Episode 56: Managing Your Practice and Reputation During the Pandemic

The effects of the coronavirus became real for Dr. Jim Cahill, an orthopedic surgeon practicing in Hackensack, New Jersey. While managing his practice’s patient load as restrictions were being lifted, he contracted COVID-19 himself. In this episode, you’ll learn where reputation marketing fits in for practices, how it helps patients make better choices, and how to keep abreast of potential COVID surges that can affect your practice.

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Full Transcript

Announcer: It’s time to think differently about healthcare. But how do we keep up? The days of yesterday’s medicine are long gone and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans. And many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together, and here are some amazing stories along the way. Ready for a breath of fresh air? It’s time for your paradigm shift.

Michael: Welcome to “The Paradigm Shift of Healthcare” and thank you for listening. I’m Michael Roberts here today with my co-host Scott Zeitzer and Jared Johnson. On today’s episode, we’re speaking with Dr. Jim Cahill, a board-certified orthopedic surgeon practicing in Hackensack, New Jersey. Dr. Cahill, thank you so much for making time to come on the show with us today.

Dr. Cahill: Well, it’s definitely my privilege and honor to be here and I’m, you know, happy to participate.

Scott: Yeah. You know, I’ve known Dr. Cahill. We were just talking a little bit before we started the podcast, how long we’ve known each other and I’ve known Dr. Cahill for…well, as long as my daughter’s been alive, so it’s close to 30 years. So, we certainly know each other well. And I want to kind of get started with like the state of orthopedic surgery. State of the state, so to speak. For you personally, in your practice, how much of a recovery are you going through at this point?

Dr. Cahill: Well, I think…just a brief background. We have a very busy, you know, successful practice and we really are focused on patient care. So there’s a lot of doctor input with our patients, we don’t let our physicians’ assistants kind of run the show and we breeze in and breeze out. And so, that’s how we practice. It’s a very patient-centric experience. And, you know, we get people better with conservative as well as operative treatment. And, you know, we try to avoid surgery, but when that surgery is necessary, we, you know, definitely do it very well with all the current techniques and technology.

So we have, you know, a very busy thriving practice kind of humming along. And then, the coronavirus happened and I think, as everyone knows, maybe I’m stating the obvious here, you know, we had to really shut almost everything down except for, you know, the most urgent of emergencies. And even, you know, having people come to your office was very challenging and problematic. And, you know, so we really had a pretty significant pause in the way we normally work and provide patient care.

And we were very flexible with it. We did some telemedicine and things like that and, you know, all the personal-protection equipment for our patients that, you know, needed our services that still came to the office. We never closed actually but, you know, as we began to reopen, I think that’s, you know, how I’m gonna begin to answer your question directly. I do apologize for a little bit of background but I do think it’s helpful.

You know, so, I think, currently, we really have rebounded quite a bit. You know, we find people that have conditions that impact their lives in a significant way where they’re either in too much pain, or they can’t function properly, or they’re not just not living their lives the way they mean to. I think most people are being pretty brave about this. They are coming to the office with protective equipment, you know, they’re wearing masks and we have socially distanced our office too, you know, with the waiting room. And, you know, we were very smart about scheduling appointments. And that that’s made us even sharpen our pencil a little more in terms of, you know, trying to be efficient but still trying to deliver that high-quality care. So you can imagine, those two goals can sometimes be in opposition.

But I think we’re doing it successfully. I think we’re recovering. It’s hard to put a number on it, but I would say it’s well north of 85% to 90% even in my practice. I think some people were a little hesitant to schedule surgical procedures, but I think that’s opened up as well right now. The hospitals I work with have really done a wonderful job in terms of having a separate and safe-care pathway for people coming in to get the services we provide. Sports injuries, ligament reconstructions, torn cartilage, new hips, new knees, and people who break bones. The hospitals and the surgical centers have really separated those patient groups. And the numbers of anybody with coronaviruses now, you know, really, in my major hospital, is really single digits. And they’re in their own little private Idaho basically, separate environmental, separate everything.

And so, I think with the testing protocols we have for staff and patients alike, things have really, you know, come on now. And I think, you know, I’ve not had one person that’s gotten an operation or been in the hospital or one of our surgical centers convert to a positive coronavirus test. So, you know, I think, given the way this virus can transmit, that’s a pretty sobering and impressive statistic in my opinion.

