like, well, what does Yeah, I got a similar story for Yeah. And I was like, that's crazy. Because, like, you know, all, you know, defend myself or whatever you want to call it, like, I'll like, correct her and stuff, but like, potentially if I sat there quietly and I was like, didn't say anything like that could completely change the whole doctor's entire line of thinking. Because if I now tell her, like, hey, like, I have like chest tightness and stuff, like her whole like, diagnostic mentality has shifted towards like, hey, this kid's been smoking forever or however long versus like, oh, it might be something completely unrelated. So like it changes the the drastically change the outcome. The question is well intended, but like the way that you ask it and the way that it gets interpreted is going to make all the difference. Yeah. And so maybe not so much on this third bullet point of psychosocial. But I went to a primary care visit one time and I went through it. A couple things happened. One, it was like the nurse, they activity level was at all And so, so which is like really. And so the nurse, like, I'm a rate is really low. And yeah, my heart rate's like in the low forties because I exercise and you're going like this. Yeah I was like yeah don't worry Like that's normal. All right. Whatever. And so then you said that I told Like, don't worry, lady, you don't know what you're talking about. Yeah, yeah, I kind of start Um, which then later on, like I was like, I was like, okay, I said, yeah, all right, can I I want a complete metabolic what's going on. She's like, all right, sure. And so get it. It comes back. My ldls are actually a little Yeah. And so they get on the phone and are high, so you should probably I had a client that told me the I was like, it's apparent. And we're we're not nutrition But I started looking into it. And because first of all, my triglycerides, which is like the free floating fat masses, it was like twenty. That number is like almost there's no fat flowing through my blood. So like the LDL number doesn't And apparently when that number is so low, your ldls will come out high. Um, and I don't know if I would have to research it more, but you're you're telling a person who at the time was running thirty miles a week and lifting five days a week to exercise more, that mentally would have, could have thrown me into a tailspin. Instead, I just said, you don't and moved on. But like, you know that that goes back to like, you're trying to you need to find like a provider. I'll be honest, I haven't gone. And this is bad. I haven't gone for a regular years because that experience So I really do need to find understanding of what my goals one hundred percent. There's and like the the when it comes to pain if people So if we define that as over Yeah, like some people have been And I'm like, that's miserable. And like it changes your brain you're like people say like, oh, But like, I got used to it. Like, that's not normal. Like, no, you you like living So it's like, okay, well, what What do you want to what do you And they're like, oh, I can just It's like, okay, that's a But I just want you to know it's And they're like, well, I've So like like and their, their because to be fair, like they gotten a lot of results. So you know, it's it's a And usually that's because one they tried was focused on the If it was focused on the right thing, the timeline wasn't right. So it's like, hey, I did it for a day when you needed to do it for a month, you know what I mean? And but even going off that, it's like the psychosocial aspect of like talking about, like you just having that conversation of like, you're not supposed to be in pain based on, like, what your diagnosis is and all that. Like, this is something that we And I think rewiring happens and Maybe I can actually get there. And like, you know, part of it's some stuff and getting them out Like that's kind of where it Yeah, one hundred percent. And the conversation like that whole like, hey, this like the reason all the other stuff didn't work before is like either wrong time or wrong place. And it's like, okay, you tried going to do A, B and C, and then We do A, B and C and they're Like I notice a significant That's a really good sign that So now we have the wrong or the Right. Knowing that and knowing your history, we get to talk through a plan and come up with the right time. And those two things together success rate than the, uh, like What's it say? What did I say? Pray. Spray and pray. Whereas, yeah, yeah, you're on Like, let me do that one. Yeah, yeah. That just sets you up for Literally talking to a guy yesterday, he's like, dude, like I have this like sharp shoulder pain. I know I should be stretching Like I know the things that I YouTube and I just get like many different opinions. This guy is trash talking. This guy who's trash talking, where to start. Yeah. And I was like, well, that's a you know, the navigation system. Yeah, super, super helpful because it shrinks that time, right? It's like it takes you six months to figure it out on YouTube. We can figure it out in six Yeah, exactly. Um, I think that's good. So we're going to move on to our So the fourth point is that radiological imaging is discouraged. And there's a couple of reasons Maybe it's not. It's if you suspect a serious Uh, fractures, grade three ligament sprains, as in, like, stuff completely pop. Things like that. Um. Or there's been unsatisfactory response to conservative care. Um, that's like. Like for you be like, you treated someone for, like, five months and there's no progression. You're going