1 00:00:01,240 --> 00:00:07,160 Today I received a curious WhatsApp from my scribe and I 2 00:00:07,160 --> 00:00:09,040 didn't know why. It was a Friday afternoon. 3 00:00:09,120 --> 00:00:12,600 He sent me a message at home he wanted to talk to me, not at the 4 00:00:12,600 --> 00:00:15,360 office and I and I really couldn't figure out why. 5 00:00:16,720 --> 00:00:19,800 And the reason he was calling is he was concerned because in his 6 00:00:19,800 --> 00:00:26,800 company, AI seemed to be like taking the place of all the 7 00:00:26,800 --> 00:00:30,040 scribes. Hello, my name is Don Pelto. 8 00:00:30,280 --> 00:00:31,680 This is Podacha Practice Mastery. 9 00:00:31,680 --> 00:00:34,480 We're helping you bring a practice to the $1,000,000 mark 10 00:00:34,480 --> 00:00:36,440 and beyond. Today I'm going to start out 11 00:00:36,440 --> 00:00:41,360 talking about my the fears of my scribe and why I reassured him 12 00:00:41,360 --> 00:00:46,360 that I'm going to keep him in my in my practice helping me for 13 00:00:46,360 --> 00:00:49,320 those that don't have a scribe, I was kind of a a late adopter 14 00:00:49,360 --> 00:00:53,320 to getting a scribe, but I think it is pretty much the most 15 00:00:54,320 --> 00:00:58,920 beneficial aspect of my practice that has helped me to be more 16 00:00:58,920 --> 00:01:01,840 present with my patients and do all the other things during the 17 00:01:01,840 --> 00:01:06,760 day and all the other things that I have to do in life during 18 00:01:06,760 --> 00:01:10,160 my work day so I can kind of buy my time back. 19 00:01:10,160 --> 00:01:14,440 So I think of my scribe more so of buying my time back than I do 20 00:01:14,440 --> 00:01:16,440 anything else. There's a good book, I think 21 00:01:16,440 --> 00:01:19,360 it's by Dan Martell that says it's called buy your time back 22 00:01:20,320 --> 00:01:24,040 and it is expensive expense, expensive expense. 23 00:01:24,280 --> 00:01:27,000 It is expensive. So if I look at my, my sheet 24 00:01:27,880 --> 00:01:31,680 like we get our expenses for the practice, it ends up being about 25 00:01:31,680 --> 00:01:34,320 $30,000 a year. And you might think, Oh my 26 00:01:34,320 --> 00:01:37,360 goodness, 30,000. Well it is pre tax. 27 00:01:37,360 --> 00:01:41,880 So I, I actually save 30% because it comes directly out. 28 00:01:41,880 --> 00:01:46,360 So I save 30%. But more importantly, I want to 29 00:01:46,360 --> 00:01:49,520 talk a little bit about what a scribe does for me in the 30 00:01:49,520 --> 00:01:52,920 office. He, he, first of all, it took me 31 00:01:52,920 --> 00:01:55,000 3 months. So he's now up and running with 32 00:01:55,000 --> 00:01:56,920 Mod Med. We recently switched from Athena 33 00:01:57,080 --> 00:01:58,960 to Mod Med. We're three to four months in 34 00:01:58,960 --> 00:02:04,000 now and he does all, all my notes, He does all of my 35 00:02:04,320 --> 00:02:07,600 prescriptions, he does all of my physical therapy orders, MRI 36 00:02:07,600 --> 00:02:12,400 orders, pathology orders, he does all that stuff. 37 00:02:12,400 --> 00:02:15,440 He sends messages to my staff to schedule surgery. 38 00:02:15,440 --> 00:02:18,640 He has like a little templates I've given him in Google Docs 39 00:02:18,640 --> 00:02:20,720 where he can know the types of surgeries that I do. 40 00:02:22,000 --> 00:02:24,920 He also reminds me of things. So when we're in, in the 41 00:02:24,920 --> 00:02:27,040 treatment room, he'll remind me that, you know, this patient 42 00:02:27,040 --> 00:02:29,920 needs to do an ABI, This patient needs to do a diabetic foot 43 00:02:29,920 --> 00:02:32,440 exam. And he's getting to kind of 44 00:02:32,480 --> 00:02:38,320 almost be an extension of, of, of myself in the practice for, 45 00:02:38,320 --> 00:02:41,000 for doing things. So it makes it a lot easier. 