How the Guardian Academy Saved Grandma
Level 1: ...And that's okay
Future Guardian,
Imagine having a toolbox of principles that could be used to save lives…
Not only in terms of enhancing quality of life but also in the tangible realm of diminishing one of the leading causes of fatalities among the elderly population.
Today we’d like to spotlight a capstone submission by Chris, also known as ‘The Balance Doc.’ With a decade of experience as a physical therapist he shares his insights on seamlessly incorporating the principles of the Guardian Academy (TGA) into his own practice.
How the Guardian Academy Saved Grandma
A capstone by The Balance Doc
My Key Takeaway from TGA: The Adaptive Dilemma
The more I work with people, the more I realize that this world has some seriously broken mindsets. Since joining, I find myself often wishing The Guardian Academy (TGA) was around when I first started practicing, as it would have shaved off years of struggle trying to understand humans and this business.
It also would probably have saved quite a few Grandmas.
Follow along & I’ll explain why.
While many of the different Guardian Academy teachings are helpful & applicable in my profession, the main overarching one that has helped me is the adaptive dilemma1. I’ll explain:
I am not brazen enough to claim that I am a better therapist than my colleagues; I don't have higher intelligence, use special techniques, nor have I taken hours of educational classes above the rest. However, despite my ‘average’ resume, my patients these days generally get better results quicker than those of my colleagues. They also stay better longer, which is a key consideration when it comes to injury healing and prevention. Why am I having these results?
I attribute them to my incredible good looks.
Just kidding. It’s all been happening since learning about how the human mind thinks, aka my education and time spent in the Guardian Academy.
Finding my Solvable Problem™: Patient Noncompliance
Ask any therapist- patient compliance is the #1 issue that holds people back from getting the results they crave. (Shocking, I know). The typical physical therapist meets a patient, talks to them briefly, gives a diagnosis and then jumps right in on it, giving the patient exercises to go home and perform ad nauseam. Sometimes literally. Their prescription is generally correct (thinking that the technical approach is what is needed: VALID).
However, due to:
1) The human condition
2) Lack of understanding by the patient
The compliance with exercises and subsequent follow-up generally stinks (not USEFUL). Because the patient doesn't understand *why* they're doing the exercises, they tend to avoid them, as exercises are generally difficult, time consuming, and not exactly drowning them in dopamine the way a good Netflix binge on the couch will.
They try them once or twice, and don't experience instant results, so they slack off. Soon, they stop doing the exercises all together. Then, they quit coming to therapy (ironically, often citing “lack of improvement”), and end up in surgery or worse.
Myself & colleagues will see this cycle repeat itself constantly, and the general consensus is to blame these patients for their “laziness” or such. I used to agree, griping along about the lack of self-discipline of humanity in general. My answer was a form of “chasing more”2- more harping on patients to exercise, assigning more exercises, pushing harder, etc. Until my time at TGA showed me what was more likely the issue.
My Macrobelief: Education, not skill, is the single most important key to changing outcomes
Since learning more about mindset, I believe an adaptive approach to patient education is key. My personal conviction is that a physical therapist's job is 90% patient education and merely 10% clinical skill/evaluation. So when my patients come into my clinic, I follow the same steps outlined above, but with one huge exception: I streamline 80% of the eval, so that I can take the largest portion of the time to simply educate them. And not just about their hip or knee. I get as much understanding and buy in from the patient as possible, we talk about mindset, and search for pain points to get to the root of what really matters to them.
Setting up Bumpers to Better Solve My Problem - AKA Compliance = Easy Exercises, Extra Ear Time & Early Expectation- Setting (Monday/Monday gain structure)
In addition to education, I’ve also implemented some “bumpers”3 to try to increase patient compliance:
During that first visit, I prescribe the absolute simplest exercise, maybe one extra if absolutely necessary. I remove the distraction of many good exercises and I focus on the one or two that will move the bar farther, faster. Because I understand now that when they start to feel better (aka quick success), they are encouraged to work harder & we are able to advance from there.
“Extra Ear Time” is my way of saying I prioritize listening to my patients. I do my best to ensure that the patient is getting what they want, not what I think is the most important. This way I can later use their own words to motivate them and focus on what matters. By periodically checking in with them & setting goals together as a team, I ensure we’re chasing the same target, and everyone stays on track.
