I want to answer the question on why my nail technician now makes
me look bad. This is kind of a tongue in
cheek type of a intro here, but I've been using a nail tech for
about 6 months in my office. The the way we use her, she has
her own nail salon and she's not as busy in the morning hours.
I guess I didn't know this, but the natural progression of
salons is a lot of afternoon appointments and weekend
appointments. And so she has her mornings for
8:00 and she was excited to work for us.
Now I want to be clear, she was not the first one that we went
through. So a lot of times we try to
perfectionize over getting the perfect person where I think in
the in the beginning you just need to get someone because you
are bad at training them, you are bad at hiring them and they
don't know what they're doing either.
And so we went through a couple of ones that didn't stick, but
finally the third one stuck. And I think this is the same
thing as well for a scribe. You can't look for the perfect
scribe. You have to just have a good
process. And I think you can even say
this for employees, right? Because employees leave.
So it's not really getting a perfect employee, it's having a
good training system for that employee.
So Marjorie is her name that works with us and she works with
me Friday mornings, half day and she does kind of all the nail
care. So I have appointments usually
every 20 minutes, but on routine days I do them every 10 minutes.
And then she has her, her appointments every 20 minutes.
So and she's doing all the nails and she's, it took me about six
months to train her. She's doing the nails because
that's within her scope. I've also trained her to do some
calluses. So I trust her.
I've trained her and I am going in and seeing each of these
patients and doing the notes. And then so I go in kind of say
hi to the patient and I do or morally my scribe does the notes
and then and then and then basically that's it.
And then I also evaluate if they need a diabetic foot exam or I
evaluate if they need AB is or something else like that.
So that's how we use Marjorie. Now, why does she make me look
bad? Well, she makes me look bad
because she doesn't make the patients bleed as much.
That's kind of my joke. She, she is a little bit, I
don't know if it's more careful or maybe I try to get out more
of the edges. And a lot of times patients come
out with two or three band aids with me, but with with her not
as much. So less band aids hurts a little
bit less. The patients tell me and they
like her. She's very good at talking like
a lot of these nail techs and hair techs and things like that
are good at doing. So that was that would be my
word to you. Now it took us, I've been in
practice for about 15 years now and it took us about 15 years to
do a nail tech. And if I could do it over again,
if you have a too, too much pent up routine care that's kind of
glutting your schedule because those tend to be low value
patients, it would be, it would behoove you to use a nail tech.
Now there are a lot of conversations regarding a nail
tech. There are all is it within their
scope is should they be treating patients?
Can they be treating Medicare patients?
I don't want to get into all of that.
I just find that in in my practice, I would be fine doing
all the all of them. I was doing them all.
We have a high comfort level and she works under me.
So basically I'm responsible. I'm going to see all the
patients. I'm always in the office and I
only do 1/2 day, so Friday, half day.
So just a thought. That's kind of how we do.
But we went back and forth with my partners of like, should we
be doing this? Is this legal?
Is, is this something that the patients would mind?
Now let's talk about patients perception.
So we put them so all the follow up patients go on her schedule.
They just say you're going to see the nail tech.
I haven't had any patients that didn't want her.
I have a couple of patients when they come in, they say I'd
prefer to see the doctor just because they maybe they like me,
they like to know about my kids, things like that.
And so I will, I will see those ones if they specifically
request. And, and the way we do it in our
office is we put a little sticky note on the door.
I don't know how you guys do it, but the way we do it for seeing
patients is we, so we know who's next.
The, the staff puts a little sticky note, a little post it
note with the patient's patient's kind of first name and
then they put in kind of what they're there for.
And this makes it a lot easier for us.
And then we also have a flagging system to know who's like the
first patient, who's the second patient, who's the 3rd patient
when we have multiple rooms kind of backed up in our office.
The the post it note is also beneficial for two other
purposes. I don't know if you use a post
it note, there's probably a better way, but I haven't
figured it out. OK, I, I know some people use
like the home screen for their computer, like they would put up
a big almost like a, a television that shows what room
to go into and what they're there for.
That might be less paper, frankly, but there's another
added benefit to these post it notes is when I do nail samples,
I just write what toe or a toenail I took and I just put
that little sticky note on there.
Same thing when I do biopsies, I put the little sticky note on
there. So it makes it a little bit
easier for, for tracking of pathology types of things in in
the office. And also, I know this is going
to sound funny, but it helps me remember the patient's name
because a lot of times there's so many patients, I don't
remember all the names, especially with the newer
patient. And so having it written down
there, I can, I can refer back and try to use their first name.
OK, so this is a recording of a Friday.
And so the first half of the day once again was, was with, with
Marjorie and seeing routine nail care.
I'm going to go through what we saw in the afternoon.
So the first patient in the afternoon was a 61 year old
female. She had right heel pain and she
got the Pelto special once again.