46 00:02:41,000 --> 00:02:45,640 And I know the concern what's happening in his work situation 47 00:02:45,640 --> 00:02:48,480 is like, I'm the only one that uses a scribe, I guess in his 48 00:02:48,480 --> 00:02:52,160 whole building five days a week. So he must be working. 49 00:02:52,160 --> 00:02:55,680 I think he's working 40 to 50 hours with me and the other 50 00:02:55,680 --> 00:02:57,080 scribes. They might be working 2 days, 51 00:02:57,080 --> 00:03:01,520 might be working 3 days. And he, he's kind of scared for 52 00:03:01,520 --> 00:03:05,520 his job. But I'm not sure if AI can do 53 00:03:05,520 --> 00:03:07,120 all of that. I know I've worked with some 54 00:03:07,120 --> 00:03:12,960 doctors and they use AI and they, they like listen to the 55 00:03:12,960 --> 00:03:16,240 conversation and then maybe do some notes and things like that. 56 00:03:16,640 --> 00:03:19,080 But then I, I'm, I'm assuming, but I, I really don't know. 57 00:03:19,080 --> 00:03:21,040 So I'd like to know if any of you do use AI. 58 00:03:22,040 --> 00:03:25,840 Like when I do a note, I just go in, login and I sign the note. 59 00:03:25,840 --> 00:03:27,040 I don't really have to do any edits. 60 00:03:27,040 --> 00:03:29,000 I'm thinking with AI you might have to edit things. 61 00:03:29,000 --> 00:03:32,520 You might have to edit the, I don't know if you can do ADMB 62 00:03:32,520 --> 00:03:36,320 prescriptions and all these other types of orders that, that 63 00:03:36,320 --> 00:03:39,440 he does for me. So I, I still think having a, a 64 00:03:39,440 --> 00:03:43,040 live scribe can be beneficial. Yes, it's an investment, but 65 00:03:43,040 --> 00:03:44,240 it's a way of buying your time back. 66 00:03:44,240 --> 00:03:49,240 And, and while I'm talking about buying time back, many, many 67 00:03:49,240 --> 00:03:55,160 docs that I, that I talk with, they want to be more efficient 68 00:03:55,520 --> 00:03:57,960 and they're not, they're not really willing to invest in 69 00:03:57,960 --> 00:03:59,120 themselves. And this is something that I've 70 00:03:59,120 --> 00:04:01,320 learned, I learned this a long time ago. 71 00:04:02,360 --> 00:04:07,240 I'm not exactly sure from who, but I try to buy my time back in 72 00:04:07,240 --> 00:04:09,800 multiple ways in the office. Other ways you can buy your time 73 00:04:09,800 --> 00:04:14,080 back is with technology. So I'm a big advocate of virtual 74 00:04:14,080 --> 00:04:15,880 assistants. So I do also have virtual 75 00:04:15,880 --> 00:04:18,480 assistants for example that answer our phones that buys our 76 00:04:18,600 --> 00:04:21,200 regular staff back. I have virtual assistants that 77 00:04:21,200 --> 00:04:24,880 help editing my videos. So I upload my videos. 78 00:04:24,880 --> 00:04:27,320 When I do my I try to do 1 YouTube short a day. 79 00:04:27,760 --> 00:04:30,960 I mean, maybe I'll like stack them like do multiple in a day 80 00:04:31,760 --> 00:04:33,760 and then my virtual assistant will do that. 81 00:04:33,760 --> 00:04:36,920 And then I use a technology called repurpose dot IO that 82 00:04:36,920 --> 00:04:41,440 sends it to all my social media. So I kind of use technology that 83 00:04:41,440 --> 00:04:44,760 way. And I and I think it would be 84 00:04:44,760 --> 00:04:47,320 different if I didn't have other things to do during the day. 85 00:04:47,320 --> 00:04:49,480 So for example, I'm real involved in my church and I have 86 00:04:49,480 --> 00:04:53,040 other types of activities I do during the day in between 87 00:04:53,040 --> 00:04:54,840 patients. And I think that the main 88 00:04:54,840 --> 00:04:57,000 difference is my other colleagues, they're just doing 89 00:04:57,000 --> 00:04:59,360 notes the whole time and I'm able to do these other things. 