Dr. Michael Greiwe, MD talks to Dr. Justin Trosclair DC on A Doctor's Perspective Podcast.…
Should elective surgeries occur during the coronavirus pandemic and how can a neuro surgeon and you start telehealth with your patients? Dr. Michael Verdon DO FACOS explains his view on the current covid-19 doctor patient landscape.
Should elective surgeries happen right now?
What would be considered Elective Spine Surgery right now?
Dr. Michael Verdon makes a good point: does the gloves and mask I wear now to treat a non emergency case that could be ascertained via doxy (video calls) be worth it, if down the line we have a massive shortage of supplies for more life threatening complications from the coronavirus?
What precautions are being taken so everyone is safe from covid-19, especially in hospitals?
Should neurologists, orthopedics, dermatologists etc be on the front line of helping with corona patients: ie operating ventilators?
Is being a healthcare worker a Calling, Profession or just a Job when you and your family could be at risk to covid-19?
How long can a surgical center stay open without elective surgeries?
Most will think “rich” doctors will be okay, but what do the nurses and other support staff do when they are paid hourly?
How does a spine surgeon convert to telehealth?
Efficiency, screening, lower overhead… is the virtual visits a paradigm shift we have been waiting to see?
How do we set up a practice with other physicians with a mix of virtual visits (telehealth) and in office care?
Finding the Pain Generator.
Find the pain generator, and you can pick the most appropriate procedure or referral to chiropractic or physical therapy. Don’t treat an MRI – treat the Patient.
How being a physical therapist fueled his desire to learn spine surgery is discussed and how that impacted his residency and clinical experience now.
Dr. Michael Verdon is a Doctor of Osteopath , a Fellow of Osteopathic Surgeons (spine) and a past Physical Therapist who also holds a business degree. He practices in Dayton (Ohio) at Dayton Neurological Associates. His passion is minimally invasive spine surgery with an emphasis on motion restoration and procedures that only need a 23 hour stay in hospital.
Show notes can be found at https://adoctorsperspective.net/150 here you can also find links to things mentioned and the full transcript.
Episode 150 elective surgeries in 2020 and telehealth, I’m your host, Dr. Justin Trosclair. And today, we are Dr. Michael burdens perspective. During 2017 and 18 podcast awards, nominate hosts and best selling author on Amazon as we get a behind the curtain look at all types of doctor and guest specialties. Let’s hear a doctor’s perspective. don’t adjust your stereo. You heard correctly. 150 episodes. Wow. Now, honestly, this should have happened in 2019. However, I had some cancellations and it didn’t happen. And then I took a break. But we are back we got a few more minisodes coming out as well as a few more interviews, doing something different this year. If you haven’t noticed, we’re just going to put them out when I finish them, record them, edit them, put them out. And this is wild times. We’re in april two 20 in the middle of a worldwide social distancing, self quarantining, Coronavirus, COVID-19 environment. And the guest Dr. Michael Verdun is a spine surgeon, osteopath fellow, and he’s an independent doctor, which means he doesn’t work like a corporation. And so he was able to pivot quickly with telehealth. So we’re going to go over what does that look like? How to do perks? A couple hindrances, but also right now, elective surgeries, I mean spine surgery. Sure, there are some cases that are like mandatory we got to get this done, but a lot of procedures what like what his specialty is, or minimally invasive 23 hours or less in a hospital type of procedures. And his motto is find the pain generator. So how are the hospitals dealing with elective base surgeries? What are their role in the pandemic that is going on? Are they expected to Run ventilators and become the go to when they normally wouldn’t even be dealing with pulmonary issues. So all those types of things are going to be answered today. Very, very excited to be at 150 episodes. Thank you so much for tuning in. Thank you so much for being a part of the program each a week. If you’re interested in a telehealth a web page, I tried to do a story brand version so if you do Dr. Justin Trosclair comm slash virtual visits, you’ll see you know, a layout explaining what telehealth is, why would you would use it, the whole marketing part. As always, the China book is still out on Amazon. And actually the no needle acupuncture book is now on Amazon Kindle and print. So that’s something new that I released maybe two weeks ago, a doctor’s perspective is not officially sponsored by anyone. So if you really love what we’re doing, head over to dotnet slash support. We are one time financial supports monthly packages where you can get the books included if you’re getting some value and you want to give back at all. greatly appreciated. All right, all the show notes and the transcript can be found at a doctor’s perspective. dotnet slash 150. Let’s go hashtag behind the curtain. Live from Germany, and Dayton, Ohio today on the show. We’ve got a spine surgeon because we’re going to talk about all kinds of things with the Coronavirus and elective procedures and all these different things that are on the doctors minds, and our hearts and our wallets. It’s very important conversation, I think. So, welcome to the show. Dr. Michael Verdun.
