Expertise and Therapeutic Alliance

[00:00:00] Welcome back to Untold Physio Stories Podcast. I'm your host, Dr. E with Mitre Manual Therapy and Edge Mobility System. Today, my guest is Dr. Noah Merrick. How's it going today, Noah?

[00:00:10] It's going good. Thank you for having me on, Erson.

[00:00:12] Yeah, no problem. What's that? Yeah, I know. Hey. Yeah, I know. I can tell people if you guys have ever – if you have a guest – if I have a guest who's like been following me for a while, you are respectful enough to say that.

[00:00:25] But, you know, I always just say I go by Dr. E because everyone gets my first and last name wrong, you know?

[00:00:32] And it gets old after a while. Like, oh, yeah. First, I think they didn't hear it right. And then they heard it right. Then they ask how to spell it.

[00:00:38] Then they look at it like, oh, whatever. They think it's Erson or Erson or Erskine. And then they butcher my last name too. And, you know, Dr. E is just easier.

[00:00:49] Nice. Yeah.

[00:00:51] But, I mean, I do like being called doctor, as I'm sure you do. You want to give a quick intro and then your story?

[00:00:56] Yeah. So, again, I'm Dr. Noah Merrick. I'm a physical therapist. I've been practicing about four and a half years out here in Oregon.

[00:01:03] Oh, four and a half years already.

[00:01:04] Yeah. Yeah. And I followed your content since, like, my first year of PT school.

[00:01:08] So, it's been kind of fun to, like, see how your kind of approach has changed and modernized.

[00:01:14] But for a little context, I mean, the context of this talk is on, like, the effect of putting your diploma up on the wall and how that can influence patient interactions and just, I think, just perceptions.

[00:01:27] So, I started in a private practice for about one year.

[00:01:30] And it was actually really nicely, like, it was a really nice look and aesthetic to it.

[00:01:35] And my boss basically right away asked for my diploma and he got it framed.

[00:01:39] And, like, kind of a – it's not like a – it's not a gold-plated frame like I've heard you talk about that you got done previously.

[00:01:44] But it's, like, a nice frame.

[00:01:45] And it was put up on, like, one of the treatment walls.

[00:01:47] And we had, like, a couple rooms so it wasn't always displayed.

[00:01:50] But it was kind of nice having, like, my framed diploma up there in a nice aesthetically, like, pleasing clinic.

[00:01:57] Fast forward a year, I ended up taking a job in a hospital-based outpatient orthopedic clinic.

[00:02:02] And I have liked this job a lot in many different ways.

[00:02:06] It's a slower pace, really experienced and smart colleagues.

[00:02:10] But I remember when I showed up on my first date because I had interviewed virtually because this was in 2021.

[00:02:15] I go into the clinic and it was – like, the gym is okay, just kind of a dated feel.

[00:02:21] But each little treatment room – and we spend a fair amount of time in our treatment rooms – is, like, kind of an older treatment table.

[00:02:28] Like, it's a small room, probably about two-thirds the size of most rooms.

[00:02:32] And there's, like, one picture on the wall, on these beige walls.

[00:02:35] And it's, like, a pale, sad flower.

[00:02:37] And I'm looking at that like, man, this environment is pretty lackluster.

[00:02:42] I need to do something about this.

[00:02:44] Three years later, I'm still there with the same flower.

[00:02:48] It was nothing different.

[00:02:49] Three years later.

[00:02:49] And I'm complaining about it.

[00:02:50] You thought you had to do something about it.

[00:02:51] Doing nothing.

[00:02:53] And, like, man, I need to – and then I read a post by Lance Malbury.

[00:02:58] And I love – he's, like, one of my favorite people to follow on LinkedIn.

[00:03:00] He's such a positive person.

[00:03:02] And he just brings up interesting conversation topics.

[00:03:05] And I couldn't find his post.

[00:03:07] But he had referenced an article.

[00:03:10] And I'm going to pull it up here.

[00:03:12] It's from the Journal of Environmental Psychology.

[00:03:15] And it's called Impressive?

[00:03:17] Credentials, Family Photos, and Perception of Therapist Qualities.

[00:03:20] And what it talked about is how putting your diplomas up would actually often increase – or putting diplomas and certifications up increase patient perception of basically like the experience and the quality of the therapist.

