Rebroadcast | Pediatrician reports—why bother?

Annie: I'm Annie.

Leah: And I'm Leah.

Annie: And this is Lactation Business Coaching with Annie and Leah where we talk about the smart way to create a compassionate and professional private practice.

Leah: Let's dive in.

Annie: Hey Leah, how are you?

Leah: Hey there Annie. I'm doing pretty good. How are things over in New York?

Annie: They're good, just the same as usual. Some babies that having a lot of trouble, but I did get an email from a client who let me know that she was still happily going at 27 months.

Leah: Oh, I love that. My favorite is when you get that just really unexpectedly or you didn't really get a good closure or something ... not get some good closure, but they just kind of petered out in communicating with you like they do and then you get some, some contact later. We had a pretty busy week here. In Houston we had our first cold snap. Oh, I know and it was so crazy. Literally there were snow flurries in Houston in November. We never get snow. I mean, it didn't stick. It was just like, Oh my gosh, I think I see something falling from the sky a little bit. That was the extent of it. But it was so crazy because of course the news people are going insane. Like it's snowing in Houston and it's only November. We don't ever even get snow - ever - so that was pretty exciting. But that also means, Oh I just don't like cold. I hate being cold. So I've been wearing...that's the hard part. I wear scrubs for my work especially when I'm in the clinic and scrubs are so cold. You just cannot keep warm in scrubs so I'm literally wearing Long Johns, and you'll probably laugh at me because it was just like 50 and then the other morning it was like 32, but that's frostbite situation for me. I found Long Johns and I totally wore Long Johns under my scrubs this week because I was a big baby when it comes to cold.

Annie: I love the cold but that's why you don't see me living in Texas. Not for me, no! So we today are going to talk about writing pediatrician reports and other reports for other healthcare providers, which is in our code of professional conduct as IBCLCs...

Leah: So important.

Annie: Is that we be clear with the healthcare team. So that's what we're going to be talking about today. Don't be scared.

Leah: I know. Everybody's running away. I don't want to hear.

Annie: Stay with us because I promise it'll be okay or at least we'll be experiencing it together.

Leah: We'll be together. We are all gonna hold hands and we're going to work through this together, guys. Don't worry.

Annie: But before we do the scary, I know Leah, you've got a marketing tip for us.

Leah: Yes, ma'am. Well, starting out in private practice, I think one of the biggest mistakes that a lot of people make is they go out and spend a ton of money on actual paper marketing materials. I made this mistake. I'm pretty sure every starting out new private practice, you're like I want all the pretty shiny brochures and this and that, and half of them end up in the trash somewhere and I've sadly had to throw some of my own away, because oftentimes those paper materials are not as valuable as they originally seem. And I think in our day and age tech is really overtaking paper stuff, so we can save the planet by not using so much paper. But it's really expensive to print things, especially if you want to get something really, really nice and sharp looking, you're going to spend a lot of money, and so you want to think about what marketing materials are truly going to be valuable to your practice. I think business cards are definitely top of the line and I like professional looking things for classes because those are oftentimes parents hold onto because they're like, Oh this has got good information on it so I'm going to hang on to this, because I have a folder where I've kept all my breastfeeding information and that folder just happens to have all your contact information on it. Whether you do that on the cheap, and this is how we did it starting out was you know those clear stickers? If you get a nice folder and those clear stickers it looks like you printed on them. So we use that and our business card, I mean we had very sharp looking class materials and I would go to moms' houses for that first visit and that would be on their coffee table so that's something to definitely invest in. But really fancy tri-fold brochures, those kinds of things, sometimes you'll not end up having those be quite as valuable. So you really want to think about what you spend your money on. And remembering that we're dealing with a lot of millennials now using our services and paper materials are not what they are going to be looking towards. They're definitely gonna be looking more towards the tech advertisement, that kind of thing so be smart about where you spend your money with your marketing materials.

