Stephanie Streit is a trauma surgeon at University Medical Center in Las Vegas. She went to med school at the University of Cincinnati and did a general surgery residency at MUSC. She is currently active duty in the Air Force. She is also the host of the Breaking Scrub Podcast, where she interviews surgeons about the interesting things we do outside of the operating room. She is convinced that success outside of the OR breeds success in the OR. Did you hear that, med student? Stop tying knots and pick up your clarinet!
We start out talking about some of the more routine and mundane parts of being a trauma surgeon. We then discuss something I didn’t quite expect: how important it is to her to address the mental trauma, not just the physical trauma, in her patients. We then discuss the beginning of a trauma assessment, which is CAB, not ABC and how stopping a life-threatening hemorrhage is likely the only thing you can do if you find yourself at the scene of a trauma. Hold pressure and stop the bleeding! We close with discussing why we podcast and her biggest takeaway from her show.
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Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.Stephanie straight is a trauma surgeon at the University Medical Center in Las Vegas. She went to med school at the University of Cincinnati and did a general surgery residency at USC. She is currently active duty in the Air Force. She’s also the host of the breaking scrub podcast where she interviews surgeons about the interesting things that we do outside of the operating room. She’s convinced that success outside of the or breeds success in the or did you hear that med students stop tying knots and pick up your clarinet, we start talking about some of the more routine and mundane parts of being a trauma surgeon. We then discuss something I didn’t quite expect, how important it is to her to address the mental trauma, not just the physical trauma and her patients. We then discuss the beginning of a trauma assessment, which is c a b, apparently not ABC. And how stopping a life threatening hemorrhage is likely the only thing that you can do if you’re finding yourself at the scene of a trauma. So hold pressure and stop that bleeding. We close with discussing Why we podcast and her biggest takeaway from her show?Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.And now, here’s Dr. Bradley Block.This episode is brought to you by Orange County, bookkeepers, healthcare, accounting, and all in one accounting firm for small healthcare businesses and private medical practices. One thing that I personally love about OCB accountants is that they are quickbook professionals with over 20 years experience focusing specific Typically on health care, the utilize a tailored approach individualized to your needs. There are a full service bookkeeping firm specializing in accounting, payroll taxes and financial planning. And for our listeners for limited time, they’re offering 25% off their services for the first three months. You can visit them at OCB med.com. That’s OCB m Ed, or call at 833-671-3873 or 949215 6200. And check out the show notes for more information. Dr. Stephanie stripe. Thanks so much for being on the podcast.Yeah, thanks for having me.So if you had a medical student who was considering going into trauma surgery,what is it that you’d want them to know before choosing the field that isn’t readily apparent during the rotation? So you got you got your third year student, they love the rotation. They’re like, Oh, torture, shredding. Definitely. I definitely To be a trauma surgeon like you, and you had to sit down with them, what were some of the things would be some of the things that you would tell them that maybe they weren’t, wouldn’t be privy to?Yeah, you know, this is happening more and more and it for some reason, It surprises me still that I get these young people who and even I’ve mentored high school students who want to be trauma surgeons, and I didn’t even know what a trauma surgeon was when I was in high school and college.Yeah, er isn’t on TV anymore,is exposure. And even most of them it was only Eric was out. It was a surgeon and all the other ones were doctors. I didn’t get that when I was in junior high either. But no. So, you know, a lot of young people will get excited by the pace or the adrenaline or they’ll have you know, one really intense interaction. Maybe somebody comes in really sick after a car crash or they’ve gotten shot and they students experiences really intense interactions, and wow, I really want that But maybe what they don’t see is the what we’re doing when that’s not happening. A lot of trauma care is not exciting. It’s following up on CT scans and doing wound care. And, you know, a lot of times it’s telling people that they’re going to be fine, because they’re not injured. And you have to be happy with those things, too. You have to be sustained by the boring stuff. And you can’t just rely on the adrenaline rush, because it’s really actually depending on where you work, it may be really few and far between how doesthe well then they can fill their time by getting active on the blogosphere, they can share they could get involved in real estate investing or something like that. Like we’re, you know, we’re seeing a lot of that out there. Well, first you said, you know, you see some patients that are fine, how I would