309 – Medical Mission Work in Honduras

Jan 12, 2024

Dr Jessica Knight, DPM, is a foot and ankle surgeon at Northwest Community Medical Group, Chicago, where she specialises in limb lengthening, deformity correction, and limb salvage of the lower extremities.

When she is not in private practice, she volunteers and does medical mission work in Honduras for the treatment of children with congenital birth abnormalities such as club foot, coalitions, and fibular hemimelia. This episode is a very inspiring story about balancing your career and family life, learning to say YES when an opportunity arises, and putting your ego aside for the greater good.

On this episode, we also discuss:

Switching her passion from sports medicine.
Finding what you are passionate about.
Playing soccer in college helped her with time management and gave her that competitive spirit.
Balancing work and life and keeping them seperate.
Saying YES, and doing scary things.
Jumping on opportunities when they arise.
What it is like to be involved in 35 to 40 surgeries per visit in Honduras and putting your ego to the side and learning from those that have far more experience.

If you have any questions about this episode, you can contact me at tyson@podiatrylegends.com

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Full Transcript

Tyson Franklin: Hi, I’m Tyson Franklin and welcome to this week’s episode of the podiatry legends podcast with me today is Dr. Jessica Knight She is from the northwest community medical group In the Northwestern suburbs of Chicago. So Jessica, how are you doing today? I’m doing well. How are you doing this evening?

I am fantastic. And we bumped into each other in October 2023 at a Chicago’s Bears game. And that was so much fun. That was, I didn’t realize so many podiatrists hung out at Bears games. And

Jessica Knight: they won, which

Tyson Franklin: made it even better. That was funny. When we did the tailgating beforehand, which I had never done before, highlight of my life is when we were in the, doing the tailgating and somebody said, I said, this is my first NFL game.

They went we apologize now for how bad the bears play. And then when we game finished, when we went back to the car park, everyone was saying, you’ve got to come to the next game. You must be a lucky charm because we never win like that. It [00:01:00] was a really good game. So we’re going to talk a little bit about your career and what you’re doing.

And especially I want to touch on the parts about you doing the limb lengthening. Which I thought is really interesting. The mission work you do in Honduras, but before we touch on all that, let’s go back a little bit. What got you into podiatry in the first place?

Jessica Knight: Yeah. I have to say it started with sports. I knew I wanted to go in the sports medicine route. I played. Soccer in high school competitively, and then in college and I was a pre med major. And one of the requirements for my degree was that I had to do some sort of internship at some sort of medical school, some sort of, to get some background, some office, follow around a physician.

And there happened to be, I went to school in Cleveland, Ohio, and there happened to be a podiatry school in Cleveland. And I really didn’t know anything about podiatry, but I was like, Hey, it’s right down the street. I need this For my major. So let me just sign up. Cut to, seeing that I could still do at that time when I thought I wanted to focus on with sports [00:02:00] medicine, I still could do all the things that I wanted to do.

Residency was significantly less. And it was something that, I thought I would do close to home because the school was right there. I ended up not going just to that podiatry school, but I checked all the boxes.

Tyson Franklin: So it’s where did you end up going if you didn’t go to the one that was close to home?

Jessica Knight: I ended up going to the Chicago one.

Tyson Franklin: Okay, but even though you’re at the Bears game with me though, that’s why. You’re a Cleveland Brown supporter.

Jessica Knight: That is why I’m a Cleveland, that’s where I’m from. That’s where my family is. I’m a diehard Browns fan.

Tyson Franklin: Okay, so once you decided, what was it about podiatry that you went, that’s what I want to do? Even though you knew you had the sports background, and you wanted to get involved in sports medicine, was there anything specific about podiatry that you went, yes, this is the profession? Yeah, I

Jessica Knight: think it was, obviously, when you’re thinking about medicine and sports and things like that, you spent, I spent some other time with some other orthopedic surgeons, but what I really liked about podiatry is there, there was more than just [00:03:00] surgery, there’s not trying to say anything negative about any other profession, but the joke with orthopedic a lot of times is injection, physical therapy or surgery.

And that’s about it. And then with podiatry, there was a lot more of actual, non surgical treatment of some of the athletic conditions that were coming in. It wasn’t just surgery or not surgery sort of thing. And I really liked that.

Tyson Franklin: Once you started it, did you still have the focus that sports medicine was going to be the area of podiatry you’re going to go into?

Jessica Knight: Yeah, I didn’t end up switching my passion until I started getting into residency and started branching out and looking at things, but I went in all of podiatry school. It’s going to be sports medicine residency. And then once they started getting my hands wet, that’s when I started to change my focus.

Tyson Franklin: See, I think that’s really interesting because I know a lot of podiatrists will start podiatry for a particular reason. Even when they graduate they still think, Oh, I want to be a podiatrist that deals with sports teams and they don’t realize that you don’t have to keep sticking with it.

You can change your mind. [00:04:00] Yeah,

Jessica Knight: absolutely. Absolutely. I also, I’m also a big component and we can talk about this a little bit when we get into more of my specialty now, we, I feel like podiatrists, we have this kind of thing where we feel like we have to treat everything. We have to be great at everything.

We have to do total ankle replacements. We have to do limb lengthening. We have to do scopes. And I, I’m under kind of my motto is you can’t be great at everything, and just picking something that you’re passionate about that you can focus on and become the best. I think it’s another thing, podiatry, even though we’re still specialized, there’s still a lot out there, that you can even

focus

Tyson Franklin: on.

Now, did you fight with that at all? Like within yourself? Because for so long, you were going to do sports medicine and then when all of a sudden your passion started to change, did you, was there any like mental games with yourself challenging your thinking? Maybe

Jessica Knight: not directly to sports medicine, but I think just trying to figure out what type of physician I wanted to be, for us, you go to college and then you go to podiatry school and then you go to residency and then myself fellowship and then practice.

So you’ve [00:05:00] never really out in the real world. So you’re a kid at heart. You’re been a student your whole life. So I think just trying to figure out the type of person that the type of physician, the way you want to present yourself, even as simple as walking into a patient’s room, how do I want to present myself?

So I don’t think it was just purely, Oh, I’m not going to be a sports med anymore, even though that’s who I was growing up. It was just soccer. I think it was more just, I think it was just more figuring out what type of physician I wanted to be, what type of. Person I wanted to be, and I think it was all in one, one big swoop.

Tyson Franklin: Yeah. And before we press record to you, you mentioned something about being like a fairly elite soccer player at college level that you found that was quite beneficial towards your career as well.

Jessica Knight: Yeah, I, you can be as simple as, time management being able to juggle multiple things to being competitive, with your teammates, but also working towards the same goal.

That I think is the most direct. Correlation [00:06:00] between athletics and just any sort of competitive, cause any sort of education job at this level can be competitive. But I just also just, knowing your boundaries, knowing how hard you can push yourself, not being afraid to do hard things.

I think that’s probably the takeaway that I use most of my life even

Tyson Franklin: today. Especially when you talk about the time management, because I’ve heard so many people going through podiatry school in the States and how consuming it is for them. And I’ve heard some people say, don’t even try to do anything else other than just concentrating on your study.

Yet at the same time you’re playing competitive soccer.

Jessica Knight: Yeah, I don’t know. I thought that was hard, but now I have a full time job. I take call every three weeks. I’m going on medical missions. I’m lecturing and I have a five year old. So looking back at college, that was easy. I’ll take that. Now it’s much

Tyson Franklin: harder.

I actually say that, I tell that to my daughter because now that she’s at university and she’ll come home and she’ll complain about, Oh my God, you don’t believe, [00:07:00] you would not believe how much work we have to do.

And I go, Oh no, I believe it. Remember, I actually gone through university. I remember what it was like. I said, I’ll tell you right now, when you get into the real world. You look back at uni and go, Oh my God, we had so much, we actually had more time than what we realized. And I think it comes back to that time management that you were talking about.

Jessica Knight: Yeah, absolutely. When all you had to do was worry about yourself. I

Tyson Franklin: remember those days. And being a sports person, that competitive side of you, did you feel when you were going through, you were competing with others or it was more of a competition within yourself? Did you just constantly keep improving and being better?

Jessica Knight: Probably both. I would even say now. In, in practice, I’m, I, as much as I try to not tell myself that I am constantly looking, at fellow colleagues felt, where, what are they doing? And I think that’s just the competitive nature of me. I’m always going to be competitive.

You can’t take that away

Tyson Franklin: from me.

