Medical Office Inefficiencies = Lessons for Dentists

Dr. Kuba is all bent out of shape today over a recent medical visit. She recaps multiple instances of inefficiencies that push her to pause, reflect, and consider the hidden lessons. She and Bethany dialogue about the potential causes of such inefficiencies as well as what dental teams can do to avoid chronic medical mistakes. Everyone can relate to those terrible medical experiences, but today’s episode will help you to stop and consider the lessons to be learned in thinking through these scenarios. 

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Transcript

00:01

Are you looking for a podcast where you can hear from real people regarding their real dental drama? If so, then you've come to the right place. Join hosts Bethany Petty and Dr. Reena Kuba as we dive into the solutions we've created and the mistakes we've made while managing dental drama.

Let's get started.

00:26

I'm good. My brain's kind of all over the place here. I do have a topic for us.

00:35

Okay.

00:36

And I will try to rein my brain in. Okay. Cuz I just feel like... What day is it? What month is it? It's freaking August apparently.

00:41

Rein the brain. Rein the brain. That's good.

00:49

Rein the brain. Okay. So, we kind of talked a couple weeks ago about being a saboteur. Do you have a saboteur in your office? Are you the one sabotaging your practice?

00:57

I experienced what I feel like this doctor completely sabotaging himself. And what I liked about it is that it wasn't dental, it was medical.

01:03

Y'all know I have said over and over again how I think medical is a show and they get away with crimes as far as I'm concerned of customer service. Y'all should be embarrassed if you're a medical doctor. I don't know you and I've not been in your office, but I can guarantee you are not following proper customer service, and y'all get away with it because you're medical.

01:30

But how you can stand the lack of satisfaction is beyond me. So, bless all of you. I don't know. Or curse all of you.

01:39

But you have enough on your plate that you don't even know because you think you're healing and you're God and it's all fine. Anyway, tell us how you really feel.

01:50

Yes. And so I say this off of endless doctor's appointments I'm taking my parents to. It's like I'm seeing nephrology, hematology, cardiology, PCP—you name it. I'm going in and out of these offices, and I have yet to find anything that I could commend about any of these offices.

02:07

That says a lot.

02:14

Yeah, that's pretty terrible. So, speaking of terrible, this is one experience that I saw. I'm picking on this doctor because I really was very tempted to send an email or call his front office and be like, "I just feel bad for him."

02:30

He's young, in his forties. I think he just turned forty earlier this year. He started another practice around the same time I had started mine.

02:40

I'm seeing so many things wrong with that. He just had a second baby this year. To me, I'm like, this guy is probably working his tail off thinking he's making good money. I have not seen his financials. I don't know.

02:54

Again, I'm not a consultant. I just know what I know from years of working with you and things that you point out to me. Bethany would probably be in hives just watching the gross inefficiencies in this office.

03:10

He's a pain doctor. I guess he's an anesthesiologist and then went into pain management. Why I'm picking on him more is because he's not affiliated with a hospital system or anything like that.

03:20

He's on his own.

03:21

He's on his own. He's like a true private practitioner just like us. So then I'm like, this podcast is meant for even chiropractors. My chiropractor is the sole owner. She bought it from the other doctor, and she's listened to some of our podcast because she's now an owner. It's not dental, but it's applicable.

03:39

I can see all the things that this guy is doing. I'm not a consultant guru, but even I'm picking up on these things.

03:56

As a consumer taking my parents to this practice, we are so fed up with the care we're getting. I'm going to elaborate on that more, but I start going, "Man, these are all relatively easy little tweaks you could be making to not annoy the hell out of your patients."

04:17

You're there to help people with their pain. I know you care about people in pain and helping them. Yet look at this laundry list of things you are doing that is actually causing your patients pain.

04:30

You could probably be helping a lot more patients if you would just do these few things of efficiency.

04:37

This last appointment I took my mom to on Tuesday was almost the straw that broke the camel's back. The back... get it?

04:45

She's having back pain.

04:47

It's to the point where even my dad, who is the most laid-back guy, was like, "You need to tell him this is unacceptable and you need to go through all of this with him."

04:58

I got home and I was like, "Did you just tell him all of this?" And I was like, "No, because he's not doing any of this on purpose."

05:08

I think he is that clueless. The doctor himself, if I were to guess, I'm thinking he's phlegmatic.

05:14

He reminds me of a lot of phlegmatic people I know.

