Episode 11: Virtual/Online Consultations – The future is here!
Dr. Franco: Welcome, team, to “Plastic Surgery Untold.” I’m Dr. Johnny Franco, board-certified plastic surgeon, also known as Austin Plastic Surgeon. You may notice we have a few new faces in the crowd here. We’ve got a little special edition of Plastic Surgery Untold. So, today, we’re actually gonna talk about virtual online consultations. And this came up amid of the COVID-19. So, let me introduce our regular cohort and then we’ll get into our special guests here. And we’ll talk a little bit about why we’re doing this cast and then we’ll actually get into what it is. So, all of you guys know celebrity anesthesia, Travis Osborne.
Travis: What’s up, you guys?
Dr. Franco: And we’ll get caught up on his life in just did a little bit. And the world’s most beautiful man, G-Berto.
G-Berto: What’s good, everyone? How y’all doing?
Dr. Franco: Well, I hope everybody is excited for our two guests. So, I’ll start next to me. This is Lindsey Mayes, who’s actually…
Dr. Franco: …our patient care coordinator. And so, some of you who’ve been in the office, I’m sure, know her. And then, next to her is Sarah Mack, who is our nurse injector. And along with being a nurse injector, she also helps with all of our patient flow in terms of labs, clearances, and so forth. So, the two of them are critical in terms of our practice’s success and then really making life easy for you. And life easy for me, which is probably most important.
Sarah: Most important.
Sarah: That’s what I [crosstalk 00:01:24]
Sarah: Most important. That’s my number one goal.
Dr. Franco: And we have them here because I think most people don’t realize, you guys, isn’t the patient experience is really 90% dependent on them, you know? And so, Lindsey is probably the person people have most contact with in our office in terms of scheduling surgery and doing those types of things. And so, brought her on so she can help with the process because I think virtual online consultations are absolutely fabulous and are gonna be a big picture over the next month for sure.
Travis: Oh, yeah. We’ve got some changes coming just socially, overall, in general, things are changing.
Dr. Franco: Maybe we can, before we dive into everything, maybe we could talk a little bit about changes that we’ve made. I’ll tell you some changes we’ve made in our office because of the COVID-19 and then maybe get you and G-Berto’s information on what things do you guys have done at your specific centers. I know, in our office, one, we’ve talked a little bit about, I think people don’t realize in medical offices how many things we do just on a daily basis that were routine that people didn’t even know about.
I mean, wiping down every counter, every room between patients, the special washing techniques of staff. How many single-use gloves, other things that are changed, obviously, between every patient? You know, things that we’ve implemented in our office to try and make things better for people is, one, anyone who wants to do a virtual online appointment is welcome to do so. And that’s everything from consultations to follow-ups.
And then, the point of this is that we’re limiting the overall flow in the office to help with some of this. Obviously, there are certain people that need to be seen, but those that don’t, we can offer this. Even if you’re someone who lives across the street, this may be something that’s easier for you. I think with the school changes and stuff, that’s gonna be something logistically that’s gonna make a big difference for people.
I’d be interested to hear from Travis at the Surgery Center or Gilbert at dermatology office, which typically has a much higher flow in terms of number of patients. And you’re at a large practice which has multiple providers and a larger amount of people coming in. What changes either of you have made in your offices?
Travis: You wanna start?
G-Berto: Yeah. So…
Dr. Franco: So, beauty before age?
Travis: I think I am older too.
Dr. Franco: He’s just a fine wine. He is just a fine wine.
Travis: Actually, no, I’m gonna start. I’m kidding.
Dr. Franco: No. What kind of changes have you guys made?
G-Berto: So, we are following pretty much all the CDC guidelines. You know, we have hand sanitizer, you know, at check-in, at checkout, in the patient’s waiting room, in the rooms. What else are we doing? We’re also offering patients the ability to, kind of, have more flexibility with their schedules and with their appointments. I know this past Friday the powers that be were, kind of, trying out, testing out different telemedicine platforms, trying to, you know, prepare in case, you know, a provider has to be quarantined, in case staff needs to be quarantined, just kind of getting ready for everything.
Dr. Franco: And to that point, I mean, and I know all of you do a lot of TMA, Texas Medical Association reading on your free time. They actually just issued a statement on Friday that they have expanded, because some of it in the past was state regulation in terms of what was allowed via telemedicine or not. And they have now expanded that where all procedures, treatments, and actually prescribing of any medication can now be approved via telemedicine.
Doesn’t even have to be video conferencing. It can be just via phone calls. I don’t know how long this will last, but during this, right now, state of emergency. And I think that’s really gonna make it easier because it had been regulation stuff that made some stuff hard for us. That was a big move by the state that’s gonna allow a lot of, I think, improved access to care for our patients from our standpoint.
Travis: I think there are a lot of people around town that are disgruntled by some of the changes that, you know, “Oh my gosh, South by Southwest is canceled.” Austin just issued something the other day that said, you know, can’t gather more than 250 people together. And the whole goal of that is just to decrease the amount of people and the possibility of exposure to other people. So, all these steps that people are taking, it’s for the public safety and it’s from a good place.
This is… They’re not being mean. They’re not telling you, you know, “Stay at home. Don’t go anywhere,” because they’re being mean. This is something that’s to decrease the transmission.
Dr. Franco: Can you maybe explain to me, because I think people are a little confused, and I had this conversation with my mom on the drive here of why we have to. And from you and Sarah who have worked in the hospital, I think people are having a hard time understanding why this decrease and why we need to expand the curve and what the actual purpose of this slowing the spread. Because the idea is not that we’re gonna stop the spread, but we’re controlling the rate and why.
Travis: Exactly. I mean, we can probably both talk about this, but there’s an incubation period and there’s also a time where during that time, you’re actually contagious as well. So, the less contact that you have with people that have been possibly exposed to the virus who are either carriers or actively have the virus, the less the transmission rate. I mean, it’s as simple as that.
So, if you decrease the amount of people that are around each other, if you don’t have these events where there’s 20,000 people around each other, you’re decreasing the risk of all of those people being exposed to even a handful of people that may be there who were carrying the virus.
Dr. Franco: And the problem becomes this. And so, you know, most of the people in this room, for this podcast, could get this and would be just fine. The issue becomes what the healthcare system can accommodate. And that’s gonna be the problem is the number of ventilators, the number of ICU beds, because of those people that exceed that. The idea is that we’re spreading this over an amount of time that our healthcare system can handle.
