PAs Go Beyond!

WEBVTT
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Welcome to Joint Effort PAs, where two orthopedic surgery PAs get real about life in medicine.
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From tips and tricks to professional growth, work-life balance, and everything in between.
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We're here to share what we've learned and what we're still figuring out.
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Let's get into it.
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What are we gonna call this?
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When did healthcare become the customer is always right?
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No, I mean it's when when did we become so accommodating?
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Why are we so accommodating?
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Because the customer is always right.
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With that mentality, we became accommodating.
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Yes.
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So we are gonna talk today about uh about that, all of those things, uh, based on some recent events, um, current events in in my life and things that happen very regularly to both of us.
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Well, tying it all together, speaking of current events, happy PA week.
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Happy P We PA week.
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Happy PA week to all who celebrate.
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Yes, yeah.
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PA week is the same non-Munday through Friday or Monday through Sunday week every single year.
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And I feel like it, I mean, you know, it it times well in your life so that you know when it is.
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Yes.
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Um, but each year there's a theme for PAs, and this one is PAs Go Beyond, which hello, that's part of our talk today.
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On brand for us.
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Yeah.
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Um, yeah.
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I do you feel like PA week is adequately celebrated?
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In my my life, yeah, or like across the profession.
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In your life.
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Uh yeah, I mean, yes and no, right?
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Like, um, as my dear, dear supervising physician will say, the more important you are, the less days you have.
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AK doctors get one day, PAs get one week.
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So that means we're really unimportant because we have so many days?
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Uh no, we don't have a lot of days compared to PTs have a month.
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Oh.
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See what I'm saying?
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I gotcha.
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Um, nurse practitioners get a week, but they also get to celebrate nurses week.
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So they get two weeks.
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A PP week as well.
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Oh, gross.
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Is there?
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Yeah, I think there is an APP week.
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Um, but I don't celebrate that.
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You know, there is.
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Yeah, it's not that I don't subscribe to that.
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No, I don't subscribe to that either.
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So just just PA week.
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For me, it always falls around my birthday, so it's amazing.
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However, uh, since it is a Tuesday this year, it started on a Tuesday.
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I feel we can still continue to celebrate Monday.
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Like Monday is still PA week.
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Yeah, right?
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Yeah, yeah, definitely.
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Especially the way it fell this year.
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Yeah, right.
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So, of course, yesterday my doc was like, PA week's over, and I was like, nope, it's still Monday.
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Three more days, actually.
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No, but it's it's funny, like on all of my like, you know, algorithms online, a lot of stuff was popping up this week about celebrating PAs, and there's a lot that people do.
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So when you ask me that question, are PAs recognized well at this facility?
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There was a shout out in the weekly email.
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I like that, I appreciate that.
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Yeah, I did gift the PAs something this year, and not even those, I don't supervise all of them anymore, but I did that.
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Yeah.
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Um, the PA that now supervises very witty, right?
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The PA that now supervises the injury express.
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I asked, I was like, hey, so this is what we do here.
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And he was like, Well, what do I get?
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You were like, You're the parent.
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Oh, sweetie.
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Yeah, like did you guys exchange your, you know, as the parents?
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Like, do you exchange gifts to each other?
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No, I thought that I was going to get him something.
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I'm still on the fence about it.
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Okay, yeah.
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Because, you know, I can Will it be reciprocated?
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No, absolutely not.
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Yeah, no.
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But that is like Christmas with your parents, you know.
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It is Christmas, yeah.
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It's like Christmas.
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Exactly.
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Yeah.
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Oh, we're not exchanging gifts this year.
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No, but I I truly mom always gets dad something.
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Right.
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And dad's like, I thought you said no.
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I know.
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But it was weird this year because um I did the same gift for all, and I had one PA.
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His last day was when I gave him the gift, which was fitting.
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Yeah.
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I had a PA that literally started a week ago.
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Or two PAs that started a week ago.
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Yeah.
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Which I was like, he hasn't really deserved that.
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Like, I, you know, I still're still PAs.
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Yeah.
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Um, but anyway, no, I uh it's just a nice, nice week to recognize all that the PAs do.
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And then Nurse Practitioner Week, I think is in early um November.
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I'm pretty sure.
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It is November 8 to the 14th.
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Doctor's Day.
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March 30th.
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It is one day.
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Look, you've got it memorized.
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I do have it memorized, yeah.
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Do you uh do you get good Doctor's Day gifts?
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Uh well, here's the thing.
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And again, going back to your original question, the doctors from the company get great gifts.
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Oh, yes, from the company.
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From the company.
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But you also, you know, get something for your doc.
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Yeah.
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Yeah.
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Yeah.
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We celebrate Doctor's Day.
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Um, when it's on a Sunday, we observe it on a Monday.
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But no, as all of us will say, every day's Doctor's Day.
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So Doctor's Day, March 30th.
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I'm getting way off topic, but I just Googled this.
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It's the anniversary of the first use of general anesthesia in surgery.
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Dr.
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Crawford Long either used ether to painlessly remove a tumor from a patient's neck on March 30th, 1842.
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Wow.
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That is the symbolism of it.
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Okay.
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Um, the red carnation is the traditional flower associated with the day.
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Representing love charity.
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We are definitely getting ready.
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I'm making a red carnation crown.
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Sash, yeah.
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Yes.
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Yes.
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Lapels.
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Almost like with the Kentucky Derby horse wears.
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I'm gonna make one of those.
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Yes.
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Okay.
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That has to be a good idea.
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We need to bank, we need to bank this idea, please.
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Amazing.
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Guess what you guys are getting this year.
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Oh my god.
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Well, so PA Right.
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So PA Week, that day, October 6th, is to commemorate the anniversary of the first PA graduating class from Duke on October 6th, 1967.
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Um, and it's the birth date of the founder of the program founder, Eugene Stead.
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So wait.
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That's a board.
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The program founder, they made it so the graduating class would graduate on his birthday?
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Yeah.
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That is like some well-planned shit.
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Okay, I'm gonna look up one more thing.
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So October 6th, 1967 was a Friday.
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Okay, I was just checking.
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If that was like a Tuesday, that would have been dumb.
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Yeah.
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You know, but still, Friday graduation is kind of dumb too.
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But yeah, usually it's like a Saturday or something.
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But yeah, interesting.
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I did not know these facts.
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Um, okay, in usual fashion, Beth, how was your week?
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Did you do anything exciting?
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My week was good.
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Um, I came, I had Friday off last week.
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I went down um to Florida for like a celebration of life funeral thing.
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So um I we got back Sunday, so Monday was uninterrupted, which is always a gamble.
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I always feel stressed, stressed out about that.
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Yeah.
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Um, but no, it was it was a very busy week.
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Um, patient-wise, very busy, surgery-wise, not as busy.
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Um, we were at um a different facility that we normally operate at on Tuesday.
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Um, and they gapped us.
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Like we had two cases, and they gapped us two hours, and we did a third case.
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So I was silently like beyond irritated.
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Yeah.
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Yeah.
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Especially because the day before I was like, hey, we have this gap.
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Can we fix this?
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And they were like, Yeah, we'll try everything we can.
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And I feel like the effort to try everything we can was not what I would have thought that is everything we can.
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I think the effort to try everything they could was to tell you they were gonna try, and then they left it at the end.
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I know, but when you tell me that and then I'm watching you the whole day and you're not doing everything you can, it bothers me.
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And again, this is my perspective.
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I'm not sure if it's reality, but um, no, we did a couple ACLs and then we did a trap transfer, which we haven't done that in a while, and that went beautifully.
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Yeah.
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Um, and then yesterday we did a combo proximal bicep teodesis, which was planned, and then in the interim, this guy tore his triceps same side, so we added that on too.
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So positioning wise, it was a whole ordeal, but um, but it's good.
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Yeah, that is a crazy one.
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Like that complicates things so much doing a like a two-stage procedure like that.
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But different different bed, different positioning, yeah, like all of it.
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Rolling a whole new bed, that's crazy.
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And everybody, everybody was pretty much on the same page, and it was relatively smooth.
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So that was good, that was good.
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But um I had a patient sent to me this week.
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I told you this when it happened.
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I had a patient sent to me this week that fell.
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Um, and I will give you the entire story.
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Yes, 82-year-old male.
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He um recently started a GLP one because his doctor said he needed to, plus his wife caught him fat.
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And uh he was it it slows down digestion, so you either have like a combination of constipation, fullness, and sometimes diarrhea.
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So, as he told me, constipation.
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So he's sitting on the toilet, bears down, literally vasovagels himself, falls off of the toilet.
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Oh my god.
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Okay.
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Now his wife finds him, calls 911.
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So it's all this whole like, you know, exposed situation.
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And he's like, guys, no, literally, I just this is not a heart thing.
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I literally just was trying too hard, right?
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Yeah, yeah, yeah.
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Anyway, he fell and he bruised his right leg.
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It wasn't even his coccix, it was like his glute.
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Yeah.
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So he came into urgent care, and urgent care sent him to me for a glute, it was a coccyx hematoma aspiration.
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And did anybody ask you prior to this if this was something you would do?
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No.
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Now, my my one of the medical assistants on my team had said, when when um I didn't even look at the schedule, right?
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So again, I expect my medical assistant to look at the schedule.
