The Modern Musculoskeletal Approach - Dr. Brett Winchester, DC

In this engaging conversation, Dr. Beau is joined by Dr. Audra Lance and Dr. Brett Winchester to discuss the evolution of clinical practice over two decades, emphasizing the importance of patient management, communication, and the integration of functional medicine. They explore the significance of confidence in patient care, the evolution of DNS, and the role of mentorship in healthcare education. The discussion highlights the need for enjoyment in work and the excitement surrounding upcoming educational events.\

Chapters

00:00 Introduction and Podcast Evolution

01:57 Changes in Clinical Practice Over Two Decades

06:05 The Importance of Patient Management

10:12 Balancing Function and Patient Communication

13:57 The Role of Confidence in Patient Care

18:09 Understanding Functional Approaches

21:50 The Evolution of DNS

26:02 Teaching and Mentorship in Healthcare

30:11 Integrating Functional Medicine into Practice

33:46 The Importance of Enjoying Work

38:11 Looking Forward to Future Education

41:55 Conclusion and Upcoming Events

Dr. Beau (00:00)

Audrey's over here shining up. So she glows. You're already, you're already out going to do Brett and I, so don't worry about it. yeah. So Brett, this is, I think you've been, well, no, you've been on this podcast twice since we called it the farm cast, but I have like podcast ADHD with the name changes. Cause you were like one of the first guests way back when on my original podcast, which I don't even know that what I was called true health or something now, but we've got.

Brett (00:06)

to.

Dr. Beau (00:29)

Brett Winchester on here who has the Gestalt Education podcast. have Audra Lance who has Mind Your Body, yeah, podcast. We got a bunch of podcast hosts. I mean, we're basically all famous. If you haven't heard of us, that's your problem. But Dr. Brett Winchester is joining us today. We're gonna talk about a menagerie of things. We have no clue where it's gonna go. I've got a list of questions, but we'll just kind of have to figure that out as we roll.

Audra (00:38)

your body.

Dr. Beau (00:58)

let me, Audrey, you're kind of buzzing a little bit, maybe not from wine, but your speakers. So let me see if I can get something going here.

Audra (01:07)

Not today, but look at my coffee mug. It's very fitting.

Dr. Beau (01:10)

Ooh, I like it. That's yeah, definitely fitting. I'm going, we just got it. Have you guys heard of the Toshibo? T -C -H -I -B -O coffee machine. It's like a grind and everything all in one. It's elite status in our office, just got one and everybody is super excited. So I'm probably gonna be broke in about six months, but yeah, totally. So was last year 20 years in practice?

Brett (01:11)

Go bird.

It's alright, worth it.

Dr. Beau (01:41)

Or was it two years ago now?

Brett (01:41)

I'm pretty sure I'm in my 22nd year, think. So yeah, close enough, yep.

Dr. Beau (01:48)

Okay, so over two decades in practice, let's lead with a huge question. What's changed? What are the biggest changes you've seen in your practice style? I know we could go way far in the medical realm, but in your practice style and our kind of group of practitioners, what's been the biggest change?

Audra (01:57)

you

Brett (02:11)

I think that the blend of what the evidence was telling us and how that is obviously critically important, then kind of learning a valuable lesson that I wasn't going to fix everybody in two and three visits, that's probably the biggest change looking back at my career that I had to learn the hard way. I always say that being in a relatively small town, having to always see my patients and run into them and then...

tell me they've done something else or tell me that they weren't doing as good as I thought they were doing. And then that was really, really humbling. And then from that, I really, really learned how to manage cases way better, I feel like. And I feel like when you're young, you do manual care, you teach rehabilitation, of course, and you cut the patient loose and you just automatically assume that they're fine.

And the reality of it is a lot of our cases require management, even in the evidence -based and functional side of things. And I mean, even people like, you know, Grey Cook, Shirley Sarman, you know, other people have talked about this also. So it's not just like our faction of people that have come to this conclusion. It's, yeah, of course we want a minimal dosage, but then, you know, you know, most of us, you know, we go get our hair cut once a month, you know, and

You could cut your own hair, but usually you have someone that you trust to advise you on that. I kind of think of ourselves in that role to kind of guide them through the musculoskeletal or the functional medicine, whatever it might be. I feel like a lot of people are afraid to say that. I just feel like anyone who disagrees with that, I kind of feel like they're not actually in the grind every day that's having to manage these cases.

And I just think finding that perfect sweet spot with every patient is kind of the skill of practice. But if you made me say it be that, the other thing would be like, I am enamored every day with the ability of the human body to adapt and compensate to things when they're not ideal. And I think you got to be careful when you're doing a job like we're doing to make sure that you're not working on an adaption and compensation.

and really pride yourself and really getting after the actual cause of the problem. So those are some things that kind of stick out. It's probably a little bit harder than I thought it was going to be maybe when 20 years ago.

Dr. Beau (04:37)

Hence the two to three visit fix everybody mindset. Yeah.

Audra (04:42)

Yeah.

