🎙️ Episode 64 – Nudging Our Patients

These aren’t just medical phrases—they’re nudges: subtle but powerful cues that steer decision-making long before our patients say “yes” or “no.”

In this short solo episode, Dr. Fred Bagares unpacks five common types of clinical nudges we hear (and use) every day in musculoskeletal care:

• Fear-based nudges
• Authority-based nudges
• Urgency-based nudges
• Fix-it framing
• Hopelessness language

🎧 Learn how these shortcuts shape the way patients interpret risk, autonomy, and what's really “on the table”—and why reclaiming our language is a step toward better shared decision-making.

⏱️ Timestamps

Time Topic
| 00:00 | Welcome + Podcast Purpose
| 00:00:40 | “She’s one fall away…” – Language with weight
| 00:01:00 | What is a nudge, anyway?
| 00:03:00 | 1. Fear-Based Nudges
| 00:04:00 | 2. Authority-Based Nudges
| 00:05:00 | 3. Urgency-Based Nudges
| 00:06:00 | 4. Fix-It Framing
| 00:07:30 | 5. Hopelessness Nudges
| 00:10:00 | Reframing language: clear ≠ coercive
| 00:12:30 | Why I started MSK Direct
| 00:14:00 | Reflection Questions + Substack plug
| 00:15:00 | Final thoughts + Thanks

#TalkRehab #DirectCare #SharedDecisionMaking #MSKCare #PhysicianVoices #OutOfNetwork #RehabilitationMedicine #HealthcareCommunication #MusculoskeletalHealth #ClinicalLanguage #PatientCenteredCare #PhysicianLeadership

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From Skeptic to Startup: How a Telemedicine Idea Survived—and Thrived—in a Broken System

In this reflective solo episode, Dr. Bagares shares the untold backstory behind his early adoption of telemedicine, the struggles of launching a cash-based virtual practice, and how he handled rejection from both peers and the healthcare system itself. A must-listen for anyone frustrated with traditional healthcare or curious about innovation in musculoskeletal care.

🎧 Topics include:

• The inefficiency of follow-ups and how email/telehealth filled a gap
• Navigating non-competes creatively
• Facing industry skepticism
• When COVID changed the rules overnight
• Lessons learned—and how they shaped MSK Direct

Whether you're a patient, provider, or healthcare entrepreneur, this origin story shows what's possible when you're willing to bet on a better way.

🕰️ Timestamps:

• [00:00:00] | 🎶 Intro & Welcome
• [00:00:20] | Why I started this podcast
• [00:00:50] | Two types of visits: new vs. follow-up
• [00:01:31] | Follow-up inefficiencies and the email solution
• [00:02:06] | Early thoughts on telemedicine (2013!)
• [00:03:18] | The non-compete challenge that pushed me toward virtual care
• [00:04:27] | Could an online orthopedic practice work?
• [00:05:39] | The inefficiencies of the traditional system
• [00:06:23] | How I performed virtual physical exams
• [00:07:00] | Why not everyone needs to be seen in person
• [00:08:00] | Waitlists, delays, and missed windows for care
• [00:08:55] | Presenting my model to skeptics (and being laughed at)
• [00:09:51] | Proving it works: walking exams and patient engagement
• [00:10:20] | The surgeon who tried to talk me out of it
• [00:11:02] | Launching anyway—cash pay, no insurance
• [00:11:59] | Building slowly… until COVID hit
• [00:12:45] | “You hit the jackpot!”… or did I?
• [00:13:57] | The collapse of my model (ironically due to insurance)
• [00:15:07] | COVID proves it can work
• [00:15:55] | Helping those who doubted me
• [00:16:21] | Patients I still care for today
• [00:17:04] | How this experience led to MSK Direct
• [00:17:43] | 🎧 Outro and invitation to connect

#TelemedicineJourney #DirectCareDoctor #MusculoskeletalMedicine #RehabRedefined #HealthcareInnovation #OriginStory #Physiatry #TalkingRehabPodcast 💡💬💻🦴💥

💬 Question for listeners:
Have you ever experienced a healthcare visit that felt like a waste of time? What do you wish was different?

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Are Our Tools Any Good?

Are our tools really the problem—or are we just not using them well?

In this thought-provoking episode, Dr. Fred Bagares, DO, takes a closer look at a recent study questioning the effectiveness of common spine injections like epidurals and facet blocks. While headlines suggest these tools are failing, Fred challenges the deeper issue: our mindset and misuse of short-term solutions in chronic care.

Drawing from over a decade of experience in musculoskeletal medicine, he unpacks the flaws in current research design, the burnout these studies provoke in physicians, and what truly leads to lasting recovery for patients in pain.

If you've ever wondered why spine care feels stuck—or how to bridge the gap between short-term relief and long-term function—this episode is for you.

🔑 What You'll Learn:

• Why injections are misunderstood in both research and real-world care
• The difference between tool failure and clinical failure
• How to help patients thrive between months 4–12, not just days 1–30
• The long-term value of coupling procedures with lifestyle changes

🩺 Ready for care that looks beyond the quick fix?
Visit mskdirectvb.com to work with Dr. Fred and get a personalized plan that moves you from pain to progress—one joint and tendon at a time.

Let me know if you'd like versions for Instagram, YouTube, or your newsletter too!

🗺️ Plan (Episode Breakdown):

[00:00:00] — Introduction
Dr. Fred opens by reflecting on the enduring challenges and evolving questions in musculoskeletal medicine.

[00:00:33] — New BMJ Study Sparks Debate
A recent study questions the efficacy of interventional spine procedures, igniting pushback from pain physicians.

[00:01:59] — The Real Worry: Insurance & Burnout
Research impacts reimbursement. Physicians feel pressure from both science and the system.

[00:03:20] — The Central Question
Are our tools truly failing—or are we failing to use them effectively?

[00:04:00] — Generational Gaps in Practice
Younger clinicians chase high-tech procedures; Dr. Fred prefers effective, simple tools that fit his population.

[00:05:53] — Short-Term Tools, Long-Term Goals
Injections are short-term tools—but they have a clear role when properly explained and integrated.

[00:06:57] — Unrealistic Expectations in Research
Comparing short-term treatments over long timelines leads to misleading conclusions.

[00:08:59] — Missing Piece in the Research
Why aren’t more studies looking at injections + therapy instead of one or the other?

[00:09:48] — Our Job is to Guide Through the Middle
Short-term tools should be the bridge to long-term solutions—like movement, nutrition, ergonomics, and lifestyle.

[00:10:58] — The Bigger Healthcare Cost Crisis
Spine care is expensive. And without deeper change, the system keeps cutting and blaming the wrong things.

[00:11:41] — New Tools, Same Problem
Fancier devices and techniques won’t fix the real issue: a lack of long-term follow-through.

[00:13:02] — A Lesson from Surgeons
Veteran clinicians succeed not because of new tools—but because they know how to choose and support the right patients.

[00:14:58] — Final Thought: The Real Question
It’s not whether the tools work—it’s whether we’re using them to their fullest potential, in service of long-term health.

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