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That did not happen.
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Yeah, like when they was bringing the patient back and it says on the appointment line, coccix hematoma drainage.
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He actually said to the more senior assistant, like, hey, do you know anything about this?
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And that senior assistant said, Oh yeah, Beth knows about it.
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So then when I went, I'm like, what's next?
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Like, ah, this patient in the room, and I I like lost my mind a little bit because we have so many other things, but that's just it's not a thing.
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There's no such thing as a coccyx hematoma aspiration.
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So now the guys like, you know, expectations are there.
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So I I I, you know, I got like I got a little pissy.
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Like, who who said it was okay?
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And my medical assistant said the other one said it was okay.
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And I was like, guys, I was physically out of town the day this person was seen.
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Like, no one talked to me.
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Like, why would you assume?
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Yeah, nobody asked me, and you just assume that.
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And I I I've seen how this has unfolded when this happens to the doc.
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And the doc loses his mind, and everybody knows not to do that because they know they know the wrath of him losing his mind.
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So again, so do you try to like emulate that?
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You're like, I lose my mind.
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Will I get the same result?
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The answer is no.
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No.
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So then, of course, my medical assistant was like, All right, I'll go in and tell him to leave.
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I'm like, no, no, no.
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He is now in sh in paper shorts.
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Yeah, we're too far in.
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Yeah.
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So I will go in and explain to this man.
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So I went in the room and he told me the whole story.
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And again, it wasn't his coccyx.
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Literally, it was like the meaty part of his glute.
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It was not a hematoma.
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The guy's on eloquist, like it was a bruise, right?
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Yeah, like you have a bruise, yeah.
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So I went through the whole motion of like ultrasounding his ass, which I did.
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Did you do it like just at that point, like as a placation?
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Like Yes, like like this is why you came in.
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So now, so anyway, so um I did that, and I told him, I said, Great news.
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It looks like your body's reabsorbing it.
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I'm not sure what it looked like a couple days ago, but this is, you know, this is gonna go away on its own naturally.
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It's gonna hurt to sit, whatever.
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So now his pants are completely down.
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He is standing because he gets dizzy when he lays down.
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So now he starts yelling at me with a shirt and no pants on about why I'm not sticking a needle back there.
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Oh, okay.
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Yeah.
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He really wanted you to.
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He did, he really wanted me to, but um, so anyway, so I went through the whole thing with him.
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Um, and it ended up being fine.
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But again, that will probably parlay very well into our topic.
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Like, why do we why do we why do we why do we try so hard?
00:11:37.919 --> 00:11:38.720
Why do we try so hard?
00:11:40.159 --> 00:11:41.360
Why do PAs go beyond?
00:11:41.440 --> 00:11:44.480
And why do we make these crazy exceptions?
00:11:44.960 --> 00:11:51.039
Like, I've got a nice little template that says my scope of practice does gluteal hematoma evacuations.
00:11:51.120 --> 00:11:52.639
Is that on my scope of practice?
00:11:53.120 --> 00:11:56.480
No, like you know, but I I mean But did I see it?
00:11:56.639 --> 00:11:59.600
Yeah, so now the next time someone's gonna be like, remember that one time she did?
00:11:59.679 --> 00:12:00.399
Like she sees those.
00:12:00.799 --> 00:12:02.159
Actually, that's Beth is the expert.
00:12:02.639 --> 00:12:03.440
She loves them actually.
00:12:06.000 --> 00:12:07.840
I love ass and ass aspirations.
00:12:08.000 --> 00:12:08.399
Yeah.
00:12:08.639 --> 00:12:12.399
Um, okay, so Hannah, just go ahead and do the intro for the week.
00:12:12.639 --> 00:12:13.440
Wait, no, how was your week?
00:12:13.600 --> 00:12:15.360
Okay, I mean, like it was good no no no no.
00:12:15.440 --> 00:12:17.919
It was like I really like it's a it's a blur.
00:12:18.080 --> 00:12:20.559
Um, other than my birthday yesterday, which was good.
00:12:20.639 --> 00:12:22.399
Everybody What'd you get for your birthday?
00:12:22.559 --> 00:12:23.600
I got a fish.
00:12:24.879 --> 00:12:25.519
Yes.
00:12:25.919 --> 00:12:28.080
Um, our athletic trainer got me a fish.
00:12:28.159 --> 00:12:36.000
It was a little bit of like an inside joke because at a leadership meeting, they had a leadership meeting like last year at some point, and I was like, you should get a fish for the white elephant thing.
00:12:36.080 --> 00:12:36.879
It would be hilarious.
00:12:37.039 --> 00:12:39.120
And they were all like, Why would you get a little bit?
00:12:39.360 --> 00:12:39.919
Why would you say that?
00:12:40.080 --> 00:12:40.960
Like, that's a weird thing to say.
00:12:41.039 --> 00:12:43.360
And I'm like, no, guys, it's so like it's funny.
00:12:43.679 --> 00:12:45.440
So I got a fish.
00:12:45.519 --> 00:12:46.559
So it was it's great.
00:12:46.639 --> 00:12:47.840
He is he's thriving.
00:12:47.919 --> 00:12:49.039
We named him phalange.
00:12:49.279 --> 00:12:51.200
He is the teamfish, Jimothy Falange.
00:12:51.600 --> 00:12:53.360
And you're keeping him at home, not at the office.
00:12:53.519 --> 00:12:55.200
Yeah, I want to keep him at the office.
00:12:55.279 --> 00:12:58.320
I'm not sure how like everyone else will feel about that.
00:12:58.399 --> 00:13:03.039
Um, upper management, I fear, will uh flush him down the toilet if they see him.
00:13:03.519 --> 00:13:09.519
Um, and some of the other docks here, I I also think would have a similar response to seeing him.
00:13:09.759 --> 00:13:12.159
Um, he's like small though, he's portable.
00:13:12.240 --> 00:13:15.600
Like, I wonder if they make little necklaces or something I could just like carry him around.
00:13:16.799 --> 00:13:17.759
Like the cat backpack.
00:13:19.279 --> 00:13:23.600
No, you should make a um like a walking stick, like the glass thing like in Jurassic Park.
00:13:25.120 --> 00:13:26.960
Yeah, like the amber mosquito.
00:13:27.279 --> 00:13:28.799
Yes, that'd be so cool.
00:13:29.120 --> 00:13:29.840
It would be very cool.
00:13:30.000 --> 00:13:30.639
I love it.
00:13:31.039 --> 00:13:31.759
Love it.
00:13:32.000 --> 00:13:34.639
Um yeah, yeah.
00:13:34.879 --> 00:13:37.519
So uh overall it was a good week.
00:13:37.840 --> 00:13:39.919
I had 14 no shows on Monday.
00:13:40.000 --> 00:13:41.039
I can't stop talking about it.
00:13:41.600 --> 00:13:44.559
Everybody in the office knows how many no-shows I had on Monday.
00:13:44.879 --> 00:13:47.840
Did you individually go through and look at what they okay, yeah.
00:13:48.080 --> 00:13:54.639
And were they things that should have come in, or do you think they were unnecessary follow-ups and they all called to cancel because they felt so good because you were so good last year?
00:13:54.879 --> 00:13:55.679
I didn't even call to cancel.
00:13:55.759 --> 00:13:56.960
I would have appreciated that courtesy.
00:13:57.039 --> 00:13:57.840
They just didn't show up.
00:13:58.720 --> 00:14:03.120
Um post it was a mix of post-ops and new stuff, like all the things, everything.
00:14:03.279 --> 00:14:09.679
Um and yeah, and then we come to find out my patients weren't getting like reminder calls and stuff, so it's its own whole thing.
00:14:10.159 --> 00:14:10.639
14.
00:14:10.879 --> 00:14:13.279
Yeah, I texted Beth on Monday, I was like, I have 14 no shows.
00:14:13.440 --> 00:14:18.000
She was like, I had to had a desperation of a coccix hematoma on my schedule.
00:14:18.080 --> 00:14:19.679
I was like, Oh, you're like I would never mind.
00:14:19.840 --> 00:14:21.440
I would have done anything to do that.
00:14:22.240 --> 00:14:22.960
Send it to me.
00:14:23.120 --> 00:14:25.120
I know, I know it's so slow right now.
00:14:25.440 --> 00:14:30.240
Um, okay, so let's get into what we want to talk about.
00:14:30.399 --> 00:14:34.559
Why or when did healthcare become a customer service agency?
00:14:34.639 --> 00:14:40.000
As one of our docs here likes to put it very bluntly, it's Burger King here.
00:14:40.159 --> 00:14:41.120
Have it your way.
00:14:41.360 --> 00:14:47.200
Uh that that's the attitude you have when the day has just beaten you to death.
00:14:47.360 --> 00:14:52.960
I'm not saying we like always come into life with that attitude, but like it can I can do it to you sometimes.
00:14:53.200 --> 00:14:59.919
So I feel like that everything else in the world is very customer service oriented.
00:15:00.159 --> 00:15:09.200
Um healthcare is moving that direction, but there are there's just some unique things about healthcare that it doesn't apply.
00:15:09.279 --> 00:15:14.960
Like it can't be as customer service oriented as everything else in life is very unique.
