Lessons Learned: David Otey, CSCS

Hello everyone, I'm Dr. Darsha Shah, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined, a podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Hey guys, welcome back to another recap episode in which Darsha and I will discuss the key takeaways from our conversation with David Ote. You know, David and I go back to undergrad and it was really good for me to catch up with him, but more importantly, learn from him because he has had tremendous growth and experience over the past 10 years or so. So I really enjoy this conversation and I hope you will too. But before we get started, just remember that this episode is being brought to you by the Doctors Unbound Podcast. Check out the show for fascinating interviews that share how physicians are making an impact outside of the hospital or clinic, whether it's founding a health tech company, running for public office, or starting a nonprofit, tune into the Doctors Unbound Podcast for weekly stories that will uplift and inspire you. And if you're interested in financial literacy and independence, Dr. Dave regularly covers those topics as he and his family are on their very own journey of achieving FI with short term rentals, subscribe to Doctors Unbound for free wherever you listen to your podcasts. Now with that further ado, here's the recap with David Ote. All right, everyone, welcome back to Medicine Redefined here with another episode of Lessons Learn and this time from none other than David Ote, ultimately what were some of the takeaways where you want to start with this, because honestly, this is what episode that I would tell listeners, and I'm not trying to set us up for failure, but to go and listen to the original, because David just did such a fantastic job explaining so many different concepts. Yeah, I mean, you know, it was definitely exciting for me to catch up with him. You know, obviously he's grown so much since the last time him and I touched base, but it was really exciting for me to learn from him. You know, he's there in the trenches, so to speak, and seeing patients, clients, athletes on a daily basis. So he knows what works and what doesn't work, right? He's in the coaching world very much. People talk a lot about people in today's day and age where you have social and you have internet and all that stuff sitting behind a computer and kind of critiquing a lot of other folks. I think we all kind of fall into the traps now and again, but you know, he's again seeing what works and what doesn't work. So just getting to pick his brain, seeing what he's learned was really good. Yeah, absolutely. And so, you know, the first thing, so I asked him a question saying, what is something that 99% of people in the fitness industry would not agree with you with? And I was caught by surprise, actually. I mean, you know, more than me, you know, being a strength coach and all, but him saying that deadlifting, you know, is not necessarily for everyone, which makes a lot of sense given that anatomically, we're all very different, right, femur length, tibial length, arm shoulders, you know, all that, all that stuff, everyone is so different. So, but when you look at every single workout program, at least that I've looked at, deadlifting is like a mainstay, right, it's one of the core exercises that we're essentially taught to do as layman to increase our strength, post to your chain, et cetera. Yeah, definitely. I think that probably for me, I was a little bit more familiar with that. That's for sure the case. I'm one of those people again, you know, I had some back issues in my life, I've beat myself up. You're in the same boat as I. And I don't do straight bar deadlift anymore, you know, it might be a Romanian deadlift or straight leg, which aren't locked ever if you're doing it right. But for me, trap arms the way to go, just, you know, when you're talking about risk-reward ratios, it's just not, for most people, majority of the people is just not there. So again, you know, you're, I think, as an athlete and the wisest you get over the years, you try to, you want to minimize the risk of injury, right, and you want to maximize the result of potential or performance enhancement. So, you know, that's kind of been my philosophy as I've gone more towards rehab side for even explosive movements. I think a lot of towards the back end of my coaching career, you know, when we were trying to get explosiveness from athletes, it would really be more about box jumps and those types of things rather than Olympic lifting stuff. Because yeah, Olympic lifting stuff is fun, but the technical aspects of the lift are so skilled that, you know, you're not getting the same reward and the learning curve is so high. So yeah, I mean, that one didn't surprise me. I think the one thing that I've started to learn and, you know, when I listen to a lot of folks who are much more mature in the field than I am, it's more than I am, they're always talking about being more of a generalist before you become a specialist. In medicine from the very get-go, we're thinking about, you know, how am I going to specialize or, oh, okay, you're going to do medicine and then what? And then what? Same thing right now, PM and R, now I'm subspecializing in sports medicine. And the quote that stuck with me that he said, you know, you want to have command where there is high demand and there's high demand in having general fitness, being well, well rounded, right? I mean, I think most people can appreciate that in other aspects of