Breaking Healthcare Silos: Rethinking Physical Therapy and Chronic Pain Care

Cameron Faller: [00:00:00] the increased specialization and fragmentation of care, the continued reliance on these diagnostic codes and these CPT to really understand what's going on, even though it's. More so adaptive for the healthcare system right now.

There's continual burnout happen. There's people leaving the profession. There's patients that aren't really getting the resources and the care that they need. I think, at least in my opinion, I don't think it's necessarily sustainable. And that's where I think in a way, healthcare itself is leaning towards this chaos. needs to be some sort of transformation now.

Mark Kargela: Today we're diving into one of the biggest problems in healthcare, the outdated, fragmented approach that leaves patients with disconnected, often conflicting messages about their health. My guest, Cameron Fowler, co-founder of the Institute of Contextual Health is here to challenge the status quo. We talk about breaking free from siloed care, embracing complexity, and building a truly patient-centered process-based approach that's reshaping how we think about health.

[00:01:00] If you're tired of the same old fix it mindset and ready to explore what real meaningful care looks like This episode is for you. Make sure to hit that subscribe button so you never miss a conversation that could change the way you think about healthcare. Let's get into it.

Announcer: This is the Modern Pain Podcast with Mark Kargela.

Mark Kargela: Cameron, welcome to the podcast.

Thanks, mark. Good to be here.

You know what, man, we go back a little ways. One fellow Michiganders where I used to live in practice where Cameron Practice and I actually know him and his co-founder of what of the business that we'll talk about today. Leonard and Leonard's actually been on the podcast as well, so we're glad to have you here.

Cameron. Cameron actually was part of modern pain care team for a bit, and I credit him for our Instagram growth. 'cause he was a beast of like content creation and things. So he's been a huge part of modern Pain Care's growth. He went on to do bigger and better things with the Institute of Contextual Health that we'll talk about today.

I'm excited to talk about it 'cause I think it's gonna help really paved the way to some new frontiers [00:02:00] in healthcare. Things that are long overdue is, and things that we rail in on the podcast about. But before we get into that, Cameron, can you introduce yourself? Let folks know who you are and what you're up to.

Cameron Faller: Thanks Mark for the awesome introduction. And it's always interesting as before I came on this morning, I'm just truly reflecting on my own journey and I got a chance to meet Mark as a grad student over at Grand Valley State University. Mark came and taught a course all about the updated chronic pain education and looking at it from the modern pain care lens. And I was so fascinated, intrigued. He was dumb enough to let me, to join him in this journey of having me help with content creation, but served as a huge mentor for me, especially for the development of my years. As a first year couple, first years clinician, but as you were saying there was a transition there back in 2021, I joined Leonard Van Gelder, who's also a Grand Valley alum.

We're both locally living in Grand Rapids, Michigan. Leonard started this. [00:03:00] Pretty much out of the box clinic that, that functions different than any other traditional physical therapy rehabilitation clinic that you can imagine. And I think what drew me closer to that was just the challenge and the curiosity of doing something different. And that has transitioned into a nonprofit that I co-founded Institute of Contextual Health. with that we have four programs, research, technology, education and rehab. Primarily we are looking at research and techno technology development. Using the clinic as more of a lab, but we do have seven clinicians, five PTs or I should say eight clinicians, five PTs and three occupational therapists that we get to implement are more of our process-based lens of care for individuals struggling with chronic pain or complex movement conditions.

Mark Kargela: We're gonna get into a little bit of the process 'cause it's a unique setting where you, y'all are looking at clinic as more of a lab. And I think that's, as a clinician, that's, I [00:04:00] look at clinic as an n equals one experiment every day. But you all, I. Are obviously implementing some processes and some things around technology.

And we'll talk even about the little EMR, which I'm always curious 'cause EMRs make me cringe just from, the archaic non-patient centered mode they often operate in. But I'm wondering if we can talk a little bit to the problem that healthcare, you and I have talked about this numerous times, but I don't think we've talked about it here, obviously in front of our audience where.

Healthcare struggles with this siloed approach. And I'd love to hear your thoughts on this siloed approach and where you feel the Institute of Contextual Health kinda steps in to maybe address that and maybe have a little bit more whole person view of health.

Cameron Faller: I'm hoping a lot of you have listened to Mark's podcast with various guests and himself speaking, and if you're listening to this, my understanding, my assumption probably is recognizing healthcare itself is very fragmented. We exist in these silos and we allow ourselves to try to treat the part that [00:05:00] we're trained to treat. Whether you're looking at it from, specifically from a rehab standpoint, you got certain specialists that only focus on backs, only focus on knees, or we can zoom out just to healthcare as a whole and you have cardio palm docs that only look at the heart and then you got ortho that only looks at bones.