00:15:15.039 --> 00:15:56.159
Um, but we do put a lot of emphasis on customer satisfaction or patient satisfaction, I should say, reviews um as a private practice, um, working for and earning your patients and like having to be very cognizant about your volume and wanting people to come see you instead of going somewhere else and um you know having to just deal with that aspect of things, and then on the flip side, the healthcare aspect of it and doing what's right for the patient and you know, treating them appropriately, but also looking at things from a business side and standpoint and how the two merge together, and sometimes they don't merge well.
00:15:56.480 --> 00:15:58.559
Yeah, and where do you draw the line?
00:15:58.720 --> 00:15:59.360
Yeah, right.
00:15:59.519 --> 00:16:20.639
So we had a staff meeting recently where the theme of it was, you know, healthcare has changed so much over the past 25 years, and you can deliver a service that is uh mediocre, you know, that's correct and you're doing everything right, but you know, it feels very clinical, it feels very sterile and an impersonal.
00:16:20.879 --> 00:16:31.200
So being in a private practice, when people take time out of their day to come in and see you, the product you are delivering is your knowledge, um, but it's you, like your personality.
00:16:31.440 --> 00:16:36.879
They're they're choosing to come to you as opposed to the next person because you put the personal touch.
00:16:37.039 --> 00:16:40.480
You're you do go above and beyond and that's right.
00:16:40.559 --> 00:16:45.440
So that's great and that's a differentiator, but when does that become too much?
00:16:45.519 --> 00:16:52.320
Like when then do patients expect, you know, uh, I I need a I need this to be comped.
00:16:52.639 --> 00:16:54.240
I need my surgery for free.
00:16:54.399 --> 00:16:54.639
Yeah.
00:16:54.799 --> 00:16:58.000
And again, I'm saying these things because we've encountered these things.
00:16:58.159 --> 00:16:59.679
Yeah, these are all realities.
00:16:59.919 --> 00:17:07.279
I mean, we want to, and that that is a goal, particularly in private practice, to be, you have to be more accommodating.
00:17:07.359 --> 00:17:12.720
Like if you work for a large healthcare system, like you're gonna get the patients no matter what.
00:17:12.799 --> 00:17:14.799
You're gonna get people through the ER.
00:17:15.039 --> 00:17:25.200
Um, you can be having a bad day and not be super personable and just do your injections and and treat the patients and get through the day.
00:17:25.440 --> 00:17:28.880
But that's not really an option in private practice.
00:17:29.119 --> 00:17:30.880
Yeah, and when when patients are off day.
00:17:31.039 --> 00:17:31.200
Right.
00:17:31.279 --> 00:17:50.319
But when patients they're coming to you for a service, they're relying on you to be the expert when they start asking for things and you start accommodating, and now you're changing the service you provide and you're making these, you know, lane changes for this one person, you're setting the expectation for your staff that your staff's like, oh, that's how we do it now.
00:17:50.880 --> 00:17:54.640
Um, or you will then tell that patient, yes.
00:17:54.720 --> 00:17:55.839
So then where's the limit?
00:17:56.000 --> 00:17:58.720
Yeah, they continue to ask more of you, more of you, more of you.
00:17:58.880 --> 00:17:59.119
Right.
00:17:59.359 --> 00:18:02.000
And you're accommodating here, but you're not accommodating there.
00:18:02.240 --> 00:18:04.559
Again, are you the asshole when you eventually say no?
00:18:04.640 --> 00:18:09.839
Or you just put your foot down and say, you know, ma'am, I've been very accommodating, but unfortunately this is you're taking it too far.
00:18:10.000 --> 00:18:10.640
This is too far.
00:18:10.720 --> 00:18:10.960
Yeah.
00:18:11.039 --> 00:18:13.119
So let's give but also give me a good review.
00:18:13.440 --> 00:18:15.200
Yeah, like I mean, I'll do it to an extent.
00:18:15.359 --> 00:18:15.519
Yeah.
00:18:15.759 --> 00:18:16.559
Just don't be mad.
00:18:16.640 --> 00:18:16.960
Yeah.
00:18:17.119 --> 00:18:19.359
Um, let's give just some like basic examples.
00:18:19.519 --> 00:18:26.799
This can be as simple as like, and we've all been in these situations and done it and um continue to do it because of this syndrome that we have.
00:18:27.039 --> 00:18:27.359
Yes.
00:18:27.599 --> 00:18:30.720
But like filling out forms and paperwork, right?
00:18:30.880 --> 00:18:35.759
We have policies on, you know, you drop it off at the desk and you pay, and it's gonna be this number of days.
00:18:35.839 --> 00:18:38.559
But have you ever had somebody come in a room say like, can you just fill this out?
00:18:38.640 --> 00:18:43.200
And it's like, you know, a couple signatures and a couple checkboxes, and you just do it, and you're like, Yeah, here you go.
00:18:43.359 --> 00:18:43.599
Yes.
00:18:43.759 --> 00:18:47.119
And now every time they need something like that, they expect you to do it that way.
00:18:47.440 --> 00:18:51.359
And they're not gonna go through the normal for it, right?
00:18:51.920 --> 00:18:58.079
Um, you know, seeing somebody who comes late and you'll you'll work them in.
00:18:58.240 --> 00:19:02.559
And now they chronically come late every time, and they're like, Oh no, Beth will she always does.
00:19:02.880 --> 00:19:04.160
She like, I I know her, yeah.
00:19:04.319 --> 00:19:06.480
Like she'll she'll work me in.
00:19:06.720 --> 00:19:12.559
Um, and like deep down it it frustrates you, and you know, you still like put on your happy face and do it.
00:19:12.880 --> 00:19:19.200
No, I have one patient that always always um just comes to the front and says, Beth said whenever I need anything, she'll work me in.
00:19:19.359 --> 00:19:19.519
Yeah.
00:19:19.920 --> 00:19:25.920
And and it happened once, and now the expectation is every time he comes in, and he actually makes kind of a scene at the front, right?
00:19:26.000 --> 00:19:27.759
So do I continue to accommodate him?
00:19:28.000 --> 00:19:35.920
I do because I would rather his energy be spent positively than negatively, like telling the entire waiting room that I'm a liar, right?
00:19:36.079 --> 00:19:36.240
Yeah.
00:19:36.480 --> 00:19:41.119
I have another patient that his wife called once, and this guy was having severe pain.
00:19:41.200 --> 00:19:42.319
I saw him the same day.
00:19:42.480 --> 00:19:43.680
Now that's the expectation.
00:19:43.839 --> 00:19:47.920
So she called on a day that I wasn't even in clinic and argued for like a half an hour about.
00:19:48.400 --> 00:19:51.440
I said that whenever he needed me, he could call.
00:19:51.519 --> 00:19:54.160
But like, right, but not when I'm not physically there.
00:19:54.319 --> 00:19:54.480
Right.
00:19:54.559 --> 00:19:54.720
Yeah.
00:19:55.039 --> 00:19:56.000
Um, we had another patient.
00:19:56.720 --> 00:19:56.799
Yeah.
00:19:56.960 --> 00:19:57.440
Yeah, right.
00:19:57.599 --> 00:19:59.440
We had another patient who wrote in this week.
00:19:59.599 --> 00:20:01.440
She was told no six months ago.
00:20:01.599 --> 00:20:05.920
She wanted a handicap pass for those driving her around.
00:20:06.079 --> 00:20:06.319
Oh.
00:20:06.640 --> 00:20:07.599
So not for her.
00:20:08.160 --> 00:20:11.519
She wanted it for anyone that was driving her around.
00:20:11.599 --> 00:20:15.920
Now, when you give a handicap pass, it's linked to a driver's license.
00:20:16.079 --> 00:20:22.400
So this time she came in, dropped off her license, and said, Okay, give it to me, and I'll just put it on different cars.
00:20:22.720 --> 00:20:29.440
I'm like, lady, like if so, if you're not driving, then someone is capable of dropping you off.
00:20:29.680 --> 00:20:30.640
Yeah, like they they can drive.
00:20:31.119 --> 00:20:33.039
So there is no parking situation, right?
00:20:33.279 --> 00:20:35.119
So why why are we doing that?
00:20:35.279 --> 00:20:36.319
Did we give it to her?
00:20:36.640 --> 00:20:38.079
Yeah, I'm gonna guess you did.
00:20:38.240 --> 00:20:38.480
I did.
00:20:38.640 --> 00:20:39.839
Also, handicap passes.
00:20:39.920 --> 00:20:40.559
I never do permanent.
00:20:40.640 --> 00:20:42.400
Do I have a handful of patients I do to permit for?
00:20:42.640 --> 00:20:42.880
I do.
00:20:43.119 --> 00:20:43.359
You do.
00:20:43.519 --> 00:20:43.759
I do.
00:20:44.000 --> 00:20:44.640
I bet you do.
00:20:44.880 --> 00:20:52.319
Or like, have you ever called somebody and like they, you know, MRI discussion or whatever, and they're like, Yeah, I I you want to schedule them to come in.
00:20:52.400 --> 00:20:57.200
And they're like, Ooh, like none of those times that you have told me that you have open work for me.
00:20:57.279 --> 00:21:00.000
Like, what about like six o'clock on a Tuesday night?
00:21:00.079 --> 00:21:02.240
And you're like, Yes.
