United States federal law concerning health information
A Hard Look returns for Season 3 with its inaugural episode! Season 3 host Steven Valentino and guest Kirk Nahra, Partner at WilmerHale and an adjunct professor at American University Washington College of Law and Case Western Reserve University, walk through the Health Insurance Portability and Accountability Act, or more commonly known as HIPAA. In this episode, Professor Nahra helps listeners understand the inception and development of HIPAA, as well as the Department of Health and Human Services's regulatory approach and framework under the law. After tracing HIPAA's history and regulatory structure, Professor Nahra then discusses the HHS notice of proposed rulemaking on access and coordinated care and how that may alter HIPAA's current applications. We conclude with a larger discussion of the ongoing privacy debate and how HIPAA or a different national privacy law can be shaped to address the growth in collected health information. If you have any questions about this episode, the guest, or the podcast, or if you would like to propose a topic or a guest, please email Steven Valentino at ALR-Sr-Tech-Editor@wcl.american.edu.
Welcome solo and group practice owners! We are Liath Dalton and Roy Huggins, your co-hosts of Person Centered Tech. In our latest episode, we're talking about fear-mongering around HIPAA compliance. We discuss the HIPAA police and why people think they're real, the consequences of noncompliance, the Office of Civil Rights (OCR), approaching security from a fear-based perspective vs a practical perspective, what to do when there's a breach of information, how disclosures frequently happen, notifying the OCR and clients, managing client trust, taking remedial action, not letting stress escalate, that notification doesn't equal punishment, reducing the likelihood of a breach, real risk scenarios for group practice, not acting out of fear, and our upcoming Distress Less series. Listen here: https://personcenteredtech.com/group/podcast/ Stay tuned for future episodes! For more, visit our website. Resources *Free* Distress Less Series (Therapy for Therapists) Article: What is HIPAA Breach Notification? PCT's Risk Analysis and Risk Mitigation Planning HIPAA Security Module (done *for* you) PCT's Group Practice HIPAA Security Programs (that also help you leverage your practice tech tools to optimize functionality, efficiency, and cost-effectiveness!) Group Practice Office Hours (direct support and consultation service from PCT team and Eric Strom, JD PhD LMHC)
Dental podcast: Welcome to DentalTalk. I'm Dr. Phil Klein. Today we'll be discussing the latest guidelines from OSHA and the CDC for infection control compliance and how it effects your practice. Our guest is Dr. Karson Carpenter, a practicing dentist who serves as President of Compliance Training Partners. He is an OSHA approved trainer who has for over 25 years designed educational programs to bring dental and medical facilities into compliance with governmental regulations including OSHA, HIPAA and infection control.
Ideas 31-40 actionable items to improve your practice today:Clean the outside windows to your office. It's a direct reflection of cleanliness. Hire someone; your time is more valuable in the lane.Employ a shredding service for PHI documents. They come monthly for a reasonable fee.Utilize an app like Dext to take pics of business receipts for purchases to store for tax purposes, audits, good bookkeeping, etc. It reads the text and categorizes purchases.Utilize a service like Compliancy Group for HIPAA compliance. I know, feels like a waste of money for this shit, but HIPAA has nothing to do with actual education IMO, it's all about documentation and having record keeping of training so when a breach occurs, you said you did your best to protect data.Your ripped and torn exam room chairs can be reupholstered rather than replacing cushions and armrests.Keep a log of all outbound tracking numbers associated with patient names to labs for shipping. It's just a matter of time before you wish you had the info for a lost job.Hire a Spanish speaker when you can. They come in clutch!!!Want to surprise a staff member with a reward? Amazon prime them something they would use like a bath bomb or dog bone for their furry beast.Update your Google My Business photos. It's the first impression when people search "optometry/optical practice near me"Invite your friends to this group, please and thank you. Join Facebook GroupLearn about PracticePal insurance softwareBookkeeping episode
Your patient's confidentiality is one of the most important aspects of their therapy experience… so how do you ensure that all of your technology and softwares are HIPAA compliant without breaking the bank? That's where Person Centered Tech comes in!We're chatting with Roy and Liath, the co-founders of Person Centered Tech, about their company and how they use technology and security as a lens to evaluate and update your operations for simplicity, usability, and cost effectiveness in your practice.Roy Huggins, LPC NCC was an independent web developer for many years before making the transition to a therapy private practice. He quickly found that the mental health profession needed expert guidance on technology topics. Roy founded Person-Centered Tech (PCT) in 2010 after helping answer a colleague's questions about legal and ethical use of email. His research to answer that first question exposed him to the industry's difficulties applying the HIPAA-mandated risk assessment perspective to issues of technology. Liath Dalton is PCT's deputy director and a co-owner. As the group practice service plan manager, Liath is especially passionate about helping group practice leaders be resourced and supported in navigating the security compliance process and identifying the solutions and processes that meet the particular needs of their practices. Liath's consultation area of expertise is focused on selecting the right combination of services and tech that not only meet the legal-ethical needs of mental health practices, but also the functionality, efficiency and cost-effectiveness needs as well.Episode Highlights:The Intersection Between HIPAA Compliance & Financial SecurityThere is a usually a concern for an expense or cost for HIPAA violations/complaintsHaving your practice set up on a robust security foundation from the start is optimal to make a greater impact on saving money in the long runThere are a number of factors within your group practice that require HIPAA compliance, and some softwares for each function are more affordable than othersTeam meetings, virtual sessions, online communication, etc.It is essential to have the right tools to make sure you maintain your client's confidentiality, but that shouldn't have to break the bankHow do you determine the most cost-effective and efficient services for your specific group practice?Most therapists rely on their colleagues and other professionals in their community for suggestions on what services to useWhile the services you're being recommended may be great – they may not be the best fit for YOUR business – that's where Person Centered Tech comes in!Links & Resources:Person Centered Tech Group Practice Tech Podcast Radical Acceptance by Tara BrachBurnout by Emily Nagoski, PhD GreenOak Accounting Therapy For Your Money Podcast
Welcome solo and group practice owners! We are Liath Dalton and Roy Huggins, your co-hosts of Person Centered Tech. In our latest episode, we're talking about ways to manage the onboarding and offboarding processes in group practice. We discuss why therapists + practice leaders in particular are burned out right now, why so many folks are going out on their own, how HIPAA is involved in onboarding and offboarding, the HIPAA Security Rule, access to PHI, background checks, due diligence, identifying roles within your practice, ways to optimize onboarding for efficiency and user friendliness, checklists, revoking access to PHI, documentation, access to records, dealing with contentious offboarding, and our upcoming free seminar on onboarding and offboarding with compliance and ease in mind. Listen here: https://personcenteredtech.com/group/podcast/ Stay tuned for future episodes! For more, visit our website. Resources Onboarding and Offboarding with Compliance and Ease in Mind -- Live Seminar on growth management and onboarding/offboarding clinicians for group practice leadership *Free* Distress Less Series (Therapy for Therapists) PCT's Free Service Selection for Mental Health Group Practices Workbook Group Practice Office Hours (direct support and consultation service from PCT team and Eric Strom, JD PhD LMHC)
In a world where people are more dependent on technology but lack the expertise to manage their own networks and systems effectively and efficiently, they turn to Managed Service Providers (MSPs). CISA has released a guide, Risk Considerations For Managed Service Provider Customers, that outlines risk considerations organizations need to consider when they partner with a MSP. We will cover this in today's episode and we are making a big announcement that you'll want to hear. More info at HelpMeWithHIPAA.com/324
Money drama is the last thing people should have to sort through following the death of a loved one. Unfortunately, many of us have heard the stories about families locked in conflict as they try to pool funds to pay for the funeral or memorial service or bickering over who is entitled to family heirlooms or property. Too many of us have firsthand experience with the family fallouts that unfold when a loved one dies. Estate planning can help avoid so much of this. Estate planning includes the process of documenting your wishes for how you want your assets and personal property distributed upon your death or incapacitation. During the new SheConfidential podcast episode, attorney Wayne Hood explains:Components of an estate plan including wills, trusts, power of attorney, advance directives, business succession, HIPAA authorization, and beneficiary designations. Why estate planning is something everyone should do, regardless of income level or value of assets.How estate planning can be used to protect and create generational wealth.How estate planning alleviates some of the stress associated with the loss of a loved one. Different considerations for those with children, those with family members who have special needs, and single individuals. The benefits of working with an attorney and other professionals to design an estate plan instead of using an online template. Why it's important to start estate planning sooner rather than later. CONTENT NOTENoneGUESTWayne HoodFounder and AttorneyInfinite Estate Planningwww.infiniteestateplanning.comFacebook: https://www.facebook.com/InfiniteplanningInstagram: https://www.instagram.com/infiniteplanning LinkedIn: @infiniteplanningYouTube @infiniteplanningFOR MORE INFORMATION Listen and subscribe to SheConfidential on your favorite podcast app. Visit https://sheconfidential.com/ for complete episode details including guest information and discussion highlights Follow on Instagram and Facebook @she.confidentialNOTEThe information provided on SheConfidential pertaining to your health or wellness, relationships, business/career choices, finances, or any other aspect of your life is not intended to be a substitute for individual consultations, professional advice, diagnosis or treatment rendered by your own provider.ACKNOWLEDGEMENTSEpisode artwork and video production by Eye AM Media https://www.eyeammedia.com/. Follow on Instagram @eyeammedia
Josh Stella (@joshstella, Founder/CEO of @FugueHQ) talks about the differences between cloud security and data center security, the value businesses place on security implementations, and enabling governance in the cloud.SHOW: 553CLOUD NEWS OF THE WEEK - http://bit.ly/cloudcast-cnotwCHECK OUT OUR NEW PODCAST - "CLOUDCAST BASICS"SHOW SPONSORS:CloudZero - Cloud Cost Intelligence for Engineering TeamsCBT Nuggets: Expert IT Training for individuals and teamsSign up for a CBT Nuggets Free Learner account AWS Data Backup for Dummies (Veeam)Choose Your Own Cloud Adventure with Veeam and AWSSHOW NOTES:PagerDuty (homepage)State of Digital Operations report (PagerDuty)Fugue (homepage)Sonatype (homepage)State of Cloud Security 2021The Cloudcast Eps.333 - DevSecOps and Governance (with Josh Stella) The Cloudcast Eps.543 - What does Security even mean anymoreTopic 1 - Welcome back to the show. It's been a complicated world for security the last 12-18 months. Tell us a little bit about your background and the State of Cloud Security 2021 report.Topic 2 - Between the SolarWinds hack, Microsoft database hack and daily breaches of 100M users, where are we with security these days? It seems as messy as ever, and yet it also seems like people aren't that concerned anymore. Topic 3 - Misconfiguration still seems to be a major issue. Isn't Automation and Infra-as-Code and GitOps catching on? Policy-as-Code.Topic 4 - We now have DevSecOps, which combines all these functions together. Who is ultimately responsible for Security?Topic 5 - When companies move to the public cloud, they still have regulatory requirements. The cloud providers have “certifications” (e.g. SOC 2, NIST 800-53, GDPR, and HIPAA, so are they responsible now?Topic 6 - How do we start matching the level of motivation the bad guys (hackers) have with the level of concern companies should have?FEEDBACK?Email: show at the cloudcast dot netTwitter: @thecloudcastnet
The podcast is back with a new name and a new, expanded focus! Harry will soon be publishing his new book The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer. Like his previous book MoneyBall Medicine, it's all about AI and the other big technologies that are transforming healthcare. But this time Harry takes the consumer's point of view, sharing tips, techniques, and insights we can all use to become smarter, more proactive participants in our own health. The show's first guest under this expanded mission is Dave deBronkart, better known as "E-Patient Dave" for his relentless efforts to persuade medical providers to cede control over health data and make patients into more equal partners in their own care. Dave explains how he got his nickname, why it's so important for patients to be more engaged in the healthcare system, and what kinds of technology changes at hospitals and physician practices can facilitate that engagement. Today we're bringing you the first half of Harry and Dave's wide-ranging conversation, and we'll be back on October 12 with Part 2.Dave deBronkart is the author of the highly rated Let Patients Help: A Patient Engagement Handbook and one of the world's leading advocates for patient engagement. After beating stage IV kidney cancer in 2007, he became a blogger, health policy advisor, and international keynote speaker, and today is the best-known spokesman for the patient engagement movement. He is the co-founder and chair emeritus of the Society for Participatory Medicine, and has been quoted in Time, U.S. News, USA Today, Wired, MIT Technology Review, and the HealthLeaders cover story “Patient of the Future.” His writings have been published in the British Medical Journal, the Patient Experience Journal, iHealthBeat, and the conference journal of the American Society for Clinical Oncology. Dave's 2011 TEDx talk went viral, and is one the most viewed TED Talks of all time with nearly 700,000 views.Please rate and review The Harry Glorikian Show on Apple Podcasts! Here's how to do that from an iPhone, iPad, or iPod touch:1. Open the Podcasts app on your iPhone, iPad, or Mac. 2. Navigate to The Harry Glorikian Show podcast. You can find it by searching for it or selecting it from your library. Just note that you'll have to go to the series page which shows all the episodes, not just the page for a single episode.3. Scroll down to find the subhead titled "Ratings & Reviews."4. Under one of the highlighted reviews, select "Write a Review."5. Next, select a star rating at the top — you have the option of choosing between one and five stars. 6. Using the text box at the top, write a title for your review. Then, in the lower text box, write your review. Your review can be up to 300 words long.7. Once you've finished, select "Send" or "Save" in the top-right corner. 8. If you've never left a podcast review before, enter a nickname. Your nickname will be displayed next to any reviews you leave from here on out. 9. After selecting a nickname, tap OK. Your review may not be immediately visible.That's it! Thanks so much.Full TranscriptHarry Glorikian: Hello. I'm Harry Glorikian. Welcome to The Harry Glorikian Show.You heard me right! The podcast has a new name. And as you're about to learn, we have an exciting new focus. But we're coming to you in the same feed as our old show, MoneyBall Medicine. So if you were already subscribed to the show in your favorite podcast app, you don't have to do anything! Just keep listening as we publish new episodes. If you're not a regular listener, please take a second to hit the Subscribe or Follow button right now. And thank you.Okay. So. Why are we rebranding the show?Well, I've got some exciting news to share. Soon we'll be publishing my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer. It's all about how AI and big data are changing almost everything we know about our healthcare.Now, that might sound a bit like my last book, MoneyBall Medicine. But I wrote that book mainly to inform all the industry insiders who deliver healthcare. Like people who work at pharmaceutical companies, hospitals, health plans, insurance companies, and health-tech startups.With this new book, The Future You, I'm turning the lens around and I'm explaining the impact of the AI revolution on people who consume healthcare. Which, of course, means everyone. That impact is going to be significant, and it's going to change everything from the way you interact with your doctors, to the kind of medicines you take, to the ways you stay fit and healthy.We want you to be prepared for this new world. So we're expanding the focus of the podcast, too. To go along with the new name, we're bringing you interviews with a new lineup of fascinating people who are changing the way patients experience healthcare. And there's nobody better to start out with than today's guest, Dave deBronkart.Dave is best known by the moniker he earned back in the late 2000s: E-Patient Dave. We'll talk about what the E stands for. But all you need to know going in is that ever since 2007, when he survived his own fight with kidney cancer, Dave has been a relentless, tireless advocate for the idea that the U.S. medical system needs to open up so that patients can play a more central role in their own healthcare. He's pushed for changes that would give patients more access to their medical records. And he hasn't been afraid to call out the institutions that are doing a poor job at that. In fact, some folks inside the business of healthcare might even call Dave an irritant or a gadfly. But you know what? Sometimes the world needs people who aren't afraid to shake things up.And what's amazing is that in the years since Dave threw himself into this debate, the world of healthcare policy has started to catch up with him. The Affordable Care Act created big incentives for hospitals and physician practices to switch over to digital recordkeeping. In 2016 the Twenty-First Century Cures Act prohibited providers from blocking access to patients' electronic health information. And now there's a new interface standard called FHIR that promises to do for medical records what HTML and HTTP did for the World Wide Web, and make all our health data more shareable, from our hospital records to our genomics data to the fitness info on our smartphones.But there's a lot of work left to do. And Dave and I had such a deep and detailed conversation about his past work and how patients experience healthcare today that we're going to break up the interview into two parts. Today we'll play the first half of our interview. And in two weeks we'll be back with Part 2. Here we go.Harry Glorikian: Dave, welcome to the show.Dave deBronkart: Thank you so much. This is a fascinating subject, I love your angle on the whole subject of medicine.Harry Glorikian: Thank you. Thank you. So, Dave, I mean, you have been known widely as what's termed as E-patient Dave. And that's like a nickname you've been using in public discussions for, God, at least a decade, as far as I can remember. But a lot of our listeners haven't heard about that jargon word E-patient or know what E stands for. To me, it means somebody who is assertive or provocative when it comes to managing their own health, you know, with added element of being, say, tech savvy or knowing how to use the Internet, you know, mobile, wearable devices and other digital tools to monitor and organize and direct their own care—-all of which happens to describe the type of reader I had in mind when I wrote this new book that I have coming out called The Future You. So how would you describe what E- patient [means]?Dave deBronkart: You know, it's funny because when you see an E-patient or talk with them, they don't stick out as a particularly odd, nerdy, unusual sort of person. But the the term, we can get into its origins back in the 90s someday if you want to, the term has to do with somebody who is involved. What today is in medicine is called patient engagement. And it's funny because to a lot of people in health care, patient engagement means getting the patient to do what they tell us to. Right. Well, tvhere's somebody who's actually an activated, thinking patient, like, I'm engaged in the sense that I want to tell you what's important to me. Right. And I don't just want to do what I'm told. I want to educate myself. That's another version of the E. In general, it means empowered, engaged, equipped, enabled. And these days, as you point out, naturally, anybody who's empowered, engaged and enabled is going to be doing digital things, you know, which weren't possible 20 years ago when the term patient was invented.Harry Glorikian: Yeah, and it's interesting because I was thinking like the E could stand for so many things like, you know, electronic, empowered, engaged, equipped, enabled, right. All of the above. Right. And, you know, I mean, at some point, you know, I do want to talk about access, right, to all levels. But just out of curiosity, right, you've been doing this for a long time, and I'm sure that people have reached out to you. How many E-patients do you think are out there, or as a proportion of all patients at this point?Dave deBronkart: You know, that depends a lot on demographics and stage of life. The, not surprisingly, digital natives are more likely to be actively involved in things just because they're so digital. And these days, by federal policy, we have the ability to look at parts of our medical information online if we want to. As opposed to older people in general are more likely to say just what the doctors do, what they want to. It's funny, because my parents, my dad died a few years ago. My mother's 92. We're very different on this. My dad was "Let them do their work." And my mother is just all over knowing what's going on. And it's a good thing because twice in the last five years, important mistakes were found in her medical record, you know. So what we're at here, this is in addition to the scientific and technological and data oriented changes that the Internet has brought along. We're also in the early stages of what is clearly going to be a massive sociological revolution. And it has strong parallels. I first had this idea years ago in a blog post, but I was a hippie in the 60s and 70s, and I lived through the women's movement as it swept through Boston. And so I've seen lots of parallels. You go back 100 years. I think the you know, we recently hit the 100th anniversary of the 19th Amendment, giving women the right to vote. There were skeptics when the idea was proposed and those skeptics opinions and the things they said and wrote have splendid parallels with many physicians' beliefs about patients.Dave deBronkart: As one example I blogged some years ago, I can send you a link about a wonderful flyer published in 1912 by the National Association Opposed to Women's Suffrage. And it included such spectacular logic as for, I mean, their bullets, their talking points, why we should not give women the vote, the first was "Most women aren't asking for it." Which is precisely parallel to "Most patients aren't acting like Dave, right? So why should we accommodate, why should we adjust? Why should we provide for that? The second thing, and this is another part, is really a nastier part of the social revolution. The second talking point was "Most women eligible to vote are married and all they could do is duplicate or cancel their husband's vote." It's like, what are you thinking? The underlying is we've already got somebody who's voting. Why do we need to bring in somebody else who could only muddy the picture? And clearly all they could do is duplicate or cancel their husband's vote. Just says that the women or the patients, all right, all I could do is get in the way and not improve anything. I bring this up because it's a real mental error for people to say I don't know a lot of E-patients. So it must not be worth thinking about. Harry Glorikian: Yeah, I mean, so, just as a preview so of what we're going to talk about, what's your high-level argument for how we could make it easier for traditional patients to become E-patients?Dave deBronkart: Well, several dimensions on that. The most important thing, though, the most important thing is data and the apps. Harry Glorikian: Yes.Dave deBronkart: When people don't have access to their information, it's much harder for them to ask an intelligent question. It's like, hey, I just noticed this. Why didn't we do something? What's this about? Right. And now the flip side of it and of course, there's something I'm sure we'll be talking about is the so-called final rule that was just published in April of this year or just took effect of this year, that says over the course of the next year, all of our data in medical records systems has to be made available to us through APIs, which means there will be all these apps. And to anybody middle aged who thinks I don't really care that much, all you have to do is think about when it comes down to taking care of your kids or your parents when you want to know what's going on with them. Harry Glorikian: Would you think there would be more E-patients if the health care system gave them easier access to their data? What are some of the big roadblocks right now?Dave deBronkart: Well, one big roadblock is that even though this final federal rule has come out now, the American Medical Group Management Association is pushing back, saying, "Wait, wait, wait, this is a bad idea. We don't need patients getting in the way of what doctors are already doing." There will be foot dragging. There's no question about that. Part of that is craven commercial interests. There are and there have been numerous cases of hospital administrators explicitly saying -- there's one recording from the Connected Health conference a few years ago, Harlan Krumholtz, a cardiologist at Yale, quoted a hospital president who told him, "Why wouldn't I want to make it a little harder for people to take their business elsewhere?"Harry Glorikian: Well, if I remember correctly, I think it was the CEO of Epic who said, “Why would anybody want their data?”Dave deBronkart: Yes. Well, first of all, why I would want my data is none of her damn business. Well, and but that's what Joe Biden -- this was a conversation with Joe Biden. Now, Joe has a, what, the specific thing was, why would you want to see your data? It's 10,000 pages of which you would understand maybe 100. And what he said was, "None of your damn business. And I'll find people that help me understand the parts I want."Harry Glorikian: Yeah. And so but it's so interesting, right? Because I believe right now we're in a we're in a state of a push me, pull you. Right? So if you look at, when you said apps, I think Apple, Microsoft, Google, all these guys would love this data to be accessible because they can then apps can be available to make it more understandable or accessible to a patient population. I mean, I have sleep apps. I have, you know, I just got a CGM, which is under my shirt here, so that I can see how different foods affect me from, you know, and glucose, insulin level. And, you know, I'm wearing my Apple Watch, which tracks me. I mean, this is all interpretable because there are apps that are trying to at least explain what's happening to me physiologically or at least look at my data. And the other day I was talking to, I interviewed the CEO of a company called Seqster, which allows you to download your entire record. And it was interesting because there were some of the panels that I looked at that some of the numbers looked off for a long period of time, so I'm like, I need to talk to my doctor about those particular ones that are off. But they're still somewhat of a, you know, I'm in the business, you've almost learned the business. There's still an educational level that and in our arcane jargon that gets used that sort of, you know, everybody can't very easily cross that dimension.Dave deBronkart: Ah, so what? So what? Ok, this is, that's a beautiful observation because you're right, it's not easy for people to absorb. Not everybody, not off the bat. Look, and I don't claim that I'm a doctor. You know, I still go to doctors. I go to physical therapists and so on and so on. And that is no reason to keep us apart from the data. Some doctors and Judy Faulkner of Epic will say, you know, you'll scare yourself, you're better off not knowing. Well, ladies and gentlemen, welcome to the classic specimen called paternalism. "No, honey, you won't understand." Right now paternal -- this is important because this is a major change enabled by technology and data, right -- the paternal caring is incredibly important when the cared-for party cannot comprehend. And so the art of optimizing and this is where MoneyBall thinking comes in. The art of optimizing is to understand people's evolving capacity and support them in developing that capacity so that the net sum of all the people working on my health care has more competence because I do. Harry Glorikian: Right. And that's where I believe like. You know, hopefully my book The Future You will help people see that they're, and I can see technology apps evolving that are making it easier graphically, making it more digestible so someone can manage themselves more appropriately and optimally. But you mentioned your cancer. And I want to go and at least for the listeners, you know, go a little bit through your biography, your personal history, sort of helping set the stage of why we're having this conversation. So you started your professional work in, I think it was typesetting and then later software development, which is a far cry from E-patient Dave, right? But what what qualities or experiences, do you think, predisposed you to be an E-patient? Is it fair to say that you were already pretty tech savvy or but would you consider yourself unusually so?Dave deBronkart: Well, you know, the unusually so, I mean, I'm not sure there's a valid reason for that question to be relevant. There are in any field, there are pioneers, you know, the first people who do something. I mean, think about the movie Lorenzo's Oil, people back in the 1980s who greatly extended their child's life by being so super engaged and hunting and hunting through libraries and phone calls. That was before there was the Internet. I was online. So here are some examples of how I, and I mentioned that my daughter was gestating in 1983. I took a snapshot of her ultrasound and had it framed and sitting on my office desk at work, and people would say, what's that? Nobody knew that that was going to be a thing now and now commonplace thing. In 1999, I met my second wife online on Match.com. And when I first started mentioning this in speeches, people were like, "Whoa, you found your wife on the Internet?" Well, so here's the thing, 20 years later, it's like no big deal. But that's right. If you want to think about the future, you better be thinking about or at least you have every right to be thinking about what are the emerging possibilities. Harry Glorikian: So, tell us the story about your, you know, renal cancer diagnosis in 2007. I mean, you got better, thank God. And you know, what experience it taught you about the power of patients to become involved in their decision making about the course of treatment?Dave deBronkart: So I want to mention that I'm right in the middle of reading on audio, a book that I'd never heard of by a doctor who nearly died. It's titled In Shock. And I'm going to recommend it for the way she tells the story of being a patient, observing the near fatal process. And as a newly trained doctor. In my case, I went in for a routine physical. I had a shoulder X-ray and the doctor called me the next morning and said, "Your shoulder is going to be fine, but the X-ray showed that there's something in your lung that shouldn't be there." And to make a long story short, what we soon found out was that it was kidney cancer that had already spread. I had five tumors, kidney cancer tumors in both lungs. We soon learned that I had one growing in my skull, a bone metastasis. I had one in my right femur and my thigh bone, which broke in May. I now have a steel rod in my in my thigh. I was really sick. And the best available data, there wasn't much good data, but the best available data said that my median survival. Half the people like me would be dead in 24 weeks. 24 weeks!Harry Glorikian: Yeah.Dave deBronkart: And now a really pivotal moment was that as soon as the biopsy confirmed the disease, that it was kidney cancer, my physician, the famous doctor, Danny Sands, my PCP, because he knew me so well -- and this is why I hate any company that thinks doctors are interchangeable, OK? They they should all fry in hell. They're doing it wrong. They should have their license to do business removed -- because he knew me he said, "Dave, you're an online kind of guy. You might like to join this patient community." Now, think how important this is. This was January 2007, not 2021. Right. Today, many doctors still say stay off the Internet. Dr. Sands showed me where to find the good stuff.Harry Glorikian: Right. Yeah, that's important.Dave deBronkart: Well, right, exactly. So now and this turned out to be part of my surviving. Within two hours of posting my first message in that online community, I heard back. "Thanks for the, welcome to the club that nobody wants to join." Now, that might sound foolish, but I'd never known anybody who had kidney cancer. And here I am thinking I'm likely to die. But now I'm talking to people who got diagnosed 10 years ago and they're not dead. Right? Opening a mental space of hope is a huge factor in a person having the push to move forward. And they said there's no cure for this disease. That was not good news. But the but there's this one thing called high dose Interleukin 2. That usually doesn't work. So this was the patient community telling me usually doesn't work. But if you respond at all, about half the time, the response is complete and permanent. And you've got to find a hospital that does it because it's really difficult. And most hospitals won't even tell you it exists because it's difficult and the odds are bad. And here are four doctors in your area who do it, and here are their phone numbers. Now, ladies and gentlemen, I assert that from the point of view of the consumer, the person who has the need, this is valuable information. Harry, this is such a profound case for patient autonomy. We are all aware that physicians today are very overworked, they're under financial pressure from the evil insurance companies and their employers who get their money from the insurance companies. For a patient to be able to define their own priorities and bring additional information to the table should never be prohibited. At the same time, we have to realize that, you know, the doctors are under time pressure anyway. To make a long story short, they said this this treatment usually doesn't work. They also said when it does work, about four percent of the time, the side effects kill people.Harry Glorikian: So here's a question. Here's a question, though, Dave. So, you know, being in this world for my entire career, it's my first question is, you see something posted in a club, a space. How do you validate that this is real, right, that it's bona fide, that it's not just...I mean, as we've seen because of this whole vaccine, there's stuff online that makes my head want to explode because I know that it's not real just by looking at it. How do you as as a patient validate whether this is real, when it's not coming from a, you know, certified professional?Dave deBronkart: It's a perfect question for the whole concept of The Future You. The future you has more autonomy and more freedom to do things, has more information. You could say that's the good news. The bad news is you've got all this information now and there's no certain source of authority. So here you are, you're just like emancipation of a teenager into the adult life. You have to learn how to figure out who you trust. Yeah, the the good news is you've got some autonomy and some ability to act, some agency, as people say. The bad news is you get to live with the consequences as well. But don't just think "That's it, I'm going to go back and let the doctors make all the decisions, because they're perfect," because they're not, you know, medical errors happen. Diagnostic errors happen. The overall. The good news is that you are in a position to raise the overall level of quality of the conversations.Harry Glorikian: So, you know, talk about your journey after your cancer diagnosis from, say, average patient to E-patient to, now, you're a prominent open data advocate in health care.Dave deBronkart: Yes. So I just want to close the loop on what happened, because although I was diagnosed in January, the kidney came out in March, and my interleukin treatments started in April. And by July, six months after diagnosis, by July, the treatment had ended and I was all better. It's an immunotherapy. When immunotherapy works, it's incredible because follow up scans showed the remaining tumors all through my body shrinking for the next two years. And so I was like, go out and play! And I started blogging. I mean, I had really I had pictured my mother's face at my funeral. It's a, it's a grim thought. But that's how perhaps one of my strengths was that I was willing to look that situation in the eye, which let me then move forward. But in 2008, I just started blogging about health care and statistics and anything I felt like. And in 2009 something that -- I'm actually about to publish a free eBook about that, it's just it's a compilation of the 12 blog posts that led to the world exploding on me late in 2008 -- the financial structure of the U.S. health system meant that even though we're the most expensive system in the world, 50 percent more expensive than the second place country, if we could somehow fix that, because we're the most expensive and we don't have the best outcomes, so some money's being wasted there somewhere. All right. If we could somehow fix that, it would mean an immense amount of revenue for some companies somewhere was going to disappear.Dave deBronkart: Back then, it was $2.4 trillion, was the US health system. Now it's $4 trillion. And I realized if we could cut out the one third that excess, that would be $800 billion that would disappear. And that was, I think, three times as much as if Google went out of business, Apple went out of business and and Microsoft, something like that. So I thought if we want to improve how the system works, I'm happy if there are think tanks that are rethinking everything, but for you and me in this century, we got to get in control of our health. And that had to start with having access to our data. All right. And totally, unbeknownst to me, when the Obama administration came in in early 2009, this big bill was passed, the Recovery Act, that included $40 billion of incentives for hospitals to install medical computers. And one of the rules that came out of that was that we, the patients, had to be able to look at parts of our stuff. And little did I know I tried to use to try to look at my data. I tried to use the thing back then called Google Health. And what my hospital sent to Google was garbage. And I blogged about it, and to my huge surprise, The Boston Globe newspaper called and said they wanted to write about it, and it wasn't the local newspaper, it was the Washington health policy desk. And they put it on Page One. And my life spun out of control.Harry Glorikian: Yeah, no, I remember I remember Google Health and I remember you know, I always try to tell people, medicine was super late to the digitization party. Like if it wasn't for that the Reinvestment and Recovery Act putting that in place, there would still be file folders in everybody's office. So we're still at the baby stage of digitization and then the analytics that go with it. And all I see is the curve moving at a ridiculous rate based on artificial intelligence, machine learning being applied to this, and then the digitized information being able to come into one place. But you said something here that was interesting. You've mentioned this phenomenon of garbage in, garbage out. Right. Can you say more about one of the hospitals that treated you? I think it was Beth Israel. You mentioned Google Health. What went wrong there and what were the lessons you took away from that?Dave deBronkart: Well, there were, so what this revealed to me, much to my amazement, much to my amazement, because I assumed that these genius doctors just had the world's most amazing computers, right, and the computers that I imagined are the computers that we're just now beginning to move toward. Right. RI was wrong. But the other important thing that happened was, you know, the vast majority of our medical records are blocks of text, long paragraphs of text or were back then. Now, it was in a computer then, it wasn't notes on paper, but it was not the kind of thing you could analyze, any more than you could run a computer program to read a book and write a book report on it. And so but I didn't know that. I didn't know what Google Health might do. The next thing that happened was as a result, since Google Health was looking for what's called structured data -- now, a classic example of structured data is your blood pressure. It's fill in a form, the high number, the low number, what's your heart rate? What's your weight, you know? The key value pairs, as some people call them. Very little of my medical history existed in that kind of form. So for some insane reason, what they decided to send Google instead was my insurance billing history.Dave deBronkart: Now, insurance data is profoundly inappropriate as a model of reality for a number of reasons. One of one reason is that insurance form data buckets don't have to be very precise. So at one point I was tested for metastases to the brain to see if I had kidney cancer tumors growing in my brain. The answer came back No. All right. Well, there's only one billing code for it. Metastases to the brain. And that's a legitimate billing code for either one. But it got sent to Google Health as metastases to the brain, which I never had. All right. Another problem is something called up-coding, where insurance billing clerks are trained you can bill for something based on the keywords that the doctors and nurses put in the computer. So at one point during my treatment, I had a CAT scan of my lungs to look for tumors. And the radiologist noted, by the way, his aorta is slightly enlarged. The billing clerk didn't care that they were only checking for kidney cancer tumors. The billing clerk saw aorta, enlarged, aneurysm, and billed the insurance company for an aneurysm, which I never had. Corruption. Corruption. People ask, why are our health care costs so high? It's this system of keyword-driven billing. But then on top of that, I had things that I never had anything like it. There was, when this blew up in the newspaper, the hospital finally released all my insurance billing codes. It turns out they had billed the insurance company for volvulus of the intestine. That's a lethal kink of the intestine that will kill you in a couple of days if it's not treated. Never had anything of the sort. Billing fraud.Harry Glorikian: Interesting.Dave deBronkart: Anyway, because a random patient had just tried to use Google Health and I knew enough about data from my day job to be able to say, "Wait a minute, this makes no sense, why is all this happening?" And I couldn't get a straight answer. You know, it's a common experience. Sometimes you ask a company, "I've got a problem. This isn't right." And sometimes they just blow you off. Well, that's what my hospital did to me. I asked about these specific questions and they just blew me off. So then once it was on the front page of the newspaper, the hospital is like, "We will be working with the E-patient Dave and his doctor." And there's nothing like publicity, huh?