Adopting Telemedicine in your practice in the COVID19 era with Dr. Sogol Pahlavan

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Hi docs. Welcome to the Entre MD podcast where it is all about helping amazing physicians just like you, embrace entrepreneurship so you can have the freedom to live life and practice medicine on your terms. I'm your host, Dr. Una.

Well, hi everybody and welcome back to another episode of the Entre MD podcast. Today I am so excited because I have my friend and super amazing pediatrician Dr. Sogol on here and we are going to be talking about all things telemedicine, how to implement it, the kind of visits, the whole nine yards. And she's been doing this for a while, so she's the go to person for this. So welcome to the show, Dr. Sogol.

Thank you, thank you for having me. It was a pleasure reconnecting with you. I know we haven't seen each other for a while and I am more than happy to help our colleagues out there try to implement telemedicine, especially in this time of the COVID pandemic, which I think has pushed all of us outside of our comfort zone. So let's get ready and embrace telemedicine.

All right, let's do it. So I know how to amazing you are and I know a lot of things about you, but I'm going to give you a moment to introduce yourself to the listeners.

You are too kind. So I am a private independent pediatrician in East Houston. I have a practice with my sister. She's a Pediatrician as well. We opened up the practice about 12 years ago and we have grown to have about eight practices providers in one location. We're in Texas, so space is not an issue. So we have about 27 exam rooms and we are a predominantly low income, underserved community, which makes it a bit challenging. And I'll start talking about it as we move on through the podcast. But my point is that if I can get my patients, which have limited resources to be able to connect with me virtually, then I think everyone out there should be able to do that. And we just have to really put our myths aside and try things.

Well, great. And I'm going to take a moment. You know, I don't think everybody on here knows how we met and literally this is what happened. So I had been following Dr. Sohol's practice for a while and I was like, she's doing all the stuff I want to do when I grow up. So I sent her an email and I'm like, hey, you don't know me, but we're on SOPIM together and I really love what you're doing. Can I fly out to Texas and just come follow you around for a day and see what you do? Show me your operation. And. And she was so gracious. She let me do that and it made a huge difference in my practice. They're very innovative. They have really good. They have really good systems and workflow and not redundancies, but, you know, things to catch things when they go bad. I mean, the whole nine yards. I still use all the stuff I learned from that. So pay attention to her. Okay. All right. So why did you decide to introduce telemedicine in your practice?

Yeah. So as you said, we are a practice that tries to be very forward thinking. The reality of the healthcare industry these days is that, yes, you're a clinician first, but if you want to survive in private practice, you really have to know your operational and you have to know the scope of your industry and how it's changing. And right now we're in this, I think this transition zone is what I call it in healthcare, to where we are really shifting from the traditional independent practices into something that's more technologically driven. And with everything that we have done, we have really looked at what is going on in other industries and how can we take what they have done and better improve the quality and the efficiency and the operation of what we do in our clinic. So that culture has been built in our clinic for years. Right. And I think that's One of the hardest things to overcome is like you want to do something new, but everybody else is holding back and is very uncomfortable. So we. So I heard, and I'm very involved, just like you are on sopm, which is this section of Administration and Practice Management, part of the American Academy of Pediatrics. And so those are where all the ideas come from. Right. It's a group of very innovative, forward thinking pediatricians that are mostly an independent practice that challenges themselves every day to stay afloat compared to the larger healthcare systems. So we knew telemedicine was something that we needed to start on and we wanted to do it slowly and not get rushed into it. And we knew our patient population, it might be a challenge, so we opted to start it about a year ago.

Okay, so a year ago. And a lot of us are just starting now. Well, a lot of people. So now you said something fascinating that I've heard multiple times, but it's just lovely to hear you say it. And that is taking looking at what is happening in other industries and bringing it into your own industry. So the way I heard it said is that sometimes innovation is not necessarily doing a new thing. It's just taking something that's already happening in another industry and translating to your own industry. So that is so cool.

Exactly. Especially with the changes in, you know, the millennials and now generation, Generation Z that's coming. These guys, this is how they live. They live online, right? And if you look at the businesses right now during the COVID pandemic that are thriving, what are they? They're all the online virtual, right? The Uber Eats and the Amazon and everyone's going curbside and online. Which I think this is, this, this is something that pushed, I think the entire world into just having a wake up call and saying, okay, we've got to gear towards this. We've got to get some resources and get some operational sense to be able to thrive.

So, so in a sense, we can almost look at some parts of our businesses as our of our practices. Like, this is an online business. Like, it's so weird to say that, but, you know, that's what it is. So what are some of the reasons why doctors are skeptical about telemedicine that you've noticed?

