Why is this section called ‘The Daily Ship’? It is my effort to ‘ship’ my work on a daily basis. I have a lot of insight to share and the best way to convey this (as well as get better at my craft) is to ship my work every day. Here is my effort to stay consistent and provide insight into Physical Therapy Delivery, Health and Longevity, and even Entrepreneurship.Enjoy…
5.20.21 – The Transition Is The Audition.
When it comes to entrepreneurship, not many people realize that you will have to work much harder than you do at your regular job. When you work for Company X, all you have to do is show up, clock in, and perform your assigned task(s). You don’t have to worry about marketing (unless you are in the marketing department), customer acquisition (unless you are in the customer acquisition department), website design (unless… you get it) , financial management, or employee training.
The reality is that you have lots of extra time when working for someone else. You can clock out, return home, and start your side hustle. In between playing with the kids, making dinner, and watching TV, you can make your knick-knack and post it on Etsy. That thing will sell within a week (because you are awesome) and voila… a quick little profit.
If making knick-knacks isn’t your thing, maybe you spend 30 minutes on your blog, providing consulting service to your client, or walking the dogs on your block for extra money… all for a small time commitment and similarly small payout. The tricky part is when you decide to stop spending your time making money for Company X and start spending more time Hustling for your Last Name.
There is a magic tipping point where you are making almost as much money on your side hustle as your main job. It’s magic because then you can seriously consider quitting the 9-to-5 and focus solely on your Business, your Passion, your Company. Getting there is tough though, it requires extra time, extra effort, and a monumental sacrifice of most of your creature comforts: no more TV, a bit (or a lot) less sleep, no more going out on the weekends. You have to ‘Make It Happen’ and that is difficult.
It quickly becomes overwhelming, you are working twice as long and doubly as hard. Then you start to question if it is actually worth it? Or if you should give up and settle for the comfort of a job with set hours and a reliable but limited income.
Welcome to your Audition. If you can’t cut it now then you may need to reconsider because entrepreneurship requires blood, sweat, and tears for years before you get your glory… but the glory is worth it. Push through and embrace the struggle, embrace the grind and embrace the roller coaster of emotions. In the end, not only will you have built something on your own but you will see it grow and reward you far beyond what your 9-to-5 ever could.
Welcome to the Game.
5.13.21 – Balance 102.
In Balance 101 I detailed the three causes of impaired balance, here I’ll show you how you can improve your ‘inner sense of balance’ by training your vestibular function. The vestibular function is very intimately connected to the movement and tracking ability of your eyes. This is called the Vestibular Ocular Reflex or VOR.
The VOR serves to stabilize images on your retinas while your head is moving. The vestibular organ (inner ear) does this by sending signals to your eye muscles to make small adjustments in an effort to keep your view steady during head movement. Without it our vision would blur every time we moved our heads, impairing our sense of balance and leading to higher fall risk.
As mentioned in ‘101’ there are multiple reasons why this reflex gets impaired or slowed, not the least of which is normal aging. The good news is that we can train the reflex to keep it sharp.
- Sit at the edge of your chair with your back straight and hold your arm straight out in front of you, making a ‘thumbs up’.
- Slowly turn your head left and right while keeping your eyes locked on your upright thumb.
- Increase speed of your head turns until your vision starts to blur.
- If and when it begins to blur, slow down (but don’t stop) until you can see clearly.
- Increase speed again until your vision starts to blur.
- Repeat multiple trials until you can increase speed without blurred vision.
- Repeat with vertical movements.
- Assume same position as before, with arm outstretched and thumb up.
- Without moving your head, switch your gaze from the top of your thumb to a mask on the wall approximately 10-20ft away.
- Return gaze to thumb.
- Repeat eye movements faster until vision blurs or you get dizzy.
- Slow down but don’t stop, then resume speed.
Performing these exercises daily will train your Vestibular Ocular Reflex and help with maintaining your balance. They are safe to do on your own without the need for assistance. I tell my patients that they are simple yet powerful. It is definitely a different form of exercise from doing a squat or a lunge, but it the right tool for the job. In the next entry I’ll talk about ways to improve balance through your feet.
5.12.21 – Balance 101.
We all get our balance from three sources of input. If any of these systems is challenged, we rely on the other two to compensate. Oftentimes we aren’t aware of a deficit in one system because the other two do such a good job picking up the slack.
