The Moment You Say No: How Clinicians Took Back Their Power

7:47PM Apr 27, 2025

Speakers:

Jeanette Benigas

Mikayla Treynor

Preston Lewis

Minivan Meltdown

Twisted Sister

Keywords:

Speech language pathology

advocacy

insurance regulations

client abandonment

setting boundaries

patient safety

documentation

professional autonomy

toxic employers

mental health

physical well-being

patient abandonment

clinical fellowship

patient advocacy

professional boundaries.

Hey, fixers. I'm Dr Jeanette Benigas, the owner of fix SLP, a grassroots advocacy firm here to challenge the status quo in speech language pathology by driving real change from insurance regulations to removing barriers that prevent full autonomy like the CCC, this podcast is your space to learn, engage and take action in the field of speech language pathology. We don't wait for change. We make it so let's fix SLP!

Hey everybody, welcome back. It's Jeanette. I've got Preston with me today. How are you, Preston?

I'm doing well. It's we're past Tax Day, so I feel like I got a very short haircut from someone that I don't like. And so I imagine a lot of our fixers are feeling that, especially if they're in the 1099, club, like some of us. But you as well, Jeanette, I have a saying in life, and Jeanette, I have a feeling you're probably much the same. I want the last check that I have a right to be to the IRS, and I want it to bounce. And it used to be Asha, but now I don't send them checks anymore, so insert the IRS and yeah, that's where we are. It's a spring of change right now. A lot of our fixers are looking at change and be a little bit about what we talk about today is when to say no.

Yeah. I have a true confession of Jeanette right now. Yeah, for many years, Tax Day has not been my tax day, and I blame it on a very early CPA that we had. He was great, but because we didn't ever owe money, I think he took on way more work than he could handle, and he would file an extension for us, and we'd just file later, and it was never a big deal because we were getting money back. And so of course, the IRS will keep your money, but even now, years later, we don't file on tax day, because we just are in this awful habit of filing an extension and doing it later. And my ADHD really, really makes that worse. I was Power of Attorney of my great aunt, and she died this year, as you said, after you die, and I just realized, shoot, I bet I have to file a tax return for that woman. And I did not file an extension. What are they going to do come after her.

Well, if there's an estate, they might, but it's not, yeah, I just tell them it's been real, and sayonara

Them and Medicaid can fight over whatever was left.

Yeah

Yeah, okay

That's how I want to do it

Today we're gonna talk about the word no. But before we jump into that, we have a new rating. This one is from AANG29222119, I listened to the episode about client abandonment. I'm so grateful for hearing this information as I was accused of this myself. I now feel much more informed on this topic, and it couldn't have been a more perfect time to be educated on it. Thank you so much for all you guys are doing. We need to continue to stand up to these toxic employers and companies. So many people have reached out to us, and I've been reading all of the messages and the stories and some of this crap is a wild

It is the timing of that pod. Jeanette and I sometimes we literally struggle up until the last 48 hours. Be like, well, you know, we've got two or three ideas. What are we going to talk about? And then we throw all those in the toys basket and say, oh, hell, let's talk about this. And I think this was a good, timely podcast, and this one is today, because so many of us are getting squeezed at the start of this year. There's a lot of fear out there due to changes that are taking place nationwide. And I think this is the time where a lot of us are taking stock. And you know, we're going to talk about the word no today, but I think, you know, if we had a soundtrack for today, Twisted Sister, 1984 we are not going to take

(music) We're not gonna take it. No, we ain't gonna take it. We're not gonna take it anymore. No way!

and that's, uh, I think that's what we're seeing more and more of and it sometimes you have to get in that uncomfortable space. I think that was ionessa that says that she's got a quote that's close to that, and I agree, you have to sometimes make yourself uncomfortable in order to make the changes and advocacy that you need to help yourself, not just in the profession, but maybe just right there in your own backyard, in your job.

Yeah. Qe asked you guys about 24 hours ago to send us some voice messages. We got a good handful of them of varying lengths. I would love to say that I've listened to all of these in advance, but I did not, because I didn't so we're gonna randomly pick some and listen and chat, and if they're awful, I'll just cut them out, and you guys are never gonna hear them. This first one put their name, but we said it would be anonymous, so we're not gonna share names.

