Episode 60: Generalist vs. Specialist: Why You Can’t Fix Everyone (And Shouldn't Try)

You graduated, you passed your boards, and you are ready to save the world. But what happens when a patient walks in with a problem that you technically learned about in school, but have no idea how to handle in reality?

In this episode, We pivot the conversation to focus on the next generation of healthcare providers. They discuss the trap that every new grad falls into: The pressure to be a "Jack of All Trades". From Mikey’s "rookie mistake" trying to rehab a complex ACL without surgery, to knowing when to refer a neuro patient out, this episode is about the power of saying "I don't know."

If you are a student or a young clinician, this episode will help you understand why "staying in your lane" isn't a limitation, it's your biggest asset for building trust.

In This Episode, We Cover:

• The "New Grad" Trap: Why young clinicians feel the need to treat everything to prove their worth, and why that backfires.
• A Hard Lesson in ACL Rehab: Michael shares a story from his first year of practice where he tried to rehab an ACL conservatively, only to have the athlete buckle under contact. The lesson? Set realistic expectations early.
• Surgery Exists for a Reason: Why being "anti-surgery" or "anti-manual therapy" is a mistake. Sometimes, the scalpel is the best tool for the job. 
• Generalist vs. Specialist: The difference between going "wide and shallow" (helping everyone a little bit) vs. "narrow and deep" (solving specific problems for specific people).
• The Power of Referring Out: Why sending a patient to a specialist doesn't lose you a client, it gains you respect and trust.
• Scope Creep: Why having a Master's in Nutrition doesn't mean you should be treating a Type 2 Diabetic's diet plan.

Resources Mentioned:

Connect with Us: Are you a student or new grad struggling with "Imposter Syndrome"? Send us a DM, we’ve been there!

