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How do we go about influencing behavior change in physical therapy? In our own life?
Relationships are an integral part of our lives, and deep listening skills are essential for both building relationships and successful patient outcomes. Dr. Ginger Garner interviews Dr. Janet Bezner and Dr. MarySue Ingman, co-author the behavioral change chapter in Dr. Garner and Dr. Joe Tatta’s new book, Integrative and Lifestyle Medicine and Physical Therapy. They discuss how their stories and experiences in physical therapy impacted their research and why physical therapy is more than simply prescribing exercises.
Dr. Ingman was inspired by her mother, who was a nurse, and wanted to enter the medical profession. She worked as an aide in a nursing home and saw how physical therapy got people moving in a way that was actually fun.
Like many others in this field, Dr. Bezner was a physically active child. She utilized activity as a way to combat ADHD. In her teenage years, she experienced a significant knee injury that required a ACL reconstruction and meniscectomy. She was enamored by the field of physical therapy from that point on.
When practicing physical therapy in hospital and cardiac settings, they experienced how telling people what to do, ultimately had no bearing on patient follow through. Even with the best and most evidence based advice.
They knew that understanding how to help people make changes in their lives was a critical skill to making positive physical therapy outcomes last. And this all started with deep listening to their patients.
As they recognized that there was more to physical therapy than physical rehabilitation, they decided to expand their knowledge. Early on in their careers, they realized that building strong relationships with patients was vital for successful patient outcomes. This realization led them both to pursue health coaching certifications and doctoral degrees in health promotion and wellness.
They have both done extensive research and have taught courses in health and wellness, motivational interviewing, and physical therapist’s role as health coaches.
Relationships are a powerful tool for helping people reach their health and wellness goals. Developing strong relationships through deep listening with patients is essential for real and sustaining behavior changes. Dr. Bezner and Dr. Ingman’s stories demonstrate the importance of relationships in physical therapy and health promotion.
In physical therapy, we are often telling our patients what to do to get better. But what happens when they are discharged from our care? What if there was a different way to help our patients achieve their goals and improve their overall health.
It turns out there is. First, you want to respect the autonomy of your patients buy building a strong relationship with each person that comes to see you. The more you do this, the you are more suited to guide them to making real and lasting changes in their lives.
For those of you that prefer video, watch this discussion around the topic of building strong relationships; and some of the challenges that physical therapists face today.
You can check out their chapter, “Coaching, Counseling, and the Science of Behavior Change” in the book, Integrative and Lifestyle Medicine in Physical Therapy.
Dr. MarySue Ingman, PT, DSc is Associate Professor Emerita in the Doctor of Physical Therapy Program at St Catherine University in St. Paul, MN. Her physical therapy Bachelor of Science Degree as well as her Master of Science Degree are from the University of Minnesota. She received her Doctor of Science degree in Health Promotion and Wellness from Rocky Mountain University of Health Professions and completed training as a Health and Wellness Coach. Her research interests include the role of physical therapists in health promotion in clinical practice.
She has published studies on motivational interviewing and the role of PTs in health promotion and wellness and has co-authored a textbook chapter on coaching for health behavior change. MarySue co-created a reliable, brief and comprehensive assessment of health behaviors (Physical Therapy Healthy Lifestyle Appraisal) that can be used by physical therapists as part of their patient examination. She has taught courses locally and nationally in health and wellness, motivational interviewing and PTs role as health coaches since 2006.
Dr. Janet Bezner is professor and chair of the Department of Physical Therapy and Associate Dean of the College of Health Professions at Texas State University. She received a bachelor’s degree in physical therapy at the University of Texas Medical Branch, a master’s degree from Texas Woman’s University, a PhD in health education from the University of Texas, and a DPT degree from Rocky Mountain University of Health Professions.
She also is a national board-certified health and wellness coach. Dr. Bezner was vice president of education, governance, and administration at APTA for nine years, and served on APTA’s Board of Directors prior to joining its staff. Janet has practiced in a variety of health care settings, including hospitals, home health, long-term care, and corporate wellness, and her research has resulted in 15 book chapters, over 30 published articles, eight grants, and numerous conference presentations on health and wellness-related topics. She is a recipient of the Lucy Blair Service Award and is a Catherine Worthingham Fellow of the APTA.
00:07 Dr. Ginger Garner: Hello, everyone, and thank you for joining us today. I have some amazing guests/authors with us, and I would like to take a moment to introduce them before we jump right in to talking with them.
I’d like to first introduce Dr. Janet Bezner, who is a professor in the Department of Physical Therapy at Texas State University. She received her bachelor’s degree in PT at the University of Texas Medical Branch, master’s degree from Texas Women’s University, PhD in health education from the University of Texas, and a DPT degree from Rocky Mountain University of Health Professions. She’s also a board certified health and wellness coach. She’s vice president of education, governance, and administration at APTA for nine years. She’s practiced in a variety of health care settings, hospitals, home health, long-term care, corporate wellness. Her research has resulted in 10 book chapters, 25 published articles, seven grants, and numerous conference presentations on health and wellness-related topics. Dr. Bezner served on APTA’s board of directors prior to joining its staff and is a recipient of the Lucy Blair Service Award and is a Katherine Worthingham Fellow of the APTA.
