Need to Know: Navigating Healthcare Systems & Your Rights

[0:00] Kathy: Hey Kathy, can your doctor just drop you as a patient? Jason: And did you know you likely don’t need a referral to start physical therapy? Kathy: Well, you’re going to want to watch this whole episode today. Jason: We’re doing another need-to-know episode today on the PTCH where we will answer questions you didn’t know you had. Kathy: Okay. So, this episode has the potential to either free you or fire you, whatever that means. Jason: Right. This is the PTCH. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? But

[0:30] chiropractors and physical therapists don’t like each other. Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Kathy: Remember, there’s no I in PTCH. Jason: All right, we are back and man, I’m excited Kathy. Yeah. Kathy: Today we’re doing part two of need to know. Jason: What do you need to know? Kathy: Yes. And so usually if you’re doing

[1:02] part two of something, it implies that there was a part one. Jason: There was. Kathy: So, if you’re listening to this and you’re shocked, you’re like, part one? Yeah. Get to work. Go watch some episodes of the PTCH Podcast and you’ll see our format for this is that we just talk about stuff that we feel like talking about. Jason: That’s right. Kathy: Well, and it’s more than that, right? We’re talking about the things that we feel like it’s really important for people to know whenever it comes to healthcare. So, we’ve got a couple of really sweet topics picked out for you today. I’m going to be talking about

[1:33] firing patients. Kathy: Yes, it can happen. Jason: Yes. And patient abandonment. Like what’s the difference? Kathy: What’s the difference? Jason: What are you talking about today, Kathy? Kathy: I am going to talk about direct access, which means you can see a physical therapist without a referral from a physician. Jason: Enticing. Good. I think these are more exciting than our last topics. But first of all,

[2:06] let’s celebrate the fact that we’re just racking up the subscribers. Yes, we’re at hundreds and hundreds. Hundreds and hundreds, right? And we’re almost to a threshold where once we reach a thousand subscribers and we have a certain number of watch hours, we can start offering like other features of the podcast like subscriptions where we can do like special episodes and things like that. Make more things available to all of you. So that’s really exciting. Kathy: Yeah, it’s really exciting. Jason: Yes. What’s been the secret to the success so far?

[2:38] Kathy: I definitely think it is the games. Jason: The games. Yes. Everybody asked, “What’s the game this week?” Kathy: Yes. Yes. And I think that we got a pretty good one today. It has potential for some serious fun. Jason: Item number two of business. Okay. I’ve had some people ask like what are you called if you watch the PTCH Podcast? And so we need to have a discussion about what’s our group of followers called, right? Kathy: I first thought of pitchers. Jason: Yeah. Pitchers. Yes. Kathy: I asked some of my employees

[3:08] and they said it’s definitely pitches. I think that one gets us in trouble though. Jason: Let’s go pitches. Kathy: Yeah. What’s up, pitches? Jason: Oh my god. Kathy: Where my pitches at? Jason: Yeah. Where are my pitches at? Like you know if you’re like a kid and you come home and your mom’s in the kitchen cleaning and like she’s listening to the podcast. Are you a son of a pitch? I don’t know. Kathy: Mom, I didn’t know you were a pitch.

[3:40] Jason: Boy, don’t talk to your mom though. That’s right. Kathy: You’re a pitch, too, though, Dad. You know, because you watch the pitch, watch or listen, consume in some way. Yeah, Jason: I think we go with pitches. Kathy: Listen, we love you pitches. Pitches. Yes. Thank you so much for making all this worthwhile. And I feel successful. Kathy: I agree. Jason: Are you feeling successful? Kathy: Yeah, I’m feeling — there’s now time for some swag. Jason: Yes, I know. We got to get the swag store online. Kathy: Yes. Jason: It’s PTCH swag. Yes, absolutely.

[4:12] Kathy: Where are my pitches? Jason: We’ll have a shirt that says, “Where my pitches at?” Okay. All right. Super. Kathy: This is a family podcast. Okay. Jason: All right. Full of family stuff. Kathy: Well, can I start? Is that okay? All right. Okay. So, this is something that — it’s a topic that a lot of people didn’t even know this was possible. Did you know that you can be fired by your healthcare provider? And that’s legal. Jason: It is. There are some people out there that assume that there is no

[4:42] scenario where your healthcare provider can just decide I don’t want to work with you anymore, because of something called patient abandonment. Kathy: Okay. But there are some reasons that your healthcare provider might decide to part ways with you. And so what I want to talk about today is how people find themselves in that situation. I think one reason — probably the most common reason that you would see today is — especially in in our

[5:13] town in particular, I’ve noticed that it’s so hard to get in to see healthcare. Jason: It is. It is. Kathy: Yeah. Like if you want a primary care doctor, you’re maybe waiting months and months to see one. You want to see a specialist, you’re waiting even longer. And so if you have not been to your primary care doctor in a while, there is a chance that you can’t get in. Jason: You’ve been fired. Kathy: You’ve been fired, right? So, they might have filled your spot on the roster, so to speak. And you’re just not able to

[5:45] schedule future appointments with them, right? Jason: And I totally get it, right? It’s for practical purposes, it makes sense. They need to be seeing the people who need help right now. And if you’ve taken a ten-year hiatus from seeing a primary care doctor for whatever reason — I’m not judging — Kathy: then there might not be room in the practice anymore for you. Jason: You should go once a year. Kathy: Absolutely. Yeah, you should go get checked out. Do I — I probably should. Yeah. Right. Jason: We just had a cardiologist on. Kathy: We did. I know. I know.

