Orthopedics in the Age of AI

What happens when artificial intelligence enters the ortho world? In this episode of Joint Effort PAs, we dive into the rapidly growing role of AI in orthopedics and medicine — from clinic documentation, imaging interpretation, and patient education to surgical planning, content creation, workflow efficiency, and the slightly terrifying possibility of robots coming for our jobs. Sidenote to docs- ChatGPT can't close as well as us. 

We talk about what AI actually does well, where it still completely misses the mark, and how providers can use it as a tool without losing the human side of medicine. 

Will AI replace orthopedic providers? Probably not.
 Will it change the way we practice forever? Absolutely.

Expect opinions, hot takes, laughs, mild existential crises, and at least one moment where we question whether the algorithm knows us better than we know ourselves.

Transcript

SPEAKER_01 0:00

Welcome to Joint Effort PAs, where two orthopedic surgery PAs get real about life in medicine. From tips and tricks to professional growth, work-life balance, and everything in between. We're here to share what we've learned and what we're still figuring out. Let's get into it. All right, guys, we're back. We're gonna talk about a very um modern topic. Yeah, I think it's modern very modern topic. Very relevant. AI use in orthopedics.

SPEAKER_02 0:31

So AI obviously has blown up over the past couple years. Um, but in medicine, I mean, we are not in our own bubble. We are exposed to it as well. And like for better or worse, um, we use it every day. Yeah. Right.

SPEAKER_01 0:46

And when was like when do you feel like AI became something you were even aware of? I feel like I'm always late to the game on most everything in life, like wide leg jeans and all the center parts. Center parts, um, socks that show past your ankles. I just recently started doing that, and I think it might not be cool anymore.

SPEAKER_02 1:09

Uh, because you're so late. Yeah, I'm so late to it.

SPEAKER_01 1:11

The notion of socks are probably back in already.

SPEAKER_02 1:14

Um honestly, I think I think like the availability of AI for me to like want to use it maybe like a year ago. But when I say it like that, if you look back at our EMR, our EMR has prompted like AI things, as has our email for a couple years now.

SPEAKER_01 1:31

That's true. Yeah, I mean, I remember like this was a long time ago, right? Gmail would, if you're on your phone and you started typing something, it would try to like finish your sentence for you.

SPEAKER_02 1:41

Yeah. So that I think um I think it's been around a long time, but I think my desire to use it and kind of lean into it for about a year now.

SPEAKER_01 1:50

Yeah. Yeah. I think the doc I work with like started using, we started talking about Chat GPT probably a year ago. Yeah. And I started using it for like more personal things at the time, and then slowly started to see the benefits of using it for work-related things. Um, and I've actually been to uh several conferences where they've had sessions on AI. So people are using AI not just in private practice clinic settings, it's not just us, it's being used in hospitals, it's being used for a lot of stuff. Um, and actually, it wasn't our our all-staff meeting this year. AI was like a big session.

SPEAKER_02 2:30

Yeah, they did a whole session on encouraging us to lean into it to make our jobs easier, which again, I feel like that is a very loaded sentence because there's so much trust that you need to put into it. And if you don't go back and check what you are essentially sending out as your own, yeah, you know, I don't want to put my my name or my stamp on something that sounds stupid. For example, I have a friend who um very recently got back in the workforce and graduated college in like late 90s. We're talking 25 years, stay-at-home mom, and now back in the workforce. So she sent me her resume, which was like the email on it, it was like a hot meal email. I'm like, girl, yeah, you gotta update this, right?

SPEAKER_01 3:11

So I know at AOL.com anymore.

SPEAKER_02 3:13

So I screenshotted it and then I put it into AI and I was like, clean this up. And it made experiences that she didn't have. And I did not check it, and I sent it to her, and she was like, I've never worked at a restaurant. And I was like, Oh, weird. Yeah, no, it like took it and made it something it wasn't.

SPEAKER_01 3:29

But um that's yeah, it it does some crazy stuff sometimes. So you do have to be careful, and I think that's like the initial like my initial thought if somebody had told me like two or three years ago, or even when I was in PA school, like, oh, you're gonna use AI to this capacity, I feel like it would have been thought of as a negative thing, like, ooh, yeah, your notes should be 100% like your own writing, and you shouldn't be like using, you know, AI to help you come up with treatment plans that should come from your own brain. But look at the progression of things from medicine like a bajillion years ago when people had to read textbooks and then like remember things and then could go back later and like pull their textbook off their shelf and you know, turn to the page and reference it. Then at at the time that I was going to school, I mean, the internet obviously was is a thing that old. Um, so you can Google things like right, you have your smartphone with you, you're on your ER rotation, and somebody asks a question, and you you can look it up within seconds and find an answer, you know, on your phone if you know where to look for the appropriate sources. Now you don't even have to know where to look for the appropriate sources, you just have your Chat GBT app up and be like, hey, what's this?