05:16

I don't think he has any clue that it could be better.

05:21

I don't think he has any clue that it's not what it could be. He thinks he's providing good care.

05:28

Before he walked in the door, I told my mom, "You be nice. You be nice. Do not go off on him. We just need to get out of here."

05:37

We were there for two hours for an appointment that should have taken literally two minutes. I'm about to go through all the things that he did wrong that he's clueless about.

05:45

When we got home, my dad was like, "Did you go off on him? Did you tell him this is not acceptable?"

05:52

It would have done no good because he has no concept that these things can and should be different.

05:59

I think I could tell he was defeated by the quick thing that my mom did say to him. You could see the defeatedness on his face.

06:07

She didn't go off on him. She just said, "Okay, if I come back, am I going to have to wait two hours again?"

06:15

He was just like, "Oh... are you mad?" And my mom was like, "Yeah..."

06:23

I was like, "Let's go. Let's go. Let's get out of here."

06:32

My sister was like, "I was going to call and tell his staff to quit overbooking him." I was like, "That's the thing. He's not overbooked."

06:42

Every time I go, there are like two other patients in the building. He's just completely inefficient with his time.

06:49

I have specific examples of how he has been inefficient. Telling them to see fewer patients isn't the problem.

06:58

That's not the problem.

07:00

Looking at his face, I could tell he probably hadn't eaten lunch that day. By the time we left the office, it was 5:30. They closed at 4:30.

07:09

So to me, I'm like, okay, you probably haven't eaten lunch today. You probably haven't gotten a pee break.

07:15

You've probably got to go home to a wife that's dealing with a four- or five-month-old and your other toddler. Your second job is about to start.

07:23

You're probably thinking, "I worked you in today and you're complaining about waiting, and I'm going to be the one to get you out of pain."

07:30

That's probably what he was thinking as he's defeated.

07:34

It's not like he's sitting there going, "Cha-ching." He has no clue how inefficient he is.

07:42

I will guide you through what I saw, and then you tell me what you think.

07:48

So, she went in about three weeks ago...

07:54

We're guessing she pulled something because we went on our beach trip...

08:01

With the PCP because we kind of didn't want to go to the pain doctor because he takes forever.

08:07

My sister is the one who usually has to take my dad to his appointments, and it's like we do everything we can to not have to make an appointment because they'll make an appointment at 11:00 and you don't get seen until 1:00 or 1:30.

08:14

Gosh.

08:19

And this is every time for a year. We laugh about it because we know it's going to take that long. So shouldn't we be the ones to be like, "Well, never mind. Why are we scheduling back in this facility?"

08:28

Yeah. But I think when we schedule back, it's because we really do like the doctor.

08:37

He does, once he gets there, help them with their pain. He speaks their language. He literally speaks Hindi, so he can help them with that. Finding another provider... it's five minutes to get to their office, so all the things that matter. It's not just convenient for me, it's my elderly parents. The time they're going to be in the car and the time they're going to...

09:00

Yeah.

09:04

So these things matter. The convenience matters and all of that. His staff is pretty nice. They're kind of useless, but they're nice. It's not like you walk in and there's no standing room.

09:12

There's always a place to sit.

09:17

So, for me, the number one bone I have to pick about it is you're trying to help patients in pain, and the majority of your patients... I've never seen a young person in there. I'll put it that way.

09:30

Yeah. It's always somebody who's at least 60-plus.

09:34

So my first bone to pick is you know these people can't sit that long. Or do you not know because you're barely 40 yourself? Which means are your parents like 60 or 65-ish and they're young and still mobile and haven't experienced pain? Are you truly unaware that this is hard for them to sit there?

09:47

Yeah.

09:54

It's kind of like in pediatrics. You come in with an infant—I can't keep you waiting there for an hour, an hour and a half, 45 minutes. That baby has feeding times, nap times, attention span times. We got to move.

10:03

Yeah.

10:09

So in peds, that's where I'm just like, we don't have time to putz around. If your appointment's at 11:15, we need to see you within five minutes of 11:15. If I'm delivering good customer service, that's the aim right there.

10:22

Now, you could say, "Yeah, I'm a Medicaid office, so I've got to pack people in."

10:30

I still... to me, I'm not okay with that.

10:38

Maybe people on Medicaid are going, "Well, that's how it is everywhere we go." But to me, that's not something I want for myself. I will pay extra money to make sure that I go somewhere that will respect my time because that's not acceptable to me.

