“There is a whole person, with a whole bunch of body systems that are all implicated or affected in all of this, but who also exists within this greater community.
And we cannot discount any of those factors if we’re really trying to make a difference in the function, in the independence, in the quality of life in our patient.”
In this celebratory recap episode, Dr. Katie O’Bright breaks down common misconceptions about primary care PT, how it actually works in physical therapy, plus how you’re probably ALREADY implementing primary care principles in your oncology patient care.
Get inspired & practice better – LISTEN NOW!
Primary care PT is *not* just direct access
This approach makes rehab MUCH more effective
No one therapist can cover everything
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About Dr. Katie O’Bright
Dr. Katie O’Bright is a board certified orthopedic Doctor of Physical Therapy (DPT) who graduated from Temple University in 2014. Upon graduation, she served in the United States Army as a Captain & physical therapist, primarily working in a multidisciplinary Soldier Centered Medical Home.
She furthered her education in the Military Musculoskeletal Residency in 2017, at which point she obtained her OCS. After her time in service, she was the lead physical therapist at the University of Oklahoma’s Stephenson Cancer Center, a team-based clinical setting where she enhanced her skills working with individuals with complex needs. Dr. O’Bright moved on to another multidisciplinary primary care practice in Pittsburgh before starting her own cash-based practice.
Dr. O’Bright is a passionate educator who serves as adjunct faculty in several DPT programs. She is also the owner of Redefine Health Education, a continuing education company that focuses on enhancing the primary care and MSK imaging skills of physical therapists. Dr. O’Bright currently resides in the Greater Chicago area, and enjoys exercising and spending time outdoors with her husband, 2 sons, and Chocolate Lab. She dabbles in painting & veggie gardening, enjoys live music, and Buffalo Bills football.
Listen to The Primary Care PT Podcast on Spotify.
Follow Katie on Instagram.
Check out more from Katie at RedefineHealthEd.com.
Transcript
Elise Cantu (00:19)
Hey, Onco PT and welcome back to this birthday episode of the Onco PT podcast. Now, if you’re an oldie, buddy, goodie, welcome back. I’m so excited you’re here. If you’re new here, if this is your very first episode of the Onco PT podcast that you have ever listened to, welcome, my friend. It is truly a celebration, especially now that you are here, because this week, the first week in December, is when we celebrate our birthday over here on the Onco PT.
Six years ago, almost exactly to the day, is when I launched my very first few episodes of the Onco PT podcast. And this all started with this crazy idea that I had. So to kind of take you back, six years ago, I had just started practicing as a physical therapist. I was newly licensed. I had that brand new piece of paper with my name on it that said, you can practice. And I was so excited to dive in to start working with.
this very, very special patient population that we call our own, which would be patients who have some kind of cancer diagnosis or cancer history. And I remember walking into my very first day of work just so excited and the world was my oyster. And coming home from that first day of work was a completely different mood. I had actually cried on the job with my very first patient. It was a very emotional evaluation that I did.
This patient was dealing with a lot as many of our patients do and I just remember feeling like I had the rug pulled out from underneath me because despite having an amazing physical therapy school education, I had a wonderful clinical rotation in oncology. I remember feeling like I still wasn’t prepared. I still didn’t have the resources.
or know where to get the resources to be able to really show up and help this patient population. And now that I was out on my own, it was kind of scary. So I come home from work, I’m talking to my now husband about this, and he was like, whoa, whoa, this is a little over my head.
And so a few weeks later, I’m opening up some birthday presents and my now husband bought me my very first podcast microphone. And he said, I can tell that you’re really excited about this. I can tell that you’re passionate about this. I can tell that you wanna talk about this. So why not build a platform and talk about this on a platform so that you can.
not only find the help that you’re looking for, but also connect with others who are probably seeking that same information. And so again, fast forward six years to this day, we’re now here. We have over 300 podcast episodes out. We have many, many new ones coming in the new year that I’m so excited to share with you. But I thought what a great way to not only celebrate the milestones that you and I have achieved together over the past few years.
here on the Onco PT, but to also take a little time to reflect over the past year. This past year has felt pretty wild, to be perfectly honest, both personally and professionally, both in good ways and maybe not so good ways. And all of that is okay, because that brings us to where we are today and it shapes us into the person, the Onco PT that you are. And I think that’s really, really beautiful. And I know as someone who is always pedal to the metal,
going at 100 miles an hour, I need to slow down and I need to look back at what all I’ve done and what all I’ve accomplished over the past year if I’m really going to look forward and have a plan and a path for what I hope to achieve in 2025. So over the next few weeks in December, we are counting down the top five episodes of the Onco PT podcast as rated by the downloads by what episode was the most
downloaded, which episodes were the most downloaded, most frequently downloaded of TheOncoPT podcast. And we are going to recap them here because simply put, these episodes are too special and these guests are too amazing to not have a listen and get another dose of their wisdom and frankly, motivation and inspiration, especially in this episode. Now in this throwback episode of the Onco PT podcast, I interviewed Dr. Katie O’Bright, who has been a
frequent guest on the Onco PT podcast. And she also holds an extremely special place in my heart because we have been very much on our own business and practice growth journeys alongside each other. And I’ve really been privileged to watch Katie as what she’s doing and then take that kind of kick in the pants energy and apply it in my own life. So Katie, if you’re listening to this, thank you so much. First of all, for the inspiration and encouragement and support that you have provided to me.
