The Art of Running on Time

This podcast will help you to become more confident with your patients , more successful in your practice or business and a leader in pelvic health , and we're going to have some fun along the way . Join us as we rise together .

We're Jesse and Nicole Cozine , founders of Pelvic Kennedy Physical Therapy and the creators of the Pelvic PT Huddle , and this is Pelvic PT Rising .

It's something that a lot of y'all struggle with .

It is stressful when you're constantly running late and making other people wait and your patient starts talking at the end of the session and you know someone else is there and you're kicking yourself because you didn't end a little bit sooner and you definitely don't want to see their picture of their dog that they're trying to find on their phone .

I mean , it's anxiety producing and I want y'all to just not have that anxiety at work around this .

It's budding up to lunch . You know the only person that you're cutting into is your own lunch . It's the last person of the day You're willing to just stay a little bit late because they really need it .

Right , there's the sense that this is a little bit of a victimless crime and , having been now on the administrative side of a clinic for seven years and be dealing with this with seven different clinicians at pelvic sanity , I can tell you that it really isn't a victimless crime . I think that's what you know .

One of the great things that Nicole just said is that you , first and foremost , are a victim of this crime and you know Nicole's been pretty open . She struggled with this when you know especially when it was just you , I think , at the clinic , nicole , when there was really no one else around that you had a set an example for . But you felt like this way .

I feel like , right , that it was a victimless crime . And in reality I really don't think it is . It does contribute to your stress throughout the day . It contributes to rushing and scarfing down lunch . It contributes to missing a potential workout because you went 15 minutes over , 20 minutes over .

You don't have time to go to the gym or you don't have time to go and have a great dinner that you make , so you stop at Wendy's on the way home , like all of that stuff has unintended consequences that I don't think we're really thinking through , when it's just like , oh , this person really needs help and you guys are all such caregivers and givers and

people pleasers and all that , but I don't think we always see those unintended consequences .

And inherently , people are extremely selfish and If you go over , if your appointment time is 60 minutes and you go to 70 , the expectation next time if it's anything less than 70 , is that I didn't get my time . And it's not that people are bad people , it's just that you're setting a precedent .

And then it's difficult for you to go back and take away time from somebody that you've given . And once I realized that and that was a very glaring story that I can share in a minute but once you realize that that people aren't actually being like , oh my gosh , thank you so much , this is so wonderful .

Even if they say it , they're not thinking it every single time and truly putting it like deep down and embodying that gratitude , they're being like oh yeah , cool , thanks . I got a lot of stuff out of that session today .

The moment you go over with somebody , that's their new expectation and it's not . Oh my gosh . Thank you so much , Nicole , for going 10 minutes over with me . It is the next time they come in . It is . Wait a second . Why are you cutting my session shorter than it was last time ?

So , for instance , if you're internal on the obtrator internist and you've almost got it released and you can feel that therapeutic pulse and it's great , but it's clock's ticking and you're like gosh , I just don't want to leave their muscle like that . And then you're going to want to train it afterwards .

And so now , all of a sudden , that one decision of you deciding to work on the obtrator internist a little bit longer now turns into a 10 minute overage , because you're going to complete that entire treatment instead of just being able to say hey , notice and say something like this is really irritated and we're going to do a short thing to calm it down now ,

but we're going to really revisit that next time .

One is a sense of fairness , and this was one of the things , I think , nicole , that really helped convince you to get better at this , because you were pretty notorious for this and but you were super cognizant too . You were a master of knowing your schedule , knowing who was coming in and you would be giving the extra time , and I pointed this out to you .

The people who are coming in right before lunch and right before the end of the day are getting significantly more treatment than everybody else on your schedule . And how is that fair ?

Just because they happened to schedule the five o'clock appointment or the 12 o'clock to one o'clock appointment time that butts into your lunch , why are they getting 20 minutes more than another patient who happens to schedule at 11 ? So something to think about there that might help you with that , with fairness .