Unknown Speaker 3:37
Thank you for having me. I appreciate it.
Unknown Speaker 3:40
You betcha. And everyone if you hear an echo one minute, I apologize. I’m trying to still figure out this new setup for a doctor’s perspective. But let’s just jump in with it the simple fun. Who are you? What do you do? And and then we’ll jump into the real questions. Okay.
Unknown Speaker 3:59
Yeah, sure. My name is Mike burgle, the neurosurgeon live in Dayton, Ohio, primarily been doing only spine surgery for the past three years now. Background I have a business degree from Loyola Marymount University and about 1000 years ago. And after that I went and got a master’s degree in physical therapy. So I was a PT first for I went and became a surgeon got interested in neurosurgery as a student trained at a pretty high volume place in Detroit, Michigan. Basically focus now on the minimally invasive spine or motion preservation of the bent towards outpatient surgery 23 hours a day.
Unknown Speaker 4:38
That’s awesome. It’s not a lot of the spine fusions just gonna be the things that can you know, we said minimally invasive,
Unknown Speaker 4:44
I do fusions are the biggest trick is what’s indicated, right? So if there’s too much motion, you really got to fuse it, someone who’s got you know, spondylosis thesis laminate, that doesn’t work. So you have to pick the right surgery for the right patient at the right time. Sometimes it’s fusion sometimes something smaller, treat the patient’s symptoms not, you know, your bank account or whatever that is.
Unknown Speaker 5:06
I love that. How Okay, so PT first? Yeah. How does that translate into you deciding when someone needs surgery? Or like what, what to recommend?
Unknown Speaker 5:17
That’s a great, that’s a great question. I actually think it helps me. Now, I had to forget all that stuff to become a resident get the residency and actually, I kind of got my way a little bit. I really got interested in spine surgery because I was suspicious. I saw a lot of patients as a therapist not get better actually get hurt. And I was suspicious this thing spine surgery didn’t work for people. And I was out to, you know, figure that one out myself. And I noticed that patients if they had the right surgery got better as long as the post operative pain goes away. So for me, now, I’m lucky I live in a community where we have a lot of great therapists who do a lot of great manual therapy. And if I’m not really sure what the pain generator is, and send them off to therapy and actually chiropractic care, work on people helped me work out the musculoskeletal problems. And if it’s not nerve root related radicular that’s persistent surgery is usually indicated. So my whole philosophy and most most surgeons I met, really dive into finding the pain generators what the biggest thing is, and I think there’s a lot of musculoskeletal medicine that really can help me determine what, who and what needs surgery and what does not.
Unknown Speaker 6:25
Right, especially if you’ve gone through a physical therapy program that you know, like and trust and a chiropractor who’s doing what they do. And you’re still not better, we’ve narrowed down a lot,
Unknown Speaker 6:36
right? I feel like
Unknown Speaker 6:38
the people around me make me better. Right? So the patients who go and get good quality spinal based rehabilitation from chiropractic care, I’m gonna do so osteopathic care to one PT, joint mobilization. It’s also those people get better without me in some ways, it just helps me because I’m not I People I can’t help. Or I’m not being fooled by things that can’t be treated with surgery, you know. So if I try to go from a very focused anatomically driven treatment module with a diagnosis up front first, then I’m usually better off. So my attitude, I try to determine the pain generator first, and then develop the treatment plan Second, you know, not the other way around.
Unknown Speaker 7:25
But I definitely hear from patients, they’re super excited whenever they go to a surgeon of any kind. And they’re like, Hey, you said not yet. No surgery yet.
