The Upper Hand: Chuck & Chris Talk Hand Surgery

Promotion of Your Practice Interests

January 22, 2023 Chuck and Chris Season 4 Episode 3
The Upper Hand: Chuck & Chris Talk Hand Surgery
Promotion of Your Practice Interests
Show Notes Transcript

Season 4, Episode 3.  Chuck and Chris discuss Chris' visit to the AAHS in South Florida and then discuss practice development.  We brainstorm the best techniques to make others in the community, region, and medical world aware of your interests.  First, of course, take great care of patients.  And then...  Join us and learn more!

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Charles Goldfarb:

Welcome to the upper hand podcast where Chuck and Chris talk Hand Surgery.

Chris Dy:

We are two hand surgeons at Washington University in St. Louis here to talk about all things hand surgery related from technical to personal.

Charles Goldfarb:

Please subscribe, wherever you get your podcasts.

Chris Dy:

And thank you in advance for leaving a review and leaving a rating wherever you get your podcast.

Charles Goldfarb:

Oh, hey, Chris.

Chris Dy:

Hey, Chuck, how are you?

Charles Goldfarb:

I'm well, you look like you're right next door. But you're not.

Chris Dy:

I'm not. It is. It is very nice in South Florida right now. I'll tell you that.

Charles Goldfarb:

Isn't it always nice in South Florida.

Chris Dy:

Not always hurricane season can be kind of rough. But ya know, I'm joining you from the annual meeting of the combined meeting of the AAHS, the ASPN. And the ASPN the last one less relevant to me. But the first two are definitely relevant.

Charles Goldfarb:

So tell me I have never been to that meeting or meetings. Tell me do you go every year? What's What's your cadence and tell me more?

Chris Dy:

Well, last year, I was supposed to go. But then COVID stuff was kind of at a bubble in St. Louis. So I stayed home and did the meeting virtually, which was a bummer. And then the 2020 meeting was our 2021 meeting, I think was also was virtual. But the last time it was in person that I was able to go was three years ago. And it was actually in South Florida. But I tried to go for the ASPN and every year, I'm not as involved in the association, although I know that they do wonderful things. I honestly as a nerd, I kind of like to spend my time with the ASPN stuff.

Charles Goldfarb:

Now, are these meetings simultaneously? Are they all mixed together? Or are they How does that work?

Chris Dy:

It's a little bit of an overlap. The Hand Association meeting starts earlier the ASPN is kind of right in the middle and incorporated in embedded in it and then the ASRM is on the tail end. So the ASPN stuff kicked off today. The association stuff has been going on since I believe Wednesday. But it's been good. I've been able to see some friends and mentors and former trainees now colleagues of ours at our wash you hand program so it's been wonderful.

Charles Goldfarb:

I love it. I love it. What are you speaking on?

Chris Dy:

I had a presentation this morning, I moderated the session on the use of patient reported outcome measures for have for nerve injury. I got swept into the moderator role at the last moment so I had to use my best Oprah skills to facilitate a good discussion. But that went very well and exciting. We've got to our partner David Bergen has a couple of podiums. So it's cheering him on for those and one of our residents are Iraqua Welbeck is presenting a podium for our lab for her OREF funded resident research projects tomorrow afternoon. And some nice posters for the lab as well. So it's been a it's a good showing for our lab.

Charles Goldfarb:

What else is going on?

Chris Dy:

Ah, not much. Aside from that. You know, I think that, you know, things have been busy as we've talked about in the past, you know, all of the holiday cancel or holidays and, you know, time away has made the clinics that you have remaining very busy and I've been feeling that too.

Charles Goldfarb:

Yeah, I'm really looking to get back to a level kind of level set. My practice it's out of control right now. And I think it's just we talked about the holidays, and but it's still overwhelming. I needed to calm down soon.

Chris Dy:

What's new in your world?

Charles Goldfarb:

Nothing. My wife's having a big birthday this weekend. So we're celebrating that.

