Today I received a curious WhatsApp from my scribe and I
didn't know why. It was a Friday afternoon.
He sent me a message at home he wanted to talk to me, not at the
office and I and I really couldn't figure out why.
And the reason he was calling is he was concerned because in his
company, AI seemed to be like taking the place of all the
scribes. Hello, my name is Don Pelto.
This is Podacha Practice Mastery.
We're helping you bring a practice to the $1,000,000 mark
and beyond. Today I'm going to start out
talking about my the fears of my scribe and why I reassured him
that I'm going to keep him in my in my practice helping me for
those that don't have a scribe, I was kind of a a late adopter
to getting a scribe, but I think it is pretty much the most
beneficial aspect of my practice that has helped me to be more
present with my patients and do all the other things during the
day and all the other things that I have to do in life during
my work day so I can kind of buy my time back.
So I think of my scribe more so of buying my time back than I do
anything else. There's a good book, I think
it's by Dan Martell that says it's called buy your time back
and it is expensive expense, expensive expense.
It is expensive. So if I look at my, my sheet
like we get our expenses for the practice, it ends up being about
$30,000 a year. And you might think, Oh my
goodness, 30,000. Well it is pre tax.
So I, I actually save 30% because it comes directly out.
So I save 30%. But more importantly, I want to
talk a little bit about what a scribe does for me in the
office. He, he, first of all, it took me
3 months. So he's now up and running with
Mod Med. We recently switched from Athena
to Mod Med. We're three to four months in
now and he does all, all my notes, He does all of my
prescriptions, he does all of my physical therapy orders, MRI
orders, pathology orders, he does all that stuff.
He sends messages to my staff to schedule surgery.
He has like a little templates I've given him in Google Docs
where he can know the types of surgeries that I do.
He also reminds me of things. So when we're in, in the
treatment room, he'll remind me that, you know, this patient
needs to do an ABI, This patient needs to do a diabetic foot
exam. And he's getting to kind of
almost be an extension of, of, of myself in the practice for,
for doing things. So it makes it a lot easier.
And I know the concern what's happening in his work situation
is like, I'm the only one that uses a scribe, I guess in his
whole building five days a week. So he must be working.
I think he's working 40 to 50 hours with me and the other
scribes. They might be working 2 days,
might be working 3 days. And he, he's kind of scared for
his job. But I'm not sure if AI can do
all of that. I know I've worked with some
doctors and they use AI and they, they like listen to the
conversation and then maybe do some notes and things like that.
But then I, I'm, I'm assuming, but I, I really don't know.
So I'd like to know if any of you do use AI.
Like when I do a note, I just go in, login and I sign the note.
I don't really have to do any edits.
I'm thinking with AI you might have to edit things.
You might have to edit the, I don't know if you can do ADMB
prescriptions and all these other types of orders that, that
he does for me. So I, I still think having a, a
live scribe can be beneficial. Yes, it's an investment, but
it's a way of buying your time back.
And, and while I'm talking about buying time back, many, many
docs that I, that I talk with, they want to be more efficient
and they're not, they're not really willing to invest in
themselves. And this is something that I've
learned, I learned this a long time ago.
I'm not exactly sure from who, but I try to buy my time back in
multiple ways in the office. Other ways you can buy your time
back is with technology. So I'm a big advocate of virtual
assistants. So I do also have virtual
assistants for example that answer our phones that buys our
regular staff back. I have virtual assistants that
help editing my videos. So I upload my videos.
When I do my I try to do 1 YouTube short a day.
I mean, maybe I'll like stack them like do multiple in a day
and then my virtual assistant will do that.
And then I use a technology called repurpose dot IO that
sends it to all my social media. So I kind of use technology that
way. And I and I think it would be
different if I didn't have other things to do during the day.
So for example, I'm real involved in my church and I have
other types of activities I do during the day in between
patients. And I think that the main
difference is my other colleagues, they're just doing
notes the whole time and I'm able to do these other things.