Scott: Yeah, I couldn’t agree more. That’s fantastic news to hear, especially…for folks who don’t know, Dr. Cahill is in the Northern New Jersey area, they were one of the first places to really get hit with a ton of cases, you know, across the Tri-State Area. And I’m just so happy to hear that, you know, it’s still crazy out there but things are settling down, that protocols are in place. You know, and I’m also happy to hear your, hey, man, you may not be at 100% but you’re working towards it. And I agree with you about the patients being brave about it. I’ve spoken to a lot of surgeons where, you know, they actually feel more comfortable in some ways in the hospital because everybody’s gowned up, got the masks on, and, you know, they’re used to being careful, especially surgeons in an operating room. It’s the folks out there who basically are saying like, “What’s going on in there?” So, when they call you, are they asking a lot of questions about COVID and how you care for them, or are they just, right now, you know, booking an appointment?

Dr. Cahill: Well, they’re booking appointments. I think my staff is very proactive to tell them how we do things. And that, if for any reason we are, you know, a little bit, you know, congested with our appointment schedule, we ask people very politely to wait in their car. I’m very blessed to have a pretty sizable parking lot in my office.

Scott: That’s good.

Dr. Cahill: That helps. And, yeah, it’s our own practices’ building and we have a nice set of parking spots. So, I would say being proactive has been helpful for us. We tell the patients in advance, you know, that they need to wear a mask. We have scheduled them appropriately. If someone is more elderly and more at risk, we try to give them a very early morning appointment to come in and be, you know, in and out of the office. We also tell them about our own, you know, protocols in our office, as far as cleanliness and, you know, wiping, cleaning, and all that good stuff.

And so, I think that’s all been very effective and successful. I think the feedback we’ve gotten from the patients has been positive. So, you know, we haven’t anybody in there, you know, trying to light a fire saying that we’re not socially distancing or kind of doing things the way that we’ve always done in doctor’s offices, people sitting arm to arm in chairs or couches or what have you. So I think that it’s been helpful for us to kind of put them at ease and tell them what we’re doing. And so, I think that’s, you know, been a good thing for the patients and they seem pleased.

Michael: Dr. Cahill, you mentioned sort of this proactive approach that you’re taking specifically with your patients in particular, but through all of this, what have you felt has been like some of the most important aspects of managing your practice through all this pandemic?

Dr. Cahill: Well, I would say the biggest thing was that we needed to very quickly learn, as, you know, a specialty for orthopedic surgery but also as doctors in general, how to continue to do we do, to give people the care they require. And not just my specialty, my specialty is very important, we help people that can’t walk and can’t function, or break bones, or have damage that we go to correct, but there are people that have heart conditions and cancer. And, you know, even though we were trying to protect people with a lockdown, if you will, or, you know, isolation, long-term that was gonna do some damage. And, you know, was gonna do functional damage as well as, you know, life-threatening damage.

So we had to find a way to really walk that tightrope and learn how to drive on a new highway basically. And I think we learned that very quickly. And I think, you know, the political inertia there was a little bit significant, depending on where you live. And there are different reasons for that that we don’t need to go into here. But they do exist, unfortunately. And, you know, I think as a…you know, the good thing about I think American medicine or, you know, people that are delivering healthcare in the United States is we learn very quickly, we’re very adaptable. I think the vast majority of us care about the well-being of our patients and find a way to continue to help them, even if that puts us at somewhat risk.

And to be very blunt, and we can talk about this, I did get coronavirus four months ago. So, I’m happy to talk about that if you guys find a time that’s appropriate. You know, I can definitely tell you my experience with that. But, you know, again that was me delivering care and still being as safe as we could be. But, you know, to get back to the original concept was I think we did learn very quickly how to deliver safe medical care for our patients.

Michael: Yeah. Let’s take the time to dive into that, Dr. Cahill. You know, as the doctor, what happens when you end up with this?