00:21:02.559 --> 00:21:03.599
Yeah, I'll come in.
00:21:03.680 --> 00:21:06.799
Yeah, I've come in, I did an injection for a patient.
00:21:06.960 --> 00:21:09.119
She couldn't come in anytime, it just didn't work out.
00:21:09.200 --> 00:21:14.000
I want to time it before therapy, so she wanted it done at seven for her PT at 715.
00:21:14.079 --> 00:21:15.039
I don't come until eight.
00:21:15.279 --> 00:21:17.680
Like, did I come in and sat there afterwards for an hour?
00:21:17.839 --> 00:21:18.079
Yeah.
00:21:18.240 --> 00:21:18.400
Yeah.
00:21:18.559 --> 00:21:19.200
You know, yeah.
00:21:19.519 --> 00:21:20.480
Will I do that for everybody?
00:21:20.640 --> 00:21:20.880
No.
00:21:20.960 --> 00:21:23.279
And I just I don't want that to get out there.
00:21:24.400 --> 00:21:26.000
Whoever's listening to this, yeah.
00:21:26.160 --> 00:21:31.680
It's not not always gonna be the case, but um, but we do, and like it it's so hard to say no.
00:21:31.759 --> 00:21:36.720
Sometimes it's more, it feels like the path of least resistance to just say yes and be accommodating.
00:21:36.880 --> 00:21:39.279
Cause it it's like it's hard to say no.
00:21:39.359 --> 00:21:42.720
Is this like a a personality syndrome?
00:21:42.880 --> 00:21:44.559
Is it like a gender thing?
00:21:44.799 --> 00:21:45.440
I don't know.
00:21:45.680 --> 00:21:46.480
Yeah, I don't know.
00:21:46.640 --> 00:21:56.799
I think um going above and beyond for some people and some patients that have certain needs, I think it is a courtesy that I don't mind extending.
00:21:56.960 --> 00:21:57.119
Yeah.
00:21:57.279 --> 00:22:08.079
When it becomes an obligation and patients who Could, you know, could come in anytime, but then inconvenience me to make it more convenient for them, that pisses me off.
00:22:08.240 --> 00:22:08.319
Right.
00:22:08.480 --> 00:22:08.640
Right.
00:22:08.880 --> 00:22:11.839
But you're not really having that full-blown conversation.
00:22:12.240 --> 00:22:16.720
So someone who wants to do a telehealth visit because they just don't want to come in.
00:22:16.799 --> 00:22:17.599
It's raining.
00:22:18.240 --> 00:22:22.400
So now I have to conduct a visit that I can't bill for because you don't want to get wet.
00:22:22.720 --> 00:22:24.240
On your own time, probably.
00:22:24.319 --> 00:22:27.039
Or like, you know, figure it out in between your schedule.
00:22:27.200 --> 00:22:37.519
Um it's even, it's even something, and I know this is so petty, but it's even something like the patient doesn't want to come in for a pre-op, and a pre-ops are very educational visits, at least on our team.
00:22:37.599 --> 00:22:44.319
We require them, unless someone had something done on one side, and then six months later they do the other side and they kind of know the drill.
00:22:44.559 --> 00:22:47.279
Um, like an ACL patient, they don't want to come in for a pre-op.
00:22:47.440 --> 00:22:52.079
And that that ticks me off because there's patients do much better if they have a pre-op and prehab.
00:22:52.240 --> 00:22:53.519
Yeah, you have to set expectations.
00:22:53.759 --> 00:22:58.240
So so now all their DMEs I have to throw in my car and carry to the hospital.
00:22:58.319 --> 00:22:58.480
Yeah.
00:22:58.640 --> 00:23:00.240
Because they won't even come in to get that.
00:23:00.480 --> 00:23:08.079
And then like in pre-op, they like probably like ask your doc something that he expects that they would already know because they like should have gone over it with you at the pre-op.
00:23:08.240 --> 00:23:09.039
And then it just ugh.
00:23:09.200 --> 00:23:09.359
Yeah.
00:23:09.519 --> 00:23:09.759
Yeah.
00:23:10.000 --> 00:23:11.519
It's not, it's not the protocol.
00:23:11.680 --> 00:23:11.759
Yeah.
00:23:11.920 --> 00:23:23.759
And yeah, deviating from the the norm for people, I had a a um oh god, situation like two weeks ago now, and it plagued me.
00:23:23.920 --> 00:23:25.759
Fortunately, it was very quickly.
00:23:25.839 --> 00:23:27.680
Like it's it's out of the way now.
00:23:27.759 --> 00:23:40.400
But I had a patient who I saw in one of our offices, totally new to me, had seen urgent care, had like some sort of cyst mass, whatever, on uh on her finger, like flexor tendon sheath area.
00:23:40.480 --> 00:23:45.440
So it was fairly large, very reasonable to excise.
00:23:45.839 --> 00:23:48.720
So she had come in, it was like a solid mass.
00:23:48.880 --> 00:23:51.599
I guess they had told her like I would probably drain it at the visit.
00:23:51.759 --> 00:23:55.200
I told her I was like, I'll try, but this is really more solid.
00:23:55.440 --> 00:23:56.400
I don't think we're gonna get anything.
00:23:56.559 --> 00:23:57.519
It's like a knife situation.
00:23:58.000 --> 00:24:00.240
Yeah, like I think we need to excise it.
00:24:00.480 --> 00:24:02.640
She's like, Well, I really wanted something done today.
00:24:02.799 --> 00:24:07.039
And I'm like, I get that, but unfortunately, like that's not, I can't do that today.
00:24:07.119 --> 00:24:09.759
Like, we like to do that under you know, sterile conditions and everything.
00:24:09.839 --> 00:24:15.359
And this is an actual procedure, like that we need to make an incision and put stitches in it.
00:24:15.519 --> 00:24:23.039
So um, we will need to schedule you to come back for that, which that was already, you know, inconveniencing her, but whatever.
00:24:23.119 --> 00:24:26.880
She was she was like, Okay, like I get it, whatever you think is best, right?
00:24:27.200 --> 00:24:32.400
Um so I told her we normally do pr procedures because we'll do them in office here.
00:24:32.480 --> 00:24:35.920
Um we can do them in a procedure room for something simple like that, local only.
00:24:36.000 --> 00:24:39.119
We do a lot of wide awake local only uh hand procedures.
00:24:39.599 --> 00:24:44.960
Um, we were in a different office location, and I was like, you know, well, I I will see.
00:24:45.119 --> 00:24:51.039
Like, there's not a medical reason we can't do it in this office, but I don't know if that's like if we're gonna be able to make that happen.
00:24:51.200 --> 00:24:57.680
Because we don't have the the supplies here that we have over there, and um it it might be a whole thing.
00:24:57.839 --> 00:25:01.359
So I I will ask and let you know if that's possible.
00:25:01.519 --> 00:25:03.759
If not, then you know it's in the other office location.
00:25:03.839 --> 00:25:05.200
She's like, Well, I can't go over there.
00:25:05.279 --> 00:25:07.039
I'm like, okay, well, I will ask.
00:25:07.200 --> 00:25:09.519
Yeah, but these are the options.
00:25:10.079 --> 00:25:20.880
Um as soon as like we went through the process of like seeing if we could do it and asking and like seeing if we could like get the stuff together, she started being really mean to all the staff.
00:25:21.200 --> 00:25:29.839
Like she wasn't per mean to me, she was just uh I don't know if demanding is the right word, but like this is what I want.
00:25:30.319 --> 00:25:37.920
And instead of me being like, oh, that's a hard no, I think I'm mentally trained to try to be accommodating for people.
00:25:38.000 --> 00:25:44.240
And if I can make something happen for you, like that's the way we we're gonna try to deliver this amazing experience.
00:25:44.400 --> 00:25:46.559
So like I I will try for you.
00:25:46.720 --> 00:25:56.559
But then when you start like not appreciating the effort and not being okay with certain parameters, like she was very picky about like the time and the date and all these other things.
00:25:56.640 --> 00:26:00.559
And I and it it got to a point it got really, really bad.
00:26:00.880 --> 00:26:23.680
And then she came back later that day into urgent, like started complaining about me and said I did nothing for her that day and she felt like she wasn't heard, which frustrates me beyond belief because I I went out of my way to hear you and give you the best option and actually try to accommodate every little thing that you wanted and to come back in, complain about me.
00:26:23.920 --> 00:26:28.319
So I told the other provider that saw her, I said, Look, I think we should refer her somewhere to someone else.
00:26:28.400 --> 00:26:34.880
Like, I don't think we should do this anymore because clearly there's there's not a trust, mutual trust situation.
00:26:35.039 --> 00:26:39.279
Um, she shouldn't be having a procedure with us if she's this upset already.
00:26:39.440 --> 00:26:39.519
Right.
00:26:39.759 --> 00:26:41.519
It's just not gonna be a good thing.
00:26:41.759 --> 00:26:42.640
Oh, no, no, no.
00:26:42.720 --> 00:26:43.680
Like she still wants to do it with you.
00:26:43.759 --> 00:26:47.200
I'm like, Yeah, but now I now we're back in a bad thing.
00:26:47.599 --> 00:26:50.400
But here's also the thing she she then gets to decide.
00:26:50.559 --> 00:26:50.720
Right.
