The Conscious Clinician Podcast

Episode 28: Taking a Patient-Centered History (SOAP Series #1)

We are kicking off a 4 part series to explore patient-centered care from where it all begins - the evaluation. We break it into sections using the SOAP note model: Subjective, Objective, Assessment, and Plan. We discuss what we could do to improve rapport with our patients, our efficiency and accuracy in getting to the root of a problem while partnering with our patients as active collaborators.
In this episode, we focus on the subjective including building rapport, understanding the patient’s experience, and wrapping the subjective up into the objective. How do we learn their story and how do we tease out what will truly help us form a great plan of care with them? Tune in next week for the Objective section tips! 
Highlights from our conversation in Episode 28
(0:34) Introduction
(1:55) Building rapport & establishing trust 
(4:34) Accepting our patients without correction
(9:31) Responding with empathy
(15:57) Understanding the patient experience 
(27:33) Asking about psychosocial factors 
(29:32) Wrapping up the subjective 
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 28
(22:52) Psychological Approaches to Pain Management: A Practitioner’s Handbook, 3rd Edition 
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Episode 27: Evolving Pelvic Physical Therapy Practice with Meryl Alapattu, DPT, Ph.D.

In this episode, Dr. Meryl Alapattu, DPT, Ph.D. shares with us her experience in assessing psychosocial factors and developing “soft skills” as a researcher and faculty member at the University of Florida. 
“I think we were a little bit late to the game in pelvic health, thinking about psychological factors” including fear avoidance. “A lot of these persistent pain conditions have similar factors that contribute to the pain experience…. [When] we look at people with pelvic pain compared to people with knee pain, for example, the types of things that they're fearful of, or the activities that they may avoid related to their pain might be a little bit different” but the underlying processes are the same. 
As clinicians, it’s our responsibility to learn about and integrate this information into our practice. “Professional development is a career-long thing that all of us are continuing to work on in some way or another.” That includes developing our soft skills to form a therapeutic alliance, communicate with our employers and colleagues, and practice ethically. Meryl also shares what the University of Florida DPT program does to help PT students develop their soft skills. 
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Meryl Alappattu, PT, DPT, Ph.D. graduated with a Doctor of Physical Therapy from the University of Florida (UF) in 2008. After graduation, she completed a year-long clinical residency at the University of Florida Health in Cancer Rehab and has continued her clinical work specializing in rehabilitation for patients with cancer and pelvic health issues. Dr. Alappattu completed her Ph.D. in Rehabilitation Science at the UF in 2014, studying mechanisms of pelvic pain in women, and is currently a Research Assistant Professor in the UF Dept. of Physical Therapy. 
Dr. Alappattu has been a member of the American Physical Therapy Association and Florida Physical Therapy Association since 2006. She has served in multiple roles in FPTA, including two terms as Vice President, and currently serves as Speaker of the Florida Assembly of Representatives. She has been a Delegate to the APTA House Delegates since 2014. She also serves on the board of directors for the International Pelvic Pain Society.
Highlights from our conversation in Episode 27
(0:34) Meryl’s introduction 
(6:09) How she came to research psychosocial factors related to persistent pelvic pain 
(10:50) Persistent pain education isn’t mainstream yet in PT 
(14:10) How much of the psychological aspect of patient care is within a PT’s scope of practice?
(20:12) The importance of “soft skills” as students and clinicians 
(28:10) Fostering self-reflection in PT graduate programs 
(31:15) Lightning Round 
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 27
Psychological Factors in Women with Chronic Pelvic Pain: Relevance and Application of the Fear Avoidance Model (Alappatu 2011)
(19:38) Empathy During Patient-Provider Interactions in Women with Chronic pelvic Pain (2021)
(28:22) Professional Behaviors Self Assessment Tool Marquette University
(32:21) White Fragility by Robin DiAngelo
Let’s Connect!
Follow Meryl on Twitter and Instagram @pundispice
Email Meryl meryl@phhp.ufl.edu
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Episode 26: Supporting New Parents’ Health with Catherine O’Brien, MA, LMFT

