1 00:00:00,640 --> 00:00:03,120 Hi, Don here. Welcome to the $1,000,000 minute 2 00:00:03,120 --> 00:00:05,720 where we're trying to get your practice to the $1,000,000 mark 3 00:00:05,720 --> 00:00:08,200 and beyond. I'm going to talk about my my 4 00:00:08,200 --> 00:00:11,080 most valuable kind of asset for the practice. 5 00:00:11,080 --> 00:00:14,520 It's called something called a dynamic demonstration. 6 00:00:15,520 --> 00:00:19,320 I got, I got this idea from some marketing people and they they 7 00:00:19,440 --> 00:00:23,720 talk about you need to do something that will set your 8 00:00:23,720 --> 00:00:26,640 experience apart from what everyone else is doing. 9 00:00:26,640 --> 00:00:30,000 So for example, if just taking plantar fasciitis as an example, 10 00:00:30,000 --> 00:00:35,240 if you just do what they can get online, you're really not doing 11 00:00:35,240 --> 00:00:38,200 anything extra maybe except a cortisone injection or 12 00:00:38,200 --> 00:00:42,840 shockwave. But if you offer them another 13 00:00:42,840 --> 00:00:45,600 paradigm or way of thinking about it, if you offer them 14 00:00:45,600 --> 00:00:49,000 additional education or ways of thinking about things that they 15 00:00:49,040 --> 00:00:50,760 don't have, it's going to set you apart. 16 00:00:50,760 --> 00:00:54,760 And specifically, I remember I was watching the how the Good 17 00:00:54,760 --> 00:00:58,320 Feet Store does sometimes wonder how in the world can they sell a 18 00:00:58,320 --> 00:01:01,400 pair of orthotics or inserts that are over the counter for 19 00:01:01,400 --> 00:01:05,319 like 2 or $3000 for shoes. And these inserts that are just 20 00:01:05,319 --> 00:01:08,600 plastic over the counter. And, and, and they call them 21 00:01:08,960 --> 00:01:11,360 orthotics 1 of it. One of their ways is something 22 00:01:11,360 --> 00:01:12,680 called the dynamic demonstration. 23 00:01:12,680 --> 00:01:15,080 So what they do is they have people stand barefoot and they 24 00:01:15,160 --> 00:01:17,520 kind of push them over or pull them forward. 25 00:01:17,920 --> 00:01:20,400 And then they have their kind of their hands clasp and then they 26 00:01:20,400 --> 00:01:22,120 can pull them forward, show the instability. 27 00:01:22,480 --> 00:01:24,760 And then they put their little inserts things underneath their 28 00:01:24,760 --> 00:01:26,560 feet only. And it makes them a little bit 29 00:01:26,560 --> 00:01:28,440 more stable. So this is called the dynamic 30 00:01:28,440 --> 00:01:30,320 demonstration. So it's something if you want to 31 00:01:30,320 --> 00:01:36,200 watch, you can just Google a these good feed store. 32 00:01:36,200 --> 00:01:38,440 Just watch the little video of how they explain. 33 00:01:39,600 --> 00:01:41,600 But what's a dynamic demonstration that I do in the 34 00:01:41,600 --> 00:01:45,640 office when I, when I treat patients with plantar fasciitis, 35 00:01:45,800 --> 00:01:48,880 one of the easiest things for the majority of patients is to 36 00:01:48,880 --> 00:01:51,320 do foam rolling on the back of the calf. 37 00:01:51,320 --> 00:01:55,280 So we have a little like ball. It's called an orb orb ball. 38 00:01:56,160 --> 00:02:00,480 A lot of people ask me who I who I get my my things from. 39 00:02:00,920 --> 00:02:04,080 There's a company, it's not coming to me right now, but we 40 00:02:04,080 --> 00:02:06,000 get it on. You can buy it from Amazon, but 41 00:02:06,000 --> 00:02:09,360 we buy it in bulk. So we can like sell at Amazon 42 00:02:09,360 --> 00:02:12,000 prices, but we're still getting the discount to make profit on 43 00:02:12,000 --> 00:02:15,000 it. It's called, I think it's called 44 00:02:15,000 --> 00:02:18,680 like athletic tech or athletic athletic tech or something like 45 00:02:18,680 --> 00:02:22,040 that. So what I do is when I'm 46 00:02:22,040 --> 00:02:24,520 treating people with planet fasciitis as I'm kind of talking 47 00:02:24,520 --> 00:02:26,840 to them and pushing the bottom of their heel and it hurts. 