Okay, welcome to the Hands-On,
Hands-Off podcast from the American
Academy of Orthopedic Manual Physical
Therapists.
I'm Amy McDevitt,
and today I decided to bring on my
good friend and colleague, Paul Minkin.
Paul has been a therapist for over thirty
years.
He's been in academics and he's also been
involved in entry-level education,
residency education, fellowship education.
And today I wanted to just have him
chat a little bit about an article called
the worst pain is an unexplained pain.
And that was published in JOSPT just
recently, but we've had some kind of off,
uh,
offscreen conversations about this topic.
And I just wanted to bring Paul on
to talk a little bit more about it.
So, um,
Paul, welcome,
and thank you for agreeing to come on
the podcast today.
Well, thanks for having me, Amy,
and you forgot to mention you're an author
on that paper too, so...
Yeah, yes, that's right.
So I'm an author.
And then we also have Jeremy Lewis as
the senior author on this paper.
And what was kind of fun, Paul,
if you don't mind me telling the story,
is the three of us were chatting at
the AOMT conference last year and just
talking about things that we're passionate
about and work that we're doing and
research and that sort of thing.
And we kind of just made a little
bit of a pact or a decision to
write a couple of passion papers together.
with each of us leading a paper about
something that we were passionate about.
And so it's this is kind of a
fun result of a conversation that started
at a conference.
Paul,
tell us a little bit more about why
this is a passion paper for you.
Well, you know,
I have always respected Jeremy Lewis's
work,
and so he gave a pre-conference course at
last year, which was outstanding,
but he brought up this
quote by Hillary Mantel that the worst
pain is an unexplained pain.
And that just really resonated with me.
And how do we make sense of that
to our patients?
And that's always the challenge, you know,
whether they come in with imaging that
shows this is going on or,
you
know the the really tough one is the
patient who has maybe symptoms and has
x-rays and has an mri and doesn't show
anything right and so like what's going on
now and i see a lot of patients
who have been to
you know,
chiropractors and physical therapists and
physicians.
And the physician tells them, you know,
it's a disc problem.
And the chiropractor tells them they've
got a vertebrae out of place.
And PTs are as guilty as anybody else
of labeling patients.
You know,
your SI is out of place or your
nominant's rotated or things like that.
So they've heard three different stories
from three different providers,
and they don't know where to go with
that.
And just trying to make sense of that
for the patient that's sitting in front of
you can be challenging.
So we'll get into talking about the ICF
model and things like that.
But as physical therapists,
we treat human beings.
We don't treat pathology.
So shifting the focus away from trying to
pinpoint the pain generator is a useless
exercise for most of our patients.
Yeah,
and you said something that resonates with
me too.
It's kind of both sides of this argument.
So it's whether the patient has had
imaging and there's a whole plethora of
things that were read by a radiologist the
patient is reading,
sometimes even before they have an
opportunity to interact with the provider
to get context.
And it's the patient who doesn't have any
findings on imaging
That feels like something has gone
horribly wrong because there's no evidence
of anything that's problematic or
explaining why they have certain symptoms.
So I like that you called that out
because it can happen on kind of both
sides of that argument.
So my first question is,
what are some of your experiences that
kind of shaped your decision to write this
viewpoint?
Well, you know, over the years,
I've had countless patients who come in
with pain,
but there's no clear structural cause
overall.
Maybe their imaging looks normal,
but their suffering is real.
So, you know,
what moved me to write this piece was
talking to Jeremy,
but also reflecting on those patients that
have bounced between providers,
each giving them a different diagnosis
overall,
and it leaves them just confused and not
sure where to go forward, afraid to move,
thinking their back or whatever is going
to explode if they
if they load it.
So in practice,
I see that the worst pain isn't the
one we can see on an MRI.
It's the one that we can't explain to
the patient in terms that they understand.
So really,
my goal is to help patients make sense
of their pain,
even when we can't pinpoint an exact
anatomical diagnosis.