And while we can recognize that this sort of mechanistic framework was really helpful for us. In the early 20th century of looking at vaccine development, looking at antibiotics, looking at these diseases that are, eradicating individuals and how do we fix those diseases? We found that it is really falling short when it looks at pain, when it looks at human performance, when it looks at trying to help someone grow.

Just in the nature of that, there's a lot more complexity involved with how, as a whole person. Even though we're a part of all of these different systems and parts, the way that they're synthesized or the relational networks inside of them are completely unique and it's important for us [00:06:00] clinicians to really understand what are all the relationships?

What are these networks inside of someone that's maybe driving some unhelpful behaviors or maybe driving something that's not necessarily leading them to a more adaptable state, and how do we initiate some sort of change with that?

Mark Kargela: I'm curious 'cause I've all read the process based, I'm actually in the process of finishing Hoffman and Hayes process based therapy book, which we'll link in the show notes 'cause I know these gentlemen are well versed in it and your staff as well. I'm wondering if you can get to a little bit, 'cause the question we always have from audience members and clinicians that we mentor and things is.

When are we stepping? Because I agree, healthcare definitively is fragmented and it doesn't serve people, especially when they're getting a fragmented stories often conflicting in nature and the person's just, has their hands on. I don't know what the heck's going on or why I'm dealing with what I'm dealing with.

With that said, there's often parts that are missing in the mental health realm of our health, which, we de-emphasize that often in healthcare we have the yearly [00:07:00] physicals. Mental health just gets, cast aside and all these different things. I'm wondering where your thoughts are in Institute of Contextual Health with the use of psychologists.

'cause I know obviously we need to have skills to recognize these psychological processes, psychologically informed care. I'm a full believer in it, but where do y'all stand on the use and making sure scope? Respect is maintained where we're not trying to step outside and treat things that as physical therapists or as occupational therapists that we might be stepping above.

How do you all deal with that? Do you have a pipeline or some folks that you interface with that can help you when you start dealing with some things that are beyond maybe the scope of what a physio or an occupational therapist could handle?

Cameron Faller: Oh, a hundred percent. There's a couple key points I might like to hit on. Nu number one, I do want to talk about this a aspect that sometimes more isn't better. You have someone struggling. With a lot of maybe pain issues and they go see a doc and they're saying, we're gonna get you set up [00:08:00] with this really intense program where you're getting pt, ot, psychology, you're going to see psychiatry.

And while that might sound really cool, and we talk about integration a lot of times. That the individuals that are in those facets, they might not necessarily be speaking the same language, which could be really important for the individual because there's a loss of coherence that they go through. And if we're thinking about, I. Recommending some sort of psychological treatment or connecting with or collaborating with a psychologist. I'm sure if you're listening to this podcast and you've treated someone in pain and you're not a psychologist you have that patient that comes in and the moment that psychology's brought up, there's often a stigma, at least in the states and in the state.

I can tell you there's a stigma associated. I'm not crazy. I have a pain, I have problems with movement, and you're the movement specialist. So we need to again, understand who is this individual. How much care are they gonna need or versus this less is more. And as a, maybe a physio, [00:09:00] can we open the door to some of this complexity and understand that there's more involved with this nature of pain and connecting, collaborating with a psychologist that speaks a similar language. It is very important, and when we can allow ourselves to maybe help them make sense. I love the sense making aspect. I know you've had some individuals talk about that with sense making, we call it functional understanding. How do we help them have a functional understanding of all of the facets involved?

And again, from a process oriented approach. not looking at these specific mechanisms of the issues in the tissue, or you're having a mo a movement problem. We're more so broadly looking at these processes or these groups of mechanisms and thinking, okay, we, we can have movement as this whole process. How much are they struggling with movement versus how much might they be struggling with some sort of cognition related to that movement or emotion related to that movement, or maybe even their self image of who they are and who they used to be. [00:10:00] And it's not our job to always manage all of those processes, but recognizing if I help you work on some of the movement aspect, but we can realize how, these emotions that are tied up into the way you feel about yourself, the emotions tied up into your overall self-image.

I have a really great. Co collaborator, that's a, that's trained in counseling and psychology, who speaks a similar language so they know the language we're using we can communicate in more of this effective, we call it a kind of a transdisciplinary or trans diagnostic way of understanding what are the processes, maybe sustaining this.

And as we communicate, it becomes a little bit more efficient or coherent for the individual. Likewise. Even with Hazen Hoffman, we've communicated with them and I think a lot of counseling and psychology they can even face similar issues versus if you're working with someone that's more traditionally, let's just say CBT of trying to control your thoughts, trying to control certain things and then you see someone else that's [00:11:00] talking to you all about less control and more about adaptability. Again, there, this individual is left to go home and they might not realize it in the moment, but unintentionally there's this loss of coherence where they're struggling. Am I supposed to fix or am I supposed to, allow there to be there and see how I can move forward.