Brett (04:43)

Yeah, because you got the human factor. You're dealing with human beings and now more than ever humans are going through really difficult things with social media and just all kinds of crazy stresses. So there's a lot of complicating factors that make our job harder, I think.

Dr. Beau (05:00)

Yeah. You'd mentioned in there, management, the two to three visits is maybe not, well, it's not realistic, it's not maybe. A lot of students and new docs and even docs have been in practice for a while, get coached on like, hey, you need to hit a certain number of visits for a treatment plan and this is the average one to look at.

is, you know, because we have a lot of docs and students that listen to this, is that something that you guys actually look at from a practice model or is it kind of just like, man, whatever that patient needs, it's a case by case basis and that's what we give them? Or are you kind of like, hey, man, we're running a business too, like we got to make sure we're not just booting them out the door. So how do you guys approach that?

Brett (05:38)

Yeah, well, I mean, I think everybody wins in the model that we're talking about because I mean, never do we talk about like just the financial side of it. It's always really what the patient needs. Now I will say we do have parameters early on. you know, just as an example, if you saw a new patient, you know, most of us are here at our office, they're gonna see that patient two, usually two times a week, unless it's like an acute disc arrangement or something like that. And then we reevaluate them at.

the three week mark and I never over promise. never, I just say in three weeks we'll reevaluate, we'll see where everything's at, but really, you know, 10 years ago, I really went all in on function and I was kind of a hypocrite because I was telling people like on the seminar circuit that I was treating function, but really at the end of the day, I was really, I was kind of a pain chaser quite honestly, if I'm honest with myself.

So I kind of just had that moment in frustration where I was like, you know what, from this day forward, I'm not doing that at all. Like I am going all in on changing the functional audit of all my cases. And if I do a good job with that, I know that the pain is going to closely dovetail with that. And I just went all in on that. And when I say that people think that, you know, I'm not being empathetic. Of course I'm being empathetic and

We're also classifying our patients like whether it's the centrally mediated case with like Annie O 'Connor, for example. So that's all kind of built into the cake, but I just felt like I was really over reliant subjectively on what the patient was telling me on how their case was. And the second I made that switch, it was the most liberating, amazing feeling in my life. Because if you think about it, it kind of takes all the pressure off really. It's like...

All I can do is try to be world class in my ability to change the function of the case. And if I'm good at that, I also sort out who's my centrally mediated case because all the audits are changing, but they're continuing to tell me that they're no better. And then the other thing is like the structural case that you and I aren't gonna help. if I have somebody who's got like a femur last tabular impingement and a labral tear, the only way that I know if that patient's gonna get better is by doing a trial of care.

The severity of the MRI, findings, tell us something, but they don't tell us everything. Like James Andrews says, if you want an excuse to do a surgery, basically do an MRI. So the severity of the MRI means something, but it's not the end all be all. The trial of care is how we know whether or not we need to escalate further medical treatment. So we are in a position to be the most amazing gatekeepers because the surgeons love us too, because if...

Dr. Beau (08:03)

Yeah.

Brett (08:22)

If you get done with us, then it's like, don't send them back to me. We tried everything. We changed function. They're ready for surgery. So I think we're really in a great position being a chiropractor, physical therapist, or ATC to be that initial gatekeeper. The hard part is, it's hard to find people in the world that are really good at that initial trial of care. we all have people that contact us and are like, who do you have in a certain city? It's like, ugh.

Dr. Beau (08:45)

Mm -hmm.

Brett (08:51)

Like, because you need them to be able to give a really good trial of care. So, yeah.

Audra (08:56)

Yeah.

Dr. Beau (08:56)

So just to, go ahead, Audra.

Audra (08:59)

Just along with that, I think that's really key and like for the students and doctors listening, because we have some of these conversations in the background of all of us. So just to like clarify and side note, y 'all, I mean, we're talking to one of the industry leaders here. He's helped, know, Dr. Bo and I like from students through now, I still call him on a regular basis and we talk through, you know, cases and everything and even business stuff. So, I mean, this is such a treat. Like, thank you for coming on here and like sharing your wisdom.

and thank you for being such a good mentor and friend and all the things like we're so excited to have you but so you were saying you know about like changing to function

Brett (09:35)

I'm excited.

Audra (09:41)

And I think where sometimes students and which is so true, like treating on that and using your audits heavily. But from like a patient care standpoint and being the doctor and building that relationship, you also talk about the effect or a lot, which we can get into. And I think managing of yes, in my head, I'm doing audits and functions, but the patient still needs to be heard. Like you need to convey to them, you're hearing what they're saying, maybe touching the pain, touching them where it hurts.

but in your head and your treatment plan you're like, okay, I'm really functioning, I'm functioning, but we're not separating of, hey, don't even listen to the patient of, it's my knee and why are you treating my shoulder? Like, you need to have that patient education and like that, like you're saying that empathy and everything. And I just wanted to hit a little bit more on connecting those dots. Cause sometimes I think in seminars it gets lost of, I only do function. I don't listen to what they say. I kind of tell them to shut up and it doesn't matter.