90 00:04:59,360 --> 00:05:01,680 So I, and I value that because otherwise I'd have to do that at 91 00:05:01,680 --> 00:05:05,120 night or weekend. A couple of other things, I 92 00:05:05,120 --> 00:05:08,040 don't know if you guys have thought about this, but like 93 00:05:08,360 --> 00:05:12,960 once you get to a certain amount of income, it's, it's, I think 94 00:05:12,960 --> 00:05:15,360 it's better to outsource things that you don't like to do. 95 00:05:15,440 --> 00:05:19,280 So I, I outsource a lot of things in my house. 96 00:05:19,280 --> 00:05:22,720 For example, I have someone that cuts my lawn. 97 00:05:22,720 --> 00:05:24,440 I have someone that cleans my pool. 98 00:05:24,440 --> 00:05:26,200 I have someone that cleans my Jacuzzi. 99 00:05:26,200 --> 00:05:29,160 I have someone that these, so you know, these things I didn't 100 00:05:29,160 --> 00:05:30,880 put in my house. I, they were in my house when I, 101 00:05:30,880 --> 00:05:34,720 when I got it, I had a handyman. I have a handyman that came and 102 00:05:34,720 --> 00:05:37,880 he did about almost $2500 worth of work, but just stuff I, I'm 103 00:05:37,880 --> 00:05:40,760 not very good at, like hanging up things, changing faucets, 104 00:05:41,920 --> 00:05:44,040 putting caulk in, in, in, in our kitchen. 105 00:05:44,040 --> 00:05:47,400 So he just got done doing a lot of these things and I think of 106 00:05:47,400 --> 00:05:49,920 this like really frees me up and I'm not too good at those things 107 00:05:49,960 --> 00:05:53,040 either. So I think, you know, both my 108 00:05:53,040 --> 00:05:55,960 scribe and these other things, I think they give you more time 109 00:05:55,960 --> 00:05:58,080 back to do what you want. And specifically in the 110 00:05:58,080 --> 00:06:00,520 practice, it helps me to be more present. 111 00:06:01,680 --> 00:06:04,840 So my typical workflow with Murali is I'll review the X-rays 112 00:06:04,840 --> 00:06:07,440 before with him and then sometimes I'll review them with 113 00:06:07,440 --> 00:06:11,440 patients, not always and but I'll just be present with the 114 00:06:11,440 --> 00:06:15,200 patients doing my treatment sheets, really being really 115 00:06:15,200 --> 00:06:17,160 involved. And I find that I'm able to 116 00:06:17,160 --> 00:06:22,720 offer more things to patients in terms of treatments because I 117 00:06:22,720 --> 00:06:25,840 don't have to document it. I know it sounds funny, but a 118 00:06:25,840 --> 00:06:29,000 lot of times it takes more time to document something that 119 00:06:29,000 --> 00:06:31,680 you're going to recommend than it is to actually recommend it. 120 00:06:32,240 --> 00:06:36,960 And I find there's no excuses for me now that he's listening. 121 00:06:36,960 --> 00:06:41,200 And so it's a real easy process. I just have a second phone. 122 00:06:41,200 --> 00:06:44,280 So I have another Samsung phone with a phone number that we call 123 00:06:44,280 --> 00:06:46,280 in. It's a Microsoft Teams phone 124 00:06:46,280 --> 00:06:49,680 number. And I could, when I was training 125 00:06:49,680 --> 00:06:51,920 him, I had him on the computer on Teams and I was sharing him 126 00:06:51,960 --> 00:06:54,160 with my screen. But now we just do it over the 127 00:06:54,160 --> 00:06:58,240 phone and then he just listens all day and I have to make sure 128 00:06:58,240 --> 00:06:59,720 I mute him. Sometimes I forget to mute him 129 00:06:59,720 --> 00:07:02,320 when I go to the bathroom, but that's kind of beyond the scope 130 00:07:03,200 --> 00:07:06,240 of this podcast. But so that is I wanted to just 131 00:07:06,240 --> 00:07:09,960 talk a little bit about how I use my scribe and it kind of how 132 00:07:09,960 --> 00:07:12,040 that makes things more efficient. 133 00:07:12,040 --> 00:07:15,240 So I would encourage you to do that if if you are at a certain 134 00:07:15,240 --> 00:07:19,560 level where you're not having enough time in your life, you're 135 00:07:19,560 --> 00:07:22,720 not have you're just too busy. Take some of these things that 136 00:07:22,720 --> 00:07:25,160 that you don't like to do. Now, I would love to have 137 00:07:25,160 --> 00:07:27,440 someone coming in, for example, do our laundry. 