{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":5.25,"endTime":7.44,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":5.25,"endTime":7.44,"body":"upper hand podcast where Chuck"},{"speaker":"Charles Goldfarb","startTime":7.47,"endTime":8.85,"body":"and Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":9.51,"endTime":11.43,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":9.51,"endTime":11.43,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":11.43,"endTime":14.37,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":11.43,"endTime":14.37,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":14.37,"endTime":16.59,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":14.37,"endTime":16.59,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":17.13,"endTime":19.02,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":17.13,"endTime":19.02,"body":"subscribe, wherever you get your"},{"speaker":"Charles Goldfarb","startTime":19.02,"endTime":19.83,"body":"podcasts"},{"speaker":"Chris Dy","startTime":20.4,"endTime":23.28,"body":"Thank you in advance"},{"speaker":"Chris Dy","startTime":20.4,"endTime":23.28,"body":"for leaving a review and rating"},{"speaker":"Chris Dy","startTime":23.31,"endTime":26.01,"body":"that helps us get the word out."},{"speaker":"Chris Dy","startTime":23.31,"endTime":26.01,"body":"You can email us at"},{"speaker":"Chris Dy","startTime":26.04,"endTime":29.46,"body":"Handpodcast@gmail.com. So let's"},{"speaker":"Chris Dy","startTime":26.04,"endTime":29.46,"body":"get to the episode."},{"speaker":"Charles Goldfarb","startTime":30.69,"endTime":31.56,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":30.69,"endTime":31.56,"body":"Chris."},{"speaker":"Chris Dy","startTime":32.009,"endTime":32.969,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":32.009,"endTime":32.969,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":33.78,"endTime":35.52,"body":"Good. We're"},{"speaker":"Charles Goldfarb","startTime":33.78,"endTime":35.52,"body":"recording it a little bit of a"},{"speaker":"Charles Goldfarb","startTime":35.52,"endTime":37.2,"body":"different time. Yeah,"},{"speaker":"Chris Dy","startTime":37.2,"endTime":40.32,"body":"Its actually daylight"},{"speaker":"Chris Dy","startTime":37.2,"endTime":40.32,"body":"outside. It's nice. Well, of"},{"speaker":"Chris Dy","startTime":40.32,"endTime":43.32,"body":"course, we're both inside and"},{"speaker":"Chris Dy","startTime":40.32,"endTime":43.32,"body":"both in the office."},{"speaker":"Charles Goldfarb","startTime":43.77,"endTime":46.41,"body":"In the office."},{"speaker":"Charles Goldfarb","startTime":43.77,"endTime":46.41,"body":"Yeah. St. Louis weather I hope"},{"speaker":"Charles Goldfarb","startTime":46.41,"endTime":48.72,"body":"it's turning for the better. So"},{"speaker":"Charles Goldfarb","startTime":46.41,"endTime":48.72,"body":"yeah,"},{"speaker":"Chris Dy","startTime":48.75,"endTime":51.54,"body":"I think it's been a"},{"speaker":"Chris Dy","startTime":48.75,"endTime":51.54,"body":"nice day, I usually get my"},{"speaker":"Chris Dy","startTime":51.57,"endTime":55.44,"body":"weather reports from patients in"},{"speaker":"Chris Dy","startTime":51.57,"endTime":55.44,"body":"clinic and when I'm in the car"},{"speaker":"Chris Dy","startTime":55.44,"endTime":57.75,"body":"all day, I have no idea what"},{"speaker":"Chris Dy","startTime":55.44,"endTime":57.75,"body":"it's like outside. And I"},{"speaker":"Chris Dy","startTime":57.75,"endTime":59.61,"body":"sometimes I think it's better if"},{"speaker":"Chris Dy","startTime":57.75,"endTime":59.61,"body":"I don't know what the weather's"},{"speaker":"Chris Dy","startTime":59.61,"endTime":60.66,"body":"like when I have to be inside."},{"speaker":"Charles Goldfarb","startTime":61.26,"endTime":63.39,"body":"Oh, for sure."},{"speaker":"Charles Goldfarb","startTime":61.26,"endTime":63.39,"body":"You know, we we may have"},{"speaker":"Charles Goldfarb","startTime":63.39,"endTime":66.36,"body":"mentioned before, in one of our"},{"speaker":"Charles Goldfarb","startTime":63.39,"endTime":66.36,"body":"surgical locations, we have"},{"speaker":"Charles Goldfarb","startTime":66.36,"endTime":68.91,"body":"windows. And for those of you"},{"speaker":"Charles Goldfarb","startTime":66.36,"endTime":68.91,"body":"who have the opportunity to"},{"speaker":"Charles Goldfarb","startTime":68.91,"endTime":71.79,"body":"operate at a site with Windows,"},{"speaker":"Charles Goldfarb","startTime":68.91,"endTime":71.79,"body":"I recommended highlight because"},{"speaker":"Charles Goldfarb","startTime":71.79,"endTime":74.82,"body":"you kind of do keep a little bit"},{"speaker":"Charles Goldfarb","startTime":71.79,"endTime":74.82,"body":"in touch with the outside world."},{"speaker":"Charles Goldfarb","startTime":75.21,"endTime":77.97,"body":"And when I'm in clinic, I just"},{"speaker":"Charles Goldfarb","startTime":75.21,"endTime":77.97,"body":"have a big window and it's it"},{"speaker":"Charles Goldfarb","startTime":77.97,"endTime":80.49,"body":"can be really hard to look"},{"speaker":"Charles Goldfarb","startTime":77.97,"endTime":80.49,"body":"outside. But it's a beautiful"},{"speaker":"Charles Goldfarb","startTime":80.49,"endTime":80.82,"body":"day."},{"speaker":"Chris Dy","startTime":81.63,"endTime":84.84,"body":"I still remember being"},{"speaker":"Chris Dy","startTime":81.63,"endTime":84.84,"body":"at the at one at that particular"},{"speaker":"Chris Dy","startTime":84.84,"endTime":87.75,"body":"site and being in Dr."},{"speaker":"Chris Dy","startTime":84.84,"endTime":87.75,"body":"Gelberman's clinic and just"},{"speaker":"Chris Dy","startTime":88.11,"endTime":90.81,"body":"feeling like I needed a refresh."},{"speaker":"Chris Dy","startTime":88.11,"endTime":90.81,"body":"Sometimes I would just watch"},{"speaker":"Chris Dy","startTime":90.81,"endTime":96.87,"body":"cars go by thinking to myself to"},{"speaker":"Chris Dy","startTime":90.81,"endTime":96.87,"body":"give myself some Zen. Yep"},{"speaker":"Charles Goldfarb","startTime":96.9,"endTime":98.97,"body":"no, it does"},{"speaker":"Charles Goldfarb","startTime":96.9,"endTime":98.97,"body":"the trick. It can do the trick"},{"speaker":"Charles Goldfarb","startTime":98.97,"endTime":102.63,"body":"for sure. But yeah, the kind of"},{"speaker":"Charles Goldfarb","startTime":98.97,"endTime":102.63,"body":"just being in the car and being"},{"speaker":"Charles Goldfarb","startTime":102.63,"endTime":105.66,"body":"oblivious. I guess there's"},{"speaker":"Charles Goldfarb","startTime":102.63,"endTime":105.66,"body":"something to that too. Yeah,"},{"speaker":"Chris Dy","startTime":105.66,"endTime":107.61,"body":"you know, there you"},{"speaker":"Chris Dy","startTime":105.66,"endTime":107.61,"body":"never know what's gonna like,"},{"speaker":"Chris Dy","startTime":107.91,"endTime":110.91,"body":"what what could be unfolding in"},{"speaker":"Chris Dy","startTime":107.91,"endTime":110.91,"body":"the world. Once you emerge from"},{"speaker":"Chris Dy","startTime":110.91,"endTime":114.81,"body":"a long case, things change I"},{"speaker":"Chris Dy","startTime":110.91,"endTime":114.81,"body":"remember. Well, I mean, I guess"},{"speaker":"Chris Dy","startTime":114.84,"endTime":117.72,"body":"we won't delve too much into the"},{"speaker":"Chris Dy","startTime":114.84,"endTime":117.72,"body":"details. But I remember hearing"},{"speaker":"Chris Dy","startTime":117.72,"endTime":121.89,"body":"about the details of January 6,"},{"speaker":"Chris Dy","startTime":117.72,"endTime":121.89,"body":"unfolding as I was leaving the O"},{"speaker":"Chris Dy","startTime":121.89,"endTime":126.96,"body":"R and other what just happened"},{"speaker":"Chris Dy","startTime":121.89,"endTime":126.96,"body":"in the world. And, and I also"},{"speaker":"Chris Dy","startTime":126.96,"endTime":131.91,"body":"remember, I was visiting Chang"},{"speaker":"Chris Dy","startTime":126.96,"endTime":131.91,"body":"Hospital in Taiwan, as the"},{"speaker":"Chris Dy","startTime":132.33,"endTime":138.51,"body":"November 20 2016 election"},{"speaker":"Chris Dy","startTime":132.33,"endTime":138.51,"body":"results were coming in, which"},{"speaker":"Chris Dy","startTime":138.51,"endTime":141.18,"body":"was also super interesting. It's"},{"speaker":"Charles Goldfarb","startTime":141.18,"endTime":143.91,"body":"funny, I as"},{"speaker":"Charles Goldfarb","startTime":141.18,"endTime":143.91,"body":"you started that whole"},{"speaker":"Charles Goldfarb","startTime":144.12,"endTime":146.82,"body":"conversation piece, the first"},{"speaker":"Charles Goldfarb","startTime":144.12,"endTime":146.82,"body":"thing that came to mind was"},{"speaker":"Charles Goldfarb","startTime":146.82,"endTime":151.11,"body":"where was I? When, and the"},{"speaker":"Charles Goldfarb","startTime":146.82,"endTime":151.11,"body":"immediate one that comes to mind"},{"speaker":"Charles Goldfarb","startTime":151.11,"endTime":154.65,"body":"when I was in the ER was"},{"speaker":"Charles Goldfarb","startTime":151.11,"endTime":154.65,"body":"September 11. I was a fellow in"},{"speaker":"Charles Goldfarb","startTime":154.65,"endTime":158.34,"body":"Cincinnati and I was in the O R"},{"speaker":"Charles Goldfarb","startTime":154.65,"endTime":158.34,"body":"and we kind of all walked into"},{"speaker":"Charles Goldfarb","startTime":158.34,"endTime":161.49,"body":"the waiting room to watch the"},{"speaker":"Charles Goldfarb","startTime":158.34,"endTime":161.49,"body":"television there is a different"},{"speaker":"Charles Goldfarb","startTime":161.52,"endTime":164.25,"body":"era a different generation that"},{"speaker":"Charles Goldfarb","startTime":161.52,"endTime":164.25,"body":"was right, you know with"},{"speaker":"Chris Dy","startTime":164.25,"endTime":167.01,"body":"one to one TV if you"},{"speaker":"Chris Dy","startTime":164.25,"endTime":167.01,"body":"probably had no remote you had"},{"speaker":"Chris Dy","startTime":167.01,"endTime":169.11,"body":"to get up and change the"},{"speaker":"Chris Dy","startTime":167.01,"endTime":169.11,"body":"channel. And you know what"},{"speaker":"Chris Dy","startTime":169.11,"endTime":169.32,"body":"little"},{"speaker":"Charles Goldfarb","startTime":169.32,"endTime":173.07,"body":"rabbit here?"},{"speaker":"Charles Goldfarb","startTime":169.32,"endTime":173.07,"body":"Yeah, yeah, exactly. Oh, and"},{"speaker":"Chris Dy","startTime":173.16,"endTime":175.98,"body":"the other the other"},{"speaker":"Chris Dy","startTime":173.16,"endTime":175.98,"body":"Where were you when thing that I"},{"speaker":"Chris Dy","startTime":176.01,"endTime":179.43,"body":"some sermons always remember is"},{"speaker":"Chris Dy","startTime":176.01,"endTime":179.43,"body":"that the day that Michael"},{"speaker":"Chris Dy","startTime":179.43,"endTime":184.5,"body":"Jackson died, I was on call, I"},{"speaker":"Chris Dy","startTime":179.43,"endTime":184.5,"body":"was a junior resident on call at"},{"speaker":"Chris Dy","startTime":184.5,"endTime":188.07,"body":"one of the hospitals and I was"},{"speaker":"Chris Dy","startTime":184.5,"endTime":188.07,"body":"just a run of distal radius"},{"speaker":"Chris Dy","startTime":188.07,"endTime":191.25,"body":"fractures, patients with this"},{"speaker":"Chris Dy","startTime":188.07,"endTime":191.25,"body":"race fractures that came in and"},{"speaker":"Chris Dy","startTime":191.25,"endTime":193.92,"body":"actually had them all kind of"},{"speaker":"Chris Dy","startTime":191.25,"endTime":193.92,"body":"set up in an assembly line, like"},{"speaker":"Chris Dy","startTime":193.95,"endTime":197.61,"body":"classic residents style, just"},{"speaker":"Chris Dy","startTime":193.95,"endTime":197.61,"body":"like ready for reduction. And"},{"speaker":"Chris Dy","startTime":197.61,"endTime":200.37,"body":"I'm just going down my assembly"},{"speaker":"Chris Dy","startTime":197.61,"endTime":200.37,"body":"line and patients start talking"},{"speaker":"Chris Dy","startTime":200.37,"endTime":204.24,"body":"to each other about how Michael"},{"speaker":"Chris Dy","startTime":200.37,"endTime":204.24,"body":"Jackson just died. I always"},{"speaker":"Chris Dy","startTime":204.24,"endTime":205.74,"body":"remember that. That"},{"speaker":"Charles Goldfarb","startTime":205.74,"endTime":207.72,"body":"is so"},{"speaker":"Charles Goldfarb","startTime":205.74,"endTime":207.72,"body":"interesting. Yeah. I don't know"},{"speaker":"Charles Goldfarb","startTime":207.72,"endTime":209.61,"body":"when Michael Jackson died."},{"speaker":"Chris Dy","startTime":209.97,"endTime":212.22,"body":"All right. Well, you"},{"speaker":"Chris Dy","startTime":209.97,"endTime":212.22,"body":"know, we have an interesting"},{"speaker":"Chris Dy","startTime":212.22,"endTime":214.8,"body":"episode today, I think we have a"},{"speaker":"Chris Dy","startTime":212.22,"endTime":214.8,"body":"case that I wanted to ask you"},{"speaker":"Chris Dy","startTime":214.8,"endTime":217.89,"body":"about how you would approach and"},{"speaker":"Chris Dy","startTime":214.8,"endTime":217.89,"body":"then, you know, I think we're"},{"speaker":"Chris Dy","startTime":217.89,"endTime":220.89,"body":"gonna get into a practice"},{"speaker":"Chris Dy","startTime":217.89,"endTime":220.89,"body":"management topic about approach"},{"speaker":"Chris Dy","startTime":220.89,"endTime":223.26,"body":"to the Worker's Compensation"},{"speaker":"Chris Dy","startTime":220.89,"endTime":223.26,"body":"Program."},{"speaker":"Charles Goldfarb","startTime":223.89,"endTime":226.08,"body":"Yeah, it's a"},{"speaker":"Charles Goldfarb","startTime":223.89,"endTime":226.08,"body":"super interesting. First of all,"},{"speaker":"Charles Goldfarb","startTime":226.08,"endTime":228.51,"body":"I think that we briefly"},{"speaker":"Charles Goldfarb","startTime":226.08,"endTime":228.51,"body":"discussed the case so we could"},{"speaker":"Charles Goldfarb","startTime":228.51,"endTime":233.79,"body":"prepare the, the, the management"},{"speaker":"Charles Goldfarb","startTime":228.51,"endTime":233.79,"body":"topic, I think, will be really"},{"speaker":"Charles Goldfarb","startTime":233.79,"endTime":237.06,"body":"fun to discuss. It's certainly"},{"speaker":"Charles Goldfarb","startTime":233.79,"endTime":237.06,"body":"something that we both think"},{"speaker":"Charles Goldfarb","startTime":237.06,"endTime":240.09,"body":"about a lot. And I think it's"},{"speaker":"Charles Goldfarb","startTime":237.06,"endTime":240.09,"body":"really important to, you know,"},{"speaker":"Charles Goldfarb","startTime":240.09,"endTime":241.86,"body":"future hand surgeons everywhere."},{"speaker":"Chris Dy","startTime":242.34,"endTime":244.32,"body":"Right. And I think"},{"speaker":"Chris Dy","startTime":242.34,"endTime":244.32,"body":"that initially work comp I"},{"speaker":"Chris Dy","startTime":244.32,"endTime":248.58,"body":"think, you know, elicits some"},{"speaker":"Chris Dy","startTime":244.32,"endTime":248.58,"body":"kind of like visceral reaction,"},{"speaker":"Chris Dy","startTime":248.58,"endTime":251.4,"body":"and a lot of people just groans"},{"speaker":"Chris Dy","startTime":248.58,"endTime":251.4,"body":"and oh, my gosh, why would I do"},{"speaker":"Chris Dy","startTime":251.4,"endTime":253.95,"body":"that? Et cetera, so painful. I"},{"speaker":"Chris Dy","startTime":251.4,"endTime":253.95,"body":"don't think it's as bad as"},{"speaker":"Chris Dy","startTime":253.95,"endTime":256.17,"body":"people make it out to be, but"},{"speaker":"Chris Dy","startTime":253.95,"endTime":256.17,"body":"we'll get to those details."},{"speaker":"Chris Dy","startTime":256.29,"endTime":258.6,"body":"Before we talk about our case."},{"speaker":"Chris Dy","startTime":256.29,"endTime":258.6,"body":"Why don't we thank our friends"},{"speaker":"Chris Dy","startTime":258.6,"endTime":259.44,"body":"over at practice link."},{"speaker":"Charles Goldfarb","startTime":259.74,"endTime":262.17,"body":"The upper hand"},{"speaker":"Charles Goldfarb","startTime":259.74,"endTime":262.17,"body":"is sponsored by Practice"},{"speaker":"Charles Goldfarb","startTime":262.59,"endTime":265.95,"body":"Link.com the most widely used"},{"speaker":"Charles Goldfarb","startTime":262.59,"endTime":265.95,"body":"position, job search and career"},{"speaker":"Charles Goldfarb","startTime":265.95,"endTime":267.12,"body":"advancement resource."},{"speaker":"Chris Dy","startTime":267.75,"endTime":270.06,"body":"Becomcing a physician"},{"speaker":"Chris Dy","startTime":267.75,"endTime":270.06,"body":"is hard finding the right job"},{"speaker":"Chris Dy","startTime":270.06,"endTime":272.82,"body":"doesn't have to be joined,"},{"speaker":"Chris Dy","startTime":270.06,"endTime":272.82,"body":"practicing for free today at"},{"speaker":"Chris Dy","startTime":274.05,"endTime":276.81,"body":"www.practicelink.com/theupper"},{"speaker":"Chris Dy","startTime":274.05,"endTime":276.81,"body":"hand"},{"speaker":"Charles Goldfarb","startTime":277.59,"endTime":279.69,"body":"All right,"},{"speaker":"Charles Goldfarb","startTime":277.59,"endTime":279.69,"body":"tell me about your case."