Latest / Faisel and Friends: A Primary Care Podcast / Ep. 99: Caring for Colleagues: the Power of the Peer w/ Dr. Mark Greenawald
Transcript
- Dr Faisel Syed: [00:00:07] Hi, everyone. I'm Dr. Faisel Syed. [00:00:08][1.4] Dr. Dan McCarter: [00:00:09] And I'm Dr. Dan McCarter. [00:00:10][1.1] Dr Faisel Syed: [00:00:11] And you're listening to Faisel & Friends, where we believe access to primary care is a right, not a privilege. [00:00:19][7.6] Dr. Dan McCarter: [00:00:19] Today, we're talking to Dr. Mark Greenawalt from PeerRx and Virginia Tech Brilliant School of Medicine about caring for colleagues, the power of the peer. Let's dive right. [00:00:30][11.0] Dr Faisel Syed: [00:00:30] In on our today. And how are you doing? [00:00:32][1.5] Dr. Dan McCarter: [00:00:33] Good. How are you, Faisel? [00:00:34][0.8] Dr Faisel Syed: [00:00:34] It's good to see you. I spoke with you, but it's always good to see you on this. That's right. Dr. Greenwald, welcome. So good to have you. [00:00:41][6.8] Dr. Mark Greenawald: [00:00:41] Hey, fellows, great to. Great to be here. It's really a it's really an honor. Quite excited. [00:00:45][3.7] Dr Faisel Syed: [00:00:47] You know, we love the, you know, your passion around wellness. What got you what got you involved in wellness? [00:00:52][5.6] Dr. Mark Greenawald: [00:00:54] There's probably lots of different stories that I could create around that. The one that that I would say is probably where this path led me in terms of where we are today was actually stems from a very tragic patient death that happened. Gosh, it was more than two decades ago. Now that and the aftermath of that which included after a year of great struggle and sucking it all up, seeking out a therapist. And I think that realizing that at that point in time, reaching out to a therapist was just not something that we were trained to do. And having done it and really changed literally changed the direction of my life in many ways and certainly anchored my career. I think that was the start of realizing that many were out there suffering in silence. And that was the moment that I realized I had been given the opportunity to speak into that. And so that that was probably lots of interest before that, obviously. But that was probably what really lit the fire in my life. [00:02:00][66.0] Dr Faisel Syed: [00:02:00] Reminds me of just being an intern especially. Yeah. You know, as I'm hearing you speak, I'm hearing like the inner intern, even in me responding to the first time something happened. Not even to death, but suffering. [00:02:14][13.4] Dr. Mark Greenawald: [00:02:15] Yep. [00:02:15][0.0] Dr Faisel Syed: [00:02:15] And it's so different when you're there, not as a student, but even, you know, even before being an attending. And it was kind of like you compartmentalize. I remember I was going to compartmentalize. It was horrible. I think about the worst death I ever had was a father getting upset at his son for getting shot with a buckshot, you know, accidentally. But he's going to lose his scholarship. And meanwhile, we're trying to explain to the father, he's got, you know, his liver was turned into ground beef, and he had moments to live, and he died. Oh, the last interaction he had with his father was that. And we're all there. And now you just experience this horrible interaction. And I remember and I don't even know if this is appropriate to even talk about. Right. But I remember just kind of the culture. Nobody's saying it but kind of like, okay, there's a 400-some-bed hospital. We got to move on to the next thing and we just kept on moving. [00:03:09][53.3] Dr. Mark Greenawald: [00:03:14] And never process that most likely. [00:03:15][1.4] Dr. Dan McCarter: [00:03:16] And you know, Mark and I, and full disclosure, have known each other for, I guess. [00:03:23][7.0] Dr. Mark Greenawald: [00:03:23] More than more than ten years then. [00:03:24][1.3] Dr. Dan McCarter: [00:03:25] Yes, more than ten years. Probably more than 30 years. Probably so. And, you know, and I happen to know that that you are married to a psychiatrist as well. And that I mean, it's hard to talk about these things. And, you know, when I hear you telling me that it's a it was a struggle, I'm wondering how. All the physio, you know. What's your advice for the physicians? How do we get past that? I mean, so many people say, well, they're connected on social media now, but people don't talk about real things on social media. They just, for the most part, talk about the good things that are happening to them, are things that are provocative and how do we how do we have connection that helps with that and how do we have connection with people when it's okay not to necessarily be our best self? [00:04:24][59.0] Dr. Mark Greenawald: [00:04:25] It's a great