10:47

Honestly, to me, the two hours we sat there was great for me because nobody was bugging me. I was shooting off marketing emails. I'm sure you could go back and see. You're like, "Man, I got five emails." I was blowing and going. Things that I don't have time to deal with in the summer, I was able to knock out.

11:03

But my mom was miserable. It's hard for her to get up, to sit down, get comfortable, and then she can sit there for about 15 or 20 minutes, but then now she's in pain again.

11:15

To ask us to sit for two hours before you walk in the door... I think the other part of it is, in her mind, the reason for this appointment—and this is not the doctor's fault, it's insurance. She went in three weeks ago with pain. She wanted a steroid injection.

11:34

So she thought this appointment was the steroid injection. Well, I had to tell her because the office called the day before and was just like, "Oh no, this is not for the injection. This is the follow-up because they've got to document."

11:42

I guess that's fair, right? For once I'm going to side with insurance companies. You've got to make sure that a doctor is not just willy-nilly giving injections to everybody. You want to give it the three weeks to say, "Were there any improvements? Has she healed at all? Did she do any therapy? Is the injection still warranted?"

11:58

Yeah.

12:04

So, fine. That's what this is. I told her, "They're not doing an injection."

12:10

She's like, "Why? I've been in pain this whole time."

12:16

I know, but for insurance purposes they've got to document. This is just going to be a revisiting—"Yeah, I'm not better."

12:20

Okay, great. Let's submit that to insurance. That's why I said it should have been a two-minute appointment.

12:24

Yeah, because last time we documented where you were hurting. We should be able to go back and say, "Okay, last time you were hurting here. Any improvements here? Any improvements there? No? Okay, great. Let's submit this to insurance."

12:34

It really should have been a 30-second appointment, honestly.

12:42

So in her mind she's like, "Wait, I've got to go, and I'm still not going to be out of pain by the time I leave that appointment."

12:46

Yeah.

12:55

That's really tough. So to me, then I start going, okay, well first of all, setting the expectation. Have we done that with our patients? If they're coming in thinking they're getting a crown, but they're not? Or, I guess in dental, a lot of times patients feel the opposite, where you're going to do all this extra stuff they don't need.

13:13

Regardless, key point number one: did you set the expectation? Luckily they did. They said, "This is not to do anything. This is to document."

13:21

Yeah. Can you imagine if that would have just come up in the appointment rather than ahead of time?

13:28

Oh gosh.

13:32

Yes. So then we're sitting there, and my mom is just restless.

13:39

When we walked in, there was only one other lady sitting there waiting. So you don't imagine you're going to wait for two hours when there's only one other patient there.

13:46

Finally, an hour and a half in, my mom's like, "Did they just forget about us?" They had already put us in a room.

13:54

I popped out, and they're like, "Oh, he's just finishing this. It might be another five or ten minutes."

14:01

I was like, "No, it's not. Always triple that." So I just said to my mom, "What do you want to do?" By this point she was crying.

14:08

She was like, "I can't believe I'm having to sit here. I'm in pain. Why does nobody care?"

14:17

The whole time you've been sitting there, nobody's popped in to check on you?

14:22

We've been in there for like an hour and 15 minutes.

14:25

We sat in reception for about 10 minutes. They put us in a room. We're thinking our turn's coming soon because there was only one other person waiting.

14:37

They got us back pretty quick. A lot of times they don't get us back for 50 or 60 minutes. This time they got us back, and we're like, "Oh, this should be quick because it's just a documentation appointment."

14:45

Then nobody came back, and of course the ten minutes was really like 35 minutes.

14:54

So he comes in and he's like, "Okay, so tell me what's going on."

15:04

I'm like, "What?"

15:12

Then he's like, "Okay, where are you hurting? Do you feel it down your leg? Do you feel it in your calf? Do you feel it in your glutes?"

15:19

The way he's asking the questions, it's like he's not really letting her finish her answer.

15:26

Then he says something about, "Well, did you see your scans?" He had sent us for a CT scan in between.

15:34

I was like, "Well, you got the scan."

"Yes, I saw the scan."

Then he goes to his computer to pull up the scan, and I'm like, "I don't want to see the scan."

15:42

"Did you get it? Do you want me to email it to you?"

No, I don't want to read the scan. The point is she's got a lot of stenosis in her back.

