The Introspective Path to Clinical Mastery | Dr. Nicky Kirk, DC

Most practitioners are navigating a maze of dogma and quick-fix solutions—Nicky Kirk unpacks how questioning every framework and embracing humility can transform your approach to patient care. In this candid conversation, Nicky reveals why mastery in our methods is a journey of continuous questioning and how the true power lies in understanding what really works, rather than what sounds good on paper. You’ll discover how to cut through the noise of technique hype and develop discernment in clinical decision-making, grounding every intervention in scientific understanding yet remaining adaptable. We break down practical tools like outcome questionnaires — how to interpret them honestly, use them ethically, and leverage their insights to improve results rather than just cover your legal bases. Plus, Nicky shares the importance of celebrating milestones with patients and colleagues, redefining success beyond the grind of constant achievement. This episode is perfect for clinicians tired of dogmatic approaches, students eager to cultivate critical thinking, and anyone interested in the delicate art of balancing science with real-world practice. If you’re ready to question methods, refine your mastery, and elevate patient care, this conversation will shift your perspective. It’s not just about techniques — it’s about becoming a better, more thoughtful healer. Nicky Kirk is a chiropractor and thought leader in neurology and movement, known for his nuanced insights into clinical frameworks and the importance of ongoing self-awareness. Through his writings and coaching, he challenges professionals to stay humble, question everything, and pursue excellence grounded in science and genuine human connection.

Full Transcript

Beau Beard (00:00.91)

Yeah. So did did you play pro soccer?

Nicky Kirk (00:04.798)

No, but you know, we could we could perpetuate that myth if we want.

Beau Beard (00:09.88)

I'll just leave this whole I'll leave this whole podcast with that. pro soccer player Nikki Kirk, transition to chiropractic and people can fact check you or not.

Nicky Kirk (00:20.724)

Just it'd be like he's equally mediocre at that as he was at soccer, which is why you won't find anything about him on either.

Beau Beard (00:30.318)

Well, I like to get into these pretty quick 'cause otherwise they seem too formal. so I just like to act like we're just talking. So I'm gonna get into it if you're ready. That's not good. All right, well

Nicky Kirk (00:38.516)

Which which we are. Yeah, absolutely. Let's go. Let's go.

Beau Beard (00:43.574)

I wanted to have you on the podcast within the first five minutes of hearing you on stage at Parker, Miami. I was like, I love the way this guy thinks. I g that's I was talking with Brett Bartholomew, you know who that is the other day, conscious coaching, and he sent me a text after we were talking, he goes, You you really like to get into the weeds, like think deeply and that's the first thing I picked up about you. I like, I really like how he is thinking about frameworks within treatment, but just kind of questioning everything, but not questioning everything in a

Nicky Kirk (00:56.276)

Yeah, of course. Yeah.

Beau Beard (01:13.888)

Pessimistic light, like just enough, you know, of that skepticism, I think, to keep us honest. But I really appreciated that. Then when I asked you yesterday, hey, is there anything you want to make sure we covered? And you pointed me to your substack, I was man, I might have a man crush on this guy now. and we definitely need to highlight that. And if you're listening to the show, you need to go read. and we'll put links to all the stuff in here, but check out his substack because that's what I'm gonna pull from. I'm basically just

Nicky Kirk (01:42.826)

Yeah.

Beau Beard (01:43.401)

Now I've got a playbook to run from. So before I dive into some of my questions, you had, I want to say, at least four or five Substack articles kinda on where you came from, a little bit of your history. So I don't wanna, you know, feel like you gotta go from you know womb to now. But just give us a primer on you know how you got into chiropractic and you know how eventually now you're in Dallas, Texas, you know, basically heading up the Parker Performance Institute.

Nicky Kirk (02:16.308)

Lost you forsake there, boo. You back?

Beau Beard (02:18.594)

Yeah, are you there?

Nicky Kirk (02:20.052)

Yeah, I just I've I've lost the video stream, but I can I can hear you. So I I I think what I heard was a little a little bit about my my my journey, but most of the interesting or intricate details are are posted up on on the substack. But here's I I don't know if I did put this in there or not, but so chi chiropractor for me and becoming a chiropractor has been it's been a sort of perpetual you know like the good the good angel and the bad angel or the devil and the angel in your shoulder.

Beau Beard (02:23.264)

Okay.

Nicky Kirk (02:49.018)

It's always been a little bit like that. And I think I think for a lot of people that I'm not gonna describe myself as a high achiever. I think you know, I think those types of you know, that sort of hyperbole is probably not not helpful. I think that's for other people to determine if what you've done is is is good, bad or or indifferent or if that is a good career pathway or not. But but but I've always and I still have although it's getting better, this

The two things, you should have you should have become a physician, or you should have gone into physiology, or you should have done this, or if you'd done gone in this direction, you'd already be doing that thing you think you want to do by now. And so my my whole career I think has been punctuated by by periods of of feeling generally just elated to be a chiropractor versus certain times of wishing I'd done anything but being a chiropractor. And you know, I have a lot of friends and colleagues that work across disciplines, you know, P

PTs, yes, I am friends with PTs, even though I say mean things about them, but I say mean things about DCs as well. NATs. I I think they all have those dialogues and those discussions and second guess. And the things that we we think are bad about our profession are are amplified or worse than other ones. So I tell the students that I'm that I'm extremely bullish about the profession, but what frustrates me is I think with many is we we can get in our we can get in our own way.

And we we should be more collaborative and we should be more ex like we should de we definitely need to, you know, keep a lid on some of the nonsense which goes on and I and I think we do need to police our own profession to a certain extent. But I that that's not me being I'm not the chiropractic police, but it but I think we we need to be more accepting of other people's ideas and I think we need to be a little bit more accepting of our own our own ability to to be wrong.

Occasionally. And it's it's difficult in a singular profession like chiropractic where we're where we're on our own substantial amounts of the time. And y that old adage if you're the smartest person in the room, find a new room and and and I think when you're a practice owner and a leader, I'm not describing myself, but could be any any person that maybe you know both

Nicky Kirk (05:08.02)

We we don't recognize that maybe we should be in a different group.

Beau Beard (05:09.368)

kinda losing you there, Nicky. You're really breaking up. I don't know.

Nicky Kirk (05:31.008)

We're back.

Beau Beard (05:32.842)

you're back right now. Yeah, and this usually takes the buffering pretty low. So I don't know. Are you on wire like pretty strong Wi Fi?

Nicky Kirk (05:45.566)

It it could be me. if if I take five minutes and switch offices, would that be okay?

Beau Beard (05:51.692)

Yeah, that's totally cool with me. I'd rather be able to be in the combo than the tech getting in the way. Yeah.

Nicky Kirk (05:57.47)

Yeah, let me give me give me two minutes. I'm gonna switch offices. There's one at the front that has wired in wired one. Should work better.

Beau Beard (06:01.41)

Yeah. You're good, man. All right, sounds good.

Nicky Kirk (06:09.994)

Yeah.

Nicky Kirk (07:12.974)

and wire.

Nicky Kirk (07:20.75)

you

Nicky Kirk (08:09.262)

Hey Bo, are you there?

Beau Beard (08:10.86)

I'm here. Yep.

Nicky Kirk (08:28.408)

Can you hear me?

Beau Beard (08:30.22)

I can hear ya. No no video though.

Beau Beard (08:39.126)

There we go.

Nicky Kirk (08:41.102)

I'm going to prop up, because I don't want to have everybody looking up at my chin while I'm speaking.

Beau Beard (08:46.604)

Ha ha ha.

Beau Beard (08:53.526)

I can just put a tropical background behind you or a you know what whatever team you whatever team is your arch nemesis will put their flag behind you absolutely.