In this episode, we have the pleasure of dissecting maternal and paternal mental health with Catherine O’Brien, MA, LMFT. She shares the common issues that new parents experience which contribute to pelvic floor conditions like dyspareunia. While postpartum is a time of massive changes, we need to listen to our patients when they feel like something just isn’t right.
Catherine helps soon-to-be parents create a postpartum plan because “there’s usually a lot of prep for a birth plan… but nobody's like, well then what happens after we bring the baby home?... Your partner is not your plan. They’re in this with you. What is your plan together?” Catherine shares her approach to creating this plan from her book Happy With Baby. This is a great episode for anyone who works with parents or is about to be a parent!
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Catherine O’Brien, MA, LMFT is a licensed marriage and family therapist and the founder of HappyWithBaby.com. She created Happy With Baby in order for new parents to discover the advice she wished she had as a parent. Catherine lives in Sacramento, California, where she enjoys paddle boarding and rowing with her husband and two kids.
Highlights from our conversation in Episode 26
(0:34) Catherine’s story & founding Happy With Baby
(6:06) New parent psychosocial factors contributing to sexual dysfunction
(10:00) Postpartum mood and anxiety disorders 
(15:17) The importance of sleep for wellbeing 
(19:14) The need for & how to create a postpartum plan
(25:55) Catherine’s book Happy With Baby
(29:12) Lightning Round
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 26
Visit Catherine’s website for more information www.happywithbaby.com
(25:55) Read Catherine’s book Happy With Baby
(29:50) The Power of Showing Up by Daniel J. Siegel and Tina Payne Bryson
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Episode 25: Physiatry in Pelvic Health with Dr. Allyson Shrikhande, MD

In this episode, we discuss pelvic health from the lens of physiatry with Dr. Allyson Shrikhande, MD. She is the medical director and founder of Pelvic Rehabilitation Medicine (PMR), offering true multidisciplinary care for people with pelvic floor dysfunction.
Allyson shares what a pelvic health physiatrist does, saying “we're trained really to look at the interplay between the organ systems with each other, as well as the organ systems with the fascia, the muscles, and the nervous system.” Physiatrists can serve as the quarterback for people with pelvic floor dysfunction, referring them to the various specialties. She also shares how all of us pelvic providers can work together and how the mind-body connection affects pelvic pain.
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Dr. Allyson Shrikhande, MD, a board-certified Physical Medicine and Rehabilitation specialist, is the Chief Medical Officer of Pelvic Rehabilitation Medicine. She is also the Chair of the Medical Education Committee for the International Pelvic Pain Society. She is working with other experts in the field of chronic pelvic pain to develop training modules for residents and physicians interested in learning about the diagnosis, treatment, and management of chronic pelvic pain. A leading expert on pelvic health and a respected researcher, author, and lecturer, Dr. Shrikhande is a recognized authority on male and female pelvic pain diagnosis and treatment.
 
Highlights from our conversation in Episode 25
(0:34) Allyson’s introduction & journey into pelvic health 
(7:02) Facilitating a collaborative approach for pelvic pain
(11:59) Tips for communicating with physiatrists
(14:39) Addressing psychological concerns in pelvic health
(19:03) Allyson’s experience in building rapport with patients  
(20:17) Patient case example
(23:10) The common culprit behind “non-responsive” patients  
(25:02) When and how to refer to physiatrists
(27:13) Allyson’s lightning round
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 25
(13:49) Working with Physiatry for Pelvic Pain (Herman & Wallace Course)
(26:36) Finding a PM&R doc 
Pelvic Rehabilitation Medicine Locations
International Pelvic Pain Society Find a Provider
Let’s Connect!
Find Dr. Allyson Shrikhande, MD on:https://www.pelvicrehabilitation.com/
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Episode 24: How to Thrive, Not Just Survive with Yolanda Johnson, MD, FAAP