15:53

What is the point?

15:55

So basically, I think his point was, "I could try to inject you between these two vertebrae, but it may not be exactly..."

16:03

Where your pain's coming from because you've got multiple areas. So, in our case it would be like, "I've got a toothache on number three, but actually five, four, two also have decay and some cracks going on, and so does 30 and 31."

16:10

Yeah.

16:17

So, we think your pain is coming from three, but I could fix three and you may still have more. Okay, great. I get it. My mouth is old. I've got cracks everywhere. I never got crowns I should have, and I never wore my mouth guard.

16:29

So he's trying to set that expectation that this may not help.

16:37

Okay, but what is your plan then? In my mind, I'm like, what is the plan?

16:41

Then he pulls up the CT. He's showing us the views of where she's got stenosis. Then he's reading us parts of the report.

16:49

I was so rude at this point because I was tired of sitting there.

16:53

Now we've come at a time where I think our appointment was at like 1:45. Well, we're getting closer to four now. I'm going to hit traffic.

17:02

Yeah. Get to the effing point already, man.

17:08

Read the room. We are not... I've already told you I'm not interested in looking at it. You're showing it to me, and I am literally looking at the floor sighing.

17:15

I'm trying to be really dramatic to get you to read my body language. I don't care.

17:21

What is your plan? Where are you going to inject first?

17:29

Then think about all the time that he's wasted going over information that you ultimately didn't even want. You wonder how many patients prior to you he had done that with.

17:34

I'm glad you said that because then at that point he said something like, "Oh yeah..."

17:43

My mom refuses to go for an MRI. She's been in one before. It's too claustrophobic. She absolutely refuses.

17:45

Will not do it. So that's why he said, "Well, let's send you for a CT scan then. At least we'll get some information."

17:55

The patient already knows that you may not be able to do a thorough job because the patient has prevented you from getting all your diagnostic tools.

18:03

Now if my mom is going, "Well, why wouldn't you know where to inject me?"

18:11

Lady, you wouldn't let me do the imaging I needed. That's why. Do you want to go do the imaging?

18:19

No.

18:20

Okay. Well then we're playing a guessing game here. You've got to be okay with the guessing game. Mind you, my parents have been patients there for like two-ish years now. We have never come back and said, "Well, you injected in the wrong place."

18:28

So again, you don't know your patients. You're having the same CYA conversation that you have with every patient. You're not reading the room. You're not remembering your patient. That's a miss in so many areas.

18:38

Anyway, so he goes, "Oh yeah, MRI. Oh yeah, you won't do an MRI. Oh well, whatever."

18:45

Then he says something about an MRI. "Have you ever had an MRI?"

18:49

You don't ask an elderly woman this random question because then my mom goes back 50 years in time.

18:57

"Well, the one time I had an MRI, and it was an open MRI because my friend was an OB..."

19:03

And I'm like, "Oh, for heaven's sake. We're going to go back 50 years. Why are you opening that can of worms?"

19:12

Yeah. Who cares?

19:15

So then I cut in. I was like, "She's not going to do an MRI. This is the best..."

19:22

Then he's like, "Oh, we don't even need an MRI."

19:24

You're like, "Then why are we having this conversation?"

19:30

When he was asking her about her pain, same thing. He was like, "Well, did you fall?"

19:40

Later when I was talking to my dad, I was like, here's the problem. He is asking these open-ended questions of an elderly person. And I'm sorry to any elderly person listening to this, but most of y'all would love to have somebody listen to your stories.

19:49

Yeah.

19:51

We could be here for the next 45 minutes recounting, "Well, was it in 1979? No, that was the time I stubbed my toe..."

20:06

Oh my God. Why would you open that can of worms?

20:08

Yeah. You should be smoother than that, sir.

20:10

You deal with elderly people all the time. You know the rabbit holes you could go down by asking stupid questions.

20:15

Narrow it down. Later at home I was telling my dad, "He's not reading the room. I don't think he's checking his chart notes from before, so you're unprepared for this visit."

20:31

Three, you're not training your team to help you. The team could be asking those types of questions.

20:36

The team should have teed you up. You really didn't even need to poke your head in. You should have just walked in and gone, "Okay, this is our plan. This is what we're going to try. You've had no improvements. The CT scan didn't give us any truly valuable information, so we're going to start with this injection."

20:51

That's what I'm going to write for. You good with that? Okay, great. Wrap it up and move on.

