Episode 16 - Charting and Setting Boundaries with Dr. Sarah SmithMar 31, 2023
Dr. Kevin Mailo welcomes Dr. Sarah Smith to the show to talk about the time investment of charting and how to set boundaries on how much work eats into your personal life and well-being. Dr. Smith is a practicing rural physician who does everything from family medicine to emergency, and she is also the Charting Coach whose program has helped hundreds of physicians.
Sarah shares her personal story with Kevin and explains how her practice in Australia eventually became a burden due to all the paperwork, the undone charting. She says she loved the people but hated the paperwork burden. She struggled under the weekend-eating charting until she had a realization and really took stock of how she spent time in her day. That led to imagining how she could change her time usage to better suit her.
In this episode, Kevin Mailo and Dr. Sarah Smith explore Sarah’s “a-ha moment”, how she coaches physicians to view their time and the work they take home, and why a mindset change and the phrase “you see the patient, you close the chart” becomes one of the keys to more efficient time usage. Sarah advocates for well-being in terms of physicians reclaiming their personal and family time by focusing on the ways in which they are in control of their own clinic time management.
About Dr. Sarah Smith
Dr. Sarah Smith is the Charting Coach for Physicians. She is a Rural Family Physician and Certified Life Coach through The Life Coach School. She helps physicians get their admin and paperwork done more efficiently to create time for the things they love.
Dr. Smith has spent the last three years coaching hundreds of Physicians, over 1000 hours of coaching, in the specific area of “getting home with today's work done”.
Resources Discussed in this Episode:
Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.
Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast, and today I'm extremely excited to introduce to you - I say I'm excited every time - but I am very excited to introduce our listeners to Doctor Sarah Smith. And I'll say a couple of words about Sarah and her practice background, and then I'll let her talk and share her journey because it's really quite remarkable. Sarah is a rural family physician who kind of does it all - family based practice, palliative care, long term care, hospitalist, and emerg - she does it all as a rural physician. She is originally from Australia and immigrated to Canada about ten years ago and I assume came for the great weather and beaches. And today what Sarah is going to be sharing is strategies around charting and practice optimization because this is something we all face in practice, right? Whether you're a radiologist or you are a family doctor or a surgeon, you've got to chart what you're doing. And we don't get a lot of training around that. We get a lot of training around like the medicine and making proficient notes. But how do you be efficient about that? How do you communicate effectively? And that's what we're going to touch on today with Doctor Smith. And with that being said, Sarah, why don't you go and tell us a little bit about your personal and professional journey that led you to this point.
Dr. Sarah Smith: [00:01:54] Hi, and thank you so much for having me, Kevin. It's really, really fun to be here. So yes, I'm from Australia and I had been in full time family medicine in Australia, having finished up all of my hospital years that we do in Australia after graduation. And we then as a family decided we wanted to see something different, so we packed up, full time family practice, I'd just got to that fun point five years in where I understood the billing, the patients, my panel, everything was kind of like ticking along quite nicely except for the paperwork. And we'll come back to that. And then we decided, you know what? We really want to see something different now. So we packed up and went around Australia for a year and a half, which was super fun. So I highly recommend semi-retirement. I think that process of giving up full time family practice, the disappointing all your patients, the little grief journey that happens when you're leaving people behind because you've loved and looked after these people for a solid five years. But the lesson on the other side of that, that you are replaceable and that's a beautiful thing as a physician. I think that was a lesson I didn't expect to learn that early in my journey. And what it did is created less of that feeling trapped in family medicine and more of that ability to figure out, Oh, this, it can be different, it can look different. I can kind of reinvent myself and it's all going to be okay. So that was part of the exiting family medicine. So we then went around Australia, I locumed for that year and a half back in emergency departments, which was super fun in the middle of frickin nowhere in Australia. And then at the end of that journey we were just sitting around as a family wondering what to do next with ourselves, and Canada had some openings, so we came here for a year and we stayed. So back in full time family medicine. And then this paperwork problem reemerged.
Dr. Kevin Mailo: [00:04:05] So it followed you?
Dr. Sarah Smith: [00:04:06] It followed me.
Dr. Kevin Mailo: [00:04:07] One continent to another continent.