Chris Dy:

The year of Talia continues the year

Charles Goldfarb:

Actually the year of Talia begins today. Ah, okay. All right. Yes, it is a big, big birthday. And my big birthday happened during COVID. So we're gonna celebrate hers. And there'll be a few events throughout the year. And yeah, it'll be fun.

Chris Dy:

That's great. Hopefully it will find some time to celebrate you as well.

Charles Goldfarb:

Doubtful. Yeah, so

Chris Dy:

I've run into I've run into several podcast fans more than several here. Who they I think they maybe they just recognize me when they hear my voice as opposed to see me in the hallway. But I have had several folks come up and volunteer how much they love the podcast. And I tell them that you you carry the load there, Chuck.

Charles Goldfarb:

Oh, did? Did you have any swag in your bag Dr. Dy?

Chris Dy:

I didn't I was honestly I was in a rush to pack for this one. I committed the sin of trying to fly out after a case but then knowing there was just enough time where I probably could come home and pack a very rushed packing. So I know that no swag mate at this time, but you know, I think we'll have a showing maybe at the academy and then, you know, we'll see the next hand Society meeting we'll see. So, Chuck, we should really thank our friends over at Practice Link. I think that we owe them a debt of gratitude. The upper hand is sponsored by practicelink.com The most widely used physician job search and career advancement resource

Charles Goldfarb:

Becoming a physician is hard. Finding the right job does not have to be joined practice link for free today at www.practicelink.com/theupperhand

Chris Dy:

and make sure you use that link, I'm gonna go refresh that a million times, just so they know that a lot of people are listening.

Charles Goldfarb:

Absolutely. Last episode, we talked a bit about claw hand. And I do think we're going to have a follow up. And maybe we can talk about really briefly on a clinical topic, but kind of loop into how we think about practice development. So we had mentioned that pediatric er, really adolescent elbow has become an increasingly large part of my practice. And it's just an interesting shift. I've been in practice a long time. And, and I'd say over the last couple years and in an accelerated fashion, it's becoming a bigger part of what I do. So I thought it'd be interesting to briefly discuss.

Chris Dy:

Yeah, absolutely. I mean, so did you intentionally? Did were you intentional about having this shift? Or do you think it just kind of organically occurred either consciously or subconsciously? Did you did you put a shingle out saying, I treat pediatric adolescent elbow?

Charles Goldfarb:

I think well, I know that you and I both have quoted Paul Manske, and I don't think it's Paul Manske's quote, but

Chris Dy:

the light... That can definitely be his. All right, well,

Charles Goldfarb:

"Life is not about creating opportunities, it's about recognizing them." And we've talked about that in at for young surgeons as a start practice. And, and no one in our group really has done a lot of complex adolescent elbow reconstruction. And so that's fallen a little bit to me, which is fine, I enjoy it. And then that evolved, and those were just intermittent cases here or there. And that evolved a little bit into OCD treatment, one of our other sports partners, Matt Smith also does some OCDs, but I've kind of that's been becoming a larger part of my practice. And then that's evolved more. So it's not something I sought out. I do like it. It's a weird thing. I'm sure you appreciate this. It's certainly a broad group of diagnoses, but many of which are unsolved. And I like that. I mean, look, nerve stuff is pretty straightforward. We know the answers. And so elbow is a little intriguing and a little black boxy,

Chris Dy:

elbows, definitely black boxy. And I'm glad that you want to dive right into that black box. I guess I would ask you with this, like, did you? We talked about recognizing opportunities? How did you recognize, at what point in this unfolding? Did you recognize this opportunity for a whole new sub specialty niche for you? And you know, what, what drove you to do that? And then what do you do when you recognize it?

Charles Goldfarb:

Yeah I definitely don't have all the answers personally, it was just recognizing that no one else in the department, you know, we have a large department, no one else really wanted to do this work. No one in the community and region was doing this work. And so it felt like an opportunity. There certainly were discussions at some of the smaller, you know, national meetings. So for example, the pediatric hand study group, we would occasionally talk about difficult elbows, even a smaller group of us at the hand society, but no one had a lot of answers, no one was doing a lot of it. And so I don't know initially was not a focus of mine, in that there was nothing intentional being done. But as patients started to come in, and how to develop that as part of the second part of this discussion, but as patients started to seek me out, it became more of an interest honestly.