00:26:50.960 --> 00:26:52.079
You can't decide to say no.
00:26:52.319 --> 00:26:58.720
Yeah, well, I just do a foot down, and I was like, listen, like I don't know what it's gonna take, but like it it's a no at this point.
00:26:58.799 --> 00:27:02.000
Like from me personally, I don't want us to move forward in this way anymore.
00:27:02.160 --> 00:27:05.359
Cause I like I was getting it from all angles.
00:27:05.440 --> 00:27:08.079
Everybody was like, Oh, this patient's so mean to us.
00:27:08.240 --> 00:27:14.079
My supervising physician was like, Why are you trying to accommodate this lady that's probably not gonna you know be nice to us in the future?
00:27:14.240 --> 00:27:16.880
I'm like, uh, this is a disaster waiting to happen.
00:27:16.960 --> 00:27:17.839
So yeah.
00:27:18.079 --> 00:27:24.720
But yeah, I mean, like, yes, we try to to go out of our way and accommodate people, but at what cost?
00:27:25.200 --> 00:27:31.440
Yeah, well, it's also conditioning the patient that then every little thing is going to be answered in that way.
00:27:31.599 --> 00:27:31.759
Yeah.
00:27:31.920 --> 00:27:39.599
So again, I don't engage in these um, these interactions with like a contract of like, hey, I'm doing this once for you.
00:27:39.759 --> 00:27:40.079
Right.
00:27:40.240 --> 00:27:48.960
You know, um, I had one guy that I had seen 10 years ago for his CMC arthritis, had done injections for him.
00:27:49.200 --> 00:27:50.480
He likes the way I do them.
00:27:50.640 --> 00:27:52.480
We opened an office closer to him.
00:27:52.640 --> 00:27:56.720
So now he went over there and he said, Listen, if I'm gonna go over there, I'm gonna need you to go over there.
00:27:56.799 --> 00:27:56.960
Yeah.
00:27:57.039 --> 00:27:58.319
And I was like, Well, I don't.
00:27:58.400 --> 00:28:02.640
Like my schedule does not allow for me to just go to another office.
00:28:02.799 --> 00:28:06.240
Um, and I will sometimes to cover, but that's not like a norm thing for me.
00:28:06.319 --> 00:28:06.559
Yeah.
00:28:06.720 --> 00:28:09.039
So I said, Hey, get with this provider.
00:28:09.119 --> 00:28:10.960
Um, this is the one that's gonna be over there now.
00:28:11.039 --> 00:28:12.240
Just do me a favor, try it once.
00:28:12.319 --> 00:28:13.279
And he hooked, right?
00:28:13.519 --> 00:28:14.319
He said, Thank you.
00:28:14.400 --> 00:28:15.759
That was a great recommendation.
00:28:16.000 --> 00:28:17.519
Then that provider left.
00:28:17.839 --> 00:28:21.519
So he called um or we called him.
00:28:21.599 --> 00:28:22.559
I looked at the schedule.
00:28:22.720 --> 00:28:26.400
I had a temp provider for a little bit, and this guy was coming in for his injections.
00:28:26.559 --> 00:28:33.119
I'm like, man, he's gonna be his expectation is he's had, and he said he's had them before, and some people do it right, some people don't.
00:28:33.279 --> 00:28:35.119
He likes this one technique, and I'm fine with that.
00:28:35.200 --> 00:28:35.920
Like, you know what you want.
00:28:36.079 --> 00:28:36.720
Like, please tell me.
00:28:36.799 --> 00:28:38.000
I don't want to mess around.
00:28:38.240 --> 00:28:43.200
So I had the um MA call this guy and I said uh just explain, hey, we have a temp provider.
00:28:43.359 --> 00:28:49.359
I I don't know that you're gonna get a great injection because this provider does not do these, and if he will, he's not gonna do them under ultrasound.
00:28:49.440 --> 00:28:51.839
So I know for you, your expectation is it.
00:28:52.480 --> 00:29:03.119
But what I can offer you is if you want to come to where I am at, and I know you don't like to, do you can, and I'm in surgery, but I will scrub out and do your injections.
00:29:03.200 --> 00:29:05.680
Yeah, and I did, I hadn't seen him in like five years.
00:29:05.839 --> 00:29:12.559
He was like, Oh my god, like that was just so and he wrote this glowing review, like she went out of her way, and you have no idea how much I appreciate that.
00:29:12.640 --> 00:29:17.119
But again, for that guy, I think he was like that's that's the exchange that you expect.
00:29:17.359 --> 00:29:19.680
That's yeah, what that's what you want from that situation.
00:29:19.839 --> 00:29:24.079
Not that I need the review from it or the glowing review, but like don't abuse it.
00:29:24.319 --> 00:29:25.119
Don't abuse it, exactly.
00:29:26.079 --> 00:29:31.119
And I had told him, I said, give me three months and I'll have somebody else who can do it, you know, no problem when you're due for another injection.
00:29:31.279 --> 00:29:36.319
And he's very, very he, you know, it was it took time out of his day to drive the extra 20 minutes.
00:29:36.400 --> 00:29:38.480
He wanted the injections because he hurt, right?
00:29:38.640 --> 00:29:42.480
He wasn't he wasn't really gonna be up for, hey, can you wait another three months?
00:29:42.559 --> 00:29:42.799
Yeah.
00:29:42.960 --> 00:29:46.960
Um, but it was it was like a mutual understanding of like, I understand what you did for me.
00:29:47.039 --> 00:29:48.079
I am really appreciative.
00:29:48.240 --> 00:29:49.839
Thank you so much for doing me a solid.
00:29:49.920 --> 00:29:50.079
Yeah.
00:29:50.160 --> 00:29:54.960
And I know that this guy's not gonna continue to you know ask for these weird above and beyond things.
00:29:55.599 --> 00:29:59.440
We have there's, you know, this this is about obviously the extenuating circumstances.
00:29:59.599 --> 00:30:06.079
There's plenty of nice normal human beings out there that you know, carry me throughout the day that I get to interact with.
00:30:06.240 --> 00:30:09.119
But what about like financial things?
00:30:09.359 --> 00:30:23.680
Like patients wanting um, you know, visits, follow-up visits to be conducted over the phone so they don't have to come in and pay for a follow-up visit or be billed for, you know, a MRI discussion, things like that.
00:30:24.000 --> 00:30:25.920
Do you yes, answer's yes?
00:30:26.559 --> 00:30:27.440
Answers yes, yeah.
00:30:27.680 --> 00:30:34.640
So my MRI discussions, especially when it is a fruitful discussion, it's not like, hey, everything's normal, continue what we're doing.
00:30:34.720 --> 00:30:40.000
When it's a fruitful discussion of like, hey, this is a you know, rotator cuffed hair, now it's full thickness.
00:30:40.079 --> 00:30:46.240
Now we have to talk about you know surgery and the timing of it and you know, recommendations for out of work and do we do this before you retire?
00:30:46.319 --> 00:30:46.720
Do we wait?
00:30:46.799 --> 00:30:50.240
When it's a fruitful conversation, those are level four visits.
00:30:50.400 --> 00:30:55.039
Yeah, you know, so if I'm doing it over the phone, now it's a 20-minute conversation.
00:30:55.119 --> 00:30:56.400
I'm not billing for that.
00:30:56.480 --> 00:30:56.799
Yeah.
00:30:57.039 --> 00:31:01.680
I I know the patients are appreciative when I do that, but I'm not gonna do that for everybody.
00:31:01.920 --> 00:31:02.480
Yeah, you can.
00:31:02.720 --> 00:31:04.400
I mean, it's not like viable.
00:31:04.720 --> 00:31:07.599
And and that's that is your time and expertise.
00:31:07.680 --> 00:31:10.559
Like you're working, yes, and you're just not getting paid for it.
00:31:10.799 --> 00:31:21.039
Now, here's where this backfires, which again is the whole nature of this conversation today, is I will do that and I will call them and go over everything, and they're like, Thank you so much.
00:31:21.200 --> 00:31:22.799
Can you write that up for me?
00:31:23.039 --> 00:31:24.000
In an email and do it.
00:31:24.319 --> 00:31:24.880
In an email.
00:31:25.039 --> 00:31:27.200
Can you send me an email summary of what we talked about?
00:31:27.359 --> 00:31:27.920
Like, what?
00:31:28.160 --> 00:31:31.279
You're like, Come in for an office visit.
00:31:31.359 --> 00:31:32.400
Then I would have done a note.
00:31:32.559 --> 00:31:34.079
You know, now they don't have an appointment.
00:31:34.160 --> 00:31:35.039
There is no encounter.
00:31:35.119 --> 00:31:37.519
Now, if I make one, now I have to say, please don't bill this.
00:31:37.759 --> 00:31:38.559
But I put it on there.
00:31:38.640 --> 00:31:41.440
So now I've done all the work for no reward.
00:31:41.599 --> 00:31:46.079
I mean, I'm rewarded in my soul, but not like monetarily, you know.
00:31:46.240 --> 00:31:49.440
Um, but I had a lady, you love this.
00:31:49.599 --> 00:31:52.480
I had a lady who we've been seeing forever.
00:31:53.119 --> 00:32:00.480
I was going to call her once and I didn't do it on the app because, of course, I was doing 500 other things, and I accidentally did it for my cell phone.
