Latest / Becker’s Healthcare Podcast / Advancing Quality, Innovation, and Patient-Centered Care at Eisenhower Health with Dr. Eric Leroux

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Advancing Quality, Innovation, and Patient-Centered Care at Eisenhower Health with Dr. Eric Leroux · Becker’s Healthcare Podcast

0:02
- There's a small circle of people who truly
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- understand what it takes to lead a health
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- system right now. The decisions are enormous.
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- The variables are constantly shifting, and the stakes
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- of getting a call wrong don't stay contained.
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- That's not a complaint. It's a structural reality.
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- And it's why the most effective c suite
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- leaders are deliberate about where they go to
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- pressure test their thinking.
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- Becker's fourteenth annual CEO and CFO roundtable
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- brings together more than 1,500
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- executive level attendees
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- and nearly 400 speakers for four days built
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- around growth, financial sustainability,
0:35
- workforce strategy, and the leadership questions that don't
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- have easy answers.
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- Join us November second through the fifth in
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- Chicago.
0:42
- For the agenda and event details,
0:45
- visit beckershospitalreview.com
0:47
- and click on the events tab in the
0:49
- upper right.
0:50
- This is Scott Becker with the Becker's Healthcare
0:53
- Podcast.
0:54
- Thrilled today to be joined by doctor Eric
0:56
- LaRue.
0:57
- Doctor LaRue's a leader at the Eisenhower Medical
1:00
- Center, a a remarkable, remarkable institution
1:03
- and campus. I've had the chance to spend
1:06
- time there, fascinating place. Doctor LaRue,
1:08
- take a moment if you could and introduce
1:11
- yourself and tell us about your career
1:14
- and and where you're most focused today.
1:16
- Oh, certainly. Thanks, Scott. It's a pleasure to
1:18
- be here and to talk with you. I'll
1:21
- give you a bit of background,
1:22
- I guess, my career and and where it
1:24
- sits today.
1:25
- I'm clinically an emergency physician. I came to
1:28
- The US from Canada for
1:30
- undergraduate
1:31
- studies, and then I studied biology at Princeton
1:33
- where I played ice hockey,
1:36
- and then worked abroad in South Africa for
1:38
- a couple years during the height of the
1:40
- HIV
1:41
- pandemic to help build treatment infrastructure
1:44
- across Sub Saharan Africa,
1:46
- and after that ended up in California at
1:49
- Stanford for medical school, business school, and residency.
1:52
- And
1:53
- I joined Eisenhower in the emergency department
1:56
- in 2018
1:58
- and
1:59
- have have, you know, moved into executive
2:02
- leadership
2:03
- roles recently.
2:04
- And so I'm currently the chief medical officer,
2:07
- chief quality officer, and senior vice president,
2:09
- and I'm also an independently elected
2:12
- board member and trustee of the health system.
2:15
- And then
2:16
- having spent
2:18
- almost a decade in Silicon Valley,
2:21
- I have
2:21
- a pretty
2:23
- prominent
2:24
- entrepreneurial and innovation streak where I've I've done
2:27
- a number
2:28
- of sort of digital health and more recently
2:31
- clinical AI work,
2:33
- including
2:34
- most,
2:36
- I guess, significantly
2:37
- cofounding
2:38
- a digital health clinical AI company called Curbside
2:41
- Health, which is focused on decision support
2:45
- in a way that is sort of physician
2:47
- and health system centric to try to take
2:50
- the best of what AI can do within
2:52
- the governance models that ensure safety
2:56
- and
2:57
- patient centeredness.
2:59
- Fantastic. So I'm gonna ask you a few
3:00
- different questions.
3:02
- I'm an avid hockey fan, so I'm gonna
3:03
- hold my hockey questions till a little bit
3:05
- later just so that audience that's not big
3:08
- hockey fans doesn't get bogged down in that
3:10
- part of the discussion.
3:12
- But but
3:13
- let's start with this.
3:15
- When you look at Eisenhower
3:16
- today,
3:17
- what are you most focused on and excited
3:19
- about? Then I'm gonna ask you the same
3:21
- question about curbside health. Where are you most
3:24
- focused and excited there? But but talk about
3:26
- Eisenhower first, and what are you most focused
3:28
- on and excited about at Eisenhower,
3:30
- and tell us about that.
3:33
- Absolutely.