Brett (10:40)

No, and I mean, I definitely, I mean, you know, and we work hard like around here is you can call it customer service, you can call it it factory, you can call it whatever you want. But I think like, and you could also call it tough love where you're basically, you're listening really, really well to the patient. But it's also, I think it comes back to also like present time consciousness, which is very few doctors in the world.

are giving you 100 % of their presence when they're with the patient. So I feel like when you do that, then you really are forced to be in the moment and do a good job. And I feel like that's one thing that people don't do a very good job of. But I think that actually helps in that because although I'm beating this functional drum, I don't think any of my patients would tell you that I'm not a good listener and I'm not hearing what they're saying. I just think like we've all been there too. We're like,

you walk into the treatment room and the patient's wanting to tell you they're no better and you slowly, subtly point out something that's quite a bit better and then they completely change their tune and they're like, actually, now that you said that, things have been quite a bit better. So I think that sometimes the changes in our world happen subtly, so they need to be pointed out. But in saying what you said, I would 100 % agree with you.

Audra (11:42)

Yes.

Brett (12:06)

There's a lot of like little soft skills that go into getting people better. Like the rapport is established in the first 13 seconds you walk into the treatment room and they've actually found that 93 % of it is actually nonverbal. So it's not actually what you're saying to the patient. It's do you have a smile on your face? Do you look like you're too busy? And then the other most important thing that somebody in this world can offer to your patient is reassurance. So

And this is why certain people who we would consider to be not very good at what they're doing, they are capable of getting miracle after miracle. And then you have like some evidence -based Kyra who's a complete superstar from a knowledge standpoint, and they have a little tiny practice that no one knows about. It's the people that are in more in the evidence -based side of it, like we're in, we have more tendency to question even ourselves. And that inadvertently gets

transferred to the patient without us realizing it. So sometimes, you know, we need to, in our world, have a little bit more certainty and confidence. And I think the soft side of being a good physician, there is so much there, Audra. And like I've spoke now over the last three years, quite a bit on this topic, which I don't talk at all about any of the clinical things, but just all the little things that make you a good healer. And being empathetic is one of them.

Audra (13:04)

me.

Brett (13:30)

I look at some of the other people in the world and I you kind of see like what their schtick is. For example, like Annie O 'Connor, the best listener I've ever been around. Stu McGill, the best coach I've ever been around. Like Mike Shacklock or Tom Michelle, they know research really well that they convey that to the patient. Therefore, they're very impressive in confidence because they are explaining the research to the patient.

And I feel like everybody's kind of got, you got to kind of find your own way, but like that's your it factor. And you know, you're doing a good job when you're exploding your practice, you know, like if you're not exploding your practice, I mean, you got to be able to take one patient and turn it into 10. And if the patient's leaving, want to refer you 10 people, then you know, you're probably on point on what you're on your education. But like, I think it is helpful for most of us because we do.

Dr. Beau (14:14)

Mm -hmm.

Brett (14:25)

air too much on asking our patients how they're doing to maybe like almost mind -deaf yourself into the functional side of it. That way you can just start like kind of thinking that or just kind of imagine like let the body tell you how they're actually doing and I think that can be helpful for the young clinician who may be shading too far into the subjective side of it, which was me by the way. I mean I have the scars to prove it so I'm...

Audra (14:29)

Yes.

Brett (14:53)

I am speaking from experience.

Audra (14:54)

And I think that's like having a little bit of control over the appointment. like, can you talk more into that of like, you know, how do you go into room and make sure you have control? Cause we've all been in that situation. I still get into it today of like, woo, I just, I'm losing control of this. Like they're taking over. Can you talk a little bit more about that?

Brett (15:16)

Yeah, I mean, if you go through your schedule today on everyone that you don't want to see today, those are all people that you're not controlling very well. Shockingly. think that that is where, and if you get around the people who are really good at this, you'll see they do a good job of establishing the control because, you know, your patient is, you know, like they're trying to manage something like your analytic patient.

Audra (15:24)

Right.

Brett (15:46)

They just are too close to the situation. And it's like I tell them, like, if I'm seeing them, like, let's just say for functional medicine, it's like, you're not going to know more than me on this. Like, I know you think that you do and you've Googled and stuff like that. So like, quit trying. Like, let, trust me to do that for you. And I think, you know, establishing that and I think to that point too, Audra, would be, because you got to be confident, you got to be certain, but you can't be cocky. So you're like,

playing in that like little delicate world there. But I think doctor certainty is so important that I don't even have words to describe how important that is. And I feel like the orthopedic surgeons are so good at that. So they basically look at an MRI and it's so clear in their mind like what needs to happen. So then you do a surgery and then, you know, the patient's all bought in. What do we do? We will,

Audra (16:14)

Yes.

