Latest / Author Hour / The Illusion of Care: Why Patients Leave the Doctor's Office Confused with Dr. Joey Rotella

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The Illusion of Care: Why Patients Leave the Doctor's Office Confused with Dr. Joey Rotella · Author Hour

• speaker-0: Welcome to Author Hour. Today I am here with Dr. Joey Rotella, the author of The Illusion of Care, Why Patients Leave Confused in the Clinical Operating System That Fixes It, which is out now. Joey, welcome to Author Hour. speaker-1: Thank you very much. I appreciate you having me, Lex. speaker-0: So let's actually get into the origin of the book to start. So it surrounds your own daughter walking out of a doctor's office, sure she understood everything they told her, and then calling you a few minutes later with no idea what to do. What did that moment make you realize? speaker-1: Well l let's backtrack a little bit because because the fact is that being a physician for the last twenty years, you there you there's a common thing. The common the common theme is physicians getting busier and busier and busier. The schedules are getting fuller and fuller and fuller. And the electronic medical risk record system came in two thousand and and about five, six, seven when I was in residency. That's a long time ago. And that complicated things a little bit. But one thing over the course of these, spanning these twenty years is patients, they show up with nothing, they leave with nothing, and they can't remember anything. So and you know, and my daughter was one example because she always used to call me up and say, Dad, what did the what did the doctor mean when when the doctor said this? Or I can't remember what the doctor said. I'm so glad my dad's a doctor because he can explain things to me. So So she called me that one time and I used one of my pencils to help explain things. I didn't talk to her on the phone. I just said, Kayla, look at this pencil. I'm going to email it to you and you tell me what you think. So that's one of I started my my ideas that I was I was building and she read the email and she said, That's exactly what the doctor said, but I couldn't remember it. And a couple of days later, the condition was completely resolved. So we knew that I knew at that particular time that this handout that I've created would make a difference. And it doesn't replace the doctor's advice. It's evidence based care plan instead of an evidence based patient education. What we found out is that patients don't necessarily need more information. You don't throw somebody a physics book and say, now you need to learn how to now you you know how to, you know. learn physics or do physics, you what we do is we don't give more people education. You give care plans because they wanna know what to do next. So I think that's a really important key characteristic. speaker-0: So you spent twenty years, over twenty years, as a family doctor before publishing this book. What's the thing you kept seeing over and over again that most people never really think about? You mentioned not going home with anything. What exactly were you seeing? speaker-1: Well the simple thing was is that when you first get out of residency as a physician, you're excited. You really want to help people. You want to learn, you want to y utilize your skill set. And during your residency program, you're you were handed out a lot of educational materials and most doctors kept a file cabinet drawer full of these educational materials. And when a patient came in, we were excited to teach. So we, so that's where earlier on in my book, the Latin word for doctor is docere, which means to teach. Therefore, the patient is the student. So there's an obligation there that thou that was lost because of the the I would say the busyness of clinics and the business of medicine, But what was lost is is the doctor as a teacher and the patient as a student in that foul cabinet drawer. remain closed over time. But I remember when I first started it that Valcan that I remember giving really excited to give out a couple of handouts and explain the conditions to patients. I was really excited to, you know, some some doctors use a whiteboard or we get sticky notes or a piece of paper out and we're really excited to teach. But over time with this electronic medical record system, it seems like we do more documentation, more authorizations than we do teaching and and I feel like that's been lost. speaker-0: I'm sure a lot of us, I know I have, nodded along at the doctor and said, got it, and then sat in the car just like your daughter with no clue what we were actually supposed to do. What's at stake here? When people leave confused, what actually happens down the road? speaker-1: Well, you you it's a good question, but what we found out is the the compliance rate of of taking medications is low and the noncompliance is high. We also find out some people utilize their medications wrongly. We have a lot of callbacks with questions, which leads to frustrated staff. Then we have a lot of portal message to physicians and then physicians Call their patients noncompliant, which I also stated in the book. But the fact is that if the doctor didn't teach the patient correctly and the patient didn't understand it, you can't be noncompliant and