Over the past few years, I hope that I am able to meet or exceed that level of support because you have been nothing but that for me. Now, in this episode where I interviewed Dr. Katie O’Bright as I’ve been talking about, we talked all about PT is at a turning point. And we talk about this a lot on the Onco PT podcast. But what I really love in this conversation with Katie is that we talk about kind of this. have, we’re at a crossroads.
We have an opportunity to keep practicing like we’ve always been practicing, or we can make a conscious choice and really show up for the full human person in front of us as primary care practitioners. Now, hold up before you get your socks in a twist. You need to listen to this episode if you haven’t already, because the action steps that Katie provides and frankly the resources.
that Katie provides on how to really leverage this in our own practice is absolutely one for the books. And you are gonna love this episode, my friend. So stay tuned for my interview with Dr. Katie O’Bright.
Elise – @TheOncoPT (06:03)
We have a very special guest today here on the Onco PT podcast. I’m so excited to have Dr. Katie O ‘Bright here back on the Onco PT podcast to really talk about what she’s doing over in her world, her realm of physical therapy, and really how it is so integral and how I think we’re going to start seeing more of this really implemented even within cancer rehab within Onco PT. So without any further ado, let’s welcome Katie back to the Onco PT podcast. Katie, welcome back.
Dr.Katie O’Bright @redefinehealthed (06:33)
Hi, hi everyone. Thanks so much for having me back. I really appreciate it. Let’s chat about primary care, what do you wanna know.
Elise – @TheOncoPT (06:41)
God. Okay, we’re going to start super basic because this is something that I think unless you’re aware of primary care PT, it’s kind of misunderstood. So what is primary care physical therapy?
Dr.Katie O’Bright @redefinehealthed (06:56)
Yeah, that’s a great, that’s just really a great place to start. So I’ll back up two seconds. I am Katie O’Bright. I am the owner of redefine health education. And I started my, my company with the physical therapist in mind that wants to move into more primary care practice. That’s how I started my career. And it’s really the best place to practice when you are integrated into a primary care team, whether that means that you’re co -located in the same physical workspace.
or whether you’re a part of a team, but maybe you’re not in the same workspace, but the concept of practice is such that the whole team is involved. And, and I just found like huge gaps with that, which is why I kind of started my business and kind of why I’m doing what I’m doing. I’m the education chair for the primary care special interest group. So we’re working on a lot of different things and, and, and yeah, that’s kind of just me in a nutshell, but to answer your question, what is primary care PT?
So I actually offer this presentation for DPT students and I’m about to offer it. I’m about to send this thing through the SIG to all of the APTA state chapters. And I’m gonna be like, okay, this is one offering where I’m gonna offer this presentation. Date not set yet, but it’s coming soon. Follow me on social media if you wanna know more about it. But it’s a whole presentation on what exactly is primary care PT.
as we are defining it. So there’s no specific accepted definition right at this moment. However, we are currently in the process of developing the primary care, primary care PT clinical specialization. So, you know, we have the board certifications in oncology, board certifications in pediatrics, neuro, ortho, all those things. Well, guess what? About five, six years in the making,
This clinical specialization is just about wrapped up and fingers crossed it will go to the APTA House of Delegates in August of 2025. So be on the lookout for that. So, but to answer your question, primary care PT is the concept of working with patients either in an integrated primary care setting or just as a first contact provider that has a close relationship with the primary care PT or excuse me, with the primary care team.
And we focus on all aspects of health that affect physical and functional health. So we’re not just evaluating patients that come in with shoulder pain specifically for their shoulder pain. If a patient comes in with a shoulder complaint, we’re able to look at their big picture, all of their health history, their family history, their risk factors, their lifestyle behaviors, their social determinants of health.
Elise – @TheOncoPT (09:45)
you
Dr.Katie O’Bright @redefinehealthed (09:49)
the population and the area in which they live, their access to care, their access to food, their access to mental health services. We’re looking at things big, big picture and then helping that patient, not just in an isolated fashion where we start with their shoulder pain and then we just work on their shoulder and then we discharge, I hate this word discharge, we discharge them and just never see them again. Or they have to come back and we have to start a quote new,
Elise – @TheOncoPT (09:55)
my god.
Dr.Katie O’Bright @redefinehealthed (10:19)
plan of care. Primary care PT is about having a revolving door relationship with a patient in conjunction with the primary care team. It’s not just exclusive to direct access, which means that you can see a patient without a referral, because you can certainly see a patient without a referral and not practice with this mindset 100%. But it’s about bringing the whole health aspects, you know, the population health considerations into play.
Elise – @TheOncoPT (10:46)
I love that.
Dr.Katie O’Bright @redefinehealthed (10:49)
not dialing into one practice area. So in the primary care SIG, we like to call our scope of practice is three feet deep and three miles wide. We are covering and understand the basics of care navigation, triage, risk factors, and all these considerations from everything from pediatric care. So pediatric to geriatric, so all ages and stages, and everything from
Elise – @TheOncoPT (11:10)
you
you
Dr.Katie O’Bright @redefinehealthed (11:18)
oncology, neurology, pelvic health, ortho, you know, all the way into health promotion, health and wellness and prevention and health promotion. So it can be a little bit of everything and it’s going to depend on where you’re at and what the goal of your practice is on how much or how little you deliver different aspects of those features of primary care PT. But that’s kind of what it is in a nutshell.