Nicky Kirk (08:57.368)

Heck yeah! That'd be great.

Nicky Kirk (09:03.823)

Don't you dare put England up behind me. I've got it.

Beau Beard (09:06.158)

Well we had a little bit of technical difficulties, but we can actually use that segue because you were kind of saying, you know, we maybe need to we need to be open minded, but we also need to rise above some of the I I I don't want to call it nonsense, but some of it's nonsense.

And that can present is technical difficulties within a profession, right? Like, this is a hurdle we need to get over as a profession, or we see this as a theme that's building. But a theme that I wanted to maybe tie a thread through this whole podcast with you is what I picked up from your substacks. I wanna know if this is a true theme or not. It kind of seems like you've always

kind of question, are you on the right path? And I even heard that in your self-intro there of like, Well should I have been a DO? Like or somebody telling you you should have, you know, had another profession. But I kind of saw that like in terms of like, Am I on the right path like in life? Am I on the right path in a profession? Am I on the right path with this patient case? Like where's that mentality or that thought process come from? Because I'm a I'm a wanderer too. Like I my parents thought I was crazy. I moved all over the United States before going back to grad school after work

working three years, then we moved to a state that we knew nobody. So I've got a bit of that nomad in me, but where where did that come from? Why you know, how is that kind of cooked into who you are?

Nicky Kirk (10:28.462)

I think part of it's a Scottish characteristic, genuinely, in as much as we're, they talk about, you know, Catholics being sort of self-effacing and self-flagellating, but I think that the Scottish mentality is whatever I do is never going to be good enough. And it's a cultural thing. If you are successful in Scotland, people will take potshots at you, not because they're mean, but it's a...

It's just a characteristic, it's an underdog sort of nation. And I'm happy to say I came from a great household with a great family and plenty of good role models around me. And my parents were kind and thoughtful and respectful. So I can't even turn back around and say, my dad was just mean to me. He wasn't. He was wonderfully supportive. So I think it goes a little bit.

deeper there, but I think introspection is good in healthy doses. When it leads to rumination and procrastination and, you know, self-hate or saying mean things about yourself, it becomes quite harmful and destructive. So the substack for me, and I'm sorry to keep referring back to it, but just because it's really a tool, the substack for me is a way for me to write

those things down and get them out and think about them. And was it so bad? None of the stuff I thought was bad ended up being bad. They were difficult at the time and they felt like it was the, a lot of them felt like they were the of the world, but they were really okay. And I have a friend who I respect greatly. This was a recent thing he told me is,

Now this made sense to me is it's really you're defragmenting your brain. Like you're taking what's in there that's ailing you at that point in time and you're writing it down. Can I do something about it now? No, or yes. But if I write it down and I defragment and I get that stuff out, it's like, what am I really worried about here? Like, am I really worried about something that happened to me 15, 20 years ago? Can I go back and change the fact that I became a chiropractor? No. Are my reasonings for being a chiropractor different than they were 25 years ago?

Nicky Kirk (12:51.278)

Yes, 100%. Because I'm not the same person as I was when I chose to study that. But do I have the choice to continue to be a chiropractor? Yeah, every single day I choose to get up and come to the office. So introspection's there. I don't think for me personally it will ever go away. it's out there to just let people know that you...

It's okay to feel these things. It's okay to feel like this is a tough profession sometimes. Like patient care is difficult. Working with people can be difficult, but also greatly rewarding. I think it's okay to feel that range and that gamut of emotions and experiences. I think it's normal. But never losing sight of the fact that you're in a meaningful profession. Maybe one of the few where you can sit down and say, is...

impactful on a personal level for patients. It's impactful to be part of a longevity and wellbeing movement. I truly think you have the option or the opportunity to make a real difference in the world, to really improve humanity. mean, how many professions can really say that if you take a step back? Like how you conduct yourself within that, that is a personal choice, personal decision.

Beau Beard (14:16.906)

Again, 'cause I'm just picking through the substack of trying to I was trying to get to know Nikki Kirk via basically blogs. Do you feel like a lot of the like geographic wandering but also questioning of the profession was I'm sure it was a little bit of all of these, but is there one that kind of weighs the heaviest of like circumstance, right? Like I know you had to move due to circumstances in some scenarios, whether it was Puerto Rico or you know, trying to go into Michigan or going back to UK.

Okay, but was it circumstance or do you feel like some of the sun you know, I there was hints of this in some of your articles of like almost like a a subconscious kind of self-sabotage or questioning, which maybe goes back to the introspection or again I get it I get it's a blend, but is there anything when you do look back you're like, hmm yeah, there was a lot of me in there rather than just being like, I have to go here now.

Nicky Kirk (15:12.024)

Sometimes I think you make a choice and maybe at the time you, your reasons could be selfish, but it doesn't necessarily make it the wrong choice. You know, like when we left Puerto Rico, I had already made a decision. I wanted to leave Puerto Rico. The fact that a hurricane came along and, you know, decimated the place, which was tragic, but, but it also meant there was no choice then to go back. So there was no turning around, but like, we could go for six months and then see how it goes. I mean, there wasn't.

There was an alternative, yeah, I mean, I guess if you're leaving a situation you don't like, I what is it that drives you to leave a situation? Is it aspiring to do something else? Is it just simply that you're looking for novelty or variety? Is it that you're truly unhappy? I don't know. mean, I've never... I think the Puerto Rico one was interesting because I was at a point, you know, emotionally where I needed to leave.

So that I push myself too far. I push myself too far with expectation and I try for too long and too hard to fit into something which I was never going to fit into. So then one day you have that realization where this is.

there's no point pushing anymore. It would be nice to get to that point earlier so that you don't have to be quite as reactive about it. But I've never once looked back on that. So that was the wrong choice. As far as, think the areas, and this probably goes way beyond anything related to therapy. I think the areas where I probably made the...

bigger mistakes or things that I have regretted might be more around relationships than career choices. I think, you know, the way that you treat people in the past is like this things that maybe said or done that I would never do now or never really thought about how that would affect or impact another person. If I ever had those types of thoughts, it's usually around that as opposed to where I direct myself. The only issue now is that because I've got a wife and...

Nicky Kirk (17:26.008)

to, well, I've had them for a long time, we've married for a long time, but this is also the realization that the decisions you make now impact greatly your family, but now in the clinic I work in, have seven or eight people here with me as you do, at your spot, the decisions you make on day-to-day basis also affect them and their families, and that's a pretty heavy weight of responsibility, so we can't afford to be quite as reactive as maybe we were when we were younger. So think maturity comes into it and...

uh that that level of consideration and i'm still working on it, you know, it's still still not an area where or i'm happy as happy as I could be with myself about how I make these decisions but the other part is when you read when you read that that blog or those posts they're over you know, you're talking about 20 30 almost a 30 year period so like a history book nothing happens for centuries and then a big war happens and then there's

chapters dedicated to the second world war, which 1939 to 1945, six years, but there's chapters on it. And then nobody talks about anything really that happened in the intervening period between the first and the second and the middle ages in England. Oh yeah, we had like a nine year war, but then nothing happened for three centuries. I'm sure that's not true. So I think it reads a little bit like that too. Periods of stability with pretty severe periods of volatility. Then another period of stability probably punctuates it quite well.

But yeah, how do you enter into periods of volatility? Earlier on burnout, dissatisfaction, ego, felt I deserved more than probably I did. But try telling a 25 year old man that, that's probably the reality of it.