In this episode, we unpack overwhelm and burnout with Dr. Yolanda Johnson, MD, FAAP. As a pediatrician, mom, and coach for women in healthcare, Yolanda knows that doing it all means burning out. She shares practical tips to start shifting out of survival mode and begin discovering who you are, how you want to work, and what needs to change.
For the first time, Dr. Yolanda shares her experience of impostor syndrome during residency and how that led to her passion for coaching. We dive deep into the counterintuitive need to slow down and do less when we feel overwhelmed, how to face our inner critics with compassion, and the power of mentorship in creating a sustainable practice. This episode helps us see that we're not alone in our struggles or our desires for a more enjoyable work-life experience!
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Dr. Yolanda Johnson is a board-certified pediatrician in private practice in the metro Atlanta, GA area, and a certified health and wellness coach.  She is passionate about helping women in healthcare conquer overwhelm, build healthy boundaries, and get unstuck.  She is mother to 4 amazing sons, and enjoys running, reading, and napping in her free time.
Highlights from our conversation in Episode 24
(0:34) Yolanda’s bio & her experience of impostor syndrome and overwhelm
(5:57) Self-reflection as an antidote to burnout
(10:23) Impostor Syndrome during residency and in work 
(15:27) Common themes from coaching women in healthcare
(22:49) How to unpack your overwhelm 
(27:55) The power and vulnerability of mentorship 
(31:28) Accepting ourselves to start thriving 
(36:08) Practicing self-compassion to reduce the inner critic and shame
(40:20) Finding a sustainable practice & discovering what we want 
(48:32) Lightning round
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast so we can reach more people!
Resources from Episode 24
(6:22) Quiet: The Power of Introverts in a World That Can't Stop Talking by Susan Cain
(6:56) Mindset: Changing the Way You Think to Fulfill Your Potential by Carol S Dweck
(11:57) Imposter Syndrome Diagram 
Let’s Connect!
Follow Yoland on IG @gobeyondcoachmd for more tips and coaching
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Episode 23: Inclusive Pelvic Health Practice with Dr. Brian Stirling, DPT, OCS

In this episode, we have the pleasure of speaking with Dr. Brian Stirling, DPT, OCS who treats male pelvic health and orthopedics. Brian shares the barriers he’s encountered as a male specializing in pelvic health as he wants to expand to treating all genders of patients. We discuss inclusive care, which develops when we have the courage to face our biases, remove educational barriers, and support a variety of providers joining the specialty!
We explore how our own fears (for our license, saying the wrong thing, avoiding litigation) have influenced our practice patterns. Brian leads us into a conversation exploring male biases in pelvic health - what male-identifying patients ask for and what our own biases as providers treating them are. This episode helps expand our understanding of an inclusive pelvic health specialty for patients and providers alike. 
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Dr. Brian Stirling is a residency trained Board Certified Orthopedic Specialist since 2020. He is a physical therapist at Agile Physical Therapy and treats pelvic health and orthopedics. When he first took a dip into treating pelvic health, his eyes opened up to a whole world of medicine that he didn't know existed. The amount of potential knowledge to gain, growth to inhabit, and patients to heal in a unique and fulfilling capacity made him excited to specialize in this field. He is eager to share his experiences as a male treating pelvic health.
Highlights from our conversation in Episode 23
(0:34) Brian’s introduction & how he got into pelvic health
(5:36) Practicing as a male in a female-dominated specialty
(8:12) How our fears have affected our pelvic PT practices 
(16:25) Integrating orthopedics and pelvic health 
(21:56) Nuances and biases of male pelvic health
(26:13) Developing inclusive care practices 
(40:43) Removing educational barriers for male providers
(45:34) Brian’s Lightning Round
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources from Episode 23
(47:42) Quiet by Susan Cain
Email Brian stirlingdpt@gmail.com
Connect with Brian on LinkedIn
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Episode 22: Preventative Pain Science with Josh Bellingham, MPT