},{"speaker":"Chris Dy","startTime":280.59,"endTime":283.29,"body":"So it's, I mean, it's"},{"speaker":"Chris Dy","startTime":280.59,"endTime":283.29,"body":"something that comes up, you"},{"speaker":"Chris Dy","startTime":283.29,"endTime":287.07,"body":"know, probably a couple of times"},{"speaker":"Chris Dy","startTime":283.29,"endTime":287.07,"body":"a year. So, you know, how do you"},{"speaker":"Chris Dy","startTime":287.07,"endTime":291.36,"body":"think about patients who know"},{"speaker":"Chris Dy","startTime":287.07,"endTime":291.36,"body":"technically how to do how to"},{"speaker":"Chris Dy","startTime":291.36,"endTime":294.63,"body":"approach indications how to"},{"speaker":"Chris Dy","startTime":291.36,"endTime":294.63,"body":"counsel patients who need a re"},{"speaker":"Chris Dy","startTime":294.63,"endTime":299.1,"body":"resection? So I'm not talking"},{"speaker":"Chris Dy","startTime":294.63,"endTime":299.1,"body":"about in the context of any sort"},{"speaker":"Chris Dy","startTime":299.1,"endTime":301.35,"body":"of oncologic issue You but I"},{"speaker":"Chris Dy","startTime":299.1,"endTime":301.35,"body":"think that's completely"},{"speaker":"Chris Dy","startTime":301.35,"endTime":305.34,"body":"different. But I had a patient"},{"speaker":"Chris Dy","startTime":301.35,"endTime":305.34,"body":"who is, you know, an older woman"},{"speaker":"Chris Dy","startTime":305.34,"endTime":309.93,"body":"in her 70s, who had a very"},{"speaker":"Chris Dy","startTime":305.34,"endTime":309.93,"body":"challenging recovery after a"},{"speaker":"Chris Dy","startTime":309.93,"endTime":314.73,"body":"complex flexor tendon surgery,"},{"speaker":"Chris Dy","startTime":309.93,"endTime":314.73,"body":"and essentially has ended up"},{"speaker":"Chris Dy","startTime":314.73,"endTime":320.46,"body":"with a finger that is flex down"},{"speaker":"Chris Dy","startTime":314.73,"endTime":320.46,"body":"in, it's the middle finger, it's"},{"speaker":"Chris Dy","startTime":320.46,"endTime":323.79,"body":"flex down at the tip joint, the"},{"speaker":"Chris Dy","startTime":320.46,"endTime":323.79,"body":"posture is about 40 degrees of"},{"speaker":"Chris Dy","startTime":323.79,"endTime":328.83,"body":"flexion really does not get any"},{"speaker":"Chris Dy","startTime":323.79,"endTime":328.83,"body":"improvement with passive has"},{"speaker":"Chris Dy","startTime":328.83,"endTime":331.38,"body":"really no tendon glide, you"},{"speaker":"Chris Dy","startTime":328.83,"endTime":331.38,"body":"know, those things we talked"},{"speaker":"Chris Dy","startTime":331.38,"endTime":334.26,"body":"about with Macy and one of the"},{"speaker":"Chris Dy","startTime":331.38,"endTime":334.26,"body":"prior episodes about tendon"},{"speaker":"Chris Dy","startTime":334.26,"endTime":337.47,"body":"gliding than any of that the MP"},{"speaker":"Chris Dy","startTime":334.26,"endTime":337.47,"body":"joint just feels stiff and your"},{"speaker":"Chris Dy","startTime":337.47,"endTime":341.07,"body":"fingers just in the way. And"},{"speaker":"Chris Dy","startTime":337.47,"endTime":341.07,"body":"it's not a useful hand. And she"},{"speaker":"Chris Dy","startTime":341.07,"endTime":343.23,"body":"has difficulty gripping and"},{"speaker":"Chris Dy","startTime":341.07,"endTime":343.23,"body":"grabbing things because she"},{"speaker":"Chris Dy","startTime":343.23,"endTime":347.67,"body":"can't initiate flexion with her"},{"speaker":"Chris Dy","startTime":343.23,"endTime":347.67,"body":"middle finger, it stays flexed"},{"speaker":"Chris Dy","startTime":347.7,"endTime":350.04,"body":"or stay stays flex, and she"},{"speaker":"Chris Dy","startTime":347.7,"endTime":350.04,"body":"can't straighten it out. So"},{"speaker":"Chris Dy","startTime":350.79,"endTime":355.56,"body":"she's about a year out from her"},{"speaker":"Chris Dy","startTime":350.79,"endTime":355.56,"body":"flexor tendon surgery, and is"},{"speaker":"Chris Dy","startTime":355.56,"endTime":359.37,"body":"just not happy. How do you"},{"speaker":"Chris Dy","startTime":355.56,"endTime":359.37,"body":"approach that situation?"},{"speaker":"Charles Goldfarb","startTime":360.12,"endTime":362.58,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":360.12,"endTime":362.58,"body":"that's an that's an interesting"},{"speaker":"Charles Goldfarb","startTime":363.63,"endTime":368.55,"body":"lead in to the topic of kind of"},{"speaker":"Charles Goldfarb","startTime":363.63,"endTime":368.55,"body":"just challenging finger status."},{"speaker":"Charles Goldfarb","startTime":368.7,"endTime":372.15,"body":"Certainly there are other"},{"speaker":"Charles Goldfarb","startTime":368.7,"endTime":372.15,"body":"potential legions one would be,"},{"speaker":"Charles Goldfarb","startTime":373.05,"endTime":376.98,"body":"you know, bony trauma or partial"},{"speaker":"Charles Goldfarb","startTime":373.05,"endTime":376.98,"body":"amputation, something like that."},{"speaker":"Charles Goldfarb","startTime":377.34,"endTime":381.21,"body":"Lots of congenital tie ins which"},{"speaker":"Charles Goldfarb","startTime":377.34,"endTime":381.21,"body":"I could bore you with for many"},{"speaker":"Charles Goldfarb","startTime":381.21,"endTime":387.18,"body":"hours. And, you know, I think"},{"speaker":"Charles Goldfarb","startTime":381.21,"endTime":387.18,"body":"when you feel as though you have"},{"speaker":"Charles Goldfarb","startTime":387.18,"endTime":391.5,"body":"maximize therapy, when you feel"},{"speaker":"Charles Goldfarb","startTime":387.18,"endTime":391.5,"body":"as though your surgical"},{"speaker":"Charles Goldfarb","startTime":391.5,"endTime":394.83,"body":"strategies to help the patient"},{"speaker":"Charles Goldfarb","startTime":391.5,"endTime":394.83,"body":"improve, have reached their"},{"speaker":"Charles Goldfarb","startTime":394.83,"endTime":399.12,"body":"limit, then you have to have the"},{"speaker":"Charles Goldfarb","startTime":394.83,"endTime":399.12,"body":"difficult discussion about"},{"speaker":"Charles Goldfarb","startTime":399.12,"endTime":403.17,"body":"whether that finger can ever be"},{"speaker":"Charles Goldfarb","startTime":399.12,"endTime":403.17,"body":"useful for the patient. And it's"},{"speaker":"Charles Goldfarb","startTime":403.17,"endTime":407.31,"body":"a discussion that in my mind"},{"speaker":"Charles Goldfarb","startTime":403.17,"endTime":407.31,"body":"shouldn't be held at one sitting"},{"speaker":"Charles Goldfarb","startTime":407.7,"endTime":411.48,"body":"is something that you have to"},{"speaker":"Charles Goldfarb","startTime":407.7,"endTime":411.48,"body":"plant the seed for and revisit."},{"speaker":"Chris Dy","startTime":412.41,"endTime":414.06,"body":"Yeah, I think"},{"speaker":"Chris Dy","startTime":412.41,"endTime":414.06,"body":"absolutely. I remember you"},{"speaker":"Chris Dy","startTime":414.06,"endTime":416.43,"body":"teaching me that. You know, Ryan"},{"speaker":"Chris Dy","startTime":414.06,"endTime":416.43,"body":"Calfee is very good at teaching"},{"speaker":"Chris Dy","startTime":416.43,"endTime":419.7,"body":"about how to broach this topic"},{"speaker":"Chris Dy","startTime":416.43,"endTime":419.7,"body":"with patients. Remember that"},{"speaker":"Chris Dy","startTime":419.7,"endTime":423.39,"body":"when I was a fellow in this"},{"speaker":"Chris Dy","startTime":419.7,"endTime":423.39,"body":"patient was not just known and"},{"speaker":"Chris Dy","startTime":423.39,"endTime":427.5,"body":"not to minimize that it wasn't"},{"speaker":"Chris Dy","startTime":423.39,"endTime":427.5,"body":"just a flexor tendon repair, it"},{"speaker":"Chris Dy","startTime":427.5,"endTime":431.28,"body":"was much more than that, in"},{"speaker":"Chris Dy","startTime":427.5,"endTime":431.28,"body":"involved trauma and pulley"},{"speaker":"Chris Dy","startTime":431.28,"endTime":436.53,"body":"issues. And, you know, there was"},{"speaker":"Chris Dy","startTime":431.28,"endTime":436.53,"body":"not great adherence to post"},{"speaker":"Chris Dy","startTime":436.53,"endTime":440.04,"body":"operative recommendations, both"},{"speaker":"Chris Dy","startTime":436.53,"endTime":440.04,"body":"in general and specifically with"},{"speaker":"Chris Dy","startTime":440.04,"endTime":442.98,"body":"regards to therapy. So, you"},{"speaker":"Chris Dy","startTime":440.04,"endTime":442.98,"body":"know, it's a challenging"},{"speaker":"Chris Dy","startTime":442.98,"endTime":445.95,"body":"situation overall, I think, you"},{"speaker":"Chris Dy","startTime":442.98,"endTime":445.95,"body":"know, all parties are"},{"speaker":"Chris Dy","startTime":445.95,"endTime":450.15,"body":"frustrated. And I, you know,"},{"speaker":"Chris Dy","startTime":445.95,"endTime":450.15,"body":"kind of talk through different"},{"speaker":"Chris Dy","startTime":450.15,"endTime":452.67,"body":"options, I feel like we had"},{"speaker":"Chris Dy","startTime":450.15,"endTime":452.67,"body":"exhausted our non operative"},{"speaker":"Chris Dy","startTime":452.67,"endTime":456.93,"body":"treatments that we've had"},{"speaker":"Chris Dy","startTime":452.67,"endTime":456.93,"body":"available to us. And, you know,"},{"speaker":"Chris Dy","startTime":456.93,"endTime":460.77,"body":"I did spell out kind of the"},{"speaker":"Chris Dy","startTime":456.93,"endTime":460.77,"body":"things that we would need to do"},{"speaker":"Chris Dy","startTime":460.77,"endTime":465.03,"body":"if we were to try to salvage the"},{"speaker":"Chris Dy","startTime":460.77,"endTime":465.03,"body":"finger and including, you know,"},{"speaker":"Chris Dy","startTime":465.03,"endTime":468.33,"body":"your stiff finger surgeries,"},{"speaker":"Chris Dy","startTime":465.03,"endTime":468.33,"body":"followed by to get full passive,"},{"speaker":"Chris Dy","startTime":468.33,"endTime":472.59,"body":"and then followed by Tina,"},{"speaker":"Chris Dy","startTime":468.33,"endTime":472.59,"body":"lysis, etc, to get some gliding"},{"speaker":"Chris Dy","startTime":472.59,"endTime":475.53,"body":"after you've, if you've been"},{"speaker":"Chris Dy","startTime":472.59,"endTime":475.53,"body":"able to maintain the passive. So"},{"speaker":"Chris Dy","startTime":475.95,"endTime":477.99,"body":"we talked about the multiple"},{"speaker":"Chris Dy","startTime":475.95,"endTime":477.99,"body":"steps that would take and that"},{"speaker":"Chris Dy","startTime":477.99,"endTime":481.5,"body":"just, you know, after multiple"},{"speaker":"Chris Dy","startTime":477.99,"endTime":481.5,"body":"visits, was not appealing to"},{"speaker":"Chris Dy","startTime":481.5,"endTime":481.77,"body":"her."},{"speaker":"Charles Goldfarb","startTime":482.76,"endTime":484.53,"body":"Right, so it"},{"speaker":"Charles Goldfarb","startTime":482.76,"endTime":484.53,"body":"sounds like at this point,"},{"speaker":"Charles Goldfarb","startTime":484.56,"endTime":488.25,"body":"you're sort of you're It was the"},{"speaker":"Charles Goldfarb","startTime":484.56,"endTime":488.25,"body":"middle finger, I'm not sure if a"},{"speaker":"Charles Goldfarb","startTime":488.25,"endTime":490.14,"body":"dominant hand or non dominant"},{"speaker":"Charles Goldfarb","startTime":488.25,"endTime":490.14,"body":"hand and I don't know that it"},{"speaker":"Charles Goldfarb","startTime":490.14,"endTime":497.31,"body":"matters. So your options really"},{"speaker":"Charles Goldfarb","startTime":490.14,"endTime":497.31,"body":"are leave it as it is. amputate"},{"speaker":"Charles Goldfarb","startTime":497.37,"endTime":501.6,"body":"at the level, the MCP joint or,"},{"speaker":"Charles Goldfarb","startTime":497.37,"endTime":501.6,"body":"you know, somewhere about there"},{"speaker":"Charles Goldfarb","startTime":501.93,"endTime":507.0,"body":"or consider an amputation or"},{"speaker":"Charles Goldfarb","startTime":501.93,"endTime":507.0,"body":"with a re resection plus minus"},{"speaker":"Charles Goldfarb","startTime":507.0,"endTime":510.39,"body":"transposition of the index"},{"speaker":"Charles Goldfarb","startTime":507.0,"endTime":510.39,"body":"finger. Is that kind of where"},{"speaker":"Charles Goldfarb","startTime":510.39,"endTime":512.73,"body":"you were and what you had"},{"speaker":"Charles Goldfarb","startTime":510.39,"endTime":512.73,"body":"discussed with the patient?"},{"speaker":"Chris Dy","startTime":513.059,"endTime":515.429,"body":"Yeah, basically,"},{"speaker":"Chris Dy","startTime":513.059,"endTime":515.429,"body":"that's it, I really honestly did"},{"speaker":"Chris Dy","startTime":515.429,"endTime":519.899,"body":"not give much of an option for"},{"speaker":"Chris Dy","startTime":515.429,"endTime":519.899,"body":"you know, an MCP level"},{"speaker":"Chris Dy","startTime":519.899,"endTime":523.259,"body":"disarticulation. And I'd love to"},{"speaker":"Chris Dy","startTime":519.899,"endTime":523.259,"body":"know, your thoughts as to you"},{"speaker":"Chris Dy","startTime":523.259,"endTime":526.349,"body":"know, whether you think that's a"},{"speaker":"Chris Dy","startTime":523.259,"endTime":526.349,"body":"surgery that provides meaningful"},{"speaker":"Chris Dy","startTime":526.709,"endTime":530.039,"body":"improvement or whether you think"},{"speaker":"Chris Dy","startTime":526.709,"endTime":530.039,"body":"that that's, you know, is there?"},{"speaker":"Chris Dy","startTime":530.099,"endTime":532.469,"body":"Is there anything aside from"},{"speaker":"Chris Dy","startTime":530.099,"endTime":532.469,"body":"array resection?"},{"speaker":"Charles Goldfarb","startTime":533.49,"endTime":538.05,"body":"I think for"},{"speaker":"Charles Goldfarb","startTime":533.49,"endTime":538.05,"body":"certain patients, an MCP level,"},{"speaker":"Charles Goldfarb","startTime":538.2,"endTime":542.52,"body":"amputation is an option, that"},{"speaker":"Charles Goldfarb","startTime":538.2,"endTime":542.52,"body":"will be the patient that just"},{"speaker":"Charles Goldfarb","startTime":543.09,"endTime":546.15,"body":"needs to get back to work very"},{"speaker":"Charles Goldfarb","startTime":543.09,"endTime":546.15,"body":"quickly, and doesn't want to"},{"speaker":"Charles Goldfarb","startTime":546.15,"endTime":552.45,"body":"think about extensive rehab, and"},{"speaker":"Charles Goldfarb","startTime":546.15,"endTime":552.45,"body":"is not overly concerned about"},{"speaker":"Charles Goldfarb","startTime":552.45,"endTime":555.36,"body":"that. cosmesis and the"},{"speaker":"Charles Goldfarb","startTime":552.45,"endTime":555.36,"body":"functional challenges that that"},{"speaker":"Charles Goldfarb","startTime":555.42,"endTime":556.74,"body":"gap can create?"},{"speaker":"Chris Dy","startTime":557.16,"endTime":559.02,"body":"Yeah, so tell me about"},{"speaker":"Chris Dy","startTime":557.16,"endTime":559.02,"body":"those functional challenges"},{"speaker":"Chris Dy","startTime":559.02,"endTime":559.68,"body":"about the gap."},{"speaker":"Charles Goldfarb","startTime":561.72,"endTime":563.58,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":561.72,"endTime":563.58,"body":"think the benefit of that"},{"speaker":"Charles Goldfarb","startTime":563.58,"endTime":566.61,"body":"surgery is you maintain the"},{"speaker":"Charles Goldfarb","startTime":563.58,"endTime":566.61,"body":"width or the breadth of the hand"},{"speaker":"Charles Goldfarb","startTime":566.61,"endTime":571.53,"body":"which, which has been shown to"},{"speaker":"Charles Goldfarb","startTime":566.61,"endTime":571.53,"body":"be correlated with strength. The"},{"speaker":"Charles Goldfarb","startTime":571.53,"endTime":575.55,"body":"negative is very simply they"},{"speaker":"Charles Goldfarb","startTime":571.53,"endTime":575.55,"body":"failed the m\u0026m test, right? If"},{"speaker":"Charles Goldfarb","startTime":575.55,"endTime":578.01,"body":"they're holding a bunch of m\u0026ms,"},{"speaker":"Charles Goldfarb","startTime":575.55,"endTime":578.01,"body":"you're gonna lose some through"},{"speaker":"Charles Goldfarb","startTime":578.01,"endTime":581.07,"body":"the gap. And I think that is"},{"speaker":"Charles Goldfarb","startTime":578.01,"endTime":581.07,"body":"that is true. We don't worry"},{"speaker":"Charles Goldfarb","startTime":581.07,"endTime":583.44,"body":"about pocket change much"},{"speaker":"Charles Goldfarb","startTime":581.07,"endTime":583.44,"body":"anymore, since none of us have"},{"speaker":"Charles Goldfarb","startTime":583.44,"endTime":586.8,"body":"it. But the m\u0026ms We still have"},{"speaker":"Charles Goldfarb","startTime":583.44,"endTime":586.8,"body":"them. Right."},{"speaker":"Chris Dy","startTime":586.83,"endTime":588.99,"body":"I'm trying to think"},{"speaker":"Chris Dy","startTime":586.83,"endTime":588.99,"body":"of, I think my daughter would"},{"speaker":"Chris Dy","startTime":588.99,"endTime":591.69,"body":"love that. She just go and pick"},{"speaker":"Chris Dy","startTime":588.99,"endTime":591.69,"body":"up all the m\u0026ms and eat them"},{"speaker":"Chris Dy","startTime":591.69,"endTime":597.99,"body":"anyway. But so, yeah, and I tend"},{"speaker":"Chris Dy","startTime":591.69,"endTime":597.99,"body":"to think that that procedure, at"},{"speaker":"Chris Dy","startTime":597.99,"endTime":600.81,"body":"least from what I've seen,"},{"speaker":"Chris Dy","startTime":597.99,"endTime":600.81,"body":"doesn't Don't necessarily"},{"speaker":"Chris Dy","startTime":600.81,"endTime":605.58,"body":"provide the earlier recovery"},{"speaker":"Chris Dy","startTime":600.81,"endTime":605.58,"body":"benefit. And I think the, you"},{"speaker":"Chris Dy","startTime":605.58,"endTime":608.76,"body":"know, objects slipping out of"},{"speaker":"Chris Dy","startTime":605.58,"endTime":608.76,"body":"the hand, you know, the m\u0026m"},{"speaker":"Chris Dy","startTime":608.76,"endTime":612.99,"body":"testing, I think that's a real"},{"speaker":"Chris Dy","startTime":608.76,"endTime":612.99,"body":"issue. But you know, I think I"},{"speaker":"Chris Dy","startTime":612.99,"endTime":615.93,"body":"get what you're saying in terms"},{"speaker":"Chris Dy","startTime":612.99,"endTime":615.93,"body":"of the breath. Do you purchase"},{"speaker":"Chris Dy","startTime":615.93,"endTime":618.21,"body":"any differently if it's the ring"},{"speaker":"Chris Dy","startTime":615.93,"endTime":618.21,"body":"finger?"},{"speaker":"Charles Goldfarb","startTime":618.72,"endTime":620.91,"body":"No, I don't"},{"speaker":"Charles Goldfarb","startTime":618.72,"endTime":620.91,"body":"think so. I mean, certainly. So"},{"speaker":"Charles Goldfarb","startTime":620.91,"endTime":624.99,"body":"the, you know, again, as we've"},{"speaker":"Charles Goldfarb","startTime":620.91,"endTime":624.99,"body":"discussed, ring fingers going to"},{"speaker":"Charles Goldfarb","startTime":624.99,"endTime":627.99,"body":"provide a little more"},{"speaker":"Charles Goldfarb","startTime":624.99,"endTime":627.99,"body":"contribution to strength, and a"},{"speaker":"Charles Goldfarb","startTime":627.99,"endTime":631.59,"body":"little less contribution to fine"},{"speaker":"Charles Goldfarb","startTime":627.99,"endTime":631.59,"body":"motor, although I think both can"},{"speaker":"Charles Goldfarb","startTime":631.59,"endTime":634.35,"body":"contribute in both directions."