Beau Beard (19:17.43)

Well you said maybe there wasn't, you know, therapeutic underpinnings of that. I think there you know, obviously there are and we can extrapolate anything, but as you become more aware of your impact on the others around you in your direct circle, right? Your family, your employees, their families, well that's also going to reflect in patient care, right? Of having more of a an empathetic or a you know, just the approach is different because you realize the effect that you're having on, like you said, that humanitarian effort versus I don't know

you were much like me when I first got into practice, it was a lot of like, you know, how many tattoos of methods can I put on my sleeve and puff my chest up of how good I am versus now it's

Well, I s I saw somebody twelve years ago that now I'm seeing all these people that are hurt or they're kids or I'm you know, I see them out and I get to hear, you know, the bad or the good, both. But it's just it changes and then you've changed along with it. So yeah, it's always different. But one one thing in the same vein that I read in there as well, which hit really home with me, so I have a six and a three year old daughter and I'm about ready to ramp up teaching poor DNS, which was a a very hard decision.

For me, because it will require require more travel. And you had an article in there specifically on this of asking, you know, why am I doing these things? Like, yeah, I like to go teach, I like to get up on stage, but you know, at that time, whenever that was being written or when it was being written about, you're busy fitting into a schedule, and you're like, you know, was it escapism or was it chasing down a passion? And I mean, those same thoughts sit in my head. So I just kind of wanted to hear you maybe extrapolate on that a little bit and maybe say,

how your minds change on that, do you still you know agree with that, you know, what that article said, or I mean I just saw you speak on a stage, you know, a few months ago. So where are you at kind of in that mindset at this point?

Nicky Kirk (21:09.868)

Before I turned 40, and actually it was Pat, it something I read that Pat Davidson, probably you're familiar with him, but not everybody would be, but he's a strength and conditioning performance guy based on your absolute character. mean, absolute legend, but I saw him and he was like, before the age of 40, I said yes to everything because you don't know what pathways or roads they're going to lead you down.

And I think the reality is it's like, don't know if you watched, what was the thing with the TVA from the Avengers, Loki, but there was a thing where they'd go off and prune out competing timelines. So there was one singular timeline. And I suppose I took the attitude like, well, I'd need to explore all these different timelines because I don't know where they'll lead. And the reality is 99 % of them lead nowhere or nowhere you want to be.

necessarily and that I think comes down to other people telling you things that, if you do this, then maybe it'll open the door for that or this idea of repricosity that the people are really just trying to get something from you.

And I think it's okay to give, but there needs to be a level of mutual respect. And, you I don't think people should act from completely selfish motives, but I think your job is to determine, as the, the invitee, is this, is this going to be a mutually beneficial situation? And if it is, so maybe I'll say this about my, something my wife told me, sorry, not to go off in a different direction here, but

When I moved, I won't say I don't see patients anymore. mean, I do, but much, much, much less than I used to. And I find identified as a clinician, identified as being a good clinician that could solve problems that knew more than other people. Like it was part of my id, like who I was. And I find it, I find it really difficult moving into more directorship role or more, you know, admin, cause I'd always thought of admin is, you know, I send you, joke is still facetiously joke about it. send emails all day and yeah.

Nicky Kirk (23:19.298)

what are like right performance reviews and approved timecards. But obviously I do a little bit more than that, but it was hard for me to let go of the patient care. And my wife framed it like this. As she said, you've you've seen patients for 20 years, whether you agree with me or not, you've helped a heck of a lot of people. And now you're still going to help people, but just in a different domain. Like you can either help people singularly, the patient in front of you, or you can, you can try to amplify your influence. So what I would say to you,

is that by going to teach another generation of practitioners, I think that's a very high level of contribution. And I would like to think that your wife and your children would be able to, know, a three and a six year old aren't gonna think about it this way. They're just gonna be like, daddy's gone, now he's home. I love it when daddy comes home. That's great. But I'd like to think that having the opportunity to contribute at a high level would be something we would aspire to do.

That would be something that we would look to do at the start of a career. So, were all of the things I did the right things? Definitely not. There were things that probably, yeah, if I look back, maybe it was a waste of time or didn't go anywhere, but it also allowed me to become a little bit more discerning about what I do go on. Like this, this podcast, I wanted to do this. This is, this for me is a great use of time. And, you know, to build, build a relationship with somebody like you, who I don't know very well, but I've heard

great things about you from Troy and from other people who've been through your program. So why would I not want to associate and spend time with somebody like that? So yeah, it's still case by case, but I think about the Venn diagram, you're still in the center, your family relying on you to provide stability, sustenance and direction.

Hopefully this doesn't come across as really misogynistic actually. You've got to be so careful these days, but they need you to be all those things. And if you chose not to go teach DNS, which you clearly want to do, and you must be pretty good at it, otherwise they wouldn't be asking you to do it. Maybe you're a bit of a shell of yourself and you're at home, because the whole time you're thinking, oh, that guy is teaching this. And I really feel like that should have been me. And I don't think that's a good place to operate from either. So, and maybe the opportunity doesn't-

Nicky Kirk (25:48.673)

It doesn't recur. know, two, three years go by, you have another kid. You know, the girls get involved in youth sports and all of a sudden it's like, I don't want to be going to Fargo. No offense to Fargo, but I have a friend there who finds that funny. I think. You know, maybe that's a choice you wouldn't want to make at that point in time, but maybe once you've been instructing for three or four years, they send somebody else to Fargo and you just get to go to nice places and take your family with you.

I took my family to Miami to conference. They weren't annoyed at me then.

Beau Beard (26:23.966)

That was one of my big goals with with teaching was, you know, exploring, knowing that it it opened up travel opportunities and but one of the big decision points for me, and it's been a theme which I I mean I'll give kudos to my wife, you know, who is a Cairo who practices in this office is she has always pushed me forward. She's like, No, you need to go do that, you need to go do that to give an example to our kids. Now you can take that too far and be selfish with it and lean on that and say, I'm being the example.

Nicky Kirk (26:31.619)

Yeah.

Beau Beard (26:53.98)

And just be, you know, vacant from your life. But that has been a big goal. But the quote that you you pulled your own quote out that I had written in here of you said nine times out of ten it doesn't delete something bigger. But I think that plays back into the the introspective wandering of if I don't do it, what if, right? It's like, well I c I am a Cairo, but I could have been a DO, right? I am a Cairo, but I could have yeah, been a you sports metaphysician. And like you said, it's

you know, we can't go prune like Loki would. All we can do at some point is, you know, start to be be more discerning and use wisdom. So basically putting, you know, knowledge into application and saying, okay, this is the best choice for me now and that's all I can do. Versus I, you know, whether you call it FOMO or whatever, but that's been a big theme of mine of like, if I don't do this, what else am I saying no to? But at the same time you're already saying no to fifteen other things by saying yes to that. So it's always pruning.

In that again, same light, you again, I think you and I are very alike and maybe that's, you know, a good or a bad thing. I don't know. We'd have to maybe ask those around us, but you had an article about champagne moments and how

They need to occur, maybe they're not the easiest thing for some people to celebrate, but also how do we determine what those should be? So any any kind of insight, because I know I agree a hundred percent. You're kind of like, we we go to school, we pass an exam, we you know, we graduate, we pass boards, we start a you know, a career, whatever that is, we make enough money to survive and it's all survival, survival, survival.

How did you start to turn that paradigm around where you're like, it's you know, it's not just go to the next thing, but I can stop and celebrate or I can say enough is enough? Like how d how do we work around that a little bit better?

Nicky Kirk (28:46.464)

Well, first of all, we're assuming that I was able to turn it around and I would still question that. But here's the things, the champagne moments are not for you. They're for the people around you. Not everybody thinks like you. I would just actually want to... My wife is also, I'm sure it says in there, but my wife is also a chiropractor. And she is my biggest advocate. She's a bigger fan of me than I am of me. And I think choosing or having them choose you the right...

Beau Beard (28:50.316)

Ha ha ha.