Obviously, she’s a very experienced speaker on topics related to health promotion and wellness, leadership, personal development, and strategic planning. And she has been facilitating strategic planning meetings and providing leadership training for non-profit organizations, academic units, and others for over 20 years. So welcome, Dr. Bezner. Thank you.
01:53 Dr. Janet Bezner: I’m glad to be here.
01:57 Dr. Ginger Garner: I am so glad that you are.
I also want to introduce Dr. MarySue Ingman. She’s an associate professor in the Doctor of Physical Therapy program at St. Catherine University in Minneapolis. Her physical therapy bachelor’s degree as well as her master of science degree from the University of Minnesota. She received her doctor of science degree in health promotion and wellness from Rocky Mountain University of Health Professions. She’s also trained as a health and a wellness coach. Her research interests include the role of PTs in health promotion and clinical practice, and she’s taught courses, as well, locally and nationally in health and wellness, motivational interviewing, and PT’s role as health coaches, which is a topic that is really near and dear to my heart.
So welcome, welcome Dr. Ingman. I’m so glad you’re here.
02:54 Dr. MarySue Ingman: Thank you. I’m actually retired faculty from St. Catherine University. I’m moving on.
02:59 Dr. Ginger Garner: Okay. Thanks. All right. Goals. Goals. Oh my gosh, I have a few more years before I can hashtag that one.
I would also like to mention, I should have a copy of the book in front of me, but it’s across my room, that they are the co-authors of the chapter in the new book, Integrative and Lifestyle Medicine and Physical Therapy, that Dr. Joe Tatta and myself co-edited and also contributed to as well. So obviously their chapter is on coaching, counseling, and the science of behavior change.
And I want to dig right into, there’s so much information that we could go over, but stories are powerful. And I think to hear your stories and where you came from and what sparked your fire and the amazing work that you’ve done, just in looking at all the years of your research spanning from 1989 and forward is really incredible. So I wanna ask each of you, and I’ll just let you chime in. Tell me a little bit about you. What’s your story? What made you choose physical therapy?
04:21 Dr. MarySue Ingman: Well, I can start. I guess, lucked into it. I knew my mother was a nurse, and I knew that I wanted to enter the medical profession. And at the time, I didn’t have a lot of role models. Neither of my parents had graduated from college. My mom had a three-year degree as a nurse, and then went on to get a bachelor’s degree. So I had in my head that, well, doctor is out of the question. Now I know that was silly and ridiculous. And I knew I didn’t want to be a nurse because I knew how hard my mom worked and I didn’t want to work nights and weekends. And so I worked as an aide in a nursing home, a nursing assistant in a nursing home and loved being with people. And saw that they would take them to physical therapy and thought, well I like to be physically active. And this is how naive I was at 16. I like to be physically active and that’s a medical profession and it looks like they’re having fun with their patients.
And so, I declared that as a major in undergrad and was fortunate enough to be successful in the required coursework, fortunate enough to get into PT school, and I loved what I was doing. And then practiced in primarily acute care and inpatient rehab, but also I was at a big general hospital. We rotated and one of the rotations was cardiac rehab. And I think it was there where I sort of felt like, okay, there’s a little bit more to this than just physical rehabilitation.
You know, started to see the whole person, although I didn’t have language for what was connecting in me. Then I started teaching and I think there again, just with my students, physical therapy and physical therapist assistant students, I saw that, you know, there was more to learning than delivering knowledge. And so relationships kind of became a really important thing and developing relationships both with patients and with my students. And I think that ultimately led me into pursuing my doctoral degree in health promotion and wellness because I thought that really put language to what I knew was the most important ingredient in successful patient outcomes. And that is developing strong relationships with patients and helping them and guiding them versus telling them how to get there and how to achieve their outcomes. So that’s kind of my story from PT to education.
07:11 Dr. Ginger Garner: Yeah, oh my goodness. Your story is an inspiration to me because when I was a new PT I knew that I wanted to focus on health promotion and prevention. I went to PT school in the mid-90s and there wasn’t a single class in that. So I had to get special permission to go to the School of Public Health, take a few classes there. And when I got out, I was idealistic and I had all these dreams of doing exactly what you’re doing right now.
But there was no space for it. And I went to my supervisor, they’re like, we don’t do that here, what are you talking about? I wanted to offer wellness-based classes and eventually I ended up quitting my first job because I was so…frankly, probably clinically depressed, you know, about the experience that I had had. But within a year, things turned around and I started doing that. So your story is a huge inspiration because if it wasn’t for both of your work, really, I don’t know where we’d be. So yeah.