3:34
- So what excites me at Eisenhower
3:37
- is somewhat unique
3:39
- to Eisenhower's opportunity, but there are echoes of
3:42
- it exciting me about the national landscape of
3:45
- health care. And so for context,
3:47
- Eisenhower is a 1,500,000,000
3:50
- nonprofit teaching hospital in Southern California in the
3:53
- Coachella Valley.
3:55
- And
3:56
- with about 460,
3:58
- inpatient beds, more than a 100 outpatient clinics,
4:02
- we do about 1,300,000
4:04
- visits a year, 100,000 emergency visits and 25,000
4:07
- discharges.
4:08
- And to get to this point, there has
4:10
- been rapid growth in the past
4:14
- ten years, but
4:15
- increasingly in recent years.
4:17
- And so the emphasis
4:19
- has been on
4:21
- providing the access
4:23
- and sort of clinical operational capacity
4:26
- to
4:27
- serve
4:28
- the patient demand and need, while at the
4:31
- same time
4:32
- maintaining
4:34
- a relentless commitment to quality and excellence.
4:37
- And sometimes
4:39
- those are hard to do in tandem, right?
4:41
- To
4:42
- maintain
4:43
- really high performance during periods of rapid growth
4:48
- is a tall order, but the health system
4:51
- has been remarkably
4:54
- successful, I guess, in doing that.
4:57
- And so that is one of the things
4:59
- that continues to excite me is that
5:02
- the needs of the community continue to expand
5:04
- and the health system is growing rapidly in
5:07
- exciting areas such
5:08
- as building out a behavioral health service line,
5:12
- new trauma program,
5:13
- recent new OB program, enormous
5:17
- expansion of an already large cardiology footprint.
5:20
- Orthopedics
5:21
- is annually recognized as one of the
5:25
- best orthopedic departments in the nation.
5:27
- And so it's to build on that
5:30
- foundation of safety and quality and
5:34
- to do it now in an era
5:36
- of
5:37
- incredible
5:39
- technological potential
5:41
- that we need to deploy
5:43
- very thoughtfully,
5:45
- and in a way that is still sort
5:47
- of patient focused, patient centered,
5:50
- mission aligned
5:51
- with the health system.
5:52
- And so
5:54
- how we do that
5:56
- is kind of the next phase of growth.
5:58
- And more specifically, I think what it comes
6:00
- down
6:02
- to is going to be how we
6:04
- reconcile the gap between
6:06
- or the space between what technology is capable
6:10
- of
6:11
- and
6:12
- what
6:13
- our system,
6:14
- our personalities,
6:16
- our cultures,
6:17
- and sort of the humanness of medicine
6:20
- is ready enough to trust and adopt.
6:23
- And that gap has widened fairly rapidly
6:27
- in recent years, and
6:29
- it's not a problem by itself. I think
6:31
- there's wisdom in the gap because we
6:34
- we owe it
6:36
- to medicine,
6:38
- and patients
6:40
- to be very
6:41
- conscientious about how we adopt and deploy new
6:44
- technology.
6:46
- And and talk about that gap. I think
6:48
- that's a fascinating discussion. The gap between
6:51
- what technology
6:52
- is ready to do
6:54
- and what
6:55
- physicians, patients,
6:57
- systems
6:58
- are ready for it to do.
7:00
- And talk about
7:02
- how that gap over time
7:04
- closes as people have more and more experiences
7:06
- and the technology gets better and better. Is
7:09
- that how that happens, or and how intentional
7:11
- does that have to be?
7:12
- I think that is a big part of
7:14
- it. So
7:15
- there was,
7:16
- there was a paper published in Science just
7:19
- at the end of April this spring that
7:22
- circulated
7:23
- quickly
7:24
- because
7:25
- the the headline was effectively AI beats
7:29
- AI outperforms physicians
7:31
- in the emergency department. So with my network,
7:34
- that that got a lot of attention.
7:36
- And
7:38
- the reason it got a lot of attention
7:39
- is because one of the most common questions
7:42
- that I'm asked and and people in positions
7:44
- like mine are often asked is something like,
7:47
- will
7:48
- AI replace physicians?
7:50
- And increasingly, I've noticed
7:53
- that people have added an additional word to
7:55
- the beginning of that question, and the word
7:57
- is when.
7:59
- It sort of assumes that it will happen.