Most of my experiences professionally over the years have been really positive and engaging, but I want to share one that was not and I had to learn how to say no, and ultimately, had to learn how to walk away from that position. So I started working for a school about three years ago, and they were very excited to have me, and I was excited, excited to start working with them, too. And I walked in on day one, and all of the students on my caseload had incredibly intense behaviors, and they were all very tall. I'm also very tall. I'm 510 and meanwhile, all the other SLPs were glad to have me, and over the course of my time there, learned why, because I was taking away the quote, unquote scary kids from their caseload. I was taking over those kids. I had one student in particular, also neurodivergent non speaking communication device and had incredibly intense violent behavior. I was going in to work with the student on my own, one on one, no support there with me, and my room was being destroyed. I was getting the shit beat out of me pretty much every session I was going to urgent care, I had a lot of physical symptoms, and then I also started having mental health symptoms, waking up in the middle of the night, panic, soaking through sheets with sweat, that kind of thing. And I finally went in and I told the administration and the lead SLP, I will not be working with this student anymore until we can get him a better support system. And in all due fairness, the lead SLP, did try to support me, but administration ultimately did not. They suggested that the student remain on my daily schedule. I refused to work with a student, and you were talking about client abandonment, that kind of thing. I had to say no. It's the only case I've ever had in 13 years where I have said no and administration has not supported me. My colleagues did, but administration did not, and I ultimately submitted my two weeks notice and found another place of employment, and I have moved on. I'm in a job now that I've been in since that time that has been wonderful and supportive, but in sharing my story, especially for younger SLPs, do not never, ever, ever apologize for setting boundaries where you are protecting your physical well being and your your mental health and your mental well being. You know, never, ever sacrifice that because that you need to be present and you need to be healthy in order to work with whatever population you work with. And if you are feeling unsafe, you have every right as a professional to walk away. And so I unfortunately had to learn that later on in my career, but it is a very clear thing that I've taken with me. So stand firm and say no and know when to walk away, especially when it affects your safety.

Really speaks to the world in which I work, in which is a psychiatric facility, there are patients that will go through periods where they just can't be seen, sometimes for a couple of weeks because, you know, you don't want to get attacked, you don't want to get spit on, you're not going to have anything productive in the way of a therapy session anyway, our, you know, our goal is to reduce these behaviors and to facilitate positive communication. If that's not happening, then you aren't being an effective clinician, and then you're also, as this lady said, getting the shit beat out of you. No one wins there. And I'm shocked. Over the years, Jeanette, and I'll ask you this question. I say this to some fellow SLPs, and they look at me just bizarre. But I'll ask you this question, how many patients have you fired over the years, Jeanette, because I have a number.

Hmm. When I was a school SLP, and then in private practice pediatrics early in my career, never then, and certainly never as a young clinician, I would say my firing of patients has come in the last few years, and I'd say maybe two or three. I can think of one in particular where the It wasn't even so much the patient. It was the family. They accused me of a HIPAA violation for scheduling. It was a home health patient, and typically the daughter was there, but then she was sick for a couple of weeks, and the son was there, and that's who I was communicating with. And so I had messaged him that I had to change an appointment date or something, and she called me and told me that was a HIPAA violation. It wasn't also there was no POA. I was not in the wrong at all. I was scheduling with the care partner who was in the home, which is what you need to do. There were no explicit instructions that she was our only point of contact. I fired them real fast. I called the office and I said, I'm not going back, because if they're willing to accuse that over scheduling, what else are they willing to do? I think that's the biggest one, and that was recent. That was in the last couple months, a small handful.