SPEAKER_02 4:45

When I was in PA school, we we were um actually documenting like writing charting that way. And it was like shorthand soap notes, yeah, you know, and then EMR, the very basic EMR was a thing when I was a PA, and then obviously that has progressed quite a bit. So even with EMR, like simplifying dot phrases, right? Like the things that you say all the time, you can just save it instead of freehand writing it. Yeah. Um, so that you know, that made things easier, but then now you take AI and you can go to the next level and um, you know, make your notes ridiculously like detailed, verbose. And we live in a world where the details that are in our notes determine how high we can bill, right? So it's time consuming to dictate all the differentials, all the things, all the conversations you had, the risks and benefits, um, the follow-up conversations, let me review all the labs. Like that's a long time. Or you can say, hey, you know, AI, take the last note, summarize it, add to this note, boom, done.

SPEAKER_01 5:42

Yeah, condense it, make it make it sound smart, make it sound like somebody smarter than me wrote it.

SPEAKER_02 5:47

Yeah. So what do you think you use AI for, like on your daily, right? So let's say you're in clinic.

SPEAKER_01 5:53

In clinic. Um, okay, so I have not gotten to the point the doc I work with uses it to make a lot of is most all of his notes at this point. I haven't gotten to that point because I'm still really like, I don't know, if old school is the word, I like to hand type a lot of stuff still. Um, but for my more complicated ones or a new visit, or if I want to be sure that I can bill at a certain level, that's what I use it for. So if I am seeing a new patient and I want to make sure I'm hitting all of the points that I need to to bill a certain level, then I put that information into AI and I say, hey, this is like a brief summary. I'll go ahead and give it like a paragraph of what I saw them for, what I did, and just like expand on it and make sure it hits all the points. And then I can go in and edit it. So I'm not just like saying, Hey, make this copy, paste, done, move on to the next. So there's still work on the back end that goes into it, but I use it for that. Um I'll use it for like decision-making stuff too, or for referencing things, you know, if like oh, what you know, med can I use, blah, blah, blah, with something like that, right? And um, yeah, you have to be careful and double check that stuff, FYI. That is true. I were this was something we were talking about like months ago. Remember when we had the patient that was like a uh axillary nerve palsy? Yes. And we were like, trap transfer, reverse, um, you know, he had he had a failed cuff repair, I think. Um, and asked AI, what are the options, you know, given all of the things going on with him. And it came up with one thing. I was like, that doesn't really sound right. Like, why couldn't we do this because of this? And then I asked AI and it's like, oh, you're completely right, and it re tracked itself, backtracked.

SPEAKER_02 7:44

Um see, I don't think that I would like totally trust AI for clinical decision making. Yeah, you know what I mean? And I don't use that. Like I use AI. I used to, I tried something on my notes where I would go in a room and I would talk to the patient, and AI would be like an AI scribe, right? So it would be like not a person, I guess. It would just be my microphone on and it transcribed the visit for HPI and then assessment of plan. I hated it.

SPEAKER_01 8:10

Yeah, now that's the one that's like that's a service that's like a HIPAA compliant AI scribe person, yeah.

SPEAKER_02 8:16

And ideally, like in theory, you put the phone down, I walk in, I'm like, oh, I just you know have my phone, I have an AI scribe, I do my visit, I come out, my note is done for me. Like that would be amazing. But it took more time to edit what it thought I meant versus what I meant, and it didn't summarize the way that I would want to do it clinically, so I got rid of that. But I will tell you, in sports world, I recently just started using this for our ACL patients. So our ACL patients, we will see back after surgery, and then once they get to return to play timeline, everybody is different, right? So, you know, I would love to say that, you know, I live in a practice where we have very specific protocols for high school cheerleaders as different than college cheerleaders, different for running backs in high school, different for running backs in college, different for defensive ends, whatever, whatever. Um, soccer players, year-round basketball players, but we don't. So I can type in to Chat GPT. I have a 15-year-old, nine-month status post-ACL reconstruction. Um uh please design a return to cheerleading, you know, focus on tumbling, whatever, or return to cheerleading, focus on stunting for six weeks. Like that is something that I mean, I hate to say it. I don't think our physical therapists have the capacity to do that. Yeah. And I don't think if you take patient A and patient B, you have such an individualized program for them based on their needs. Or let's say I have a 13-year-old, um, five or sorry, 13-year-old, six foot two basketball player, a skeletally immature, status ACL surgery, um, Medicaid, so limited PT visits, please incorporate a six-month plan for physical therapy and home exercise.

SPEAKER_01 9:55

Like, hello, like that's AI is great for that kind of stuff. I feel like it I when I first started using it, I used it to create my workout programs for myself.

SPEAKER_02 10:04

Yes, yeah.