Yeah, yeah, I think that's true.
And I think it's something that I see
in my setting because I treat, you know,
a little bit of a different population
working in a health care system for a
hospital is that, you know,
trying to describe to patients some of
these things are normal age related
changes and they may or may not be
pain provoking.
And so I think that's another kind of
layer to this conversation is we don't we
shouldn't have an expectation that imaging
looks normal in people that are over the
age of fifty or sixty or seventy.
Or even younger individuals, you know,
I treat a lot of college age students.
And, you know,
the research shows that especially with a
condition like back pain,
the individuals who have never had back
pain are going to have findings very
commonly on imaging.
So, you know,
saying that that's the cause of their pain
is not valid.
Yeah, yeah.
And so I love this.
This part of the argument comes early in
the paper and there's a quote here I'm
going to read.
It's receiving a diagnosis carries a
personal significance for patients as it
provides a framework for understanding
their pain,
validates their experience and guides
their recovery.
So yet, you know, the article says,
you know,
the worst pain is an unexplained pain.
So how do you balance the need for
diagnostic clarity and
with the reality that some musculoskeletal
conditions lack a clear structural cause?
Well, that's why I'm honest with patients.
And I do talk about the research that
looks at asymptomatic individuals with
whatever their condition is,
whether it's shoulder pain, back pain,
hip pain,
you know, those kinds of things,
the prevalence of pathoanatomy in
asymptomatic individuals is through the
roof.
So just starting off, you know,
with that and, you know,
I tell them that it's very unlikely that
I'll be able to exactly pinpoint what
structure is causing your pain,
but my job is to kind of listen
to you as a human being and examine
you and come up with all of the,
contributing factors that may be playing a
role in why you have pain,
whether that's limited mobility,
limited flexibility, limited strength,
lack of sleep, poor nutrition,
high stress, those kind of things.
So just reinforcing to the patient that
human beings are complex organisms,
that there are multiple factors that
contribute to a pain experience.
My job is to tease out which ones
can we identify, which ones can we modify,
and moving forward,
from that standpoint.
Yeah.
I don't know if the profession has
evolved, Paul, or if we've evolved,
but I feel like I also see things
in a different lens.
And I used to just think in terms
of, okay,
they have low back pain and this is
the multimodal approach and these are the
interventions.
And
Somehow now there's and maybe it's because
there's been more work in the area,
but I'm thinking and looking at so many
different things,
including what you just spoke to,
which is lifestyle factors,
but also what's going on in their lives
and where they live and how they function
and what kind of transportation they
access and, you know, spirituality.
And there's all these other dynamics that
play in.
that I never really appreciated before.
So I don't know if we've changed or
if the profession has changed and really
decided to put a spotlight on some of
these other more person-centered factors
that really matter.
Yeah, I think it's both.
I think hopefully we continue to evolve
and start to realize, again,
that we're treating human beings.
We're not treating pathology,
especially as
as physical therapists and that kind of
thing.
And then one other point I wanted to
comment on, you know,
I also teach in fellowship and I had
a fellow say once, you know,
if a patient comes into me and brings
their MRI, I tell them,
I don't even want to see it.
And, you know, for me,
that is like slapping the patient in the
face.
They've spent this time,
this money to get this image and you
won't even look at it.
Now, we've talked about how, you know,
pathoanatomy is prevalent in asymptomatic
individuals,
but you need to validate that patient's
experience,
what they've been through and that kind of
thing.
So I will take the time to pull
it up.
Let's look at this and go through it.
And then I will look at what they
find on the imaging and I will tell
the patient my job is to see if
what I find in my clinical exam correlates
with what we see on the imaging.
If it does, great, we'll move forward.
If it doesn't,
then there are some other things that we
can treat.
And again,
it is common for individuals to have
pathoanatomy on imaging that does not
correlate to symptoms.
Yeah.