question, Dan, and as you likely know, that was the impetus for me starting the PeerRx med program, the this idea. That we only reach out when we're in crisis. And the challenge with we physicians, the way we're wired, the way we're socialized, is that when we're in crisis, we don't trust anybody. So nobody could possibly know what's going on for us. And so having somebody who is a trusted other, who gets us in good times that we've developed rapport with, we've developed some respect for, we've developed some trust around so that when things go south and we know in our careers, we're going to have times when things are just not going to have gone well. We already have somebody built in so that we can go to them. I call them our 2 a.m. friends. Like, who are those people? You're going to call it to em when your life is collapsing around you and it's not your partner's spouse. And I believe in health care. We all need one of those people who have the initials M.D. or DEO after their names because they get what's going on. So, Dan, getting back to your question about my wife, Joanne, you know, she's she's a psychiatrist. I'm not practicing now, but was at that time. And and she was the last person I would have gone to with this. And it literally took me a year before she basically said, you need to go see somebody because I was able to put up front and we are boy, we're you talk about, you know, the the this whole idea of a lot of what we do in health care is a performance art. And Fazal, you just you said that really well about there you were. You just saw this incredibly tragic thing happened right in front of you. Boom, cut next scene. And you just went on and nobody processed it. And as an intern or or somebody early in their career, even a medical student, you look at that and you think, well, I guess that's the way it is. I guess that's what we do around here. So, Danny, you know, it's interesting that I just I continue I'm part of our residency faculty here, and I actually meet with our first year residents on a regular basis. We call our our in our groups stands for reflection and renewal. And we just gather it's just the first year residents and myself and another facilitator we just met yesterday. So this is quite fresh because we had this very conversation that they all shared, that they were feeling incredibly isolated and they have a group chat, they have all these things. And so we talked about that and literally said the only way this is going to happen is if you build it into your schedule, check in with my colleagues. And that's what that's what I do every Monday with the buddy check with Purex is nudge people. And it was interesting when I when I first started that program and know it's not quantum physics, it's very simple. It's a buddy system is essentially what it is. And what people said to me is you're helping me do what I intended to do and I always intend to do and I never quite get to, which is kind of the story of our lives as physicians often. And so just that nudge allows people to say, okay, you know, now I have to do it. Because Mark just sent me an email and told me I need to, I need to check in. And they do. And when they do, you know, the stories that I've heard are just phenomenal in terms of just that very thing. People starting to hear stories that they've literally carried with them sometimes for 20, 30 years that have continued to corrode them on the inside. And yet they finally have somebody who is that trusted other who can kind of just stand as a witness. And it's nothing. You tell your story and people say, Wow, I bet that was really hard. It's like, thank you, like validation after all these years. And Dan, I bet you've probably carried some stories as well. We had a quite an amazing residency and yet, you know, we didn't really process some of those things. It was a pretty upbeat residency as well. [00:08:17][232.2] Dr. Dan McCarter: [00:08:17] Yeah, no, I agree. And I think when things have happened, it has there were things even going back to residency. I remember there was fortunately things turned out well, but I remember being put in situations where things could have gone so sideways so badly, so quickly that as a especially as an intern, should have never been placed in those situations. And, you know, I think we all like to tell the war stories. But, you know, I think when we see what happens to veterans coming back from war, even the fact that we use the military analogy is probably a sign that we should be careful what we're getting into. [00:09:04][47.1] Dr Faisel Syed: [00:09:05] There, the importance of just having that time schedule. There's something about having the time scheduled and that expectation that's created. I'm I'm part of a faith like a faith neighborhood faith