I have probably fired six patients over the years, and I was in my second year at a SNF and skilled nursing facility. Those who make where that most of our audience is. And you know, in that first CF year, you're just trying to, you know, get your feet about you. But think back to that second year when I had this patient that was very verbally abusive, just habitually So, and I had done a good job documenting the things that he was saying that were hateful, the lack of progress. Had some refusals in there. Finally sat down one morning across the room from him, and he started in again. And I just said, Look, we can, we can end this right now. I think that we should end this, don't you, because it doesn't seem like we're making any headway here. And he completely agreed. And then said something really ugly again, just, you know, at this point I'm thinking here, I'm offering you an off ramp. And he was just still a SOV and Jeanette, this was in the days when we had the paper charts and the big binders, and I just literally went to the orders page, wrote the DC order, and just whipped the pen across there, and I said, done goodbye. And I walked out of there. He was the first one I ever fired in the current setting that I'm in. It's kind of, it's a little harder when you have patients that are deeply psychotic and just kind of lost, or if you have somebody who's, you know, very severe autism, certainly you have to put your boundaries in place. But usually it's the ones that you aren't getting through to that just really they're there to undermine the therapeutic process. And so I think you have to have that boundary to fire some patients and just say, I can't help this person. Because if you think that you can, then you really are going to not be doing your other patients a service, because you're going to be getting the shit beat out of you, like our caller said.

Yeah, I think that is a really good point to bring up too is that we are the expert in the room. We're the expert at the table, and we're autonomous, so we're the ones in charge. Our bosses can't tell us who's appropriate to see and who's not appropriate to see. That's our job. I think that probably does come with some issues. You're saying, I'm not going to see this person, because your boss is there to make money, and it's your job to make them the money, and in return, make a little bit of money. So I would just say, in those instances, make sure you're documenting everything, and you have a really solid paper trail of what has gone on, because also that can lead, in some cases, to a patient abandonment, accusal, which, whether it is or not in a situation where you're being physically injured that does not fall under that umbrella, you can walk away as quickly as that clinician Did on the call. But just make sure, because people are crazy, some of these stories I've seen have been a lot, so always protect you first. Ready for number two?

I am let's hear it.

I have learned the power of saying no, but I will tell you the one time that I really had to put my foot down. A skilled nursing facility I worked at was putting my license in jeopardy. They would get patients in and not confirm what the hospital what the diet orders were. And there was one specific patient that had come in when I had a few days off, and the order from the hospital said nectar liquids only. He had no alternative source of nutrition, and nobody thought to follow up on this. So I come in to the facility three days later, this man hasn't eaten for three days. They've just been giving him nectar liquids on his tray, and it's on the weekend. So nobody is around to try to figure this out. Nobody thought call and clarify the orders, nothing. So this all just gets rolled down the hill to me, well, because it was on the weekend, there was no nursing supervisor there. I was put in this Hard Rock in a Hard Place of figuring out what to do. Because do I send him back to the hospital. Do we get him on a diet? I'm kind of blind by just a clinical bedside exam, but I looked through his chart, there was nothing too concerning, like neurological otherwise, I think he was recovering from a hip surgery, and so I put him on mechanical soft after doing a trial, but I ordered a mobile MBs to come, and they came two days later. And turns out he was aspirating everything, his medical chart, his records that I got were not complete, complete. He had an ACDF at some point that we could see that was causing significant problems. The problem was that he ended up going back out to the hospital and getting a peg to but he ended up dying. A couple of weeks later, I documented like crazy, I put down all of my clinical reasoning for the things that I did, whether it was right or wrong, what nursing did and didn't do, the barriers that I had in making clinical decisions because of the situation that I was put in, so that it if ever came back on me. I had my documentation. Well, I got calls from everybody and their dogs from the highest up in the company, wanting me to change my documentation because they didn't want to be liable for what had gone on with this? I absolutely refused to do so to the point where I ended up resigning from that position. I don't want to work in a place where, you know, I might lose my license. And that wasn't the only incident, but it led to me starting my own mobile practice, and I could not be happier. So sometimes saying no really can lead you on a path of figuring out like a better path forward, working for myself and actually being able to treat patients without all the bullshit barriers is fantastic. So lesson learned, Never change your documentation and know when you really need to say no.