Brett (16:42)

Hymn haul about you know, well I think we might be able to help you and like you're not even confident about the functional findings that you're looking at if you could just convince the people that are in our world that like if you could get it as Excited about your functional findings is the orthopedist is on their structural findings You're gonna see a completely difference in the compliance to whatever you're recommending to the patient But for some reason because we question so much and I guess we don't believe it ourselves it

that part's kind of challenging, I, to your point, and I work hard with our people here and our interns. Like if you're not confident in the beginning, fake it until you have the confidence, but like that's where like some of us need to do some soul searching on the technique systems that we're bought into because you're not confident and certain because you're not getting the results that would make you confident and certain, you know? But if you've seen some...

Audra (17:34)

you

in.

Dr. Beau (17:37)

One to dig in, dig in with the.

Brett (17:39)

I was entirely... sorry about that.

Dr. Beau (17:42)

I was just gonna say, because we really, keep talking about this functional approach, which we all assume everybody knows what that means, right? And again, there may be patients listening, whatever. A lot of times I think, and Brett, you have way more interns flowing through your office than I do, but sometimes it almost seems like the expectation of some people that are a little green is that the functional approach would be,

like you're treating, you're always treating something that doesn't look like it would apply directly to what's going on. They're like, you have to be treating away from the side of pain. has to be some like almost like, how did you pull that rabbit out of the hat? So I just wanted you to, maybe that is the case. Maybe. So how I always kind of like frame this is if somebody walked into my office, I 99 % of the time they'd understand, they'd just be like, I kind of get what you're doing. They wouldn't be like, why were you working on their big toe to like fix their left wrist pain? So

Do you feel like that is the case or do feel like, man, it's just a grab bag, it's a patient presentation or like, because I think that gets coached into people that like if you are treating too close to the side of pain or local function versus like distal function, that's almost like a shameful thing to do.

Brett (18:56)

No, and I think that's a misconception. I do think we tell those stories though because they're very inspiring for people to make them look globally. And I think like it depends which technique system that we're talking about. For example, like MDT, is a big part of one of the things we do here. I mean, that is 100 % a local treatment. That is like taking the painful joint and seeing if there's a directional preference.

Dr. Beau (19:03)

Yeah.

Brett (19:23)

If you're working with athletes, you're probably going to have shockwave and laser, all that treatment's going right to the area of complaint. The soft tissue techniques are often, they don't have to be, but they're going to the area of complaint. But then if you have in your triage system, like DNS for example, DNS is really unplugged from where the symptoms are and really trying to find where the key link is.

we work hard on, so like we might be doing something locally because you got to play the game tonight, but then overreaching, we're still working on the big global finding. But I think like the big thing when you're young to kind of appreciate is that you could do local treatment and turn the intrinsic muscles on in the foot and completely change the range of motion of the hip, or you might not have that miracle happen.

But understanding if you're on the key link, whatever the key link is, you're gonna have the greatest effect on all the audits across the body. So that's how you actually know that you actually are on the key link. you know, the human body's an absolute puzzle, but I tell our young, until you gain your confidence, treat locally. You'll have, if you took the next patient that walks in, who's got a sore shoulder, do a subscapularis ART move.

Do a DNS, three DNS corrective exercises. Mobilize your CT junction or manipulate there. And if you take 100 patients, 90 of them are gonna get better with that approach. But as you get better and better at this, you get more of like a sniper where you know exactly what you need to be doing. And as it turns out, the more patients that you see, the more money you make. Funny how that works. like.

Audra (20:52)

you.

Brett (21:05)

being efficient with your assessment actually rewards the people who are bought into this because you're still getting a world -class result as you're seeing more people and you're making more money, but I guess you could argue that you're helping more people too. So it's not just a selfish money.

Audra (21:05)

Hmm.

Dr. Beau (21:21)

Well, I think you're also buying exploratory real estate by building rapport and reassurance in those first few visits. If you do treat locally, just because you might get lost. If you try to jump to this, like, you know, extrapolative functional approach. And I think that's what a lot of new docs need to do is like, make sure that the person understands what they're doing, that they can have a result. And then you can be kind of playing around on the fringes, which they'll never even know or be aware of what you're doing. And then little by little, you're like,

kind of like a researcher like, I kind of made this correlation. That takes years. some people, yeah, it might be better than others at pattern recognition or just the manual skills or have an intuitive approach to it. But I just feel like I wanted to ask that question because I think that's kind of the story gets built that you have to be treating things that you wouldn't almost put together to be considered a functional approach. And I think that leads people very astray.

Brett (22:15)

No, I would not know that's like what people say and I don't think that's the case honestly. I do think though like most people, know, like especially if you're young, that's where like I love our buddy, you know, Grey Cook because Grey Cook has made people look globally, you know, like no one's made people look more globally in the world of what we, you and I do in the last 20 years than him because the SFMA

is a way, I'm not going to say it's the end all be all by any means, but it is a way to make you a young clinician look globally and then gain confidence on finding a problem that's away from the side of complaint. But I think also, if you can buy into the idea that in our first year of life, if everything's developing the way that we want, that the body is such a pure, perfect point. You don't have any trigger points, you don't have any joy blockage.