Elise – @TheOncoPT (11:50)
you Katie. So I didn’t really put it together until I actually like saw a post you did a couple weeks ago. But this is not actually a new thing. I think this is something that a lot of us, myself included, are very unaware of, very uneducated about. But now that I’m thinking about it, we actually did an Oxford debate our first semester of PT school in one of our classes.
And our topic was actually PT in primary care. And I remember our team absolutely got annihilated in the debate because we thought we were talking about direct access. Because at the time, Texas actually did not have direct access in any capacity. Now it’s a little more expanded. But we made that absolute confusion. And I think that kind of informed me for a few years of like,
Dr.Katie O’Bright @redefinehealthed (12:31)
Mm -hmm.
Elise – @TheOncoPT (12:44)
I don’t actually understand what primary care is. And so I’m so excited that you’ve really taken the lead on educating the masses on like, what does this actually mean? Because even in the definition that you just provided, that covers so much more than what I had even considered. And I’m obsessed with the fact that you talked about not just, you know, the person and what they’re experiencing in the silo of like,
that person, but also in the area they’re in, like geographically, population -wise. I mean, right now I’m just spinning my wheels thinking about like how much of that is not really considered in the context of physical therapy when like that is super, super important. So, my God, thank you so much for establishing that first of all.
Dr.Katie O’Bright @redefinehealthed (13:27)
you
Yeah, so on that note on population health, if you don’t understand if a patient has access to a safe home and workplace, somewhere where they can go and they feel safe and they feel comfortable and they feel
contrast, they feel entirely isolated. If you don’t know if they have the transportation means to come see you and continue to see you. If you don’t know if they have access to food and clean water and access to money and finances. And like just thinking about certain populations that I’ve studied in the past, there are some people that live in areas where the only groceries
Elise – @TheOncoPT (14:24)
Yes.
Dr.Katie O’Bright @redefinehealthed (14:27)
with processed food and no produce. And that’s the only thing that they have in like a 20 mile radius. Like that’s it. So you gotta know the population that you’re working with. And those are some screening items in particular that set apart the primary care clinical specialist from somebody who’s just performing in a direct access capacity.
Elise – @TheOncoPT (14:56)
We already established that primary care physical therapy is not just direct access, right? What are maybe some other misconceptions or misunderstandings that the average physical therapist has about primary care physical therapy?
Dr.Katie O’Bright @redefinehealthed (15:09)
Right, the other top one outside of the direct access thing is the fact that it is just isolated to neuromuscular skeletal. So when I think about a lot of the history behind primary care, PT comes from the military.
I was in the military, that was my first job out of PT school. And as you would suspect, the military does have a very high percentage of musculoskeletal, musculoskeletal injuries and, you know, chronic conditions and things like that. So primarily speaking, since 1972, I believe, the the
military physical therapist has been functioning in a role of physician extender specifically for neuromuscular skeletal complaints. When we translate that into the private sector, the public sector, you know, the non -federal world, if you will, it then becomes looking at how our movement system and how our physical function has been affected by all of these non -communicable diseases, including
cancer, including diabetes, hypertension, and atherosclerosis, chronic stroke, and even down to mental health disorders that prevent people from having the necessary means, both internal and external, to participate in functional care. So if you think about somebody with depression, somebody with
we know this now, that one of the first line treatments for depression and anxiety should be exercise. And that’s not something that most physical therapists or most of the general consumer, patient consumers out there, that they would know that a physical therapist can help guide them through that process. And again, that just circles back to like, that’s the role of what a primary care.
PT does, it’s not just isolating into this neuromuscular skeletal triage, it’s understanding the depth and breadth of how all of your body systems can influence our body’s ability to interact with our environments and our quality of life and all of the other, you know, morbidity and mortality factors that go along with that. So one example of this would be
So historically speaking, it was neuromuscular skeletal triage and care management. And to some degree, it still is that. It just depends on like, if you’re in, let’s say you’re in a co -located primary care clinic, and they’ve got a really high volume of musculoskeletal problems, it might be that you’re assigned to that clinic and your primary role is musculoskeletal triage. And you might not be able to handle any volume outside of that. But if you’re in a smaller,
smaller area with maybe a little bit lower volume, you might be considered the key functional, physical functional healthcare provider that can help patients across the spectrum. And one example of this that I love is, you know, a patient that comes in with a history of COPD, who just starts in a new role where she retired and is now working with her Meals on Wheels organization.
And this patient comes in with a primary complaint of neck pain. But when you actually go and you dig a little bit deeper, she’s getting her she’s on her body chart. And I know for those that are listening, her body chart is kind of pointing to like the anterolateral aspect of the neck, which when we think about that, we think, okay, is that a cardiopulmonary referral pattern? Or is that accessory muscle as accessory respiratory muscle use? And when is she getting the symptoms? And is it exertion dependent?