Jessica Knight: And I always say to, again, going back to referencing the mom, being a mom is the hardest thing I’ve [00:08:00] ever had to do. But, everybody gets their self worth from something, whether it’s being a spouse, a parent, and for me, I’ve always gotten my self worth through my job, and it continues to be, and so I think that’s another reason if that’s what gives me my self worth, I’m constantly going to be looking around, comparing myself because that’s who’s me, that’s what makes me happy.

Tyson Franklin: Yeah, and talking about the motherhood side of things, how did you balance that with your career? And then did you take a certain amount of time off after you had the, after the birth, or did you go back into work fairly early?

Jessica Knight: I Went back to work fairly early, seven weeks is how much I took off.

I, every day, I had someone tell me a long time ago, and I fully believe this, and this might be controversial because everyone I say to yells at me. I had a guy say to me, you can only have. Two of any three things at any given point, be a good doctor, make a lot of money and be a good dad.

That was like the reference. And he said, most people, when they start out, they’re a good doctor. They’re making a lot of money, but they’re just [00:09:00] not around for their kids much. And then as you get older, you’re more established in your practice. So you’re making a lot of money. You’re there for your kids more, but you’re not on top of the newest and greatest.

You’re not doing your CMEs, going to courses, things like that. So you’re not as good of a doctor. I still believe that now. I don’t think it needs to be as gray or black and white. I think, how I apply that to my life is either week by week or month by month, this week, I’m on call.

So I’m not going to see my family. I’m going to focus on work next week. I’m not on call, I’m going to put the phone away and focus on my family. So I think it’s just more of a balancing, not trying to do it all, but just breaking it up and Focus on what’s going to be the most important thing this week or this month.

Yeah. I

Tyson Franklin: heard somebody else describe it once that you can balance all things perfectly, but at any given time, you cannot focus on more than one thing. So somebody said, so if you’re building your business, that’s going to be from a certain time during the day, you are building your business, but you’ve got to be able to switch off.

And then when you get home, you are [00:10:00] 100 percent with your family. Yeah, absolutely. And then there’s certain times if you’re at a conference, for example, you’re at that conference, you’re there to learn and you give that a hundred percent, you don’t think about the business, you’re not thinking about your family, you’re there for the conference.

And it’s being able to put them in silos at different times, even though there’s crossover, but you’ve got to give each thing. And I remember with my wife, when I was setting up the clinic and our daughter was little, and she just understood that at certain times when I was at work, I was 100 percent focused on work.

But then when I come home, I was 100 percent focused at home.

Jessica Knight: Yeah. Absolutely. I’ve had some other women podiatrists give me advice saying no, bring your kids to the courses to hire a nanny and bring it. And I just can’t do that because to your point, if I’m at the conference, I don’t want to be thinking about what my kid’s doing, what such and such doing, when whatever area I’m in, whatever zone I’m in, that’s my a hundred percent.

And I don’t want to be thinking about anything else.

Tyson Franklin: Yeah. I did that once. I went to a podiatry conference and [00:11:00] my wife now, I think we were only recently married and I went to the conference and she came along with me. And I didn’t really enjoy the conference and it wasn’t because my wife was there.

It’s just while I was at the conference, I was, I knew my wife was by herself. And it was in an area where there wasn’t a lot to go and do. So when I finished, I felt obliged that I had to not catch up with everyone around the bar and have a few drinks and talk about what we learned that day or other parts of podiatry, but I felt obliged.

I had to go and see my wife. And I wanted to see her as well. It wasn’t that I didn’t want to see it, but I was torn between the two things. And I only ever did that the one time. And yeah, I’d rather, if we go on a holiday, my wife won’t be going on a holiday and that’s it, or I go to a conference.

Jessica Knight: Yeah, I agree.

Tyson Franklin: I agree. Yeah, unless my wife can be involved in the conference, because I do I run workshops every now and then, and we ran one last year, and usually I do them by myself, and [00:12:00] this time I had my wife come along with me and help me, and it was the best thing, best event I’ve ever run, was having her there, and what the best thing about it was the feedback from the group, were saying that you can get up and tell a story, you could explain something to us, but then you would turn to your wife and then she would comment what it was like.

Cause she used to work at the front desk, how, what I was saying affected the front desk. So it was getting different perspectives on it. And I walked away from that thing. I’m never going to do a workshop again without my wife being there. So you can blend things. You can blend things together.

Like you said, as you get older, your priorities change as well.

Jessica Knight: No, that’s one of the things that I even say I’m fascinated about even in marriages, because, I think You know, I’m eight or nine years out of fellowship at this point, and how I’ve changed as a practitioner is a lot.

And then you look at as an individual, I’m 10 years into marriage, how much I’ve changed. And so I’m, that’s, I’m always fascinated with people that have been married [00:13:00] for 40 years, because you’ve had to change and how do you change together versus, just two separate people, because you’re bound to change after.

And I’m always fascinated. I always ask my old patients how long have you been married? And what’s the secret sort of thing? And, sometimes I’ll get cheeky answers. Sometimes they’ll give me some good,

Tyson Franklin: good, some good advice.

So when you were doing your residency, is that when that’s when you were exposed to the limb lengthening?

Jessica Knight: I was, it’s actually in the medical mission that kind of started it.

Tyson Franklin: Because let’s go back. How’d you get on the medic? Go back one more step then. How did you end up on the medical mission in the first place?

Jessica Knight: So yeah, my residency program was one of those programs that just somehow got involved in, in, in this mission that started actually started in like 1976, it was Southern California podiatrists, and they would take their residents and go down to Mexico and.

Just do clubfoot casting and it started there and then it progressed to [00:14:00] El Salvador. And then I think in 2000 is when they started going to Honduras. And I honestly couldn’t tell you how my residency program was when there was a couple that were associated with it. But basically we went down there and did the scut work.

So I lucked out and I got to go my first year because my older residents were scared to go to Honduras. yeAh. And I was just side me up. sO I was able to go down all 3 years of residency. And, it’s 1 of those where, you know, even as a practitioner now, you I’m successful practitioner.

I’ve done fellowship. I run, I have my own practice, but you go down there and you do Scott work. So when you’re. A resident, you’re cleaning instruments, you’re the circulator. And then after a year or so, you get to run the back table. And then after that, and that’s when I started to see some real deformities, mostly clubfoot.

But there’s all kinds of other upper and lower motor neuron pathologies. And that’s when I really started to look at these severe deformities. I what I fell in love with is, [00:15:00] I use the example, my dad was a carpenter and he used to sit there at the kitchen table and do these crazy math things and build things and was able to just look at something and put it together.

And I started to use that kind of same sort of concept with looking at these crazy deformities, it wasn’t as easy as, okay, that I am angles 15, this is the procedure. You were seeing these complex things that didn’t really have a textbook answer and you just had to figure it out.

And that’s where I started to fall in love with more of this deformity correction, limb lengthening things, as opposed to the sports medicine. I loved the puzzle and trying to figure it out.

Tyson Franklin: So with the people that said they didn’t want to go because they were scared to go down there, why were you not scared?

I don’t know, and I’ll point out to people who are only listening to the podcast and not watching the video that, you’re six foot five and you’re Yeah. , I know under 250 pounds. So you’re a scary woman.

Jessica Knight: , I, yeah, I know. Bless my husband ’cause I give him a hard time all the time.

I say to him, I go, you know what? I wish I could have followed the rules, but I am, if I [00:16:00] was a white old male, I could play by the rules and get ahead in life, yeah. I feel. 5’2 blonde girl, I have to do scary things. I wouldn’t made it to where I was if I didn’t have to do scary things.

No, I saw it as an opportunity and I was going to jump on it. And yeah, I could have, could I have been abducted and who, who knows? Yeah, but life is life. I would have always regretted it. And now. We’ve been going 12, 13 years, and it’s a big part of my, we go multiple times a year now, and it’s a big part of my life.

I’m glad I took the opportunity. , and there were two, two men who didn’t want to go. So I will say that.

Tyson Franklin: Yeah. And I’ll know you should point that out. And what could go wrong with a five foot two blonde American girl in Honduras? What could possibly go wrong? And what I think is interesting though, and this is when I always say to people.

That when you’re presented with an opportunity, sometimes you just got to say yes. Yeah. And even if you’re scared, you just say yes. Because you have a look at what it’s done to your career. [00:17:00] Now the ones that said no, I don’t know if you remember who they are or what they’re doing now. Do you know where they are in their careers?

No,

Jessica Knight: I don’t. I don’t at all.

Tyson Franklin: So that’s interesting. There’s a big takeaway there for everybody.