00:32:00.640 --> 00:32:08.319
Now, when you do that, there there are the only time this happens is for the wrong patients and they always save my number.
00:32:08.480 --> 00:32:08.640
Yeah.
00:32:08.799 --> 00:32:09.519
They just do.
00:32:09.680 --> 00:32:11.599
So this lady will call or text me.
00:32:11.759 --> 00:32:12.880
She will call me at midnight.
00:32:12.960 --> 00:32:17.039
She called me during my 9:30 soccer game and was like, Why haven't you called me back?
00:32:17.200 --> 00:32:18.240
And I I know.
00:32:18.400 --> 00:32:20.559
So now if I block her, oh whatever, whatever.
00:32:20.640 --> 00:32:26.000
Anyway, so she um said to me, Hey, I fell, I hurt my knee at work.
00:32:26.160 --> 00:32:27.279
Can I come in and see you?
00:32:27.359 --> 00:32:28.480
Did you get my x-rays?
00:32:28.559 --> 00:32:29.839
Why haven't you called me for an appointment?
00:32:30.000 --> 00:32:34.400
And I just, you know, so I'm trying to tell my medical team, I need you guys to call her.
00:32:34.559 --> 00:32:40.240
But I said to them, do not specifically accommodate her, do not give her a special spot, put her in the next open spot.
00:32:40.400 --> 00:32:44.160
Like, you know, she's already violating that like personal whatever.
00:32:45.039 --> 00:32:51.039
So she did like five, six years ago, she brought in um her aunt and her aunt came in with her.
00:32:51.200 --> 00:32:52.960
She said, Hey, can you look at my aunt's hands?
00:32:53.119 --> 00:32:55.599
She's got carpal tunnel, among like a hundred other things.
00:32:55.839 --> 00:32:57.359
Do you think you can give her injections?
00:32:57.519 --> 00:32:58.640
And you've had that happen, right?
00:32:58.880 --> 00:33:03.119
With patients are so I'm like, Oh, you've got to add them onto the schedule, you add them on the schedule and then on the back end.
00:33:03.440 --> 00:33:10.319
So she then says to me via text, whatever, whenever it was, hey, you guys no longer take my aunt's insurance.
00:33:10.559 --> 00:33:15.119
Any way I could bring her to the appointment and you just inject her, like on the down low.
00:33:15.279 --> 00:33:15.759
What?
00:33:16.079 --> 00:33:17.680
I'm like, and she texts you this.
00:33:18.079 --> 00:33:18.960
She texted me that.
00:33:19.279 --> 00:33:19.599
Yeah.
00:33:19.759 --> 00:33:23.440
So now if I say, I mean, of course I was like, listen, I I can't do that.
00:33:23.599 --> 00:33:25.839
Like, I, you know, apologize, I can't do that.
00:33:26.160 --> 00:33:29.920
She brought her anyway and then put me on the spot.
00:33:30.000 --> 00:33:31.839
And then everyone's like, my hands, please.
00:33:32.000 --> 00:33:34.240
Yeah, she's like, I can't even hold my phone.
00:33:34.319 --> 00:33:36.160
And I'm like, fuck, you know, like yeah.
00:33:36.240 --> 00:33:37.920
Now I'm like, now I have to be the asshole.
00:33:38.160 --> 00:33:38.319
Yeah.
00:33:38.960 --> 00:33:41.119
I and I've had that happen multiple times.
00:33:41.279 --> 00:33:45.359
I had a a husband I was seeing and he was coming in for something.
00:33:45.519 --> 00:33:53.680
His wife had like a$3,000 balance, and we told her she couldn't be seen, and she did a tag along with her husband when she was in the room, asked me to see her.
00:33:53.920 --> 00:33:54.400
Yeah.
00:33:54.640 --> 00:34:07.759
How like is that does that correlate in any other career or like service where you have this expectation where you just can dictate, like, oh, I I want this done, but not going to pay for it?
00:34:07.920 --> 00:34:08.079
No.
00:34:08.320 --> 00:34:17.440
We had a patient last week who was scheduled for a procedure and we require upfront payment or at least a percentage of it, refused to pay.
00:34:17.760 --> 00:34:24.000
And I'm not saying that I don't like have sympathy for, you know, financial difficulties and things like that.
00:34:24.159 --> 00:34:31.760
Um, yes, there's programs for payment plans and assistance and and whatnot, but there's a way to go about it.
00:34:31.840 --> 00:34:37.440
And this individual chose to berade the staff and you know, yell at the time.
00:34:37.599 --> 00:34:38.880
This is a longtime patient.
00:34:39.039 --> 00:34:39.519
Yeah, yeah.
00:34:39.679 --> 00:34:46.400
Like cussed everyone out and said, I expect that you guys will still do it on this day.
00:34:47.360 --> 00:34:47.920
What?
00:34:48.159 --> 00:34:54.880
Like your rules don't apply to me because I've been giving you my business for for somebody to yell and threaten when it's gets threatened.
00:34:56.159 --> 00:35:00.079
Um and what's more is like sometimes they get their way with it still.
00:35:00.239 --> 00:35:01.599
And well, of course they do.
00:35:01.760 --> 00:35:06.480
We we have a football coach that's been a long time, he's been a coach for like 20-something years.
00:35:06.639 --> 00:35:08.719
I'll get a text from the the doc that I work with.
00:35:08.800 --> 00:35:11.119
He's like, Hey, so-and-so's coming in.
00:35:11.280 --> 00:35:13.360
I told him 11, but he's gonna show up whenever.
00:35:13.440 --> 00:35:15.679
Just make sure you see him and don't make them wait.
00:35:16.159 --> 00:35:20.320
Yeah, like you so this is special accommodations for a VIP.
00:35:20.800 --> 00:35:26.400
I understand that, but when it came time that he needed something done surgically, send him the foot and ankle team.
00:35:26.480 --> 00:35:27.840
Yeah, and those rules don't apply.
00:35:28.000 --> 00:35:28.960
Yeah, you know what I mean?
00:35:29.199 --> 00:35:29.360
Yeah.
00:35:29.440 --> 00:35:33.920
So like you when you're not when your opponent's at 11, you show up at two, they're actually not gonna see you.
00:35:34.000 --> 00:35:34.239
Yeah.
00:35:34.400 --> 00:35:40.639
Then I have to hear about it on my end because then I'll get the text back that says, hey, you know, we sent them over here.
00:35:40.719 --> 00:35:41.760
How come that didn't go well?
00:35:41.920 --> 00:35:44.880
I'm like, well, it didn't go well because this guy flies by his own rules.
00:35:45.119 --> 00:35:53.119
Yeah, but like I I wish these people would sometimes understand that like you're you're trying to help them and you're trying to go out of your way and like just don't abuse abuse that.
00:35:53.760 --> 00:36:00.719
Um I want to run through some things and you tell me if you have done them or not.
00:36:01.199 --> 00:36:01.920
God, okay.
00:36:02.159 --> 00:36:03.519
The answer's yes, but go ahead.
00:36:03.840 --> 00:36:05.039
The answer is yes, to all.
00:36:05.280 --> 00:36:14.559
Um, have you ever stayed late because somebody wanted you to see them at a different time and you decided to not go home and eat dinner because you saw them instead?
00:36:14.719 --> 00:36:14.880
Yes.
00:36:15.119 --> 00:36:18.400
Have I left the office and then come back because yeah, yeah.
00:36:18.480 --> 00:36:19.679
I mean, they called after hours.
00:36:19.760 --> 00:36:21.840
Sorry, I meant I'm, but you know, I'll be there at six.
00:36:22.079 --> 00:36:22.639
Can you be there?
00:36:22.719 --> 00:36:23.119
Damn it.
00:36:23.280 --> 00:36:23.679
You know?
00:36:23.920 --> 00:36:35.920
Um gone to a different office location, like had clinics somewhere, and like on your way home, went to this office and did saw somebody here because they didn't want to go see you at the other location.
00:36:36.320 --> 00:36:36.960
Yes.
00:36:37.599 --> 00:36:44.880
Um we already covered this, but like calling somebody just because it more convenient to do a teleapointment.
00:36:45.119 --> 00:36:52.239
Um, reorganized your entire weekslash surgery schedule to accommodate a patient that like couldn't get time off work or something.
00:36:52.800 --> 00:36:53.920
Yes, I'm doing it next week.
00:36:54.159 --> 00:36:54.480
Okay.
00:36:55.519 --> 00:36:58.079
Um seeing somebody more than 30 minutes late.
00:36:58.880 --> 00:36:59.440
Who hasn't?
00:36:59.679 --> 00:37:00.079
Who hasn't?
00:37:00.559 --> 00:37:01.360
Who hasn't?
00:37:01.599 --> 00:37:12.960
Um didn't want to come in for a follow-up appointment, just wanted you to order imaging, order surgery, insert whatever request, just do the thing.
00:37:13.280 --> 00:37:17.360
So like yeah, did not follow protocol because yes, yes, yeah, yes to that.
00:37:17.679 --> 00:37:25.679
And sending in prescriptions that like you haven't seen them for a follow, but like you get a m like a text or a message like just refill this immediately.
00:37:26.079 --> 00:37:27.519
And why is it not done 10 minutes later?