Unknown Speaker 7:32
So it’s funny, some patients, yes, some patients, they want to just be fixed. And so it’s challenging because I’ll see them and I’ll say, Hey, we need to do therapy or pain injection and they’ll say Doc, I’ve already done that doesn’t work. In my answer is where did you go? What did you have done and it really wasn’t directed at the problem. Then I tell them, you have to reevaluate. I mean, in all of our professions across the board, we have people who are really probe problem driven meaning They want to solve problems and then other people who are kind of going through the motions, unfortunately, yeah, I mean it all across all spectrums of life, you know, you see that and so I just try to find like minded individuals that do things that are not in the same discipline. So pain doctors, chiropractors, therapists that wanted, you know, and we kind of refer to each other, no, I can do this, you can do that, why don’t we work together. So we all get to do more of what we’re really trained to do.
Unknown Speaker 8:28
That’s very good. I know, I could probably do another 20 minutes of just picking your brain on that as a chiropractor trying to develop these relationships because you’re obviously a person that we want to have on our referral list. And the same for you We want you want to be on our list of Hey, you can’t fix them, send them but we’re gonna we’re gonna table that for a little while. Okay. So it was on a LinkedIn post, we saw each other we were comment on somebody’s thread and it was really interesting about elective surgeries in general and right now Everybody knows there’s a lot of doctors chiropractors pts, everybody’s kind of just shutting down, we’re not essential. Right? It comes to say as well what is considered an elective surgery in? Is it post vulnerable? What are your thoughts just generally on that before we dive deeper?
Unknown Speaker 9:16
So that’s a great question and I’m pretty pragmatic about that. You know, so for me as a neurosurgeon, I’m lucky because everything potentially could be, you know, non elective if I really want to push but a lot of things are chronic and stable and can be managed with for me with patients primarily it’s the patients can alter their symptoms by position or activity and tell them you know, you need to try to hold off on this at the moment. If they have progressive pain, usually neurologic dysfunction, you know, foot drop, that kind of thing. is not record compression. myelopathy those those those are no longer I can’t wait. I don’t know when they’re So in Ohio, we stopped operating about the 15th of last month. Wow, Ohio was one of the first states to aggressively just ban elective surgery. And so we had to talk to people and could they be manageable medication, epidurals for the time being, which has been stopped as well. And then we would just kind of hold off a lot of people it was their activity level was making them more symptomatic. So if they could mod modify their activity levels to kind of modulate their symptoms, I would say do that. I also looked at patients who were over 70 basically said, you know, do you really feel like this is necessary for you right now. That being said, I did a surgery yesterday. I have one coming up in a week or so here. In Ohio, we have Well, the American College of Surgeons put out some guidelines for us and then each individual facility is determining by committee who goes to surgery and who does not. It sounds scary. But if you have a clinical rationale as to why you’re doing the surgery, in bed, racked up by documentation imaging findings it’s usually okay that being said it’s a little you know, it’s weird being in the hour there’s no one around You’re the only one it’s very quiet so thanks for the question.
Unknown Speaker 11:12
right i mean heart surgery is typically you know, one of those things that’s not having you need to have it
Unknown Speaker 11:16
Unknown Speaker 11:18
You need to get your l five taken care of I mean, maybe maybe we don’t, but is there a real concern in those facilities versus like a hospital because you know, I think a big hospital I think, Oh man, if there’s 25 people in there is the whole hospital contaminated kind of or what
Unknown Speaker 11:34
so when we when this came out my first thought was why can’t a C’s be used to help with this and and they the ASC is quickly within 24 to 48 hours said we’re we’re not going to do it so they completely shut the doors down. Then it became Should we get to one or two facilities and so in our my town I live in the hospital systems are isolated the patients on one or two floors one or two buildings, so they’re trying to keep clean and infected patients completely apart. I did surgery I did. The hospital had yesterday, they have a whole floor that’s locked down that no one can get in and out of. So there’s really no way for people to get cross country or very minimal cross contaminated. I think you’re trying to keep traffic flow low. So I had to go through the front door with everybody else to get my temperature checked and all that stuff, which is all good. You know, I mean, there’s, you know, although one of the hospitals here in town, they found out people are trying to sneak in through the side door and people just don’t really get it. I think there’s a there’s a real sense for you know, that’s this is for the for whatever kind of person and that obviously this virus is not really discriminating amongst people, places, time socioeconomic status, parts of the hemispheres, whatever. It’s an