Jessica Knight: Yeah, that is true. That is. I still get a little scared every time I go down there because I always fly in by myself and hope that someone’s at the airport to get me. Sometimes there hasn’t been but if you’re just passionate about something and I, you have to take a chance, you can’t live your life, not taking chances.

Tyson Franklin: So you said, so now you’ve been down, was it 13 times?

Jessica Knight: 12 years and now we go twice a year. Probably say maybe 15, 16 times

Tyson Franklin: now. Okay how do you work out when to go down? Because you’ve got your own practice that you’re running. So when you’re going down to one of these like medical missions, how do you put the stuff together?

How do you get what you need down there? Do you pack stuff up and take it [00:18:00] with you? Or does the government down there help organize it?

Jessica Knight: No, so I’m lucky enough in that the, some of the founding fathers they’re retired from actual practice, but they still go down there out of Kaiser. They help rally different supplies that we need.

We have industry that will give us things. So those get shipped down. I think the hardest thing for me is I work for a. A medical group. So I only get so many weeks off a year. I have to get permission for my boss. It’s not like I can just close my doors. Yeah. So I take vacation time, and that has become harder now that I have a family when it was just me, I was like whatever, that sort of thing that has, but again, going back to what gives you your self worth and what makes you happy.

You always hear, they always tell the moms, you need to make yourself happy. If you’re not happy, you’re not going to be a great mom, but I would say that for anybody, if this is what I’m passionate about, it makes me happy, it gives me my self worth and so I’m going to find a way to do it and maybe that will mean later on in life I might miss a little bit of a vacation it’s [00:19:00] nothing in life comes without some sort of sacrifice.

Tyson Franklin: No, but you’re setting a perfect example for your son. And I’ve got a podiatrist I know in South Australia, Mark Heard, and I remember talking to him years ago and every year he would take his kids to, I think it was Indonesia and they’d help build orphanages there.

And that was part of it. That was like a family trip that they would do because he wanted his kids to see what it was like. In other parts of the world and how people don’t always have what they have in Australia. And he said that has really grounded them and made them, they were just.

incredible kids. So I think what you’re doing is a great example for your son.

Jessica Knight: Yeah. A lot of the older practitioners bring their kids around 13, 14, and they get put to work like all the rest of us, but it is an eye opening thing. I was a little bit, when I became a mom, I didn’t know how I was going to act because there’s a lot of kids, when I get emotional, it would be, and I was quite [00:20:00] surprised actually with my reaction.

I got really. Bad. I was, I left mad. And the reason I was mad is I was looking at these parents, both moms and dads, but obviously I’m going to relate to the moms. And I’m looking at these moms who put their kids on their back and walk for days to bring them to our clinic to hope that we pick.

Their child to correct their feet and literally would do anything. They do anything for the kids. And the only reason why they’re there and I’m here is we were just born in different places. That’s it just born. And it just made me so mad about how unfair life was. And it’s just, it’s, I thought I’d be emotional.

I’d be, looking at these kids and I just get so mad about how unfair life is, and then when you come back here and people are like, Oh, Pull up your bootstraps or, all those other things that you people have no idea. People have no idea. People

Tyson Franklin: have no idea. I know we joke about it all the time.

We will be complaining about something. And then if you’re with a group of close friends and someone goes, oh yeah, first world problems, geez, my internet’s a bit slow. [00:21:00] No . I’ve gotta get new tires on the Mercedes-Benz. I know. Yeah. Do you know how expensive they’re, and you’re like first world problems?

Jessica Knight: I know. I will say clinic is a little rough coming back the first week or two because I just don’t have any tolerance. For anything that is not, for someone to come in complaining of their left pinky toe hurting them in their six inch heels. It takes me a week to simulate back to the problems here and not be so

Tyson Franklin: callous.

So are you looking for other podiatrists to help you down there? Are you always looking for volunteers to get in and help you out?

Jessica Knight: We are. We are. I guess my biggest disclaimer is that, regardless of how successful you are in the profession, because we’ve had some big names come down. Yeah. You start at the bottom and work your way up.

I think that would be. The biggest thing about coming down it’s definitely hard work and you work, we set up the ORs, we clean the instruments, we turn over the rooms, we screen the kids. It’s, [00:22:00] you’re doing medical student work while you’re down there. You’re a medical student down there, so I think that’s the biggest thing. Sometimes people come in thinking that they’re going to get handed the blade and, and it doesn’t work like that down there. You gotta, I’ve been going for 12 years and I’m still the low man on the totem pole,

Tyson Franklin: but I think that’s good though. I think it’s good that you can put your ego aside and you just go down there as a group.

It’s not about who’s the best surgeon, who’s this, it’s everybody starts at the bottom and you’re, you work your way up like the kitchen hand in the restaurant.

Jessica Knight: One day I’ll be, one day I’ll be the sous chef.

Tyson Franklin: So .

You said with the mothers, you’re putting these kids on the back and they’re all coming to the medical clinic. And then you’re saying you have to select them. Yeah. How do you turn people away though? I

Jessica Knight: know. Oh my gosh. The reason I’m sure this is a given, but I’ll just say it.

Yeah. So it’s obvious, we’re not picking, out of preference or things like that. Most of these kids had some sort of neurological underlying condition, so a lot of cerebral palsy, we’ll see things like that. So we’re looking at these kids as, let’s [00:23:00] say we correct their feet and their legs, are they going to be able to walk, a lot of them, and if they’re not going to, then the risk of putting them through surgery, it’s not worth it, so it’s mostly just screening people that we can actually help. And then we’re lucky that there is medical students down there. That will help us. I speak white girl Spanish. So I can understand most of it, me speaking down there, they’re looking at me like, who’s this white girl trying to speak Spanish?

A lot of the older attendings are pretty good, pretty fluent, but we do have medical students there, the from Honduras that help us out. And it’s the same ones we see almost every year until they graduate and move on. So they help us interpret, but it is, it’s heartbreaking. They dress up the kids thinking that.

If they’re dressed nice, we’ll pick them. They don’t quite understand that. We’re just trying to find people that we actually can help. And I would say that’s probably the worst, seeing these parents just devastated. Just devastated.

Tyson Franklin: Yeah. And it also, like you said, it’s part of, once you do the surgery and the [00:24:00] healed is how are they then going to function in the community?

So if you have someone that’s got a certain deformity, you can fix that. And then, they’re going to be a really high functioning person in the community that is going to take precedence over somebody that you can fix, but they still may never walk. Yeah,

Jessica Knight: absolutely.

Tyson Franklin: Absolutely. That’d be tough. Who tells the parents,.

It’s

Jessica Knight: really the medical students that really sit and explain. And I honestly think it’s better that way. Because they’re from there so they can relate. They’re also really good about, we have anywhere from 100 to 200 kids that we just have to go through. We go there for 4, 3 days and just all day, 8 to whenever we get through and just screen all these kids.

We have them walk. We do biomechanical exams. We do a neurological exam. And so we’re like go. But the medical students will take the parents aside and we’ll sit down and talk to them, so even though we. We don’t mean to rush through people, but we have to, if we see someone coming in with Walker [00:25:00] who can’t even bend their legs and they’re just using their upper body to move, we know that we’re not going to be able to help them.

dismissing them. We’ll have the medical students sit down with them and talk to them about everything. A lot of times we’ll give them things for AFOs and, cause there is an orthopedic there that works with us too. So he does help out in as far as that aspect goes. But it’s the medical students, they usually spend the time with them.

Tyson Franklin: Okay. And we thought like you specialize like in limb lengthening limb salvage . What’s the most common thing you’re actually doing with Dan in Honduras?

Jessica Knight: Yeah, so that actually is more just clubfoot surgery. Okay. We do tons of clubfoot. We don’t really have, at least in my group, I know there’s been other groups that go down with the external fixators and the IM rods and are able to do some of that sort of limb lengthening things down there.

We don’t, we have Steinmann pins, we don’t have an x ray. We’re dealing with basic suture and Steinman pins. So it’s mostly just clubfoot correction. We can do a flat foot here and there, but we [00:26:00] focus on more of the severe deformities.

Tyson Franklin: Okay. So how many surgeries would you be doing per visit?

Jessica Knight: Usually I would say it’s about 35 to 40. So they give us. 4 rooms in the operating room. And we just, depending on how many lead surgeons we have, we just start booking up the rooms. I’d say we probably do about 4 or 5 surgeries a room a day.

And we start at the morning, we go until we’re done, we wake up and do it again. So I’d say probably about 35, 40 surgeries. Okay. There’s a time that we go down.

Tyson Franklin: And then before each trip, like you said, when you get back, it takes you a week or so to get used to Martha with the sore little toe with the six inch heels.

