Hi Reader

Last week I asked you to write down the one task in your practice week that you do manually, repeatedly, and kind of dread.

A lot of you wrote back.

Scheduling follow-ups. Chasing no-shows. Sending intake forms by hand. Re-explaining the same billing issue to the same insurance companies. The answers were different but the tone was almost identical across every reply: yeah, I know. I've known for a while.

That's actually the more interesting problem.

Knowing isn't the bottleneck

Most Telehealth providers I talk to are not confused about what's slowing them down. They can name it. Sometimes they've been naming it for over a year.

What they can't quite explain is why they haven't fixed it yet.

I've heard a few versions of this: I looked into a solution once and it got complicated. I don't have time right now to set something up. It feels easier to just keep doing it this way. And underneath all of those, usually: What if I change something and it breaks something else?

This is the real ceiling. Not the broken process — the invisible force field around it.

The workaround that became the workflow

Here's what tends to happen. Early in a practice, you hit a gap. There's no good system for something, so you improvise. You handle it manually. It works well enough, so it becomes the default. And then, slowly, the workaround becomes load-bearing. It's woven into how the week runs. Touching it feels risky.

The problem is that workarounds have a tax. They cost you time every single cycle. And unlike a real system, they don't get more efficient as you grow — they get more expensive. The manual follow-up call that took 10 minutes when you had 20 patients takes proportionally more at 60. The gap you're papering over personally gets harder to paper over.

By the time a practice reaches the plateau, the workarounds are usually invisible. They're just "how we do things here."

What actually breaks the pattern

It's rarely a technology epiphany. Usually it's a small permission shift: I'm allowed to spend two hours this month fixing something that saves me two hours every week from now on.

That math is obvious when you say it out loud. But it doesn't feel obvious when you're in the middle of a full schedule and the workaround is, technically, working.

The practices that break through don't do it by becoming more disciplined or more organized. They do it by finding one specific thing that's costing them more than they realized — and deciding that this is the week it stops.

This Week's Challenge:

Take the task you named last week. Now ask yourself honestly: what has actually stopped me from fixing this?

Not "I haven't gotten to it." What's the real reason? Fear it won't work? Don't know where to start? No one to help you think it through?

Write that down. Because whatever you just wrote is the thing worth solving — not the task itself.

Hit reply and tell me what the real blocker is. I mean it — I read every response. And if I've helped someone get past the same thing before, I'll tell you exactly what moved the needle.

Want to work through your specific blockers together and map out what a real fix looks like?

Talk soon, -Dan.

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Also: Want to go back and look at our previous Telehealth Tips? Click Here​