equal opportunity offender across all spectrums, and I think it kind of is a little humbling, you know, he doesn’t really care who you are and when you do female associated economic status, what religion you belong to what political party, what tax bracket it’s in. So there’s just a lot of not understanding what is actually going on. At the same time people get sick and I work in health care. And it’s hard for me to sit by and watch patients suffer from stuff that could be easily treatable. You have to ask yourself, if are the gloves and mask I’m using going to be one less opportunity to help someone else down the road in a couple of months. We had a patient who had a fracture, and she wanted to die for classes. She keeps calling the office and I keep telling her I can’t do that. I mean, it’s just not there’s another treatment option available to you. And she doesn’t seem to understand that if I’m going to probably have to have a discussion along the lines of would you want me to let your child die? Because you needed you wouldn’t wear a brace or you wouldn’t change your behavior. And unfortunately, sometimes you need to be that direct with people because, you know, that’s what happened in it. They had to avoid treating folks. In it that’s we’re not used to doing that kind of stuff, it becomes a very, but this is a different time in place. because it’d be different do the hospitals
Unknown Speaker 14:12
on the floors Is there a way to with air conditioning systems in the in the airflow are those like self contained per floor
Unknown Speaker 14:20
now so don’t they make negative flow rooms right for real estate in the past for hospitals in the United States, we would have certain kinds of flow rooms but those are rooms and those isolated rooms is one or two rooms and all hospital if you have 1000, that hospital 20 rooms will be that way. So no, yeah, it’s not that way. This has more to do with just wash your hands. Just don’t touch. don’t sneeze on anybody. Just don’t touch. I mean, that kind of stuff. basic basic hygiene that your history has a way of teaching us all over again, all the time. And I this is one of those things. I mean, this is this. In some ways, it looks a lot similar to what the Spanish Flu look like. No, neither you or I were alive then. But I think this is very, very similar. And I think it’s going to get people’s attention in a way that they don’t. They did they would choose to do a camp they could, you know,
Unknown Speaker 15:11
yeah, I just sometimes I wonder We’ve had a few outbreaks in the past 10 years. And I just wonder if we’re trying to correct from the wrongs we’ve done before, like, Oh, we didn’t handle it that serious. And now it’s, we’re taking it seriously. And then I wonder what happens to the economy and then three years from we get another new virus, what they do then, and that’s a lot of speculation, but
Unknown Speaker 15:32
right. So some sub The beautiful thing about what we have right now compared to everything else is the amount of information right so this platform that you and I are talking on right now didn’t really exist. The last time h1 N word came around it. Some people say that COVID-19 is this is the third time it’s circling the earth. You know, it’s gone around. I feel like a lot of it made this may get people’s attention, but you know, I I don’t know. I really Remember, 2008 pretty sick, I was not really I was in residency not starting my career yet. And I felt like I was lucky that I was sheltered in a training environment. But a lot of people have forgotten that. I’m looking at some stuff today about mortgage rates in the States or provinces going to probably be a significantly high foreclosure rate. That means that people over borrowed again, and this is just 10 years later. So we have short term memory problem. Culturally, the last I’m not talking about anybody else. But in the West, we don’t remember anything. My wife is Chinese, and we were talking about, you know, they shut down the whole country or whatever for like a month and I was like, Dude in America, that that could break a lot of people and because no one’s gonna be longer than a month, we know it’s gonna be like a 60 or 90 day situation when it comes out. So in the States, it’s scary because you can see people not really preparing for a longer haul. And you know, I think they’re going to try to give people some money, but it’s hard. Are you with cash? How are you with invested in your own personal finances? And how leveraged are you? I think it’s gonna be pretty profound. The changes that are going to come around afterwards are going to be pretty significant. I think technologies like this are going to bring us all closer together. But yeah, it’ll be interesting to see this is a very interesting time. So I’m not really sure how it’s all gonna play out.
Unknown Speaker 17:25
Right. And I want to talk to you about the telehealth component. But before I do I have some questions. I’m kind of like looking over here to, to see what we’ve hit and whatnot. I’ve seen some concerned nurses, you know, especially nurses, doctors on the front line, train this, and they’re really concerned about, I got to go to work, and then we got to come home to my family. And I don’t really want to do either one of those. What Yeah, but that’s like, that’s their calling this their job, like, are they able to just say, Hey, you know what, I’m done. If I have to quit whatever I gotta do, I just it’s not worth the risk to me. My family’s time to be selfish. How do we wrestle with that?