When you’re about to go down there, do you still get excited about each trip?

Jessica Knight: I get nervous. I get nervous. Okay.

And I get nervous because it’s purely me. This is all me. Nothing against, it’s that competitive nature, not, I’m still a junior attending, I’m not one of the main attending. So it’s [00:27:00] that constant trying to work to get better, to get to that next level, and so I’m always, I feel like a resident, when you’re sitting there and having the intending lead over you.

And it’s crazy cause I’ll put on external fixators by myself in the OR and don’t think anything of it, but I’m down there, just nervous. I get nervous, I would say.

Tyson Franklin: So that’s interesting. So back in the real world, back in America, you’re doing all the surgeries whenever you want without anybody looking over your shoulder, but then when you’re still down there, you’ve got somebody looking over your shoulder and you’re assisting.

Jessica Knight: Yeah, and I get pimped, I, they say, all right, even during the clinic, we’ll have a kid walk and they’ll say, what muscles are firing, what nerves are not working, what joint is pronating and, I, I get pimped just like I was a student and then in the operating room.

All right, walk me through skin to skin. How are you going to treat, how are you going to do this? And what happens when you open it up and the EHL tendon is not on the toe and it’s on, which happens all the time with these crazy deformities, [00:28:00] how is that tendon firing? If it’s out of, out of its phase and things like that.

So it’s still very much, and then you learn a lot. That’s the other nice thing about it, just being in that environment and being like, oh crap. There’s so much I still don’t know after being in practice, and that’s an awesome thing, just to constantly challenge.

Tyson Franklin: Yeah, I was going to say that, that constant like feedback from the other surgeons and them asking you questions has to keep you at the top of your game.

Jessica Knight: Yeah, absolutely. Yeah, I’m studying just And maybe also study. Yeah, that’s what I’m doing on the plane ride down there because I don’t have time in normal life. I sit there and just read everything and study as much as I can. And then at night, going back to the hotel room and just studying again, it’s essentially what it is.

Tyson Franklin: At what point do you think that you will move yourself up the rung, that you will be one of the top surgeons down there? You got to wait for someone to leave and then everyone moves up the rung. I was going to say, when someone dies. When someone dies. Yeah. I was going to say die, but I didn’t want to be morbid when someone dies.

Jessica Knight: No, they’re doing it [00:29:00] perfectly and that, even though I’ve been coming for 12 years, it’s not like I’ve been doing these surgeries for 12 years, and it’s not anything that you can really read in a book. It’s just seeing it and seeing it, especially when you come back, when I first started coming right out of practice and I couldn’t take a lot of time off of work.

I would just come down for the surgeries. I’m like, Oh, I don’t need to be in clinic. I’m attending now. I don’t need to. And someone pulled me aside and said, actually the clinic is more important than the OR because you’re seeing the surgeries that you did the year before and seeing how that surgery affects their gait and how they’re functioning.

And then also just understanding the pathology and why you’re doing what you’re doing when they’re on the table and they don’t have any function. Everything looks great afterwards. So then I switched it. And if I have to leave at all, I actually will leave a surgery day earlier and make sure that I’m there all for clinic.

So long story short, it’s more or less based on them pimping me, when I start to become more. Knowledgeable and clinic when I start to have better answers and these are [00:30:00] crazy deformities that, it’s, I’m never going to have it all figured out, but when I become more comfortable and I can express more knowledge of how to treat these crazy things and, because they’re.

I used to think that they were just harsh, why are they so harsh? And then as I got all older and probably more confident in myself, they’re just so passionate. They’ve been doing this since 1980, this is their life. They grew this program. They’re harsh because these are kids that they’re trying to help.

And they just don’t want some yay. Who has great CV in there, doing things that they don’t necessarily know what they’re doing, and. I think that’s a great thing to have someone so passionate about this project, so passionate about these kids that this is, they want to make sure that they’re leaving it in great hands.

I think it’s a wonderful environment.

Tyson Franklin: What I like about what you said earlier on too, you said they don’t have an x ray machine down there. And I assume in your own practice, before you’re doing surgery, you’d be having x rays, you’d have MRI, you’d have all the tools ready to [00:31:00] get prepared for the surgery.

I totally get why, like you said, you’re seeing crazy things that you’ve never seen before. These guys have been seeing for over 20 something years. So it’s purely, it’s experience of when they see something, their mind is already clicking into gear. This is what we need to do. This is what we’re probably going to see when we open it up because we don’t have the luxury of an x ray and an MRI beforehand.

Jessica Knight: Yeah, I’m in the world of, 3D cat scans now, like we can have someone stand on and get a three dimensional image, so that’s just the way that, I, we also live in a litiginous society where, so maybe I don’t think I need a CT or an MRI, but I’m going to order it to back up what I think my diagnosis is, so my mind just tends to work that way in this. And then I go down there and you just have to completely turn it off. And I can’t work that way anymore. That’s why clinic is so important.

It’s not because of ego. It’s not because of seniority. It’s just to your point. The only way that you’re going to be at that level is just [00:32:00] experience and coming down once a year. Is not enough experience, and the ones that kind of started this, they were going, they started in their residence program.

They were going every 2 weeks, they were driving there in Southern California. So they drive down to Mexico and see the clinic and do surgery. So they were going pretty frequently and they realize that they understand that they’re to the level because they have the luxury of going multiple times.

And, us younger guys coming up. aren’t ever going to be to that point. But on the same token, I don’t expect them just to hand over the blade, just because I’ve come 12 times, that sort of thing. Yeah,

Tyson Franklin: there’s a podcast or a video I shot a few weeks ago. And it was just talking about when you’re employing somebody and you’re tossing up someone that’s got three years experience or someone who’s got 20 years experience.

And I said, does the person that has 20 years experience, do they really have one year’s experience, but they’ve repeated it 20 times compared to the person that’s got three years experience who actually has three years. of experience. And how you’re talking about this, just, you can think about [00:33:00] a surgeon might have 40 years experience of doing surgery with the luxury of x rays and their MRIs .

And then they get taken down there where they do not have any of that, that their 40 years experience is not the experience that these guys have in Honduras. Yeah, absolutely. It’s hands on learning. It

Jessica Knight: is. It is. And again, it makes you appreciate the things that you, like clinic, you know, we, as a student, we all hated clinic even now we much rather be in the OR than talking to patients all day.

So it helps you to appreciate those sorts of things and the things that you can learn in clinic

Tyson Franklin: too. This has been actually really interesting. I knew we were going to talk about this because. You sent me a bit of a bio and you briefly mentioned mission work in Honduras, but I didn’t think we were going to be talking about it for this long, but this has been really interesting.

And the other part when you said that, and that you specialize in limb lengthening.

Jessica Knight: Yeah. So that became more popular in fellowship. I would say, so I think the most common thing that [00:34:00] we see in podiatry world is breaking that, breaking metatarsia, the gradual lengthening. So you use those sort of principles of, cutting the bone and lengthening it and osteogenesis of the bone, trying to, growing the own bone at a certain rate and you apply it to, the tibia So You know, I would say my practice, in fellowship, you’re in this kind of bubble world where people fly all over to this, to Baltimore in order to have this done, that’s not the real world.

I would say more in my practice, I see it more with. I Have had a couple of chronic clubfoot, 40, 50 year old guys that have been working their whole life and their one leg is shorter than the other because it’s the clubfoot. And so when I fix the clubfoot, I would put on an external fixator and lengthen the limb severe infections where you resected a lot of bone and now they’re shortened trauma to things like that.

That would be more of what I see, but it’s the same principles. The body’s a remarkable thing. You just need to help it. Cutting the bone and distracting it. certain rate that the body will start to regrow its own bone and you can create [00:35:00] deformities through the external fixators. Our orthopedic colleagues are now doing it in femurs and upper extremities with an internal rod that has a magnet.

So instead of having to put an external fixator on and then, either turning the struts or. Associating it with a computer program, there’s an actual magnet that’s in the rod. So you put the magnet on the outside and just move it and that kind of moves the bone. Yeah. It’s called the precise nails.

What we used in fellowship a lot. We don’t have anything really in the foot and ankle world yet for that, but they’ve been doing it for a while now in the long bones, femur, tibias, things like that.

Tyson Franklin: Do you ever, this will be a silly question probably, but do you ever get anybody comes in?

They know that you do limb lengthening and they want it done just to be taller.

Jessica Knight: I haven’t, but I know back in Baltimore they do and there is a physician that will do it.

Tyson Franklin: I don’t know. I’ve heard of it being, I have heard of it being done and I’ve read things about it being done, but I just wonder sometimes about the ethics of [00:36:00] doing it.