48 00:02:27,120 --> 00:02:30,040 And then as I'm talking to them and teaching them, I'm rolling 49 00:02:30,040 --> 00:02:33,840 out the back of their calf and I use like a ball or a foam 50 00:02:33,840 --> 00:02:35,400 roller. And then this loosens up the 51 00:02:35,400 --> 00:02:37,160 back of the calf. And a lot of times by loosening 52 00:02:37,160 --> 00:02:39,320 the back of the calf and I don't even touch the bottom of the 53 00:02:39,320 --> 00:02:42,200 foot, but there a lot of their foot or heel pain goes away. 54 00:02:42,600 --> 00:02:45,240 We used to use something else called trigger point tools, TP 55 00:02:45,240 --> 00:02:47,720 tools, but they don't allow us to sell them anymore. 56 00:02:47,720 --> 00:02:51,440 And that was like a, almost like a dumbbell type of roller that 57 00:02:51,440 --> 00:02:55,480 really penetrated deep into the back of the calf and the 58 00:02:55,480 --> 00:02:58,120 posterior tibial tendon. And it made their foot, foot 59 00:02:58,120 --> 00:03:00,880 pain a lot of times go away. So you have them walk before and 60 00:03:00,880 --> 00:03:03,480 then walk after doing that. And then that's the dynamic 61 00:03:03,480 --> 00:03:06,120 demonstration showing that the foot pain goes away. 62 00:03:06,120 --> 00:03:07,840 So it builds credibility for patients. 63 00:03:08,680 --> 00:03:11,720 I would do it even with Shockwave if Shockwave worked 64 00:03:12,640 --> 00:03:13,880 that well. It does have a little bit of 65 00:03:13,880 --> 00:03:16,360 anesthetic effect, but I just wanted to share that one thing. 66 00:03:16,520 --> 00:03:19,600 So if you can, as many dynamic demonstrations as you can do 67 00:03:19,840 --> 00:03:22,240 that just kind of wow patients. I know other other people do it 68 00:03:22,240 --> 00:03:24,840 with my colleague here. He does it with like a 69 00:03:24,840 --> 00:03:27,720 functional movement screen. He has them do like a, a partial 70 00:03:27,720 --> 00:03:33,600 screen to show their, their lack of flexibility and weaknesses, 71 00:03:33,880 --> 00:03:37,560 like a single leg stance and a single leg squat and just 72 00:03:37,560 --> 00:03:40,480 showing how they're all wobbly. And then just kind of going back 73 00:03:40,480 --> 00:03:41,720 to, OK, you need to strengthen your core. 74 00:03:41,720 --> 00:03:43,880 So talking about things that they've never heard of single 75 00:03:43,880 --> 00:03:48,000 leg stance, squatting, core instability, needing to 76 00:03:48,000 --> 00:03:52,360 strengthen your, your core and all these things that no one 77 00:03:52,360 --> 00:03:54,000 else talks about. For example, he also talks about 78 00:03:54,000 --> 00:03:56,920 belly breathing, things like that can activate these core 79 00:03:56,920 --> 00:03:58,760 muscles. So patients don't really always 80 00:03:58,800 --> 00:04:00,760 understand everything, but they're like wowed because 81 00:04:00,760 --> 00:04:02,240 that's a demonstration that they've never got. 82 00:04:02,360 --> 00:04:04,400 OK, so let's go into the day here. 83 00:04:05,760 --> 00:04:09,240 First patient was a 55 year old with a right deltoid, medial 84 00:04:09,240 --> 00:04:13,960 deltoid injury shockwave #2 out of four, this one. 85 00:04:14,000 --> 00:04:17,680 He also has kind of a sub tailor joint bone marrow edema, so 86 00:04:17,680 --> 00:04:19,640 we're kind of doing that whole area in there as well. 87 00:04:20,120 --> 00:04:26,400 Next was a 19 year old patient with right kind of heel. 88 00:04:27,760 --> 00:04:30,320 Looks like they had ingrown toenail. 