Nicky Kirk (29:16.598)

the right spouse and being a chiropractor and chiropractic being such a unique profession, having a wife who is a chiropractor and a husband who is a chiropractor makes all this stuff so much, much easier, especially around philosophical discussions and her understanding actually how hard it would be for you to even have these opportunities. Like nobody will understand that like she does. So when she says pursue it, you can pursue it with gusto.

and that's all that matters. So I love that. But yeah, maybe champagne moments are not for you and I. Maybe we just continue to push and make those happen for people around us. But the point of the article really is that just because we don't want to sit and acknowledge an important milestone does not mean to say that we shouldn't, your parents, whether they financially or emotionally supported you through school,

or set the pathway to get there. don't think they would want a champagne moment when you walk across the stage. The doctorate title, that's worthy of celebration. Even if you maybe like me turn around and be like, I don't use it. I don't introduce myself as Dr. Kirk or Dr. Nikki. I just don't do Never did. It's not just an age thing. I just never really did. But that's a source of pride for certain people. I think my kids think it's kind of funny and cool.

think it's like coach Dr. Nikki or whatever, or Dr. Coach Nikki, depending if we're in the clinic or doing soccer. But that would be, you've got to sit and look who's around you and acknowledge did they contribute to it. Was this a really meaningful moment in somebody's life, but it was pass-a to you because you're used to hitting goals or you're used to accomplishments? And maybe we don't have...

big enough goals to get to. Like if you, you know, when you're done teaching your first DNS class on this new pathway, do you just go out for dinner afterwards or do you, you know, how do you notate it? Because it's significant. Like how many people want that or think they should have that role or that position? I mean, don't know. That's who I look at it. So maybe you and I just keep grinding on, but.

Beau Beard (31:34.296)

Yeah. That's a very good, very good point.

Nicky Kirk (31:42.966)

Maybe we allow the other people to celebrate.

Beau Beard (31:45.871)

Yeah.

I really like that and you know, it's that's also not that we have to accept it, but I think a lot of that is the mentality of the day, right? The the hustle culture, you gotta keep going, just keep going no matter what and you know 'cause I've been guilty of I feel like if I pause it's like well if you pause and celebrate, well you're saying like, that's the end but it doesn't like you say I I really appreciate that insight of well, who are the people that help you get there? You know, who are the people that sacrifice of you not being around when you were doing XYZ or you know

helped you in whatever way they could or, you know, just want to see you also celebrate yourself. Like people that love you want to see you be happy and if they don't if they think you're miserable grinding for them, sometimes, you know, they feel like they pushed you into these scenarios, you know, maybe for the wrong reasons. Where you know, and I think that's that is important. In that same vein of champagne moments you talk about play and I mean we could go fifteen different ways with this, especially with what we do for a profession, but

W why and then how? So why do you think play is missing, let's say in adults' lives, right? Whether that's within our profession, just you know, adults in general. And then how can we cultivate that a little bit better? I know you talked about sports specifically, but like why do you think that just goes away? Right? You kinda talked about this trimming over time of play and we just kinda get into the doldrums, but why is that the case? Why why do some people keep it and others don't?

Nicky Kirk (33:12.53)

I think most of us leave the best of ourselves at work in the office and we have nothing left to give on the other side. Genuinely.

Beau Beard (33:21.838)

So do you think do you think we're playing in work then?

Nicky Kirk (33:26.326)

Yeah, I think so. think we're in here and DNS is a great example. You're regressing people through different types of movements that may seem kind of silly. I mean, if you're trying to explain to somebody for the first time the premise of what this is based and yet they still can't do it. People don't want to feel foolish. So let's try and make it fun or interesting. I'll try to do it and I'll make fun of myself. I I constantly

joke and quit at work, which maybe is really annoying for people. I don't know, but I enjoy it. But then when I get home, okay, my kids are now of an age where they just want to be in their room and left alone and that's fine too. But my kids are, my son was just battering a soccer ball, breaking my fences actually in my backyard. He's terrible at soccer. It's just also how I know that this sort of nature nurture argument, he's good at hockey, fortunately, he's got something going for him.

Beau Beard (34:20.214)

Yeah.

Nicky Kirk (34:25.602)

You know, my wife's like, why don't you go out there and kick the ball with him? I say, why would I not do that? I'm always telling people how much better I am at it than he is. So why would I not go out and show him how the old man still can smash the fence better? It's just a fence, but. It just doesn't occur to us, and I think the other the other part, if you work for an organization or institution, it's like you've got your boss face, you've got your dad face and they've got your home face and your

wife face, you hopefully you guys still get some time together away from that. It can be difficult to remember who's who and which is which. And. But I even just think it's like that that stupid thing, you know, I went for a hike, like I just disappeared off. We were back in Scotland, so that was what made me think about it. I went for a hike and I I was going to go on the path that was already trodden down the tractor pathway and I thought, screw that.

It's much faster if I just go through this thicket of wood and you know, I end up getting myself all scratched up and I kind of get stuck. But in the interim, I'm like, I'm going to be really careful going over this fallen tree because I don't want to fall. And think when I was a kid, I would have jumped on this thing and seen how I would be springing on it, jumping and yeah, I might have fallen and hurt myself. But I wouldn't be thinking about falling and hurting myself before I got on there. Now all I'm thinking about is

like, I don't want to get scratched or what if I get an infection or I'm going to have to find a careful way to get around this. And that was just what sprung the thought. so I was like, you know, we lose, and I think, you know, DNS and some of the therapies we do are interesting too, because I think what Dan John said, it's like, if somebody over the age of six is on the ground, there's like a 99 % chance they did not mean to be there. And he's right. So we lose.

I don't know, somehow we adopt this sort of old serious persona and we, you know, these movement capabilities that we had or the, just the joy in jumping on a, on a bench and off a bench, they, they stopped, but they never, they never stopped being fun. We just stopped doing them. And it's, I don't know. I think also like, I've been listening a lot to Jimmy Carr lately and he's, he's funny, but philosophical. It is true. It's like, you know,

Nicky Kirk (36:52.98)

limited time on around well like limited time to enjoy stuff so why are we not trying to extract what joy and fun we can from the even the minutiae of things i'm so crap at this by the way but at least i'm thinking about it

Yeah.

Beau Beard (37:11.564)

No, I agree. I I mean I even this sounds very I don't know, even the best descriptor, but kind of the mask based on even like what you wear, right? I come into the clinic and I'm like, I don't want to get dirty, like my dog wants to jump on me, like I gotta go to work. If I know I'm going f I just went for a run before I did this, if I'm running on the trail, like I'm looking for like bashing through water. So it's like literally as stupid as it sounds, you know, changing the clothes, which you know can change how you

Nicky Kirk (37:39.094)

you

Beau Beard (37:41.501)

you act but I think we do as you said walk through life with masks, right? Whether that's a patient presenting to you a certain way because they have to protect themselves or how I present at home because I've dumped out all of my, you know, extrovert energy and I'm actually an introvert and I gotta go home and just, you know, still put out for the kids and, you know, be alive. But I I think that's a big deal of being aware of it and creating action around that awareness takes energy. And I think that's the other part of this is like are

do you have enough energy and I that's a big part for me now of just like not that I'm in the longevity game but I've had to realize like if I go crush a twenty mile run like I'm not the greatest dad to be around because I'm just kinda

And then, you know, if that becomes the theme that I work all week, that's what I do on a Saturday, like that's not great. Versus I could do a twenty minute workout, still feel okay with myself and then have plenty to, you know, give back to everybody. So I I just think being aware, creating a little bit of action, taking the route, right? The not the trodden path, you know, even though it may end up in some scratches and a bump or two is the the first step.