SPEAKER_01 10:05

Very, very um capable, I feel like, because I've been following different programs for 10 years now, and I felt like what it came up with was very legitimate. You know, what I've had professionals make for me in the past. Um, so I do think that's a really good way to use it, you know. Notes and documentation, um, answering patient questions. It can a little quicker.

SPEAKER_02 10:32

So I did one yesterday. I have this one patient who wrote in, like, we're seeing her for her shoulder, right? Hey, I'm seeing a massage therapist for my shoulder because his shoulder's like really tight. She doesn't want injections, whatever. And I'm noticing now after the massages, I have light cramps. I've done electrolytes, I take magni magnesium. Like, what else is going on here? Literally, chat GBT'd light cramps after massage. What is the lab work I need to order? What are the supplements I need to take? And that's I sent that to the lab, yeah.

SPEAKER_00 10:57

Yeah.

SPEAKER_02 10:58

Because um, you know, I mean, like again, in my wheelhouse, yeah. Like my go-to is like low potassium. Yeah. Her CK is probably high.

SPEAKER_01 11:06

Yeah, but this just like kind of packages it all together for you in a way that sounds nice that you're not like you know those things, and you're gonna be able to catch if something it's saying is grossly off, but it's just making it quicker for you. Yeah. Um, prior auth letters or denials or like um medical necessity letters. Yeah, we do it. So if we get denials and I need to write a letter of an appeal or something like that. Um Yeah.

SPEAKER_02 11:32

So again, like um, I want to do an Oates for a patient. Please, uh, please write a letter of medical necessity differentiating success rate with Oates versus microfracture versus um ORIF and cite six resources. Yeah. Like that's done in three seconds.

SPEAKER_01 11:50

Now the resources thing. You have to be careful with that, because it makes up resources sometimes. It uh it fabricates studies uh wild that it feels bold enough to do that.

SPEAKER_02 12:01

But but I would say um, you know, not to to knock our PT friends, but very specialized PT protocols, um templating certain things, and then you know, I think just streamlining everything. I don't use it for documentation. I really don't because I don't I don't like it. Yeah, I don't trust it.

SPEAKER_01 12:17

Yeah, I mean I I do think that it helps me know at least how many points I have to hit from a billing perspective, and it helps me like create that initial outline that I can then go and um and you know build off of basically.

SPEAKER_02 12:32

So do you think new PAs coming out of school should be fearful of AI, or do you think they should lean into it? And I'm I'm gonna tell you where I'm going with this.

SPEAKER_01 12:41

Double-edged sword, I feel like. Um I feel like even myself, I've gotten really reliant on it, even in the past couple of months. It's so easy to, you know, you have a question about something, just pop it in there and get an immediate answer and not go through the traditional means of researching something and finding out the answers yourself that you're not really getting like that solid background knowledge. Um, it's just an instant, immediate gratification. We live in instant gratification society.

SPEAKER_02 13:12

But it's it's tricky though, because let's say you're a new PA and let's say you're working in our urgent care and you see a patient come in with medial knee pain. And if you don't ask the right question, like, hey, what are the differentials for medial knee pain? Yeah, that's gonna give you everything, and then your notes gonna sound stupid. Versus I have a 15-year-old female, non-contact injury to the knee, this is how she presents where the differentials, right? So I think if you're allowing AI to do the work for you, it's a crutch. Yeah. I really don't think that that's gonna benefit. Also, if a patient can just put in on their own, hey, it hurts on the inside part of my knee. What is this? Like, how are you any better than that?

SPEAKER_01 13:48

Yeah, back to your point, will we be replaced by AI?

SPEAKER_02 13:52

No, no, no, we don't have the type of career that is. No, it's also we personally never be replaced.

SPEAKER_01 13:59

Can't be replaced by AI. Can you be replaced by AI? Maybe I need to be able to do that. That's a different question. You need to look inwards for that answer. Um, but I know we certainly can't. Um AI do the best job assisting in a carpal tunnel release. No. Probably not.

SPEAKER_02 14:15

But honestly, we are so heavy procedural-wise, I don't think that's ever going to be replaced. And I think the nuanced stuff that we do, um, again, like if I have a patient that comes in for their algorithmic one-week follow-up, three-week follow-up, and everything is going normal, okay, great. Like that feels routine as I'm doing it. Could an AI do that? Sure. But I think getting your hands on somebody and talking to them and putting it all together.

SPEAKER_01 14:42

Like, would a person come into like an office room and like talk to talk to a robot and be like, How are you? Good, good, see you later.

SPEAKER_02 14:49

You know, no, no, but like I I mean, compare that to like a restaurant. You can come in and tell a robot what you want to eat. Yeah, yeah.

SPEAKER_01 14:58

They might do a better job sometimes.

SPEAKER_02 14:59

They might do a better job, yeah. But um, if someone comes in and they're struggling with something and you kind of have to tease through that at the visit, I think that's you know, that's what we do every day. We problem solve on the fly, and I just don't think AI can replace that. And if they do, I feel like it would be like put into lanes, like in scenario one, it's this, scenario two, it's this. Whereas you and I know sometimes there's so much overlap. Yeah.