8:01
- And
8:02
- this paper
8:04
- was sort of saying, you know, the software
8:06
- is better at some core emergency medicine functions
8:08
- than emergency physicians are. But
8:11
- I read that as someone who's,
8:14
- you know, been an emergency physician for ten
8:16
- years, and I recognize that that is not
8:18
- new. In
8:21
- in since 2016,
8:22
- we've been tracking areas where
8:25
- software systems outperformed
8:28
- highly trained specialists,
8:30
- even,
8:31
- you know,
8:32
- retinologists,
8:34
- you know,
8:35
- the Googles I think it was Googles. We
8:37
- have to might maybe fact check that. But
8:39
- there was,
8:40
- a sort of pattern recognition model that could
8:42
- diagnose diabetic retinopathy with higher fidelity than a
8:45
- a retinologist.
8:47
- And that's been true for a long time.
8:49
- And so the gap is not, can the
8:52
- technology do it? It's, what is the technology
8:55
- best suited to do in support of the
8:59
- ultimate endpoint of optimal patient care, and where
9:02
- does the physician sit in delivering
9:05
- optimal patient care? And and that that comes
9:08
- in
9:09
- around
9:10
- trust.
9:11
- And so
9:12
- it's almost like there are two clocks turning
9:15
- that govern the speed of tech adoption in
9:18
- a way. The first is the rate at
9:20
- which technology
9:21
- can increase. And, for example, we see, like,
9:25
- the sort of theoretical doubling time today of
9:27
- new medical information is, like, seventy three days.
9:29
- Right? That's the rate at which the corpus
9:32
- of medical publications doubles every seventy three days.
9:35
- That's impossible to keep up with. Right?
9:38
- Physicians adopt or adjust their practice patterns on
9:41
- more of a generational
9:43
- timescale, right, not a month timescale.
9:46
- And so
9:47
- technology
9:48
- must help bridge some of that gap, But
9:50
- some of it also needs to persist while
9:52
- the humans act as sort of the,
9:55
- not quite gatekeepers, but to some degree,
9:59
- the governance process on the rate
10:02
- of the rate and the how and the
10:04
- when of
10:05
- where the technology gets deployed and for whom.
10:09
- No. Let me ask you two follow-up questions
10:10
- on this because a a couple of things
10:12
- you said resonates so deeply.
10:14
- In oncology,
10:16
- my impression
10:18
- from watching some close colleagues go through some
10:20
- very difficult cancer,
10:23
- diagnosis and treatments and ultimately deaths
10:26
- is that the oncologists
10:29
- are so deeply overwhelmed by the amount of
10:31
- information out there
10:33
- that both they need the information as a
10:35
- copilot,
10:36
- but even with the copilot,
10:38
- it is just overwhelming the amount of cancer
10:40
- diagnosis is in our country versus the number
10:43
- of specialists in our country. That's one I'd
10:44
- love your thoughts on. It because it seems
10:47
- like the information's processing in every seventy three
10:49
- days, and the oncologist, like you said, are
10:52
- are humans that are exhausted, that are worn
10:54
- out, that are overwhelmed, and trying to keep
10:56
- up with it all and keep up with
10:59
- compassion with their patients. So that's one question
11:01
- or a concept I'd love your thoughts on.
11:03
- The the second concept or thought that I'd
11:05
- love your thoughts on is this. In certain
11:08
- areas, it seems like, for example, primary care,
11:11
- that the the ability for AI
11:14
- to help a really well trained nurse practitioner
11:17
- or PA
11:19
- close the gap on what a primary care
11:21
- physician could do
11:23
- is,
11:24
- maybe one of the way I mean, in
11:26
- the primary care side, it seems like we've
11:28
- got 450,000
11:29
- primary care physicians in the country,
11:31
- something like that,
11:33
- 350,000,000
11:34
- people. It seems like we are so
11:36
- never gonna catch up to the amount of
11:37
- primary care doctors we need
11:40
- versus
11:41
- population,
11:42
- but then AI with NPs and PAs and
11:44
- so forth can cause a lot of that
11:46
- gap. So your thoughts on the oncology primary
11:48
- care situation, I'd love to hear your thoughts
11:49
- on that, if if you don't mind. Oh,
11:51
- yeah. Great question,
11:53
- at either end of the sort of clinical
11:56
- complexity spectrum, if we call it that. And
11:58
- so first on the
12:00
- highly specialized arena of
12:03
- oncology care, where the evidence
12:06
- moves incredibly fast,
12:08
- and
12:09
- this is
12:10
- it's become
12:12
- almost essential to have
12:14
- some level of co pilot support to keep
12:17
- up with it.