08:20 Dr. MarySue Ingman: Yeah, I resonate with the finding your spot. And I think that was the other thing that I kind of looked into is that Janet, when I started at Rocky Mountain for my doctoral science degree in health promotion and wellness, Janet was the program director then, and there was an inter-professional program. There were two PTs, myself and Dr. Duff Black. And I think that the three of us upon graduation, were like, okay, now we need to do something with this. We need to bring it to our profession. And so that was, again, sort of one of those things that being in the right place at the right time and networking with the right people has really done.
08:58 Dr. Ginger Garner: Dr. Bezner, how about you?
09:02 Dr. Janet Bezner: Well, my story isn’t dissimilar to MarySue’s. I was an athlete as a child and my mom encouraged me to get into sports because I was ADHD. I was diagnosed when I was like seven or eight. I was one of the first kids, way back in the early sixties, that was diagnosed with ADHD. They put me on drugs and my mom really hated what the drug did to my personality. So she took me off the drug, cut out all sugar in my diet and sent me outside to play every time I got home from school. She took me to the library and checked out tons of books and said, when you are in your seat at school and you finish your work, you’re going to read a book. And if you finish one, you’re going to read the second book.
So my mom, who had no no college education, she just figured out how to manage me. So she put me into athletics. Of course, I love sports. I had to play on the boys’ baseball team at one point in my life because there was no girls’ sports.
And of course, I had an injury in high school, a really bad injury. I tore my meniscus, tore my ACL. And back then that was, that would have been in the early 70s, mid 70s, they didn’t have arthroscope. So I had a full blown open knee surgery. They took out my meniscus, which was a terrible idea. But that’s what they did at the time. They fixed and secured my ACL and I went on to play college sports. But that experience really changed my life because prior to that, I was headed towards engineering. My father’s an engineer and I love math and science. And my dad was delighted because my older brother hated school and he wanted one engineer out of the family. So I was headed to engineering until I hurt my knee and had physical therapy and I was like, oh my gosh, what is this?
And so I was really just enamored with the idea of physical therapy for some of the same reasons MarySue mentioned. I love being physically active. I love movement. I saw its contribution to health and well-being. And so, so that was when I was 16, I think. So I set myself on a course to get to PT school, which I did. I graduated PT school at age 20. So super young, couldn’t even drink. And, you know, really never looked back. I mean, I would agree with MarySue. I was completely lucky. I just started treating patients and then I found myself in a community based hospital in my second job, sort of early in my career still. And I had an opportunity to be on the ground floor of creating a cardiac rehab program. And so I was the exercise part of that and started working in outpatient cardiac rehab. It didn’t take me long to get frustrated because I knew how to create an exercise program. I understood the science. I just couldn’t get anybody to do it.
So I realized, you know, I had a bachelor’s degree in PT. So I had two years of pre-reqs, which is pretty much all science. And then I had PT school, no courses in behavior change, health promotion, wellness, nothing, which wasn’t a fault of PT. It just is where we were at the time. And so I got hungry for more information. So I went and did a master’s degree in in PT, which was in cardiac rehab at TWU. But again, no, nothing on social science, nothing on behavior change. So so then I started teaching as well.
The degree in PT went from a B.S. to an M.S. And they said, you’re really great, but you got to get a Ph.D. if you want to keep teaching. So I went to the University of Texas and found this degree in health ed, which was really a focus on health promotion and health, health behavior change. So that really made me, I think, complete as a professional and I was exposed to corporate wellness in my PhD because our department at the University of Texas supported to corporate wellness programs, which were really world class at the time. And I found myself sitting in an office one day talking to an employee who had “flunked” his health risk appraisal. To keep their benefits at this corporation, they had to take an annual health risk assessment. He had come out with like four or five risk factors. And I was sitting across from this guy who was an executive at the company. And his dad had died of a heart attack at like age 48 or something. He had all these risk factors and he basically didn’t feel like he had any issues at all. He was a happy guy, married, two kids, loved his children.
And I couldn’t get his attention to motivate to get motivated to change his behavior. And so that’s where I discovered I needed more skills about health coaching. And it was a number of years later before I went back to get my health coaching certification. And that was thanks to MarySue, who just called me one day and said, Hey, let’s go get our health coaching certification. And I was like, well, we have PhDs, do you think we really need it? And so we did a little more research, and she convinced me and we registered together, we were in the same cohort, and we loved it. And it did provide so much additional information and skill that I’m grateful today to have and share it with everyone that will listen. But that I think really was a turning point for me, was realizing that was something to add to the rest of our knowledge.
15:01 Dr. Ginger Garner: Yeah, I think that that was probably the most frustrating part of being a new PT 25 plus years ago, was trying to get people to follow through with what you wanted them to do. And also feeling that sense of that same similar sense of not having all the skill set that was needed. And that’s what opened my brain up to integrative lifestyle, health promotion, because my curiosity for it really started in PT school. But like I mentioned, was incredibly disappointed to find out there was not a single class offered on it. So that’s kind of a good segue into the next question, which was, we’re kind of already there into that question of how did you become interested in using, whether it’s integrative, lifestyle-driven, you know, topics in your research and or your practice in physical therapy?