Yeah, I I don't I'm just kind of hopping through the substack, but if I jumped back out of the substack verse for a second and went back to what initially led me wanting to have you on the podcast was you were speaking with Troy, who, as you mentioned, has been in her office, and the main theme that I drew from your talk was

basically always questioning the frameworks and the methods that we're operating within and using to make sure that we're not being dogmatic, but also to make sure that it's as efficacious and you know and efficient as it could be.

Beau Beard (39:25.42)

When we look at these things, you know, whether DNS, a great example, right? 'Cause I think it's a pretty broad conceptual framework and then we can go to really specific stuff like something like Grasston, right? Or you ISTM where like, that's a specific method. Do you have any tips or t specific actionable items for like a student or a new doc when you're when they're approaching like maybe a new seminar, they get really caught up in something, XYZ, you know, alphabet soup of how do they pump the brakes, how do they question appropriately, and then how do they

move forward without completely shelving something but also not completely becoming you know coltish about that thing.

Nicky Kirk (40:03.865)

Weirdly, I gave a talk yesterday to the Neuro Club on campus and it was, I feel bad saying this, but I sort of forgot I was giving the talk. I knew I was giving it at some point, I just didn't remember it was yesterday. So I put together a framework, I'm just gonna say functional neurology, chiropractic neurology, or as I asked the professor who was there yesterday, what do we even call this anymore? And he's like.

clinical neuroscience, I'm okay, I can totally get on board with that. That's a really good term for the application of, you know, brain-based rehab, I guess, in this world that keeps us out of trouble and is sensible. But the whole, so that was the premise. I like, I wanna go in here and my concern for students more than anybody else or people who are new to it is don't get fooled and tricked by the jargon and the speculation.

in the sort of, I would call it a flight of fancy, but the pieces of any names technique, or I call them the acronyms, they may, mechanistically, they may be extremely sound, but look for commonalities. So I drew a corollary between DNS and PRI, for example, not that they're exactly the same, but there's certain similarities. And you could,

you have somebody who's a pure DNS or PRI practitioner, if there is such a thing. mean, but let's just assume for the sake of my argument that they are. They may both get somebody better. And I also told the students that I don't believe that's regression to the mean. You know, like I don't believe somebody suffered with something for 25 years and coincidentally regressed to the mean in that six weeks where they happened to pass by your office. Like I don't.

buying to that or ascribed to that at all. I think that's a safety net for other practitioners because they don't understand what you understand. But look at the commonalities between let's say a DNS and a PRI. What do they do and do really, really, really well and that we know is effective, is a good therapeutic intervention. Just take respiratory control or regulation. mean, just take that. That is a good intervention.

Nicky Kirk (42:24.418)

And they're both really good ways of transferring that, actually integrating that into movement pattern or treatment. But if they're both using similar sort of interventions or at least a similar approach to it, but they both have pretty wildly, I think, different explanations to how it works, don't worry about the explanation. And certainly don't repeat it to patient if you don't fully understand it. Like if it's too singular or too unifying and it's...

Sounds really complex. Don't repeat it. Patient doesn't care. That's your ego. Just take the good stuff from it. I mean, everybody says this, but just take the good stuff from it and be happy with getting effective results. The flip side to that though is I think if we're gonna do something, we should be bloody good at it. A mastery. So how long would it, in your opinion, would it take for somebody to develop mastery of the application of DNS?

Beau Beard (43:22.328)

for my mentors never. I mean they you know they talk they talk about it as looking out into the ocean because we're not the DNS is that, but it kind of makes you question like, what am I doing with every intervention, right? What effect am I having from a mechanical to a physiologic to a neurologic? And when you do that, you see the unending rope. Now when we say I I agree with you, like mastery for I guess competency for now feeling like there's some ownership, I mean it takes

Nicky Kirk (43:25.741)

Right.

Beau Beard (43:52.295)

Much longer than most people think. I mean that's the tough thing, right? Five years a year in I thought I knew way more than I did five years in, 'cause then I realized how much or how little I knew a year in. You know, and you just kinda keep going down that path.

Nicky Kirk (44:05.735)

So I do think you have to also get off the fence and say, this is what the experience in my office is going to be like. So I can't just dabble in this particular framework. If I'm gonna do it and I ascribe to it, I better get good at it. what I didn't want people to take from my presentations, and I'm sure some did, because I could see some people shifting uncomfortably in their seats.

even at the student club is, I never at any point said DNS or PRI or ART or FRC or dry needling or any of the other or functional neurology. I never at any point said that they were flawed systems or bad systems. What I said was that the way that they're globally implemented, the explanation and the mechanisms that are given to patients,

are sometimes exaggerated. So don't base it, don't base your decision on that stuff. Like you have to, you have to, it's what do I see myself doing every day in practice? What do I see myself doing with a patient in the moment? And what approach is going to allow me to do that and take joy in my work? You've got to be joyful practitioner. Like I always tell the, what is your fear when they get stressed?

Everybody assimilates or works differently, but I say like everybody deserves to find joy in their work. So don't go into a chiropractic clinic where the emphasis and focus is on the adjustment. If you don't find a lot of joy in that approach, don't try and fit yourself into it. That's a big mistake that I see happen to a lot of people. And then they're like, oh, it's the profession. It's like, it's not the profession. Profession's fine. It's been here for over hundred years.

It's your current experience of the profession. So dig a little deeper, but don't get fooled by somebody else's interpretation of what it is that's happening. What Ron Horuska says about, I'm probably killing his name there, but what he says about PRI, by the time that's filtered out through 10, 15, 20 generations of practitioners, interpretation of the lens is not the same. Chiropractic functional neurology is...

Nicky Kirk (46:34.198)

is probably one of the worst for that. what I tell people is if you listen to these podcasts, they'll be a tiny, tiny, tiny, tiny little bit on a good quality bedside neurological exam that by the way, we're all trained to do very well.

and then it gets into all the brain pathways and the neural networks and interaction and it's like that may be what's happening but I tell them there's a tool to determine what's happening it's called functional MRI then you can look at what neural networks are being activated and how they're interacting with each other in a specific task but it's very expensive and not practical for patients so don't worry about that stuff just look at the application of what you know and look at the effect was it what you wanted to happen? Good.

Now can we do more of it and make it stick? Whether it's eye movements or whether it's canal positioning, whether it's being able to squat without knee, whatever it is. That was the point I was trying to make. And I do worry sometimes it gets, I would hate to think somebody came out and say, well, Dr. Kirk or Nikki was bashing DNS again or Nikki was bashing PRI or Nikki was bashing this whole other profession.

I don't do that. And I think if people knew me and knew how self-effacing I was, they'd understand that my perspective was like, who am I to sit here and criticize these guys? I haven't even got my own stuff together. But on the other hand, I just think it's a really important message to get out, especially in the information era.

Beau Beard (48:03.438)

But I I a hundred percent agree with the look at the utility of the method or the concept or the technique. I wanna I'm gonna get your take on this. So I've always told you know all the when I dealt with a ton of students through RTP or if it's somebody coming in here or a new doc, that the way to kinda, you know, non-bias confirm and beef back that, you know

being sold basically snake oil, you know, in the form of, you know, alphabet soup, name your technique, was to be really sound at the basic sciences, which is kind of the flip of what you're saying, you're like, kind of okay, get rid of the explanation. Is it effective? So I just I kinda want your take. I always told students, I was like, we go through our first year, year and a half, maybe even two years of you know, graduate school at Cairo

And it's like we just want to get done so we can move on to the clinical stuff. But it's like the way that you can pull the the curtain back on the Wizard of Oz selling you, you know, whatever method is to say, Well that doesn't make sense

Right. I for me that would be the first step. So if somebody was explaining some histological change is occurring with this soft tissue technique, I'm like, that's not how that happens. I'd be like, whoa, whoa, whoa. Now, the crazy thing is, you and I both know, you can still get people, and I'm air quoting this better with something with a poor explanation, right? You can still rub a tool over somebody and I think it was explained in fifteen different ways for 20 years and it would still work in some scenarios. We're like, So how do we kind of I hope you're picking up what I'm putting down there like

How do we compete with, okay, I want myself and students and doctors to understand obviously, you know, physiology and biomechanics, but then at the same time, so much of what we do is placebo and how we deliver the methods and techniques, how do we weigh those two where we're we're being scientifically sound but also realizing like we probably don't understand the neural networks and pathways enough to say that, but we can still be effective. Like how do we do that dance in, you know, as a clinician?