},{"speaker":"Charles Goldfarb","startTime":631.59,"endTime":634.35,"body":"But now I don't I don't think"},{"speaker":"Charles Goldfarb","startTime":634.35,"endTime":637.68,"body":"the ring finger fundamentally"},{"speaker":"Charles Goldfarb","startTime":634.35,"endTime":637.68,"body":"changes because in my mind, in"},{"speaker":"Charles Goldfarb","startTime":637.68,"endTime":641.31,"body":"my mind, the ideal procedure, no"},{"speaker":"Charles Goldfarb","startTime":637.68,"endTime":641.31,"body":"matter if it's middle, or ring,"},{"speaker":"Charles Goldfarb","startTime":641.82,"endTime":645.42,"body":"is re resection with a"},{"speaker":"Charles Goldfarb","startTime":641.82,"endTime":645.42,"body":"transposition of the adjacent"},{"speaker":"Charles Goldfarb","startTime":645.42,"endTime":648.42,"body":"digit. And I'm not sure if you"},{"speaker":"Charles Goldfarb","startTime":645.42,"endTime":648.42,"body":"immediately think about the"},{"speaker":"Charles Goldfarb","startTime":648.42,"endTime":650.58,"body":"transposition. And we can talk"},{"speaker":"Charles Goldfarb","startTime":648.42,"endTime":650.58,"body":"about pros and cons of"},{"speaker":"Charles Goldfarb","startTime":650.58,"endTime":654.33,"body":"transposition, versus trying to"},{"speaker":"Charles Goldfarb","startTime":650.58,"endTime":654.33,"body":"close down the space. But I've"},{"speaker":"Charles Goldfarb","startTime":654.33,"endTime":656.79,"body":"been very happy with"},{"speaker":"Charles Goldfarb","startTime":654.33,"endTime":656.79,"body":"transposition."},{"speaker":"Chris Dy","startTime":657.3,"endTime":659.25,"body":"For sure. And before,"},{"speaker":"Chris Dy","startTime":657.3,"endTime":659.25,"body":"I think that would be a great"},{"speaker":"Chris Dy","startTime":659.25,"endTime":662.61,"body":"topic to discuss. And before we"},{"speaker":"Chris Dy","startTime":659.25,"endTime":662.61,"body":"pivot to that, I mean, how do"},{"speaker":"Chris Dy","startTime":662.61,"endTime":665.4,"body":"you approach this if it's an"},{"speaker":"Chris Dy","startTime":662.61,"endTime":665.4,"body":"index or a small finger?"},{"speaker":"Charles Goldfarb","startTime":667.29,"endTime":670.77,"body":"Yeah, so"},{"speaker":"Charles Goldfarb","startTime":667.29,"endTime":670.77,"body":"actually, in the last couple of"},{"speaker":"Charles Goldfarb","startTime":670.77,"endTime":675.15,"body":"months, I think I've done a"},{"speaker":"Charles Goldfarb","startTime":670.77,"endTime":675.15,"body":"couple of each of those. I think"},{"speaker":"Charles Goldfarb","startTime":675.15,"endTime":677.91,"body":"they're much more"},{"speaker":"Charles Goldfarb","startTime":675.15,"endTime":677.91,"body":"straightforward, in the sense"},{"speaker":"Charles Goldfarb","startTime":677.91,"endTime":682.86,"body":"that I do array resection. And I"},{"speaker":"Charles Goldfarb","startTime":677.91,"endTime":682.86,"body":"don't necessarily feel as though"},{"speaker":"Charles Goldfarb","startTime":682.86,"endTime":685.74,"body":"I want to take out the entire"},{"speaker":"Charles Goldfarb","startTime":682.86,"endTime":685.74,"body":"array. Because there's"},{"speaker":"Charles Goldfarb","startTime":685.74,"endTime":688.92,"body":"negatives, right, we have"},{"speaker":"Charles Goldfarb","startTime":685.74,"endTime":688.92,"body":"tendons inserting onto the base"},{"speaker":"Charles Goldfarb","startTime":688.95,"endTime":693.51,"body":"of most of our metacarpals. And"},{"speaker":"Charles Goldfarb","startTime":688.95,"endTime":693.51,"body":"I want to maintain those if at"},{"speaker":"Charles Goldfarb","startTime":693.51,"endTime":696.45,"body":"all possible. So my goal if it's"},{"speaker":"Charles Goldfarb","startTime":693.51,"endTime":696.45,"body":"an index finger, is an"},{"speaker":"Charles Goldfarb","startTime":696.45,"endTime":702.39,"body":"amputation, mid metacarpal, with"},{"speaker":"Charles Goldfarb","startTime":696.45,"endTime":702.39,"body":"an oblique cut in the in the"},{"speaker":"Charles Goldfarb","startTime":702.39,"endTime":705.93,"body":"metacarpal. So the liquidy is"},{"speaker":"Charles Goldfarb","startTime":702.39,"endTime":705.93,"body":"from distal and ulnar to"},{"speaker":"Charles Goldfarb","startTime":705.93,"endTime":710.46,"body":"proximal and radial and flipped"},{"speaker":"Charles Goldfarb","startTime":705.93,"endTime":710.46,"body":"for a small finger amputation."},{"speaker":"Charles Goldfarb","startTime":710.52,"endTime":712.59,"body":"What about you? Pretty"},{"speaker":"Chris Dy","startTime":712.59,"endTime":715.98,"body":"much the same. I like"},{"speaker":"Chris Dy","startTime":712.59,"endTime":715.98,"body":"that you're not trying to close"},{"speaker":"Chris Dy","startTime":715.98,"endTime":718.05,"body":"a gap or anything like that. I"},{"speaker":"Chris Dy","startTime":715.98,"endTime":718.05,"body":"don't have to worry about"},{"speaker":"Chris Dy","startTime":718.05,"endTime":721.38,"body":"transposition. And I think the"},{"speaker":"Chris Dy","startTime":718.05,"endTime":721.38,"body":"aesthetics of it are much nicer"},{"speaker":"Chris Dy","startTime":721.44,"endTime":726.21,"body":"for the index and for the small."},{"speaker":"Chris Dy","startTime":721.44,"endTime":726.21,"body":"But ya know, I think that, you"},{"speaker":"Chris Dy","startTime":726.21,"endTime":729.78,"body":"know, for me getting back to"},{"speaker":"Chris Dy","startTime":726.21,"endTime":729.78,"body":"this case, I don't necessarily"},{"speaker":"Chris Dy","startTime":729.78,"endTime":735.15,"body":"always think about the going to"},{"speaker":"Chris Dy","startTime":729.78,"endTime":735.15,"body":"a transposition. Because I have"},{"speaker":"Chris Dy","startTime":735.15,"endTime":738.72,"body":"found that in my limit, somewhat"},{"speaker":"Chris Dy","startTime":735.15,"endTime":738.72,"body":"limited experience with this,"},{"speaker":"Chris Dy","startTime":738.72,"endTime":742.02,"body":"that I have been able to really"},{"speaker":"Chris Dy","startTime":738.72,"endTime":742.02,"body":"use those deep transverse inner"},{"speaker":"Chris Dy","startTime":742.02,"endTime":745.56,"body":"metacarpal ligaments to close"},{"speaker":"Chris Dy","startTime":742.02,"endTime":745.56,"body":"the space in a way where I don't"},{"speaker":"Chris Dy","startTime":745.56,"endTime":748.5,"body":"feel like I'm missing a whole"},{"speaker":"Chris Dy","startTime":745.56,"endTime":748.5,"body":"lot. I mean, have you what's"},{"speaker":"Chris Dy","startTime":748.5,"endTime":750.42,"body":"been your experience with"},{"speaker":"Chris Dy","startTime":748.5,"endTime":750.42,"body":"patients who have had the"},{"speaker":"Chris Dy","startTime":750.42,"endTime":753.66,"body":"transposition those who haven't,"},{"speaker":"Chris Dy","startTime":750.42,"endTime":753.66,"body":"and what the classic teachings"},{"speaker":"Chris Dy","startTime":753.66,"endTime":753.99,"body":"were?"},{"speaker":"Charles Goldfarb","startTime":755.04,"endTime":757.41,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":755.04,"endTime":757.41,"body":"I think you can close the space"},{"speaker":"Charles Goldfarb","startTime":757.41,"endTime":761.82,"body":"down. I think it never looks"},{"speaker":"Charles Goldfarb","startTime":757.41,"endTime":761.82,"body":"exactly right. But it can look"},{"speaker":"Charles Goldfarb","startTime":761.82,"endTime":767.22,"body":"good enough for some people. I"},{"speaker":"Charles Goldfarb","startTime":761.82,"endTime":767.22,"body":"have had patients and I don't do"},{"speaker":"Charles Goldfarb","startTime":767.22,"endTime":772.65,"body":"that really anymore. My go to is"},{"speaker":"Charles Goldfarb","startTime":767.22,"endTime":772.65,"body":"a transposition. But I have had"},{"speaker":"Charles Goldfarb","startTime":772.65,"endTime":775.44,"body":"people where it stretches out"},{"speaker":"Charles Goldfarb","startTime":772.65,"endTime":775.44,"body":"with time. But I think many"},{"speaker":"Charles Goldfarb","startTime":775.44,"endTime":777.9,"body":"people will be satisfied with"},{"speaker":"Charles Goldfarb","startTime":775.44,"endTime":777.9,"body":"that. And it certainly is a"},{"speaker":"Charles Goldfarb","startTime":777.9,"endTime":780.36,"body":"quicker recovery, although I"},{"speaker":"Charles Goldfarb","startTime":777.9,"endTime":780.36,"body":"would say not dramatically"},{"speaker":"Charles Goldfarb","startTime":780.36,"endTime":783.24,"body":"quicker than the transposition."},{"speaker":"Charles Goldfarb","startTime":780.36,"endTime":783.24,"body":"Because you do have to give time"},{"speaker":"Charles Goldfarb","startTime":783.24,"endTime":786.06,"body":"for soft tissue healing, which"},{"speaker":"Charles Goldfarb","startTime":783.24,"endTime":786.06,"body":"you know, can be less"},{"speaker":"Charles Goldfarb","startTime":786.06,"endTime":787.41,"body":"predictable. Right?"},{"speaker":"Chris Dy","startTime":787.41,"endTime":791.31,"body":"Of course, when you do"},{"speaker":"Chris Dy","startTime":787.41,"endTime":791.31,"body":"your transposition, how are you?"},{"speaker":"Chris Dy","startTime":791.88,"endTime":794.94,"body":"I guess, maybe explain what a"},{"speaker":"Chris Dy","startTime":791.88,"endTime":794.94,"body":"transposition is for those that"},{"speaker":"Chris Dy","startTime":794.94,"endTime":798.24,"body":"may not be familiar with that."},{"speaker":"Chris Dy","startTime":794.94,"endTime":798.24,"body":"And then we'll have what's your"},{"speaker":"Chris Dy","startTime":798.24,"endTime":800.22,"body":"bony fixation like? Yeah, and"},{"speaker":"Charles Goldfarb","startTime":800.22,"endTime":801.78,"body":"I should"},{"speaker":"Charles Goldfarb","startTime":800.22,"endTime":801.78,"body":"preface it by saying the reason"},{"speaker":"Charles Goldfarb","startTime":801.78,"endTime":804.18,"body":"I like the procedure is in part"},{"speaker":"Charles Goldfarb","startTime":801.78,"endTime":804.18,"body":"because I've done it a lot,"},{"speaker":"Charles Goldfarb","startTime":804.18,"endTime":807.09,"body":"because I do it in the"},{"speaker":"Charles Goldfarb","startTime":804.18,"endTime":807.09,"body":"congenital population, with"},{"speaker":"Charles Goldfarb","startTime":807.09,"endTime":812.31,"body":"cleft hand, commonly, and an"},{"speaker":"Charles Goldfarb","startTime":807.09,"endTime":812.31,"body":"injured worker, you know, less"},{"speaker":"Charles Goldfarb","startTime":812.31,"endTime":815.55,"body":"commonly, but sometimes, and so,"},{"speaker":"Charles Goldfarb","startTime":812.31,"endTime":815.55,"body":"essentially, what you're doing,"},{"speaker":"Charles Goldfarb","startTime":815.55,"endTime":818.19,"body":"let's use the middle finger as"},{"speaker":"Charles Goldfarb","startTime":815.55,"endTime":818.19,"body":"the example, if your middle"},{"speaker":"Charles Goldfarb","startTime":818.19,"endTime":823.95,"body":"finger is either absent or"},{"speaker":"Charles Goldfarb","startTime":818.19,"endTime":823.95,"body":"traumatize, especially if you"},{"speaker":"Charles Goldfarb","startTime":823.95,"endTime":828.81,"body":"have a good third metacarpal,"},{"speaker":"Charles Goldfarb","startTime":823.95,"endTime":828.81,"body":"then the goal is to cut your"},{"speaker":"Charles Goldfarb","startTime":828.81,"endTime":834.03,"body":"index metacarpal removed part of"},{"speaker":"Charles Goldfarb","startTime":828.81,"endTime":834.03,"body":"the, the so cut that second"},{"speaker":"Charles Goldfarb","startTime":834.03,"endTime":839.61,"body":"metacarpal and then cut out the"},{"speaker":"Charles Goldfarb","startTime":834.03,"endTime":839.61,"body":"distal part of the third"},{"speaker":"Charles Goldfarb","startTime":839.61,"endTime":842.64,"body":"metacarpal. And then you're"},{"speaker":"Charles Goldfarb","startTime":839.61,"endTime":842.64,"body":"bringing your entire index"},{"speaker":"Charles Goldfarb","startTime":842.64,"endTime":846.84,"body":"array, you're placing it on the"},{"speaker":"Charles Goldfarb","startTime":842.64,"endTime":846.84,"body":"on the proximal aspect of the"},{"speaker":"Charles Goldfarb","startTime":846.84,"endTime":851.67,"body":"cut third, metacarpal, and then"},{"speaker":"Charles Goldfarb","startTime":846.84,"endTime":851.67,"body":"plate and screws to fixate the"},{"speaker":"Charles Goldfarb","startTime":851.67,"endTime":855.36,"body":"finger. And that widens your"},{"speaker":"Charles Goldfarb","startTime":851.67,"endTime":855.36,"body":"first webspace, which"},{"speaker":"Charles Goldfarb","startTime":855.48,"endTime":858.51,"body":"theoretically gives you a"},{"speaker":"Charles Goldfarb","startTime":855.48,"endTime":858.51,"body":"functional advantage, or"},{"speaker":"Charles Goldfarb","startTime":858.51,"endTime":861.9,"body":"certainly not a disadvantage."},{"speaker":"Charles Goldfarb","startTime":858.51,"endTime":861.9,"body":"You can try to preserve the"},{"speaker":"Charles Goldfarb","startTime":861.9,"endTime":866.34,"body":"origin of the ad Dr. Policies"},{"speaker":"Charles Goldfarb","startTime":861.9,"endTime":866.34,"body":"and done correctly, the"},{"speaker":"Charles Goldfarb","startTime":866.34,"endTime":871.08,"body":"aesthetics are amazing. Function"},{"speaker":"Charles Goldfarb","startTime":866.34,"endTime":871.08,"body":"is great. The hands a little"},{"speaker":"Charles Goldfarb","startTime":871.08,"endTime":875.49,"body":"narrower, but you warn patients"},{"speaker":"Charles Goldfarb","startTime":871.08,"endTime":875.49,"body":"about that beforehand. Right."},{"speaker":"Chris Dy","startTime":875.52,"endTime":877.59,"body":"Right. I think I think"},{"speaker":"Chris Dy","startTime":875.52,"endTime":877.59,"body":"that's those are all really good"},{"speaker":"Chris Dy","startTime":877.59,"endTime":880.68,"body":"points in terms of, you know, I"},{"speaker":"Chris Dy","startTime":877.59,"endTime":880.68,"body":"think the counseling is key"},{"speaker":"Chris Dy","startTime":880.68,"endTime":885.21,"body":"about what to expect. How long"},{"speaker":"Chris Dy","startTime":880.68,"endTime":885.21,"body":"do you think it takes for that"},{"speaker":"Chris Dy","startTime":885.24,"endTime":888.51,"body":"transposition bone work to heal"},{"speaker":"Chris Dy","startTime":885.24,"endTime":888.51,"body":"standard kind of orthopedic unit"},{"speaker":"Chris Dy","startTime":888.51,"endTime":889.23,"body":"of six weeks?"},{"speaker":"Charles Goldfarb","startTime":889.74,"endTime":891.96,"body":"I think it's a"},{"speaker":"Charles Goldfarb","startTime":889.74,"endTime":891.96,"body":"little longer. I don't know if"},{"speaker":"Charles Goldfarb","startTime":891.96,"endTime":894.3,"body":"you've had experienced or what's"},{"speaker":"Charles Goldfarb","startTime":891.96,"endTime":894.3,"body":"your experience? I would say I"},{"speaker":"Charles Goldfarb","startTime":894.3,"endTime":897.63,"body":"tell people eight to 10 weeks."},{"speaker":"Charles Goldfarb","startTime":894.3,"endTime":897.63,"body":"We work on motion right away."},{"speaker":"Charles Goldfarb","startTime":897.63,"endTime":900.15,"body":"That's the other beauty to"},{"speaker":"Charles Goldfarb","startTime":897.63,"endTime":900.15,"body":"therapy you know very quick Do"},{"speaker":"Charles Goldfarb","startTime":900.15,"endTime":903.36,"body":"you have good bony rigid"},{"speaker":"Charles Goldfarb","startTime":900.15,"endTime":903.36,"body":"fixation? I think it just takes"},{"speaker":"Charles Goldfarb","startTime":903.36,"endTime":906.12,"body":"a little bit longer. There's a"},{"speaker":"Charles Goldfarb","startTime":903.36,"endTime":906.12,"body":"little bit of federal factor"},{"speaker":"Charles Goldfarb","startTime":906.12,"endTime":909.48,"body":"intraoperatively. And maybe I do"},{"speaker":"Charles Goldfarb","startTime":906.12,"endTime":909.48,"body":"more stripping than I would like"},{"speaker":"Charles Goldfarb","startTime":909.48,"endTime":913.11,"body":"to admit of the bones which may"},{"speaker":"Charles Goldfarb","startTime":909.48,"endTime":913.11,"body":"delay healing to some degree."},{"speaker":"Charles Goldfarb","startTime":913.62,"endTime":917.25,"body":"But I think it's it's, it's it's"},{"speaker":"Charles Goldfarb","startTime":913.62,"endTime":917.25,"body":"a little longer than typical."},{"speaker":"Charles Goldfarb","startTime":917.58,"endTime":920.55,"body":"But patients are happy. They're"},{"speaker":"Charles Goldfarb","startTime":917.58,"endTime":920.55,"body":"in removable brace. They're"},{"speaker":"Charles Goldfarb","startTime":920.55,"endTime":923.55,"body":"working on motion, and hopefully"},{"speaker":"Charles Goldfarb","startTime":920.55,"endTime":923.55,"body":"healings on eventful"},{"speaker":"Chris Dy","startTime":924.0,"endTime":926.97,"body":"and how do you orient"},{"speaker":"Chris Dy","startTime":924.0,"endTime":926.97,"body":"your bone cuts? So that, you"},{"speaker":"Chris Dy","startTime":926.97,"endTime":930.3,"body":"know, you get the to decrease"},{"speaker":"Chris Dy","startTime":926.97,"endTime":930.3,"body":"the fiddle factor? Or do you get"},{"speaker":"Chris Dy","startTime":930.3,"endTime":931.62,"body":"the bones and then figure it out"},{"speaker":"Chris Dy","startTime":930.3,"endTime":931.62,"body":"later?"},{"speaker":"Charles Goldfarb","startTime":933.21,"endTime":938.34,"body":"I, well, you"},{"speaker":"Charles Goldfarb","startTime":933.21,"endTime":938.34,"body":"sort of want enough tension. So"},{"speaker":"Charles Goldfarb","startTime":938.34,"endTime":943.32,"body":"you're getting kind of automatic"},{"speaker":"Charles Goldfarb","startTime":938.34,"endTime":943.32,"body":"compression. And so I sort of"},{"speaker":"Charles Goldfarb","startTime":943.38,"endTime":946.38,"body":"either try to cut them at equal"},{"speaker":"Charles Goldfarb","startTime":943.38,"endTime":946.38,"body":"levels, that is the index"},{"speaker":"Charles Goldfarb","startTime":946.38,"endTime":949.2,"body":"metacarpal and the third in the"},{"speaker":"Charles Goldfarb","startTime":946.38,"endTime":949.2,"body":"in the in the middle finger"},{"speaker":"Charles Goldfarb","startTime":949.2,"endTime":954.48,"body":"metacarpal. Or else try to cut"},{"speaker":"Charles Goldfarb","startTime":949.2,"endTime":954.48,"body":"the index finger metacarpal, a"},{"speaker":"Charles Goldfarb","startTime":954.48,"endTime":958.41,"body":"little shorter, so a little bit"},{"speaker":"Charles Goldfarb","startTime":954.48,"endTime":958.41,"body":"of a longer residual stump, and"},{"speaker":"Charles Goldfarb","startTime":958.41,"endTime":961.56,"body":"then I kind of tilted in and pop"},{"speaker":"Charles Goldfarb","startTime":958.41,"endTime":961.56,"body":"it over before I put my plate"},{"speaker":"Charles Goldfarb","startTime":961.56,"endTime":961.77,"body":"on."