89 00:04:30,680 --> 00:04:35,400 They did an Ind and I gave this patient antibiotics, but they 90 00:04:35,400 --> 00:04:38,680 also had glass in the heel. I'm sorry. 91 00:04:38,720 --> 00:04:40,960 They had glass in the heel. 19 year old female glass in the 92 00:04:40,960 --> 00:04:42,920 heel. I took it out, got an X-ray, did 93 00:04:42,920 --> 00:04:47,000 an ultrasound, did an Ind, and then gave antibiotics. 94 00:04:47,320 --> 00:04:49,680 This was one that came from our urgent care website. 95 00:04:49,680 --> 00:04:52,440 Once again, I've been kind of talking about how this has 96 00:04:52,440 --> 00:04:54,720 really helped us. So we have an urgent care page 97 00:04:55,000 --> 00:04:56,880 and we've been seeing many patients from this now. 98 00:04:57,800 --> 00:05:02,480 Next was a 51 female #2 out of 6 for Shockwave for heel pain 99 00:05:03,680 --> 00:05:05,760 number. Next was a 37 year old female 100 00:05:05,880 --> 00:05:09,080 for left fibula fracture and chronic ankle pain. 101 00:05:09,640 --> 00:05:13,480 We did an MRI. The fracture is healing well, 102 00:05:13,480 --> 00:05:14,920 but she still has this ankle pain. 103 00:05:15,800 --> 00:05:19,200 Next patient was a 82 year old male for right midfoot 104 00:05:19,200 --> 00:05:21,720 arthritis. We got X-rays bilaterally and 105 00:05:21,760 --> 00:05:24,360 we're going to do orthotics for him to reduce the midfoot 106 00:05:24,960 --> 00:05:27,600 movement. We did talk to him about a meso 107 00:05:27,960 --> 00:05:30,360 brace, but a lot of patients don't like those. 108 00:05:30,360 --> 00:05:32,680 So that's why I just kind of talked about it. 109 00:05:32,680 --> 00:05:34,040 But I said maybe orthotics will be better. 110 00:05:34,040 --> 00:05:36,600 So usually just kind of know my thinking. 111 00:05:36,600 --> 00:05:38,760 I'm usually talking to them about either the surgical 112 00:05:38,760 --> 00:05:42,120 intervention, then the bracing intervention and then the 113 00:05:42,120 --> 00:05:44,040 orthotic intervention. No one wants surgery. 114 00:05:44,520 --> 00:05:48,560 Very few people want to wear a brace even though it works a 115 00:05:48,560 --> 00:05:50,400 little bit better. And then people are more willing 116 00:05:50,400 --> 00:05:53,600 to do an orthotic or like a cortisone injection or shockwave 117 00:05:53,600 --> 00:05:55,360 or something else like that. So I always kind of start out in 118 00:05:55,360 --> 00:05:58,280 like worst case scenario and then kind of work my way, work 119 00:05:58,280 --> 00:06:03,760 my way back and then it reduces their kind of objections to the 120 00:06:03,760 --> 00:06:06,040 orthotics. Next patient was a 13 year old 121 00:06:06,040 --> 00:06:16,640 female with a wart follow up and then after Kanthurden and the 122 00:06:16,640 --> 00:06:22,280 next patient was a 65 year old fractured fifth met on the left. 123 00:06:23,560 --> 00:06:27,680 She's status post for shock waves and the gap is healing and 124 00:06:27,680 --> 00:06:30,880 she's doing really great. This she had a huge gap because 125 00:06:30,880 --> 00:06:35,280 it it it, it was a like a, a transverse fracture, an oblique 126 00:06:35,280 --> 00:06:39,200 fracture and it really healed in well and it was really, really 127 00:06:39,200 --> 00:06:43,320 impressive for this patient. Next was a right 47 year old 128 00:06:43,320 --> 00:06:45,040 female with the right plantar fascial pain. 129 00:06:45,040 --> 00:06:46,920 She got my Pelto special with meloxicam. 130 00:06:46,920 --> 00:06:49,200 I'm going to see her back in three weeks for an ultrasound. 