to say, hey, you Hey, an MRI might actually, like, be beneficial in your case. Um, so it's really those two main points and then three, it's like it's likely to change management which like hey, you might actually have, uh, displaced, uh, fracture in your back. You might actually need surgery Like that will change your That that would be that's how But yeah. So right. Radiological imaging is often And I know you're big on this because like for low back pain, it's like the general recommendation is never get an x ray. But also in the chiropractic convince people, hey, this is We'll fix it. Alrighty. Here we go. This is one of my favorite So with X-rays and MRIs. If it's to your point, if it's to do in the office necessary if scary tumor like big scary stuff uh, imaging necessary outside of I tell people all the time, is, uh oh, I just want to see It's like, okay, your health, Once you do see it. Right, let's go down that rabbit Once you do see it, then what It's like, oh, then like, we can just, like, do what we've been doing, right? It feels like an unnecessary A lot of the times, um, usually psychosocial and like, the trust is something that's such a hard Because if you take fifty fifty them probably have some form of significant findings on the MRI The other half probably has no findings on an MRI, and they do have pain. So what you see on an image does not explain your pain usually, which is why the like this exists now. It's like, hey, it's probably going to cause you like people get imaging for clear answers, but it actually adds a layer of confusion because they're like, hey, I'm in pain, but my MRI is clean. Now, more confused or the flip? It's like I thought I was fine, but I get this imaging and I have all this stuff wrong with me. It's like, no, I'm scared. Not helpful in ninety plus No, it's funny because obviously back stuff and in the shoulder, like slap tear. So like tears in overhead Uh, like, within their labrum, actually don't don't get imaging Rehab it for three months and Um, there's also a really cool where they just healthy baseball They just took MRIs of all their Half of them had labrum tears recommended to have surgery on Um, so yeah, yeah, yeah. If I could say like to someone like, it's like, you know, you want to have good bedside manner and like, but like the people who I've been working with for a while and, like, they get my sense of humor and they trust me and everything. Um, if they ever, like, came to me and was like, I think I should get an MRI, I'm like, okay, why? lot. Like, I just want to see what's It's like, okay, let's say we And it's like, uh, like they get Yeah. For what you're dealing with, it's they're not going to magically all of a sudden get surgery. They might get a cortisone injection and like that would be it. Most people are working with me to avoid surgery in the first place. Yeah. Like like if you if you go talk to a surgeon, like, surgery is probably going to be a much more likely outcome than talking to me. Yeah. Like, you know what I mean? So it's you have to know who If you're going to a butcher, You know, if you go to the it's like who you your first point of contact. I forget what the exact study We'll have to look this up. If you go talk to a surgeon as your first point of contact, your chances of getting surgery For back pain is like ten x, right? Yeah. If you need it or not. Right. Like so there, there is so much surgery where people are getting That is not necessary. And like that low back. That's pretty extreme. But like that happens all the Like I had someone go and they're like, yeah, we didn't really see much on the MRI, but we're just going to scope your knee anyway. Yeah, I didn't see much. Let's scope it. Then I'm like, why are we getting everything in the first place? It's like, let me just like, let some stuff up. Like, I don't know, that's And we can kind of wrap up on with the imaging. So, um, so there's a study. It was in Finland, no clue how this study got approved, to be perfectly honest. But like it was, you know, when you're talking the shoulder pain and doing so like they had two groups, one like they both had shoulder pain. And the what you're supposed to So you're supposed to go in and shoulder to relieve some space. Well, in half of them they went And the other half, they just Did nothing. They just cut the skin, right? Yep. And they had the same exact I want to say I don't. There may have been a separate The same study. They also had a study that just did conservative treatment the entire time. And I think they all just over a year, they all did exactly the same thing. They were all they all did the Yeah. Time. Time is a very good healer. It's if you get stuck in, like, a wheel, like of, hey, I need to stretch or hey, I need to do whatever. Like, what do they say? They say, uh, what's the Insanity is like doing the same Different results. Yep. So, hey, I just need to stretch It's like, hey, how long does You know, twenty minutes an hour It's like, okay. So you can either like that can Like you can do that every day. And like, you have to, like, single day because like that's Or you can go and like actually to feel like it needs to be that you don't have to go do Right. Both are options you pick. Yeah. So now I think that that wraps this episode up, I think pretty well. Um, we'll get six more seven, six to seven more points next episode. Um, yeah. Yeah. Cliffhangers. A lot of stuff. Unless. Unless you're into the research And go find the article. Um, really? Yeah. Probably not. Probably not. That's what we're here for. To sift through all of it so Go fix yourself.