Chris Dy:

How did you did you just have because we're so focused on our day to day and very myopic, many times, and just getting through the day getting through the week, did you just look up and one day say, God, I've had a lot of these, or did a resident sometimes it's a resident or fellow that points it out saying, I thought I was gonna see so and so with you. But now all I'm seeing is this, then you're like, Oh, I guess I have done a lot of that.

Charles Goldfarb:

I think it's really the former, it's, you know, I always describe my practice as having three parts. One is the congenital hand part. Another is the sports wrist in hand. And this clearly has become the third leg, in addition to the true third part, which I guess is bread and butter hand surgery. It just did just happen. The resident has pointed that out in the past, and it just happened. And now I'm at the stage where I'm seeing enough of it, that I sort of feel like to truly help. I don't want to say solve, because I don't know that I can do that. But to truly help advance our knowledge. On some of these conditions. I need a few more patients, right, take OCDs, for example. I think I have a busy OCD practice with about 30 or so a year. And I believe that's a lot. I don't know that for a fact. But I believe that's a large number. And then these really complicated Um, elbow, I'll just say in general issues in the adolescent are less common, but more complicated. And so trying to share that information, trying to develop a way to let patients know that I'm interested in that that is a tricky process.

Chris Dy:

Yeah. 100% agree with, with all the things that you said, you know, I think it is, you seem to be at this kind of precipice where you're like, you know, if I just worked a little more on this and really dedicated more of my practice. But again, it's hard because you your bread and butter hand practice, which all of us have it, or at least in our division, you know, that that's not going to slow down, unless you intentionally put a throttle on it. Yeah, I guess what I'd ask, as a follow up is, you know, how do you start to get the word out? And you know, what are the channels that you work through? And how do you then organize your workflows and your screenings and everything to make sure that you're essentially getting what you want to see?

Charles Goldfarb:

I think that's a great question. And you certainly have some answers to that, because you've done a lot of different things to build your name as a referral. You know, we're for a location for complicated nerve. I'll give one example, maybe 10 years ago, noticed a number of kids that had a radial head fracture, that was largely cartilaginous was underestimated on the X ray, and led to radiocapatellar, posterior subluxation, and rapid development of arthritis. So I saw three or four of those kids and as a devastating injury. And then I talked to my friend, Don Bae in Boston, who also has an interest in this area, he has seen a few of those kids. So we put our kids together and wrote it up. And I think it's a real thing. But it's interesting. I don't know that. I don't think that led to any more referrals to us. I don't know if it changed anyone's practice in the emergency department to identify these issues. So I don't know how the best. I don't know what the best way to let people know this is of interest. I don't know that scientific publication is necessarily the route. But sometimes it feels like the only route and maybe is continued publications on us on a special area.

Chris Dy:

Yeah, no, I that was actually a good lead into the question I was gonna ask you, because I mean, that's the familiar route. That's the traditional route. But some would say maybe that's a bit anachronistic, you know, this society is different now. And the way we disseminate information is different. Even looking at something like, you know, you get something in a journal is an open access journal, because that's what patients are reading. And if you're looking truly to generate a lot of interest in this, I mean, you need to be optimized in terms of your search easily findable and not behind the firewall. Because yeah, we had a, we had a patient come up to see us from Florida for a plexus injury. And they had done the research and they had pulled papers, but all the papers they pulled were open access. And ironically, one of the papers that this mother had pulled was one of ours that was open access. So it's, that's where that's where people are. And I'm wondering whether in 2023, whether it is through things like Instagram, Tik Tok, and whatever else the new medium is going to be heading, maybe that's the way to get the word out.

Charles Goldfarb:

So let's talk about a few of those things. So we've talked a little bit about publication. And I agree with your point on open access, which to me is never the first choice. In fact, it's often the last choice, because it comes with my writing a check, and I haven't had, quote, unquote, had to do that often. But I think you're right, patients can access more. And that's important. Any other thing before we change to different other ways to promote a surgery or a niche? Any other things regarding general publications?