And I find myself having that conversation
actually quite a bit with my patients
because most of them present to PT with
imaging in hand because we're in a
hospital-based system and that's just how
that system works.
So tell us a little bit about how
the ICF model and maybe using language
surrounding a functional diagnosis might
help some of this situation with our
patients.
again we're trying to identify things that
we can treat you know we're not going
to go in and fix somebody's disc or
if they've got a torn labrum in their
shoulder or something like that so you
know i'm going to be identifying uh
impairments to movement you know you look
at the mission statement for uh the apta
you know optimizing human movement and
that type of thing so my exam is
really focused on barriers to the tissue
that whatever tissue it is that they've
injured
uh making a complete recovery so that
includes physical factors like you know
strength flexibility mobility those kind
of things but also those other lifestyle
uh things that we talk about so i
tell my patients at the end of the
exam look
You have back pain.
I don't know exactly what the structure
is,
but these are the key impairments that I
have identified that I think are barriers
to you getting back to doing what you
need to do.
And we're going to focus on treating those
because the research would suggest if we
improve those things,
it's likely that you'll feel better.
Yeah.
And we speak to in the article a
little bit about using words like pain.
things are irritated or sensitive,
or I find myself with patients using,
you know, you're not really,
you're sensitive to load right now.
And those, those resonate with patients.
Like your nerves are irritated,
things like that, instead of using,
you know,
more of that pathoanatomic language that
we know can,
can in some patients be harmful,
but I do feel like patients understand it
when we break it down in that way.
Have you ever had trouble kind of
implementing some of that language and
talking about, you know,
mobility impairments or movement
coordination or things like that with
patients?
Yeah.
I mean, that's, that's always a challenge.
I mean,
a lot of patients come in with the
thought that pain equals harm.
Every time I feel pain,
causing damage to the tissue overall.
And so that's the first thing we need
to kind of straighten out.
And I'm a big advocate of pain science
education,
but I think a lot of it has
gone way overboard that we don't need to
get that detailed with our patients
overall.
Look, there's
these things that are contributing to the
symptoms that you're having.
And like you said,
your tissue just got overloaded.
If you are a sedentary individual and you
help a person move and you expose your
back to loads it hasn't seen in ten
years,
we would expect that you would be a
little bit sore.
And it does all come down to load
and building the tissue's biologic
capacity to tolerate load.
And if you explain it in those terms
to patients,
it tends to resonate with them.
Yeah.
So do you mind if we go off
script for a minute and I play the
patient with my imaging in hand and you
kind of reframe the conversation?
Sure.
All right.
So I'm going to, for a moment,
pretend that I'm much younger.
I'm a thirty five year old female.
But, Paul,
I've been having all of this pain going
down my right leg and I had an
MRI because my doctor thought that would
be the next step.
And I have disc herniations.
So I have disc herniations that they said
L three and four, L four, five,
both on the right and the left side.
And I've got some disc herniation.
decreased disc height is what the MRI
report had said.
And so, you know,
what are we going to do about this?
I don't know that I think physical therapy
is going to work because we talked about
injections.
Yeah, so first of all,
I want to validate that your pain is
real,
and I apologize that you have to go
through that.
And I understand that may be difficult for
you to be going through that.
Again, with my exam,
I'm going to be trying to correlate what
we see on imaging with some of the
symptoms that you have,
and they may correlate with
what we see on the imaging and they
may not.
But we do have some good treatments that
we know that can decrease the load in
the region here and optimize the mobility
of the tissues around there.
But really our goal is to create the
optimal environment for your back to
recover from whatever is going on in that
region.
There's likely with the imaging findings
that we're seeing some inflammation,
some overload in through that area.
And if we can get that calmed down,
then the tissue can heal.
As soon as that starts to heal,
your symptoms will improve.
There may be flares as we kind of
go through things.
Obviously,
if the imaging is showing all of those
things overall that are going on,
we want to be respectful of that as
we're progressing through.