Mark Kargela: This gets into this idea of complexity, which is what we deal with. And, but our, I think as clinicians we. I don't wanna say shy away from, but it makes it uncomfortable when complexity hits us. It's much easier to just, this is a simple facet GL issue or things and ignore the complexity out of a, probably a self-serving preservation approach as clinicians use.

I'm wondering how you all kind of view complexity in how you deal with it clinically with patients. 'cause obviously. We've come from probably a traditional view in pain where, and especially, and you and I both have been through the traditional manual route where we're gonna take the com complexity of the presentations were, because we didn't have enough com complex skills in our hands to, to address some of these things.

It was some [00:12:00] sort of, some really, high level or very complex dysfunction in the tissues that we were gonna find. And obviously that was a failed pursuit as although. Folks still continue to search for that, unfortunately. But anyway, that's for another podcast. I'm wondering how you all deal with complexity.

How do you embrace it and use it to help people have that coherent experience to explain? 'cause you're right, I think we see patients all the time who have gotten this incoherent narrative coming from all these different people. All speaking a different language, all given people like, and how in the heck would a patient have any sense of coherence when they've gone through a system that's so fragmented and siloed?

But I love how you guys view or hear how you guys view complexity and leverage kind of that understanding and how you work with people.

Cameron Faller: I think for starters we all need to learn how to reflect internally on our own journey and realize that. As if you're working with an individual, there's just two humans in the room, and we're both trying to, work together, collaborate together to [00:13:00] figure out how do we move forward, how do we move forward in an efficient and an adaptable way? In complexity sciences. So a lot of this is driven from complexity sciences and we also lean into a lot of the evolutionary sciences based on adaptation and and our. Contextual worldview, we call it a successful working. I think it's important to realize that. Complexity. I love the phrase complexity can sit at the edge of chaos. And the moment things are feeling uncertain, the moment that things are starting to feel chaotic the you're going through a bit of a transformation, this could be helpful because, nothing remains in complete order. So us trying to allow there to be a control nature, us trying to fix, to maintain this order. It's not. How we've evolved as individuals. It's not how we have evolved as humans. There's a transformation that needs to occur and by allowing us to be open. So one of the first skills that we have to train our own clinicians, we have to practice ourselves. We are trying to train individuals in the room is let to be [00:14:00] open to the uncertainty.

Uncertainty that exists. Now again we can have some sort of form of functional understanding or start to make sense of this in some way, shape, or form. But we always wanna leave that room for uncertainty to be there because the only thing that's gonna happen is as we're opening and leaving it there and time evolves, there's going to be these little seas of coherence that form in this ocean of chaos. That are starting to refine, that are starting to clarify, this is the direction we need to go. I think the biggest standpoint, especially as clinicians, time is a big piece that we always preach, but it needs to be as we're practicing certain maybe strategies or as we're educating, as we're looking at this from more of the process based lens, we're introducing some sort of change to what the current status is. We're. Observing that over time, allowing that there to be uncertainty there, allowing there to be a form of that chaos. But as there's this kind of refinement, this coherence that [00:15:00] builds, we can start to understand selecting this strategy seems to be more helpful for you. And as we continue to select that, what happens?

And then that uncertainty starts to become a little bit more understanding. The second category, we have openness, but then there's just the awareness piece. So that's where the awareness comes in. We're starting to be aware when I do X, Y is more likely to happen and it's non-linear.

We, we love to say how things are non-linear, so unfortunately this isn't the causal. If X happens, Y always happens, but it's assuming it over time and it's looking at it in different contexts. bring someone into the clinic, it's great what happens when they go home into their own environment, into their own social relationships, into this own, the society that's sustaining many of the unhelpful behaviors that's persisting in their condition. So if we can initiate that change and they're changing in their own context. We're starting to build a little bit more clarification, understanding that this is the direction we need to go, but if we're not leaving room for uncertainty that exists and we're just trying to continue to [00:16:00] find that order to find that, fix it to manage it, we're just gonna continue to unfortunately be adding fuel to the fire and allow them to maybe get better for a little bit, but then it's just gonna come back and it's gonna come back a little bit worse.

Mark Kargela: I think having that clinical flexibility and clinical ability to let the complexity sit in the room and work with somebody to hash that out a little bit, and like you said, it's a, the n equals one situation with a patient of finding what strategies start to move people forward and starting to build a little bit of a coherent narrative with somebody.

As you start tackling different things that show up when we're trying to get people back to moving, especially moving in ways that reflect the values they wanna live by and all that good stuff. I want to bring this a little bit back to, because. Healthcare and business. It's a tension, and as much as we don't like it, it is what it is and I've grown to say we owe it to the public to find a financially stable model to be able to deliver this 'cause.