138 00:07:27,440 --> 00:07:29,280 We already have a house, you know, person that comes in and 139 00:07:29,280 --> 00:07:31,520 cleans every couple weeks. But someone do the laundry for 140 00:07:31,520 --> 00:07:33,120 my wife, but she's not interested in that. 141 00:07:33,120 --> 00:07:35,680 So I can't buy her time back if she doesn't want to. 142 00:07:37,200 --> 00:07:41,200 And so there are other things that, and I'd like to do, but 143 00:07:41,200 --> 00:07:46,000 that's part of the benefit of like having a partner at my work 144 00:07:46,440 --> 00:07:49,800 or a wife here at home. Because I otherwise I would 145 00:07:49,800 --> 00:07:52,160 probably spend everything buying all my time back and then I 146 00:07:52,160 --> 00:07:53,080 wouldn't, I don't know what I would do. 147 00:07:53,320 --> 00:07:55,400 I, I try to do more of the things that I like to do, which 148 00:07:55,400 --> 00:07:58,640 is like these things. OK, let's go into the day. 149 00:07:58,640 --> 00:08:05,720 This was a Friday that I am recording my my treatments here, 150 00:08:06,600 --> 00:08:08,600 the first half of it. So this was a kind of a 151 00:08:08,600 --> 00:08:10,880 different Friday was a pretty successful one. 152 00:08:11,160 --> 00:08:12,840 But I'm going to say the pros and the cons. 153 00:08:12,840 --> 00:08:16,640 So this day, and I'm not, I'm not, how do you say bragging 154 00:08:16,640 --> 00:08:18,000 about this? And I don't normally see this 155 00:08:18,000 --> 00:08:19,640 many patients, but we saw 50 patients. 156 00:08:19,640 --> 00:08:21,800 No, I'm not a person. If you look at my numbers, 157 00:08:21,800 --> 00:08:25,880 normally it's 20/22/23 patients when I'm in a normal day. 158 00:08:26,560 --> 00:08:30,760 Friday is my routine day and I and I have been having Marjorie. 159 00:08:30,760 --> 00:08:33,720 So she's my nail tech. So we together, I think we 160 00:08:33,720 --> 00:08:37,360 probably saw probably 40 or 35 in the morning. 161 00:08:37,960 --> 00:08:40,360 And then in the afternoon I just saw my normal 10 or 12. 162 00:08:40,600 --> 00:08:43,320 OK, that, that's how it was. But the morning was pretty busy. 163 00:08:44,200 --> 00:08:46,920 Thankfully we stayed on time, but there was some drawbacks and 164 00:08:46,920 --> 00:08:50,480 let me explain. So first of all, Marjorie, she 165 00:08:50,480 --> 00:08:53,760 forgot her, she has these little glasses that she use like almost 166 00:08:53,760 --> 00:08:56,240 like loops, surgical loops, but they're for nail tech. 167 00:08:56,640 --> 00:08:57,920 She forgot them. She had to leave, but that was 168 00:08:57,920 --> 00:09:00,960 no big deal. I, I was able to do the, do the, 169 00:09:00,960 --> 00:09:03,320 the treatments. So I, I do all the treatments 170 00:09:04,680 --> 00:09:08,160 and so usually it's nails and calluses for the patients. 171 00:09:08,600 --> 00:09:13,160 And the, the challenge with seeing that many is Murali gets 172 00:09:13,160 --> 00:09:17,080 bogged down and he is just basically just working on the 173 00:09:17,080 --> 00:09:18,720 notes. And so I'll, I'll type little 174 00:09:18,720 --> 00:09:22,040 notes in into, there's a little like a little note section in my 175 00:09:22,400 --> 00:09:25,720 EMR if it's something different. So if it's the same, he knows 176 00:09:25,720 --> 00:09:27,560 it's the same. So trim nails and calluses the 177 00:09:27,560 --> 00:09:29,840 same thing. The, the challenge is when I'm 178 00:09:29,840 --> 00:09:34,760 seeing that many, I think we're losing money for in two specific 179 00:09:34,760 --> 00:09:39,960 aspects. 