And I think people have to understand this is part of being a good neighbor and understanding, like, look, you know, it’s the vast majority of people that get COVID-19 are gonna be absolutely fine. But if you think about it, 1%, 2%, 3% of our entire population starts to become a very, very large number that our healthcare system cannot manage. And so, the idea is we’re trying to make sure that our healthcare system still has the capability to treat those that do have problems.
Travis: Especially when you’re exposing that pathogen to the elderly folks and any young children that are at highest risk for having, you know, morbidity and mortality from this disease process. So, and like you were saying, the ventilator number in the U.S., that’s a stagnant number at this point. I mean, we can’t just overnight pump in, you know, 50,000 new ventilators into the U.S. So, if we exceed that number, I mean, we don’t really have any other options. So, it’s just about limiting the exposure, limiting the amount of people that are exposed to the pathogen.
Dr. Franco: Lindsey, maybe tell us a little bit in the office, calls that you’ve gotten, things that you’ve heard. I know that we’ve had a little bit of both extremes. People wanting to move their surgeries up, trying to get in ahead of this, we’ve also had people wanting to reschedule. Maybe give us just a little feedback of what you’ve heard from our patients and thoughts.
Lindsey: Yeah. And I think right now their concern is mostly, A, either wanting to get their surgery or procedure done now before they put a pause on anything or, B, pushing it back because they are not sure when it’s going to…basically, what’s gonna happen over the next month.
Dr. Franco: And I think that’s important is…
Lindsey: So, it’s the two mediums, yeah.
Dr. Franco: This isn’t a sprint. And I know I got us out of kind of normal order, but I thought it was important to touch base on some of these topics. I thought it was important to know why we’re doing this special edition of “Plastic Surgery Untold.” But Lindsey, if you’ll let me regress a little bit, I wanna give our two guests a chance to introduce themselves and why they’re a part of this podcast today. And hopefully, depending on how they do, will be a part of our future endeavor. So, maybe we’ll just go from right to left. Lindsey, give us a little background on you and how you ended up as part of our practice and so forth like that.
Lindsey: So, I have been in aesthetics for about 10 years plus, well, 10 plus years. And I wanted a change. So, I love the aspect of being able to…
Dr. Franco: What did you do in aesthetics before being a patient care coordinator?
Lindsey: I was doing facials basically…
Dr. Franco: An aesthetician?
Lindsey: Yeah. Thank you.
Dr. Franco: Okay. Cool.
Lindsey: All of my coffee has not yet processed. So, facials, you name it, I did it. And I just wanted to take that next step on where my career was going. So, [inaudible 00:10:18].
Dr. Franco: And what do you do? So, for people who don’t know what a patient care coordinator is, like, what does that mean to the average person?
Lindsey: Awkward silence. I, basically, hopefully…
Dr. Franco: Just tell us what your day is.
Lindsey: My day is answering patient calls, just providing, kind of, everything that they need to. So, answering about surgical procedures, how their preop process is gonna go, how their recovery is gonna go. If they have questions about X procedure. So, you know, breast aug, you know?
Dr. Franco: Because the patient care coordinator in the practice typically leads people through their practice. So, this is gonna be your concierge that’s gonna lead you through the system. And so, when people are, one, calling to get information and then being led through it. And so, that’s why I think it’s important for people to meet Lindsey, our PCC, because this is the person who’s gonna help guide you through the journey.
And so, they’re gonna give you information coming in so that when you meet with me, you have a worthwhile visit that’s very informative and you already know what questions to ask. And then, afterwards, no question like anything else after the visit, then you really, you know, a thousand questions pop up so you have a point of contact afterwards and then she’s the one that’s gonna work with you in the surgery centers to make sure everything flows.
Because when people schedule, that’s just the beginning. Then get into preop. And then going into everything else afterwards, the postops, the other things that need to be done. And then this leads to Sarah, can you introduce yourself and we’ll talk a little bit about what you do?
Sarah: Yeah. Hi. So, I’m Sarah. I’ve been a nurse for 12 years. I’m newly into aesthetics. It’s something I’ve always wanted to do. I’ve actually spent the last 12 years in the emergency department so I can speak to, you know, the panic and frenzy that comes with things that we’re dealing with at this time and, kind of, the ins and outs of all of that. But currently, now, I’m happy to be at Dr. Franco’s office.
Right now, I have two roles, I would say, in the practice. My first initial role was, kind of, going in and doing assessments with Dr. Franco. I’ve learned, you know, the ins and outs of the sizing of, you know, anything from a breast aug all the way up to postop, you know, questions and things like that. I also play a role in obtaining labs, EKGs, mammograms through your primary care physician before your surgery reviewing the results and, kind of, chatting with Dr. Franco about if we need any interventions or anything like that, so.
Dr. Franco: And I think people forget how many people are involved in your care and how many things need to be done before we actually get to see one celebrity anesthesia, Travis Osborne. But us doing a good job between Lindsey and Sarah decreases the awkward conversation. When I talk about awkward silent conversation, weird.
Travis: Oh my God.
Dr. Franco: Travis Osborne has to come to me and say, “Hey, we gotta cancel your surgery.”
Travis: Cancel. Yep.
Dr. Franco: That’s an awkward conversation between me and him and then an awkward conversation with the patient, especially if we’re doing people from out of town, even people in town. If you’ve taken off two weeks of work, you’ve gotten grandma coming in, you got the in-laws coming in, you’ve already weathered that storm, and now you get your surgery canceled and you can’t just ship the in-laws out.
Travis: Sometimes, you wish you can. Just kidding, if y’all are listening.
Dr. Franco: I think it’s important for people to know how many people are involved in their care and why, you know, they are so important to the day. When you and I come to do stuff, that’s what makes stuff smooth. And you can tell me, but you probably see a difference from office to office, those that are organized and those that are not.
Travis: Big time. I mean, you guys do a great job. We’ve spoken, you know, at length.
Dr. Franco: He’s on payroll, so we gotta say that.
Travis: We’ve spoken at length, you know, over the past couple of years we’ve been working together about what can we change preoperatively, what can we do prescreening wise, we just trickle down to helping make that system much more efficient. And now, you guys are, you know, y’all are stellar as far as catching stuff early.