Dr. Cahill: Sure. Well, happy to tell you my experience. I got it very early on and I either got it from, you know, possibly a family member because I have kids in school or possibly from work. And I got it very early in the course, really right as March transitioned into April. And I probably picked it up right before they said, you know, you really should wear masks, you know, 24/7. Because originally, there’s been some controversy, “Do masks help? Do they make a difference?” You know, originally it was just, “Stay 6-feet away, wash your hands, don’t touch your face.” And, you know, I was doing all that. 

And then, right when I masked, probably a few days later, I started having a few little symptoms just like a little dry cough, you know, nothing crazy. You know, I didn’t lose my sense of smell or anything, had no shortness of breath. So I think I picked it up during that kind of week, towards the end of March I guess, before we all decided, “Hey, masking is probably the thing to do here.” So, again, probably I had about six or seven days of symptoms. I was tired, I felt a little cloudy-headed and had that dry cough. My fever never went above 101. And I did go on the hydroxychloroquine and the Z-pak. I did do that, I had no side effects from it. And I did take it early in the course and I wasn’t even sure if I had it initially honestly. And then, you know, I was able to get a test and figured out I did.

And, you know, I took the medicine and I had a very brief course of it and, you know, came through it pretty strong. So, you know, I’m 57, I’m in good shape. I’m not overweight and I don’t have any comorbidities like diabetes or hypertension. So, people with all those other factors and if you’re overweight and have those comorbidities, if you’re 40 and plus, you know, you got some problems and you may get real sick. And, you know, fortunately, I didn’t. One of the weeks that I quarantined for two weeks was my vacation. So that was…

Scott: Lucky you.

Dr. Cahill: Yeah, exactly. Well, my vacation was canceled anyway because of this. And then, I stayed out of work two weeks and, you know, got an antibody test shortly after and, you know, registered very high on the antibody scale. So, you know, in a way, that empowered me I guess. I felt very strong after that. But, you know, I realized it’s a very variable, you know, condition and some people do well and some don’t. I still think the statistics show the vast majority of healthy people do great.

So, you know, most of my patients are quite brave I would say. You know, like when I make an oblique reference, you know, “We’re here to keep you safe,” they’re like, “Hey, doc, I’m tough. You know, I’m here, I’m gonna protect myself as best I can and I’m gonna kinda push my way through this.” And even some of the more elderly people, you know, these are people, you know, that went through the Korean war and the Vietnam war. And, you know, I still see some World War II people, greatest generation, but they’re here with Saint Peter now, unfortunately, and not with us as much. But these elderly people, they’re very tough and they’re brave. And I’ve been very impressed by them, put it that way.

Michael: Well, thank you for sharing that. That’s really interesting to hear. Yeah, like both, “Here’s how we’re handling this but here’s how I even experienced this,” and how you’re back into the swing of things. Transitioning a little bit, you know, you’ve talked some about the sort of patient input that you’re getting through all of this. You know, and there’s a process that we work with you on and we work through a partner to help provide reputation marketing, actually gathering reviews more proactively. How have you seen that impact your practice and how is that part of managing your practice today?

Dr. Cahill: Sure. Well, do you mean in a normal setting or how the reputation marketing has helped during the pandemic? I just, you know, I almost think of it in a bi-modal manner personally. But all encompassing. 

Scott: Yeah, I think you’re right. It might be a good idea like pre-pandemic, as I mentioned earlier, I’ve known you for such a long time. I thought one of the things, as the person who helps market your practice, that we gotta get the word out just about how much time and effort you do take to take great care of your patients. Having known you for a very long time, you are not the guy that zips in and zips out, you will listen, you will talk, you will spend a significant amount of time with all of your patients and you never leave them until they’re comfortable and happy and know what to expect. And I remember having a conversation with you like, “Hey, you know, reputation marketing would be helpful for you because of those things.” So, maybe talk a little bit about it pre-COVID and then post-COVID.

Dr. Cahill: Sure. No, I’m absolutely happy to do it. And, you know, look, we have different ways of doing things in the office. There are certainly times when we do a quick follow-up if someone who’s doing well and we don’t, you know, sit there and talk about the weather. But I will say that, you know, the hardest thing for me I guess was I was, you know, in practice for a good amount of time I think perfecting my patient interaction and also enhancing my surgical experience and sharpening my skills. And that’s a wonderful thing.

