Words are powerful.
Words reflect our attitudes towards people, events, and ourselves.
Words can reveal our outlook on the nature of the world.
Words are reciprocal.
Words can influence our attitudes towards people, events, and ourselves.
Words can reinforce our outlook on the nature of the world.
A driver cuts you off on the highway and forces you to slam on your brakes to avoid a collision -
‘That asshole! What the hell are they thinking?! I’ll punch ‘em in the face!’
‘Holy shit! I’m glad I saw that coming. Is everyone okay back there?’
Are our attitudes towards people, events, ourselves -
Gratitude amidst the flow?
If our outlook is more defensive, reactionary, angered,
We will find shit to be angry about.
If our outlook is more gratitude,
Then we will find more opportunities to see joy.
Our words hold power.
Words reflect and influence our attitude and outlook,
Our words also reflect and influence our attitudes regarding those we interact with.
Enter a patient into your treatment room.
They seek your expertise and care regarding a medial knee pain.
After your evaluation, you summarize their presentation and it sounds like this:
‘The pes anserinus and medial collateral ligament of your left knee are both inflamed because you have weak, poorly testing hip abductors and weak external rotators. The medial and lateral hamstrings both test poorly. You also have an externally rotated L leg, a leg-length discrepancy, and an asymmetric pelvis and lumbar spine because of your weak core muscles. The poor position of your lumbar spine and pelvis are causing the poor function and weak muscle testing at your left hip and subsequently your left knee. Also, your left foot is flat - pes planus as we call it - and it forces your knee to crash inward even more. We need to fix your posture, add an orthotic arch supports, strengthen your weak core, strengthen your left hip to fix your knee.’
Here is a list of shit that is wrong with you.
Or, a summary could sound like this:
‘Thank you for this opportunity to work with you. Our focus will be to build up the protection of your left knee. The hip is in charge of controlling the side-to-side and twisting motion of your leg; including your left knee. Your hip is not as efficient as it could be, allowing more stress to your knee. That is related to some asymmetry of your pelvis. We will retrain some key core muscles how to do their job better to hold your pelvis. That will allow a stable base for your left hip muscles to work and become more efficient at controlling your knee. Your foot served you and your knee well without help up until this injury, so we may or may not need a little kickstand to help as we regain your hip.’
Words are shapely.
Do I see a problem
Do I see opportunity?
If I find myself using negative or destructive words,
My interactions will offer negativity, de-constructiveness.
If I find myself using generative words,
My interactions will offer gratitude, constructivity.
Which brings us back to the car cutting us off on the highway.
Do we respond with retributive, violent words?
Or do we respond with words of gratitude,
Even in the wake of potentially life-threatening event?
Words are reflective.
Even the subtle ones shown in the evaluation summaries.
Their implications are larger than many would think.
Do we see the patient as a set of problems that we have to fix?
Or do we see the patient as a gift,
An opportunity to share your talents with and care for?
If I see problem,
I see inconvenience,
I see that which I want to avoid,
To protect me and my interests -
Then the patient is an intrusion,
An actual problem,
A disruption to my day.
The patient is one of many that are in the way of me leaving work
To head back to my house.
If I see opportunity, however,
If I see an invitation
To offer my care and skillset -
Then the patient is a gift -
Part of the actual thing I get to participate with,
The purpose of my day.
The patient is a part of my intention and fulfillment
To enjoy throughout my day.
Words speak, even if we aren’t aware of what they are saying.
If I saw patients as a problem, inconvenience or
Part of something that I have to get through to get home,
Patients will pick up on that same negativity.
If that is the picture someone’s words paint for me,
I would find it hard to want to participate with that intent.
I would be very disinterested in working with that person.
I would care less about the exercise or activity I was asked to do at home.
I would find it difficult to keep those appointments.
If I saw patients as opportunity, gift -
Part of the joy of my day,
Patients will pick up on that generativity.
If that is the picture your words paint,
I would find more ways to participate with that intent.
I would be very interested in working with that person.
I would care about my responsibility in participating with my care, at the clinic and home.
I would work hard to keep those appointments.
Our words are reflections of how we see the world.
How we see the world is shaped by the lenses we have been handed and adopted over time.
The health of our lenses has great impact,
As does the health of our words,
On the health of the care we provide.
By Dr Adam Fujita PT, DPT CAFS
I met a guy who is passionate about cycling,
His responsibility to the community,
His responsibility to the environment,
And his responsibility to his physical therapy profession.
He started a clinic on one of the main cycling thoroughfares in a city of the Pacific Northwest-
Allowing accessibility to cycling commuters -
For physical therapy treatment,
And bike tune ups.
It’s located not far from his home - Allowing the freedom to walk his kids to school everyday.
He has paperless faxing, repurposed waste water, a contract commitment of his employees to bike to work at least 300 days a year - helping fulfill his commitment to caring for the environment.
And last we chatted, he was looking for more personal/organization development content for himself and his workers.
His passion is not for everything. But that which he is passionate for, he looks to fully embrace throughout -
And built his business around.
His business caters to his lifestyle.
Not the other way around.
He knew at least enough of himself and the why behind what he wanted to do.