In this episode, we dive deep into pain science how-to’s with Josh Bellingham, MPT. As a physio, Josh is passionate about providing accessible resources to people with persistent pain. He believes that the relationship between a patient and provider is the vehicle for changing limiting beliefs, which ultimately are the reason people make progress. 
Josh is an advocate for using current pain science with ALL people experiencing pain, at any point along their journey. We explore how this looks for different populations and how to tell if someone is willing to "go there". He shares how the Loeser “onion ring” model of pain helps us see the various layers of inputs that facilitate or inhibit pain. We also discuss how to handle imaging and “diagnosis seeking” in a pain-science-informed, patient-centered way. 
Josh shares metaphors for describing pain as an alarm, the development of pain sensitivity, and contextual factors which create physiological responses such as muscle guarding. He’s also an advocate of adding pain science to people’s lives outside of the clinic, through social media, apps, and Netflix. This episode is an easy listen to review pain science concepts and come away with new clinical pearls!
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Josh holds a Bachelor's degree in Kinesiology and a Master’s degree in physiotherapy from the University of Manitoba. Josh began his career with a focus on exercise and sports performance, but over the years developed a passion for understanding and managing complex pain. Josh has completed a variety of courses in pain management through "Pain BC" and regularly participates in their weekly clinical discussions. In addition to working full time in private practice, Josh is also active on his website, chronicpainphysio.ca as well as Instagram to advocate for and support people living with chronic pain. When he’s not in the clinic or working on content for "Chronic Pain Physio", you’ll find Josh hiking in the mountains of beautiful British Columbia.
Highlights from our conversation in Episode 22
(0:34) Josh’s background and current projects
(6:03) Pain science for acute care / chronicity prevention
(10:35) Metaphors for explaining pain 
(20:09) Loeser’s “onion ring” model of pain in clinical practice 
(24:26) Listening vs special tests for understanding pain 
(27:01) How diagnostic imaging contributes to uncertainty, feeling out of control, and lack of information
(33:35) Responding to people who’re seeking a diagnosis
(42:46) How to meet people where they’re at for pain science 
(49:20) The overlap between psychology and physical rehab for pain 
(55:54) Josh’s Lightning Round
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources from Episode 22
Check out Josh’s Website - https://www.chronicpainphysio.ca/ and follow him on IG @chronicpainphysio
Loeser’s “onion ring” model of pain
Burnout & How To Complete The Stress Cycle (Podcast)
Headspace - Guide To Meditation (Netflix)
Headspace - Guide to Sleep (Netflix)
Tame The Beast - Rethinking Persistent Pain (Youtube)
OA Optimism with Greg Lehman (Youtube) 
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Episode 21: Intersections of Sexuality, Racism, and Healthcare with Dr. Uchenna "UC" Ossai, DPT, WCS, CLT

In this episode, we discuss how you can’t separate racism from healthcare with Dr. Uchenna “UC” Ossai, PT, DPT, WCS, CLT. As the only Black pelvic health physical therapist certified in Sexuality Counseling, UC has been empowering people to embrace their sexuality with their whole selves - and in spite of what society may be telling them. 
This leads us into discussing the spectrums of pleasure, joy, race, sexuality, and how these factors all affect a person’s experience of sex. We explore the archetypes which affect black women’s health and sexual wellbeing, in the context of a country-wide awakening to racism and oppression. 
UC says “You're going to have racist ideology and behaviors, and you're going to ascribe to it because it's in everything. It's like really not fun glitter. And once you understand that it's there,  then you can actually have more peace.”
In order to be conscious clinicians, we must be aware of the systems at play around us, learn the histories that led to our present day, and seek out mentors. Only when we are aware of history can we truly begin to make meaningful changes in our friendships, educational systems, and clinics. 
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Dr. Uchenna “UC” Ossai PT, DPT, WCS, CLT is the creator/founder of YouSeeLogic, a judgment-free social media platform dedicated to the sex education and empowerment of adults/”grown folk”.  When it comes to sexual intelligence and great sex education, Dr. UC embraces always being unapologetically real and authentically kind.  She is also an assistant professor at the University of Texas Dell Medical School for the Department of Women's Health and manager of the pelvic health physical therapy program at UT Health Austin.  
Highlights from our conversation in Episode 21
(0:34) UC’s intro & current projects
(3:47) Pleasure as an act of rebellion 
(7:08) Racism in the places we live, learn, and work
(17:24) How to practice inclusive anti-racist care
(23:49) UC removing the performative mask & self-care
(31:13) Harmful archetypes of black women which drive sexual (dys)function 
(41:15) Accepting the word “racist”
(44:32) Lightning Round Questions
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources from Episode 21
To be in touch with UC visit www.youseelogic.com and follow her on Instagram @youseelogic 
(20:12) UC’s course: Intersections of Race and Power: Healthcare Redefined (Live 6/26/21) 
(38:37) Dr. David William’s Ted Talk: How Racism Makes Us Sick
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Episode 20: A Patient's Perspective of Conscious PT Practice with Katie