[musical interlude]Harry Glorikian: Let's pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that's to make it easier for other listeners discover the show by leaving a rating and a review on Apple Podcasts.All you have to do is open the Apple Podcasts app on your smartphone, search for The Harry Glorikian Show, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments. It'll only take a minute, but you'll be doing us a huge favor.And one more thing. If you like the interviews we do here on the show I know you'll like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.It's a friendly and accessible tour of all the ways today's information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.The book comes out soon, so keep an eye out for the next announcement.Thanks. And now back to our show.[musical interlude]Harry Glorikian: One of your slogans is "Gimme my damn data," meaning, you know, your patient records. And so can you summarize first, the state of the art prior to this digital transformation? Why was it historically the case that patients didn't have easy access to charts from their doctor's office or their visits? Why has the medical establishment traditionally been reluctant or maybe even unable to share this data?Dave deBronkart: Well, first, I want to explain the origin of that of that term. Because the speech in September of that year that launched the global speaking had that title. What happened was that summer of 2009, my world was spinning out of control as I tried to answer people's questions and get involved in the blogging that was going on and health policy arguments in Washington and so on. And so a real visionary in Toronto, a man named Gunther Eisenbach, who had quite a history in pioneering in this area, invited me to give the opening keynote speech for his annual conference in Toronto that fall. And several times during the summer, he asked me a question I'd never been asked. I came to learn that it was normal, but it was "For our brochure, we need to know what do you want to call the speech? What's the title of the speech?" And I remember very well sitting in my office at work one day saying into the telephone, "I don't know, just call it 'Give me my damn data, because you guys can't be trusted." And much to my amazement, It stuck.Dave deBronkart: I want to be clear. Under the 1996 health information law called hip hop, you are entitled to a copy of every single thing they have about you. All right, and a major reason for that. Back in the beginning was to detect mistakes. So it's interesting because HIPAA arose from health insurance portability. 1996 was when it first became mandatory that you had to be able to take your insurance business elsewhere and therefore your records. And that's the origin of the requirement that anybody who holds your health information as part of your insurance or anything else has to be really careful about not letting it leak out. And therefore and it has to be accurate. Therefore, you have a right to look at it and get any mistakes fixed. But. Foot dragging, foot dragging, foot dragging. I don't want to. As we discussed earlier, there are some doctors who simply wanted to keep you captive. But there are also, the data was also handwritten garbage at times, just scribbles that were never intended to be read by anyone other than the person who wrote the note in the first place. Harry Glorikian: Well, but, you know, I'm not trying to necessarily defend or anything, but but, you know, as you found at Beth Israel Deaconess, and I talk about this in The Future You as well, part of the problem is most of these things that people look at as large electronic health record systems were are still are in my mind designed as accounting and billing systems, not to help the doctors or the patients. And that's still a major problem. I mean, I think until we have, you know, a Satya Nadella taking over Microsoft where he, you know, went down and started rewriting the code for Microsoft Office, you're not going to get to management of patients for the betterment of their health as opposed to let me make sure that I bill for that last Tylenol.Dave deBronkart: Absolutely. Well, and where I think this will end up, and I don't know if it'll be five years or 10 or 20, but where this will end up is, the system as it exists now is not sustainable as a platform for patient-centered care. The early stage that we're seeing now, there is an incredibly important software interface that's been developed in the last five or six years still going on called FHIR, F-H-I-R. Which is part of that final rule, all that. So all of our data increasingly in the next couple of years has to be available through an API. All right. So, yeah, using FHIR. And I've done some early work on collecting my own data from the different doctors in the hospitals I've gone to. And what you get what you get when you bring those all in, having told each of them your history and what medications you're on and so on, is you get the digital equivalent of a fax of all of that from all of them. That's not coordinated, right. The medication list from one hospital might not match even the structure, much less the content of the medication list. And here's where it gets tricky, because anybody who's ever tried to have any mistake fixed at a hospital, like "I discontinued that medicine two years ago," never mind something like, "No, I never had that diagnosis," it's a tedious process, tons of paperwork, and you've got to keep track of that because they so often take a long time to get them fixed. And I having been through something similar in graphic arts when desktop publishing took over decades ago. I really wonder, are we will we ultimately end up with all the hospitals getting their act together? Not bloody likely. All right. Or are we more likely to end up with you and me and all of us out here eventually collecting all the data and the big thing the apps will do is organize it, make sense of it. And here's a juicy thing. It will be able to automatically send off corrections back to the hospital that had the wrong information. And so I really think this will be autonomy enabled by the future, you holding your own like you are the master copy of your medical reality.Harry Glorikian: Yeah, I always you know, I always tell like what I like having as a longitudinal view of myself so that I can sort of see something happening before it happens. Right. I don't want to go in once the car is making noise. I like just I'd like to have the warning light go off early before it goes wrong. But. So you mentioned this, but do you have any are there any favorite examples of patient friendly systems or institutions that are doing data access correctly?Dave deBronkart: I don't want to finger any particular one as doing a great job, because I haven't studied it. Ok. I know there are apps, the one that I personally use, which doesn't yet give me a useful it gives me a pile of fax pages, but it does pull together all the data, it's it's not even an app, it's called My Patient Link. And anybody can get it. It's free. And as long as the hospitals you're using have this FHIR software interface, which they're all required to, by the way, but some still don't. As long as they do this, My Patient Link will go and pull it all together. Now it's still up to you to do anything with it. So we're just at the dawn of the age that I actually envisioned back in 2008 when I decided to do the Google Health thing and the world blew up in my face.Harry Glorikian: Yeah. I mean, I have access to my chart. And, you know, that's useful because I can go look at stuff, but I have to admit, and again, this is presentation and sort of making it easy to digest, but Seqster sort of puts it in a graphical format that's easier for me to sort of absorb. The information is the same. It's just how it gets communicated to me, which is half the problem. But but, you know, playing devil's advocate, how useful is the data in the charts, really? I mean, sometimes we talk as if our data is some kind of treasure trove of accurate, actionable data. But you've helped show that a lot of it could be, I don't want to say useless, but there's errors in it which technically could make it worse than useless. But how do you think about that when you when you think about this?Dave deBronkart: Very good. First note. First of all, you're right. It will...a lot of the actual consumer patient value will, and any time I think about that again, I think a lot of young adults, I think of parents taking care of a sick kid, you know, or middle aged people taking care of elders who have many declining conditions. Right. There's a ton of data that you really don't care about. All right, it's sort of it's like if you use anything like Quicken or Mint, you probably don't scrutinize every detail that's in there and look for obscure patterns or so on. But you want to know what's going on. And here's the thing. Where the details matter is when trouble hits. And what I guarantee we will see some time, I don't know if it'll be five years, 10, or 20, but I guarantee what we will see someday is apps or features within apps that are tuned to a specific problem. If my blood pressure is something I'm.... Six years ago my doctor said, dude, you're prediabetic, your A1C is too high. Well, that all of a sudden brings my focus on a small set of numbers. And it makes it really important for me to not just be tracking the numbers in the computer, but integrate it with my fitness watch and my diet app.Harry Glorikian: Right. Dave deBronkart: Yeah, I lost 30 pounds in a year. And then at the age of 65, I ran a mile for the first time in my life because my behavior changed. My behavior had changed to my benefit, not because of the doctor micromanaging me, but because I was all of a sudden more engaged in getting off my ass and doing something that was important to me.Harry Glorikian: well, Dave, you need to write a diet book, because I could use I could stand to lose like 10 or 20 pounds.Dave deBronkart: Well, no, I'm not writing any diet books. That's a project for another day. Harry Glorikian: That's it for this week's episode. Dave and I had a lot more to talk about, and we'll bring you the second part of the conversation in the next episode, two weeks from now.You can find past episodes of The Harry Glorikian Show and MoneyBall Medicine at my website, glorikian.com. Don't forget to go to Apple Podcasts to leave a rating and review for the show. You can find me on Twitter at hglorikian. And we always love it when listeners post about the show there, or on other social media. Thanks for listening, stay healthy, and be sure to tune in two weeks from now for our next interview.
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• Support our show here and all podcast platforms https://aliasconnect.co/morsecodepod • Merch Store --> https://TheMorseCodeOnline.com/Merch • Proudly brought to you by Cold River Vodka! Go find the spirit of Maine at @ColdRiverVodka on Twitter/Instagram and online at https://www.coldrivervodka.com The Whoadster is back and we talk: -NBA Media day (and apparently unlimited HIPAA violations) -The NFL is absolutely barbaric -Who was the wildest boy from the new Dark Side of the Ring "The Plane Ride From Hell" episode? -Unfortunatly, much more! Make sure to follow @DustyWhoads on twitter and "The Art Of Bore" Podcast on all platforms
The Return of Why Therapists Quit Curt and Katie chat about how therapists can maintain joy in their practice when they begin to feel burned out. We explore different ways to incorporate self-care into your life and practice, including making future plans and developing your whole identity. We also talk about how privilege impacts therapists' ability to engage in self-care and career opportunities. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: Discussion of why Katie has not quit the field. Fighting burnout by focusing on what brings you joy in your practice (the Marie Kondo approach). The importance of self-care and incorporating new hobbies/interests into your life. Assessing the distinction between “not great days” and a “not great workplace”. Considering privilege in the ability for therapists to engage in self-care as well as career opportunities. The impact COVID has had on therapist's being able to participate in self-care. Learning how to incorporate time to make plans for future career goals. How to notice burnout and sacrificial helping. The importance of fostering all aspects of your identity (because you are not your job). Our Generous Sponsors: SimplePractice Running a private practice is rewarding, but it can also be demanding. SimplePractice changes that. This practice management solution helps you focus on what's most important—your clients—by simplifying the business side of private practice like billing, scheduling, and even marketing. More than 100,000 professionals use SimplePractice —the leading EHR platform for private practitioners everywhere – to power telehealth sessions, schedule appointments, file insurance claims, communicate with clients, and so much more—all on one HIPAA-compliant platform. Get your first 2 months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Go to simplepractice.com/therapyreimagined to learn more. *Please note that Therapy Reimagined is a paid affiliate of SimplePractice and will receive a little bit of money in our pockets if you sign up using the above link. RevKey RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener. Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Marie Kondo Steven Covey's Big Rocks Relevant Episodes: Why Therapists Quit Why Therapists Quit Part 2 Burnout or Depression We Can't Help Ourselves Quarantine Self-Care for Therapists The Danger of Poor Self-Care for Therapists Negotiating Sliding Scale Overcoming Your Poverty Mindset Career Trekking with MTSG Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2021 Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Full Transcript (autogenerated): Curt Widhalm 00:00 This episode is sponsored by SimplePractice. Katie Vernoy 00:02 Running a private practice is rewarding, but it can also be demanding SimplePractice changes that this practice management solution helps you focus on what's most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing. Curt Widhalm 00:18 Stick around for a special offer at the end of this episode. Katie Vernoy 00:23 This podcast is also sponsored by RevKey. Curt Widhalm 00:26 RevKey is a Google Ads digital ads management and consulting firm that works primarily with therapists digital advertising is all they do, and they know their stuff. When you work with RevKey they help the right patients find you ensuring a higher return on your investment in digital advertising. RevKey offers flexible month to month plans and never locks customers into long term contracts. Katie Vernoy 00:48 Listen at the end of the episode for more information on RevKey. Announcer 00:53 You're listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 01:09 Welcome back Modern Therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all sorts of stuff things that we do things that we don't do, things that our profession does for us. Katie's giving me the work that I'm still not back into good episode intros. We're starting today with a little bit of feedback from one of our listeners, we got a message on our Facebook account from Jennifer. I'm gonna paraphrase a little bit of this. Jennifer writes, hi, Katie. And Curt, this love letter is well overdue. I earned my Master's in 2018. I was a relative newbie therapist when the pandemic hit. And I've been providing telehealth to a lot of my clients and been struggling with some stuff. I'm paraphrasing here. And one day I found your podcast, appreciate a lot of the things that we talked about. And just as things were starting to feel good, like the world was opening back up, again, the Delta variant hit. And especially in response to some of our episodes, looking for a little bit of a hope here of how do we keep going? How do we not just fall into those traps and things like our episode around why therapists quit? How do we survive in our careers and not just wanting to give up and go and be in any other profession? Katie, why haven't you quit yet? Katie Vernoy 02:57 I think I have several times. I think that the the definition of quitting can be very different for folks, I've not left the profession. So maybe that's the accurate thing. But I left community mental health, I've switched my private practice a number of times I've worked in the profession and more of an advocacy framework. And so the first thing that I would say is I've not seen it as a single career that has one particular path, but instead a an evolution of how I work and how I interact with the work and where I find my place in it. So I think the short answer is I keep assessing myself and the work and trying to realign it pretty frequently. Actually, Curt Widhalm 03:50 I would describe my approach is kind of the Marie Kondo approach, does this part of my job bring me joy. And what I've found and this does come with some experience in the fields, some longevity, some being in some positions where I can cut out or throw away some of the aspects that just no longer feel like they are bringing joy to me bringing me back into the profession. But a lot of that permission for me, comes with community. It comes with being around a lot of like minded therapists that give the permission and the support, to be able to take some of those leaps to be able to recognize that the safety of something being done just because I've always been doing it that way. And it can be let go. It can be something where if it doesn't emotionally pay off, it doesn't monetarily pay off for me that it's something that I don't have to be beholden to forever. And I say this as somebody who is very much Are you a completionist? Somebody who likes to finish video games to 100% to not give up on things in the middle that, for me, a lot of it does come from having the permission given to myself to not stay stuck in things just because it's, it's there. And it's what has been. Katie Vernoy 05:25 I like that because it provides this ongoing assessment of what brings me joy, like Marie Kondo, but it also is not sticking to something, you know, this is the sunk cost fallacy, like, just because I've started it just because I've invested invested time or money in it doesn't mean that I need to go down this direct path. And I think that can be really hard. Because if you've invested in a lot of time and energy into a specific niche, for example, you've you've networked and created relationships. And I think for you this was around autism, right? You did a lot of networking, and there was a lot there, and you still work with with autistic clients. But I think there's that, that element of once that was not your area of focus, she moved back. I've done that with trauma work. I've done that with, you know, trauma survivors and different things in that way. But I think that being able to identify what doesn't bring me joy anymore, what doesn't seem this sounds a little bit mercenary, I guess. But what isn't bringing the return on investment that you would like whether it's an emotional return on investment or a financial one, I think being able to drop those things can be really good. I actually, when I talk to consulting clients about this, because this is one of the things that is a big conversation, especially for mid career therapists is if you started from scratch, you know, what would you put back in? And I guess this is Marie Kondo. So maybe this isn't that earth shattering. But even just taking away your whole schedule, like everything is off the table, and you start from scratch, and you only put the things back in that really energize you bring you revenue, which may not energize you do the things that you're required to do. And whether it's Stephen Covey's big rocks, or or some of these other concepts of really sticking to the highest priorities, and only allowing them back in can be very helpful. And oftentimes, we can't do it like, next week, oftentimes, it's like, okay, let's look at next year. So three months from now, your schedule is now fresh, you might put clients back in the same time slots, but you may not you may put them at different times of day, you may not have all the same clients, because some of those clients are emotionally draining you in a way that you recognize that you're probably not doing your best work with them. But I think being able to take away those things that aren't working, no matter how much time and effort you put into them, no matter how much you feel like that's what you should do, I think can be very helpful. I mean, there's practical things to think about, you know, income and all of those things. So this is more of a high level philosophical conversation than a practical one, in this moment, but I think, actually starting from scratch, in your mind, you don't have to burn everything down. But like, doing the thought experiment of starting from scratch, I think can be very helpful. Curt Widhalm 08:24 On one hand, the need for mental health and mental health related services seems to be at an all time high, as far as coming out of the pandemic fingers crossed that we're coming out of it. But the the need for mental health and mental health related services is quite high. And with that, at least at this point in the foreseeable future, and comes a little bit more freedom to be able to take some risks, because the need for mental health service providers is going to remain strong for quite a while here. And so it's not like we're in a situation where if we were to leave, you know, an agency stop a practice or something like that, to go and explore something new. That it would necessarily be something where you can't go back, that there is some overall professional job security here. And we're seeing this expand just beyond the traditional, providing direct services to clients and a number of different ways, whether that's entrepreneurial yourself and maybe moving into more coaching program type things or courses, courses or any of those kinds of reaching stuff. Yeah, I've never seen more positions in corporate environments that are requiring people to have a mental health background to come in. And so there is a lot of options out there that you can take advantage of and think gets our fear of losing what we have that often keeps us subjected to staying into the same positions over and over again. And to Katie's point, this also does require some thoughtfulness and some planning, this can't just be like an impulsive, like, I had a bad day at work on Thursday and Friday, I'm going to accept a job wherever offers next. So one of the things that I occasionally get a question from clients is, you know, would you care for me if I wasn't paying for your time. And my answer to that is usually, the some version of my care exists, because I care for you, as a human being, a lot of what you're paying for is, for my experience, any wisdom that I'm able to bring, and most of all, that you're ensuring that I'm prepared, that I'm taking care of my life enough that I am ready for the sessions to be able to take on what you're bringing in, what you're paying for is the thoughtfulness in the preparation for our time together for that character come out. And it's with that same kind of intention that I'm looking at this kind of a question of, its being able to put that kind of thoughtfulness in place for yourself, to be able to be in a position where you're able to make a shift to continue to take care of yourself. And if you can see beyond, you know, a bad experience with a couple of clients, you can see beyond a bad experience with a supervisor or toxic co worker or a mountain of paperwork, whatever it is, and say, you know, overall, this was a bad day. But this is still an environment where I can continue to show up and have that care, as I define it for myself, does help to answer some of that question when it comes to how do we stick with some of these things? I'm not great days. Katie Vernoy 12:09 I like the distinction between not great days, and not great work environments. I think, if the not great days stack up, it could be that it's not great work environment, or it could be that you've chosen something that aligns when you're fully resourced and doesn't align when you're not. And so some of this and we have a lot of different episodes on systems of self care or addressing burnout, or is it burnout or depression, like we have a lot of different episodes that can talk about addressing burnout specifically. And, and some of that is being in the wrong place. But some of it really is working without that thoughtfulness, and the deliberateness that Curt's talking about with taking care of yourself so that you can continue to show up. I want to extend that even further. Because I think, folks, and maybe this is a very Western idea or something that's, that's very present in the United States. But I think folks have this notion around, I have to be growing and expanding and getting better and creating the next big thing. And I have to keep increasing my revenue, or you know, those types of things. And I think when, when we see it rather as seasonal, or seasons of our career, I think that can be helpful. I was talking to a dear colleague recently, and she was talking about coming out of a toxic work environment and basically, not cruising, and I wouldn't say it was that but like, creating something that was very doable. There wasn't challenged, there wasn't growth, and I'm overstating it to make the point. But it was something where there was restfulness, in how she chose to do her work, you know, the client, she chose to work with the time she spent on the work, she was very, very deliberate in charging premium fee. So there was fewer clients and creating that space. And then after that timeframe, when she felt rejuvenated and ready to tackle the next big thing, she found another job and then was able to take on another piece of things in our profession. And so I really like that concept. Because there are a lot of folks who will be burnt out or they'll be ready to quit. And instead of taking care of themselves, they'll jump into programs that are designed to be a lot of work to get to some place in the in the future. You know, like, do all this work and make a lot of money. And when someone's burned out or when someone's ready to quit, they may not have those reserves. And so you have to assess that for yourself. But if you don't have reserves, you don't necessarily have to make drastic changes. You may just have to back off a little bit and refocus on your life for a while rather than your career. If you can do the work, you can set your set your career in a doable space. Does that make sense? Curt Widhalm 15:07 Does. I wonder how much of this is really just coming from a place of privilege, though. But absolutely for those of us who have survived, as long as we have, we talked about this in our state of the profession episode this summer that a lot of the younger therapists as compared to other age, demographic, tripling, maybe I don't want to stay in this profession. And that's going to come at a time when you don't have a lifetime of savings built up. But you are more sensitive to having to work unpaid or underpaid jobs, that you might not be in a position to make some of these decisions where your responsibilities to family might be a lot bigger proportion of your life, especially if you have young children. So creating the space in here also for those, and remembering back to the time in our lives where we weren't quite so privileged to be making some of these decisions. I know in leaving the agencies that I did at the times that I did, and being unhappy in some of the work environments, I don't think I ever felt that I was in the wrong field completely. It was very much recognizing that there are good places and good opportunities that I was doing what I wanted to do in creating healing in the world. It was just not in that particular environment. And it was recognizing that one agency is not representative of all agencies. And part of that perspective, once again, comes back to community, it comes back to the ability to have trusted peers have, you know, your own therapy to not think about therapy all day long to have other hobbies and interests that go and make you you. And I recognize particularly for this, you know, last year and a half during the pandemic, that a lot of people's abilities to go and do things that aren't therapy have been shut down. And a lot of us filled in that extra time with more work. And so, you know, we've been talking about this, the faculty level at the university that I teach in that one of the issues that we're anticipating with students is how much that they're used to working now, and being able to accrue their hours towards graduation and licensure by being able to fit in more, because everything's over telehealth. And when we inevitably returned to more of a program wide face to face role in things that students are going to have a shift in and struggle with house, how much slower things are going to be accruing for them. I say all this to say that it's really being able to take that step outside of yourself, which requires downtime, which requires an ability to get a different viewpoint on what you're doing, not in the sense of making what is happening around you. Okay. But doing it in a sense of Are you okay with what's happening around you? Katie Vernoy 18:36 when we're looking at self assessment, I agree, we need to have downtime, we need to have space. And as you were talking, I was really resonating with this concept around privilege, and how at different stages of your career at different places in your life are different socioeconomic status, different societal pressures and levels of oppression, like I think that this challenge is going to be different for different folks. And so in looking at that, and looking at having some downtime to make an assessment, or looking at finding ways to make your agency job better, or finding ways to make your career more sustainable, I think we have to really honor that when you're feeling stuck. When you see no other way to do what you're doing. It's very hard to do any of this. And so, if we can't get any space at all, I think it's going to be very hard for people to not quit. And when I've been in those situations, whether it was when I was in an agency job or just other periods of my life. I think the way that I didn't quit when I didn't quit was finding the smallest space that I could preserve from my own. Or maybe maybe It's better said a small space, but the biggest space that I could preserve for my own to plan for what I did next, whether it's doing that assessment and finding out whether you're able to do what you want to do and the place that you're at, but also to have your exit plan, because I worked in community mental health, and I did not feel like I could just quit and start a private practice and do all the things like I wasn't able to do that I wasn't able to take that on that financial risk on. So for me, it was carving out a little tiny piece of time, where I started figuring out what I needed to do to start a private practice. And I started figuring out what I needed to do to get on insurance panels, or whatever it was, at certain points, it was carving a little bit of time to look for jobs, when I was still wanting to move from place to place and having people around me hold me accountable to finding a new job, I think people get really caught in well, another agency might be just as bad, it doesn't make a difference. And I really argue that that's not necessarily the case. And that you need to talk to your colleagues and your cohorts and that kind of stuff to see what what the experience is because sometimes just taking that little bit of a little bit of time to put in an application or to make a plan for your exit, or whatever it is, can be the way that you stay. Because it gives you a breath of fresh air, like, I'm gonna have my escape hatch. And I think I even called it that when I started my private practice, or when I started applying for other jobs, like I have my escape hatch, and adjustment that I wasn't stuck, there was an endpoint, it was a nebulous endpoint, but it was an endpoint. And I think that does help. Curt Widhalm 21:44 I have found that, you know, emotionally taking vacations is appropriate. Getting away from work, is as much as our profession as a calling, as much as we're deeply emotionally invested in the work that we do with our clients. And whether we get a return on that emotional investment or not. The end of the day, it's still a job. that it takes a certain kind of ability to show up for that job, as compared to many others takes a certain level of awareness, it takes a lot of ability to care and recharge for yourself. And in a number of our episodes before we've talked about that self care is not an option. Self Care is a discipline. And I can speak for myself on this third, when I go on vacation, I like to completely not deal with work as much as I can to really be separated from it. Even if it's just like one day on a on a weekend of like, here's my day to go spend in the kitchen doing things where there's a beginning, middle and an end. And it's practical and delicious. These are the kinds of things that at least recharged me for the next day of work. It's and this has been particularly hard during COVID of, Oh, well, I got nothing else to do. So I might as well throw another couple clients on my schedule, or I might as well dive into this thing. And then just like anything else we can become so enveloped in whatever our work or what our interests are that it just consumes us and leaves us not wanting to look at it at all. And that's not unique to our profession. It's not even unique to jobs, it can be done with hobbies, it can be done with side hustles. That the key is balance. And it's finding what your right balance is Katie was describing as I'm describing of like taking some intentional rest time away from it. Katie Vernoy 24:02 I've I've talked to a number of clinicians who had not taken vacations for years. And I would call a day off a day off not necessarily a vacation day, Curt. So I think you also need to take a real vacation, your plate. But I think that there are there are many different reasons people don't take time off work. One is potentially they don't get paid and that that income is needed. And and that's that's relevant. And I think there are different conversations that we've had and we'll link to him in the show notes about money and trying to make sure that you're earning more money and that kind of stuff, and planning your money based around taking vacations. But the other thing that I've really seen is there are folks who either just don't even think about it, they don't plan ahead and they just don't schedule the time away. And I'm not talking like a Caribbean cruise I'm talking about even just staying home and watching Netflix and chilling for a week and not answering your phone, whatever it is, whatever you can afford, actually vacating your work, I think is important. But people won't do it because my clients need me, subconsciously, maybe it's I don't deserve it. And I think and this speaks to and we probably have an episode early on where I talk about sacrificial helping, but it's it's this relationship that we have to ourselves and our work that I think can get in the way. And really being able to address that I think is, you know, what I'm thinking is kind of our last points that we'll make on this is if you're constantly sacrificing yourself, if you're constantly putting yourself in this place where you're doing, doing for your clients, for others in your life, more so than you're doing for yourself. Self Care doesn't necessarily land on your list. And it also doesn't, it's not necessarily sufficient, because you're constantly in this place of less than and of service, and you're not necessarily feeding yourself. And I'm not talking about folks who find great joy and meaning and helping people that is exactly why I'm in the profession. It's that that is who I am, that is all that I am. And I will sacrifice everything else in my life to that purpose. I think that becomes really hard. So when we're in this place, and I think this can happen, when we have clients that are in high crisis, it can happen when especially early in our careers when we're feeling like our clients are very dependent on us and and we think we have to rescue them all. Or maybe that was just that, that that sacrificial piece can come in, and that that's not sustainable by any stretch. And so I think it's important to also I guess, to say, looking at the relationship you have with yourself and the work, and maybe go into back what Curt said like it's a job. It's an awesome job. It's a job that is very meaningful and can be very powerful and make a big difference in the world. But it's your job. It's not who you are. Yeah, it's Curt Widhalm 27:10 not an identity and your only identity. Katie Vernoy 27:13 Because we are saying that everybody's modern therapist, so we've given them we've given them an identity point. Okay, Curt Widhalm 27:21 fair, fair. And since it's not your only identity, it's not the only identity that you should be shaping. It's not the only one that you should be subscribing to. And it's dealing with that imposter syndrome of people who've honed that part of their identities, especially in your early career when you're looking at people who've been in the field 1020 3040 5060 years, that part of how they got there is going through what you're going through now. So form all of your identities, Katie Vernoy 27:54 spend time with all of them. So Curt Widhalm 27:59 if you have questions for us or would like to suggest an episode, as you can tell from several of our last episodes, we are responding to our listeners. And you can reach out to us on our social media or through our websites. MTSGpodcast.com. And until next time, I'm Curt Widhalm with Katie Vernoy Katie Vernoy 28:19 thanks again to our sponsor SimplePractice. Curt Widhalm 28:21 SimplePractice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use SimplePractice to power telehealth sessions schedule appointments, file insurance claims market, their practice and so much more. All on one HIPAA compliant platform. Katie Vernoy 28:39 Get your first two months of SimplePractice for the price of one when you sign up for an account today. This is collusive offer is valid for new customers only. Please note that we are a paid affiliate for a SimplePractice so we'll have a little bit of money in our pocket. If you sign up at this link. Simplepractice.com/therapy reimagined. And that's where you can learn more. Curt Widhalm 29:00 This episode is also sponsored by RevKey. Katie Vernoy 29:04 RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services. RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. Curt Widhalm 29:28 You'll never receive a data dump report that means nothing to you. Instead, red key provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. Katie Vernoy 29:44 You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener Announcer 29:51 Thank you for listening to the Modern Therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
One of our big seven things we really care about at TARTLE is government and corporate transparency. Normally, when this topic comes up, we are calling one or the other out for their lack of transparency. Today, we actually get to go the other way for once. That is thanks to the governor of Alaska who recently ordered the justice department to investigate the state's health department. If that sounds unusual, it is. Governments typically don't publically announce that they are investigating themselves. What could have prompted the unusual action? It turns out Alaska's Health Department has been using data in ways that not the governor disapprove of, they may also have violated federal HIPAA laws. As with so many other things in the last year and a half, the situation was prompted by COVID. What they did was set a program to call senior citizens in Anchorage and enquire as to their vaccination status. The health department also outsourced that particular activity to third-party contractors. The program was begun to help people understand and take advantage of the availability of the COVID 19 vaccines. However, there are several questions to be asked. Did the seniors of Anchorage actually need any help with this? Did they ask for it? Did the health department actually ask them? What about the data? Whether or not a person has a particular vaccine is sensitive medical data, data that should not be getting shared with a third party, the ones doing the actual work. Finally, one has to wonder just what the state was doing with that data in the first place. Public emergency or not, the government should not have that kind of information about individuals. How did they acquire it and for what reason did they do so? Once data starts to get shared like that, from one group to the next, it becomes harder and harder to track exactly what is being done with it. The sovereignty over the data has been lost and anonymity, in this case, is obviously also compromised. From those third parties, a patient's data could be sold virtually anywhere, including their identity. Fortunately, once news of the program got out (thanks to one of Anchorage citizens blowing the whistle), the governor stopped it and ordered the investigation. In at least this instance, Governor Mike Dunleavy showed real leadership. Not only did he shut down the program, he ordered the investigation, and even more importantly, did so publically. And it gets better. Dunleavy ordered a full review of all the data sharing agreements for the state, promising to put policies in place that would prevent such a thing from ever happening again. It isn't often you see this kind of transparency coming from the government. For that, he should be commended. www.tartle.co Tcast is brought to you by TARTLE. A global personal data marketplace that allows users to sell their personal information anonymously when they want to, while allowing buyers to access clean ready to analyze data sets on digital identities from all across the globe. The show is hosted by Co-Founder and Source Data Pioneer Alexander McCaig and Head of Conscious Marketing Jason Rigby. What's your data worth? Find out at: https://tartle.co/ YouTube: https://www.youtube.com/c/TARTLE Facebook: https://www.facebook.com/TARTLEofficial/ Instagram: https://www.instagram.com/tartle_official/ Twitter: https://twitter.com/TARTLEofficial Spread the word!