think that those wouldn’t end up in front of you like what are the patients our the patients that are fine, ending up being evaluated on it? trauma surgeon if they’re fine?Well, you know, it really depends on what kind of center you work in and what kind of trauma system you’re in, that most trauma centers are dictated by some variation of the CDC guidelines on what’s called pre hospital trauma field triage criteria. So those are CDC recommendations for who should be taken to a trauma center that doesn’t necessarily say who should be a trauma activation, meaning the trauma surgeon is there when they get there. But every center and every system is a little bit different on how it actually brings the trauma surgeon to the ER how and when or for whom I should say the trauma surgeon is brought into the emergency department for when the patient arrives, there’s a degree of what’s called over triage in every system, which means that it’s basically Better safe than sorry, that you would rather over call your trauma surgeon than under call your trauma surgeon. So there’s always a person percentage of people who end up you know getting a full evaluation and going home at the end of the day because even though things look bad on the scene, you know, by mechanism, maybe it was the car was dented by more than 18 inches in the passenger compartment for example, which is a can be a marker for somebody being injured, but in modern day vehicles, that’s often just a reflection of how the materials are meant to crumble and is not actually and people are actually quite safe. So those those triage mechanisms are meant to be better safe than sorry, got it.You were kind of getting into that. And this is something we spoke about on your show, which was finding joy in the routine. So you said you know the routine stuff for minefield it would be like ear wax and that’s what we discussed. Like I just didn’t I enjoy it. much I enjoy removing it but like I have, you know, these recurring patients where it’s like low stress situation, how you doing, talking about your family, I’m kind of like a barber it’s, you know, if I find out join it. So, first, you mentioned a couple. But could you elaborate more on on some of the more routine things and then go into some of those routine things that you manage to find the joy in that on the outside look kind of boring?Sure. So you know, blunt trauma is most of what we do. So that’s people who get into car crashes or motorcycle crashes or they fall. And they often have relatively low energy injuries. And the ones that bring them into the hospital most often would be things like having broken ribs, and there’s a lot of anxiety associated with broken ribs because it’s your breathing. And if you if it hurts, every time you breathe, a lot of people will become very anxious about that. And they can get into this kind of mental spiral. And, you know, and then they’re coughing and then they’re not using good respiratory mechanisms, and then they’re actually ending up in a more morbid Not that’s not the right word. But they they can end up in a being a little sicker than they necessarily were to begin with because they become so anxious and so fixated almost on their breathing and on their on the injury. So part of what I tried to find comfort in or not comfort but I find joy in is coaching people on the experience of discomfort, fulfillment, I think you find your mean you find fulfillment in this Yeah, that’s that’s a better word for it. I when I can coach people through the discomfort and have them be more be you know, just breathe easier, literally, and figuratively breathe easier on the other end of it. That’s a really common thing that I didn’t think that I would find fulfillment in but I dowonder the difference between your field Mine is, you know, I’ve ongoing relationships with a lot of my patients. And, and you don’t. And so when you choosing the field, I would think that that’s something that you kind of actively decide is less of a priority, right? Like is is the doctor patient relationship yet somehow you’ve managed to make that an important part of your, your practice. Like that’s something that’s that’s become important to you that you find fulfillment is that is that interaction?Oh for sure. It’s definitely different than what you have where I don’t see people over and over again. Well, hopefully I don’t see people over and over again. And so maybe don’t necessarily get to know their families or follow their kids sports, like you might get to but the intensity of the situation definitely creates an opportunity for a really meaningful patient interaction, just the samereal human connection. Mm hmm.And it can be really hard, you know, a lot of patients, probably one of the things that I hear You know, really, really often that is frustrating to me. And almost hurtful is how often patients say, well, you don’t understand. And it’s no matter how hard I try, no matter how long I sit and try and listen, the intensity of the situation really is isolating to patients in a way that’s very unique and very personal. And so I can’t possibly understand I don’t know what their what it is that they’re losing out by being in a hospital bed. I don’t know, their financial situation or their family situation that’s being harmed by them being in a hospital bed and not being at work or being in school or whatever it is. But it’s, I