assume that the patient understands when they really didn't. So that's an important distinction to make. And I would say like a lot of bounce backs to the emergency department, a lot of anxiety about what is going on in in their body, they were noticing that a lot of the care plans were decreasing the anxiety and patient had more confidence in their care. So just a few points point points to make is that if if somebody is confident, less anxiety about their care, and doctors have fewer porter messages more messages and phone calls, to me that's that's a winner. speaker-0: Mm-hmm. speaker-1: And also people get better. Now Does some studies show depends with what what kind of patient education there there there is, but and for specific diagnosis, the outcomes, haven't been studied broadly because there's a lot of conditions. So when I'm building these pencils, we're we're already at 3,000 pencils for every, trying to get to every drug, condition, and procedure. So there's a lot of them. So it's hard to say, about outcomes just yet, but that's that's a future study. And excited to be a part of. speaker-0: Okay. So was there a moment where you saw up close what this lack of communication or lack of written instruction was doing, not just to patients but to doctors too? I I know you mentioned, you know, the staff getting more calls and getting getting into more conversations that should be unnecessary, but was there a moment where you saw doctors specifically having a negative impact with this kind of care? speaker-1: Well, let me let me let me answer something not that specific question, but I'll go into something else really quick. Is one of the reasons I say it's an illusion of care is because and and the hot topic about five to ten years ago was burnout. And that burnout was a lot of it was placed on insurance companies, no you know, no doubtly. However, when a physician is taught in residency and learns more continue education and excited to teach their patients something and you only have fifteen minutes or so with each patient, you know when you left that room they didn't fully grasp what you told them because you didn't have enough time, you didn't have the appropriate handouts, and you have to move on to the next patient. And then you have to move on to the next patient. And there's two more patients up and you're you're seeing This high volume practice, that in itself leads to a burnout because the fact is that a physician goes home every night knowing that most of their patients didn't grasp what they said. You can't teach somebody with a high risk condition in a high risk medication everything they need to know in five to ten, five to ten to fifteen minutes. And they leave with nothing. And then you go on and you repeat that over and over again. you feel you it doesn't make a physician feel good knowing that none of the patients grasp exactly what you said. And so I think that is a form of burnout. So when I've been handing out my pencils, it seems to get a little bit of a gratitude where you have patients are saying thank you. I understand this. And that feeling of them grasping your information and knowing what to do next does make a physician feel good and it decreases, I'm gonna just say some of the burnout, right? Because burnout is is a broad, a broad definition and and there's different reasons, but I think it does help for sure. speaker-0: Yeah. So in situations where physicians aren't handing out those pencils, which we'll get more into in a second, and these patients are looking at their doctors and they're nodding along and they're saying that they understand, but then immediately walking out of that office not understanding, why do you think the patients in the moment are saying that they get something that they're not quite ask actually grasping? speaker-1: Well, it's because medicine has built a routine. speaker-0: Yeah. speaker-1: And it's habitual. I didn't make it up. I'm just a part of it. Right? Your front office collects copates. You get seated. The medical assistant rooms you with the vital signs and you get shoved into a relatively cold room with sterile paper or stuffed in the corner and says, wait there till the doctor shows up. And you sit there for a very long period of time. And then you might be playing on your phone or reading something, and then all of a sudden you hear a Knock on the door and then you get startled a little bit and and all of a sudden, has this happened to you, Lex? speaker-0: Absolutely. speaker-1: Yeah. Exactly. It happens to most you know, most of us. And then all of a sudden you get started a little bit and the doctors you can tell the doctor's in a rush. I mean, you know, the no no doctor comes in here and sits back and says, Hey, you know, Lex, what's going on? You know, some doctors do, but most doctors don't. And then all of a sudden You you're like, okay, doctor. And and in the back of your mind, you're like, he's he's in a rush. I'm just gonna tell him what needs to be told. He asks me a couple of questions and he says, Okay, this is what you need to do. And you're like, Okay, do you understand? And you're like, Yeah, I understand, I think. I don't know, maybe we'll see, and then all right, we'll we'll see you next time. And then you both walk walk out, and then the front office