Welcome solo and group practice owners! We are Liath Dalton and Roy Huggins, your co-hosts of Person Centered Tech. In our latest episode, we're talking about stress management and money with Julie Herres from GreenOak Accounting. We discuss overwhelm, stress cycles, why things are so stressful for group practice owners right now, private practice trends, time vs. money, ways to manage increased stresses, business health and money from a holistic perspective, hiring challenges, managing fear and scarcity, investing in support, delegating tips, practical steps to manage finances effectively, service selection and setting up systems, and HIPAA considerations with accounting software. Listen here: https://personcenteredtech.com/group/podcast/ Stay tuned for future episodes! For more, visit our website. Resources Green Oak Accounting, specialized accounting for mental health professionals and group practices Julie and Green Oak Accounting's podcast, Therapy for Your Money Julie's EHRs and QuickBooks articl PCT's Free Service Selection for Mental Health Group Practices Workbook Group Practice Office Hours (direct support and consultation service from PCT team and Eric Strom, JD PhD LMHC)
This episode talks about HIPAA (Health Insurance Portability and Accountability Act) and how it applies to your vaccination cards and status. Be aware, be safe. Get ExpressVPN, Secure Your Privacy And Support The Show Become A Patron! Patreon Page *** Support the podcast with a cup of coffee *** - Ko-Fi Security In Five —————— Where you can find Security In Five —————— Security In Five Reddit Channel r/SecurityInFive Binary Blogger Website Security In Five Website Security In Five Podcast Page - Podcast RSS Twitter @securityinfive iTunes, YouTube, TuneIn, iHeartRadio,
Episode 226: How to Fire Your Clients (Ethically) Part 1.5 Curt and Katie chat about different therapist-client mismatches and how to manage them. We explore how to balance dealing with discomfort in therapy and seeking consultation with knowing when and how to refer out clients. We also talk about how to incorporate ideas of redefining and decolonizing therapy. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: How to manage situations when the client having a clinical need that the therapist does not feel capable to treat. Different kinds of therapist-client mismatches. Cultural considerations in therapist-client matching and incorporating ideas of redefining and decolonizing therapy. How to refer out clients when there is a mismatch and what to do if the client doesn't want to be referred out. What to do when you have different ideologies than your clients. The benefit of sitting with discomfort when you disagree with your client and knowing when to seek consultation. How to support clients when they aren't aware that a different therapeutic style (e.g., direct vs. indirect) may be beneficial to them. The importance of reviewing treatment plans with client (even when not required). Revisiting how to address therapy interfering behaviors and how to appropriately terminate with clients when necessary. Barriers in referring clients out. Our Generous Sponsors: SimplePractice Running a private practice is rewarding, but it can also be demanding. SimplePractice changes that. This practice management solution helps you focus on what's most important—your clients—by simplifying the business side of private practice like billing, scheduling, and even marketing. More than 100,000 professionals use SimplePractice —the leading EHR platform for private practitioners everywhere – to power telehealth sessions, schedule appointments, file insurance claims, communicate with clients, and so much more—all on one HIPAA-compliant platform. Get your first 2 months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Go to simplepractice.com/therapyreimagined to learn more. *Please note that Therapy Reimagined is a paid affiliate of SimplePractice and will receive a little bit of money in our pockets if you sign up using the above link. RevKey RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener. Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Relevant Episodes: How to Fire Your Clients (Ethically) Make Your Paperwork Meaningful Therapy is a Political Act The Balance Between Boundaries and Humanity Is Therapy an Opiate of the Masses? Ending Therapy Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2021 Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Full Transcript (autogenerated): Curt Widhalm 00:00 This episode is sponsored by SimplePractice. Katie Vernoy 00:02 Running a private practice is rewarding, but it can also be demanding SimplePractice changes that this practice management solution helps you focus on what's most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing. Curt Widhalm 00:18 Stick around for a special offer at the end of this episode. Katie Vernoy 00:23 This podcast is also sponsored by RevKey. Curt Widhalm 00:26 RevKey is a Google Ads digital ads management and consulting firm that works primarily with therapists digital advertising is all they do, and they know their stuff. When you work with RevKey they help the right patients find you ensuring a higher return on your investment in digital advertising. RevKey offers flexible month to month plans and never locks customers into long term contracts. Katie Vernoy 00:49 Listen at the end of the episode for more information on RevKey. Announcer 00:53 You're listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 01:08 Welcome back modern therapists This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast where we talk about all things therapists and picking up on last week's episode responding to user reviews, we felt the food getting a little more nuanced and a couple of things. But this review sparked a couple of ideas, check out last week's episode about therapy interfering behaviors. We also wanted to dive into a little bit more of the firing clients maybe terminating prematurely before clients end up getting to their goals, we might want to call this episode firing your clients ethically, Part 1.5. Like it's cuz this does help us dive into a little bit more of some situations where this comes up. We'll talk about this from a clinical approach. We'll talk about this as far as broadly, some of the ways that I've heard ethics committees talk about bad therapy when clients have felt abandoned by therapists, this kind of stuff. So Katie, and I wanted to talk about what are some times where we've heard therapists, quote, unquote, firing their clients looking to terminate prematurely referring out, etc. So Katie, what is first on our list today, Katie Vernoy 02:37 the most frequent one that I've seen that I've experienced is this idea of a client having a clinical need that either pops up or was on assessed, you know, wasn't appropriately assessed at the beginning, that I don't feel capable to handle. And I see this a lot, where folks will say, well, this person has psychosis or they have an eating disorder, or they have substance abuse, or they have something and I'm not an expert in it. And so I am going to refer them out. And there have been times when I've chosen to refer out and there have been times when I have kept the clients and, and created a treatment team around myself so that there was expertise present. But I see that a lot. I think people get very worried, and sometimes with good reason that if they keep a client for whom they don't have the appropriate clinical expertise, that they will be hurting the client. And so they then terminate the client, which can mean that the client feels abandoned because they have, especially if they've already developed a relationship with you, or if they had difficulty finding a therapist in the first place. And there's not great referrals. So I think that's potentially where we start is when a therapist feels like this is not my expertise. But they've already shown up in your office, either for one session or for 10 sessions. And this is a new clinical issue that pops Curt Widhalm 03:57 So Katie and I, before recording today, we were talking about a couple of different areas where this has come up in our careers. And part of managing some of these particular situations is having honest discussions with clients. This might be something where it's a lot easier when it's in those first couple of sessions of, Hey, we don't have a real strong therapeutic relationship. But I don't have the skills to be able to help with the goals that you're coming in here with and especially if there may be more high risk or specialized sort of treatments you brought up about eating disorders before the show was recording here. These get a little bit trickier when you're much deeper into relationships with clubs. And for instance, eating disorders that show up in clients after a couple of years of treatment where you have a very strong relationship with a client and it might be outside of your wheelhouse. I've had a couple of clients that I've worked with for a very long time that have eventually started exploring transgender identities and things that are not necessarily within the specifics of my specialties. But feeling the confidence in a therapeutic relationship and knowing what it's like working with me over the long term to begin to explore some of these new identities. And I think, in the way that Katie and I have talked about this is a lot of times, it's not necessarily firing those clients, but it's helping to be able to develop a treatment team of specialists around who's working with those clients to be able to help the clients reach their goals, while also still having the emotional space and the trust in the relationship that they know that they're going to be taken care of. Katie Vernoy 05:57 For me, I see it as a very attachment based style of therapy that I do, because I think I do longer term therapy, it's very relationship based. And so if I can't be the expert in the room with my clients, I act as a trusted person in their life who's going to figure it out. And I'm going to get the right people around them. And I'm going to advocate for them. Some of this comes from my history of doing more on the kind of social work and of pulling together treatment teams and resources and advocating for my clients. But there are a number of times throughout my career where something has come into my client's life, we have a very strong relationship, and I start doing research, I start gathering people around them. And the work that I do may be impacted by that there may be things that I bring in that is relevant to that particular treatment issue. But it may also be just me talking with them about like, how's it going with a specialist? How are you taking care of yourself? What do I need to know to support you during this time? You know, it's it's something where it has to be within the relationship because a brand new client having to tell you what they need, doesn't feel appropriate, but a client that's been with you for years and has this new issue that they're facing, I think it would be pretty bad. If you were to say, Okay, I'm out, because I don't know about this. So you're on your own, because people are not just these new treatment issues are not just diagnoses. Curt Widhalm 07:27 And what you're describing There is also getting your own consultation and learning and developing some new skill sets alongside of that, it's not always going to be possible to out of the blue be able to develop a new best practices sort of treatment for these kinds of clients. And that's where handling these difficulties. I think we've discussed this in enough episodes before and just kind of a general enough knowledge within the community that we can move on to our next thing on the list here. Katie Vernoy 07:59 So one more, I think clients often opt out. But I think sometimes for especially those therapist pleasing clients therapist might have to do it is a therapist like relationship mismatch, that there's something in the relationship that just seems to be getting in the way of the treatment being successful. Curt Widhalm 08:20 And so sometimes this can be personality wise, this can be things where the agreement on what the treatment plan is, isn't the same. It might be things that a client is particularly hoping can be addressed in therapy that the therapist doesn't or won't work on. And maybe to give an idea of something like this is if a black client is showing up to therapy with issues of depression and wants to talk about some of the systemic causes, especially in the news here in the last couple of years and issues related to that as being part of the causes towards the particular depressive symptoms of this client. With the therapist only wanting to focus on things like medication adherence and behavioral activation techniques that don't necessarily take into account what the client is asking for in those therapeutic sessions. This has the potential of being in one of those areas where clients asking for something a therapist isn't providing. As it's described, this isn't really bad therapy. It's technically sound by using evidence based practices here. But I'd be hesitant to call this good therapy by any means because the client is expressing a desire to be exploring something with the therapist is completely sidestepping. Katie Vernoy 09:51 I think when we look at it that way, this is where folks come talking about redefining therapy or decolonizing therapy. I think there are arguments, that's pretty bad therapy, when a client clearly is bringing in things that they would like to address, and the therapist is refusing to talk about them, and not seeking any insight from the client on their methods of healing. And so we'll link to a couple episodes in the show notes that kind of talk more specifically about how you can talk more about those types of issues if those that's what your clients seeking out, but yes, I don't think it's unethical or illegal therapy. But Curt Widhalm 10:28 I do. And that's, that's the wording that that I should use here is that not that particular example. But some of the ethics committee discussions that I see from time to time fall into categories like this, where a client is asking for something very, very specific that the therapist is not addressing, that doesn't go against an ethics code, it doesn't go against a legal statute that falls under this category of just a really bad client therapist match. And I agree that with redefining therapy, reimagining therapy, that decolonizing therapy, by those definitions, that is bad therapy. Yeah. For me, legal and ethical standpoint, there are no legal or ethical codes that define it as such. And so sometimes we'll see client complaints about this that, you know, from a decolonizing, or a reimagining standpoint, would find frustration with that therapist not being investigated not being seen as a, somebody contributing to bad therapy, it's because the rules of law, the rules of ethics don't have anything to investigate those against and therefore there's no punishment to be given, if there's no rule against it. Katie Vernoy 12:01 My hope is that if someone had that type of a complaint, rather than putting up a huge defensive structure, that they would actually look at what that mismatch was, because to me, I feel like there are clients who need that seeing that being known to be able to make any progress in therapy. And I think sometimes those clients will opt out and recognize that this therapist is not seeing me not potentially even doing some micro aggressions or macro aggressions like it could be something where the mismatches big and I think, bordering on unethical, although I don't know that I have a code. So I won't I won't go that far. But I think that the problem is that some clients, especially clients who have been, who have identities that have been traditionally marginalized, I think they may not know that anyone would be any different. And so my hope is that if a therapist is getting any kind of feedback, or having that push back, that they would make that referral to someone who could have those conversations, I just don't feel convinced that that's going to be the case, I feel like that could be a missed, you know, kind of blank spot in their education and their self awareness. Curt Widhalm 13:14 At best, it's in that missed blank spot. You know, there are therapists that we have to admit that are out there who will actively go against and argue against that. And those cases, would be very bad therapy. And this is looking at some of those situations too. And this falls across ideological spectrums, here. But when you get into imposing values onto clients, for not believing in whatever it is that you believe, that is bad therapy, especially to the clients perspective, now, I think we're way off of where this episode's focus is supposed to be, as far as when those situations come up from the therapist side of things, you know, give you the credit as a listener here, that you're not imposing your values on the clients here, but when those clients do bring up opposite ideas of how you practice, the show here, we're big advocates of putting your values out there of kinds of work that you do so that way clients can self select in, but sometimes you're gonna end up with clients who don't match up with those things, stances on vaccine mandates, mascot mandates, these kinds of things that a lot of people are gonna have a lot of different ideas about, that this might be a mismatch. It's not something that can necessarily be ignored, but it's not necessarily something that's the place of therapeutic focus. Or is it? Katie Vernoy 14:49 I mean, I think it's client by client and therapist by therapist, I think the to get us back into how to ethically fire your clients part 1.5 or whatever. We're going to call I think the assessment of is this ideological difference, this mismatch sufficient that you believe you cannot do effective therapy with this client, and then referring them out appropriately, I think is important, but I chose so Curt Widhalm 15:14 in your mind, how does that referral work? Like, Hey, I think you're an idiot for this thing that doesn't have anything to do with you coming in, like, how do you see those referral conversations going? Katie Vernoy 15:30 I am not referring someone out because they have an ideological difference. But if they're wanting to talk about things that I have absolutely no experience about, you know, or I don't have a space to you know, I don't feel comfortable in that space. And it's not something that I want to subject them to, as I find my footing, I might say, Hey, I'm noticing that these are the types of things that you're wanting to talk about. And it's outside my my area of expertise. So I want to connect you with somebody for whom that is an area of expertise. And Curt Widhalm 16:01 if that client says, Now I like you enough, we can we can teach you Katie Vernoy 16:06 taking that question. I mean, that is that that is harder, because I don't want to abandon my client. I don't want to be in a place where I'm allowing my own, you know, ideological things to get in the way. But if it's truly an ideological difference, whether it's about political ideology, or something along the lines of vaccinations or different things, you know, the things that I may have a strong opinion about, but my clients either have a strong other opinion, or I think the one most recently, it's been kind of vaccine hesitation, I most of my clients are vaccinated, some are not. And for me, I think what I end up doing is I follow the lead of the client, and I work to identify where their mind is, and try to understand them. And that doesn't require an ideological knowledge. Just trying to understand their perspective and look at it doesn't require an ideological knowledge. And I try to determine, do I need to know more about this in order to work with them? Or is is it central? Or is it not central? Curt Widhalm 17:10 So for those clients that continue to bring things up, because occasionally I'll get clients on the US ideological stance that are just kind of my rights to not get vaccinated? clients? They will, I don't know, get emotionally momentum going in a direction that even an exploring where you're going here, that they'll start to maybe rope you in with like, you know what I'm talking about, right? Don't you agree that people's rights are important? That, you know, are these half sort of things? Do you step in at those times, knowing that you're sitting there being like, I don't agree with literally anything that you're saying right Katie Vernoy 17:54 now. I think what I've done at different points, sometimes I'll go to psychoeducation. And say, I'm hearing you and I hear that you're saying this, one thing that I'm reading is is this. And so sometimes I'll go to a Hey, let me just add a little bit little tidbit not say like, Oh, well, I think you're totally wrong, but go to like a tidbit of, you know, I actually did that or, or even say, Well, I don't know, I actually, you know, that's not something that I've been looking into, could you share with me some of the things that you're reading, because then I get a better experience of what rabbit holes are going down? Curt Widhalm 18:33 I'm not, I'm not giving those YouTube links that get sent to me, you know, these 30 minutes, here's where all of the vaccines things are wrong. I'm not clicking on those. Katie Vernoy 18:45 But I think they're they're there. There's knowledge that potentially you can gain about where someone's head's at, when you actually ask them, how they got there, and not looking at trying to switch it. But I think there are times when just understanding and listening and then providing a little bit of information kind of from outside their information bubble can have an impact. But sometimes it just becomes very clear that there's not common ground. How about for you? How do you manage it when clients are having these gigantic conversations with lots of emotion about things that you think are absolutely wrong? Curt Widhalm 19:23 I do a lot of reflecting back even when there's direct questions back to me. What does this mean for you? How is this impacting your day to day life? What can you do with this it's very narrative approach in a lot of ways, and I have had some successes where clients are like, Thank you for listening to me, maybe you can help me get some perspective on some other ways of looking at this that is just kind of this being able to validate the process rather than the content of what's discussed. And I'm afraid that a lot of therapists would get sucked into the content part of these arguments and feel Like this is something that I can't help you with. And therefore, I need to go back to what we mentioned earlier in the episode and refer out to somebody who can validate the content of what you're talking about here. Like we mentioned in last week's episode, this is being able to have a really good idea of what your limits are, what kind of impact that the clients are having on you being able to sit with it. And that's, that's a part that, especially developing therapists I see struggle with a lot because this pulls up a lot of that imposter syndrome stuff is just because you're having anxious or bad feelings of what a client is saying, separate from our other fire of clients ethically episode doesn't mean that you're not necessarily providing good therapy in those situations. Just because we want therapy to be easy and us to heal everyone doesn't mean that we're not going to run into some uncomfortable situations with clients. I was sharing with one of my other Professor friends here recently about some of the role plays that I bring into the especially like practicum classes when people haven't started seeing clients yet, just like getting them prepared for stuff. And of course, I'm going to pick situations that make the therapist kind of uncomfortable, and it's surprising how few of these I've ever had to make up completely to kind of put, you know, developing therapists on the spot. And when I was sharing some of these with my professor friends, they were like, what kind of a practice do you have? These are pretty like everyday sort of things. These aren't even like the egregious ones. I say all that to say that sitting through a lot of stuff that makes us uncomfortable, can have a very deep impact for clients that we might feel mismatched with. But it comes back to attuning yourself to the relationship. Now, at that point, and again to the thing from this episode that we seem to have veered really far off from is when we get to those points, and it's still not working out? Is it time for a premature therapeutic sort of termination? Can I help a client in that situation? Yes. Can everybody okay, I would like to think everybody has the capability to know. But if you feel that it is interfering with yourself so much before you get to the point of referring out clients for you feel that the mismatch is so great, ethically, what you're going to want to do is have some really in depth consultations, that some clinical supervision from some people that are not going to just be part of a Facebook group that you're only able to explain, you know, in a few sentences, what's going on. And the chorus of commenters is going to, you know, give you seven or eight words as far as what you should do, but pay for a good consultation around how to manage it, and document that consultation. Not in the client chart, though, not in the client chart, but protect yourself in your process notes that you've explored the ways that this impact could be happening with the client. So that way, it's not just a rash decision, that this is part of the extra workout side of the session that makes you as a better therapist that can lead to trying to provide space for a client to grow. If the results of that consultation are Yeah, you should probably refer this person out, you've got some better community understanding and thought process that goes into it. But if there's space for you to work on and address through some of these issues with clients, depending on whatever specific content it is, with whatever it is that they're bringing up. premature termination at that point, falls more into bad therapy than it does to providing a good space for them. Katie Vernoy 24:18 Making that assessment I think, can be tough, and I want to get to that. But I want to talk about one more mismatch that I think is actually not as interesting as what we've been talking about. But I think it is an important one to put in there. And then maybe we can talk about how to make the assessment because I think making the assessment and then having really good consultation, I think can be very important. But the other mismatch really is style or personality. You know, whether you're a directive therapist, a non directive, therapist, those types of things, I think that those, they actually make a big difference. And I've had clients where they've been able to give me the feedback and I can shift and be less more or less directive. But I think there's some of us that are just more or less directive. Again, oftentimes when clients are empowered, they opt out themselves. So you're not doing this premature termination. But I think it is important to talk about it just a little bit. Curt Widhalm 25:12 Absolutely. And as somebody who does far more to the directive side of things, I tend to advertise to my community, the people who come to work with me, they know that I tend to be more directive more honest in the way that I put myself out there, then maybe some of their other therapeutic experiences, clients who want that, and the values that we put forward here, our work is put your values out there, let clients self select into this kind of stuff. Katie Vernoy 25:45 But sometimes clients don't know they operate in because they think it's a good match. But then you can see them either pushing back against you being directive or shutting down. And I think I think the assessment becomes the clinicians responsibility if the client isn't understanding that that's what the problem is. Curt Widhalm 26:06 And so those directive therapists out there in this situation would likely have very little problem directing that conversation to that particular problem. Katie Vernoy 26:15 The opposite, though, I've seen where the non directive therapists kind of stay in therapy with some of these clients forever, and maybe this is you and I bias because we're both more directive. But I've had clients that didn't realize that they wanted more than they were getting, and I think non directive therapy can be hugely beneficial for some folks. Absolutely. But for for clients that want more, if they don't know that that's the case, how do we recommend that non directive therapists try to figure that out? Curt Widhalm 26:45 I'm gonna be totally biased towards the directive end of things. It's creating the space for that discussion, and really saying, personality wise, that's just not who I am. I can't provide what you're looking for in this situation. That is a really good conversation to have with people, because it's either going to lead into Yeah, but I still like you, as the therapist. Yeah. But what you're asking for is not something that I can really do or be like, you're asking a tiger to change it stripes like, yeah, at that point, it's being able to then have a proper termination, even if it's incomplete towards therapy goals in order to help those clients get matched with somebody who is going to be able to provide what they want. Katie Vernoy 27:38 I think the knowledge that's required for that conversation, maybe some that either the clients asking for more, the therapist is recognizing that the style isn't matching up. I think sometimes that's not evident. I think people typically can kind of flow together. And if the style is a mismatch, sometimes that's not identified. But I think what can be identifiable? is lack of progress on treatment goals, or stagnation on treatment goals, or the Hey, how are you doing very little going on in the therapy session, that I think therapists, as a matter, of course, should assess progress on treatment goals, and be able to identify that there are a few different things and they want to assess if therapy doesn't seem to be moving forward. Curt Widhalm 28:23 And some of the ways that you can manage that is making sure that you go back and revisit your treatment plan with your clients every so often. And I know that that's a, I was gonna say, a lot more popular in DMH work, but I don't know that popular is the right word that Katie Vernoy 28:39 consistent usually requires. Wire. Yeah, that's probably best. Curt Widhalm 28:46 But for independent practice, doctors, practitioners who aren't, you know, as adherent to those kinds of contracts or rules that require you to go back to those treatment plans, do it anyway. So that way, these kinds of things can emerge sooner and have conversations with your clients about, hey, we're not making any progress towards this goal. What's going on with this? That does allow for the are we doing things right? Is this something that you would get this better out of treatment with somebody else that makes it more of a joint decision, rather than just the therapist being the all knowing or all scared of having to have that conversation with a client, that honest relationship, there's typically really helpful. Katie Vernoy 29:41 And when you were talking about that, I was remembering a conversation we had really early on in the podcast with Dr. Melissa Hall. I think it's making your documentation meaningful or meaningful documentation, something like that. But she actually really talks about the clinical loop and how making that a regular part of your process helps you close And I play but it also opens this conversation for folks who aren't quite sure what's not working. Because I think when you're documenting and paying attention, I think that can be very helpful. So we've talked about a lot of different things, I think there's, you know, we could go more into a client not making clinical progress as a reason to potentially prematurely terminate. Curt Widhalm 30:22 I do want to bring up though that man, sometimes building off of last week's conversation around some of these therapy interfering behaviors, there may be times when even examining it through that lens, when you've consistently had these conversations with clients that you've sought the outside consultation, you've documented that the clients continue to break more egregious boundaries, but maybe not to the threatening level of the ones that were discussed in our first episode on firing clients ethically. And these are things where it might be breaking boundaries outside of sessions showing up to your office and hanging out way too long disrupting behaviors in the waiting room that you know, maybe couples who start their arguments in the waiting room that are interfering, the session that you're having and stuff like that, yeah, where those types of behaviors are things that are impacting other people in your practice, that weren't really straightforward boundary conversations that if they continue to happen, are things that you continue to bring them up if those conversations that were used suggested last week in the podcast about how this impacts things, and there is a an active refusal to follow those are acknowledge that those are even problematic behaviors that are impacting you, and especially other clients, that can be a cause that you should very much document quite well, as far as you're welcome to services, not in this way. And if these are things that are coming up, here are appropriate referrals that, you know, we've talked about in termination episodes before being able to provide, these are behaviors that you're demonstrating pair impacting me, we have tried to work on them, they are continuing to impact me in a way where I can no longer serve you. I have sought out consultation, I am working on this. And it is agreed that I am going to cause you more harm. Because of the feelings that are developing, then I can benefit you from this point. That is inappropriate referral. And that is inappropriate termination. They're Katie Vernoy 32:49 the things that come to mind for me, if I don't have the capacity, and that could be strong clinical expertise. But it also could be time I had a client that I had to refer out because they needed more than I had time to take care of Sure. If they if the relationship is not one, that there would be an element of abandonment, the feeling of abandonment, abandonment is different than the abandonment of just saying today was your last session, audios. The treatment Alliance and we talked about this a lot in both of these episodes. But if the treatment Alliance is strong, there may be things that could be overcome that in other situations, it would be recommended to refer out. But I come back to something that I think is going to be very rampant right now, especially for certain types of specialties and certain types of things is the availability of more suitable resources. And so maybe as our last point, because we are getting pretty long here. But as our last point talking about, I've made the assessment, I've done the consultation, I've had the conversation with the client, I am unable to keep the client ethically, legally, logistically, whatever it is, and I'm having a hard time finding suitable resources to refer them to. At that point, some people keep clients. And I think that there are pros and cons there. But what is our responsibility? If there are just no therapists that are capable of helping this client? Curt Widhalm 34:26 I think with the accessibility of telehealth now that this is much less of a problem than it has historically been that with providers in every jurisdiction now able to provide telehealth easily that this is going to be where, especially in the private practice end of things, those referrals are more easily found. Hired, indeed higher severity clients, those being sought out through things like DMH you're going to have agency policies that you're going to have to follow in those situations but To give maybe an anticlimactic answer, I don't think that this is as big of a problem here in 2021, as it has historically been described, there, lots of referrals out there, there are clients and therapists who can match across distances now. And that's, you know, one of the things that being more digitally accessible helps to alleviate some of these issues when it does come to providing care for these kinds of clients. Katie Vernoy 35:30 So basically, the answer was, I'm not going to answer you, okay, because it's not that big of a problem. Curt Widhalm 35:37 Pretty much. Katie Vernoy 35:39 So I'm going to actually just put us put my spin on it, because I do think it actually is still a problem. But I think the problem is not more, is there any available resource? It's, is there an acceptable resource to the client? Because oftentimes, it does mean having a therapist who is telehealth and they want to be in person or someone who is not maybe as close of a personality fit but has a specialty and doesn't take their insurance. I mean, there there are some issues here. And I think it's something where, and maybe you can correct me if I'm wrong, in good faith, providing as many as close good enough referrals to this client as you can and trying to do what you can to do some linkage is sufficient. Yeah. Okay. Curt Widhalm 36:28 You should let us know what you think of this episodes, especially in our Facebook group, the modern therapist, group or on any of our social media. You can also leave us a rating and review and we'll include our show notes over at MTSGpodcast.com. Also, there is still like, hours left for you to be able to get your virtual therapy, reimagined 2021 tickets. We are going entirely virtual again this year, we had hoped to have some people come out and join us in Los Angeles, but enter in the meme of my fall plans and delta variant. Yes, but there's still time you can get those tickets over at therapy reimagined conference calm. And until next time, I'm Curt Widhalm with Katie Vernoy. SimplePractice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use SimplePractice to power telehealth sessions schedule appointments, file insurance claims market, their practice and so much more. All on one HIPAA compliant platform. Katie Vernoy 37:37 Get your first two months of SimplePractice for the price of one when you sign up for an account today. This is collusive offer is valid for new customers only. Please note that we are a paid affiliate for a SimplePractice so we'll have a little bit of money in our pocket. If you sign up at this link. Simplepractice.com/therapy reimagined. And that's where you can learn more. Curt Widhalm 37:57 This episode is also sponsored by RevKey. Katie Vernoy 38:01 RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services. RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. Curt Widhalm 38:25 You'll never receive a data dump report that means nothing to you. Instead, red key provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. Katie Vernoy 38:42 You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener Announcer 38:48 Thank you for listening to the Modern Therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
Federal Trade Commission's (FTC's) https://r20.rs6.net/tn.jsp?f=001DmoQmZGawGFuIrtFSsppf_qjr-ms8700xt7tFnTAeFWg6WAYvOfQH6NmUt0XXq5SVg5ngdHQ3LV_f3OXUbBTgOgApWaSL0xw0H_LdDT7W5Xqam6nWCeTwBlXArhPwGKXHHXjOM09O17LJbsw9OlAKf06gxgn2Yn4O9lrKQneYVhfnmNA3qxl77jeLOjMxRk4xQh_GEYyW8DHDVkxADYJYY-PFI3Uo3HtGsDm_9WPF0dhAHhxEEAYJbatvYatn1VmsHwOHqqhkLhDGkxtIJHLnvs6jb6GUPXLPJuNN9gEa2m2jvieCHNri0IM0AuEl_3w_9-vh27puIw=&c=gNSKdKi7IxJnC9qBDlXigimvpt1enw9pgGSiRkknrlzLPDQ_1DwqSQ==&ch=F8np4XgtAaV0q_qqp41F0Vt-ynhOQn0fqLtk6Ys6WsAVvWgiViFgkA== (statement) from Sept. 15, 2021 clarifying the definition of a personal health record under its Health Breach Notification Rule to include third-party apps and the FTC's intent to hold non-HIPAA covered third-parties responsible for the disclosure of that personal health information. This is good right. Well, like everything in the world there are always tradeoffs. We explore the tradeoffs on today's show.