This is, I firmly believe that our [00:17:00] society needs to go away from, recognize the strengths at times when a very specialized. Siloed person might be helpful, but even then it should be fit into a narrative. But how do you look at, 'cause there's so much that rewards a lack of complexity and just following a algorithm and a lot of our healthcare systems were formed on how do we decrease variation, strip it down to a very focused funnel, people, and let's take individuals and funnel them into these group statistically generated pathways that don't always fit a unique person.

How do you balance that and 'cause again, you, there was just a post Adam Kins made, which I fully resonated with where, it's the shame and physio where clinicians who are effective at getting somebody back to living and engaged in a short time period are punished. Like we, the less you see in, the more you have somebody engaging individually, independently back into things you're almost punished.

It's the people that, can see people 20 to 30 visits of [00:18:00] just the same old. Symptom modifying hands-on work that I got stuck in early in my career or whatever it is. How do you all balance that tension to, to recognize, hey, we have a business and we need the ability, I know you went for a nonprofit, which I think obviously has some strengths to that model as well, but I'd love to hear how you all deal with that.

'cause it's a definite question we get from people of I want to treat this way. Nobody around me treats this way and my, in fact, some of my supervisors don't like the fact that I'm not having people in at the volume and frequency that would maximize revenue in a situation.

Cameron Faller: This probably could be a whole two or three part podcast series to really dive into, which is fun. And let me just say this for starters. I, days are difficult, weeks are difficult. We, I love to post on social media about how great things are and how awesome, this is.

But the reality is this is a David versus Goliath battle. The powers that be. Trying to sustain this nature of the world that we've existed for so long are so strong. And to be an [00:19:00] individual, to be even a company, to even be a community to trying to create the change they wanna see. I. It is really exhausting and I think people feel rewarded in the sense that there's something motivating them towards a value of, maybe making a difference in some individual's lives and stuff. So we gotta remind ourselves, we gotta reflect ourselves on the people we are helping. Mark, your podcast alone probably has helped, hundreds if not thousands of individuals.

Really kudos to you on that. We look at this as networks, relationships, I love to think about relationships and we can look at this from different scales. for an individual, there's this relationship of all of our different systems inside of us. Again, our nervous system, cardiovascular system, immune system. And one thing is for certain is that these systems are trying to work together to keep us healthy. But there could be change at one level of the system such as, our immune system might start to kick up cancer cells what's adaptive to that immune system? [00:20:00] It's just doing what it's trained to do is pro proliferate.

More cancer cells could be harmful to me as an individual. And so what's adaptive at one level might be unhelpful or maladaptive at another level. And I think this is important for us to clarify when we're looking at healthcare in this large sector. is trying to exist as trying to move forward in a fee for service model. Many of the things that have been adaptable, such as productivity metrics the increased specialization and fragmentation of care, the continued reliance on these diagnostic codes and these CPT to really understand what's going on, even though it's. More so adaptive for the healthcare system right now.

It's there. There's continual burnout happen. There's people leaving the profession. There's patients that aren't really getting the resources and the care that they need. And it's, and I think, at least in my opinion, I don't think it's necessarily sustainable. And that's where I think in a way, healthcare itself is leaning towards this [00:21:00] chaos. needs to be some sort of transformation now. It can't happen overnight. It's gotta happen over time and I think that there's these little ripple effects or these trickle down effects that happen when we start to introduce these changes. But, allowing ourselves to try to work with the complexity where there's this huge whole person, everything about them is completely unique. But we're relying on these reductionist mechanistic diagnosis. We're relying on the mechanist reductionist CPT codes. It's gotta be very challenging for clinicians to work in a system, trying to be in the coal mine, to be in the trench navigating the sea of chaos when the system itself is not set up to take care of you. And kudos to you. There, there needs to be both of us in this world because we have a lot of individuals that need help and need to get taken care of. Not everyone can just, jump ship and join onto a completely different way. There needs to be research, there needs to be outcomes assessments on is this truly appropriate?

We need to [00:22:00] slow down, the same time, we need to start to look at these novel ideas, this process-based approach, and figure out is this at least a little bit more sustainable? For everyone involved, for the clinicians, for the patients, for the healthcare system. Can we make this workable for everyone so that this ecosystem of a healthcare system is thriving rather than this whole ecosystem just burns and collapses?

Mark Kargela: There's definitely some issues to be had there for sure. And you read again, Hoffman's and Hayes book, which we will link it. It's the. The way they kind of address and they approach the alternative to the DSM model of diag, basically pathologizing life, right?

If you're sad about a event in your life, you have a diagnosis of depression, where maybe these things are just normal human responses that we evolve to have in response to challenging stimuli and since and difficult situations that we face in life and we don't necessarily need to.