Dr. Sarah Smith: [00:04:09] Right, across continents. Totally different government system, billing system. Even the way we see patients in Canada, different from Australia. So in Australia it's one room, that's your office and your patient room. So you've got to exit one patient before you can get your next one in. So you're really limited in the number of patients you can see a day. Like it really puts a significant time delay in turning over appointments, versus in Canada I had an office, two consultation rooms, somebody to usher my patients in, tell them to get undressed and put gowns on, or anything of that nature. So it was a totally different practice and - boom. I'm back to this point in my family medicine day, where I don't know when I'm going to be home. Hours after the last patient left. I get a text from husband almost every day saying, When are you home? Because it's dinnertime. So I hurry up and pack up and head home knowing full well I'm not done, nowhere near done. After family time is done for the night, I'm back on the computer. Hours and hours every night. And my weekends were also disappearing in, I've got paperwork. Like this was a common thread that I was noticing. And throughout my career I'd asked every mentor, How do we do this? How do we do the paperwork? What do you do to overcome like the paperwork? It was just all consuming. My mind was constantly thinking about the work that wasn't done, and it was a huge burden. And so that was where I found myself. Unhappy.
Dr. Kevin Mailo: [00:05:48] You bet. And I think what you're sharing is the same frustrations that physicians coast to coast in this country face with, you know, what appears to be ever growing paperwork and EMRs have not necessarily helped this. And so before we dive into, you know some specifics around, you know, charting and workflow, talk to us - I mean, you touched on this - but talk to us in more depth about the why. Why is this so important in our lives? And I'll share a couple of my own thoughts on this. But why do we need to be doing better with our charting?
Dr. Sarah Smith: [00:06:23] Yeah. So my big a-ha, I was standing somewhere in my living room, in my house somewhere, and my kid's in grade ten at that point. He's older now and I just, and it's still emotional a little bit, of course I'm going to miss it. I'm going to miss his last two years of being at home. Because of the paperwork. And that for me was enough. In addition to that, when I'm looking after physicians, it's about, they're diluting their income. They're under-earning even if they're earning. You've earned the money in the room most of the time, like occasionally, if you're doing it same day and you're in that file a bit longer, you might get some time modifiers depending on which part of the country you're in. But for the most part, we have earned the money in the room. Now, if we listen to what doctors are saying, that every hour of time with my patients equals an hour of admin time, now we're diluting our income, right? If you actually work out your hourly rate at that point, significant difference.
Dr. Kevin Mailo: [00:07:33] Oh, massively, massively. Right? And this matters. I mean, it's actually something we teach at Physician Empowerment's finance classes, right? Is that we discuss the notion of hourly rate. And the hourly rate doesn't just include your clinical work, it includes your administrative time and charting time. Right? You know, and it's not about creating more space to see more patients. It's about doing better on the ones we've got so that we create more time for ourselves and for our families.
Dr. Sarah Smith: [00:08:06] Yeah. When I was in this moment, before I changed it, my days felt heavy, trapped, drowning, overwhelmed, I dreaded work. I was seeing as many people as I could fit in in a day, and that was too much. And then every single request that came in, like, now we want you to monitor, you know, whether they're a smoker or not. Now we want you to measure their height and weight once a year. Any other requests just felt like they were stripping me of anything I had left. It was, the ask was too much. And so it felt like I had no control over my clinical day whatsoever. It was already packed. Don't ask me to do anything.
Dr. Kevin Mailo: [00:08:52] It's a lack of control.
Dr. Sarah Smith: [00:08:53] I can not do it.
Dr. Kevin Mailo: [00:08:55] And that is tied to well-being across many, many industries and fields, is a sense of lack of control and disconnectedness. Please keep going. This is very good.
Dr. Sarah Smith: [00:09:07] Then I would take three forms home on the weekend. Right? At the end of the consultation they hand you a form, Oh, can you get this done? When you get a minute? My brain would say, There's an hour of my life gone. That was a sentence my brain had about this form. And it wasn't just an hour. If I took those three forms home for the weekend, I would tell my family, I can't go to that barbecue. We can't go to the lake. I have paperwork. I would spend all weekend cleaning my cupboards, washing down, you know, the kitchen was sparkling because I was procrastinating these forms. And then I'd go to work Monday morning having not done them. When I finally did them, I got 90 bucks, right? For three forms.
Dr. Kevin Mailo: [00:09:50] Right. What is that worth? What was that worth over your weekend?