Yes. I,

Jessica Knight: I guess I don’t know the ins and outs of the people that are doing it, so I can’t. No make a educated comment. But I do have some apprehension about that.

Tyson Franklin: I’m glad it wasn’t as silly question as I thought then.

Jessica Knight: No, it’s not. I even say my whole thing is I talk about bunion surgery.

I say, listen, you can be the Perfect patient, I can be the perfect surgeon and complications can still happen. Risk versus benefit. I just, the risk of limb lengthening for cosmetic purposes, I

Tyson Franklin: But I suppose it’s like any cosmetic surgery. Yeah. But, yeah, I always say that even when you’re just doing a simple nail surgery, you always say to patients, as soon as you start breaking that skin, things can go wrong.

Yeah. Now, it really, it rarely does it, but any form of surgery, there’s going to be, there’s always a chance of complications.

Jessica Knight: Yeah, absolutely. Absolutely. I wish you would have remembered. I don’t know if you read it. There was a study that came out this [00:37:00] past year and it wasn’t a, it wasn’t a very good study, all the female surgeons that I know jumped on it and posted on Instagram where they said female surgeons got better outcomes than male surgeons and they were just looking at like patient satisfaction scores, nothing solidified.

And, I read it a little bit and it wasn’t a great study, but I started to think about that and more for kind of, again, my own practice. And I think at least for me, I have better outcomes now, maybe because I’m a little bit better surgeon than I was before. But I think I’m better at choosing my patients because now I’ve seen the complications, right?

You come out, you want to do surgery on everyone, save the world, and then shit hits the fan, excuse my language. And then you start really looking at your patients. And I would say that’s changed a lot for me and I will say, and correct me if I’m wrong, this could be controversial, at least in my own experience, I feel like at least the women that I know were much better at checking our ego.

So when you have a patient that comes in and wants surgery, I’m okay if you’re like, Oh, Dr. Knight, she can’t do the [00:38:00] surgery. She told me not to do it. I’m going to go. That’s fine. If you think. That I’m not a great surgeon, and that means I’m not doing your surgery because I don’t want your surgery.

That’s fine. My ego is fine. I’ll be just fine sort of thing. And I think that’s something to, over time as you start to practice Maurice, you start to, you should start to check your ego a little bit more and realize that you shouldn’t be operating on, on everyone. And it’s okay. If you get a bad review, or if it’s okay, if Mr.

Smith doesn’t think you’re a competent surgeon, as long as you know that, you’re making the right choices. I thought. Okay. But that was interesting too. I think ego has a lot to do with surgery and outcomes as well and picking the right patient.

Tyson Franklin: Yeah. I haven’t read that article, but I have heard that mentioned before.

And I was going to say one of the things I was gonna say, there’s two things. One was probably the ego. I think some male surgeons might have a bit more ego than female surgeons, but I also think women in general. Have more of a caring nature than males. Now I’m saying that’s not just a [00:39:00] generalized rule, but women have more of that nurturing, caring side of them.

Whereas guys are, sometimes we’re still a little bit like cavemen. Yeah. And no.

Jessica Knight: So I always use this story. My own life. So I wasn’t planning on being a mom. It was an oopsie baby. I loved him to death, it wasn’t like I grew up saying, oh, I had this inclination, but life happens.

And here I am. And the best story I could give is that, when my baby was young and. I would be holding him and he would throw up on me and himself. My first inclination was to clean off the baby and then clean myself. My husband was holding in the baby would throw up on her. His inclination was to clean off himself and the baby.

And it doesn’t make them a bad guy. Doesn’t mean it’s just to your point. I feel like there’s something in us women as much as I don’t want to admit it because I’m a very, women can do everything and run the role. But there is something innate in women, and I’ve seen that as becoming a mom, you’re absolutely [00:40:00] right.

Tyson Franklin: Oh, no, I remember if my daughter looked like she was about to vomit, I would be handing her to my wife. I try to get her as far away from me as possible. And the same thing, you can see, you can be on an airplane, and some woman could be walking down with a baby. And if the head is pointing towards any of the guys, you see all the guys move slightly, and you see the women leaning in.

Oh, isn’t that a cute baby? And the guys are going, Oh my God, I hope that baby doesn’t vomit. So I totally understand that a hundred percent. So I think, you know what, men and women are different, but I think we just got to accept that.

Jessica Knight: Absolutely. And there’s nothing wrong with that. I think that’s the other thing is.

You’re a woman in a man’s world trying to act like a man. And I think we, myself included, have figured out all wrong, women and men are different. That’s great. You should embrace what makes us different and what makes you better as a woman and what makes you better as a man. And I think that’s what we should be focusing more on.

Tyson Franklin: Yeah. Cause my wife is anything like me. I wouldn’t be with her.

Jessica Knight: Yeah. Same with me. I [00:41:00] couldn’t marry me.

Tyson Franklin: Oh no. And my daughter’s boyfriend, I just feel sorry for him because she is so much like me. And my wife just goes, Oh my God, she is so much she looks like my wife. She says, but she just, she’s got your personality.

It is it’s genetic, which I love. And that’s why my, yeah, my daughter and I get on so well. So Jessica. I want to thank you for coming on here. This is, I really enjoyed this. Not that I haven’t enjoyed my other guests, but this has just been a completely different talk on a subject that, and I mentioned before that I had an Australian podiatrist on who does work down in South America, which I am going to share your details with each other because I think he would appreciate being in contact with you.

But no, Jessica, this has been absolutely fantastic. So thank you very much. Thank you. I appreciate

Jessica Knight: it.

TRANSCRIPT (UNEDITED)

[00:00:00] Hi, I’m Tyson Franklin and welcome to this week’s episode of the Podiatry Legends Podcast. Podcasts designed to help you feel see and think differently about the podiatry profession.

[00:00:09] Today is a solo episode and the reason I’m doing a solo episode because there’s a topic that I think is overlooked by a lot of business owners, not just podiatry business owners, I think business owners in all industries. And that is creating a disaster folder. I think every business needs to have a disaster folder.

[00:00:33] And if you’re thinking, what is a disaster folder? It is a folder where you record potential disasters that could happen in your business and what you do to not mitigate that from happening, but what you do once it has happened. So, yes, you should have things in place that you should always try and lower your risk of disasters happening, but there’s things that will happen in your business that are out of your control, and when it does [00:01:00] happen, everybody on your team needs to know exactly what to do next. If, if every problem becomes really business owner dependent, you never get a break from your business. Your team needs to be able to make decisions.

[00:01:17] And they need to know they have your support when they make these decisions. And it’s based on what is in your disaster folder. And if it’s all documented and they follow the disaster folder step by step all the way through, then they have nothing to be concerned about. Cause they followed all the steps and you know that everything has happened properly.

[00:01:36] So here’s a scenario that I want you to stop and think about. What would you do if you arrived at work tomorrow morning and your premises was not there? What would you do? And when I mean not there, I mean it’s been burnt to the ground, or you’ve had a cyclone, it’s just, it’s, it’s just not there, it’s disappeared.

[00:01:54] What would you do?

[00:01:56] Do you actually have it mapped out, what you would do? [00:02:00] Does your team know what the game plan is? Do they know what to do next? And could they implement that game plan, If you were not around, if you’re away on holidays, could they straight away implement it? Now I know the building burning down is an extreme example, but sometimes I think you’ve got to talk in extremes so that the point is really driven home.

[00:02:20] Or if you are away, does your team know at least the first few steps to get things underway until you actually return?

[00:02:28] So I’ll give you an example. In Cairns, we get a lot of cyclones. And most years we’re always preparing for it. That’s just what we do. We’re in a cyclone area.

[00:02:38] And I had actually prepared for that, knowing that potentially We could turn up to work after a cyclone and the roof be blown off the clinic or the clinic has been damaged in some way that we could not work there. I did have a game plan in place and some of the things I wrote down here, I had other locations mapped out, medical [00:03:00] centers, Physiotherapy clinics that I knew.

[00:03:03] I went around to other places and I actually said to them, Hey, if for some reason my clinic became damaged and I needed somewhere to work from very quickly, could I use one of the rooms in your center? And they said, yes, and went great. So I mapped that down. These are the places you call first that we can actually find a room.

[00:03:21] And the other reason I chose a medical centre and physiotherapy clinics was because they also had examination benches, which meant we could use them straight away with our patients.

[00:03:31] We also had a list of other vital equipment that we needed, a list of stock that we needed straight away, and where you can actually get them from. I’d also reached out to a number of other podiatrists I knew, not just locally, but around Australia and Queensland that I said to them, if something ever happened, could I rely on you to supply me with certain stock items by this time?