[00:03:34] And interestingly, I actually read through this, they were often viewed as being friendlier than the therapists.

[00:03:40] This was done in psychologists, I believe.

[00:03:42] They were thought to be friendlier than the psychologists that displayed no credentials.

[00:03:46] And across the board of my clinic, there are zero credentials in patient rooms.

[00:03:52] So, anyways, I was like, all right, I've seen a research paper on this.

[00:03:56] I've seen Lance Malbury post about it.

[00:03:57] I'm just going to do it.

[00:03:58] So, I got – I dusted off my framed diploma.

[00:04:01] I put it up in my room.

[00:04:03] I also got a couple like nice anatomy posters.

[00:04:05] It's not pathoanatomy.

[00:04:06] It's just anatomy, which I think is a nice – like it looks cool.

[00:04:09] It's not overly intimidating.

[00:04:11] It's like, what the heck?

[00:04:12] I'll just throw up my diploma.

[00:04:13] And like almost the –

[00:04:15] No huge red disc.

[00:04:16] What's that?

[00:04:17] Yeah, no herniated jelly donuts anatomy, which is cool, I think.

[00:04:24] But I put up my diploma on the wall.

[00:04:27] And like the first day – and definitely the first week I would get multiple comments on it.

[00:04:31] I had a few patients saying, oh, I didn't know you went to Pacific University, which is a local school where I live.

[00:04:37] Or, oh, yeah, I know so-and-so is going here.

[00:04:39] So, it just kind of spurred conversation.

[00:04:41] And then I had multiple people say, oh, I didn't know you had a doctorate.

[00:04:45] And I actually go back and forth in introducing myself as doctor.

[00:04:49] It's still a challenge because no one else in my clinic does.

[00:04:51] And my name badge at work says NOAA and then Merrick DPT.

[00:04:55] And that's how all – like I work for a big health system.

[00:04:57] That's how all of ours are.

[00:04:58] So, it's a little bit – it's still a challenge because it's such a contrast from like the rest of the system and my coworkers.

[00:05:06] But anyways, I had a lot of them say, oh, I didn't know you had that much education.

[00:05:09] I didn't know you had a doctorate.

[00:05:11] And then I had two patients that I had been working with for a while.

[00:05:13] And then when they saw that I put that up, they both said the same thing.

[00:05:16] They said, thank you for putting in the time to learn and become such a – like thank you for putting in the time to learn so much and become good at what you do so you can help me.

[00:05:25] And both of them said that I never had someone basically thank me for my years of learning and years of education because I think often we feel kind of like we spent seven years in school.

[00:05:37] We don't get paid enough.

[00:05:39] You know, blah, blah, blah.

[00:05:39] It's kind of lame.

[00:05:40] But it feels nice, I guess, to be recognized for that.

[00:05:43] And then the other little side effect.

[00:05:45] Yeah, I don't think I've ever been thanked for that.

[00:05:47] I've been doing this 26 years.

[00:05:50] Yeah.

[00:05:51] It was an interesting –

[00:05:52] That's a really nice thing to hear.

[00:05:53] I had two people say that.

[00:05:55] And then the other interesting thing is I feel like it gives me like a little – I don't know what you want to call it, a little dopamine boost or a little sense of pride when I look over and I kind of see my diploma on my wall.

[00:06:06] Like not that obviously credentials are everything, but they're not nothing.

[00:06:09] And I think patients would agree with that statement.

[00:06:11] I think that's how I feel.

[00:06:12] Like it feels – I mean kind of cool to see – look up there and see a nice-looking diploma that's framed and looks professional.

[00:06:18] Like it makes – it almost cues me like sit up straighter and take even more pride in what I do.

[00:06:24] And I do take a lot of pride in what I do.

[00:06:25] But I think just putting your diploma up – I mean the simple takeaway from this is putting your diploma up I think can be a really positive thing for the patient interaction.

[00:06:33] And even for yourself just to see that as a cue of like this is what we've learned and studied.

[00:06:37] Like let's take this seriously and do a good job.

[00:06:40] And then one more little comment I'm going to add here.

[00:06:43] So now I'll let you have a comment because I've been talking a lot.

[00:06:45] But –

[00:06:46] No, that's fine.