Another one of this is just the trust that's implicit . When you put down here's the start time and here's an end time and you violate that , you really are violating trust Now , even though it's in someone's favor , you are giving this inherent impression that you are not somebody who is trustworthy .

And I said acupuncture when I you know , like in this days I'm in this like amazing , like state I love acupuncture , by the way , and I love my clinician , but I specifically told her I need to be out by this time and she went over and then I didn't have a way to know what time was . In fact , I lost all sense of time .

I come out thinking like that and that was an amazing session , not , oh my gosh . Thank you so much for going 30 minutes over . I feel amazing , but I was like shit , you fucked up my whole schedule today .

And I think that sometimes , when your your session time just keeps inching a little bit more and more , what you're not taking into account is the other person's expectation that you will end on time and that they're scheduling something else and they need to pick up their kids at a certain time .

And it's just don't assume that it's a good thing that you're going over .

I'm not there right on time , so now they're coming late and their expectation is that you're going to see them for their full appointment time . Now you've created this self-fulfilling prophecy . Even on the days where you are running on time , your patients are not running on time because you've trained them not to .

That's a pretty common practice , and so what ends up happening is that , like Jesse said , it's a self-fulfilling prophecy . So you go 10 minutes over . Now you start the next person , and let's be totally real that that person is going to start 15 minutes late , right ?

So you inch and inch and inch , even every time you're late , because the further along it gets it's like oh well , whatever , I'm screwed today . Kind of like eating some french fries when you're trying to work out . I don't know if anyone else is like that , but I'm like , ah , shit , I ate wrong today . I might as well just scrap it all , skip the workout .

Are you surprised when you're running late ? Or is it a really deliberate decision ? Is it something where you are maybe not feeling ? If you're working in a cash practice or you have a cash practice , you're not feeling really confident in the value you're providing . So why is this happening ?

But then , once you get that , we can start to get practical in the cold . First of all , just have a clock that's easily viewable Like if you don't know what time it is , your course you're going to be fucking late .

You're just glancing at it all the time , so make sure it's in an easily accessible place where it's going to catch your gaze , where you don't have to turn your head , Because all y'all know that we feel weird if we're going to make a deliberate effort to go and turn our heads because we think the patient's watching us like a hawk and they probably are .

So you've got to make sure that it's within your line of sight during all of the transitional movements and stuff that you're in transitional positions that you're going to get your patient in .

If I've never been person to wear a watch , to wear a watch , but a lot of y'all have Apple watches and you can set your timer for it to buzz or ding or whatever you want to do . That's great too . There just needs to be some place that is very consistent with how you practice so that you can physically look at the damn clock , Okay .

that and we need to make sure we also hit this . And you said that your back's bothering you , so we need to make time for that today .

And so now you are narrating what you're going to be doing in the session , also reminding yourself of time and also telling the patient we're going to get to a couple of these things and I'll never forget one of the people that I was mentoring one time said would do all of that stuff and would say what she was going to do and then , for whatever reason she

was , if she was going to work on someone's exercises or take a look at something that she would always say we'll do that in a second , we'll do that later , and then she would get to what she wanted to do , and then she would get lost in that .

And then the patient was being like well , hey , you said that we were going to like look at my exercises , can you just do that ? Well , she's now already running out of time and now the thing that you said and promised to the patient , you're not doing .

So another practical tip as you're narrating out loud like that , if you find that a patient is like Ooh , I agree , that is really what we need to do , then you need to say cool , out loud , say , great , let's do that right now so we don't run out of time , and make sure , because that's the most important thing to them .

They're literally telling you that , so do it first so that you can give it more time if you need to .

Another one that I love for you that you've said before is if they're going to cry or if they've got questions , get it out early , don't ? I mean right , you know the people .

I've even had this on , like our business coaching calls , everyone's so wow , we get some tears and sometimes it's even from our mentees and you know , it's like oh if that's going to happen , like let's get that out at minute 20 and not wait for minute 55 for the breakdown .