The first is visual, what our eyes can see. It is much easier to maintain our balance in a well lit room versus in the pitch black. Similarly, we challenge our balance every time we close our eyes.
Commonly impaired by:
- poor vision/need for glasses;
- Poorly lit room
The second source comes from our feet and their ability to feel the ground and report back to our brains. Somatosensation and proprioception tell us if we are on a flat surface or rocky surface, how our weight is distributed, and what angle the ground is at according to the level of bend in our ankles.
Commonly impaired by:
- Diabetes (or neuropathy from any source)
- Cold feet / Reduced blood flow to feet
- Shoes with poor support
The third input comes from our inner ear. In each ear resides a vestibular organ with semicircular canals that send signals about our position in space directly to our brain (Imagine a carpenter’s level but more complex).
Commonly impaired by:
- Ear infections
- Use of antibiotics (and some other meds)
- Head injury/impact
- Normal aging
- Don’t ignore your poor balance. Whether you are 20 yrs old or 80 yrs old, one bad fall and its ‘curtains’ for you.
- Keep walkways well lit during the day and install a bathroom nightlight.
- Avoid standing or walking with your feet touching each other, a wider base of support will provide more stability and internal feedback about where you are standing.
- Wear your glasses
- Ask a therapist how to compensate for ‘Vestibular Hypofunction’.
- *** I’ll be writing about this next***
5.11.21 – Selfish > Lazy (Story Time).
As a Home Health Physical Therapist I visit many different neighborhoods. I’ve never felt in danger but I definitely know which part of the city I’m in whenever I get there. Last week I needed coffee so I went through a McDonalds drive through in an especially rough area.
The pot holes in the street were bigger than some of the cars, the apartment buildings were in disrepair, and there was evidence of homelessness whichever way I chose to look. The car in front of me was occupied by a woman locked in verbal combat with her kids over an issue with Happy Meal toys. (I could here everything clearly even though I was in a different car.) It was an area that most people would typically shy away from if given the choice.
I got to the drive through menu and a low and flat voice said ‘go ahead.’
Me: “I’ll have a medium black coffee please.”
(I wait a few seconds)
Me: “Did you get that?”
So I pull through. The lady ahead of me passed a handful of cash to the attendant while her kid simultaneously threw a little toy truck out of the passenger window. She storms out of the car, picks up the truck, get in slams the door and peels off screaming.
I pull up and say ‘hi’ to the cashier… He looks right at me, says nothing and holds his hand out. I give him the credit card, he scans it and hands it back without looking at me.
‘Thanks!’, I say.
He says nothing and closes the window.
OK… I pull up to the next window where the aforementioned lady was just screaming her head off.
I put on a smile and say ‘hello’ when the guy opens the window to hand me my coffee. He looks sincerely shocked at my greeting and says ‘hi, sorry about the wait’.
I told him it was no problem and to have a nice day. He told me to do the same and was smiling when I drove away. He literally leaned partially out of the window as I was inching away to say ‘have a nice day’.
In the middle of a terrible neighborhood, surrounded by angry people, a simple smile and a kind word can shine like a light in the fog and kindle happiness and a sense of togetherness.
The second guy got that. I get that. Even if you only do it for yourself, smiling is contagious and kindness spreads.
The first guy… I think he was lazy. It wouldn’t take much to put on a smile, or even to utter a kind word. Especially when it’s your job to interact with people. Even if he didn’t mean it he could have been selfish and tried smiling for his own good. Or acting differently in a self-serving effort to entertain himself. Even that would have been a welcome distinction.
At that point I wasn’t happy to be there, but a modicum of kindness made a lot of difference to both myself and the second guy.
Was it selfish on my part? Did I smile with intentions aimed at them or at myself? Doesn’t matter. In this case selfish turned out to be way better than lazy.
5.10.21 – Authentic Strength.
For slightly over 6 months I’ve been training in calisthenics. I’ll be honest, at first I thought that work meant jumping jacks and toe touches. Man was I wrong…
Roughly 7 months ago a new guy joined our gym. It was hard to ignore him when he was the only guy in the gym doing handstands, hand stand pushups, muscle ups (look it up if you don’t know), and pull ups with 180lbs hanging from his waist.