Your soft tissues are perfect. If you did a neurodynamic test and the patient was able to relay the information, all of that would be perfect. In my mind, what I'm imagining is I'm restoring every single patient that I see back to that state. I could have an 80 -year -old stenotic patient, for example, that I'm gonna see today. That's never gonna happen, of course, but in my mind, I'm imagining that's what I'm doing, and I feel like your patients will be better off if that's kind of your mindset.

But I think also like in a treatment plan, you have your chiropractic miracle, which is you've done one adjustment. We've all been there and like you've changed someone's life for whatever the reason is. And then you have whether or not on the other end of the continuum, they would require an orthopedic intervention, which is less than 1 % of the people that we see. So in between there, you have what I call the functional black hole. And that is where the evidence -based crowd is doing a horrible job of managing. So you didn't get a miracle day one or day two.

you know they're not going to surgery, your miracle now needs to occur over a three month period. And you can still get a miracle, but it's just not like that overnight miracle. So what do you do? You slowly start chipping away at function, you know? And that's where like the clinical auditing process helps you so much because you're basically getting the roadmap on what you need to be changing as you're moving down this functional journey. And then as it turns out, you get your miracle, but you get it three or six months later.

Dr. Beau (24:19)

Mm -hmm.

Brett (24:38)

And you get it the the old -fashioned way through hard work and home exercise and You know all the things people know it just we become so into like instant gratification That like if something doesn't work for a day. We think we're doing the wrong thing Which is a huge mistake and changing function takes time and the analogy I use my patients is like you don't put braces on your teeth wake up the next day and be like my teeth are straight rip off the braces no, it's like a two -year process of your teeth being sore and

Yeah, and then you wear a retainer after that and like some things just need and require a little bit of management.

Dr. Beau (25:15)

Yeah, which I mean you mentioned DNS and again most people listening probably know what that is but you know you're an OG of DNS. I kind of got into it early when you know the original crew was going back and forth to Eastern Europe and back.

Again, we led with the question of kind of what's changed in your clinical perspective. I know DNS has changed massively from not even being called that to now being called DNS and then all the changes that have occurred in between. But with our upcoming course that we're hosting you for in April next year in Nashville, what have been the biggest changes or the biggest change, I guess, in DNS since you first got involved with it? And I know there's a ton, but is there one or two things that stand out to you?

Brett (26:02)

Yeah, I we've just gotten way better at teaching it. And I feel like I think we've unplugged a little bit from like the perfectionism of human movement to where we feel like, okay, this joint has to be like in this specific position. Otherwise, it's a problem. And I do feel like early on that created a little bit of a problem because people would leave a seminar, like people would be afraid to move literally because they didn't think they were moving like in the ideal strategy. So I feel like

unplugging from that was, was critically important. And then DNS is a very active treatment approach versus originally it was very passive because of the heavy influence of reflex locomotion. And, I think that like, those are the big things. And I think since it's still in its infancy, so really we're still like, we're not even at 20 years old yet. So, I mean, by the year and we were just with, Pavel here recently here in St. Louis at the DNS war Congress.

He's always changing also. So I mean, it's kind of an exciting time in DNS because people are all over the world doing different things and we're all working with different patients and athletes and we're coming back together and we're being like, wow, this is miraculous for this particular patient type, for example. So that's what continues to get better. I feel like from a teaching standpoint, it's like now you could say, hey, Brett, what do you?

What do you like from DNS and spinal stenosis? And I could rip off five different things, whereas before we weren't good at doing that. Now we just have more context to give people advice with the patients that are currently seen. And I do feel like too, we've made it, it's easier to, it's way easier to apply, way easier to apply than it was 15 years ago. We honestly, early on, we did a horrible job, myself included, at teaching it.

But then you just kind of get better if you, I think, I don't know if anyone's probably taught more DNS seminars in the last 15 years than me. And I feel like being out on the road and have people ask me difficult questions, having some of my so -called enemies in the room to question everything that I'm doing, it just kind of makes you stronger and be able to go back and think about things differently. And that's, I think, what

part of the process of making it kind of change the way that it has for the better. For those of us on the western part of the world, probably getting more English instructors has also helped maybe just because there can be a problem with translation and stuff like that. So feel like that also has probably been helpful for the Americans and Canadians probably.

Audra (28:46)

Yeah, and one of my favorite things about like going to any of your courses, especially DNS though, is just like that applicability. Like you talk about clinical cases and give, like we'd show practice patients and you're saying, well, if this case comes in, this is what you do on Monday. And I think that's really helpful to like tie it all together, especially if it's your first DNS course, you know, you're drinking through a fire hose. So what at this DNA course, like content -based, like what?

is the meat of it, what are you kind of teaching, what should people expect?

Brett (29:17)

Well, I think like the one thing that I feel like if people can buy into and really understand, like, and one of the main tenants of DNS is intra -bondal pressure. So people know that they give lip service to it, but I feel like very rarely do people actually understand that. So like, if people can take that away from the first, that's just the first day in A, it's well worth your money there.