Chris Dy:

Well, I mean, I think that publication is the way in our world of academia and societies to let people know, this is something you're interested in. And especially if you're first to to get there, you'll be cited more often. And if you build a small series of papers on the topic, then you become the subject experts. So I think there's a role for that. And I think a lot of the ways that, I think, at least I have, and I think probably you have as well approach, you know, developing reputation is using a combination of techniques. So not just, you know, the traditional academic way. But some of the newer ways to I think open access is really powerful. I mean, it is truly a shame that it cost so damn much. But that is how you get the word of the the point of all of our efforts and our scholarship is so that people will read it. It's not just patients and families. It's practicing surgeons and practicing clinicians that are not at academic institutions and don't have access to all the journals. We take it for granted that we can log into our VPN and get whatever we need. Um, I think that if for people to really read it, you know, the stuff that gains the most traction is the stuff that is available freely and openly. And I have no idea I'm not an expert by any means in terms of where publication and scientific publications are going and how journals are going to maintain sustainability. But it is truly a shame that open access cost so much unless you are funded through, you know, certain grant mechanisms, or they have to make it open access.

Charles Goldfarb:

Yeah, all true, all good. And I think you're right, it is about if we're truly going to establish, you know, expertise. It is about repetitive publications to build your name in the scientific community. But you also need to simultaneously build your name and in the public space, to generate patient, you know, interest in what you're doing. And so, you know, the other example we have here in St. Louis, the first one that comes to mind is paradise tabular osteotomies, with John Clohisy. And, and I think that's been his approach is to publications speaking at national meetings. And it also helps if it's a procedure, or a diagnosis that is particularly challenging that others really don't have an interest in doing. And if they don't have an interest in doing that, then they're more likely to refer to you.

Chris Dy:

Yeah, exactly. Exactly. And I think John, was on the front end of the website thing, too, which I think helped a lot in terms of driving patients to his practice. You know, I guess the more I think, generalizable or relatable topic to a lot of people who are listening who may not necessarily want to be the world's expert in, you know, adolescent OCD, but just want people to know that this is something that they do, and they're really good at and refer to them regionally. Yeah. How would you approach that? Like how to? Are you? Are you letting your work speak for itself? Which I think is kind of what the default position for many of us, are you found on the pavement on pediatricians doors? Or what are you doing?

Charles Goldfarb:

Yeah, I think traditionally, it would mean my or you're going to talk at different hospitals in the, you know, 300 miles from St. Louis kind of deal. I don't think that's practical, or, honestly very doable today. So I think it is electronic connection, you know, being in the Google search. And also, once you've been in a community for a while you develop those relationships with other orthopedic surgeons, other plastic surgeons, other pediatricians, and I think those relationships grow. And patients, I'm sorry, and physicians can turn to you as a resource, but more and more as patients driving their own referrals. And so that gets back to the Google Search being on the first page. And how do you do that? Publication? certainly can. I think what's worked for me and congenital hand and continues to pay dividends? Is my blog, there is no question I get. It's about three or four random emails a week from patients. And some of these are from foreign countries where they're just looking for insights. Some of these are from, you know, closer, where they might come to see me for a visit, but the blog is paid dividends.

Chris Dy:

How do you handle because I think what, what's one of the hesitations that some folks have about engaging in some of those non traditional means, like a blog, like social media is, how do you handle the medical legal risk that comes with that on top of obviously, the tremendous amount of time and effort and energy that you put into it?

Charles Goldfarb:

Yeah, the time, effort and energy are tough. You know, I think, you know, doing it in a HIPAA compliant way is obvious, you need to do that. And I think it's just putting your thoughts out there for people to consider, and then potentially figuring out how to make contact with patients in an educational way, I have never found it helpful or necessary to say something negative about anyone else. There are those that will. And so far, there's never been any negative consequences, at least to my knowledge, but I try to just be honest with patients and and if they have a physician they're working with, I may suggest they ask the right questions, you know, how often is the physician to see this particular problem? And are they particularly interested in it? So leave the patient to ask the right questions, but I'm not gonna say anything negative about anyone ever.