Because if so, what’s going on with her COPD that might be causing that? So then we have to think about how are we gonna manage this from a musculoskeletal perspective if it is those accessory muscles, but how are we also gonna look at, okay, when’s the last time that you talk to your pulmonologist about your medications? Are you desaturating with physical exercise? And if so, do we need just a medication adjustment or do we need supplemental oxygen? So we play such a tremendous role there.
And I think that in general, the general outpatient physical therapist is not really thinking about these things. Because I find that in our education system, cardiovascular and pulmonary is almost kind of reserved for acute care and inpatient rehab. And maybe a little bit of home health, but then we sort of fail to translate that into the long term. This is a chronic condition. How do we even look at this and assess it in management?
that in and of itself is primary care PT.
Elise – @TheOncoPT (20:13)
really liked. So at CSM in February, I attended a session that was led by Dr. Rebeca Segraves and this amazing team that actually were across disciplines, like not just within, like there was acute care PT. They had a patient perspective. They also had a doula and the conversation itself was around peripartum, cardiovascular, cardiopulmonary health and disparities. But
One of the questions after the session was done that an audience member asked is like, this is really important. Where do we talk about this in PT school? And immediately Rebeca was like, in every unit. Like we can’t just have, and I’m thinking back to my own PT school experience. It was like we had ortho and then we had neuro and then we had wound care. And then there was cardiopulmo over here.
And in actuality, we really need to be marrying those throughout because we don’t, or we shouldn’t just look at our patient’s shoulder dysfunction. And we see this, I think cancer rehab and OncoPTs are maybe a little more attuned to this, but I know I need to be better about this. We need to be better about this as a health community of like, we can’t just look at our person and see that they have.
left upper extremity lymphedema. Like we have to also consider that there are significant, and you and I just chatted about this, cardiopulmonary implications after their cardio and pulmonary toxic chemotherapy, and then the radiation that they received for their breast cancer treatment that are all focusing in this area. And it, like Rebeca’s answer, like I said, was just so simple, but so profound.
in so many different ways of like, we can’t just look at one body system in this person. We have to think about all of the body systems, but then taking it that step further of all of the body systems in this human who lives in a very dynamic environment and is part of a, maybe a family unit and maybe works or, you know, like the example you gave is a volunteer with meals on wheels. Like there is a, there is a whole person with a whole bunch of body systems that are all
implicated or affected in all of this, but who also exists within this greater community. And we cannot discount any of those factors if we’re really trying to make a difference in the function, in the independence, in the quality of life in our patient.
Dr.Katie O’Bright @redefinehealthed (22:47)
And by the way, that same patient that we’re talking about lives with her adult son with autism. And so that in and of itself is like she’s a care, she’s in a caretaker role and she doesn’t have anybody else that lives with her. Does she have any other? So what if it comes down to she needs supplemental oxygen and nobody else is really picking up on this? What does that mean for her? Her?
Elise – @TheOncoPT (23:01)
Yeah.
Dr.Katie O’Bright @redefinehealthed (23:14)
adult son with autism that lives with her and depends on her and relies on her. There’s so many different factors to looking at the, just the context in which a human being is living that are gonna affect their outcomes and that are going to affect our ability to work with them. So if you don’t start out by painting a good picture of what that patient’s life is like, and what I like to envision whenever I see a patient for the first time is I’m,
I’m literally creating this picture and I’m like, when I close my eyes, I can kind of see what their day is like from, you know, breakfast to bedtime. And what’s happening in between and you know, how much stress is there or how much happiness is there? How much joy? How much this and that? And all of those factors are going to tie into their risk factors and their ability to be successful with what you’re doing. And that’s going to tie into then your
your treatment plan and your treatment goals for them. So if you fail to do that, you’re kind of doing yourself a disservice, because you’re probably going to end up working a lot harder to try to figure it all out on the back end.
Elise – @TheOncoPT (24:28)
this excites me but it also gives me a little
anxiety. Here’s why. That is a lot. It’s a lot to consider. How logistically can we implement this into our practice? Because I want to be as excited as I am. I also want to make sure that we’re putting tools into the listener’s hand on how can you start implementing this more holistic whole person approach into your day to day clinical care.
Dr.Katie O’Bright @redefinehealthed (24:41)
a lot.
Mm -hmm.
Mm -hmm. Yeah, that’s a really good question. And it sounds overwhelming, but it’s really not because a lot of it you’re already doing anyway. What I do is I start out. So whenever I teach my primary care courses, I always start by talking about initial intake and you can use. So a lot of people have qualms with the intake forms. I get it. I do too. I developed my own intake form specifically to address and go hand in hand with what I need to collect in my.
in my interview with the patient and when I am receiving their history and all of that. So there’s not anything on my intake form that I wouldn’t, if they didn’t have time to fill out the intake form that I wouldn’t then ask in the session. Now, let’s say there are time constraints. Got it. We live in the real world. That happens all the time. People come late, stuff happens. So you can get patients that are not the cream of the crop with.
providing their history and can go off on tangents. I go on tangents too, I get it. So in the real world, if you don’t get to all of it on day one, make sure you’re getting to all of the stuff that’s really important. And again, that comes back to your triage. Does this person have anything presenting today that I need to address today or within the next week or two? And if that’s the case, so that’s like priority number one, all of the other additional lifestyle and contextual factors can come.