16:06 Dr. MarySue Ingman: Yeah, I was just thinking of that as Janet was talking of you know, being in a general hospital and we did the rotations and especially in the outpatient ortho practice. And even in my clinicals, and I graduated from PT school in 1983, so forever ago, but always feeling like, why are these people coming back? I felt like, and oftentimes it was low back pain and, you know, we weren’t very sophisticated back then in how to manage low back pain or as sophisticated as we are now. And I knew intuitively that there’s more to their pain and how they’re managing pain than the pathophysiology that’s going on, that there’s this whole person.
And so, you know, again, because relationships are really important to me, we’re trying to get to know what’s their family life and heard some really hard things going on in their life and, you know, trying to without preaching to them, but help them see the connection on maybe some of those things and, um, how they were eating and so forth. So, I think it just became, I got frustrated of like, why am I keep hitting my head, keep hitting my head against the wall and not being heard. And of course I didn’t have the skills. I didn’t know, you know, I was still telling them what to do based on sort of my experience or what the people around me. And so it wasn’t based on science or evidence. And the health coaching is really what gave me the tools to be able to basically meet the patients where they’re at and to respect their autonomy of ‘they’ll make the change when they’re ready.’
And in addition to that, of trusting that they kind of they know themselves best. So, you know, really putting that onus on them that you hold the wisdom. That you need to make these changes. It’s just a matter of having the support at the right time and somebody to guide you in that. So, to me, I think that my experience and then the knowledge and information on the social background. I used to think when I was a PT and banging my head against the wall, like, I wish I had a psych degree. I wish I knew more about psychology, you know. And so again, didn’t have the great language of like what lifestyle medicine was, but I knew intuitively that, that was the missing ingredient in all of this, in my practice.
18:39 Dr. Ginger Garner: Yeah, you mentioned a word that I thought of earlier, Janet, when you were speaking, which was intuition. To intuitively know there was something that we didn’t have at the time in order to validate their experience and also help them come up with reasons as to why they should quit smoking or reasons as to why they feel like, you know, being more active would be helpful.
Do you have anything else to add to that answer?
19:15 Dr. Janet Bezner: Yeah, I, you know. My story isn’t dissimilar, but the turning point for me was, I, one day I made rounds with the cardiologist in the inpatient side at this cardiac rehab program. And we didn’t really do much rehab on the inpatient side at that time, just made sure they were safe to go home and then they started outpatient. But I went into the room with the physician and he, the physician was a male, was talking to a male patient who was probably 48 or 50. And just had a heart attack, first sign, first symptom. And he said, well, “Mr. Smith, you know, you’ve had a heart attack. So you have to start exercising. You have to change your diet. You have to stop smoking and you can’t have sex with your wife. Any questions?”
And I was like flabbergasted that, that, I mean, he kind of just dumped that, walked out of the room, left me standing there. I could obviously see the patient was in extreme distress by that message. And I realized, oh my gosh, what am I supposed to say? What do I do now? What do I say? How do I help? I mean, no one can just do all that like that, even if you’re motivated. So I realized that healthcare system was you know, we were scaring people, honestly, into behavior change. And I knew from my own limited experience that that wasn’t going to work.
So that really, I think, was a big wake up call for me that there has to be a better way. And it is, as MarySue said, through relationship building and treating adults as autonomous people who have choices and giving them choices and rationale and supporting them to make the decision. And helping them and encouraging them when they fall down, which they’re going to do. So I think that, combined with my personal commitment to health and wellness and what I had learned for myself, really drove me to want to share that with others, both through my profession and my patients in my family, in my community. And so that, that really, you know, drove me to set a goal to really bring health, emotion, wellness into physical therapy. And I’ve really dedicated my career to that. For the last 40 years, that’s been my goal. And I was lonely at first, because I was one of the only ones that I knew who was singing that song. So thankfully I learned patience and I met great people along the way. And now it’s a thing. So there’s people like Ginger and Joe and others who are really carrying that flag. And it just makes me as happy as can be because I can stay home now and y’all can do it all.
22:13 Dr. Ginger Garner: Yeah, I think that was one of the driving intentions when I first, this was years ago, sent an email to Joe, I’m like, you know, we should do a book on this. We really need to bring people together on that because of being able to say that the next generation doesn’t have to feel homeless or lonely or fight their way through the proverbial jungle trying to figure out and create a path where there wasn’t one before. And I feel like, you know, that your work and the book and other work that’s gonna follow has made it much easier. So people don’t have to question their own value as a physical therapist, they know that they have the the knowledge and the training to do this and I think that brings up a really important point because If you’re listening and you’re just starting out as a physical therapist, you know this question is for both of you. What do you think the biggest challenges are that are facing PT’s today?