1 is that I, I was doing AB is once a year and 180 00:09:39,960 --> 00:09:43,440 there was no recall system because Murali is too far behind 181 00:09:43,440 --> 00:09:46,720 to remind me and I don't look. And the second thing is I wasn't 182 00:09:46,720 --> 00:09:49,160 doing diabetic foot exams once again, because I'm, I'm not like 183 00:09:49,160 --> 00:09:53,400 logging into every single patient to, to do that. 184 00:09:54,000 --> 00:09:57,200 And so I think it to do it better, I may have to log in 185 00:09:57,200 --> 00:10:00,800 every single time, especially if Morali was behind trying to work 186 00:10:00,800 --> 00:10:03,240 on all these notes because I'm doing the joke is it takes me 187 00:10:03,240 --> 00:10:05,800 less time to do the nails and calluses than it does for him to 188 00:10:06,920 --> 00:10:08,600 do the notes. So I think if I didn't have a 189 00:10:08,600 --> 00:10:09,720 scribe, it would be a lot harder. 190 00:10:10,400 --> 00:10:11,720 So I think those are two drawbacks. 191 00:10:11,760 --> 00:10:14,720 And I guess, yeah. So I'm not doing as many Abis, 192 00:10:14,720 --> 00:10:16,320 not doing so many diabetic foot exams. 193 00:10:16,320 --> 00:10:20,280 And so I think and also I'm not looking as much for other type 194 00:10:20,280 --> 00:10:23,200 of pathology when I'm that busy, when I'm that busy. 195 00:10:23,200 --> 00:10:26,040 So I just want to go through the kind of the pros and the cons of 196 00:10:26,040 --> 00:10:28,160 having described the benefit is certainly we're seeing more 197 00:10:28,160 --> 00:10:30,520 patients. Marjorie is getting very good at 198 00:10:30,520 --> 00:10:35,520 nails and helping me out. And so I it was a good choice. 199 00:10:35,840 --> 00:10:37,960 And I guess the other drawback, because we have a second 200 00:10:37,960 --> 00:10:40,440 provider, another doc in the office that day and we only have 201 00:10:40,440 --> 00:10:43,480 six treatment rooms. So basically I'm commanding 4, 202 00:10:43,720 --> 00:10:46,920 he's only getting 2. So it kind of potentially could 203 00:10:46,920 --> 00:10:49,040 slow him down. And then last week, for example, 204 00:10:49,520 --> 00:10:53,840 we just got I, I, I delete, I tend to get a little distracted 205 00:10:53,840 --> 00:10:57,720 once in a while, as you can imagine, by these podcasts by 206 00:10:57,720 --> 00:10:59,560 doing things. And so I was like running 20 207 00:10:59,560 --> 00:11:01,520 minutes late and just threw the whole day off. 208 00:11:01,520 --> 00:11:04,800 And there was like standing room only in the waiting room because 209 00:11:04,960 --> 00:11:07,160 you're pushing that many patients and we don't have a ton 210 00:11:07,160 --> 00:11:09,960 of chairs in our waiting room. And so it just what it was my 211 00:11:09,960 --> 00:11:14,160 fault when I, you know, when I, when I got behind. 212 00:11:14,280 --> 00:11:19,040 OK, let's go into the day after that, the afternoon. 213 00:11:19,040 --> 00:11:21,200 The first patient was a 91 year old male. 214 00:11:21,200 --> 00:11:24,640 He had a, a laceration on the anterior aspect of the leg. 215 00:11:24,640 --> 00:11:27,560 He was there for routine care, had a little laceration due to 216 00:11:27,560 --> 00:11:32,040 his swelling. He was kind of slow to heal and 217 00:11:32,040 --> 00:11:34,520 draining because of the venous stasis he has. 218 00:11:34,960 --> 00:11:40,520 So we did a UNU boot on him. A lot of the times in the past, 219 00:11:40,560 --> 00:11:42,640 I was very, I kind of still, I'm needy. 220 00:11:42,640 --> 00:11:45,080 That's what my staff tell me. But I was more needy. 221 00:11:45,400 --> 00:11:48,040 And now I've realized it's just easier for me to do the una boot 222 00:11:48,400 --> 00:11:51,320 than have my staff, especially on Fridays or you know, the days 223 00:11:51,320 --> 00:11:53,440 when they're really busy. I do train my staff to do that. 224 00:11:53,440 --> 00:11:56,400 But it was just, it was just easier for me to do the, the una 225 00:11:56,400 --> 00:11:57,720 boot. Usually they do una boots for 226 00:11:57,720 --> 00:11:59,640 me. Next was a 59 year old man. 227 00:11:59,640 --> 00:12:03,000 He had an orthotic adjustment. This was kind of a struggle 228 00:12:03,200 --> 00:12:05,880 because he was dissatisfied with the orthotics. 