12:18
- And
12:20
- to the to that end, I mean,
12:22
- we I have seen this broadly in in
12:25
- the market and,
12:27
- you know, curbside health has partnered with Memorial
12:29
- Sloan Kettering
12:31
- and the cellular transplantation
12:33
- team for exactly that purpose, and they have
12:36
- independently published and presented internationally and nationally
12:40
- on being able to better adhere to state
12:43
- of the art best practices and then the
12:45
- clinical and operational outcomes that flow downstream from
12:48
- that adherence to best practice.
12:51
- And so in the most complex arenas,
12:55
- having
12:56
- an aid that facilitates and sort of
13:00
- empowers and supercharges the clinician,
13:04
- is becoming
13:05
- I believe it will become
13:07
- necessary
13:08
- if it's not already. And to go back
13:10
- for a moment to your earlier question around
13:13
- the gap between
13:14
- capability
13:15
- and deployment and sort of what drives the
13:17
- adoption in this arena,
13:19
- one of the one of the key
13:22
- underlying factors that is distinct from what the
13:25
- technology can do, but it's more of a
13:28
- structural
13:28
- component,
13:30
- I think it will we might see a
13:32
- turning point. Now this is, you know, maybe
13:34
- a bold prediction, but we might see a
13:35
- turning point sometime in the next year or
13:37
- two when maybe there's
13:40
- a landmark legal case
13:42
- where
13:43
- a plaintiff wins
13:45
- on the basis
13:46
- that
13:47
- a clinician or health system did not use
13:50
- available
13:52
- AI technology
13:53
- to support patient care. That, quite frankly, almost
13:56
- has to happen because it's almost like the
13:58
- old days of you didn't get an MRI,
14:00
- you didn't get a test, you didn't get
14:01
- an x-ray, and you can't really really diagnose
14:04
- without the MRI or whatever it might be.
14:06
- Certainly, there's gonna be spots where a doctor
14:09
- who's not on their game
14:11
- in in any profession always have bad days.
14:14
- I'm I'm a lawyer by background. If any
14:16
- lawyer says they're perfect every day, they'd be
14:18
- they'd be telling you incorrectly, we're all human.
14:20
- But, certainly, there's a spot if you didn't
14:23
- fact check or case check or, in this
14:25
- case, check what the AI says about the
14:26
- diagnosis.
14:27
- It's it's gonna be so clear that some
14:29
- diagnosis will be missed that without the AI,
14:32
- they might not have been. I think that's
14:34
- a fascinating perspective I've heard before.
14:37
- Yeah. Thanks. From you.
14:38
- Well, thank you. On your on your second
14:41
- question around the access piece related to primary
14:45
- care,
14:47
- The capacity that can be unlocked
14:50
- around diagnosis,
14:52
- care management,
14:53
- optimal referral patterns
14:55
- is significant,
14:57
- and
14:57
- I believe we will increasingly
15:00
- see
15:01
- PAs, NPs, and other types of caregivers
15:04
- able to
15:06
- deliver the level of sort of decision making
15:10
- and patient care
15:12
- that would have historically
15:14
- been achieved
15:15
- maybe by professionals
15:17
- that are less numerous and, frankly,
15:21
- higher paid and so on. And
15:23
- as those shifts happen,
15:25
- the capacity at the primary care level increases
15:28
- in two ways. One is
15:30
- people without access get increased access to
15:34
- preventative
15:35
- and preventative medicine and sort of chronic disease
15:39
- management. The second piece
15:41
- is an increased ability to manage in the
15:44
- primary care office things that are today being
15:47
- referred out to the specialists, like cardiology,
15:51
- like pulmonology,
15:52
- GI, and so on. And we know
15:55
- many of us have, or our family members
15:57
- have experienced the long wait times that often
16:00
- accompany the need to see a specialist.
16:02
- And so
16:03
- that's where
16:05
- the primary care physician,
16:07
- in partnership with other allied professionals and other
16:10
- clinical caregivers,
16:11
- really work as a team
16:13
- supported by the technology so that they're managing,
16:16
- you know, maybe slightly more complex heart failure
16:19
- or COPD
16:20
- than they would have previously,
16:22
- and then they still sort of refer to
16:25
- the specialists when needed. But those transition points
16:29
- are sort
16:30
- of shifted on the curve,
16:33
- to
16:34
- increasingly to generalists,
16:36
- potentially. And and so there's these sort of
16:39
- a double
16:40
- a double unlocking of capacity
16:42
- that is made possible through the support of
16:46
- sort of decision decision aid technologies.