},{"speaker":"Chris Dy","startTime":962.85,"endTime":967.29,"body":"Fancy fancy. And I"},{"speaker":"Chris Dy","startTime":962.85,"endTime":967.29,"body":"think for those listening, it's"},{"speaker":"Chris Dy","startTime":967.29,"endTime":970.71,"body":"important to note that we are"},{"speaker":"Chris Dy","startTime":967.29,"endTime":970.71,"body":"preserving our insertions of our"},{"speaker":"Chris Dy","startTime":970.71,"endTime":975.09,"body":"ecrl and B respectively. So our"},{"speaker":"Chris Dy","startTime":970.71,"endTime":975.09,"body":"bone work is distal to that on"},{"speaker":"Chris Dy","startTime":975.09,"endTime":977.37,"body":"those metacarpals. Yeah, and"},{"speaker":"Charles Goldfarb","startTime":977.37,"endTime":980.22,"body":"this is one"},{"speaker":"Charles Goldfarb","startTime":977.37,"endTime":980.22,"body":"again, there, you know, you do a"},{"speaker":"Charles Goldfarb","startTime":980.22,"endTime":984.78,"body":"lot of work that that generates"},{"speaker":"Charles Goldfarb","startTime":980.22,"endTime":984.78,"body":"high patient satisfaction. And I"},{"speaker":"Charles Goldfarb","startTime":984.78,"endTime":988.68,"body":"like to think that I do as well."},{"speaker":"Charles Goldfarb","startTime":984.78,"endTime":988.68,"body":"There's nothing like this, when"},{"speaker":"Charles Goldfarb","startTime":988.68,"endTime":991.86,"body":"you have a patient with a really"},{"speaker":"Charles Goldfarb","startTime":988.68,"endTime":991.86,"body":"difficult problem. Typically,"},{"speaker":"Charles Goldfarb","startTime":991.86,"endTime":996.51,"body":"one that's been a problem for a"},{"speaker":"Charles Goldfarb","startTime":991.86,"endTime":996.51,"body":"long time after a trauma. That"},{"speaker":"Charles Goldfarb","startTime":996.51,"endTime":1001.76,"body":"patient satisfaction for this"},{"speaker":"Charles Goldfarb","startTime":996.51,"endTime":1001.76,"body":"surgery is amazing. And you"},{"speaker":"Charles Goldfarb","startTime":1001.76,"endTime":1004.07,"body":"know, it just it takes a very"},{"speaker":"Charles Goldfarb","startTime":1001.76,"endTime":1004.07,"body":"difficult situation waiting"},{"speaker":"Charles Goldfarb","startTime":1004.07,"endTime":1005.27,"body":"provides a really good outcome."},{"speaker":"Chris Dy","startTime":1005.75,"endTime":1008.06,"body":"Yeah, absolutely. I"},{"speaker":"Chris Dy","startTime":1005.75,"endTime":1008.06,"body":"have a former patient of mine"},{"speaker":"Chris Dy","startTime":1008.06,"endTime":1012.38,"body":"who has had this done and some"},{"speaker":"Chris Dy","startTime":1008.06,"endTime":1012.38,"body":"pork steaks often show up in the"},{"speaker":"Chris Dy","startTime":1012.38,"endTime":1017.81,"body":"office. I don't know, what's"},{"speaker":"Chris Dy","startTime":1012.38,"endTime":1017.81,"body":"your what's your take on on"},{"speaker":"Chris Dy","startTime":1017.81,"endTime":1020.27,"body":"consuming things that patients"},{"speaker":"Chris Dy","startTime":1017.81,"endTime":1020.27,"body":"bring in for you?"},{"speaker":"Charles Goldfarb","startTime":1021.26,"endTime":1023.72,"body":"I don't"},{"speaker":"Charles Goldfarb","startTime":1021.26,"endTime":1023.72,"body":"hesitate unless it's a weird"},{"speaker":"Charles Goldfarb","startTime":1023.72,"endTime":1028.49,"body":"situation where you're not sure"},{"speaker":"Charles Goldfarb","startTime":1023.72,"endTime":1028.49,"body":"if the patient likes you know, I"},{"speaker":"Charles Goldfarb","startTime":1028.61,"endTime":1032.42,"body":"you know, it's interesting. I"},{"speaker":"Charles Goldfarb","startTime":1028.61,"endTime":1032.42,"body":"occasionally am gifted food, I"},{"speaker":"Charles Goldfarb","startTime":1032.42,"endTime":1035.3,"body":"would say more often it's"},{"speaker":"Charles Goldfarb","startTime":1032.42,"endTime":1035.3,"body":"beverages."},{"speaker":"Chris Dy","startTime":1036.11,"endTime":1038.27,"body":"Right. Okay, well,"},{"speaker":"Chris Dy","startTime":1036.11,"endTime":1038.27,"body":"yeah, those are safer, I guess."},{"speaker":"Chris Dy","startTime":1040.13,"endTime":1044.06,"body":"Yeah, I guess the last thing I"},{"speaker":"Chris Dy","startTime":1040.13,"endTime":1044.06,"body":"want to ask you about the rate"},{"speaker":"Chris Dy","startTime":1044.33,"endTime":1047.12,"body":"resection is how do you design"},{"speaker":"Chris Dy","startTime":1044.33,"endTime":1047.12,"body":"your incisions, you have a lot"},{"speaker":"Chris Dy","startTime":1047.12,"endTime":1049.25,"body":"of experience with kind of"},{"speaker":"Chris Dy","startTime":1047.12,"endTime":1049.25,"body":"incision and web space"},{"speaker":"Chris Dy","startTime":1049.25,"endTime":1053.33,"body":"management from your PT and"},{"speaker":"Chris Dy","startTime":1049.25,"endTime":1053.33,"body":"adolescent practice. So how do"},{"speaker":"Chris Dy","startTime":1053.33,"endTime":1055.16,"body":"you design these incisions?"},{"speaker":"Charles Goldfarb","startTime":1055.73,"endTime":1058.16,"body":"Yes, sort of,"},{"speaker":"Charles Goldfarb","startTime":1055.73,"endTime":1058.16,"body":"I think there's a lot of"},{"speaker":"Charles Goldfarb","startTime":1058.16,"endTime":1061.82,"body":"different ways to do it, what"},{"speaker":"Charles Goldfarb","startTime":1058.16,"endTime":1061.82,"body":"you really have to be careful of"},{"speaker":"Charles Goldfarb","startTime":1061.82,"endTime":1068.27,"body":"is creating the interval between"},{"speaker":"Charles Goldfarb","startTime":1061.82,"endTime":1068.27,"body":"your explicit if you're taking"},{"speaker":"Charles Goldfarb","startTime":1068.27,"endTime":1071.45,"body":"out your middle finger, once you"},{"speaker":"Charles Goldfarb","startTime":1068.27,"endTime":1071.45,"body":"excise the middle array, you"},{"speaker":"Charles Goldfarb","startTime":1071.45,"endTime":1074.15,"body":"have to create a web space"},{"speaker":"Charles Goldfarb","startTime":1071.45,"endTime":1074.15,"body":"between the index and the ring."},{"speaker":"Charles Goldfarb","startTime":1074.48,"endTime":1077.24,"body":"And so there's different ways to"},{"speaker":"Charles Goldfarb","startTime":1074.48,"endTime":1077.24,"body":"do that I sort of tried to make"},{"speaker":"Charles Goldfarb","startTime":1077.24,"endTime":1083.03,"body":"a racket incision. But I create,"},{"speaker":"Charles Goldfarb","startTime":1077.24,"endTime":1083.03,"body":"I tried to do it in a way that I"},{"speaker":"Charles Goldfarb","startTime":1083.03,"endTime":1086.0,"body":"use the web space that exists"},{"speaker":"Charles Goldfarb","startTime":1083.03,"endTime":1086.0,"body":"between the index and middle"},{"speaker":"Charles Goldfarb","startTime":1086.0,"endTime":1089.72,"body":"finger and sort of just shifted"},{"speaker":"Charles Goldfarb","startTime":1086.0,"endTime":1089.72,"body":"over. So you're not you're not"},{"speaker":"Charles Goldfarb","startTime":1089.72,"endTime":1093.23,"body":"sewing in the apex of the web,"},{"speaker":"Charles Goldfarb","startTime":1089.72,"endTime":1093.23,"body":"if that makes sense. You're sort"},{"speaker":"Charles Goldfarb","startTime":1093.23,"endTime":1099.14,"body":"of taking skin. For those on"},{"speaker":"Charles Goldfarb","startTime":1093.23,"endTime":1099.14,"body":"YouTube, you're taking skin off"},{"speaker":"Charles Goldfarb","startTime":1099.14,"endTime":1103.04,"body":"the index finger and leaving"},{"speaker":"Charles Goldfarb","startTime":1099.14,"endTime":1103.04,"body":"this whole web space. And then"},{"speaker":"Charles Goldfarb","startTime":1103.04,"endTime":1106.91,"body":"it becomes your new web space"},{"speaker":"Charles Goldfarb","startTime":1103.04,"endTime":1106.91,"body":"between your index and ring"},{"speaker":"Charles Goldfarb","startTime":1106.91,"endTime":1110.15,"body":"finger. So is there good"},{"speaker":"Charles Goldfarb","startTime":1106.91,"endTime":1110.15,"body":"technique descriptions, but I"},{"speaker":"Charles Goldfarb","startTime":1110.15,"endTime":1113.03,"body":"think that's the important part"},{"speaker":"Charles Goldfarb","startTime":1110.15,"endTime":1113.03,"body":"of how you access everything"},{"speaker":"Charles Goldfarb","startTime":1113.03,"endTime":1116.21,"body":"else less important, but it's"},{"speaker":"Charles Goldfarb","startTime":1113.03,"endTime":1116.21,"body":"the webspace, which is critical."},{"speaker":"Charles Goldfarb","startTime":1116.66,"endTime":1116.96,"body":"Yeah,"},{"speaker":"Chris Dy","startTime":1116.96,"endTime":1119.78,"body":"no, I think that's,"},{"speaker":"Chris Dy","startTime":1116.96,"endTime":1119.78,"body":"that's well said, I remember I"},{"speaker":"Chris Dy","startTime":1119.78,"endTime":1123.29,"body":"was telling our resident who was"},{"speaker":"Chris Dy","startTime":1119.78,"endTime":1123.29,"body":"working with me, Dr. Jesse, who,"},{"speaker":"Chris Dy","startTime":1123.71,"endTime":1128.3,"body":"at the time, that when I was at"},{"speaker":"Chris Dy","startTime":1123.71,"endTime":1128.3,"body":"the VA, as a resident, they were"},{"speaker":"Chris Dy","startTime":1128.3,"endTime":1131.63,"body":"getting rid of a bunch of books."},{"speaker":"Chris Dy","startTime":1128.3,"endTime":1131.63,"body":"And the one book that I took"},{"speaker":"Chris Dy","startTime":1131.63,"endTime":1135.32,"body":"from that was a book called"},{"speaker":"Chris Dy","startTime":1131.63,"endTime":1135.32,"body":"Atlas of amputations, which has"},{"speaker":"Chris Dy","startTime":1135.32,"endTime":1138.77,"body":"been an incredible book for the"},{"speaker":"Chris Dy","startTime":1135.32,"endTime":1138.77,"body":"rare occasion where you're"},{"speaker":"Chris Dy","startTime":1138.77,"endTime":1142.61,"body":"doing, you know, kind of more"},{"speaker":"Chris Dy","startTime":1138.77,"endTime":1142.61,"body":"major non digital amputation all"},{"speaker":"Chris Dy","startTime":1142.61,"endTime":1145.04,"body":"over the body, just all the"},{"speaker":"Chris Dy","startTime":1142.61,"endTime":1145.04,"body":"incision designs was definitely"},{"speaker":"Chris Dy","startTime":1145.04,"endTime":1147.68,"body":"a wartime book, but very cool."},{"speaker":"Chris Dy","startTime":1145.04,"endTime":1147.68,"body":"Very interesting."},{"speaker":"Charles Goldfarb","startTime":1148.13,"endTime":1151.34,"body":"Yeah. What's"},{"speaker":"Charles Goldfarb","startTime":1148.13,"endTime":1151.34,"body":"your the another tangent? I'm"},{"speaker":"Charles Goldfarb","startTime":1151.34,"endTime":1154.88,"body":"looking at my bookshelf here in"},{"speaker":"Charles Goldfarb","startTime":1151.34,"endTime":1154.88,"body":"my office. How often do you"},{"speaker":"Charles Goldfarb","startTime":1154.88,"endTime":1157.1,"body":"access books, real books?"},{"speaker":"Chris Dy","startTime":1157.82,"endTime":1163.79,"body":"Ah, you know, earlier"},{"speaker":"Chris Dy","startTime":1157.82,"endTime":1163.79,"body":"on in practice, I would go to"},{"speaker":"Chris Dy","startTime":1163.79,"endTime":1166.7,"body":"books pretty frequently. I"},{"speaker":"Chris Dy","startTime":1163.79,"endTime":1166.7,"body":"actually have two copies of Dr."},{"speaker":"Chris Dy","startTime":1166.7,"endTime":1170.12,"body":"Goldman's nerve repair Blue"},{"speaker":"Chris Dy","startTime":1166.7,"endTime":1170.12,"body":"Book, which for anybody"},{"speaker":"Chris Dy","startTime":1170.12,"endTime":1174.32,"body":"listening is a fantastic book"},{"speaker":"Chris Dy","startTime":1170.12,"endTime":1174.32,"body":"that is timeless to volumes you"},{"speaker":"Chris Dy","startTime":1174.32,"endTime":1178.31,"body":"can oftentimes find it on Amazon"},{"speaker":"Chris Dy","startTime":1174.32,"endTime":1178.31,"body":"if you find it yet because it is"},{"speaker":"Chris Dy","startTime":1178.37,"endTime":1181.25,"body":"an awesome resource. But I used"},{"speaker":"Chris Dy","startTime":1178.37,"endTime":1181.25,"body":"to have I used to use it pretty"},{"speaker":"Chris Dy","startTime":1181.25,"endTime":1183.53,"body":"frequently so I should keep a"},{"speaker":"Chris Dy","startTime":1181.25,"endTime":1183.53,"body":"copy here in this office and one"},{"speaker":"Chris Dy","startTime":1183.53,"endTime":1186.08,"body":"at home. Because I was able to"},{"speaker":"Chris Dy","startTime":1183.53,"endTime":1186.08,"body":"pick up a couple of different"},{"speaker":"Chris Dy","startTime":1186.08,"endTime":1187.46,"body":"copies Wow,"},{"speaker":"Charles Goldfarb","startTime":1187.49,"endTime":1190.97,"body":"that's"},{"speaker":"Charles Goldfarb","startTime":1187.49,"endTime":1190.97,"body":"something Yeah, i i You know, I"},{"speaker":"Charles Goldfarb","startTime":1190.97,"endTime":1194.06,"body":"still expect if I write a"},{"speaker":"Charles Goldfarb","startTime":1190.97,"endTime":1194.06,"body":"chapter I want a physical"},{"speaker":"Charles Goldfarb","startTime":1194.09,"endTime":1197.78,"body":"textbook doesn't always happen"},{"speaker":"Charles Goldfarb","startTime":1194.09,"endTime":1197.78,"body":"anymore, which is really"},{"speaker":"Charles Goldfarb","startTime":1197.78,"endTime":1202.19,"body":"frustrating to me because the"},{"speaker":"Charles Goldfarb","startTime":1197.78,"endTime":1202.19,"body":"ebooks I personally, and I know"},{"speaker":"Charles Goldfarb","startTime":1202.19,"endTime":1204.74,"body":"I'm old ebooks don't resonate"},{"speaker":"Charles Goldfarb","startTime":1202.19,"endTime":1204.74,"body":"with me. Well,"},{"speaker":"Chris Dy","startTime":1204.74,"endTime":1206.78,"body":"I mean, honestly, if"},{"speaker":"Chris Dy","startTime":1204.74,"endTime":1206.78,"body":"you had the chapter like, would"},{"speaker":"Chris Dy","startTime":1206.78,"endTime":1210.53,"body":"you actually read the textbook"},{"speaker":"Chris Dy","startTime":1206.78,"endTime":1210.53,"body":"as I've got some editions that"},{"speaker":"Chris Dy","startTime":1210.53,"endTime":1214.19,"body":"I've written recently? I don't"},{"speaker":"Chris Dy","startTime":1210.53,"endTime":1214.19,"body":"think I've ever actually opened"},{"speaker":"Chris Dy","startTime":1214.19,"endTime":1215.9,"body":"it to be honest with you. No,"},{"speaker":"Charles Goldfarb","startTime":1215.9,"endTime":1217.52,"body":"I don't open"},{"speaker":"Charles Goldfarb","startTime":1215.9,"endTime":1217.52,"body":"it. I've started to give them"},{"speaker":"Charles Goldfarb","startTime":1217.52,"endTime":1220.91,"body":"away to residents and fellows."},{"speaker":"Charles Goldfarb","startTime":1217.52,"endTime":1220.91,"body":"know I'd still open them, but I"},{"speaker":"Charles Goldfarb","startTime":1220.91,"endTime":1221.54,"body":"just want it"},{"speaker":"Chris Dy","startTime":1221.99,"endTime":1224.69,"body":"right. If you put in"},{"speaker":"Chris Dy","startTime":1221.99,"endTime":1224.69,"body":"all that volunteer work to do"},{"speaker":"Chris Dy","startTime":1224.69,"endTime":1229.43,"body":"it, I still remember bringing"},{"speaker":"Chris Dy","startTime":1224.69,"endTime":1229.43,"body":"you a copy of my acsh elite"},{"speaker":"Chris Dy","startTime":1229.43,"endTime":1233.0,"body":"athlete book and seriously"},{"speaker":"Chris Dy","startTime":1229.43,"endTime":1233.0,"body":"asking you to sign it during"},{"speaker":"Chris Dy","startTime":1233.0,"endTime":1235.46,"body":"fellowship and you've rejected"},{"speaker":"Chris Dy","startTime":1233.0,"endTime":1235.46,"body":"and just laughed in my face."},{"speaker":"Charles Goldfarb","startTime":1235.7,"endTime":1238.25,"body":"I've learned"},{"speaker":"Charles Goldfarb","startTime":1235.7,"endTime":1238.25,"body":"since that I've grown I think it"},{"speaker":"Charles Goldfarb","startTime":1238.25,"endTime":1242.51,"body":"was a very briefly I was"},{"speaker":"Charles Goldfarb","startTime":1238.25,"endTime":1242.51,"body":"recently on a business school"},{"speaker":"Charles Goldfarb","startTime":1242.51,"endTime":1246.47,"body":"trip to DC and we had a lot of"},{"speaker":"Charles Goldfarb","startTime":1242.51,"endTime":1246.47,"body":"policy experts come to the"},{"speaker":"Charles Goldfarb","startTime":1246.47,"endTime":1249.77,"body":"Brookings Institute, and talk to"},{"speaker":"Charles Goldfarb","startTime":1246.47,"endTime":1249.77,"body":"us about different policy things"},{"speaker":"Charles Goldfarb","startTime":1249.77,"endTime":1254.24,"body":"and there was a really, really"},{"speaker":"Charles Goldfarb","startTime":1249.77,"endTime":1254.24,"body":"good speaker and I bought his"},{"speaker":"Charles Goldfarb","startTime":1254.24,"endTime":1256.55,"body":"book and asked him to sign it"},{"speaker":"Charles Goldfarb","startTime":1254.24,"endTime":1256.55,"body":"and he didn't bat an eye."},{"speaker":"Charles Goldfarb","startTime":1256.58,"endTime":1260.12,"body":"Clearly he makes a lot more than"},{"speaker":"Charles Goldfarb","startTime":1256.58,"endTime":1260.12,"body":"I have. Right,"},{"speaker":"Chris Dy","startTime":1259.7,"endTime":1262.618,"body":"right. Exactly. Yeah."},{"speaker":"Chris Dy","startTime":1259.7,"endTime":1262.618,"body":"Okay, fine. So before we talk"},{"speaker":"Chris Dy","startTime":1262.675,"endTime":1265.765,"body":"about our worker's compensation"},{"speaker":"Chris Dy","startTime":1262.675,"endTime":1265.765,"body":"topic, we should thank"},{"speaker":"Chris Dy","startTime":1265.823,"endTime":1268.856,"body":"checkpoint. The upper hand is"},{"speaker":"Chris Dy","startTime":1265.823,"endTime":1268.856,"body":"sponsored by checkpoint"},{"speaker":"Chris Dy","startTime":1268.913,"endTime":1271.66,"body":"surgical, a provider of"},{"speaker":"Chris Dy","startTime":1268.913,"endTime":1271.66,"body":"innovative solutions for"},{"speaker":"Chris Dy","startTime":1271.717,"endTime":1274.864,"body":"peripheral nerve surgery."