But the goal is to get you back
to doing the things that you want to
do and
you know not laying around we know that
bed rest and things like that just tend
to make these symptoms worse on on
multiple levels both from a healing level
and a psychological level so you know i
don't want to dismiss what we see on
the imaging but you know there's plenty of
people out there who have really uh
terrible looking backs on on imaging who
have no pain so there's no reason why
you can't get back to doing what you
need to be able to do
Yeah, that was pretty good, Paul.
I'll give it a nine out of ten.
Maybe a ten out of a ten if
you inserted a little teach back in there
or something.
But no, I'm joking.
That was great.
I think you covered so many bases.
You talked about maybe decreasing some
catastrophizing if that's present because
you kind of normalized a little bit of
the imaging.
But then you also talked about
contribution of lifestyle factors and
other things that we'd be doing together
in physical therapy in order to mitigate
some of that pain.
But I think it's great to just give
people an opportunity to hear what a
conversation might be like that you would
have with a patient.
You started to talk a little bit about
lifestyle.
And so the article did cover some and
highlight some of these lifestyle factors
like sleep and stress and nutrition and
How do you kind of integrate those into
your treatment plan?
Or maybe you titrate them in over time
without overwhelming the patient or maybe
stepping out of our scope of practice?
yeah so that's a great question you know
one of the things i'll use especially with
somebody that's had symptoms for a while
going on is i'll have them watch that
youtube video explain pain in five minutes
because it does such a nice job of
going through all of the different
lifestyle things that may be contributing
to symptoms such as sleep and stress and
nutrition and activity levels and
And that type of thing.
So I like to really frame lifestyle as
part of recovery.
It's not an add on.
And I explained to patients that pain is
like a dimmer switch.
So things like movement, sleep, stress,
all have the ability to either turn that
dimmer down or turn it up.
And then I try to pick, you know,
after the patients watch that five minute
video, I say,
did anything resonate with you there on
your sleep and your diet?
your exercise levels, your stress levels,
things like that.
Did anything resonate with you on that
front?
And they'll always come up with one.
Yeah,
I should get some more sleep or I
should drink more water or things like
that.
And then I'll pick one small achievable
change at a time.
So maybe let's increase your activity.
Let's try and have you go for a
every day.
Or let's come up with a consistent
bedtime.
Why don't you start going to bed at
the same time every night so you get
a consistent amount of sleep so your
tissues can heal?
So I try not to become a nutritionist
or a psychologist.
I just try to help them see how
these habits can influence healing and
collaborate with them on coming up with
some strategies that may help them.
Yeah.
And I think based on my experience,
even incremental change has changed.
So even if we can help them implement
a little bit of extra sleep or a
fifteen minute walk,
and I usually say to patients outside
always, you know,
unless it's it's not safe or the weather
is not in favor,
it's so good for you to do that.
But, you know,
there is a lot of power in it
being incremental.
And I don't think we're necessarily
outside of our scope and making those
recommendations.
Yeah,
and it can be overwhelming for patients if
you throw it all at them at once.
I need you to eat better,
and I need you to sleep better,
and I need you to drink more water,
and I need you to decrease your stress
levels,
and I want you to do some mindfulness
kind of things.
The patients are like, whoa, whoa, whoa.
This is physical therapy, isn't it?
Yeah, yeah.
You talked about the importance in the
article of language,
and we did talk about this already a
bit,
but what are some common phrases or
metaphors that you have found helpful or
maybe even harmful in communicating things
to patients?
Well, we've all heard these,
but I see college-age students who are
told by their healthcare provider,
you have the spine of a
It's out of alignment or you need to
be careful.
You could make this worse, you know,
those kinds of things.
You know,
really educating the patients that really,
if we're talking about back pain,
your back is strong and it can tolerate
a lot of load.
It's not going to explode if you bend
forward,
which a lot of patients truly believe
that,
that if they bend forward and try and
touch their toes,
something terrible is going to happen.