Dr. Sarah Smith: [00:09:56] Right? If like the actual amount of money I got for those three forms, maybe maximum 500 bucks, but not worth a whole weekend of, I can't I've got paperwork. The mental energy attached to that, the disappointedness I had about myself not getting them done, even though I'd given up a whole weekend for it. So maddening, just maddening. And the fact that it had been there at the beginning. I took these two years off thinking I'm in a better place, get to my next workplace, new continent, same things happening. I'm like, What has gone wrong?
Dr. Kevin Mailo: [00:10:31] Absolutely true. Right? So this isn't just about money and our hourly rate. This is about, this isn't just about time management. This is much bigger. This is about our personal well-being. And our psychological well-being. We should all have healthy boundaries between our places of work and our homes, and the charting issue erodes that massively. Massively, right? And it's important to be able to set up boundaries, right? We talk about boundaries with our patients. We talk about boundaries with colleagues, but it's also boundaries with ourselves in terms of charting and paperwork. And it's not just about saying no to another useless meeting or saying no to another committee that you didn't really want to sit on, if I can be blunt. It's also about saying no to that impulse to do more paperwork, right. Or just, you know, putting too many patients in and not having enough space or time to chart properly.
Dr. Sarah Smith: [00:11:29] The other thing was when I would chart in the evening after everyone's gone to bed, or in the morning, you know, get up at four in the morning because I was too tired the night before.
Dr. Kevin Mailo: [00:11:40] Oh, goodness.
Dr. Sarah Smith: [00:11:40] Didn't think I was hurting anybody. It was only it was like, well, there's no one else awake, so it's not hurting anyone to do it then. And I heard this from a physician recently as well in my program that, you know, I wasn't hurting anyone when I was charting in the morning, but I realized I was hurting myself because I wasn't getting the sleep I needed, which meant the next day wasn't as efficient. My brain was already tired before I even turned up because I'd already been on the computer for three hours before work even started. So it is impacting our lives even when we're trying to hide it in the minor hours of the evenings or mornings. So.
Dr. Kevin Mailo: [00:12:19] Well, and even just, we're just not as joyful in our personal lives. I mean, how do you feel about going to the gym after getting up at four in the morning to chart? Well, how much mental energy do you have for your practice or yourself or your family life?
Dr. Sarah Smith: [00:12:33] Yeah, I hadn't exercised in years and I wasn't alone. When I'm talking to physicians who are in the pain of this right now, haven't exercised in years, haven't picked up a book in years, haven't sat on the couch and watched a movie with my family without thinking about work for years. I haven't had a weekend for years. This is not uncommon. Like literally all weekend, I've got no other hobbies anyway, I might as well just do my paperwork. It just becomes a familiar and comfortable cycle that if we're not aware of it and taking notice of it, it starts to just be there as a thing.
Dr. Kevin Mailo: [00:13:10] Absolutely. Absolutely. So, Sarah, take us through your process. What's your approach? So we know how important this is, not only about practicing better medicine, but about being happier, being more psychologically healthy. Talk to us about your process. Tell us how that works.
Dr. Sarah Smith: [00:13:31] So, all of us work in different environments, we have different EMRs, different staff, different patient appointment lengths, different things we're doing in our clinical day. So some of us will be family physicians, some of us will be other specialist types, but we all have to see patients, do the documentation, and then we have the rest of today's work. So we start separating it out into the patient protected time where we're seeing patients and closing charts. And then we have the rest of today's work, which, you know, for a number of years I didn't even notice that work as an actual math, right? So it was just stuff that happened to me during the day. My inboxes, my messages, my forms. There was no think to it, it was just other randomness about my day. It wasn't something I was ever paying attention to and I was never doing efficiently. So, for instance, when I was first noticing my clinical day - and I think that's where we start, we just notice first what's happening - we see patients, then we come out, we sit at our desk because maybe some intention of doing the work, right, of the documentation from that encounter and what happens, Oh, there's three patients waiting. Off I go, next patient, right? Or I sit down, I see that blinky thing in the corner that says I have things in my inbox, so I open it up, I look at the first one, I'm like, Well, I don't have time to do that right now. So I close it. But instead of doing the documentation, I go to the next thing on that work list. Oh, I don't have time for that either. So now we're doing work twice, right?