},{"speaker":"Chris Dy","startTime":1271.717,"endTime":1274.864,"body":"Checkpoint surgical is always"},{"speaker":"Chris Dy","startTime":1274.922,"endTime":1278.412,"body":"striving to elevate the clinical"},{"speaker":"Chris Dy","startTime":1274.922,"endTime":1278.412,"body":"practice of peripheral nerve"},{"speaker":"Chris Dy","startTime":1278.47,"endTime":1281.732,"body":"surgery by providing surgeons"},{"speaker":"Chris Dy","startTime":1278.47,"endTime":1281.732,"body":"with new techniques to help"},{"speaker":"Chris Dy","startTime":1281.789,"endTime":1283.22,"body":"improve patient outcomes."},{"speaker":"Charles Goldfarb","startTime":1283.22,"endTime":1285.113,"body":"Checkpoints"},{"speaker":"Charles Goldfarb","startTime":1283.22,"endTime":1285.113,"body":"surgical is newest"},{"speaker":"Charles Goldfarb","startTime":1285.176,"endTime":1288.775,"body":"intraoperative nerve stimulator."},{"speaker":"Charles Goldfarb","startTime":1285.176,"endTime":1288.775,"body":"The Gemini bipolar nerve"},{"speaker":"Charles Goldfarb","startTime":1288.838,"endTime":1292.563,"body":"stimulator does just that. With"},{"speaker":"Charles Goldfarb","startTime":1288.838,"endTime":1292.563,"body":"a bipolar stimulation probe"},{"speaker":"Charles Goldfarb","startTime":1292.626,"endTime":1295.972,"body":"Gemini provides finely"},{"speaker":"Charles Goldfarb","startTime":1292.626,"endTime":1295.972,"body":"controlled stimulation even at"},{"speaker":"Charles Goldfarb","startTime":1296.035,"endTime":1299.949,"body":"that particular level, allowing"},{"speaker":"Charles Goldfarb","startTime":1296.035,"endTime":1299.949,"body":"surgeons to take actions based"},{"speaker":"Charles Goldfarb","startTime":1300.012,"endTime":1303.926,"body":"on the most precise information"},{"speaker":"Charles Goldfarb","startTime":1300.012,"endTime":1303.926,"body":"available. To learn more visit"},{"speaker":"Charles Goldfarb","startTime":1303.989,"endTime":1307.398,"body":"www.checkpointsurgical.com"},{"speaker":"Charles Goldfarb","startTime":1303.989,"endTime":1307.398,"body":"Checkpoint surgical driving"},{"speaker":"Charles Goldfarb","startTime":1307.461,"endTime":1310.807,"body":"innovation in hand surgery Oh,"},{"speaker":"Charles Goldfarb","startTime":1307.461,"endTime":1310.807,"body":"nerves surgery driving"},{"speaker":"Charles Goldfarb","startTime":1310.87,"endTime":1314.09,"body":"innovation in nerve surgery,"},{"speaker":"Charles Goldfarb","startTime":1310.87,"endTime":1314.09,"body":"Chris not hand surgery"},{"speaker":"Chris Dy","startTime":1314.09,"endTime":1319.07,"body":"your fire your fire"},{"speaker":"Chris Dy","startTime":1314.09,"endTime":1319.07,"body":"Chuck, you're fired. The purple"},{"speaker":"Chris Dy","startTime":1319.07,"endTime":1323.15,"body":"stimulator is what I also call"},{"speaker":"Chris Dy","startTime":1319.07,"endTime":1323.15,"body":"the Gemini because that's the"},{"speaker":"Chris Dy","startTime":1323.15,"endTime":1326.09,"body":"bikecad Keep the can't keep it"},{"speaker":"Chris Dy","startTime":1323.15,"endTime":1326.09,"body":"straight between the Guardian"},{"speaker":"Chris Dy","startTime":1326.09,"endTime":1329.57,"body":"and Gemini and his major faux"},{"speaker":"Chris Dy","startTime":1326.09,"endTime":1329.57,"body":"pas on the alliteration in terms"},{"speaker":"Chris Dy","startTime":1329.57,"endTime":1332.6,"body":"of like making them both G's,"},{"speaker":"Chris Dy","startTime":1329.57,"endTime":1332.6,"body":"because it's really confusing."},{"speaker":"Chris Dy","startTime":1334.16,"endTime":1336.32,"body":"So it just ends up being I want"},{"speaker":"Chris Dy","startTime":1334.16,"endTime":1336.32,"body":"the blue and I want the purple"},{"speaker":"Chris Dy","startTime":1336.32,"endTime":1336.59,"body":"one."},{"speaker":"Charles Goldfarb","startTime":1337.28,"endTime":1340.76,"body":"Yeah, which is"},{"speaker":"Charles Goldfarb","startTime":1337.28,"endTime":1340.76,"body":"more than I could ask for. Dr."},{"speaker":"Charles Goldfarb","startTime":1340.76,"endTime":1345.62,"body":"D, you and I are an academic"},{"speaker":"Charles Goldfarb","startTime":1340.76,"endTime":1345.62,"body":"medicine. Do you have any idea"},{"speaker":"Charles Goldfarb","startTime":1345.62,"endTime":1346.82,"body":"what your payer mix is?"},{"speaker":"Chris Dy","startTime":1348.23,"endTime":1353.42,"body":"I actually do. I"},{"speaker":"Chris Dy","startTime":1348.23,"endTime":1353.42,"body":"can't. I don't know, I know what"},{"speaker":"Chris Dy","startTime":1353.42,"endTime":1354.26,"body":"my collection rate is."},{"speaker":"Charles Goldfarb","startTime":1356.69,"endTime":1358.79,"body":"Asking for"},{"speaker":"Charles Goldfarb","startTime":1356.69,"endTime":1358.79,"body":"specifics. But right"},{"speaker":"Chris Dy","startTime":1358.79,"endTime":1360.8,"body":"now I'm trying to"},{"speaker":"Chris Dy","startTime":1358.79,"endTime":1360.8,"body":"think like I have a general"},{"speaker":"Chris Dy","startTime":1360.8,"endTime":1363.14,"body":"sense of what my payer mix is"},{"speaker":"Chris Dy","startTime":1360.8,"endTime":1363.14,"body":"because you know, we do get our"},{"speaker":"Chris Dy","startTime":1363.14,"endTime":1368.03,"body":"dashboard every month and I try"},{"speaker":"Chris Dy","startTime":1363.14,"endTime":1368.03,"body":"to look at it. I can tell you"},{"speaker":"Chris Dy","startTime":1368.03,"endTime":1370.46,"body":"what I feel like the biggest"},{"speaker":"Chris Dy","startTime":1368.03,"endTime":1370.46,"body":"ones are and what the smallest"},{"speaker":"Chris Dy","startTime":1370.46,"endTime":1374.99,"body":"ones are. But I mean, how do you"},{"speaker":"Chris Dy","startTime":1370.46,"endTime":1374.99,"body":"Did you always keep tabs on that"},{"speaker":"Chris Dy","startTime":1374.99,"endTime":1377.75,"body":"when you were in my stage? Well,"},{"speaker":"Charles Goldfarb","startTime":1377.75,"endTime":1380.9,"body":"part of the"},{"speaker":"Charles Goldfarb","startTime":1377.75,"endTime":1380.9,"body":"question is simply, academic"},{"speaker":"Charles Goldfarb","startTime":1380.9,"endTime":1386.03,"body":"medicine in 2024, is very"},{"speaker":"Charles Goldfarb","startTime":1380.9,"endTime":1386.03,"body":"different at most academic"},{"speaker":"Charles Goldfarb","startTime":1386.03,"endTime":1390.05,"body":"institutions than it was, I"},{"speaker":"Charles Goldfarb","startTime":1386.03,"endTime":1390.05,"body":"don't know, 1020 30 years ago,"},{"speaker":"Charles Goldfarb","startTime":1390.05,"endTime":1394.1,"body":"in the sense that you're not"},{"speaker":"Charles Goldfarb","startTime":1390.05,"endTime":1394.1,"body":"hiding in a very controlled"},{"speaker":"Charles Goldfarb","startTime":1394.1,"endTime":1397.22,"body":"environment. You're not salaried"},{"speaker":"Charles Goldfarb","startTime":1394.1,"endTime":1397.22,"body":"without any knowledge of what's"},{"speaker":"Charles Goldfarb","startTime":1397.22,"endTime":1402.26,"body":"going on. I think most academic"},{"speaker":"Charles Goldfarb","startTime":1397.22,"endTime":1402.26,"body":"practices are like ours, where"},{"speaker":"Charles Goldfarb","startTime":1402.26,"endTime":1406.37,"body":"we are certainly aware of every"},{"speaker":"Charles Goldfarb","startTime":1402.26,"endTime":1406.37,"body":"aspect of the financial part of"},{"speaker":"Charles Goldfarb","startTime":1406.37,"endTime":1407.12,"body":"our practice."},{"speaker":"Chris Dy","startTime":1408.2,"endTime":1411.65,"body":"Yeah, no, I think"},{"speaker":"Chris Dy","startTime":1408.2,"endTime":1411.65,"body":"that, you know, you could just"},{"speaker":"Chris Dy","startTime":1411.65,"endTime":1414.71,"body":"kind of put your head in the"},{"speaker":"Chris Dy","startTime":1411.65,"endTime":1414.71,"body":"sand and you know, you know, get"},{"speaker":"Chris Dy","startTime":1414.71,"endTime":1417.71,"body":"paid what you get paid. But I do"},{"speaker":"Chris Dy","startTime":1414.71,"endTime":1417.71,"body":"think we're all at least the"},{"speaker":"Chris Dy","startTime":1417.71,"endTime":1420.86,"body":"people that lay in here tend to"},{"speaker":"Chris Dy","startTime":1417.71,"endTime":1420.86,"body":"be the type where you're pretty"},{"speaker":"Chris Dy","startTime":1420.86,"endTime":1423.95,"body":"type A and you're motivated, and"},{"speaker":"Chris Dy","startTime":1420.86,"endTime":1423.95,"body":"you kind of you know, everybody"},{"speaker":"Chris Dy","startTime":1423.95,"endTime":1428.84,"body":"likes to know what's going on."},{"speaker":"Chris Dy","startTime":1423.95,"endTime":1428.84,"body":"You know, it's particularly if"},{"speaker":"Chris Dy","startTime":1428.84,"endTime":1431.33,"body":"you're in a position where"},{"speaker":"Chris Dy","startTime":1428.84,"endTime":1431.33,"body":"sometimes, you know, you are"},{"speaker":"Chris Dy","startTime":1431.6,"endTime":1435.56,"body":"incentivized to, to know what's"},{"speaker":"Chris Dy","startTime":1431.6,"endTime":1435.56,"body":"going on in terms of how you can"},{"speaker":"Chris Dy","startTime":1435.56,"endTime":1437.42,"body":"improve your efficiencies, etc."},{"speaker":"Charles Goldfarb","startTime":1437.42,"endTime":1440.365,"body":"Yeah, and I"},{"speaker":"Charles Goldfarb","startTime":1437.42,"endTime":1440.365,"body":"may be giving too much credit, I"},{"speaker":"Charles Goldfarb","startTime":1440.432,"endTime":1444.181,"body":"don't think I am and if"},{"speaker":"Charles Goldfarb","startTime":1440.432,"endTime":1444.181,"body":"listeners, you know, correct me,"},{"speaker":"Charles Goldfarb","startTime":1444.248,"endTime":1448.399,"body":"that would be great. I really"},{"speaker":"Charles Goldfarb","startTime":1444.248,"endTime":1448.399,"body":"think Dr. Gelberman, who was our"},{"speaker":"Charles Goldfarb","startTime":1448.466,"endTime":1452.683,"body":"chair from 1995, to 2014, here"},{"speaker":"Charles Goldfarb","startTime":1448.466,"endTime":1452.683,"body":"at Wash U was really the one who"},{"speaker":"Charles Goldfarb","startTime":1452.75,"endTime":1456.7,"body":"helped to change sort of the"},{"speaker":"Charles Goldfarb","startTime":1452.75,"endTime":1456.7,"body":"orthopedic perspective on what"},{"speaker":"Charles Goldfarb","startTime":1456.767,"endTime":1460.717,"body":"academic practice meant, and"},{"speaker":"Charles Goldfarb","startTime":1456.767,"endTime":1460.717,"body":"evolved to more like a private"},{"speaker":"Charles Goldfarb","startTime":1460.784,"endTime":1464.667,"body":"practice where we wanted to and"},{"speaker":"Charles Goldfarb","startTime":1460.784,"endTime":1464.667,"body":"needed to know sort of the"},{"speaker":"Charles Goldfarb","startTime":1464.734,"endTime":1468.75,"body":"financial parameters of our"},{"speaker":"Charles Goldfarb","startTime":1464.734,"endTime":1468.75,"body":"practice, and didn't just like I"},{"speaker":"Charles Goldfarb","startTime":1468.817,"endTime":1470.96,"body":"said, bury our head in the sand."},{"speaker":"Chris Dy","startTime":1471.26,"endTime":1475.4,"body":"So I mean, obviously,"},{"speaker":"Chris Dy","startTime":1471.26,"endTime":1475.4,"body":"I owe a lot to a doctor"},{"speaker":"Chris Dy","startTime":1475.4,"endTime":1478.52,"body":"gelderman And a huge mentor to"},{"speaker":"Chris Dy","startTime":1475.4,"endTime":1478.52,"body":"me. Why do you say that though?"},{"speaker":"Chris Dy","startTime":1478.52,"endTime":1482.27,"body":"I guess you know more about kind"},{"speaker":"Chris Dy","startTime":1478.52,"endTime":1482.27,"body":"of how he came and changed or,"},{"speaker":"Chris Dy","startTime":1482.3,"endTime":1484.34,"body":"you know, started things here."},{"speaker":"Charles Goldfarb","startTime":1485.39,"endTime":1488.72,"body":"Yeah, I just"},{"speaker":"Charles Goldfarb","startTime":1485.39,"endTime":1488.72,"body":"My sense is that 30 years ago,"},{"speaker":"Charles Goldfarb","startTime":1488.72,"endTime":1493.22,"body":"there wasn't a lot of attention"},{"speaker":"Charles Goldfarb","startTime":1488.72,"endTime":1493.22,"body":"paid in academic practice, about"},{"speaker":"Charles Goldfarb","startTime":1493.25,"endTime":1498.74,"body":"our views about how an academic"},{"speaker":"Charles Goldfarb","startTime":1493.25,"endTime":1498.74,"body":"orthopedic surgeon could"},{"speaker":"Charles Goldfarb","startTime":1498.74,"endTime":1502.73,"body":"generate more revenue Who, and"},{"speaker":"Charles Goldfarb","startTime":1498.74,"endTime":1502.73,"body":"there really wasn't a sense of"},{"speaker":"Charles Goldfarb","startTime":1502.76,"endTime":1507.53,"body":"kind of shared financial benefit"},{"speaker":"Charles Goldfarb","startTime":1502.76,"endTime":1507.53,"body":"in the sense that if I worked"},{"speaker":"Charles Goldfarb","startTime":1507.53,"endTime":1511.1,"body":"harder, I made more money. And"},{"speaker":"Charles Goldfarb","startTime":1507.53,"endTime":1511.1,"body":"the people that doctor"},{"speaker":"Charles Goldfarb","startTime":1511.1,"endTime":1514.79,"body":"government attracted here, even"},{"speaker":"Charles Goldfarb","startTime":1511.1,"endTime":1514.79,"body":"back in the day, that model"},{"speaker":"Charles Goldfarb","startTime":1514.79,"endTime":1519.23,"body":"appealed to them. And we kind of"},{"speaker":"Charles Goldfarb","startTime":1514.79,"endTime":1519.23,"body":"developed a practice based on"},{"speaker":"Charles Goldfarb","startTime":1519.23,"endTime":1521.39,"body":"that, obviously, I didn't know"},{"speaker":"Charles Goldfarb","startTime":1519.23,"endTime":1521.39,"body":"what every other practice, I"},{"speaker":"Charles Goldfarb","startTime":1521.39,"endTime":1523.94,"body":"don't know what every other"},{"speaker":"Charles Goldfarb","startTime":1521.39,"endTime":1523.94,"body":"practice and academic practice"},{"speaker":"Charles Goldfarb","startTime":1523.94,"endTime":1528.62,"body":"was doing. But my sense was, he"},{"speaker":"Charles Goldfarb","startTime":1523.94,"endTime":1528.62,"body":"was the kind of really one of"},{"speaker":"Charles Goldfarb","startTime":1528.62,"endTime":1531.98,"body":"the first if not the first to"},{"speaker":"Charles Goldfarb","startTime":1528.62,"endTime":1531.98,"body":"really push that model, I"},{"speaker":"Chris Dy","startTime":1531.98,"endTime":1534.92,"body":"think is people, you"},{"speaker":"Chris Dy","startTime":1531.98,"endTime":1534.92,"body":"know, who either were here and"},{"speaker":"Chris Dy","startTime":1534.92,"endTime":1537.8,"body":"took leadership positions"},{"speaker":"Chris Dy","startTime":1534.92,"endTime":1537.8,"body":"elsewhere, or came and kind of"},{"speaker":"Chris Dy","startTime":1537.8,"endTime":1541.01,"body":"understood what, what he was"},{"speaker":"Chris Dy","startTime":1537.8,"endTime":1541.01,"body":"doing here. There's a lot of"},{"speaker":"Chris Dy","startTime":1541.01,"endTime":1544.55,"body":"things that he initiated here"},{"speaker":"Chris Dy","startTime":1541.01,"endTime":1544.55,"body":"that seemed to have permeated to"},{"speaker":"Chris Dy","startTime":1544.55,"endTime":1548.27,"body":"other places in terms of, you"},{"speaker":"Chris Dy","startTime":1544.55,"endTime":1548.27,"body":"know, you know, incentive"},{"speaker":"Chris Dy","startTime":1548.27,"endTime":1551.48,"body":"programs for academic"},{"speaker":"Chris Dy","startTime":1548.27,"endTime":1551.48,"body":"productivity, you know, making"},{"speaker":"Chris Dy","startTime":1551.48,"endTime":1557.93,"body":"sure that that you knew that"},{"speaker":"Chris Dy","startTime":1551.48,"endTime":1557.93,"body":"there were opportunities to, to"},{"speaker":"Chris Dy","startTime":1557.93,"endTime":1561.05,"body":"earn more, if you were more"},{"speaker":"Chris Dy","startTime":1557.93,"endTime":1561.05,"body":"productive, I remember asking"},{"speaker":"Chris Dy","startTime":1561.05,"endTime":1564.92,"body":"him to have an extra research"},{"speaker":"Chris Dy","startTime":1561.05,"endTime":1564.92,"body":"day, which the standard for here"},{"speaker":"Chris Dy","startTime":1564.92,"endTime":1568.34,"body":"was to have one admin slash"},{"speaker":"Chris Dy","startTime":1564.92,"endTime":1568.34,"body":"Research Day, and then for"},{"speaker":"Chris Dy","startTime":1568.34,"endTime":1570.89,"body":"active clinical days, and I told"},{"speaker":"Chris Dy","startTime":1568.34,"endTime":1570.89,"body":"him that I ultimately wanted to"},{"speaker":"Chris Dy","startTime":1570.89,"endTime":1576.38,"body":"have an NIH K award, which meant"},{"speaker":"Chris Dy","startTime":1570.89,"endTime":1576.38,"body":"having 50% research time, you"},{"speaker":"Chris Dy","startTime":1576.38,"endTime":1579.32,"body":"know, for a surgeon, and I said,"},{"speaker":"Chris Dy","startTime":1576.38,"endTime":1579.32,"body":"Alright, welcome. When I start,"},{"speaker":"Chris Dy","startTime":1579.32,"endTime":1582.62,"body":"can I just have to research"},{"speaker":"Chris Dy","startTime":1579.32,"endTime":1582.62,"body":"days? He's like, Yeah, you could"},{"speaker":"Chris Dy","startTime":1582.62,"endTime":1585.86,"body":"do it. But he made sure and my"},{"speaker":"Chris Dy","startTime":1582.62,"endTime":1585.86,"body":"agreement is very clearly stated"},{"speaker":"Chris Dy","startTime":1585.86,"endTime":1590.81,"body":"that it is potentially at the an"},{"speaker":"Chris Dy","startTime":1585.86,"endTime":1590.81,"body":"opportunity cost at the my own"},{"speaker":"Chris Dy","startTime":1590.81,"endTime":1593.69,"body":"personal incentive may be"},{"speaker":"Chris Dy","startTime":1590.81,"endTime":1593.69,"body":"compromised if I'm spending all"},{"speaker":"Chris Dy","startTime":1593.69,"endTime":1595.1,"body":"that time on research."},{"speaker":"Charles Goldfarb","startTime":1595.97,"endTime":1598.31,"body":"Yeah, that"},{"speaker":"Charles Goldfarb","startTime":1595.97,"endTime":1598.31,"body":"that that certainly is correct."