So I, and I value that because otherwise I'd have to do that at
night or weekend. A couple of other things, I
don't know if you guys have thought about this, but like
once you get to a certain amount of income, it's, it's, I think
it's better to outsource things that you don't like to do.
So I, I outsource a lot of things in my house.
For example, I have someone that cuts my lawn.
I have someone that cleans my pool.
I have someone that cleans my Jacuzzi.
I have someone that these, so you know, these things I didn't
put in my house. I, they were in my house when I,
when I got it, I had a handyman. I have a handyman that came and
he did about almost $2500 worth of work, but just stuff I, I'm
not very good at, like hanging up things, changing faucets,
putting caulk in, in, in, in our kitchen.
So he just got done doing a lot of these things and I think of
this like really frees me up and I'm not too good at those things
either. So I think, you know, both my
scribe and these other things, I think they give you more time
back to do what you want. And specifically in the
practice, it helps me to be more present.
So my typical workflow with Murali is I'll review the X-rays
before with him and then sometimes I'll review them with
patients, not always and but I'll just be present with the
patients doing my treatment sheets, really being really
involved. And I find that I'm able to
offer more things to patients in terms of treatments because I
don't have to document it. I know it sounds funny, but a
lot of times it takes more time to document something that
you're going to recommend than it is to actually recommend it.
And I find there's no excuses for me now that he's listening.
And so it's a real easy process. I just have a second phone.
So I have another Samsung phone with a phone number that we call
in. It's a Microsoft Teams phone
number. And I could, when I was training
him, I had him on the computer on Teams and I was sharing him
with my screen. But now we just do it over the
phone and then he just listens all day and I have to make sure
I mute him. Sometimes I forget to mute him
when I go to the bathroom, but that's kind of beyond the scope
of this podcast. But so that is I wanted to just
talk a little bit about how I use my scribe and it kind of how
that makes things more efficient.
So I would encourage you to do that if if you are at a certain
level where you're not having enough time in your life, you're
not have you're just too busy. Take some of these things that
that you don't like to do. Now, I would love to have
someone coming in, for example, do our laundry.
We already have a house, you know, person that comes in and
cleans every couple weeks. But someone do the laundry for
my wife, but she's not interested in that.
So I can't buy her time back if she doesn't want to.
And so there are other things that, and I'd like to do, but
that's part of the benefit of like having a partner at my work
or a wife here at home. Because I otherwise I would
probably spend everything buying all my time back and then I
wouldn't, I don't know what I would do.
I, I try to do more of the things that I like to do, which
is like these things. OK, let's go into the day.
This was a Friday that I am recording my my treatments here,
the first half of it. So this was a kind of a
different Friday was a pretty successful one.
But I'm going to say the pros and the cons.
So this day, and I'm not, I'm not, how do you say bragging
about this? And I don't normally see this
many patients, but we saw 50 patients.
No, I'm not a person. If you look at my numbers,
normally it's 20/22/23 patients when I'm in a normal day.
Friday is my routine day and I and I have been having Marjorie.
So she's my nail tech. So we together, I think we
probably saw probably 40 or 35 in the morning.
And then in the afternoon I just saw my normal 10 or 12.
OK, that, that's how it was. But the morning was pretty busy.
Thankfully we stayed on time, but there was some drawbacks and
let me explain. So first of all, Marjorie, she
forgot her, she has these little glasses that she use like almost
like loops, surgical loops, but they're for nail tech.
She forgot them. She had to leave, but that was
no big deal. I, I was able to do the, do the,
the treatments. So I, I do all the treatments
and so usually it's nails and calluses for the patients.
And the, the challenge with seeing that many is Murali gets
bogged down and he is just basically just working on the
notes. And so I'll, I'll type little
notes in into, there's a little like a little note section in my
EMR if it's something different. So if it's the same, he knows
it's the same. So trim nails and calluses the
same thing. The, the challenge is when I'm
seeing that many, I think we're losing money for in two specific
aspects. 1 is that I, I was doing AB is once a year and
there was no recall system because Murali is too far behind
to remind me and I don't look. And the second thing is I wasn't
doing diabetic foot exams once again, because I'm, I'm not like
logging into every single patient to, to do that.