Dr. Kevin Mailo: [00:15:12] Wow, yes.
Dr. Sarah Smith: [00:15:12] And we're task switching, so we are draining our decision making.
Dr. Kevin Mailo: [00:15:19] Yeah. Absolutely.
Dr. Sarah Smith: [00:15:20] So we've come out of the room, we've spent two minutes effing around in our inbox or thinking about, Oh, I've got three patients waiting five minutes, ten minutes, forty-five minutes behind, and off we run to the next patient. So what are we doing now? We're taking that last encounter and we're packing it into our working memory. Now physicians are very, very amazing with our working memory, right? We can pack in a huge amount in there. And we've done it for so long that we just do it automatically. But you're in the next patient's room, you're listening to that story, you're wondering about the minutes behind you, and the things in your inbox that are kind of starting to collect. And then you're like, Oh yeah, I mustn't forget to do that referral that I said I would do for the patient number one. Oh, hang on, there's somebody in front of me talking. Wait a minute. Kind of rewind back into them. Kind of, Remind me again, what did you say? You kind of, so you're not even present in the room. Okay. So by the time we get anywhere close to the end of the morning, our brain is exhausted. We've been doing all of this stuff.
Dr. Kevin Mailo: [00:16:33] Absolutely. It feels like an emergency shift. The task switching, the carrying a whole bunch in your head simultaneously, without question.
Dr. Sarah Smith: [00:16:42] You get to lunch and you're like, okay, I'll get at least some of those charts done. So you, with all very good intention, jump into your charts. Or maybe you think, Oh no, the inbox is more important. So you jump into the inbox, whatever it is you decide to do, you kind of just do it the way you have always done it for a number of years, right? There was no teaching on this. It was just whatever we happened to think was most important or prioritized. Or maybe we just sit there for the first ten minutes of lunch thinking, well, where do I even start? There's so much to do. And even that level of, that was the energy you needed to start. And you're using it to figure out what do I do first? But it really doesn't matter what you do first because it all needs to be done, right? Then we hit the afternoon. Woof. Hyped. If we're lucky, we've had water and food. Some of us have run so far behind, we're running into the afternoon having not stopped at all. Our bladders get bigger, our working memory is working really hard right now. Multiple tabs open. Okay. It's exhausting. It's exhausting. So we teach you, you see a patient, you close the chart, you see the patient, you close the chart. That's our patient protected time. What is left? What's left is the rest of today's work. Now we need to figure out how much is that? What is that worth in time? If I was to sit down and with the time to say yes to that inbox, what's it going to take to empty out two days work? Not the backlog, not yesterday's charts, not like last week's labs. We're just thinking about what is the work of today. And actually starting to just be curious about that. So that's the starting blocks, is noticing, measuring, starting to be curious about how could I change this and do it differently.
Dr. Kevin Mailo: [00:18:41] Absolutely. Absolutely. So what approaches do you take in terms of like, a charting review. If you can take me through where to start on making things better with a client. What does that start with?
Dr. Sarah Smith: [00:18:59] Yeah, so we're trying to find your most simple solution to getting your charts done. And so you might type, you might dictate, you have a process that you're already familiar with. We want to optimize that. So we're not wanting you to change your EMR or learn a new system or buy a scribe. This is not how it works. This is about you in the environment that you work right now, right? So this is you with your EMR, your staff right now, the patients you have, and saying, if I wanted to see patients and close charts, now what? What already exists at the end of this consultation, how long does my charting take? What is in my note and why is it in there? You know you are the boss of your note. You know what needs to be in your note. We need to, obviously, what happened, what were the pertinent features that support the working diagnosis and the differential? What was the plan? What was the education given? What was needed for insurance, if you're in the US right, to be able to get some things approved. So whatever that looks like. Now we've got neurologists, rheumatologists, neuroophthalmologists, psychiatrists, who thought this was impossible, too. Family doctors think it's impossible. And they're doing it. Seeing patients and closing charts. So it's not impossible. And if there's any other message, it's that you can create impossible if you want to. But it is not like a tomorrow we're going to have, it's a if you want this, what do I want to work on first? What looks like low hanging fruit about this idea, right?
Dr. Kevin Mailo: [00:20:47] I love that.
