Questions founders ask before we speak
Answered by Dermot Rock
Osteopath and doctoral researcher in Human Performance and Innovation, University of Limerick
Updated
Most founders arrive with the same few questions. What this work is, what I measure, how any of it reaches their judgement, and what a year together can honestly promise.
I have answered them here as plainly as I can. Where the evidence is strong, I cite it. Where it is unsettled, I say so.
If your question is not here, ask me directly. I reply to every enquiry personally.
On this page
What this work is, and what it is not
Founders often try to place this work next to something familiar. It sits close to therapy, wellness and medical care, and it is none of them.
Concerned with
How it relates to this work
- This practice
Private clinical performance work
Concerned with
The physiological state in which you make decisions, and how it affects your cognition.
How it relates to this work
I measure physiology and cognition, monitor change over time and guide behavioural change, for one person over twelve months.
Therapy
Concerned with
Thoughts, emotions, relationships and mental health, worked through in conversation with a trained therapist.
How it relates to this work
I do not provide therapy, and this work is not a substitute for it. The two can sit side by side.
Wellness
Concerned with
General habits, often through programmes, apps or devices designed for many people at once.
How it relates to this work
This work starts from your own baseline and reads every change in the context of your life. There is no standard plan.
Medical care
Concerned with
Diagnosing and treating illness.
How it relates to this work
This work does not diagnose or treat disease and does not replace your doctor. When something needs medical attention, medical care comes first.
Is this therapy?
No. Therapy works through thoughts, emotions, relationships and mental health in conversation with a trained therapist. My work concerns the physiological state you decide in: your sleep, cardiovascular function, blood markers, body composition and cognition.
We will talk about the demands on you, because they shape that state. But I do not provide psychotherapy or treat mental health conditions, and the engagement is not a crisis service. If therapy would help you, it can run alongside this work.
How is this different from a wellness programme?
A wellness programme usually starts with a standard plan and fits the person around it. I start with you. I establish a baseline across physiology and cognition, watch what changes, and make behavioural changes based on what your own measurements show.
There is no universal lifestyle prescription. The aim is to learn which changes are useful for you, and to drop the ones that are not.
Is this medical care? Will it replace my doctor?
No. The engagement does not diagnose or treat disease, and it does not replace your doctor or any specialist you see.
If testing shows a result that warrants medical investigation, I will raise it with you, and it should be taken to an appropriately qualified healthcare professional. Medical care takes precedence over anything we are doing.
Read the medical disclaimerWill you prescribe or change my medication?
No. The interventions in this work are behavioural: sleep, nutrition, physical activity and recovery. Decisions about medication stay with your treating clinician.
Please do not start, stop or change prescribed medication on the basis of anything from this engagement or this website.
Why call it clinical if it is not medical care?
Because the work follows clinical method: assessment, interpretation in context, intervention and reassessment, applied to one person over time.
I qualified as an osteopath in 2011 and have worked in strength and conditioning since 2007. Both disciplines demand attention to how one individual functions and responds. Clinical describes how the work is done. It is not a claim to provide medical treatment.
Who will I actually work with?
Me. The engagement is a direct, one-to-one relationship with me, Dermot Rock. I hold your assessments, monitoring data, reports and interventions as one picture, so you are not handed between disconnected specialists or left to read a dashboard yourself.
Alongside the practice, I am undertaking doctoral research in Human Performance and Innovation at the University of Limerick.
More about meWhat I measure
I measure what can reasonably be measured and keep only what helps us understand your cognition. These are the measures the engagement uses. The plan is set around you, and not every client takes every test.
What it gives me
Its limit
Blood testing
What it gives me
A broad view of relevant physiological markers, interpreted for you and repeated where useful.
Its limit
One result is a snapshot. Its meaning depends on your context and on how it changes over time.
Genetic testing
What it gives me
Context about predispositions that may bear on your physiology.
Its limit
Genes do not determine your outcomes. Findings are read alongside what I observe in you.
Standardised cognitive assessment
What it gives me
A cognitive baseline, repeated through the engagement. Cognition is the measure the rest of the work answers to.
Its limit
Scores can rise with familiarity alone, so I read repeat results with that in mind. (Bartels et al., 2010)
Sleep
What it gives me
How long and how regularly you sleep, from wearable and at-home measurement.
Its limit
Wearables estimate sleep rather than measure it directly. Patterns over weeks count for more than any one night.
Cardiovascular function and blood pressure
What it gives me
Measures of how your heart and circulation are working, tracked across the year.
Its limit
Readings vary with time of day and circumstance, so trends carry more weight than single readings.
Body composition
What it gives me
The make-up of your body, measured at baseline and reassessed where useful.
Its limit
A change shows what is happening. It does not, on its own, explain why.
Ongoing wearable monitoring
What it gives me
A continuous record of sleep, activity and cardiovascular measures between assessments.
Its limit
Wearable data is read alongside the wider assessment and your life, never as an answer in itself.
I also record behaviour: sleep habits, nutrition, physical activity and recovery. Those are what we change. The measures above show how you respond.
Why measure so much?
I do not set out to collect as much data as possible. Each measure gives a different view of the same person, and I keep the ones that help explain your cognition and your decisions.
If a measure or an intervention does not help with that, I drop it.
Will every client take every test?
No. The assessment and monitoring plan is guided by your needs. Additional investigations may be considered where appropriate, but nothing is applied automatically to every client.
Do I have to read and manage the data myself?