on visit two or in a follow -up or maybe when you’re drafting your note after the patient leaves and you’re writing up your evaluation, maybe you consider like, I really would like to know more about this. I have a section in my note where it says at next visit, and then I address so that I can recall everything that I need to go over. This is not something that all needs to happen on day one. It’s.
having the fundamental knowledge to understand everything that you would like to address in an ideal world, and then sprinkling it in throughout that course of care that you’re working with someone. People get really hung up on the fact that when you have an intake form, we gotta cover everything in the evaluation, and that’s just simply not true. I also, there’s some really weird, and I don’t understand how,
how this is, because I’ve never practiced this way as a PT and I was never taught this way fundamentally. But there, when I worked at this one clinic that was very short lived, very short lived, because I just didn’t work out, the culture was not working out. But they were like, okay, this is what you do in the evaluation, and you set up this plan of care, and then that plan of care must be followed. And they would track it. Like, if you write in the initial plan of care that the patient’s gonna be seen two times a week,
It doesn’t then become this autonomous like, if they don’t ultimately, you know, a couple of weeks down the road don’t need two times a week, then we adjust that. And because that’s what we do. There’s that kind of weird nonsense with that. That is not primary care PT. That’s just like a business model. And it’s not a sustainable one, really, truly. But I kind of just lost my train of thought because I was thinking about how bad things are along that way.
Can you remind me where we were going with that? I do this at least once a podcast.
Elise – @TheOncoPT (28:23)
Honestly, I’m just so distracted by how dysfunctional that is. Like.
Dr.Katie O’Bright @redefinehealthed (28:29)
It is. It’s true. It’s a very typical outpatient corporate metric that is tracked where they’ll look at the initial evaluation and if you set this frequency in a plan of care, then they want you to follow through with that for X amount of visits. And it’s very silly. It’s extremely silly. It makes absolutely no sense. It’s not… It’s bordering fraudulent in my opinion because then you’re touching into medical…
necessity. But that model does not work in anything that I’m talking about. It just doesn’t work. So that’s what I’m talking about is like just having the flexibility to adjust things with your patients over time and ultimately having that revolving door model. And let’s say you do work in the insurance world, totally fine. You can set up a physical therapy episode of care per whatever the insurance guidelines are.
But then please continue to offer the patients additional options outside of insurance that meet your, like how you wanna deliver their sustain, their enduring care. So if you wanna have wellness visits, if you wanna have touch points or booster sessions, please offer a hybrid payment model that doesn’t necessarily have to meet their insurance and at least offer it to them.
Patients are willing to pay out of pocket, especially as insurance is covering less and less and less. You’re gonna see it a whole lot. I don’t even know how we got to that Elise but it just bothers me, so.
Elise – @TheOncoPT (30:00)
Yeah. You know, and I think, no, I’m really here for it. And that’s one of the things I’m actually looking to do in my own private practice, which is like, you know, I’m obviously doing my one -on -one sessions, but one of the, my God, one of the big things I see in my world, and I’m sure in others, is balance problems. And so what I’m envisioning and what I’m working towards is like, once a week, I’m going to start doing a balance class.
group class, come on over, it’ll be like, I don’t know, five bucks or whatever. And then there’s a social component. There’s also working on obviously the balance part, which is a big deal. And that’s yet another way that I can ensure that I’m working with my patients on this. If nothing else, I might provide them an opportunity to structurally and supervisively get some of their HEP done. So I think, again, I think what I really, really like about the primary care,
considerations is a lot of this is what we talk about at Onco PT. We want to look at the whole person. We want to look at all of their body systems. For me, as I’m hearing Katie talk about this more of, you know, what are some of those other considerations even outside of that person that are crucial to consider? And I want to bring in something that a previous guest had talked about that really just layers in with what Katie’s talking about really nicely. You know, I’ve had Alex Hill,
pelvic PT on the podcast multiple times now. And we’ve talked about, you know, how do we have some of these hard conversations about, you know, pain and pooping and sex and all the things that people just want to cringe when we talk about. Maybe we don’t talk about that on the first visit, like Katie was saying. Maybe we talk about that a few visits down the road. But what a great opportunity to show the patient, you know, not just with pelvic floor dysfunction, but also the other things that Katie’s bringing up here. What a great way.
to demonstrate that we are looking out for that person and the whole person in the context of the world that they live in and what they have to do and what they need to do to get by, then to be asking these questions and to be having these conversations.
these things that this human has to deal with on the day in and day out of just trying to survive some days.
Dr.Katie O’Bright @redefinehealthed (32:22)
gosh, like you you hit the nail on the head like it because if we don’t understand if we don’t understand those factors about our patient and then we just sort of do like this. Oh, this would be best for so let’s say somebody had it like a tendinopathy Okay, this is what’s recommended for the tendinopathy. Blah, blah, blah, blah, blah, blah. This is how many times you should come in. This is what you should be doing at home. And if we don’t start thinking about what that patient’s home life is like, maybe they’ve got like six kids. Maybe they’ve got
Elise – @TheOncoPT (32:49)
Yeah. Yeah.
Dr.Katie O’Bright @redefinehealthed (32:50)
and maybe they commute an hour both ways to work. Is your, you know, tendinopathy program that needs to happen, you know, twice a day and it’s gonna take them 20 minutes to complete actually gonna work for that patient? Like, let’s think about that because in my world, as you know, a business owner, mom of two, wife, like lots of community stuff and school stuff going on,
Elise – @TheOncoPT (33:07)
Yeah.