23:27 Dr. MarySue Ingman: As an educator for over 30 years, one of the things that I loved seeing in students as they graduated and entered the profession, and as I continued to stay in touch with them in their early years, was that enthusiasm. Like, I entered this profession because I wanna help patients, I wanna help people. I love that, I like learning the new skills. And they enter the profession with that enthusiasm and then what was hard was seeing that light dwindle in them after a few years of clinical practice.
And, you know, a lot of things have happened, including a global pandemic, which has impacted people’s work and jobs and the area of PT that they practice in was maybe impacted. But it just broke my heart to see that dwindle, that light dwindle and the reason why they entered the profession. And in talking to them, oftentimes it was like, I’m just met with so much productivity demands or the pace is so fast or reimbursers. I’m constrained by reimbursement and what I can do or how much time I have with patients and so forth. And I think that is, it’s real, it’s for sure real. We have to do it to both and. We have to meet those demands and we need to provide quality care. And you need to stay rejuvenated and alive and be authentic in your clinical practice and bring that joy and that spark that brought you there. And I really think, there is no, you know magic medicine that will keep a person from facing those realities and addressing those easily. But I do think remembering and falling back on that: this is a whole person. I’m not just here to treat their pathology, that I can maintain those relationships that were so important to me and why I entered this profession.
And I think we’re also seeing a lot of different ways to practice PT, to be a professional in physical therapy, whether it be in a healthcare system, whether it be out of a healthcare system, whether it be private pay, whether it be through reimbursement. And so I think that…that is, I’m optimistic. It’s sad when I see that, but I am optimistic that I feel like each new class that came is starting to embrace the importance of lifestyle medicine, health and wellness within themselves and with their patients. And so they’re taking care of themselves to kind of help and prevent some of that burnout that might happen early in their career.
26:22 Dr. Ginger Garner: Yeah, yeah, I definitely felt that. You know, it was a very, very long time ago, but I definitely felt that, and that was a big driver for my choices as a clinician, the very things that you’re speaking about. So Janet, do you have anything to add to that?
26:45 Dr. Janet Bezner: I think Mary Sue summed that up perfectly. The way I would characterize that is that physical therapists in general don’t get the respect they deserve from the health care system. I think we own some of that fault ourselves because we’re not comfortable with conflict and we don’t toot our horn, so to speak. But I think the system is also at fault. So we don’t get the respect that we need. And so we’re not paid what we deserve. And that results in the scenario that MarySue nicely described. And I couldn’t agree more with the solution, which is we all have to participate in spreading the news about the value of physical therapy. And it’s hard to be a clinician under these circumstances. I’m grateful every day that I’m in academia and somewhat sheltered from that. But I also have a skill set that people will pay for. So I make it okay and I don’t have to deal with those pains every day, but we do as a profession.
27:57 Dr. MarySue Ingman: Yeah, one of the things that in this, especially the students that graduated in 2020 and 2021 that were entering the profession during the pandemic, in the heat of the pandemic, and sometimes waiting to find a job. And one of the pieces of advice I said to classes was, “there’s a lot of places you can go for continuing education. And sometimes you need some clinical experience to do those continuing education, especially a more advanced course. And other times you can do it as a new grad. Health and wellness coaching or advanced training in health and wellness and lifestyle medicine is one of those things that a new grad can get that added certification and enter the profession or somebody who’s late in their career like we both were Janet and bring it to your career even later and it can transform your career.” And so I think thinking about you know where you want to spend your continuing education dollars too can be really helpful.
Something to consider, like what certification do I want and what, how will it add to my whole profession. I’m not saying it’s for everyone, but I do think at that time, especially when people are either changing careers or working to find their space, their place in the profession, that is, I find it to be a certification that can take you in a lot of different directions.
29:26 Dr. Ginger Garner: Yeah, there is a lot of wonderful continuing education out there. And for, we mentioned a lot of challenges that as PTs, you know, we’re, we’re facing in the next generation of PTs are facing.
So if we kind of break those down a little bit just to review, for everybody listening, is one, is…
Yes, integrative medicine, lifestyle medicine is absolutely within your scope of physical therapy practice, your scope of professional practice, but you may not feel like it’s in your personal scope of practice, and then that’s where you have to vet and decide, where do I go? Which training do I want? And when do I need it? And can I budget for that? And there are a lot of options out there for that.
I think the second part of that that I’m hearing is also safeguarding your own health and wellbeing. I know what it feels like to, you know, within the year, within the first year of my practice, I was considering quitting and leaving. I was so disenfranchised. So I know deep down in my soul what that feels like. And our current system, it’s not from some inherent weakness that I had as I was just a terrible PT. It’s if our system isn’t aligned with our core values and how we want to help people, and they’re butting heads because, you know, drugs and surgery are reimbursed, but not physical therapy as well, then we exist in a broken system trying to, you know, ride the tricycle with one wheel off of it. So you also have to realize, you know, if you’re listening to this, that, you know, some of that is not your fault. It’s not just being stronger. It’s not just being more determined and having a stronger will. It’s investing even a little bit in the future so that other PTs don’t have to, and all PTs don’t have to struggle as much.