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: 0:01

Welcome to the podcast, the professionals providing insight so you can go fix yourself. The podcast hosted by Mike Bruno, 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 this podcast 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. Links to our show can be found in the show notes on any platform that you are listening to. So today you had your coffee You read that? Yeah. So to be honest, I so what I Um, I made decaf coffee and then it, and I did that first. That sounds counterintuitive. Well, it's. I didn't want, you know, I took rolled around in the mud. But it was like a Courtney. Hi, Courtney. I see you. You can't hear you. Oh. That's hysterical. Um. But. Yeah. So I don't know. I was just trying to have a went and picked up more coffee, Yeah. No, I'm no scientist, but that just sounds like you're, you know, what's the what did Gardner Minshew. It's Gardner Minshew, right? He, like, hit himself in the with that story. You mentioned the story last Did I? Yes. Yeah, but that's like the whole It's like. Like, do whatever it takes. It's like. No, you know what you are? You're that guy who goes to thousand calories worth of food, That's exactly what that is. It's like because health care, it's like, I'm going to get a burger, but I'm take the bun off. Yeah, I'm gluten free. I can only McDonald's Yeah, it's. Yeah, it's probably. I'm not judging you, but I'm Um, anyway, what are we talking We we we are going to talk about of your scope. And I'm saying element because I always think about The Big Lebowski. Like, you have your element, You're watching Big Lebowski. I mean, I'm a movie guy. I know that's a cult movie, but I can't quote it. Yeah. Uh, that's anyway. But it's like you're out of your I forget whether we're even talking about something about Vietnam. Like, it's like the characters would just start kind of talking But, yeah, out of your scope and especially if like, you're for just start out and knowing when isn't something I should to refer this out. So obviously, as an athletic that we see like acutely that right, broken clavicle and you Like, that stuff's very easy. But we I actually my first, my first year practicing had an ACL and she wanted to do conservative treatment for it and which isn't there's actually a lot of research saying that it can it just takes the same amount. Now that I know this, it just do a conservative rehab as it like do surgery and go through Um, the issue was that she like she it was like it happened she could get back in May. So, you know, I went through the She actually got very far. We she was able to do So. Right. We got her her range of motion She was able to do agility and But as soon as it became her knee shifted on her. So pivot shift went down. And that was pretty much the end But probably like I did that all Like that was a rehab I did on my own as a first year person getting surgery. She did end up getting surgery. Yeah. And, you know, it still ended up I don't they may have they did a But I'm trying to remember, like there's probably a meniscus with that pivot shift mechanism. Um, because I don't think the always correct, but I don't meniscus tear on it. But, you know, that's probably Right. She kind of like it was kind of who will let me come back? Like who will let me try this like maybe should have set some Like, now if someone comes to don't want to get surgery, it well, what are your goals? Like if you want to do something want to do it sometime soon. Like you might want to go just want to go back to that at Maybe we wait a little bit stuff that came with ten years So trying not to take on too hundred percent I had this He blew out his knee and went to talk to a doctor, and the doctor was deciding if he was going to do surgery or not and asked him, are you competitive in any type of sport? Are you running a marathon? He was like, no, uh, describe And they said, you can get away Coping is the word. So yeah, you can get away with And he went to a personal his rehab in that regard. And he hasn't had any issues since because he's not sedentary. But he's not like he's not going He's not like college soccer, Yeah. So if he went and got like he would run into some more But the word he loves to throw And I'm like, besides you, I've So that was probably some, some, uh, for what, MCL or was it the MCL like, uh, PCL, MCO something else. Yeah. I mean like yeah, it's like, something down in its place? Sure. But like whatever I that's yeah, concept is like can your so for standpoint like the ligaments Those are your last resort. So can you get strong enough or your body is able to. The muscles are able to take enough for the demands of what That's the balance. If you if you need to rely on stop, you're probably at an Yeah. Yeah. Um, I think Bo Jackson, when he, Yeah. He is so strong. His like, foot was planted and Yeah. Like he was getting tackled. Yeah. Pulls his own hip out of its Yeah. Which is insane that he's that Because that is like hips get dislocated like that because of car accidents, not on the field injuries. So. Um, I digress. The important part, the depends on your demand. So you I always tell people you will give you my best opinion on So in that example with that soccer player, like having all this experience, now if you put she puts a target on the wall and it's like, okay, we can do conservative care and we can do that, but these are the associated risks. If you go with surgery, you're better place to return faster. Mhm. That has to be your call. Right. I can tell you like this is how This is how we're going to I had a conversation the other who's got like a really, like, He has symptoms down the leg and not for nothing. I'm having a kid in, like, four Like, I can't even, like, bend Like, I have to go back to work I really don't want to have what to do. And we went through, like, a trial treatment and didn't get any response. Yeah, dude, surgery exists for a You're a good candidate for Like, I know you don't want to do it, but given that you have a compressed timeline and you have to, like, get back to work and being a dad very soon, the rehab on that. Ideally, you'd have surgery. Like you come out of that minor rehab is going to be able want to be faster. Now, if you want to take the conservative approach, the timeline just goes and extends if you different situation and you were just really avoiding surgery, then we can have that conversation. But