Ask Kati Anything ep.78 - Kati Morton's Mental Health & Psychology Podcast1 (0:48) What's the best way to build self esteem after years of emotional and physical abuse? I was abused as a child and it feels like no matter how hard I try, my inner monologue/strongly held beliefs always...2 (18:43) Did going to school to be a therapist bring things up for you? I just started my program and I'm loving it, but I've noticed that a lot of people in my program are struggling to an...3 (24:17) Is it possible for someone with narcissistic personality disorder to be aware they have the disorder? It seems like a lot of therapists...4 (30:44) Have your clients ever gotten mad or angry at you during a session? If so, do you ever get frustrated with them/ not want to work with them anymore? How would you go about it?5 (38:29) In my last session with my therapist, she told me something that my mom told her. My mom doesn't believe I was molested by my brother. Her exact words were “my brother and I used to be...6 (45:21) I've been suicidal for two years and there's only been a few days when my severe depression and suicidality lifted a little bit. What would you say to someone who really, really doesn't want to live...7 (51:45) Recently my therapist was talking about finding a way to release all the anger I have towards my childhood, not having the life I wanted and anger towards the ...8 (57:11) I was reading up on HIPAA for school recently and was wondering: why can patients be denied access to their psychotherapy notes? It seems unproductive if we can't ...9 (1:02:34) What is your take on those who believe mental illness isn't real? Any reasons you've heard to try and prove this statement? I've heard a few different arguments but ...10 (1:06:45) Before I ask my question, I wanted to say thank you to you and Sean for putting in the time to do AKA. I think it helps a lot of us feel heard and validated, and helps ...Video version of episodes https://youtu.be/WG-j4vtcYIsKati's Amazon Suggestions https://www.amazon.com/shop/katimortonONLINE THERAPYI do not currently offer online therapy. My sponsor BetterHelp can connect you with a licensed, online counselor, please visit: https://betterhelp.com/katiPATREON https://www.katimorton.com/kati-morton-patreon/Opinions That Don't Matter!video https://www.youtube.com/channel/UCs58xfxPpjVARRuwjH8usfwaudio https://opionstdm.buzzsprout.com/EMAIL email@example.comMAIL 1779 Wells Branch Pkwy #110B, Box #353 Austin, TX 78728My new book TRAUMATIZED is available for preorder! Order your copy today https://geni.us/Bfak0jSupport the show (https://www.patreon.com/katimorton)
Ask Kati Anything ep.78 - Kati Morton's Mental Health & Psychology Podcast1 (0:48) What's the best way to build self esteem after years of emotional and physical abuse? I was abused as a child and it feels like no matter how hard I try, my inner monologue/strongly held beliefs always... 2 (18:43) Did going to school to be a therapist bring things up for you? I just started my program and I'm loving it, but I've noticed that a lot of people in my program are struggling to an...3 (24:17) Is it possible for someone with narcissistic personality disorder to be aware they have the disorder? It seems like a lot of therapists...4 (30:44) Have your clients ever gotten mad or angry at you during a session? If so, do you ever get frustrated with them/ not want to work with them anymore? How would you go about it? 5 (38:29) In my last session with my therapist, she told me something that my mom told her. My mom doesn't believe I was molested by my brother. Her exact words were “my brother and I used to be...6 (45:21) I've been suicidal for two years and there's only been a few days when my severe depression and suicidality lifted a little bit. What would you say to someone who really, really doesn't want to live...7 (51:45) Recently my therapist was talking about finding a way to release all the anger I have towards my childhood, not having the life I wanted and anger towards the ...8 (57:11) I was reading up on HIPAA for school recently and was wondering: why can patients be denied access to their psychotherapy notes? It seems unproductive if we can't ...9 (1:02:34) What is your take on those who believe mental illness isn't real? Any reasons you've heard to try and prove this statement? I've heard a few different arguments but ...10 (1:06:45) Before I ask my question, I wanted to say thank you to you and Sean for putting in the time to do AKA. I think it helps a lot of us feel heard and validated, and helps ...Video version of episodes https://youtu.be/WG-j4vtcYIsKati's Amazon Suggestions https://www.amazon.com/shop/katimortonONLINE THERAPYI do not currently offer online therapy. My sponsor BetterHelp can connect you with a licensed, online counselor, please visit: https://betterhelp.com/katiPATREON https://www.katimorton.com/kati-morton-patreon/Opinions That Don't Matter!video https://www.youtube.com/channel/UCs58xfxPpjVARRuwjH8usfwaudio https://opionstdm.buzzsprout.com/EMAIL firstname.lastname@example.orgMAIL 1779 Wells Branch Pkwy #110B, Box #353 Austin, TX 78728My new book TRAUMATIZED is available for preorder! Order your copy today https://geni.us/Bfak0jSupport the show (https://www.patreon.com/katimorton)
In this episode, we are joined by Bryan Oram, AVP of Strategic Healthcare at Podium, as he discusses where a healthcare practice should start first when implementing texting, what critical actions should be moved to texting, how texting can help providers get more reviews, and how texting can play by HIPAA rules.This episode is sponsored by Podium.
You know how we love to pass along guides and resources that can help you improve your organization's privacy and security programs. Today, we are going to review a recent resource guide put out by HHS' ASPR TRACIE office called Healthcare System Cybersecurity - Readiness and Response Considerations. This guide is packed with very helpful tips, best practices, and resources surrounding cybersecurity and responding to cyber incidents. And it's FREE! More info at HelpMeWithHIPAA.com/322
My guest today is Justin Waldron, co-founder and President of Playco. Justin is a pioneer of the social gaming industry after he co-founded Zynga at age 19, and he has continued to build games ever since. In our conversation, we cover how Justin sees the future of gaming as social platforms evolve, how gaming may be the next tool for content creation, and how Playco has approached aligning incentives for game creators and players. As talk of the metaverse becomes more mainstream, it's fascinating to hear directly from those around it. I hope you enjoy my conversation with Justin Waldron. For the full show notes, transcript, and links to mentioned content, check out the episode page here. ----- This episode is brought to you by Klaviyo. Klaviyo is the ultimate marketing platform for e-commerce. With targeted segmentation, email automation, SMS marketing, and more, Klaviyo helps you create your ideal customer experience. See why brands like Living Proof, Solo Stove, and Nomad trust Klaviyo to grow their business. For a free trial, check out klaviyo.com/founders. ----- This episode is brought to you by Vanta. Vanta has built software that makes it easier to get and maintain your SOC 2, HIPAA or ISO 27001 reports at a fraction of the typical cost. Founder's Field Guide listeners can redeem a $1k off coupon at vanta.com/patrick. ----- Founder's Field Guide is a property of Colossus, Inc. For more episodes of Founder's Field Guide, visit joincolossus.com/episodes. Stay up to date on all our podcasts by signing up to Colossus Weekly, our quick dive every Sunday highlighting the top business and investing concepts from our podcasts and the best of what we read that week. Sign up here. Follow us on Twitter: @patrick_oshag | @JoinColossus Show Notes [00:02:47] - [First question] - His thoughts on the metaverse and why it's so interesting [00:06:07] - The ways hardware and software will shape the future of digital worlds [00:08:23] - Examples of how these digital experiences might look in the years to come [00:10:45] - His background, history, and his life before founding Playco [00:16:31] - Ways content creates human interactions and its role in user retention [00:18:43] - How successful social media platforms encourage user interaction [00:20:51] - Games becoming a way to create content and being a creation tool [00:23:06] - This history of user-generated content for pre-existing games [00:27:32] - Defining what instant gaming is and how it's different from traditional gaming [00:30:24] - The technological problems and hurdles in creating games that load instantly [00:34:00] - Parallels between instant gaming and cloud-powered processing [00:36:43] - What types of games are most desirable for games shared via links [00:38:58] - The feel of this model working in real-time and the project that's furthest along [00:41:37] - Lessons learned about working with and structuring partnerships with social media and content creation giants [00:45:06] - Ways in which social network platforms are evolving [00:48:04] - Playco's business model and smart approaches to generating revenue [00:50:28] - The role NFTs might play in instant gaming and making crypto mainstream [00:53:03] - Crypto wallets and building one in house versus using a 3rd party wallet [00:54:17] - What the best case scenario will look like for Playco in a decade from now [01:00:44] - Other companies to go check out that leverage and empower individuals
RESIDENT SCRAMBLE! All the residents are with new attendings. It messes a lot up. Arizona fucks it up by telling Jackson about April's pregnancy. She betrays not only her trust...but HIPAA?? Greys Discussion: 16:18 www.patreon.com/theoncallroom
I work with dental offices and do a lot of dental inspections/consults. I help people identify what they need to do differently. We talk through OSHA, HIPAA, infection control, radiology, medications, state board compliance, etc. But I get really excited about infection control and sterilization. That's my stage—my moment to shine. In this episode of Talking with the Toothcop, we're going to talk about instrument processing and cleaning procedures. Find out what you could be doing wrong and what to do instead! Outline of This Episode [0:49] Time to redo the 75 Hard Challenge! [6:00] Check out ProEdge Dental at https://proedgedental.com/toothcop! [7:16] What a sterilization room should look like [10:46] Don't neglect monitoring your ultrasonic [14:37] Follow manufacturers instructions for use [16:45] Other things to note when using your ultrasonic [20:20] Learn more about protectIt dental at https://dentalcompliance.com/drugkit [21:46] Check out the 2021 Dental Compliance Bootcamp! What a sterilization room should look like I've seen thousands of sterilizations rooms. Some are great, some are poorly designed, and some just don't shock me anymore. What should it look like? It needs to be physically segregated into different areas for instrument receiving and cleaning, decontamination, preparation and packaging, sterilization, and storage. There needs to be a “cleaned” area and a dirty area. I can't tell you how often I see cross-contamination issues. When you bring the instruments into sterilization, the rest of the processes need to move in one direction. If you move in the opposite direction, you're contaminating what's supposed to be sterile. Don't neglect monitoring your ultrasonic A sterilization area contains two major processes: instrument cleaning and sterilization. If you don't do one part right, it impacts the entire process. There are monitors in place for the sterilizer, color-changing indicators on instrument peel-pouches, and indicator tape on instrument cassettes. They give us visual confirmation of whether or not the sterilization process worked. People often monitor the sterilization indicators but neglect the cleaning side of the process. You can't just assume the instrument washer or ultrasonic is working effectively. Just because it sounds like it's working properly doesn't mean it is. You need a qualitative test—like a foil test—to make sure that it's working properly. It needs to be done frequently. When those machines fail, they don't sound any different. It is not obvious. I don't love the foil test. What do I prefer instead? An ultrasonic cleaning monitor. It can be ordered through your dental suppliers. Get and use that weekly. Record in your records that it passes inspection. It gives you information on several data points: cavitation, enzyme concentration, and more. Follow manufacturers instructions for use (IFU) Are you using the correct concentration of enzymes in the ultrasonic? More than half of dental offices aren't. Whatever product that you use for ultrasonic enzymes, make sure you follow the manufacturer's instructions for use. People frequently use the wrong concentration, which is why I'm partial to tablets. It's easier to calculate. Secondly, people don't understand the water capacity of the ultrasonic. The box says “one tablet per gallon” so they drop one tablet in, not realizing they have a three-gallon unit. One tablet won't cut it—you're off by a lot. I was in an office last week that had a three-gallon ultrasonic and they were putting in one tablet. According to the IFU, they were supposed to be using two tablets per gallon. They should have been using six tablets total! What's an easy way to track this? Buy a label maker and print the name of the product and the number of tablets/ounces required each time you fill an ultrasonic. Other things to note when using your ultrasonic What else do you need to focus on? Run the ultrasonic with the cover on. When the cover is not in place, you're spewing aerosols of biohazards into the air. If you don't have a cover, get a replacement. Anything that has moveable parts or hinges must be in the open position before it goes in the ultrasonic. If you're not doing this, bioburden accumulates in the jaw or hinge. Those parts must be exposed to be adequately cleaned and sterilized. Cleaning time is important and it varies per dental instrument. Review the IFUs for each individual piece you have as well as peel-pouches and instrument cassettes. If you run the instruments and find when you're rinsing them that they're still dirty, what do you do? Run the cycle again. Fight the urge to manually scrub instruments. You will never do as good of a job as the instrument washer/ultrasonic. Tune in next week for part II—the sterilization process! Resources & People Mentioned Check out the 75 Hard Program Ultrasonic Cleaning Monitor Check out the 2021 Dental Compliance Bootcamp! Check out ProEdge Dental at https://proedgedental.com/toothcop! Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube
Shelly Avery is a member of Microsoft's Healthcare Solution Acceleration Team, helping Healthcare customers digitally transform their businesses. As you listen to this conversation you'll realize, as we did, that Shelly knows the tech AND the human side of the tech very well! References in this episode: FHIR Tom Scott - There is No Algorithm for Truth Episode Timeline: 4:30 - The high value of customization and integrations in BI in the current era of Middleware, Microsoft Teams and how good it is at connecting humans, The speed of Innovation at MS (some of which is directly customer influenced) 32:10 - Microsoft's FHIR (Fast Healthcare Interoperability) is revolutionizing the rather large problem of interoperability in the Healthcare space 49:30 - Microsoft Viva is born from My Analytics, Rob gets into Headspace, using data for nefarious purposes Episode Transcript: Rob Collie (00:00:00): Hello friends. Today's guest is Shelly Avery. We've had a lot of Microsoft employees on the show and Shelley continues that tradition. The reason we have that tradition is because there are so many interesting things going on at Microsoft these days. And Shelley brought some super fascinating topics and perspectives to our conversation. For instance, she has a deep background and history with the Teams product for Microsoft. And so we got into the question of what is it that makes Teams so special? I really, really, really appreciated and enjoyed her answer. Rob Collie (00:00:31): And given her current focus on the healthcare industry and on health solutions, we talked a lot about how Microsoft's business applications and Power Platform strategy is actually a perfect fit for what's going on in healthcare today. We did touch on some familiar themes there, such as the new era of middleware, how a 99% solution to a problem is often a 0% solution to a problem. How even 100% of a solution itself is a moving target. And my only slightly partisan opinion that may be Microsoft's competitors in all of these spaces should just save themselves the trouble and tap out now. We talk about the virtual teams that exist on the Teams team at Microsoft. Sorry, I just had to work that into the intro. Rob Collie (00:01:17): I learned a new acronym, FHIR, which is the new upcoming regulatory and technological standard for data interoperability in the healthcare space. We talk a little bit about Veeva. Have you heard of Veeva? I hadn't. It's one of those technologies with a tremendous amount of potential to be used in a positive way and maybe a little bit of potential to be misused if we're not careful. And that conversation was also the excuse for our first ever sound effects here on the Raw Data Podcast. We spared no expense. An iPhone was held very close to a microphone. All in all, just a delightful conversation. I smiled the whole time. We also had the ever upbeat and awesome Krissy in the co-pilot's chair for the duration of this conversation. And with that completely unintentional rhyme out of the way, let's get into it. Announcer (00:02:04): Ladies and gentlemen, may I have your attention please? Rob Collie (00:02:11): This is the Raw Data by P3 Adaptive Podcast, with your host, Rob Collie. Find out what the experts at P3 Adaptive can do for your business. Just go to p3adaptive.com. Raw Data by P3 Adaptive is data with the human element. Welcome to the show. Shelly Avery, how are you doing this morning? Shelly Avery (00:02:35): Hey guys, doing good today. Rob Collie (00:02:37): Well, thanks so much for being here. Another brave soul, first time meeting us. You're willing to have it recorded. That's into the breach. I like it. Shelly Avery (00:02:45): It's good to meet you guys. I'm happy to talk to you today. Rob Collie (00:02:48): We brought Krissy today. Krissy Dyess (00:02:49): How's everybody doing? Rob Collie (00:02:51): How are you Krissy? I mean, it's earlier your time. Krissy Dyess (00:02:53): It is early. Yeah. So normally we do these in the afternoon, but it's early. I'm enjoying the sunrise this morning. Rob Collie (00:03:00): Oh, fantastic. Krissy Dyess (00:03:00): Doing good. Rob Collie (00:03:01): Yeah. A cup of joe, maybe. Krissy Dyess (00:03:03): I don't drink coffee. Shelly Avery (00:03:04): I've had two today. Rob Collie (00:03:05): Shelly, I actually already noticed that. I had noticed before we started recording that the color of your coffee cup changed. That, yeah, she just hot swaps the coffee. Shelly Avery (00:03:16): Travel mug to drop off the kids this morning and then real mug once I got back to the home office. Rob Collie (00:03:22): So Shelly, why don't you tell us what you're doing these days. Give us your CV. Shelly Avery (00:03:25): I am at Microsoft now. I am in a new role that Microsoft has created. I am on a team that is called the Healthcare Solution Acceleration team. And our job is to really help our healthcare customers digitally transform their businesses, hopefully using Microsoft technology. But I've been here five years. I started as a technical specialist, helping customers migrate from on-premise server base infrastructure to Office 365, Exchange and SharePoint in OneDrive. And then Microsoft Teams came around because it wasn't around. It didn't exist when I started, and I became a Microsoft Teams technical specialist. I thoroughly enjoyed it. I loved it. Shelly Avery (00:04:12): Teams has really empowered the world to figure out how to do work different. It created lots of opportunities for people to create new ways of solving their business problems. And it was a lot of fun to be able to partner with our customers and really help them understand how technology can be an advocate for them and just help them do things faster and more efficiently and on their own terms. And so that was super fun, especially working with healthcare. I learned through that about some other features that Microsoft had, not that I didn't know, they didn't exist, but Power Platform, Power BI, Power Automate, Power Apps, and then later Power Virtual Agents. Shelly Avery (00:05:00): And using those inside of the UI of Microsoft Teams to even further enhance what Teams does, which is communication and collaboration, but then putting apps, low-code, no-code apps, and BI and data at the fingertips of these individuals to really, really step up their game and how they're solving their business problems. It's just been super fun and I thoroughly enjoy it. And so taking all of that into my new role, specifically working with healthcare and trying to help them accelerate solutions in their organization to solve their business problems. I thoroughly enjoy what I do every day. Rob Collie (00:05:41): Do you think that your recent background in Teams was a selection criteria for going into health? It would really seem to me like that strong basis in Teams is really quite an asset for you in the healthcare specific role. Shelly Avery (00:05:55): Well, I of course would love to say yes. And I think it is for me, that's how I learned. It's a background that I feel like I'm an asset to my customers, but my new team is comprised of people from all different backgrounds. And so what our new team hopes to be is people who are deep in various different technology areas so that we can lean on each other's expertise when a solution isn't bound by Microsoft Teams. So maybe we need to create a bot in Azure and build it off of a SQL database and put it in Teams. And so we're crossing the entire Microsoft stack. And so, yes, I'm deep in Office 365 and Teams and getting much better into the Power Platform, but as soon as I need to build a bot in Azure, I'm like, "What, how do I do that?" Shelly Avery (00:06:59): So I need that other person on my team who is deep in that area. We're here with you guys. I know y'all are deep in Power BI. We have data scientists on our team and experts in Power BI, which I am not that, but I leverage them because when I talk to my customers, they want to create dashboards and reports that they can have actionable insights on. And so I understand the use case or the problem they're trying to solve. And then I work with my data scientists on the team to help. We come together and bring our skills together to help the customer. So it's just a super fun team. We all geek out in our own area. Rob Collie (00:07:38): Yeah. I mean, it is really a perfect little microcosm of what Microsoft is trying to do with the Power Platform in general. Isn't it? Years ago when they renamed, they Microsoft renamed the Data Insights Summit to be the Business Applications Summit, it wasn't really clear what was going on. There just seemed like one of those funky Microsoft renames. You know how Microsoft changes the acronyms for all you folks in the field, every 18 months, just for yucks. It seemed like one of those, but no, that wasn't it at all, right? There actually was a really long-term grand plan that was already clear behind the scenes there, that just wasn't really clear on the outside. Rob Collie (00:08:18): And all of these technologies coming together, the low-code, no-code or rapid development, whatever you want to call it, right? All of these tools, they enable something to come to life that every single environment, every single customer is different and their needs are different. Their fundamental technological systems that they use, all their mind of business applications, all of those are different and unique. They're unique mix. Plus then you add in the unique challenges that are going on in their particular environment. Rob Collie (00:08:45): You want something off the shelf, but at the same time, if it's not incredibly flexible, if it's not incredibly customizable, it's never ever, ever going to meet the needs of that reality. And I think Microsoft has one of the strongest long-term bets I've ever seen Microsoft make. And it's been really interesting to see it come into focus over the years. Shelly Avery (00:09:06): I'm glad you see that and a lot of people do, but we have a lot of customers. I keep saying health because that's who I work with, that there are health care pointed solutions that are out there that have a single purpose and they are off the shelf. And they do usually do a great job at what they do, but they only do one thing. And we find that almost every application or SaaS that they subscribe to or purchase, has to be connected to data or systems or things like that. And then they have 50 different apps all connected to 50 different things, and it becomes complex. And you have service contracts and everything has to be managed. And so we are pushing that we have a turnkey solution. Shelly Avery (00:09:54): We're actually saying the opposite. We have a solution that gets you 80, 85% of the way there, but then that last bit is fully customizable to make it exactly like you want. And so sometimes that's hard to tell a customer that, "Hey, you're going to pay for something and then you have to build it," or, "You have to pay someone else to help you build it." And they have to be able to see the benefit of that to keep costs down and reduce complexity and app sprawl is something that we see a lot. And so being able to streamline that is something that we definitely try to do and help our customers understand the benefit of. Rob Collie (00:10:33): Sometimes 99% rounds to zero. You have a 99% solution to something, but you simply cannot do the last 1%. And a lot of cases, that's just a failure. I think a lot of off the shelf software, even if it got to 99% of what you need, which is a phenomenal number, it's still not doing it. Plus we also got to remember that the 100% target is also not static. Things change. Even if you're 100% today, your needs tomorrow are going to be different. The ability to customize, the ability to create new integrations and new applications, even if they're lightweight within your environment, is an ongoing must. Rob Collie (00:11:16): I think approaching this as a platform while at the same time making that platform very humane, it doesn't require me to sit down and write C-Sharp every single time I need something new, that's just amazing. I think if you zoom back on all of this, it's almost obvious once you know what to look for. All of the individual systems that we buy, and this is even true of our business here at P3. We're, "Best of breed," in terms of all the line of business software that we've adopted. Best of breed, AKA, whatever we stumbled into at that particular point in time. All those little silos, those line of business silos are very competent. Maybe not excellent all the time, but they're very competent at what that silo is supposed to do. Rob Collie (00:11:59): But an overall business environment, an overall team environment doesn't stop at those silos. It's like the whole thing. It's the whole picture. It's the whole organic total across all of those silos. That's where you live. You don't live in one of them. And so integration across them of various flavors. I think we're in this new second or third era of middleware right now. And Microsoft is just so, so, so well positioned in this game. I didn't see this coming. I just woke up one day and went, "Oh, oh my gosh. Look at what my old buddies are up to." Checkmate. It's been really cool to watch. Shelly Avery (00:12:40): Yeah. It's been really awesome to be here and live it. Sometimes when you're in it, you don't see it happening. And then you look back and you say, "Wow, we've come a long way in the last three years or five years." Rob Collie (00:12:52): Yeah. Let's talk about Teams a little bit more before we switch back into health. Shelly Avery (00:12:57): Yeah, sure. Rob Collie (00:12:57): I find the Teams phenomenon to be just fascinating, which is another way of saying that I missed it a little way, right? Back when I worked on the Excel team, every few years whenever office would finish a release, there'd be like this open season of recruiting. People could move around within office, like a passport free zone. You could just go wherever you wanted. I always struggled to get people who had never worked on Excel to come work on Excel. It was scary. Rob Collie (00:13:24): They've been working on things like Outlook or Word or something like that. It's easy to be, "An expert user of Outlook." It's easy to be an expert user of Word. In other words, the difference between the 80th percentile user of those apps and the 99th percentile user of those apps, it's hard to even distinguish. You can't even really tell the difference between them and practical usage. That's not true for Excel though, right? Shelly Avery (00:13:44): Right. Rob Collie (00:13:45): An Excel expert is like a magician compared to an amateur. And so that was really intimidating, I think. That was the fundamental reason why people struggled to take the leap to come to the Excel team. They felt more comfortable where they were, but a pitch I always gave, which were about a 20% success rate, was data fits through a computer really well. A CPU can improve data. It's built for that. Whereas Outlook and Word, even PowerPoint, I've revised my opinion on all of these since then, but this is me in my early 30s. Going, all those other things, those are about ideas, and communication, and collaboration. Rob Collie (00:14:25): And that's all human stuff. And human stuff doesn't really fit through a CPU all that well. It doesn't come out the other side, enriched in the same way that data does it. Hubris in hindsight, right? I said, "There's never an end to how the improvement that can happen in Excel." Whereas something like Outlook or Word, might be essentially nearing its end state. Then comes Teams, right? Teams is the kryptonite to that whole pitch. I hear myself back in the early 2000s, Teams is all about human interaction. I guess that's what it does. Rob Collie (00:15:02): I guess, to me, it's this alien form, Teams has just exploded. People love it. It's everywhere. I mean, this is an impossible question to answer, but I'm going to ask it anyway, because it's fun to do. What is it? Why are people so excited about Teams? For a while there, it's like SharePoint held a fraction of this excitement. It's in a similar spot, the hub for collaboration in the Microsoft ecosystem. It feels like Teams has said, "Here, let me show you what that really looks like." Shelly Avery (00:15:36): Yeah. I'll do my best to try, but this is my opinion. I don't know what anybody else thinks, but I think it takes the best of the consumer world and the best of the enterprise or commercial world and puts it together all in one app. It has things that when you chat with somebody, it's like you're using a text message. So it's no different than, if you're an Apple user, you open your phone and you go to the green text message app or you go to the Teams app and it looks exactly the same. It has gifts and it has reactions, and you can put stickers and memes in there. And so it's super fun. Shelly Avery (00:16:19): But then you take that enterprise and you can also share a OneDrive link or create a meeting or send someone an Outlook invite or whatever. So it takes that enterprise and mushes it with consumerism. And so it's like taking Facebook and LinkedIn and Office and SharePoint and smashing it all into one app. And so you can have fun with it. You can build relationships with your colleagues or even people external to your organization, but then you can also build presentations and dashboards and create, and even use the Power Platform from a low-code dev perspective, right inside of Teams. Shelly Avery (00:17:02): It spans the spectrum of fun to developing brand new stuff. And so everybody can get something out of it and they can use it the way they want to use it for the purpose that they need to work on, whatever they're doing for the day. And so it can be great for various different people in various different ways. Rob Collie (00:17:28): I love that answer. Krissy Dyess (00:17:29): I have a different perspective. I came from a background of data and technical and all of that type of thing, but this Teams, really with everything transitioning to remote in a hurry over the last year, I feel like it really helps with a level of organization and communication and assets that you talked about, Shelly, to centralize all that because in a difference of data coming at you from many places, now we have communications, now we have remote teams. Krissy Dyess (00:18:05): And I love, like you said, it is fun, it's interactive. Here's where I'm struggling a little bit with Teams. I love it, but what is proper Teams etiquette in terms of like meetings and conversations? For example, I'm having a meeting and I don't want to interrupt somebody, so I'm going to put it in the chat. But then sometimes people feel like, well, the chat is still a form of interruption. I see it as a form of participation. And so I think people are still learning how to embrace these tools. Shelly Avery (00:18:38): Yeah. Well, I think that it also comes to culture. Krissy Dyess (00:18:41): Sure. Shelly Avery (00:18:41): And Microsoft has an amazing culture. We have been on a journey through Satya, our CEO, on really changing the culture of inclusivity and a growth mindset. And it's interesting when we interact with customers who don't have a very friendly and open culture. But I think you use it the way it works for you and for the people that you're working with and your culture. So if you're in a small team setting and it's friendly people, you should feel comfortable to use it the way that it makes you feel comfortable. Shelly Avery (00:19:23): But if you're in a quarterly business review with executives, I mean, think about it. If you're going to lunch with your buddies, you're going to act different than if you're going to a formal dinner with executives, right? And so you use the technology in a way that you would use real life. And so if I'm going to lunch with my buddies, I'm going to be cutting up and giving them funny gifts and patting them on the back. And if I'm in a business meeting with executives, I'm going to have my best dress on and my polite manners. So I'm going to act that way in a meeting too. Krissy Dyess (00:19:51): I totally agree with you. I've had the opportunity recently to work with the Microsoft team and I agree there's a completely different culture than what we see, even from my background, even from our culture, I mean, we're all friendly and stuff. Every organization does have their own culture and exactly what you pointed out, even within that organization, there are different levels and cadences. Shelly Avery (00:20:13): Yeah, it's crazy. So I spent the last three years helping IT organizations deploy Microsoft Teams. And I did that in the midst of COVID, in healthcare. So when you say remote work overnight, literally help telecare organizations enable 35,000 individuals for Teams over a weekend. To the question about culture, it was very difficult for some of the IT organizations to say, "Well, what should we allow our users to do?" There's sensitivity that you can set on gifts in a team. You can say, do we want them to be explicit or PG-13 or PG or G? Shelly Avery (00:20:58): And I had one organization that if there was anything to do with a gift that had to do with politics, that was seen offensive, because what if I sent you a Trump gift and you were a Biden person. I mean, how dare you do that? And so that company was very, very sensitive and they would only allow gifts at a G rating. And a G rating were like cartoons and stickers, where other organizations are like, whatever. If you don't like it, don't use it. Shelly Avery (00:21:29): So there's definitely different cultures and different organizations across the country. And so luckily, there are the controls in the back end and the administrative section on those kinds of things. And then for data too, do you want data to be shared externally or do you want people to be able to chat externally or not? And who do they want to be able to chat with? So there's lots of governance and data protection controls in the background. Krissy Dyess (00:21:58): And being a data person, what is really cool about Teams and all these things that you just described is on the backend, all of that stuff is just data. That's why you can control. That's why you can help your organization with these. And I think that's really cool. I am super excited about Teams. I was excited about Power Pivot in