If a patient has, you know, diabetes, having lab work sent off, if they have a heart history, if they’re on, you know, antihypertensives or different medications, you guys are great. Sarah will send people or recommend people go out and get an EKG and Dr. Franco sends them out to their primary care, gets that stuff knocked out so that I’m not dealing with that for the first time when I see the patient day of surgery. Because that is a very awkward conversation.
Dr. Franco: It’s heartbreak for everybody.
Travis: It is. It is. Because, for me, I don’t wanna lose that case either. Because I’m doing that case. I have already set my day up to accommodate that five- or six-hour procedure. We’re ready to go. We’ve got everything ready there. We’ve got staff there at the surgery center. So, it hurts everyone and that’s not something that we take lightly at all. So, that has, you know, almost dropped our cancellation level to zero.
Lindsey: And I think one of the things too with our patients is me speaking to them ahead of time helps the consultation with you go so much smoother and they can actually focus on their consult and what their goals are versus, kind of, like that background question. Say, like, financing, pricing what happens before, how do I travel? So, that’s my goal is to have all of those questions answered so then you are just focusing on…
Dr. Franco: On the actual procedure.
Dr. Franco: 100%. And I think this is where their pre-phone call when they talk to you really gets through a lot of the stuff because it’s hard in a short amount of time. Everybody gets nervous. And so, I think the more they can answer, then just the few remaining things are great. I also think it’s important for them to understand why they get 5,000 phone calls from the two of you.
Dr. Franco: Because the more we can do, and this is why we’re so strict about trying to get labs, everything done three weeks before. And then, you know, this is a perfect segue to roll into virtual consults because I think that virtual online appointments are absolutely incredible. I think this is the wave of the future. I think that, you know, for all the difficulty and uncertainty of this current situation, I think with intense adversity comes great innovation.
Dr. Franco: And I think that this is gonna force us to become better. I think this is gonna force us to be more accommodating. You know, we’ve talked, and it’s been anyone who’s been watching politics for the last year, you know, four or five years, you know, eight years.
Man: Easy. Easy.
Dr. Franco: Healthcare is a big issue. And how do we have access? I think the idea of telemedicine, virtual consults, these things, is gonna increase this greatly. There’s again, to the limit of what our healthcare system can do, we’re pushing that. And so, I think there’s ways to expand that. You look at a state like Texas, and Lindsey can attribute to this, 70% of our patients come from outside of Austin. Many people wanna come in, they wanna come to a specialist. But it’s a… How many people do you get call and say, “I don’t wanna drive 5 hours for a 30-minute appointment and then 5 hours back,” because it may be a 30-minute appointment for us, but that’s a 12-hour day for them.
Lindsey: There are a lot of calls and, one, they wanna meet you in person and have that one on one connection. But two, some of them feasibly with children day to day activities lives, they just can’t. And so, that’s what I’m here for is to set up that virtual, you know, whether yourself and to, kind of, go over the same questions, and we go over the same thing, virtual or an office. So, that way they’re as prepared as they can be.
Man: What I think is so cool is that you guys already have a virtual console platform built into your system. So, this COVID-19 and the coronavirus, this wasn’t you guys going, “Oh my gosh,” hitting the panic button, “What do we do now?” You’re just saying, “Hey, let’s do this for more patients now and make it completely available to everyone now. That way we’ve got a nice segue into this instead of reinventing the wheel.” You guys have been doing this for a while.
Dr. Franco: You’d be surprised how many people have reached out to me over the last three days on how we do our system. And we’ve really tried to share that with everybody because I think that, one, it’s the wave of the future. Two, I think it’s the wave of right now to make stuff safe.
But let’s do this, if you guys don’t mind, just because I feel like we’ve got a good background, but let’s maybe go to the very beginning and then, kind of, go through how and exactly what a virtual online appointment is. Because I think we’ve been talking about it and I don’t think everybody knows and how they get started. So, maybe if Lindsey and Sarah will help me work through this and we’ll start at the very beginning to work through. And I would love you guys to jump in with questions is…
G-Berto: I’m actually gonna take some notes because this is all new to me. So, I’ll just be kind of over here.
Dr. Franco: Well, because I’m gonna…
Lindsey: Do you want me to schedule a virtual for you? Can I schedule you [inaudible 00:18:21]
Dr. Franco: So, maybe for his [inaudible 00:18:22] which we talked about in episode three, if you guys wanna go back. You know, we could do a virtual. You gotta send some good pictures.
Dr. Franco: Why don’t we do this? Let’s do this right now. I think this would make it easy. Let’s do a little role play for people. I think this would make stuff easy. So, Gilbert is calling. Maybe let Lindsey take it and let’s say G-Berto is from the Valley and…
G-Berto: We could say that.
Dr. Franco: And it’s a little far for him to come. Mom can’t drive him. He’s doesn’t got his own car yet and he really wants these cap implants. How can we make this happen? Can we do this?
Dr. Franco: Can we do a little role play?
Dr. Franco: All right. Ring, ring, ring.
G-Berto: Ring, ring, ring. Hello?
Lindsey: Austin Plastic Surgeon. Dr. Johnny Franco’s office. This is Lindsey.
G-Berto: Hi, Lindsey. My name is Gilbert. It’s nice to talk to you. I actually had some questions about possibly coming in to visit Dr. Franco. I’m interested in maybe getting some calf implants.
Lindsey: Oh, wonderful. How long have you been considering some calf implants for?
G-Berto: About a week.
Lindsey: Okay. That’s okay. Any?
Dr. Franco: You just saw “Entourage.”
Sarah: Dr. Franco gave him a complex.
Lindsey: Any major life changes you’re going through? Midlife crisis maybe?
G-Berto: Are you saying that I’m old? You can’t even see me through the phone.
Sarah: You said [crosstalk 00:19:34.851] why we have a virtual consultation.
G-Berto: I’m a beautiful man.
Lindsey: Exactly. So, where are you calling from?
G-Berto: I’m coming from the Rio Grande Valley.
Lindsey: The… Five, six hours away? Is that…?
G-Berto: About five, six-hour drive, yeah.
Lindsey: Okay. So, you planning on driving out for the afternoon or would you like us to schedule you a virtual consultation?
G-Berto: What’s a virtual consultation?
Lindsey: So, virtual consultation. Dr. Franco does either on WhatsApp, but basically, what he’s gonna do is you’re gonna send him some pictures and he’s gonna have that one on one with you, FaceTime, you know, that way you don’t have to drive six hours away.
