🎙️ 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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🎙 Episode 61 – Do Disc Herniations Go Away?

Podcast: The Talking Rehab Podcast
Host: Dr. Fred Bagares, DO
Location: Virginia Beach, VA

Back pain can stop you in your tracks—sometimes literally. In this episode, Dr. Fred Bagares explores the often alarming diagnosis of disc herniation. Whether you've had an MRI that showed a large herniation or woke up one morning unable to move, the big question remains: Do disc herniations actually go away?

You’ll learn about the anatomy of disc injuries, why symptoms don’t always match the imaging, and how healing often happens even when things look scary on paper. Dr. Bagares also shares the clinical signs he watches for, conservative treatment approaches, and how to avoid unnecessary surgery.

⏱ Timestamps:

• [00:00] – Introduction to rehab and the episode's purpose
• [00:33] – Why back pain is so frightening and disorienting
• [01:34] – Focus of the episode: Do disc herniations go away?
• [02:00] – Three common ways disc herniations present
• [02:51] – Pain patterns: radiating pain, leg symptoms, and “the pop”
• [03:26] – Anatomy of a disc (jelly donut analogy) and what goes wrong
• [04:16] – When disc herniations affect nerves and cause radiculopathy
• [04:46] – Classic clinical sign: patients who prefer to stand
• [05:26] – Why sitting often worsens symptoms
• [06:01] – Typical treatments: PT, injections, massage, traction
• [06:44] – Can a disc herniation resolve on its own? (Yes – and here’s how)
• [07:38] – Improvement doesn't always mean the disc is gone
• [08:56] – Is treatment shrinking the herniation? (Not necessarily)
• [10:00] – What actually happens as the disc resorbs (bulge vs. blowout)
• [10:45] – The real role of treatment: symptom control while nature heals
• [11:26] – The risks of inactivity: joint issues, blood sugar, muscle loss
• [12:19] – Timeline matters: when is conservative care likely to work?
• [13:44] – When symptoms persist beyond 6 months, surgery may be considered
• [14:30] – The paradox: large herniations are more likely to heal
• [15:28] – Final thoughts: be patient, stay hopeful, stay informed

🗣 Call to Action:

If you're dealing with back pain or were recently diagnosed with a disc herniation, don't panic—get informed. Follow Dr. Fred Bagares on Instagram and Facebook (@drfredbagares), and subscribe to The Talking Rehab Podcast for more expert insights on musculoskeletal medicine.

Let this episode empower you with realistic expectations, practical advice, and hope for healing.

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🎙 Talking Rehab Podcast – Episode 60: "The $2,000 Hip Pain: Why Systemic Solutions Matter"

In this episode, I walk you through a real case involving a 10-year-old boy with hip pain. What started as a simple clinical concern quickly turned into a reflection on the inefficiencies of our healthcare system. I share what it’s like navigating specialty referrals, high deductibles, and trying to advocate for timely, affordable care—while practicing in a direct care model.

If you’ve ever wondered what “value-based care” looks like in the real world, or how something as basic as getting an x-ray can spiral into a $2,000 hospital visit, this episode is for you.

🕒 Timestamps for Key Moments:

• [00:00] – Why I started the podcast and what rehab means to me
• [01:00] – Busting the myth: direct care isn’t just for the wealthy
• [02:00] – The clinical case: a 10-year-old with progressive hip pain
• [03:00] – Ultrasound findings and the red flags every clinician should know
• [04:30] – Top differential diagnoses: SCFE, LCPD, and transient synovitis
• [05:30] – Calling the pediatric orthopedist: the reality of gatekeeping and systems barriers
• [07:00] – “Send them to the ER” – the most costly, inefficient route
• [10:00] – My alternative: working around the system to avoid unnecessary costs
• [11:00] – What this experience says about our healthcare priorities
• [12:00] – A call for new care models: direct orthopedic care and transparent pricing
• [13:00] – Is ultrasound underutilized in pediatric ortho triage?
• [14:00] – A message to medical students: question what you've been taught
• [15:00] – Final thoughts and a call to rethink what "value" really means in care

🎯 Whether you're a provider, a parent, or a med student, this story is a glimpse into the decisions we’re forced to make when systems get in the way of solutions.

🔗 Follow me on Instagram, Facebook, LinkedIn, and YouTube @drfredbagares
📍 Explore more via Linktree

👉 If this story resonated with you, subscribe, leave a review, and share the episode. Let’s continue reimagining better care—together.

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🎧 Sailboat or Rowboat: Motivation vs. Discipline in Rehab

In this episode of the Talking Rehab Podcast, I explore a powerful analogy I shared with my kids: are you a sailboat or a rowboat? Sailboats move when the wind (motivation) shows up — but rowboats move when the person rowing decides to act, regardless of external forces. This concept becomes incredibly relevant in rehabilitation.

I dive into how discipline, not motivation, is the more reliable path forward for those dealing with chronic pain, musculoskeletal conditions, or slow progress in recovery. I talk about the dangers of waiting — for the right diagnosis, perfect treatment, or ideal circumstances — and how that delay often leads to greater pain, disability, and missed opportunities.