life, but that's the case in fitness as well. And then he talked a lot about how this system is so complex. For us going through functional anatomy and biochemistry and just drinking through the fire hydrant through medical school and we sometimes lose sight of that, just a whole approach of how complex it is and how much we little know, how much, how much, how little we know exactly, sorry, I'm still shaking off that apple pie that I had last night. But for us, both of us, that comes back to the whole osteopathic roots, right? The tenets of structure and function being interrelated and so that was refreshing for me to hear. Yeah, absolutely. And I think going along that point when we're in medical school, learning about anatomy, I mean, I had an MSK block at VCOM because we're drinking from the fire hydrant, just just so much knowledge and information coming towards us, it's tough for us to sometimes break it down and realize that not everyone is made up of the same muscle and bones, right? But as we go through our medical training, we just take what we've learned and we apply it to every single individual, every single patient. And that's not necessarily the best way to do it. And then he kind of David Otay went down the route of individualization and how every single client he has is made up differently, right? And he said the only thing in 99.9% of humans is the instinct to survive. And that's literally the only thing that makes us similar, but everything else from diet to fitness to, you know, our ratios in terms of our arms and legs, everything, everything is super different. So what makes us think that, and he gave the example, ultimately, you could have a slice of pizza, maybe burn it off, but then for me, you know, I'll ask, hey, how come I can't do that? Well, I made up totally different than you, right? So I think- Which couldn't be further from the truth because I cannot have a flight of pizza and- Oh, I can't either anymore. That's why I think- Last night Thanksgiving dinner was a little rough for me, a little too many carbs, but- But yeah, I mean, it's just- it's so true, and I think for us in the medical field, and I think the theme that we're seeing in every single episode here that we're doing is individualization, personalization, how do we get the right information to the client or to the patient that's best for them? And, you know, I brought up the- you- I brought up the idea that I do intermittent fasting, and it came down to self-experimentation for me. I really had to go through about now three years of different forms of fasting and really figure out what works best for me. Yeah, absolutely, and, you know, on that note of individualization, and then again, talking about the classic barbell deadlift, right? You asked him at one point, obviously with your history, you know, if you had some issues there with the back and somebody told me, okay, deadlifting is just contraindicated, never again for you, right? Which now we know better, and obviously people who are actually doing it, and I think there's a lot more physicians who are appreciating the value of exercise and are getting more into it, and so they know for themselves what, you know, what actually entails when we're talking deadlifting, and there's tons of variations. But I still see this so many times, right? So on the inpatient rehab side, we often get people after back surgery, who it'll be like, okay, can't lift more than 10 pounds. I don't understand how I'm supposed to discharge somebody, and for the next six weeks, they can't lift anything. You know, how many things in just natural life way more than 10 pounds? So, you know, things I think are getting better in the regard a long time ago when people would have back pain, it would be okay, immobilization, and just laying bed. Now we know that's not the case, right? You know, your red flag symptoms aside, you try to get early mobility, it's going to be better. Early mobility, the ICU is better. Early mobility with this COVID situation, people in the ICU is getting better. But the point that I want to make with that is, especially when somebody has knee pain or has back pain or has shoulder pain, just contraindicking exercises 100% for that patient without looking at context. It's so important. Like for instance, the classic example is, I remember I've talked about Eric Ressie quite a bit because I just do think that he's such a smart person. You know, he, the example he gave is, you know, he tore his cuff back in high school or something because he was kind of an elite tennis player, and he has no issues bench pressing. He's been a power lifter, like putting a 400 pounds bench press, but he can't do overhead presses. You know, the same respect, somebody could have labial pathology in the shoulder, and, you know, they can't do, they can't do bench press, but they might be able to do shoulder press. I mean, again, there's so many nuances to that stuff. It's so important to understand. And that's where it comes so important to do an appropriate assessment on every single person and understand the context and understand, you know, the biomechanics of the exercise. And so my favorite quote from him, I've quite a few, but this one says, we should contraindicate people from exercises, not exercises from people. Right? And that's, I think in my physicians, we often tend to do that. And somebody's like, oh, your knee hurts. Okay, dead lives bad or life squats bad, lunging is bad. Right. Maybe you're not right for lunging. There's no exercise that's bad. And