Annie: I don't even want to talk about what happened the last time I cleaned out my consult bag, and I found a bulk at the bottom that I'd spent money making and then they made their way into the bag and they never made it out

Leah: Isn't that so sad? I mean, it's all lessons learned, and we're just getting to share with you guys so you don't have to spend all your money on that and then sadly throw them away later.

Annie: Yes. So speaking of things that are going to get thrown away, let's talk about pediatrician reports.

Leah: Oh no!

Annie: Because they don't read them. Let's just get that elephant in the room out of the way. The reason we don't want to talk about pediatrician reports is because we're all sitting here thinking, why bother if they don't read them? And maybe you have some pediatrician that does read them. I actually have this one in the area who reads them and he always writes back with comments and then I'm like, you're amazing. We have this one big practice here in New York City and basically run by Baltimore' I'll put it out there - They're just a very kind of stressful practice to deal with when you're a lactation consultant. They are huge and they have branches all over New York City.

Leah: Oh wow.

Annie: They are super popular and they have one fax number for every location. So literally I hit fax and this is just going into the void. Not only is it going to a practice whose philosophies are kind of in many ways diametrically opposed to what I'm trying to counsel families about, but literally I just picture this fax machine...

Leah: Just dumping it into a trashcan somewhere.

Annie: Like the end of Raiders of the Lost Ark, you know in that big warehouse, putting the Ark of the Covenant back on a shelf. That's where I picture that fax machine is.

Leah: Oh my goodness. That's hilarious. I will say I have had pediatricians definitely read my reports. I've had some call me back on them, and I will say how we got invited into the paediatric office we now work in. Basically we're their staff in there full time. They were referring to us a lot and they started referring to us because the other practice they were referring to never sent reports and we did. So they were like, I love knowing that my client or my patient actually went and saw you. Otherwise I had no idea I was recommending that and I had no confirmation that they went out and did anything, and that's kind of what started the process. Then they were like, well we now we want you here with us so it can definitely pay off to do these reports, but I am certain that a fair number of the ones that I send are kind of a check mark because I think most practices they have to sign off on things that come across their desk but are they read and then signed off on, or is it just kind of glance and sign and shove it in the file so it can be scanned into... Who knows?

Annie: But let's take a step back though and talk about why is it so important that we write these care plans, whether or not somebody reads them cause there are good things that are happening when people read them or at least you are saying somebody has to at least file it so it will make its way into the baby's chart.

Leah: Right.

Annie: Why fundamentally is it important for us to be creating these care plans regardless of where they end up?

Leah: If we want to ever be seen as part of the medical care team, we have to act in that role and being part of an allied health care provider -that's what we're classified as - that means we don't work alone. We don't just solo care for patients. We are in a care team and so to be part of that care team and what our code of professional conduct says is you have to communicate, and the most effective and kind of standard way to do that is to have reports sent out about our consultations and I think it's really, really important for our profession that we're consistently doing this. I know some lactation consultants only do it may be in certain situations, but I think even if it's just for the sheer fact of saying we want to be part of the care team, we want to be a respected allied healthcare professional, we want to collaborate with you, that's how we get this done.

Annie: I think it's even beyond just saying we want to. We're saying we are.

Leah: Yeah, definitely.

Annie: We are part of this care team. I don't need your permission to be part of this care team. I'm telling you that I am because I saw this family and this is what happened.

Leah: Now I'm reporting to you.

Annie: And now I'm reporting what I saw. You know on a little mini side note, anyone who is in network with insurance and if you're using evaluation and management codes, one key component of those codes is called counselling and coordination of care, meaning the communication that you're doing with anyone else who is part of the baby's or mother's or parents' healthcare teams. So that's the OB, the midwife, the pediatrician, any other specialists that is getting involved but we actually have to be doing that if we want to be able to use the code.

Leah: Right. To be able to do billing.

Annie: Yeah. And it's one thing to say I'm recommending that they see this person, but going one step further and actually reaching out to that specialist or sending the report to the care plan that says I believe this family should have this evaluation done or see the specialist. It really does ... for those, if you're in network with insurance you might actually have even more than just your ethical obligation. There might even be a contractual one as well.