Unknown Speaker 17:59
So I have a friend of mine who’s so I’m an independent physician. And I was employed until about a year ago. So I left employment a year about a year and a half ago. And I was trained by independent physicians and I was actually got the look of shame by taking a job from a corporate perspective that was really looked down upon. And I came to a talent. There’s a lot of independent talks in one of my friends who’s an older doc who’s very successful as a big business private practice. He said, You know, when he got into training, it was a calling. You went into medicine as a calling, and he said that it became like a profession, you know, and he goes now since the job, and I’ve seen a lot of stuff posted recently about I’m not going to put my family at risk. And, you know, I mean, I’m a neurosurgeon. I’m not Am I running into the DEA to take care of COVID patients? Am I going to work in the ICU? I don’t want to do that if I don’t have to. And I probably wouldn’t do that. Because that’s not what I feel like I’m called to do, but when it just becomes a job You’re pretty much not really committed and you’re going to wrap wrap it up. I’ve seen that in the last five or six years. Yeah, my shifts over, I gotta go in. People get sick all the time. Yeah, so I don’t, you know, as a physician, I can’t turn it off. You know, that’s just the way I was trained. We were trained to respond. I don’t think that’s going to happen. I mean, to me, that’s somewhat the socialization of medicine. And there, this is just a symptom of people saying no, not on Not on my watch. The question is, each individual’s got an answer to that for themselves. Is this a calling? Is this a profession or is this just a job? It’s just a job and yeah, don’t don’t put your family at risk in harm’s way. I feel like if your child doesn’t have significant risk factors, ie asthma or pulmonary problems, really but I think your risk is kind of low. That’s what the statistics bear out if you know, if you’re Obviously you need to be careful about elderly family that you’re around, you know, some people are not going home, they’re staying at a someplace close to their facility. So I’m not here to judge. I’m just saying everyone has to ask that question and answer it for themselves. Right. But that’s the state of medicine, at least in the West, it
Unknown Speaker 20:20
seems that way to me. And in a follow up in a
Unknown Speaker 20:23
sense, neuros, porthos, dermatologist, renal Doc’s, quite frankly, you may not have very much ventilator experience,
Unknown Speaker 20:32
residency, you don’t want to run in your bed, I want to kill you quickly. And then I have no experience. And I feel like am I doing you more harm than good? I don’t think it’s worth you know, if you have a problem that I can I’m trained to hit I spent from the age of basically 25 to 40, taking care of musculoskeletal problems and learning how to operate in the nervous system.
Unknown Speaker 20:56
So I shouldn’t come to you for diabetes help.
Unknown Speaker 20:58
Unknown Speaker 21:00
Bro can figure it out, but probably not gonna, maybe I’ll get lucky. But anybody can read what’s on the internet and what to do. So that’s the other part of it, too. There’s a lot of people Oh, well, now you should get retrained to address this problem. And I’m kind of sitting there thinking, did you pay my loans? And I was getting trade. I mean, so there’s, a lot of people are expecting what other people should do. And you just need to do what’s in your own heart and follow through on that.
Unknown Speaker 21:24
Yep. This is a very non judgmental podcast we’re having right here. Because this is just Brian. We just got to take care of yourself. I think, in in where you’re at, like you said, everything you said, Let me repeat. I just I agree with you. You just have to be smart for your family for yourself. And nobody’s Well, people will judge you. There’s that
Unknown Speaker 21:44
temporary problem. You don’t need to make it permanent. Mm hmm. Right. So we’re gonna get through this. It’s gonna look different on the other end, but I don’t, you know, I’ve had to learn in my life. It’s not my job to fall in other people’s swords. Everybody’s got it. You’re responsible for them. So, in speaking of swords, this is the next
Unknown Speaker 22:03
question. Non doctors listen to this podcast. Sometimes, they probably don’t have a very big bleeding heart for the rich, quote rich doctors who make over 400,000 a year and oh, they’re not able to do surgeries and yada, yada. But assuming these doctors are living within their means, they are probably going to be quite fine for a while. The person that I’m concerned about is the nurses and the support staff who work by the hour. What happens to them?