Pelto special is the night splint foam rolling in morning
stretch. She got X-rays, she got
ultrasound, and she was wearing fit flops.
I don't know if you know fit flops, so I usually recommend
UFOs, but I think the fit flops are probably OK.
She's going to be working on the soft tissue and if it doesn't
get better, she's going to follow up.
I her her ultrasound was not all that big.
So I think a lot of hers has to do with the tightness.
And so I think with the taking care of the tightness, she'll
feel better. I did have two care reflex
patients. One was a 71 year old female.
We did bilateral care reflex and she purchased the kit.
The other one was a 38 year old female for left care reflex.
Now I'm trying to have these care reflex patients be seen in
my in Marjorie schedule for two reasons.
One, because it just takes me forever to make it look good and
I tend to get really behind as I'm doing them.
And it's really not the largest check.
Maybe it's OK if they're doing 2 nails.
So, so 2 nails, I charge 125 for the first nail and then 50 for
the second nail and then we charge 75 for the kit.
So for two nails, it's a little bit better if they're just
coming in for one nail or let's say the darn thing falls off and
I'm not charging them at all or just doing an office visit.
It's not really the most beneficial.
So I'm, I'd like to have Marjorie do more of those.
Once again, that's within her scope of practice.
Next patient was a 65 year old female for right Achilles tendon
pain. She is a nurse practitioner
dermatology. She has some bulbous change.
She has a very small bulbous change in the back of the
Achilles. It's not too severe hurts a
little bit. We talked about her Aquinas that
she has bilaterally did the Pelto special once again, night
splint foam rolling, morning stretch and I'm not going to see
her back if if the pain gets worse, she'll come back in.
But her pain level isn't all the time and it's not very high and
so she would certainly benefit from Shockwave and I talked to
her about Shockwave, but if the pain isn't all that bad, I'll
she's not too motivated to do that.
Next patient was a 66 year old man.
He's doing Q tenza #2 The only struggle I'm still having with Q
Tenza is the documentation in our medical record because
there's two options with Q Tenza. 1 is like the buy and
Bill and the other one it meaning that means we buy the
product and we build the product.
And the other one is where it goes to a specialty pharmacy and
we just get the product in. So those are kind of the two
ways depending on their insurance.
They, they kind of help us with that.
And then when they come in and we, we apply it, the application
is really easy and we've, we started out by doing everything
ourselves. Now basically I go in, I see how
they're doing, staff does the vitals, I apply it, put in a
timer for 15 minutes, put it on the door and then my staff
checks them at 15 minutes. The vitals checks them at
another 15 minutes and then puts this like gel stuff on there to
chelate or to pull away all the capsaicin and then they're on
their way. So I only see them for that must
be maybe 2 minutes. So it's real quick.
It does take up a room in your in your office because I have to
sit there for 30 minutes. But besides that it was, it was
fine and, and he's getting benefit from it.
Next was a 84 year old man with a left hallux Ind and the and
the last patient was a 56 year old female.
So she has, this is kind of a challenging one.
She has bilateral forefoot pain and she's like she works on her
feet all day. She works in a factory.
She didn't really get better with what we gave her with the
shoe changes with the I gave her a Medrol dose pack.
Another doctor gave her gabapentin because it's possibly
nerve pain. It could just be that she's
working now. I'm not sure if she's just not
wanting to work or what, but she she when patients come in and
ask about like FMLA, our family medical leave act, I think, man,
how do you live on that first? But I guess if you don't want to
work. So I'm not too much of A
stickler for that. So I'm going to see her back in
two months and she doesn't want to work for two months.
And I'm thinking, what would I do for two months ago?
Crazy. But that was what she wanted.
So and then I said if it's not getting better after a couple of
months, then we'll get an MRI. But I don't think there's really
anything big going on with this patient.
OK, once again, I hope you guys found this beneficial.
I am putting together a challenge, a practice Podiatry
practice mastery challenge. We're going to do a six month
challenge. So if you'd like to be part of
it, shoot me an e-mail, e-mail dot at Podiatry practice
mastery. The whole goal would be to
optimize, to get your practice past your personal production,
past the $1,000,000 mark. That's what I'm doing with all
these podcasts. But I find a lot of times it,
it's better to have a little bit of accountability.
I was talking to a doctor recently.
He, he was struggling with some simple, simple things.
But it, it's not obvious when we're in the midst of it and
we're really, really busy. So if you want to be a part of
another group of it'll be only podiatrist there.
We're gonna have a small group. I limited the number.
You should be seeing some emails if you're getting my emails.
If you don't get my emails, shoot me e-mail and I'll add you
to the e-mail list if you want that.
If you have any questions, let me know.
I think it would help you because I think that
accountability can be beneficial.
Okay, talk to you tomorrow.