So first of all, knowing it’s not your fault. We can’t just be, you know, smarter, etc. Because, for example, I have a private practice now, I had no business classes, you know, I just we were just thrown out there and said, good luck, start your practice, right. So we have to learn so much on our own. So I just want to give some applause and encouragement to all the PTs out there that are doing this in broken systems that are doing this without the business training. We don’t have MBAs. I wish I had an MBA every single day, but I don’t know if I could tolerate, you know, getting another degree, although not for the want of it, it’s just expensive, right? Education is expensive.
And I think the third part of that is, if you’re really safeguarding your health and wellness as a practitioner, and you’re vetting what good CE is out there, the third thing is making sure you’re a member of APTA, I think we should probably plug that. What are your thoughts on that? I have been the volunteer for APTA NC as our legislative chair for a few years now. So I’m constantly beating that drum about advocacy and talking to all the PT schools and PTA schools here in North Carolina, to take them through legislative, you know, activities and things like that. But I know that you guys have some wisdom there to share on how PT should be or can be involved.
32:49 Dr. MarySue Ingman: I’ll let you start on this one, Janet, if you’re okay with that.
32:54 Dr. Janet Bezner: Okay, sure. Yeah, I could not agree more that being a member of APTA is a minimum. You know, I worked at APTA for almost a decade, and I saw firsthand that our ability to influence as an organization, which is how our political system works, was severely limited by the number of members that we had. So when you’re in Congress and you’re testifying for or against a piece of legislation, which is how it works. You say I am here today representing the American Physical Therapy Association. We represent 20% of the physical therapists in the country. Now, there’s not an organization that represents more, but that just doesn’t sound very impressive does it, you know when when some of the medical groups can get up there and say we represent 85%, you know, so you know that what you’re saying is, is a majority opinion.
You know, APTA can’t do that, and it severely limits our ability to influence. So being a member is I mean, it’s the most important thing you can do to secure your future because laws are made in our capital, Washington, D.C., by people who have no idea what you do every day. No idea. They’re farmers, they’re lawyers, they’re grocery store owners, they’re they come from all walks of life. Some come from medicine, but a small amount. And so having a relationship with your legislature, legislators to tell them what it’s like to be a physical therapist and that you do this work and then you get paid not enough to keep your doors open to make a margin. You know, that makes a difference. And it’s their constituents that you’re treating that aren’t getting the services that they need. So, you know, our health care system is messed up. It’s not, we’re not going to fix that unless we, to my opinion, throw it out and start over. And I don’t know which political party, which administration is going to have that political will. Not sure. Might not happen in my lifetime, but we need, we can do a lot to influence where we are now and get the resources that are there and that do exist.
So, but it’s going to take all of us. And, you know, even if you just don’t want to worry about the business part, I mean, Ginger, you have a private practice, you have to worry about it or else you don’t put food on your table. But a lot of us, a lot of people just want to go work in a facility where somebody else is dealing with all of that. Well, I’m pretty sure you probably ask for benefits and salary. And I don’t think you have the right to ask for benefits and salary unless you’re a member of APTA, because the benefits and salary that you get are directly related to payment policy and regulation, and that influence occurs in Washington, D.C. and in your state.
So to me, being a member of APTA is just a part of being a professional.
36:01 Dr. MarySue Ingman: So well said. I think the other thing I just saw recently, and people might be familiar with Healthy People, the national organization that sets goals and outcomes for the health and well-being of our people, of everyone, young and old citizens of the United States. And there are a lot of organizations that are at the table that help set those goals and objectives and APTA is one of those. And they’re one of them because, we, because of the dues and the membership that we have that allow them to advocate and being a player, a player at a table as big as Healthy People 2040, we’re in now, they just developed the objectives for that, is really, really important and gives us, our profession, the credibility and the recognition that we deserve and that we’re working so hard to obtain.
36:57 Dr. Ginger Garner: Very well said, because I don’t think…Let me back up one step. I’ve been teaching integrative and lifestyle medicine-based continuing ed for, this will be year 20, 22. So I have taught that around the world and…you might imagine, you won’t be surprised at how much pushback I get from those people in the integrative world who say, APTA does nothing for me, integratively, right, for the holistic, right. So I’m constantly, you know, addressing that in teaching continuing ed as a result, because people don’t understand even how a law gets made, you know, just the basic explanation of that. They also may not understand how much weight and how important your state legislators are, in addition to your congressional representatives, and that a lot of the ways that you get paid or not happen at the state level. And that being a member of your state chapter as well as APTA, I wholeheartedly agree, is a bare minimum way to be an advocate.