And then, so once we've established exactly what that should look like with the patients, then we start building on developmental exercises from that. That's kind of the foundation. The other thing is a lot of the assessment in all of DNS is in the A course. So you learn how to like really look globally at the patient and look at, you know, if we're talking about SFMA, that's like a movement assessment globally. DNS is more of like a stabilization assessment globally.

So then it gives you some tools to kind of look at the body that way. To the patient thing, now I always challenge myself to have really difficult patients there because I've learned that it's good pressure and it also, like you should have nothing to hide. And I actually learned this from Scott Urbawe, he's one of the gurus in MDT. And he told me one time, he goes, my job when I work up a patient in a seminar,

is actually not to create a miracle. My job is to expose the system. And if I do a good job of doing that, then I did my job. Of course, we're all rooting for our patients to get better when we see them. when you see a patient live in front of a bunch of people, really what you're wanting to actually accomplish is you're wanting to expose what the system is. And then hopefully you get lucky and you have a good result. I think that's like the goal of and we'll definitely in Nashville, we'll find some patients to.

to work with, I'm sure. So that will be a highlight of that. And then, yeah, I think it's one of my favorite courses to teach. I think it's like, it's really good. I mean, there's always fluff in every seminars, but I feel like in A, there's really not that much fluff. And what I like about A2 is on the Sunday morning, there's a two -hour section on ontogenesis. And I've worked really hard to make that information applicable, where you're just not sitting there looking at

a bunch of useless pediatric stuff that you're never going to use, like always trying to tie that back to the adult patients and make that information a little bit more useful.

Dr. Beau (31:49)

I like that you said, you know, expose the system because I, don't know if you remember this, whenever I interned in your office, which was man, that was like 12, 13 years ago now that I was going to go take a DNS a seminar and you're like, I'm being honest with you. I would just kind of take what I've taught you in here and I would try to apply it for awhile because you even told me you're like, it's hard to apply. And I probably, a lot of that was coming from, like it was hard to teach at that time. So it was like, and then when I took the NSA, you know, after I actually graduated,

and then I was like, get what you're saying. Cause you like, I left that seminar. I was like, I don't know. So I liked that you're like, Hey, we have more applicability. We have a system, know, systematic approach. you're leaving that seminar now like, I know how I can implement this, what to look for in an assessment. So I think that's for anybody listening, it's looking to go or hasn't gone or even refreshing those skills because it's evolving all the time. would assume like that's the highlight now for me is coming from, you know, I kind of learned Brett was just.

I don't know, got baptism by fire like, hey, let's do this, let's do that. And then I was like, eh, you you go to their first course like, I get it. Like you saved me. Going back to you as an educator, and this is getting a little bit away from DNS, but like you've been a mentor to a ton of people. I mean, you have ton of interns. I was an intern in there. You've been a mentor to Audra. And there's always kind of that like, you know, ripple effect of like,

you're actually having more of an effect on people because of the people you've taught. So it gives you a much broader reach than you being like the best in the world. But I actually took your TMJ course. So this just speaks to you as an educator. And we were talking briefly before that you were probably most proud of your TMJ course. So I took that course. I thought I was decent at teaching TMJ. And then you literally in that course, you're like, man, this is a system. Like this is one of those things that I think you can have a playbook for.

So here's my kind of, I guess, sales pitch for that TMJ course, but just a fun story to tell that during that course, you bring up a lot of research on, the one that I'm talking about now is migraines and like the correlation or maybe causation of TMJ dysfunction and migraines, in particular migraines are so, so idiopathic. So I had a patient that came in, she has had migraines since she was like five years old, she's now in her mid 50s, she's been treated with everything you can,

medical cocktail and every treatment. And we literally run her through an exam. actually ordered a full spine and Mariah to rule out, know, syrinx and some different things. And she comes back in and I'm like, you know, one of the main functional findings that we found, which gets into the function play was like, you know, the three knuckle test, she looks like she's been chewing on leather. She's got giant masseters. Like I was like, you know, I think we should just run with this, even though she had no primary TMJ complaint, just migraines.

and send her home with a McKinsey -esque approach to start. And she literally comes in the next time. She's like, I'm out of migraine sense. And just like, know, full mouth opening, running through it. And now we're over a month in and she's like off medication and stuff. And it's just one of those that you're like, it was almost, if you had no functional approach to lean on, I would have been completely lost. Cause she had no symptoms, right? Of TMD. Everything else was like.

peachy besides having these like almost constant headaches that would, you know, flare up and down. So I talk about all that to go back to this mentorship piece that a, if I hadn't spent time in your office, B, if I didn't know who you were as an educator and C, had I not taken that particular course, there's one case where I'm just like, well, I got to refer them out because I'm just lost. so when you approach like that TMJ course is kind of your course.

Do you feel like there's still gaps in your education that you're trying to fill that then help you be an educator? Do you feel like you're kind of at that level now where you're like, man, I know there's always something you could learn or you like, really think I need to start pouring more out into our profession and into our colleagues. Maybe it's a little more of your opinion. You're not necessarily just teaching DNS. We're not teaching MPI. It's more of like, hey, I've had a lot of swings.