229 00:12:05,880 --> 00:12:10,040 He he he had more of like a cave his foot, so he needed more of 230 00:12:10,040 --> 00:12:13,560 like a lateral, A lateral wedge on on the device because he was 231 00:12:13,560 --> 00:12:17,560 leaning over too much to the like the lateral aspect of his 232 00:12:17,560 --> 00:12:20,320 foot. That the challenge was is when 233 00:12:20,320 --> 00:12:22,440 he picked up his orthotic, he didn't make the six week follow 234 00:12:22,440 --> 00:12:24,720 up, which which I don't know if the staff are saying. 235 00:12:25,040 --> 00:12:25,960 So I have to check with my staff. 236 00:12:25,960 --> 00:12:27,840 I don't know if they're saying it's optional, but he didn't 237 00:12:27,840 --> 00:12:29,600 make it. And so he was upset he had to 238 00:12:29,600 --> 00:12:31,560 come back. But I just kind of explained, 239 00:12:32,080 --> 00:12:33,880 you know, it's normal to have adjustments. 240 00:12:34,080 --> 00:12:38,400 I made the adjustment. I, I re took pictures of his 241 00:12:38,400 --> 00:12:40,680 foot and they're going to send a new, new device with some built 242 00:12:40,680 --> 00:12:42,720 up laterally. And he might be better off 243 00:12:42,720 --> 00:12:45,800 actually, because when they send us a new pair, they don't take 244 00:12:45,800 --> 00:12:48,440 back the old pair And I, I kind of Jerry rake them with some 245 00:12:50,360 --> 00:12:53,080 lateral posting and it felt better for him. 246 00:12:53,240 --> 00:12:55,240 So that was that was that patient. 247 00:12:55,240 --> 00:12:59,520 Next was a 78 year old female status post fracture of the 2nd 248 00:12:59,840 --> 00:13:03,880 digit. She is, she had routine care as 249 00:13:03,880 --> 00:13:05,400 well. So some of these routines, I 250 00:13:05,400 --> 00:13:07,040 don't know why they're showing up on my afternoon. 251 00:13:08,160 --> 00:13:09,720 They usually don't. I think it's because they had 252 00:13:09,720 --> 00:13:11,440 additional things. This was like status post 253 00:13:11,440 --> 00:13:14,080 fracture and they're just showing up and I'm doing the 254 00:13:14,080 --> 00:13:16,840 routine as well. I think sometimes my staff just 255 00:13:16,840 --> 00:13:19,960 don't know where to put them, especially when we have a 256 00:13:20,160 --> 00:13:22,360 virtual assistant scheduling. I think he just puts them 257 00:13:22,600 --> 00:13:26,280 wherever 85 year old female, new patient routine. 258 00:13:26,360 --> 00:13:29,120 So routines, new patients that are routine. 259 00:13:29,120 --> 00:13:31,280 I don't make them see me on Friday mornings. 260 00:13:31,280 --> 00:13:33,800 They can see me any day, but then I have to follow up on the 261 00:13:33,800 --> 00:13:35,800 on the Friday with me or one of the other doctors. 262 00:13:36,440 --> 00:13:43,120 Next was a 86 year old male that that had a right had right ankle 263 00:13:43,120 --> 00:13:44,560 pain. Now this is interesting. 264 00:13:44,560 --> 00:13:48,680 This gentleman, he came in, he had right ankle pain and he saw 265 00:13:48,680 --> 00:13:51,520 my blog on ultrasound. He came in, he said, you know, I 266 00:13:51,520 --> 00:13:54,680 don't want X-ray. I, I think I had an X-ray before 267 00:13:54,680 --> 00:13:56,560 I want an ultrasound because I saw your blog. 268 00:13:57,160 --> 00:14:00,000 So we sent out a blog, we sent out a newsletter once a week and 269 00:14:00,000 --> 00:14:02,160 this newsletter was about ultrasounds and that's why he 270 00:14:02,160 --> 00:14:03,440 came in for that. So we did an ultrasound. 271 00:14:03,440 --> 00:14:07,400 He had a little swelling around the tib bands in that area and a 272 00:14:07,400 --> 00:14:09,920 fusion. And so I did a little, little 273 00:14:09,920 --> 00:14:12,080 cortisone injection, but one CC in there. 