SPEAKER_01 15:21

Also, the hands, it can't replace our hands.

SPEAKER_02 15:24

Can't replace our hands, uh-huh.

SPEAKER_01 15:26

So that's that's important.

SPEAKER_02 15:27

Most valuable assets. Yes. But I think again, for new PAs, I think relying on it to take the place of knowledge not good, because guess what? You have to take your boards again and again and again without AI. Without AI. So you definitely need that, um, that there. Now, with that being said, in the world of orthopedics, don't you think that there are some things that can be replaced?

SPEAKER_01 15:50

I do. I mean by AI. Yeah, yeah. And I mean, we going back to note-taking, that's definitely one of them. AI scribing, like I think that's becoming big everywhere. Um, I think that it also, and this isn't really answering your question, it's kind of going off a little bit, but it it empowers patients a little bit to know maybe more about their conditions and options coming in because AI is actually pretty solid. Yeah. I was looking at some studies a couple weeks ago in one of the hand surgery journals about the accuracy of uh, I think it was specifically diagnosing carpal tunnel symptom for patients plugging in, hey, these are my symptoms. What do you think I have? And it was pretty dang accurate in diagnosing carpal tunnel um versus, you know, the person coming in and being diagnosed with it. So pretty similar.

SPEAKER_02 16:39

Um but I think the conversation though, like what it is lacking, and again, maybe finally here are my symptoms I recovered tunnel. Okay, I am a full-time mechanic. What are my limitations? Like you can ask follow-up questions, but at the same time, if they saw you, they have the atrophy, they've been numb for three years, like that's a conversation.

SPEAKER_01 16:56

They don't know how to ask for what they don't know about. Correct. Yeah. And they also can't, you know, AI can't deliver the treatment plan, can't do the injection. Um, but yeah, there you don't know what you don't know. So yes, the person can plug in, I have numbness in my hands, and AI can say you have carpal tunnel syndrome, but the person isn't even thinking to ask, like, do they have any other ridicular symptoms? You know, which fingers AI is coming up with what it the most common, most likely scenario, but it's not looking at all the other subtleties that that we would look at.

SPEAKER_02 17:29

So now, as far as um the dangerous side of AI, again, I uploaded my friend friend's resume and it completely fabricated like experiences she didn't have. So let's say you're gonna use this. Yes, there's fake citations sometimes. Yeah, um, when I was using it for um, like I was trialing an AI scribe, it was just making stuff up, you know. Like I think it was taking what I was saying, and I guess implied if AI can do that, I don't know, but it implied and then put it in the the medical note. Now, as you know, or maybe people don't know, patients love to pull up their notes and read it. I didn't say that. Yeah. When you said I refuse this or I elected to do this, that's not what really happened.

SPEAKER_01 18:14

Like they can they can tear you away apart. Yeah, they really will. I got I got like a bad review a couple weeks ago. My note wasn't even closed yet, like it was still in the process of like draft form. It was draft form, and they could see it and they were like, Oh, you didn't write about XYZ in there. And I'm like, Well, my note wasn't even done yet. Yeah, like, oh, the information like that you wrote was totally inaccurate.

SPEAKER_02 18:37

Yeah.

SPEAKER_01 18:37

I'm like, dude.

SPEAKER_02 18:39

Yeah, I know.

SPEAKER_01 18:39

Come on.

SPEAKER_02 18:41

I know. Um, in you know, in other, you know, things that we do every single day. I think sometimes if I'm trying to communicate something via email, I have put my email into Chat GPT and said, like, clean this up, make this more professional. Yeah, you know, try to sound less less angry, annoyed. Yeah. So that'll that'll help me, but do I do that with everything? No, because it's kind of time consuming. I don't want to. Yeah. I don't want to go through six versions of what I want to say because I will have said it and maybe I wanted to sound annoyed when I sent it.

SPEAKER_01 19:08

Yeah. Yeah, yeah, yeah. I know. Sometimes I will plug messages into chat before I send it, and it's like, hmm, you're coming off really emotional here. Like, try this instead. Like, maybe that was the purpose. Maybe I wanted to sound emotional. So I did yesterday, I asked Chat GPT, can you give me some trends of the most common things that I've asked you over the year? Um, and it said the most common things that I will plug in are um billing and coding optimization. So I use a lot of for that. Um, improving surgical workflows, practice efficiency, expanding procedural skills, um, and orthobiologics regenerative medicine, research IRB questions, and um how to become more specialized. So those are the biggest things that that I use it for, at least. Also creating a media and brand presence, but that's more related to this. That's personal. I went off about how many times I ask for skeleton-related graphics.