Nicky Kirk (50:05.519)

So yeah, neurology is neurology and physiology is physiology. So we know, so even if we look at some of older theories like the, know, the said principle in physiology, knowing how long physiology takes to adapt and different systems adapt to different speeds or velocities, but they don't change instantaneously permanently. So you can get variability in autonomic tone in an instant.

And that may be extremely desirable. Like that's brilliant for somebody who has dizziness or disequilibrium. But how do you prevent that system from returning back to the status quo? It's reinforcement of our neurological and physiological principles. Like what is balance comprised of? What's the fastest way and the correct way within our scope to help somebody stabilize their system?

when the vestibular system is telling they're moving, but they're That we can pin back on our neurological exam. Why it's occurring or why patient A versus patient B had different responses to treatment, that's where some of the nuance or the variability is. And that's when you have to then look again at patient B and say, this needs a slightly different approach. Maybe this wasn't a peripheral.

issue, maybe this was a central issue and I made a mistake. I think as far as the training, so I told the students this yesterday, like your neurological exam that you do in school will serve you extremely well in practice. Just don't take three hours to do it. That's all. Just figure out what the pertinent information you need is and base it from that. But again, if somebody has a peripheral neuropathy or I hate to use the term sciatica, but you know, so we know what we mean.

If they have diminished reflex, you're probably not bringing that back in one treatment. But you can use a neurodynamic technique to modify symptoms and then reinforce that over time. If it's a, you know, with an upper limb issue or peripheral nerve entrapment, nerves get tethered when scar tissue forms around them. I've seen, we have a practitioner downstairs who comes up and messes around with tuning forks on scar tissue. I mean,

Nicky Kirk (52:30.862)

I could think of a neurologically based explanation for that, but I wouldn't tell the patient. 100 % sure that's exactly what's happening. And therefore every person that comes in with a neurogenic presentation, I'm going to stick a tuning fork on it. That would be crazy. People would think I was crazy. Not that I'm saying that. think they're crazy. it's just that lack of discernment. So I kind of think anything goes, but you have to ground it back in what you first of all understand to

to be first of all, in our scope. And second of all, it has to be sensible, the sniff test, like it has to be sensible. So it's that same thing, like we all know it when somebody, there's that moment of awe, especially when you're younger practitioner, you go and see somebody do something, there's that moment, it's like, how did he do that? And I don't know if you're like me, but I tell people this all the time. I love watching people work on people. It's how I know I think I'm in the right professions. Like I still love watching chiropractors and know, NPTs.

work on people is fascinating. It's really cool. Just to see how they position themselves, how they handle the patient's body weight, how they make the patient feel at ease. Why did they do it that way? Why did you not do this? So there's still an investigative side to it. It's great. But yeah, in a roundabout way, we ground ourselves in science. We understand that physiological change and alterations take usually three months. And it should be actually helpful because it should help.

signpost somebody through a treatment program. If you can explain that well. And there's plenty of physiological work to draw from. that, think the 1930s-ish, maybe even the 1920s, know, adaptation to impose demand. It's, yeah. We know that from the tendonopathy literature.

Nicky Kirk (54:28.674)

Yeah. And then the cortical involvement of it, we know that there are brain changes that occur. that was another framework that I love Phil Glasgow. I've met him a couple of times and I deeply respect him. And I spoke to him fairly recently because he's also now in a leadership role. And we were kind of joking about the different demands of that. But he coined that training, rehab is training in the presence of injury. And this is

This is 2016-2017. He may not even think that anymore. But nonetheless, it's permeated the rehab vernacular. And it's a great expression. It's really catchy. I don't agree. I think that with chronic pain, the body changes. We don't get synergistic absorption of forces anymore. We get changes in reflexes, latency, central drive.

So I completely disagree with that sentiment. But I didn't when he said it. When he said it, I'm like, that's brilliant. That's the best thing I've ever heard. I'm going to apply that to everything I do. Now with bit of neurology mixed in, I'm like, that's not strictly correct. And I know he didn't mean it that way. Yeah.

Beau Beard (55:41.977)

That's a perfect example, right?

First principle of going back to a basic science and saying it made sense at the time, but now the more I've dissected it based on my knowledge and how my knowledge was expanded, that doesn't really sit, you know, with me the same way. One of the things when I as I was reading through on your articles that I wanted to kinda or add a question about was, you know, you'd mentioned the variability, patient A, patient B, you know, seemingly same patient, same intervention, different outcomes. You have to kind of start nuancing and changing and paying attention.

It seems like one of the ways within the Park Performance Institute that you've implemented to try to get ahead of that variability based on, you know, basically pain classification or kind of, you know, the

The other aspects outside of the pathway anatomical aspects was, you know, using some questionnaires like PhP nine and on this kind of you called it five minute, you know, pre assessment assessment. The question I had, and you could explain better than me, you know, the green, yellow, red light, which I like that and that all makes sense. I've always and maybe this is my own personal flaw, I've had major issue with outcome assessments and basically surveys because I mean there's even data on this that people don't answer

them honestly. So then when I give somebody a questionnaire and they know that what they're being questioned on is going to be used, I don't want to say against them, but like for something. Like I'm giving you this for a reason. They tend not to answer honestly. And then the people that do answer maybe in the extremes, whether it's a yellow flag or this questionnaire, maybe almost I don't I'm not saying this is true, but a little in the malinger. They want to answer extreme because they know they're going to get a response.

Beau Beard (57:30.545)

So how do we appropriately use things like questionnaires for, you know, whether it's pre and I I like the aspect of the follow up based on what we're seeing in that pre assessment, right? The determination of the or the expectation changes based on what we see up front. I love that. But how do we appropriately use them use those and not go all in on them or how much validity do we do we give things like that, I guess?

Nicky Kirk (57:55.865)

There, we had Tommy Wood come through the clinic. It sounds like I'm named, I'm not a name dropper, but he, I only bring him up because he happened to be here. And somebody raised a question around the subjectivity of these types of questionnaires. And I think the topic was possibly recovery or something along those lines. And he and I almost, somebody asked, how do you, what,

with all the equipment and technology you have in this clinic, what's your best assessment? And I said, questionnaires, like outcome questionnaires, because they're the most heavily studied, the most strongly validated, and they communicate across professions. know, like a PT, post-West three is kind of a crappy one, like a PT would know an OS West three, a pain management physician would know an OS West three, even the insurance company knows what it means.

So there's a utility in that. And some of the more comprehensive ones, think the foundational level, you if somebody's coming in, they've got relatively inconvenient low back pain, paperwork and administrative burden, they're weighing that up. Everything in the brain is a calculation of how much is this worth to me and how much effort do I really wanna put into this. So if somebody's coming in and they're not,

They really just want to get a little bit of relief and get a little bit better, but they're not particularly invested in long-term health and wellbeing, which by the way, I'm totally fine with as a personal choice. They're just not going to care about the outcome questionnaire. They're like, got to fill this in for the doc, which is not the right way to look at it, but it's utilitarian for them in that moment.