[6:16] Jason: You got to go get your blood pressure, your cholesterol, all of it, man. Kathy: Yeah. But usually, Jason, I’m like, “Hey, give me a look. Do I look okay? Do I look okay to you?” Yeah. I was probably fine. So, yeah. Right. So, Jason: so that’s one of the reasons that might happen. Now, we’re going to get to this, but that doctor who has fired you, so to speak, still has responsibilities towards you, and we’re going to get to that. Kathy: So, let’s talk about the reasons that you might be put in the penalty box, I guess, whenever it comes to your doctor and you might find yourself

[6:47] dismissed from a practice. So, we’re going to talk about that. We’re also going to talk about what are the steps that need to be taken by your provider in order to fire you and kind of what are your rights around that type of situation. So, the most common reasons that you might find yourself fired would be like non-compliance, if you’re making a threatening or unsafe environment, missed appointments, those types of things. And these are all inbounds for

[7:18] dismissing a patient. Jason: Yeah. So, non-compliance would be something like, if we sit down and it’s like, hey, here’s a treatment plan, and I’d like you to follow the treatment plan, and we don’t agree fundamentally on what the treatment plan should be, chances are typically you’re just going to walk away and not come back. But if you’re insisting on coming back and asking me to do something that I feel like is going to be unsafe, and I get this sometimes. Kathy: Yeah, I bet. Jason: I have some people that are like, I just need you to adjust this, just adjust it

[7:49] like this and do that and it’s like that’s not safe. Like the way that you’re asking me to do that, Kathy: not safe, Jason: right? And so then if we can’t like get over that then we’re going to need to part ways, right? One thing that I don’t tolerate is I don’t tolerate people messing with my staff. Kathy: Yes. 100%. Jason: Yes. So, if you want to come in and you want to swear at my staff, you put hands on my staff,

[8:19] you want to be verbally abusive, like call people stupid and things like that, all things that have happened at my clinic, I don’t want to see you. Kathy: Yeah. You’re not invited back. Jason: You’re not invited back. And I have the right to dismiss you as a patient for those types of things. Also missed appointments. So, if you’re not showing up for your appointments and you’re taking up a time slot that another patient could be using, then we’re going to dismiss you from the practice because otherwise you’re wasting

[8:51] time and resources. And then the other probably most common thing is if there is some sort of situation where you’ve racked up a big bill, you’re still insisting on being seen and you’re refusing to pay or give us the means to collect, right? On your payments, then we have the right not to continue to let you rack up more of a bill that you’re also not going to pay. So, those are the things — like, I can give you

[9:21] some — you want to hear some stories? Kathy: I would love it. Jason: Okay, I’ll give you some more stories. The very first patient that I ever dismissed, this was like my first year of practice. I had somebody who came in and they were like, you know, I’m really down on my luck and yada yada and I don’t have any money, but I’m really hurting. So, I talked to my mentor and I was like, what do you do in a situation like that? He told me about working out a financial hardship plan and so we did that and it’s like, look, you have to

[9:51] follow the plan. I’m giving you this discount and, you know, if you don’t follow the plan then we can’t continue working with you. And she just disappeared and then she disappeared for a few months and then one night I was just randomly down at the clinic — I think we were doing an event or something like that — and she called. I was like, what? So I picked up the phone, I was like, hello. She’s like, yeah, oh, I need — can I come in right now? Because I’m like, where are — like, do you see the lights are on? Like, what is going on? Kathy: How did you know I was here? Jason: Yeah. And she was like, “Oh, I was stuck out of town and I didn’t have a way to get there.” And I was like, “For

[10:21] months?” So, like, “How’d you get food?” Kathy: Yeah. Jason: So then it was like, “Listen, we’re not going to be able to continue.” I had a guy who he actually put hands on one of my staff members. Kathy: Yeah. And like she was trying to help him get scheduled and he reached over the counter and grabbed her shoulder. So, he got a warning and it was not a very happy warning. Kathy: No. And then another time he came in and he made a front desk person cry. He had gotten something wrong Jason: and he was like, “No, that’s not the way

[10:51] it is. Are you stupid?” Like, “Are you stupid? Are you stupid?” And he was really belligerent about that. And so, before he left the clinic, he had a letter from me inviting him to never ever come back. Kathy: Not darken these doors. Jason: Yes. And we actually looked him up later and this is a guy who had had some legal trouble — like, he had stabbed somebody with a screwdriver. He had tried to contract to have somebody killed before. Kathy: My goodness. Jason: Yeah. So, our instinct was pretty good on that, you know. And it’s not to say that if you are a bad person — which, you know,

[11:22] I don’t know if I’d categorize them that way. Some people might — but bad people deserve healthcare. They do. Kathy: Everybody does. Jason: They absolutely do. Like if you’re in prison, you have a right to healthcare, right? If you’re a jerk, you have a right to — you don’t believe like me, you don’t look like me, you have a right to healthcare. Kathy: What you don’t have a right to do is be abusive to people. And that’s the kind of thing that will get you dismissed, right? And so, that’s the type of thing where sometimes if people find that they’ve been dismissed from a practice, it can be that I’m — I’m so

[11:54] surprised, but like you have to think about the interactions that you’re having with people there. Like when you showed up, did you threaten to sue the doctor? Because if you do, yeah, it’s gonna be very difficult for that doctor to continue working with you. Right now, there is a line between, like, hey, we can’t have you threatening us, and what would be called retaliation, where it’s like — but a direct threat is a

[12:24] direct threat. And like, you have a right, if you’re a provider, to dismiss people who are threatening you, your business, the people that are working for you. And so that’s important. Retaliation would be like — um, sorry — retaliation would be like, hey, your kid’s football team beat my kid’s football team, so you’re not a patient anymore. That’s retaliation.

Kathy: Oh, you can’t do that.

Jason: No, sorry.

Kathy: Yeah. So, I don’t treat anybody.

[12:54] Jason: Well, I don’t treat anybody from CV, or —

Kathy: Well, not after you said that. Just kidding.

Jason: Yeah.

Kathy: So, all right. Right. Don’t you feel like there’s this era of kind of like entitlement? I’m entitled to this appointment. I’m entitled to the care that I want.

Jason: I mean, the patient is — let me walk that back. Like, I listen to the patient and I want to

[13:24] give them what they need, but they’re also not entitled to dictate the care that I’m going to give them.

Kathy: Yes. Right. Yeah.

Jason: We did go to school. Even though we’re nerds, we have some evidence behind — method to the madness of what we’re doing. And so, just because I’m not, you know, rubbing your feet for an hour — that doesn’t give you the right to tell me how to do it. Like, I don’t deem that to be medically necessary. Therefore, I am not going to do that.

[13:54] Kathy: Yes. Absolutely. And you kind of touched on the two most recent times. I make it sound like I do this all the time. I’ve treated like probably 20,000 people and I’ve dismissed less than a dozen. Okay. Right. But all of them stick out in your mind because it’s always something that’s out of the ordinary. Like, one of the most recent ones was the person wanted me just to rub their back.

Jason: Yeah.