And I've got some thoughts. Is that kind of where you're headed or is it still, hey, we got these really good playbooks, why stray from it?

Brett (36:16)

I feel like, I mean, the it's like looking out in the ocean. really feel like, I mean, now I probably like my biggest, I mean, now I see so many functional medicine cases now where like, I think one thing I'm kind of is amazing me currently at the moment is how many like middle aged female menopause patients, difficult musculoskeletal cases are related to like fluctuations in estrogen, progesterone, testosterone and like.

how important that is even in the musculoskeletal world is like a valuable lesson that I'm learning right now. So like, I feel like the thing that I'm currently kind of amazed with is these patients that aren't responding well to the model, which usually, you you plug in the model, the patients get better until they don't. And one of the reasons is, is because the body's so complex. I mean, it could be because of autoimmunity, it could be because of hormonal problems, metabolic, and like, I think...

you know, for the aging clinician, you start to learn to appreciate those things a little bit more. And then I feel like as an educator, my job is not to go somewhere on a weekend and sound or look smart. My job is to, if I'm a bunch around a bunch of tri ones who are learning to adjust, I have to almost like just put myself back in that moment and be like, you know, and not even talk about all the other things we could talk about. I mean, they need to learn how to palpate joint blockage and how to do an adjustment.

me sounding smart on the stage does nothing for them. So I think always just trying to be a chameleon and morph yourself to who the people that you're talking to are, that's what actually makes for good educators. And I feel like there's not enough of those people in the world that are just willing to humble themselves and talk to a bunch of try ones or try twos on how to get good at manipulation. And so to answer your question, though, I feel like where I'm really learning a ton about is more like

in the functional medicine side of it as it relates to musculoskeletal medicine and you know, like kind of filling that need for my patients and then educating the world on some of those thoughts is probably the, you one of my future things. Besides the obvious stuff, the, even like the TMJ, like, I mean, the more I'm around dentists and orthodontists and stuff like that, the more I'm learning about in their world, like whether that's palate expanders, whether that's tongue tie, whether that's...

you know, just surrounding myself with the right people to kind of like understand that. So I would say, no, I mean like it's like you think you get to a certain level and you just don't like you just, you just want to learn more. You just keep, you know, it's just like more. It's like this thirst that you, you just can't get enough of, but it's like fishing or golfing and you you catch a big fish or you have a great drive and it's like, it just what keeps you going. And we always joke around here. You get absolutely.

Dr. Beau (38:53)

Mm -hmm.

Brett (39:08)

your face kicked in and you're like, you leave the office, like you're like, I just don't even want to do this anymore. And for some reason you wake up the next day and you want to do it again. It's like the coolest thing ever. And I think like if you can learn to treat all of your patients, almost like a puzzle and almost just love the process and revel in like the, you know, the complexity of it all, you never really burn out. You just like, you're like a little kid every day. It is kind of like, my God, I cannot believe this connection.

And that kind of gets you through dealing with all the difficult people, which we all have to deal with, which all of us see the same people in our day. They just have a different earth costume and a different name. But really, whether you're in Troy, Missouri, or Birmingham, or Nashville, or Sydney, Australia, we're all seeing the same people. So it's just whatever we can do to continue to push the profession forward.

Audra (40:02)

And I know like at Gestalt, you guys combine the fun with the learning and that's like a game changer and that draws more people and it's just like, I know I'm gonna get to go have fun and network with other doctors and everything. And I know we're playing on the same thing. Thank you for, you know, showing us that. Since you've been through this.

like in a lot of other cities with your company, how important that is and what a game changer for people's like learning experience of combining, hey, we're gonna hang out and have either intelligent or non -intelligent conversations, but have fun and like relax a little bit. And I know I walk away feeling like I learned way more, but then also got another level of like connection and networking and this was even more worth it.

Brett (40:51)

Yeah, I mean, I've definitely learned from Taylor and some of our younger docs here, Pete and our other associates, Taylor and Austin now, where they know how to have fun. really, I knew how to have fun when I was in undergrad and things, but then I took the first 10 years of my career and I put my head down and I just was a grinder.

And now I'm different. I've kind of learned like it's actually the world's a better place when we learn how to have fun and it helps with the culture of the office. It helps with the culture of teaching. just yeah, I think that that's that's a special part of it. And I think that like it's it's understated. But, know, 30, 33 percent of your life is spent working. Thirty three percent of it's hopefully spent sleeping. And then you have your family, your hobbies and stuff like that. So.

If you're going to spend 33 % of your life doing something, then you better be having fun doing it or else it's going to be a long life.

Audra (41:50)

And what are you most excited for about coming to Nashville for this course?

Dr. Beau (41:52)

Thank

Brett (41:55)

Well, first of all, to hang out with you guys. like that is an educator back to what Bo was saying earlier. Like the biggest compliment for me is to see like people that, you know, we've had an influence on like go on and like lead our profession like you guys have. And it's just like, to me, that's like so gratifying and like whenever I see like on social media, like you guys doing great things, it's like, it almost makes me blush because I'm just, it makes me so proud. But

And then like as far as like that, I mean, Nashville so fun. I mean, like if you don't have fun in Nashville, that that's your own problem. So nothing's better than a night out on Broadway or day drinking in Nashville. So yeah, I think Nashville is just kind of the new Las Vegas for us in the Midwest and it's a great city. And then you surround yourself with great people like yourself. It's a recipe for a lot of education, but also a lot of fun. So that's.