Leah: Absolutely. It's such an important point to bring up because I think sometimes we hate them so much. We hate doing these reports so much. We're trying to figure out how do we get out of having to do this, but I think it does a disservice in so many areas if we're not consistently sending these reports out. And I think the thing that most people have resistance to doing reports is it's a time suck. I mean it is just an extra step that we are all having to kind of chain ourselves to the chair and make ourselves power through and get them done. But if you talk to any healthcare provider in this day and age, everybody's complaining about charting. I have a friend who's a pediatrician and she has struggles with charting and we all do. We're all in it together. So I don't think that we're unique in that.

Annie: We're not. And I think we might have a burden that we can get hung up on the idea that this document is a piece of marketing material, which it is because we are sending it out there and these doctors are getting to know us and how we practice from what they're reading and what we're writing. But I think we can get maybe a little too panicky about what it looks like. Is it written well? Is it formatted well? Is it on nice letterhead? Those things might be incidental and if that is something that is sucking time out of your day, I would say let that piece go, because the most important thing is we want to document what we're recommending to the families and we want to have it in the families, particularly in the baby's chart, and especially for dealing with supplementation, any situation where we've got a baby who is not doing so well and who needs supplementation or who needs some kind of medical treatment. We really want in there that we saw it because we can't be perceived as a lactation consultant who didn't tell somebody they needed to feed their baby, and I think that is a key number one thing. If there's nothing else that goes in your pediatrician reports, you are reiterating the importance of feeding that baby because we do have very powerful messaging from some anti-lactation consultant groups out there who really want the world to think that lactation consultants don't care about babies and that we think breastfeeding is more important than babies and that is not true. And so if there's one thing you can do, you can counter that message by saying "educated parents on the science of a good feeding. Recommended supplementation where necessary" so that they are seeing that we care.

Leah: Right. Absolutely. Yeah. I think that's a huge point and just that your recommendations. I think we've probably all had this happen where what the mom can take in and then regurgitate to say like, Oh my lactation consultant told me to blah, blah, blah blah blah. Of course we've got the care plan in the mom's hands, but if she didn't bring that with her to the pediatrician report, she might not be able to verbalize exactly what we said. And so we need to be that bridge and make sure our exact message is getting portrayed correctly and we're getting the information and then we can collaborate and we can all work together, be on the same page to assist these families when they're having struggles like this. So I definitely think some of the key things that need to be included in a report to whether it's the pediatrician or another care provider, one is - and I learned this the hard way - is you need the mom's and baby's, both of their full names and both of their birth dates, because so many times they can't find the charts on just the names alone cause there's multiple people with those names. So this note, because we've had them call before long, long time ago when I first started out, and I think I only had the baby's date of birth or something on there, and so the OB's office was like, we can't find this person. I'm like, oh sorry. So I learned that. And some of the other things I think might be important is what the mom or what the report was? What are they coming to you for? What's their goals? What are they looking to achieve with your visit? Four star assessments?

Annie: And to know in order to kind of organize your thoughts around that, a lot of people use the very straightforward SOAP template, which is Subjective Objective Assessment Plan and those sections for pediatrician report can be really short like subjective - "breastfeeding troubles. Parents are reporting their baby is always hungry" and then objective meaning "I observed a feeding and this was the transference here. How much the baby weighed and all of those kind of details and they don't have to be written out. It doesn't have to be a story. It can be really short and factual, short hand. Assessment is what do you think is going on and here's where you're going to pull out your writing skills to really say this is what I think is going on. This is your moment to do some persuasive talk with them.

Leah: Sometimes, that's also called the impression. Of course that doesn't go with the SOAP, but I like the wording as an impression because this is the impression that I got from what I saw today. This is what I think is going on, and then the plan is the recommendations for said impression or assessment.