group. And not every week, but almost most weeks we get together with all different backgrounds. I mean, it's a group of fathers who we meet together to talk just to talk about the challenges of being. A father today compared to even just a generation ago. And I remember in the beginning I had one of our neighbors was pushing for me to come in there and I thought, oh, would this be something that we're okay, We're okay. My goodness. That what happens when it's scheduled and you've got that nudge or that little slight nudge. [00:09:26][21.5] Dr. Mark Greenawald: [00:09:54] It doesn't it doesn't take much. And I think about our conversation that we had yesterday with our first year residents. None of that conversation would have happened had we not designed that and created that space for them. And yet what we talked about was essential. And it was lots of emotion that came out with it. And so, yeah, it's it is it is important. And of course, you know, the challenge that I think we face as physicians and you may have been experience of this even with some men's group is I just don't have time. Right. There's never a time for that. And that's why, you know, even even this idea of saying and I look them all in the eyes yesterday and I said, if you received a text this morning from one of your colleagues that said simply, you got this today, how would you feel about that? Every one of them lit up. It was like, oh, my God, that would have been amazing. And I thought, okay, that's 10 seconds, max. And you can you can light up somebody's day. And so, particularly if it's coming from somebody who knows what you're going through, it makes all the difference in the world. [00:10:56][61.8] Dr. Dan McCarter: [00:10:56] And so how do you. I've heard of other organizations that have done peer support. Ah, coaching. But it's almost a it's almost code for that person's having trouble and we want to fix them. And so how it sounds to me and I know the answer, but I will I ask, do you wait for somebody to get in trouble before you start these groups, or do you start them prophylactically so that when they get in trouble, they're part of that group? [00:11:28][31.7] Dr. Mark Greenawald: [00:11:28] Oh, yeah. And yes, absolutely. Let me just go back to the peer support piece, Dan, because I think that what you're describing, there's two things that you just described in there. One is what I think is is happening in a lot of health systems right now and a lot of other groups that we talk about in terms of peer support. In some cases, they're called like the second victim program or something like that in our own organization. It's called the Trust Team. And what those are peer support when something bad has happened. So, so so it's a reactive process. Something bad happens. We swoop in to say, how are you doing? And the data says that most physicians say, I'm fine. I got this right. And so so the engagement that physicians have around that is is not very high. And part of that, of course, is that we are the we are the care givers, not the care receivers. And it automatically places you at a power differential. So somebody is coming to help me versus a mutual peer support where it's like somedays I'm going to be cheering you on and some days are going to be cheering me on. And if you need professional help. Well, you know, part of my I think my role as a colleague and friend, because I know you well, would be to say, hey, this is bigger than you right now. And being able to then support you as you go along now. The third thing you talked about is this idea of coaching and that gets into a tender spot for me because I have trained as a leadership and executive coach and do that as part of my work and coaching. Even in our organization. 15 years ago, coaching was a disciplinary action. So coaching, as you point out, Dan, was what happened to you as your last chance on the way out the door? And and so it was it was really it was looked upon as very punitive. Whereas you both know, of course, that coaching is something that many people you have to get to a certain level of organization to have the privilege of being able to have a coach who's going to help you accelerate your growth as you go along. And so it's all those extremes now. I do coach, I do coach some people. I'm asked to come in and coach some folks who are struggling. But it's it looks very different because in that case, the intention is to say we want to invest in this person because we believe in them and they've hit they've hit kind of a speedbump right now and we need to help them get over their speed bump and we need somebody to come in and provide them a different perspective. But yes, having developed and you all can probably relate to this in your residence that you likely and Dan and I went