[00:06:47] Hey, it's your story.

[00:06:49] There was – I couldn't find it this morning when I was searching through the paper.

[00:06:53] But there was a comment – so when I was deciding like what kind of decor to put up in my room and it ended up being my diploma in three vintage anatomy posters, which I think are really cool.

[00:07:04] But when I was deciding – I'm like well should I do something more patient friendly that it's more like motivating or like a person or someone running.

[00:07:12] I don't know.

[00:07:12] Something that maybe patients would like more.

[00:07:14] But I didn't know and I felt like it was just analysis by paralysis.

[00:07:17] So I just bought the posters, put them up.

[00:07:19] And then reading this paper after the fact, it basically says if you as the clinician are in an environment that you like more, your mood is likely to be better and the patient interaction is likely to be better.

[00:07:31] So I think the takeaway is if you like your treatment room, as long as there's nothing that should be really overtly harmful on the walls to patients, it's probably better to put something up on your walls rather than just have like four plain walls in your room like I had aside from this pale flower for years.

[00:07:46] So that's my story.

[00:07:47] It's been nice having that up in my room.

[00:07:49] I feel like I take more pride in my little room now.

[00:07:51] It's got some decor in there and it's got my diploma in there.

[00:07:53] It makes me take ownership.

[00:07:54] That's great.

[00:07:54] It's your room now.

[00:07:55] Yeah, totally.

[00:07:56] Totally.

[00:07:57] Yeah.

[00:07:57] No, that's awesome.

[00:07:58] I love to hear that.

[00:07:59] You know, it's funny when I was first four years of my practice, when I was taking all my con ed courses and everything, I mean, I had my doctorate and I can't even find this.

[00:08:08] I'm so disappointed because after I heard, after I read at Lance on my podcast, he talked about this and I saw that post where he showed like the four identical pictures.

[00:08:18] And there were certain things.

[00:08:19] The only thing I saw actually without looking at it quickly, I didn't see like the family pictures and stuff.

[00:08:24] And people had commented, oh, the family one seems warm.

[00:08:27] And I have all that stuff too.

[00:08:29] I have pictures of my dogs, pictures of my kids and all that stuff.

[00:08:31] And I have like a crucifix and I have an American flag and people comment on all that stuff.

[00:08:36] But I don't have anything about credentials.

[00:08:37] I feel like my office feels warm and I love it.

[00:08:40] But I've been searching for my like super huge gold plated DPT degree, you know, and then my fellowship at first, you know, going back again, first like several years of my career, I was taking like whatever.

[00:08:54] I had, you know, 70 courses, I got all these certifications.

[00:08:57] And every time I got a certification, I would just put them up and I just entire wall patients used to always comment on.

[00:09:03] And it's funny because I always introduced myself as Dr. Relioso.

[00:09:07] But I said, you can call me Urson.

[00:09:08] And I don't say that anymore.

[00:09:11] And I felt like when I was your age and I was young, and I guess now that I'm old, no one questions that I have a doctorate.

[00:09:16] But I mean, people would all say like, oh, I didn't know you had a doctorate.

[00:09:18] And it would kind of irritate me because I was like, oh, well, I would think for some reason on day one when I said, my name is Dr. Relioso.

[00:09:25] Like, I realized, and it's a joke, but not a joke now, because I've heard that people only hear whatever, 30% of what you're saying anyway.

[00:09:34] You know, so how could I expect them with all that information, all that huge pathoanatomical like diatribe I had on day one, you know, early on in my career?

[00:09:44] How could I expect them to remember?

[00:09:46] They probably wouldn't get my name right anyway, you know?

[00:09:49] And I was kind of like offended that they forgot I had a doctorate.

[00:09:53] But in the meantime, I told them to call me Urson.

[00:09:55] Yeah, yeah.

[00:09:56] Yeah.

[00:09:57] But I would say, you know, Lance also posts stuff about people respect that.

[00:10:03] And the story he told on my podcast is, he said, oh, my name is Dr. Mabry, but you can call me Lance.

[00:10:08] And a guy actually got upset at him.

[00:10:11] Right.

[00:10:12] He's like, what, are you doing me a favor?

[00:10:14] Yeah.

[00:10:15] You know, and it's funny because, again, I've never had that as a reaction.