Unknown Speaker 22:30
Yeah, that’s a real problem. You know, and I know a lot of people who’ve been furloughed already, and so I kind of worry about that, too. I, I feel like that’s where I see the corporatization of medicine as a challenge because the people that work for are not exactly taking the pay cut. Right. The physician, they’re not working for doctors, they’re working for accountants and finance people. And unfortunately, those are kind of just statistics on a page for the for corporations. Those are just a lot, you know, financial losses, not familiar losses, not and I think that’s where the communities are gonna have to absorb that loss. And they’re the real deliverers of care. Right? Those are the people who are really caring for folks. So, yeah, I agree. I think those are the people who do the work, you know, it at least care for patients, the direct care to the patient, and their highest risk, and they have the lowest pay. And, you know, they’re the ones literally in the trenches. And, yeah, there’s going to be casualties, unfortunately. But again, those people are trying to feed their family. Most of us want to, at the end of the day, want to take care of our family go on. Yeah. I mean, if that’s across cultures, boundaries, most of us no matter where we live, that’s all we really want to do. And so in some ways, those people are doing the best they can for their families and that they’re putting themselves I mean, it’s the greatest act of love I could ever imagine you’re putting yourself in harm’s way for someone who cannot thank you or pay you. That’s pretty that’s pretty Mobile stuff,
Unknown Speaker 24:01
right? Let’s transition. Okay, telehealth, chiropractors, physical therapists primary care. I can see us all. Let’s teach you some exercises. Right, Billy? What’s your blood pressure been in the last five days? Right? Okay, we’re gonna keep the medicine the same. I can’t take your blood work right now. But let’s just assume everything is you know, I mean, they can do their job. I think, however you, I don’t know what,
Unknown Speaker 24:24
what can you do? So I’ve actually switched my practice to tell you how it’s completely in the last week. Okay. It’s incredibly useful. I think it’s going to be a major paradigm shift for how I practice medicine. I do need to physically examine patients, no doubt, but I can also screen imaging and look at patients and have them move around to know if they need to see me in the office. So that’s how I’m using it right now. So instead of seeing every patient, the office, the patients who come to the office have a reason to be there, meaning they’re either going to go to surgery or I need to follow up on something with them physically. I have patients that travel you know, as a patient travel three hours to see me the other day for a wound check. Not worth it just shows Tell me your take your camera and put it to your back. Let me see. Yeah, it’s really pretty easy. So I loved it the patients, I asked them all to a person, how do you? What do you think about this? My patients range from 20 to 80 years old. So obviously, the 20 year olds are going to pretty, pretty easy with the technology, the eight year olds really struggle with it. But at this time, they’re happy on reaching out to try to contact them and they know they’re still in under someone’s care, emotionally as it were. And I think that’s just important. But yeah, I’m able to send patients links for exercises, right? Or I have some Doc’s in my town, a chiropractor who’s willing to see patients for adjustments and stuff and work around it. So I think it’s gonna make me more efficient, it’s certainly going to lower my overhead, you know, I don’t need to have a big office anymore. I can have one day off so I can read somewhere and be very fast. I’ll move very quick. And that’s going to give me a major competitive advantage in the marketplace as opposed to if I’m working for cheap Healthcare System to turn on a dime is impossible. I mean, the Titanic couldn’t move. That’s why it hit what it had. But if you’re a little digging, you can move pretty quickly. And so that’s, I think the advantage in the marketplace. If you can leverage technology, you’re going to be in good position. I’ve seen some things on LinkedIn the last week or two, we’re going to teach you how to take advantage of this new technology called telehealth, and I’m sitting there thinking, you should have switched to that a couple weeks ago, if you really needed to. So but most of the people who switched or independent folks private and then quickly adapted to the technology in the market, they anticipated what was happening in the United States. The reason it was never adopted was around billing, and then they unwind those bills completely. So you get paid to do it.
Unknown Speaker 26:47
That’s what I was about to ask you. That’s a lot of people’s mind is cannibal insurance. Is it just cash? Can I get the full rate that I was getting before and maybe not, maybe you get 30% less The from the patient’s point of view, the doctor said it’s gonna be this time I call in we take care of it. I don’t have to wait in his office for three hours because he had an emergency pop up and you just everyday you know, every Monday I just call after call after phone call.
Unknown Speaker 27:13
Yeah, I think that’s an effective way to do it. You can take one day and stack visits into that office on one day right now stateside wise for Medicare, we’re getting the same exact rate of face to face for telehealth visit for right now. I think they’re going to probably look at that and say is that a lower cost of care for them to deliver and maybe give you a percentage of that but even if it’s pennies on the dollar, you can probably roll through some of those visits quicker and leave your time in the office for more productive time frame. And like you said, if you if you’re able to pivot out of a high overhead,
Unknown Speaker 27:47
right situation that is fantastic. I just kind of feel for these patient these doctors who own their clinics, and they’ve got all that overhead.