She went the way of the fees, or at least doing mobile diagnostics. I didn't catch which, but she's after your own heart. Jeanette, yeah, she raised a good point, because it hearkened back to something that I dealt with at a building one time, where if you don't feel like the building has got your back, or if you have to draw a line on something and they've bristled against it, you really should evaluate your relationships there and see how comfortable you are, because you possibly could be set up in the future for something else. And she found like she took the height or took to heart that advice. I can remember one time trying to put a patient on a free water protocol, and I had a nursing staff that just said, No, we we don't do that here. We won't be doing that here. And all of my documentation at that point had led up to this is what we're working toward. So I was faced with the decision of, what do I just bend to what they want? And I put in the notes that nursing is opposed to this protocol. Do I go back and change my notes, or do I stick with what I've got? I stay with my notes because it showed what my clinical expertise was. So in the instance of this patient, she got put in a very difficult position due to poor records handoff that you know, can you imagine? I mean this, this poor gentleman being thrust into a facility like that, gosh, and she did the right thing. She took all the proactive steps, and that is what you want to do. But wow, those situations happen far too often.

I think this applies to our school SLPs, our pediatric SLPs, also, I feel like we always end up leaning medical just because that's what we do. But if I can think of a situation like, if your student never has the AAC device charged, the teacher is responsible, or the aide, or whoever is responsible for plugging it in at night, or it goes home and it doesn't come back, or the family doesn't charge things like that, make sure that you're just documenting that, because that impacts your ability to do your job. And if those are your goals, and they never have it available, how are you how are you going to make progress? Those are times when you might say, I'm sorry. I'm not treating the student until the student has what he needs for us to make progress. So I really respect the person who just called in for leaving that job, something that kept popping into my mind, and then you kind of said it without saying it, I heard a saying once, when someone shows you who they are, believe them. And so that company was really showing her who they were, and she left. Left. So good for her. I didn't imagine that this is where these stories were gonna go. When we posted, I was thinking these were people who were gonna say no and just carried on in their job. But so far, two for two, both people left, and I think that was justified, but at least they didn't get fired. And I think that's the point these people have made, the decision to leave, which empowers them even more.

And we've said this before, Tiffany and Moniz and her group has. It's you know, how many people really do get fired? Maybe we should have a future episode where that happens. Tell us your story about getting canned. Maybe we're not the best one, but I think for every firing, there are probably 500 threats.

Yeah, that's a major number, but for sure.

But I mean, it feels that way. It feels that way. I'm not talking about resignations. I'm talking about absolute termination escorted to the door. Are there bad SLPs out there that deserve to get terminated Absolutely? You know, we're not a perfect profession by any stretch, but so often we hear, Oh, I think I'm going to get fired. I'm going to get fired because I was point 3% you know, off my productivity figure for the room for the week. Or I think I'm going to get fired because I've got too many people on my caseload at the school and, you know, I've not been able to do this or this and this. Come on, try to live in realville. Know your worth. Those are a lot of empty threats, and sometimes that's just threats in our own head, our own self doubt.

One other thing that we have been hearing and that we've we've seen a story just our team was approached when you are asked to change documentation and you refuse make sure you're keeping a record of that documentation. Printed out, email it to yourself, save it somewhere, because we have heard a story of a company going in and changing someone's documentation. You just want to make sure you're always protecting yourself. A lot of EMRs will show if there was a change, it won't allow it to be deleted, but my guess is that this particular EMR wasn't going to show that, or else that company wouldn't have done it. So in this case, they were logging in under this clinician's name. I don't know how they were doing that, but just make sure if, if there's a situation where you're saying no where you're documenting what happened, just make sure you're keeping a record, because you don't want them to go in. Change the documentation, put the liability on you, and then it's a he said, she said, and you have no proof.

I, as I mentioned earlier on, that free water protocol story, where I had a building that didn't want to comply with that. I before I left, and I'd let the regional know, I said, I don't think I can service this building any longer. Here's why, actually had some good support on that. But before I took that stand, I just took out my phone and I took, uh, copies, you know, just on screenshots of my last five or six notes showing that pre water protocol recommendation and stating that nursing didn't wish to do that. Some people could say, Well, someone could go in and change your notes. But there are other convenient ways where software failures could occur. We updated our system, or we just switched to a new Amr. You you you want to be protected, because perhaps that conversation doesn't happen right? Then perhaps the building gets sued six months later by this family for something, and they want to go back to a certain point in time. If you've got a record of that for a while, then you're standing up for the thing that defines you as an SLP, and what is that? Your license? Yeah, let's jump into the next one.