And went for it.
Yvon Chouinard’s life was all about the outdoors, climbing. Surfing. Early on, he wanted to make himself better climbing gear. So he did. He learned the craft and made his gear. And then started selling it to friends. And a business was born. When the surf was good, they grabbed their boards and closed the shop.
As he continued to grow and learn, he wanted to make more responsible climbing gear that had less impact on the earth (old gear would gouge the rock wall or be set as ‘permanent’ metal in the rock). So he did (removable, reusable, laser durable - last longer, have to consume less product). And his business was learning how to be guided by a responsibility to that which they loved - the environment.
He started making better climbing clothes because sport-specific clothing did not exist for climbers. More functional, more durable - last longer, promoting less consumerism. He started seeing the positive impact he could have on the environment but assuming responsibility for material sourcing, waste-repurposing, and ethical workforce standards.
Yvon also recognized his responsibility was a business owner, taking care of the families of his workers with daycare, paternity leave, maternity leave, etc.
He gave workers the freedom and trust to get their work done however they chose. If the surf was good, they weren’t in the office.
(There is so much more greatness and detail of this story found in ‘Let My People Go Surfing.’ I am doing Patagonia no justice with this summary.)
Yvon Chouinard did shit that he liked and wanted. And built a business around it. Climbing gear. Surfing. Love and respect to the environment. Love, respect, and freedom for his employees. The ability and freedom to support others (NGOs) that have similar passions. The ability for his business to be a model for other businesses beyond the triple bottom line. He created and is creating a way for him and his passion.
What we take, how and what we make, what we waste, is in fact a question of ethics.
These are but two stories of people envisioning beyond our current conventions,
Brave enough to put it into practice.
Leaders created businesses that were trusting, people-focused endeavors around a unifying principle to carry forward. The primary focus was not profit, but their people and their cause.
Your business fosters the cause, the cause draws the people.
You and your leaders take care of the people, their commitment to the business and the cause is bolstered.
The people feel safe, cared for, and poured into, and they will take care of the product and revenue.
With their commitment to the cause and the delivery and quality of the product, with the revenue they generate, your business for the cause perpetuates.
It’s a generative cycle.
For some time, I fostered fulfillment within the construct of physical therapy and the health care industry. Instead of forging a completely unique situation for me, I worked within the confines of someone else’s clinic setting to find my way.
My passions, for a long while, were shown in the process of physical therapy.
The education, the sleuthing, the problem solving, the details, the intricacies of interventions, the details in learning palpation skills and effectively making change to tissue and joint mobility.
Getting people a step or two further along. Promoting health, movement, active lifestyle.
Working as a clinician helped fulfill certain passions of mine-
Deep dive into complex material with continual practice/refinement -
Forward progress and opportunity with people/patients -
The freedoms to pour into ventures beyond the treatment room -
Long training seasons
Health, movement, active lifestyle.
I had a level of balance within it all.
Not perfect. I worked at someone else’s business that had it’s own way.
There certainly were flaws of the business and flaws that I brought to the table.
But I was able to carve out a way for me to navigate my passions and lifestyle.
In other words,
People don’t have to quit their jobs to find a level of fulfillment.
You don’t have to start your own business around the physical therapy, cycling, and environmental responsibilities to find joy.
Nor do you have to work to revolutionize business on a global scale.
You have what you are looking for.
Find your generative lens.
By Dr Adam Fujita PT, DPT, CAFS
I played hockey.
I was a defenseman.
My dad worked hard.
And made sacrifices to afford me the opportunity to play hockey.
Shit was expensive.
And time -
He would cut out of work early to get me to practices and games.
He would bring his briefcase and do work while waiting in the stands.
Or some other time thereafter.
My first year
I was bad.
Like real bad.
He invested a lot into that first year.
All of the years, really.
But the first year was rough.
Coach Fox of the GP Bruins wasn’t the most patient of coaches to help a newbie learn and grow.
The season was challenging enough that my parents were questioning if I would want to play another season.
But I did.
And that season was great.
Somehow I was laser better than that first year (by means of 'house league' talent).
My dad used to play beer league hockey before I came along.
He played goalie for ‘Sparkle City’ (a team born from the workers at Detroit’s Water and Sewerage Department).
He donned his 1979 goalie skates and started helping coach my teams’ goalies.
One fine Saturday morning practice at Liggett Ice Arena on Cook Road,
The defense was working on shots from the point.
Feeding the puck from the corner to the blue line, over to the high slot
for a shot on net.
Concurrently, my father was working with the goalie on cutting down angles,
Awareness of the post- goalie stuff.
As we cycled through the drill,
Focusing on quick movement of the puck,
Accurate passes at the point,
Head up to see where you were passing,
Where you were shooting,
And a quick release shot,
My turn came.
A teammate fed the puck from the corner,
Over to my defensive partner.
He floated me the pass,
And just as quick my shot was off.
As I looked up,
Shortly after the release,
I see our goalie, Kris -
Not squared up to my shot -
But standing in front of the net.
With my father.
It was a fairly good shot.
Just off the ice.
Great for a tip or redirect in the slot
During a game.
But it wasn’t a game.
It was practice.