Chris Dy:

Right now, obviously, that's the I think that's the approach. But as you mentioned, not everybody follows that. You mentioned getting a rep, you know, gaining a reputation locally and regionally with you know, referring clinicians, therapists and physicians. How long do you think it takes to get that type of and forgive me for using this term because I can't think of a better one market penetration in terms of like your name being like, hey, Chuck is Chuck Goldfarb is the person for adolescent OCD is in St. Louis in the Midwest?

Charles Goldfarb:

Yeah, I certainly don't know if I'm there for that particular diagnosis. And you're right, I neglected them. mentioned therapists previously close relationship with a therapist or at least the understanding had to be a close relationship. It's reliable results that a therapist may see in their office time and time again, does pay dividends. And you and I have talked about this, and it absolutely generates referrals. It takes time, it's why it makes it daunting to think about moving, ever, at least for me, I would say 510 years to really have people think about you on a regular basis for different things, whether that'd be bread and butter hand to the more uncommon conditions that we see. What do you think, do you think that's, that's right, five or 10 years?

Chris Dy:

I think so. I mean, you know, so it does all start kind of organically and takes a long time to build. And it's one or two patients here or there for one or two referring clinicians. And, you know, I think that recently, we were in our complex nerve clinic. And Macy, who is our wonderful hand therapy guest on the pod. She also works in our complex neuro clinic with us. And she noticed in one of our recent clinics, that there was a bit of a sea change in terms of the referral patterns that were coming in. And like I said earlier, like you're so involved in the day to day in the myopia of your life that you don't take a step back and say, Wow, what has changed. And at that point, we were just, I was entering my seventh year at WashU, on the faculty. And that's when I realized, like, I think people are sending stuff to us, you know, specifically for, you know, for mine and David Bergens opinions on stuff. And that's just starting, I think, so it takes a while. And I think that we've made a lot of efforts to truly do the work, do consistent work, reliable results, you know, be good communicators. But it's a big investment of time. I mean, some people would say, seven years, is that worth it? But I think we're finally getting to that point where we're, you know, and as it's no secret time by listening that St. Louis is a competitive regional landscape for peripheral nerve.

Charles Goldfarb:

Yes, yeah, it. I think you said it. Well, I think you have to be patient. And let's be honest, in your first and second year of practice some of these unusual conditions, you're you're not an expert, you may have an interest in so your skills, knowledge, etc, have developed, and your patient population has grown. I think that's, that's really great. What do you think about Twitter, and Instagram, maybe Facebook as well. So I'll start. I quit Twitter, which

Chris Dy:

is related to the Elon thing or

Charles Goldfarb:

for sure. 100%

Chris Dy:

says the sesame man who drives the car.

Charles Goldfarb:

I had to drive an electric car and there's not another that compares in my mind yet. And I did buy the car before the Elan thing really went deep. But it's partly that and partly I need to give up something I don't think Twitter necessarily or Instagram is about patients. I think it's about the medical community and education. For trainees and the like, Facebook may be different. I'm not really on Facebook, it's linked to my Instagram stuff. How do you think about those social media opportunities?

Chris Dy:

I think you're right, definitely for sure about Twitter, in the medical community, I think you will potentially get some interest from patients on Instagram and Tiktok. You know, I've gone back and forth on the social media thing, which is interesting, because you and I have presented on the social media stuff. And that's kind of part of our sticks, is you know how to navigate that. But it just takes so much time and effort and energy. And it's just like you said, sometimes you have to give some stuff up, whether that's conscious or unconscious. You know, I've seen some great examples of people who have really accelerated their career reputational growth, again, not necessarily patients but their reputation among the community at large, especially among the younger generation with the with social media. For example, I know that Johnny Liu listens. Johnny is a fantastic peripheral nerve surgeon at Chengdong in Taiwan. Incredibly excellent surgeon, very well trained, does the research, you know, spent a year, maybe two It's Susan Mackinnon and her lab, got a Master's, he has all the bonafide academic credentials, but has taken his reputation, I think, to the next level with his work with the international microsurgery club on Facebook, and showing some amazing cases and results on social media and HIPAA compliant way, of course. But I think that people look at him as a leader in the space as kind of one of the young guns in peripheral nerve and rightfully so because again, he has all the academic bonafides but has moved his reputation along I think with a wider reach, because he's been very savvy on social media, and I admire him for that. So I think there's definitely a way to do it. Just that's not going to generate patient referrals necessarily, although it might. That's not the reason to do it. And I think we've said that before on the pod.