that's what I tell patients to be like, oh, what do you think about squats? What do I'm like, no exercise is bad, just as some people aren't set up for it. Right. Yeah. That makes a lot of sense. I think this could lead us into my next takeaway where we had a conversation about science and research and, you know, how we're starting to learn way more than we ever have about exercise science and weightlifting and muscle building and fitness, but it just takes forever. But it takes forever because it can sometimes just be so difficult to get the right sample size and doing the right research. And we all, like, said the same thing that great research and great science takes time. It just does. So what are your kind of thoughts on that? Yeah. I mean, that's a difficult one. It has been for me for a long time. But at the same time, I think that in our profession, it is important, right? We do have to come from a science background because I think that there has to be a higher level of accountability. I'm not to say that strength coaches, physical therapists, all those, are we obviously David is one of those people who has who holds himself accountable and his colleagues accountable. I think the difficulty always comes is for me, it goes back to rule number one, do no harm, right? In the case for osteopathic medicine, this is the case for whether it's orthobiologics or acupuncture or cupping, whatever it is, you need to be able to understand the anatomy, the physiology, the pathology well enough that whatever treatment or intervention you're doing does no harm first and foremost, because that's our rule. And he said that, right? Even though he's not a physician, he said that you as a trainer are the most frequent healthcare advocate, right? And your rule is to make sure this person stays healthy for the long term. So if you are going to do some type of exercise or treatment or invention that isn't, quote unquote, rooted in science or has tons of meta analyses behind it to be able to support that that's part of the treatment protocol, you better be able to explain it and you better understand what the risks and benefits are and then have that discussion with the patient. You and I have talked about this before, what traditional evidence based medicine means versus what evidence based medicine truly means is the triad, right? So I mean, that's, I think that's always going to be a difficulty in our profession, but I don't think it has to be a limitation if that makes sense. Right. Yeah. No, absolutely. Completely agree with that. So that kind of, so the next takeaway that I really took from him was, and I've never seen anyone do this, but he calls up his patients or clients', client's doctors to figure out what exactly, you know, might be recommended from that doctor. And so I just, I thought that was super cool and I, and as you mentioned, and as he said, that trainers and fitness trainers are pretty much seeing these clients on an almost everyday base. There are at least three times, right? They're the face and the front line essentially for their client's health. So it's very important to talk to the client's doctor and kind of figure out, hey, what is recommended? This is what I'm seeing from my end. What are you seeing from your end? Yeah, that, yeah, that kind of blew my mind because it's not like a crazy out of left-field concept. It's just like, why are we not doing that more? It's just a sign out. The simply, that's where it is. And I think that, you know, I think some of it probably has to do with ego. Some of it probably has to do with not even being aware, maybe not even being aware that the patient has a trainer, maybe patients involved in a class because you're not asking questions. How often are people during your history and physical? I do my very best because I'm passionate about it, but we ask, hey, what's your exercise like? What's your diet like? Right? So if you never asked a person what their exercise is like, they might not disclose that they're see a trainer unless that they're there for shoulder pain and they got hurt and that's what the dysfunction is. That's a limitation. So I think that's part of it for sure. But yeah, I know that's one of the things that I'm going to start doing ASAP. I got to make a time. I have to make time for that because, you know, again, some of the other things that we've talked about, you have to practice what you preach. But also, if at the end of the day, patient is priority number one and you're in it because you want the best for the patient, then you're going to do that sign out. I mean, there's been ACGME rules back and forth about 24 hours, 16 hour shifts and this and that. And it's all what rooted on signouts and making sure a handoff is appropriate for patient safety. Why is this any different to me? It's not absolutely. Absolutely. And there's a great book by Ron Epstein called Attending. It's about mindfulness actually for physicians and how we can be more mindful and more present with our patients. And one of the things he talks about is spending the extra 15 to 30 minutes on the front end, even though it's going to take up more time, but doing your due diligence to making sure that this patient's taking care of will save you hours on the back end. And I think we all talked about how our goal shouldn't be to keep this patient with us for years and years. Our goal should be, hey, we got you fixed up, you're a free bird now. You've learned everything you needed to know and come see me, you know, if need be. But I don't