Kathy: Just — something like that. And that wasn’t the only reason, but it was

[14:24] like I had to tell them I’m not going to do that, because there’s no therapeutic value in me just doing this. It makes me feel uncomfortable. And so, we’re not going to do that. And then they also wanted to sue, and they also were shaking me down. They were like, “Hey, if somebody’s not happy with their treatment, like, do they just get like a free — ” something like that? I was like, “Are you serious?” And so, yeah, I had to write the letter and say, “Yeah, we’re not going to be able to work with you anymore.” No. Then the other person — I had somebody

[14:55] who came in and just made a big scene in the lobby, and they were yelling, “You’re denying me healthcare because I’m disabled,” as they were like walking out. And I said, “Well, wait a minute. Wait a minute. I’m not denying you healthcare. You’re walking away while I’m trying to talk to you. We’re trying to resolve this and have a conversation.” And the big issue was that we were smiling at this person.

[15:26] Jason: Yeah. And the smile said —

Kathy: — that we wanted them to leave. We didn’t want them to be a patient there.

Jason: Interesting.

Kathy: And so, made this big scene and everything, and was yelling things like, “You’re denying me care. This is patient abandonment.” And —

Jason: That Mandy, she smiles too much.

Kathy: Right. Well, so the funny thing is, in the lobby of my clinic, I now have the PTCH Podcast running. Yes. And they were like, “Look at you. Like, you’re smiling right now.” I said, “I probably am. Like, I’m a pretty happy person. I smile a lot.” They’re like,

[15:57] “Well, but you’re smirking at me.” And they’re like, “I’m going to take my camera and take a picture so that you can see.” I said, “You don’t need to. Look at that TV right there. That’s me on the TV, right? That’s my podcast. And what am I doing?”

Jason: Smirking.

Kathy: I’m smiling. I’m a smiley person, and I’m going to smile when I’m in my clinic. I smile at everybody. “What would you like my face to be doing right now?”

Jason: And that’s when I got told that I was a horrible person.

Kathy: Okay.

Jason: And that I was denying them care. And so —

Kathy: Okay, off they went.

Jason: Wow. So, yeah,

[16:27] that’s an exciting day.

Kathy: Yeah. Then you got to follow that up — like, follow that up with a please don’t come back.

Jason: Please.

Kathy: Yeah. This isn’t working out for both of us. So —

Jason: It’s not you, it’s me.

Kathy: Yeah. Except it’s you.

Jason: Yeah. It’s not us. It’s definitely you. So, I want to talk about how this has to be done though, because if you’re a patient and you want to end a doctor-patient relationship, all that’s required is that you just not go back. That’s it, and that’s pretty simple. And that’s it. If you are a

[16:58] provider though, there’s a few more steps, and this varies across different disciplines and in different states, but in general, if you’re going to be dismissed as a patient, the provider should let you know in writing. Okay? And it’s good practice to let you know a reason for why you’re being dismissed. Certainly cannot dismiss people for discriminatory reasons, like — you know, it can’t be like, “Well, can’t be my patient ‘cause you’re Black.” Yeah, that’s illegal.

[17:28] Kathy: Yeah. So, you can’t use reasons that are discriminatory, but in general terms, like, we don’t allow people to be violent or loud or, you know, rude or things like that. And so there should be some sort of a reason. There’s also — you have to give them some sort of coverage, so to speak. So there are some cases where you can just be like, “We’re done,” and your

[17:59] Notice is one day. It’s today. Otherwise, you have to kind of give a grace period for people to try and find something new, or if they need emergency care. Fortunately, in the world of chiropractic and physical therapy, there are no emergencies. Right.

Kathy: Yes.

Jason: So if you have an emergency and you’ve been dismissed from a physical therapy or chiropractic clinic, go to the ER, right? They’ll get you taken care of.

Kathy: They have to take everyone.

Jason: Right. Exactly. But if you go to the ER and you know you’re engaged in some of these behaviors, they have to support you until they can get you

[18:30] somewhere else, right? Unless you’re posing an immediate threat, right?

Kathy: Mhm.

Jason: The other thing that needs to be done is you need to let that person know about what now happens with their records, right? So you need to offer, “Hey, when you find another provider, we will communicate with them about your treatment needs and everything like that.” Otherwise you are disadvantaging them from being able to

[19:00] seek further care somewhere else. Every place is not a good fit in healthcare, and that’s just fine. But you need to be able to help people to get to the next thing.

Kathy: Mhm.

Jason: Now, in Oregon, they’ve done something for chiropractors that I really think is — I don’t know — it’s kind of dumb. And if you’re listening to this and you’re on the Oregon Board of Chiropractic Examiners, I love you. I used to be one of you. And so I get it. Like, people have their opinions. What do they do?

Kathy: Well, I wish I would have seen this

[19:30] sooner because I would have told them, “Guys, this is dumb.” But they have a requirement that if you’re going to dismiss somebody, you have to give three references of where they can go.

Kathy: Oh, well that’s kind of fun though.

Jason: It’s kind of fun, right? Because then you’re playing “who’s the chiropractor that I hate the most,” right? And so it’s like, man, I’ve been getting a lot of referrals from Jason lately, right? But the dumb thing about it is that guy who like assaulted a staff member — where am I supposed to?

Kathy: Yeah, that’s not fair.

Jason: Yeah. No. So it’s like, yeah, bro, go figure

[20:02] it out. You know, you’re not a nice guy, and I’m not going to send him to a place where there are relationships that I value and people that I trust, you know. And so that’s kind of a crazy requirement, I think. And three is an arbitrary number.

Kathy: Yeah. Why three?

Jason: Yeah. That made sense maybe in the ’70s when you had to go to the phone book or something like that, but it’s —

Kathy: Google.

Jason: — 2021. Yeah. You have an unlimited

[20:32] list of people that you can go see.

Kathy: It’s 2025, by the way.

Jason: 21st century. That’s what —

Kathy: Okay, Jason, I told you before this episode —

Jason: I didn’t — Kathy.

Kathy: Four years.

Jason: You know, when — my wife and I have been married for about 12 years. She’s like, “Can’t believe we’ve been married for seven years. Can you believe that?” And I was like,

girl, it’s been — like, yes, it technically has been seven years. It’s been over. She’s like, “Really?” I was like, “Yeah, you know, we have an

[21:04] 11-year-old daughter, right?” So now I always joke with her about that and, you know, there’s not a single time that it hasn’t got me in trouble. So it’s glad — glad that it’s immortalized on the PTCH Podcast. Oh yeah, totally. So

um, so yeah, so those are — I think those are the big things — is that people should know that there is a potential for you to be dismissed from a healthcare provider and that it is not necessarily patient abandonment when you do that. I guess I didn’t talk about what abandonment does look like.