says, Hey, before you leave, do you wanna reschedule? And that's basically the routine that we've developed here. And correct me if I'm wrong, but this would normally happens. Yeah. So, that that necessarily doesn't have to like completely change, but I think that you can you can change a couple habits and rearrange the workflow a little bit in order for most of the focus to be on patient understanding and comprehension, confidence and clarity before they leave. speaker-0: and that goes back to the whole conversation of doctor actually coming from the word teacher to teach. It's it's an instruction more than it is just throwing information at somebody and hoping that it sticks, right? speaker-1: Yeah, you have to realize, well, and I'm I don't mean to be you you personally. I'm saying people need to realize, and I also teach this to my my third year, fourth year medical students as in residence when when I I taught, I had a 10 year of teaching and I still teach today actually a student yesterday. But nobody in my practice wants to be there. Nobody in a doctor's office wants to be there. Usually they're they're anxious, they have symptoms. most people think that, they go to the doctor's office for, common colds and this and that. But some people, wake up with paralysis, some people wake up with blindness, some people, have strokes, some people have, all kinds of issues. They don't want to be there. They they want, they want to they want, a diagnosis. They want to know what's going on and what's going to happen next and what to do when they leave that office and what they do at home. So nobody at the doctor's office wants to be there. So we have to treat people with a little bit of empathy as well as what I used what I call goal-oriented medicine, if it's not something acute, but more chronic issues, w get to know the person so you can relate to them on a personal level. So, you know, to in order for them to have the best h health outcomes. Like for example, if you know here in Scottsdale where I live, there's a lot of golfers. So if somebody comes with an issue, I'm like, okay, we need to take care of this issue. This is how we're gonna do it so we can get you back on the golf course, swinging away and and and back with your buddies. That'd be great, Doc. What do I need to do? Now we put the plan together. So you can actually get some information from patients and turn it into a goal-oriented response. Some people call that motivational counseling or motivational, motivational goal setting, but it it's it's the relatability of of each particular patient in order to to for them to comprehend and get motivated to follow through with an action plan. speaker-0: What would you say to a doctor listening to this who says, I just don't have time to get to know all of my patients in this way? speaker-1: Well, I I would I would say that most doctors do get to know their patients. I I I'll say that they do. Most of them do. I wouldn't say a pathologist working in the hospital, they don't get to see patients or a radiologist, they don't. But most people who who who go in outpatient specialties and they have continuity of care, like a family doctor, a pediatrician, a neurologist, an a g endocronomist, and you know, a cardiologist, they get to know their their their their their patients. But the time Is a lot of people don't have time to discuss these care plans, which I completely understand and I get, because of the fact is that the electronic medical record system didn't build this in from the very beginning, nor did they build in a lot of you know issues that patients could have solved, or say our physician's office could have solved that deals with. With patient education, and comprehension understanding. So one of it's very simple. Like, for example, I would have to say, like when when somebody who's born in America, the United States, they should have a permanent health address from birth for the rest of their life. Like they carry around all their medical records. That should just happen, especially in the future with AI. So if you wanted to take your medical records and ask. Let's say an AI, you would just be able to if if your medical records from birth were just emailed to you, you'd have a email, all your medical records, then you can ask your AI or or questions if that's through the way you want to go. But also those each doctor's office would have all of those. That doesn't exist. I know it's scattered and it's piecemeal through portals, but it's a simple thing that patients really need to own their own medical records. not not scattered through multiple states and multiple portals. So I think it's very important to start that now. It should have been started 15 to 20 years ago. And then two is that we turn patient education into evidence based care plans. So we're not necessarily telling people like people don't want to know like, you know, the the pathophysiology of disease. Well some people do, but they want to know, okay, Doc, this is what I have, but what do I need to do to get better? And what do I need to avoid? what should I be doing at home? What habits do I need to change? What do I need to change in my lifestyle? How do I take my medications? What do I need to look out for? And if those are in paragraph format on four or five