through this together. We had a very tight-knit residency group. Yeah. And so we kind of this was kind of natural for us in some ways. And yet I'm not sure that we even talked about those things that we were really struggling with because there's still kind of that posturing. There's still we were all we were all, you know, high achievers and very much striving for excellence. And so showing that weakness was really something that was not that certainly did not come natural for us and really wasn't modeled for us. I think our faculty were uber competent and they were amazing humans. But I can't recall too many times where they talked about when they messed up, which, you know, which is part of we all, we all have and we all know that. And those are the stories you need to be telling all the time. But certainly that provides some important perspective. [00:14:51][202.9] Dr Faisel Syed: [00:14:52] You know, you what you bring up about having it scheduled. This is sticking out to me because in my mind, when I think about peer support and even as we think about, you know, how can we help our doctors, there's got to be something that initiates it with the doctor. You know, you've got a doctor that's no longer engaged, maybe looking disheveled, maybe have some signs of unhealthy coping strategies with something going on in life, and then that will trigger a conversation. And it feels like, you know, because you need buy in from the doctor as well. This idea of having it regularly scheduled suddenly, I don't know if this is this is interesting, Dr. Dan. I mean, I'm trying to I'm you know, I'm hearing him speak. And at first when I thought, know how we can how could you how could you make the time for this? But now, as I'm hearing him speak with, this needs to be part of our regular weekly. We have regular calls on patients admitted in the hospital. Why can we not have a regular time for at least the doctors that are center to come together now, have you extended outside of the of the physicians with nurses and some of the support staff? [00:16:06][73.6] Dr. Mark Greenawald: [00:16:06] So we have folks who are involved in the program. Yeah, it's called Purex Med. And that was the obvious initial focus. But we have folks, we have certainly have advance care providers who are part of it. I have health care administrators who are part of it, nurses who are part of it, folks who are crossing over disciplines, if you will, like a pharm.d matched up with a physician or we have one of our one of our Ph.D. psychologists is matched up with one of our former residents here. So they're there, folks. And there's a lot there's a lot I don't know because I don't track those. You know, these are people who pair up themselves. And what one of the things that so when I envision this and I'm a family doc so I'm very practically minded and really want to keep things as simple as possible and thought about the model for this was the really though I came out of the military as part of my background. The model was the YMCA swimming program, which I grew up in. And you know, in the if you all, if you're familiar with the model at all, essentially you never go swimming without a body. And periodically they blow the lifeguard blows the whistle and says, Buddy, check. And you have to go to the side of the pool and you have to hold your hand up with your buddies hand to show. And they kind of go around and count, make sure everybody's okay. And so the premise was essentially to say, as we travel on this journey, are we checking in with each other to truly make sure that we're okay and normalizing that So it's not I'm going to check in with you because you're disheveled. Because you've been. [00:17:38][91.6] Dr Faisel Syed: [00:17:38] Yeah. [00:17:38][0.0] Dr. Mark Greenawald: [00:17:39] I'm just going to check in with you because that's what we do here. That's part of our culture. And so this it's applicable to everybody. We have medical students doing it. And, you know, so it really, though my blog is focused on physicians, then the blog topics are universal. It. Folks are doing it. And the other piece about it that's so nice is it's not dependent on a system. Like you can you can do this. You know, my organization, Curling Clinic, hasn't embraced this as an organization. Our department has certainly encouraged it more than our other departments. But it doesn't matter because you're not it's totally not dependent on that. So the other piece is when I designed it, so I was a little tongue-in-cheek. But the process I call PR x 90 a little bit, PR x 90, basically. Exactly. But PUREX 90 basically says that in as little as 90 seconds, once a week, you can check in with your body like literally a text, a quick phone call, whatever, whatever you do. And that's all it