Annie: Exactly what you told them to do, and for the assessment you can get kind of scared to say, well I'm not allowed to diagnose. I'm not allowed to prescribe for the plan because I'm not a licensed medical professional or it's outside of my scope of practice, but you can always say, I suspect, I believe this may be happening. I recommend evaluation by a specialist for this possible condition. You can really couch what you're saying in this language where you're not acting outside your scope but you're being pretty specific about what you want these other doctors to look into and we want them to be on top of.

Leah: I like the wording, like I'll say I suspect restricted lingual frenulum as evidenced by ... you know, like poor elevation of posterior tongue clicking while feeding. And then after that I'll say I recommend further evaluation with whoever I'm saying the evaluation should be with to rule out whatever it is, so usually ankyloglossia. So I like the as evidenced by, because it kind of backs up what I'm saying. So I'm not just saying I suspect this and I'm just throwing this out there but I ride along with that cause I think a lot of people who are reading the report might just read your impression because they don't want to get to the meat of it. I just want to get down to the meat. What are you saying? That's an important part to really have your wording make sense in clear, concise thoughts.

Annie: I think it's a fine line though with writing something that is actually going to be read, and knowing your audience that they are just going to skim it. They aren't going to really go into line by line what I put for this feeding evaluation. At the same time, I wonder in terms of advocacy, the effect of continually sending more detailed observations, maybe even including assessment tools that you're using in the actual tool and I do this sometimes where if I do the Martinelli assessment tool for lingual frenulum function, I send the whole thing. I used to send it as a PDF that I was actually filling out in check boxes. Now I have it templated in CHARMS so that it's light.

Leah: That's nice.

Annie: It's there and it says the name of the tool. It's got every line of the tool, my score for it, my score at the end and I always include a link to the actual documentation for the tool. And I have the same for the Dobritz frenotomy decision tool, which I love, which is not yet validated but will be soon, but I do use both. Those are the two that I use in my practice and I have the link and I'm like, if I keep sending this over and over again and especially cause I'm dealing with the same pediatricians over and over again, and they are seeing there is consistency in what I'm doing, that my impressions are not just me thinking about it and it's not something that's in my mind, but that I am running all of my babies through the same tool, and I'm also running this tool on babies where things aren't happening. So sometimes the score is high, but not always. Like I just have this... maybe I'm just looking for a pie in the sky, but thinking that she keeps using this tool. Is there something to it? Maybe we could use it.

Leah: No, I think that's an amazing way to help educate too, because whether or not they're actually reading in detail, we will never have the opportunity to utilize the fact that they could read it unless we put that information in there and make sure that we're giving them the opportunity to see what exactly we're doing to come to these findings. So I think that's super valuable and an awesome way to expand the reports that you're sending and validate what you're doing.

Annie: I think this is a good moment to just give a little word of reminder or caution that if you're dealing with a situation where there is real trouble, so you have a baby who is not having diapers and not transferring milk, and you're concerned, and especially if you're concerned about the family's ability to comply with your care plan, please call that pediatrician every time. Pick up the phone because that information ... this is a baby. This is a baby's life. We do have that. Thankfully most of us are doctors, so we're getting them in a moment where they're not in a life threatening situation. But this is an important thing that we're doing and so if you are worried, if you are feeling scared for a baby, pick up the phone and call. You are never going to regret doing that.

Leah: Yeah, I've done it and it's always so well received. Every single time I've called, the doctors are always so appreciative and are on top of it and I've never had anybody like why are you telling me? I've never had any negative feedback from it. I've always had great feedback and sometimes I can't get the doctor on the phone right that minute, but I'll say, let me talk to their nurse and I'll tell the nurse I'm faxing over a report. It's urgent. This is the situation. Please have the doctor call me back and verify that you guys got the report and if they have any questions or need to discuss. So if you can't get the doctor right then, you can always usually get their nurse and be able to flag that report coming through and I'll oftentimes send them kind of right away, try to stop then and to write them as quickly as I can, so that they also have a paper something and a phone call right in front of them. There's no denying that I did my part to try to stop any negative things from happening to these sweet little families that were trying to help. But I think that's super important and it's one of the valuable things about remembering that we're part of this care team is that we're not in this alone, and when we are concerned we do need to collaborate and come together even more so.

