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Hey guys, Don here. 
Welcome to Podiatric Practice 

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Mastery. 
I'm going to go over the 

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$1,000,000 minute here. 
So we are on day #10 of our 

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medical record transition, so. 
We're starting to find where. 

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Everything is. 
At I'm able to get to the right 

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level visits. 
I got out of the office at 5:00.

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Which is. 
Better than before I wasn't. 

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Able to write down so I usually.
Keep a separate. 

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List of things that I want to 
talk to you guys about, but I'm 

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having a hard time. 
There's a schedule I can print 

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out within Modmed, but it's not,
I don't know it. 

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There's just a lot of stuff on 
it and it's not clear enough for

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me of, of what I'm doing and 
there's not enough room to write

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on. 
So I'm thinking about making a 

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different method of, of writing 
it down. 

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The kind of different, I don't 
know, piece of paper or 

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something like that because I'm 
too busy trying to worry about 

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the EMR than I am about like 
documenting what I'm doing for 

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you only because I'm still 
training my scribe. 

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So kind of what happens First 
half of the day was fine. 

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Work through lunch was able to 
document some stuff. 

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And then at the end of the day, 
I'm just wanting to get my get 

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out of the office. 
So but I can go over the first 

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half of the day kind of what we 
saw. 

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So first patient this was a 
sister and brother that they 

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came in a. 15 year old girl she 
had. 

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Swift #4 and she's going to be 
back in three months. 

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And then little boy, he tried to
do Swift. 

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He was six. 
He just couldn't tolerate it. 

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I don't know about you, but I 
went up to about 6 for him and 

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he just, he preferred can 3rd. 
And so I did, a couple of many 

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cried too much and I had to make
him. 

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Feel better by. 
Showing a magic tricks. 

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If you don't know, that was my 
backup guy. 

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I wanted to, I don't know if I 
told you guys this yet, but I 

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wanted to be a. 
Magician in the past and so 

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medicine is my backup gig. 
If you ever want to see a magic 

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trick, just ask me. 
But I showed him some magic. 

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Tricks and he was better. 
Next patient was a new patient 

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that came in for bilateral 
planet fasciitis. 

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I got X-rays ultrasound office 
visit for this one here and I 

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think hers was more due to 
Aquinas. 

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She's 29. 
So we were working more on that 

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with like night splints, foam 
rolling, morning stretch, things

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like that. 
I think she'll I think she'll 

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get better with with that more 
so because I did the ultrasound.

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I didn't see a lot of thickness 
in her fashion. 

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She's kind of young. 
Next patient was shockwave #2 

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out of out of 6 for Shockwave. 
She's doing better. 

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Next was a routine that somehow 
got in there, but actually did 

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the routine note pretty well. 
I was surprised, but when they 

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were. 
So right now with this new 

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system is like they have to get 
the date last seen and all these

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other things to, to finish the 
note and I have to figure out a 

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way to communicate to my staff. 
So they weren't their office 

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visit was like made for an 
ingrown tonial, not so much for 

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routine care. 
So we have to kind of clarify 

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that for the staff. 
I'm still kind of learning about

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that. 
Next patient was a 74 year old 

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that had an exostectomy on the 
medial 3rd digit. 

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So I did that. 
I'm still learning how to put 

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exostectomies in the note. 
So there's like a, a certain 

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template that I have to use, but
I have to put in a lot of the 

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verbiage for it because it's not
in there. 

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Like it comes basically with a 
lot of boilerplate stuff, but 

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you have to modify it. 
So that's what I'm, I'm working 

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on is modifying that. 
Next was #6 out of 6 for 

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Shockwave. 
This is for plantar fasciitis 

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for this patient. 
Now the nice thing, I think. 

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I've been, I told you a couple 
months I've been starting to do 

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6 and everyone and I. 
Think the reason I like to do 6 

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now is like by the 5th or the 
6th the benefits from the first 

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one is. 
Working and I like to be there 

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as they start to feel better 
because I can not guarantee, but

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I feel a lot more comfortable 
when I finish the 6th one if 

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they're starting to feel better 
at that time that that they are 

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going to continue to improve at 
my at my six week follow up. 

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In the past I used to do 3 and 
then they weren't any better at 

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3:00 and they just had to kind 
of trust and trust and obey and 

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wait. 
And this way being there when I 

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when they're feeling better 
makes them feel more confident, 

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makes me feel more confident 
another. 

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Way kind of around that if you 
still want to do 3 and I've 

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heard this from another person. 
Is they do only three sessions, 

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but they do them every two 
weeks. 

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So by the third one in six weeks
they would hopefully start to be

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feeling better from the first 
one. 

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That's another way of doing it, 
but I'm still kind of doing the.

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6 for most of my patients. 
So I I didn't. 

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So the next one was, oh, this 
was a gentleman he was here for,

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he had a really bad fracture of 
his distal distal phalanx. 

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He's a diabetic. 
It was kind of a common rooted 

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fracture and the thing really 
never healed. 

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I was just giving it time and we
gave it in many months and we 

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may have to excise this fracture
just because the piece is kind 

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of lifted up quite a bit for 
him. 

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So that's something I'm going to
refer to my other, one of the 

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other doctors over here next was
a, a fungus patient. 

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So that was a I'm still learning
to like the fungus used to be 

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really easy but now I have to do
the LFTS and the trybenafin. 

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But. 
You don't just do it like an 

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Athena. 
It sends it automatically. 

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With this new system I have to 
go in there and and send the 

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medication. 
I have to send the LFTS. 

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So it's a little bit challenging
because all the faxes aren't in 

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there exactly where I send. 
Them to so it's. 

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Kind of a pain. 
So that's one of. 

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The kind of. 
The frustration points with this

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new system is is sending stuff 
at. 