All impressive feats that caught my eye but hadn’t yet made me want to explore it. I was happy doing squats, bench presses, deadlifts, and curls. Now let me paint you a picture… I’m 5’11” tall, I weigh 175lbs and I used to be an amateur bodybuilder, I still have the basic shape. This guy is maybe an inch shorter, visually narrower, and probably wouldn’t catch your eye in a quick glance.
One day I was finishing up at the gym and went up to the bathroom to wash my hands before leaving. Handstand guy had finished in the shower and was shirtless in the locker room. He was chiseled: Abs, full chest, rounded shoulders, traps, and an admirable muscled back with a significant v-taper. Holy shit.
I went home and did a bit of Google-ing about calisthenics.
Calisthenics definition: “Gymnastic exercises to achieve bodily fitness and grace of movement.”
OK… but what else?
Well, it turns out that Calisthenics played a big role in how ancient warriors and the Famous Sparta Warriors trained. That makes sense, they didn’t have modern training equipment yet they are known to be at the peak of physical strength and agility. Walking weapons who were visually and practically imposing… now I’m more interested.
I made a basic plan and changed my training, I also quickly befriended Handstand Guy (whose name I learned is Chris). One day I saw him doing bench press and deadlifts. I asked him about that, ‘I didn’t think you did the basic lifts?’ He said something real interesting. He explained that he uses some of the ‘basic’ exercises as supplemental movements to build strength for the classic calisthenics moves. He then said this:
‘I’ve never weight trained. I started calisthenics a couple years ago and now I find that I can do everything that you all can do with equal weight, but you all can’t do what I can do’.
Now Chris is a very kind person and those words on the screen probably come off as self-absorbed but he presented it matter-of-factly with no mockery. It didn’t take much thinking to realize that this was absolutely true. He was benching more than most of the guys in here were able to. He was deadlifting more than most of the guys. Nobody in the place was able to hold a handstand with good alignment, let alone maintain balance while performing multiple handstand pushups. Nobody could rip off 10 strict muscle ups or do multiple chin ups with the equivalent of a large man hanging off his waist.
Since that realization I have trained almost exclusively in Calisthenics and realized first hand that this shit is way harder than he makes it look. It involves building immense ligament strength, an iron-clad core, more flexibility than I’ve ever had, Superman Shoulders, and incredible amounts of strength… Authentic Strength.
Plus, after decades of training I’ve found something new and endlessly interesting that challenges me in new ways. It is a huge thrill to learn a new skill and realize I now have control of my body in ways I never explored before. It doesn’t hurt that this training is yielding a significant level of improvement in my physique and overall gravitas. The unexpected thing is that I’ve even incorporated some of these principles in my therapy practice.
In another entry, I’ll describe how physical therapists can utilize Spartan Training when rehabilitating the geriatric population.
5.7.21 – No Reason Not To Own A Business.
I am from Ohio and live here currently but I have lived in Atlanta, GA and also Fort Worth, TX. When I was in Texas I owned a cryotherapy clinic called Celsius Cryo Spa. We had a physical location in a busy area with lots of traffic. I owned it for 2 years before selling it and returning to Ohio for personal reasons. We sold for a profit and walked away. That profit was modest. It helped us finance the return home and gave me a few months where I could tend to family without having to work, but it is gone now.
Flash forward to today and I own 3 businesses. Rehab Revolution is the only one that is traditionally profitable (so far). However, each business allows me to lower my tax burden and keeps a LARGE percentage of my income in my bank account instead of in Uncle Sam’s greedy palms… legally.
What I didn’t know back in Texas was that the tax code is designed to incentivize people to start businesses/create jobs/contribute to a productive society. The rules are written to allow us a break if we are adding value to the community around us. If you can do that, then you are legally allowed a tax break for things like education, marketing costs, a percentage of your home and utilities, any meal you eat while discussing business, travel expenses, the cell phone you use to conduct business, the car you use for your business, and many more business-related expenses.
With this in mind, there is no excuse not to start your own business. Whatever you currently do for your job, you can also do as a side hustle. Are you an electrician? Start a local service to fix peoples faulty light switches. Are you a teacher? Start a tutoring business. I could go on and on.
Setting up the business is cheap and easy. You can research how to do it online or you can reach out to someone who has already done it. Guiding you through the process is a piece of cake. After that, hire a tax professional to do your taxes at the end of the year and give you some guidance throughout. You’ll pay for their services but you’ll save more money than it costs and you can write that off too!
5.6.21 – A Simple Way To Work With Retropulsion.