Dr.Katie O’Bright @redefinehealthed (33:17)
There’s a lot of things that wouldn’t work for me that a PT, if I were to go to PT and they were to give me like a traditional plan or recommendation, I would be like, nope, can’t. I just don’t have the time. I don’t have the time. We need to focus on something smaller. And again, I’d say this all the time, do not hit patients with the kitchen sink, because nothing’s gonna stick. Focus on like the biggest priority at that time. But then again, in that…
Elise – @TheOncoPT (33:28)
Yeah. Yeah.
Dr.Katie O’Bright @redefinehealthed (33:43)
you know, at next visit or in subsequent visits, part of your note, you can reference back to the things that then become important. And including the patient in that process, you know, maybe you identify in your screening that a patient does have trouble with depression or anxiety. You know, maybe that patient, and you’re questioning, maybe that patient just doesn’t want to go down that road with you. And, but maybe as you continue to work with them,
Elise – @TheOncoPT (34:06)
Meow
Dr.Katie O’Bright @redefinehealthed (34:11)
And as you continue to identify like some of their barriers with, you know, program adherence or lifestyle alteration, then it might come out. And then you’re already aware of it. You already are kind of set up to provide them with not only your caring words and thoughts that you care for them and that you’re here for them, but also to set them up with resources that are going to work with them, whether that’s a therapist that can get with them via telehealth.
or somebody that’s in close proximity to their home and you already have all of those resources kind of like laid out and lined up. So you’re not blindsided when somebody is like, by the way, you know, so on your, on their intake form, maybe they circle something related to sexual function, but you don’t get to it on day one. And they come down and I had this happen to me. I had a man and we were sitting in the middle, the middle of a clinic, like where people like other patients were. And he was like, yeah, I just have, I just have all of this pain when I ejaculate. And I was like,
I was totally blindsided because I just wasn’t aware or I wasn’t tracking that I had forgotten about it. It was just something on the intake form that I forgot to ask about. And then I was totally blindsided and I was also like, I could sense that I was uncomfortable and I could sense that he felt that I was uncomfortable. And then it just turned into like, my God, I lost the therapeutic alliance with this patient. So layering all of those things out is really important to…
Elise – @TheOncoPT (35:31)
Yeah.
Dr.Katie O’Bright @redefinehealthed (35:36)
sustaining your therapeutic alliance with a patient. And again, that’s all coming back to your patient’s going to come back to you as their primary care PT.
Elise – @TheOncoPT (35:49)
so much how I feel like I feel like Onco PT is close. I feel like we have a good understanding of just how much the whole body is affected by cancer and cancer treatment. But I there’s more we can do like I’m just reflecting my own clinical practice right now. I’m like there is more that I can be doing to adopt more. It really is a much more proactive thinking.
Dr.Katie O’Bright @redefinehealthed (36:01)
Yeah.
Mm -hmm.
Elise – @TheOncoPT (36:18)
than what I think, physical therapy for a long time and still continues to be very reactive. And I think this really forces us to think more proactively, which is a shift. It’s an adjustment, but we really have to embrace this. What are some other ways, Katie, that we can kind of marry or meld OncoPT and Primary Care PT as we are working with our cancer survivors?
Dr.Katie O’Bright @redefinehealthed (36:24)
Mm -hmm.
Yeah, I mean, as you just said that I was reflecting back on and I don’t know if I said this earlier, but I spent a year at the University of Oklahoma’s Cancer Center. And after working in the military, active duty military for four years, that was such a big step for me. And it was an area where I was like, my gosh, like I and here I am like coming out of the military, like thinking I know a lot of things I had just gotten like my OCS.
And just thinking, I know a lot of things about a lot of things. And then I go in and my very first patient had, he came in with hip and back pain, but he had a large abdominal incision that was from a colorectal resection surgery. He had an ostomy. He had this, he had a wound back because the wound was dehissing and he just comes like strolling and he’s like, all right, help me out. And I was like,
Okay, I don’t know anything about anything about anything now and that setting, the cancer setting really helped pull all of the pieces together for me. And I was just like, because again, we’ve talked about this, cancer is something that affects all body systems. And it’s also something that not only from like a physiologic perspective, but from a psychosocial socioeconomic perspective, it also affects that as well.
Elise – @TheOncoPT (38:07)
Absolutely.
Dr.Katie O’Bright @redefinehealthed (38:08)
So internal and external factors are impacted by this. And that experience truly led me to learn more about how impactful exercise and therapy can be for individuals that are dealing with impairments and problems that span the spectrum of health.
And so I gained such a big appreciation for like the neurologic system and the cardiovascular and pulmonary system, the immune system working in cancer care. So I think if there’s any specialty that is well equipped to look at the big picture, it’s going to be your onco, population onco specialty. So, you know, round of applause for all of you there because you already have so much to think about and,
And so don’t ever, don’t ever think that it, you’re, that you’re missing something because nobody can cover everything. and everything does not need to be covered. So it just kind of depends on the patient in front of you and you just kind of follow this priority. you know, in order of priority with the things that the patient is presenting with. And I just think I’m very passionate about like just keeping the door open so that when things.