G-Berto: Oh, that sounds interesting. I might be interested in doing something like that.
Lindsey: Absolutely. Let me get some information from you. We are gonna need some pictures of your calves, right, for the calf implants?
G-Berto: Okay. You want my calves or the calves that I want?
Lindsey: So, yours and your wish photos of those calves.
Lindsey: Whose are they? Who are you taking?
G-Berto: Arnold Schwarzenegger.
Lindsey: Okay. Perfect. I don’t know. Yeah, we’re gonna have to special order some really big ones. But absolutely. I’ll get some information from you and we can get you scheduled for a virtual. And Dr. Franco will give you a call and I’ll go over some more questions for you.
G-Berto: Fantastic. Let’s get this started.
Lindsey: Let’s do it.
Dr. Franco: So, I think a couple of the cool things here is, one, it just starts with an initial call. And the point that they both made is pictures. So, people can just directly email us pictures. We also have started a new electronic medical record called SIM Plus that actually allows people to upload an app on their own so they can upload their pictures directly on their app, which makes stuff a lot easier. But even if you don’t wanna do that, you can directly email.
I do encourage people the better the pictures, the better the consultation. And then, Lindsey mentioned FaceTime, WhatsApp, Skype, the beauty and where technology has changed, and I was interviewed recently about virtual online asking what type of special technology do you need? This. You got a phone. If you got a phone, you can do it.
Lindsey: No flip phones.
Dr. Franco: I mean, unless you’ve got the flip razr that G-Berto’s dad has.
Lindsey: My mum still has that.
Dr. Franco: Which is a true story.
Lindsey: My mum still has that.
G-Berto: He will not get, like, a regular smartphone.
Dr. Franco: But if you have any type of smartphone, you can do this. And so, that is the absolute beauty of technology today is that all you need is a phone and you can do this. So, emailing pictures. So, then the next step is once G-Berto’s sent some quality pictures of his calves…
G-Berto: When you say quality, that means like I can be in my bedroom, with the lights dim just right, and taking pictures from weird angles. Right?
Dr. Franco: Yeah. I mean, I wouldn’t scroll back through your phone looking for pictures you sent at 2:00 in the morning to an ex. Probably not the best pictures. But the better the pictures, the better idea that your physician’s gonna have.
Dr. Franco: So, you know, good lighting. If you can have someone else take them, put the phone on a timer because a little bit of distance and perspective makes stuff a lot easier. If you’re wanting to send pictures of your calves, probably not wearing pants or joggers is probably not the best idea so we can actually see your calves, that tends to be helpful.
Lindsey: Can you get your mom to take them for you?
Man: Now with your dad’s razr.
G-Berto: Not with my dad’s flip phone but maybe in between her driving me back and forth to school.
Dr. Franco: What? But so, let’s finish through the process. So, we’ll send the pictures. And then, once we get all of that, we schedule a time just like we would any other office visit where it’s dedicated for you and I to talk. And so, Lindsey will help with all of that to get that scheduled so that you have time blocked out, I have time blocked out. You know, please bear with us. We try to be on time just like any other appointments. Sometimes, it’s plus or minus a few minutes. We do our best.
Then with that time, I also encourage people, in your car, with your family, you know, with the radio jamming is probably not, we don’t encourage any virtual telemedicine while you’re driving, you know, is less than ideal. But the more that you can be in a good spot to have a good conversation just like you would any appointment is gonna be super helpful. And then we can discuss about all the pros and cons, all the things that we can do with the surgery.
Once we get done with that, then it gets pointed back to Lindsey, and then she will send a quote, estimate, anything like that so that people have a good idea of the procedure. Once they decide, “Hey, that sounds great. You know, here in a month, I wanna do my calf implants,” then we get the ball rolling and Lindsey will actually get all those appointments set up. Another preop, which sometimes we can do virtually or in office.
And then, we’re able to see people either the day before, if we haven’t, do the surgery, the follow-up, and then a week and a half follow-up, you know, to the extent. And there’s difference. It varies depending on the procedure we get. All those sets of people can be followed up. Once we get those dates set and then we have people like Nurse Sarah jump in and help in terms of labs, other things, because to Travis’s point, the better we can be organized about all of those things.
And nowadays, you can get all your labs done at home in the Valley and then faxed over to us. And so, all this stuff, the world has gotten really small. But that’s why I think sometimes seeing how many calls you get from, you know, Lindsey and Sarah and all the people involved in making sure that’s streamlined.
Lindsey: I promise…
Sarah: Go ahead.
Lindsey: Sorry. Your patient safety is our number one concern and your number one concern. So, if I am calling you or Sarah calling you about your labs or EKG or whatever else, I promise we’re not being annoying to you, or maybe we are, but it’s we care so much about you guys that it is truly our number one concern because it’s an elective procedure and we don’t want you on the table with anything, you know, underlying.
Sarah: Yeah. From a healthcare perspective, being in medicine for 12 years, a lot of people come in for an elective surgery. They get their routine lab work and overall, they believe they’re generally healthy. Some people haven’t been to the doctor in two or three years. And then, that’s when we come up with, “Hey, your blood…”
Dr. Franco: If I’ve never been seen, I don’t have any medical problems.
Sarah: Exactly. Right? How many times have you heard that? And then we find out your blood sugar is 300. We now have to get you to an endocrinologist and it’s three weeks before your surgery, that’s where it kind of puts us in a little bit of a bind.
Sarah: The odds of seeing an endocrinologist or cardiologist within 12 hours of you finding out your lab work is off is pretty not possible. So, I just like to express the fact of the importance of people getting labs done almost first. As soon as you know you’re gonna book that surgery, get that lab work done. That way we have time to either push back your surgery or, kind of, deal with any results that we may find that you may not know about.
Man: One question I have, real quick, is how does, like, patient privacy play in the virtual consult role?
Dr. Franco: I think this is a couple of things. And one of the things, like, SIMPlus, this new plastic surgery app has really made a big difference because it is based on a HIPAA secure platform where patients can upload. It’s password protected. And so, not only is the phone password-protected, so is the app and getting into things, our email is actually run through a HIPAA secure platform. So, that’s why it’s secret.
That’s why we try to limit patients just texting us or doing things randomly to different people’s phones so that we do try to really keep people’s privacy. We also try to have people limit pictures to the specific body area. You know, and even, I think some people don’t realize, even like on our website, just in talking to the HIPAA stuff is we have, like, case numbers on there.