Retropulsion is a tendency to lose your balance posteriorly, or backwards. Often it is associated with postural instability and a loss of postural reflexes as we age or as it relates to disease (Parkinson’s). Another cause that I happen to have seen a lot lately is CVA (stroke). Here, a persons sense of balance and proprioception (joint position in space) is disturbed due to the insult to the brain.
There is a simple way to work with this that I have been having a lot of success with. I will have the patients simply stand on a wedge. I have a semi-soft balance wedge that looks like a big piece of cheese. I assist them to stand on it at the tip of the ‘cheese’ with their heels on the thinnest part and their toes angling up toward the thickest part. This puts them in a position to be tilted backwards and they must subtly shift their weight forward to avoid falling.
It is very difficult at first and requires hands-on assistance to achieve a sense of balance, but with practice they can stand still on the wedge and eventually perform other tasks while on the incline. This seems to reset their positional sense and diminishes the tendency for retropulsion.
Another way is to sit on a chair and scoot to the edge. Position your legs wide and place an oversized bouncy ball (you can find in the kids section of many stores) on the floor between your feet. Reach down and grasp the ball with both hands before standing up. This promotes the sequence of leaning forward and keeping your weight shifted anteriorly during the sit-to-stand movement.
These are two examples of relatively simple ways to address a seemingly daunting impairment. If you or your loved one has suffered a stroke, has Parkinson’s, or any other form of retropulsion, these are interventions that you could try at home. Of course use common sense and be sure you are able to support them if they lose balance.
5.5.21 – Averaging Down.
Something that I’ve been thinking about lately is a particular aspect of Investment Strategy called ‘Averaging Down’, and I’m trying to look for parallels in my businesses, my family life, and in general.
If you’re not familiar with Averaging Down, here is my (admittedly simplistic) way of explaining it: Lets imagine you bought 1 share of Rehab Revolution Stock at a price of $100. At this price you make a profit at anything above $100. After a week of holding it, the price drops to $50. Shit! You took a heck of a loss, right?
WRONG… for two reasons.
1.) You didn’t lose money unless you sell your share and lock in that loss. You still own the same amount of equity in the company regardless of price.
2.) If you have done your research and TRULY BELIEVE in the company, this presents an opportunity.
I’m assuming you believe in me and my company so you decide to buy another share at $50. Now, you own two shares and your average price of purchase is $75. Therefore, you only have to see the price rise above $75 to see a profit.
Assuming you have researched well and believe in the company/investment, Averaging Down can be a powerful tool.
Surely there are parallels… how does this apply in my life? my business? my relationships?
5.4.21 – The Gift Of Presence And A Documentation Sandwich.
As it turns out, the Secret to Happiness is also the secret to being a good physical therapist.
We are told ‘Carpe Diem’, ‘live in the moment’, and ‘be present’. This is all good advice for husbands, fathers, brothers, friends, and physical therapists too.
In the 21st century, there is insidious ‘villain’ who steals our attention… technology.
I’m a father of two young girls and of course I love to play with them. There will come a day when they don’t want to play with me, so I’m enjoying this while it lasts. But the following happens way too often: I’ll be on the floor playing and one or both of them is doing something cute. I’ll reach for my phone to take a picture. I take the picture, then check the picture, then notice I have an email, then see there was a missed text message, then I think that I should put the picture on Facebook to show everyone the cuteness. Then I hear, “daddy will you play with me?”
“I am playing with you, dear”. Let me just put the finishing touches on this post… “daddy, will you play with me?”
Kids know when they don’t have your full attention. It literally makes A WORLD of difference to put your phone in another room and give them my undivided attention.
I see an obvious parallel in Physical therapy. Patients know when you are there for them and when your nose is buried in your work tablet. This seems obvious but we are also being pressured to complete Point of Service Documentation. In theory, this is a good idea: you start and finish your documentation while with the patient. However, we do A LOT of documentation and to complete it all while with the patient demands too much of our attention, attention that the patient needs and deserves.
To combat this I create a ‘Documentation Sandwich’. That is, I document before knocking on their door, and after I leave their home.
When I arrive at a patients house I immediately pull up the note and fill in all the (redundant) demographics and environmental questions. I finish as much of the note as I can before I even see the patient (remember, you can always go back and change something if new information arises). Hopefully this only leaves the objective measures, interventions provided, and assessment.