And I, again, I hate the word discharge. I don’t like the concept of discharging a patient. I think it should always be like a follow -up as needed or let’s check in in six months. and I get that the insurance system is a little difficult with that, but I think that we’re evolving. So to answer your question, which was how can uncle PT’s, you know, do a better job of this? I think you’re already doing a really good job of this. but then the, my only other addition would be if you know of in.
Elise – @TheOncoPT (39:39)
Mm -hmm. Yeah.
Dr.Katie O’Bright @redefinehealthed (40:01)
And maybe primary care PT doesn’t exist yet in the area that you work where you have a PT that either identifies as a whole health primary care PT or PT is integrated into primary care. My only suggestion would be if you are practicing in a cancer population, all your patients are going to end up going back to primary care at some point. So maybe offering to do some, you know, a presentation for your local primary care teams that a lot of your patients go to.
Educating on how you can help them throughout these processes and how maybe physical therapists of other specialties can cover down on some of the things that they may expect to see over time. I think just an increasing awareness amongst the primary care community is a really helpful thing. But then also amongst our local physical therapy community is a really big thing too, because I think.
a lot of these patients are probably going to like general orthopedic practices, PT practices, where the general ortho practices may or may not be well suited or well equipped to be able to meet their needs as well as you, the specialist can. So I think it all just comes back to like awareness and communication and, you know, driving home that community concept. I love all of those things.
Elise – @TheOncoPT (41:23)
I really like the community aspect that something that really resonates with me. And again, to kind of pull forward what Katie said previously about you don’t have to do it all either. This is where I really love, you know, I’m working with a patient right now who we’re working on, you know, different side effects.
related to her cancer and cancer treatment, but one of the things she’s really dealing with is the psychological implications of having a cancer diagnosis and going through that treatment and whatnot. And so what I’m able to do is leverage, you would really benefit from seeing the quality of life provider at the cancer center where you’re at.
Dr.Katie O’Bright @redefinehealthed (42:03)
Mmm.
Elise – @TheOncoPT (42:03)
I know who that is, I can help at least get you connected with that. So, you know, I’m screening for these issues, but then I know this is where my expertise ends, right? This is the line. I know who’s going to fill in and, you know, step up to that line and take it from there kind of deal. And I think that’s where we really have an advantage in Onco PT is we know.
very acutely that if a person is diagnosed with cancer, they are seeing multiple oncologists. They are seeing multiple other specialists as part of their care team during this process. And we are a part of that. And I think we really kind of have to look at that more in physical therapy as like, and I love you keep coming back to this, Katie, this primary care team, primary care team. Like we are a team in all of this.
Dr.Katie O’Bright @redefinehealthed (42:35)
Mm -hmm.
Mm -hmm. Mm -hmm.
Elise – @TheOncoPT (42:57)
and how can we leverage other team members in our greater community to really step up and fill in those gaps that the patient might be experiencing. my God, this makes me so excited, Katie.
Dr.Katie O’Bright @redefinehealthed (43:09)
Yeah, and that’s huge. And I also want to reiterate, so coming back to the team concept, I will always refer to it as such. I believe that we are all better together. I do not believe that PT can solve the world’s problems or patients’ problems entirely. I do believe that we need to work in the context of our community, whether we are able to be co -located in a physical space or formally be a part of a team in a formal way.
Elise – @TheOncoPT (43:38)
Mm -hmm.
Dr.Katie O’Bright @redefinehealthed (43:38)
Because you will just keep doing that. Just make it a part of your everyday thing. I’m a part of this patient’s healthcare team. Whether or not other healthcare providers on that team agree with that or not, it’s not your problem. Most of them are going to say absolutely yes, 100%. I don’t want you to get into the mindset that…
people are not going to want to do that, but I wanna paint a real picture here. And that’s the real picture of, you know, my current practice, I have a very small, you know, my full -time gig is, you know, education and doing this, you know, running redefined health education, raising my boys, et cetera. But I do have a small home slash mobile practice here in my hometown.
And one of the things that I run into because I am not co -located anywhere, I do not have a health system affiliation. I’m not a part of a unified EMR is when I call other offices, I get stopped, hard stopped by the clerk. And it’s like, all right, leave it, fax a note, leave a message. If we feel like it’s necessary, we’ll get back to you. And it’s like, dude, can I just please, like, please just let me talk to somebody and they will understand why I’m calling. And it’s like,
So you will run into that. And that’s a part of the way that our system works. Everybody is fricking busy. Like beyond especially primary care, this is part of the problem of our system. They see like 60 patients a day. Do they want to see that much? Absolutely not. They are so strapped for time. They’re so burnt out, which is why a lot of them are leaving. So please understand like their reality is not amazing either. And they probably do want to call you back, but maybe they just don’t have time.
Elise – @TheOncoPT (45:14)
No.
