Hey guys down here. Welcome to Podiatry.
Rex Mastery kind of going over the I call the $1,000,000
minute. They said things to help to get
to the $1,000,000 mic and beyond.
This is a recording of a day in the clinic on a Tuesday.
So this is a full day. I'm in my my Worcester office.
So good, bad and ugly. First patient was a no show and
I had another patient 10:00 that was a no show, but the other
ones kind of showed up. So let's go over.
First patient was a a Lamisil. Follow up 31 year old male got
my fungal nail kit and the Lamisil.
So one thing I've started to do, if you've seen my treatment
sheet for for gibenophen, for Lamisil, it has like visit 1
nail sample. I'm not the way I'm kind of
explaining it now is I just crossed it off and I say, you
know, this could they could bill your insurance a couple $100 for
this nail sample. So I'm not going to do that.
I'll save you this money, save you the visit.
We'll start the treatment. If we see clearing, that's
great. If we're not seeing clearing,
we'll either take a sample or switch it to another medication.
So that's kind of how I'm doing it.
And I have this all on my 11 sheet that I give them.
And then I find like the key. And I was listening to a guy
that I really like, Alex Ramosi. He talks a lot about marketing
and business. And one of the reasons we a lot
of, we don't have a system, if you don't have a system of how
to explain things to patients, you're not going to do as much
of the self pay or a lot, a lot of the procedures, you have to
have a system. So I find this paper really
gives me a system. It's all written down kind of
the process, the, the medication, the LFT and then all
of the, the treatment, other things like the biotin, the
shoes app and the, and the shoe spray.
It's all in like a system. And so it's able to bring up the
per visit value for my fungal nails higher than anyone else's.
And, and so I think if you can do this, not just with your nail
fungus, but if you can find a way to do this with, for
example, your plantar fasciitis, your at least tendonitis, these
other things. I, I used to use presentations.
Now I like the paper a little bit better, either one that I
have in my pocket, my little prescription sheet that I use or
the printed one. And if you have the system, you
have all of the like your, hey, this is how we do things here.
So you can do this with like plantar fasciitis, as I've
explained as well. And it just really delineates
the process and makes it easier and clearer for patients of what
you're going to do. So that's why all my patients
get this fungal kit. My staff know what it is.
Sometimes they say no to it, but for the most part it, it just
makes it a lot easier. So just just a recommendation
for you. If there's things that you're
you have that you're not doing that you believe in, it's
probably because you're too busy and you don't have a system.
There are certain things that you have that you don't believe
in. So let me give you an example.
I have Formula 7 here. I don't really believe it that
works that well. So I don't have it in a system,
but I do have my my with the other things in there, like for
example, the foam roller and the night splint and the and, and,
and the anatomic shoes. And these are kind of all in, in
the, in the system of how ioffer things to patients.
And this is how you can get the per visit value up.
Also orthotics and other types of things like that.
It's part of the the system of how we treat patients.
OK, enough on that blurb. Next patient was she has a
midfoot arthritis and she had a cortisone injection to a couple
of those joints. One thing we've learned with the
new EMR is that with Mod Med, when you do an injection, you
have to, there's a kind of a screen that you can see body
parts like tendons, ligaments, joints.
So when you do a joint injection, you have to pick the
joint pitcher which you're selecting.
But she did 2 joints. And the nice thing with with
Modman anyway is it bills for both of those joints.
And I did it with ultrasound guidance and she felt better
afterward and she's going to come back as needed.
Next was a number six out of six.
This was a anterior calcaneal beak fracture that was not
healing for a few months in a Cam boot.
And we did 6 sessions of Shockwave.
I'm going to see her back in six weeks to see how it's doing and
get an X-ray at that time. Next was this is a patient.
I've never had anyone that's done this many, but she's on
Swift number 7 and I and I also just throw on kanthurdin.
So one thing I've learned if I do swift and kanthurdin, they
get kind of mad if I bill insurance at the same time.
So I either do the swift and just throw on the Kanthurdin as
a, as a bonus type of thing. I don't bill them for that
because then it's just, it's too prohibitively expensive.
Or I'll, I'll just do the Swift without the kanthurdin.
But in her case, it's been so long, I can tell it's getting
better because I find with Swift that the, the, the warts become
less kind of less thick, less elevated, less bumpy and stuff
like that. So she, I think she's almost
there and I'm going to do a six week follow up.
So usually for Swift, first four I do weekly.
I'm sorry. First four I do monthly and then
as I'm doing additional ones, I'm adding like time to it like
6 weeks or a little bit longer just to give the immune system
time. Next was another patient with
midfoot arthritis that had orthotics and she had her
orthotics, but she also got a a cortisone injection for those.
No follow up. Next was a patient that got a
diabetic foot exam and he had some plantar fascial pain.
So we got a plantar fascial injection and he's going to be
seen back every three months for for routine care.
So an office visit with those things.
Next was a 51 year old that had a poor old keratoma.
So I did that lesion destruction for that.
So in my new EMR, it's going to say borrow possible wart.
And So what would be the diagnosis because that's what's
covered by insurance. Then she also has a lateral scar
on the lateral ankle with a surgery by another doctor.
