Hey guys, Don here. Welcome to Podiatric Practice
Mastery. I'm going to go over the
$1,000,000 minute here. So we are on day #10 of our
medical record transition, so. We're starting to find where.
Everything is. At I'm able to get to the right
level visits. I got out of the office at 5:00.
Which is. Better than before I wasn't.
Able to write down so I usually. Keep a separate.
List of things that I want to talk to you guys about, but I'm
having a hard time. There's a schedule I can print
out within Modmed, but it's not, I don't know it.
There's just a lot of stuff on it and it's not clear enough for
me of, of what I'm doing and there's not enough room to write
on. So I'm thinking about making a
different method of, of writing it down.
The kind of different, I don't know, piece of paper or
something like that because I'm too busy trying to worry about
the EMR than I am about like documenting what I'm doing for
you only because I'm still training my scribe.
So kind of what happens First half of the day was fine.
Work through lunch was able to document some stuff.
And then at the end of the day, I'm just wanting to get my get
out of the office. So but I can go over the first
half of the day kind of what we saw.
So first patient this was a sister and brother that they
came in a. 15 year old girl she had.
Swift #4 and she's going to be back in three months.
And then little boy, he tried to do Swift.
He was six. He just couldn't tolerate it.
I don't know about you, but I went up to about 6 for him and
he just, he preferred can 3rd. And so I did, a couple of many
cried too much and I had to make him.
Feel better by. Showing a magic tricks.
If you don't know, that was my backup guy.
I wanted to, I don't know if I told you guys this yet, but I
wanted to be a. Magician in the past and so
medicine is my backup gig. If you ever want to see a magic
trick, just ask me. But I showed him some magic.
Tricks and he was better. Next patient was a new patient
that came in for bilateral planet fasciitis.
I got X-rays ultrasound office visit for this one here and I
think hers was more due to Aquinas.
She's 29. So we were working more on that
with like night splints, foam rolling, morning stretch, things
like that. I think she'll I think she'll
get better with with that more so because I did the ultrasound.
I didn't see a lot of thickness in her fashion.
She's kind of young. Next patient was shockwave #2
out of out of 6 for Shockwave. She's doing better.
Next was a routine that somehow got in there, but actually did
the routine note pretty well. I was surprised, but when they
were. So right now with this new
system is like they have to get the date last seen and all these
other things to, to finish the note and I have to figure out a
way to communicate to my staff. So they weren't their office
visit was like made for an ingrown tonial, not so much for
routine care. So we have to kind of clarify
that for the staff. I'm still kind of learning about
that. Next patient was a 74 year old
that had an exostectomy on the medial 3rd digit.
So I did that. I'm still learning how to put
exostectomies in the note. So there's like a, a certain
template that I have to use, but I have to put in a lot of the
verbiage for it because it's not in there.
Like it comes basically with a lot of boilerplate stuff, but
you have to modify it. So that's what I'm, I'm working
on is modifying that. Next was #6 out of 6 for
Shockwave. This is for plantar fasciitis
for this patient. Now the nice thing, I think.
I've been, I told you a couple months I've been starting to do
6 and everyone and I. Think the reason I like to do 6
now is like by the 5th or the 6th the benefits from the first
one is. Working and I like to be there
as they start to feel better because I can not guarantee, but
I feel a lot more comfortable when I finish the 6th one if
they're starting to feel better at that time that that they are
going to continue to improve at my at my six week follow up.
In the past I used to do 3 and then they weren't any better at
3:00 and they just had to kind of trust and trust and obey and
wait. And this way being there when I
when they're feeling better makes them feel more confident,
makes me feel more confident another.
Way kind of around that if you still want to do 3 and I've
heard this from another person. Is they do only three sessions,
but they do them every two weeks.
So by the third one in six weeks they would hopefully start to be
feeling better from the first one.
That's another way of doing it, but I'm still kind of doing the.
6 for most of my patients. So I I didn't.
So the next one was, oh, this was a gentleman he was here for,
he had a really bad fracture of his distal distal phalanx.
He's a diabetic. It was kind of a common rooted
fracture and the thing really never healed.
I was just giving it time and we gave it in many months and we
may have to excise this fracture just because the piece is kind
of lifted up quite a bit for him.
So that's something I'm going to refer to my other, one of the
other doctors over here next was a, a fungus patient.
So that was a I'm still learning to like the fungus used to be
really easy but now I have to do the LFTS and the trybenafin.
But. You don't just do it like an
Athena. It sends it automatically.
With this new system I have to go in there and and send the
medication. I have to send the LFTS.
So it's a little bit challenging because all the faxes aren't in
there exactly where I send. Them to so it's.
Kind of a pain. So that's one of.
The kind of. The frustration points with this
new system is is sending stuff at.