takes. You got this today. So, for example, one of my buddies knew I was doing this podcast today. I got a text right before we came on here that said, Hashtag, you got this. So so it's those little things that that again, we're human and we know those things can be uplifts for us. So pure x 1990 seconds, once a week in as little as 92nd, 90 seconds, once a week, and then every 90 days. 90 minutes and that's the quarterly check in to say let's get together for a longer period of time. And I and I prompt folks with questions around that to say, you know, you check in, do your regular check in, but set some goals, ask some questions to each other, something as important as what he's struggling with. When's your next vacation? Right. Because we have we physicians. You know, that's we don't do that well. And we have some partners here who literally haven't taken vacation in over a year. And this is it's like that's just not that's just not okay. And so having somebody who's asking you those questions and and and other questions as well, we have folks who have set specific goals that they have somebody then who can hold them accountable for that, you know, accountability, encouragement, all those things that we know are important. Many of us do that. Likely your men's group does a little bit of that in terms of when you all meet, but we don't do it as much professionally, you know, And yet and yet, you know, we all have professional goals that we're we're striving for who is cheering us on around those. And so that's it's all those things that really to me helps redefine what collegiality can look like. And I do think that was modeled for me during residency because one thing I saw with my faculty was I think they were all friends. Yeah, they enjoyed each other's company beyond just being parallel private corporations. Yeah, I think happens in many organizations. So, yes, I think about this. I think about you all. I've I've, I've become a student of Chen Med in many ways. And that's a that's a whole other story. But you all are building delivered culture. Yeah. And I love that. And I'm a big fan of that. I've written an article about that very thing about creating a culture by design. And, and so this would be something very simple to incorporate into that culture that says part of what we do is we check in with each other, not just theoretically is a good and kind feeling, but literally it's scheduled and we check in with it. Be fabulous. [00:21:15][215.9] Dr Faisel Syed: [00:21:16] And so what could away to the patients if we don't take care of our doctors first, for God's sakes, and especially now. Dr. Dan, what's the statistics now with physician burnout in America? Is is it like 60% of doctors, 70% experience something? It's a very high number. [00:21:32][16.4] Dr. Dan McCarter: [00:21:33] When you have an expert with us. I'm not hazard a guess. So Mark is the one to answer that question. [00:21:38][5.8] Dr. Mark Greenawald: [00:21:39] Medscape literally just this week came out with their 2023, I think it was called this year Burnout and Depression Survey. Now, of course, they spread it out across disciplines, but the highest was at 65%, which is it's the usual suspects in many ways emergency medicine. This year, I think it was infectious disease. Interestingly, the lowest group is is still public health, which was shocking to me this year, though. They went up by about ten percentage points over last year. And so, yeah, it's but when you look at the mean across all of them were in the mid-fifties most likely and that's that's consistent across a lot of different groups and it's interesting I'm actually giving a talk next week for a group of farm these and so I've done some research on our Pharm.d colleagues and their rates are even higher which just stunned me just absolutely stunned me So so yeah it's and you know, when you think about that data, I think we're so we're we've heard that so much that it's almost like we're numb to it like yeah it's about 50% right now and it's you know I, I picture sometimes when I'm working with some health care leaders, they're kind of they're kind of sizing that up and saying, yeah, 50% sounds about right. Like, like it's just like, that's okay, you know? And what I, what I try to help people understand is if you truly if you truly comprehended that 50% of your workforce is emotionally impaired. Yeah. In health care, you shouldn't as a health care executive, you shouldn't sleep at night until you have a plan to try to address that. And yet it's happening every night. And, you know, and what we know about that is that the conversation has almost become so that we've almost become numb to it. And what I've started to do more and more is frame it as a quality and safety issue, and then you're going to