And then also, you know,
the pain science stuff,
pain does not equal harm.
You know, if we can...
get that into patient's head.
Yeah.
You,
you helped somebody move last weekend and
your back is really sore and it's probably
going to be sore for, you know,
a period of time overall,
but pain does not mean you're causing any
damage to the tissues overall.
And then really getting the patients to
think about their body is a complex system
that requires, you know,
not just strength and mobility,
but all those other lifestyle factors,
appropriate sleep and decreased stress
levels and those kinds of things.
Yeah.
And I have another kind of separate
question.
I remember we talked about this with
Jeremy when the three of us were just
kind of having a conversation about some
of this.
But at least where I'm working in
outpatient and hospital system,
imaging is a huge barrier.
And I spend a lot of time undoing
it.
You know,
I have a patient that comes with imaging
and then we have to talk about,
you know,
thinking about the imaging in a slightly
different way.
And it's not catastrophic and your body is
strong.
And to your point, you know,
your lumbar spine is well supported
ligamentously and by all these muscles.
And maybe you're just reacting,
the tissues are reacting to some load.
But Jeremy was describing he didn't quite
have the same problem because they don't
utilize imaging as readily or as often as
we do in the United States.
what, where do you see the,
how are we ever going to kind of
get around this culture?
And maybe it's too big of a question
for, for, you know,
us to even think about,
but it's really a barrier in my opinion
to recovery.
What do you think the answer is at
least in the United States and in our
health system in terms of our utilization
of imaging or over-utilization,
I should say?
Yeah, well,
it's got to be a systemic change overall.
And if we just followed the guidelines,
I mean, the guidelines are very clear.
If you have a new onset of back
pain with no red flags,
imaging is not indicated.
Don't even go there.
But unfortunately, like you said,
when you were talking about Jason,
you know,
He feels like he has to order the
imaging or whatever.
It's kind of part of the script that
you go through.
But, you know, really changing that,
if you read the guidelines,
they are very clear.
And if we just followed that, you know,
on the radiology front, it's interesting,
you know, where I practice up in Boulder,
a lot of the radiologists are starting to
put little blurbs at the
Patients who are from thirty to forty,
it's common to see this or that,
just to put that in on the bottom
so that the patients can see that some
of these findings are normal in people who
don't have symptoms overall.
The setting I work in,
about seventy percent of the patients we
see are direct access,
so they come in and see us first.
Man,
seeing somebody with two days of back pain
who has not seen another provider is,
you know,
life-changing as a physical therapist
compared to the patient who has seen ten
providers and had pain for five years and
had all the imaging and things like that.
You know,
those are so much harder patients to treat
overall because they've got all of this
information in their head that is just,
you know,
we've done a lot on expectations.
Their expectation is rude, right?
Their back is broken.
Yeah.
I envy you, Paul.
I haven't seen a patient with acute low
back pain in over ten years.
Unfortunately,
we don't have direct access in our
hospital system,
which is unfortunate because we're in a
state that allows direct access.
But I'm not going to stir up that
hornet's nest at the moment.
But it's unfortunate because I believe,
and you know this too,
the trajectory can be so different
um,
when you see someone just a couple of
days out of an injury or a new
onset of pain versus someone that I
usually can't see for eight to ten weeks.
And by then they've already had imaging
and a whole plethora of other things have
happened, um, you know, in that,
in that time, which is just, um, again,
it's just unfortunate.
Yeah.
You know, I had to, uh,
taught a course this weekend and had a
great discussion with some of the people
there and, um, the, uh,
uh, we, we kind of talked about,
you know,
primary care physicians role in treating
conditions like back pain.
And, you know, in my opinion,
and you've taught the medical students at
the university of Colorado as well,
they get very limited training in
musculoskeletal conditions.
So for a primary care physician to see
a patient with back pain to me is
out of their scope of practice overall.