Pathologize it, but help people have processes to manage it and move forward and stay pointed towards the things again that are [00:23:00] meaningful for them. Now. And now, selfishly, I when you talk, when we shared some of the stuff you wanted to speak about before we went on today I saw, 'cause we spoke before about EMRs, how, they're a necessary evil at this point.

And not that the people behind them are bad people, but I think it's a total reflection of how care has strayed so far away from. Truly person focused care to where there's so much ticking the box and box checking. I have chart reviews due when I get back in from vacation. And that's like my dreaded activity in the world, but it's part of what I have to do.

I'm wondering how you all look, 'cause that's part of your technology approach is this look at a more custom EMR that maybe serves a more process based. Helpful, human-centered view of care. I'd love if you could touch on that, maybe how you guys are looking at that and where you are in the process with it.

Cameron Faller: Yeah, definitely. Before I do. And this is me trying to collect my thoughts where we're at. And I do, I wanna just I'll say this point [00:24:00] as we were talking about, looking at some new ways of diagnosis and everything, and I do think we, we gotta owe it to when they're can you hear me, mark? Okay.

Mark Kargela: Yes.

Cameron Faller: internet said it was unstable, so wanted to make sure you could still hear me so well. Okay. We owe it to all of the research, all of the individuals before us because there's times where there is that cancer, there's times where there is that disc herniation that does need some sort of surgery. But again, it needs to be understanding what's the history and the context behind the person. So not every disc herniation needs to be pathologized, but we need to understand when we do need to lean into it versus not. And I think that sometimes when we talk about our framework people think it's like an us versus them, but it's always a building and a transition with. Now I know, again, I don't want to continue down that mold, but I just wanna make sure that we respect everything that's been going on. And it's not that we're doing everything wrong or whatnot, there's a lot of things we're doing well. It's [00:25:00] just understanding when we, our protocols, when our, diagnosis become limiting and they don't explain the full person, that's where we gotta pivot. now we can, and this kind of segues into our EMR 'cause a again we look at this from a system higher than us of how do we, how are we documenting, how are we writing our notes? And, recognizing that a lot of patients, they have access to their notes. How many patients come in and they show you their imaging results before they even talk to their physician, before they talk to the radiologist and they're Googling it. And we gotta recognize there's even a lot, a little bit of articles like. They're off the top of my head, but they're just showing the differences of outcomes when someone reads their report versus when they talk to someone that can explain them to the report. the way our EMR system is set up is, again it's more sustainable for this mechanistic i reductionist narrative of explaining human conditions and. The codes we use the ICD 10 codes, the CPT codes, it's [00:26:00] all governed towards these fix it kind of culture. Now we can't just do away with this because it's how we are supposed to communicate is how we're supposed to record. Part of our goal, part of the technology we're developing is we're ultimately trying to develop the first process-based electronic medical record system and our clinic case management is. Hugely important to us. We are a multidisciplinary clinic. We have PTs, we have OTs, and then we also contract with speech pathologists outside. And we also connect and collaborate with psychologists outside. And again, when you have two different EMRs, none of them communicate well. It means some of them can communicate to some extent, but I think we are, we're in such a struggle here where you're trying to get information on a patient, but you can't see into someone else's EMR.

And if you can, sometimes there's just certain things that are hidden. And so the EMR that we're trying to develop is more of this, I don't know, I don't wanna say this. allowing us to case manage more [00:27:00] effectively. So basically everything a patient fills out from their forms to things that the clinician's documenting on things that might be helpful, unhelpful, is getting tracked.

And we're utilizing a lot of artificial intelligence, AI intelligence to. And to take these large data sets of information from the patient manage it more in a way, synthesize it in a more of a way. That's way too outta mind for us we don't have the brain space, the brain capacity to really do and it can help us actually understand, with what we're doing, are we helping the individual move forward? We have the EMR that's automated. A lot of the processes that clinicians don't like to do it's allowing the clinician to pretty much go in the room, work with the patient. Now, the way that we talk to patients is really hard to, classify into a neuromuscular reeducation code or a therapeutic exercise code. Or a therapeutic activity code. So again, we've allowed ourselves to look at what processes we're trying [00:28:00] to gauge with what activities are we trying to do, what's the intention or the result we're trying to get, and how best does that match up with maybe CPT code or how best does that match up with one of the diagnostic codes? We're moving away from us trying to diagnose and think of what code we wanna use and then do that. Versus ultimately providing a treatment, allowing AI to help us actually categorize it in a medical compliance way. Something that takes a lot of effort and then, can write a, at least a little narrative about it.

That is sometimes, again, hard for us to really capture, especially as physical therapists. It's so easy for us. I get all of these things. I wanna talk to this person about behavior change, but I also have to get four units in. And the only thing I know what to do is squats and the total gym and the bike.