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The end it was a little bit 
more. 

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Automated than this, I'm still, 
we're still figuring out kind of

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the workflow and sometimes you 
forget like if you're going to 

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go get an LFT. 
And and you? 

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Don't you don't fax it. 
So I used to just save it and it

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automatically faxed it but now 
it doesn't do it. 

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Next patient was a neuroma 
patient that had orthotics and I

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can't remember all these other 
ones that I did in the 

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afternoon. 
So I'm not even going to try to 

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guess here, but there was there 
was once in the afternoon I was 

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seeing. 
So it's we're we're pretty much 

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back up to full, full speed 
here. 

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My my buddy. 
Neil here he. 

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He really liked doing the. 
The iPad version, he's been, 

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who's playing around with that? 
We still have a trainer, so we'd

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pay it for a trainer for two 
days and then we paid for 

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another trainer for another two 
days. 

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But I think it's going to make 
it easier and they're able to 

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explain a lot of these questions
that we have. 

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In the office, so I think the. 
Really getting the trainer in 

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house is going to be a good 
thing. 

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And I think I told you our our 
biller kind of left. 

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We had a remote builder. 
She was in Florida. 

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She used to be here, but then 
she moved to Florida. 

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So she's been helping us 
remotely and she kind of kicked 

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the bucket and said she wanted 
to leave and do something else. 

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We kind of went back to her and 
said just to help us with this 

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transition because it's kind of 
a transition closing the books 

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within Athena. 
Like you have to continue to 

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post things there and then with 
Mod Med we might not need a full

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time book bookkeeper or I'm 
sorry Biller, because it's. 

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More. 
How do you say it? 

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The billing is kind of inter 
interweaved in it and I think 

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that you can't really close the 
notes. 

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I'm still not pleased like with 
me right now. 

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I'm still not pleased with the 
way my notes look. 

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I'm trying to work with Murali 
like a place because a lot of 

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times there's a lot of bloated 
notes, like just stuff that's in

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there that's not really 
pertinent. 

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So I'm I'm trying to figure out 
a place to put my additional 

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findings. 
So basically there's a template.

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Or something called. 
A plan additional finding we can

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put stuff in there and I'm I'm 
trying to figure out like we 

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have to figure out a place where
like what I really need to know 

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because there's only a few 
things you really need to know 

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for the patients like a. 
Lot of the other. 

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Stuff is. 
Just for billing. 

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But I want to put like all the 
real pertinent stuff so I know 

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where it's at. 
If doctors want to read the note

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like, that's the stuff they 
should read, because otherwise a

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lot of it's just. 
Just a lot of the fluff to get 

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the billing up. 
So that is what's going on 

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there. 
So about the drama with my, with

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my, with my dad. 
Everything is getting a little 

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better. 
If you don't know, my dad's got 

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some dementia and so we're kind 
of dealing with that. 

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He's he's getting a day program.
He's doing a little better and I

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found with him it's. 
Just better to just kind of go 

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around, go along with. 
What he's? 

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What he's saying and what he's 
doing like agree that Oh yeah, 

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We'll, we'll, we'll, we'll. 
Send you home next week and and 

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things like that. 
So it's working working better. 

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So thank you for those that. 
Have emailed me about that or 

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had similar situations. 
Kind of working through that. 

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So I don't really have any other
bandwidth for other stuff for it

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like this mod Med. 
I'm thinking it's by day 30 it's

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going to be good. 
Like I said, I'm on day 10. 

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I think by day 30 it's going to 
be a lot better and I'll be more

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up and out and be able to get 
back to doing other other stuff.

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But in the. 
Practice. 

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I feel, and I've mentioned this 
before, if the medical record 

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doesn't move real smooth like if
I am my my. 

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My scribe. 
Isn't working great? 

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I have a hard time thinking 
outside of the box and being 

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more productive in terms of 
billing and practice management.

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I think it's because your mind 
can only so focus on so many 

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things. 
And I feel like since I'm so 

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focused on this EMR, I'm like, I
want to do whatever is easiest. 

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And I think I've mentioned that 
before. 

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I think we tend to want to push 
the easy button if we're too 

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busy doing other things like, so
if you're too busy doing the 

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notes, you're going to want to 
push the easy button just to do 

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the easiest thing versus what's 
either best for the patient or 

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the most profitable. 
And this is something I'm 

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realizing because I'm in the 
midst of it right now with this 

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EMR switch. 
Whereas before, when it was 

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really easy for me to do the 
EMR, I was able to be more 

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present and focus and listen 
and, and, and, and give the best

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care for the patient. 
So. 

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That is. 
Kind of what? 

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I'm working on here kind of 
concerns I have just so you 

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know. 
There, there was a patient that 

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it's in PES and serranus. 
I don't really treat that 

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usually. 
And I'm still I'm, I'm not sure 

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if that's within my scope 
because it looks like the soft 

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tissue close to the knee or in 
Massachusetts. 

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Can I do that? 
They have flat feet. 

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So I'm treating the flat feet, 
but I'm thinking about like, can

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I do shockwave on on that area? 
I think it's kind of analogous 

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to other areas, but I don't know
because I don't, I don't see a 

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ton of it. 
Or should I just refer it out? 

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So that's one question I have 
right now for me. 

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And another is there's a 
vascular group that's wanting to

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refer a charcoal patient over to
me. 

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And I don't do a ton of wounds 
and I, I kind of knee jerk said 

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yes because I'm usually able to 
take any, any patient, but then 

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I'm usually going to refer them 
out again, probably to the wound

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care center. 
So these are kind of things 

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that. 
I'm kind of trying to deal with 

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during the day and you try to. 
Do the best you can with this, 

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but we'll talk next time. 
Thanks.