00:37:27.679 --> 00:37:28.880
Yeah, all of it.
00:37:29.280 --> 00:37:30.480
Um questions for you.
00:37:30.800 --> 00:37:34.639
Again, these are a little taboo, so you can say no comment.
00:37:34.880 --> 00:37:40.719
Have you ever adjusted uh patient billing because you felt bad for them?
00:37:40.880 --> 00:37:49.280
AKA 90 day global's over, they come in on like day 92, yeah, and they didn't realize there was a copay, and you feel bad.
00:37:49.360 --> 00:37:53.280
So instead of doing like a level three, you do a level one, or you just say no charge?
00:37:53.760 --> 00:37:56.320
Yeah, I have I've no charged a couple of those.
00:37:56.480 --> 00:38:04.079
Because I I feel like for the post-op issue, like sometimes it's so close to it, and it could be our schedule that wasn't accommodating, like we only have clinic two days a week.
00:38:04.239 --> 00:38:08.400
If we couldn't get you in the week before and now you're like five days out of it, like whatever.
00:38:08.559 --> 00:38:10.559
Yeah, I'm gonna no charge you for that.
00:38:10.800 --> 00:38:20.480
Um, now if like you come in for that post-op, but you're like, actually, this leg, this arm, and need you look at these things.
00:38:20.559 --> 00:38:22.480
No, that's not gonna fly.
00:38:22.719 --> 00:38:31.119
Have you ever come in on a holiday to see a patient because they had a need, you knew the office was closed, but you kind of knew you needed to do something?
00:38:31.519 --> 00:38:35.039
Hmm, a holiday specific or weekend.
00:38:35.280 --> 00:38:36.639
Oh, yeah, definitely a weekend.
00:38:36.800 --> 00:38:44.719
Like I've had somebody that we, you know, we're gonna take a cast off or something like, well, we're just casting you for this game and we'll take it off in urgent care the next day.
00:38:44.960 --> 00:38:50.480
Or um, I am well, I guess this doesn't count.
00:38:50.559 --> 00:38:54.960
Like I was working urgent care anyway, and just like had some of my patients who didn't want to come in during the week.
00:38:55.119 --> 00:38:58.559
I was like, I'll be here this week, and if you want to just come in, then I'll see you then.
00:38:58.800 --> 00:39:04.159
Um, so I guess that wasn't as much me going out of my way, but I definitely have gone out of my way to do that.
00:39:04.480 --> 00:39:13.280
Have you ever done a procedural thing for a coworker without doing the appropriate documentation?
00:39:13.679 --> 00:39:14.239
Yes.
00:39:14.400 --> 00:39:14.639
Yeah.
00:39:14.880 --> 00:39:15.360
Every day.
00:39:15.519 --> 00:39:18.880
Not every day, it's dramatic, but it feels like it's sometimes no.
00:39:18.960 --> 00:39:21.840
I mean, we we gotta help each other out.
00:39:22.000 --> 00:39:25.679
Sometimes it does come back to bite you, though, so it does, yes.
00:39:25.920 --> 00:39:35.280
Have you ever um met a patient outside of work to go over something or to fix a dressing or to do something like that?
00:39:35.599 --> 00:39:42.079
You mean like meet me at the Walmart parking lot and I'll put your dressing on, or like meet me at the office?
00:39:42.400 --> 00:39:43.199
That yes.
00:39:43.519 --> 00:39:44.159
Yeah.
00:39:44.480 --> 00:39:48.719
Like at a random location, no, like I haven't told them to like my house or anything.
00:39:48.960 --> 00:39:51.360
Okay, well, not your house, but like for instance.
00:39:52.000 --> 00:39:52.719
Where are you going with this?
00:39:52.880 --> 00:39:53.440
What did you do?
00:39:53.679 --> 00:39:55.119
What did I what did you do?
00:39:55.360 --> 00:40:09.039
I had a patient who had teller dislocation, multiple, um, and was a soccer player and was going to a tournament down in Wilmington and wanted her knee taped, and the tray they don't have a trainer, right?
00:40:09.119 --> 00:40:09.280
Yeah.
00:40:09.440 --> 00:40:14.880
So I was like, I will be there with my kid at the same tournament.
00:40:15.039 --> 00:40:15.199
Okay.
00:40:15.760 --> 00:40:19.039
If you just want to text me, like I can I can help you out.
00:40:19.440 --> 00:40:19.679
Yeah.
00:40:19.760 --> 00:40:19.920
Yeah.
00:40:20.159 --> 00:40:21.440
I think that's that's reasonable.
00:40:21.920 --> 00:40:23.280
It's like going above and beyond though.
00:40:23.360 --> 00:40:27.119
Yeah, it is going above and beyond, but like I don't like that's part of the the syndrome.
00:40:27.199 --> 00:40:29.360
Like, I don't yeah, that makes sense.
00:40:29.519 --> 00:40:30.159
Yeah, I see it.
00:40:30.480 --> 00:40:31.760
But it is going above and beyond.
00:40:32.000 --> 00:40:35.280
But have you done a surgical consultation for a patient?
00:40:35.760 --> 00:40:41.599
You didn't know it was a patient, someone injured themselves, it falls right under your category and you're not working at the time.
00:40:41.840 --> 00:40:42.320
Oh, yeah.
00:40:42.400 --> 00:40:45.840
Yeah, like a curbside consult, family, friend, whatever.
00:40:46.159 --> 00:40:52.880
Yeah, and again, the going above and beyond, you've done that to tee them up to just go get uh treatment somewhere else.
00:40:53.679 --> 00:40:58.239
Yeah, I have a friend, I have a friend who talks about you know her mom all the time, and her mom's got knee pain.
00:40:58.400 --> 00:41:03.840
And I, you know, she was like, Hey, so you think when I come over to your house to work out, I can bring my mom, you can look at her knee.
00:41:04.079 --> 00:41:06.079
Like, oh, okay.
00:41:06.239 --> 00:41:06.639
Like, right?
00:41:06.800 --> 00:41:08.480
So I look at her knee, she's 75.
00:41:08.559 --> 00:41:09.360
It's arthritis.
00:41:09.440 --> 00:41:11.280
I think you should do a stereo and then do gel injections.
00:41:11.360 --> 00:41:11.679
No problem.
00:41:11.760 --> 00:41:12.559
Guess where she goes?
00:41:12.719 --> 00:41:13.440
Somewhere else.
00:41:13.920 --> 00:41:14.400
Yeah.
00:41:14.559 --> 00:41:15.039
Yeah.
00:41:15.280 --> 00:41:15.760
I hate that.
00:41:17.280 --> 00:41:19.599
But again, above and beyond, at what cost?
00:41:19.920 --> 00:41:21.119
Please go above.
00:41:21.280 --> 00:41:24.400
I mean, look, I I love what I I love accommodating patients.
00:41:24.480 --> 00:41:28.079
I love feeling like I helped somebody out and made their life a little bit easier.
00:41:28.320 --> 00:41:28.800
I like that.
00:41:28.960 --> 00:41:37.119
I want to be able to do that, but I it doesn't feel good when it's when people are mean.
00:41:37.280 --> 00:41:37.920
Yeah, no, it doesn't.
00:41:38.320 --> 00:41:38.960
Take advantage of it.
00:41:39.199 --> 00:41:45.840
So, you know, and I get we have patients too that like think my life is not the only important life out there.
00:41:46.000 --> 00:41:50.480
They have things going on and their schedule is crazy and they have their own stresses and everything.
00:41:50.559 --> 00:41:54.400
So like some of it comes from frustration on their end and they're hurting and and whatnot.
00:41:54.639 --> 00:41:55.920
We get all of those things.
00:41:56.079 --> 00:42:06.559
But like, at what point do you still put your foot down and say, hey, like you can't expect this about like there's these boundaries and also like you can't talk to us that way.
00:42:06.800 --> 00:42:10.079
Can you imagine ever like talking to a paid be like, hey, don't speak to me that way?
00:42:10.159 --> 00:42:13.599
Oh my god, no, it's but this is this is the whole this is the whole kid thing.
00:42:13.679 --> 00:42:15.360
This is like reprimanding your children.
00:42:15.440 --> 00:42:23.119
Yeah, you know, like um, listen, the you were your behavior was inappropriate, you can't do that again, or there will be consequences.
00:42:24.079 --> 00:42:25.760
Have you ever said that to a patient?
00:42:26.000 --> 00:42:31.679
Um, not in that way, but I told this one patient who does the whole add-on, add-on, add-on, add-on.
00:42:32.000 --> 00:42:35.679
You know, I was like, listen, I've been very accommodating for you.
00:42:35.920 --> 00:42:42.480
I told you when you came in for this appointment, you said it was your right shoulder, your right shoulder only, and now you're asking me about your left elbow.
00:42:42.800 --> 00:42:42.960
Yeah.
00:42:43.119 --> 00:42:44.800
Like, I can't do that.
00:42:44.880 --> 00:42:46.400
I don't have the time carved out for that.
00:42:46.480 --> 00:42:49.920
I put you on the schedule today as a last minute, like, you're taking advantage of me.
00:42:50.079 --> 00:42:51.360
I've I said that, you know.
00:42:51.519 --> 00:42:51.760
Yeah.
