You need to know their goals. The patient’s goals will drive the treatment! Is there a goal to reduce the pain in the knee so they can sit for work, or is their goal to recover from an ankle sprain to get back to playing collegiate level basketball? The #1 thing we can do is understand their goals, this drives the treatment strategy, the virtual strategy, and ultimately determines if we are the right fit to help this patient.
One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?
In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. Kellen Scantlebury.
Dr. Kellen Scantlebury received his Doctor of Physical Therapy degree from Stony Brook University in 2013. He received his bachelor’s of science degree from LIU Post, where he also was a four-year starter on the Men’s Basketball Team. Upon graduating from Stony Brook University, Kellen’s passion for health and fitness pushed him to start Fit Club Physical Therapy. Fit Club is an orthopedic physical therapy and sports performances clinic that specializes in helping active New Yorkers get back to their goals.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
I identify as a doctor of physical therapy, an entrepreneur, an athlete, a father, and a husband. These are all adjectives that describe me and can help provide anyone with some context as to who I am. I often am told by my patients that I look really young. Some don’t believe that I am the owner of the company or they question my credentials because of how “young” I look. It always makes me laugh a little but also always serves as a reminder that I have something to prove every day!
I got started in the health industry after a long career as an athlete. I broke my foot as a senior in college playing for a nationally ranked Division II school and that was my first experience with physical therapy. My doctor at the time was also young and really understood my goals and the level of competition that I was looking to get back to. He successfully pushed me to get back on the court that season and we ended up going to the elite 8 and finishing the season as the second-best team in the nation. That experience opened my eyes to the field of physical therapy and I haven’t looked back since.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My favorite life lesson quote is “Make Better Choices Consistently”. I didn’t get it out of a book, it actually was something I said to a family member and it stuck with me. It’s kind of my mantra right now and has really been instrumental throughout the pandemic and quarantine. It’s easy to make the right choice every once in a while. I used to be like that. I would make a good decision, something that was great for my company or family, and then feel like I could slack off and afford to make more hasty decisions. What I have found to be instrumental in my success is having these choices build on each other for a compound effect! This has helped with momentum and buy-in, two things that I feel are needed for any successful business in 2021.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
I do have a specific person, I will not mention them by name for the purpose of this article. This person actually screwed me over and provided me with the biggest blessing at the same time. I was renting space for my practice as part of a sublease originally and the individual who I was subleasing from ended up really screwing me over. I had a “Launch Party” for my company on a Friday afternoon. We had a dj, the drinks were flowing, decorations, photos, and videographer, we had it all. I was so excited to have gotten the business off the ground and running and wanted to share my excitement with all the staff and the community.
That Monday following the weekend I was called into his office. I was thinking maybe he would congratulate me on the party or let me know we got a little too carried away but was floored when he told me he was terminating the sublease and I had 30 days to move my practice. After okaying the Party and fully understanding why I was hosting it. I had 2 full-time employees who worked for me a part-time coordinator, and hundreds of patients that just celebrated with me and now I had the embarrassment of this moment, something that was completely out of my control and not my fault that was causing me to have to call into the question my business.
Those 30 days were filled with stressful nights, bitter feelings, a 14 day trip to Europe, and a lot of searching to find my next home. The one thing that I did, kept going. I never gave up hope, and always had a deep belief that things would work in my favor. With some help, I was able to find the perfect space for my practice and we have been successful in helping many New Yorkers achieve their health goals. This unfortunate event that happened to me forced me to be uncomfortable and have to take a huge leap of faith. One I didn’t think I was ready for but I had two options, sink or swim. I have been performing “swimmingly” well since then and look forward to the opportunity to continue to help people in the best city in the world, NYC.
Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?
As a physical therapist, there are some distinct advantages to having the patient in front of me. The main one is I can touch and feel the patient. We use touch to determine muscle tightness and strength, we use touch to see if there are knots present in certain muscles or if certain parts of a tendon are painful or tender to the touch. We touch to assess “endfeel” of a joint or how limited a joint may feel when approaching the limits of its range of motion. These are some of the main advantages for our genre of health in having the patient present in front of you for the evaluation. This combined with their subjective information is helpful in forming a diagnosis and plan of care moving forward.