If you're delaying those conversations it's because you're not comfortable , and so you're trying to find a way to talk about it the whole time , and then , right at the last minute , you ask the one question that's going to bring on the tears or really get to the heart of why they're having their pelvic pain or something .

And now you're up a creek because now you can't just be like , oh okay , well , why don't you take that clean X box and go over here instead of having another patient coming in ?

work .

So and then you know I think that some of my clinicians , when I've told them , you know , certain wait , I don't make all my patients cry , but you do know , when you are together , when you're sort of at an emotional place with your relationship and with your treatments and you're getting to something , and every once in a while they'll surprise you with something

and get emotional about something that you didn't anticipate them getting emotional about .

But , especially as you are getting to know your patients a little bit more , you can tell that there's , there's something there and we're going to work on talking about it and it's going to come up as they progress in their care and it's a very necessary part of their healing process .

But it can really screw up your time if it's not happening in the right part of the session and , quite frankly too , it's not fair to them to wait until the end to talk about something super personal and emotional or challenging in their life right now .

So those things you know , you can control as much as you can of getting some of those things out in the beginning so that you have time to really dive deep with people and decide is this something that I can help them with ? Or is this something that we're going to need to bring in another mental health counselor for , or whatever ?

So I don't , just to be clear , I do not make my patients cry within the first 10 minutes of meeting me .

However , if there is something that I know we really are getting down into , some of the real why about what is happening , or why is this bothering you now , or why is this so distressing to you there's always an emotional reason and , taking that biopsychosocial approach , we have to talk about those things so that we can assess their severity and what , how much ,

they're contributing to the symptoms . And it's best if we do that towards the beginning of the session so we have time to complete a conversation .

Is that the thing that is ? Maybe you finish the hands on portion in plenty of time , but you've got 16 things that you want them to work on and then all of a sudden they have questions about them . And one of my favorite questions so far in the whole accelerator program was Nicole said look , I give people three things to work on when they leave .

Three things , Max .

But if it's not , and you're just kind of adding stuff on and on and on , that might be the reason that you're running over , because of course , if you give somebody 10 things , they're going to have questions on two of them and you've got to anticipate that .

So if you have somebody that has no kinesthetic awareness , that has never worked out in their life , and you're going to give him something with a fair band , then they might not do it well at the beginning , but that person's going to need way more time on teaching an exercise to them than somebody who you know is a crossfitter , that does freaking , whatever the

hell kind of lifts and power clean and this and that whatever they're doing over there .

So anyways , bottom line is my analogy or my talking point here is if somebody is like a very avid worker , outer person and lifts weights a ton and you're going to give them something like a kettlebell swing , you might have to tweak it a little bit but they're going to know how to hold the damn kettlebell .

You know they are going to have no how to bend forward . They're going to know how to hip hinge , hopefully . You know you might have to tweak their form but they're going to get it . So that person needs less time to teach an exercise . The other person is going to need more time .

So know your audience , know who you're talking to and put that into your plan for time .

How do you get that person out of the room who's just lingering ?

They just get wrapped up . They really resonated with you . They really just want to keep . It's a good sign that someone wants to stay in a public health rehab like a treatment room . They're not running for the hills . But it also just means that you need to get better at wrapping up your session in a concise manner .

So your sentence needs to end on a downturn . You don't need to invite any other questions . You should have already answered their questions . You should end on a period in terms of end on a sentence with a period , not hate . What else do you have ? For me ? It just needs to be like I'll see you at your next appointment . I think it's on Tuesday next week .

I'm really excited to see you have a great day and you're walking out as you're doing that . If you know that somebody takes a long time changing , then you need to end earlier , or you need to have them completely get dressed 15 minutes prior .

You're going to do their exercises or their homework or their education clothes , and so you can be flipping the room and also doing any education that you need to at the same time . There's just a variety of different ways to do this .

I think the biggest thing is just to be cognizant of the people that tend to linger and create a sentence that ends with a period that means you need to leave . In a nice way , and this is a perfect example too .