},{"speaker":"Charles Goldfarb","startTime":1598.31,"endTime":1605.78,"body":"And I would say that not only"},{"speaker":"Charles Goldfarb","startTime":1598.31,"endTime":1605.78,"body":"So, again, if you understand one"},{"speaker":"Charles Goldfarb","startTime":1605.78,"endTime":1608.9,"body":"compensation plan of the many"},{"speaker":"Charles Goldfarb","startTime":1605.78,"endTime":1608.9,"body":"that exist, you understand one"},{"speaker":"Charles Goldfarb","startTime":1608.9,"endTime":1611.24,"body":"compensation plan, and we're not"},{"speaker":"Charles Goldfarb","startTime":1608.9,"endTime":1611.24,"body":"here today to discuss our"},{"speaker":"Charles Goldfarb","startTime":1611.24,"endTime":1615.02,"body":"compensation plan. It, you know,"},{"speaker":"Charles Goldfarb","startTime":1611.24,"endTime":1615.02,"body":"again, if listeners are"},{"speaker":"Charles Goldfarb","startTime":1615.02,"endTime":1618.26,"body":"interested, we can certainly"},{"speaker":"Charles Goldfarb","startTime":1615.02,"endTime":1618.26,"body":"dive deeper into this topic. But"},{"speaker":"Charles Goldfarb","startTime":1618.26,"endTime":1621.77,"body":"not only were we incentivized to"},{"speaker":"Charles Goldfarb","startTime":1618.26,"endTime":1621.77,"body":"think about our clinical"},{"speaker":"Charles Goldfarb","startTime":1621.77,"endTime":1627.17,"body":"productivity, we are also sort"},{"speaker":"Charles Goldfarb","startTime":1621.77,"endTime":1627.17,"body":"of responsible for controlling"},{"speaker":"Charles Goldfarb","startTime":1627.17,"endTime":1631.34,"body":"our own expenses. And sometimes"},{"speaker":"Charles Goldfarb","startTime":1627.17,"endTime":1631.34,"body":"practices have part of that"},{"speaker":"Charles Goldfarb","startTime":1631.34,"endTime":1635.57,"body":"equation and not the other. But"},{"speaker":"Charles Goldfarb","startTime":1631.34,"endTime":1635.57,"body":"we had to think about both. And"},{"speaker":"Charles Goldfarb","startTime":1635.57,"endTime":1638.63,"body":"I think maybe that's what made"},{"speaker":"Charles Goldfarb","startTime":1635.57,"endTime":1638.63,"body":"it more unique at the time is"},{"speaker":"Charles Goldfarb","startTime":1638.63,"endTime":1642.26,"body":"that not only should I think"},{"speaker":"Charles Goldfarb","startTime":1638.63,"endTime":1642.26,"body":"about how can I boost revenue,"},{"speaker":"Charles Goldfarb","startTime":1643.19,"endTime":1646.82,"body":"but I also needed to think about"},{"speaker":"Charles Goldfarb","startTime":1643.19,"endTime":1646.82,"body":"how I could control my own cost"},{"speaker":"Charles Goldfarb","startTime":1646.82,"endTime":1651.2,"body":"who I hire to help me all those"},{"speaker":"Charles Goldfarb","startTime":1646.82,"endTime":1651.2,"body":"kinds of things. Right."},{"speaker":"Chris Dy","startTime":1651.2,"endTime":1654.5,"body":"So I mean, to your to"},{"speaker":"Chris Dy","startTime":1651.2,"endTime":1654.5,"body":"the to the former about boosting"},{"speaker":"Chris Dy","startTime":1654.5,"endTime":1656.81,"body":"revenue. And I think the"},{"speaker":"Chris Dy","startTime":1654.5,"endTime":1656.81,"body":"intensive your question, I"},{"speaker":"Chris Dy","startTime":1656.81,"endTime":1660.14,"body":"remember, I think her learning"},{"speaker":"Chris Dy","startTime":1656.81,"endTime":1660.14,"body":"from you that you know, probably"},{"speaker":"Chris Dy","startTime":1660.14,"endTime":1663.02,"body":"work comp is the one thing"},{"speaker":"Chris Dy","startTime":1660.14,"endTime":1663.02,"body":"accepting work comp is one thing"},{"speaker":"Chris Dy","startTime":1663.02,"endTime":1665.69,"body":"you can do to really shift your"},{"speaker":"Chris Dy","startTime":1663.02,"endTime":1665.69,"body":"payer mix. I mean, I guess, in"},{"speaker":"Chris Dy","startTime":1665.69,"endTime":1668.75,"body":"some systems, you could choose"},{"speaker":"Chris Dy","startTime":1665.69,"endTime":1668.75,"body":"whether or not and then how much"},{"speaker":"Chris Dy","startTime":1669.08,"endTime":1673.01,"body":"to see patients with Medicaid."},{"speaker":"Chris Dy","startTime":1669.08,"endTime":1673.01,"body":"You know, I personally have an"},{"speaker":"Chris Dy","startTime":1673.01,"endTime":1677.09,"body":"open door for that. But and, you"},{"speaker":"Chris Dy","startTime":1673.01,"endTime":1677.09,"body":"know, I know that taking workers"},{"speaker":"Chris Dy","startTime":1677.09,"endTime":1680.24,"body":"compensation does allow me to"},{"speaker":"Chris Dy","startTime":1677.09,"endTime":1680.24,"body":"really shift that part of my"},{"speaker":"Chris Dy","startTime":1680.24,"endTime":1683.96,"body":"payer mix in a way that you"},{"speaker":"Chris Dy","startTime":1680.24,"endTime":1683.96,"body":"typically will, will reimburse"},{"speaker":"Chris Dy","startTime":1683.96,"endTime":1685.37,"body":"at a higher rate than the other"},{"speaker":"Chris Dy","startTime":1683.96,"endTime":1685.37,"body":"payers."},{"speaker":"Charles Goldfarb","startTime":1686.24,"endTime":1687.98,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1686.24,"endTime":1687.98,"body":"well said. And that's exactly"},{"speaker":"Charles Goldfarb","startTime":1687.98,"endTime":1691.94,"body":"how I think about it in the"},{"speaker":"Charles Goldfarb","startTime":1687.98,"endTime":1691.94,"body":"sense that I have a large number"},{"speaker":"Charles Goldfarb","startTime":1691.94,"endTime":1695.78,"body":"of pediatric patients, but I"},{"speaker":"Charles Goldfarb","startTime":1691.94,"endTime":1695.78,"body":"don't I have a completely open"},{"speaker":"Charles Goldfarb","startTime":1695.78,"endTime":1699.02,"body":"door policy to any patient."},{"speaker":"Charles Goldfarb","startTime":1695.78,"endTime":1699.02,"body":"Without any restrictions"},{"speaker":"Charles Goldfarb","startTime":1699.02,"endTime":1702.02,"body":"whatsoever. That is not"},{"speaker":"Charles Goldfarb","startTime":1699.02,"endTime":1702.02,"body":"universally the case. I'm"},{"speaker":"Charles Goldfarb","startTime":1702.02,"endTime":1704.57,"body":"talking across the country"},{"speaker":"Charles Goldfarb","startTime":1702.02,"endTime":1704.57,"body":"across different practice types."},{"speaker":"Charles Goldfarb","startTime":1704.78,"endTime":1707.48,"body":"And for good reason, to be"},{"speaker":"Charles Goldfarb","startTime":1704.78,"endTime":1707.48,"body":"honest, I mean, that, you know,"},{"speaker":"Charles Goldfarb","startTime":1707.51,"endTime":1710.63,"body":"Medicaid, for example, and it's"},{"speaker":"Charles Goldfarb","startTime":1707.51,"endTime":1710.63,"body":"vary state by state, right"},{"speaker":"Charles Goldfarb","startTime":1710.63,"endTime":1713.99,"body":"states generate their own rates"},{"speaker":"Charles Goldfarb","startTime":1710.63,"endTime":1713.99,"body":"for Medicaid, and so certain pay"},{"speaker":"Charles Goldfarb","startTime":1714.02,"endTime":1717.47,"body":"states better than others, you"},{"speaker":"Charles Goldfarb","startTime":1714.02,"endTime":1717.47,"body":"will lose money every time you"},{"speaker":"Charles Goldfarb","startTime":1717.47,"endTime":1720.08,"body":"care for a Medicaid patient."},{"speaker":"Charles Goldfarb","startTime":1717.47,"endTime":1720.08,"body":"Now, as a physician, I still"},{"speaker":"Charles Goldfarb","startTime":1720.08,"endTime":1722.51,"body":"think it's important to care for"},{"speaker":"Charles Goldfarb","startTime":1720.08,"endTime":1722.51,"body":"all those patients. But how do"},{"speaker":"Charles Goldfarb","startTime":1722.51,"endTime":1725.09,"body":"you balance it? I don't think"},{"speaker":"Charles Goldfarb","startTime":1722.51,"endTime":1725.09,"body":"taking commercial insurance"},{"speaker":"Charles Goldfarb","startTime":1725.09,"endTime":1728.75,"body":"balances. Commercial insurance"},{"speaker":"Charles Goldfarb","startTime":1725.09,"endTime":1728.75,"body":"can typically help pay your"},{"speaker":"Charles Goldfarb","startTime":1728.75,"endTime":1733.16,"body":"bills. But if you really want to"},{"speaker":"Charles Goldfarb","startTime":1728.75,"endTime":1733.16,"body":"sort of balance the low payers,"},{"speaker":"Charles Goldfarb","startTime":1733.16,"endTime":1736.73,"body":"you need the high revenue of"},{"speaker":"Charles Goldfarb","startTime":1733.16,"endTime":1736.73,"body":"work comp, which again, not true"},{"speaker":"Charles Goldfarb","startTime":1736.73,"endTime":1739.79,"body":"for every state, but for many"},{"speaker":"Charles Goldfarb","startTime":1736.73,"endTime":1739.79,"body":"states, it is financially"},{"speaker":"Charles Goldfarb","startTime":1739.91,"endTime":1742.76,"body":"advantageous to care for work"},{"speaker":"Charles Goldfarb","startTime":1739.91,"endTime":1742.76,"body":"comp patients. Yeah,"},{"speaker":"Chris Dy","startTime":1742.76,"endTime":1744.62,"body":"absolutely. I mean, I"},{"speaker":"Chris Dy","startTime":1742.76,"endTime":1744.62,"body":"think when I was starting out,"},{"speaker":"Chris Dy","startTime":1744.86,"endTime":1747.29,"body":"you know, I still do a fair bit"},{"speaker":"Chris Dy","startTime":1744.86,"endTime":1747.29,"body":"of health disparities research."},{"speaker":"Chris Dy","startTime":1747.29,"endTime":1750.65,"body":"But my one of the big things I"},{"speaker":"Chris Dy","startTime":1747.29,"endTime":1750.65,"body":"was doing early on was looking"},{"speaker":"Chris Dy","startTime":1750.65,"endTime":1754.07,"body":"at policy changes, such as the"},{"speaker":"Chris Dy","startTime":1750.65,"endTime":1754.07,"body":"Affordable Care Act or otherwise"},{"speaker":"Chris Dy","startTime":1754.07,"endTime":1758.57,"body":"known as Obamacare, and how that"},{"speaker":"Chris Dy","startTime":1754.07,"endTime":1758.57,"body":"may have shifted, you know,"},{"speaker":"Chris Dy","startTime":1758.57,"endTime":1762.8,"body":"delivery of care. And because"},{"speaker":"Chris Dy","startTime":1758.57,"endTime":1762.8,"body":"Medicaid is a state by state"},{"speaker":"Chris Dy","startTime":1762.83,"endTime":1766.85,"body":"based program, and the thrust of"},{"speaker":"Chris Dy","startTime":1762.83,"endTime":1766.85,"body":"the Affordable Care Act was to"},{"speaker":"Chris Dy","startTime":1766.85,"endTime":1769.88,"body":"increase Medicaid enrollment, we"},{"speaker":"Chris Dy","startTime":1766.85,"endTime":1769.88,"body":"were super interested in seeing"},{"speaker":"Chris Dy","startTime":1769.88,"endTime":1773.81,"body":"if you know, Medicaid, expansion"},{"speaker":"Chris Dy","startTime":1769.88,"endTime":1773.81,"body":"plans actually moved the needle"},{"speaker":"Chris Dy","startTime":1773.81,"endTime":1775.82,"body":"in terms of, you know,"},{"speaker":"Chris Dy","startTime":1773.81,"endTime":1775.82,"body":"increasing the care that was"},{"speaker":"Chris Dy","startTime":1775.82,"endTime":1778.61,"body":"delivered, because maybe people"},{"speaker":"Chris Dy","startTime":1775.82,"endTime":1778.61,"body":"were just getting insurance and"},{"speaker":"Chris Dy","startTime":1778.61,"endTime":1780.95,"body":"name and, you know, one of the"},{"speaker":"Chris Dy","startTime":1778.61,"endTime":1780.95,"body":"papers that we wrote was"},{"speaker":"Chris Dy","startTime":1780.95,"endTime":1785.06,"body":"actually looking at variability"},{"speaker":"Chris Dy","startTime":1780.95,"endTime":1785.06,"body":"state by state in what Medicaid"},{"speaker":"Chris Dy","startTime":1785.06,"endTime":1787.43,"body":"will reimburse for certain"},{"speaker":"Chris Dy","startTime":1785.06,"endTime":1787.43,"body":"procedures. And, you know, it"},{"speaker":"Chris Dy","startTime":1787.43,"endTime":1790.94,"body":"was fascinating paper. You know,"},{"speaker":"Chris Dy","startTime":1787.43,"endTime":1790.94,"body":"it shows it's all over the map."},{"speaker":"Chris Dy","startTime":1790.94,"endTime":1792.92,"body":"And it totally depends, you"},{"speaker":"Chris Dy","startTime":1790.94,"endTime":1792.92,"body":"know, if you're in Alaska,"},{"speaker":"Chris Dy","startTime":1792.92,"endTime":1797.21,"body":"Medicaid is great payer. But if"},{"speaker":"Chris Dy","startTime":1792.92,"endTime":1797.21,"body":"you're in Missouri, not so much."},{"speaker":"Charles Goldfarb","startTime":1798.17,"endTime":1801.68,"body":"Yep, that's"},{"speaker":"Charles Goldfarb","startTime":1798.17,"endTime":1801.68,"body":"exactly right. And so Oh, you"},{"speaker":"Charles Goldfarb","startTime":1801.68,"endTime":1806.78,"body":"know, it. Again, this is a huge"},{"speaker":"Charles Goldfarb","startTime":1801.68,"endTime":1806.78,"body":"topic. So maybe we'll just, we"},{"speaker":"Charles Goldfarb","startTime":1806.78,"endTime":1812.33,"body":"can revisit it, I think. But if"},{"speaker":"Charles Goldfarb","startTime":1806.78,"endTime":1812.33,"body":"we talk about work comp, for"},{"speaker":"Charles Goldfarb","startTime":1812.33,"endTime":1815.39,"body":"those listeners who aren't"},{"speaker":"Charles Goldfarb","startTime":1812.33,"endTime":1815.39,"body":"familiar with it, so essentially"},{"speaker":"Charles Goldfarb","startTime":1815.39,"endTime":1818.6,"body":"work comp is caring for the"},{"speaker":"Charles Goldfarb","startTime":1815.39,"endTime":1818.6,"body":"injured worker. And every state"},{"speaker":"Charles Goldfarb","startTime":1818.63,"endTime":1822.02,"body":"has its own guidelines about"},{"speaker":"Charles Goldfarb","startTime":1818.63,"endTime":1822.02,"body":"what that means. So I think"},{"speaker":"Charles Goldfarb","startTime":1822.02,"endTime":1826.07,"body":"every state, if, if a worker has"},{"speaker":"Charles Goldfarb","startTime":1822.02,"endTime":1826.07,"body":"a finger amputation working on a"},{"speaker":"Charles Goldfarb","startTime":1826.1,"endTime":1831.08,"body":"on a industrial line, that's"},{"speaker":"Charles Goldfarb","startTime":1826.1,"endTime":1831.08,"body":"work comp, but certain states"},{"speaker":"Charles Goldfarb","startTime":1831.08,"endTime":1836.06,"body":"make compensation for repetitive"},{"speaker":"Charles Goldfarb","startTime":1831.08,"endTime":1836.06,"body":"use activities. Carpal Tunnel is"},{"speaker":"Charles Goldfarb","startTime":1836.06,"endTime":1838.67,"body":"very different state by state,"},{"speaker":"Charles Goldfarb","startTime":1836.06,"endTime":1838.67,"body":"we happen to live on the border"},{"speaker":"Charles Goldfarb","startTime":1838.67,"endTime":1841.7,"body":"of Illinois and Missouri. And so"},{"speaker":"Charles Goldfarb","startTime":1838.67,"endTime":1841.7,"body":"the two states are very"},{"speaker":"Charles Goldfarb","startTime":1841.7,"endTime":1845.3,"body":"different, how they think about"},{"speaker":"Charles Goldfarb","startTime":1841.7,"endTime":1845.3,"body":"it, but you have to learn the"},{"speaker":"Charles Goldfarb","startTime":1845.3,"endTime":1848.27,"body":"rules of the game. It's a"},{"speaker":"Charles Goldfarb","startTime":1845.3,"endTime":1848.27,"body":"different kind of patient care"},{"speaker":"Charles Goldfarb","startTime":1848.27,"endTime":1849.35,"body":"than everything else we do."},{"speaker":"Chris Dy","startTime":1850.25,"endTime":1851.75,"body":"You know, and I"},{"speaker":"Chris Dy","startTime":1850.25,"endTime":1851.75,"body":"actually want to push back on"},{"speaker":"Chris Dy","startTime":1851.75,"endTime":1855.77,"body":"that a little bit, is it? I"},{"speaker":"Chris Dy","startTime":1851.75,"endTime":1855.77,"body":"think it's not necessarily that"},{"speaker":"Chris Dy","startTime":1855.77,"endTime":1859.07,"body":"different, I think the rules are"},{"speaker":"Chris Dy","startTime":1855.77,"endTime":1859.07,"body":"a little bit different. You"},{"speaker":"Chris Dy","startTime":1859.07,"endTime":1862.67,"body":"know, in terms of, actually, you"},{"speaker":"Chris Dy","startTime":1859.07,"endTime":1862.67,"body":"know, most people, I think a lot"},{"speaker":"Chris Dy","startTime":1862.67,"endTime":1865.16,"body":"of people their first blush,"},{"speaker":"Chris Dy","startTime":1862.67,"endTime":1865.16,"body":"when they think about work comp"},{"speaker":"Chris Dy","startTime":1865.16,"endTime":1867.59,"body":"is, you know, it's so painful,"},{"speaker":"Chris Dy","startTime":1865.16,"endTime":1867.59,"body":"so much paperwork, it's, you"},{"speaker":"Chris Dy","startTime":1867.59,"endTime":1870.17,"body":"know, I just want to take care"},{"speaker":"Chris Dy","startTime":1867.59,"endTime":1870.17,"body":"of the patient, I feel like, you"},{"speaker":"Chris Dy","startTime":1870.17,"endTime":1872.75,"body":"know, I started, I decided I was"},{"speaker":"Chris Dy","startTime":1870.17,"endTime":1872.75,"body":"going to take it just as"},{"speaker":"Chris Dy","startTime":1872.75,"endTime":1874.67,"body":"honestly, starting in practice,"},{"speaker":"Chris Dy","startTime":1872.75,"endTime":1874.67,"body":"I think he told me, I should"},{"speaker":"Chris Dy","startTime":1874.67,"endTime":1877.61,"body":"take it, so I took it. And I was"},{"speaker":"Chris Dy","startTime":1874.67,"endTime":1877.61,"body":"like, Alright, I'm gonna do"},{"speaker":"Chris Dy","startTime":1877.61,"endTime":1882.65,"body":"this. And at the end of the day,"},{"speaker":"Chris Dy","startTime":1877.61,"endTime":1882.65,"body":"it does help, you know, support"},{"speaker":"Chris Dy","startTime":1882.68,"endTime":1885.35,"body":"my ability to take care of any"},{"speaker":"Chris Dy","startTime":1882.68,"endTime":1885.35,"body":"patient with a nerve injury,"},{"speaker":"Chris Dy","startTime":1885.77,"endTime":1888.23,"body":"regardless of their ability to"},{"speaker":"Chris Dy","startTime":1885.77,"endTime":1888.23,"body":"pay. So that's super important"},{"speaker":"Chris Dy","startTime":1888.23,"endTime":1892.46,"body":"to me. So it keeps my part of"},{"speaker":"Chris Dy","startTime":1888.23,"endTime":1892.46,"body":"the practice solvent, you know,"},{"speaker":"Chris Dy","startTime":1892.46,"endTime":1895.58,"body":"so that I can you know, kind of,"},{"speaker":"Chris Dy","startTime":1892.46,"endTime":1895.58,"body":"I feel like I can deliver that"},{"speaker":"Chris Dy","startTime":1895.58,"endTime":1899.51,"body":"level of care to whoever needs"},{"speaker":"Chris Dy","startTime":1895.58,"endTime":1899.51,"body":"it for nerve injury. So you told"},{"speaker":"Chris Dy","startTime":1899.51,"endTime":1902.36,"body":"me to take it makes sense for me"},{"speaker":"Chris Dy","startTime":1899.51,"endTime":1902.36,"body":"to help with my nerve program."