And sometimes people wanna know who is a specific person on these case numbers stuff. Those case numbers are actually made up because they’re not tied to any medical record number. It’s something for the website that they do, but it’s not tied to anything in our office. And purposely done so that if that got hacked or we got hacked, there’s no tie between those numbers.
Man: Oh, it’s interesting.
Dr. Franco: And so, I don’t think, again, people realize how many steps we take internally, you know, to protect some of this stuff. And you know, to their point, I think that Lindsey and Sarah will tend to blow up your phone over and over about these labs and different things. But you know, to both of your points, if, you know, at three weeks you still have time to, you know, change your work schedule, reschedule that date, you know, reschedule grandma to come and help and so forth. If you wait till the day before, especially if you’ve flown in from out of town or something else, this is a huge, you know…
Dr. Franco: …whoopsie for your entire life stuff. So, one, a lot of small stuff we can still get taken care of if we got a little bit of time. If there really is a big issue, we can reschedule this. And we have time and you can still change your work schedule, change other things. So, I know we’re a pain sometimes, but we’re honestly doing it with your best interest in mind.
Travis: Absolutely. I think it also puts us in a weird position if they come into town 24 hours before the procedure and like, “Oh, I haven’t had all my labs yet,” or, “I need to knock one more thing out.” That’s stopped big time. We’ve made huge changes over the past two years to really get that streamlined. But when that happens, it puts us in an awkward position because if we do find something, we can’t proceed.
Like, we need to get everything taken care of. Like Sarah was saying, it’s the patient safety first. And these are elective procedures. We’re not doing any lifesaving butt transplants or you know what I mean?
Dr. Franco: It depends who you ask.
G-Berto: These calves will be lifesaving.
Dr. Franco: And we’ve talked about consultations, but I think both of you can attest to, it’s not just consultations, follow-up appointments, because a lot of those, you schedule as well.
Lindsey: Absolutely. So, we actually just had a recently, you know, out of town patient, San Antonio, not too far away, ask. And I reached out to her, you know, just having had surgery a couple of weeks ago, would you like to have a schedule that a virtual instead of driving into the office? You know, that way, you know, you’re not coming in and having that added contact with other people.
Dr. Franco: And this is something we did even before COVID-19.
Lindsey: Mm-hmm. Absolutely.
Dr. Franco: I think now it’s become even more important. I think it’s gonna continue to be because for patients from out of town, sometimes it’s hard to have somebody drive them, sometimes just especially other follow-ups if things are going really good. You know, and then if we see something online that we need to have you come in, we can always do that. But a lot of times, most of the follow-up and people who’ve had surgery can attest to this, a lot of the follow-ups is just, “Can I do this? Can I do X?” And so there’s a lot that we can do in a more efficient manner.
Sarah: Yeah, I agree. And with the app, I think I’ve had a lot of contact with our patients as far as just, kind of, sending me stuff over you. So, I like everyone to know that I’m available now just because you have so much going on. It’s really great to be able to see postop photos, see little incisions that people have concerns about. They’ll message me on the app, I’ll run it by Franco as long as everything looks good.
That way, I’m constantly contacting them, messaging them. Some people send me stuff at 10:00 at night and I get right back to them. So, I think everybody’s really liked that aspect of it.
Lindsey: Same thing with myself. They’ll send me a picture and I’m like, “Oh, I’m not a nurse. I didn’t go to school for that. Let’s send it over to Sarah,” and you do. You review it and send it to Dr. Franco and, yeah.
Dr. Franco: And this has been one of the great things because going to your guys’ point about, you know, being secure and patient privacy is, you know, it’s put physicians in a weird world because we wanna be available on access. And anyone who’s had surgery with us knows that they have my cell phone, they have access to me.
But the great thing about doing everything through our new app is that, one, if Lindsey has a conversation with somebody and then Sarah needs to follow up or vice versa, everybody, kind of, knows what’s been going on. Because there’s nothing more frustrating than telling the same story 16 times. And also, you know, for us, it helps because we’re not trying to store pictures, even though it’s a HIPAA secure email type stuff in that type of thing.
So, now they’re in their app. And a lot of this thing is just following trends as you both know, over time, you know, in terms of are people progressing. One snapshot is sometimes really, really hard for us. And now, especially, and Lindsey can speak to this better than I can but, you know, a lot of our online virtual appointment stuff, most of those people schedule months and months in advance.
And it’s nice to have everything in one spot so that when we do their virtual preop, you know, six months later, their pictures are still there in this secure spot, which is pretty incredible in terms of technology.
Travis: That is really cool.
Dr. Franco: Can you guys talk to me a little bit, because I think people forget, well, some of this has got a lot of prints, from an anesthesia standpoint, you guys do a lot of pre-screening calls as well. And that’s not new for you all.
Travis: Yeah. So, at the surgery center, I mean every patient is called and we do a thorough history with them over the phone. One of our nurses does it and that is basically a catchall or we try to catch all with that. And we’ve got specific criteria that that nurse knows to look out for. And if it needs to be escalated or punted to the anesthesia team, then we, before the case, will actually give that patient a call ourselves.
I mean, I call patients on my cell phone, “Hey, wanna have a chat? You marked down that you had X, Y, and Z. What does that mean? What kind of meds are you actually on? What are you doing at home?” Just so that we can be prepared day of so we don’t have any last-minute cancellations. Again, this is all being done behind the scenes to prevent last-minute cancellations, to promote patient safety. I mean, there’s a whole team working together to get things done as efficiently as possible the day of.
Dr. Franco: I would love to from beautiful man, G-Berto, and Sarah. Sorry, you’re just Sarah. What role do you guys think this has? Because obviously, from Lindsey’s standpoint, from a surgery standpoint, this is not new and this is incredible. And I hope to just grow this. But I think that there’s a place for this for the noninvasive, for the injectable stuff as well.
And I’d like to hear your guys. Because a lot of people just wanna know, kind of, am I a candidate for lips, for fillers and my, you know, do I need to do surgery? And I feel like that’s a great opportunity space for the two of you guys and see what you two think.
Sarah: Yeah. I mean, I think with injectables, a lot of times, people can make this every three months, six months or even once a year a visit to our office. So, I think allowing the virtuals, like, we do a virtual consultation of the face. Sometimes, I think a lot of clients come to us and want lip filler for the lines around their mouth and then we’re able to, kind of, explain to them during the virtual, although, you know, you would look great with, you know, a little bit more plump lip, that may not address the issue at hand.