So if you’re a member, thank you, because you are an advocate by doing that. And then you can take it to the next level if you want, because there are many ways to volunteer, some great, some small. For example, I have started a program called, and it’s not the only one, that it happens in a lot of other states as well, that you adopt a legislator program. That can be state or federal. And it’s just the concept of if you’re a key contact for your district, that as the legislative chair or whomever that may be in your state, I would send out an email with a template that says, can you email and make a phone call to your representative because we have an issue coming up, or we don’t at all, because you can’t ask a stranger for a favor necessarily. You can, but they may not listen.
And so I think it’s important for everyone to understand that if you don’t have a relationship with your representatives, you’re not probably going to be listened to. And if you’re not a constituent in their district, you’re definitely not going to be listened to, because they wanna hear from the people inside, their district and in their, that they know that they’re a constituent. So, all that to say that, in North Carolina, for example, it only takes five or 10 minutes of your time to be a key contact. So if you don’t know that there’s a legislative committee at the state level and one for the federal level as well then get involved with that because we hope that this textbook, the work that both Mary Sue and Janet are doing are for the future. They are to pave this way to make, to raise and elevate the status of physical therapy in the healthcare profession, to help us do what at heart we want. We want to help people, but we have to make sure that the system we work in, their values are aligned with the ability to practice integrative and lifestyle medicine. And unfortunately right now they’re not, but every state in APTA is active and I sit on those meetings all the time and every one of them wants to see increased payment and increased exposure and elevated awareness.
All right, guys, that’s my plug. That’s our plug for joining and getting involved.
And this is a really good time to shift because I have some questions I want to ask before we have to wrap it up, wrap up. But your chapter is amazing, and I want to thank you for contributing that to the book. It would not have been worthy of propping up, you know, a coffee table and if your chapter had not been in there because I think it’s the most important thing that we do as therapists, because if you can’t convince someone to follow your excellently scaffolded program, then it’s all lost, right? So what would you say is like a huge or little takeaway, clinical pearl? What’s the one thing from the chapter you think people need to know?
41:33 Dr. MarySue Ingman: Well, I’ll start, I think It is some of the very basic skills of communication that we probably all have learned at one point in our education, whether it’s pre-PT or PT or life, and it’s about listening. And listening from a place of, I believe, curiosity is the…coming from a place of curiosity can never be bad. I’m accused a lot of asking a lot of questions. That’s just my personality. And so I do have a curious mind. Sometimes I have to be careful about that. So it doesn’t come across as like probing or you know, or getting too personal, but I think coming from a place of curiosity helps to get conveyed to the recipient that you are hearing them because you ask follow-up questions.
When I fully acknowledge that for some of us that comes quite naturally and that it doesn’t come naturally for others and that’s okay. I think there’s still a way to be able to if you’re the type of person that you know you are listening, but maybe don’t know what to say or what the follow up is to say a patient saying, “Yeah, I know my, you know, I know I’m getting a little thicker on the waist and I’ve been thinking I want to maybe lose a little weight” and not knowing what to do with that information is.
It’s you can’t go wrong by just reflecting back what you heard. It can be as simple as you’re ready to lose a little weight. And just stating that conveys to them you’re not telling them how the pressure you’re not by them saying that doesn’t make you responsible for now developing a plan for how they need to lose weight. You’re just acknowledging I hear you. And what more do you want to say? So reflecting back is one way to do that. Um, and I think it’s easy to, it’s hard to do that with topics like weight. We hear that all the time when we talk to practitioners about health and wellness and how to have these conversations with patients is like weight tends to be a sensitive topic.
And it might be, but just practicing that, reflecting back what you’re hearing, even in personal relationships with your partners, with your children, with your neighbors of, something as simple as, I watched the ads on the Superbowl and I liked the ones about the dog. I love that one. “Dogs are really important to you”. Might just be something that you’re saying back that shows that you listened in a deeper way than we’re used to having people listen to us. I think the typical way is somebody says that and the subject changes and there it’s reflected. We say something about ourselves. And so I think just remembering that you’re just keeping the door open for your recipient or the person you’re conversing with to continue to share more and share more.
So that’s, I think that’s my nugget that I don’t think you can go wrong, and we give you lots of ideas and examples and case studies in the chapter on how to begin to have those conversations.
44:50 Dr. Ginger Garner: Yeah, yeah, the chapter is very helpful for lifestyle appraisal, for understanding how you can practice deeper listening, you know, with your patients, and how to maybe sometimes refrain from giving advice, because we like to do that. It’s not always the best thing to do. Janet, do you have anything to add on that one?
45:16 Dr. Janet Bezner: Yeah, I agree with Mary Sue that listening, it starts with listening. I think what we say and how we say it is, is really also very important, and it definitely starts with listening. I’ll give one example I think, physical therapists and all healthcare professionals are trained to judge, right? So when we evaluate, we’re judging.
And in this realm, it’s very natural for us to also judge. So I’ll just give a little example that I give to the students all the time. So a patient like Mary Sue just described says, you know, I know I’m gaining a little weight and I would really like to lose some weight. A typical sort of knee jerk response would be to say, “ great.” Right? “Great. You want to lose weight.” In other words, you’re motivated. However, that’s a judgment.