16:49
- Not even a question. And it's fascinating to
16:51
- see the evolution and the cascading evolution.
16:54
- Let let me ask you another question.
16:56
- You were
16:58
- born in Canada,
17:00
- played college hockey,
17:02
- then went to Africa to,
17:04
- to to help treat people in Sub Saharan
17:06
- Africa
17:07
- in a completely different part of the world.
17:10
- Are you a unicorn in that way, or
17:12
- do you know do do you know another
17:14
- college playing hockey player
17:16
- who
17:17
- went on to be a physician and then
17:19
- spent time in Africa
17:21
- helping to treat communities there?
17:24
- Oh, I
17:26
- that's hard to say. I was
17:29
- I, you know, I love and loved hockey,
17:31
- but I was also happy to hang my
17:32
- skates up and board the plane to
17:35
- to go to Africa.
17:36
- There's no way for me to know that.
17:39
- But nothing nothing feels
17:41
- peculiar or strange about it, perhaps because
17:44
- my wife is a former professional tennis player
17:46
- who's a physician.
17:48
- So we we just I don't know. We
17:50
- we found our way through athletics into medicine
17:53
- together, and we met in residency
17:55
- in the same program, actually.
17:58
- So
17:59
- it's it all feels normal to me. The
18:02
- one one thing I'll share about
18:04
- the the global perspective and how it relates
18:07
- to the broader conversation around, like, what is
18:10
- exciting and what's the opportunity
18:12
- here for us in health care and in
18:14
- medicine in the future is that I think
18:16
- we we truly have the ability
18:19
- now, and if not very soon,
18:21
- to turn evidence and knowledge
18:24
- into
18:25
- consistent practice and outcomes
18:28
- at massive scale
18:29
- like never before. Like, it's historically been
18:33
- a sort of accident of geography and timing,
18:36
- whether you would
18:38
- be in a location where your physician might
18:40
- be an expert in whatever ails you.
18:43
- And increasingly, those
18:45
- sort of knowledge and access barriers will be
18:48
- broken down, I believe, and they should be
18:51
- so that
18:52
- the
18:53
- sort of diagnosis and management
18:56
- that a person gets is as if they
18:58
- were being treated by the world's expert in
19:00
- that particular circumstance and who also knows that
19:03
- individual
19:05
- on a personal level. That's only capable through,
19:09
- you know,
19:10
- technology that scales across
19:12
- across
19:13
- a range.
19:15
- Correct. Correct. And that's sort of the the
19:18
- the era of the end
19:20
- of the kind of primary care physician that
19:22
- we all had because that level
19:25
- of direct personal contact like that
19:28
- seems to be very
19:30
- challenging. Whereas,
19:32
- you take artificial intelligence, you couple with primary
19:34
- care, you couple with PAs and nurse practitioners,
19:37
- we move more in that direction. And, again,
19:39
- we always in The US are very upset
19:41
- about the per capita amount of doctors to
19:42
- population.
19:43
- But when we've studied this for neurosurgery
19:46
- in other areas in Africa,
19:48
- they they would be thrilled to have our
19:50
- percentages
19:51
- and ratios, of course.
19:53
- That's a great point. And
19:55
- right now, I think the projections are that
19:58
- we're we're facing
20:01
- an impending global health worker shortage of
20:04
- either 30,000,000 or 50,000,000. I'll have to double
20:07
- check. In any case, an enormous
20:09
- an enormous shortage of necessary global health
20:12
- workers, and projections are that we have
20:15
- an increasing
20:16
- shortage of physicians in The United States.
20:19
- Those numbers are extremely difficult,
20:23
- to hold on
20:25
- to too tightly
20:27
- because of
20:28
- the capabilities
20:29
- that are increasingly unlocked through technology. So if
20:33
- if one physician can currently see, you know,
20:36
- 14 patients,
20:38
- maybe 20 patients in a day, depending on
20:41
- the specialty, maybe 40 in some clinics,
20:43
- that may get multiplied by an order of
20:46
- magnitude if that physician's
20:49
- expertise can be
20:51
- multiplied and sort of disseminated
20:53
- through
20:54
- some sort of a team model that is
20:56
- tech enabled.