[00:03:55] And they said, yes. So I had them all listed down as well. So straight away, [00:04:00] if I was away on holidays and my team turned up and there was damage to the building, for whatever reason, Forget about cyclones. If it was a cyclone, I’m probably in town. But if it was fire damage, something like that, and I’m away.

[00:04:11] They knew what to do in the next steps. They had a list of people they could call. Straight away, they knew what stock items we needed, what equipment we needed, and there was a list of people that we could actually call upon to get them, and suppliers. I had a list of suppliers on who supplied what, where they were, how fast they could actually get it to us.

[00:04:27] So straight away, they could, Take advantage of this list that I’ve done, get the ball rolling, and if I was able to get back and help out, I got back. But if not, at least they could get things started. They weren’t all just sitting around going, Oh, well, it looks like we’ve got a couple of days off until Tyson gets back.

[00:04:43] No, I wanted them to get the ball rolling, so when I came in, there was some momentum already started. Advantage we also had though, when there were cyclones, especially like in Cairns, is we get a few days warning. So when there’s a cyclone off the coast, it doesn’t just hit over night and we’re, Oh, wow, [00:05:00] that was a surprise.

[00:05:01] We know it’s coming. And we’re, we’re prepared for it as a team. We would normally have a conversation about it as well. So I think in your area where you are most places, there’s some form of natural disasters that will happen. Make sure you have a game plan in place and what you do step by step when that happens.

[00:05:19] Now look, we’re hoping for this is like insurance having your disaster plan. Disaster folder is almost like having insurance. You don’t want any of this to ever happen, but when I go some through some of these other things that I’m going to list, you’ll go, okay, yeah, these have happened or yes, potentially they could happen.

[00:05:38] The whole idea of the disaster folder is to create an extensive list of things that can go wrong. And having a team on board, knowing what to do next. I’m going to run through a few other things, oh, now there’s a quote that I want to share with you as well by Dennis Waitley and it was, plan for the worst, expect the best and be prepared to be surprised. [00:06:00] Now, I’ve lived by this quote and some people have said to me, Oh, don’t you think, , planning for the worst is negative?

[00:06:07] And I disagree because I think it’s a smart move. I think planning for the worst that could happen, which is exactly why we take out insurance. But think about it seriously. The reason you take home insurance, It’s because you’re, you’re betting the insurance company, something’s going to go wrong, but they’re betting you something won’t.

[00:06:27] So pretty much you’re, it’s not negative to take out insurance. It’s, I think it’s stupid not to take insurance. I don’t think planning for the worst is a negative thing. I think planning for the worst is a smart thing to do, but if it never happens, you can go.

[00:06:43] Thank God that didn’t happen. That is a bonus.

[00:06:45] And I’ll tell you a funny story. A friend of mine, Dave Frees, that you’ve probably heard me mention. Well, he’s been on the podcast and I talk about him every now and then. And I go to his event every October in Arizona. And I was with Dave Frees one day. [00:07:00] And he, he wasn’t feeling too well. He wasn’t sure if he had a flu, a bug, or what was going on, but he was, he was feeling quite ill that he felt like he was going to be sick.

[00:07:09] So we went out for lunch and while we’re out, while we’re having lunch, I was cutting my food quite small and I was chewing it a lot. And Dave said to me, you seem to be chewing your food a lot more than normal. I said, well, Dave, it’s because you’re sick and you don’t know exactly what it is. I have this fear that whatever you have, I might get and I might be sick and you already said that you have thrown up. Now, I’m chewing my food really, really well. Just in case I do throw up, I want it to come out a lot easier than having chunky bits of food because I’ve scoffed it down too fast.

[00:07:45] And he actually said, that’s really, really smart thinking. Now, it never happened. I was fine, but at least I was prepared for the worst. But I expected the best and, I wasn’t surprised about anything. I didn’t get [00:08:00] sick, which was absolutely fantastic.

[00:08:01] Now the, the other part too, there’s always going to be new things that are going to crop up that will be added to your disaster folder that you might think you have everything in there. And just when you think you have everything in there, Something else might happen.

[00:08:13] You never thought about that. Like I said, I’ve got a list we’re going to run through and hopefully I cover a lot of items, but yeah, going back four years ago, who would have thought a simple little, uh, virus. would have thrown us all into turmoil. Yeah, when COVID hit, nobody planned for that.

[00:08:29] When I had my disaster follow, there’s no mention of COVID in there at all. So something like that was very unplanned. I think was something none of us could have planned for. But what did you learn from it? And I think If you haven’t done it already, you should sit down and think, what did I learn from that experience?

[00:08:48] What could I have done differently? Could I have handled things a little bit better? But document things. If something like that ever happened again, which hopefully it’s unlikely, but if something like that did happen again, have you got stepped out? Does [00:09:00] everybody on your team know what you’re going to?

[00:09:02] Once again, that’s like building, burning down. That was, that was a major sort of event. So it’s unlikely that something like that is going to happen again.

[00:09:11] And they always say that adversity is a great opportunity to, to learn.

[00:09:16] Now, the best part about adversity, no matter what type of adversity is, it is an opportunity to learn. And I think it’s really important to realise whatever’s happened in the past, you can’t change the past, so you should not focus on it. And that’s in all aspects of life. What you can control is what’s happening right.

[00:09:34] now, which will have a direct effect on what happens in the future. So if you’re listening to this podcast now and you’re thinking, Oh yeah, should we have a disaster folder or not? Should we start one? I think you should, because what you do today could pay dividends in the future because it’s something that you’ve got to understand.

[00:09:53] And no matter how you want to dress this up, shit happens. It is just one of those things. It’s part of life [00:10:00] that things happen unexpectedly and when it does, those that are prepared, win. Now, going back to the COVID example. I know when COVID happened, if I still had my podiatry clinic at the time, I don’t think I would have been too concerned financially because I always prepared.

[00:10:23] I had my clinic set up in a way and had bank accounts set up and I used to move money in there over a number of years, that I had enough money in there that my business could run for probably about 12 months. With no income coming in, and that was just a backup plan that I always had. So no matter what would’ve happened with Covid, I would’ve financially been prepared for that.

[00:10:41] I would’ve kept my whole team on. Nothing would’ve changed for them, which meant they could have afforded their lifestyle on that as well. I wouldn’t have had to let anybody go. That is all preparing for shit happening and you just can be prepared that when it happens, those that are prepared will win.

[00:10:58] Those who are not prepared, and I know [00:11:00] people, not just, I mean, in podiatry podiatry, that had businesses that they lived week by week or month by month. And when COVID hit, they, I know a few of them that closed down. I know a few that really struggled and I know some that are still trying to recover because they spent all the money when the good times were happening and they didn’t prepare for a downturn.

[00:11:22] So I always say cash is king and it’s one of those things that you need to have a good cash reserve behind you. And if you do have a good cash reserve behind you, you’ll always make really smart decisions. When money is tight and you’re under pressure, you know that you can sometimes make bad decisions or poor decisions.

[00:11:39] And it’s like, you take your dog for a walk. This is what I mean about preparation. You take your dog for a walk. When you take your dog for a walk, you take poo bags. Why do you take poo bags? It’s because you know. Your dog is probably going to poo. Now I see people walk in their dogs and they don’t have a poo bag.

[00:11:56] I’m thinking, did you not prepare or do you just not care? [00:12:00] When it comes to your business, it’s the same thing. You know that certain things in your business are going to take a poop. So be prepared with your poo bags. This is what the disaster folder is all about.

[00:12:11] And you also got to prepare for.

[00:12:13] adversity. Now, depending on what country you’re in, if you’re in a country that plays rugby union, you will know of the All Blacks. Now the thing with the All Blacks, they are the most successful sporting team in the history. When you look at their win loss rate, they are just far and above anybody else.

[00:12:34] And It’s just, they’re always an amazing team to watch play no matter who they’re playing. And yes, they do lose occasionally, which surprises everybody. And if there’s any Kiwis listening to this, uh, podcast, they’ll be going, yeah, All Blacks. They know how good they are. But the thing with the All Blacks.

[00:12:50] It’s partly due with their team culture. They have a fantastic team culture, and I’ve got a separate talk all about the All Blacks team culture that I’ve done, not on this podcast, I’ve just done previously. [00:13:00] And, but like most successful sporting teams, they prepare for adversity. They prepare for bad weather.