And so I think it to do it better, I may have to log in
every single time, especially if Morali was behind trying to work
on all these notes because I'm doing the joke is it takes me
less time to do the nails and calluses than it does for him to
do the notes. So I think if I didn't have a
scribe, it would be a lot harder.
So I think those are two drawbacks.
And I guess, yeah. So I'm not doing as many Abis,
not doing so many diabetic foot exams.
And so I think and also I'm not looking as much for other type
of pathology when I'm that busy, when I'm that busy.
So I just want to go through the kind of the pros and the cons of
having described the benefit is certainly we're seeing more
patients. Marjorie is getting very good at
nails and helping me out. And so I it was a good choice.
And I guess the other drawback, because we have a second
provider, another doc in the office that day and we only have
six treatment rooms. So basically I'm commanding 4,
he's only getting 2. So it kind of potentially could
slow him down. And then last week, for example,
we just got I, I, I delete, I tend to get a little distracted
once in a while, as you can imagine, by these podcasts by
doing things. And so I was like running 20
minutes late and just threw the whole day off.
And there was like standing room only in the waiting room because
you're pushing that many patients and we don't have a ton
of chairs in our waiting room. And so it just what it was my
fault when I, you know, when I, when I got behind.
OK, let's go into the day after that, the afternoon.
The first patient was a 91 year old male.
He had a, a laceration on the anterior aspect of the leg.
He was there for routine care, had a little laceration due to
his swelling. He was kind of slow to heal and
draining because of the venous stasis he has.
So we did a UNU boot on him. A lot of the times in the past,
I was very, I kind of still, I'm needy.
That's what my staff tell me. But I was more needy.
And now I've realized it's just easier for me to do the una boot
than have my staff, especially on Fridays or you know, the days
when they're really busy. I do train my staff to do that.
But it was just, it was just easier for me to do the, the una
boot. Usually they do una boots for
me. Next was a 59 year old man.
He had an orthotic adjustment. This was kind of a struggle
because he was dissatisfied with the orthotics.
He he he had more of like a cave his foot, so he needed more of
like a lateral, A lateral wedge on on the device because he was
leaning over too much to the like the lateral aspect of his
foot. That the challenge was is when
he picked up his orthotic, he didn't make the six week follow
up, which which I don't know if the staff are saying.
So I have to check with my staff.
I don't know if they're saying it's optional, but he didn't
make it. And so he was upset he had to
come back. But I just kind of explained,
you know, it's normal to have adjustments.
I made the adjustment. I, I re took pictures of his
foot and they're going to send a new, new device with some built
up laterally. And he might be better off
actually, because when they send us a new pair, they don't take
back the old pair And I, I kind of Jerry rake them with some
lateral posting and it felt better for him.
So that was that was that patient.
Next was a 78 year old female status post fracture of the 2nd
digit. She is, she had routine care as
well. So some of these routines, I
don't know why they're showing up on my afternoon.
They usually don't. I think it's because they had
additional things. This was like status post
fracture and they're just showing up and I'm doing the
routine as well. I think sometimes my staff just
don't know where to put them, especially when we have a
virtual assistant scheduling. I think he just puts them
wherever 85 year old female, new patient routine.
So routines, new patients that are routine.
I don't make them see me on Friday mornings.
They can see me any day, but then I have to follow up on the
on the Friday with me or one of the other doctors.
Next was a 86 year old male that that had a right had right ankle
pain. Now this is interesting.
This gentleman, he came in, he had right ankle pain and he saw
my blog on ultrasound. He came in, he said, you know, I
don't want X-ray. I, I think I had an X-ray before
I want an ultrasound because I saw your blog.
So we sent out a blog, we sent out a newsletter once a week and
this newsletter was about ultrasounds and that's why he
came in for that. So we did an ultrasound.
He had a little swelling around the tib bands in that area and a
fusion. And so I did a little, little
cortisone injection, but one CC in there.