And then we're doing these. And even though I'm educating the patient's still got this idea of I'm not strong enough because I can't do enough squats. And there's that lack of coherence again and again from a clinical standpoint, your system is [00:29:00] almost forcing you to stay in these mechanistic reductionist patterns. Now we're in the, we're, this was developed last year. We released it in October. There's so many updates that we need to continue to do, so it's been really fun for us to, again, look at this clinical space and as we're utilizing this EMR, one thing that we're hoping to release soon is a client portal app that gives them access to basically, it them access to all of the skills the clinician's. Educating with them gives them a chance to communicate with them, and the app is gonna be where that open network where depending on who they want to see their records, the counselor, the speech pathologist can log into that app and see, oh, we're working on, processes, engaging with movement.

But there's also a lot of unhelpful thoughts they have and their motivation. They haven't really clarified their values. So from the PT perspective, we're working on movement, but counseling, seeing that we haven't clarified our values and counseling's able to do that, counseling's able to put a note on there so that when I go in there I can see counseling.

Talk [00:30:00] to you about motivation and it sounds like you're really valuing maybe some sort of productivity or maybe you're valuing I need to get out in the community more. How can I, as a physical therapist continue to, help select those behaviors from my perspective. And that's where that true again, dis transdisciplinary work comes in because it's this cohesion of information that we're all on the same team.

We all understand what we're trying to accomplish. And for the most part, it's patient led. The client portal can be completely patient led, where if we're trying to empower them to make the change that they want, they can also decide. Who they want to see, who they want access to their records. And then when we're starting to transition away from, let's have some independence, they know they always have a team they can fall back onto. It's a really short answer to probably something way more complex in depth, but.

Mark Kargela: No, it gives us a good understanding of where your thought process is with it. I love the thoughts behind it as far as trying to have more of that cohesive narrative in the EMR that the person can see [00:31:00] and the healthcare team can have the ability to create a cohesive narrative just because there's all that interconnectivity, interdisciplinary connectivity that helps.

The story stays somewhat on script for to like, where it's building upon it, not fragmenting it and causing it to, to be, where patients are getting pulled in 15 different directions. So I love the thoughts. You spoke a bit about how AI's role in this and it's the capacity of ai. I'm excited about it too.

I feed data, I talk to AI just as much as I talk to many humans these days just because it's helped me really. Put thoughts and organized thoughts and the kind of ideas I have helping me hash out some ideas and different things. But I'm wondering where you see AI serving us in.

Healthcare, obviously from a data management and ability to take in massive context of data that, we're limited in the human brain to be able to take into, yet the criticism becomes, Hey, this, there's a lack of the human connectedness of me sitting in front of a person and [00:32:00] really leveling with them, validating their experience and all this stuff.

Where do you see the, I guess that's maybe a couple part question of like, how do you see AI functioning the role, and then where do you see it? Fitting in with, without losing that human experience that, oftentimes people value.

Cameron Faller: Yeah. Man, that's such a hot topic and so many books around it. And there's people way more knowledgeable than me of what they can accomplish. And I think anytime you bring up AI there, there's always this. kind of, fear and this worry about what that means for our professions, our security to the patients we work with.

And I think for starters, just keep in mind that ai you train ai, there's a human that can train ai. So of course, one of the things is you can train AI. And this is one thing that's actually happening, AI is getting trained in more of this mechanistic framework of spinning out exercises for low back pain or spinning out movements and strategies for all of these things.

And I know UK there's been some [00:33:00] articles out there about how they released their first AI generated physio, which if we allow ourselves to, stay within the protocol mechanistic framework, I, me personally, I feel that. AI has a potential to almost do our job as well, if not better if we're just solely doing that.

But when you actually look at this from more of the complex lens and trying to synthesize all of this information from multiple disciplines and really understand what do we need to talk to this person about? How do we help this person move forward? It can become such a helpful tool, from something as simple as.

Work comp, return to work. I wanna write a return to work letter based off this patient of their progress. Something that might have taken me an hour or two hours to do. It's got information on there. It's got all of my notes. I can click a button and it can write. My language, everything that I've used to working with this person and sp out a very awesome argumentative paper support [00:34:00] letter, medical support letter for this patient with helping them to return to work. Now again that's just, that's more time in my mind. That's more time for me to spend with patients. That's something that's. It's gonna serve a lot of individuals from a very helpful standpoint, because something that used to take me a long time, or even emails of, I'm trying to email this patient. I can click a button that the email generates with the skill I want, and then also I can set up a little standard that's gonna send push notifications to their phone. Hey, have you drank enough water today? Maybe we're talking about that. Maybe we're just talking about daily walks. Tell me about your daily walk today.