131 00:06:49,200 --> 00:06:52,280 Impossible shockwave. This is one that wasn't ready to 132 00:06:52,280 --> 00:06:56,840 do shockwave right away. I usually tend to kind of run 133 00:06:56,840 --> 00:06:59,920 right into Shockwave, but she wanted to try some of the other 134 00:06:59,920 --> 00:07:02,000 things first. Next was a 59 year old female 135 00:07:02,200 --> 00:07:05,760 that assist at the DIPJ. It returned talk to her about 136 00:07:05,760 --> 00:07:09,600 doing a fusion in the future because it she's drained it 137 00:07:09,600 --> 00:07:12,360 multiple times and used Coban, but it continues to come back. 138 00:07:12,600 --> 00:07:14,040 She also has bilateral heel pain. 139 00:07:14,040 --> 00:07:16,920 So we did an ultrasound and we showed her that it was normal. 140 00:07:16,920 --> 00:07:20,040 So she's just going to do the the foam rolling and and things 141 00:07:20,040 --> 00:07:24,000 like that for her heel pain. Next was a 60 year old female 142 00:07:24,280 --> 00:07:28,760 with left Hallux limidis and then she has right Achilles 143 00:07:28,760 --> 00:07:31,200 tendonitis. So we did #1 out of 6 for her 144 00:07:31,200 --> 00:07:34,680 shockwave for Achilles. Next was a 50 year old male with 145 00:07:34,680 --> 00:07:39,520 left hallux that was WAVY. We did a nail sample. 146 00:07:39,520 --> 00:07:48,880 He also had a left wart and an IPK and so he he didn't really 147 00:07:48,880 --> 00:07:50,560 want any treatment. This isn't, this is not that 148 00:07:50,560 --> 00:07:52,160 common for me. For some reason he wanted to get 149 00:07:52,160 --> 00:07:54,600 a second opinion. I'm not sure from who he didn't 150 00:07:54,600 --> 00:07:57,320 want treatment but we talked to him about doing lesion 151 00:07:57,320 --> 00:07:59,480 destruction and also swift and canthered. 152 00:08:00,320 --> 00:08:04,000 Next was a 63 year old female for left foot. 153 00:08:04,440 --> 00:08:07,200 She had kind of a complex issue with her foot a lot of pain so 154 00:08:07,200 --> 00:08:11,440 we did a MRI for the foot and the ankle also I recommended PT 155 00:08:12,120 --> 00:08:15,640 and she had a lot of pain. This patient kind of that was it 156 00:08:15,640 --> 00:08:19,080 took me a long time that one. Next was a 48 year old male with 157 00:08:19,080 --> 00:08:23,960 left peroneal pain. We did E pad for this and also 158 00:08:23,960 --> 00:08:26,720 had some sinus tarsi bone marrow oedema. 159 00:08:26,720 --> 00:08:30,240 So this is number one out of four for this patient. 160 00:08:30,240 --> 00:08:33,520 Not sure why it was done for. I think this one was maybe. 161 00:08:33,840 --> 00:08:35,919 I got a second opinion with one of my colleagues and they tend 162 00:08:35,919 --> 00:08:40,520 to do 4 shockwave sessions. Next was a 75 year old male that 163 00:08:40,520 --> 00:08:42,200 had gout follow up. He's doing much better. 164 00:08:42,200 --> 00:08:45,520 No follow up for this. Next was a 68 year old shockwave 165 00:08:45,520 --> 00:08:48,000 #2 out of 6 for posterior tibial tendon pain. 166 00:08:49,400 --> 00:08:51,120 On the right. They got new shoes. 167 00:08:51,120 --> 00:08:52,880 They're starting to feel better and they're going to go through 168 00:08:52,880 --> 00:08:55,360 the rest of these treatments. Next was a 44 year old female 169 00:08:55,760 --> 00:08:59,960 with left Achilles, kind of talked about eccentric loading 170 00:09:00,360 --> 00:09:03,920 and they had a house, had a IPK, did lesion destruction on that 171 00:09:03,920 --> 00:09:06,040 and I took a nail sample. That a nail issue as well. 172 00:09:06,920 --> 00:09:08,160 I'm going to see them back in three weeks. 173 00:09:08,160 --> 00:09:11,560 If their Achilles isn't getting better, then we're going to do 174 00:09:11,560 --> 00:09:14,200 shockwave. Next was a 85 year old. 175 00:09:14,680 --> 00:09:21,080 She had midfoot arthritis. I did #5 of it out of 6 for 176 00:09:21,080 --> 00:09:22,520 shockwave for the bone marrow edema. 