It's like you're doing so good , You're almost there , and then they're like and let me just pull up in my phone one picture of my son and he just got married and like oh great , Kathy , hey , you mind stepping outside here for a second and finding that while I'm flipping the room , I just want to make sure I can get in with my next patient on time .

So why don't you find that on your phone ? I'm going to do this and I'll be right back . So you put a Kathy in a corner flipping through her phone , albeit weirdly with one pointer finger , and then she can still show you a picture of her son's wedding .

It's going to be great , but your other patient can already be back , Kathy can show you her picture and then she can also be going up to the front to schedule more appointments .

So I love that little narration piece like hey , where it's affirmative at first and then it's also like and this is what I'm also going to do , so it's yes , cool , let's do that and let's do it this way , type of a thing .

So sometimes they make shit up and then you're obligated to answer it and no one wants to be there . So just make sure to wrap all that stuff up earlier in your session and use what I call the last five to really have it be like that's your show . The last five is summarizing the session .

It's doing getting out everything you need to do and all of the talking stuff that the patient should have done is should already be completed .

How do because it seems like you can't just go in on on Monday after having listened to this podcast and being all fired up and knowing why it's so important going on Monday and then just start being on time because all your people are going to be flipping out like what the hell is going on .

Honestly , I was notorious for this , you guys , because it was not modeled to me well in the previous place that I worked before I opened my own clinic , and so it was compounded , with me feeling like I needed to go over because now I'm running this cash practice , in combination with the fact that I never have seen it running on time with the previous place

where I was at working , my mentor didn't , was always late .

And then I got burned a couple of times when I was running late and then someone had to leave early , they would have been totally fine getting a 45 minute appointment , but when I'm running 10 minutes late , a 35 minute appointment they're not cool with .

So I just literally announced it , I picked a day and I was like I'm not being late as much as I can help it from this moment forward . And I literally just told my patients .

I said , listen , I have been so terrible with being late and it's not fair to you , it's not fair to me and I'm starting to resent being here and I just need to get better and I need you to help me stay accountable . And so I am going to be ending your sessions or 55 minutes .

I'm going to be ending every time at the 55 , you know , five minutes to the hour and we're going to help each other be on time . And that means that I know that you've been coming late because I've been late .

But now , from this moment forward , I want you to be here a little bit earlier than at the top of the hour and we're going to both see how that works .

And that's great and it's worked in great , because you're basically calling yourself out to your patient and then they're helping you by doing that and then , once you've said it out loud once , then you can use that same thing . So if you're getting to 45 minutes and they're asking some really complex thing , you can be like you know what ?

We don't have a ton of time to thoroughly get to that today , so we're going to table that . If that's okay with you , move that to next session . We'll start with that . And then I want to make sure we get to whatever . This exercise and that exercise today . How does that sound ? Oh , this sounds great , perfect , wonderful . Now we're off of that .

I make a note in my chart that we're going to start with this next time and we're good to go .

If we believe that we're coaching , that it's an ongoing process , that they're in charge of their own healing , then trying to cram all this stuff in it doesn't make sense because you're not going to cure them with that one extra mode , that one extra thing , that one extra obtrator intern is release , whatever the hell that is .

Committing to yourself that you are going to start to run on time and you're going to use these practical tips here and you are going to announce it to your patients , because you've probably been a chronic late person and they're used to it too , and so everyone needs to change , and it's going to happen next week . So I hope this has been helpful for you .

It's been so freeing to be able to run on time , to feel like you don't have to be everything to everybody at all , and it is significantly helpful in decreasing stress at work .

You've got five days left to get those and then Pelvicon 2023 is gone forever . So make sure you're heading to Pelviconcom , check those out , as always . Thank you all so much for listening in . I hope this has been helpful . I hope this gives you some actionable stuff to be doing to be staying on time next week . Please reach out , talk to Nicole .

If you are having any sort of hard time with this or if there's something on this that really called you out , let us know . We always want to keep this conversation going .