Let me know what you're thinking and how that went and. Know something that would take us so much time and energy to do is very easy. The other piece that we're using ai, so more of the larger, the data conceptualization, which I think I just read today from Yuval Noah Harari very knowledgeable man in the AI space. He said something about, AI can process a million words per minute and it can get through about 6 billion words in about an hour or so. And just thinking about [00:35:00] all of this information and how it's helping us understand certain patterns, I. if we're looking at this from a process-based lens and there's so many different directions, we can, go to take this person, we don't wanna try to allow ourselves to think of everything they need to do.

You need to sleep better. You need to walk daily, you need to eat healthy, you need to do these exercises. You need to reduce stress. You need to go out in the community. That's way too much for one person to understand. So instead that's from the transdisciplinary team. As we're looking at this, you are thinking of what process might be the most helpful to create this little change, this variation. And if we're having them sign into this app, it can send them daily emails or daily push notifications where they're literally tracking. Is this something that I'm doing? How well is this helping me? And over time you can actually, depending on the goal or the outcome you want to see, you can see is this moving us closer towards it?

If not, that gives us an opportunity to pivot. And what it's doing is from all of these [00:36:00] different disciplines is taking all of the outcomes that they're seeing, computing it together, spitting out some information for us clinicians to critically analyze and to critically think. Okay. I think this person may really benefit from this adaptive strategy.

Now, the human piece is, I didn't have to spend all of these hours trying to do that. It's just giving me some ideas. Now, my job is, how do I synthesize this? How do I bring it to the person in this n equals one experience, knowing who they are, knowing how their emotions are, knowing how things we talked about before, and actually get them to understand and make the change that we wanna see.

And in the same time. If they're able to, put little pieces of feedback in into this app, it's going to be able to give us information based off of, Hey, this kind of language is not helpful for them. Hey, this kind of, things you're trying is not helpful for them. You gotta do something else.

But that human pieces, there still needs to be a person sitting behind all of these screens to make that synthesized decision and then to communicate with a patient.

Mark Kargela: Yeah I agree. I don't think [00:37:00] there's gonna be a point where you can take the. Human connectedness. I just think there's also a evolutionarily wired seeking of a person to help, right? To, in tradition, if you've Ben and DE's work seeking a healer where we're, that's just something we're wired in.

Whether that's ever gonna be somebody who seeks some sort of robotic AI interaction and with other ever can replace it, I. Don't think so. Although I, there's things I didn't think AI could do and now look what the heck it's doing these days. But in, in respect of your time. And I'd love to hear kinda your thoughts on where you think we need to go.

You guys are going in a couple directions with technology research, education, and then patient care. I'm wondering let's tackle education. 'cause I think that's, and that could be another. Multi episode podcast series in itself. Where do you feel? 'cause to me, education still lies in the days of yesterday, where we're still cordoning off people in the categories and separating professionals into [00:38:00] their nice siloed buckets.

Although there's, different things, our university has a big interdisciplinary, movement to make sure we're communicating and interacting with each other as professionals so we can understand and. Respect the roles each of us play in that journey with somebody, but where do you feel like we need to be going on the education front, if we're gonna start implementing this type of approach within healthcare?

Cameron Faller: Yeah. Awesome question. And, I'd have to listen to the, true conversation, sometimes when we talk about these things, there can be such a doom and gloom oh goodness. Like we're gonna fail. Nothing good's gonna happen. My firm belief, the reality is we're going to evolve as a healthcare.

I don't know. How long, I don't know, the exact steps, but also I know is when we look at history of how we've evolved to today, every time when things feel chaotic, it just, there's this new emergence of something a little bit better for that time. I think it's important for us to appreciate, the chaos that we're living in. This is the signal that there's a transformation that's gonna happen. And when we're open [00:39:00] to it, when we're aware, when we can be active in our day-to-day operations of, we have a really good opportunity of helping that person in front of us. We have a really good opportunity of working with a team just to introduce some little things here or there. All of that is, plays a huge role into, again, the continual evolution of us as a whole healthcare sector. What. Educational piece. For, I'll speak mostly to probably physical therapist physios, mainly because that's my training. But I truly think everyone can benefit from just some basic psychological flexibility, training and psychological flexibility.

It's got the word psychological in it. It doesn't mean you're a counselor, doesn't mean you're promoting you're actually doing counseling type activities. But there, psychological flexibility is, is basically the understanding of a little bit of what we're talking about with the openness and awareness, but it's our ability to handle stressors and demands when things feel pressing.

It's our ability to navigate through these stressors, these demands in a more helpful way. So for us and our clinicians that we hire [00:40:00] in, everyone needs to get trained in psychological flexibility, mostly for ourselves because burnout exists, hardship exists, and we gotta apply these principles to our health. And then as that patient comes in, we have a little bit more of a lived experience of understanding how do I teach them? And I know, mark, you said you're going through some of the ACT courses, so I'm sure you're quite familiar with psychological flexibility. These are strategies being taught in third world ward, countries that are like war torn strategies that are being taught all over the globe.