And in in that I talked to her about doing some like treatments
for the scar laser can sometimes help.
So she was going to be thinking about that, but I did offer her
that the laser, the laser I just do it's for scar.
I do laser. It's can sometimes heat it up
and kind of help lay down the scar a little bit better, a
little bit in a more organized fashion.
Next was a ulcer kind of that came back, kind of brided the
ulcer. He's going to come back in two
weeks. Next was a 58 year old that had
once again lesion destruction as well, kind of poor keratoma type
of thing, or IPK. Next was a six year old little
boy. He's he had a kind of a unique
thing. He had this like elevated 2nd
digit, like a curly toe bilaterally and it's overlapping
the bunion in a little bit or the the hallux doesn't really
have a bunion, but it overlapped, overlapped the
hallux. So I recommended him 0 shoes,
Xero and correct toes. And then he also had a retro
Nicky on the left hallux. I don't know what caused this,
but he had a retro Nicky with kind of swelling at the base
erythema. I don't think his shoes were too
small. They may have if anything been
too big but we're just going to let it be to see if it gets
better. I don't really have great
solutions for this. I told him that the nail might
get thickened and then we might have to take off the nail.
I don't know if anyone has any other great inject things if
anyone's tried like cortical steroid injections for these or
anything else that's worked for these.
But usually I just abolce the nail and or just wait and deal
with the nail changes that happen.
Next patient was a #4 out of 6 plantar fascia.
She I added to her. So she had done 3 sessions and
then she came back six weeks later.
Now this is number we're going to set number 45 and six up.
So I did #4 today I encourage you to do foam rolling in bed.
Some of the older patients, they can't do foam rolling on the
floor. They can't get down to the
floor. So I have them do foam rolling
in the bed. Next was a X-ray for status post
exostectomy and a medial 5th toe.
This is like one of my favorite procedures to do.
So she has this and she's also going to be having a
bunionectomy here in a couple months.
For the bunion, she was scheduled two months before a
wedding she needed to go to. So I advised her to wait till
after the wedding. Now this changing of surgeries
can kind of be a pain for my surgery schedule.
So recently we had a office meeting and we're going to start
like doing like a an admin fee. I think it's like a $200 or
something like that to change that because it takes a lot of
extra work. I don't know if anyone else does
that, but if they have everything scheduled and then
they want to change it for like a a random thing, do you guys
charge for that? I'd like to know if other people
charge. We're going to try it.
I just hope it doesn't come back to bite us in the butt, but
that's something we're going to be doing here until it changes.
If it changes, I'll let you know.
Next was this was my MVP, my most valuable patient.
He's a 63 year old guy. He has bilateral aquinus, really
big calves, plantar fasciitis bilaterally, but it hurts worse
on the left. So the way I determined which
one is worse is I did an ultrasound and in the left was
really thicker, darker. And so the plan is he's going to
treat the Aquinas on both sides with bilateral night splints
just so he doesn't have to wear them more than three hours.
And he's going to do shockwave on the left side.
And I did start shockwave that same day for him.
So he did number one out of six. He's going to get bilateral
night splints, foam rolling and I'm going to see him back in a
week to do the next ones. So that was my MVP patient and
at the third visit I, I told him he's going to be scanned for
orthotics. So I tell them like after a few
weeks then that's what we're going to scan for the orthotics.
Next patient was number of shockwave, 4 out of 6 for
plantar fasciitis. Next patient was a 58 year old
female follow up on a fracture got X-rays and it did show some
cortical irregularity and so just confirm that that I didn't
see last time because it was a a newer 1.
Next patient was a 12 year old boy that originally was seen for
flat feet and apophysitis. His orthotics, he was really
wearing them they're kind of worn out.
So we got a second pair actually with the, the company we use to
get a second pair for just the scanning fee.
So it's $100. And so they did that one.
They want a another pair. So they, they paid full price
600 for one and got us and then got that other one for 100.
And then the next one we'll do at 100 as well.
So we're just kind of going back and forth for that.
This was a little 12 year old boy and the next patient was a
39 year old for did kanthered in for a wart.
Next was another kanthered in for a wart.
And there's another patient that had some neuropathy and so we
did gabapentin for this one. And he is kind of a challenging
1 because he had a kind of a blunt trauma that kind of caused
like an RSD on a, on the plantar sesmoid region.
And we've, we've done shockwave, done orthotics, nothing's really
helped him. He's been really shrugged off by
a lot of other doctors and he's like asking for a sesmoidectomy
or a neurectomy. And I was like, I just have
never done one of those for this condition.
So I sent him to get a second opinion with one of my, one of
my, my buddies here. So Yep.
So that was the day. Hope that was helpful for you.
Just trying to share kind of what my thought processes and
things. Hope this is beneficial for you
guys. Just so you know, we're, we're,
we're starting some touches on developing a, a mastermind kind
of a small group. I'm going to limit it to, I
think it's 5 or 6 people that we're going to be meeting to do
like a hot seat kind of mastermind group.
So if you guys are interested, shoot me an e-mail
don@podiatrypracticemaster.com. And if there's other things that
you do that I'm not like talking about, let me know and I'll I'll
share it with other people. OK, thanks.