[00:10:18] I think it's kind of a strange reaction, but it's true.

[00:10:20] Like, who are you doing that for, right?

[00:10:22] Because it's almost like, and that's what I've had so many PTs who are so pro-DPT talk about.

[00:10:29] Like, what is this weird reverse psychology we have kind of like, oh, I'm being humble.

[00:10:36] Like, no other doctoring profession has that.

[00:10:38] And I don't know if like DOTs or PharmDs also have this kind of humbleness to them.

[00:10:44] You know, but like MDs and chiropractors and podiatrists and dentists have no, like, it's rare that they would say, call me by my first name.

[00:10:52] Right.

[00:10:52] You know?

[00:10:52] Right.

[00:10:53] Right.

[00:10:53] It's a strange thing.

[00:10:55] I think you go to all this school, you want this respect and everything.

[00:10:58] We think somehow we're going to have better therapeutic alliance, but it might actually be affecting your therapeutic alliance.

[00:11:03] Especially when people are like, oh, wow, maybe I can, like, I don't need to listen to this person.

[00:11:07] They're like a technician.

[00:11:08] Yeah.

[00:11:09] Yeah.

[00:11:10] Yeah.

[00:11:11] I've had people make that comment before.

[00:11:12] I remember when I worked in a busy clinic and I was doing something with like assessing breathing or assessing blood pressure or something like that I thought was rather mundane.

[00:11:22] And my coworker who is like a DPT, he's a fellow and everything, got his patient who was currently walking.

[00:11:30] I was like, what is that guy, a doctor or something?

[00:11:33] I don't know.

[00:11:34] I don't know if I had a stethoscope.

[00:11:35] It was something so mundane.

[00:11:36] Yeah.

[00:11:37] And then I was like, we're all doctors here.

[00:11:40] Yeah.

[00:11:40] And he's like, what?

[00:11:41] You are?

[00:11:42] He's like, I just thought, because we had like rented space.

[00:11:45] We weren't a pop.

[00:11:46] So we rented space from an ortho and he literally thought we were like the orthos technicians.

[00:11:50] He's like, I thought you guys were a bunch of techs.

[00:11:52] Yeah.

[00:11:52] Yeah.

[00:11:53] And I was like, oh man.

[00:11:55] I said that.

[00:11:56] That's a way.

[00:11:56] I've got one comment off that.

[00:11:58] This was the most shame I think I've ever felt during my education was it was in my third year of PT school.

[00:12:06] And we were filling in for, it was a small private practice for the clinic owner that was out that day.

[00:12:11] And I was like with slash shadowing like his other therapist that was like taking over his patients that day.

[00:12:16] And she just did like the exact same thing that he had done the two before, which to me is kind of like, but like he was sitting there doing like shoulder pulleys.

[00:12:23] And this kid's like, so do you have to go to school for this?

[00:12:28] And I, I, I, my emotion, I didn't even know.

[00:12:33] I just felt shame.

[00:12:34] I'm like, ah, ah, I've actually, I I've heard that before too, but it wasn't directly related to me.

[00:12:43] It was in a way it was my wife's, my wife's aunt.

[00:12:48] So I treated her.

[00:12:49] She had like this vertigo.

[00:12:50] She'd been going to a physio in Canada for like a year with, she's like, oh yeah, you know, he like ultrasounds me and he realized my vertebrae or whatever.

[00:12:59] And all I did was give her like, like rotation and retraction rotation to the right, which completely like abolished her year long vertigo.

[00:13:08] And it's just like, wow, I, she's like, you, did you go, you went to like more than you went to school for this, right?

[00:13:15] And I was like, yeah, I have a doctor.

[00:13:16] She's like, you know, honestly, until right now, I thought you guys all had like, um, were like trade degrees or like, uh, you know, like two year degrees.

[00:13:25] I mean, you see some of the way that like the, especially the really exercise based, like exercise, exercise, exercise based clinics are, and it kind of looks like that.

[00:13:32] It kind of looks like they're just, it does because you don't even like spend time.

[00:13:36] And I often say, yeah, like these, like we're not a commodity when you're, when you work in a mill, you're not a commodity.

[00:13:43] And like, if you just get handed an exercise card and someone spends five minutes with you, it's hard to believe that they're a doctor.