Kathy: Yeah. What is that?

Jason: Yeah. So patient abandonment is — first of all, if I don’t give you a good treatment plan, like I don’t tell you — like if you come in and get treated — I’ll pretend I’m a surgeon, okay.

[21:36] So I do a surgery and I don’t give any steps for follow-up, you know, in terms of “you need to go do physical therapy” or “you need to take this pain medication.” I don’t have any follow-up instructions.

Kathy: I’m abandoning you

Jason: after I’ve gotten you partway into a treatment plan, right? If I decide that I’m going to go on a sabbatical and I don’t inform you

[22:08] or I don’t set up some sort of continuation of care, that could be considered patient abandonment, right? Or if I don’t give you reasons for why you can no longer come to my clinic, and if you try and get your records sent somewhere else and I don’t provide them, or I’m not willing to do the other things that I have a duty of care to you for — then those are things that are considered patient abandonment. And so

[22:38] that could — in a lawsuit, it could end in discipline on your license, things like that. So if you’re a provider listening to this — and I know that we do have some that listen —

Kathy: Mhm.

Jason: — you know, get some advice on how to write a good dismissal letter. If you’re a patient who feels like you’ve been abandoned, you know, reach out to somebody, maybe get a lawyer and find out just how to advocate for your right to receive some healthcare. But above all, just be a good, nice, decent person. Understand that a

[23:10] lot of the issues that we face are directed at staff. They’re not even directed at providers.

Kathy: No.

Jason: Like how you treat staff really, really matters. You’ll get the stuff that you want nine times out of ten if you’re just really nice to the staff. You will get the boot if you — if you show your butt —

Kathy: And I mean that literally and figuratively —

Jason: — then you’ll get the boot from my clinic, at least. So, fortunately, like I said, we haven’t had to do it very many times, but yeah. Have you ever had to dismiss

[23:41] somebody?

Kathy: Yeah.

Jason: Yeah?

Kathy: Yeah. Many, many, many cancellations and missed appointments and no-shows. And then I happened to see that person out to eat that night.

Jason: Oh.

Kathy: “I had stomach surgery.” Okay. And then I saw him that night at the restaurant.

Jason: That’s what happens in a small town.

Kathy: Yeah. Yeah. Careful who you lie to.

Jason: That’s right. So needless to say, yeah, we had to say,

Kathy: “Ma’am,

[24:11] “thank you, but no thank you.”

Jason: Adios. Yeah.

Kathy: Yeah. Yeah. It’s you, if you don’t show up for your appointment, we can’t fill it.

Jason: Yeah.

Kathy: We lose money.

Jason: Absolutely.

Kathy: Yeah. And I also feel like, you know, frustration is at a high level, especially in this town, because it is hard to get in to see any provider.

Jason: Mhm.

Kathy: Right. And the reason for that, you know, this is — it’s been going on for a long time. We know that we knew this was going to happen, that we had —

[24:42] you know, we knew that we were going to have issues finding healthcare providers.

Jason: Mhm. Mhm.

Kathy: Right. There just aren’t as many as there were. And this is the reason why it’s so hard to get in to see people. So the people who are still providing healthcare, be nice to them.

Jason: They’re the ones that stayed.

Kathy: Yeah. You know —

Jason: And it’s stressful. Yeah.

Kathy: I mean, not looking for a pity party, but it’s like, you know, just understand that your person — that you’re working with — is probably managing way too many people.

[25:12] Way too many. You know, the physicians, especially in this town, are just under a ton of stress and so many patients that they have to care for, and then their staff, too. And so I understand the frustration of patients. I’m on the patient side, too, and I have a hard time getting in.

Jason: Oh, gosh. I’m so embarrassed by something now that happened years ago. I think I was in college, but I went and I saw a doctor and — gosh, I don’t even remember what it was for, but my issue became the

[25:44] bill, right? I got the bill. It was more than I thought it would be. And I was like, “Wait a minute, he didn’t even do anything.” All he did was he looked at me and I didn’t even get better. I called and I made a whole big scene and everything like that, and they were like, “Well, we’ll talk to the doctor and see.” And he was like, “No, you still have to pay.”

And so I was like, “All right.” So I had to make payments and everything like that.

Jason: And like now I’m super embarrassed about

[26:14] it. One, because that doctor actually became a good friend of mine and colleague and referred people later. And so if you’re listening and you know who you are, I am so sorry. And two, it’s like now I understand on the other side of it that it’s not just about the things that you’re doing for that person. It’s about understanding what’s the next right thing to do. So if you come in and I do an exam and I determine you’ve got to get to the ER, it’s not like I didn’t do anything. I maybe saved your life, right?

[26:45] Kathy: Yeah.

Jason: So, but I don’t think a lot of people understand exactly how that works. I get it from a frustration standpoint. Yeah, it’s frustrating, but just be nice to the staff.

Kathy: Absolutely. Yeah.

Jason: What’s that saying? You get more — you get more with honey than —

Kathy: Yeah.

Jason: Vinegar.

Kathy: Vinegar. Yeah.

Jason: Mhm. That’s — yeah.

Kathy: You haven’t heard that saying?

Jason: Yeah. I haven’t heard it any other way.

Kathy: Just say that.

Jason: Yeah. Mhm. That’s it. No, that’s good.

[27:16] All right. I think I’ve said everything that I need to say about patient abandonment, firing patients, and things like that. So just be kind. Be kind to everybody.

Kathy: Yes. Whether you’re a patient or a provider.

Jason: Mhm. So —

Kathy: I agree.

Jason: All right. So Kathy, can you tell us more about this direct access thing? What is this?

Kathy: What do you know about direct access? Well, now you know me, so I have schooled you on direct access. I’ve informed you. So you know what it is.

Jason: I do. But I’m asking for

[27:47] Kathy: Okay. You know, all of our PTCHes out there.

Jason: All right, PTCHes, listen up.

Kathy: Oh, we’ll see if this survives this episode. And if it doesn’t, this will be the greatest episode that we do.

Jason: The truth.

Kathy: All right. What is this deal with direct access? Well, back in the day, you know, and I think this all goes back to the fact that, as you learned a long time ago, physical therapy was

[28:18] started by a woman.

Jason: Yes.

Kathy: And so for the longest time, physical therapy and its services were seen as kind of like an ancillary service —

Jason: Extra stuff.