21:00

She went to an orthopedist last year, and that's how he was.

21:06

He made you feel heard, did not make you feel rushed, but was really in there for two minutes.

21:11

Because he was able to say, "This is what I'm seeing. This is the plan, and this is why. If this doesn't work, we're going to come back and do this. You good? Great."

21:18

This pain doctor couldn't do it more opposite.

21:27

He was taking way too much time trying to communicate that feeling rather than asking very clear and pointed questions, showing body language that says, "I'm really into this and I'm really listening," but only needing to be in there for two or three minutes to get it right.

21:42

I think he's laid back and doesn't get on with it, which I see at every single appointment I take my parents to.

21:56

Why are you reinventing everything? That tells me you either don't take good chart notes...

22:02

Or you're not reading them. Or both.

22:11

Nobody wants that at this point when you've waited two hours.

22:16

You want to be out of that office. Then he said something to my mom like, "Oh, are you in pain?"

22:26

We have nothing better to do than sit here for two hours. Yes, she's in pain.

22:33

Now you seem unempathetic because you're asking such a blatantly stupid question.

22:42

Do you not know me well enough to know that I'm in pain? That's why we're walking in the door. You're called Pain and Spine.

22:50

Yes, every person scheduling an appointment is in pain.

22:56

So to me, you're just completely missing it. Even when he started his second office, I kind of said something because it was around the time I started mine.

23:04

Did you hire an associate?

23:12

Oh gosh. So basically you've taken all your patients from one office and scheduled them in the second one.

23:20

What's the point?

23:21

Was it to gain more patients? You may gain some, but you're only in that location two days. Now you're in your primary location three days.

23:29

Can you manage that patient load?

23:32

If you're already struggling with the patient load you have, and you're struggling because you're inefficient, opening a second office... how did that help?

23:43

I'm like, who's advising you?

23:48

Probably nobody. And if he's phlegmatic, he's probably not directing his team in ways they can help.

23:56

Exactly.

23:57

He's just like, "I've got to do it all." He's got capable team members there to help, but they don't know how.

24:06

Exactly. What should have happened in this appointment is the assistant who got us back...

24:14

She did ask about my mom's pain. "Where are you? What's your pain on a scale of zero to ten?" Okay, tell me about where...

24:21

You can train your team. They're not the doctor. They don't know about the vertebrae and all the nerves, but you could have a definite system.

24:28

Same as what we do. A child comes in with a toothache, and if the team comes back and says, "She's having a toothache..."

24:38

Exactly.

24:39

Obviously you're there for a reason. I see you're on the schedule for a limited exam.

24:43

So then you'd just be restating the obvious. All the questions our team can ask the patient...

24:50

When are you hurting?

24:53

When did it start? Do we seem to have any sinus issues? They're gathering all of that information for me. Take an IO. Take a PA.

25:02

Take a PA.

25:03

Yeah. So all of that, you're teeing me up for all the things I need to know. So when I walk in, I'm going, "Okay, I know Johnny's hurting on tooth number J, but I don't see any decay on any of these things. You're telling me we're hurting kind of up in that upper left area."

25:20

So we're not hurting with hot and cold, and we're not hurting with chewing, right? Did Natalie convey that properly?

25:25

Yep.

25:26

Okay. I'm thinking it's sinus pressure because I can hear him. He's very congested today. And by the way, number 14 is soon to erupt, as we can see on this X-ray.

25:32

Yeah.

25:35

Now I'm going to take a look in his mouth, make sure I don't see any canker sores or any trauma or anything. But short of that, y'all were just in three months ago. We saw nothing on that radiograph, and comparing it to today's, I don't see anything different there either.

25:41

So my suggestion is going to be: follow up with your PCP if you need to, give some allergy meds, and call me if symptoms persist or worsen.

25:53

But I think if you're wondering if something's wrong, I don't see anything wrong at this point.

25:57

Yeah. Johnny, open up. Let me take a look. Yep. See, Mom? There's no canker sores. Your brushing looks good. Everything seems fine. Is that a workable plan for you? You're going to let me know if anything happens.

26:02

I mean, we're in and out. I'm not reinventing the wheel. If my team just said, "We're in pain," and then I go in, "How are y'all today? Blah, blah, blah. Tell me about this. Tell me about that." And then if I'm at that point going, "Okay, what X-ray did I last have?" Now I'm digging through chart notes.