Right? So now we’re reinforcing that societal tendency to judge people as good or bad. And judgment is in the way of somebody developing their own self-efficacy and autonomy. So that is not in effect good. And it may motivate your patients to do things because you want them to. So think about that. Once discharge happens, you’re not there. Are they going to be motivated to do it? They’re no longer pleasing you. So the goal in these interactions, no matter what element of physical therapy you practice, where, who they are, the goal is to make your patients autonomous. to guide them to learn autonomy. So they’ll continue to do what you taught them when they leave you. So we have to refrain from judging. So the response to that is, “wow, it sounds like you’re really motivated. How can I help you? How can I help you?” “What do you think is the first step?”
Never why, that’s another pearl. Never ask a why question. You have to be really skilled to ask a why question without judging.
“So tell me more about that. What’s sort of behind that?” “It sounds like now is the right time.” “Give me some more information.” “I want to understand so I can best support you.” “How can I help you? “What’s the step?”
These things roll off my tongue because Mary Sue and I have been doing this a long time. But I couldn’t agree more. Practice this with your children, your spouse. They will love for you talking like this. They will love it for the same reasons your patient does, because you’re not judging. You’re reflecting, you’re listening, you’re supporting. And so I’ve really, this is not natural to me. I couldn’t agree with Mary Sue more. It is natural for some people. It’s not natural for others. It is not natural for me. I have had to work at this really hard. It’s probably the hardest thing I’ve had to work on in my whole professional career. That and learning patience. But you can learn it. You can learn it. And once you do, you don’t ever have to go back.
48:23 Dr. MarySue Ingman: Yeah, what Jen and I are talking about is empathetic listening, just listening kind of with, you know, trying to understand the whole person. And I know when I was, I don’t know if it was in my health coaching or in graduate school of learning, like, when you are being listened to. And just think about this personally, anytime somebody has listened to you with their whole being, and you felt completely heard that there’s nothing that feels much better than that. It feels really good and you feel it in your body.
And I tell my students, I say to say, be that therapist that when a patient walks away from you, they describe to their partner people in their life like, well, that was different. And in the best possible way that that was different.
And because they walk away feeling like I wasn’t judged, I wasn’t preached to. I got advice, but I felt like it wasn’t preachy advice or I felt understood. I felt heard. And so be that different. Be that person that, the therapist that your patients walk away saying that you’re different.
49:27 Dr. Ginger Garner: Yeah, that’s that is such I think that’s the best compliment that you can receive as a therapist is for a patient to walk away and go, I finally feel heard. I finally feel seen. And I know that, you know, we’re, we’re not just PTs here, we’re also patients, and that we’ve had that same experience where we come out of an office and we did not feel heard at all. And so I think that’s one of the best things that you know, that can be said about us as clinicians. Because listening is so important. It’s vital, and like I said, I’m a little biased, but I think y’all’s chapter is A1 at the top of the list because otherwise we can’t move people. We can’t even force the horse down to the water to drink. We really have to be the guide on the side and not the sage on the stage, as is said.
Speaking of listening, this is a probably, this is just a fun last question that I like to throw out because when I am stressed or when I feel stuck and stagnant, I turn to music. And many people have their things, right? I turn to music. Just before this interview, I was practicing my violin because I’m a perpetual beginner violinist.
It’s very humbling. So my question is, what song would represent physical therapy and what we do the best, if you had to pick?
51:06 Dr. MarySue Ingman: Well, I didn’t have an answer to this, so you go, Janet, because I know you had one..
51:09 Dr. Janet Bezner: Okay, my song, the very first one that came to mind and always comes to mind is a song called We Are Family by Kool and the Gang. And that song holds a special place in my heart because it was popular when I was in PT school. And PT school holds a really special place in my heart because the people I met in PT school are still some of my closest friends. And I just feel like we are family. Physical therapy of all the health professions, we really make, we create environments where people can feel like they’re themselves. And that’s super important to me, that sense of belonging. And it’s one of the key reasons I’ve been a physical therapist now for 42 years and you know I’m not ready to quit so that’s why.
52:06 Dr. Ginger Garner: Awesome, thank you. So we are family. Thank you. Yeah. All of my brothers and sisters and me.. Yeah, I love it. Yeah. Oh my gosh, this has been so, this has been so much fun. I have been looking forward to seeing you in person as in-person as Zoom can allow us to be during all this pandemic time.
The new book, Integrative and Lifestyle Medicine and Physical Therapy Practice. We persisted through COVID and all of the things that happened during the pandemic to get this out to you guys. We do hope you enjoy it. You can go to optp.com and find the book there and anywhere books are sold. And thank you guys again. Thank you, Dr. Bezner. Thank you, Dr. Ingman for your time and your expertise and for paving the way.
53:03 MarySue Ingman: Thank you
53:08 Dr. Janet Bezner: Thank you. Have fun and carry on, Ginger.
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