based on what you're telling and a lot of people will be. It sounds contraindicated to like everything that we always talk about, but it exists for a reason. Like it's important to to know when to use those type of things. Yeah. Yeah, sir, surgery still exists It's just I think it's always And that's why I'm kind of going you're out of your element. If you're out of your element, like, what are all the options Can you lay that out for whoever sure that you can kind of put Um, it's like what you just I had a baseball athlete. He had surgery in high school, so I didn't deal with this, but he was telling me that, you know, I'm from we're from Delaware. He was from middle of nowhere And he went to whoever, like the And he was like, it was for a Uh, he ruptured patellar And he was like, hey, I'll be I've done five of these. I'm going to send you elsewhere. Like, I'm not the guy to be And that, like, if you go to a doctor and like, they're especially a surgeon, they're willing to send you elsewhere, like, awesome. Because like, right in Delaware And even then, like when I was anytime I had a UCL. So Tommy, like, kid had to get Tommy John, um, if they ever saw one of our local, one of our local surgeons. First, none of them. There was one guy who would Um, and he would just do it like care as much. But the other guy who was also like he was still a little bit like, hey, I'm gonna you're go to Philly stock like, let's I got enough enough practice and that I can do this. So like making sure you have people like out of your element to a doctor to be like, how many How many, how often have you Like hopefully they're honest one way like hopefully if you're when we were our younger years, do everything because you're did the experience. I should be able to do it. But honestly, people probably respect you more when you just say, hey, this isn't this isn't me. Oh, I'm a huge stay in my lane I say that all the time. So when people are asking me like that, that even like a this is what I know. It's not my expertise. If you want more in depth, you should talk to X, Y, and Z. And that's why you have a referral source. Um, but I am not a good fit for I tell people no. And it could It could be from like what their There's a lot of different reasons why something could not work. And you have to be very aware of them in and then they don't get for, that's on you. Right. Yeah. And if you knew that at the jump and you're like, ah, give it a shot. That's a really tough place to work from because then you're always like, you know, working from behind. And I had a, I had a guy who on the phone told me he had a spinal cord injury when he was a kid. And he was said, oh, I've, you manage, I drive, I work like I'm So like, if you didn't know, you you didn't, if I didn't tell tell by looking at me. And I was like, okay, like, I'll take your word for it. Let's like, come in for a He was like, he's more of a Yeah, yeah. I don't want to say paralyzed. Like, he was very functional not like what your your have done nothing for him Yeah. I was like, dude, this is not this is not my this is not my world. And he was talking about and he thought that all tied And I said, okay, we we can so shoulder discomfort and stuff. That's in my wheelhouse, but results that you want. If you want to just work on your for, like, symptom relief, sure. But it is not going to solve the Like you have to be very aware And then we ended up not working So it's all about giving people, their own choice and like, because a lot of the times it's It's really hard to make a decision with incomplete information. I mean, also, you're a lot of stuck in this because you feel your advice, opinion. You feel like you have to say, but it is very important that it you have to frame it in a way they want to be certain about because at the end of the day, scenario for you. You don't want to start in, you know, uh, six weeks into a plan of care. And it's like, all right, well, And what's what's going on like, Did I just piss a bunch of money Like that's something that's true that you have to think about, right? There's a lot of when when you marks, there's probably double their head as a, as a. Oh yeah. Yeah. So if clients ask you like, hey Like can I get better. And also I also have a conversation a lot of times timeline. It's like when can I expect to It's like, okay, first we really better because there's better There's better mean less pain. Yeah. Because I think something in to guess, especially with people Like they get a little bit more they are actually a little more expectations, especially if for a long time. Like, right. Most of the time they're to feel see, I was about to use want to be be able to walk for a Yeah, yeah, I always say who've seen a lot of people to keep playing the game. It's not to win. It's not there's no finish line Because if you're going through soon as I'm out of pain, then making progress or like putting get to that point. Right. It's it's so the people who work with me understand that, hey, getting out of pain is part of the process and part of the experience, but I'm chasing like, I want to play golf when I'm ninety and like, right now I'm sixty. So like, that's not going to be That's going to be a thirty year And it doesn't mean you're going to be working with me for thirty years. It means in the three to six together, you are taking all of it down in a way that works for life so that you become your own able to navigate your health as the principles and the So yes, we'll get out of pain and we'll be able to learn some cool stuff and do all these things. But the important thing is that you can then take that and get creative with it ten years down the road. Yeah. And because the way you play golf in your sixties is not the same way you play golf in your seventies 80s definitely not nineties, so that it all changes. You know, you're constantly grow and adapt with you. If I tell you three sets of ten dead bugs today, next year, that might not be applicable, like it might be too easy or it might be too hard. I don't know. You have to always be growing The name, the name of the game Yeah. Yeah. Agree? Yeah, I think it's. Yeah it. Right. I think as long as we have that conversation like I think that's, that's the problem that a lot of healthcare providers honestly even still as they get experience like you don't have a conversation with what their goals are, where are they trying to achieve. Making sure that, you