},{"speaker":"Chris Dy","startTime":1902.66,"endTime":1905.15,"body":"And then I didn't find it to be"},{"speaker":"Chris Dy","startTime":1902.66,"endTime":1905.15,"body":"that painful to be honest with"},{"speaker":"Chris Dy","startTime":1905.15,"endTime":1907.7,"body":"you. You know, I remember"},{"speaker":"Chris Dy","startTime":1905.15,"endTime":1907.7,"body":"watching you and being in your,"},{"speaker":"Chris Dy","startTime":1907.73,"endTime":1910.73,"body":"in your clinic is a fellow and"},{"speaker":"Chris Dy","startTime":1907.73,"endTime":1910.73,"body":"kind of seeing the steps and"},{"speaker":"Chris Dy","startTime":1910.73,"endTime":1913.88,"body":"getting some advice from you and"},{"speaker":"Chris Dy","startTime":1910.73,"endTime":1913.88,"body":"Ryan Calfee early on about kind"},{"speaker":"Chris Dy","startTime":1913.88,"endTime":1917.54,"body":"of how to handle it. And it's"},{"speaker":"Chris Dy","startTime":1913.88,"endTime":1917.54,"body":"seemed okay, so far, we are very"},{"speaker":"Chris Dy","startTime":1917.54,"endTime":1920.99,"body":"fortunate to have an excellent"},{"speaker":"Chris Dy","startTime":1917.54,"endTime":1920.99,"body":"work comp team that helps kind"},{"speaker":"Chris Dy","startTime":1920.99,"endTime":1925.31,"body":"of keep things organized for us."},{"speaker":"Chris Dy","startTime":1920.99,"endTime":1925.31,"body":"But how, why do you think it's"},{"speaker":"Chris Dy","startTime":1925.34,"endTime":1927.17,"body":"so different in terms of patient"},{"speaker":"Chris Dy","startTime":1925.34,"endTime":1927.17,"body":"care?"},{"speaker":"Charles Goldfarb","startTime":1928.34,"endTime":1931.04,"body":"Essentially,"},{"speaker":"Charles Goldfarb","startTime":1928.34,"endTime":1931.04,"body":"in my for, first of all, I, I"},{"speaker":"Charles Goldfarb","startTime":1931.04,"endTime":1934.7,"body":"guess I do agree with you, you"},{"speaker":"Charles Goldfarb","startTime":1931.04,"endTime":1934.7,"body":"know, once you have jumped"},{"speaker":"Charles Goldfarb","startTime":1934.7,"endTime":1937.73,"body":"through the hoops, and"},{"speaker":"Charles Goldfarb","startTime":1934.7,"endTime":1937.73,"body":"understand the rules of the"},{"speaker":"Charles Goldfarb","startTime":1937.73,"endTime":1943.13,"body":"game, then you take care of the"},{"speaker":"Charles Goldfarb","startTime":1937.73,"endTime":1943.13,"body":"patient. And that's the goal."},{"speaker":"Charles Goldfarb","startTime":1943.49,"endTime":1948.29,"body":"But it's the hoops you have to"},{"speaker":"Charles Goldfarb","startTime":1943.49,"endTime":1948.29,"body":"jump through and understanding"},{"speaker":"Charles Goldfarb","startTime":1948.32,"endTime":1951.71,"body":"the rules. And once you have"},{"speaker":"Charles Goldfarb","startTime":1948.32,"endTime":1951.71,"body":"that down, then you just do what"},{"speaker":"Charles Goldfarb","startTime":1951.71,"endTime":1955.82,"body":"you do. And the other thing"},{"speaker":"Charles Goldfarb","startTime":1951.71,"endTime":1955.82,"body":"that's that's hard, I think, is"},{"speaker":"Charles Goldfarb","startTime":1955.85,"endTime":1961.67,"body":"we as physicians, most of us are"},{"speaker":"Charles Goldfarb","startTime":1955.85,"endTime":1961.67,"body":"not experienced or necessarily"},{"speaker":"Charles Goldfarb","startTime":1961.67,"endTime":1964.43,"body":"comfortable with hard"},{"speaker":"Charles Goldfarb","startTime":1961.67,"endTime":1964.43,"body":"conversations with patients,"},{"speaker":"Charles Goldfarb","startTime":1965.24,"endTime":1969.08,"body":"telling them that you're going"},{"speaker":"Charles Goldfarb","startTime":1965.24,"endTime":1969.08,"body":"back to work. Because if it's a"},{"speaker":"Charles Goldfarb","startTime":1969.08,"endTime":1971.69,"body":"non work comp patient, it's sort"},{"speaker":"Charles Goldfarb","startTime":1969.08,"endTime":1971.69,"body":"of up to the patient to a"},{"speaker":"Charles Goldfarb","startTime":1971.69,"endTime":1974.48,"body":"certain degree, I don't really"},{"speaker":"Charles Goldfarb","startTime":1971.69,"endTime":1974.48,"body":"push non work comp patients. And"},{"speaker":"Charles Goldfarb","startTime":1974.69,"endTime":1977.72,"body":"if they they have time and are"},{"speaker":"Charles Goldfarb","startTime":1974.69,"endTime":1977.72,"body":"able to take more time off, I"},{"speaker":"Charles Goldfarb","startTime":1977.72,"endTime":1980.81,"body":"don't push them that hard. But"},{"speaker":"Charles Goldfarb","startTime":1977.72,"endTime":1980.81,"body":"for comp, you have to send them"},{"speaker":"Charles Goldfarb","startTime":1980.81,"endTime":1984.02,"body":"back to work in a you know, with"},{"speaker":"Charles Goldfarb","startTime":1980.81,"endTime":1984.02,"body":"restrictions, perhaps but you"},{"speaker":"Charles Goldfarb","startTime":1984.02,"endTime":1988.22,"body":"send it back to work early. As"},{"speaker":"Charles Goldfarb","startTime":1984.02,"endTime":1988.22,"body":"one example of one of the hoops."},{"speaker":"Chris Dy","startTime":1988.91,"endTime":1991.76,"body":"Yeah, and I think I'd"},{"speaker":"Chris Dy","startTime":1988.91,"endTime":1991.76,"body":"love your thoughts on this. You"},{"speaker":"Chris Dy","startTime":1991.76,"endTime":1994.76,"body":"know, I'm very clear with"},{"speaker":"Chris Dy","startTime":1991.76,"endTime":1994.76,"body":"patients before surgery, I think"},{"speaker":"Chris Dy","startTime":1994.76,"endTime":1997.37,"body":"this is where expectation"},{"speaker":"Chris Dy","startTime":1994.76,"endTime":1997.37,"body":"setting is super important in"},{"speaker":"Chris Dy","startTime":1997.37,"endTime":2000.82,"body":"the context of work comp, saying"},{"speaker":"Chris Dy","startTime":1997.37,"endTime":2000.82,"body":"most patients after the surgery"},{"speaker":"Chris Dy","startTime":2000.82,"endTime":2003.82,"body":"are back to doing these things"},{"speaker":"Chris Dy","startTime":2000.82,"endTime":2003.82,"body":"by this time, after this"},{"speaker":"Chris Dy","startTime":2003.82,"endTime":2006.34,"body":"surgery, I expect for you to"},{"speaker":"Chris Dy","startTime":2003.82,"endTime":2006.34,"body":"return to work with some"},{"speaker":"Chris Dy","startTime":2006.34,"endTime":2009.31,"body":"restrictions on this date. And"},{"speaker":"Chris Dy","startTime":2006.34,"endTime":2009.31,"body":"as we go every month or six"},{"speaker":"Chris Dy","startTime":2009.31,"endTime":2012.34,"body":"weeks, I'm going to relax those"},{"speaker":"Chris Dy","startTime":2009.31,"endTime":2012.34,"body":"restrictions gradually until I"},{"speaker":"Chris Dy","startTime":2012.34,"endTime":2014.38,"body":"feel like you're at the point"},{"speaker":"Chris Dy","startTime":2012.34,"endTime":2014.38,"body":"where you can get back without"},{"speaker":"Chris Dy","startTime":2014.38,"endTime":2015.31,"body":"any restrictions."},{"speaker":"Charles Goldfarb","startTime":2016.39,"endTime":2019.81,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2016.39,"endTime":2019.81,"body":"that's exactly how one should do"},{"speaker":"Charles Goldfarb","startTime":2019.81,"endTime":2023.14,"body":"it. And almost all one has to do"},{"speaker":"Charles Goldfarb","startTime":2019.81,"endTime":2023.14,"body":"it. It doesn't always mean it's"},{"speaker":"Charles Goldfarb","startTime":2023.14,"endTime":2025.69,"body":"well accepted. And it's"},{"speaker":"Charles Goldfarb","startTime":2023.14,"endTime":2025.69,"body":"sometimes it's not even the"},{"speaker":"Charles Goldfarb","startTime":2025.69,"endTime":2028.6,"body":"worker is the family member. And"},{"speaker":"Charles Goldfarb","startTime":2025.69,"endTime":2028.6,"body":"there's all kinds of questions"},{"speaker":"Charles Goldfarb","startTime":2028.6,"endTime":2031.54,"body":"and and that's the other part,"},{"speaker":"Charles Goldfarb","startTime":2028.6,"endTime":2031.54,"body":"you have to be willing to spend"},{"speaker":"Charles Goldfarb","startTime":2031.54,"endTime":2034.24,"body":"more time talking to the patient"},{"speaker":"Charles Goldfarb","startTime":2031.54,"endTime":2034.24,"body":"and the family about what to"},{"speaker":"Charles Goldfarb","startTime":2034.24,"endTime":2037.72,"body":"expect, you often have to talk"},{"speaker":"Charles Goldfarb","startTime":2034.24,"endTime":2037.72,"body":"to a nurse case manager or an"},{"speaker":"Charles Goldfarb","startTime":2037.72,"endTime":2042.58,"body":"insurance adjuster to seek"},{"speaker":"Charles Goldfarb","startTime":2037.72,"endTime":2042.58,"body":"approval or get, you know,"},{"speaker":"Charles Goldfarb","startTime":2042.58,"endTime":2045.94,"body":"testing done. Those are just"},{"speaker":"Charles Goldfarb","startTime":2042.58,"endTime":2045.94,"body":"some of the hoops you have to"},{"speaker":"Charles Goldfarb","startTime":2045.94,"endTime":2049.36,"body":"jump through. But in many"},{"speaker":"Charles Goldfarb","startTime":2045.94,"endTime":2049.36,"body":"states, the jumping through the"},{"speaker":"Charles Goldfarb","startTime":2049.36,"endTime":2051.19,"body":"hoops is financially worth it."},{"speaker":"Chris Dy","startTime":2052.12,"endTime":2054.22,"body":"Yeah, I think so. And"},{"speaker":"Chris Dy","startTime":2052.12,"endTime":2054.22,"body":"you know, I think you mentioned"},{"speaker":"Chris Dy","startTime":2054.22,"endTime":2056.41,"body":"the nurse case manager, I don't"},{"speaker":"Chris Dy","startTime":2054.22,"endTime":2056.41,"body":"know how you feel about this. I"},{"speaker":"Chris Dy","startTime":2056.41,"endTime":2058.9,"body":"mean, I feel like you know, we"},{"speaker":"Chris Dy","startTime":2056.41,"endTime":2058.9,"body":"often talk about how, you know,"},{"speaker":"Chris Dy","startTime":2059.41,"endTime":2062.47,"body":"physical therapists and"},{"speaker":"Chris Dy","startTime":2059.41,"endTime":2062.47,"body":"therapists, OTs can be a very"},{"speaker":"Chris Dy","startTime":2062.47,"endTime":2066.79,"body":"valuable, you know, informal"},{"speaker":"Chris Dy","startTime":2062.47,"endTime":2066.79,"body":"source of referrals. I feel like"},{"speaker":"Chris Dy","startTime":2066.79,"endTime":2069.04,"body":"some of the nurse case managers"},{"speaker":"Chris Dy","startTime":2066.79,"endTime":2069.04,"body":"see some of the stuff that we do"},{"speaker":"Chris Dy","startTime":2069.04,"endTime":2070.75,"body":"and how we take care of"},{"speaker":"Chris Dy","startTime":2069.04,"endTime":2070.75,"body":"patients. And I think that"},{"speaker":"Chris Dy","startTime":2070.75,"endTime":2073.42,"body":"helps, you know, build"},{"speaker":"Chris Dy","startTime":2070.75,"endTime":2073.42,"body":"additional referrals to our work"},{"speaker":"Chris Dy","startTime":2073.42,"endTime":2076.69,"body":"comp program. As word gets out"},{"speaker":"Chris Dy","startTime":2073.42,"endTime":2076.69,"body":"of, oh, you know, Dr. Goldfarb"},{"speaker":"Chris Dy","startTime":2076.69,"endTime":2079.03,"body":"can do this, that and the other"},{"speaker":"Chris Dy","startTime":2076.69,"endTime":2079.03,"body":"and you know, Dr. D is pretty"},{"speaker":"Chris Dy","startTime":2079.03,"endTime":2081.49,"body":"good at the nerve stuff, that"},{"speaker":"Chris Dy","startTime":2079.03,"endTime":2081.49,"body":"kind of thing. I feel like I've"},{"speaker":"Chris Dy","startTime":2081.49,"endTime":2085.06,"body":"seen some of the same nurse case"},{"speaker":"Chris Dy","startTime":2081.49,"endTime":2085.06,"body":"managers because they've, you"},{"speaker":"Chris Dy","startTime":2085.06,"endTime":2088.12,"body":"know, they've been happy with"},{"speaker":"Chris Dy","startTime":2085.06,"endTime":2088.12,"body":"how not necessarily, they don't"},{"speaker":"Chris Dy","startTime":2088.12,"endTime":2091.54,"body":"know what we do in ER, but"},{"speaker":"Chris Dy","startTime":2088.12,"endTime":2091.54,"body":"they've seen how people do and"},{"speaker":"Chris Dy","startTime":2091.54,"endTime":2095.14,"body":"also how we handle those"},{"speaker":"Chris Dy","startTime":2091.54,"endTime":2095.14,"body":"situations. So"},{"speaker":"Charles Goldfarb","startTime":2095.14,"endTime":2097.21,"body":"relationship"},{"speaker":"Charles Goldfarb","startTime":2095.14,"endTime":2097.21,"body":"building is everything in this"},{"speaker":"Charles Goldfarb","startTime":2097.21,"endTime":2100.51,"body":"field, and we probably don't do"},{"speaker":"Charles Goldfarb","startTime":2097.21,"endTime":2100.51,"body":"enough of it, but I can say"},{"speaker":"Charles Goldfarb","startTime":2100.51,"endTime":2104.08,"body":"unequivocally that when a nurse"},{"speaker":"Charles Goldfarb","startTime":2100.51,"endTime":2104.08,"body":"case manager is with a patient"},{"speaker":"Charles Goldfarb","startTime":2104.11,"endTime":2107.86,"body":"in our clinic, it is good for"},{"speaker":"Charles Goldfarb","startTime":2104.11,"endTime":2107.86,"body":"the reasons you stated, right?"},{"speaker":"Charles Goldfarb","startTime":2107.86,"endTime":2110.83,"body":"It can help us build a bigger"},{"speaker":"Charles Goldfarb","startTime":2107.86,"endTime":2110.83,"body":"work comp practice, and it helps"},{"speaker":"Charles Goldfarb","startTime":2110.83,"endTime":2115.3,"body":"communicate with the patient, I"},{"speaker":"Charles Goldfarb","startTime":2110.83,"endTime":2115.3,"body":"get frustrated when a patient"},{"speaker":"Charles Goldfarb","startTime":2115.63,"endTime":2118.99,"body":"does not allow the nurse case"},{"speaker":"Charles Goldfarb","startTime":2115.63,"endTime":2118.99,"body":"manager in the room. And that"},{"speaker":"Charles Goldfarb","startTime":2118.99,"endTime":2121.18,"body":"happens sometimes. And that's"},{"speaker":"Charles Goldfarb","startTime":2118.99,"endTime":2121.18,"body":"always under the instruction of"},{"speaker":"Charles Goldfarb","startTime":2121.18,"endTime":2124.84,"body":"attorney who I know means well"},{"speaker":"Charles Goldfarb","startTime":2121.18,"endTime":2124.84,"body":"for their client, but nurse case"},{"speaker":"Charles Goldfarb","startTime":2124.84,"endTime":2128.29,"body":"manager have helped the process"},{"speaker":"Charles Goldfarb","startTime":2124.84,"endTime":2128.29,"body":"a good nurse case manager helps"},{"speaker":"Charles Goldfarb","startTime":2128.29,"endTime":2132.1,"body":"the process and so it for me,"},{"speaker":"Charles Goldfarb","startTime":2128.29,"endTime":2132.1,"body":"they are they are always an"},{"speaker":"Charles Goldfarb","startTime":2132.1,"endTime":2136.45,"body":"asset, but I look at it like"},{"speaker":"Charles Goldfarb","startTime":2132.1,"endTime":2136.45,"body":"that, not as someone that I have"},{"speaker":"Charles Goldfarb","startTime":2136.45,"endTime":2140.23,"body":"to explain things to, but that I"},{"speaker":"Charles Goldfarb","startTime":2136.45,"endTime":2140.23,"body":"do explain things to and then"},{"speaker":"Charles Goldfarb","startTime":2140.23,"endTime":2142.33,"body":"they can spend additional time"},{"speaker":"Charles Goldfarb","startTime":2140.23,"endTime":2142.33,"body":"if necessary, talking to the"},{"speaker":"Charles Goldfarb","startTime":2142.33,"endTime":2143.83,"body":"patient. Yeah,"},{"speaker":"Chris Dy","startTime":2143.83,"endTime":2147.94,"body":"and I think that once"},{"speaker":"Chris Dy","startTime":2143.83,"endTime":2147.94,"body":"you know, they, they they're in"},{"speaker":"Chris Dy","startTime":2147.94,"endTime":2151.0,"body":"the room, and you know, the"},{"speaker":"Chris Dy","startTime":2147.94,"endTime":2151.0,"body":"points that you need to hit to"},{"speaker":"Chris Dy","startTime":2151.0,"endTime":2154.36,"body":"make sure that they get the"},{"speaker":"Chris Dy","startTime":2151.0,"endTime":2154.36,"body":"information they need. I love"},{"speaker":"Chris Dy","startTime":2154.36,"endTime":2156.94,"body":"it, when they're happy that I"},{"speaker":"Chris Dy","startTime":2154.36,"endTime":2156.94,"body":"have addressed, you know, kind"},{"speaker":"Chris Dy","startTime":2156.94,"endTime":2159.82,"body":"of the things they need to write"},{"speaker":"Chris Dy","startTime":2156.94,"endTime":2159.82,"body":"the report, I've said, I'm going"},{"speaker":"Chris Dy","startTime":2159.82,"endTime":2161.95,"body":"to do this note for you, we're"},{"speaker":"Chris Dy","startTime":2159.82,"endTime":2161.95,"body":"going to get therapy"},{"speaker":"Chris Dy","startTime":2161.95,"endTime":2165.07,"body":"prescription for you. And, you"},{"speaker":"Chris Dy","startTime":2161.95,"endTime":2165.07,"body":"know, just make sure"},{"speaker":"Chris Dy","startTime":2165.07,"endTime":2166.78,"body":"everything's tidy. And I think"},{"speaker":"Chris Dy","startTime":2165.07,"endTime":2166.78,"body":"you know, for the people that"},{"speaker":"Chris Dy","startTime":2166.78,"endTime":2169.72,"body":"are listening, and if you're"},{"speaker":"Chris Dy","startTime":2166.78,"endTime":2169.72,"body":"starting out just know what they"},{"speaker":"Chris Dy","startTime":2169.72,"endTime":2172.57,"body":"expect of you and deliver it."},{"speaker":"Chris Dy","startTime":2169.72,"endTime":2172.57,"body":"And it does end up being a"},{"speaker":"Chris Dy","startTime":2172.57,"endTime":2176.41,"body":"pretty reasonable relationship."},{"speaker":"Chris Dy","startTime":2172.57,"endTime":2176.41,"body":"I mean, how do you as we start"},{"speaker":"Chris Dy","startTime":2176.41,"endTime":2179.32,"body":"to wrap up? I mean, how do you"},{"speaker":"Chris Dy","startTime":2176.41,"endTime":2179.32,"body":"talk to new faculty about you"},{"speaker":"Chris Dy","startTime":2179.32,"endTime":2183.01,"body":"know, whether, you know, to take"},{"speaker":"Chris Dy","startTime":2179.32,"endTime":2183.01,"body":"to become part of the work comp"},{"speaker":"Chris Dy","startTime":2183.01,"endTime":2187.15,"body":"program, and have kind of pearls"},{"speaker":"Chris Dy","startTime":2183.01,"endTime":2187.15,"body":"about how to how to approach"},{"speaker":"Chris Dy","startTime":2187.18,"endTime":2188.71,"body":"organization and that kind of"},{"speaker":"Chris Dy","startTime":2187.18,"endTime":2188.71,"body":"thing."