And I think that just gives them a really good summary of what to expect when they do actually come for their visit. And then, if they are traveling from out of town or further away, they, kind of, have a really good idea of the products they’ll get, the cost of everything ahead of time and I think they’re prepared to come into the office.
Dr. Franco: Because we had that on Friday.
Dr. Franco: We had someone who wanted to do something. And basically, what they needed or what, you know, I suggested they needed was different than what they had planned. And so, at least this way it wasn’t a big shock when they come and they can still make a decision whether that’s a good spot for them. Beautiful G-Berto?
G-Berto: I think for me, in my practice, it’s gonna be more of, like, a developing trend because we haven’t been in that arena before using telemedicine, virtual consults, things like that. The other place I think it would be…
Dr. Franco: But even for follow-ups though.
G-Berto: That was what I was gonna say, I think for follow-ups, it would be great because you can sometimes save that patient a visit from having to come in. And I usually tell all my patients I’d really like to see you back in a couple of weeks just to make sure everything’s settled in well, you know, if we need to do any touch-ups, we can do it then. But that’s gonna save them, like, you know, another visit time away from their work, their family.
Travis: Another two hours from work, a roundtrip.
G-Berto: Yeah. Yeah, yeah. Absolutely. So, I think that, in my opinion, I think that it has a very powerful impact in that regard.
Dr. Franco: Because even with Botox fillers stuff a lot of times, if it’s new to people, they just have a lot of questions. And I know the two of you guys get postop questions stuff all the time and they just wanna know is this normal? And again, even if you just live in Waco, try to drive into Austin into the morning from Waco. That’s a two-and-a-half-hour trip.
Sarah: Oh, yeah.
Dr. Franco: Easily.
Dr. Franco: And for you to walk in for two minutes and be like, “Oh yeah, that’s normal.”
Man: Looks good.
Sarah: 100%. I think that’s why I’ve been loving the app. I mean, some of our clients I talk to a couple of times a day for the first few weeks after their surgery, but just reassuring them, “Hey, what you’re seeing is normal. This is something we’ve seen hundreds of times. You know, it looks good, don’t worry about it. Feel free to message me at 10:00 tonight if you want.”
Travis: And so, as listeners of this show know, my wife had surgery on her knee about six weeks ago. And that was one of the biggest [inaudible 00:35:39]. My wife’s an occupational therapist. She sees all these patients postop and she really helps with, like, ortho injuries. So, when she’s going through it herself, she’s looking down and, like, “Is this normal for my knee to be like this?” And just having that ability to message back and forth with her surgeon and say, “Hey, is this a normal finding? Is this okay? Like, can I progress to, you know, doing X, Y, and Z?” Those little answers are so comforting to the patient.
Sarah: So comforting.
Travis: Now being on, you know, this side, the caretaker and on my wife being on the patient side, you realize, like, from that standpoint, it is so nice to hear that from a provider or from a nurse in the office saying, like, “Hey, it’s totally expected. You’re all good.” That little bit of reassurance sometimes is a huge mental breakthrough for patients.
Sarah: Yeah. And we always do offer the clients that if you absolutely are just, you know, completely unsettled with the issue and you wanna come in, we’re happy to take a look at you and get you in for an appointment.
Lindsey: We always [inaudible 00:36:35].
Sarah: But I can’t tell you how many clients are just, “Okay, love it. Great. I’ll write you tomorrow if I need to,” you know? Or…
Dr. Franco: But also, I think people understanding that how much work that Lindsey and Sarah do to get people prepared because there is a lot of pressure on us and that’s why sometimes I feel like we’re being a little hard with the patients, but it’s for their own good. And you can attest to this. I mean, it’s heartbreak if they come in and we have to reschedule them. And so…
Lindsey: Oh, absolutely. Especially if a client’s, you know… And sometimes, it’s as simple as, you know, getting an abnormal EKG, having to go for, excuse me…
Sarah: Referral to cardiology?
Lindsey: Thank you. See, this is exactly why this is not my…
Man: Teamwork makes the dream work.
Lindsey: So, but yeah, it is. Especially when you have that patient who’s been wanting this procedure done, you know, for two years, a year, you know, and there’s kind of…
Dr. Franco: 100%. And you’d be surprised how many times, you know, Lindsey will be like, “Oh, this patient flies in at 10:00, they’re seeing us at 2:00.” There’s a lot of logistics that goes into this. And so, you know, part of me, just reiterating that over and over is please bear with us. When we call and follow up with you 1,000 times, it’s really because we’re trying to make this smooth for you, I promise. I promise.
You know, they’re working hard just because they want this to be a good experience. And unfortunately, sometimes, if you have a hard time reaching them, it’s because they’re reaching out to other people. I promise we’re not just, you know, hanging out, playing, you know, with little TikTok or something else.
Sarah: Oh my gosh.
Dr. Franco: What other, before we get back into a little other sides of stuff, any other take-home messages on virtual online appointments, consultation stuff? I mean, the one I would say is virtual online, and I’m trying to stop saying consultation and say appointments, because we can really do this due to all of your points for follow-ups, for injectables, for other things. And we don’t have Katie Jay here, but even people who have skincare issue stuff, this is a great option for them. So, any take-home messages?
Lindsey: Just the calf pictures, the clearer the better for your appointment regardless. So, if you’re doing a follow-up or, you know, coming into our office or virtually for the first time, just making sure those pictures are super clear that way we can give you the best.
Dr. Franco: And we give them guidance.
Lindsey: Oh, we do.
Dr. Franco: So, if it’s a breast, if it’s a butt, we’ll tell you which way. So, if it’s a breast, here’s the specific angles we want. If it’s a butt, we even go down to like what kind of panties and other things to wear.
Lindsey: Exactly. Absolutely.
Man: I just wanna say the word “panties.”
G-Berto: I mean, [inaudible 00:39:01].
Lindsey: Oh my gosh, how long have you been waiting to say that for?
G-Berto: I’ll make sure to make my mom use a ring light when she takes the pictures.
Dr. Franco: What panties should Gilbert wear on his calf pictures?
Sarah: We have some in the office that are nice little paper string…
Sarah: Oh, yeah, there we go. The paper ones.
G-Berto: Are they free?
G-Berto: Can we? Can we?