Dr.Katie O’Bright @redefinehealthed (45:28)
but the ones that you’re able to connect with, it’s like, my gosh, like, thank goodness. What’s the best way that I can contact you in the future? cause it took me a long time to be able to actually talk to you. And then in those circumstances, in my experience, I, they’re like, Hey, just text me whenever, like text me when you got a problem and I’ll give you a call. and that ends up becoming really, really, really helpful. So you are a part of that patients team.
and establish yourself as such. Don’t ask permission, don’t do this and that. You’re part of a collaborative healthcare team, but there’s a big culture shift that still needs to take place amongst all healthcare professionals, PTs included, that that team really does exist. And we need to be a part of facilitating that change. So,
Elise – @TheOncoPT (46:10)
you
Dr.Katie O’Bright @redefinehealthed (46:24)
In my opinion, don’t take no for an answer. Like you’re part of that patient’s healthcare team. You deserve to be, you know, included, respected, treated as such. 100%.
Elise – @TheOncoPT (46:36)
Have you ever heard of, you know, when you hear a no, it’s not right now?
Dr.Katie O’Bright @redefinehealthed (46:41)
Yes, yes. In fact, a couple of years ago at CSM, I don’t even remember what it was about, but I got up to the mic in one of the sessions, asked a question, made a comment. And then General, Deirdre Tehan, she’s one of, she’s the, like the first general of the SP Corps, like physical therapist, woman, amazing. She came up to me afterwards and she was like, you’re a shining star. I remember her saying this because like, it was like,
my gosh, this is like a, you know, God amongst us. Say, you know, like, I think you’re a shining star and she said something along the lines of, don’t stop. Don’t stop. When you receive no as an answer, no is just a temporary resolution to yes. And I loved that and I was like, yes, I love it. I’m going to keep going. And I hope that that’s motivation for everybody here because I think.
Elise and I were just talking before we actually started recording. Thank God that we can give each other the energy because the barriers that exist to prevent our profession moving forward are almost insurmountable. It seems sometimes, but you just have to keep going. It’s about grit and perseverance and about just being dedicated to this culture change and being dedicated to doing right by our patients and by, you know, our, our healthcare community.
at large. So yes, no is just a temporary resolution toward yes.
Elise – @TheOncoPT (48:14)
I love that so much. I have actually, so I keep this note on my desk and I moved it over here like the other day as I was straightening up. But it’s a quote by famous aviator, Bessie Coleman, which is, every no takes me closer to a yes. Which it’s so funny that, like I mentioned that in a podcast episode I did last week and it’s coming up again, which I think speaks to.
Dr.Katie O’Bright @redefinehealthed (48:17)
Love it.
Yes.
Elise – @TheOncoPT (48:40)
just kind of what’s happening right now in healthcare and this shift that needs to happen. It is happening in some areas. It’s not happening in other areas, but just, just keep going friend because you’re doing the good work out there. And man, I think this is why I have the podcast. It’s really to be amped up and encouraged and motivated by people like Katie. When the going gets tough and I’m disheartened and discouraged. And then I get on here. I’m like,
Dr.Katie O’Bright @redefinehealthed (48:53)
Mm -hmm.
Mm -hmm. Mm -hmm.
Elise – @TheOncoPT (49:09)
Yeah, Katie, yeah, let’s go. How can people connect with you, follow you, learn more from you on Primary Care PT and all the things?
Dr.Katie O’Bright @redefinehealthed (49:11)
Dude, same. Dude, same. Same.
Mm -hmm.
Yeah, okay, so I have the Primary Care PT podcast. So go ahead and have a listen to that. Lots of great episodes coming out, including this is actually me and Elise doing a swap episode. We just recorded her episode with me. I’m recording my episode with her and then we’ll send it out into the nether world so everybody can listen. So I have the Primary Care PT podcast. You can also follow me on social media at redefinehealthed. The only one that doesn’t have that is.
Elise – @TheOncoPT (49:45)
the universe.
Dr.Katie O’Bright @redefinehealthed (49:55)
X, which it’s hard for me to even say that. And that one’s at redefine con ed, because it was one character too long. I need to revisit that. You can email me. My website is redefine health ed .com. And that has all of our coursework out there. I have a primary care foundations for primary care PT course that we keep adding to adding layers to. We also have a musculoskeletal imaging certification.
Elise – @TheOncoPT (50:03)
Yeah, they’re dumb.
Dr.Katie O’Bright @redefinehealthed (50:22)
courses in rheumatology and all different like specialty topics along the primary care space. Just content that is generally less well served by, you know, your general ortho courses and your general neuro courses. We try to like bring out those different, you know, other primary care considerations into our coursework. So redefine health ed .com and yeah, so one of those places you’ll be able to find me.
Elise – @TheOncoPT (50:50)
my God. And we will of course link to all of that in the show notes for today’s episode. Katie, I can’t thank you enough. I’m so glad that we did our episode batch recording because I felt like you amped me up over on that, on your podcast, and then you come over here and just drop all these pearls on my podcast. Like it’s such a good way to, I think, get reinvigorated and re -ignited in the passion of like…
let’s go out and change the world. And we’re not all gonna change the world at the same time in the way that we want to, but it really comes down to you could potentially be changing that patient’s entire world for the better. And we have a responsibility to do that. And it’s through leveraging this holistic whole person perspective that I think primary care has a really.
Dr.Katie O’Bright @redefinehealthed (51:19)
Yes.
Yes. Yes.
Elise – @TheOncoPT (51:40)
solid strong grasp on that we need to pick up more of. And I’m just really excited about that.
Dr.Katie O’Bright @redefinehealthed (51:42)
I am too, you and me both. Thank you so much for having me. I really appreciate it.