start getting people's attention in a very different way than poor doctors. You know, it's hard for people to pity doctors. [00:23:34][114.7] Dr. Dan McCarter: [00:23:34] I don't remember the exact statistic, but I have heard that you reach a certain level of burnout. It's like almost being under the influence of of drugs, of alcohol or some other drug. And so, you know, if we said that 50% of our workforce was coming to work every day, you know, they were stopping to have four or five beers in the morning before they showed up at work. I think we would all be concerned with that. But yet, you know. [00:24:02][27.4] Dr. Mark Greenawald: [00:24:02] We're airline pilots, right? I mean, if it was airline pilots, there'd be congressional hearings. People would be pounding their fists demanding that something be done. And yet neurosurgeons are going. Into the O.R. right now and operating on people's brains. And half of them are likely emotionally impaired in some way. [00:24:18][15.6] Dr. Dan McCarter: [00:24:18] So when you're talking about the PeerRx and you're looking at doing it as an organization or a group with a large practice, do you think it's better for people in the group together to be peer are partners, or is it better for them? I'm thinking I was just we were at the VA RFP meeting last week and I was talking to a group of former residents from UVA that, you know, that's the cool thing about having that interaction over time. And they were talking about how they have a text group and they're probably five, six, seven years out of residency now, but they still text each other with complicated patients to get a curbside consult. And I was just wondering what your thought if if your residents develop their PR partners there, do they continue with them or do they add more or do you see how do you think people should do that? [00:25:16][57.7] Dr. Mark Greenawald: [00:25:16] Yeah, no rules. I have three folks who I who regularly am in touch with. And they really are three colleagues. Three colleagues. Not all of them are here. One of them is in Minnesota. And we're all speaking into different aspects of our professional lives in many ways because there were a lot of different hats. But one of them excuse me, two of them are here because they know what's going on right here. And I need that. So to answer your question, Dan, the. Yes, more than one is great. Do you need to have it in the organization? Maybe some organizations who have embraced this more as an organization that the challenges that they've gotten into have been assigning them. Like, you know, it's when you talk about something like this again, you think about the vulnerability it takes to share some of the things even that we've talked about right now. Having somebody who's a veritable stranger is likely not going to be the way you're going to tell that soil that you're going to need somebody who you've developed rapport with for whatever reason, you're drawn to them because you have some kind of things in common. You're this the same age you trained in the same region, whatever those things are. But having that as an inroad versus just kind of somebody who's a stranger in some programs, I've tried to do it kind of a mentoring process. You know, a senior with a junior mentoring process is are great. I'm a huge fan. That's not what this is like. This is a peer who you're you're traveling the journey with or peers. The other thing that I've seen happen is is folks, it's almost like the men's group that you have Faisel. So, if you're men's group, then kind of paired up or tripled up and you had kind of micro-groups who then came together, so you had a group of two or three who then you guys would go off and talk about some even deeper stuff and then come back and regather with a bigger group. That that's the way it really when it works in really healthy way, that's the way it really works. Well. And, you know, so from a leadership perspective for you all thinking about how do we normalize this whole idea of peer connection, period, you know, and if they want to if they want to peer connect with their residency classmates or their medical school classmates, as long as you know they've got somebody who they're checking in with, that should be the most reassuring thing from a leadership perspective. [00:27:44][148.0] Dr Faisel Syed: [00:27:44] Yeah, you know, to make it work. And, you know, we you know, we work within the full risk model. So it is a relationship-based model. You have the PCP is are intimately in, you know, leading teams. They're intimately working with each other, actually. But right before I jumped on on this, I had a PCP just they sent me a text that she knew what to do with shoulder a steroid injection in the shoulder. She said, well, those calcified tend