know, about where they're going. And obviously there's cases uncertain, it's like, hey, I I can either research more for you because it kind of falls in my wheelhouse, and it's just something I don't deal with on a regular basis. Or it's, hey, I know this person who could probably help you better. Yeah, one hundred percent. I have a buddy down the street especially because if people So even if I think that I can reason, like financially or time like they can't commit to a full Um, I always say like some dude, Like, what are you doing right If they say nothing, it's like You have to fix this. It doesn't have to be with me. But you have to go get this. Yeah. Yeah. That's a that's how you build some good relationships and trust. One hundred percent. That's what it all is. Yep. Hell, yeah. Um, so as far as mindset goes, Mikey, what would you say your in this context, what is your mantra like? What is the thing that you would say if you had to distill it down into a sentence when you talk to new clients or other providers, right. Like what is the thing that I mean, I always go back to if You stumped me because I like I And I like always talking about like, not not to be out of your element. Like, I like that idea because element, like, right. What do you think about? It's like, if I dropped if you a swimming pool meet, I am out I don't know what's going on or Right? You get hesitant, you don't know how to talk to people, you freeze up and that's all just not good. Like none of that works out very So for me, it's like the whole talking with other health care limits, know when to refer like something that healthcare learn because like right, I have and I don't and I stay in my to be honest, I don't do it Like there's a bunch. And same thing with you, a bunch lot of general stuff that like, and like, you know, hey, if times a day, that probably is Like, that's general But like if someone goes, hey, I this blah blah blah? I'm like, yeah, I'm probably not Like, right, I'm going to have dietitian at that point. Yeah. Like and I always I'm a firm exists if you want it to. So when people are talking about Yeah. Like I see it all the time in Oh, I can help anybody from you probably can. But is it better to be wide and narrow and deep? Would you rather help some fewer people, get much better results, Like a little bit? Yeah, it's it honestly does become like, what do you preface? Like it's either you're helping helping a small select few, but And so as a like if you're helping a wide variety of people, you're you kind of forces you to apply the same intervention over and over again. Right? That's, that's that's part of Whether it works or it doesn't, It might work for most people, but what what it stops you from doing is being able to, like, correctly evaluate someone and, like, really figure out what's going on. Yeah. Helping everybody helps nobody. And if all you have is a hammer, Yep. So in that case, that's when the minute appointments and no it's the same for adjustments. That's where those people get because, you know, they have set they only have five minutes with that the shotgun approach has best chance of getting them some and going through all that. People are like, oh, this is my And they tell me I have to come back three times a week for six months. If that's if that's what someone thinks is their best option, it's that or surgery, then they have to make a decision with that context. If they don't know anything else the hardest part is knowing. Like when you talk to one you their opinion. Very rarely are they going to give you options outside of that. Right. Yeah. So if a surgeon's from what I've heard recently, surgeons are pretty good about getting better at, hey, you're not a surgical candidate yet. You should try conservative Yeah, but they kind of stop Well, I'll be honest, too. So like the. And so step in the right It kind of changes because a lot system that have their own So it's like to the whole because they're still just going So like that, I think that's a little bit more. And maybe they're like, well, a surgical candidate. And then we get PT plus surgery, Yeah, that might be a money Put your tinfoil hat on. Yep. You know do all that. But the at the end of the day, healthcare provider needs to give you their expert opinion Yeah. Completely agree. Yeah. It's funny you talk about even know, I would see so many Like, I would get stuck into the hit all the potential things baseball athlete as opposed to well, does does this guy shoulder range of motion? Does this guy actually need the need rotator cuffs? Like like, right. It does become like when you you're just not you're taking a Yeah. And I mean, I've heard this analogy before too, where if you're if you, God forbid, you need heart surgery, do you want the guy who's done ten thousand and who's a heart surgeon and a specialist, or do you want the general surgeon who normally does knees? Yeah, depends on the problem. Now I will say, like if you have you don't have any. So that's where it's like if you don't have any problems and you're trying to get general healthy or like it's not as big of a deal, whatever you're dealing with, like, yeah, go to the general, it'll probably be fine. Like if you want to start that But like when you start getting getting back from something and running or rock climbing or go find that person. You definitely should go. Your approach should be general So I am in the narrow position because most of the clients that I've worked with have tried the general stuff and it hasn't worked. So they continue to filter, filter, filter until they find a specific solution. And that's me. Yeah. So in that case, all of those general back pain solutions and And they're like, okay, I'm effort and energy doing this. Would they have saved a bunch of money long term if they just Yes, but to your point, if the, little stretching and the for like two years, it's not But a lot of people are going to be like, oh yeah, I'm willing to take that. Mhm. And you know that's okay. Like I'm not here to tell you like what solution you should have. But I'm here to tell you that if mountain, don't go up there You know what I mean. Yeah. That is a you have to you have to the problem. Yep. Sweet. Yeah, that was good. Good little rebound at the end Um. Love my analogies. Oh, man. Yeah. All right. I think I think that's good. I think we're good. It's great. That is. Yeah. Um, go for yourself. Yeah, we'll we'll work on that.