SPEAKER_02 20:08

Okay, I mean, but duh. I recently, if I just look at my log here, I have um return to sport timeline draft for athletes of various whatever, um, morel laval lesion treatment when it is when I want to avoid surgery, just because there's certain things that we do and don't do. Um, MPFL reconstruction for patients with multidirectional instability. Like I wanted hard statistics on that. Um, return to ACL, return to play after ACL reconstruction and emotional impact, how to measure emotional readiness. Uh, post-PRP inject uh injection instructions for patients. I have patients that I do PRP on and they want to know like when you inject my shoulder for a rotator cuff partial tear, what can I or can I not do? And then that's different than my elbows, that's different than my arthritic patients, that's different than my knee patients. So, do I have a protocol for all of them? No. Is it great to have them leave with something in hand? Yes. Yeah. Um, but again, that that happens very quickly.

SPEAKER_01 21:04

So medical professionalism immediately followed by chaos. This is what Chat GPT literally said to me at the end of that prompt. You go from can you help structure a prospective post-operative pain study with IRB considerations to make me a cartoon T-Rex with a banner going across its chest that says 101 trapezium saved? Did I do that within the same 20 minutes? Yeah. Yes, I didn't know. Yes, I did. Okay. Yeah. And the the T-Rex came out. I wanted it to look like the Jurassic Parts. Explain yourself. Oh, yeah, yeah. When like the banner falls on the banner falls on the T-Rex, it is goring. Yeah, and I wanted it to say I won't, it was gonna be this whole thing. It is this whole thing. So great scene. It's fantastic.

SPEAKER_02 21:45

Um so I I so I think we we think um for patient education, definitely a plus. Yes. Okay, for help with um consolidating thought processes, I think a plus. Yes, yeah. Like here's my labs, here are I have this, um, you know, is it better to do this? Is it better to do that? Yeah. Um, billing encoding, how to make your notes a little bit more robust so that you can bill encode the way that you want to. Um, but I don't necessarily think for me, it's not going to replace how I see patients. And that's never the intention, at least. Yeah.

SPEAKER_01 22:19

It never will be that. We did also use it um for clinic workflow optimization like templating.

SPEAKER_02 22:26

Yeah.

SPEAKER_01 22:26

So we had it create, hey, we want to see um, you know, six patients in an hour with you know the what makes the most sense for new versus post-op versus follow-up. Um, and these are the hours with a break in between this, structure this template. So um that's something really useful that it can come up with.

SPEAKER_02 22:45

Or schedule. Like I have five providers, I need to cover three locations. Here are vacation days. Can you please create a schedule where everybody works this amount of hours per week? Perfect. Um, and again, I think it just makes things faster. Like that instead of spending three hours on that, you know, give me three versions of this template. Perfect.

SPEAKER_01 23:05

Yeah. I think for you and I, AI is like I we can do more now. We can do more now. We can do more now. I needed something to allow me to get just closer and closer to the edge. That's one way of saying it. To tiptoe. To tiptoe. But I think, yeah, I think AI has a great place in medicine and orthopedics. Um, and I think you know, it can't really replace us, but it can make us more uh efficient in many ways.

SPEAKER_02 23:34

I'll tell you what, it can replace radiologists. I think AI can definitely replace like if you put in an image and ask for a X-ray review, like why do you need a radiologist? Totally.

SPEAKER_01 23:46

And I think it it could. Yeah. Now, can it replace though, like my clinical interpretation uh like my live read of it? No. Because that's the same as having a radiologist, right? The radiologist isn't putting their hands on the patients, they don't really know the clinical story. They are just looking, observing, reporting. And that can be replaced. What can't be replaced though is you have the patient in front of you, you get the images and you're correlating now based on your exam. Yeah.

SPEAKER_02 24:13

So can it replace um our call center?

SPEAKER_01 24:17

Yes.

SPEAKER_02 24:17

Yeah, maybe it can. Easily well, I'll tell you what, because without the clinical knowledge, someone calls and they say, Hey, my right shoulder hurts and it's burning from my shoulder to my fingertips and I can't move my neck, they put that on the shoulder team. Yeah, yeah. Yeah.

SPEAKER_01 24:30

And I'm not saying like AI couldn't get those types of things wrong, but how much more wrong is it gonna get it? The error and the accuracy will be very similar.

SPEAKER_02 24:38

Yeah. Eerily similar. I think pathology too. I think pathologists are gonna go, you know, and even um like triage, we don't really have someone who does triage, but if you plug in your symptoms, they can triage it as like, you know, urgent, not really urgent, and definitely not urgent, right? Um, but being surgical providers, I think we rely on our hands to fix things in a non-algorithmic way. At least what we do, everything's a little bit different. So I feel safe.

SPEAKER_01 25:07

Yeah, I feel safe from AI as well. Um, and I feel supported by AI. Yeah, me and AI have a symbiotic relationship.

SPEAKER_02 25:14

I don't want though, I don't want patients to come in and feel like they're getting nothing more than what they could have typed in their computer. So my personality also cannot be replaced.