26:18

I'm not doing that in front of the parent.

26:25

Why? Why trap myself in that room when I could be checking other patients?

26:30

But then also, if you came into that, let's just call it unprepared. If you are data gathering yourself for the first time, you haven't gone back and looked at the last X-ray that you had on the tooth. You haven't gone back and looked at the chart notes. Then you feel this pressure to perform.

26:46

Yes.

26:47

So now we've got to pull up the X-ray, and we've got this moment where we're like, "Well, we need to recover and make sure the parent knows that I know what I'm talking about. So let me walk you through this X-ray. Let me show you all the things."

26:55

So when I think about the pain doctor for your mom, I'm wondering if some of that is, "I've got to contribute some value to this appointment to help smooth some things over."

27:03

Whereas, if you've done all your homework, your team's gotten all the relevant information, you've looked at the prior chart note and the X-rays, you're walking in and you're already 70% through that appointment.

27:18

Yes.

27:19

Now you just need to finish it.

27:25

Now in my office, that patient didn't wait two hours. That patient didn't wait at all. They were brought back. But still, the fact that I'm coming in... I've been able to check other patients in that same amount of time that my assistant's data gathering, and then I come back and I repeat it. So it's not like I'm just not listening to you.

27:41

Yeah.

27:48

I'm repeating back and going, "This is what Natalie told me—that you're this, this, this. Is all of that correct?"

27:53

Great. Well, I went ahead and looked at the last note, and the last note we mentioned that there was no molar. Is there still a molar there? We're not sure.

28:00

Okay. I don't think so based off the photo we took, but when I compared it to last time..." So I'm teeing myself up to look like I'm not just bumbling in here with no knowledge.

28:10

I'm in here and I have thoroughly armed myself with everything, and I am up to speed on this situation. Unless you have anything to add.

28:18

No.

28:19

Did I get it all right?

28:20

Yep.

28:21

Okay. And you're out the door.

28:26

If you are a storyteller, maybe you've got four kids and you can't keep your kids straight.

28:29

Now I've trapped myself in the room even longer because you're like, "Wait, was that Jimmy or was that Johnny? I can't remember. Wait, who was it? When were they hurting?" Patients can really muddle up the situation.

28:36

So how are we taking control of that? Controlling the narrative, making them feel heard at the same time, making them get the value of why they came.

28:45

Because if you're leaving and I'm not giving you an antibiotic, I'm not giving you a pain med, I don't have a plan, it's very possible you could leave upset with me going, "She didn't listen to me."

28:54

Yeah.

29:00

Because she didn't spend enough time with me. But my argument back is, was it useful time or useless time?

29:07

To me, I think that's probably what he was doing. He's like, "Oh, they've waited this long." His team has already told him. I've already popped out asking, "Are we being seen today or not?" So now he's trying to perform.

29:19

And I'm like, "But I don't have time for this."

29:22

Yeah.

29:23

I just want to get out of here because either way, you're not going to give her an injection today. There was no reason. His assistant could have gotten all of that information, and then all he had to do was, between patients, excuse me for one moment, pop your head in and then leave.

29:38

Yeah.

29:39

Now let's assume my mom was in a Chatty Cathy mood and you didn't want to get yourself trapped. That's where you could be like, "Oh, is there more to it than this? Okay, I'll be back."

29:50

Yeah.

29:52

I want to hear this. This is important information. Let me pop over, get this other patient wrapped up, and I'll be back to listen further.

29:58

Then we could be like, "No, no, no, no. We're good. There's no new information to add."

30:03

Right. You're setting everybody up for failure here. And then just looking at him... you look tired.

30:10

Yeah. It's an hour past when you should have left this building. You're exhausted, but you did it to yourself.

30:16

Yeah. So when my sister's like, "I'm going to ream the front desk out."

30:19

Why? What is the purpose of that? The front desk can't do anything until he decides to train them up.

30:24

And then I'm assuming too, while he's in the room with you, there's nobody in the room with him like a medical assistant.

30:29

There was this year. I feel like in the last three or four months. But I'm like, you're not contributing anything either. You need to give her a lot more to do.

30:37

If he was leaving now, not until 6:00, does he still have all of his chart notes to go back and review? Does he have all this admin stuff that he's likely doing after patient care?

30:51

I would bet he is. Even though he's got her there, just kind of knowing the other phlegmatics I've worked with, I'll leave it at that, it probably is going to be done on their time when they're ready to do it.