to notice this is that the ratio she was just wanted to make sure the ratio you know, it was a simple stupid question. And I say it's not a stupid question, you know. Yeah, sure. You know, you already knew what to do. And she replied back with so appreciative. Yup. [00:28:12][27.7] Dr. Mark Greenawald: [00:28:31] That's culture right there. [00:28:32][0.9] Dr Faisel Syed: [00:28:32] It's a culture, but within the transactional model in a AMA and the models outside, you know, I see it with the direct primary care doctors who aren't concerned with all of that, you know, that they're just focused on the relationship. Right. But for most doctors who are still in that, hey, I've got this productivity, I've got to see so many patients every day. The role of the doctor, like you said, people don't feel bad for the primary care doctor. The doctor doesn't have very little control over the schedule. Patients are just kind of put. To create that type of intentionality in a model that has become even more transactional. Even the culture of medicine is in that system has become transactional. I don't know how we could create a buy-in. Accept what you said that, hey, actually this is dangerous for patients. [00:29:22][49.4] Dr. Mark Greenawald: [00:29:23] Yeah. Now you're talking buy-in from the physician. [00:29:25][2.5] Dr Faisel Syed: [00:29:26] The administrators. [00:29:26][0.1] Dr. Mark Greenawald: [00:29:28] Oh, absolutely. The buying from administrators is is happy. Doctors are going to make much more in much more. You know, in even in the transactional model. I live in that. So I live in that world. You know, most of my own conversation is our view, our view driven, not all of it, but even in that model, their quality metrics, you know, there's there's PE for PE work. There are reasons why there's there's patient satisfaction scores, there's all those things. So there are reasons why it should be very important for administrators to do that. Oh, and by the way, there's also trying to recruit for new physicians when you lose one because you've treated them like they're replaceable part of and that we know there's an economic cost to that and that economic cost is substantial. And so there's a lot of compelling reasons why you would want to make sure that your team is a very happy, highly functioning, well-oiled team is really you know, there's it's it's it's I think it is a mistake for any health care administrator, health care leader to think that any of their teammates in 2023 is an interchangeable part. Hmm. And that's that's thinking that all health care teams are created equal. And again, you know, the analogy I would give is when you're heading into the O.R. as a patient for surgery, do you want to know that that team has worked together before? Gosh darn right. And you want to know that they actually like each other. You're darn right. Well, why would we want it to be any different for the people who we care for? Right. Right. Neighbors who could be our own family members. [00:31:03][94.4] Dr Faisel Syed: [00:31:03] Thank you so much, Dr. Greenwald. What a great conversation. [00:31:06][2.2] Dr. Mark Greenawald: [00:31:07] Well, I sure enjoyed it. It's nice to meet you. And Dan, it's always great to see you as well. What a gift. [00:31:11][4.3] Dr. Dan McCarter: [00:31:11] Yeah, absolutely. No, this is this is great. And thank you for doing this. You're right. I think, you know, I think back on during residency and we had some of the great mentors and, you know, but I think there was still the feeling that you didn't talk about there were certain things you didn't talk about. And when bad things happened, you didn't talk about those. And I think I think we do our colleagues a favor when we share when things don't go well, because they don't go well for everybody sometimes. [00:31:46][34.5] Dr. Mark Greenawald: [00:31:47] Totally agree. Because we know it happens. Well, guys, thank you so much. [00:31:49][2.6] Dr Faisel Syed: [00:31:50] What are your thoughts on caring for colleagues? The power of the peer. You've heard ours. Now we want to hear yours. Let's start a conversation. Head over to chenmed.com/podcast-connect and send us your thoughts. If there's a certain topic you want to hear about on this podcast, let us know. [00:32:05][15.5] Dr. Dan McCarter: [00:32:06] If you like this episode. Leave us a review and tell us how we're doing. And don't forget to subscribe wherever you listen to podcasts so you never miss an episode. [00:32:14][8.4] Dr Faisel Syed: [00:32:15] I'm Dr. Faisel. [00:32:15][0.6] Dr. Dan McCarter: [00:32:16] And I'm Dr. Dan. [00:32:17][0.6] Dr Faisel Syed: [00:32:17] And we'll see you again next week. This podcast is brought to you by ChenMed and produced by SplitPrism Productions. [00:32:17][0.0] [1848.3]