pages, nobody reads them. speaker-0: Hm. Hmm. speaker-1: So my pillars for the pencil is they're very intentional. The first point of my pencils is that they're relatable. So when you get a new drug, a new condition, or have to go through a procedure, it's relatable and they're all written in first person. So when somebody reads it, they're reading if, you know, I I need to do this, I should look out for this. I know that if my blood pressure is this high, I know to call the office when when when it's this. So all the pencils are written in first person and they're they're appropriate because they're given for the new diagnosis condition or a procedure. Second of all, second of all, they're an action steps. So they're all check boxes and they're all action items. So first person action items. So you can actually, the front office could actually notice a person reading them and checking them off really quickly, right? And so you can in a roundabout way, not studied, but verify a level of comprehension understanding. And they're all in written. between the third and fifth grade reading language on purpose. So everybody and we're not talking about like reading level as in the form of like the general population's reading level. We're saying medical reading level. So when you look at these these long words that are difficult to pronounce, even for some physicians, you know, all these these newer drugs and new, you know, and these the some conditions, you know, have long names. But Think of somebody who's never heard that before when you have somebody talking to them that's been studying it for years. There's a difference. So we need to make this a third or fifth grade reading language and we need to make it recognizable, meaning that we have a pencil for each condition and medication across all specialties. So if you go to a primary care doctor's office or you go to a cardiology office or you go to your pediatrician's office, they all give you a pencil care plan. And it takes literally five to ten to twenty seconds to print them off and hand them to the patient. And at least they're going home with something. And I think that one of the best compliments that I've gotten so far was not of my book, but of the pencils, was when a patient of mine was I was seeing and he stopped me for a second. He said, Just wanna let you know that my wife really loved your pencil. And we talked about it at dinner. speaker-0: Wow. speaker-1: And I was like, well, you did? So the care went home with them. They talked about it at dinner, which basically means they're willing to make some change some habits, to change some things so they can get better. So it's really important. I don't know. you're young, but I have a new a new granddaughter and I asked my daughter, what vaccines did you you get at the last visit? Because it was last week and she had two two band-aids on her thighs. And my daughter's like, I don't remember. So So did you did you get anything when you you came home? She's they didn't give me any paper. Nope. okay. So then then you call my dad and my dad, hey dad. He's like, Joe, what about my blood pressure medication? It's high today. I'm like, what are you taking? I don't remember. Let me look at the bottle. Hold on. What did the doctor say? It's I don't know. I think I go for a test. Okay. So we're used to it in the society of going to a dinner table, and and the answer is I don't know. And then as or maybe you don't know, but as a lot of people know that a lot of people come to the doctor's office with their parents, right? Not the as you're getting older, so they can understand what the doctor said because they know that their parents are not gonna understand what the doctor said and they don't know what to do next. So I think it's important to start off with something that we've ignored for a very long time. And something to make it very simple that takes less than, fifteen seconds to print out a pencil for a patient before they go home. speaker-0: Yeah. I I really like what you're saying about that accessibility piece of making it readable for most people who are not familiar with the medical field. I mean, I'm in a similar situation as your daughter where my mom's a nurse and she's really, really good at it. And so growing up and even into my adulthood, I would leave doctor's appointments and I would call her and say, This is kind of the situation. I don't think I'm really understanding. Can you break this down for me? And she would have to re-explain it in a way that made sense to me, but with pencil, it's it's automatically doing that. You're making it relatable and you're making it accessible and it's something that somebody can walk away with and not have to make that phone call, right? speaker-1: Correct. And and I d this is well, the that's the goal. And when you asked me earlier, like what do you think pencils will do as an outcome, it will, for example, give you clarity, comprehension, understanding of your condition when you left the doctor's office. Your phone calls to your mom, it was was the easy easiest way because you know that she had the knowledge to do it. And thank God your mom's a nurse. That's a wonderful profession, very, very caring. And But the whole point is is that most people don't have that. Nope. So you have everybody that's