Kathy: Extra on the side.

Jason: Yes.

Kathy: And so the — I’m going to say the American Medical Association — did not want patients to be able to just go see a PT on their own.

Jason: Mhm.

Kathy: They wanted to be the gatekeepers.

[28:49] Jason: Yeah. They wanted to kill chiropractic.

Kathy: That’s what I — how did chiropractors not have to go through direct access?

Jason: Oh, dude. We’ll do a whole episode about this, but the American Medical Association actually tried to eliminate the chiropractic profession at one point.

Kathy: Okay.

Jason: Yeah, there’s a whole story to it.

Kathy: Oh, that sounds like a good story.

Jason: It is a whole episode in and of itself, but it’s crazy. And it even involves the Church of Scientology.

Kathy: What?

Jason: Oh my gosh. This is a teaser for another —

Kathy: It

[29:20] is a teaser for another one. I’ll tell you the whole story, but I do not want to take away from this at all. Yes.

Kathy: Okay. Okay. So basically, you know, American Medical Association — I don’t want to throw them under the bus. Let’s just say —

Jason: Well, they are the —

Kathy: They them. They are the they them.

Jason: Just say they them.

Kathy: Yeah. I didn’t mean it like that, though.

[29:50] That’s not how I meant it to be.

Jason: All right. The AMA.

Kathy: Yeah. So the concern was over patient safety.

Jason: Yes.

Kathy: Supposedly.

Jason: Yes.

Kathy: Or: we can’t let these women be seen without us men telling them that they can be seen by them.

Jason: Hey, what happens if you give them an exercise?

Kathy: Yeah.

Jason: So they were concerned — physician groups —

Kathy: Yes.

Jason: As I’ve read.

Kathy: Mhm. Physician groups that physical

[30:21] therapists lacked the training to diagnose serious conditions — which, maybe at the time, 1940s, ’50s, and ’60s, it’s possible that they didn’t have it — and the physicians felt like they needed to screen the patient first for cardiovascular issues, fractures, tumors, etc., etc. So before you could go off and do these wild and crazy exercises with a broken leg —

Jason: Right.

[30:51] Kathy: I need to make sure that this patient should be able to be seen. Jason: Yeah. Listen, listen, guys. Have you ever done a clamshell? Okay. Have you done a clamshell? If you — if you try doing a clamshell and we don’t know about your cardiovascular status or like what drugs you’re taking, things like that, Kathy: I mean, Jason: it’s dangerous. It can get bad fast, right? Have you ever tried to do a side bridge? A side?

[31:21] Kathy: Yeah. Jason: Right. Kathy: Mhm. Jason: That can hurt. Kathy: Shoulder rehab band work. Jason: Right. Kathy: That’s right. Jason: Yes. Kathy: Dangerous stuff. Jason: The other thing was the physician wanted to make the plan. Like the physician wanted to say, “You need to do this exercise. You need to do this exercise, but I’m not going to watch you do it. This lady over here is going to watch you do it.” Okay. Well, and let’s not forget too that Kathy: there is a financial incentive Jason: to gatekeeping Kathy: Exactly. Jason: entire access to another healthcare

[31:53] profession. Kathy: So everybody — everybody who goes to see a physical therapist — Jason: Yeah. Kathy: the doctor’s got to get a little piece too. Jason: Yeah. They wanted — they wanted the copay. Kathy: Mhm. They wanted — well, not just the copay, but they wanted — they wanted you to come in, talk to them for 10 minutes, and say, okay, you should go to physical therapy. Jason: Meanwhile you waited, you know, 6 months to get in to see your doctor and you could have been started rehab. Kathy: You could have been done with rehab. Jason: You’re right, you could have been done with rehab. Kathy: The other concern they had was this —

[32:24] kind of makes me laugh — but cost and over-utilization. Jason: The physicians were worried about overutilization. Kathy: You know what, you’re getting too much physical therapy. You’re getting too much exercise, too much rehab. Jason: We got to cut back. I need you to cut back. Kathy: Too much flexibility, right? Jason: The fitness is here. We want to hear. Kathy: Oh, and this — and in my research, I read this sentence. Opponents of direct access

[32:56] worried that the patients might seek physical therapists for conditions that would resolve on their own. You don’t need hope for that. Just wait eight months and that foot will be healed. Jason: Here’s a straw. Suck it up. Right. Kathy: Well, and you know, can we just — so overutilization is just one of the most bogus Jason: Yeah. Kathy: bogus claims out there. Like, does it exist? Yes. My profession is probably

[33:28] more guilty of overutilization than most of them out there. But even still, even within that, like the people talking about overutilization tend to be Jason: insurance companies. Kathy: Yeah, and people who want to Jason: get a piece of the pie whenever it’s — whenever you’re doing the healthcare thing. And people who are doing like pre-authorizations and managed care plans and stuff like that — it is not for the benefit of the patient.

[33:58] Kathy: No, it is not. Jason: No, it’s like Kathy: for the bottom line. Jason: Yeah. You’re at much bigger risk of having bad effects from not having an intervention, especially one that’s as benign as something like massage, physical therapy, chiropractic. Kathy: You’re at much bigger risk of not being able to have access to that than you are of, oh my gosh, we did too much. Jason: Right? My experience is most people, they just get freaking bored with coming in to see a chiropractor. Absolutely.

[34:28] They get bored with — I mean, I even hear — I just got tired of going to PT. Yeah. Kathy: I just — it’s like it handles itself. They just don’t want to pay for it. No, that’s what it is. Jason: It really comes down to that. Yeah. I’m going to tell one success story. I was able to argue to get some more visits for my patient that had rotator cuff repair, which is notoriously long rehab. We’re talking six, seven months — Jason: because the shoulder’s not complicated. Oh,

[34:58] my goodness. Kathy: It’s not the most mobile joint. Jason: We got a win this week, so I’m really happy about that. I mean, we got four more visits, but hey. Kathy: Yeah, Jason: four is better than none. Kathy: Yeah, so stupid. Jason: Yeah. And that’s just not something you want somebody to rehab by themselves. Kathy: No, I don’t want to rehab that by myself. Jason: No, you don’t want them YouTubing that. Kathy: Mhm. Oh gosh. Jason: Don’t ChatGPT that. Kathy: Yeah. Jason: Okay. So, how did direct access evolve? Kathy: I don’t know. Jason: You don’t? Kathy: No. I think that you’re about to tell me though. Jason: I am. So, the APTA, which is the American