Excel, and I was excited with Power BI Desktop, and what you explained too, how it starts to integrate the Power Apps, the bots, all of that into this changing ecosystem of how we work, the ability to bring that from the top level all the way down to the frontline workers, to impact and drive actions, I am super excited about Teams. I can't wait to see how organizations learn more, how that they can adopt these tools, because I think there's so much that people just don't know because it is so new and it's a different way, just like Power BI was. Shelly Avery (00:22:57): I'll give you an example about that. We have this one group inside of Microsoft, it's called the [SLATE 00:23:04] team. And you know how Microsoft is with making acronyms. I have no idea what SLATE actually stands for, but what they do is they work with customers who have a unique idea and they help them build low-code or apps inside a Teams. And they built this one app called the Company Communicator. Basically what it is, is it's like a mass texting app, where I can create a little message and push it out via chat or via a Team to everyone in the organization or to a subset of people. Shelly Avery (00:23:39): And it created a cute little adaptive card where you could put a headline and a picture, and then a little message. After that got so popular, Microsoft built it into the product, right? It started from a customer, it went through a program. It was customer purpose built. Then it got so much organic growth through all of our customers loving this idea of pushing notifications. So we turned it into code and now it's in the product. I think that, that is so cool, how Teams is democratizing the ability for customers to influence product and future releases that now everybody in the world gets to take advantage of. Shelly Avery (00:24:28): So that's another thing that I just, I love about it as a product, but also we call it the Teams team at Microsoft, is they're innovating so fast and I'm just a few months out of that role and I already feel behind. I just saw a blog with what's new in Teams in August. And I'm like, I need to go and read this to make sure I know everything that's new because they just come out with so much new stuff every month. And it closes the gap, Rob, you mentioned earlier, when a product's only 99%, it's really zero. Shelly Avery (00:25:03): I think the bet on Microsoft is, it might be 99% today, but it's probably going to be 100% in a couple of months because we're innovating so fast. And your 99% today, isn't going to be your 99% in six months. And so it's a moving target, not only for the customer, but for Microsoft too. And so we want to catch up with features that are on the backlog, but the backlog just keeps growing and growing. And so the faster we can innovate and build these into the product, we will. Rob Collie (00:25:33): I just feel like if you're watching a really high stakes chess match, which I never do, but imagine that you did, to the untrained eye, this is an even game. And all of a sudden, one of the chess masters just resigned, just tips the king over and says, "Yeah, I've lost." I just feel like as a software industry, we should just take a moment and say, "Hey, Salesforce, all your other, your SAP, do y'all just want to call it, you want to just tip your Kings over, save us all a lot of trouble." I don't even work for Microsoft and I'm looking at this going, "Oh, boy." Remember, I'm not paid to say this. I really think Microsoft has really, really, really dialed it in. Rob Collie (00:26:16): I'd like to also go back to your answer about why Teams is so special. I think it was a perfect answer. Rewind 10 years, 11 years, I'm struggling to explain to people why this whole DAX and tabular data modeling thing that was only present at that time, only in the Excel environment, and only as an add in, it was, in some ways the most primitive exposure possible of this new technology. I was trying to explain to people why this was so special. And it was particularly difficult to explain it to people who had intimately known it's [4Runner 00:26:49], which was the analysis services multi-dimensional. Rob Collie (00:26:52): And really, technologically speaking, there wasn't too much about this new thing that was superior. If you looked that gift horse in the mouth and examined its lines and everything, you'd be like, there's really not much different here or it's clearly better. Now it had one thing that was clearly better, which was the in-memory column oriented compression. And that was pretty sci-fi. That was pretty cool, but it wasn't the tech. It wasn't like one of these was able to make the CPU scream at 500% capacity or something like that. It wasn't that at all. It was that this new tech fit the way humans work so perfectly. It met the humans where they were, whereas the previous one forced the human world to bend to its will. The humans had to come to it and meet it where it was. And this is a very subtle and nuanced point. Rob Collie (00:27:49): But in practice, it is everything. In practice, it means that a company like ours, that operates completely differently than the data consulting firms and BI professional services firms of the past, and really honestly, today, I think most firms are still operating that old way. We're a completely different species of a company. And we exist because these tools work a different way for the humans. And over and over and over again, this is why the ROI from Power BI is so insane when you use it the right way, when you really lean into it strikes. Your explanation about Teams, it echoed that for me. It's professional tool that fits the humans really well. Rob Collie (00:28:36): And you don't typically talk about stuff like that. If you're a technology professional, those kinds of answers, you're always looking for some sort of more hardcore answer. It's capabilities. Look at the check boxes it's got on the box, right? This other description of it fits the humans really well, it's not a good sales pitch, but in reality, it's everything. It's a difficult thing to do, right? Rob Collie (00:28:59): One of its chief strengths is also just, doesn't make a good sound bite or like, oh, okay. So now you have to wait and see it for yourself. You have to experience it. And I think that's what we've seen. Is that the people who've really leaned into Teams, they all have this surprised reaction, or they say, six to 12 months after really getting into it, as they describe how much they like it, there's this undertone of, "Yeah, it's really turned out to be amazing." You can tell that they didn't quite expect it. And now they're a convert. Shelly Avery (00:29:31): Well, I think a lot of IT organizations, they push applications out and Teams to the masses is, oh, it's just another application that IT is forcing us to use. And they're resistant to change because the last app IT pushed out wasn't great. And then they finally get in there and they do what you and I are talking about. They chat in it, they text in it, they meet in it, they have fun in it. And then six months later, they're like, "How did I do my job without this?" They enjoy it. It's easy to use, it's very accommodating and friendly to different personalities and different work types. And it's so unique in the way that you and I and Krissy can all use it all day long, every day, and we use it completely differently, and yet we all have the same opinion of it, is it works great for me. Rob Collie (00:30:30): That's the whole mark of a successful product. And one that spreads itself, right? It develops impassioned evangelists. Again, just like everyone else, I would not have seen that coming. Shelly Avery (00:30:41): You were at Microsoft from an Excel Power Pivot perspective and you now are not, and have started your own business and they're successful in that. I know people that worked at Microsoft and literally quit Microsoft just to be a YouTube star on how awesome Teams is and all the cool stuff you can do with it, and they've made a living out of it because it's a product that does so much and it's never ending in the way that it can be used and how unique it is. It blows me away when I actually saw a gentleman who was at Microsoft as a product manager and I followed him on YouTube, and then one day he said, his YouTube post was, "I am retiring from Microsoft." And he was younger than I am. I'm like, "How are you mean you're retiring?" Krissy Dyess (00:31:32): I followed the same story that you did, Shelly. I know exactly who you're talking about. What I really love, what the appeal of it to me is, is it's always these little things that people don't know that make the biggest impact. And when you're in an environment where you're not exposed to people doing those neat tips and tricks, having the ability of finding somebody out onto YouTube sharing that, and then you can bring it into your organization and start to spread it, it's really impactful because a lot of times people think, "Oh, it needs to be this complicated technical solution." And honestly, it's always the little things that people are like, "Wow, I didn't know I could do that." Shelly Avery (00:32:12): Agreed. Rob Collie (00:32:13): So let's turn the corner. Let's talk about health, Shelly. Where should we start? Shelly Avery (00:32:16): Well, when you were talking earlier about how Microsoft Teams is this new thing, I think people had an aha moment and I think there is an aha moment that is about to come in health. And I'd love to talk about that for a minute. I think it plays into your audience well because it's about data. Rob Collie (00:32:41): Very important question. Are there people involved? Shelly Avery (00:32:43): There are people involved. Rob Collie (00:32:45): Oh, okay then. We're good. We're good. Shelly Avery (00:32:46): Yeah, yeah. Rob Collie (00:32:47): Okay. All right. Shelly Avery (00:32:48): Yeah. There is interoperability of data in health. So think about, from a human perspective, heaven forbid you get in a car accident and you go to an ER and they have to bandage you up. That ER is owned by some health organization and they now have data on you, but it's not the same health organization where you go to see your primary care physician. And so how does your primary care physician know about your ER visit and how do they know what medicines that you were given and whether those had adverse reactions to you or not? Shelly Avery (00:33:22): Well, without interoperability of data, that just doesn't happen. And there is an old version of healthcare interoperability called HL7. Again, another acronym, but the new interoperability standard is called FHIR, Fast Healthcare Interoperability. The idea of FHIR is supposed to be universal so that that ER can digitally transfer that information to your PCP, your primary care physician. And so your medical record and your information can stay up-to-date with all the people that are medically treating you or for even you, like if you move to another city and you want to say, "Hey, I need all my information. I'm going to take it to my new doctor." Shelly Avery (00:34:10): And so this idea of interoperability, it's not a Microsoft thing. It's a healthcare standard that is happening in the industry. But what Microsoft has done is we have gone full steam ahead on this FHIR interoperability and built a stack of technology solutions based on ingesting data through FHIR. And we have a bunch of healthcare APIs, FHIR API being one of them, to now take all those low-code, Power Platform, Microsoft Teams, bots, and hydrate those apps with all of this data from healthcare to now be able to really unleash this data. Shelly Avery (00:35:02): So you need an app to have a rounding solution bedside in a hospital. You now have the ability to suck that data in from Rob, that he's been to the ER and his primary care physician, and now you're in for knee surgery. And so I have all that information that's aggregated from all over, and now it's in this cute little rounding app that we built off of Power Platform, or same thing with Power BI, or a chat bot in Teams. We can chat this health data and say, "Hey, is Rob's labs ready yet?" And the chat bot goes and sucks that data in and says, "Yes, here's Rob's labs. Here's the link to it." Shelly Avery (00:35:44): And so just being able to unleash that and build these apps or bots or experiences for the human to be able to interact with that data is really what we are trying to do. And so I'm super excited about it. This is a new team that I'm on and this is really what we're trying to drive. So I think it's going to be game changer for the industry. Rob Collie (00:36:09): So this is my first time hearing of this new interoperability standard. First of all, FHIR, it sounds cool. I like it. It definitely sounds like it's useful for sharing healthcare and patient information across organizations. Do you also see it as something that's going to be useful even within an organization, like between the silos, between these different systems within a single entity? Shelly Avery (00:36:32): Yes. And it will do that first before it goes across organizations. And- Rob Collie (00:36:37): Okay. Shelly Avery (00:36:38): This is a challenge internally too, because there's software technology that these electronic medical records, that your medical record, my medical records sit in at each of these organizations. And most large healthcare providers have multiple instances of these electronic medical records. Sometimes they have multiple different types through mergers and acquisitions and growth over time, or this department got an upgrade, but the other department didn't. And even amongst themselves, they can't share information with each other. And so if a call center services 10,000 patients, but they have four different electronic medical records, when Rob calls into that call center, how the heck do I know which one you're in and who you are and all that? Shelly Avery (00:37:30): So if we can use this FHIR interoperability to aggregate all of that and have it in a single place, now we've built this great call center app that knows that Rob is calling in and who you are. And I immediately have your information. I could say, "Oh, Rob, are you calling about the meds that you got from your ER visit last week?" It's very personalized. So let's personalize care. Let's have better patient engagement. Let's round with our patients and have the right information where we need it, regardless of where the original data sits. Rob Collie (00:38:01): So it's a new standard, FHIR, right? Shelly Avery (00:38:04): Yes. Rob Collie (00:38:04): And so let's pretend I'm a healthcare organization and I have, again, these, "I've got a best of breed set up." I've got a jillion different siloed line of business systems. Some of them are new, some of them are not. These older systems that I have, they're not going to be playing nice with this new FHIR standard. They haven't even heard of it, that software. So- Shelly Avery (00:38:24): That's correct. Rob Collie (00:38:25): How do I, as an organization, connect those wires when some of my more long-ended two systems aren't going to be supporting the standard natively? Shelly Avery (00:38:36): And that's part of our challenge right now. A lot of the customers that we're talking to, they see the future, they like the vision that Microsoft is painting. They want these human interactions like we're discussing, but they'll say to us, "We aren't ready for FHIR," or, "We haven't made that transition yet." Our comment back to them is we can help you get there. And it is a requirement that they get there by a certain date in the future. So why not have a company like Microsoft help them? Shelly Avery (00:39:11): Now, it's not necessarily an easy task. There are data mappings that have to happen. And a lot of these electronic medical systems are in the old standard, which we can map from the old standard to the new standard. It takes a little bit of manual work, but you only have to do it once, because once you do it once, it's in the standard and now you've unleashed that data. There's also custom fields though. Some developers- Rob Collie (00:39:38): Of course. Shelly Avery (00:39:38): Have gone into these electronic medical records and they built some custom field that doesn't map to FHIR. So then you got to have somebody who knows that. And so there is hard work to do it in the beginning. I'm not trying to say that there isn't, but we do have healthcare interoperability partners, and system integrators, and Microsoft to help these organizations get into that standard. And the new marketed term for all of this is the Microsoft Cloud for Healthcare. Shelly Avery (00:40:10): And so it's all about ingesting that data and then unleashing that data to create these great, either apps or applets, or bots, or scenarios that empower the people who either work at these systems or even for patients to be able to interact with and have better experiences for themselves. And so, you only have to do the hard work once and then it's in there. And so you're right. It isn't a turnkey, there is work that has to be done, but they're going to have to do it eventually. So we'd love to be able to partner with them and help them get to meet those regulatory compliances that are coming in the near future. Rob Collie (00:40:52): Yeah. Another example of where it's good to have a platform, right? Shelly Avery (00:40:55): Right. Rob Collie (00:40:56): If that missing 1% is interoperability, that's a big 1% that a platform like Microsoft is very, very, very prepared to help you connect those dots. It also, it's really helpful that these older systems that we're talking about, if they already had to, as you pointed out, if they already had to play ball with an older interoperability format, that's end sharp contrast to your average line of business software that has no interest in interoperability at all. T Rob Collie (00:41:26): he average line of business system is like, no, no, no, no, no. We are a silo and we like being a silo. And why would we ... Mm-mm (negative), no. We are here to hoard the valuable data that is collected in here. Mm-mm (negative), no. Even though it sounds rightfully like labor intensive, one time investment, compared to the average interoperability game that happens across the world, across all industries, it sounds like there's already a really, really, really strong starting point. That's a big, big, big point in your favor. Plus if it's going to be a regulatory standard in the future, that is unheard either. Shelly Avery (00:42:00): Right. Krissy Dyess (00:42:01): I'm curious though, as to what changed, because honestly, it is one of the reasons why I'm appointment averse, is because every time you go into a different doctor and it's really common for people to move nowadays. And you're like, oh, I got to fill out all the same forms, over and over again. In my mind, I always thought it's somewhere. Why can't it be everywhere? I guess I thought maybe there was some privacy reason that was the blocker. Has something changed there? Shelly Avery (00:42:28): You're absolutely right. And no, there is still what's called the HIPAA regulations. And so the entire Microsoft Cloud for Healthcare is HIPAA compliant. It does meet all of the requirements for that. And so the FHIR standard, FHIR mandate is under that HIPAA compliance. And so that's a U.S. regulation. It's not in the EU or others. They have their alternative to HIPAA around keeping healthcare information protected. And it's important to be able to do that. And so the old HL7 standard of interoperability was highly customizable and the new FHIR standard is less customizable, and that is how it is able to have more liquid interoperability. Shelly Avery (00:43:27): I'll give you an example. Sex and gender are two completely different things. And we know that in this day and age, but in the FHIR standard, there is a born sex and it is one or another, and you can't really change it. But in the HL7, you could add seven or eight or nine or 10 different categories for that. So when you have the FHIR standards met, born sex is a one or a zero, basically. Right now they have the other category of gender that there's a bunch of options there. And then they even have another category. And so it's creating the standard that everyone in healthcare has to meet as opposed to going in and making it where I can make 37 customizations because in my hospital, I allow them to have 37 choices. Shelly Avery (00:44:28): Religion is another one. Religion is huge. I mean, there's endless amounts of religions. In the FHIR standard, there's a set amount and then in other. And so you have to fall into either the set amount or other, and that allows for that more liquid interoperability, or that is the goal. That's the goal of FHIR. Now, I'm getting a little deeper into more of the regulatory compliance and how the standards work. There's tons more deep technical experts on healthcare compliance than I am. I'm more of a technologist than a healthcare compliance expert, but knowing how it works a little bit helps you understand why the technology is empowering or we hope in the future has the potential to empower the industry to be able to do more with this data. Rob Collie (00:45:18): Even that little deep dive there, I mean, that really, for me and for the listeners, you really just certified your bonafides there. If anyone was wondering how deep you were into this stuff. You always got to be careful. You're not the expert on that. There are people who know it much better than you. The fact that you know that much while also being on top about all those other stuff, you're in the right role. Like Holy cow. Shelly Avery (00:45:41): For my role, they did require healthcare expertise. And we have another team that partners with us that actually are folks from the industry. So we have MDs, PhDs, ex-CIOs and nurses with their RNs, from industry that work at Microsoft as the healthcare industry team, that partner with us around more of these deep healthcare needs. And when we're talking to chief medical officers or chief nursing officers, who doesn't like their title to be matched. Shelly Avery (00:46:18): So when we have a chief medical officer like Dr. Rhew at Microsoft, or a chief nursing officer, or ex-CIOs of healthcare organizations to come in and talk to current CIOs, they feel like we're talking to them from their shoes. And so my team partners with that industry team. Not that they aren't technical and don't understand how the technology works, but we are supposed to understand healthcare enough and how the technology fits for those healthcare scenarios and use cases that they need help with. Rob Collie (00:46:52): To use a metaphor, if you're going to build re race cars, it helps to hire some people who drive race cars. Shelly Avery (00:47:00): Exactly. Rob Collie (00:47:00): Right. I've seen this evolution on the Excel team over the years too. There's more and more people on the Excel team who came up not originally as software engineers, but as people in finance and things like that. Whereas I was a computer science major that had to learn Excel in order to work on the Excel team. And so it was, if you populate a team with nothing but me, back then anyway, you end up with a team of mechanics who has no idea what it's like to go into turn three cars ride. I'm using a racing metaphor. I don't even watch racing. I find it incredibly dull, but I love a good metaphor though. Shelly Avery (00:47:40): Sure. Absolutely. I think Microsoft has done that and is continuing to expand that industry team, even our president of health and life sciences comes from the industry. A lot of our leaders from even a marketing perspective or from a product development perspective, they're starting to hire from the industry. Rob Collie (00:48:03): That's wisdom. That's humility. I think 20 years ago, we would've probably seen Microsoft put some up and coming computer science guard in that role. And you still need those people for sure. Someone who grew writing C++ isn't going to know everything that they need to know. It's again, there's this whole notion of collaboration. The thing we keep coming back to. It takes a lifetime to amass the expertise to be truly good at something. Rob Collie (00:48:29): And so, guess what, you're never going to find everything that you need in one person. You're going to need people with different histories in order to be successful. And so it's simple. And yet I don't take it for granted, when I see teams being assembled this way, I've learned to respect it, that it is a necessary and good thing. It's always worth praising even if it seems like it's table stakes. A lot of people don't view it as table stakes. Still, they've got some things to learn. Krissy Dyess (00:48:55): So Teams is empowering, it's a central hub, it's a window into all these other applications, the Power BI that brings the insights, the bots, the Power Apps, the drives actions. Tell me a little bit about the Veeva. I hear about Veeva, that whole human side. Tell me how you're seeing Veeva start to make its way to help balance, I think. Rob Collie (00:49:21): And what is Veeva? Krissy Dyess (00:49:21): Yes. Veeva. Shelly Avery (00:49:23): Yeah, sure. Microsoft Veeva is what we have marketed the name of our employee experience platform. If you're a Microsoft E, you've probably seen in the past years something in Outlook called MyAnalytics. MyAnalytics was the very early stages of what is now Microsoft Veeva. MyAnalytics was a analytics engine that had some AI in it that would give you insights about your day, or your week, or your month. It would tell you, "Hey, Shelly, you were meeting with Krissy like every week for a few weeks and you haven't talked to her in a while. Do you think it's about time to reach out?" And then it will even give you a button that says, chat with Krissy now, or schedule a meeting with Krissy now. Krissy Dyess (00:50:18): And I love that. Shelly Avery (00:50:19): Yeah. It would pop open your calendar- Krissy Dyess (00:50:21): Because I would forget. You have all your lists and you have all your things. And honestly, when those things would come across, I was like, "Oh, yeah, you're right." And I was like, wait a minute. The technology is getting on top of all this stuff that I can't keep track of. It's amazing. Shelly Avery (00:50:34): Yeah. That was the beginning of it. Microsoft also came out with another tool called Workplace Analytics, which was the next step of MyAnalytics, where it would anonymize the data and send it to your manager or to your direct report and it would go up the chain all the way. So if my manager had 10 people on it, he would get a daily or weekly report that said, "Hey, your 10 people, this is what they're doing. They're multitasking in their meetings or they're working after hours. Hey, maybe you should encourage them to close the lid of their laptop at night. Let them have better work-life balance." It provides the manager with insights. Right? Krissy Dyess (00:51:17): That's right. Because these are important. This is important to your overall health of your business, your company, your culture. Shelly Avery (00:51:24): Exactly. So Microsoft Veeva took MyAnalytics and turned it into what is now called Veeva Insights. And then there is Manager Insights and Workplace Insights. And so insights is really just a rebranding and a movement from MyAnalytics in Outlook. And it's now insight of Microsoft Teams. Because Teams has that developer side of it, there's so much more that you can do with that information in Teams than it is within Outlook. And so it gives you nudges also to set focus time on your calendar or set learning time on your calendar, and it updates your status, your green, yellow, red, to focusing or away or things like that. And so it uses AI to help you know maybe when you're overworking or who you might need to collaborate with. Recently, Microsoft made a investment with a meditation company, Headspace. Krissy Dyess (00:52:30): Yes. Yes. See, this speaks to me. I love it. Shelly Avery (00:52:33): Yeah. It's built into Microsoft Veeva. What I use it for is there's a feature called your Virtual Commute. We all used to drive in and drive out of the office and you had, and I forgot about it, but you had that me time in the car. We could listen to a podcast or veg out on the radio or something, but it was some me time while you were in the car, going home from work. And we lost that when we all went remote. It's like I literally shut my computer and then I walk in the kitchen and start cooking dinner. It's like, where is that me time? And so I use the Virtual Commute and I don't use it every day. It's about a five to seven minute decompression. It says, are you ready to wrap up your day? Krissy Dyess (00:53:17): I need this. Shelly Avery (00:53:17): Do you have any last minute emails you need to send? Do you need to create any to-dos? And it integrates with Microsoft to-dos, so you can click on things and say, add to my to-do. And then it walks you through a little meditation. Yeah, Rob's got it on right now. Krissy Dyess (00:53:38): This feels amazing. You just took this conversation to a new place and adding in the music. I'm feeling it. This is just taking work to a new level. Rob Collie (00:53:50): Imagine a world of Raw Data. Data with the human element. Krissy Dyess (00:53:58): No, no. Make it come back. Shelly Avery (00:54:00): Yeah. Krissy Dyess (00:54:00): Oh, no. Can we get that? Rob Collie (00:54:06): I couldn't help it. Krissy Dyess (00:54:08): No. This is what people need. Honestly, when I heard about this, and I'm surprised when I say Veeva, people are like, "What's Veeva?" And I loved your explanation because it gave so much more detail and history, people need this. Think about like, it gives tap it into how long you've been sitting and giving you that balance. This is amazing. Wow. I'm even more excited about this. Shelly Avery (00:54:31): Well, and I think- Krissy Dyess (00:54:33): I think I can make it another 50 years in the work environment now, like [inaudible 00:54:37]. Rob Collie (00:54:37): I said, that was the plutonium battery that you needed. Shelly Avery (00:54:41): Well, and it's so cool because just like there's a Teams team, there's a Veeva team and they are just getting started. They're integrating LinkedIn learning into Veeva learning and all these other learning platforms. So you can learn right in the UI of Teams and you don't have to single sign on and then MFA and forget your password to log into all these other learning tools. And it allows you to share it right inside of Team, say, "Hey, team, I just did this great learning. I think it'd be great for you." Shelly Avery (00:55:11): And customers can upload their own learning modules to it. There's Veeva topics, which is this Wikipedia where it's self-curated information. And what is great, like we've talked about acronyms at Microsoft, every acronym has a topic page now at Microsoft. So anytime you type an acronym, it hyperlinks it. So I'm chatting you in Teams and I say FHIR. And it's like, what the heck is FHIR? You hyperlink it and it gives you an explanation of what FHIR is. Krissy Dyess (00:55:43): That's game changer in itself. Rob Collie (00:55:46): So, does it also pick up pop culture, like if I type IKR, I know, right? And someone else doesn't know what that means. Usually I'm on the receiving end of this. Someone used an acronym yesterday in a chat with me that I'm sitting there going like, "Oh, what new hipsters saying is this?" And it turned out, no, no, no, no, no. That's the customer, Rob. Krissy Dyess (00:56:08): Here's something really weird too. I love this Veeva thing. I love Teams and all this productivity and pulling all the pieces together. Gosh, back in the day, when I moved from back east to Phoenix out west and I started working at the company I was with, they actually had a meditation person that would come in every so often and they would have us stand up and do exercises. And then even to just like little chair massages and it all- Rob Collie (00:56:41): Please continue. Krissy Dyess (00:56:42): Right. Oh, this is just as amazing. I don't even know what track you got, what meditation track, but I just need this in my day. And so many other people do. Rob Collie (00:56:55): Do you see that? I feel compelled to not even hold the phone steady. I have to move it in a circle, a very gentle circle as I play it into the microphone. I didn't even know I was doing that. Shelly Avery (00:57:06): It makes you want to sway. Rob Collie (00:57:11): Yeah. In the middle of the meditation music, you heard my reminder for my next meeting go off. Oh, it really spoiled the mood. Krissy Dyess (00:57:21): And you haven't reviewed that 50 page slide deck. And then- Rob Collie (00:57:25): That's right. Krissy Dyess (00:57:26): Here it goes. Reality comes right back in. You're like, "Oh, okay. Veeva, Veeva, help me." Shelly Avery (00:57:32): I Mean, not to pitch, I'm not selling Veeva anymore. I'm a user of it, but those are also things it does. It gives you alert in the beginning of the day that says, "Hey, Shelly, here's what your day looks like. You got these six meetings. Here's a PowerPoint that you were working on, that might go with this meeting. Do you need to review it?" The Outlook team has also built in, I don't know if you guys have seen this. In Outlook now, you can create 25 minute meetings, 45 minute meetings or 55 minute meetings that either start five minutes late or in five minutes early to give that bio break meeting buffer between meetings. Krissy Dyess (00:58:14): That's right. Shelly Avery (00:58:14): Because when you're fully remote, all I do is sit around and I click the join button all day. I need to go refresh my drink, I need to stand up, I need to stretch. And so, again, we talked about culture at Microsoft earlier, and Satya has been on multiple news outlets talking about how we were the customer zero for Veeva and for this workplace balance. And it's so incredibly crazy to me how much people care about people. It's what we need to do as a human race. We just need to care about people more and allowing technology to play a part in that. It's so cool that we have that. Hopefully organizations take advantage of it for their employees. So more people can have ... It's just the little things- Krissy Dyess (00:59:06): It is the little things. Shelly Avery (00:59:06): You mentioned, Krissy, earlier, it's the little things, like five minute less meetings. It's a sign of respect. Let me use the restroom. Don't be mad at me if I'm not on at the top of the hour. I need two minutes to jump from my last meeting to switch my train of thought to get into the next one. And I think that it's super cool that I get to be a part of a company that's offering that to others. And I hope the rest of the world sees it and gets to take advantage of it. Krissy Dyess (00:59:35): This week, just recently, because I am seeing the five minute grace period, the meetings start five after, but I just, this week, because now people are starting to creep in at 10 after. So it's like everybody expects that five minute because exactly like you said, you're on back-to-back meetings, you don't get a break, but now that five minutes, now it's okay if you're 10 minutes after. Then it's going to be 15. Right? Rob Collie (00:59:59): Yeah. It's like back when I used to teach classes, I would tell people we're going to take a five minute break and we'll resume in 10. Right? Shelly Avery (01:00:08): Yeah. Krissy Dyess (01:00:09): That's right. Rob Collie (01:00:10): But if I tell you it's a 10 minute break, it becomes a 15 minute break. You can't have that. So just say, "Five minute break, but I'll see you in 10 minutes." Krissy Dyess (01:00:17): When I was training, there was no break. So all my students out there- Rob Collie (01:00:20): You just powered through? Krissy Dyess (01:00:22): Because there was so much cool things that I ... I was like, "No breaks. Let's keep going." And they're looking at me. Rob Collie (01:00:28): In the morning, everybody please come in, sit down at a seat that has a book in front of it. And in the bag next to it, is your astronaut diapers for the day. Krissy Dyess (01:00:38): Don't drink water or you might have to go. Rob Collie (01:00:41): Yeah, yeah. We have capitas. Krissy Dyess (01:00:43): I was a different person back then. Now I'm embracing the Veeva and the breaks. I feel sorry for all my students, but that's what I did, because there was so much cool stuff. No breaks. Rob Collie (01:00:52): While we're on this topic, just briefly, this Veeva thing, it seems like one of those technologies that it's not the only thing like it, for sure. But it can be used for good, but it could also be used in a very dark way, if we're not careful. When we were talking to Jen [Stirrup 01:01:08] on a recent podcast, even dashboards reports and things can be used as a form of workplace surveillance. I do see all of the glass half full potential here. Are there any concerns about customers saying, "Yeah, yeah, yeah, we'll use this for the positive, the meditation and the humane," but then they just turn around and roll it out as like the Amazon horror stories of the driver's not allowed to take bathroom breaks. And this is a means of enforcing that. Shelly Avery (01:01:36): Yeah. I think there is fear of that. I mean, I know a ton of people they put duct tape over their cameras and they don't want windows hello because they think the world's spying on them. There are just people that have that fear. Rob Collie (01:01:49): I don't know any of those. Shelly Avery (01:01:51): Yeah. But I think Microsoft is trying to protect customers a little bit in this area, that you are the only one that can see your data. Everything else is anonymous. Now, if you're a team of one and you report to your manager, obviously the manager is going to know it's you or a team of two, there are those things. But as you go up from a manager one to an M two, to a director, to a VP, and then all the way up to HR, unless you're a very, very small company, the data is segregated into demographics, and geographies, and departments, and roles, and skills, and tenure. And they slice and dice that data to learn insights as to how one population is performing or working over another population. Shelly Avery (01:02:42): I think it was one engineering group at Microsoft that was really, really being overworked. Not that they weren't all being overworked. I'm sure everybody is overworked in every position at every company everywhere. But there was this one in particular organization at Microsoft, I think they were putting in like 18 hour days. It was ridiculous. And the feedback they got from these individuals was, "We have to work after hours because we are in meetings all day." And they were individual contributor. They were coders. They needed that three to four hours to get that line of code written or tested or whatever. Shelly Avery (01:03:17): They made a meeting free Wednesdays. They literally wouldn't allow people to have meetings. Now you could collaborate with people and set your own, but no internal or manager type meetings those days. And the productivity of that group after three or four months, just completely changed. And so using the data, that's what the data is meant to be there for. Now, there are people in the world that are just going to make Ponzi schemes. They're just evil people. Data can be used, I'm sure in malicious ways. I think Microsoft is trying their best to make it so they can't be super micromanagement at least down to the individual level. Rob Collie (01:04:02): It's a certainly a very, very challenging frontier for a technology company, right? We're going there as an industry. It's inevitable. It's happening. There's no point in trying to say, "Oh, no, let's put up the firewall here." We're seeing this thing. This goes back to my original, something I said a long time ago in this discussion about how certain things don't go through a computer very well. I think this is one of those examples. We're seeing it with Facebook and YouTube. Technology companies, they're in the position now, these companies, of being the arbiters of truth and there's no algorithm. Rob Collie (01:04:36): There's actually a really great YouTube video, or this one guy in the UK talks about, there is no algorithm for truth, but we've created these platforms that are the primary disseminators of information in the world and they're completely and forever ill equipped to be arbiter of truth. Wow, look at the world that we're in. So, I don't think this particular topic is on that scale. It doesn't have that same reach. I don't think as the other things, but I think it's a cousin of those problems in some ways. It's a more solvable problem, I think, than the Facebook and YouTube problem that we're seeing. But this is where the real stuff is. Is like, how do we deploy these things in a way that is a net benefit to humanity? And not just as a net benefit to shareholders. Shelly Avery (01:05:27): Exactly. Rob Collie (01:05:28): That's attention, especially I think in the United States. It's a very different dynamic like in Europe, for instance. I can imagine the adoption profile of something like Veeva in Europe will be very different than in the USA. Shelly Avery (01:05:40): Well, it will have to meet European standards. European has GDPR around privacy laws. And so there might be different settings or features that can or can't be enabled in a product like Veeva in UK or in Europe to comply with those. Rob Collie (01:05:58): A lot of consumer products in the United States, they have to meet California standards. Shelly Avery (01:06:03): Exactly. Rob Collie (01:06:04): And then because of that, the whole country is California in terms of its standards, because you're manufacturing product. Software's a little different, it can be tuned differently in different places. Shelly, I have really enjoyed this conversation and thank you so much for making the time. You also get a gif of yourself. Why don't have to be mentioned that. Krissy Dyess (01:06:19): A G-I-F not G-I-F-T. Gif. Rob Collie (01:06:22): Right. Not a gift, but it is a gift- Krissy Dyess (01:06:24): It's a gift or a gif. Rob Collie (01:06:29): Or a gif. Yeah. Shelly Avery (01:06:29): Yay. Fun. Rob Collie (01:06:29): Yeah. Krissy Dyess (01:06:29): And you could frame it. Rob Collie (01:06:29): It needs to be a movable frame. We could sell it as a