If you're using the larger scale ones, so profile of moods, or with our veterans, I mean, they sort of have to do it, otherwise they don't get to come in. So there's also that, but there's also the...

Beau Beard (59:57.005)

Well can we can we double click on that for a second? When your when money or care is dependent on it, I do think it's going to change it.

I right, it's kinda like if I know I won't get a paycheck if I don't do my job, I will do my job, right? I might not like doing my job, but I'll still do it to a sufficient level because I know I there's an expectation. So I do so that kinda gives a qualifier, right? Which I love that. But it all like you said, you can shade this. I just wanted to touch on that 'cause I think that's a very good point of like basically the environment dictating some of the importance of these things.

Nicky Kirk (01:00:33.708)

Yeah, I think if you have the time to explain why that why I took the time as a clinician or as the care director, why I took the time to specifically pick out these three questionnaires that I'm not going to ask you to spend 15 minutes of your time completing them. There's a really good reason for it. And the reason for us is it's we can correlate your perception of your life versus

what we're finding in our clinical exam. And it gives us another dimension to your current status, the likelihood of you getting better. I can take this information and this is now, who said stack in the odds, Brandon Marcello. I use this all the time in practice. It's like every piece of information I gather from you allows me to, it allows the odds to be stacked in favor or against a good outcome for you. So if I have,

Accurate good information doesn't have to be perfect. It just has to be what you're thinking in the moment if I have this I can use that and Apply it in a way that's gonna stack the odds and you getting what you want, which is to get better as quickly as possible and There are a digger there a deeper dive then Most most clinics will do a ph29 Because insurance company requires it. Well, that's a really crappy. Well, it's a good reason getting paid is a good reason

That's not a good reason for the patient. We need to get a PHQ-9 because I need to cover my butt that I asked you these questions in case something, in case you fall into a state of depression when you leave here, at least I asked you if you were depressed or not and you said no. Yeah, so I'm good because I asked you the question. Like that's just risk management. Like that's not for the patient, that's for the practice. So.

Beau Beard (01:02:12.622)

Yeah, they're never never looking at it. It's in the file. Yeah. Yeah.

Nicky Kirk (01:02:25.228)

I think if you can just communicate that this is just as important as anything else, because this is the only time where you might get to explain to me how this is affecting your life on a day-to-day basis. And that's it. And then when we're done, we can see if that improved. is for you. This is not going to insurance, well it might, but this is not going to insurance company for reimbursement. This is, maybe we use it for case studies. So the veterans are interested because they...

First of all, they don't believe they deserve to be in the clinic. So somebody else should have this, not me. So we just tell them this, like, if we can show positive changes in these over the treatment, we can turn that into viable research that's going to allow more veterans to have access to this type of care. And we can help you more. So I think it depends on the questionnaire, but the why is way more important than the what.

But you're never gonna change somebody's attitude about doing an oswasy or a vas because they're completely utilitarian and that, you know, if your focus is on pain, when the pain is gone, it's just, they know and they're used to that. So yeah, just use them diligently. That's all. And recognize that every piece of paper is another ask of a person's.

time and cognitive energy. So try to not be sort of too routine about it. But if it's part of your process for getting into the office, mean, we have to do it. We have to do it for risk management. Fortunately, we're beholden to the same, sometimes higher standards, I think, than colleagues. But again, that's just my personal or peers. I sometimes think that we're held to higher standards unfairly. But yeah, that's my take on.

Beau Beard (01:04:18.424)

No, I I like it and again I'm always because so I'll give an example and I'm not throwing anybody under the bus here. So Troy, who you know I both know, was asking, you know, would I ever entertain doing a yellow flag risk questionnaire for every patient that enters the office? Well then our newer doctor, because they're all kinda in the same RTP vein, they're all talking about the same stuff, he kinda had the same question. He goes, Can I do this to all my patients? And I go, So I said, Why do you want to do it? Like, what's the impact?

For you to do this thing. And he goes, Well, I think it'll help me kind of, you know, categorize obviously pain better, but give a better phenotype of the overall person. And I go, if you're going to use it appropriately, but my thing was, how are you explaining to them why you're doing this? And this is probably just time dependent on where they are in their career, they don't have a great explanation.

Nicky Kirk (01:05:11.735)

Yeah, because you got these

Beau Beard (01:05:12.086)

Because they they couldn't ex they couldn't explain it to me in a way if I was a patient I'd be like, okay. It was kinda like, Well, I'm classifying your pain and I'd be like, Why are you classifying my pain? Well, because that changes how to treat you. So you treat everybody different like it just kinda led in this like spiral of like, I think you're gonna create more questions that you don't have good answers for, which then burns time. I think you should just not do it yet. Maybe in a year you do it when you would have a much better grasp why you would be doing it. And then if you want to do it with everybody or if it's you patients.

specific, to at that point. But that was my take on that at least.

Nicky Kirk (01:05:45.55)

I think that's the right answer. if they, well, they probably haven't, because why would they think it? Like, why would anybody think about this type of thing? if you look at how these things are actually created and how the research, they're for a specific and stated purpose, like it's been researched against a specific research question to fulfill one thing. So if you're trying to use it for something, which is not that, they're screeners. I mean, it's a screening form. So.

Mike's our country, that was like, you don't think you get a sense of that just from speaking to the patient. I mean, maybe that's a skill you need to develop first and then maybe when something flags that you want to screen for and it's appropriate, we can administer that questionnaire, we'll keep it on hand. But we don't use them routinely, yellow flag, and we probably have more reason than most to use that questionnaire.

My thing with that one in particular is it's almost leading anyway. even if you send, like if you send somebody that says yellow flag questionnaire and they go and chat GP like yellow flag, well, this person thinks I'm a malinger. They think it's in my head. Nothing good's going to come of that. So that's, I don't knock them for asking the question. It's coming from a great place, right? It's just, just keep the main thing, the main thing right now. Like listen.

Beau Beard (01:06:50.018)

Yeah, that was yes.

Beau Beard (01:07:07.546)

yeah.

Beau Beard (01:07:13.578)

I have kind of you mentioned this too, and I kinda I'm I'm a bit of a nerd and maybe OCD, but there's a term Tom Sachs, industrial designer and artist, and Adam Savage from Mythbusters. they call it nulling, which the we'll we'll sidestep why it's called nulling, but that's just organizing all the tools in your workstation, right? At parallels or 90 degrees. And then in the chef's world, that would be called, you means and boss. Like we're gonna put all the ingredients out and get them. That's all we're trying to do as a clinician. That's what they were trying to do as a student.

student. It's one more piece of information that they think gives them the full, you know, menu or full tool list out in front of them. But like you said, a lot of times we get thrown off course early in our careers based on information that is information great, do the full neurologic workout, but what was meaningful and useful to this case at this you know point in time. That's that's the nuance of becoming a clinician and making good clinical decisions. That's that's tough.

And my take was sometimes the more information you have on that work table, the harder it gets where you're not easy upfront. I don't know.

Nicky Kirk (01:08:15.631)

And then the work, what I didn't think about, but the other part of that is if you use that questionnaire, not knowing what the purpose is, and then they flag up as having, you know, if they flag up positive on it, you're actually supposed to refer them out. You know? So yeah, no good.

Beau Beard (01:08:31.266)

Right. Less ha less hands on referral out yeah, like yeah.

Nicky Kirk (01:08:36.482)

Yeah. So yeah, that was a whole can of worms. I mean, that's the only time we've used them is like, need to substantiate why we're making this referral and why we thought it was a good idea.