[00:13:47] Yeah.

[00:13:47] Even though the average doctor, MD doctor spends like 20 seconds, they say like 20 seconds before they make an diagnosis.

[00:13:54] Yeah.

[00:13:55] Yeah.

[00:13:56] Totally.

[00:13:56] Yeah.

[00:13:56] Do you feel that the time that we spend with patients makes it harder for us to want to call ourselves doctor?

[00:14:01] I mean like the, the frequency and how often we might see patients makes it harder compared to like, if you were only seeing them like.

[00:14:07] You get to know the better you mean?

[00:14:08] Yeah.

[00:14:08] Like if we were, if like, that's something that I've wrestled with is like, if I see someone like only a few times and it's, it's easier.

[00:14:13] If I see, the more I see someone, the more after a certain amount of time, it feels awkward to me rather than just going by first names.

[00:14:21] Like, you know what I mean?

[00:14:22] Have you felt that way?

[00:14:23] Cause I feel like that's one thing that is harder.

[00:14:25] I probably haven't felt that way for years, but on average, I only see my patients like every other week, every week, once a week and like two to four times anyway.

[00:14:32] So I don't remember half of my patients.

[00:14:35] What's that?

[00:14:35] Post-op patients?

[00:14:37] No, I don't.

[00:14:38] That's why.

[00:14:39] Yeah.

[00:14:39] Those are some of the longer.

[00:14:40] I mean, I get it.

[00:14:41] Like, but I mean, there are patients I've seen for years.

[00:14:43] Like I'll see people that I'm very friendly with, and I know like all about them, you know?

[00:14:49] And we talk about our dog and we talk about our kids and I know every time they're going to where they're going on vacation and everything.

[00:14:55] And, you know, usually they just call me doc.

[00:14:57] Yeah.

[00:14:57] And that is like the, the familiar, like familiarity, you know?

[00:15:02] When you think about like these old, old school kind of like, um, you know, small town, the doctor who saw everyone and knows everyone's name, they all just call them doc.

[00:15:11] And that's kind of like as informal as it gets.

[00:15:14] Totally.

[00:15:15] Yeah.

[00:15:15] Yeah.

[00:15:16] So you can make a new year's resolution.

[00:15:20] Only Dr. Merrick for now.

[00:15:21] I've tried it a few times.

[00:15:23] I feel like there's a lot of inertia because just, again, my first name is already my badge.

[00:15:28] I don't know if that's going to change.

[00:15:28] It's a, it's a hospital system thing, but actually even our doctors have that.

[00:15:32] You can just put a little sticker in front of it.

[00:15:34] Put a little sticker.

[00:15:35] Dr. Noah.

[00:15:36] Yeah.

[00:15:37] That actually might be easier.

[00:15:38] I don't know.

[00:15:39] I feel like sometimes I don't know.

[00:15:40] Who's going to say something?

[00:15:41] Dr. Noah.

[00:15:42] Like, well, are they going to say like, oh, you're not a doc.

[00:15:45] You don't have a doctorate?

[00:15:45] Yeah.

[00:15:46] I do.

[00:15:47] Yeah.

[00:15:48] That's for sure.

[00:15:49] Right.

[00:15:49] Yeah.

[00:15:49] I see.

[00:15:50] I clearly do.

[00:15:52] Yeah.

[00:15:52] I'm sure it might be.

[00:15:53] I don't know if it's different.

[00:15:54] I haven't had a lot of hospital based PTs come in, but you know, even in a clinic, people, especially working with older clinicians and they may or may not have a doctorate.

[00:16:03] They went back for their transitional.

[00:16:05] So they don't like really see it.

[00:16:06] And it's usually all those new grads who are kind of like are all gung ho about the doctorate.

[00:16:10] Then they just get shut down.

[00:16:11] Yeah.

[00:16:11] But people who either don't have it or they went through the transitional, they only got it because I don't even know.

[00:16:16] It's like if you got it, why did you get it?

[00:16:17] If you still paid a decent amount of money for it, you're not going to call yourself doctor.

[00:16:20] It's kind of a strange thing.

[00:16:21] Yeah.

[00:16:22] Totally.

[00:16:23] That's true.

[00:16:24] Like I've got this extra guy with a master's in PT.