No. Monitoring is there to inform the work, not to give you another set of numbers to manage. I review the data, and before each fortnightly call you receive a written report on what has changed and what deserves attention.
How is my health and genetic information handled?
Health and genetic information is particularly sensitive, and I treat it that way. It is processed only where data protection law allows, and the information collected depends on the scope we agree.
Read the privacy policyHow physiology reaches your decisions
Judgement is cognition at work, and cognition runs on a body. The connection is not simple, and it differs between people. Parts of it are well documented.
Sleep restriction
Two weeks of six hours' sleep or less a night produced cognitive deficits equivalent to up to two nights without sleep. Participants' own sleepiness ratings suggested they were largely unaware of it.
Van Dongen HPA, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness. Sleep, 2003.Sleep and the kind of decision
Sleep loss most consistently slows attention and makes it less reliable. Flexible, creative and emotionally loaded decisions suffer more than rule-based reasoning.
Killgore WDS. Effects of sleep deprivation on cognition. Progress in Brain Research, 2010.Stress
Even quite mild, uncontrollable stress can rapidly impair the prefrontal cortex, the part of the brain behind our highest-order thinking.
Arnsten AFT. Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 2009.None of this means a number decides for you. It means the state you decide in can be measured, and is often hard to see from the inside.
How does monitoring physiology actually inform my decisions?
In three ways. First, it shows the state you are deciding in, which is hard to judge from the inside. In one sleep restriction study, people's own sleepiness ratings barely moved while their cognitive performance kept falling.
Second, it shows patterns over months, such as how short sleep or demanding weeks affect your cognition. That lets us place consequential decisions where your state is best.
Third, it shows whether the changes we make are working, rather than relying on how they feel.
Can physiology tell you whether a decision is right?
No. No biomarker, score or wearable reading measures the quality of a decision, and I do not claim otherwise. Physiology describes the condition of the person deciding. The decision, and its consequences, stay yours.
Is decision-making readiness an established measure?
Not yet. It is the subject of my doctoral research at the University of Limerick, which asks to what extent decision-making readiness can be determined as a physiological construct.
The relationships between physiology, cognition and judgement should not be assumed to be simple or the same for everyone. The engagement investigates them carefully in one person. It does not apply a finished science to you.
Why does cognition sit at the centre?
Because it is the link between the state of your body and the quality of the decisions you are equipped to make. Every other measure earns its place by helping to explain or improve your cognition.
A standardised cognitive assessment sets the baseline and is repeated through the year, and I read the results alongside your physiology and the circumstances of each test.
Why twelve months?
Because a single measurement rarely tells the whole story. Measurement, intervention and reassessment need time to inform one another.
Twelve months allows a baseline, a reassessment each quarter, and enough time to separate lasting patterns from individual readings.
What an engagement can and cannot promise
Founders are right to be wary of claims in this field. This is what I can commit to, and what nobody can honestly promise.
What I can commit to
Twelve months of one-to-one work with me.
A baseline across physiology and cognition, with a reassessment each quarter.
Ongoing monitoring, with the equipment included in the agreed programme.
A 30-minute video call every two weeks, with a written report before each one.
Direct messages with me between calls, whenever you need to.
Behavioural changes chosen for you, monitored, and kept or dropped on the evidence.
What I cannot promise
Guaranteed improvements in health, cognition, judgement or decisions.
Diagnosis or treatment of illness, or a replacement for your doctor.
Therapy or crisis support.
A single score or biomarker that stands for your judgement.
Answers about what you should decide.
That what works for someone else will work for you.
Will this make me a better decision-maker?
I cannot promise that, and you should be wary of anyone who does. Taking part does not guarantee improvements in health, cognitive performance, judgement or decision-making.
What I can promise is a rigorous investigation. We measure, intervene, observe how you respond and refine. The objective is to understand what influences your capacity for consequential decisions, and to act on what the evidence supports.
Can you share results from other clients?
No. The work is confidential, so I do not discuss other clients. Their results would also tell you little about your own, because the same intervention can produce different results in different people.
What does the engagement cost, and what is included?
The engagement is $125,000 for twelve months. That covers the clinical work and the resources to deliver it: the baseline assessment, blood and genetic testing with interpretation, standardised cognitive assessment and repeat testing, monitoring equipment, individual behavioural interventions, regular video consultations and written reports.
See the full engagementWhat do you expect from me?
Time, attention and a willingness to challenge assumptions, including assumptions about your own performance.
The work suits people who already take sleep, nutrition, physical activity and recovery seriously, and who will examine their own behaviour and act on what they learn. It is not built around quick fixes.
What is the first step?
A conversation about the work, your circumstances and whether the engagement is an appropriate fit. It is confidential and there is no obligation.
Ask a questionAsk a question, or discuss fit
If something here is unclear, or you want to know whether the engagement suits your circumstances, send me a note.
I will reply personally. If it makes sense to talk, we will arrange a confidential first conversation. There is no obligation.
Sources
- Van Dongen HPA, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness. Sleep, 2003.
- Killgore WDS. Effects of sleep deprivation on cognition. Progress in Brain Research, 2010.
- Arnsten AFT. Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 2009.
- Bartels C, Wegrzyn M, Wiedl A, Ackermann V, Ehrenreich H. Practice effects in healthy adults: a longitudinal study on frequent repetitive cognitive testing. BMC Neuroscience, 2010.
This page is general information, not medical advice. Read the medical disclaimer.