Finally, I set expectations early and realistically. This is my form of building “allegiance capital” with my patients. I teach them about the healing process and how healing doesn't happen in a straight line. They need to expect to have both good AND bad days. The key is zooming out and looking at how they are feeling week over week. Daily evaluation in this field is a recipe for disaster and depression. Why?
Because, humans are stuck in their own daily, wildly irrational emotions4. When they have a good day, they have a tendency to overdo it, and then the next day, they end up feeling worse. Do they blame the good day and their subsequent enthusiasm for their bad day?
Nope.
They fall into despair, convinced they're moving in the wrong direction. As we know, a negative result hurts more than a positive one feels good. So on day one, I prioritize teaching them to zoom out, and to look at their healing week compared to week. Let’s compare Monday’s, not Monday to Tuesday. And I teach them that as long as Mondays keep getting better, then they're moving in the right direction.
Additional Action: Expanding My Reach, Improving Outcomes, and Ultimately Saving Lives
So how did TGA save Grandma? Well, did you know falls (aka falling down the stairs, tripping over the edge of a rug, stepping off a curb, etc) are the leading preventable cause of injury? In fact, they are in the Top 5 preventable causes of death in the United States, and perhaps the world5
Why? Well, it’s not always the fall itself that kills people (unless it was a super aggressive curb). Generally the journey is much more insidious. Grandma falls, breaks her hip, then heads to the hospital. There, the combination of pain and medicines keeps her stuck in bed, breathing shallowly. Then that ineffective breathing pattern combines with the bed rest, allows a nasty case of pneumonia to brew in her lungs. The pneumonia is what ultimately is fatal in many cases.
But if it’s not pneumonia, it’s a head bleed from being on blood thinners, or a hospital-acquired infection, a blood clot from surgery or bedrest, or a plethora of other things that end her life. Pretty bleak picture right? Hospitals & medical professionals agree. They spend millions upon millions on infection control measures, early mobility campaigns, blood thinners, etc, trying to prevent these outcomes every year.
But what if we can prevent the fall in the first place? We stop all that suffering and misery before it ever gets a chance. Instead of looking for flashy solutions to problems we created, what if we used that fabled “ounce of prevention” & learn to be happy when the bad things doesn’t happen (Aka the fall). Grandma lives & the world is a better place for it. Using TGA principles, I’m getting that all-coveted therapy result-compliance. With this increased compliance, the grandmas in my clinic leave with better results, stay better, and stay off the ground.
But I took it a step further- When I realized education was such a key in fixing my problem, an obvious idea presented itself. I didn’t need to see people in person to get results- I can educate them right from home (my own backyard, in fact). I wanted to expand my reach, and with technology, I could easily do just that. This vision is why I created The Balance Doc. On my youtube channel, I am using the education from TGA combined with my physical therapy expertise to hopefully prevent falls and ultimately help save lives.
In conclusion....
When I originally joined, I was looking to solve my financial stress, and my solvable problem was a number and a money goal. And while I still have that goal, I’ve really enjoyed realizing that these principles have endless other applications, ones that can truly change lives and end real-world suffering. “Saving Grandma” is just one application of many that can be taken from this awesome community.
I look forward to hanging out with you all more often, as I create more time in my schedule to grow with the guardian community.
Life’s been a little crazy lately (anyone else here recently welcome twins into the family? ), but in the future, I would like to host a quarterly(ish) call and talk about the human body, fall prevention/what you can do today to keep yourself young and shatter-proof.
Or just chat about how you can fix your own (human-body-related) solvable problems.
Until then I will be hanging out with my family.
And saving the world, one Grandma at a time.
See you on the other side!
Dr. Chris “The Balance Doc”
Congrats Chris on having this Capstone approved. A great demonstration of Living To Learn and Giving To Earn.
Welcome to the Guardian Tier of the Guardian Academy, you’ll fit right in!
Live to Learn. Give to Earn.
The Guardian Academy.
PS. You can start to develop your own toolbox here.
That is the best summary I have ever seen about the interactions between the professional and the client. I suffer from expecting my people to KNOW what I am talking about because they nod along and agree. I like this point...a lot.