still find that very motivating, to try to try to understand,well, you’re you’re highly trained for the physical trauma, but you’re also managing to treat the simultaneous mental traumayou know, I try but that’s something Our whole system just really doesn’t do a good job of, we’re just now starting to recognize the long term psychological consequences of physical trauma. More somewhere between Some studies have said, you know, 20, and up to 60% of patients will have symptoms of either depression or PTSD or both at six months after a significant trauma. And our system just is not good not capable of absorbing that right now. But the first step is is acknowledging that it’s happening. And and that starts with the immediate post trauma care while they’re still in the hospital.Yeah, it seems like a great opportunity to even you know, once they’ve had time to process the whole situation to inform them that this is a possible outcome that they need to be aware, so that rather than you know that they they see it happening to them.And I, you know, that’s a conversation that I have in clinic and follow up a lot. And sometimes even just acknowledging it is a huge relief to patients when even just saying it out loud and saying it’s okay. And this is normal. Sometimes that’s enough to take a little bit of the burden off in the short term while they can while they’re still recovering. But we definitely saw a lot of work to do as a as a system.Oh, I’m sure I’m sure they think they’re going through going mad. You know, they’re they’re falling apart at the seams and, and this is they don’t know where it’s coming from. And yeah,yeah, they feel weak. They feel like they did something wrong and they feel like, you know, other people don’t feel this way. It’s incredibly isolating, especially when you end up you know, relatively homebound or missing your work or your school or whatever your routine is. And they definitely get into a spiral and sometimes just Now alleging the spiral is enough to at least slow it down, if not break it.This conversation with a trauma surgeon is definitely not going in the direction that I thought it was. But But still, it’s, you know, extremely interesting, extremely informative. So but let’s get let’s get back on the path of the of the physical trauma. So, let’s say you get called to evaluate a patient and you’re the second physician to see this patient. So, you know, it’s still still I’m not so clear on the pathway of who gets seen by the ER doctor and who gets seen by a trauma surgeon. But let’s say for whatever situation, either the ER doctor and internist, maybe in a resident that’s rotating on your service, either way, you are the second physician to see this patient. What do you hope has already been done and I know I haven’t given you any information about what the trauma was. But that’s kind of what I’m looking for is like, you know, ABCs the ABCs of traumaWhat I was going to say, I hope somebody already did the ABCs Yeah, depends on depends on the situation because if somebody has already seen them before me, then the chances are they’re not as sick. But yeah, I hope somebody has done the ABCs and somebody got an IV and Okay,come on, you’re stuck in the elevator just like help me out with this scenario here. Right? You’re you’re running down seven flights of stairs because the elevators broken and there’s already another doctor there. What are you hoping this doctor has already done by airway, breathing circulation, so thatbreathing circulation so in in trauma, you know, a lot of people will put it as Civ especially for penetrating trauma. You know, so if there’s uncontrolled bleeding, I hope somebody put some pressure on it or put a tourniquet on it. If it’s an extremityand don’t do that nosebleed please.My neck, you know,we cut off the circuit Quarterstopped, we stopped,can’t get the start at two been in the immediate care for trauma, you’re looking at the things that can kill you right away. So those are your tension pneumothorax, your cardiac champ, an odd traumatic brain injury related respiratory failure, and then uncontrolled hemorrhage. Those are your immediate life threatening things that I that are always on the top of my list whenever someone comes in to make sure that they’re not present. So I hope that somebody is doing that for me.And then and then what happens from there. So so you’re going to control a hemorrhage, you’re going to make sure that there’s not some immediate like life threatening injury, like tension pneumothorax, cardiac term temper nod or they’re going to herniate their brainstem potentially and stop breathing. And then and then what happens from there with regards to the assessment,so depends on in general, we’re following what’s the American College of Surgeons advanced trauma, life support and so on. After you do your primary survey where you’re looking at airway, breathing, circulation, disability and exposure, then you’re looking, you’re using things like chest x rays and fast exams, which is an ultrasound to the abdomen and the heart and the lungs. And, again, looking for those immediately life threatening things. And if those aren’t present, then you moving on to your secondary survey, and you’re creating a plan to finish your assessment. So in most cases, if people don’t have an immediate life threatening thing, they don’t need to go to the operating room right away. Most