want you to come see me every month, every two months. That's not the goal of what a physician should be. Absolutely. Yeah. I love that, man. You know, another thing that I remember, which actually was surprising to me, I think that in today, with the world, how 2020 has been, and COVID and everything, obviously small businesses have taken a huge hit, right, the financial impact this whole pandemic has had on us. And I've got a lot of friends who are trainers and have their own small businesses and they've kind of suffered. And so I think that you and I are fortunate that we've had a job and we don't have to worry about our income taking a hit, but not everybody can say that at the same thing. But when he was talking about it, you know, he was saying that to make that point home about, hey, patient is a number one, they're number one priority. So he was saying that if somebody is compromised, immunocompromised or lives with somebody also might be immunocompromised, and you're asking them to come in, I mean, that's such an ethical dilemma that both of us can appreciate because our job, you know, it's not, we're needed, right? We're not losing our job any time soon, hopefully. But these trainers can't say that. I mean, you know, it's a very difficult decision to kind of come to terms with that and say, hey, you know what, we're going to cancel your sessions because I'm concerned about you, you know, however you feel about like the whole pandemic thing, but so it just goes back to that priority number one for me, do no harm and for him to take it that step, like I'm going to, it's like a very self sacrificial, but at the same time, it's really so freaking hard, you know? So that one was kind of crazy to me because me being a physician, I've had these, these friends and stuff that I had who were trainers, they asked me, what should we do, should we cancel, should we not, should we make our sessions virtual? And honestly, my response more than once has been, listen, man, I think the doctor and me says that yeah, we shouldn't have small gatherings and all that stuff. That's why I didn't see my family for Thanksgiving. But I can't, I'm not in your, in your shoes, I don't know what it's like to take a 50% pay cut. Yeah. Yeah. You know, so that one was kind of mind going to me, but also pretty awesome. Yeah. It's a tough time and I don't know, I don't know, we'll kind of see where it all goes, but hopefully everyone listening here, staying safe, being safe, staying smart as well, and hopefully it'll go away soon. The next takeaway I took from Dave was, you talked about goals, right? Patients have a lot of goals and sometimes they're so minute and it's essentially the trainer's job as well as the physician's job to kind of tease out what really matters in that patient or client. So he talks about how everyone has five pounds to lose, right? And then we lose that five pounds. And then what do you do from there? No one's ever satisfied, he says, oh, I have another five pounds to lose. But are those five pounds that you need to lose worth the stress, worth the waking up and trying to figure out everything to the exact science and he always talks about why do we start fitness in the first place, right? So he started 14 years ago, I started probably around like 16 or 17 years old. You started around that age as well, I think, right? It's why do we start fitness in the first place? It's not necessarily to hit a number, he says, it's not necessarily to hit a certain fat percentage. It's because you want to become fit overall and whatever that means to somebody, whether it's stronger in general, better aesthetically looking, a little quicker, maybe more agile, maybe a little bit sport specific. But I think as we go down this journey, we often get a little too nuanced rather than looking at the big picture and saying, hey, I'm here to just kind of move, get some movement in, get fit and do what I can overall in a general picture. Yeah, I probably would have been smarter to start at 16. I started lifting when I was 13 and benching three times a week because, you know, more is better logically. My shoulders are jacked up, that's why, but I digress. Yeah, no, all that note, you know, his coaching philosophy, when I asked him how to get people to buy in, I mean, you and I have talked about this so many times, that's what I'm trying to refine because I think that's arguably the most valuable thing I think after getting all the information down, putting it in practice. This is the most important thing because we're in the business of dealing with people, and they're out, and he just simplified it and said prioritize the people. That's how simple it is, you know, and then it's all about habit coaching, but just give them a routine, give them one habit, and give them context too. Again, going back to the idea, not only with injury, but the example that he used was with children, you know, giving context, get them to buy in tremendously. I think the challenging part, sometimes we don't do it, obviously, time sometimes can be a limiting factor in clinic, but also we have to be educated enough and well versed in the topic enough that we can simplify it in layman's terms for the patient, and be able to field any questions the patient might have, because that's how patients are really going to buy in. If you tell them, do X, Y, and Z, and you don't address their follow-up questions of why X, Y, and Z are so important, and what implications they can have, it's very unlikely that the patient's going to be