On this 79th edition of Ask Charlie Anything, Charlie takes the questions you email him at Freedom@Charliekirk.com including: Does HIPAA protect employees from Biden's latest tyrannical overreach? Can conservatives sue our way out of tyrannical overreach? Is Freedom of Movement a Human Right and what would the Founders think of Joe Biden's latest COVID rules? What is a 'Spiral of Silence?' and much, much more. Support the show: http://www.charliekirk.com/support See omnystudio.com/listener for privacy information.
Personalization is the key to creating lasting relationships with patients. And while many were slow to adopt this mindset, most healthcare providers now know what they must do. Engaging today's patients requires knowing and accommodating each patient's communication preferences, personal needs, and healthcare-shopping habits. Providers who deliver personalized experiences are rewarded with more personal patient connections, longer relationships, and increased revenue. Tune in to this episode of Ignite as our guests, CEO, Alex Membrillo, and SVP of Healthcare Marketing, Lauren Leone, discuss personalization best practices while keeping HIPAA compliance. Twitter https://twitter.com/CardinalDM Facebook https://www.facebook.com/CardinalDigitalMarketing LinkedIn https://www.linkedin.com/company/cardinal-digital-marketing/mycompany/
What to do When Clients Get in Their Own Way Curt and Katie chat about what therapy interfering behaviors (TIBs) are and how to address them in therapy. We explore the balance between reducing barriers for clients while also holding them accountable for their behavior. We also talk about how to identify if it is the therapist or the client engaging in a TIB. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: What therapy interfering behaviors (TIBs) are and how TIBs show up in the therapy room. How to address TIBs in therapy (we may disagree a little here). The balance between reducing barriers for clients and holding them accountable. If you should still have session when a client shows up late. Using appropriate self-disclosure to address TIBs. Should you fire clients for TIBs? When therapists engage in TIBs. How to evaluate if it's a client TIB or therapist TIB. Managing imposter syndrome when a client becomes hostile because the therapist cannot provide what the client wants. Our Generous Sponsors: SimplePractice Running a private practice is rewarding, but it can also be demanding. SimplePractice changes that. This practice management solution helps you focus on what's most important—your clients—by simplifying the business side of private practice like billing, scheduling, and even marketing. More than 100,000 professionals use SimplePractice —the leading EHR platform for private practitioners everywhere – to power telehealth sessions, schedule appointments, file insurance claims, communicate with clients, and so much more—all on one HIPAA-compliant platform. Get your first 2 months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Go to simplepractice.com/therapyreimagined to learn more. *Please note that Therapy Reimagined is a paid affiliate of SimplePractice and will receive a little bit of money in our pockets if you sign up using the above link. RevKey RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener. Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Relevant Episodes: How to Fire Your Clients (Ethically) Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2021 Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Full Transcript (autogenerated): Curt Widhalm 00:00 This episode is sponsored by SimplePractice. Katie Vernoy 00:02 Running a private practice is rewarding, but it can also be demanding SimplePractice changes that this practice management solution helps you focus on what's most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing. Curt Widhalm 00:18 Stick around for a special offer at the end of this episode. Katie Vernoy 00:23 This podcast is also sponsored by RevKey. Curt Widhalm 00:26 RevKey is a Google Ads digital ads management and consulting firm that works primarily with therapists digital advertising is all they do, and they know their stuff. When you work with RevKey they help the right patients find you ensuring a higher return on your investment in digital advertising. RevKey offers flexible month to month plans and never locks customers into long term contracts. Katie Vernoy 00:49 Listen at the end of the episode for more information on RevKey. Announcer 00:53 You're listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 01:10 Welcome back Modern Therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all things therapist related what we do with our clients the things that we do, outside of the therapy room, things that we do inside the therapy room. I don't know I'm back to not introducing podcast well. Katie Vernoy 01:34 This is a podcast interfering behavior. Curt Widhalm 01:38 On that note, Katie, do you know what you call an Interrupting cow? No. All right, Dad jokes aside. After our episode on firing your clients, ethically, we got a review on Apple from Apple user, vinyl dash. And I'm going to paraphrase quite a bit of this here. But this is a review that we're actually going to have two episodes of response. So we do appreciate all of the feedback that we get from our modern therapist community here. And we do look at a lot of them. So please give us ratings and reviews. Let us know what we're doing well, what you'd like to see us cover. You can do this on any of the review sites or on our social media join our Facebook group, the modern therapist group. But there is a lot here that came from this review. In response to that episode on firing our clients. Apparently, we miss some opportunities for some nuance, and especially in the case of firing our clients. The only issues that we discussed were when therapists feel unsafe or threatened. True, yes. And maybe we could have done a better job of titling that episode to something about therapists safety and firing clients they're going back to this review as a private practice therapist far more common scenario when considering premature termination comes from what they call in DBT, therapy, interfering behaviors or just repeated boundary violations. And after addressing them in session and attempting to help client gain awareness about these behaviors outside of the therapy relationship. These are far more nuanced situations that don't make this reviewer feel unsafe, but do ultimately make it sometimes impossible to continue seeing the client when the clients are often already struggling with abandonment issues. And this user would like us to maybe address that a little bit more. We're going to have this episode and next week's episodes cover some of the nuance here because we try to keep our episodes here about 30 minutes, it doesn't always allow for us within a single episode to get into a lot of the nuance here, Katie and I were talking about now there's kind of two different things here. One is talking about therapy, interfering behaviors and managing them. The other is maybe some other non threatening situations where it might be right to terminate with clients. And that's going to be for next week here. So therapy interfering behaviors, Katie, I think it might help our audience here to know a little bit about how this shows up in the therapeutic relationship. This is something that we know comes from the DBT worlds but whether you're a DBT practitioner or not, this happens across a variety of practices. Katie Vernoy 04:42 When we look at therapy, interfering behaviors, I think there's acknowledgement that these can happen both from the client and the therapist. And so I want to make sure that we put that front and center because I think oftentimes, clients get blamed for interfering in therapy and I think therapists can contribute and we'll get into that more later. But looking at some of the therapy interfering behaviors that I think are most difficult, and maybe we can just start with the logistical ones up front, are coming late to session missing sessions, last minute cancellations, no shows not paying, maybe trying to reach out to therapists repeatedly in between sessions kind of crossing those boundaries. But I think the the logistical ones, rather than the clinical ones, I think are ones where people can really get in trouble. Where if you're looking at a business model, if you have clients that are consistently not paying or late canceling or, you know, or even canceling right on that, you know, whether it's 24 or 48 hour mark, and you're not able to fill those session times, I think, from a business standpoint, the no brainer is just fire him right, like just these clients need to go. But I think that there are clinical reasons not to and I think there's also actually business reasons not to as well. But how often do you experience these types of therapy interfering behaviors, because I think the argument that a lot of people make is that if you set up your practice properly, and you have appropriate boundaries, you don't see these as often. But I actually think that they're clinical. And I think that some practices will always see them, at least at the beginning. To a certain extent, Curt Widhalm 06:17 I think that I run into them a lot less now than I did earlier in my career. And part of that is having structured my business with some of the things that we've talked about on the podcast before. Having a client credit card on file shirt makes it to wear them for getting their checkbook doesn't become a therapy, interfering behavior, it's pushing a couple of buttons that allows for me to charge those cards in the first place. Having automated appointment reminders, sure, makes no showing for sessions a lot easier. But probably the most important thing that I've learned is addressing stuff with clients as soon as possible. Yeah. And this is something where I don't consider myself a DBT therapist, but the more that I read about DBT, the more that I recognize that I do use a lot of DBT principles in my practice. And I think one of the main things that I do with my clients, and I have a practice that mostly works with adolescents, so this also includes therapy interfering behaviors from their parents, yep, is not letting a lot of these feelings swell up, and being able to address it right away in the next session. Or if I am getting a lot of frequent contact in between sessions, you know, those clients where you see their phone number pop up, yet again, you get that little feeling in your stomach, where it's like, yep, dealing directly in the therapeutic relationship with clients about how these boundaries end up being crossed, and how it's something that interplays within our relationship, and is likely interplaying within the relationship those clients are having in other places in their lives, is something where providing that direct feedback to them. With the goal of continuing therapy successfully, when you were talking about that there's a lot of therapists who are really quick to, you know, wanting to get rid of these kinds of clients is, this is really coming from the empathic place of I want this and us to work together. And here's the impact that this is having, not only on your progress, but on our relationship towards that progress, that really sets a foundation of GRE addressing these behaviors, we're addressing them again, and we're addressing them again, that helps to bring this insight up for clients that I do see them start to have more of a understanding of the impact of what they're doing, not just for themselves in kind of saving themselves out of their own anxiety plays, but also within the context of the relationships of the people around them. Katie Vernoy 09:01 I love those interventions. And I also think they're challenging because oftentimes it means putting a little bit more of you in the room, and it's working in the transference, so to speak, how you're treating ni is probably how you're treating others. And let's let's work it out between us. And I think that works really well. But it does make an assumption that there's something that they're doing that is consistent across their life. And that may be true, and I think we need to assess that. But I think I actually start further back, which is trying to understand why it's happening. You know, I go from a place of someone's not doing some overt or covert behavior to try to interfere with therapy, but that there may be logistical issues. You know, the first thing I do is I ask them, is this the time for therapy? Do we need to make a different schedule? Do we need to move this around? Is there something that's keeping you from wanting to come to therapy You know, it's looking at what what is their experience? And is there something in their life that's getting in the way of therapy and not just like, Hey, this is how they treat everyone. They're always late. They always are inconsistent and over inconsiderate, but actually like, did we schedule it a bad time? And part of your clinical issue is that you want to please me, so you don't feel comfortable asking for a different time. So you're always running late? Is it the way that I start therapy annoys you? And so you're you're hesitant to come in? I mean, I feel like to me, and maybe this isn't that different than what you were saying. But I feel like, oftentimes, the assumption is that this is a resistance or a therapy interfering behavior, which I guess it is interfering with therapy, but it may actually be logistical and practical, and just like, Hey, I realize that I'm exhausted at nine in the morning, and I'm going to sleep through my alarm, and I can't do it. So we need to schedule it after to, you know, it's not that I don't want to see you, it's that I've made a commitment I can't keep, Curt Widhalm 11:01 I think, and maybe where I'm shying away from this a little bit is for some clients, you might be asking for an insights that they don't necessarily have the capability of being able to look at themselves yet. Sure. I work very much in the present the relational aspects of things, and for me with those particular kinds of clients, and as this review is pointing out, being able to talk about the impact that somebody's behavior has, in real time on the person that that behavior is having is the very DBT intervention of modeling emotions and thoughts and being vulnerable about what's happening, you know, everybody's favorite DBT intervention, dear man, of being able to describe what that impact is, and being able to model how that's happening. And sometimes I'll even go so far as to say, here's, here's, dear man in practice, here's me describing what your impact is on me. And here's me expressing what that impact does for me, and once again, asking you to look at how these actions in the collective of them has that and you know, reaffirming, are you really committed to changing these kinds of behaviors, knowing that these behaviors have an impact. This way, it's not getting a lot into the why it's not getting into, you know, the potential of being able to externalize the responsibility onto anything else, traffic, trauma, anxiety, whatever else it is. But looking at the personal responsibility, that's still part of the behavior in real time as it impacts when somebody, ideally, you as the therapists, if you're following what I'm describing here, in a way that is managed, you know, maybe with a slight annoyance, yeah, I'm annoyed when you don't show up when you say that you're going to show up. That helps a real relationship to develop. So that way these clients have the ability to work through these therapy, interfering behaviors, and outside of the room, relationship interfering behaviors, that allows for that insight that you're talking about to start to develop and be able to be expressed more effectively. Katie Vernoy 13:29 So I agree that's a great intervention. I don't think that that's a bad intervention. I think that it's a wonderful intervention. I think the addition and it sounds like you're saying that maybe this is not a good addition, is actually trying to see if there's anything that's happening on the therapist side of the street coming as a human and saying, Hey, is there a way that we can make this better? Because Is this the right time for you to show up? Is this is there something there because to me, going from the this is your behavior, and you're doing it wrong, doesn't acknowledge that there are real life situations that can get in the way of people doing stuff that when those things are resolved, and when they are actually talked about and it's acceptable to be a human and have some of these things happen? And it's not like, Hey, this is this is a problem behavior, you need to fix it. But it's like, Hey, this is what I'm seeing. I'm trying to understand it. What do you understand about it? What do I understand about it? What can we do about it? It's not saying, Hey, stop it, which is, I think can with the power differential, I think can happen. And I think people can feel very turned off by that. Curt Widhalm 14:33 Oh, to clarify, I'm not saying what you're doing is wrong. What I'm saying is this behavior has this impact. Okay. And by virtue of being able to bring it up in this way, what we're doing is we're coming to the place that you're describing, which is coming to a joint solution on how to make things work together. And ideally, if a client is able to follow that same sort of process of being able to say when You do this, it impacts me this way. That is therapeutic growth in very much the same way that we've just modeled and is something that we would hope to be able to create the space for them to have that real relationship with you as the therapist there. Katie Vernoy 15:14 So the big difference then from something that you might do in a, personally is that you just start from a place of this is therapeutic material, and we need to address it, yes, instead of Hey, what's going on? Curt Widhalm 15:26 Right, because especially with these kinds of clients, we're exhibiting these kinds of therapy interfering behaviors all over the place. There's never a bad time to enforce limits, unless it's way too late. And those limits are the things that we hope that people read in our informed consent, the things that everybody is agreeing to, at the beginning of the first session, when you know, here's all of our practice policies that they're just kind of glossing over, because what they're there for is I want to be healed, I want to be out of this feeling that they're just kind of Yeah, yeah. Now, let me tell you about, it's important to come back to what those limits are, as those limits are being tested, and repeatedly being tested, that leads us as clinicians to feel like, are we actually providing this client with good therapy? Katie Vernoy 16:17 Some of this It sounds like might be stylistic. And I think it probably depends on the clients that you're seeing, and that kind of stuff, how you approach it, I think, I think we're saying very similar things. I think the nuance here is, for me, I start from the relationship and trying to understand what's happened to you from for it sounds like for you, you start within the relationship and, and holding a boundary. And that doesn't suggest I'm not also holding the boundary. It's just I think we there's not one right way to get to the conversation of Hey, this behavior is interfering with therapy, it may also be interfering with the rest of your life. And how do we make you more successful here, as well as how do we extrapolate that out to your life. Curt Widhalm 17:03 And I think the approach that I'm taking here is that I'm wanting to keep the client engaged in the process of what is happening, and not bypassing what's happening in the moment and immediately jumping out to other places that this could possibly be happening. And if there is a therapist pleasing aspect of clients in these situations, you can get to kind of this bypass or this ignoring of other places that this is happening for those clients, you know, oh, no, I don't see this happening in other places, even when it totally is that they're just trying to be like, you know, I'm a good client, you know, this is the only place that it's coming up where we might, you know, be chasing a rabbit down one path that needs to go several different paths. I don't know if that metaphor works, but Katie Vernoy 17:56 I think it's understandable. But yeah, I mean, I think it's some of this is so unique to each client, though, it really depends on what they're working on, and what the therapy and interfering behavior is, I think, Curt Widhalm 18:08 within this, and you brought up earlier about some of the logistical aspects of this comes with the way that we might choose to run our sessions. How for you, if a client's running late to a session, do you set limits on like, well, if you're not here by 20 minutes, and we're canceling the session, and I'm just going to charge you anyway. Katie Vernoy 18:28 Sometimes it depends on the client, I have clients that have chronic illnesses, and different things that may interfere with their ability to come right on time, or those types of things. And so those are discussed and addressed. But I don't necessarily say if you're not available by this time, I'm going to close the session out like I'm not going to, I'm not going to do a 30 minute session, if you show up 20 minutes late, I don't say that, for me the flexibility of enforcing the time limit, and charging them for the session, kind of whether they show or not, I think that lives, but I think the tardiness is more enforced interpersonally and if someone's 20 minutes late, or 30 minutes late, and they're like, hey, should I still come? I say no. But if if they come into a session at the 1520 minute mark, or they tell me Hey, I'm going to be there in five minutes, I will honor the session. I think for me there's a humanity that I add that maybe others see is not having great boundaries. But for me that that I understand that people have unique experiences and my timeliness is pretty good. Overall, my attendance rates pretty good overall, I kind of go from the place of I understand and value that you're doing your bus and if you're not showing up on time or you're not showing up consistently, that's something we need to talk about. So that's how I manage it. How do you manage it? Curt Widhalm 19:54 If the client is 48 minutes late session, we have a two minute session. And I say that because I mean, if they're paying for a 15 minute session, and I've got that 15 minutes blocked out for them, but if they show up, it gives us the opportunity, even in those two minutes to begin to address what is happening and what the impact is. Yeah. And you'll see this in a variety of situations, I'm going to change a bunch of details about a client here. So that way, I can keep this anonymous at a client several years ago, that would always have digestive issues. The minute before the sessions were to begin in our office, this client would show up to the office, they will call eight, and my office would go on appropriately, about eight or nine minutes before the session, but it would be as soon as I would come out, hey, I gotta go the bathroom. And it would oftentimes be 3040 minutes in the bathroom, that when this client would eventually come back, the discussion would be, what are you getting out of the therapy, because, you know, what we've agreed upon. And the treatment plan that we set out together was to be able to look at the way that your behaviors are kind of procrastinating. And it sure seems like this is happening here. And what I'm hearing from you that therapy is not being successful, I look at moments like these. And it feels like you're trying to blame me for therapy not working. But we're missing 40 minutes out of the session. This is where it took several months of having conversations like these a number of times when this client was upset because I was charging them for the agreed upon our and, you know, having these two 510 minute sessions that address these behaviors, this client terminated with me for a while and came back 18 months, two years later, and said that that was an opportunity that they saw that they were having this kind of avoidant behavior with a number of other places in their lives. But it took somebody consistently pointing that out to them, for them to now come back to therapy and want to actually start addressing it. So clients like these can seem highly motivated, even in the midst of their therapy interfering behaviors going on. Yeah, but setting up this foundation, and really being able to not go beyond your own limits as far as what you're emotionally, having happen with the clients managing your own countertransference. But appropriately, self disclosing can set these clients up for a lot longer process of being able to come to the realizations that they had hoped that they would get in the first place. And this is where a lot of my clients come to eventually say something to me as far as this is what makes your therapy very real. You're very honest about what you're doing. And about the impacts that things are happening. You're not just kind of setting up some rules and not explaining why. Katie Vernoy 23:16 I think that's the important point is explaining why the rules are there and having that transparency, because I think if it feels punitive, if it feels dehumanized, you didn't show up until two minutes. So we'll do the two minutes and I'm charging you for the whole time. I think that doesn't necessarily resonate with some folks. And so I think if it's like you're describing, you're actually talking about it within the relationship. I think that is so critical, because so many of the clients that I've had come to me have talked about feeling like their therapist didn't care about them. They were very punitive toward them, or they didn't see them. And I think for me that that element of being able to hold both pieces, the strong boundaries and infrastructure, as well as the caring human connection. I think that's what's most important to me. Curt Widhalm 24:07 And this comes back to the idea of we can't infantilized or treat our clients like they're inherently weak, that having a real relationship, even if it's a chaotic real relationship is something that does provide the space for growth for these kinds of clients and ultimately allows for the growth of the clients to be able to carry the same kind of principles through other places in their life, and being able to consistently show up and have that acceptance of our own limits. Being able to describe the acceptance were on limits, and really being able to model it even when it's initially in bringing it up with clients like this drives our own anxiety through the roof because it's not an easy transition of going from a therapist. Who's expecting clients show up and just immediately start doing the work to being able to address things immediately, because we're trying to keep that professionalism in place. But I think being able to have that honest relationship to appropriately self disclose wouldn't you know, when we hear about this appropriately, self disclosing for the client's benefit, where I don't talk about things is, I don't talk about them not showing up is having impact on my money, I don't want them to take the message that they're just you know, in my life, because they're paying me part of that is maintaining the boundary of you reserve some time, that time, cost this amount of money that time was reserved for you, and I'm holding that boundary with you. Yeah, I don't, you know, put this in sort of this punitive. Well, you did this. So I'm doing this, it's more in that nuanced. I had this experience of your behavior. And it left me with this impact. It is radically self accepting my own reactions to that. I don't go so far as to being like, and I want to punish you for this. Katie Vernoy 26:15 But I think oftentimes, folks will see consequences of their behavior as punishment. That's why how it is presented, how the boundaries are presented are important. I'm looking at the time and I want to shift to some other stuff, because I think we're, we've we've covered I think, the logistical elements except when do we fire clients for these types of boundary crossings of coming late missing sessions last minute cancellations are not paying? Curt Widhalm 26:41 I typically don't I find that all of these behaviors are in yellow words, grist for the mill of psychotherapy, that these are all processable, being able to continue to talk about it, you know, if it's logistical things like, okay, scheduling is something that it's hard for clients to get to our office during rush hour, we'll work towards appropriate accommodations. I don't make promises of let me move seven other clients so that way you can get your ideal time. It's let's look at my calendar and see if there is a more appropriate time that you can fit in. Yeah, that is, again, it's bringing together these principles of I have limits to Katie Vernoy 27:28 Yeah, I think you finish there, I start there, I think we have a similar way to handle it. But I actually there are times when I think that it may be appropriate to terminate with clients. One is if they truly are not paying the credit card on file is expired, and they're not getting back to you at a certain point for keeping that client. I think if clients are consistently missing, you know, last minute cancellations, and you're seeing them very infrequently. I think there's a time at which that becomes clinically irresponsible to have them on your caseload. I think if you're able to keep the conversation going, that's one thing. But I think if it's something where you're absolutely not doing any treatment with them, because they come in once a month, you're discussing therapy interfering behaviors with them, they go all right. All right. All right, and then they don't come back for three or four weeks. I think it's I think at some point, you know, you do have a responsibility both to yourself and to your client to not pretend that therapy. So shifting gears, there are these logistical reasons that I think we've talked about pretty well. But there's also some clinical reasons that are called therapy, interfering behaviors, whether it's not trying out interventions, not participating, not speaking a lot asking or demanding more than a therapist can offer, or even being disrespectful or hostile or critical to the therapist. And I would refer people for that part, potentially back to the episode on how to fire clients ethically, although I think there's ways to keep those clients are not expressing your emotions effectively as another one just to add that in. But when I'm thinking about this, for me, I go to this conversation that we've had about resistance. And some of this I feel like is blaming clients for therapist failures. Say more, if a client is not trying out an intervention that a therapist think is the right intervention, or they're not engaging in the conversation in the therapy room, or they're asking for more than the therapist can offer. And I think the assessment of what that means, potentially the client is saying, I don't agree, I don't I'm not signed on for this treatment plan. You're not helping me to have an engaging conversation here. And I want more than what you're offering to me because I don't feel like I'm getting better. Now. Obviously, the assessment is the most important part of that. But I think if therapists go to my clients are interfering with their own behavior because they're not trying what I want them to do when they're not talking to me and they're not and they're asking me for more I think the therapist needs to do a self