Annie: Absolutely, and the pediatricians, I think that the good ones appreciate it and the good ones will start to value what we're doing if they aren't already. When they see that we aren't just out there doing what we want and thinking that breastfeeding is this isolated thing, or it gets them to see that, as we hear a lot of times in our circles that we would all love to see communicated in the wider medical community, breastfeeding as a vital sign. Breastfeeding as something that tells us what's going on with this baby or with this family and that when they see us taking it seriously in that way, that's going to counter their impression of us as just some nice lady who comes over and tells you it's going to be okay. If only! If only that was my job! My goodness!

Leah: No, I know it's definitely a challenge because behind the scenes we're dealing with such complexity and I think what is portrayed out there. you know, it's like we just go help moms pop the baby on and then we leave and that's the end of it, and I'm like, Oh my gosh, it's so much more. So these reports can really have such a big impact and they're definitely a necessary part of our work life.

Annie: So what are the strategies to make that work? I know the paper way of doing things is, and there is nothing wrong with doing it this way where you've got the forms in triplicate and you check off the boxes and one goes in the chart and one goes to the family and one gets sent to the pediatrician in the mail or by fax. That's one way to do if you have an actual physical fax machine. I think a lot of us are using some kind of electronic means to store our documents. You use Mobile Lactation Consultant, which I've also used. How do you do it?

Leah: Yeah, I've really morphed over the years. So when I started, let's see, seven years ago, I actually started with paper charting. So I've done that and what we did then was we had a paper chart and then we typed up a report from that and then faxed that and that was painfully time-consuming, but my volume was a lot smaller back in those days. And then I started using MLC probably three or four years ago, maybe three years ago and I still was charting and then writing a separate report in a template. I had a template and I was writing out basically what I wrote in a more concise form. I used to write these really lengthy, so detailed on MLC, and then I would try to write that in a concise way on my report and then send that. That was also just painfully long as I'm basically doing the same thing twice in two different ways. One really lengthy, one really short, and it was when this last year at LC&PP, everybody was talking about ways to do charting and more efficient and I know you were in on these discussions that we had late into the night in the conference rooms after everybody had left. But I learned about or a strategy to make your charting then be your report by exporting a portion of your chart. So that's what I do now. I have a very systematic way that I chart with very specific things and specific boxes, and then when it exports, it looks like this really lovely report. It all comes out really nice if I do the systematic way and I get everything that I was getting out of doing it twice, doing it once. And so what I chart is then the report. So when I'm done charting, I'm also done with my reports and three clicks later it's faxing off.
So that has changed my life. I cannot even tell you. I used to get 10,15 reports behind where I have to spend a whole Saturday just trying to force myself to write reports. I would give so much time to report. So it was so, so hard on me and I am not a writer and I am dyslexic, so it's just painful to write. And so it was just always such a challenge for me. So I have been so liberated. I usually within a day or two have my reports done, obviously because I have my charting done and then my assistant faxes them out. So we fax urgent things right away. But otherwise she has one day a week that she faxes everything for the last week. So we do it on Thursdays, so she will fax everything for that week and the Friday before. But if anything is needing to go out sooner, obviously we'll fax right away. But on just kind of our standard where there's no major red flags. The other thing that I will say about when to fax, I always in my visits ask when their next pediatrician visit is because I always want the pediatrician to have it before they go. So that might be a time where I have my assistant fax sooner. It would be like, oh they have a pediatrician on Wednesday, please make sure this goes out. And that makes a huge difference because then I'll tell the parents, oh good, let them know. I'll have my report there and if there's anything y'all want to talk about, it'll be there for the pediatrician to read, and kind of pulling this all together and the parents can know confidently that I have sent that over for them. So what kind of strategies have you found to be effective?