[00:13:08] They don’t just play the game and train in perfect weather conditions all the time. They prepare that one day it might be really hot, it might be really cold, it could be raining, and they modify their game based on what is actually happening around them. They have to prepare and plan for a player being sent off unexpectedly and being down one man.

[00:13:31] So instead of having 15 people on the field, they might have 14 or sometimes 13. And when that happens, they know that they’ve got to adapt the game. Oh, wow. We’ve had two players turn off. What do we do now? They would have planned for this in training. If they had a key team member injured during the game and they come off, okay, they still got 15 people, but everybody has had to shuffle to a different position, especially if that person was [00:14:00] a key player.

[00:14:01] They don’t sit and go, Oh, geez, we’ve just lost our, our captain and a number one player. Oh, well, it looks like we’ve lost the game now. No, straight away they shifted. And the reason they do that is because they do it in training. And this is why your team needs to understand what your game plan is. How the disaster folder works.

[00:14:20] What you have lined up for different things. If everybody is on the, is in, in your team knows the plan, they’re preparing for adversity, when something happens, everybody knows how to shift and shuffle. No different to if a podiatrist rang up suddenly and said, I’ve had a car accident on the way into work.

[00:14:37] Now what? What does everyone do? Do they just drop their lolly bag or are the things in place that you’re actually going to run through? And I’ll go through this in a sec.

[00:14:44] And the other part about the All Blacks that I think is really important, and this is something that I read about them. They practice and they drill for the worst situations. Which is player being sent off in injury, bad weather. They practice it. They might have it all happening in one game, bad weather, [00:15:00] key players injured and people sent off, but they expect the best outcome and by doing that they sometimes surprise themselves.

[00:15:09] I’ve watched some games this year in the NRL, in the rugby league. And there’s been teams that have had two or three players sin binned or sent off during the game, yet they have still ended up winning the game. And the reason they’ve done that is because they’ve got to practice and drill. This is what happens when in this scenario, we will do this.

[00:15:29] This is where we’ll move players around. And when they’ve done that, they’ve ended up winning in the end through planning for adversity or preparing for adversity. planning for the worst, expecting the best, and then being surprised with the outcome.

[00:15:42] So I’ll run through what was in my disaster folder, just so you’re aware. And the first thing I had in there was I had goals and objectives of my podiatry clinic. I wanted the team to know what the goals and objectives were of my podiatry business. I [00:16:00] had an explanation of what the purpose. of the disaster file was all about.

[00:16:03] I wanted them to understand why this folder existed. I had the responsibilities of every team member and the reporting process. Who reported to who? I think that’s really important. There needs to be, there needs to be a hierarchy on what’s going to actually happen. , I had end of day preparation and what needed to be done before the next working day and why each of these things was actually necessary.

[00:16:28] I had a patient appointment ranking system. So I don’t believe that all appointments are equal. Depending on how you have your clinic set up. But for the way that my business ran, we saw a lot of biomechanical sports people and we still saw routine foot care, but certain types of routine foot care could wait another couple of days if needed.

[00:16:51] Whereas someone who needed nail surgery, to me, that was more of a priority. Or somebody had a sports injury, that was more of a priority. So we had our [00:17:00] patients all ranked. So if something happened, if somebody called in sick, we would look at who was booked in and we would maneuver things around based on that.

[00:17:07] And we would talk about it on a regular basis in our team meetings. We also made sure that we had the business owners contact details there. I think it’s really important that every team member knows how to get hold of the business owner. We had all the emergency contact details,

[00:17:25] in our folder we also had the details of all our supplies and every year that was updated. And I had this other thing that we used to call the annual, nut and screw review. So one day a year, and I did this myself actually, but I still had it in the schedule to do one day a year I would go into the clinic and my job was to go around with my spanners and tighten every single thing that had a nut or a screw attached to it.

[00:17:53] And you’d be surprised how many things loosen up over a year, whether it’s the bottom of chairs, [00:18:00] the back of some benches. It could be table setups. It’ll amaze you. And we used to have this, uh, little bowl that sat in, that sat in our kitchen. And it said, if you ever find a nut or screw or bolt anywhere, do not thrown away.

[00:18:15] Pick it up, put it in that bowl. I guarantee I’ll know where it goes, or when I’m going around doing my review of my nut and screw review, I will find where that actually needs to go.

[00:18:26] The next thing, the next section we actually had in the folder was our electrical section, which what happens when, uh, there’s no power when you arrive at the business. So your team member arrives, they open up the door, they go to flick switch and there’s no power. What do you do? Or the power goes off during your normal hours of operation.

[00:18:45] What do you do then? Or there’s just an electrical fault, whether it’s lights, light switches, power sockets. If something looks a bit dangerous, you don’t want anyone playing around with it. You need to call someone straight away. And who is your preferred electrician? And do you have a backup electrician if the [00:19:00] first one is actually unavailable?

[00:19:01] And even if you have illuminated signs or lighting outside of your business, it might be security lighting. If something’s faulty there, you the sooner you get onto it, the better. I think there’s nothing looks worse than when I see a sign that a business. Like a podiatry clinic that has illuminated signage and one letter is out and you look at it and you go okay, maybe it’s just gone out, but a week later it’s still out, a month later it’s still out, two months later you see a second light out, six months later those two lights are still out and you go, to me that doesn’t reflect very well on that business. You’ve gone all the effort having an illuminated sign, yet nobody is actually keeping an eye on it. And so that’s something that everyone should keep an eye and who do they call when that actually happens? You probably find that business, the business owner may not be around and all the team members, they all see it, but they go, we don’t know who we’re supposed to call.

[00:19:53] So they just don’t do anything about it at all, and it reflects poorly in the business. The next section we had was on plumbing [00:20:00] and that related to your toilets and bathrooms, the sinks and basins. Any outside issues or leaks and who is your preferred plumber? And our plumber was also our roofing guy.

[00:20:13] So if we had any leaks in the roof, our plumbing person and roofer was also in that particular section of the folder.

[00:20:20] So the next section we had was what we called, , technology. And this was , we actually had an IT guy who, our consultant, and we had them come into our clinic and actually do a presentation for our team. And it was surprising, one, how much everyone actually enjoyed that, but he ran through scenarios with them on when this happens with a computer or you got this fault, what do you do?

[00:20:46] And, and I remember once one of the receptionists calling me saying, Oh, internet’s not working. I’m like, Oh, okay. And so then I’ve gone into work and then you found out, okay, the internet wasn’t working on their machine. It was [00:21:00] working everywhere else. It just wasn’t working on their machine. Or they’re saying there’s a problem with the network, but then, or there’s a problem with the computer, but then it wasn’t plugged in.

[00:21:10] Now don’t laugh at that because you probably, we’ve all had that happen. But there’s some of the things we had in the technology section where what happens if you do have a computer crash or there is a breakdown, what does the team do? If there’s a fault with the modem that you, there is no internet.

[00:21:25] What do you do? Now these days it’s great because you can easily hotspot in so many different ways, but if there’s a modem fault, if there is no internet, if there’s a Wi Fi problem, what do you do? If you have iPads set up, what if they’re not working? Where do you get them fixed? If there’s website errors, I used to look at the website as part of your technology.

[00:21:44] I used to look after our website. So most of those things I would actually always be looking at. And maybe your team doesn’t look at your website, but they need to, if you don’t look after the website yourself, Somebody on your team needs to be looking at it because it’s not uncommon for [00:22:00] links just to break or pages just not to work.

[00:22:02] Don’t know how the gremlins get in there, but they actually do.

[00:22:06] If you have a telephone system and there’s faults there, who do you call or who do you contact? Printers and scanner faults. Any If you do have an IT consultant, make sure their contact details are there, that your team can jump straight on board and actually call them if there’s a problem.

[00:22:24] And if you have a security system in your business, if you’ve got security cameras, the way that that’s set up, if there’s a problem, if there’s a fault, who do you call to make sure everything is actually on track?

[00:22:35] Oh, just a side note too, when it comes to technology, I think it’s really important that to never rely just on one person. When it comes to the IT technology and websites of your business, you need to have multiple contacts because if you’ve got somebody who’s designed your website for you, and it’s like a one man or one person operation, and all of a sudden they [00:23:00] decide, I don’t want to do this anymore.

[00:23:01] I’m going to become a barista. What do you do? So you need to have a backup plan. If you were, if the website person goes, who do you go to now? You could go to podiatryclinicwebsites.com. That’s always a good place, but just be prepared.

[00:23:16] we had an it guy who was fantastic, never let us down. And that was all great, but I did have a backup plan if for some reason they got hit by a truck and I needed to get somebody else in.

[00:23:27] So always be prepared for that.