[00:16:26] Then we still have two bachelors of PTs at our clinic.

[00:16:29] Got some older ones.

[00:16:30] So, but I, yeah, I lean towards wanting to do it more and more.

[00:16:36] But I also, there's also the co-workers.

[00:16:39] You can do it.

[00:16:39] I guess so.

[00:16:40] I have faith in you.

[00:16:41] Yeah.

[00:16:42] Yeah.

[00:16:42] It sets the, it sets the foundation so that I can say, you know, I don't actually ever point to it, but, you know, it's just nice having it there.

[00:16:49] Yeah, for sure.

[00:16:50] All right.

[00:16:50] Hey, well, thanks for coming on and telling your story.

[00:16:52] And actually I saw for your email because like your email, you're still using your pacific.edu email.

[00:16:57] Yeah.

[00:16:58] Yeah.

[00:16:59] That you've been a long time insider.

[00:17:00] So thanks for that.

[00:17:01] Yeah.

[00:17:02] Yeah.

[00:17:02] You're welcome.

[00:17:03] Thanks for having me on.

[00:17:04] Appreciate it.

[00:17:04] All right.

[00:17:06] Uh, so people, where can people find you?

[00:17:08] LinkedIn?

[00:17:09] Instagram?

[00:17:09] What?

[00:17:10] Anything?

[00:17:10] LinkedIn is the best, is the best way.

[00:17:12] I'm, I'm moderately active on there.

[00:17:14] Um, I actually think LinkedIn is the most productive social media platform I've been on personally.

[00:17:19] And it's more positive.

[00:17:20] You actually learn something.

[00:17:22] It's way more positive.

[00:17:23] I mean, even when you're getting trolled, it's only by like one or two people.

[00:17:26] It's not like the majority troll.

[00:17:28] There's so many good conversations.

[00:17:29] If you guys aren't on LinkedIn.

[00:17:31] Yeah.

[00:17:31] And you are a professional PT, chiropractor, whatever.

[00:17:33] The conversations on there are amazing.

[00:17:35] And I've gotten so many, I mean, business-wise, I've gotten so many leads on courses just from

[00:17:39] like regular posting that I haven't gotten in years.

[00:17:43] Um, it's been a real golden age for me, just like regularly posting the same content I've

[00:17:48] always posted on Facebook and Instagram and YouTube on LinkedIn, because there's actually

[00:17:51] like great conversations there.

[00:17:53] And I find that people aren't also posting like things just to get people kind of, there

[00:17:57] are a lot of people, PT's on X and Facebook, whatever, who just post like the controversial

[00:18:02] posts that are getting people talking.

[00:18:04] And I find it's actually just normal, great educational conversations.

[00:18:07] Yeah.

[00:18:08] Yeah.

[00:18:08] More productive than Twitter X.

[00:18:10] That's, I left that two years ago.

[00:18:11] I haven't looked back, but LinkedIn is very productive.

[00:18:13] Awesome.

[00:18:14] Yeah.

[00:18:14] I still post my content just to post, but like, I don't, I don't ever engage.

[00:18:18] People are always just like, I just feel like it's just mainly for complaining, you know?

[00:18:23] Yeah.

[00:18:24] Yeah.

[00:18:24] All right.

[00:18:25] Awesome.

[00:18:25] Hey, you have a Merry Christmas.

[00:18:26] You too.

[00:18:27] Merry Christmas.

[00:18:28] If you guys enjoyed, remember to leave your, leave your window open.

[00:18:31] Uh, if you guys enjoyed this story, enjoyed the story, have any comments or questions,

[00:18:36] please, uh, reach out to Noah or myself.

[00:18:39] And as always, Dr.

[00:18:40] Merrick, I should say, and as always, you guys have a great day.

[00:18:43] Make sure to rate Untold Physio Stories five stars for every list of the podcast.

[00:18:46] That goes for you, Doc.

[00:18:48] If you haven't rated Untold Physio Stories five stars, please rate us five stars on Apple

[00:18:52] and Spotify as that really helps our discoverability.

[00:18:56] And, uh, probably taking some time off for the holidays.

[00:18:58] So Merry Christmas, Happy New Year to everyone.

[00:19:00] And I'll see you in the new year.