Unknown Speaker 27:56
There’s gonna be a lot of real estate available for sale.
Unknown Speaker 28:00
Feeling in for me from a medical standpoint might be time to invest in something but it’s another investment market that may or may open or you’ll see more consolidation even in the independent side hey can I was talking to talk today you got timeshare space available? yes great, why don’t even go look at it because I need to change my schedule. So for me it’s great because only half a day as opposed to three half days or four half days. So it I think it might help me personally but I think a lot of people might start looking at their own brand a lot differently.
Unknown Speaker 28:31
But that is very promising. I think to a lot of people who are here this telehealth is available even for a spine surgeon. So like I always say listen to what we just talked about and think about it and then try to implement it to your own clinic What can you offer what can you do so that you don’t go broke? And you’re able to still help patients during this time?
Unknown Speaker 28:50
I mean, I look at this whole situation is the technology is new we use an example are companies like that team, you know, Microsoft Teams Yeah, Doc see me. So I use doc see me? Right. Totally HIPAA. Exactly completely HIPAA compliant changed. I mean, I think that that’s, by the way, I’m not being sponsored by any one of those companies I just named. So please, me neither, but if you want to let me know, no disclosures, but it just it will change the nature the way we communicate, period. I mean, I think we’re, it’s really gonna be a game changer. So would you want to go back to the way it was? Now that you’ve experienced telehealth, I’ve been waiting for disruption for a while. So this is a pretty good opportunity for us to take advantage of and I’ve had more people work with different ideas about how we can push the needle forward and it’s almost like there’s no looking back. No, I think we were we were heading into a really it was in a we were heading into the abyss. And I don’t necessarily know if there was any open mindedness around lowering costs for Karen. Suddenly, everybody’s open minded so
Unknown Speaker 30:00
desperation. You know, as a chiropractor, we’ve really, really slowed down on the in the progression of like the medical doctors who said, oh, let’s all get together, open a group, right split costs, split revenue, split that revenue by like marketing. And a lot of chiropractors don’t do that. So now we’re hearing things where maybe they might start doing that. And as far as I’m concerned, that’s a great thing. Interesting. Yeah, it’s really sad that we haven’t really done that and come together but y’all were doing that for a while and now maybe it’s turning into we all just rent one building and I take money and you take Friday’s and we just kind of do this telehealth and just use it when we need it.
Unknown Speaker 30:32
So there’s been some discussions I’ve heard from people talking about virtual medical models where there’s medical MSL, the medical service organization with the in the state’s corporate practice of corporate medicine across state lines. So in then you get what happens is a bunch of independent people can come together share resources and still have separate tax ID numbers but share the back end or lower your your total costs of overhead and that only makes sense. You know, I think Do you want to definitely share overhead costs if you can always, if there’s a way, like so you’re a chiropractor, I would say you’re a musculoskeletal physician. I do surgery, is there a way we can have synergies together? You know, I’m sure there is, you know, there’s there’s more than enough for everybody to eat. Is there a way that you know, I, as far as I’m concerned, the most entrepreneurial
Unknown Speaker 31:26
physicians I’ve ever met are chiropractors, I mean,
Unknown Speaker 31:29
that’d be a necessity out of necessity completely. I get that. But it’s like, you got to take your hat off to this whole profession that has survived basically on a with a compass and a knife in the middle of nowhere, and just really well, and I just, I have a lot to learn. I mean, look, I think physicians have a lot to learn from everybody and everything. But chiropractors really understand marketing and patient treatment better than anybody in cost. For sure. There’s no doubt in and if you think otherwise, and you’re just not looking at the whole picture.
Unknown Speaker 32:00
There’s a lot of kooky chiropractors, though. And we’ve,
Unknown Speaker 32:03
there’s a lot of kooky doctors to man. So don’t worry about it.
Unknown Speaker 32:06
We’re locking them in, though, like we have actually reported a lot of people for putting out crazy things on Facebook and stuff like that. So when it’s all said and done, who knows what, how this is going to play out, but we’re the evidence based people are hoping that it’ll stop some of these crazy things from getting out there so often,
Unknown Speaker 32:22
all of us need to do that.