patients are going to end up in the cat scanner.So we’re going to change the scenario a little bit. So one thing that I like to cover on this podcast is, is how to be a good referring doctor. So if I’m interviewing a specialist, what is it that you want your referring doctors to know so that they can do something before they refer to you or stop referring you this type of patient or something like that, but I would imagine you don’t really have referring doctors right now. You know, that they’re just that’s not helpful. end up in your travel bag. So on the other hand, right. The other thing that I like to cover is what every doctor should know about your specialty because we’re all doctors, right? And so there’s a certain expectation of what we’re going to know. And so, you know, I had spoken to an ER physician about a cardiac arrest. How do we handle that? If we’re a pathologist, who knows what cardiac tissue looks like, under a microscope, but right, they don’t know how to deal with cardiac arrest. so in this situation, we’re gonna make it more of a trauma situation. I’m out for a walk with my family, right. And I see a car Korean into a tree. So I run up to see how the drivers doing. And everybody’s looking at me and expecting me to know exactly what to do. If you could walk us through a trauma assessment where you don’t have access to your cat scanner where you don’t have access to maybe a syringe to to emergently drain cardiac temping odd if I if that’s actually you know how you do it or put it another way Let’s say I’m in Iraq. I like to choose other specialties, right? So put another way, I’m a neurologist that happens to be a bystander at the trauma. But I’ve left my reflex hammer and tuning fork at home.But everybody’s looking at me to do something because I’m a doctor. Sure.So I would say, first of all, your pre hospital providers are your best friends. So first thing is just call 911. You can’t you really can’t do a whole lot without your tuning fork. So if the things you can do on scene after trauma would be to assess for life threatening bleeding elbow, I’m sure a lot of people have heard of stop the bleed, which is a campaign that was started by the American College of Surgeons along with the joint trauma system and the pre hospital organizations to teach bystanders how to be lifesavers when it comes to life threatening bleeding. So I think any physician should be able to look for and assess for life threatening bleeding and then try to stop it. I carry attorney Get with me almost all the time, but I don’t expect everybody else to. So just doing things like holding pressure to an area that’s bleeding to try to slow it down until pre hospital providers get there. Did you use something like a belt? You know, we don’t really recommend that people try to improvise tourniquets mostly because while you’re trying to improvise the tourniquet, there’s still bleeding. And the majority of bleeds can be stopped with direct pressure or with packing a wound with something like a you know, clean t shirt. Most bleeding is going to be venous so you can overcome the pressure in the venous system, just with direct pressure most of the time.Sorry, while we’re on the topic of tourniquet, I think it just bears mentioning for my specialty that you can’t turn a kit a nosebleed so a lot of people when they’re trying to stop a nosebleed will put the pressure over the nasal bones. Mm hmm. Thinking that that’s where the blood supply comes from. Mm hmm. That is not where the blood supply comes from. The blood supply comes from underneath the septum. It comes from behind the septum. It does not come from the the skin or the nasal bones, you’re not creating a tourniquet effect by doing that, you’re just waiting for the blood to clot. So if you are going to stop a nosebleed, you pinch the nostrils shut. That’s it because the vast majority nosebleeds are from the anterior septum. And you put pressure on the ampere septum by pinching the nostril shut. So sorry, I thought you mentioned the tourniquet and applying pressure, so I just wanted to put that little PSA in there. Okay. Sorry. Okay. So, so, so don’t go looking to improvise a tourniquet your bandana? Whatever, just put pressure on it.How muchOkay, so that but you said it’s not ABCs? Right? It’s si si a bea lot of time, man. It’s me. Okay, because, you know, in the majority of preventable deaths from trauma is from hemorrhage. So if you can find external hemorrhage or an external source of hemorrhage and slow it down or stop it. That’s the most The way that you can be most impactful, got it.Okay. And then you can even task somebody with doing that, once you’ve identified it, put them on it, and then you can go over to the airway.Yeah. And you know, because there’s not a whole lot you can do without your trusty oxygen tank, they you carry around. So there’s not a whole lot in the pre hospital setting that a doctor can do, apart from try to do like a jaw thrust, because in general, we don’t, you know, and when people are in a significant trauma to the point that they have an airway problem, we also worry about their spine. Yeah, so you don’t want to move them around a whole lot. Or for example, put them in a position of comfort or recovery position, which is typically kind of on their side towards almost towards a fetal position.Although you don’t want them to swallow their tongue turn them on