The end it was a little bit more.
Automated than this, I'm still, we're still figuring out kind of
the workflow and sometimes you forget like if you're going to
go get an LFT. And and you?
Don't you don't fax it. So I used to just save it and it
automatically faxed it but now it doesn't do it.
Next patient was a neuroma patient that had orthotics and I
can't remember all these other ones that I did in the
afternoon. So I'm not even going to try to
guess here, but there was there was once in the afternoon I was
seeing. So it's we're we're pretty much
back up to full, full speed here.
My my buddy. Neil here he.
He really liked doing the. The iPad version, he's been,
who's playing around with that? We still have a trainer, so we'd
pay it for a trainer for two days and then we paid for
another trainer for another two days.
But I think it's going to make it easier and they're able to
explain a lot of these questions that we have.
In the office, so I think the. Really getting the trainer in
house is going to be a good thing.
And I think I told you our our biller kind of left.
We had a remote builder. She was in Florida.
She used to be here, but then she moved to Florida.
So she's been helping us remotely and she kind of kicked
the bucket and said she wanted to leave and do something else.
We kind of went back to her and said just to help us with this
transition because it's kind of a transition closing the books
within Athena. Like you have to continue to
post things there and then with Mod Med we might not need a full
time book bookkeeper or I'm sorry Biller, because it's.
More. How do you say it?
The billing is kind of inter interweaved in it and I think
that you can't really close the notes.
I'm still not pleased like with me right now.
I'm still not pleased with the way my notes look.
I'm trying to work with Murali like a place because a lot of
times there's a lot of bloated notes, like just stuff that's in
there that's not really pertinent.
So I'm I'm trying to figure out a place to put my additional
findings. So basically there's a template.
Or something called. A plan additional finding we can
put stuff in there and I'm I'm trying to figure out like we
have to figure out a place where like what I really need to know
because there's only a few things you really need to know
for the patients like a. Lot of the other.
Stuff is. Just for billing.
But I want to put like all the real pertinent stuff so I know
where it's at. If doctors want to read the note
like, that's the stuff they should read, because otherwise a
lot of it's just. Just a lot of the fluff to get
the billing up. So that is what's going on
there. So about the drama with my, with
my, with my dad. Everything is getting a little
better. If you don't know, my dad's got
some dementia and so we're kind of dealing with that.
He's he's getting a day program. He's doing a little better and I
found with him it's. Just better to just kind of go
around, go along with. What he's?
What he's saying and what he's doing like agree that Oh yeah,
We'll, we'll, we'll, we'll. Send you home next week and and
things like that. So it's working working better.
So thank you for those that. Have emailed me about that or
had similar situations. Kind of working through that.
So I don't really have any other bandwidth for other stuff for it
like this mod Med. I'm thinking it's by day 30 it's
going to be good. Like I said, I'm on day 10.
I think by day 30 it's going to be a lot better and I'll be more
up and out and be able to get back to doing other other stuff.
But in the. Practice.
I feel, and I've mentioned this before, if the medical record
doesn't move real smooth like if I am my my.
My scribe. Isn't working great?
I have a hard time thinking outside of the box and being
more productive in terms of billing and practice management.
I think it's because your mind can only so focus on so many
things. And I feel like since I'm so
focused on this EMR, I'm like, I want to do whatever is easiest.
And I think I've mentioned that before.
I think we tend to want to push the easy button if we're too
busy doing other things like, so if you're too busy doing the
notes, you're going to want to push the easy button just to do
the easiest thing versus what's either best for the patient or
the most profitable. And this is something I'm
realizing because I'm in the midst of it right now with this
EMR switch. Whereas before, when it was
really easy for me to do the EMR, I was able to be more
present and focus and listen and, and, and, and give the best
care for the patient. So.
That is. Kind of what?
I'm working on here kind of concerns I have just so you
know. There, there was a patient that
it's in PES and serranus. I don't really treat that
usually. And I'm still I'm, I'm not sure
if that's within my scope because it looks like the soft
tissue close to the knee or in Massachusetts.
Can I do that? They have flat feet.
So I'm treating the flat feet, but I'm thinking about like, can
I do shockwave on on that area? I think it's kind of analogous
to other areas, but I don't know because I don't, I don't see a
ton of it. Or should I just refer it out?
So that's one question I have right now for me.
And another is there's a vascular group that's wanting to
refer a charcoal patient over to me.
And I don't do a ton of wounds and I, I kind of knee jerk said
yes because I'm usually able to take any, any patient, but then
I'm usually going to refer them out again, probably to the wound
care center. So these are kind of things
that. I'm kind of trying to deal with
during the day and you try to. Do the best you can with this,
but we'll talk next time. Thanks.