Boundary one, staying within my contractual hours. I do not work outside of them, and I had to make a facilitator understand that that is how it works. She was upset that I had not read her email, and I asked her if she has sent it after four o'clock. She responded yes, and I let her know I don't work past four o'clock. I will read her email when I get a chance to boundary two. I had close to 200 kids one year, no assistant, and they wanted me to not only work my school, but cover additional schools, and they expected me to do therapy as well. I set my foot down, and I told them there was no way I'd be able to do that. Number three, boundaries for my CF wise, they were told that they were responsible for all the compensatory time, not mid year. And I let them know that set your boundaries, and we don't go past that. There are a lot of SLPs out here that are only interested in evaluations and writing reports. There are those that only want to do the therapy, and there are those that like to do both. I wish that the school district would kind of have those areas that SLPs can. Have been to and we could all just work how we want to work. And then today, instead of being instead of going in through the platform to see that, I have done my work, everything was uploaded because I hadn't uploaded the little Excel spreadsheet that they created, all of a sudden, now I'm not doing my job. We're not doing that at the end of the end of the school year. So I'm kind of fed up with speech, and I wish they would take us seriously, and they certainly need to pay us accordingly. And that's all I have. Thanks.

That person is a queen.

Yeah, yeah, and organized

Throw it down girl.

The bullet point numbers. I love it.

Listen, these are my boundaries, period.

Yeah

Don't cross them. Some good points, though. I loved the first one, not working

Well there. There is a huge line between and you can have your own boundaries within your own private practice and your small business. For those of us that are in the 1099, sphere, we have to look at it as a small business, even if we do contract with an employee, sometimes those boundaries are set based on how we want to set them as individual contractors or as private practitioners. But for those of you in the w2 world who are punching a clock, you need to use that clock to your advantage, because your employer is using it to their advantage. When you're not on the clock, then you're not getting paid. So unless you like practicing and being a free therapist and volunteering your time, you need to let these folks know what your boundaries are, and that's it. You know, you don't need to be dealing with company emails and texts on vacation. You know, I have let clinicians know in the past that may be filling in for me, that I'm there on an emergency basis for the other SLP, that's coming in. That's a professional courtesy. But I don't want to hear from a rehab director. I don't want to hear from school administrator while I'm on my vacation room with my family time, and if you don't feed that monkey from day one, then it often won't come back and ask for another snack. So...

I think that is a firm boundary that I've set when I'm doing PRN, if I am working, I am on the clock. And the last episode that we did, I was sitting in a supply closet. I clocked out. I didn't bill for any of that, but that particular building was a certain number miles away, and I've seen this year that they've gone in and adjusted the system that it will only allow you to put in x number of miles, and when I do that kind of work, from the minute my big toe crosses the threshold of my door, I am on the clock, so they are paying me full mileage and full travel. I don't drive to these buildings far away unless they compensate me for my time, and they've now capped the number of miles that you can put in. So when I realized this was happening a couple months ago, I called the regional and I said, How do you want me to put this in? You guys better figure this out, because whatever this rule is, I never agreed to it. And so now they have me put the miles in for the day before. You can't do it for the day after. So I just have to put the miles in on the day before and make a note for what it's for. So I guess that I didn't I guess that was a no that I said, like, No, I'm not doing this unless you're giving me what you need. And even this week for that, I didn't clock out because I or I didn't clock in and out because I wasn't yet done with the paperwork. I had to get home and get my kids off the bus, so I thought I would be back this past Monday, and then they ended up not needing me. So I never finished the paperwork. I never clocked in and out. My regional lives right behind me, so I was gonna go finish there, but we needed to get my time on the clock. So he went ahead and clocked me in and out. I kind of guessed with how much time I would have left on the paperwork. And he went to put in the mileage, and he's like, I think it was 150 miles or something it would allow. And I drove 152 and I said, Well, you can put it in the day before, or give me 15 more minutes on the clock. I don't care what you do. I even that two miles, which, by the way, they pay us 35 cents a mile. We are talking about 70 cents. I made him figure out how he was going to pay me 70 cents.

