I’m a questioner. At least that’s the conclusion my wife Claire came to after reading Gretchen Ruben’s book “The Four Tendencies.” The book separates people into four categories. Questioners, who want justifications to everything, and want to know WHY. Obligers who need accountability. Rebels who want freedom to do something their own way, and Upholders, who want to know what should be done. 

I can’t argue with the conclusion Claire came to. Throughout my life, I questioned rules, the way things were done, and why things needed to be the way they were. I can now look back and say thank you to everyone who didn’t strangle me. 

I wholeheartedly believe that this tendency is also the reason my clinic exists, and why we’re obsessed with delivering both a high level of customer service and an absolute commitment to getting the best outcomes for our clients. 

Fun Fact: We use the word clients over patients, because the word patient is defined as someone who is receiving what someone else is giving, in this case care. However a client is using the services of a professional, and the service we provide is good care, accountability, & teamwork between provider and client. We do not administer plans without the cooperation of our clients, it’s a team effort to develop the plan that best suits them to achieve the lifestyles that they want and deserve. The difference is subtle, but profound. Patients do what you say, clients are active participants. 

This is an important distinction to make. As a provider, when I graduated from USC and got out into the “real world” I was honestly disheartened by the system I found myself a part of. We have a high volume model focused on keeping people from getting too debilitated, but without any service or ability to get them to a higher quality of life. This isn’t an isolated situation. Recent polls have shown that over 55% of physical therapists are looking to leave the profession because of it. They’re frustrated by the inability to give people what they deserve, a higher quality of life that they look forward to. Patients are shuffled into this model and at the mercy of the whims of the insurance company and the high volume clinic. “Oh you have neck pain today? That’s too bad, your prescription just says knee pain, I can’t work on your neck (because insurance won’t pay). Here’s a hotpack.” 

Fast forward to yesterday, Claire and I are sitting on the couch watching the show “Explained” on Netflix. We decided on the “sugar” episode and I sat back and got ready to watch what I presumed would be an episode on how sugar has been a cause of many health issues. I have to say, the episode had a perspective that caught me by surprise, and was dead right. 

The episode details the quest that scientists have been on to develop artificial sweeteners that have similar effects on us as sugar, but without the calories. We have likely spent billions on this quest. At the conclusion of the show, one of the scientists (who actually had a breakthrough in sugar technology just last year), states the truth. Sugar is not the problem, our habits are.

For years I’ve looked at the food pyramid, and the criminalization of fats, as something that has set our society up for a lot of avoidable diseases. But no matter how much people know that, they find themselves falling into old habits. It’s not the pyramid’s fault, it’s the habits that have been hardwired into us, and these habits are hard to break, but not impossible. The problem is that people try to change the wrong things when it comes to their habits, they try to change the outcomes, instead of the internal processes that lead to the habit. 

This type of change requires a shift, from patient (passive) to client (active). To change your habits requires dedication, and an active pursuit of the knowledge of how to do just that. There’s no way that’s able to be accomplished in the 7-15 minutes you get with your GP at your office visit. Unfortunately, because we’re late to the party on understanding this, we’ve got a medical system in which prescription medications reign king. Why try to change someone’s habits (hard to do), when you can just take this pill? Unfortunately what ends up happening to a lot of our clients, is that they’re never even told that there is a better way. 

Take for example, that only 7% of people with back pain are ever referred to PT. That’s 90% of what we treat at our clinic, and over 90% of our clients get resolution of symptoms and return to active lifestyles. Instead what you see are stories like what 12 News published the other day. The headline reads “Scottsdale Doctor Pays 400k For Accepting Monetary Gifts from Chandler-Based Opioid Maker.” 

I’m the first person to let you know that I will not hold someone guilty by accusation. But Aucom’s razor states that the simplest explanation is usually the one that’s true. And the facts of the case are that money went from this company to this doctor, and this doctor also prescribed these medications.

Unfortunately, prescribing opioids instead of good physical therapy is all too common. But wait, before you blame the doctor for not sending people to PT, consider this. Most doctors get terrible feedback from their clients about PT. Why would that be? Because when PT’s are seeing 20-30 patients a day, and only able to spend 10-20 minutes with them, and then have to pass them to an aide or a technician for the most important part (movement), you don’t get great results! So doctors stop sending, and who can blame them? 

Here we are, back at why our clinic is built the way it is. I’m grateful to our clients and staff, for wanting and expecting more of themselves. I’m proud to be a questioner. I don’t ever claim to have all the answers, but I’ll find more questions, and hopefully get closer to the right ones. 

For more on habit change, I recently did a podcast where I explain habits and how to change them in a scientific way that is well researched, and available in an easy to understand book called “Atomic Habits.”