All right,
today we've got a legend in the house,
someone who spent his career standing at
the crossroads of science,
clinical mastery, and military precision.
Dr.
Gail Dow is the clinician scientist who
doesn't just talk evidence,
he generates it.
He's mentored generations of residents and
fellows
pushed PT diagnostic competency forward
and published clinical trials that have
shaped how we treat chronic
musculoskeletal conditions.
If you care about advanced clinical
reasoning, fellowship training,
or the future of PT's role in global
health, buckle up.
This is going to be a good one.
Let's get into it.
Gail, welcome back to the show.
Well,
thank you very much for allowing me to
sit here with you today.
Last time we recorded, we were in person.
We were at the AOMT conference in Reno.
So my first question is,
did you make it out of there with
all your money or did you lose?
Did you leave some in the machines or
on the tables?
No, I escaped there relatively unscathed.
My problem was I was up twenty five
bucks in the first day and then down
one hundred twenty five bucks.
That's how that's how the law of averages
gets you.
Yes, yes, yes.
I didn't go through that.
That's because you're smarter than me.
That's why you're the guest and I'm just
the silly host.
All right, so let's start with this.
You've mentored physical therapists across
every level of training,
but I want to know this.
What's one trait you see in the clinicians
who really take off after fellowship?
Is there one trait or many that you
probably can see in people and when you
see it,
you know this person's going to take off?
Well...
I think it is the clinician that realizes
patients are complicated.
And with that,
there comes a certain humility you have to
have to think that no matter how much
effort I put into this or how hard
I've worked,
I'm still relatively unprepared to take
care of the complexities that I'm likely
to encounter on a day-to-day basis.
And I think that the more hungry that
either residents or fellows when they go
into training are, you know,
the more they really want to be able
to offer their patients that's uniquely
skillful.
You know, they just,
they bloom in the training and their
trajectory for their post-training growth
is really more sharply elevated and they
just, they continue on that pathway.
Yeah.
And you've been doing this for a long
time.
Is it fun, I imagine,
to run into people you mentored five, ten,
fifteen years ago and kind of listen to
the stories of where they've gone since
then?
Oh, yes.
And at times it's almost like the
mentoring role has changed.
You know,
I can go to them and talk to
them or ask them questions.
And, you know,
they've been able to specialize in things
that I have not or they've gained
experiences that I don't have.
And,
So it just kind of flips the mentor-mentee
thing.
But that's one of the most rewarding
things, I think,
of someone who has been in my position
and had some opportunity to work with and
help the growth of some of these
clinicians.
Yeah.
Well, let me flip it then.
You've worked as a mentor with mentees.
Not everybody probably...
should be a mentor.
I just mean like, what, what are, what,
what makes a good mentor?
How did you know that mentoring, um, it's,
it's one thing to be a good clinician,
but I'm guessing vastly different to be a
mentor to someone else to do that.
Yeah, I think,
I think you have to be,
be willing to, um,
be a role model and to,
to be exemplary.
And, and there's times when
You have to break down what you're doing
so it's consumable,
so they can see exactly what that is.
And then, you know,
there's just times when the ethics of
certain situations, you know,
will challenge a mentor.
And, you know,
you have to be willing to show your
cards.
And I think, you know,
you want to make sure you stay on
the high ground and
so that the mentee can see the complexity
of the decisions you had to make,
how you got there,
and why you did what you did.
Now, Gail,
you're a strong advocate for physical
therapists as frontline diagnosticians.
Is there a story that you've got,
a moment when a PT's diagnostic skill
really changed a patient's medical path?
Anything come to mind?
Well,
I guess I've seen it so many times
where, um, we've had, um,
physical therapists, you know,
take patients that have been sent to us
and they've been through a fair medical
process and their diagnosis is such that,
you know,
they do not belong in physical therapy.
And it's, it's hard for,
for one to stand out, but these things,
you know,
ranging from
know trainees being in a line with chest
pain and they were having you know
myocardial infarction to tumors growing in
in young people's long bones to um you
know infections and leukemia and you know
it just the list keeps on and on
but you know i think physical therapists
you know,
do really well at being able to interview
their patients,
particularly if they've had some advanced
clinical training,
residency and fellowship level training,
and they can quickly determine, you know,
this just does not seem to be appropriate
for physical therapy.
So it's, you know,
I have some teaching examples sometimes
that I use, but, you know,
it happens frequently enough that it's
really not one unique thing,
but it's almost like
You know,
if you had oversight to all the therapists
that work in most of the settings that
I've been in,
it's probably every other day somebody
pulls some patient out of there that
doesn't belong in that clinic.
That's great.
You mentioned advanced clinical reasoning.
When you think about that,
when you think about advanced clinical
reasoning,
what's the biggest unlock that most
clinicians miss early in their careers?
Is there something holding them back?
You mentioned a minute ago, really,
really being able to understand that the
patients are complex.
That's got to be one of those unlocks.
Is there anything else?
Well, I think for someone like me,
who I was very internal
with my processes.
And, you know,
I think that there was a lot going
on and I think I'd had lots of
experience and there was things that,
you know,
I could just kind of tell what it
was when you see it walk in the
door.
But until you bring your reasoning out and
look at it and examine it and probably
have somebody help you with that,
you're not, you're not going to be as,
as clean and as efficient as you could
be.
And so,
You know,
if you take what's implicit and make it
explicit and get it out where it can
be seen and where you're, you know,
you're making mistakes or you're jumping
to certain things or you're not exactly
asking the right thing or you've missed
opportunities.
Those are the kinds of things that will
elude someone that probably hasn't been
through some formal training in how to get
better at clinical reasoning.
It sounds like it's the physical therapy
equivalent of you got to show your work,
not just your answer in math class.
It's pretty much it.