20:57
- There's just different options to scale that ability
21:01
- that
21:02
- can become
21:03
- a little bit less
21:05
- maybe, doctor centric as the rate limiting factor.
21:08
- And when that happens,
21:10
- I hope we're wrong about the
21:13
- projection of
21:14
- shortages.
21:16
- That's not an argument for
21:18
- avoiding trying to,
21:20
- you know, increase the supply of
21:23
- of experts in medicine at all. It's just
21:26
- we need to pay attention to
21:28
- how we can meet the needs through
21:31
- multiple different channels.
21:33
- And, doctor Le Roux,
21:35
- I'm gonna give you one of the great
21:37
- examples
21:39
- of ChatGPT
21:39
- or AI today. If you'll bear with me
21:42
- for a second. Mhmm. Let me know if
21:43
- you're ready. I'm ready.
21:45
- So we asked ChatGPT
21:48
- for a player that played hockey in college
21:50
- in The US,
21:51
- then went to medical school, and then practiced
21:53
- medicine in Africa
21:55
- for some time like doctor Eric Gureux.
21:58
- And what ChachiPT
21:59
- tells me, Eric Gureux is probably the best
22:01
- known moderated example of exactly that type of
22:04
- career.
22:05
- His path is remarkable.
22:07
- Played division one hockey as a starting goalie
22:09
- at Princeton University,
22:11
- and what you might not know in adult
22:13
- hockey is goalies always play free,
22:16
- won the 2,006
22:17
- hockey humanitarian work for a service work while
22:19
- still a student,
22:21
- spent significant time in Kenya
22:23
- before medical school as an HIV counselor,
22:27
- lived in a rural village, and also worked
22:29
- in Ecuador at a malaria clinic,
22:32
- and earned both an MD and MBA at
22:34
- Stanford University.
22:37
- And and and it really remarkable.
22:40
- ChechiPT, at least as a first run, could
22:42
- not find any other NCAA hockey players who
22:45
- followed that same path of NCAA hockey, particularly
22:48
- goalie,
22:50
- medical school, and then substantial clinical or public
22:53
- health work in Africa.
22:55
- It was simply remarkable
22:56
- as an aside.
22:58
- That's well, that's,
23:01
- thanks for sharing. That's it's a a funny
23:03
- thing that JAD GBT even knew I went
23:05
- to Ecuador. That's interesting. Good for it.
23:09
- Right. It says it's one of the clearest
23:10
- and most inspiring examples that we've come across,
23:13
- And so I thought that was just fasting.
23:15
- Alright. Anyways, doctor LaRue, I I've gotta let
23:17
- you go. What an amazing chance to visit
23:19
- with you. I'm so glad that
23:22
- that you had gotten through somebody at Eisenhower
23:25
- on our podcast. But what a remarkable, remarkable
23:28
- career.
23:29
- At some point, we'd love to have you
23:31
- speak, of course, at a Becker's Healthcare Conference,
23:33
- but
23:34
- truly remarkable. And and who was the better
23:37
- athlete, you or your wife? Because both of
23:39
- you played at a very high level. Who's
23:41
- the better athlete?
23:43
- Well, thanks, Scott. I'd I'd love to participate
23:45
- in future conferences, and,
23:48
- I'll have to hand it to her.
23:50
- We do have
23:51
- we do have some very,
23:53
- you know,
23:54
- energized
23:55
- battles on the tennis court from time to
23:57
- time these days.
23:59
- You know,
24:00
- god bless that. You know,
24:03
- it's, good, good fun. And we we find
24:05
- the trick in our family is always to
24:07
- have a pro on the court as well,
24:08
- though you've got one in your wife because
24:10
- that avoids some of me and Liz try
24:13
- wanting to to,
24:15
- to kill each other, which I know I
24:16
- shouldn't say that word. But yes. But that
24:18
- helps a lot to reduce tension is having
24:21
- a a third party on the court as
24:22
- well, if not a fourth. Anyways, doctor Wirr,
24:24
- what a pleasure to visit with you. What
24:25
- a fascinating, fascinating career. Thank you so much
24:28
- for joining us today. Thanks for having me,
24:30
- Scott. I really appreciate your time. Thanks so
24:32
- much.