that's not like my daughter, not like yourself, going home, going like, what the hell the doctor said. And then some and the worst case scenario is they don't follow through. They just ignore it and they move on. And you see that sometimes. And I've seen that, of course. being a physician for a very long time, you see a lot of people just don't pick up their prescriptions. Or, they're like, I really didn't I feel okay, so I really don't need to take it. Right? Or they'll I I see this a lot actually. They go to the hospital. They they they the hospital discharges them with thirty days of medication, let's say for high blood pressure, because an easy example to discuss. And then all of a sudden they call me up they call us up, let's say a month or two later and say my blood pressure's high again. I'm like, You didn't did they give you any refills? No. Did you make an appointment with us so we can make sure you're continuing on the medication? I didn't know I had to take it anymore. You're like, Yeah, you do. And but that's not the patient's fault. Again, that's The doctor's the teacher. The the patient is the student. The doctor need to teach the patients that you you need you need to continue this, unless you know things change or when to stop it or when to start it. So there's a lot of confusion out there and it doesn't have to be. So I'm I'm nitpicking on one particular aspect of medicine, being being a physician and a chiropractor, as you know, and really good at, you know, diagnosis and treatments, but at the same time within this this realm of of electronic medical records, a little bit of the patient burnout, me switching from insurance based practice to a direct primary care practice and always wanted to write a book. I'm like, what topic should I really pick on that I could really make a difference that we can do today? So I know there's a lot of healthcare books out there, and I've read them, and they're wonderful. Some are some are hypothetical. We need to do this, we need to change this, we need better policies for this, which which probably we do. But I I wanted to do something where a physician could read this book, and that's why I intentionally made the book short. Easy reading, non-technical, just so they can do something tomorrow. And then when a patient reads it, I would say, act like a student. Go in there with the pen and the paper, take notes, learn as much as you can from the doctor before you leave. And if we can just change the culture a little bit to bring that doctor as a as a as the teacher and the patient as a student. I think we'd be better off in the healthcare scheme of things. speaker-0: Yeah. The beauty of this book is really that it's applicable to both sides. I mean, I'm not a physician, but I can imagine, just like you're talking about, that feeling of frustration, that burnout of it seeming like you're doing all you can to help your patients and they're just not getting it. And then on the side of the patient, which I have been, that feeling of that went over my head. I I have no idea what they're talking about. And now I'm going home and I'm by myself and I have nobody to turn to with this kind of medical advice. And I don't know what what I'm supposed to do with it. And I think that's what's different about this book compared to other healthcare books, is it it does go into both sides and almost everyone's been on one side or both sides at some point. So I I wanted to know, did you have somebody specific or a group of people in mind when you were writing this book that you were hoping you could reach? speaker-1: How is no, I didn't. So they always ask that question before you write your book. Yeah, who's your audience? Yeah. but I I thought like I, my audience is physicians, my aud my audience is healthcare providers, my audience is the general public because I want to know I want to tell them why there was a disconnect between physicians in a hurry, which I did. I'm not blaming physicians either. It was just the whole s how the whole system came together. And also I want to discuss the topic of with patients to to arrive a little bit of a little more prepared and and and and eager to learn and and and and the solution to that is is is is very simple. So it's not it's not this is not really complicated. It's just basically taking the mindset of the physician to make sure that they teach and the mindset of the of the the patient to learn a little bit. And moving forward, I would have to say that when when a physician goes into the exam room, you have different levels of comprehension. You have somebody that comes in with not a lot of let's just say healthcare data. They forgot what they forgot the medications they used before. They don't remember the the imaging studies that they had before. They don't even remember the doctor's names that they seen, versus somebody comes in with high levels of comprehension. That they have a binder with them, with a care plan, perhaps previous doctor's visits notes, previous imaging studies, as well as their recent laps. Those are highly productive visits and they don't take very long because all the data is there. And so those could be quick visits, but they're highly they're they're usually those quick visits are more productive than re-explaining yourself with somebody