And there's a certain willingness.
I mean,
it's a little invasive to have someone
come into your space and say, well, okay.
But there was some things you could have
done better here.
And your thoughts are personal and so on
and so forth.
So it really is a willingness on the
mentor's side to get a little bit of
the
mentee on them and you know and to
be a little invasive and then you know
and then mentee has to be accepting of
that you know if you get if you
get defensive then that's where where
growth stops yeah i i imagine setting good
expectations early on in that process of
i'm going to push you but there's a
reason to it it's not me trying to
step on toes or or make you defensive
there's a method to it so i imagine
setting good expectations is probably
important
Yes.
I think good communication both ways there
is very helpful.
Yeah.
You've said that physical therapists are
an untapped contributor to world health.
What's one global health problem you think
PTs are really uniquely positioned to help
and impact?
I think, you know,
just musculoskeletal health, you know,
worldwide would really
benefit from unfettered access to physical
therapists and their low-risk,
high-benefit strategies, you know,
things that don't push patients down the
pipeline of advanced imaging and invasive
things, you know,
whether it's diagnostic invasive things or
whether it's treatment invasive things,
that there's so much that physical therapy
would have to offer.
And, you know,
and I think at times we have this
wrong with third party payers thinking,
well, you know,
we'll save some money and we won't pay
for physical therapy or,
and really it's the opposite.
You know,
you need to open your portals up and
get these patients, you know,
out of probably the whole medicalized
pipeline and get them into someone that
can help these patients
be more active and be healthier and,
you know,
and have things that some strategies that
are, that are lower risk and less costly.
All right, Gail,
we're going to play red light,
green light here for all the clinicians
listening.
What's one habit you think they should
stop doing tomorrow and one habit they
should start.
What's a red light and a green light.
If they want to become sharper, safer,
more effective,
what do you typically suggest?
I would say,
If possible,
I would try to make your administrative
processes as efficient as you can.
Yeah.
And spend more time with your patient.
That would be my big green light.
Get your hands on them,
get your interaction to be more intensive.
And, you know,
I think it's very hard to replace a
highly qualified and trained physical
therapist in meds for our clinical
settings.
And so the intensity of the interaction
between the physical therapist
and the patient is, I think,
where the true value is.
So that's definitely green light.
All right, excellent.
Gail, this was outstanding.
Nice little short burst of insight.
You spent a career proving what skilled,
well-trained physical therapists can do,
not just for patients,
but for the profession and for global
health.
Love your mix of curiosity, rigor,
mentorship,
exactly what keeps pushing together
physical therapy.
So thanks for doing what you do here
with AOMT and for the profession.
Well, thank you very much, Jimmy,
for having me.
And I would add one thing.
A colleague sent something to me a couple
of days ago and posted on Baylor,
where I have a faculty appointment as a
full professor.
They've got my name and profile and that
I am in the top two percent of
cited researchers in my field,
which is truly amazing for me just to
think.
I'm a grassroots guy.
You know, I worked with colleagues.
We took clinical questions that were
relevant and we did studies to try to
get answers to those questions and we
pushed them out into quality journals.
And just to see that to be in
the top two percent of cited researchers
is amazing.
That is amazing.
How what led you to tackle on
big questions like that?
Doing research,
none of those are small questions.
It's got to be big.
What sort of made you feel like, yeah,
I can do this and it's worthy because
the effort is large?
Well, I think it is.
In some of these trials,
it's about equivalent to raising a child.
But when you take something from concept
to publication, it may take a few years.
And
I think it's just being hungry as a
clinician and you have these questions and
the literature doesn't provide the answer
to it.
You think you see this,
but you don't know.
And so now it's a matter of putting
it to the rigor of a clinical trial.
And I think clinicians and those that
indeed have some advanced training and
some advanced education are in a great
position
to design clinical trials.
And, you know,
at times you may want to consult with
people that are in full-time research
positions and so forth.
It isn't like you're,
you're out there all by yourself, but,
you know,
I think a group of motivated clinicians,
you know, working and, you know,
and most of our research was,
was unfunded,
not connected to any big grants or
anything like that.
And, but,
so I think it points to the power
of, of,
what someone who's motivated to get more
information,
to be able to use it in clinical
practice,
what you can be able to accomplish.
Yeah.
All right.
I said last question before,
but I'm going to say last question again.
What would you say to that clinician out
there?
They're not a researcher.
I'm using air quote.
They're not a researcher.
But what would you say to them of
why it will help their career and,
of course, big picture,
help the profession of taking on either a
large or a small research project?
Because we need those clinician
researchers.
You do.
And I think what they can really add,
one, you have the patients.
So you have the subjects for any clinical
trial.
And you may have the question,
and there's nothing wrong with
collaborating with a research center or an
educational program of one sort or
another,
whether that's at the entry level or
that's a graduate level program.
And you might be able to look at
their research question that they're about
ready to embark on and say, you know,
I'd do that a little differently.
I don't think that question is so
relevant, you know,
because from what I'm seeing,
if we would tweak this or do this
a little bit differently,
that might be a much better question.
You know,
maybe it would yield you something that
clinicians need in order to be able to
go in and do business on a,
on a day-to-day basis.
And I think that's what you would have
the most to add, you know, and if,
if you think, well, you know, in the,
statistical analysis or maybe what is the
most rigorous design or something like
that.
Yeah,
there's plenty of room for collaboration
with those things if you feel like that's
not exactly your skill set.
Yeah, and we need that, right?
The researcher and the clinician,
they just bring different things to the
table.
I imagine it's probably better than the
sum of their parts.
Oh, yes.
Love it.
All right.
I promised you last question.
I got it.
Gail, appreciate some insight.
We'll love to have you back on the
show sometime soon.
All right.
Thank you very much.