274 00:14:12,960 --> 00:14:15,880 Next was a 50 year old female. She had left plantar fasciitis. 275 00:14:15,880 --> 00:14:20,560 She's #5 out of 6 of of Shockwave next was a 38 year old 276 00:14:20,560 --> 00:14:24,440 female. She had a right foot Aquinas and 277 00:14:25,160 --> 00:14:29,480 this one here she had a lot of tightness that was causing some 278 00:14:29,560 --> 00:14:33,240 some arch pain. So not really plantar fascial 279 00:14:33,240 --> 00:14:36,080 pain, but more on the arch and I think it was all due to the 280 00:14:36,080 --> 00:14:38,800 Aquinas. So I did my dynamic 281 00:14:38,800 --> 00:14:40,640 demonstration that I told you about where I take like this 282 00:14:40,640 --> 00:14:46,920 orba ball or B and and I rolled out the back of the calf and and 283 00:14:46,920 --> 00:14:49,320 then her arch pain kind of like went away magically. 284 00:14:49,320 --> 00:14:53,000 So she got night splint foam rolling with that or ball and 285 00:14:53,000 --> 00:14:54,920 then in the morning stretch for her and I'm going to see her 286 00:14:54,920 --> 00:14:57,480 back as needed. Next was a 85 year old female 287 00:14:57,480 --> 00:15:01,960 that had left foot Cellulitis. I gave her an antibiotic and put 288 00:15:01,960 --> 00:15:07,320 her in a surgical shoe. Next was a 35 year old female. 289 00:15:07,320 --> 00:15:13,280 She had a left 5th met fracture. Now this was an interesting one. 290 00:15:13,840 --> 00:15:19,320 She was in a surgical shoe and it's been about 3 months 291 00:15:20,200 --> 00:15:21,720 actually. Sorry this is not the fifth met. 292 00:15:21,720 --> 00:15:24,160 This is a 5th digit. This is interesting because she 293 00:15:24,520 --> 00:15:27,960 had a fracture right at the DIPJ and I looked at her previous 294 00:15:27,960 --> 00:15:32,600 X-rays and it was originally was a fused 5th toe at the DIPJ 295 00:15:32,600 --> 00:15:35,640 which is pretty common and she fractured right through it and 296 00:15:35,640 --> 00:15:37,800 she was in a Cam boot for three months, wasn't getting better. 297 00:15:37,800 --> 00:15:40,000 I'm sorry she was in a surgical shoe wasn't immobilizing it 298 00:15:40,000 --> 00:15:41,200 enough. So we put her in a Cam boot. 299 00:15:41,200 --> 00:15:43,880 I'm going to try one more month and if not I told her about 300 00:15:43,880 --> 00:15:47,520 doing shockwave focused only or non radial only. 301 00:15:47,760 --> 00:15:50,560 I'm starting to call things in the office either radial or non 302 00:15:50,560 --> 00:15:52,840 radial. Just the reason for that is 303 00:15:52,840 --> 00:15:56,480 because we have two focused device, but they don't they're 304 00:15:56,480 --> 00:15:59,000 not OK. We have we have the, the, the, 305 00:15:59,200 --> 00:16:02,320 the storage device which is really focused and then the, the 306 00:16:02,400 --> 00:16:04,280 software which they call unfocused. 307 00:16:04,560 --> 00:16:08,640 So to not 'cause confusion and they do very similar things. 308 00:16:09,640 --> 00:16:13,040 We when we, when we build things and when we schedule things, we 309 00:16:13,040 --> 00:16:16,640 say we're going to do radial and non radial versus focused or 310 00:16:16,640 --> 00:16:18,560 unfocused to not to not confuse things. 311 00:16:19,480 --> 00:16:23,280 And then the the last one's a 49 year old female for left fourth 312 00:16:23,400 --> 00:16:26,880 met base fracture. So this was a patient. 313 00:16:26,880 --> 00:16:30,200 She is a diabetic neuropathic fracture to 4th met base. 314 00:16:30,200 --> 00:16:35,280 She's a teacher. She's really not getting better 315 00:16:35,280 --> 00:16:37,680 with this. And she had been in a Cam boot 316 00:16:37,840 --> 00:16:41,000 and it's been about four months. And I'm, I'm, I'm concerned that 317 00:16:41,000 --> 00:16:45,640 these ones delay, tend to delay and due to her neuropathy, I'm 318 00:16:45,640 --> 00:16:48,840 concerned it could, you know, turn into like a shark go foot 319 00:16:48,840 --> 00:16:51,840 or something else if she just keeps walking on the darn thing. 