Dr. Sarah Smith: [00:20:48] And stepping towards the very first step towards it and just not giving up. If we quit, we just get what we have right now. Which is disaster. Horrible. Don't like it. Unpleasant. I'm done with this. And if it's, I want something different, it's like any goal you've ever run towards, right? It's uncomfortable. It's different. It takes a lot of mental energy to do it differently, but it's figuring out what would make this easier for me. We come up with, we come up against a lot of objections, right?
Dr. Kevin Mailo: [00:21:23] How often do you see that there's just too much getting put down in the EMR? Like it's too verbose. Do you see that a lot or is that not a major issue?
Dr. Sarah Smith: [00:21:32] So the too much, too verbose, or it's got to be perfect. Absolutely part of this journey, right? Absolutely it's part of this journey and it's the noticing why you're doing that. So what is in your note and why? Right? And I often say, this is one of the little marks, who are you imagining is reading your note? Like, actually get a picture of that person. When you recognize who they are, and it may be someone from your past, so for me, it was a white haired white guy professor. Right? And he was a little frightening in my medical school. And he didn't like me at all. When I realized I thought it was him who was going to look over my shoulder at my notes, I'm like, Why would I let him decide to give up my evenings and weekends. Just one of the tricks of like, that different perspective. Is that, Oh, interesting.
Dr. Kevin Mailo: [00:22:34] Absolutely. Absolutely. What about the role of templates? Talk to us about that.
Dr. Sarah Smith: [00:22:41] Yeah, Anything that helps you. Like, so the template. So there are, you know, Facebook sites where people share templates and that, maybe that's not the right option for you. We want something that you're going to use without having to edit it too much. Same with your short phrases and other things you pull into the chart. If you pull them in and then edit them for the next three minutes, that's ridiculous. Stop it. Find something that works for you. Do I use templates? Not really. Like, I've got like a three in total that I use. I don't, that's not my style. But this is not about me. This is about you. What's going to make it more simple, easy, faster for you. That is what we're looking for. And that's what we're always looking for when we're talking to physicians is, I'm noticing, you know, what they're doing right now and how they could make some easy changes. That's what we're doing, we're just kind of taking a look at what's already happening and optimizing that.
Dr. Kevin Mailo: [00:23:43] Do you find that there's a difference between family physicians and, let's say, clinic based specialists or the issue is pretty much the same?
Dr. Sarah Smith: [00:23:52] So yes and no. So when we're looking at if consultant specialists, so somebody is going to be seeing this patient once, it's somewhat different than the family doctor who's seeing them over like that continuity. So there is differences in the content of what's required within that appointment and the who is receiving the information that's being gathered in that consultation. So there absolutely is different reasons for these consultations, different objectives at the end, but that's also important. So what is the objective? What is the question I'm being asked when I'm seeing this patient, could help you run this consultation more efficiently. So running the consultation has its own skill sets. And for instance, if a psychiatrist is being asked which medications might most help this patient, they're not necessarily being asked, have we got the diagnosis right? So it could actually change the objectives of how we're going to approach this consultation.
Dr. Kevin Mailo: [00:25:07] Got that. What about the laundry list of issues that comes up? I mean, I remember that from my family medicine training. You still see it in the emerg occasionally, especially with our geriatric patients. Right? We have to sit down and go, wow, there's a lot here, you know, a patient comes in with a family member or loved one. So talk to us about that. Is this a, is this a time management thing where you say, listen, these all are important issues should we reschedule so we can go through these with a little bit more time, you know? Or is there also an element of charting here? Talk to us about what this looks like.
Dr. Sarah Smith: [00:25:41] Yeah. So this is like a really broad topic and that's okay. Let's try and handle it from a few different places. So the patient comes in and says, you know, I've got back pain, I need my meds renewed, and, you know, by the way - it's usually when you put your hand on the doorknob to end the consultation - and by the way, right? Or here's my list. I haven't been able to get in with you for a while. So it's again part of this taking notice of our clinical day and what we always do. So if your next access visit is in a month, but physicians will often say yes to the ask in the room because they know it's a month away until they can get the next patient in, like to get them back in. Notice that. Notice that. Oh, I see the way I've designed my appointment schedule, it's fully booked for four weeks. That's not helping me because now I say yes to the list in the room because I've got nowhere to put them next week. Oh. Now what about our appointment list? So in Canada the really nice thing about physicians that I've noticed, Canada to US it's a little bit different, is the level of autonomy that we often have in Canada. Not all of us, but many of us. So that appointment list is set up that way because that's how everybody else has set it up. If we actually think about, well, what would help me? Oh, I could get them in next week. That would be helpful. Now what? How could we start to think about that? So just, it's taking a step back from the busy and saying, well, why am I making these decisions? Because they are the executive decision maker. You are the executive decision maker in your appointments. Number two, our patients never, ever, ever understand how long it takes to do back pain. How long it takes. How long it takes to renew scripts. No idea. Okay.