[00:23:28] So, and the next thing that we actually had in our section or in our sections was just about equipment. And you might be thinking, Oh, okay, well, what did you have in the equipment? And this was like, well, because it’s not just our podiatry benches, our televisions that we had set up, there were faults there.

[00:23:45] What do you do? These days, if there’s a problem with your TV, you’d probably throw them away and buy a new one. They’re cheap enough. But our autoclave, who looked after that? Everybody needed to know. Your hydraulic chairs and benches, dust extraction units and grinders. If you have a [00:24:00] treadmill, who comes to fix your treadmill if something goes wrong? And other just miscellaneous items in your clinic, if that breaks or something goes wrong, where do you actually get it fixed?

[00:24:13] Now, this is a big one. This was. Uh, the section that we just call their ProArch team, and this is what do you do if the receptionist calls in sick and cannot work? And is it a short term problem or is it a long term problem? Does everybody know what to do? What happens if the receptionist just resigns suddenly or you’ve let them go suddenly?

[00:24:35] What happens if a podiatrist is sick? What happens if a podiatrist resigns suddenly? Oh, I’m leaving at the end of the week or I’m finishing up in two weeks. Are you prepared for this? What if there’s an injury to a team member? I had podiatrists who had been fixing up a window or doing something at the window, broke, sliced the hand and they were off for a [00:25:00] couple of weeks.

[00:25:01] You couldn’t plan for that, but we had, did have that in the disaster folder, so we knew basically what to do. And this comes back to some of the earlier sections about ranking your patients. Because these things, they’re not all in silos, each of these sections. They all do actually relate to each other. The last thing I’m going to mention in this part is just about, if there’s complaints to the podiatry board, or some other health organisation.

[00:25:30] What do you do when a complaint from a patient comes into the clinic or is sent to the registration board and the registration board then contacts the podiatrist? What do you do? And I’d had team members who this had happened to and they just went to water. They didn’t know what to do. They, they were in panic mode.

[00:25:52] I’m saying to just settle down. You’re innocent until proven guilty. And looking at what you’ve done here with the patient, you’ve done nothing wrong. [00:26:00] So there’s nothing to be concerned about, but you still need to have a plan in place because what if they did do something wrong? Are you prepared for that?

[00:26:09] So these are things that you need to think about and the things that you need to consider and then plan putting things in place in case something like this actually goes wrong.

[00:26:20] Now some of the other sections that we, , had is legal issues. So, there was a section in there for that. We had another section for window and glass breakages. There’s urgent and non urgent. So if glass gets broken, especially if it’s an outside glass panel that come into your clinic, that’s pretty urgent.

[00:26:39] So who are you going to call when that actually happens? And, uh, how much are you prepared to spend to get something like that fixed? Now, I know if it’s a security issue, you want it fixed fast. You need to have a list of people that you can contact pretty quickly. And also your car parking. What if there’s a car, if there’s a car park for your patients and there’s a car [00:27:00] actually blocking the entrance?

[00:27:01] What do you do? You’re going to get the thing towed away. There’s unauthorised parking, but even cleaning and maintaining your car park, I think should be in that disaster folder because things can happen. I remember a neighbour’s tree falling down into our particular car park, not only did it damage the fence, but also blocked part of the car parking.

[00:27:23] Straight away, what do you do? And it might be funny, you might be thinking, well, how do you prepare for that? How would I even think of some of the things that are going to happen? This is what I was talking about, where your disaster folder is developed over a period of time.

[00:27:37] I’ve given you a list of things here that you could listen to this, take some notes and go, okay, I’m going to start putting some things in place. Some of the more important ones, a tree falling over from a neighbour’s house into your car park may never happen. But there will be other things that will happen that you will, you just won’t even think about.

[00:27:55] But when they do happen, as soon as they happen and the dust has settled, start [00:28:00] documenting. If this happened again, how would we actually handle this process? Would we do it the same way or would we handle it differently? We’d had cars in our car park get broken into, staff car park, and sometimes patients.

[00:28:11] Over the years, it didn’t happen all the time. But when it happened, what was the process that we actually went through with contacting the police? These are things that when they happen. That’s when you start adding it to the disaster folder we had been broken into. So when your clinic gets broken into, what’s the steps that you go through?

[00:28:31] Should you be touching anything or should you be leaving it until you call the police, but you still got to run a business. What’s your protocol on doing all that? What are you checking on to see what’s been taken and what has not been taken? These are things you need to discuss as a team. So everybody is basically on board.

[00:28:45] And some of the last things that we actually had in our disaster folder. Were just general items like handyman. We, we had a couple of handyman that we could get hold of just to do odd jobs around. Sometimes. We had some water damage once in the ceiling, [00:29:00] damaged some of the plaster, so we got something in just to fix up that plaster work.

[00:29:05] I’ll tell you, having a couple of hand handyman available are a godsend. We have council details in our disaster folder, where if you have a landlord or there’s a body corp, you want to have all those details readily available. Because if something goes wrong, you need your team to be able to contact the landlord or contact the body corp if it’s applicable to them.

[00:29:25] Unless you’re the landlord of your own building. And other documents. We had our insurance documents in our disaster folder. So when something happened, we knew exactly we’d look. And every year when things were updated, that’s where we’d go to. And the last thing we actually had in our disaster folder, which I think everybody should have, because I know everybody runs around looking for these things, is equipment warranties.

[00:29:49] We’d have all our warranties for all our equipment, everything. In that same folder, because if something broke, we straight away, we’d go to there, we could look up the warrant. We knew if [00:30:00] it was still under warranty and it would get replaced or, you know, it’s out of warranty. Is it worth fixing? Or do we dump it and get something new?

[00:30:09] So I know there was a lot in that. And I was talking to a podiatrist the other day and I was telling him about this disaster folder. And I told them that I was going to do this podcast. And they told me a couple of things. They said, Oh, have you thought about including this? Which I hadn’t. One was they had to.

[00:30:24] Let go of an unsafe podiatrist. A podiatrist was doing something in the clinic that was very unsafe for the patients and had to let them go. Suddenly I went, that’s a good one. Didn’t have that one. They had another team member who had some major psychosis, just had a mental breakdown in the clinic. And thinking, nah, never had that one happen either.

[00:30:44] So that’s something else you can actually add. They did mention burglary and the other part, this was actually a really interesting one that they mentioned. They had the business set up in a particular, in, inside another business. So it could be, you could be renting a room. Say for example, let’s say [00:31:00] from a physiotherapy clinic, you had a room rented there.

[00:31:02] Everything’s going fantastic. But then all of a sudden that physiotherapist, Well, that business has gone into bankruptcy and that front door has been locked and you are not allowed access to it because the receivers have taken it all over and this actually happened to them. It wasn’t a physio clinic, it was another sort of business and they could not get in there to get their equipment out and all of a sudden all the patients couldn’t be treated, they couldn’t get hold of their equipment and it, I think she said, took something like a week before they could get in there and finally get this stuff out.

[00:31:32] Now, if you’re set up in that way, if you have clinics set up in multiple places, this is something you should probably think about. That if something like that happened, do you have a backup plan that almost goes back to my original thing, when I said that if you turned up and the building had burnt down?

[00:31:46] If there was a cyclone and part of the roof had been blown off, what happens if you turn up and there’s locks on the door and you’re not allowed in there? You need to find another location, you need to do it fast, because you need to be treating your patients, because that’s the only way that you make money, and just keep [00:32:00] the ball rolling.

[00:32:02] So I hope you enjoyed this episode. If you have any questions, please Please send me an email, tyson@podiatrylegends.Com, or you can send it tf@tysonfranklin.Com. So I’ve got the Podiatry Legends website and there’s also the Tyson Franklin website. And just let people know in the UK, if you happen to be listening to this, I will be doing a one day podiatry Marketing 2025 Workshop in Liverpool on Monday, the 3rd of February. It’s going to be the day before the foot and ankle show that runs for two days on the 4th and 5th. If you want to know more about it, please send me an email tf@tysonfranklin.com. I’ll put you on my priority list. As more information comes up, everyone that’s on my priority list or the people who are subscribed to my newsletter will get all the information first.

[00:32:55] There’s only going to be 20 spots available. So [00:33:00] if you’re on my priority list, you’re going to find out all the details first and be able to register first. Then it’ll be people who are on my newsletter. If you don’t currently get my newsletter, go to my website, tysonfranklin. com. You can subscribe through it from there.

[00:33:13] I think you can from the podiatry legends website as well. Anyway, that’s it for me this week. I want you to look after yourself, look after your family and I will talk to you next week. Bye for now.