In this episode, we have a special guest, Katie, joining us. Katie is actually the patient from Episode 19: Putting It All Together: A Case Study of Conscious Clinical Practice. This is a unique opportunity for a former patient and provider to reflect upon their experience working together. Be sure to listen to Episode 19 first for context! 
Katie shares his first reaction to E:19. In his words “It was fascinating to hear the two of you talk together and to learn what does it sound like when practitioners are talking to each other and what are some of the common thoughts or assumptions or experiences, especially working with someone who has chronic pain.” 
We dive deeper into his corrections for E:19, the power of focusing on what’s important to the patient about their pain, how providers’ responses can build and break rapport with patients, how our time in PT was different than his prior experiences, and share how we were both affected by working together. This is not one to miss! 
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Katie is a Director of Finance for a small nonprofit. His journey with chronic pain led him to change career paths six years ago, going back to school for an MBA, having previously worked in outdoor education – running rock climbing, ropes course, and canoeing programs with kids. Katie is queer and transgender, and a writer and activist on gender justice, who recognizes that chronic pain and other chronic health conditions are much more prevalent in marginalized groups who often experience chronic trauma and stress. These days, Katie enjoys playing fetch and going for walks with his goofy pitbull, Loki, but he is looking forward to rock climbing again someday.
Highlights from our conversation in Episode 20
(0:34) Introducing Katie 
(2:01) His first reaction to Episode 19
(5:44) Katie’s E:19 correction - the link between stress & pain 
(9:28) The pivotal moment of discovering neural tension 
(11:22) How providers are (unintentionally) gaslighting 
(15:00) Katie’s side of the initial evaluation 
(18:10) What’s important to patients vs providers about pain
(22:05) A trauma-informed perspective 
(25:17) Providers are specialized but patients are specific 
(28:23) What patient’s DO want from healthcare providers
(32:43) Generalists, specialists, and connecting the dots
(37:04) Pain rating scale and management
(40:15) On asking patients what they want 
(45:26) Nocebic quotes from Katie’s healthcare providers
(51:02) “You’re not fragile” 
(54:48) Lightning Round
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources from Episode 20
(0:43) Episode 19: Putting It All Together: A Case Study of Conscious Clinical Practice
(55:24) My Grandmother’s Hands by Resmaa Menaken
(58:03) Radically Listening to Transgender Children
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Episode 19: Putting It All Together: A Case Study of Conscious Clinical Practice

In this episode, Monika shares a case study to illustrate integrating the principles of emotional intelligence, trauma-informed, and patient-centered care. It's a story we're all familiar with: a man with chronic low back pain. 
He was in the midst of a prolonged flare-up when they started working together and had seen many physical therapists before. She realized that she would have to do something different if they wanted a new result. 
With this in mind, we discuss how Monika:
Prepared herself mentally and emotionally for a different approach
Shifted her focus from “fixing” to collaborating 
Listened closely
Managed her own emotional reactions 
Confronted her own biases about injections
Challenged his fear-avoidance beliefs (gradually)
Tune in to hear his story and her behind-the-scenes thought processes. We hope this inspires you to reflect on a case and share it with a conscious clinician!
Note: Some details have been omitted and/or changed in order to maintain patient privacy. The patient consented to share this material. 
Highlights from our conversation in Episode 19
(1:41) Case introduction 
(5:18) Patient-centered history taking 
(12:06) The power of preparing for patient care 
(13:49) Trauma-informed care in action 
(16:46) The ripple effect of conscious clinical practice 
(19:30) How did follow-ups go?
(25:24) Injections, nocebo, and self-awareness 
(28:58) A major turning point in autonomy 
(34:50) Planning for the future 
(38:56) Reconciling your identity with chronic pain
(40:39) Wrap up and final thoughts 
Thank you for listening to The Conscious Clinician! If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources for Episode 19
(5:18) Episode 6: History Taking Pearls & Pitfalls
(10:15; 26:02) Episode 12: Our Words Have the Power to Heal and Harm 
(12:17) Episode 15: The Power of Understanding Patient Beliefs with Mike Nelson, DPT 
(13:20) Episode 4: The Fixer
(13:49) Episode 9 Dr. Brie Robertori, PsyD on Vicarious Trauma in Healthcare and Episode 8: Dr. Krystyna Holland on Trauma-Informed Pelvic Health Practice
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