evaluation, are you actually aligned with what the client wants to work with? And what they want to work on? Curt Widhalm 30:09 And you gave a couple of answers even within your question there. One is, if this is not the treatment plan I agreed to, then you've done the wrong treatment plan is the therapist. And that's where you need to go back to part of this is going to be dictated by the theory that you're working from, that. A lot of times what I'll see is especially like kids with anxiety, that don't want to use anxiety management techniques, and I'll hear parents, you know, come into the beginning or the end of the session and be like, my kids still anxious. Okay, let's shift treatment theories, let's go from working CBT with a kid to family systems to see how parents are reinforcing some of the anxiety relief seeking behaviors that running to mom or dad to appease some of the anxiety rather than having mom and dad reinforced, now's the time to use those anxiety techniques to be able to clinically address this in a way kind of is going to really depend on the context of whichever client but it takes the step back on the therapist part to really evaluate is the working Alliance there, do we agree on what the problem is and how we're going to get there, because that's going to set up your treatment plan. And your treatment plan is going to be something that the client, clinically ethically should be involved with, if they have any capacity to start working on it. And that is going to be the vast majority of clients. So this is part of where really being the therapist is being able to have that wide variety of different ways to approach this, as you described, Katie Vernoy 31:55 the other element is potentially my framework, which is the client as the expert of their own experience. And so if I were to suggest a specific intervention, they come back the next week, they haven't tried it, or they didn't do the homework or whatever it is they didn't do it, my approach will potentially be the same regardless if I think it's therapy interfering, or I had a, you know, an misalignment on the treatment planning. But it's what happened? What made it so that you chose not to do that? And how do we either figure out how you do it, which is, hey, you interfered with therapy? Because you didn't do what I told you to do. And we all agreed that you were going to do it and it's great. Or it's how did I What did I miss? What's not feeling right for you? What are the steps, maybe were three steps forward, and we need to take five steps back to identify the behavior ahead of it that's getting in the way of you being ready for this, that or the feelings or emotions or whatever the perception ahead of it. That's that you're not ready for this. To me, I feel like when clients consistently are coming in Week after week, not having done the work, so to speak. My instinct is not that's a therapy interfering behavior. My instinct is that it's me, I'll address it similarly. But I think for me, it's sometimes I hear clinicians getting very upset because their clients aren't doing what they think they should be doing. And I'm always cautious to assume that therapy interfering behaviors on the clients part. Curt Widhalm 33:31 It's worth evaluating. Why can't it be both? That Katie Vernoy 33:37 absolutely is. Curt Widhalm 33:40 And this is, again, working radically within what's happening in real time in that relationship with clients is being able to explore both with clients that, hey, you're here to work on these things. We've agreed to this plan. Is this a plan that we need to reevaluate so that way you can be successful? Sometimes, yeah, where I often see this coming up is kids who are drugged into therapy by their parents, and the kids don't really want to be in therapy. But then it's being able to shift what therapeutic goals are to something that does speak to the kids. It's being able to frame it in a way these are, you know, the therapists responsibility ends of things. But I've worked with plenty of kids who don't agree that the problem is what the same problem is that their parents bring them in with. And again, this comes with some of the experience, particular to my practice the intake session, I make sure that parents are involved in the first several minutes of the session to be able to say, all right, describe what you want for your kid here. And you know, after a few minutes of laying out kind of what the problem is, what the limits of confidentiality are all those you know, wonderful four session things. And I send mom and dad back out To the waiting room, I'll turn to the kid and be like, Alright, I heard mom and dad story, what's up with him, and kids almost universally are like, Alright, see, now I get to describe what my part of the problem is. It's it's a symbolic shift over to the client and that situation to give them more control over the therapy process. So that way, it's meeting the client where they're at, not where somebody else wants them to be. And this is where clients will talk about, you know, my therapist forced me into this thing I didn't want to do. But you can set your client and therefore yourself up for more success by really focusing on that therapeutic alliance upfront to make sure that you're working towards the thing that you both agree that you need to be working on. Katie Vernoy 35:46 Well, and I think, to me, a critical distinction is desired outcome and intervention. Because I think, and this is just a nuance to kind of explain it to the audience, I know that you agree with us. But we agree to work toward an outcome, I don't know, except for more specific types of treatment, like EMDR, DBT, that kind of stuff that people are agreeing on specific interventions. I think that those things, by nature need to be fluid, unless there's an evidence based practice that suggests a specific structure for the therapy. And so to me, and maybe this comes back to motivational interviewing, and how do we get the person ready to go and make sure that it's their decision to make a change, or maybe it goes to really understanding the client as a human and being present for them while they figure out, you know, their particular method of healing. I also think that there's things that we can't know, deeply in our souls, and maybe not even intuitively because many of us didn't learn these things in grad school, but the different cultural methods of healing and being able to align those I think, if we are caught in our own, this is what I think my clients should do. I think we're going to experience more of these types of therapy, interfering behaviors versus coming from a place of collaboration and connection when we when we run up against these things. Curt Widhalm 37:13 Absolutely. You're right. I was ready to fight you when you said that. You knew that I would agree with it. But Katie Vernoy 37:20 I know you all too well. So the final one is this kind of disrespectful, hostile critical, the therapist are demanding more than the therapist can offer. And I think that's similar to what we were talking about with safety. But we talked to in that regard, we were talking about how to fire the client in that episode, which will obviously link to in the show notes. But I think that there's also, how do you actually deal with that if you're wanting to keep the client in the session, if a client is being hostile towards you, like absolutely hostile? Curt Widhalm 37:49 I think that a lot of times, this is where those kinds of behaviors first bring up a lot of that imposter syndrome for a lot of therapists have like, oh, they're seeing through what I can't do. And, again, this comes with experience, it comes with supervision, consultation, your own therapy, of being okay with where your limits are, sometimes clients are going to ask for more than what you can provide. And it's okay to be honest of this is, you know, something that you as a client, you're asking for something that I can't do. And there might be feelings, there might be continued hostility about that. Now, this is honestly mostly where I would suggest that you talk about this as far as clinical techniques. I want EMDR, I want brain spinning. I sorry, I can't do that. That's not part of my training, that helps to, again, model an appropriate reaction, don't take it necessarily, personally, but it's being able to first recognize your own feelings that are coming up in these situations helps to more successfully navigate this. Clients are going to have bad days from time to time, they're going to project stuff onto you that you're going to be the target of whatever just happened to the car. Again, number of teenagers that show up in my office just upset of whatever the conversation was in between school and my office ends up being something that gets kind of pushed at me. So the first steps of it is, is there still a place to make therapy work? Sometimes these clients have these moments, and it makes them very unlikable in the moment but getting through these moments are things that helps to make the real relationship of therapy continue to grow and develop, which makes these clients more likeable. But it's being able to know your own reactions know your own limits within what's coming up as appropriately, setting the right kinds of boundaries. doesn't help me when you Talk with me like this. And if it doesn't help me, it's not helping us. Katie Vernoy 40:03 Yeah, I think there's I mean, I always go back to, is the client hostile towards me? or angry at me because of a clinical misstep or an interpersonal misstep? I always want to have that assessment be the first thing that I do. And sometimes it's like, absolutely not, I was fine. This is, you know, whether we call it transference or therapy interfering, or whatever, you know, then then I'm okay, you know, my side of the street is clean over here, let me figure out what's going on for them and help them to process it, and not necessarily give them the same experience someone outside would give them because most people would walk out of the room or snap back or whatever. But give them an understanding of what that experience is and what they're putting out. So I see that there have been times when clients are pissed at me because I made a mistake. And so I think, recognizing that there are times that I'm going to have to come back and say, Hey, I missed something there. Let's talk that through. And most of the time, not always, but most of the time, the client and I are able to come to a better understanding and improves communication. And it's also modeling, apology and repair, as well as providing them with an opportunity to figure out what do I do when I've blown up at somebody, and then the relationship continues, which I think is really powerful. So to me, I feel like there's, there's a lot that as therapists were being asked to do, that potentially no one in their life would put up with, for our clients. And so to me, it's it's sorting out how do we walk through them in a way that allows for healing to happen, while then still taking care of ourselves. So when I've got a client that's hostile towards me, whether I've done something or not, I'm gonna be calling colleagues to consult or at least event or whatever, so that I can get myself back in the right place. If I've got clients who are consistently making my schedule of mass, I might consult again and say, Hey, you know, what boundaries? Am I missing? How can I get this back under control? Or what are the things that are coming up for me that I keep helping this client move their appointment all over the week? You know, whatever it is. But I think the doing of these things of having these hard conversations of giving this feedback that most people won't give our clients, I think is hard enough. But it is we did sign up for it. Maybe not every client maybe not every situation, but we did sign up for this. Curt Widhalm 42:37 We would love to hear more from you. You can talk about the episode in our Facebook groups bot and therapists group, let us know on social media or leave us a rating and review but we'd love to hear about how you handle therapy interfering behaviors from your clients. And you can check out our show notes at MTSGpodcast.com. And also check out the now entirely virtual therapy reimagined 2021 conference, we've had to make some adjustments. We're looking at the COVID numbers and decided that we'd love to hang out with you. We don't want to hang out with the Delta pair yet. So join us online you can get your virtual tickets over at therapyreimaginedconference.com And until next time I'm Curt Widhalm with Katie Vernoy. Katie Vernoy 43:27 Thanks again to our sponsor SimplePractice. Curt Widhalm 43:30 SimplePractice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use SimplePractice to power telehealth sessions schedule appointments, file insurance claims market, their practice and so much more. All on one HIPAA compliant platform. Katie Vernoy 43:48 Get your first two months of SimplePractice for the price of one when you sign up for an account today. This is collusive offer is valid for new customers only. Please note that we are a paid affiliate for a SimplePractice so we'll have a little bit of money in our pocket. If you sign up at this link. Simplepractice.com/therapy reimagined. And that's where you can learn more. Curt Widhalm 44:09 This episode is also sponsored by RevKey. Katie Vernoy 44:13 RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services. RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. Curt Widhalm 44:36 You'll never receive a data dump report that means nothing to you. Instead, red key provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. Katie Vernoy 44:53 You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener Announcer 45:00 Thank you for listening to the Modern Therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
September 13, 2021: The regulatory environment drives healthcare. And as IT leaders, we HAVE to understand it. Mari Savickis, Vice President, Public Policy at CHIME joins us today to discuss HIPAA, information blocking, price transparency, AI, machine learning and interoperability. The Biden Administration announces ambitious initiatives to bolster the nation's cybersecurity. Tech giants Amazon, Microsoft, Google, IBM, and Apple have pledged a combined $30-plus-billion cybersecurity investment. Plus all you need to know about the HIPAA proposed rule and telehealth's battle over state lines. Key Points:Make HIPAA and information blocking definitions the same [00:16:30] When it comes to price transparency, it's buyer beware [00:22:15] AI and machine learning gain steam [00:37:20] We need to have better interoperability and standardization for the public health infrastructure [00:39:12] Subscribe to CHIME's weekly briefings - email@example.com://www.cisa.gov/jcdcStories:Tech Giants Commit $30B to Cybersecurity After White House Meeting - SDxCentralTelehealth's limits: Battle over state lines and licensing threatens patients' options (medicalxpress.com) CHIME HIPAA Proposed Rule cheat sheetBiden Administration Unveils $65 Billion Plan to Combat Next Pandemics After Covid – NBC4 WashingtonThe White House FACT SHEET: Biden Administration and Private Sector Leaders Announce Ambitious Initiatives to Bolster the Nation's CybersecurityThe White House: American Pandemic Preparedness: Transforming Our CapabilitiesPredicting the future of healthcare: 10 takeaways from HIMSS21 | MedTech Dive
This week Shivhon Adkins, Founder of Medical Receptionist Network discusses Quality Measures and Organizational Culture. Visit us at www.medicalreceptionistnetwork.com today. Medical Receptionist Handbook to Success available now on Amazon! https://amzn.to/2IeFwy6 Don't forget to subscribe to the Medical Receptionist Network podcast! Need CPR Training? Visit https://www.ProTrainings.com for CPR, HIPAA, Ergonomics, Self Defense courses and more. Use discount code for savings: CPR-MRNCPR Need a new planner? Check out our Affiliate LOA, click the link to learn more https://manifestationplanner.com/free... Be a guest on the MRN Podcast, visit https://calendly.com/mrnetwork/30min to schedule or email firstname.lastname@example.org Episode 18 References: Agency for Healthcare Research and Quality https://www.ahrq.gov/talkingquality/measures/types.html CMS.gov https://www.cms.gov/files/document/2020-mips-call-quality-measure-overview-fact-sheet.pdf Merit-Based Incentive Payment System (MIPS) https://www.aapmr.org/quality-practice/quality-reporting/merit-incentive-payment-system Advanced Alternative Payment Models (APMs) https://qpp.cms.gov/apms/advanced-apms
Social media is full of people who speak “confidently” about topics that they simply do not fully understand. HIPAA is one of those topics. Today, we are covering 7 HIPAA facts that we hope will set the record straight about frequently misunderstood HIPAA topics. More at HelpMeWithHIPAA.com/321
CHIME Wrote this recently in response to the proposed HIPAA rule change.We are concerned about the implications of proposals involving personal health applications (PHAs) calling for covered entities (CEs) to transmit electronic health information (EHI) to PHAs without requiring those PHAs to include privacy and security controls or sign Business Associate Agreements (BAAs); Valid concern but the battle is over and PHAs accessing patient information on behalf of the patient is protecting by law and future penalties. What can we do? BAA's don't work in this framework. So what can we offer our patients to protect them from the wild world of PHAs that are going to start knocking on our API door?#healthcare #api #healthIT #cio #cmio #chime #himss
How did Joe turn March 2020, his worst sales month ever, into April 2020, his best sales month ever - despite the pandemic? Well, building a successful business during a pandemic takes a little bit of luck, a whole lot of creativity, and the skill to see the potential in every situation. From hiring the right teams to pivoting during times of uncertainty, every decision you make is a “make-or-break” decision - especially when the market is in turmoil. This has been Joe Brown's life for the past 3 years and, during the pandemic, when other startups were shutting down, he built a “faster horse.” Communication, asking questions - of your customers and yourself - and understanding the value of social proof in today's digital healthcare solutions are just the beginning. Tune in for Joe's incredible story. Here are the show highlights: What startups need to know about building an amazing team (7:37) Ask yourself the right questions (15:00) How to build social proof into a “faster horse” (23:19) Build a solution that can evolve or cross-over (25:48) How to address HIPAA and PHI in your healthcare solution (29:42) Why social proof is incredibly important (31:39) Guest Bio Joe Brown is Founder and CEO of DearDoc, an artificial intelligence solution that engages patients on healthcare websites. After being approached by a family member who needed some advice on how to drive business, Joe parlayed his expertise into a vision that is changing patient/doctor communications. Joe received his Bachelor of Science in Business Administration, Marketing/Global Business from the University of Arizona - Eller College of Management. If you'd like to reach out to Joe, you can find him on LinkedIn at Joe Brown. If you're interested in learning more about DearDoc, visit their site today at GetDearDoc.com.
VP Marketing at Veyo, a company dedicated to next-generation patient transportation, Sarah Kuntsal, gets "radically transparent" about the challenges of marketing in a highly regulated industry, like healthcare. From creating meaningful interactions during lengthy sale cycles to ensuring initiatives follow the guidelines of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), there's certainly no shortage of daunting obstacles quarter over quarter. In this episode, Sarah shares why HIPAA is tricky and reveals what she's doing to keep her teams up to par with non-stop, ever-changing regulations and how she's uniting sales and marketing. She explores why content creation is helping her team thrive in reaching and engaging potential partners. And even explains why she's not focusing on advertising this year, and what she's doing instead! A must-listen episode for anyone marketing in a regulated industry.
Preparing for a third-party security assessment or compliance audit can be a daunting experience -- especially if it's your first time. Tune in this week as Jen Stone (MCIS, CISSP, CISA, QSA) speaks with Brian Gross (VP, Product & Technology, FISERV) about how he prepared his organization to respond successfully to a PCI DSS assessment, followed by a HIPAA audit.Listen to learn:How a third-party assessment can benefit your businessWhere to start to build your security programWhat elements support successful completion of an auditLearn more at SecurityMetrics.com
In this episode, Stacey is joined by David Nettleton to discuss some of the key topics from the recent CSV Virtual Week panel "CSA Revolution." The session "CSA Revolution" was intended to provide a better understanding of the intent and scope of the FDA's Computer Software Assurance guidance while highlighting CSA's relationship to other existing regulations. David will share his expertise on some of the ideas and concepts shared in the discussion. About Our Guest: David Nettleton is an industry leader, author, and teacher for 21 CFR Part 11, Annex 11, HIPAA, EU General Data Protection Regulation (GDPR), software validation, and computer system validation. He is involved with the development, purchase, installation, operation, and maintenance of computerized systems used in FDA-compliant applications. He has completed more than 300 mission-critical laboratory, clinical, and manufacturing software implementation projects. He can be reached at email@example.com For information or to register for Validation Week 2001 visit: VALIDATION WEEK 2021 Voices in Validation brings you the best in validation and compliance topics. Voices in Validation is brought to you by IVT Network, your expert source for life science regulatory knowledge. For more information on IVT Network, check out their website at http://ivtnetwork.com.
Episode 224: Are You Even Trauma-Informed? An interview with Laura Reagan, LCSW-C, on trauma-informed care, including what it looks like in practice. Curt and Katie talk with Laura about the barriers clients face when trying to find a good trauma therapist and how trauma therapists can advertise in a trauma-informed way. We also explore how COVID is impacting trauma treatment and tips for providing virtual trauma therapy. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Laura Reagan LCSW-C, Laura Reagan, LCSW-C is an integrative trauma therapist, clinical supervisor, consultant and coach. Since 2015 she has hosted Therapy Chat Podcast, where she interviews therapists, authors, researchers and other experts about psychotherapy, trauma, attachment, creativity, mindfulness, relationships and self compassion. In 2021 she launched a new podcast entitled Trauma Chat for anyone who is curious about what trauma is, how it shows up in our lives and how to find the right kind of help for your specific experience. She is the founder of Trauma Therapist Network, a website providing information and resources on trauma and a membership community for therapists. Learn more at www.traumatherapistnetwork.com. In this episode we talk about: Who Laura Reagan is and what she puts out in the world. What therapists get wrong with trauma-informed care in regard to advertising. How trauma therapists can be trauma-informed in their advertising. Factors that make it difficult for clients to find a good trauma therapist. What is trauma and what is trauma therapy? How COVID is playing a role in trauma treatment. Tips on how to provide effective virtual trauma therapy. What therapists can do to support clients that do not have an ideal virtual environment. If therapists should obtain more trauma training due to the impact of COVID. Considerations therapists can make when deciding to specialize in trauma. Our Generous Sponsors: SimplePractice Running a private practice is rewarding, but it can also be demanding. SimplePractice changes that. This practice management solution helps you focus on what's most important—your clients—by simplifying the business side of private practice like billing, scheduling, and even marketing. More than 100,000 professionals use SimplePractice —the leading EHR platform for private practitioners everywhere – to power telehealth sessions, schedule appointments, file insurance claims, communicate with clients, and so much more—all on one HIPAA-compliant platform. Get your first 2 months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Go to simplepractice.com/therapyreimagined to learn more. *Please note that Therapy Reimagined is a paid affiliate of SimplePractice and will receive a little bit of money in our pockets if you sign up using the above link. RevKey RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener. Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Trauma Therapist Network Therapy Chat Podcast Trauma Chat Podcast Relevant Episodes: Managing Vicarious Trauma What the Grief Just Happened? Trauma Informed Workplace Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined Conferences Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript (Autogenerated) Curt Widhalm 00:00 This episode is sponsored by SimplePractice. Katie Vernoy 00:02 Running a private practice is rewarding, but it can also be demanding SimplePractice changes that this practice management solution helps you focus on what's most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing. Curt Widhalm 00:18 Stick around for a special offer at the end of this episode. Katie Vernoy 00:23 This podcast is also sponsored by RevKey Curt Widhalm 00:26 RevKey is a Google Ads digital ads management and consulting firm that works primarily with therapists. Digital advertising is all they do, and they know their stuff. When you work with RevKey, they help the right patients find you ensuring a higher return on your investment in digital advertising. RevKey offers flexible month to month plans and never locks customers into long term contracts. Katie Vernoy 00:49 Listen at the end of the episode for more information on RevKey. Announcer 00:53 You're listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 01:09 Welcome back Modern Therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast about all things therapists for therapists. And we are once again joined by one of our therapy reimagined 2021 speakers. And returning to the podcast for the first time in like three plus years is Laura Reagan LCSW. And we are so excited to have you back. And once again talking about a lot of ways that we can improve and working with clients with trauma. So thank you for spending some time with us today. Laura Reagan 01:45 Thanks so much for having me back. I'm really excited to be here. Katie Vernoy 01:49 Yay. We're so excited to have you back. And we always ask our folks who are you? And what are you putting out into the world? And we'll share your other episode in our show notes. But you're putting something new out into the world. So for our new listeners, who are you and for our long standing listeners, what are you putting out into the world now? Laura Reagan 02:08 Well, one of the things I put out into the world is that I'm a trauma therapist in the Baltimore area. And I work with clients directly and run a group practice. But also, I have two podcasts now, therapy chat, which has been out for six years. And then my new show is called trauma chat. That's really for the general public to learn about trauma and connected with both of those, after years and years of being asked by so many listeners for how they can find a trauma therapist, I created a new resource that's called trauma therapist network that includes information and resources about trauma. And it has a trauma therapists directory, which is the part that to me is the most exciting because it feels like something that's been needed for such a long time Curt Widhalm 02:55 When it comes to trauma informed care that this is not just the things that we say and do when clients have come in, we've had a couple of sessions with them that a lot of this starts from people's first Google search of us that really being informed comes with the ways that we even advertise ourselves. In your experience of working in the trauma community and with trauma therapists. What are you seeing that some therapists might not be doing right, that might not be the most trauma informed as far as even like their advertising goes? Laura Reagan 03:35 Well, that's a great question. I mean, one of the things is, if anybody pulls up a listing on Psychology Today, for example, everybody knows that is a pretty big therapists directory, you might, you know, you might find Suzy Smith, LPC and, you know, Eugene Oregon, who, there's 50 checkmarks, filled in on Susie's profile that say, you know, beginning with A, it's like, ADHD, anxiety, you know, depression, that everything and then when you get to P, it says, or T trauma slash PTSD. So, if someone is looking for a trauma therapist, and they find that, you know, and they also see that Susie specializes in Bipolar Disorder, you know, every mental health diagnosis under the sun, it's for the potential client who's looking they're like, so what lets me know, this person knows about trauma, like it seems like they do at all it's like a general kind of thing. And, you know, trauma is so specific, even though it's super common in mental health treatment seeking populations. You know, it's a very common experience for people. It's not the same as just, I know how to help you with anxiety. People who are looking for a trauma therapist are overwhelmed, because trauma makes you feel overwhelmed. And it, you know, it's hard to focus, there's a lot of ways that it can really impact you. So once you realize that you need a trauma therapist, and you go looking for one, and then you've, you know, Susie and 25, other people come up on that page on Psychology Today. And they all have all the same things marked. It's really hard for clients to discern how to know if this is going to be the right person to help them with the specific thing that they need help with. Because even in the umbrella term of trauma, there's so many specific types of trauma that are not all. treated the same way even though you may use some of the same methods, it's, you know, you need some specific understanding of how those particular issues affect people. Katie Vernoy 05:52 What would you recommend that trauma therapists, true trauma therapists do to make it clear that they are trauma therapists? The type of traumas they work with? Like, what what do you think would be helpful? And I think kind of nodding to Curt's question, what would be trauma informed in them setting up a profile or a website? Or those types of things? What are the things that would be helpful there? Laura Reagan 06:16 I think some of the things that are really important are, you want to come across as non judgmental, not just say, I'm non judgmental, but you want it to feel like that when people look, and people want to feel that you're going to understand them. They want to feel a warmth from you. But also like, not too jargony not too wordy. You know, like, concise, speak to Curt Widhalm 06:43 Don't, don't throw out the 9 million acronyms of letters that all of us therapists are so keen on collecting. Laura Reagan 06:51 Right? limited to six or less different acronyms after your name. Maybe two, if you have to. But um, no, just like, you know, they want to, they want to know, like, do you know how to do EMDR? What population Do you specialize with? You know, Curt you and I talked to my podcasts recently, and you work with teens. And you can use EMDR with a broad range of presenting issues, but let them know what you're good at what you're really experienced with so that they can see, okay, I have combat trauma, and this person has specialization in people who lived through their house burning down. You know, it's not the same. I mean, there's similarities, there's a lot of overlap in all trauma work. But there's, there's also, you know, there's a difference between someone who was physically abused in childhood, someone who was emotionally neglected, someone who was sexually abused in childhood, someone who was raped in college, you know, they're all the different, someone who lost a parent when they were 15, someone who lost a parent when they were five, you know, different, even different developmental stages of traumatic experiences can impact us differently. And, you know, was it an ongoing traumatic experience, like being in an abusive relationship as an adult? Or was it a, you know, trauma from being assaulted at a bar fight, it's different. So people who work with trauma, do know those differences, but they may not always convey that in what they're presenting out to clients who are looking for them. Curt Widhalm 08:36 So you're speaking to, you know, this from kind of the therapist side of things as far as things that we do that confused clients? Are there other things that we might not be touching on yet that makes it really hard for clients to find a good trauma therapist? Laura Reagan 08:56 Well, yeah, what comes to mind immediately is that people don't recognize that they have trauma, which is one of the reasons why I made trauma chat, podcast and the website, because experiences that are common, like feeling like nobody paid attention to you when you were growing up. That's not uncommon in our culture, in the US, but you know, if you feel worthless, and you don't love yourself, you hate yourself. And it's related to that. You think you hate yourself, because you should be hating yourself because you're awful, but really, it's because of what what happened when you were younger. So I think a big piece is and one of the things that I'm really trying to do both with therapy chat trauma chat, while all three the website are to help people begin to recognize that if you feel this way and this happened in your life, it's highly likely that the reason you feel that way is because you're impacted by trauma or and when I say trauma, and this isn't what everyone does, but for me when I say trauma, I'm really lumping attachment wounds from childhood into that as well, because those are, you know, part of what makes part of what makes healing from trauma so difficult. After you go through a traumatic situation, if people help you, they believe you, they care, they take it seriously and they, you know, they attend to what you need, you're going to not be as likely to have long term impact like PTSD, as you would if you you go through something and it's minimized, your parents are telling you not to just, you know, get over it not talk about how you feel. And I'm like keep saying like childhood trauma, because that's what's so prevalent. We know from the adverse childhood experiences study, it's more than 60% of adults in the US. But, you know, it's pretty much thought to be carries over around the world have childhood trauma. So if, if people don't take you seriously, they don't believe you, they minimize invalidate, and they're not attuned to how you're feeling, following those traumatic experiences, you're much more likely to develop PTSD, or complex PTSD symptoms. So the attachment piece is an important part of healing from trauma. Katie Vernoy 11:25 So I'm hearing you say that therapists need to be specific and talk about the types of traumas they work with. But there's also this other piece of being able to really educate or explain what could be trauma, you know, these attachment wounds or those types of things so that clients can identify themselves and and know, they're getting a trauma therapist that has particular training, as well as they can identify that they have trauma, and I see how that could be very, very helpful. I, I guess, and and this is maybe maybe I'm going down a rabbit hole, but I feel like there's there's kind of the colloquial, I'm so traumatized this is trauma, everything has become trauma. And then there are the types of things that really require trauma informed or specific trauma treatments. So I guess the question is a two part like, what is trauma? And what is trauma therapy? Because I think, for our we have, like you we have audience that is both therapy, therapy therapists and therapy clients. And so how are you defining trauma and trauma therapy? Laura Reagan 12:38 That's a good question, I guess, it depends would be my best answer. But, you know, so if you if you're someone who, let's say you have persistent anxiety that you've dealt with, say, you're 35 years old, you're you've always been anxious, and then you become a parent and your anxiety starts to increase, you may not be thinking, I need to go find trauma therapy. So a therapist who's trauma informed, should be able to identify that it's highly likely that someone who's