their side. Yeah, not not a good idea.Right. So that’s where the pretty much the only thing you can do pre hospital before your MS folks arrive is to do something like a job for us to keep their their fair is open if their mental status is altered, otherwise, you know, the majority of people will breathe, it will be breathing just fine on their own.They’re awake, just stop their bleeding. So that remain awake. Yep. Okay, and then just wait for 911 I think that’s, that’s something that separates physicians from from lay people in situations like this is we kind of understand when we’re at the limits of what can be done, like, you know, someone else might be running around. I don’t know, what else can we do? What else can we do? What else can we do? The doctor you know, we know this is it. This is what we can do. We just have to wait. And then you know, wait for em is too common?Yeah, I’ve you know, I’ve stopped it car crashes and motorcycle crashes and even as a trauma surgeon, apart from I literally will come to the scene with my tourniquet in my pocket and assess for life threatening bleeding and somebody’s bleeding. No. bleeding. Are you bleeding to death? No. We’ll wait. We’ll wait for the ambulance. See at the hospital.Yeah, just picking up the shift right now. So let me reach it. I’ll be better if I just get back in my car. Exactly. Right. He there.Exactly right.Okay, so is there anything else about trauma surgery? Knowing that this is a primarily physician audience, maybe some trainees that that you want to tell us?Um, you know, it’s a really it’s a changing fieldchanging Really?Yeah, that you know, there are more and more women in the field.More and more people are getting involved in advocacy and public health and are really trying to be a part of injury prevention solutions. So in the same ways that cars were made safer through research and advocacy in the 50s and 60s that, you know, has drastically brought down the rate of injury and death due to Road Traffic incidences. physicians are just are trying to do the same sorts of things when it comes to violence, interpersonal violence, gun injuries, especially when it comes to children. And also things like elderly falls, which is the fastest growing mechanism for trauma. activation these days is elderly people who fall so a lot of your trauma surgeons are out there trying to come up with solutions to make your community safer. Not just the not just the Cowboys slinging scalpels in the emergency room.Yeah, the social determinants of health, the things that are more likely that you will be the person that ends up in, in the trauma bay is something that that will have a far more powerful effect on the outcomes of the population, you know, minimizing how social determinants of health can affect outcomes, I guess, will have an outsized influence to, you know, our ability to suture,right. And so, you know, ultimately we’re trying to put ourselves out of business through, you know, public health mechanisms. Yeah, another,you’re not likely to happen anytime soon.Well, but you know, you say that, but in Europe, for example, trauma surgeons are orthopedic surgeons, because the vast majority of trauma there is falls in Road Traffic incidents. And so the majority of injuries are orthopedic interesting, whereas in America, they have always been general surgeons because there’s an outsized proportion of interpersonal violence that needs immediate, you know, life saving intervention within the first hour of injury that is in the chest or abdomen or the peripheral vasculature. That’s why general that’s why general surgeons are trauma surgeons in the United States. So there’s examples across the globe of how, how we can do better how we can do better. Yeah, good way to put it.See, I thought in Europe, they were they were all the surgeons were barbers, because they were the only ones with the sharp instrumentsback in the day. Yes. But yeah, the trauma surgeons are the orthopods. Interesting.So taking a little turn away from trauma surgery. I know you’re not No longer doing the podcast, but I loved it while it was around. And is there anything that you would like to mention that you learned from doing your podcast about medicine? from some of your guests? your podcast wasn’t about medicine, right? It was outside the operating room. It was all about what we do outside the operating room. So one or two highlights of your favorite interviews and you know, it doesn’t have to be mine.I did learn a lot andI think theI think I needed the podcast more than any listener did. Because that helps me to remember that we’re all just human beings trying to do our best and what your best is, and my best is and somebody else’s best is not the same thing. So you know, one of my guests was a woman who, I mean, she just had it all and did it all and she had the the world’s greatest A CV, that every you know, college kid who wants to be a doctor would just dream of.She hated it,and was miserable and almost quit before she, you know, took a step back and found different ways to look at her life and what she wanted and how she was going to get there. And, you know, she’s still a very intense, very driven, very motivated person, but it was through having an executive coach and then becoming an executive coach that she was able to just put a different lens on her path and her motivation and what she ultimately wanted