Annie: So when I was doing Mobile Lactation Consultant, I did the same thing that you do, and I still do it now that I'm using CHARM, it's the same thing. I chart as if I'm talking to the pediatrician, I mean not directly, but I'm thinking what do I want them to know about this baby? And for me, I send my workflow is that as soon as I'm done, it gets sent.

Leah: That's awesome.

Annie: So I would generate the PDF on my iPad and then I would click 'export' and it would go to my email for email to fax, and I would always use the open visit simplified.

Leah: Yes, that's what I use.

Annie: Even though I used to wish I'd had this, but at least it's got the basic stuff and it looks really clean and nice.

Leah: Yeah. And I think it's easy to read and the big points are there and what I fill in those boxes ... I've kind of broken it out so like in my observation box, it kind of looks like an assessment. So I have like 'mom observation' then 'infant observation', so I have it kind of broken out in there so hopefully it's easy to read. But it's also nice for me because I have a very strategic plan for my charting, which helps me get it done a lot faster. So I don't chart very well. I know it seems like everybody's been talking about charting and the bane of our existence with charting and reporting. I don't usually do a ton of charting in my visit. I stopped after in-between visits or at a set time when I get home and finish all my charting. I put key points, but I don't do what I do for my report actually at that time, because I am not good at charting and talking at the same time.

Annie: Yeah. I mean it's hard. Everybody's got a different strategy like being able to do that. I'll do some charting while they're changing a diaper. I'm a fast typer and I can do it without looking and I can type while talking. That's just from years of practice and just from really from being an assistant for so many years and nobody stops for anything.

Leah: So you better know how to get it done.

Annie: I mean, I used to take dictation. My boss would tell me letters and he would stand over me and be telling me the letter. I'm typing it and he's correcting me while I'm typing and he's like, this has to go out by fax in 5 seconds. So I have got some honed skills, so that's me and that's my skill set. If you don't have that, that's fine because maybe I might not be as good a listener as somebody else because I'm always thinking and trying to do two things at once. But what I do in CHARM is I maintain one chart for the parent and one for the baby. So in the parent's chart is where all of the instructions go. So they've got that field that's instructions, and then when you sign the chart it gets automatically shared with the client. So all of my details, my links, my care plan. And then what I do is anything that is specific to the babies, so any supplementation plan or referral for evaluation by a specialist, I paste that in the baby's chart in the treatment notes section. So not in the instruction section because if I put it in the instruction section when I signed the chart, it's also going to go on the patient portal, and that's going to be two things that are the same that the client is going to see and I don't want them to have to parse that. So I put it in treatment notes because then it gets faxed to the pediatrician, but it's not getting shared with the client and it's just basically the same. And I'll put that...I'll say instructions given to parents. So then what the pediatrician is getting, everything that I've charted about the baby, I put feeding evaluations in the baby's chart and then I copy that into the mother's chart, but I don't always put everything there. I'll put things like, what position we used? Was a good transfer? Was there pain? But I won't do like all of the jaw excursions and audible swallowing that I put in his chart. So I do try to keep two tabs open and so I'm kind of going back and forth between tabs and then it gets a little messy. Sometimes I don't always do it right. And then I was doing with CHARM where I was generating reports and it's a report that pulls from fields they've got. You can set it up in the settings so that you're actually specifying which fields in the chart you want it to pull from. So it can get very specific, and I made this pediatrician report that I really liked but I would have to be on my computer because unlike Mobile Lactation Consultant, when CHARM would generate that PDF, it couldn't bring it up on my iPad and attach it to an email in my email client. I was like, that's weird.

Leah: Yeah. That is challenging.

Annie: So then I was doing it when I got home and downloading it to my desktop and then I decided I don't want to do this anymore because that's taking up my time. So I spend the $20 a month for the fax integration for CHARM, which I originally thought was a stupid amount of money to pay twice as much as an email and fax service, except I hit a button that says fax. It brings up a window. I type in the pediatrician’s name, I hit fax and it's gone.