I mean, they can handle the, the, the,
you know,
major conditions and things like that.
But that would be like us trying to
treat somebody with a complex, you know,
endocrine problem or something like that.
You know, the physical therapist,
the providers who should be the front door
to the management of musculoskeletal
conditions and not that we can diagnose
cancer or some of these other
But we know the patients that belong in
our clinic today and those that don't,
and we refer appropriately.
I mean,
we've published a report on over sixteen
thousand patients seen direct access.
We didn't miss a single fracture or tumor
or that type of thing.
So, again,
we should be the ones seeing them.
And if we do,
the trajectory is completely different.
Yeah.
Yeah, I agree with that.
I was just yesterday I was talking to
Stephen Spoonmore,
who we both did research with many moons
ago,
and he has worked for a number of
years up in Alaska with some of the
indigenous populations.
And we were talking about this really cool
idea.
you know,
primary care model that they were trying
to get off the ground where, you know,
patients are being triaged by this team,
including primary care and sometimes
behavioral health and PT as a part of
that in order to kind of have this
team-based approach to determining,
you know, the best path for the patients.
And I think that's,
I think it's really cool.
And I think it's kind of the ideal.
So, you know,
hopefully we can continue to work towards
those, those models.
Yeah.
Rebecca Griffith in the emergency room
getting physical therapy in the emergency
department.
That is life-changing overall for
everybody involved,
even the healthcare providers.
Yeah, absolutely.
And she's done some great work, I believe,
in really messaging that and how important
that is at both a national and
international level,
which hopefully is another kind of agent
for change.
So in terms of education, I mean,
we're both entry-level educators,
but on top of it,
you educate in some residency and
fellowship.
From that lens,
what do you think needs to change in
terms of how we educate students or
learners, I should say,
to better
be prepared to kind of have this
person-centered,
non-pathoanatomical approach?
And how do you still talk about
pathoanatomy without it translating to the
speak that we use with the patients?
Because we're advocating in this article,
in this viewpoint,
to really talk about more of a functional
diagnosis.
Yeah, I mean...
It's kind of the nature of the beast
that we need to teach our students how
to do all these exam things.
And we have all these special tests that
purportedly identify structural pathology
and things like that.
But I'm really trying to move my students
away from that.
I'll teach them those tests,
but I also teach them how to interpret
the findings,
meaning that you can't rule in most
conditions that we're seeing and really
emphasizing that
teaching them how to connect with people
and how to improve the therapeutic
alliance and treat the human being that's
sitting in front of you.
This is not a knee.
This is not a shoulder.
This is not a back.
This is a human being that has complex
things going on.
So part of it is just
It's habit.
It's what's been done before and that kind
of thing.
So we really need to shift the educational
model from teaching our patients to look
for something that's broken or something
to fix and steering more towards that ICF
model to think in terms of
function and how impairments affect a
human being's daily life,
not just what structures are involved.
So, you know,
I try to present a balanced approach with
it.
But unfortunately,
they need to learn some of these special
tests for the board exams and things like
that.
Right.
But
You know,
I really do look at individuals now from
that ICF model.
They have low back pain width.
What's the underlying impairment that's
most likely to give us the biggest bang
for our buck from the intervention
standpoint?
And then really teaching them about the
therapeutic alliance and taking time to
get to know the individual.
You know,
I've said over and over again to my
students, you know,
your interaction may outweigh your
intervention.
Yeah, yeah.
It is tricky because we have to kind
of teach both things and then at the
same time somehow cohesively deliver a
message that we don't want to be
over-emphasizing pathoanatomic terms with
patients.
I was just teaching in our hybrid
immersion at University of Colorado
yesterday,
and I
we were working on teaching shoulder
content.
And one of the ways I felt like
I could kind of try to couch this
together is we were talking about shoulder
pain with movement coordination deficits.
But then we were talking about what
pathologies might kind of nest underneath
that.