that has a lower level of health comprehension because they didn't They didn't gather their data all along. So the whole point is that with this, and I've seen p patients that have high levels of comprehension with those binders take on insurance companies, get prior authorizations, get and imaging improved all on their own without the need of a a physician, because they had all the data. And I'm not saying that's that's that's we we want to do that across the board, but I've seen that multiple times. So I think that if we can show show patients that with the the comprehension that's lower a way to make each visit compounded over time with education, we can turn all the low low levels of comprehension to high levels of comprehension. For example, if you teach a diabetic every single visit, and we know they need to come in there at least three months to check on their hemoglobin A1Cs, If we teach them every single visit over the course of two or three years, they should be an expert in diabetes. So instead of just coming in and leaving, we we we we really ascertain the idea the doctor is a teacher and we we need to educate these patients and they need to take ownership of that education, And I'm not even I'm in in time to be honest with you, I can say that if every patient really carried a health binder. It would be much better for them. For example, if my daughter had a health binder, what on every pediatrician's appointment for my granddaughter Monroe, she would have that for the rest of her life. You carry that in from your teenage years to your college years to your young adulthood. And then when you're older, you know, you can kind of take out the fluff. But what I'm saying is you can still still keep that binder. And as you're getting older, that that binder carries around with you. To each doctor's office. Now that binder could be electronic somewhere, but that doesn't exist where everybody goes that the medical records follow you. For example, if you went to California and then you got you got sick and you're in the hospital, those records don't automatically transfer somebody else. Yep. And then you went to somebody else and they go to they go to another state and they go to another state, or you go to independent providers' offices. Those those records can start to be scattered over time. And so But there's only one person that's been to each of those particular locations, and that's the patient. And so they could they could potentially do that. Now, I hope some tech person out there in this world will create something from from from an email account or permanent address, a health address from birth to the rest of your life to carry all of this. And I think it'd be better for everybody. There'd be no more searching around. I I can't tell you how many times a day I I hear. Did you get my records? I'm like, I'm working on it. But you were there. You could have grabbed your records while you were there. You sign a little piece of paper, have them email them to you, but we can't do certain things because of because of HIPAA, what whatever. But at the same time, these people were there, they could gather their their medical records or and keep them with them and then bring them in. Some people do, some people don't. But we need to make that process easier. speaker-0: Yeah. And that goes right back into that pencil method where the patient comes prepared, they have their materials, and then the physician can add to that. I mean, every appointment, if you're walking away with something written down, you're walking away with something tangible, then that just feeds right into that that exact loop of of coming more and more prepared every visit. speaker-1: Yeah. So you that's the mo yeah, two two points. One is that you're you're you're preparing for the visit because you know that if you did if you looked at what you're supposed to do, these are the questions and comments and concerns you can bring up with the physician that you know, like and trust, which is the goal of medicine. And then the doctor can teach you or you or in you and follow the same plan or change directions depends on how you feel. So I think that's that's very important, you know? And so It's the heart of it. it's it's not it's not complicated. I know we we're advancing so much, especially with new technologies, new surgeries, we're advancing new medications and even these electronic records hopefully will start to advance. But out of all these advancements, I've always thought to myself, the patient. level of understanding is not advancing as fast. And there's a there's a in my book I describe like it it takes a drug company a whole lunch, an hour to explain medications to doc to the doctors, the new doctors. They take them out to dinners, you know, to and give talks and there's seminars. And then we're supposed to translate that in five minutes to a patient. Right. You know, without any handouts or without, you know, you know, anything that With with multiple conditions and multiple, problems all at one visit, it's it doesn't make that much sense. So we we need to improve that. And I'm not saying, and I'm being honest here, I'm not saying that pencil is the solution to everything. I'm just saying it's a first step where when somebody shows up with nothing and leaves with