31:02

But I'm like, no wonder you're tired all the time because I happen to know you just started this other practice and you have another baby at home.

31:08

Yeah. There's no way you're getting enough sleep, enough rest, enough you time, and you're just burning and going, completely oblivious and completely inefficient.

31:18

Yeah.

31:18

At what point are you going to burn out, dude?

31:21

But then I also sit here and think about, as we discuss it from a medical standpoint and the inefficiencies of that medical atmosphere, you're absolutely right. It parlays over into dental all the time. We have to ask ourselves the same questions. Are we making some of the same mistakes that this doctor is making? Are we either unaware of the impact of those, or are we feeling like we're burning out at both ends and we can't figure out why?

31:46

I would wonder how many times the way that we're conducting the schedule and managing it... is it truly efficient enough?

31:54

That's exactly what I was thinking.

32:02

I think I see this because I can tell from my own self. If I haven't looked at that chart ahead of time...

32:11

Because you're asking, "What brings you in today?" You should know what brings us in. She was in pain three weeks ago. You sent us for a CT scan, and you should know that you haven't done anything to relieve that pain.

32:18

Why do you think we're here?

32:21

Why do you think?

32:24

Yeah. You haven't paused. But could your team member have updated you on all that?

32:32

But I don't think you've trained your team up to do that.

32:35

Yeah.

32:40

They're all sitting around trying to figure out how to support. There's nothing they can do because you haven't guided them to do that.

32:48

So for me, if I were able to say, "Hey, man, have you ever thought about getting some coaching? Consulting? Maybe he needs a counselor too. What do I know?"

32:56

But you are grossly inefficient in a lot of ways. Who am I to say that to him? I just feel bad. You're this young doctor who's got a lot on your plate, and you've got a gift of helping people.

33:05

Patients feel comfortable with you. You don't have an air about you. You speak multiple languages. You make your patients feel comfortable. You're not intimidating.

33:16

You're very knowledgeable, and yet your patients are leaving pissed off and trying to look for other providers because of these inefficiencies. Or they're coming back because they do like you, but every visit they're leaving going, "God, am I going back to that place again?"

33:24

Dissatisfied.

33:33

Yes. I just feel bad. Has nobody bothered to tell him this?

33:36

Yeah. And oftentimes you can't see that for yourself. You know something's broken. You know the day feels far too stressful, but you can't figure out how to fix it. I feel like that's very common.

33:49

So my key takeaways there, and I think they parlay to dental as well. Number one: are you training up your team?

33:57

Mm-hmm.

33:58

Two: are you doing the prep work you need to be doing?

34:06

And I think three was... I don't even remember what three was.

34:13

Well, I would say at least three, from my perspective, is do you have somebody from the outside that can look and evaluate how you're conducting appointments?

34:22

To me, the key person in that room with him is the medical assistant. If she's in there with him, then he could consistently ask her, "How do you feel that conversation went? What could I have done to do it better and faster?"

34:39

If your team can get comfortable giving you that feedback, or pick a couple of patients that you know and trust and ask, "I'm really working on making appointments better. What do you like most about the appointment? What could I do to make things more efficient for you?"

34:47

We're so afraid to ask for feedback—from coworkers, from colleagues.

34:56

For this pain doctor to go to another private practice colleague's office and watch their operations. "Let me see how you do it. Let me see how you conduct that appointment."

35:05

I think we're so hesitant to do that because it's an investment of time. It's awkward to ask for that feedback. Or do we really want to hear that feedback?

35:20

But play out what happens if he doesn't do anything different. He's already got two small kids at home. He's leaving the office way later than he should be. He's probably got all this admin to do at night. He's burning out at 40.

35:33

You're talking about your livelihood here. Yes, it's uncomfortable to ask for that feedback and make the investment of time to get it. But if you don't, you're talking about 15 or 20 years of feeling burnt out. That's not worth it either.

35:48

To me, it makes more sense to pause, get the feedback from either patients, team members, or colleagues, and help yourself run things more efficiently.

35:58

But I think in his case, I don't think he thinks he's doing anything wrong.

36:01

The fact that you're waiting for two hours doesn't seem to bother him.

36:07

I don't know what to say about that.

36:12

Yeah. To me, that should be unacceptable across all fields. If we've got those kind of wait times...