Lindsey: They’re not reasonable, they’re just disposable.
G-Berto: Oh. God, no.
Dr. Franco: You want beautiful G-Berto to reuse paper panties?
Lindsey: No, no.
G-Berto: Oh my God.
Dr. Franco: They’re recyclable.
Lindsey: They’re disposable. So, you can have multiple pairs.
Dr. Franco: So, quality pictures. What else?
Lindsey: Quality pictures. Just being as open and honest as you can and upfront about any medical history. And even though I’m not a nurse or clearly a surgeon, I can at least give you a little bit of background of what we might need, what we’re looking for, kind of, what hoops you might have to honestly jump through before having your procedure. So, just being, again, upfront and honest with that really, just really helps.
Dr. Franco: Because I think people don’t realize when Lindsey does the first call stuff, if there’s something that’s a red flag, she’ll come to me. So, even before we get a chance to talk virtually, I can say, hey, yeah, that’s someone who I would wanna see the hematologist, the cardiologist, you know, that’s something that her and Sarah would talk to and they can get that ball rolling. Because it’s even better if you talk to me and say, “Hey, I already have an appointment on Tuesday for, you know, to see the hematologist. We’re getting this ball rolling.” You know, there’s things like that that just keep the process going.
Lindsey: Well, especially when they’re traveling from out of state and they’re flying. Again, it’s their safety and if there’s an issue, we want someone that’s close to home for them. So, then that way they have that point of contact and so, at least…
Dr. Franco: Don’t hide stuff. Because the anesthesia guys are sneaky.
Lindsey: Oh, they’ll find it.
Dr. Franco: They will get it out.
Travis: I will find out.
Dr. Franco: And I feel like it’s the like anesthesia gas confession session.
G-Berto: Oh, for sure.
Dr. Franco: Because they get into the room, they’re looking up at these lights, and we’ve at least two or three times [inaudible 00:40:57], “Wait, wait, wait. I have a confession.”
Lindsey: So, what kind of confessions? Or what we’ll just put that, halter that, stop that we don’t even know until the day of.
Travis: Honestly, we use…
Dr. Franco: They smoked a cigarette when they were 13 or something like…
Travis: We do such a good job pre-screening patients at the surgery center and then you guys do such a good job that we’re not really running into that problem of day of hard stops. Basically, one of the only day of hard stops for us is if you eat on your way to the surgery center. If you don’t follow the NPO or no-eating guidelines prior to the procedure. That’s the only one where I’m like, “Ah-ah. We can’t do this case,” because that’s not safe for the patient. Other than that, I mean, if they have something that’s huge in their medical history and we have just dropped the ball on everything pre-screening, maybe, but that has happened.
Dr. Franco: Extraordinarily rare.
Travis: Oh, yes.
Sarah: Yeah. And I think something to talk about too is that patients are, kind of, sort of fearful that you’re gonna tell them they cannot do the surgery at all if they admit something to you, when in fact it’s usually just us sending them for clearance through a specialist, a little five-minute conversation with you. And then I think that’s…
Lindsey: But we help them, like, every step of the way. So, as long as they’re, I mean, just upfront about everything and just being open and we’re with you every step of the way. So, we will guide you and, you know, through the beginning for booking the consultation to the end. We’ll tell you when you need to start massaging, and if we didn’t give it to you, then you probably don’t need it.
Dr. Franco: And if we truly don’t do your surgery, it’s probably a good thing.
Dr. Franco: That’s because producer Donald has been tapping his watch for the last like 10 minutes. So, this is just a super incredible topic right now for the times. It’s also something I’m obviously very passionate about because I truly think this is a way to expand healthcare to all. And while I get that we’re a boutique in terms of plastic surgery, I think there’s some stuff that we can help be, you know, international leaders in terms of telemedicine, online consultations for the entire medical field. And that’s why I’m open to share our processes with anybody. But can we do a little fact or fiction for you all? And so, maybe we’ll do a little something. And so, fact or fiction, I never get upset in the office. This goes for both of you. Whoever wants to answer.
Lindsey: Rightfully so when you do. [inaudible 00:43:23]
Travis: Be honest, ladies. be honest.
G-Berto: Y’all were just talking about honesty.
Lindsey: If you are ever… I’m like…
Sarah: I’ll answer this. I feel like rightfully so. I mean, working in medicine for 12 years, I feel like when Dr. Franco is upset, rarely, about something, it’s because it has to do with, you know, a concern for, you know, making sure that the patient is safe, we’re making sure that things are followed up on. It’s a concern like that. It’s not just a…yeah [inaudible 00:43:53].
Dr. Franco: Fact or fiction, this is the greatest job either of you have had in the world.
Lindsey: Fact. I’m not just saying that either.
Dr. Franco: Let’s do…
Sarah: No, I’m happy to be here.
Dr. Franco: Because there’s two of you, I wanna skip ahead to another one. Probably my favorite section of this is something called “Behind the Bovie.” And we’ve touched a little bit, but I’d like for each of you to give the listeners a little something that they wouldn’t know. One, from a nurse injector, a nurse standpoint, one from a PCC, something that they don’t know that you guys do behind the scenes that would be a cool little nugget for them.
Sarah: From the nurse injector and just kind of your assistant in the office as far as dealing with clients pre-and-postop, I just think the depth of how much we look into everything. I mean, it’s a constant check, double-check, triple-check, you know, Dr. Franco reviews your labs. I review your labs just in case one of us may not see something for whatever reason that the original lab work, you know, you have highs and lows of all your labs.
If it didn’t flag on there, there’s a concern. I think we’re just really, really thorough, and constantly doing so many things than people realize. I think they show up to the office, they say, “Hey, I had a great conversation with Lindsey. She answered all of my questions,” but there was probably 30 steps that went into all of that before you walked through the doors.
Dr. Franco: That’s the one that popped into my head is I don’t think people realize, even though I’m only in the office two days a week, all the real work gets done on the days I’m not there.
Sarah: Correct. Yeah.
Dr. Franco: And people don’t realize that when you guys are seeing patients with me, you’re not getting a lot of, I’m doing quotation marks here, “work done” in terms of helping people prepare but, you know, that you guys, and we have some fabulous MAs in the office that help as well. You know, how often you guys meet and, you know, Lindsey does a lot of the initial consultation, but how much of this stuff, you know, we do as a team in terms of meeting together, people follow up, calling, following up on the other office. I don’t think they realize how much work goes into preparing people…
Lindsey: Just one client.