Dr. Kevin Mailo: [00:27:51] Yeah, the way I heard it when I was taught, actually when I was in Edson, I forgot to mention on the podcast, Edson is a very special place where you practice where you live, Sarah, because I spent nine months there during medical school, um, during my clerkship years. But I remember one of my preceptors saying exactly that - the patient comes into the encounter with one agenda and you have your own agenda, right? Like they want something for their back pain and you want to make sure that it doesn't need imaging, that there are no red flags there. Right? And of course, you know, treat it. But, you know, it's about reconciling those differing agendas.
Dr. Sarah Smith: [00:28:29] Yeah. And so it's not about I don't have time for this or I've got too many patients today or I, you know, it's nothing to do with it. Right? Patients are always self-centered. Of course they are. They don't care that you haven't peed today, that you haven't had lunch yet. They've got their idea of what they want, but it's up to us to guide them in what I can do for you well, right. So, I would like to have the opportunity to do a good job for this back pain. Right? So we're going to do the normal important things like check for red flags, hear a little bit of the problem, and then deflecting it to the next appointment is not about I don't have time today. It's about, I want to do a good job for this. Let's rebook that. So it's, is this a one problem per visit? No. You are still the boss. So it's about saying I am making the choice to say yes to this request or deny this request. I am deciding to say yes to this little old lady because I know she's traveled three hours and her daughter lives in B.C. and now is here in Edson with her. I'm going to say yes to spending that little bit more time here today at the cost of, of course I'm going to be running 20 minutes behind at the end of this, that's okay, I've decided to. Rather than, Oh, I can't believe they did this to me. Don't they understand I only have 15 minutes or 10 minutes? Don't they understand I only get paid $31, $38 for this? Like, whatever that internal frustration is that we're hearing, it changes when we start to be the decision maker, the one who is in control of this clinical encounter.
Dr. Kevin Mailo: [00:30:22] Absolutely.
Dr. Sarah Smith: [00:30:23] That's the change. That's the biggest change. So when somebody brings a list in. I'm totally fine. I'm not immediately going to that place of, of course they did, is what my brain said. Of course they brought a list.
Dr. Kevin Mailo: [00:30:37] It's that notion of acceptance.
Dr. Sarah Smith: [00:30:39] And it's totally fine because I know how to handle a list, a request, I know what I will say yes to, and I know when I'll say no. And even when the patient has a grumpy face, says something different than what I was expecting other than a loving comment, it's okay. I can hold space for me to be okay that I'm doing the best I can with what I'm given.
Dr. Kevin Mailo: [00:31:01] Good. I love that. So, Dr. Smith, Sarah, we actually have to wrap up. I can't believe it went by as quickly as it did. Absolutely loved it. And this is so important to physicians. You know, I just keep coming back to your personal story and what charting meant to you or disorganized charting meant in your own life. Right? And I think that's so powerful to share that, because I think we're all feeling feeling that, you know, regardless of practice, background, we struggle with it. I'm just going to leave a teaser out there for our listeners. But Doctor Smith also goes much broader than this and discusses practice optimization or what was your term for it, Sarah?
Dr. Sarah Smith: [00:31:44] Sustainable clinical medicine.
Dr. Kevin Mailo: [00:31:46] Love that, love that. And so we're going to get you back on the show later to hear more about this because obviously it's more than just what we're doing and charting. And so again, I sincerely want to thank you for your time today on the podcast, Sarah. Thank you so much. And if anybody is looking her up, she is the charting coach.
Dr. Sarah Smith: [00:32:05] Yeah, ChartingCoach.ca
Dr. Kevin Mailo: [00:32:07] The ChartingCoach.ca. Love it. Thank you so much.
Dr. Kevin Mailo: [00:32:12] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.