always been anxious is probably anxious because of something related to either unmet attachment needs in childhood or something traumatic that happened, that they may not be identifying that way. And so you know, you would want to know, if they've been through anything traumatic. And I think, you know, this is a sidebar, but one of the big mistakes that therapists make is they ask people in the initial intake, do you have any history of trauma? And the person says, “No”, and they go, “Okay, well, you have anxiety, so we'll just work with the anxiety.” And yeah, you should work with the anxiety, of course, but, you know, longer term trauma therapy is always about, why do you have this anxiety, you weren't just born with anxiety, or you were, but it's got to be related to something. Somehow it started, you know, that's not our natural state. So, of course, feeling anxious is something we all have. And sometimes we're sad, but I'm not talking about just sometimes being anxious or sometimes being sad, but I'm talking about like, persistent, always anxious, you know, and sometimes it's panic attacks or whatever. So, a trauma informed therapist could identify that this person probably is impacted by trauma and asked questions about their family of origin or their relationships just to get, you know, a sense of what that's like and maybe figure out what their attachment style is, and, and work with that even without really saying, we're going to work with your attachment style, and we're gonna work on healing your attachments and all that. So, then there's people who are like, I've been to a therapist. I've learned coping skills It's great. But they don't always work. Some of these things just I can't seem to change. And that's when people are more likely to be searching for real. Like, I want trauma therapy. And then they think you know that a lot of people think that means like, I'm going to go to therapy, I'm going to tell my story from beginning to end, you know, I'm going to talk about what happened, and until it doesn't hurt to talk about it anymore, but that's not really what most of the time is happening in trauma therapy nowadays. Laura Reagan 15:32 So it's more, you know, for me what trauma therapy is, I use a longer term model, I usually work with people for, you know, a minimum of a year, but usually, you know, two to three years or more, because it takes a while to heal the attachment wounds that, you know, through the therapeutic relationship in the work. So, there's a three phase approach that explained in Judith Harmons, 1992, book, Trauma And Recovery, that, you know, it starts with safety and stabilization, then you move into remembrance and mourning, and then integration of the traumatic experiences into your life. So it's basically taking someone from being very fragmented at the beginning and in crisis. So it's emotional safety and physical safety that you're working with, depending on their situation. And then remembrance and mourning is, you know, all those fragments that have not really been able to be part of who you are, because your capacity to cope during those experiences was overwhelmed. You know, you begin to look at them and say, oh, when, you know, the first day of school when I was so scared, and you know, my mom didn't even ask me how my day went when I got home. Or, you know, so I just felt like, I couldn't talk about it. And I just had to deal with it by myself. Now, that might be considered traumatic. I know, people might not really necessarily think of that that way. But yeah, or I went home and no one was there. And then, you know, just like usual, everyone ignored me. And I felt alone. And I just went and played video games until I fell asleep or something like that. That's when you start to look at those things and say, “How did I really feel about that”, and, you know, begin to work with expanding the person's window of tolerance, to be able to think about those experiences and feel the emotions that go with them without having to dissociate from them. And then kind of grieving what was lost. And then reintegration is when you kind of are like, bringing it all back to being one whole person with those experiences that yes, they did happen, but they don't derail you now, you know, they were painful, but you can talk about them, you can feel the feelings, and you can still stay within your window of tolerance. I mean, briefly, that's what, that's what trauma therapy is like when you're doing longer term work. And I think a really important piece is understanding dissociation, which is something that even for people who get training in trauma, a lot of times dissociation is not part of it. And so they don't learn how to assess and identify when the client is dissociating during the sessions. And so sometimes they're accidentally re traumatizing the client by, you know, getting into material that the client is seemingly, they're talking with you about it, but really, they're not fully here with you at all. And you don't, you don't know how to, you don't know how to like see that when it's happening and help them get back to being within their window of tolerance. So that's a really important piece is the dissociation and that's still just kind of beginning to come to some people's awareness, despite the fact that, you know, places like ISSTD have been talking about it for, like 30 years. Curt Widhalm 18:55 I don't think that this conversation is complete in modern time without bringing up, how are you seeing the role of COVID play out and some of this longer term treatment to? Laura Reagan 19:05 Yeah, well, for me, I'd be interested to hear if you want to share anything about that. But for me, it's like, if you're working with people virtually during COVID, how safe are they where they are, even first of all, like, do they have privacy? And how? How much in survival mode are they right now? You know, being able to assess how well they're really functioning. Because if they're doing their session at home, and they do have privacy, it might look like they're more grounded than they would normally be in the session. But what's, you know, how supportive is their environment when when the session ends for them to have space to feel what they feel and I'm pretty cautious about I definitely have not been doing as deep work with most of my clients during COVID Because, you know, I know that they have an ongoing trauma that they're living through now. And for some people, it's much more that they're really in crisis and in survival mode. And for other people. They are okay, because they're really well resourced. But somewhere in the middle, I think there's somewhat of a complacency about COVID, for many of us at this time, but, you know, if you think about what's going to activate your threat response system, in response to a trauma, you know, an invisible threat outside that is in all other people, and you don't know what, who's the one that's going to cause you to get the life threatening disease, that's a pretty severe an invisible threat that you have no control over is pretty much a huge trauma trigger. And, and the long-sustained time of living under that, sort of like living in an abusive home and just being so used to it that you don't even know you're in an abusive home. Katie Vernoy 21:05 It's interesting, because you talked about the virtual elements, as well as the the kind of the collective trauma of COVID. I know, for myself, I have, I've had, it's gone in phases, where there's been a lot of safety and resourcing and coping strategies and trying to make sure kind of like, let's get from day to day, let's get through this thing. And then there are times when it feels like things can go deeper. But I've also been very cautious of going too deep, because I think there isn't the same resources. You know, social support looked very different for a long time. And still does, I think people are, you know, I've also got clients who are setting better boundaries, because there's this, you know, this way to do it. So I think that, you know, it's definitely an individual experience. But for me, and I think this continues forward, because we have some therapists who want to stay virtual kind of continuously, like, this is the new thing, I'm gonna be virtual forever. And I think it, I kept wanting a resource that's like, okay, okay, I know how to set up the setup. I know, ethically and legally what to do with a virtual therapy office. But how do I do good clinical work? And I think on top of that, how do I do really good trauma informed care? via video? And so what do you know about that, Laura? Because Because you're in this space, and you're talking to so many people, what are the best practices, especially for trauma survivors, folks, you know, that have had and technically I guess all of society is being traumatized. So this is everyone. But how do we do this? How do we do this? with video? Laura Reagan 22:45 Yeah, I don't think I have all the answers by any means. But I think it's umm, I didn't think that the presence and energy would be able to be felt, as well through virtual therapy, as it turns out to be, you know, I can still be talking with someone, yesterday I was talking with someone and a couple things, they said, I got chills all over my body. You know, and that's a typical, like your mirror neurons picking up what the other person is feeling during a session. So that's normal during an in person session to just be having all kinds of somatic indicators telling you, either your stuff is getting triggered, or giving you information about what's coming up for the other person. And that's still happens in virtual sessions for me, but you know, I think it's the relationship and the presence that you bring, and really knowing your client and being attuned to what's happening. There's a lot of drawbacks. I mean, I do practice from a somatic perspective, and I can't see their whole body. You know, so a lot of times, like, they're kind of shaken a little bit. I'm like, you know, what's is your foot going, like, what's happening? What are you noticing right now? And they might say,” Oh, well, you can't see. But my foots like shaking really fast”, or things like that, or, you know, there's a lot of limitations to it. But another thing that sort of a unexpected twist, for my experience of it is, is noticing how some of my clients are so much more comfortable, because they're at their house, and they're not in my office space, you know, which I think of as this warm and safe little nest for them, but that's not necessarily their experience. They've they're coming here, it's my it's my warm nest, it's not their warm nest. So yeah, those are some of the benefits being able to be in their own space and feel comfortable and then being able to take care of themselves and not having to drive because sometimes when you leave a therapy session, you're a little bit disoriented and then you got to go back out in rush hour traffic. So but I would say you know, all the typical things about, certainly if someone's in an unhealthy relationship or an unsafe relationship, that therapist should be very attuned to who's there any signs that, you know, the someone else could be, you know, intruding or crossing boundaries about the client's privacy, especially teens, you know, kids, parent that's just sort of standing like right out of the frame where you can't see them. And the kids like, acting less open, and you're not sure why but you hear sneeze and you're like, wait a second. Or you notice I'm looking, you know, it's like, what's what's happening? So? I don't I don't have all the answers on that. But it's definitely a dance. Curt Widhalm 25:47 What kinds of things have you learned over this last year, as far as supporting clients in their environments where they are facing kind of this constant, like, if I go outside COVID possibility, if they are in their houses, with the very people who have caused all of those emotional traumas from growing up, etc. Anecdotally, what are you finding works for your clients, Laura Reagan 26:18 As the therapist, you have to be very flexible. And attunement is just so important, you know, knowing your client, and I've seen people's dissociative symptoms worsen when they're, let's say, a college student who goes home for the summer, and they're in their parents house, and that's where their abuse took place. And, you know, even though no one else is home during the session, they can't feel grounded and safe there. So, you know, let's say we were doing phase three work before COVID, we're probably going to be doing phase one work, you know, safety and stabilization. So, but again, some people can go deeper than you expect. Maybe they can go deeper than they did when they were in your office or my office, because they feel comfortable where they are. So they can let their guard down more I don't, you know, it's probably a balance, some people are more constricted, and some people are more expansive, because of the fact that they're doing the session in their house. But I know for some clients who have some physical disabilities, and a lack of privacy at home, there's been great difficulty in being able to find virtual sessions to be effective, because there's many factors that are interfering with being able to just even be comfortable in the session. Katie Vernoy 27:52 So I think we could dive into virtual therapy forever, because I think there's going to be so much more therapy done there. But I guess I want to switch gears a little bit and go to the fact that most of society has had at least a small t trauma, if not a big T trauma with a global pandemic. And there is a huge need for therapists to at least be trauma informed, if not to become trauma therapists. So for the new therapists, for the students out there, what is it important for those therapists to know, when deciding to specialize in trauma. Laura Reagan 28:31 There's a set of factors that should be present if you want to practice in a trauma informed way. And it has everything to do with how you are with the client, how the space is that you are with the client in so if you're together in a physical space, you know, everything from the way the lighting is, you know, I mean, there's a big difference between how comfortable people feel when they walk into a waiting room with indirect lighting and comfortable seating and a fountain going and some spa music versus clinic where it's institutional looking fluorescent lights. And we can't always control that. But, you know, everything we can do that makes it feel more calm, and regulating to the nervous system, all the way around, both from the space and the way we interact with people is, is really important. And I mean, like you, I think that everyone's going to need to be at least trauma informed because of the pandemic. But I also think that everybody really needs to be trauma informed anyway, because of how prevalent trauma is. You don't have to specialize in trauma. But you should assume that the majority of people that you come into contact with as clients have experienced some kind of trauma like you said, little t trauma or something that's probably related to why they feel the way they do. And an empathic attuned presence is more important than any training you get in having successful therapeutic relationships with clients who have experienced trauma, be really cognizant about victim blaming and minimizing and like, you're still upset about that. But that was five years ago, 20 years ago, you know, because that's what people think already, people who've experienced trauma. You know, there's certain phrases that everyone says, if they've been through trauma like, well, what I went through wasn't that bad. I mean, so many other people have been through so much worse, that's almost like a script that every single client who has trauma says, or well, I should have known better, or I shouldn't have done this, or well, it's pretty much my own fault, because this, those are clues that the person might be having a trauma reaction, so but also the importance of self-care for the therapist, you know, and this isn't about directly how we work with clients. But it is because if we're not taking care of ourselves, getting enough rest, sleep, there's rest, and then there's sleep, two separate things, movement, oftentimes being in our own therapy, to work through our own issues that we've had in our lives, being aware of vicarious trauma, if you do work with people who have experienced trauma, and I think vicarious trauma is worse, when you don't really understand the impact of trauma on your clients, because you don't understand why you're having the reaction you're having. But vicarious trauma is pretty much an occupational hazard for therapists and therapists who work with trauma. So the way you space out your sessions, the more you make sure that you are, well, obviously, the better you'll be in your work with clients. And when you aren't able to do that as much as you need. That's when we risk doing harm, which we never want to do. Trauma informed, I think if you have a trauma informed approach, working with trauma, clients who have trauma is appropriate. But if you don't believe in trauma, or you don't think it's really you think it's just nothing special. Nothing different. And it's tricky, because our schools of our grad schools don't really teach us about trauma in general. You can really, unintentionally do harm, and it can drive people away from seeking help. It's, it's really hard for people who have trauma, to ask for help anyway, because their experiences, nobody cares. No one will understand. It wasn't that big of a deal. There's just something wrong with me. And that's why it seems like such a big deal to me. And those unfortunately, those messages get reinforced through negative experiences in therapy, even when it's unintentional on the therapist part, Curt Widhalm 33:10 Where can people find out more about you, and all of the projects that you've got going on? Laura Reagan 33:18 Everything I'm doing now is on my website, traumatherapistsnetwork.com. And I would like to say that Trauma Therapists Network and the directory that it has, it's not just for people who specialize in trauma, if you use a trauma informed approach, you can definitely sign up. Because, you know, some people might think, Oh, I'm not certified in trauma. So I shouldn't sign up for this. But it's really about really letting people know what you know. So there are places to, you know, the checkmarks are like what types of trainings you've had? And what specific areas of trauma you do best with? You know, is it domestic violence? Or is it combat trauma? Or is it loss of a parent and childhood? Or is it someone who was in a car crash, or bike accident? It's all it's all there and needing help. And all of those presentations are there, people are out there. And if you can let them know what you know, they can link up with the one that's really the right fit for their specific situation. And that's, that's the whole idea of the directory aspect. Katie Vernoy 34:31 You said that it's a directory and a network I what are the other things that are included there? I know you have your two podcasts, what else? What else? What's the whole picture? Okay, yeah. Laura Reagan 34:41 So of course, it's it's developing. I mean, it's it just went live 10 days ago, but right now it has blog posts that are you know, informational about trauma and there are more being added all the time. The podcasts episodes are there with transcripts for both podcasts. And there are resource lists of specific things. So not everybody who has trauma wants or can get trauma therapy for whatever reason. So hotlines, websites, books, podcasts, and one of the things I really like and want to develop for therapists who participate is for them to be able to share the blog posts that they've written podcasts that they've been on, not just therapy chatter, trauma chat podcast episodes, but their, you know, think your podcast and other things that people have done YouTube videos, they have courses they're offering. So it's a way to really let people find help with trauma, whether it's just learning about it, or reading about it, you know, and, and pursuing something on their own to taking a course doing some kind of webinar, you know, somatic work in trauma, that isn't therapy, you know, so. And then for the therapists, again, it's also going to be, we're going to gather, so I don't know when we'll be able to gather in person, but we're going to have at least virtual meetings where you know, we can share and support one another. And because, you know, whether you're a therapist or a client, trauma is very isolating. And so the more we can bring connection, that's why I'm calling it a network I want I want clients to feel like they're connecting. And I want therapists to feel like they're connecting both with clients and other therapists and other people who do this work. Katie Vernoy 36:41 That sounds amazing. Curt Widhalm 36:43 And we'll include links to all of Laura's stuff and her network in our show notes. You can find those over at MTSGpodcast.com And check out all of the latest updates on the therapy, reimagined conference and all of our speakers and all the cool things that we're doing for that you can find that out at therapyreimaginedconference.com, and follow us on our social media. And until next time, I'm Curt Widhalm with Katie Vernoy and Laura Reagan. Katie Vernoy 37:12 Thanks again to our sponsor, SimplePractice. Curt Widhalm 37:15 SimplePractice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use SimplePractice to power telehealth session schedule appointments, file insurance claims market, their practice, and so much more. All on one HIPAA compliant platform. Katie Vernoy 37:33 Get your first two months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Please note that we are a paid affiliate for SimplePractice. So we'll get a little bit of money in our pocket. If you sign up at this link. Simplepractice.com/therapyreimagined. And that's where you can learn more. Curt Widhalm 37:54 This episode is also sponsored by RevKey. Katie Vernoy 37:58 RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. Curt Widhalm 38:21 You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. Katie Vernoy 38:38 You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener. Announcer 38:45 Thank you for listening to the Modern Therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
How would the Endangered Species Act protect Mugato? Could the Ferengi operate a Mugato preserve? And did Tendi violate HIPAA? Join Josh and Nari for their legal analysis of Lower Decks and see how mediation is a lot like diplomacy. Support the show (https://www.patreon.com/thelegalgeeks)
Welcome solo and group practice owners! We are Liath Dalton and Roy Huggins, your co-hosts of Person Centered Tech. In our latest episode, we're talking about using the internet securely wherever you are. We discuss what an internet connection actually is, vulnerabilities in network connections, network security, guest networks, physical security of network hardware, Virtual Private Networks (VPNs), avoiding lag time with a VPN, using personal devices, cellular hotspots, and our course on security and home offices. Listen here: https://personcenteredtech.com/group/podcast/ Stay tuned for future episodes! For more, visit our website. Resources Remote Workplace HIPAA Security Module (document pack + training) On-demand training: Teletherapy From the Home or Mobile Office: HIPAA, Ethical, and Standard of Care Issues (1 CE credit hour, legal-ethical) Article: With a VPN, Your Staff Can Work Just About Anywhere Article: The Traveling Telemental Health Therapist's Best Friend: VPNs Free Service Selection PCT Workbook Group Practice Office Hours (direct support and consultation service from PCT consulting team and teletherapy & HIPAA attorney Eric Strom, JD PhD LMHC)
My guest today is Gabby Dizon, co-founder of Yield Guild Games or YGG. In 2020, Gabby and his co-founders built YGG around the growing “play-to-earn” economy within blockchain-based games. Based in the Philippines, YGG effectively backs players - who might not otherwise be able to afford to play - in exchange for a share of their profits. Today, YGG is paying out over a $1mn US dollars a week to players within its community - largely concentrated in their home country of the Philippines. The play-to-earn model has seen its most rapid growth in the popular NFT-based game “Axie Infinity”. Players earn tokens within the game which can be exchanged into local currencies or be used to purchase more digital assets. For a sense of how this market has expanded, Axie Infinity has already reported over $1.5bn in sales over its history- and nearly $900mm over the last 30 days. The speed at which these games and the ecosystems around them are growing is remarkable. In our conversation, Gabby explains YGG's decentralized structure, the unit economics of their business model, and how he deals with the volatility of crypto assets when trying to build a durable, long-term business. We also discuss the broader metaverse landscape, how it might evolve, what might derail it, and the technicalities of building a token-based, as opposed to equity-based, business. I hope you enjoy this wild conversation with Gabby Dizon. For the full show notes, transcript, and links to mentioned content, check out the episode page here. ----- This episode is brought to you by Klaviyo. Klaviyo is the ultimate marketing platform for e-commerce. With targeted segmentation, email automation, SMS marketing, and more, Klaviyo helps you create your ideal customer experience. See why brands like Living Proof, Solo Stove, and Nomad trust Klaviyo to grow their business. For a free trial, check out klaviyo.com/founders. ----- This episode is brought to you by Vanta. Vanta has built software that makes it easier to get and maintain your SOC 2, HIPAA or ISO 27001 reports at a fraction of the typical cost. Founder's Field Guide listeners can redeem a $1k off coupon at vanta.com/patrick. ----- Founder's Field Guide is a property of Colossus, Inc. For more episodes of Founder's Field Guide, visit joincolossus.com/episodes. Stay up to date on all our podcasts by signing up to Colossus Weekly, our quick dive every Sunday highlighting the top business and investing concepts from our podcasts and the best of what we read that week. Sign up here. Follow us on Twitter: @patrick_oshag | @JoinColossus Show Notes [00:03:34] - [First question] - What Yield Guild Games is and what they do [00:04:30] - The growing popularity of play-to-earn games in the metaverse [00:06:07] - Major categories of digital assets that exist today [00:08:11] - How players can earn money playing Axie Infinity [00:10:47] - The business model of YGG and what they offer to players [00:12:42] - Potential earnings of playing Axie Infinity [00:15:03] - Possible risks to demand and what the Axie economy could be in a few years [00:17:54] - Evaluating games that are worth investing in [00:19:55] - The kinds of things that will be most valuable across games in the future [00:21:37] - Differences in value between cosmetic and utilitarian in-game purchases [00:23:04] - Key focuses of YGG over the near future [00:24:47] - What's different about labor and capital in the metaverse [00:27:11] - How tokenomics works and value grows for a DAO [00:29:02] - Ways DAOs are better or worse than traditional equity tables [00:30:11] - The state of YGGs economics today [00:31:16] - The Guild's player retention and growing their scholars [00:32:54] - Barriers to entry for building a competitive DAO like YGG [00:34:14] - What made Gabby so interested in crypto originally [00:36:38] - His personal journey to crypto games [00:37:53] - Jobs that may carry over from the real world into the metaverse [00:39:36] - Companies that will arise focusing solely on in-game item creation [00:41:18] - Base layers of infrastructure needed to create the best future for crypto gaming [00:44:32] - Shared qualities between games that have a high replayability rate [00:46:40] - Good and bad tokenomic ecosystem designs [00:48:17] - What the biggest risks are for the future success of crypto gaming [00:49:26] - What factors will ensure the future growth and adoption of crypto gaming [00:50:25] - How much fiat flows through Axie and the growing value of in-game assets [00:52:05] - Whether or not we'll see purchasable utility items in the future [00:53:21] - What he's most excited about for the future of the metaverse [00:54:52] - The kindest thing that anyone has ever done for him
Get CE off your to-do list! Start earning your CE credits today at https://rdh.tv/ce HIPAA: Do Dental Professionals Fully Understand ‘Protected Health Information?' By Tanya L. Smith, RDH, BS Original article published on Today's RDH: https://www.todaysrdh.com/hipaa-do-dental-professionals-fully-understand-protected-health-information/ Get daily dental hygiene articles at https://www.todaysrdh.com Follow Today's RDH on Facebook: https://www.facebook.com/TodaysRDH/ Follow Kara RDH on Facebook: https://www.facebook.com/DentalHygieneKaraRDH/ Follow Kara RDH on Instagram: https://www.instagram.com/kara_rdh/
Have you ever heard tech folks refer to a computer problem as an ID10T error? You probably thought it was some highly technical term geeks use. Well, it's not and today we are going to talk about a couple posts and articles where folks' are flying their ID10T flag high and proud. And hopefully try to prevent you from making an ID10T error. More info at HelpMeWithHIPAA.com/319
Drink along as we spend 5 minutes arguing over each of the following 12 topics: HIPAA. The nature of AI. The JFK Jr. conspiracy. Intellectual property. The 2+2=5 controversy. Political parties. Voting IDs. Jeff Bezos suing NASA. What are dreams (this was a dumb topic). Sex workers deserve to have safe and reliable sites to advertise & host content. Covid lab leak. Chinaaaaaaa has a better foreign policy that the US. Grab 6 beers and join us on this week's episode. --- Support this podcast: https://anchor.fm/None_Taken /support
My guest today is Max Simkoff, Founder and CEO of Doma. Max founded Doma in 2016 after experiencing the pain and manual process associated with title insurance and real estate transactions. With a background in predictive analytics, Max built Doma to bring a digital-first approach to a historically manual and labor-intensive process. In our conversation, we cover the history behind mortgage closings, where title companies fall into that process, and how Doma is using technology to improve the client experience. We also discuss Max's formative experiences at his previous venture, Evolv, and the lessons he's learned from taking Doma from an idea to a public company. There are many great lessons in this episode, and Max's entrepreneurial energy shines throughout. Please enjoy this great conversation with Max Simkoff. For the full show notes, transcript, and links to mentioned content, check out the episode page here. ----- This episode is brought to you by SnackMagic. SnackMagic is the only 100% customizable snack and swag service that allows recipients to build their own snack stash. Whether you want to thank your global team, need goodie bags for your upcoming hybrid event or want to stock your office pantry, the menu of over 1,000 types of snacks and sips covers just about every preference. To learn more and get 10% off your first order with code Patrick at snackmagic.com/patrick. ----- This episode is brought to you by Vanta. Vanta has built software that makes it easier to get and maintain your SOC 2, HIPAA or ISO 27001 reports at a fraction of the typical cost. Founder's Field Guide listeners can redeem a $1k off coupon at vanta.com/patrick. ----- Founder's Field Guide is a property of Colossus, Inc. For more episodes of Founder's Field Guide, visit joincolossus.com/episodes. Stay up to date on all our podcasts by signing up to Colossus Weekly, our quick dive every Sunday highlighting the top business and investing concepts from our podcasts and the best of what we read that week. Sign up here. Follow us on Twitter: @patrick_oshag | @JoinColossus Show Notes [00:03:17] - [First question] - What Doma does and what they do for customers [00:04:38] - What Title is and why it sits at the center of such a large transaction [00:08:41] - Overview of the business economics of this space [00:13:55] - How the ecosystem works writ large [00:18:05] - The formative business experiences he had that led him to today [00:23:03] - What it means to be great at this whole process [00:26:53] - The thing Doma tries to predict and the inputs that allow them to do so [00:32:50] - Defining his biggest roadblocks and how they've changed over time [00:36:02] - Managing stakeholder expectations and perception [00:40:22] - Learning to walk to the line of having a large vision and communicating it [00:42:51] - What his loose screw is as a founder [00:45:06] - The square-peg-round-hole they encountered during the pandemic [00:51:20] - What the counterproductive byproduct of his genius is [00:53:35] - Figuring out where to take the company next [00:56:52] - The big lessons learned from interacting with capital markets [00:59:30] - Other entrepreneurs he feels are maniacs that he respects [01:00:55] - What will be the biggest contributing factors to their success over the next decade [01:02:44] - The key ingredients for building a winning team [01:04:34] - The kindest thing anyone has ever done for him
My guest today is Sameer Shariff, co-founder and CEO of Cambly. After starting his career at Google, Sameer founded Cambly in 2013 as an on-demand service to learn English. At the touch of a button, Cambly connects its global user base into a 1-on-1 conversation with an English speaker. During our conversation, we cover the origin story of the business, what Sameer views as the core functions of the two-sided marketplace, and how the team approached scaling a product that was international from day one. Once you hear Sameer talk, you quickly realize the size of Cambly's market opportunity and why it may have been easy to overlook this problem. I hope you enjoy this great conversation with Sameer Shariff. For the full show notes, transcript, and links to mentioned content, check out the episode page here. ----- This episode is brought to you by SnackMagic. SnackMagic is the only 100% customizable snack and swag service that allows recipients to build their own snack stash. Whether you want to thank your global team, need goodie bags for your upcoming hybrid event or want to stock your office pantry, the menu of over 1,000 types of snacks and sips covers just about every preference. To learn more and get 10% off your first order with code Patrick at snackmagic.com/patrick. ----- This episode is brought to you by Vanta. Vanta has built software that makes it easier to get and maintain your SOC 2, HIPAA or ISO 27001 reports at a fraction of the typical cost. Founder's Field Guide listeners can redeem a $1k off coupon at vanta.com/patrick. ----- Founder's Field Guide is a property of Colossus, Inc. For more episodes of Founder's Field Guide, visit joincolossus.com/episodes. Stay up to date on all our podcasts by signing up to Colossus Weekly, our quick dive every Sunday highlighting the top business and investing concepts from our podcasts and the best of what we read that week. Sign up here. Follow us on Twitter: @patrick_oshag | @JoinColossus Show Notes [00:03:05] - [First question] - What led him to the original concept of Cambly [00:05:21] - Beginning to learn the scope of the problem and what solving it unlocked [00:07:58] - What Cambly is and how they started tackling the problem [00:09:15] - Lessons learned about the challenges of building an alive marketplace [00:11:41] - Technical challenges and the enabling technologies that allowed it to happen [00:12:59] - Deciding on what to focus on first when it comes to students [00:15:24] - Figuring out the formula for unit economics and the pricing structure [00:17:02] - Learning what doesn't work in their business model [00:18:07] - Setting up quality control measures and moderation [00:21:01] - Tools and services that will improve their experience in the future [00:23:18] - What the 11-star version of Cambly would look like in a decade [00:26:56] - Ways in which their software and concept could be applied elsewhere [00:28:30] - Setting themselves up for success and fine-tuning the matchmaking component [00:30:37] - Driving users to the platform and audience building strategies [00:33:46] - Making the platform feel native to each country it serves [00:35:59] - Surprising lessons learned around distribution and market penetration [00:37:13] - The biggest boss battles faced as a business [00:40:17] - Advice he would give to founders in a similar situation [00:41:32] - How he's personally changed the most across this journey [00:43:32] - Ways he's shifted to a state of letting go and trusting his team more [00:45:14] - Lessons learned from studying Airbnb [00:47:22] - The kindest thing anyone has ever done for him