compliant about it, and in the same sense, you know, checking your ego at the door was the one thing he would tell himself when he was, I guess, a teenager. Yeah. You know, again, I've talked about this throughout the trail, everybody that I've talked to is, you know, I've learned just as much from my non-physician colleagues as I have from physicians, you know, professors in medical school and stuff, taught me a lot of awesome things, but at the same time, so have people like Dave and, you know, licensed massage therapists and those type of things, and so after at the end of the day, he said, when you strip everything down, you strip away the certifications, the medical degrees and all that stuff, at the root of it, we're all just people, and we can connect there, right? And so that's, to me, he's talking about having empathy. What more, what's more valuable as a physician to having empathy with your patients, right? That one, again, was good for me to kind of reflect on as well. Yeah, absolutely. And I think, you know, talking to Dr. Simone Maven in our first episode in our day of day, common theme is that physicians are also coaches, and it comes down to changing behavior, right? Behavior modification, slowly but surely, not just saying, like you said, X, Y, Z, but giving them context and helping people understand the why behind things, I think, will really resonate with patients. So cool. Anything else? Yeah, you know, when I talk to all these people who I think are smarter than I, I'm just trying to figure out what the similarities are between what they're saying. And I asked, I remember, we asked Dr. Maven, what her definition of functional training is, and then we asked him, or I don't know if we asked him, but Dave talked about how his goals have changed, went from being wanting to be a 400 pound bench, or whatever the example of, I don't know who he gave, whose femurs were Boeing, and he was like, how many they're going to die, and the crazy example, yeah, that was wild. But he was talking about, we exercised too, so he can translate to everyday activities. I mean, that, to me, is the pure definition of functional training. And if you remember, someone said the exact same thing. So I thought, obviously, that was cool. And I think in a nutshell, that explains it real well. The one thing I did want to caution to people is I went into physical medicine or rehab. Again, a very similar background and, you know, like Dave's doing now, that's exactly what I was doing essentially. But what I went into medical school, I wanted to do non-operative sports medicine. And that's when I found PM and R, because I believe that a lot of these pathologies that we see could be treated non-surgically, and they can, but at the same time, you have to know the role of surgery where it's appropriate. And not everything can be, and I kind of had this mentality in the beginning when I was young and naive, and I was like, oh, yeah, you know, it's surgeries, and that's in the serious surgeon unnecessary, but that's not the case. So like the classic example would be, you know, 17-year-old, who maybe has a peripheral meniscus tear, because it's traumatic, you want to get them to surgery, because today in meniscal preservation techniques are very, very good. You're not going to heal that non-surgically. Now obviously orthobiologics and biologic augmentation has a different role, and that's a different discussion. But this is exactly where the medical knowledge and keeping up with that's important too, and learning from surgeons. So if you're a non-surgical nature, you can learn a lot from surgeons as well, and vice versa. So definitely want to say that, because again, like I said, if you had talked to me seven years ago, I would have been like, nah, surgery is not necessary, and that's not always the case either, so. Yeah. Definitely. I'm kind of still in that mentality, right? So I need to, that's something that I need to learn and grow on, and as you know, I continue down my medical journey here or something, I'll definitely gain more knowledge with. So. Awesome. Cool. All right. All right. Yeah. That was an awesome lessons learned. A lot of nuggets in this episode. So again, guys, this is definitely one where I think you might want to check out the full hour and a half, because me and Allsmosh were mind blown to say the least. But thank you again for checking out another episode of Medicine Redefined, and we'll keep coming at you guys with some more. Thanks. Until next time. That's a wrap on the show. But want to again, share how you can find the Doctors Unbound Podcast on your podcast app. If you have a minute and you're not driving, look the podcast app on your phone that you're listening to this show in, search for Doctors Unbound. Click subscribe, and that's it. Thanks for supporting fellow physicians as they pursue incredible lives out of medicine. See you there. Alrighty, everyone. We really hope you enjoyed this episode of Medicine Redefined. Just as a reminder, everything in this episode is for general information only. It does not cost you the practice of medicine, and we are not providing any medical advice. No patient physician relationship is formed, and anything discussed on this podcast does not represent the views of our employers. If you got value out of this podcast, please, please feel free to subscribe, share, rate, and review this podcast, and be sure to send it to your loved ones so that they can also be on track as 2021 approaches. Let's put the health back in health care.