Dr. Franco: …for those things so that when I walk in on Tuesday and Friday morning, there’s, you know, 16 charts on my desk to sign up that are all laid out for scheduling, doing this. And working even with the surgery centers as Travis knows. I mean, him and I probably talk at least four or five times a week in terms of schedule stuff behind. And a lot of that, you know, gets punted to Lindsey and to your team at your surgery center to make sure stuff’s smooth.
Travis: Lindsey… Yeah, she’s in constant communication with our scheduling, our scheduling office, and our director to make sure that patients are getting in, we can schedule appropriately. And that’s a lot behind the scenes that people don’t see. They see the, “Hey, why can’t…?
Dr. Franco: When you’re saying it out loud, I’m like, “Oh.”
Travis: Why can’t I schedule Wednesday at 7:00? Like, I don’t understand.” Well, there’s a lot of people involved. Does the surgery center have enough staff? Is their time? Is the OR open? Is it, you know, do we…? Not just nurses…
Lindsey: Do we have the lab? Yeah.
Dr. Franco: Do we have labs? Do we have an anesthesia? Do we have all those things? So, I think that’s super important. Can we jump to a quote of the day? Does anyone have a quote? I feel like G-Berto has the little, like…
Travis: Yeah. He’s got the sneaky eyes today.
G-Berto: I feel like I can contribute.
Dr. Franco: Well, please. Why, please.
G-Berto: I have one I think is appropriate, given the topic, at least for me.
Dr. Franco: Indulge us.
G-Berto: So, Ralph Waldo Emerson said, “Do not go where the path may lead. Go instead where there is no path and leave a trail.” For me, that applies because this is all new territory for me with telemedicine and, you know, virtual consults and virtual follow-ups and things like that. So, this is like me going where there is no path. You know?
Dr. Franco: So, would you say that we are a path?
G-Berto: Y’all are trailblazers is what I’m saying.
Dr. Franco: That’s what I’m talking about.
G-Berto: Yeah. You got machete out, man. You’re just cutting…
Sarah: I was waiting for… Oh, there it goes.
Travis: …cutting the trail.
Dr. Franco: I mean, growing up as a small child out in the rural community on the ranch, you know, working from sunrise to sundown I feel like I’m more prepared.
Man: I don’t know how much I believe that, but okay.
Man: I got a picture of…
Man: I can barely handle that.
Dr. Franco: We’ll find that for you. I think that’s a great one. You know, I think that that really sets to the times now. I think you can either be someone who says, “Woe is me, the sky has fallen.” Or you can say, “Hey, you know, I’m gonna be a leader. I’m gonna create a new path. I’m gonna set forth and help lead the way through this.” And I hope that we’re trying to help and like I said earlier, as to anyone who’s listening, if there’s any physicians, other things, we’ve actually talked about this topic yesterday on RealSelf University to help guide some of the other physicians on how to do this. So, there’s gonna be some different platforms, but anyone can reach out to us. I’m sure that Lindsey and Sarah would be happy to talk to any other practice or office team members if they would like some assistance because we truly wanna help everybody.
Sarah: Mm-hmm. Sure. I think another one of the last good point to kind of bring up to summarize everything though also would be a big concern, I’ve noticed there’s patients who are asking, you know, is the surgery center safe with the COVID-19? And I think that’s a really great point because you’re not in a hospital setting. And I think that you could maybe speak a few things on that just to reconfirm.
Travis: Yeah. So, similar to you guys in the office, people, you know, they don’t really recognize or understand that we’re always taking the right personal protective equipment and gloves and sanitation of the room and wiping everything down postoperatively and even the waiting room and everything. We’re already doing that. That’s not something that just started because of COVID-19.
The other thing, we have taken steps to limit the number of people in the ORs. We’ve taken steps to limit the number of extra staff that offices can bring to the surgery center. We’ve limited how many family members patients can bring back to one in the preop area at this point. And these again, are not to be mean, we’re just trying to decrease the amount of people…to decrease the potential for transmission.
Lindsey: But you’re not a hospital either. So, you are a surgery center. You have to be healthy, right, to have an elective procedure so you don’t have all of the fever patients and, you know, cough, cold, flu, whatever it is.
Travis: That’s exactly right. We don’t have any inpatient medicine patients or anything like that. We’re just a surgery center, not just a surgery center, but we are a surgery center. We’re not attached to a hospital so we don’t have those other high-risk patients.
Dr. Franco: And that’s, to Lindsey’s good point there, and it’s not just now, but we also don’t have the patients who are having wound debris meds and other bacteria and those type of things. I think, to her other point about that, is that it’s also not the high flow of, you know, when I was in Taiwan, there was 110 OR beds in the hospital.
Dr. Franco: Correct me, but you guys have three at the surgery center?
Travis: We have three operating rooms.
Dr. Franco: Very boutique, very, you know, so there’s a limited amount of ORs, people, at any one time. And this is just, again, safety and so forth.
Lindsey: I think a lot of people don’t know that either because they think of surgery center… Okay, well…
Travis: “Oh my gosh, I’m gonna go to a big tertiary hospital.” That is not the case. You know, we…
Sarah: That’s really good.
Travis: We are just three ORs and a preop area and a PACU area and that’s the entire facility, and a waiting room. So, yeah, that…
Dr. Franco: I think that was an incredible point. So, I appreciate it, guys. I appreciate all of you. I think this was an incredible topic. I think the timing was good and we wanna do our part to share that. So, I appreciate everybody coming in for a special edition.
Lindsey: Hopefully, you’ll invite me back.
Dr. Franco: Well, we’ve gotta take a team vote after this. So, we’ll see if you guys…
Sarah: Is Lindsey voted off [inaudible 00:51:22].
Dr. Franco: See Lindsey and Sarah back, [crosstalk 00:51:23].
Lindsey: No more awkward silence, I promise.
G-Berto: So, I’ll be expecting an email about my virtual consult or?
Lindsey: Where are your pictures?
Dr. Franco: That’s what I’m talking about. You gotta lay down the law.
Lindsey: Make those pictures.
Dr. Franco: Well, I wanna thank everybody for coming in. I wanna thank producer, Donald, for tapping his watch 12 times during this episode. Thanks for staying, for watching “Plastic Surgery Untold,” the number one podcast as voted by me. Thank you. See you guys. Bye.