Charles Goldfarb:

Yeah, that's great. That's a perfect example. What about surgical video creation, it's not something I've done a lot of I've done a little bit of it. But it seems like our residents and fellows, don't seek the textbook chapter first. In preparation for a case more and more, they want a surgical video that just shows them how to do it. Now, I have a lot of problems with that. But I'm not going to change that I'm not trying to change that. That's just the reality of how people seek at least hopefully only part of their surgical education. I personally think that's probably important moving forward, we just haven't done a lot of it.

Chris Dy:

100% agree. I mean, you know, it is what it is, it's the YouTube generation. So it's a generation self included, that is used to getting things on demand in terms of videos and content and access. And I think that's only going to continue to evolve that way. Now, you know, what I've tried to do at the beginning of the rotation, when I remember, with our residents and fellows, as I asked them, how they learn, are they what how are you going to prepare for this case? Are you going to go pull an article, you're going to pull a chapter are you going to watch a video? What are you going to do and then I'll say, alright, if you're going to watch a video for say, for example, we're preparing for a an older nerve transposition, I say, alright, I have an article on this that I wrote, here's a chapter if you want this, or if you're gonna watch a video watching this video. And you know, you don't have that breath for everything. You only have it for certain topics. And honestly, it helps if you yourself have vetted the video. But I think that that's almost impossible. And we know that there's a ton of variation in quality accuracy in the videos. And there there are folks really interested in making things more consistent and higher quality, but it just takes so much time, money effort to do those things. I mean, I think a great example of the use of surgical videos, is Susan McKinnon. I mean, you know, Dr. MacKinnon was already going to be one of the greats and legends in peripheral nerve surgery. But I think her reach and her legacy has been solidified by just the incredible quality of content and volume of content that she has provided over the last 10 years. The number of people that have watched her videos is incredible. I remember going to India as a for our microsurgery experience, and then having them watching the video of the nerve transfer that Dr. MacKinnon had done. So I mean, it's an incredible region and her her work is fantastic. But I think that it's in she will admit, and she's told us how tough it is to produce something of that quality is hard. So in terms of the thinking of all the things that we need to do as educators, now we have to make videos too. And I'm not saying what was me, but you know, because if we're gonna make something, it's gonna be good. And that's just hard.

Charles Goldfarb:

That's exactly right. So let's close if you're okay with that, with maybe two or three things that we are doing that we think is important, and we'll continue to do to develop our niches and maybe one thing we're considering doing more of in the future. Does that sound okay?

Chris Dy:

Sounds good. And you have to go first. And so it was your idea?

Charles Goldfarb:

I guess good because I got an easy one. I think the first and far and away the most important thing is take great care of patients. You do that first and the therapists in your community will see it, the referring physicians will see it. If you take the good care and good personable care of patients in the long run that's going to benefit you. The question is, are there shortcuts to speed the process?

Chris Dy:

Yeah, 100%, I think that continuing to do the work is one of them. I don't remember the entirety of the structure of your question, because I was so intently listening to your response. But in terms of things that I want to do to get better, we're really trying to focus on the education piece for patients. And I think that that is something that will help us move forward, I think in terms of being known in the patient, community and patient advocacy community at large as if we get better at the education piece. And, you know, we've partnered with the United brachial plexus that work on some of our education projects and grants. And that's something that will take a few years to see to completion. But I think that's what we're going to move towards

Charles Goldfarb:

building on that one, I would add that patient education is a pure, good way to help the medical community. And so that's what my blog is. It's not about self promotion, although some people may see it that way. It really isn't. It's about sharing my thoughts on different conditions and trying to provide a patient friendly educational resource. And that's what it's done. And I recognize that the time spent, if you're going to measure by the number of patients received is not worth it. It feels good. And it does stand the test of time. So that for me is something I have done and what I will continue to do.