177 00:09:23,200 --> 00:09:25,480 Also I did a sinus tarsi injection for her. 178 00:09:26,360 --> 00:09:29,440 Next was a 15 year old female that had a wart. 179 00:09:30,600 --> 00:09:34,560 This was a LVP. You know what LVP is? 180 00:09:34,600 --> 00:09:38,400 LVP is a least valuable patient. So I had That's my new 181 00:09:38,440 --> 00:09:41,080 abbreviation for this. So LVP meaning it's a level 2 182 00:09:41,080 --> 00:09:43,480 visit usually. Wart was doing better. 183 00:09:43,720 --> 00:09:45,560 Maybe didn't even need to see this one back because she's 184 00:09:45,560 --> 00:09:48,400 feeling better. These LV PS least valuable 185 00:09:48,400 --> 00:09:50,800 patients, I tend to put them in double book them or put them in 186 00:09:50,800 --> 00:09:53,000 a 10 minute slot in addition to other things. 187 00:09:53,000 --> 00:09:57,320 So I'm starting to do that as well, taking these kind of 188 00:09:57,320 --> 00:10:00,160 simpler wart follow up things and putting them into double 189 00:10:00,160 --> 00:10:02,200 booking them to 10 minute slots because they don't take a long 190 00:10:02,200 --> 00:10:05,080 time and they're really not most valuable patients. 191 00:10:05,280 --> 00:10:07,600 If I had like a nurse practitioner, I would probably 192 00:10:07,840 --> 00:10:10,560 transfer these to those that practitioner. 193 00:10:11,480 --> 00:10:16,520 Next patient was a 81 year old female left the 1st first MPJ 194 00:10:16,520 --> 00:10:20,640 fracture, did an X-ray. They already had a boot and 195 00:10:20,640 --> 00:10:24,720 other things like that. Did fracture code and this 196 00:10:24,720 --> 00:10:28,560 patient as well came from the urgent care web page. 197 00:10:28,880 --> 00:10:31,880 Next was a 41 year old for left nail fungus. 198 00:10:31,880 --> 00:10:35,200 They did my Lamisil kit with Lamisil. 199 00:10:35,200 --> 00:10:38,600 Next was a 63 year old with a bilateral fifth met head pain, 200 00:10:38,920 --> 00:10:42,000 did an orthotic adjustment and a fifth met cut out in their shoe. 201 00:10:43,040 --> 00:10:45,480 Next was a 55 year old for right Achilles pain. 202 00:10:45,480 --> 00:10:47,320 Did that pelto special meloxicam. 203 00:10:47,360 --> 00:10:50,080 See them in three weeks for possible ultrasound and 204 00:10:50,080 --> 00:10:52,880 shockwave. Last patient of the day was a 71 205 00:10:52,880 --> 00:10:55,240 year old female for sesmoid fracture follow up. 206 00:10:55,320 --> 00:11:02,320 They had no pain once again, that was LVP least valuable 207 00:11:02,320 --> 00:11:03,920 patient. So I'm trying to distinguish now 208 00:11:03,920 --> 00:11:07,480 what are the MVPS and the LVPS least valuable patient or most 209 00:11:07,480 --> 00:11:10,880 valuable patient just so you kind of keep your focus on how 210 00:11:10,880 --> 00:11:14,160 to get the most valuable patients better, faster and how 211 00:11:14,160 --> 00:11:17,000 to reduce the follow-ups for the least valuable patients or 212 00:11:17,000 --> 00:11:19,800 double book them. So anyway, hope you guys found 213 00:11:19,800 --> 00:11:23,280 this beneficial. If you want, I was talking to 214 00:11:23,280 --> 00:11:27,040 you today about this kind of this dynamic demonstration. 215 00:11:27,080 --> 00:11:30,320 If if you want to know kind of how I do that, have any other 216 00:11:30,320 --> 00:11:32,960 questions, shoot me an e-mail. I'm happy to answer or walk you 217 00:11:32,960 --> 00:11:34,080 through that. If you have other things that 218 00:11:34,080 --> 00:11:36,600 you do dynamically that work well and kind of wow patience, 219 00:11:36,600 --> 00:11:37,600 let me know. I'd love to hear. 220 00:11:37,760 --> 00:11:39,520 Don at Podiatry practice mastercom. 221 00:11:39,560 --> 00:11:40,160 OK, thanks.