Where you - practice.
And get coached up.
Back to me just looking up.
Fresh off the toe of my Sherwood Feather-Lite 5030 Paul Coffey stick
Was well on its way toward the net.
Where my father was coaching Kris, our goalie.
It sounded like the puck hit the side of our garage.
At ankle level.
Just above the CCM 1979 goalie skates.
I recall feeling the impact as loud as the echo of the talus-shattering shot.
A stout collision, felt through the air, sheet of ice, and my soul.
Gary, as many affectionately called my father,
Offloaded half of a guttural grunt
On his way to bitting his lip
In his newfound distal discomfort.
As dads do.
And my head was down.
Had my head been up,
I would have seen that my father,
Gary as it were,
was standing there the whole time.
And seeing that he was there for me,
A part of what I was doing,
Giving of himself to one of my passions,
Perhaps that blow to his right talocrural joint -
Gary’s ankle as it’s affectionately referred to -
Would have survived the day.
And Gary -
Father as it were -
Would have endured far less -
Had I had my head up.
By Dr Adam Fujita PT, DPT, CAFS
When working with a patient,
Tell yourself a story.
Tell your patients a story.
Create the story out of their plan of care.
Narrate to them what is going on, where they are in the story, etc.
Bring them along the journey.
Of what is seen (but not necessarily fully understood)
And what is not seen - which is your thought process - (which can’t be known until it is spoken aloud).
I learned this trick from a friend back in undergrad.
And then really ran with the idea years later teaching grad students on their clinical rotations. It was a great way to instruct a student (and patients) in real time.
From what the potential thought processes were heading into the visit,
To what I needed to learn (testing),
To what I needed to do (treatment based on the testing results),
And what we were going to do to keep the change (patient’s work between visits).
How that day’s objective fit in the overall presentation,
And progress of the plan of care.
Language is big here. A bit more ‘insider’ clinical language with a student/colleague. More translated and analogized language for patients.
Narration helps keep your eyes on the prize.
Keep the data in front of you.
Keep the thought process alive and progressing,
Guiding your clinical decisions.
Telling the story tightens up your game.
It is hard for your concentration to wane or
Become relatively lazy
Or ‘phone in’ a visit
When you are committed to telling a story.
'They' say -
You know something well when you can teach it.
Telling a story also
Invites patients into the work that is involved in their care.
Without narration, a patient may experience you ‘pushing on a sore part of a muscle,’ nowhere near where their actual pain is.
With narration, they may see the fascial restrictions found within the gluteus medius are propagating an externally rotated left lower extremity that is forcing valgus stress of the pes anserinus as the patient plows through the medial region of their knee in each stance phase of walking, worsened while running (and that doesn’t even mention the rotated left innominate feeding the restricted left glut medius that seemingly stems from the impaired relationship between the left internal oblique and left hemi-diaphragm.)
The story welcomes patients into the whole process of their treatment plan.
Everything you are doing for them -
All of the evaluation, testing/retesting, skilled interventions -
Or did for them - schooling, continuing education courses, certifications, mentorship, studying, researching, etc. -
All of which pours into your clinical thought process and skill level to work with them on making positive change.
The narration experience helps to better inform the process and results we are all in and heading towards.
Patients may not value your skillset, your efforts, your brain as much if they do not know/see much of what is going on.
Gift them the experience.
A writer told a story about how he was on his way to a speaking event
And stopped off at a coffee shop since he was quite early.
After reviewing his notes,
He left, only to find his keys were locked in his car.
Approaching being late for his event, and with growing anxiety,
He called a locksmith.
One happened to be around the corner.
The truck arrived.
The locksmith exited his truck with tool in hand,
And within seconds, the door was unlocked.
With a charge of $225.
A moment of jubilation.
And jubilation quickly thwarted.
In that moment, the writer felt ripped off.
He paid, and headed to his event.
It took some time for the him to figure out why he felt so slighted.
The writer surmised that he wanted there to be more of a struggle, more work involved to resolve the situation.
The situation was ‘big’
And he wanted the solution to feel equally ‘big.’
He did not feel slighted by the cost.
He wanted the amount of work involved
To match the size of the problem.
He wanted the experience of the solution
To match the experience of the problem.
Though the result was exactly what he wanted,
He wanted the process to be seen - experienced -
So that it would match his experience of the problem.
Telling a story
Keeps focus in your clinical decision making process and intervention.
It allows your patients to see and experience the efforts involved.
You work hard.
The story reminds you of that.
It helps your patient see and understand that.
And you both have the opportunity to see your value in that process throughout -
And not pin all of the value on an end result.
Waiting for the end result, delaying worth until your patient leaves the clinic pain free,
Devalues your daily experience;
Your daily investment.
It takes the worth out of your daily efforts and responsibilities.
Not finding the full value of your daily work,
Yet working so hard throughout your day -
Such a disparity loses sight of fulfillment, joy.
High value unnoticed is hard on the soul.
Telling the story
Illustrates the craft in each part of your day,
Highlighting the value you provide,
Allowing your soul to shine.
By Dr Adam Fujita PT, DPT CAFS
8 Years of clinical experience in the physical therapy environment.