Beau Beard (01:08:45.054)

Wonderful. Yeah. And I c yeah, 'cause I don't want anybody to feel like I'm knocking that form and we ping we use all of Annie's work to pay and classify every patient. We just do it in a little faster, more simplistic way, I would say, just so it's usable and easy. but yeah, we have used it where it becomes utilitarian to the patient themselves. I'm gonna have you fill out this form. We're gonna go over what the findings of the form would say based on their basically equation and algorithm.

Nicky Kirk (01:08:50.221)

Yeah.

Beau Beard (01:09:12.758)

And that is to me, I already know what the form is saying. It's another way of saying it without me saying it. Right? The form says it now. So here we go. This is why we're, you know, heading this way. Whether that helps or not in some scenarios, sometimes it doesn't, but sometimes it does and yeah, that's what we use for.

Nicky Kirk (01:09:29.198)

And I think maybe sometimes it's cathartic like if you if you are experiencing or suffering pain or discomfort Sometimes it's quite quite cathartic. So yeah, you know what? This is like some days of seven or eight out ten and I'm gonna put it here That's quite cathartic too. So, know a lot of people when you when they you know, tired I don't want to bother my family about it like it hurts every day So like what nice to come in and be like, yeah, this is really really really significantly affecting my happiness and well-being Okay, then write it down and we'll we'll fix it for you Yeah

Julie noted.

Beau Beard (01:10:01.049)

Alright, well being respectful of your time, I've got to hit you with these two questions that I give every guest. you can go any domain or direction with these, so it's kinda open. the first one is what is something that you long held to be true that you have completely about faced or changed your mind on? Again, it can be in any realm, doesn't have to be within the professional realm. it could be anything. I've had people talk about UFOs or their favorite food, it can be anything.

Nicky Kirk (01:10:29.016)

that I was somehow special and deserving of unique treatment and that the rules that apply to everybody else didn't apply to me. That's probably been the most helpful thing that I've dissuaded myself of from my early 20s.

Beau Beard (01:10:45.752)

then the opposite of that. So what is something that you're like, I n I know this is this is the way it is, this is true, but there's no peer reviewed article or meta analysis out there that's gonna say that's the case.

Nicky Kirk (01:10:59.374)

I probably go to the flip side of the coin that which is there are people that know a heck of a lot more than me in certain areas and I Need to be able to control in certain circumstances and that may actually be better Globally that that's probably been being a Being a big and helpful one for me as far as

I guess Scotland being good at football was something I held to be true and clearly isn't.

Beau Beard (01:11:31.5)

I'm curious. If you don't, that's fine. Do you have any examples of where that's come into play of how do you to kinda like, you know, give a little bit of like, okay, this is where I need to step back or, you know, hand the baton off.

Nicky Kirk (01:11:44.942)

Yeah, I could give you a really specific one. the, just in the current clinical environment, the level of comfort of handing somebody over to one of the clinicians here, knowing that they will probably do a better job than I would have done, feels amazing. It's really nice to advocate for somebody else and say, I could see you, but I have somebody here that is going to absolutely blow that out of the water for you. So that's something I couldn't imagine myself ever having said 10 years ago.

Beau Beard (01:12:13.89)

And you think that's more you or do you think that's the environment you're in today? I'm sure it's a little bit of both.

Nicky Kirk (01:12:19.758)

I think it's probably just being humbled. I had an interesting moment a few years ago with a colleague of mine where he, you know, I put this down to him just not having kids. So he's just got way more time to go study things and do things and whatever. So that's probably just me being easy on myself. But I remember sitting, he's a very good friend, but I remember just sitting and having a pint with him and he'd done something really good. So guess we were having a champagne moment or he was allowing me to have one with him.

And I remember just sitting there and I had this realization. It's like, you know, I feel like you being as good as you are at what you do has somehow given me permission to no longer feel like I need to be the best at that. It was a really weird, and I don't know if it meant anything to him, but it meant a lot. I've just sitting there over a pint. I was like, you know what? don't need to, I don't want to be in this rat race anymore. Like it's comforting. It was comforting to know that there's somewhere, someone out there that I could, I could rely on and send somebody to.

And that was really cool. A little bit 10 years ago. Yeah.

Beau Beard (01:13:20.686)

When I think that's it's

I think it's cooked into you as an athlete, right? To because you wouldn't refer somebody to the better athlete. Right. You wouldn't be like, Hey, there's this guy that would just wipe the you know, the pitch with me. Why don't you go talk to him? You're like, No, no, no, like I'm I'm working, I g I'll get better. We are all working to be better, but we're also like you said early on in the podcast, like we're all in a humanitarian profession. So if the end goal is the you know, the person with patient centered care, I mean that's but I I love that sentiment of like it's almost like

like you have to take a deep breath, like, yeah, I could I could send somebody over there and like they will just, you know, kill it. yeah, I'd I'd have to, you know, as I said, I've paralleled a lot of your thoughts here in that one for sure of seeing what's been really cool for me is the further I go through practice of then getting to interact with, you know, students and not all students are the same. Some students are, you know, at a certain level or knowledge base that others aren't, and then working with clinicians and seeing them develop and then kind of seeing, you know, standouts or you know

I guess a different

Different areas of expertise even. Right? Somebody may not be the most methodologically sound, right? They may not be the best adjuster, best off tissue, but then they have some other superpower and then realizing that, right? Like I heard the quote the other day, like your job isn't to raise your kid and to mold them into what you think a good kid is, it's to figure out who they are and like develop that. It's kind of the same thing for that clinician. You're like, you're really good at this. I thought I needed you to be this and that's just not the case. But I can still really like capitalize on that.

Beau Beard (01:14:54.704)

so yeah I love that that's kind of the the ending point there. any last kind of words of wisdom, advice, anything to look forward or look into that you want to leave us with before we jump off here?

Nicky Kirk (01:15:12.661)

I have concerns about I think the rising cost of living, cost of education. So I find myself deeply concerned with people who are coming into the profession now and trying to find their way. And there's a couple of things that people said, know, one Cairo coach I worked with when I was really young, he said, the weirdest thing about this profession is you could have somebody come out and earn 35 grand a year.

And you could also have somebody come out that could be making $2 million and they could double their income because of the way the profession is. It's the classic Taleb, the same Taleb, you know, anti-fragile profession. And I find a lot of comfort in that. But this environment that people are coming into, we need to continue to strive to be better and offer more value and keep patients.

central to it and I'm globally very very positive about our future because I really think that longevity medicine and wellness are things that we've been talking about for centuries in profession when nobody else was and we were being called quacks and now it's finally here we're in a little bit of danger of being usurped by concierge medicine, pts and I have a little that concerns me a little bit.

I feel like that's going to be left on the table if we're not careful. that's probably my parting thing is you can be exceptional clinician and stay true to the roots of the profession and have a very successful career and a joyful career. And I think that's where I'm at in my career now is trying to make sure that people understand that, that you're coming into good profession for good reasons and you can...

you can be confident that if you do things the right way, you're going to be fine.

Beau Beard (01:17:09.836)

that I agree, that message is definitely needed and more than ever on in a ver for a variety of reasons. So thanks for leaving everybody that. And thank you A so much for coming on the show, but B for just doing what you're doing and thinking the way that you do. And as I said, I wanna point people back your sub stack because you have a plethora of articles on there, but it's I appreciate it because the thought process that goes into it, it's not just information being put out in a digital format. It's you can see how you think and I think that's a

a it's a rarity, especially nowadays with all the the AI kind of blah that's out there it kinda cuts through that a little bit. So thank you for doing that as well.

Nicky Kirk (01:17:48.693)

my pleasure. I'm going to keep doing it.

Beau Beard (01:17:50.927)

Alright, well I'll look forward to it. Thank you again for coming on here, Nikki. I really appreciate it.

Nicky Kirk (01:17:55.363)

My pleasure, Beau. See you soon.