Chris Dy:

Yeah, and I think the big is the biggest thing, if you're looking to truly move the needle and look at, you know, number of patients seen for a certain condition, probably the best yield is to talk to not necessarily referring physicians all the time, or if you, you know, following up with people, and just saying, Hey, doctor, so and so or, Hey, you know, therapist, so and so thank you for sending this patient over, you know, here's the standard note. But if you happen to have a cell phone number, or a call, you know, email address, people really appreciate those extra steps. And it you know, it's just, you know, one domino at a time, and then it comes. And I'm still in the process of trying to navigate that, but I think if you are able to do that, it's probably the biggest bang for your buck. Think that's right.

Charles Goldfarb:

From a local, build your name process, there's nothing better than that. And it is about personal touch. You and I are position where we can and should build a if we can build a number of patients, we should report the findings, you know, we should publish our results, it's the way we move things forward. And, and small retrospective studies are not the way to do it. But there are a starting point, registry work which we're both interested in is more effective, and also builds a community, people typically across the country. So that's been something that I think has been very important for me and something I'll probably look to do with the elbow as well.

Chris Dy:

Right? And then you know, and you mentioned that but it should not be under emphasized that you have to start with a small retrospective series. You can't get the big money to do big grants unless you have something published out there. And yes, from a scientific rigor perspective, that prospective stuff is the way to go but you got to do it all you got to be able to, to publish with what you can and sometimes that's your own patients other people's you know, stuff that's publicly available. But you got to do the small stuff in order to get to the point where you are ready for registry stuff. So

Charles Goldfarb:

anything you're gonna do differently in the future? Are you thinking about more videos?

Chris Dy:

I think about it think about all the time I mean, I would love to like you know, just say hey, you know, just go watch this video that I made because it's exactly how I do it but I wish I could it's just it's just another thing and we've talked about just adding more things to the plate but it's I don't want to put something that is you know, not the highest quality that's that's not reflective of ultimately what we want to represent now whether it's better to have nothing I don't know what about you videos before we close out?

Charles Goldfarb:

I do I want to do that. It's not only it prolongs the actual surgery and so neither you nor I are sitting around trying to take longer in a surgery and then the cost to have it done well iPhone iPhones are great whether they're good enough to to you know, produce a video that is that we're proud of I'm not sure maybe maybe an iPhone is but you still have to have someone shooting the video so yeah, I want to do more of that.

Chris Dy:

shooting and editing and you know, I tried to wear a GoPro my first couple of years in practice and my neck hurt First off, but it just it was too much video to try to edit down so I gave up on that. But hopefully, the Google Glass technology will come back and it's all going to be figured out by

Charles Goldfarb:

now that's exactly right. Well, I think this was fun to talk about and maybe we can circle back if we're still doing the pot and a year or two and we can review again it Yeah, it's a really interesting topic that every surgeon every therapist thinks about maybe some of our thoughts are helpful for others I hope so.

Chris Dy:

I hope so. Well have a wonderful rest of your day and enjoy the year of Thalia it dot dot dot dot and

Charles Goldfarb:

have a good time in South Florida. I'm sure it's gonna be rough, but hang in there.

Chris Dy:

Oh, it's it's so cold here, Chuck. - goodbye.

Charles Goldfarb:

Hey, Chris, that was fun. Let's do it again real soon.

Chris Dy:

Sounds good. Well, be sure to check us out on Twitter@Hand podcast. Hey, Chuck, what's your Twitter handle?

Charles Goldfarb:

Mine is@congenitalhand. What about you?

Chris Dy:

Mine is @ChrisDSyMD spelled d-y. And if you'd like to email us, you can reach us at handpodcast@gmail.com.

Charles Goldfarb:

And remember, please subscribe wherever you get your podcast

Chris Dy:

and be sure to leave a review that helps us get the word out.

Charles Goldfarb:

Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand. Come back next time