to get out of life. And it was enlightening for me to see somebody. You know, when we, when we think about, we see stories of people who change careers or who change who burned out, you know, terminal a burnout. You know, we think of people who like run off and be Yogi’s or run a smoothie shop or something. We don’t think of people who burn out and come back. And she burned out and came back even stronger in a way that was really, really motivating, really powerful to me. And she also reframed burnout for me a little bit in a way that I guess kind of unburden me a little bit of my own guilt, about, you know, the days when it’s hard to get going. So that was probably the thing that, that I was most impactful for me about doing the podcast. And like I said, I think I think I sought out the guests that I needed more than what anybody who might have been listening needed.Doesn’t this is this is you’re basically saying my podcast right here, which is I just, I have questions. I would like them answered. And I figured if I’m interested in finding these answers than others, People are interested in finding these answers, but it’s still all about me. Soone has to be right. Because, you know, like, people don’t realize how much work this is, you know, you’ve got a wife and three kids and it’s nine o’clock at night. And here you are, you know, talking to a relative stranger on the other side of the country. It’s, it’s work, it’s fun work, but it’s work and it takes time. And so you have to get something out of it too.But I think to what you were saying about the the burnout and and how you got something out of it. I think it’s it’s important to have these haven’t cultivate these outside interests. You know, I when I joined my practice, I was, I guess, 3332. And this was after that same training, the rest of us do, right, I went to college. I took a year off in between, I went to medical school, I did my residency. So every four or five years, you were onto something different. Mm hmm. I was hired. I got My job, had my exam rooms, and I looked at my exam rooms. And I said, Okay, so this is where I’m going to be for the next 38 years. Hmm.And isn’t that horrifying,like doing the same things over and over. And so you need to have those, those those other things. And you need to be able to evolve in your in your job, right, you need to be able to keep improving to know like, you know, keep going to conferences, keep reading, keep learning so that you can keep evolving. And it’s not the same thing. Because the way that I’m treating sinus infections now might not be the way that I’m treating them. 10 years from now, the way I’m doing sinus surgery now, there’s probably not going to be them doing sinus surgery 10 years from now, so you know, so improving your craft in this way. But also you got to have that outside stuff. You got to have the outside stuff. So you’re not just grinding and grinding and grinding and grinding and grinding. So there’s like a different, something just completely takes you out of that. And that’s that’s what it sounds like that’s what it was for you and that’s what it was. That’s what it is for me.You know, and the, you know, the thing that my guests said the most, which, you know, I still kind of hold on to is that whatever it was that they were doing outside of the operating room, it made them a better doctor. Yeah. So, you know, we go through all that training and you know, I spent 11 years after college, and every single day, it was all about the patients, and it was all about the patients. And if it ever wasn’t about the patients, then you were wrong. And it’s got to be about the patient.terrible person. Yeah.Right. And you know, and then you lose what precious hours of sleep you might get, because you didn’t make it about the patients and it still is. But so many people acknowledged over and over and over again, that whatever they were doing made it easier to show up the next day refreshed or invigorated or whatever you want to call it, and able to make it about the patients because if you’re miserable, and all you’re thinking about is how you don’t want to be there then that can’t be about the patients either.Yeah, the facts are wrong. Absolutely for sure. so wonderful. Well, I do miss your podcast. I hope you I hope you do manage to find find a way back to it but if you don’t know, I’m glad you’re finding the reason that you’re not doing it is because you don’t need it anymore. Because you found if you’re finding joy in other things in other ways like like hockeyabsolutely that’s that’s where my my extra time goes now is being the world’s greatest amateur 36 year old female hockey player.Fantastic and I love the that you drop that Slap Shot reference in our conversation before the show. What incredible movie incredible movie if you’re listening to you haven’t, and you’ve never seen it Paul Newman, the Hanson brothers.Classic, most beautiful man to ever live Paul Newman.Well, Dr. Stephanie strike. This has been a long time coming. I’m glad we were finally able to do this and it’s been a lot of fun.Thanks, Brad. Appreciate it.That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm or wherever you get your podcasts. If you have a question for previous guests or have an idea for a future episode, send a comment on the webpage. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.Transcribed by https://otter.ai