Many mickels makes a muckle. And you think 70 cents? Well, I've seen rehab companies up close and personal call clinicians. The next day, after putting their productivity in, had a PTA that was 86.8% regional calls there and wants to have a 10 minute chat about productivity. Now they spent 10 minutes in resources when this person could have been treating to. Talk about how, you know, she might have couldn't get the mouse to work on her keyboard, to clock out the day before. I mean, whatever the case was. So if they're going to be petty and you know that way, then fine, we can be just as by the members. And, you know, hard ass is the next person. So I think that's the culture that we live in now. If we had a bit more of a relaxed thing where we didn't have companies that, you know, put a cap on the number of miles that you could clock when you go to their building, then I don't think he would be so hard nosed on it. Jeanette, but you know, this is, if this is the world we're going to live in, then, by golly, we're going to live in that world.

And I do want to mention it wasn't the regional like, he didn't even fight back. I think he gave me like, 10 or 15 more minutes on the clock, so I really made out and but then was very under productive. But hey, he's the regional he gets to decide. So he's actually, if he's not a speech pathologist, he's a PT, he's a, he's a fixed, SLP, follower. I don't know if he listens to the podcast, but, um, yeah. So he just, you know, he fixed it. It's not his rule. Let's jump into one more. I was thinking we'd only do three, but Preston and I share a lot on this podcast. Our regional liaison, Michaela, sent something in I'm seeing here. So Michaela always has good stories. I think we should give her a little bit of the spotlight, and I'll have to cut that all out if she names what company she was working for, but let's see what Michaela had to say. We'll wrap up with her.

Hello, it's Mikayla with Fix. SLP, I actually have a story that I feel like applies that I don't talk about too often. I was one month into my career, so I was in my clinical fellowship year, and I was working in a very rural skilled nursing facility in Michigan. I was working with a resident who had dementia, and I remember I was seeing her at breakfast in her room. She was upright in a chair, but she was having a lot of pain, and just kept wanting to get back to bed. So I remember finding the PTA, who happened to be walking down the hall, and asking if she could help get the patient back in bed. She went to grab an aide for assistance, and the aid and the PTA began to bicker about how to go about getting this patient back in bed. Long story short, the aid became just frustrated, and she shoved the patient back. And thankfully, the patient did not hit her head, but she was really close. The patient ended up falling back on the bed, and the bed was against the wall. There was no injury. However, it was very jarring and pretty traumatic for everybody involved. The aid ended up storming out, and the PTA went to immediately report to the appropriate people, being the administrator, the director of rehab while I remained with the patient, and that is where I personally, quote, unquote, went wrong here. So with this specific company, they did have a policy in our handbook that stated, If abuse occurs, we are first to remain with the patient to ensure their safety, and then immediately report the incident, which is what occurred. So I remained with the patient while administration was brought back to discuss what occurred. Given this was now over a decade ago, but in my head, I feel like it was like maybe 10 minutes of me waiting with the patient, feeling pretty shocked and honestly pretty afraid of what was going on, but administration came back and basically told me and the PTA to keep her mouth shut, to keep our heads down, they were going to handle it. Even being one month into my career, I recognized that this was wrong, so the PTA and I called the state, and by the time the state actually got in there, I had been written up on a pip I had been suspended, and it was all really traumatic for me. I had trusted my clinical fellowship supervisor. I really put a lot of faith in her to have my back. And looking back, she just didn't. She was not on site, but she was pretty close with management. Later, kind of worked her way up in the company. And I just realized they just wanted a body there in the rural skilled nursing area, like they they just want to keep me there. And I knew after all of that, that I was either going to quit or I was going to get transferred. Those were the only options for me. I ended up being transferred. However, it was a nightmare remaining there for a few months from July until I was transferred to a big. City another skilled nursing facility, but in a bigger city in September, I was dealing with honestly, a lot of harassment from my Dor. She would tell me I needed to come in at 7am when no one else was there, but she did not give me a key to the therapy room, so I had to rely on nursing if they had a key, but sometimes I would literally not be able to get into the therapy room for over an hour. I would walk in on this director, talking about me, calling me names. It was really hostile. And nobody in the company had my back. I transferred to another sniff, and it was a wonderful experience, I swear, having an amazing experience saved me in that company. And two and a half years later, I became a director for that company. I was a director of rehab for many years for them, and I just have this theory that not all, but some of the best therapists are the ones that stand up even when companies or other people try to scare them into shutting their mouths. So I always promote advocating for your patients, because it doesn't mean that you advocating is the end of your career. In fact, it's probably setting you up for bigger things down the road.