On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?
There are some unique challenges to telehealth or Virtual Rehab as we like to call it at Fit Club. Wifi, noise, space are some of the main issues we face when performing these virtual sessions. Some of our patients are in the mountains upstate and their service is poor. The connectivity can be a limiting factor for this kind of medicine. With parents and kids both being home, working from home, and going to school from home, noise can be a limiting factor. We don’t all have big houses here in NYC so having 4 people in a 1 bedroom apartment can get a bit noisy. Wireless headphones are a big + for our virtual sessions for this reason. Lastly, space is a challenge for many New Yorkers. Many people have a space big enough for them to eat, sleep, and wash. For physical therapy we require patients to move, walk, squat, plank, all this requires space. These are three of the main challenges that I have endured during the virtual rehab and telehealth phase of our company.
Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)
The 5 things you need to know to best care for your patient when they are not physically in front of you — — Physical Therapy Edition!
1. You need to know their goals. The patient’s goals will drive the treatment! Is there a goal to reduce the pain in the knee so they can sit for work, or is their goal to recover from an ankle sprain to get back to playing collegiate level basketball? The #1 thing we can do is understand their goals, this drives the treatment strategy, the virtual strategy, and ultimately determines if we are the right fit to help this patient.
2. The second thing you need to know is what equipment they have available to them. Based on the equipment available I can come up with specific therapeutic programs for the patient. If the person only has bands we need to develop a plan of care with bands. If the person has a gym set up we can add some different movement patterns because they have more available to them. Once you know what the patient has available to them you can reverse engineer the best treatment strategy to help them with their specific goals.
3. You need to know their expectations of the treatment. Not all telehealth is the same, not all virtual appoints are made equal. What we do is figure out the expectations of the patient, then we reset them, then we exceed those expectations! If someone isn’t expecting to squat on camera then they won’t be wearing the most appropriate clothing to allow them to perform the movement pattern with the full range of motion. We set the expectation of what to expect prior to the first virtual rehab session to make sure our patients come prepared and we do not waste time during our/the patient’s sessions!
4. The 4th thing you need to know to best care for your patients is their tolerance for virtual appointments. Some patients want the virtual appointment because it fits best into their schedule. Some patients choose virtual because they are looking to protect themselves and their families during the quarantine. Knowing where your patient is on this spectrum can be vital for long-term care. Many of our patients start off virtually and transition to in-person once we reach a certain threshold of recovery. Knowing whether your patients are comfortable to be treated in-person at some point or if they prefer to stay virtual allows you to best plan for the short-term and long-term goals of your patients.
5. The last thing you need to know to best care for your patients is their general interests. You want to be able to connect with your patients, zoom fatigue is real and appointments can get stale with poor communication between provider and patient. We see patients multiple times a week virtually so we need to be able to reduce the virtual fatigue by keeping the patient engaged. Knowing about their interest whether sports, arts, or family can help move the appointment along and make the experience more memorable for the patient. Your patient will talk about their experience with you, you want that banter to be positive!
Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?
Telehealth or virtual visits allowed us to help our patients in a time when it was frowned upon to be in contact with other human beings. During the height of the quarantine our patients were all moving less, were stressed, and for many patients with orthopedic injuries, decreased movement and added stress is counterproductive to their rehab. Virtual appointments allowed us to keep in contact with our patients and do what we do best, analyze movement! I don’t need to be in front of you to examine your hip hinge pattern, I can do that through the camera on my computer and provide feedback in real-time to my patients to help them achieve optimal movement strategies for rehab. This allows me to make sure patients are engaging the proper muscles and doing so at the right time.