Dr. Beau (42:29)

You

Brett (42:51)

probably what I'm looking, yeah, now I'm old enough to where I kind of look for, am I going to a great spot? Do they have good wine there? Are the people good? Yeah, and that, so that kind of checks all boxes for me there in Nashville.

Dr. Beau (42:59)

You

Well, and funny enough, you're part of the story of, know, Audra and I as whole run into an education company and why it's called Blackjack Education. Because, you know, we spent a little time in the casino in Prague and maybe they weren't as big of a fan of how we had fun as Americans as we were. That's kind of what we're aiming for. So like you said, Nashville or Nash Vegas is kind of becoming this small, you know, Midwestern or Southern Vegas.

And that's a big aim of this is we know from, I'm going to be honest, like I told Brett before this, like I've stole a page out of your playbook in terms of how our office runs. Like we have essentially communicated like group office for the docs and like, you know, there's a bar in there. It doesn't mean we're drinking in between patients, like we're, we want an office where if you wanted to hang out here and talk about whatever it is or clinical stuff, you, you would feel comfortable doing that. And I,

Audra (44:00)

you

Dr. Beau (44:04)

We know that's a game changer in other companies, so why not in the medical field where it can be a bit stodgy and maybe uppity is not the right word, but it's like, I'm a doctor and this is a place of higher learning that needs to smell like leather and mahogany or something. So yeah, I stole a page from you and that's what we want to also really focus on at these courses because it is three days of information and you can attest to this. know, Brett, on that third day.

everybody looks like a deer in the headlights or a zombie because it's not that it's bad information whatsoever. It's so much great information that you're just, you don't know what to do. So I think if you can keep the fun and the motivation and the networking high that kind of offloads that pressure and refreshes you a bit. So that's a big goal of Audra and I for this upcoming seminar in April.

Brett (44:54)

No, think that, I mean, that is absolutely, and I learned that too in our office actually. When, cause our center area was all divided up originally. And one day I'm like, you know what? I don't like this. I think we're just going to knock down the walls. So then we knocked down two walls to open it all up. And I mean, that's led to a sports book that we run out of there, a full bar. I mean, it is just a disaster in there, but all, all I think in a, in a good way.

The new thing we're wanting is we're wanting a roulette wheel with the electronic readout and we want our, we're going to have an omelet station I think and make the interns cook us omelets in a tuxedo.

Dr. Beau (45:37)

Wow, we've got a ways to go to get to that echelon. So we got goals to strive for at least.

Brett (45:44)

Anyways, yeah, no, the point back to, yeah, let's have a little bit of fun.

Dr. Beau (45:49)

Yeah. Well, Audra, anything else? Any, you know, pressing questions or are we leaving off on the fun component and, you know, expect that everybody just show up in Nashville now and, you know, go sign up immediately after you listen to this.

Audra (46:04)

I mean, I feel like we won that round.

Dr. Beau (46:07)

Yeah.

Brett (46:07)

Yeah, yeah, think so. Yep.

Dr. Beau (46:09)

Well, to reiterate one more time, the person that I quote from a professional standpoint as a mentor, the most in our office, or when I teach myself is you. And the person I've probably learned the most from is you. And that's not just in the respect of things that you teach for. It's overall because I think you're a great integrator, which is one of the things that I want people to realize that applicability means that you're able to integrate something like DNS into other tools you might have.

if it's in addition to and I think you're one of the best in the world and I think you're a king at that like, hey, this is how you can apply this. This is how you can do this right now. You got to these other things like you can pay attention to this, but this gets you further down the road. So that's what I'm looking forward to. I don't remember the last time I took the NSA. It's been a few years now. So it'll be cool to just see what's changed, see you teach that. So I'm looking forward to it as well.

Audra (47:03)

I second that. All the things.

Brett (47:03)

yeah, it's going to be a big time. Yeah.

Dr. Beau (47:06)

Well, not to be a dog on this too much, but April 4th through the 6th, go check out blackjackeducation .com to sign up. Brett's going to be there signing autographs besides teaching. We've got some gambling coming. I don't know if it's going to be a roulette wheel readout right in the seminar, but there'll definitely be some cards and some money thrown around for sure.

Brett (47:30)

Ew, I like where your head's at. That makes a lot of sense.

Audra (47:34)

Yeah.

Dr. Beau (47:34)

Alright guys, if you have any questions hit us up on social media. Anything else, Audra?

Audra (47:39)

No? Can't wait to see ya!

Dr. Beau (47:41)

All right. Thanks again, Brad, for being on here. We appreciate you, See ya.

Brett (47:44)

Bye team. Bye.

Audra (47:45)

Yes, thank you. Bye.