00:42:51.920 --> 00:42:53.519
And it also can create confusion too.
00:42:53.599 --> 00:43:02.800
I think sometimes if we become so accommodating, like, are we just setting that precedent and then being the martyr, but the the patient doesn't recognize that they are putting us out.
00:43:02.880 --> 00:43:05.360
And so like it comes as a shock when they're like, Oh, oh my God, I didn't realize that.
00:43:05.519 --> 00:43:05.840
No, it is.
00:43:06.079 --> 00:43:07.840
It's you're yeah, you're you're digging your own hole.
00:43:08.000 --> 00:43:08.079
Yeah.
00:43:08.239 --> 00:43:09.440
Um, but you know what I do love?
00:43:09.599 --> 00:43:13.440
I saw a lady this week who was walking down the hall and I recognized her.
00:43:13.519 --> 00:43:17.119
We we did her ACL, I don't know, like eight years ago, something like that.
00:43:17.280 --> 00:43:22.480
Um, and I recognized her because every time she came in for a post stop, she brought in homemade pepper jelly.
00:43:22.559 --> 00:43:24.079
My husband like devoured it, right?
00:43:24.239 --> 00:43:26.880
So we're walking down the hall and I was like, oh my God, pepper jelly.
00:43:26.960 --> 00:43:28.400
Because of course I don't remember her name, right?
00:43:28.639 --> 00:43:29.039
Pepper jelly.
00:43:29.199 --> 00:43:30.000
And she said, Oh yeah.
00:43:30.079 --> 00:43:34.079
She was, I'm not seeing, um, yeah, I'm not seeing you, my son play football, he got a concussion.
00:43:34.159 --> 00:43:39.440
So she was saying, so I catch her on the way out and she said, I just want to let you know that I had such a great experience here.
00:43:39.599 --> 00:43:43.119
I sent you, and then she named like five or six people, and her network.
00:43:43.280 --> 00:43:47.039
Again, she's like a mom, so she's 40 something, she's got a kid in high school.
00:43:47.360 --> 00:43:54.800
Three or four of the people she named, we had done surgery on, and they were like they were um her kids, friends, schoolmates, teammates, whatever.
00:43:54.960 --> 00:43:57.519
So, again, like what you do, that is your reputation.
00:43:57.840 --> 00:43:59.760
Word of mouth is powerful, word of mouth is powerful and
00:44:00.000 --> 00:44:01.599
When you work in a private practice, that is it.
00:44:01.679 --> 00:44:03.280
So of course it made me feel good.
00:44:03.679 --> 00:44:03.920
You know?
00:44:04.079 --> 00:44:05.760
Um, but I think that's what we're trying to do.
00:44:05.920 --> 00:44:06.800
It's what we're trying to do.
00:44:06.880 --> 00:44:20.239
But I think developing what your um uh how you see patients and your demeanor, I think that's important, and the ability to go above and beyond when it is appropriate for certain patients, but not making that your norm.
00:44:20.400 --> 00:44:21.360
And that's the difficult thing.
00:44:21.599 --> 00:44:21.840
Yeah.
00:44:22.000 --> 00:44:22.800
When do you do it?
00:44:22.960 --> 00:44:23.760
When do you not?
00:44:23.840 --> 00:44:27.199
And put your foot down and how do you protect yourself and the staff around you?
00:44:27.360 --> 00:44:45.119
Because side note, I will say one of the most painful things that can be a after-effect of something like this is the uh the downstream effect of somebody being verbally abuse, like mean to staff, mean to you, what whatever.
00:44:45.280 --> 00:44:52.000
And as it escalates up, the the person above uh dissipates it.
00:44:52.079 --> 00:44:55.679
What I'm trying to say basically is like cut that, whatever.
00:44:55.920 --> 00:45:03.039
What I'm trying to say is like somebody is mean to your staff and then is nice to you when you come in.
00:45:03.280 --> 00:45:04.800
And so it's it's a power move.
00:45:04.880 --> 00:45:05.440
It's a power move.
00:45:05.679 --> 00:45:08.559
Is that though belittling your staff?
00:45:08.639 --> 00:45:13.840
Does that I know because I've worked on all sides of it, like that is hurtful to them, right?
00:45:13.920 --> 00:45:17.760
Because it's like they are it's okay for them to be treated that way.
00:45:17.920 --> 00:45:29.199
Or if have you had a patient that's like been not super nice to you, and you know, then the the doc accommodates what they're wanting to do, and it's like okay for them to not to treat you that way.
00:45:29.360 --> 00:45:31.280
And like I I get it, I get it.
00:45:31.360 --> 00:45:40.719
And these are very multifaceted circumstances, but like, yeah, those those are tricky because you have to like protect those around you too.
00:45:40.880 --> 00:45:41.199
Yeah.
00:45:41.440 --> 00:45:41.599
Yeah.
00:45:42.079 --> 00:45:46.880
No, it's super tricky, but I also think when patients come in and they do that, it's a power move.
00:45:47.039 --> 00:45:47.280
Yeah.
00:45:47.519 --> 00:45:53.599
I think once they get your ear into the provider's ear, they know that whatever you say about your interaction is gonna trump everything else.
00:45:53.679 --> 00:45:54.719
It just it creates that.
00:45:54.800 --> 00:45:56.400
I know, and I think they do it on purpose.
00:45:56.639 --> 00:45:56.960
Yeah.
00:45:57.519 --> 00:45:58.559
It's weird.
00:45:59.199 --> 00:46:00.400
Um, okay.
00:46:00.719 --> 00:46:02.000
So I don't know.
00:46:02.079 --> 00:46:04.239
I don't even know how how to end this, how to close it.
00:46:04.400 --> 00:46:14.400
I did have some things that were like comparing this to other uh jobs and things, and like it's just like it's not comparable.
00:46:14.559 --> 00:46:25.280
Like, yeah, you wouldn't ask other, you wouldn't like go to the shop and you know, ask for something to be done for free just because you can't afford it at the time.
00:46:25.840 --> 00:46:43.199
I know, but again, in the world where there's AI and you have a virtual assistant available all the time, and even we've seen things change for us, that the ways patients can get a hold of us, you know, goes into setting expectations of 100% availability all the time.
00:46:43.440 --> 00:46:47.599
So it used to be that you have to call between the hours of eight and five.
00:46:47.679 --> 00:46:56.000
And if you don't, like I call, you know, my dentist, it's never opened past 12 on a on a Friday, and I know I'm not getting a hold of them until Monday.
00:46:56.079 --> 00:46:56.159
Right.
00:46:56.320 --> 00:46:59.519
It is not the expectation that I can like go online and text them.
00:46:59.760 --> 00:47:00.960
Our system, you can.
00:47:01.119 --> 00:47:01.519
You can, yeah.
00:47:01.760 --> 00:47:04.239
You can go online and you can text and you can leave a message.
00:47:04.400 --> 00:47:15.119
And because that opens the door for that being an available way of contact, now that patient is actually mad that you did not reply for three days because they did Friday at six and you didn't get back to them till Monday.
00:47:15.199 --> 00:47:16.159
Why did you wait three days?
00:47:16.239 --> 00:47:20.000
I'm like, listen, like, but I mean that device is not turned off.
00:47:20.239 --> 00:47:23.519
That's not like our system says, Hey, you can't do it.
00:47:23.760 --> 00:47:26.079
They allow you to, therefore, it's setting the expectation.
00:47:26.239 --> 00:47:30.960
I think the world that we live in and where this is all going is it's not gonna get it's not gonna get easier.
00:47:31.199 --> 00:47:33.840
But um pair that's not like limit on these things either.
00:47:33.920 --> 00:47:50.639
Like somebody can send us a portal message and ask the entire visit to be repeat, you know, continue to ask you questions that should theoretically be an in-person discussion, and you're spending your after hours time, your weekend time doing your your job.
00:47:50.880 --> 00:47:51.840
Yeah, doing the visitors.
00:47:52.079 --> 00:47:53.360
Do you even have a life anymore?
00:47:53.599 --> 00:47:56.000
Like, are you ever not working?
00:47:56.320 --> 00:48:00.639
The answer is no, the answer is no because PAs go before PAs go beyond.
00:48:00.719 --> 00:48:01.679
That's a great way to end it.
00:48:01.920 --> 00:48:02.719
Yes, yes.
00:48:03.039 --> 00:48:05.280
With that, happy PA week.
00:48:05.360 --> 00:48:08.159
Don't forget that it still continues on Monday.
00:48:08.480 --> 00:48:16.159
So whoever's listening to this Monday morning, just remember that it's still PA week and I want my last 24 hours of recognition.
00:48:16.320 --> 00:48:18.480
Yes, and we do appreciate PAs.
00:48:18.639 --> 00:48:22.880
And I even those that work here and those that I've worked with in the past, I think you guys are all great.
00:48:23.199 --> 00:48:25.360
Um, so till next year.
00:48:26.000 --> 00:48:26.559
Bye.
00:48:26.800 --> 00:48:27.280
Bye.
00:48:37.199 --> 00:48:39.679
Thanks for tuning in to Joint Effort PAs.
00:48:39.840 --> 00:48:45.840
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00:48:46.000 --> 00:48:50.800
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00:48:51.039 --> 00:48:51.920
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