SPEAKER_01 25:24

No, no, I mean like they come in for the experience that I'm giving them. Yes, yes, yes, definitely. Theatrical.

SPEAKER_02 25:31

Definitely, definitely.

SPEAKER_01 25:33

So will I continue using it? Yes. Yeah, but I think AI is like one of these trendy things that five years from now people are gonna be like, oh, remember when we used Chat GPT for everything? I don't know. We're definitely gonna get like more. Are we gonna have like a robot sitting next to us in two years?

SPEAKER_02 25:47

I hope not. I hope not. I just don't want to share the space, you know what I mean? Um no, I think I think it's a good thing right now, especially when we live in a world of high volume and um uh the need for high output, right? So I think if this makes our jobs easier, it's allowing us to meet the demands of the market, unfortunately.

SPEAKER_01 26:07

So I mean, you have to part of the grind.

SPEAKER_02 26:10

But I'm interested to see if if like in the future, can it predict patient outcomes? Can we avoid unnecessary things? Like, I wonder if we can use that for more positive patient outcomes, I guess. I don't know.

SPEAKER_01 26:22

Yeah, yeah. Just yeah, but we'll see. Well, everybody has to wait till the end of the episode for a weekly recap. The best part listen in.

SPEAKER_02 26:31

I know we went right for we went right in today, but um, let's let's track back. How was your week? It was okay. It was okay, it was okay.

SPEAKER_01 26:42

Okay. Um we had 10 cases this week, which sounds really low for hand surgery, but we had a lot of big we did three total shoulders this week.

SPEAKER_00 26:51

That's big, yeah.

SPEAKER_01 26:52

Um, as a part of those 10. So there's that. Um, yeah, at a super busy clinic Monday and yesterday. I've been trying to level up my numbers, just adding on more and more people. I am so close to breaching the 100 mark, okay? Patients per week. 99 last week. That's it's that's impressive. Yeah. I mean, in the week before, also 99. Like, why couldn't I have the 100th person?

SPEAKER_02 27:18

Were you incapable of that? Like, don't you think next week you could find one more patient?

SPEAKER_01 27:22

Well, I'm not scheduled for as many next week, so the chances are are lower. Like, I didn't know that I was at 99 until I went back and looked for the week. If I had known, hey, you're gonna be at 99, 100% I would have walked outside and pushed somebody down a flight of the yeah. Yeah, no, absolutely. For let me check you out and make sure you're okay.

SPEAKER_02 27:40

Yeah, okay. Speaking of statistics, um, the doctor that I work with, uh uh, we have a surgery center on site, as you know, right? Yeah. There's an email that goes out every week that is from our our um surgery scheduler scheduler that is utilization per week. Our doc is 100% every eligible surgery center case he does at the surgery center. So it shows, which is hard to look at each week, loss of potential revenue. So these are these are numbers that we could have that we don't because we've chosen to do these cases elsewhere. Now, I had a thing this week where we had a day at an outside facility. The only reason we go to an outside facility is when something is not best suited medically or otherwise, right?

SPEAKER_01 28:27

And those typically shouldn't count against you if the insurance doesn't. They don't, they don't. It's not authorized, yeah.

SPEAKER_02 28:32

So this list that we get every week is eligible patients that could be done at the surgery center were done at the surgery center. Okay. So fast forward to Wednesday. Um, we were operating at another facility half day and then going to see clinics second uh going to clinic second half of the day. We had two cases posted, and asia told us in order to do the day, you need to find a third case. You have to, or we cancel the day. Okay. So if we're talking about like net profit, loss, whatever, I would rather lose some at the surgery center here and fill your day.

SPEAKER_01 29:05

You have to, yeah.

SPEAKER_02 29:06

So you would have done the same thing.

SPEAKER_01 29:08

Oh, 100%. Okay.

SPEAKER_02 29:09

Yes.

unknown 29:09

Okay.

SPEAKER_01 29:10

Because you otherwise you lose out on two cases you could have done, and also just your time that day.

SPEAKER_02 29:15

So we did a mass excision on this guy. I think I talked about it before, but he was injecting himself with testosterone in his deltoid. He got himself infected. He had this massive abscess for two years, PS. We did an I and D, packed it with stimulon, and then we should have put a drain in. We didn't. He developed a hematoma. I aspirated as I aspirated as much as I could. I assumed that there was clotted mess in there. So I'm like, all right, let's take you back in and evacuate the hematoma. There's no implants for that case. There's no way that's going to pay up. That's not that's not a profitable case, right? Yeah. So I was like, that's the perfect guy to do at the surgery center. I knew what I was doing. I knew that I was a few. Yeah, you knew you were a mess at the number. I did, yeah. But I thought it was the right thing to do. Anyway, so Tuesday, the day before our three-case Wednesday, one patient canceled because of a cardiac thing. And I was like, oh my God. So anesthesia, do they need us to find another case? Like, let's find another case. And our surgery scheduler was like, no, they're good with two. Wait, so if they're good with two, they would have been if I didn't add this guy. Yeah. So I disclosed the facts to the surgeon that I worked with yesterday. And he was like, How could you do this to me? Because his number No, the number's not his number's not zero now. Now I'm hoping that this met some criteria of it couldn't have gone here anyway, or it slipped through the cracks. I'm hoping nobody sees it. But if it were me, shoes were reversed, I would have been so mad that I had a perfect record and now there's a blip. Like I get it.