Next was a 50 year old female. She had left plantar fasciitis.
She's #5 out of 6 of of Shockwave next was a 38 year old
female. She had a right foot Aquinas and
this one here she had a lot of tightness that was causing some
some arch pain. So not really plantar fascial
pain, but more on the arch and I think it was all due to the
Aquinas. So I did my dynamic
demonstration that I told you about where I take like this
orba ball or B and and I rolled out the back of the calf and and
then her arch pain kind of like went away magically.
So she got night splint foam rolling with that or ball and
then in the morning stretch for her and I'm going to see her
back as needed. Next was a 85 year old female
that had left foot Cellulitis. I gave her an antibiotic and put
her in a surgical shoe. Next was a 35 year old female.
She had a left 5th met fracture. Now this was an interesting one.
She was in a surgical shoe and it's been about 3 months
actually. Sorry this is not the fifth met.
This is a 5th digit. This is interesting because she
had a fracture right at the DIPJ and I looked at her previous
X-rays and it was originally was a fused 5th toe at the DIPJ
which is pretty common and she fractured right through it and
she was in a Cam boot for three months, wasn't getting better.
I'm sorry she was in a surgical shoe wasn't immobilizing it
enough. So we put her in a Cam boot.
I'm going to try one more month and if not I told her about
doing shockwave focused only or non radial only.
I'm starting to call things in the office either radial or non
radial. Just the reason for that is
because we have two focused device, but they don't they're
not OK. We have we have the, the, the,
the storage device which is really focused and then the, the
software which they call unfocused.
So to not 'cause confusion and they do very similar things.
We when we, when we build things and when we schedule things, we
say we're going to do radial and non radial versus focused or
unfocused to not to not confuse things.
And then the the last one's a 49 year old female for left fourth
met base fracture. So this was a patient.
She is a diabetic neuropathic fracture to 4th met base.
She's a teacher. She's really not getting better
with this. And she had been in a Cam boot
and it's been about four months. And I'm, I'm, I'm concerned that
these ones delay, tend to delay and due to her neuropathy, I'm
concerned it could, you know, turn into like a shark go foot
or something else if she just keeps walking on the darn thing.
So I recommended number one out of four for focused only
shockwave. So she did number one out of
four. I'm, I'm for, for, for the OR
non radial. So for the non radial one, I'm,
I'm still doing 4 for the bone fractures.
And I've started to offer patients if they want quicker
treatments or to get not, not really better faster, but if
they just want to get the treatments better, they can do
treatments every three to seven days.
Majority do every seven days for the finances, but some want to
get things done faster, so they do it every three days.
So this is something that I've been offering to patients more
frequently and some of them are taking up on it only because
they want to get things done faster.
I think there is always a desire with patients for speed and I
think that's the benefit of Shockwave to begin with is they
want a speedier recovery then they would normally just
waiting. So I think a lot of things you
can, so you can both speed it up with Shockwave, but then offer
them, hey, you can come in every three days.
It might be logistically a little bit of a challenge for
the practice if you're if you're too busy with patients.
Like certainly as you can see, like shock waves really glut my
glut, my schedule, but there's not enough patients for me to
offload the shockwave yet. I've thought about like if I
took a day off, that would be nice.
I could take a day off, have someone else do the shock waves
and then I would be at about the same demand for patients.
But right now there's not that much demand because if I didn't
have all these shock waves in my schedule, it may be a lighter
schedule for me. That's that's where I feel
that's kind of the fear of where I'm at right now.
OK, once again, I hope you guys enjoyed this.
I am putting together a challenge, a six month challenge
for a few select podiatrist if you want to be part of it.
It'll be helping to get your practice to the $1,000,000 mark
and beyond. If you've heard these things
we've talked about here, if I'm the beneficial, we'll kind of
work with them in a small group we're going to be meeting once a
month and they're going to have like small group like
conversations via WhatsApp. OK.
If you're interested, shoot me an e-mail
don@podiatrypracticemastery.com or you can go to that website
and learn more about it. OK, Talk to you tomorrow.