[35:30] Physical Therapy Association, said, “Well, the heck with this, you know, we’re going to show them that we’re smart enough to see patients without seeing a physician.” Kathy: Mhm. Jason: So, we’re going to make all our PTs doctors. Kathy: There we go. Jason: Not real doctors, though. Kathy: No. DPTs. Jason: We’re going to give them a DPT degree. Kathy: Yes. Jason: Yes. So, we thought that we would elevate our education to include learning how to see the red flags. Is

[36:00] this — is that leg broken? Kathy: Mhm. Jason: Is this cancer? I mean, I can’t diagnose cancer, but I know the red flags. I know the signs, right? Kathy: Mhm. Jason: If you’ve got pain at night, you’re losing weight and you’re not trying to lose weight — those are my first two red flags. Like, hm. Kathy: Yeah. Jason: And this pain never goes away no matter how you move your back. Kathy: Yeah. Hm. Let’s go see your primary care. Jason: Well, and your primary care isn’t diagnosing cancer either. Kathy: No, exactly. Jason: They’re looking for red flags and they’re sending them to an oncologist or a pathologist or something like that.

[36:30] So, it’s like Kathy: Yeah. Exactly. So, yeah. So, you know, we learned how to take blood pressure, which we found out today is very important. Jason: Yeah. That must have taken forever to learn how to take blood pressure. Kathy: It takes — Jason: you know, 3 years — Kathy: at least. Jason: At least — Kathy: it was on my final practical — Jason: years, or a trip to CVS to the pharmacy. Kathy: Yeah. So our degree evolved to a doctor so that we can — we have some

[37:02] training in differential diagnosis. Clearly not the same as a primary care physician. I don’t want to pretend like I know as much as a primary care physician. Not at all.

Kathy: Well, people aren’t going to you for those things. Right.

Jason: Right. Right.

Kathy: Oh, my prostate. That’s outside my box.

Jason: Yeah. Yes. Exactly. Differentially diagnose me, please. Right.

Kathy: Yeah. So what I do know — I know enough when something is not musculoskeletal.

Jason: Yes.

Kathy: So, and that’s all I — that’s really what I need to know. Like, this needs further exam.

[37:32] Yeah, autoimmune disease — like, I can tell when something is not musculoskeletal in nature. So then the other thing we did, we dug deep and we started to study the evidence and cost effectiveness of PT. So, Dr. Julie Fritz, if you haven’t heard of her, she’s a legend.

Jason: Okay.

Kathy: University of Utah — she did this study in 2017 and it’s actually entitled “Cost Effectiveness

[38:02] of Primary Care Management With or Without Early Physical Therapy for Acute Low Back Pain.” So she did an economic evaluation, and in this study she found that choosing physical therapy as an early intervention saved a significant amount of money. What they did is they studied two groups: one went to physical therapy for about four sessions, and then one just tried to get better on their own — the wait-and-see approach. You

[38:33] know how that goes, right?

Jason: And so, choosing physical therapy over traditional primary care management — what she found saved approximately $4,000 per patient.

Kathy: Oh, that’s all.

Jason: That’s it.

Kathy: Okay. That’s all.

Jason: Scans, injections, medications —

Kathy: All the things. If you go to PT first, the physical therapist gets them moving, shows them some exercises, shows them that they can get better by doing these things, because they don’t need

[39:03] the X-ray, they don’t need the MRI, they don’t need the injection or surgery for that matter.

Kathy: Such a great point, because I think one thing that people underappreciate is that, like, you and I are musculoskeletal problem specialists, right? We

Jason: know what looks like what in our world, right?

Kathy: I’m not a cardiovascular specialist, right?

Jason: No. And so if you came to me with a cardiovascular problem, I would be like, there are probably some tests that we can run. So let’s do a

[39:36] heart catheterization. And it’s like, is that the right call? I don’t know. I don’t do a bunch of them, though, and I know that’s a test, so let’s order it.

Kathy: Yeah.

Jason: Right. And, you know, not knocking internal medicine doctors or primary care, but they don’t see the same stuff that we see. And so they’re very quick to get to the MRI, very quick to get to the X-ray. Yeah. Because that’s kind of the culture and the training — is there a test that we can run for that? Well, yeah. It’s an orthopedic test. It’s a basic neuro exam, right?

[40:07] Those are the things that are going to get you rolling, and then it’s like, what are the tools that are available? And so you play to your strengths. And so I think that we save money because we can play to our strengths, and we tend to be small clinics. And so I don’t have a million-dollar MRI machine sitting in my clinic. So I’m going to find a whole bunch of things that

Kathy: evidence says are very effective starting places, but they aren’t going to, like, be ringing bells on people’s wallets and purses. I don’t

[40:38] even know what that means. I just said that.

Jason: I said that. Ringing bells

Kathy: and that, you know, on their wallets.

Jason: Yeah. On their wallets. Rings. Do you have a bell on yours?

Kathy: I got to check mine. I need to put some bells on it. Anyhow,

Jason: but, you know, in their defense, those are their tools, right? Primary care.

Kathy: Absolutely. Their tools are medicine,

Jason: scans, images, tests. What are our tools? Our hands.

Kathy: Hands,

Jason: right? Exercises.

Kathy: Our witty repartee.

[41:09] Jason: That’s right.

Kathy: Our humor, our disdain, our disappointment, our stern looks.

Jason: Yeah. Yeah. You know, we can provide what we give them in that moment. You know, it might be a massage that first visit. We might do some manual therapy just to calm their nervous system, and they’re going to walk out of there feeling just a little bit better —

Kathy: or fearing a little better —

Jason: or more fear.

Kathy: I’ll take either. Right.

Jason: Yeah. So, those are the

[41:39] tools that we have to offer. There was another study done — we’re getting back to direct access, why PT is a good choice. This one in 2018 — they analyzed data from a spine management program that found patients who chose direct access to physical therapy saved on average $1,543 over the course of a year compared to those who went through the traditional medical referral. So, if that doesn’t ring bells on your wallet, I don’t know

[42:09] what does. Do you want to save $1,500?

Kathy: Yes.

Jason: Okay. There you go.

Kathy: Go to PT.

Jason: Yes. Yes, ma’am.

Kathy: I’m going right now.

Jason: Get my check ready.