320 00:16:52,240 --> 00:16:55,520 So I recommended number one out of four for focused only 321 00:16:55,520 --> 00:16:57,360 shockwave. So she did number one out of 322 00:16:57,360 --> 00:16:59,760 four. I'm, I'm for, for, for the OR 323 00:16:59,760 --> 00:17:02,040 non radial. So for the non radial one, I'm, 324 00:17:02,320 --> 00:17:06,040 I'm still doing 4 for the bone fractures. 325 00:17:06,560 --> 00:17:11,200 And I've started to offer patients if they want quicker 326 00:17:12,000 --> 00:17:14,760 treatments or to get not, not really better faster, but if 327 00:17:14,760 --> 00:17:16,800 they just want to get the treatments better, they can do 328 00:17:16,800 --> 00:17:18,520 treatments every three to seven days. 329 00:17:18,520 --> 00:17:21,520 Majority do every seven days for the finances, but some want to 330 00:17:21,520 --> 00:17:23,680 get things done faster, so they do it every three days. 331 00:17:23,680 --> 00:17:27,319 So this is something that I've been offering to patients more 332 00:17:27,319 --> 00:17:29,840 frequently and some of them are taking up on it only because 333 00:17:29,840 --> 00:17:31,320 they want to get things done faster. 334 00:17:31,760 --> 00:17:37,160 I think there is always a desire with patients for speed and I 335 00:17:37,160 --> 00:17:39,800 think that's the benefit of Shockwave to begin with is they 336 00:17:39,800 --> 00:17:44,200 want a speedier recovery then they would normally just 337 00:17:44,200 --> 00:17:46,200 waiting. So I think a lot of things you 338 00:17:46,200 --> 00:17:49,120 can, so you can both speed it up with Shockwave, but then offer 339 00:17:49,120 --> 00:17:50,400 them, hey, you can come in every three days. 340 00:17:50,400 --> 00:17:53,120 It might be logistically a little bit of a challenge for 341 00:17:53,120 --> 00:17:56,080 the practice if you're if you're too busy with patients. 342 00:17:56,080 --> 00:17:59,000 Like certainly as you can see, like shock waves really glut my 343 00:18:00,000 --> 00:18:05,160 glut, my schedule, but there's not enough patients for me to 344 00:18:05,920 --> 00:18:09,880 offload the shockwave yet. I've thought about like if I 345 00:18:09,880 --> 00:18:11,680 took a day off, that would be nice. 346 00:18:11,680 --> 00:18:14,920 I could take a day off, have someone else do the shock waves 347 00:18:14,920 --> 00:18:17,400 and then I would be at about the same demand for patients. 348 00:18:17,400 --> 00:18:19,640 But right now there's not that much demand because if I didn't 349 00:18:19,640 --> 00:18:22,320 have all these shock waves in my schedule, it may be a lighter 350 00:18:22,320 --> 00:18:24,120 schedule for me. That's that's where I feel 351 00:18:24,120 --> 00:18:26,480 that's kind of the fear of where I'm at right now. 352 00:18:26,760 --> 00:18:29,560 OK, once again, I hope you guys enjoyed this. 353 00:18:29,920 --> 00:18:33,320 I am putting together a challenge, a six month challenge 354 00:18:33,320 --> 00:18:35,640 for a few select podiatrist if you want to be part of it. 355 00:18:36,160 --> 00:18:38,600 It'll be helping to get your practice to the $1,000,000 mark 356 00:18:38,600 --> 00:18:40,360 and beyond. If you've heard these things 357 00:18:40,360 --> 00:18:43,280 we've talked about here, if I'm the beneficial, we'll kind of 358 00:18:43,280 --> 00:18:45,200 work with them in a small group we're going to be meeting once a 359 00:18:45,200 --> 00:18:48,200 month and they're going to have like small group like 360 00:18:48,200 --> 00:18:50,280 conversations via WhatsApp. OK. 361 00:18:50,480 --> 00:18:51,640 If you're interested, shoot me an e-mail 362 00:18:51,640 --> 00:18:54,760 don@podiatrypracticemastery.com or you can go to that website 363 00:18:55,200 --> 00:18:57,720 and learn more about it. OK, Talk to you tomorrow.