We also look at common reasons patients hesitate to act: fear of disappointment, lack of instant results, or waiting for specialists. I share why investing consistent effort — even in imperfect conditions — often yields the best outcomes.

Whether you're a patient, clinician, or someone navigating your own recovery journey, this episode is a reminder that progress is possible — but it starts with you picking up the oars.

⏱ Timestamps

• 00:33 – Parenting, motivation, and the "sailboat vs. rowboat" analogy
• 01:50 – Motivation is fleeting; discipline is reliable
• 04:04 – How discipline applies in rehab settings
• 06:00 – The risk of waiting for ideal treatment conditions
• 07:07 – Why pain, disability, and disappointment increase with delay
• 08:44 – The long referral cycle for musculoskeletal patients
• 10:00 – Understanding the fear of trying and failing
• 11:21 – Short-term vs. long-term treatments: a warning about quick fixes
• 13:00 – The emotional cost of waiting too long
• 15:01 – Muscle loss, missed life events, and poor conditioning from delay
• 16:01 – Final thoughts: build discipline, don’t wait for perfect timing

🎯 Call to Action
If this episode resonated with you or a patient you know, share it. And remember to subscribe, rate, and review so we can keep helping people take back control of their recovery.

Let me know if you'd like this rewritten for your blog, newsletter, or social media!

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In this episode of the Talking Rehab Podcast, Dr. Fred Bagares dives into the evolving role of artificial intelligence in the healthcare space, particularly within the world of rehabilitation. From streamlining administrative tasks to improving accessibility for patients with language or hearing challenges, AI clearly has its benefits. But is it making healthcare more human—or less?

Dr. Bagares shares real-world examples from his own practice, discusses how he's experimenting with AI tools like ChatGPT, and questions the growing trend of replacing human interaction with automation in medical settings. If you're a healthcare provider, patient, or simply curious about how tech is shaping your care experience, this episode will challenge your thinking.

Timestamps:

• [00:00] Intro: What is rehabilitation and why this podcast exists
• [01:00] The inspiration for this episode: AI in patient communication
• [02:00] Pros of AI in clinic operations and task automation
• [04:00] Using AI to simplify patient intake and FAQs
• [05:00] Improving accessibility through transcription and translation
• [06:00] The trade-off: Efficiency vs. Human Connection
• [07:00] Concerns with AI replacing frontline communication
• [08:00] Automation fatigue: Is AI really answering the patient’s question?
• [10:00] Communication as a therapeutic tool in rehabilitation
• [12:00] Multidisciplinary care and the problem with fragmented communication
• [13:00] Why human interaction is still irreplaceable
• [14:00] Final thoughts: AI as a support tool, not a replacement

Call to Action:
Like what you heard? Make sure to subscribe, leave a review, and share this episode with someone who's curious about the future of healthcare. For more movement-centered insights, follow me @drfredbagares or visit linktr.ee/drfredbagares. See you next week on The Talking Rehab Podcast.

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🎧 Episode 57 – "Value in a Visit: A Doctor Becomes the Patient"

Hey, it’s Dr. Fred Bagares. In this episode, I share my recent experience as a patient in a traditional insurance-based clinic—something I rarely do since switching to direct care practice.

I went to see an ophthalmologist for some concerning floaters, and the visit made me reflect deeply on what value truly means in a medical encounter. As someone who's worked hard to build a personal, relationship-driven practice, it was eye-opening (pun intended) to sit on the other side and witness a very efficient—but impersonal—system at work.

If you’re a physician, patient, or just someone curious about what truly matters in healthcare today, this episode will give you a lot to think about.

🕰️ Episode Highlights & Timestamps:

• [00:00] – Why I saw an ophthalmologist (and what triggered the visit)
• [01:00] – First impressions: busy waiting room, multiple waiting areas
• [02:00] – A step-by-step walkthrough of the visit logistics
• [03:00] – The actual medical encounter: 7 minutes with the doctor
• [05:00] – Breaking down what I paid for vs. what I experienced
• [06:00] – The disconnect between medical quality and emotional experience
• [08:00] – What patients value in healthcare vs. other service industries
• [09:30] – Why the human side of care still matters—barbers, vets, and doctors alike
• [10:30] – "Price is what you pay. Value is what you get."
• [12:00] – How direct care models offer a more meaningful patient interaction
• [13:00] – Rehab isn’t transactional—it's relational and nuanced
• [14:00] – Why insurance-based systems often fail both patients and clinicians
• [15:00] – A challenge to both patients and physicians: What are you going to do about it?

This was a personal one. It reminded me why I started MSK Direct in the first place—to offer something better than a system that often prioritizes process over people. If you’re fed up with 7-minute visits and checked boxes, this episode is for you.

👉 Don’t forget to like, subscribe, and share if this episode sparked something for you. Let’s keep the conversation going about what healthcare could and should be.

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