So much wisdom there

Well, and explains a lot of her scrappiness, which, you know, we see on display quite often as a colleague and part of the picture team. It's no surprise, I love hearing her voice, and she's just a very powerful individual. And that shows, you know, from an early age, she was thrown right into the fire and to see, really, I mean, that's patient abuse, what she witnessed, and then to for somebody to try to turn that ring on her right. And she stayed in that situation. I think a lot of us would have said, you know, Larry, they get the hellfire. I'm gonna do the CF somewhere else. And she pressed forward. She's tough. She's gritty.

Well, I'm glad that she called this state that was the right thing to do.

Absolutely.

Yeah, always stand up for your patient because they they can't stand up for themselves or your student or your client. We're not just talking to medical patients here, but always, always do the thing that you would want someone to do if it was you or your family member. That's sort of how I operate. If this was me, if this was my mom, if this was my kid, what would I want to happen? And I think when you operate by that set of standards, it can really make a difference in your practice. And people see that.

And a word about the keys. This is a small thing, but advice from Preston, don't let some building just tie you into knots and have you waiting 1520 minutes when you first get there on keys, if that's an issue. Now, this is, you know, unsolicited advice, but I'm going to offer this up. If you're consistently going to a building, you've asked them for keys, and they're sketchy acting about it and weird. Take it from me. It's worth the $4 or whatever would be to take that key. Oh, just, just show up a little early one day, get a copy of that key. If you've got a store nearby, run by make a copy of that sucker. And I had a couple buildings, Jeanette, where I would make a copy of the key if I knew they were going to be tricky. And rather than carry them, because I had, you know, multiple keys, or, like, you know, some sort of evil dungeon master with a big ring of keys, I would hide them in different places of the building. And I had one where it was behind, like the bird aviary or something just in, you know, discrete places where the therapy room key can be found. And I always knew, yeah, there it is mine, or under the aviary, you know, hey, it Time is money. And I knew I was going to be coming back there for the next couple of years. I was not going to chase down the NDS nurse who was usually out there smoking a cigarette, and was like, Get out of my way, so...

My advice too. Yes, make that copy of the key. But also, you're on the clock. From the minute you walk in that door, you're on the clock.

Oh, my ass is getting paid at the locksmith, I can assure you.

Yeah, if they want to hide the key or not give you one or be assholes about it, you are on the clock. They can pay you to sit there for an hour while you wait for someone to come open the door, you're on the clock. You they can use you however they want to when you're in their building, and if that's how they choose to use your skilled and precious time that's on them, not you, just document it. Keep notes. Keep a little we've talked before about a time on it. That's, you know, part of the time on it. Eight to 9am sat outside the door while I waited for someone to let me in, because I'm not allowed to have a key. That will come to an end real fast when administration starts reviewing those notes and seeing what they're paying you for.

And if you want advice on. How to get compensated back for the key. Usually just wait until you meet the PRN Coda that comes in there, and it's like, how did you get in here? I had to wait yesterday for so long. And then you kind of just put a little jar out there and say, Well, you know, if $5 ended up in that cup, there might be another key in there. It's kind of like a paying it forward thing to your other PRN therapists. These are, these are the ways around the rules, according to Preston, so proceed carefully. But by golly, go in there and get the job done and see your patients.

Yeah, all right, Preston, I think we're gonna wrap up. We're recording early this week because you and I are taking a little vacation. Not together, but we'll be both gone at the same time, and we'll be back in a couple weeks. We're gonna make it so there's no lapse in what our fixers are hearing for the first time ever. We're gonna be out ahead, and we won't skip a week. I'm so proud of us. So thanks for fixing it!