nothing, we gotta correct that. Now a patient could show up with a level that they wanna learn, they can write some things down and they leave with a care plan. And I think that's a first step to better patient comprehension and understanding. speaker-0: Switching gears just a little bit, I'm curious about the book making process. So how did you and Scribe come together? And what was the hardest part of actually laying this all out on the page? speaker-1: Well, to be honest with you, I mean, I always wanted to write a book. I you know, I had a concept of a book about four or five years ago about preventative medicine. I just never really fully, you know, wanted to I didn't have a a lot of passion because of the way this the the insurance company was was looking at the the preventative exams versus what the patient's expectations were. And then I came across David David Goggin's book. And I that was by Scribe. And I'm like speaker-0: Can't hurt me. speaker-1: Yep. Yeah, Ken Herman. I'm like, and then all of a sudden I'm like, well, that's Scribe Media. They write books. They can help people write books. And I'm like, I and then I next thing you know it, I I reached out and because I had this concept of a book written, mostly written, I would say, but there's a big difference between like what you put down on paper and you know, basically what is published. Yeah. And and I knew that well, I know that I'm not a good writer. I needed help. and so, when you when you when you ask for help and you know, get help and you have to work at it. So even though you're not good at something, doesn't mean you can't do it. Yeah. So, you know, it took me, you know, a l a couple late nights of work, you know, outside the clinic office to come home. skip a couple gym sessions, a lot of gym sessions, actually. But anyway, you skip a lot of gym sessions and you go home and you know, read, reread, rewrite, and then and then talk to, you know, the editor and and make changes and then reread and rewrite and make changes. And all of a sudden, when I was looking at the manuscript that I when I first started with it, you know, chapter by chapter, I'm like, this is turning into a book. And so It it was it was nice to see that transformation. So even though that you have, let's just say two hundred pages, hypothetically speaking, two hundred pages on on a on on a piece of paper does not equal a book. speaker-0: Yeah. Not quite. So what would you say to someone who's got an idea they think could fix something real, just like yours, but feels they're not ready or that they'll never be ready to write it all down? speaker-1: Well, there's a th I that's a good question because there's a saying I don't know who I'm quoting, but there's a saying that says ready enough. speaker-0: Mm. Yeah. speaker-1: So, you don't you don't you mean you don't need to be ready exactly in the right moment to do something. You have to start somewhere. And so like my advice is that you're you're probably ready enough. If you got your thoughts and and and on on on paper, you have a good conclusion that can come up with a summary of what you want that ends with the con conclusion. You And and you think that you're ready, you're ready enough. You've got to start. And also I would have to say that, there's people willing to help you. Mm-hmm. So, I'm not good at podcasts, I write, the so we're we're here. I don't know if the lights right, I don't know your microphones right. but I'm ready enough. I'm I'm I'm willing to put myself out there and do it. And then if I look back at this and I made a mistake, I can fix it. So so you you just just like a manuscript or a book. But what I liked about Scribe is that is that they take people who are ready enough, they polish it, and you have time to go over it and over it and over it again to make sure it's it looks good and it it reads appropriate. And then there's small little nuances that most people don't think about that scribe really helped me out with. you you don't think about the size of your book, you don't think about the font, they don't think about the page layouts, you don't think about the front cover, the back cover. And then, and you have to have the illustrative artist to to create the cover. And by the way, I'm getting a lot of compliments on my cover and I don't take credit for I take credit for the idea of the maze with the pencil, but I'm not an artist and the illustrator was amazing. And so that's a little that's a that's that's a big deal on a book too. You you want to have that little appeal. And so there's there's so there's a lot of lot of things that that go into a book rather than just, pen and paper. speaker-0: Yeah. It's it is a great cover. I love the cover. And Joey, you were absolutely more than ready enough for today. But to close out, where can people find the book and where can people keep up with you? speaker-1: Thank you very much. And you can find me at the www.illusionofcare dot com. There's no th and before the illusion of c illusion of care. So it's just w dot illusion of care. And my pencil health method is www.pencilhealth.com. speaker-0: Thank you, Joey, for coming on. We are so glad that the illusion of care has hit shelves. speaker-1: Thank you so much. I appreciate that. I appreciate everything that scrap did for me.