},{"speaker":"Charles Goldfarb","startTime":2190.48,"endTime":2192.85,"body":"I think it's"},{"speaker":"Charles Goldfarb","startTime":2190.48,"endTime":2192.85,"body":"really important that a new"},{"speaker":"Charles Goldfarb","startTime":2193.3,"endTime":2196.27,"body":"partner understands what they're"},{"speaker":"Charles Goldfarb","startTime":2193.3,"endTime":2196.27,"body":"getting into. Because for you"},{"speaker":"Charles Goldfarb","startTime":2196.27,"endTime":2198.82,"body":"and I, if someone says, Yeah, I"},{"speaker":"Charles Goldfarb","startTime":2196.27,"endTime":2198.82,"body":"want to take work comp, and they"},{"speaker":"Charles Goldfarb","startTime":2198.82,"endTime":2201.73,"body":"do a lousy job, they don't get"},{"speaker":"Charles Goldfarb","startTime":2198.82,"endTime":2201.73,"body":"their notes dictated in a timely"},{"speaker":"Charles Goldfarb","startTime":2201.73,"endTime":2203.59,"body":"fashion, they don't get the"},{"speaker":"Charles Goldfarb","startTime":2201.73,"endTime":2203.59,"body":"patients back to work, they"},{"speaker":"Charles Goldfarb","startTime":2203.59,"endTime":2206.02,"body":"don't communicate well, it"},{"speaker":"Charles Goldfarb","startTime":2203.59,"endTime":2206.02,"body":"actually ends up being a"},{"speaker":"Charles Goldfarb","startTime":2206.02,"endTime":2209.02,"body":"negative for all of us. And so I"},{"speaker":"Charles Goldfarb","startTime":2206.02,"endTime":2209.02,"body":"want to make sure they"},{"speaker":"Charles Goldfarb","startTime":2209.02,"endTime":2211.51,"body":"understand what they're getting"},{"speaker":"Charles Goldfarb","startTime":2209.02,"endTime":2211.51,"body":"into. And it's just it really"},{"speaker":"Charles Goldfarb","startTime":2211.51,"endTime":2214.24,"body":"boils down to communication,"},{"speaker":"Charles Goldfarb","startTime":2211.51,"endTime":2214.24,"body":"verbal communication in the"},{"speaker":"Charles Goldfarb","startTime":2214.24,"endTime":2219.1,"body":"office, understanding of why it"},{"speaker":"Charles Goldfarb","startTime":2214.24,"endTime":2219.1,"body":"matters, to get patients back to"},{"speaker":"Charles Goldfarb","startTime":2219.1,"endTime":2222.88,"body":"work, why it matters to close a"},{"speaker":"Charles Goldfarb","startTime":2219.1,"endTime":2222.88,"body":"case, as soon as one is able"},{"speaker":"Charles Goldfarb","startTime":2222.94,"endTime":2227.92,"body":"what it means to watch a patient"},{"speaker":"Charles Goldfarb","startTime":2222.94,"endTime":2227.92,"body":"plateau. And then ultimately say"},{"speaker":"Charles Goldfarb","startTime":2227.92,"endTime":2231.43,"body":"that they're at maximum medical"},{"speaker":"Charles Goldfarb","startTime":2227.92,"endTime":2231.43,"body":"improvement, other tools we have"},{"speaker":"Charles Goldfarb","startTime":2231.43,"endTime":2235.09,"body":"at our disposal. So it's, it's"},{"speaker":"Charles Goldfarb","startTime":2231.43,"endTime":2235.09,"body":"to everyone's advantage that if"},{"speaker":"Charles Goldfarb","startTime":2235.09,"endTime":2237.82,"body":"we're going to take care of the"},{"speaker":"Charles Goldfarb","startTime":2235.09,"endTime":2237.82,"body":"injured worker, we do it well."},{"speaker":"Charles Goldfarb","startTime":2238.66,"endTime":2241.9,"body":"Because then it's good for our"},{"speaker":"Charles Goldfarb","startTime":2238.66,"endTime":2241.9,"body":"entire practice. Right."},{"speaker":"Chris Dy","startTime":2241.93,"endTime":2243.52,"body":"And then I guess there"},{"speaker":"Chris Dy","startTime":2241.93,"endTime":2243.52,"body":"are two things I want to ask"},{"speaker":"Chris Dy","startTime":2243.52,"endTime":2247.96,"body":"you. One, how do you utilize the"},{"speaker":"Chris Dy","startTime":2243.52,"endTime":2247.96,"body":"functional capacity evaluation"},{"speaker":"Chris Dy","startTime":2247.96,"endTime":2250.48,"body":"as patients are kind of"},{"speaker":"Chris Dy","startTime":2247.96,"endTime":2250.48,"body":"wrapping, you know, towards the"},{"speaker":"Chris Dy","startTime":2250.48,"endTime":2253.21,"body":"tail end of their care, but"},{"speaker":"Chris Dy","startTime":2250.48,"endTime":2253.21,"body":"still have some issues? And then"},{"speaker":"Chris Dy","startTime":2253.24,"endTime":2258.76,"body":"you've seen them plateau? And"},{"speaker":"Chris Dy","startTime":2253.24,"endTime":2258.76,"body":"what was I can't even remember"},{"speaker":"Chris Dy","startTime":2258.76,"endTime":2261.34,"body":"the last Oh, yeah, ratings, how"},{"speaker":"Chris Dy","startTime":2258.76,"endTime":2261.34,"body":"do you handle the ratings?"},{"speaker":"Chris Dy","startTime":2261.58,"endTime":2263.77,"body":"Because I think that was one"},{"speaker":"Chris Dy","startTime":2261.58,"endTime":2263.77,"body":"thing where I was not like,"},{"speaker":"Chris Dy","startTime":2263.77,"endTime":2266.92,"body":"initially enthused about doing"},{"speaker":"Chris Dy","startTime":2263.77,"endTime":2266.92,"body":"but as I've done more of them,"},{"speaker":"Chris Dy","startTime":2266.92,"endTime":2269.05,"body":"like, Oh, this is actually not"},{"speaker":"Chris Dy","startTime":2266.92,"endTime":2269.05,"body":"that huge deal. Not big of a"},{"speaker":"Chris Dy","startTime":2269.05,"endTime":2269.32,"body":"deal."},{"speaker":"Charles Goldfarb","startTime":2270.61,"endTime":2275.5,"body":"Yeah, ratings"},{"speaker":"Charles Goldfarb","startTime":2270.61,"endTime":2275.5,"body":"are a huge discussion. They're"},{"speaker":"Charles Goldfarb","startTime":2275.5,"endTime":2280.09,"body":"done differently state by state."},{"speaker":"Charles Goldfarb","startTime":2275.5,"endTime":2280.09,"body":"Some states require us the AMA"},{"speaker":"Charles Goldfarb","startTime":2280.09,"endTime":2282.67,"body":"Guides, and they'll mandate"},{"speaker":"Charles Goldfarb","startTime":2280.09,"endTime":2282.67,"body":"which edition of The American"},{"speaker":"Charles Goldfarb","startTime":2282.67,"endTime":2287.38,"body":"Medical Association guides, I"},{"speaker":"Charles Goldfarb","startTime":2282.67,"endTime":2287.38,"body":"use the AMA guide, to kind of"},{"speaker":"Charles Goldfarb","startTime":2287.38,"endTime":2289.87,"body":"give me a general sense when I"},{"speaker":"Charles Goldfarb","startTime":2287.38,"endTime":2289.87,"body":"was starting out in Missouri,"},{"speaker":"Charles Goldfarb","startTime":2289.87,"endTime":2295.99,"body":"you're not supposed to. And I"},{"speaker":"Charles Goldfarb","startTime":2289.87,"endTime":2295.99,"body":"try to just give an honest"},{"speaker":"Charles Goldfarb","startTime":2295.99,"endTime":2299.56,"body":"assessment, because what often"},{"speaker":"Charles Goldfarb","startTime":2295.99,"endTime":2299.56,"body":"happens is I'll give my best"},{"speaker":"Charles Goldfarb","startTime":2299.56,"endTime":2302.23,"body":"honest assessment. And I'm not"},{"speaker":"Charles Goldfarb","startTime":2299.56,"endTime":2302.23,"body":"saying other people aren't"},{"speaker":"Charles Goldfarb","startTime":2302.23,"endTime":2305.86,"body":"answering honestly. But they may"},{"speaker":"Charles Goldfarb","startTime":2302.23,"endTime":2305.86,"body":"get sent by an attorney or by"},{"speaker":"Charles Goldfarb","startTime":2305.86,"endTime":2309.73,"body":"work to a different physician"},{"speaker":"Charles Goldfarb","startTime":2305.86,"endTime":2309.73,"body":"who may lean on the employee"},{"speaker":"Charles Goldfarb","startTime":2309.73,"endTime":2314.11,"body":"side who are or who may lean on"},{"speaker":"Charles Goldfarb","startTime":2309.73,"endTime":2314.11,"body":"the employer side. And one can"},{"speaker":"Charles Goldfarb","startTime":2314.11,"endTime":2318.31,"body":"see ratings, there are carpal"},{"speaker":"Charles Goldfarb","startTime":2314.11,"endTime":2318.31,"body":"tunnel, permanent disability"},{"speaker":"Charles Goldfarb","startTime":2318.31,"endTime":2325.51,"body":"ratings of you know, 40%, I"},{"speaker":"Charles Goldfarb","startTime":2318.31,"endTime":2325.51,"body":"mean, just crazy stuff. And so I"},{"speaker":"Charles Goldfarb","startTime":2325.51,"endTime":2329.92,"body":"think our best asset is being"},{"speaker":"Charles Goldfarb","startTime":2325.51,"endTime":2329.92,"body":"sort of the neutral arbitrator"},{"speaker":"Charles Goldfarb","startTime":2329.95,"endTime":2334.15,"body":"who just says what we think, as"},{"speaker":"Charles Goldfarb","startTime":2329.95,"endTime":2334.15,"body":"honestly as we possibly can, I"},{"speaker":"Charles Goldfarb","startTime":2334.15,"endTime":2339.55,"body":"think that's appreciated both by"},{"speaker":"Charles Goldfarb","startTime":2334.15,"endTime":2339.55,"body":"the worker, I hope, by work"},{"speaker":"Charles Goldfarb","startTime":2339.55,"endTime":2343.12,"body":"comp, and all and the next step"},{"speaker":"Charles Goldfarb","startTime":2339.55,"endTime":2343.12,"body":"is the administrative judge, the"},{"speaker":"Charles Goldfarb","startTime":2343.12,"endTime":2345.31,"body":"attorney, the you know, the"},{"speaker":"Charles Goldfarb","startTime":2343.12,"endTime":2345.31,"body":"judge who's going to ultimately"},{"speaker":"Charles Goldfarb","startTime":2345.31,"endTime":2347.23,"body":"arbitrate whether settlement"},{"speaker":"Charles Goldfarb","startTime":2345.31,"endTime":2347.23,"body":"looks like,"},{"speaker":"Chris Dy","startTime":2347.23,"endTime":2350.294,"body":"right right now. So I"},{"speaker":"Chris Dy","startTime":2347.23,"endTime":2350.294,"body":"think the the FCE is, is"},{"speaker":"Chris Dy","startTime":2350.361,"endTime":2354.225,"body":"helpful, because I think it"},{"speaker":"Chris Dy","startTime":2350.361,"endTime":2354.225,"body":"gives me some numbers and some"},{"speaker":"Chris Dy","startTime":2354.291,"endTime":2358.555,"body":"objectivity around, you know, to"},{"speaker":"Chris Dy","startTime":2354.291,"endTime":2358.555,"body":"base my or final rating on. You"},{"speaker":"Chris Dy","startTime":2358.621,"endTime":2362.819,"body":"know, I think the ultimate test"},{"speaker":"Chris Dy","startTime":2358.621,"endTime":2362.819,"body":"of people's feelings about work"},{"speaker":"Chris Dy","startTime":2362.885,"endTime":2367.082,"body":"comp will be if they've made it"},{"speaker":"Chris Dy","startTime":2362.885,"endTime":2367.082,"body":"to the end of this episode. And"},{"speaker":"Chris Dy","startTime":2367.149,"endTime":2370.946,"body":"when we look at our download"},{"speaker":"Chris Dy","startTime":2367.149,"endTime":2370.946,"body":"stats to see maybe don't put"},{"speaker":"Chris Dy","startTime":2371.013,"endTime":2375.21,"body":"work comp in the title, Chuck,"},{"speaker":"Chris Dy","startTime":2371.013,"endTime":2375.21,"body":"if they actually kept listening."},{"speaker":"Chris Dy","startTime":2375.276,"endTime":2375.61,"body":"Well,"},{"speaker":"Charles Goldfarb","startTime":2375.64,"endTime":2378.49,"body":"you know, it's"},{"speaker":"Charles Goldfarb","startTime":2375.64,"endTime":2378.49,"body":"funny when I look at my patient"},{"speaker":"Charles Goldfarb","startTime":2378.49,"endTime":2381.58,"body":"reviews, like when people take"},{"speaker":"Charles Goldfarb","startTime":2378.49,"endTime":2381.58,"body":"the time these days to fill out"},{"speaker":"Charles Goldfarb","startTime":2381.58,"endTime":2385.99,"body":"a Google review. I know we"},{"speaker":"Charles Goldfarb","startTime":2381.58,"endTime":2385.99,"body":"talked about this, I know who"},{"speaker":"Charles Goldfarb","startTime":2385.99,"endTime":2389.59,"body":"all the negative comments are,"},{"speaker":"Charles Goldfarb","startTime":2385.99,"endTime":2389.59,"body":"they're all were calm. I know"},{"speaker":"Charles Goldfarb","startTime":2389.59,"endTime":2392.74,"body":"that and I know exactly who each"},{"speaker":"Charles Goldfarb","startTime":2389.59,"endTime":2392.74,"body":"patient was and why they were"},{"speaker":"Charles Goldfarb","startTime":2392.74,"endTime":2395.95,"body":"mad at me. But the flip side of"},{"speaker":"Charles Goldfarb","startTime":2392.74,"endTime":2395.95,"body":"that is we don't always see the"},{"speaker":"Charles Goldfarb","startTime":2395.95,"endTime":2399.4,"body":"patients who are appreciative of"},{"speaker":"Charles Goldfarb","startTime":2395.95,"endTime":2399.4,"body":"the care. And you know, I think"},{"speaker":"Charles Goldfarb","startTime":2399.43,"endTime":2402.7,"body":"most people People want to get"},{"speaker":"Charles Goldfarb","startTime":2399.43,"endTime":2402.7,"body":"back to work, want to do it as"},{"speaker":"Charles Goldfarb","startTime":2402.7,"endTime":2405.85,"body":"soon and as safely as they"},{"speaker":"Charles Goldfarb","startTime":2402.7,"endTime":2405.85,"body":"possibly can, which of course is"},{"speaker":"Charles Goldfarb","startTime":2405.85,"endTime":2406.51,"body":"our goal to"},{"speaker":"Chris Dy","startTime":2406.9,"endTime":2408.82,"body":"write of course. And I"},{"speaker":"Chris Dy","startTime":2406.9,"endTime":2408.82,"body":"guess one thing that's not"},{"speaker":"Chris Dy","startTime":2408.82,"endTime":2411.55,"body":"necessarily just work completed,"},{"speaker":"Chris Dy","startTime":2408.82,"endTime":2411.55,"body":"but I feel like I need to be"},{"speaker":"Chris Dy","startTime":2411.55,"endTime":2414.13,"body":"better about handing patients"},{"speaker":"Chris Dy","startTime":2411.55,"endTime":2414.13,"body":"the cards that say, please leave"},{"speaker":"Chris Dy","startTime":2414.13,"endTime":2417.25,"body":"an online review. Because you"},{"speaker":"Chris Dy","startTime":2414.13,"endTime":2417.25,"body":"know, it's the happy patients"},{"speaker":"Chris Dy","startTime":2417.25,"endTime":2420.25,"body":"who want to do something that"},{"speaker":"Chris Dy","startTime":2417.25,"endTime":2420.25,"body":"thank you. I still love cookies,"},{"speaker":"Chris Dy","startTime":2420.28,"endTime":2424.03,"body":"I will take them any day a week"},{"speaker":"Chris Dy","startTime":2420.28,"endTime":2424.03,"body":"for steaks, you know, beverages"},{"speaker":"Chris Dy","startTime":2424.03,"endTime":2426.19,"body":"as well, but an online review"},{"speaker":"Chris Dy","startTime":2424.03,"endTime":2426.19,"body":"probably helps more than"},{"speaker":"Chris Dy","startTime":2426.19,"endTime":2428.23,"body":"anything else, because there's"},{"speaker":"Chris Dy","startTime":2426.19,"endTime":2428.23,"body":"so much bias with you guys to"},{"speaker":"Chris Dy","startTime":2428.23,"endTime":2428.92,"body":"leave a review."},{"speaker":"Charles Goldfarb","startTime":2429.58,"endTime":2431.74,"body":"I need to do"},{"speaker":"Charles Goldfarb","startTime":2429.58,"endTime":2431.74,"body":"more of it as well. I just don't"},{"speaker":"Charles Goldfarb","startTime":2431.77,"endTime":2434.5,"body":"I think there's something about"},{"speaker":"Charles Goldfarb","startTime":2431.77,"endTime":2434.5,"body":"me that doesn't feel 100%"},{"speaker":"Charles Goldfarb","startTime":2434.5,"endTime":2435.82,"body":"comfortable. We're"},{"speaker":"Chris Dy","startTime":2435.82,"endTime":2438.19,"body":"too we're too old"},{"speaker":"Chris Dy","startTime":2435.82,"endTime":2438.19,"body":"school. Like I'm the same way"},{"speaker":"Chris Dy","startTime":2438.19,"endTime":2440.2,"body":"but I mean, you know, it's the"},{"speaker":"Chris Dy","startTime":2438.19,"endTime":2440.2,"body":"new generation. You just got to"},{"speaker":"Chris Dy","startTime":2440.2,"endTime":2441.4,"body":"get after it. It"},{"speaker":"Charles Goldfarb","startTime":2441.4,"endTime":2443.2,"body":"matters and"},{"speaker":"Charles Goldfarb","startTime":2441.4,"endTime":2443.2,"body":"there's there's data out there"},{"speaker":"Charles Goldfarb","startTime":2443.2,"endTime":2446.95,"body":"that says it matters. Hey, if"},{"speaker":"Charles Goldfarb","startTime":2443.2,"endTime":2446.95,"body":"you did make it to the end and"},{"speaker":"Charles Goldfarb","startTime":2446.95,"endTime":2451.39,"body":"you want to hear more work, cop,"},{"speaker":"Charles Goldfarb","startTime":2446.95,"endTime":2451.39,"body":"well, maybe we'll avoid Yeah,"},{"speaker":"Chris Dy","startTime":2451.39,"endTime":2453.43,"body":"good. Oh Goldfarb with"},{"speaker":"Chris Dy","startTime":2451.39,"endTime":2453.43,"body":"all the the fan favorites"},{"speaker":"Chris Dy","startTime":2453.43,"endTime":2457.0,"body":"congenital and work comp. All"},{"speaker":"Chris Dy","startTime":2453.43,"endTime":2457.0,"body":"right, have a good one."},{"speaker":"Charles Goldfarb","startTime":2459.88,"endTime":2461.86,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2459.88,"endTime":2461.86,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2461.86,"endTime":2463.42,"body":"real soon. Sounds"},{"speaker":"Chris Dy","startTime":2463.42,"endTime":2465.76,"body":"good. Well, be sure to"},{"speaker":"Chris Dy","startTime":2463.42,"endTime":2465.76,"body":"email us with topic suggestions"},{"speaker":"Chris Dy","startTime":2465.76,"endTime":2469.3,"body":"and feedback, you can reach us"},{"speaker":"Chris Dy","startTime":2465.76,"endTime":2469.3,"body":"at hand podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2469.96,"endTime":2472.09,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2469.96,"endTime":2472.09,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2472.09,"endTime":2473.05,"body":"get your podcast."},{"speaker":"Chris Dy","startTime":2473.47,"endTime":2476.29,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":2473.47,"endTime":2476.29,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2476.29,"endTime":2476.71,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2477.46,"endTime":2480.01,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2477.46,"endTime":2480.01,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2480.01,"endTime":2481.33,"body":"music. And"},{"speaker":"Chris Dy","startTime":2481.33,"endTime":2483.46,"body":"remember, keep the"},{"speaker":"Chris Dy","startTime":2481.33,"endTime":2483.46,"body":"upper hand them back next time."}]}