Unknown Speaker 32:24
Yeah. Across the board. Fantastic. Did we skip anything that was on your heart that you wanted to talk about? Well,
Unknown Speaker 32:30
I’m open to talking about whatever you want to. I’d love to circle back and talk about one day if you ever want to do something like that. I’d be happy to do that to the whole the whole, but that’s up to you.
Unknown Speaker 32:42
I’ve got a few more minutes if you do. If you have a an angle that you wanted to flesh out a little bit, we can do that.
Unknown Speaker 32:48
Well, I think the main reasons people don’t get better from spine surgeries. There’s no diagnosis. That’s the bottom line. You need to have an anatomic diagnosis to drive treatment,
Unknown Speaker 32:59
more than just the bolts.
Unknown Speaker 33:00
Correct voltage is something that happens when you’re like on a high school date or something like that. That’s not a treatable problem. You know, it’s good to hear both always makes me uncomfortable. I can’t talk about that in front of patients. I get very nervous when they started talking like that. But yeah, it’s, you know, treat the MRI treat the patient. Right. And, and the symptoms have to correlate with anatomic pathways, ie things that we know, like, referred pain maps, trigger points, dermatome maps, some note, something that we know, otherwise, you know, you’re potentially someone’s revenue. It’s not a patient and that’s really not what we want to do.
Unknown Speaker 33:35
You know, Brian, rich, Dr. Brian, right. to Oklahoma. No, he’s doing a lot of RF and those little transmitters usually you’d put them in a spine and it would stop the spine pain, but now you can put them at
Unknown Speaker 33:48
like a cord stimulator.
Unknown Speaker 33:50
Yeah. But now you can do them in like peripheral nerves like the Nhi and all these kind of things. That
Unknown Speaker 33:56
I haven’t heard of that. I understand it actually. I have heard of it. It’s not common practice. But yes, I can understand why peripheral stim would work. I think I want to get down to the causes and conditions like why is the multiply firing? That’s really what it? Is it the multiple that’s causing the back pain? Or is the poster? Is it? Or is it the response ligament? Or is the facade joint like really get down to the causes and conditions?
Unknown Speaker 34:18
How does that change what you do?
Unknown Speaker 34:20
Block different nerves? No. Like it’s more typifies, by firing deserve bellies too big. Do we need to lose a little weight? Do we need to flex? Do we need to work on your posture? Do we need to improve your flexibility? Do we need to prove joint dynamics? Is it a spondylosis thesis that needs to be corrected? Do you have an outline or do you have a number compression, you know, aren’t like that get down to the root causes and conditions. Why did this COVID thing happened that someone’s sneezing? Well, hon, I mean, was there a problem somebody washed your hands? Or was there some other insidious thing that happened? You know, really, not. Right now we’re fixing the symptom, but we’re we’re out at a cause to I’d like to try to get to causes.
Unknown Speaker 35:02
That’s awesome. That’s kind of what we were saying a lot of us were as well we’re, we can go through the motions, we can just turn you on your side and give you a side posture. But what why? What is the point? Right? Better diagnostics? And you are, the more you’d like that you can prescribe the right exercises, right, and the treatment, and then they actually get better. And if they don’t, at least, you know, like, hey, it’s probably not going to be this because this usually works on 90% of the people and it didn’t work for you.
Unknown Speaker 35:28
Unknown Speaker 35:30
All right. Well, that this has been great. on my end, I really appreciate your time and willingness to come on the podcast for your first time ever. And hopefully, we’ll be able to disseminate this and get some good information out there so people can calm their fears
Unknown Speaker 35:45
a little bit more.
Unknown Speaker 35:46
Oh, you have a web page or anything like that, that people can find you. I have a
Unknown Speaker 35:52
HTML for just my practice. I can send it to you.
Unknown Speaker 35:55
I don’t have to top my head basically. Dating girls fine.
Unknown Speaker 36:00
I’m not I’m not that savvy. Nobody, like
Unknown Speaker 36:03
I got a web page. I don’t know. I don’t know
Unknown Speaker 36:05
what I don’t use it.
Unknown Speaker 36:08
Unknown Speaker 36:15
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Unknown Speaker 38:38
We just went hashtag behind the curtains. I hope you will listen. integrate with some of these guests have said by all means please share it across your social media writer view. And if you go to the show notes page, when all the references for today’s guests, you’ve been listening to Dr. Justin Trosclair giving you a doctor’s perspective.
Transcribed by https://otter.ai
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