And there's really fascinating research coming out of how psychological flexibility itself has been shown as one of the best mediators of change. A little bit better than self-efficacy, a little bit better than therapeutic alliance. And again, more research will come to tell of how truly beneficial it is, but from a, at least a rehab standpoint, understanding that there's more that, that, that exists than just the tissues that we work with the movement.

We're trained enough in that we don't need more, probably manual therapy courses. We don't need to get into more depth of the movement dysfunctions. We just need [00:41:00] to recognize, yeah, there's thoughts, emotions, there's attentional processes that exist and I might not need to necessarily deliver interventions with that, but now I'm trained enough to make a personal aware of that and maybe there. Maybe they're very against going to counseling. Maybe they've done counseling before, but it was unhelpful. You know what? I actually have someone that might be a little bit of a better counselor, or I'm gonna open that door. And I think our ability for clinicians, when you're doing anything from a complexity standpoint, to get that basic understanding of psychological flexibility can be huge for yourself, for all your patients.

Mark Kargela: I totally agree. I think one of the things we're working through is to help clinicians be able to do act type thing, psychological flexibility training on themselves. 'cause it was one of the things that, as I've gone into it for the last few years really has helped me, not just professionally, but personally, really 'cause life is, I, and I think healthcare tends to pathologize life, but I think when we recognize life comes with its pains.

It struggles, it's difficulties and being able to thrive in the presence of those and still be [00:42:00] able to point ourselves towards the things that matter to us in life can be huge skills that I don't think we train anybody be it a healthcare professional or person in general. I think it has the ability to improve instead of pathologizing, the normal responses humans have to difficulties of sadness, anger, depression.

You, let's help people be able to engage in things that still are meaningful to them in the presence of some of these difficult situations. Give 'em the support they need. I know I'm preaching to the choir with you, but I think there are some movements that I think we can make to really make healthcare, true healthcare, not just illness care.

Reactionary. Let's wait till the wheels fall off on somebody and then try to give them this. incoherent narrative. And I also have, as I've been talking today, and this is me, oftentimes I've had to recognize I have really painted a doom and gloom scenario. And I know you spoke to this earlier in the podcast, there are people doing some amazing things in healthcare and there are physicians, surgeons, and others.

Ian Harris, orthopedic surgeon on our podcast has [00:43:00] recognized this and many others who are. So I think the awareness and the awakening is starting and it's just, there's a lot of systemic barriers of. Of a language we speak, of how we communicate what we're doing, paying for, or billing to insurance companies.

I think there's just a lot of incentives out there that are gonna be hard to move. But I think if we can make it more of a ground, kind of ground level, effort where we got people on the front lines, clinicians and the people, the consumers really generating this change. I think we have some opportunities to make some big things happen over in the future.

And thankfully we have folks like you and Leonard up there in, in Grand Rapids that are trying to push the envelope a little bit. Anything if, as far as folks trying to get in contact, they wanna learn more about what y'all are doing up there with the human rehabilitation framework and all the things you're doing for your EMR.

How can folks get ahold of you, Cameron and get to know a little bit more?

Cameron Faller: Yeah. It's, it we started the podcast with you saying that I did a lot of content generation for you on social media. Me, myself I had my, my, my third son was born [00:44:00] this past March, and I found myself getting way too ingrained with social media that I needed to create a healthy boundary for myself.

So I used to share all of my socials and probably only thing I have left is my Instagram cam Fowler DPT as my Instagram handle, but our website, contextual health.org. It's got a lot of information about the four. Programs that we offer. My emails, cameron@contextualhealth.org. I'm always open to emails, love to hop on and have conversations like this. I have a, you can know, you can have the to-do list a mile long, but I'd much rather be doing something like this than actually doing what I'm supposed to do,

Mark Kargela: Yeah, this is me escaping some of the difficult emotions and situations in my life through, through podcasting, which I think is pointing me towards my values. So I feel like I'm in a good spot with it, but probably some maladaptive behaviors in there somewhere. But I appreciate your time, man.

It's always good to chat with you again. Really kudos to you and Leonard for what you're doing up there in Grand Rapids. You have all our support to keep pushing the envelope and hope you [00:45:00] continue to make the changes you're after.

Cameron Faller: Alright. Appreciate it Mark. Thanks so much for having me on.

Mark Kargela: Wherever you're at listening, we'd love if you could subscribe to the podcast. If you're watching on YouTube, if you could like and subscribe. If any of you have any questions or you're struggling with some of the systemic stuff, share this episode with somebody that might be able to spur some thoughts on their part and hopefully help some other people.

So we'll leave it there this week. We'll talk to y'all next week.