Upon seeing the patient I take vitals and record those, but the rest of the visit my tablet is in my bag while I attend to the patient and their needs. They have my full attention and they know it.
After completing the visit and exiting the house, I re-open the note and use the voice-text feature to record interventions provided, patient response, and assessment.
The Documentation Sandwich Method has allowed me to thrive as a Home Health Physical Therapist. It addresses two notorious concerns in home health: 1) It allows me to provide personal and intimate care where I give my complete attention and can work generously for the patient. 2) I do ZERO documentation at home. When my work day is done, it’s done. I go home and give my full attention to my wife and kids.
I train my employees to do this and I encourage you to try it.
5.3.21 – The Telehealth Movement.
Covid-19 has changed our world in many ways. This is true globally as well as locally. Physical Therapists had to adapt and change like everyone else. The rise of telehealth and virtual visits has fundamentally changed how we deliver services… or has it?
With telehealth visits there is obviously no hands-on treatment. No measuring, no palpating, no tactile cuing, and no massage. You would think that would severely limit our treatment options and more importantly, our outcomes.
Remarkably, we are finding that is not true. In one study published in the National Library of Medicine, the researchers looked at a cohort of 3883 telehealth visits over a period of 2 months. The study reported that 94% of patients were satisfied (based on a 5 Category Satisfaction Survey) and 92% said they would attend telehealth therapy again.
It makes me think… we can have the same success with our patients by delivering knowledge and direction over an internet connection and empowering them to take control. Sounds a lot like the mission statement of Rehab Revolution.
5.2.21 – It Doesn’t Have To Be Like This.
Is there rule that says you have to hunch over as you get older?
I feel badly for the generation prior to mine (I was born in ’84). Nearly everyone I encounter says some version of ‘it’s just part of getting older’. Well, that’s bullshit.
To my knowledge, there are 2 clinical studies that link genetics with spinal curvature/kyphotic posture. One was a twin-study that acknowledged its results may be inflated due to the congruity of the twins’ lifestyles. Another study found that slightly over 50% of people with Kyphotic posture inherited it, but then went on to state the genetic variable was actually paraspinal muscle size. TRANSLATION: Folks who have genetically smaller (and therefore weaker) paraspinal muscles tend to develop forward posture.
Side note: Vertebral fractures and disc degeneration accounts for only 12% of people who have kyphosis.
The solution, as I see it, is to educate the population that this is largely preventable and reversible if addressed early on. Mild amounts of targeted exercises can go a long way towards preventing postural decline and the cascade of subsequent problems.
Just like we all know we shouldn’t smoke, we also all know that we shouldn’t sit and be lazy. Yet here we are… most folks sit a lot. By choice or for work purposes, we sit a lot. I’m guilty of it too.
Here is a summary of what happens: Our hip flexors get tight and pull our pelvis out of alignment; our spinal musculature goes on vacation because they don’t have to work when you are sitting in a chair; our pectorals/chest muscles get tight from sitting and tighter from typing with forward-rounded shoulders; our rhomboids/middle back gets lazy as we slouch in our comfy seat; our scapula adopt a protracted position due to the tight chest and lazy rhomboids; our neck muscles (sternocleidomastoids and scalenes) get tight as we stare forward and downward at our screens; this forward head posture creates anterior translation and shear forces on the cervical vertebrae and leads to Dowager’s Hump (look it up).
Phew… that was a lot. Put it all together and you end up looking like the Hunchback of Notre Dame.
This is solvable! You are not doomed, there is no rule that says you must succumb. Simply stand up, strengthen your back muscles, stretch out the tight ones that I listed, and move your body. Instead of working hard at your desk job only to come home and collapse on the couch or recliner, exercise the aforementioned muscles for 10-15 minutes. Even if you are in the 50% of the population who is genetically ‘doomed’ with weak spinal extensors, you can strengthen them. I promise it is science, not magic. If you don’t know what to do or where to begin, contact Rehab Revolution and we will get you started on a program.
My big hope and the mission of Rehab Revolution is to change your thinking from ‘helpless-victim-of-aging’ to an empowered understanding that you have more control than you think.
5.1.21 – How Do We Thrive In An Age Of Abundance?
I think the answer lies in the notion of Gift Culture.
We truly live in an Age of Abundance. Almost anything you can think of, you have a LOT of it (or at least access to a lot of it).