But, you know, if people don’t know about it and, you know, certainly word of mouth is a very important part of what I do, it still is to this day even in this information, you know, superhighway now or, you know, almost like a warp-speed-type “Star Trek” situation with how easily we get information on our phones and our computers and everything. So word of mouth was always something I did great with but there were always a subset of patients that would see me for one thing, and then a few months later, a year later or two years later, they would see someone else for something different. And then I would see them a couple of years later for something and they would say, “Oh, I didn’t know you did that,” because you’d see in their history they had a procedure or they had something or they… 

And I’d say, “Oh, you know, what happened?” “Well, yeah, doc, I didn’t know you did that.”

So patients are under the impression, I think, that many of us in the orthopedic field do one thing. And there are guys that do that in the, you know, tertiary, you know, care centers. And, you know, some people do orient their practices to do, you know, a very limited thing. But we have a pretty broad-scoped practice doing, you know, the full gamut of sports medicine and joint replacement, you know, as well as traumatic injuries.

So, you know, I think what reputation marketing did for me was it kind of validated that, you know, our experience was a good one with patients and having patients give that feedback to other patients where it’s, you know, kind of metric and documented. And, you know, it’s for real. I mean, there are plenty of doctors that, you know, come out and say, “Hey, I’m an expert in this field,” and the experts in their field look at the guy and they’re like, “Well, maybe in your mind.”

But, you know… So, I think it’s been a very validating thing, both for patients and for our practice, to really, you know, confirm that we’re doing a good job for people. And, you know, people always…look, there’s a very variable experience in medicine. Some clinicians are…you know, they just don’t have that desire and really that like, I guess is a term I would use, of meeting people. They just wanna do what they need to do and move on. And, you know, look, personalities vary, I guess is a charitable way to put it.

So, I guess with us…pardon me…with us, you know, getting that type of information out with reputation marketing, it sort of validates, you know, the competency of your practice, the patient friendliness of your staff as well. Because how many times have people called the doctor’s office and they spoke to nurse Ratchet on the phone and it was, you know, really a very unpleasant experience. That happens to me to this day. And I even tell a practice, “I’m a doctor,” not that I expect to be treated like a king but, you know, maybe, you know, kind of amp down the salt and spice a little bit sometimes. And that doesn’t always happen.

So, this has been a wonderful thing. And, you know, so, pre-pandemic, I got information out about what I do, how I do it, what our office is like, and, you know, documenting the patients that we’ve done surgery on and just visit our office. And really got it out there, that we’re doing a good job, and doing a good thing, and the patients, you know, can tell we like what we do and we’re there to help them. So, I think we were doing very well with that. And there’s always ways we can, you know, sharpen our pencil again, as I said before, you know, to make it even better. And, you know, things are always changing. So, you know, the people that helped me with this, fortunately, are doing a great job. And we’re always trying to make it just a little bit better. So…

Scott: Yeah, that’s great. You know, I always tell other surgeons that I work with I know that there’s always a special line, like a back line to call to or a cell phone. But I always tell the docs that I start to work with, especially who are investing reputation marketing, like, “Just call the main line, see what it’s like.” You know, because you don’t realize for your own practice. So, any surgeon, you know, out there with a private practice, it’s a very different experience. And it’s always, like when you’ve got the time, eye-opening to just dial the main number and, you know, see how they get through the phone and what they do. And those practices that are well-trained and kind of in sync, you can really tell very quickly and efficiently. But then, post-COVID, right, so we get into a post-COVID thing, do you see patients filling anything out where they’re saying like, “Hey, I was nervous about, you know, the possibility of getting COVID or I really like the way they spread everybody out in the…”?

Dr. Cahill: Yeah, we have gotten very good reviews in that regard. And I probably should spend a little more time personally reading them. And I do at times but one of my staff members is designated to kind of follow some of the stuff. And, you know, she’s had some family health issues of late too so we kinda have not circled back on it in terms of the actual data. But the feedback we’re getting, on a personal level, is that we’re doing a great job.

So I think the post, you know, pandemic…actually, we’re not post-pandemic yet, but post occurrence of the pandemic is I think what we stressed with our reputation marketing and our communication on all the platforms was that, “Hey, we understand. We know what you’re going through, we know what you want. You wanna be safe and we’re gonna tell you how we do that.” So I think that’s been helpful and I think that’s put a lot of patience at ease very quickly. And particularly, when they come in, they kinda realize, you know, it’s like the [inaudible 00:18:48], like Master Shades, in other words, that it wasn’t just words on a screen, that we’re actually doing it. So I think that was helpful.