SPEAKER_01 30:46

Yes. But like uh so this that report used to frustrate the shit out of me, and honestly, it still does. Yeah. Um, I think it's a lot easier to get close to that 100 mark when so like we have two weeks a month where we don't even have block time here. I know. Like we're not ever gonna get to 100. That's not feasible.

SPEAKER_02 31:03

But the the the chart does not say that. The chart does not have a little like look at the addendum to see like this is what I've said all along.

SPEAKER_01 31:11

It needs to be based on percentages of your block time utilization. Did you bring, based on how much time you have your percentage of your eligible cases here? And then we would be pretty darn close to 100%. But if we have 50% of our time that's not even allocated there, well, we're gonna have some blue cross patients that have to go somewhere else.

SPEAKER_02 31:32

Well, tell you what, there should be another email that comes out saying, uh, you know, or just what makes the most sense too for the day. Or just saying, like, you know, look at what these people did to survive this week.

SPEAKER_01 31:42

Like, you know, like an award for thriving.

SPEAKER_02 31:44

I don't like how I have thriving email. Um, but anyway, so we will receive that email of what we did this week Monday.

SPEAKER_01 31:51

So I'm not looking forward to that. I when I see it, I'm gonna cringe. I know, I know screenshot it.

SPEAKER_02 31:57

I know, I know, I know. Um, but other than that, like clinic was clinic was all right, surgeries were were good, full, full days. Um, the PA that I work with, he um he's he's in the military, and this is his last two and a half week stint that he has to go do whatever he does before he retires. Vacation. So now vacation he's vacation, vacation. So the dates are May 28th, which is like a Thursday, so Thursday, Friday, off the next week, off the next week, back on June 15th. Like when I say that, that's half a month. That's a long time. Now, and it's May 15th, I am already getting the front desk coming back to me and being like, hey, you're booked out. Yeah. Hey, you're booked out. So my team was like, hey, where can I add this? And I said, Oh, did you ask the other PA? They're like, No, he's really particular about double books. I'm like, listen, when you go away on quote vacation for two and a half weeks, you don't get an opinion. No, like this is no, you you must push him also. Yeah, yeah. Like I don't just ask me. This is a tangent, but you know, yeah, I yes, I have capabilities. I have my upper limit, and then I have my like undisclosed upper limit. Yeah, those are different numbers. Whereas he has his hard stop. Like, I we ignore your hard stop when you quote put us in this situation. Oh my god. So anyway, so that was, and I will have to do this now all next week and half of the next week. I hate that. I know. Yeah.

SPEAKER_01 33:19

Over you're gonna have to overcrush the next few weeks.

SPEAKER_02 33:21

Yeah. So I'm um I'm mentally preparing for that.

SPEAKER_01 33:24

Uh we had like some weird, complicated surgery things happen this week, too, that annoyed me. I had a cancellation on Thursday. It was very ironic, actually. Like a patient I saw on Monday, I sent you the X-rays. This severely displaced thumb fracture, right? Um, so you know, Spanish speaking family. I don't speak Spanish. I wish I did. I've got a 550-day-day streak on Duolingo. It's not proven helpful to me up to this point. So there's no benefit to that. Duolingo, you need to step it up for your medical providers. Um so anyway, the the patient themselves spoke English. The parent didn't speak English. I wasn't prepared going in the room. Like nobody tells me, like, oh hey, you're gonna need an interpreter or whatever. So I just walk in blindly, start going, they're communicating back and forth. So I'm like, all is fine. But then I finish the visit and the mom's like, oh, like, do you speak Spanish? I'm like, no, like I would have been this whole time if I could. Right.

SPEAKER_02 34:23

I didn't enjoy this visit either.