Leah: It's done? Oh wow!

Annie: It's done, and I don't care what it looks like. I don't care what happens. Really? I hit that button. All I know is they get it. I'm done. I'm assuming they get it because some of the pediatricians that I'm friendly with do tell me that they get it and it's just done and I'm not doing it at home while I'm telling my kids, hang on, hang on. No more, not in my house. I'm trying to eliminate that so that's how I do it and I would love to take this moment to segue into my tech tip for the episode, because it really does tie directly into this topic that we're doing.

Leah: Awesome!

Annie: I would love for you to be thinking about harnessing the power of copy and paste. There are things that you are going to say the same way every single time. There really isn't that much variation in what we're doing. You know, we're not neurosurgeons. Even though what we're doing, we know it is highly complex and it's beautiful the way you've got two people working together and all of the nuances and subtleties. They're legitimately things that you're like, I'm never going to find another way to say this, or go look at the last three charts that you did or the last three pediatrician reports. Take something, copy it and put it in Google Keep or Notes on iOS. It doesn't have any client information in it. There's no privacy issues and then just copy and paste that in there. Don't try to rewrite it every time. Don't try to give these any style at all. This is just communicating information.

Leah: I think that's awesome, and I use a couple of different ways similar to this is I have Phrase Express, which I really like and I use that on my iPad and I have all my different recommendations for care plan in different sections, but the other thing that I use a whole lot, almost even more is text expanders. I do have quite a photographic memory, so I thought it was going to be really hard at first to remember all the little phrase would give you the expanded text. But it's actually been really easy for me. And how I have done it is I do dot and then a word and then it brings up a whole paragraph.

Annie: Yeah, that's nice. Those are great.

Leah: Yeah, it's really nice. All the websites that I want to share most often, I have those on there because I do use Spruce on my phone, and so for moms like, Oh my gosh, I don't know something, I can just be like, here's the website and it's just like dot.pump or dot.whatever it is, and I can send it instantly without a whole lot of additional thinking that has to go on to find it. So I think it's so valuable to take the time to create all that. It does take time. You have to plan time, sit down consistently start making those protocols or text expanders or however you're going to approach it, but that is an amazing tech tip and actually, I think one of those LC&PP late night discussions was all about this and I learned so much that night that we chatted about all this, or I don't know when it was - night, day, sometime - and I learned so, so much and I have utilized it tremendously in my practice, which has definitely helped me be way more efficient in all these areas that we've talked about today. So I think we're really all working towards trying to be more efficient, working on different strategies and I think together we'll get there and I would love for you guys listening to come to this conversation with us in the comments on this or on our Facebook. Talk to us about what's working for you guys because I think that's one very valuable thing that we can share is yes, there are things that we haven't tried yet. So what's working? What's not working so we can all hack this together.

Annie: No, listen. I love hacks. Tell me you figured something out. I 100% want to hear it and I'll be all about it. Yeah, I'm obsessed.

Leah: I know, and I love trying different things because I would have never thought that these apps would be so helpful. And then I was like, you know what? I'm just going to give it a try and really changed my practice so much. So be willing to try new things. But this has been a great topic, Annie and one that's so, so important. I'm so glad we took the time to really hash through the dreaded physicians' notes.

Annie: Yeah, it wasn't so bad.

Leah: No, it wasn't as bad and it actually is just so nice to know that we're all trying to get through this together and to be a team of these professionals who really are making a difference in these moms and babies, all these families that we're working with. So it's been good talking to you today.

Annie: And you too, as always. So I look forward to our next conversation. I hope you have a fabulous week with your families that you're working with.

Leah: Thank you. You too. I'll talk to you soon. Bye.

Annie: Bye.

Leah: Thanks for listening to Lactation Business Coaching with Annie and Leah. If you liked this podcast, please leave us a rating and review on iTunes, Stitcher, Spotify, wherever you're listening right now. Don't forget to hit that subscribe button so you never miss an episode.