But still,
because we don't have confidence,
we know for sure that someone has
multi-directional instability or that they
have a laboral issue.
It's still just a hypothesis under this
broader category of movement coordination.
And so I was trying to figure out
a way to kind of house pathoanatomy under
each of these,
but being very explicit with the students
that we don't have confirmation all the
time that this is exactly what we're
dealing with and it can be harmful.
to describe pathoanatomy to the patient in
the absence of clarity.
Because to your point earlier,
even with imaging,
we don't have a hundred percent clarity
that that's the pathoanatomy that's kind
of driving the symptoms.
So.
Yeah.
And I, you know,
I've used that engineering that, that, uh,
uh,
meme or whatever the engineering flow
chart where does it move yes should it
no then you know then what are we
going to do we're going to stabilize it
we're going to put some duct tape on
it or that kind of thing right try
and uh
You know,
hold it down a little bit or keep
it from moving too much.
Or does it move?
No.
Should it?
Yes.
Then that's WD-Forty.
Squirt some WD-Forty on it so it moves
a little bit better.
So applying some manual therapy.
So when I use those same kind of
descriptions to patients,
you're a little stiff through here.
You're not moving like you should be.
And if we can improve the mobility here,
then it's likely that it will decrease the
amount of compensation you need to do at
the level above.
Or if you're moving too much,
we need to just improve your body's
ability to stabilize that level and keep
it from getting irritated by moving beyond
its normal physiologic motion.
Yeah.
And I agree.
And I think that actually makes sense to
people.
Somehow we just get tempted to kind of
fall in the trap of pathoanatomy,
but that's not always the most productive
place to go.
But I agree.
I think that language makes a ton of
sense to people.
Um, so as we kind of close up,
what are some things that you're currently
working on or what, what,
what other passion projects do you have?
Are you working on any research right now?
What, what's, uh,
what's blowing your hair back at the
moment, Paul?
Well, I guess you don't have that much,
so.
I'm really moving into looking at burnout
and mindfulness and things like that.
We're working on a project where we're
looking at dry needling.
We just published a case report on a
patient that I caused pneumothorax on,
which I think as a profession,
we need to be honest and say these
things do happen and the prevalence is
probably much higher than we think it is
overall.
You know,
we're going to explore that and kind of
survey emergency room physicians and kind
of see how often do they see patients
who have developed a pneumothorax due to
potentially needling or those kind of
things.
But we're also, you know,
Josh Cleland and Megan Donaldson and I are
working on looking at burnout in academic
faculty.
There's a lot of evidence in medical
literature, but as far as allied health,
physical therapy, speech,
occupational therapy,
we don't really have a good handle on
the level of burnout in academia overall
because I've been through it.
Josh, my best friend, has been through it.
And it's definitely challenging.
So number one,
what's the prevalence of burnout in
academic faculty?
And then ultimately,
how can we improve that or decrease the
likelihood of that happening?
So those are a couple of the big
things that I'm working on.
But I have my finger in a lot
of different things,
educational competencies and things like
that.
But plenty to keep me busy.
Yeah, great.
Well, I look forward to, you know,
catching up at the conference,
which is coming up in a couple weeks,
and then also seeing the fruits of your
labor in terms of some of this burnout
work, which, you know,
is very different from, I think, medicine.
And so I love that you're calling that
out and doing a little bit more work
to explore maybe what some of the
differences are and how we can mitigate
it.
Because it's hard work being in academia,
lots of high expectations.
And so I look forward to hearing a
little bit more about that.
Yeah, one more quote from Julie Whitman.
I remember she told me, you know,
in academia,
once you get on the treadmill,
you can never stop running.
So that's how it works sometimes.
That resonates.
All right, Paul.
Well, it was a great conversation.
And thanks so much for the conversation
about some of the work that you're putting
out there.
And we shall see you again when another
brilliant paper comes out.
We'll bring you on and unpack it together.
All right, thanks so much, Amy.
All right, thanks.