Kathy: That’s right. And of course, we had somebody look at Medicare data — that’s the bellwether in our profession — like, what does Medicare charge? What does Medicare pay? Right. So, they analyzed Medicare data and they found that over a 12-month period, the average spending for beneficiaries who started physical

[42:40] therapy was 18% lower than those who started with injections.

Jason: There you go. Yeah. And then 54% lower than those who started with surgery.

Kathy: Well, that makes sense, right?

Jason: Yeah. Totally.

Kathy: I mean, you’re saving —

Jason: surgery is basically free. Yeah.

Kathy: Yeah. So, those —

Jason: Well, and a lot of people after you have surgery need physical therapy anyway.

Kathy: Yeah. Yeah. Yeah. So, that’s my case for direct access and why,

Jason: in the state of Oregon, you can see a physical therapist without a referral

[43:12] from a physician, except for some insurance companies. So, call the clinic, and the clinic should be able to tell you whether you need a referral or not. But likely, like 95% of the people do not need a referral. Just come to PT.

Kathy: And as somebody who can write referrals to physical therapists,

Jason: honestly, it just feels silly. It’s —

Kathy: why not?

Jason: It’s so dumb. Like,

Kathy: it’s — I send people to physical therapy all the time,

Jason: but that physical therapist should not

[43:42] need to check in with me on the treatment plan, right? It’s like, bro, you know what you’re doing just as well as I do, and there’s a reason I sent them to you. Kathy: Yeah. I don’t want to deal with it. That’s usually how you send it to me. Jason: That’s the reason. It’s the expertise, Kathy. Yes. Kathy: But yeah, you know, as we as a society work to make healthcare better, there’s just some of these things that have to change where some of these egos or

[44:13] special interests or — traditionally this is the way that we’ve done it — that has to melt away so we could do something that is lean, fast, efficient, effective, evidence-based, Jason: and ultimately ends up being more cost effective and better for patients Kathy: and is not just something where it’s like, well, we have to serve the old ways of doing things. Otherwise, healthcare is so expensive. Such a huge chunk of our gross domestic product

[44:43] is healthcare, and man, you would think that we would be healthier as much as we spend. Jason: Yeah. Kathy: Yeah. Jason: ROI. Kathy: ROI. Jason: Not good. Kathy: It’s not, it’s not— Jason: it’s not panning out for us right now. Kathy: Goodness. Did you have more to say about that or should we play a game? I’m ready for a game. Jason: Okay. Well, this game is gonna be a little bit different. I call this pitch or pass. Okay. We’re just gonna have a little back— I don’t even know, I don’t even know if there’s a way to keep score in this game. I just think

[45:14] it’s going to be something fun. Kathy: All right. Jason: So, we’re going to throw out— you pick some people, I’ll pick some people. Okay. And we’re going to throw out a name to each other and you tell me— I’m going to give you a name, you tell me pitch or pass. Kathy: Go ahead. Jason: In what way? Kathy: Okay. So pitch would be like, “Yeah, let’s get him on the show as a guest.” Jason: Oh, come on. Kathy: Talking about why would this be a good person to come on the show, or pass — like we don’t want them, right? Jason: Okay, fair. Kathy: And you know, maybe it gives us a little direction for the future. Maybe it gives us a chance to talk about some

[45:45] people. Jason: Give me a lot of time to prepare for this. Kathy: No. Well, okay. So, would you like me to ask you a person first? Jason: Ask. Kathy: All right. I got a list over here. Let’s go. Joe Rogan — pitch or pass? Jason: That was one I was gonna bring up. I want him on. Kathy: You want him on? Let’s go. Jason: Yeah. Kathy: Bring it, Joe. Jason: Yeah. I think it would be good because then he gets to see what’s coming. Kathy: Yeah. Jason: Right. Hey, Kathy: absolutely. Jason: This is how you die. Kathy: No, just enter the gauntlet.

[46:15] Jason: The PTCH Podcast just kind of steamrolls the Joe Rogan Experience, right? The JRE. There you go. So, yeah, I think let’s get Rogan on. Kathy: Let’s go. Jason: Yeah. Kathy: Okay. Okay, I got one for you. Jonathan Smith. Jason: Jonathan. Oh, Kathy: come on. Don’t you want to know what really happened at the end? Jason: You know, I’m not really interested. I don’t — I think I know enough. I’m going to pass. Kathy: All right. Jason: I pass on Jonathan. Kathy: But don’t you want to know the truth? Jason: I think I do, actually. Yeah. So, Kathy: so you don’t want to know the truth?

[46:45] Jason: No. No. I just — I don’t know that I could sit and do that interview and not ask some mean questions. Kathy: Okay. Jason: Which — I don’t have bad — I think he’s a great guy. I’ve met him a few times. He’s awesome, actually. Kathy: He was playing football at Oregon State whenever Mandy was dating a football player. So she knew him better than I did. Jason: Oh wow. Okay. Kathy: Not a bad guy, but man, there was

[47:15] some dicey stuff about that. Jason: Want to keep it positive. Want to keep it positive. Okay, Kathy: that’s fair. Jason: RFK Jr. Kathy: Oh yeah. Heck yeah. Jason: Yeah, let’s pitch it. Kathy: Let’s bring it. Jason: Oh, that would be great. I would just have so many questions and I could just — and then I could tell everybody basically everything this man answers — do the odds, right? Kathy: Okay. Along that line, Dr. Oz. Jason: Dr. Oz. Oh my gosh. Yeah. Oh, Kathy: we just had a cardiologist on.

[47:45] Jason: Yeah. So, I would say pitch. Kathy: Yeah. But with some reservations, because that guy — he just wants the spotlight. Jason: Yeah, he does. Kathy: Right. And so like, I don’t think that we could actually have a conversation with him. Jason: No. Kathy: He would just try and hijack our podcast. Jason: I feel like he’s a cartoon. Kathy: Yeah. Yeah. Right. Jason: He’s two-dimensional. Kathy: I think so. But imagine the views that we would get. Jason: Exactly. So Kathy: that would be a good one.