This was evident when I was working with a patient who was suffering from low back pain. As part of their rehab process, it was important to teach them proper core bracing exercises and techniques. This was easily able to be done through zoom and the patient was able to use my cues to perform the desired movement that would help her. Instead of having to wait for months for an in-person appointment or risk getting infected, she was able to get the help she needed without having the pain potentially get worse due to inactivity and poor sitting posture at home.
Virtual appointments also allowed us to help many more people than we typically would help. Virtual appointments opened up doors for us to help patients across the country. We had patients in California, South Dakota, Arizona, and Florida. Typically these patients would seek the help of someone local but because of our expertise, brand, and the fact that we offered virtual appointments these patients choose to keep their appointments with our team in a virtual manner. This was huge for us during the height of the pandemic!
Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?
My belief is that the technology itself is the most effective tool. Being able to mute a room when you are presenting a seminar, being able to see others through a screen that is encrypted to allow for safe communication of personal information, being able to share your screen to show the human anatomy and explain specific muscles to patients and clients. This was all very helpful. When you perform a Telehealth appointment and you are in someones living space, there is a different level of intimacy about the appointment. Not in a sexual way of course but you feel like you know the person on a deeper level because you have seen their living space and vice versa. Especially during the height of the quarantine when we were not leaving the apartment for anything other than real necessities. This (virtual rehab) was the outlet everyone was looking for in their day to get away from work and focus some time on themselves. This allowed us to serve not just a physical therapists but also as mental health coaches in some aspects for our patients. Connecting the two is huge for long-term healing!
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
If I could design the perfect telehealth system it would come equipped with appointment reminders 15 minutes before the appointment that was sent via email and text. It would allow for the appointments to be recorded and automatically sent out to the patients following completion. It also would be well encrypted for patient privacy. Lastly, It would have a count-down timer to alert the patient and the doc of when the appointment would/should end.
Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?
One of the main issues we have with patients is the wifi connection and getting used to the virtual technology. For many, this is a new frontier and it can be frustrating and challenging to older patients especially. It would be nice for patients to test out their wifi connection and their ability to hop on a virtual appointment prior to their actual appointment time. Most times patients are booked back to back, so maintaining the schedule is important to the flow of the day.
Connection and wifi trouble slow down the appointment times and can create tardiness of the medical practitioner for his/her later appointments.
The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?
VR is really exciting for the world of physical therapy! Being able to simulate balance challenges for patients who are fall risks is a huge avenue that I would love to explore. Even simulating game-like conditions for athletes is something that is really intriguing to me. This can be game-changing technology that significantly impacts the way we rehab our patients and hopefully helps us provide better outcomes for our patients. I am very excited about what the future holds. The challenge is going to be who adapts to this technology. The people who can quickly pivot and add these to their practice and help patients will be set up for success as the world continues to become more and more digital.
Is there a part of this future vision that concerns you? Can you explain?
I am all for technology. It’s here and it isn’t going anywhere. I personally choose to embrace the change and be a leader in the space driving change. As long as we are keeping the patients first, I have no problem with technology assisting us as we help patients rehab.
Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Wow, this is a fully loaded question. As a black man in the healthcare space, I would love to create more opportunities for minorities to foster their interest and development in the genre. I would love to create middle school and high school programs exposing kids to different medical professionals that look like them and came from where they came from. I want these kids to hear the stories of these professionals, their trials and tribulations, and what it took for them to achieve what they achieved in life. Sometimes you just need to know that something is attainable before you go out and get it. I think this would bring so much good to the children in some of these underserved communities and really help the world as a whole, grooming and mentoring future healthcare providers. We see how important health is especially in a pandemic. Our frontline medical workers really saved the day in conjunction with the scientists who worked tirelessly to develop a vaccine for this new virus. This would be a dream come true for me to mobilize a movement that could spread this message across the country.
How can our readers further follow your work online?
For anyone who is interested in following my journey, and please do, you can follow me @dr.kels on IG, Kellen Scantlebury on Linkedin, and you can email me personally at [email protected]
Thank you so much for the time you spent doing this interview. This was very inspirational and we wish you continued success.