- Food can be found at any corner or even delivered to your door.
- TV/movies/music/literature all reside in your pocket computer (aka cell phone).
- (Too much) Information is readily available via Google, Twitter, and Facebook.
- I’d even argue that money can be abundant since there are plenty of ways to hustle some dollars from your couch.
So what can we place value on? What more is truly unique? A commodity? Even a rare occurrence? Unfortunately the answer is kindness/gifts. If you can find a way to Gift someone with your kindness, then you can thrive.
Remember it’s not a gift if it’s paid for, but the kindness and sincerity with which you deliver services IS a gift.
Everyone wins with a gift:
- The receiver is genuinely appreciative due to the gift’s rarity (kindness is something that is no longer abundant in our society).
- You get to feel like you actually made a positive impact in the receiver’s day. Everyone likes to feel important and you are definitely important now that you’ve contributed to their day.
- Also, the Universe tends to reward charity with more of the same.
Here’s an interesting analogy:
If you have a $100-bill and you clutch it and won’t let it go, there is no room for anyone to put another bill in your hand.
Similarly if you hold onto and don’t share your kindness, people will see that there is no room to give you any kindness.
4.30.21 – EVERYTHING We Do Has Value.
There is value and purpose in all of our actions, the difficulty comes in recognizing our true audience at any given point during the day.
Eating (selfish), having conversations (generous or selfish), checking your email generous, selfish, or lazy), holding the door for someone (generous or selfish), even sitting on the couch watching TV (selfish or lazy) has value… to someone. Are your actions generous, selfish, or just lazy?
Selfish actions are not inherently bad. Eating is selfish, that should be obvious and there is nothing wrong with that. We need to eat to survive and this is true for many other things, but we sometimes turn what should be a generous act into a selfish one. When the Physical Therapist stops attending to the needs of the client and simply shows up to get the job done and get out, that is selfish. When the Nurse doesn’t really listen to the what the client is saying and dominates the conversation in an apparent effort to demonstrate his/her knowledge or feel a sense of superiority, that is selfish. Selfish actions can feel right and good in the moment
Lazy actions are dangerous. They can be selfish: like when we walk past the trash on our floor instead of picking it up. This is a selfish conservation of energy and shirking of responsibility. When the physical therapist assumes his/her clients blood pressure is within normal limits and omits the vital sign assessment. That is lazy and dangerous. We should strive to avoid lazy actions so that we don’t find ourselves on a slippery slope.
Generous actions are how we serve others. Cook dinner with care and love for the benefit of your spouse’s and kids’ enjoyment. Hold the door for someone with a smile and kind word so they know you are giving your extra 10 seconds to them and not just holding it out of a sense of forced duty. Listen to your clients and respond to what they are telling you. Meet their obvious needs but also the underlying need to be heard and reminded that they are a person and not just a patient. As a physical therapist, do your Work for the client and not for the paycheck. You’ll find that acting this way is generous to them but also generous to yourself.
4.29.21 – The Difference is the Human Connection.
“People will never forget how you made them feel.”
That is part of a famous quote from Maya Angelou. It has been co-opted by countless others in the arenas of sales, marketing, and psychology. It applies equally as much to Physical Therapy, or any healthcare discipline really.
This has been the not-so-secret ‘Key’ to my success as a Physical Therapist. I say not-so-secret because I’ve done my best to teach all of my cohorts this concept. I was a clinical instructor when I lived in Texas. I would receive students from graduate programs and teach them how to deliver PT services. From Day One I would implore them to talk to everyone like a friend first and like a patient second. Don’t change your tone of voice and don’t condescend.
I have served as Program Director at an inpatient rehab facility. I tried to lead by example and let my team see my treatment and interview methods as often as possible. Currently I train new employees for the company I work for and I train employees of my own company, Rehab Revolution. My message remains clear: ‘Your patient must like you if you want them to do what you ask.’
It helps to remember that every patient you meet used to be like you… healthy, vibrant, and independent. Go back further: Every patient used to be a child, playful and full of energy. They never imagined they would have a limb amputated due to diabetes or that they wouldn’t be able to walk across the room because of congestive heart failure. Every one of these people is an actual person, deserving of empathy, respect, and friendship.
If you let them know that you still see them as an interesting person despite their debility, then they will follow your instructions to the letter and get better clinical outcomes. This is how we truly make a difference and how we work generously instead of selfishly.