Jared: Dr. Cahill, I think that’s a great part of reputation marketing to realize is there’s so much of a consumer’s decision that they are helping them shape and form. And part of it is helping them understand all the things you do and seeing those reviews, that is important. I mean all of those help a consumer make a healthcare choice. And that’s kind of where I’m wondering about another component of this. At the end of the day, we’re helping patients make better healthcare choices. So, how does the reputation of your practice feed into that? How do you help a patient make a better healthcare choice by the way you’re doing reputation marketing?

Dr. Cahill: Well, I think what we’ve been doing is to try to put patients at ease because patients are very anxious when they have an injury or they know one of their joints is heading south and they need to have the procedure. And there’s a lot of information, for good and for bad, and even some misinformation. So we try to really, I guess, get that early on when someone’s looking to kind of, you know, put them at ease, to disarm them, and to appropriately educate them in an efficient way where they don’t get lost in the sauce of terminology or marketing…or I guess slickness is a word I would use.

We try to be informative and give people really what they need to hear early on so they can say, “Hey, these guys are speaking my language. I think I could, you know, sit and talk to this guy.” Because, you know, a lot of the patient criticisms I’ve seen over the years, you know, and I do watch my own self for at times is that, “The doctor wasn’t listening to me,” or, “I just saw the PA or the nurse, the doctor whizzed and he was in and out and he was gone. And, you know, he used some terminology and I didn’t really understand what he said. And god, he talked about surgery awful fast,” and, you know…so, all that stuff that I try to put…you know, because reputation marketing is such a broad term. I mean you think it would…and reputation was, “Was this a good guy or a bad guy? Is he acclaimed in his field or not? You know, is he this? Is he that?”

I think it’s just such a bigger picture than just that one term really, you know, describes. And it’s almost like voting in a way for politician. Like, would you sit and talk to the person or not? And that’s, again, a topic we don’t need to go down the road on. You know, for good and for bad. I think that helps. So I hope my thoughts there were, you know, cogent enough to answer the question.

Scott: Yeah, you know, as you were mentioning, you know, as you’re in practice for a while, you start to get better at understanding what to say, what not to say, when to say it, how to explain it better. But, you know, one thing I knew about you the first day I met you was that, you know, you were a very nice guy. And it really came across to a lot of your patients that you really cared about them. And we are getting to the point where we need to close up time but you sincerely are one of those guys who’ve always cared, you know, about the patient.

Dr. Cahill: That’s kind of you to say. Thank you.

Scott: Yeah, it wasn’t about the surgery, it was always about like, “How am I gonna better take care of this person and what do we need to do? And then we’ll figure it out,” you know, that kind of…

Dr. Cahill: Sure. Yeah, and I think, you know, the other thing we’ve done too is to maintain our technical proficiency. You know, you’re in practice 20 years, you know, things do change and you wanna make sure your patients know you change with it and that you’re technically current. And I think all the things you just mentioned like about my interest in my patients’ well-being, I think that’s great and I love it. And you really can’t fake that, to be honest. But, you know, patients do look for that technological savviness as well. And, you know, you always hear some people say, “Well, I don’t care what his personality is as long as he’s good at what he does.” And, you know, they say that until it happens and then they…

Scott: I agree.

Dr. Cahill: …don’t like it. So, you know… But it is kind of, you know, something that cuts both ways. So…

Scott: You’re absolutely right. Well, look, we could keep talking for a long time. As a matter of fact, we’re gonna have to close up now, wrap up the show, so to speak. Excuse me. And, Dr. Cahill, thanks so much for your time. Really appreciate you stepping away for a little bit and spending some time with us.

Dr. Cahill: Very good. It’s been my privilege. I look forward to speaking to you guys again. And, you know, it’s funny how the time goes by so quickly, you just don’t realize it. So I hope I’m of value to people that are listening. And, you know, I welcome anyone who wants to come and see us.

Scott: Sounds good. Everybody have a great day.

Announcer: Thanks again for tuning in to “The Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neural practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.