[48:15] Jason: What about Damian Lillard? Kathy: Dame. Sure, absolutely. Why not — Jason: pitch it? Kathy: Let’s pitch it. Jason: Yeah. You know, he’s back in Portland, so Kathy: I think — I would definitely love — if you’re listening, Mr. Lillard, we would love to have you on. Jason: I heard he’s one of our new subscribers. Kathy: I hope he is. Yeah. Jeez. Well, and so one thing that’s kind of interesting, one question that I would want to ask him is — the very first chiropractic patient’s name was Harvey Lillard. So I want to ask him — and Harvey Lillard

[48:46] was Black. Jason: What? Kathy: Yeah. And so I want to ask him like, do you know in your family history, is there a man named Harvey who miraculously got his hearing back after he got a chiropractic adjustment? Jason: So yeah. So Dame, if you’re listening, give us a call. We’ll even let you spit a few bars. You could do a little rapping on the show about the PTCH Podcast. Kathy: Okay. Jason: You got anybody else? I think this would be a great

[49:17] conversation. Oprah. Kathy: Oprah. Jason: I mean, that’s the unicorn of all the unicorns, right? Kathy: Yeah. I mean, if we could do like a PTCH Podcast favorite things episode. Jason: Yes, I would pitch her. Right. Kathy: You get a car. Jason: Yeah. You get a Hypervolt. You get a — yeah. You get WGO. You get a blood pressure monitor, right? Kathy: That’s right. Jason: All right. Okay. Elon Musk.

[49:50] Jason: Now, I got to pass on that. Sorry, that rolls my stomach. Kathy: Sorry. How about you? Jason: I think I would be interested. I’d be interested just because, you know, Elon’s not perfect, and but he’s done some amazing things. I would be interested, actually, in talking to him about Neuralink. Have you heard about that? Kathy: Which one’s that? Jason: Oh, Neuralink. They are actually installing like chips in brains.

[50:20] Kathy: Oh no. Jason: Which sounds like very scary stuff, but it’s also got a really bright side where the people who are testing it right now are people who are paraplegic. Kathy: Okay. Yeah. And so there’s a lot of really cool applications — like there’s some of these people that are able to control a wheelchair with their brain, and it’s changing some lives, making them better. And so that’s one of the visions that he has with it — like, you know, maybe you can control a prosthetic with it and

[50:50] things. And so I think something like that would be interesting to talk about. Kathy: But I also — that do it for you? Jason: It’s another thing where it’s like it’s a personality that’s so big that it’s like, are you just going to hijack the show? Yeah, definitely. Kathy: Which is basically everybody. Jason: Yeah. Yeah. How about — Kathy: Except for you, Dame. You’d be cool. We want you. Yeah. Jason: Absolutely. Okay. Kathy: What about Sydney Sweeney? Jason: Oh, Sydney. I don’t even know. First of all, I learned about her this weekend.

[51:21] I had no idea who she was. Why are we — what are we mad about? Kathy: Yeah. So, the Sydney Sweeney thing. It’s weird. So, Sydney Sweeney — I mean, she’s like, there’s some people that are just like, she’s the most beautiful woman ever, which — I think she’s okay. Jason: She’s pretty. Kathy: Yeah. Right. I don’t think that she’s ugly, but it’s like I mean, I’m not like, “Oh my gosh, Sydney Sweeney.” Jason: So, she did this jeans commercial, right? And the thing —

[51:52] was Sydney Sweeney has good genes. So there’s some people that are like, this is a statement about eugenics because she’s got blonde hair and blue eyes, and the implication — yeah, the implication is that if you look like Sydney Sweeney, you’ve got good genes. Kathy: Okay. Jason: It’s like, okay, I get it. But also, guys, come on, use your brains. Kathy: It’s a jeans commercial. She’s wearing a jean jacket. She’s wearing jeans, and it’s spelled J-E-A-N-S. And she looks how she looks,

[52:22] right? It’s like — she can’t do anything about the blue eyes and the blonde hair. It’s just — she’s got — and that’s a phrase that people use. Oh, this person’s got good genes. We use it about athletes all the time. It’s like, if you want to look at it as this is white supremacy and everything, fine — do that. But it’s like at the same time, come on. Kathy: Yeah. Jason: Come on. So, can she come on the show? Kathy: Absolutely. Jason: No, I’m just kidding. Well, I just — I don’t know what we would talk about. That’s a thing. Yeah. I think we

[52:54] would pitch Sydney Sweeney just because it might bring attention. It would basically be — I think the kids call it aura farming. Kathy: Oh, or clout chasing. One of those. Clout chasing. Okay. Jason: Yeah, that’s what we would be doing with Sydney on the show. I don’t really understand what she would be doing. Kathy: All right. Well, I think the pitches should leave a comment. Jason: Yeah. Pitches. Yes. Listen up, pitches. We want you to tell us who would you pitch or pass on the PTCH Podcast. So, leave that in the comments.

[53:24] That would be a really great thing to know. And if it seems like something we pitch hard enough, maybe we go out and we get that person. Kathy: Hey, maybe. Jason: Yeah. Or do you agree or disagree with any of our pitches or passes here? Kathy: Yeah, let’s hear it. Jason: Yeah, that sounds like it’s probably about time to wrap up there, Kathy. So, takehomes. Kathy: Takehomes. Let me think about what did I learn from you today. Jason: Now, this should be quick.

[53:55] You can be fired from your doctor. Kathy: Yeah. Jason: Mm-hmm. Kathy: Yeah. Jason: Don’t be a jerk. Kathy: Please don’t. Jason: It’s a low bar. Kathy: It’s not hard, right? Yeah. Okay. All right. I think my takeaway from what you said is that — and you really got me thinking about this — some of the things that we say are in the name of safety Jason: Yeah. Kathy: are not really there to serve

[54:26] patients. It’s there to serve systems, or people, or companies, and things like that. And it’s worthwhile taking a good hard look at that and figuring out what’s really good for — Jason: Yeah. Why are we really doing this? Kathy: Yeah. You got the wheels turning. Jason: Oh wow. Okay. I don’t know that that is going to change anything. So I’ve got very limited wheels. Kathy: All right. Well, as always, thank you so much for listening to this point. We would like you to like this, and we

[54:57] would love a subscription. Share this with somebody who you feel like needs it. Like, I don’t know, if you were listening and I had fired you — Jason: No, just — no, just kidding. Please stop listening. Kathy: He wants you back. No, but share it with somebody who can’t figure out why their doctor won’t talk to them, why they can’t get in to see a physical therapist. We’d love a review. I think we’ve done very well in subscribers. We have not done well in reviews — not that the reviews

[55:27] have been bad, but we just haven’t gotten very many. So big favor ask: please leave us a review. It matters. Jason: It does matter for us. Kathy: Yes. Okay. Well, I think I’m good. You got anything else to add? Jason: There’s one more thing. Kathy: What’s that? Jason: There’s no I in pitch.