SPEAKER_01 34:25

So then, of course, you know, I'm like, Do you need me to get an interpreter? Yes. So I go out, get one, I repeat the entire visit. Oh, god. Which is also like it's almost triple repeated because the interpreter has to say back and forth each thing that I say. So this is now triple the time of a normal visit or everything. Yeah. And, you know, whatever. It's a it's a good visit. Everything's fine. They're like, Yeah, we're gonna move forward with surgery Thursday, blah, blah, blah. Um, I tell them to hear out from our scheduler for confirmation. Um, everything gets like set and good to go. Thursday, we're in the OR. Circulating nurse is like, hey, you think you guys will have any cancellations today? Because stuff like that happens a lot. I was like, huh, no, I don't think so. Although I will say, if it were to be anybody, the last patient of the day doesn't family doesn't speak English. So, you know, if there's any miscommunications from that would be the one to go. Literally not, but 10 minutes later, somebody our scheduler emails me and is like, hey, I got this weird email, and I think the last one of the day is probably canceling. So the day after I saw them in clinic, they went to another facility, another orthopedic office, right? Which fine, get a second opinion. Yeah. I I think that's great. No problem with that. At the second opinion, they told them to go to the children's ER. So they had already seen our urgent care, closed reduction, saw me scheduled for surgery because it's not reduced enough and it it's an unstable fracture, it needs a pin. So they go see the second opinion who tells them, hey, go to the ER for a closed reduction, which they've already like done. So then they send them to the ER. The ER does a closed reduction. I didn't look at the images if they made it look any better than our origin care's closed reduction. Um, then the ER tells them it still needs a pin and schedules them for outpatient surgery the following week. So literally just repeated the process.

SPEAKER_02 36:24

Oh my god.

SPEAKER_01 36:25

Yeah. Do you think it was so annoyed?

SPEAKER_02 36:28

But do you think that the patient's family didn't know enough of what they had already had done and signed up for that they thought that this was different?

SPEAKER_01 36:35

Yeah, I mean, like that has to be, or they were already so far into like I have no idea. I wish that I could figure out what the reasoning for that is. I I will never know. I wish that I could know though, because it's it is eating me away.

SPEAKER_02 36:50

Yeah. Um, I had a patient, I think I talked about this a couple weeks ago. My son had a soccer game late on a Friday night, and this kid hurt his knee. I went out on the field and I examined him and I told his mom, who again kind of understood English, dad, not at all. Yeah. Um, that I think he tore his ACL. He went in, as I had suggested, to urgent care the next day, which is shocking, right? Because normally that doesn't happen. Got his MRI, got his brace, whatever, tore his ACL. So I saw them for pre-op and I walk walk in the room. And again, this is my son plays on a team. The practices started August 5th, and they're still going. This is a nine-month commitment. Three days a week plus games on the weekends plus a tournament. Yeah. You know, every couple months. So I walk in the room. Mom was like, Oh, do you remember us? Yeah. Yeah, I remember. She goes, Remember, we were the ones on the field? Yeah. I was like, Yeah, no, I I do. I know you guys, right? And she goes, So you were right. It was like, yeah, but right now you just told me you didn't think I was. So that's this cool. Yeah. It was like, it was, it was like two slaps. I like walked in the room and like punch you once, punch you twice, and I was a little bit like stunned. You remember us? I'm like, yes, I remember you. Oh, and you were right. No shit, I was right.

SPEAKER_01 37:55

Like, I don't know. It was really questionable.

SPEAKER_02 37:58

It was super, it was super annoying. And I was I wasn't, but I was trying to like keep my demeanor like positive and all that, but I'm so fucking pissed. Like it just got me, it was like annoyed me.

SPEAKER_01 38:07

Do you feel like in those situations, sometimes like people that that is the culmination of people like truly not understanding what you do? Yes, like they come in and see you in an office setting and they're like, Oh, wait, like you're actually doing this. Yes, like so.

SPEAKER_02 38:22

What was also annoying, and again, this is what I can pick up on, and this is why I'll never be replaced by AI, is as I was talking and I got more clinically detailed, she kept looking down at my badge. Yeah. Like to see like what I think she still didn't know. I think she still thought like I was a medical assistant or something. Because it was confusing to her as I started talking more.

SPEAKER_01 38:44

Like, she's like, Things are coming out that I wouldn't expect to be coming out from you.

SPEAKER_02 38:48

I know, which means she already made her assessment of me, which I'm like really annoyed about, but anyway.

SPEAKER_01 38:55

Yes. I hate that.

SPEAKER_02 38:57

I know it's annoying. Anyway, um, but other than that, other than that, decent week. Yeah, it's a decent week.

SPEAKER_01 39:03

So next week we'll we'll crush it all over again. Yeah, next week's week leading up to Memorial Day.

SPEAKER_02 39:08

I I love like I love like looking forward to things.

SPEAKER_01 39:10

We're uh are we going to see Hamilton the same weekend?

SPEAKER_02 39:14

I think so. Not this weekend, next weekend.

SPEAKER_01 39:16

Yeah, not like right now, next.

SPEAKER_02 39:18

Oh, I'm going a couple days after you.

SPEAKER_01 39:19

Okay, yeah, I'm going the day before Memorial Day. Oh, we'll have to talk about that too. Home and check. Yes.

SPEAKER_02 39:24

We'll have to talk about that too.

SPEAKER_01 39:25

All right. Well, until next time. All right, have a good one.

SPEAKER_02 39:38

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