36:20

Maybe he doesn't even know that there are those kinds of wait times. But why would he not know?

36:24

Why would he not know? It's a small practice.

36:26

You can look at the schedule and be like, "So-and-so was scheduled at this time. I got in there at this time."

36:31

Maybe he doesn't know what time he got in there. Maybe he's not paying attention to that. But that's where the team can help too.

36:39

I don't know what medical software has, but a lot of our software tracks the appointment—what time they arrived, what time they were seated. Are we looking at that?

36:47

If we don't have software that can track that, people can. You've got an assistant in there.

36:51

Have her document. I call it a time study.

36:56

Document what time the patient got here. What time were they seated? What time did the doctor get in? What time did the doctor touch a tool to the mouth?

37:02

How long did we touch a tool to the mouth? Did he or she have to get up and go do exams? How long were they gone? When did they come back?

37:11

We can really focus on efficiency if we will try to focus on efficiency.

37:17

I think it's time well spent, honestly. But I think the problem in this case, and I think for a lot of us, is going to be, "No, it's not a problem..."

37:25

Doctor's office or whatever it is. Or, "I'm the only show in town. People will have to come here."

37:34

I don't know, but just for your own satisfaction—not even your own satisfaction—your own productivity.

37:36

Yes.

37:36

I don't know. It just seemed like we were breathing the air in your office for two hours that we shouldn't have been breathing. You should have gotten us on our way so you could pack in somebody else.

37:45

Yes.

37:49

I'm sure you didn't get paid much for this revisit from insurance. You would think you'd want that to go as quickly as you could so you can get the approval for the big-buck procedures, which would be the injections.

37:57

My mom's like, "I don't want to go back there."

38:05

I'm like, "Where else do you want to go? We're going to have to start over at this point. We've already made it there. Get this one last injection, and then I'm going to try to get you an appointment somewhere else."

38:14

We may hate that person even more. We don't know. But luckily, we're not in Podunk, USA. We're here in Dallas. We have options.

38:20

Anyway, this was the only other slight thing that I was saying. Here's an example of a non-sabotage.

38:29

It was the nail salon. My niece was in town, and my niece and one daughter wanted a pedicure. I had already gotten a pedicure about two weeks ago, so I was like, "I'd rather just be in and out."

38:36

I walk in with them. They get started. I come in and sit in one of the empty seats, and I can hear, in a different language, the tech working on my daughter holler out to the manager.

38:44

The manager comes back, they're speaking in another language, and then the manager looks at me and says, "Nah, yours looks pretty good. You were just in a couple weeks ago."

38:59

I was like, "Yeah, I was. I'll be back next week. I want to keep my appointments separate."

39:08

She was like, "Okay."

39:08

I know what was happening. That tech was like, "Here's another victim. Why is she not getting anything done? She's got no polish on her nails..."

39:16

Yes.

39:18

She's got polish on her feet, but why can't we? We've got two techs sitting around that could be working on her too.

39:24

To me, you're trained to go, "Who else here could..." Scheduling Institute teaches us this. Somebody walks in with four-year-old Johnny and Mom is carrying another baby. Has the baby been seen? When was the baby's last visit? You try to get...

39:32

It's a win-win for everybody.

39:40

Absolutely. It's helpful for the parent because she's not having to reschedule the baby at a different time.

39:48

We can go ahead and get that done today.

39:49

It's helpful for the practice because we took one kiddo and turned them into two today. It's a win-win. So, watching for those opportunities.

39:57

Is your team trained up? This tech was trained up to go, "Another victim."

40:02

Somebody else. She's got to need something.

40:04

We offer waxing. We offer nails. We offer feet. She's got to need something. See what she needs today.

40:11

I thought that was a brilliant example of, "We're paying attention."

40:15

This lady's literally sitting in a chair. We can make the most of our time. We've got people available. Let's be super efficient and get her taken care of as well.

40:23

Absolutely. That's a well-trained nail technician.

40:28

How about that? So the nail salons have it down, and the medical offices don't. What does that say about us?

40:37

Have I said how unimpressed I am with medical?

40:41

I don't know if that's come across clearly enough in this podcast.

40:52

All of them. Yes. Yes. That is what I'm saying. All of them.

40:57

Thanks for joining the conversation today. We hope that you are comforted in knowing that you are not alone, but we also hope that you're walking away with some really great tips and tricks to try in your practice.

41:10

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41:18

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41:29

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