So I think change makes everyone uncomfortable. Right. If you just put telemedicine aside, just any change in your traditional way of training or working or operating. So some people are more comfortable with change and they jump in and they're like, let's do it. And a lot are very conservative and they allow fear and the uncertainty kind of to hold them back. And so I think that's, it's a, it's a shift in your mindset. Right. That's the first thing that needs to be done. Because if you, if you started, you'll love it. I love doing telemedicine. My patients love me doing like you will. I've never heard of. I don't think I've gotten any feedback about anyone hating to do it, except for, I will say the technical issues. But that just kind of takes time to wrinkle out. Which even now I haven't wrinkled it out all the way. But the concept of connecting over, you know, the phone or the screen, My four and six month olds are more engaged with me on the screen because that's what they're used to. Yeah, they sit.

Yeah.

My toddlers fight to come to, you know, take turns. Oh, I want to see the doctor. This is so cool. You're on the other side. Yeah. So super positive feedback from parents and the kids.

That's really good. So would you consider that you were really resistant to it? Not resistant at all.

I wasn't, but that's just the kind of person I am. Whatever new thing comes up, I'm like, let's do it.

Okay.

And I'm kind of on the other end. I'm a bit impulsive. So I take it. I go 120 miles with it and I'm like, everybody is left behind. So I've learned to kind of, you know, pull back and say, okay, this is the pace that we need to do this, and we need to create a team to do this. And this is not like a solo project. So it's been a great learning experience for me as well.

Awesome. So, yeah, so we just rein you into 100%, not 120. How about it? And actually, I had a kid the other day, I think he was 16 or so. And you know, his, his mom called to set up the telemedicine visit and I got to see him and he's like, doctor, is this how we're seeing. You're seeing patients now? I'm like, yeah, that's, that's the new thing. He's like, well, that's what's up. I was like, well, doctor now.

So that's what's up.

I'm like, I can live with that. You know, I'm a cool doctor, you know, says the 16 year old male. So I'm, I'm really cool. I know. So what kind of patient visits are you able to handle with telemedicine? Because the thing is like, okay, wait, I can't, like I can't examine the patient, I can't put hands on them. So you know, what kind of visits are you using that for?

That's a great question. So when we started, it's 2020, so we started like second quarter of 2019, kind of playing with it. And what we did, whenever we start a project, we start. We have set eight providers. So we start with one provider and we create our team of champions. So there's a clinical champion and then there's a non clinical champion.

Can I interrupt you for a second? All right, people. So you see why I flew out to Texas to go follow, right? It was not like we just started telemedicine. No, we have eight providers. We started with one and then we had a clinical champion and a non clinical. You see how the whole process of this. So pay attention. All right, I'm sorry, go ahead.

Yeah, yeah. So usually it's either I'm the clinical champion or my sister's the clinical champion. So we start with one entity, one team, and then if it's. It works, then we roll it out slowly to the other individuals. And so, and this when you do telemedicine specifically for us because of the platform that we're using and our patients did a little bit of more hand holding and we got a champion from the front one. My rns was on our team and then myself. So it was a team of three people. And obviously you want billing, you want some education with the billing department as well. But there's this. Not that difficult. It's just some changes that you can built into your EHR as well. So that was our team. So we started with only behavioral appointments, which are super easy to do because there's not that. I mean, there's as far as a physical exam, you don't need to listen to the heart or the lungs or the abdomen when you're doing. And when I say behavioral. We have a large population of kids with adhd. We've stopped sending those kids out to psychiatry because of the access issues with Medicaid specifically. So we're treating those kids and then anxiety because of the increased numbers that we're seeing in teenagers with anxiety. So we have trained our physicians through the AAP and some ECHO projects to be able to treat just simple anxiety. If it gets too more complicated, then we send them to psych. So ADHD and anxiety have been. That was our first. First like behavioral health that we Started out with. And again, it was just my patients or just my sister's patients. And then this year, what we did at the beginning of the first quarter, we stepped it up a little bit more right before COVID and we said, you know what? Let's try to add some sick visits. Right?

Okay.

And we played around with different models. So our sick visits, we wrote a protocol as to what sick visits. So rashes are awesome, right? Those are super easy. You don't need to. You just need to look at the rash. And then, like, a lot of the infant ones worried, well, reflux. I need to change my formula. Colic. So those that parents love because you're saving them so much time and it's an inconvenience for the mom that's, you know, is postpartum with the infant to come to your office and get exposed. And so it's great. It's a great marketing tool. And then now that we're in the COVID we have added, like, gastro, if we know that they have gastro. Vomiting, diarrhea. I have done telemedicine with wrist injuries and knee injuries or ankle injuries. I had a kid last week during COVID that was on a playground or somewhere and fell like, three days ago. Came back to mom and was having some swelling, and I said, okay. And I literally, mom through the exam. Parents.

You made mommy a doctor?

Yeah, I made mommy a doctor. That's exactly what I did. And there was clear point tenderness at the wrist. And I said, mom, come pick up an X ray form. She went for an X ray. It was broken. And so without even a visit in the clinic. Right. So I would say behavioral health. Then add your rashes as you become comfortable. Then start adding the infants and the worried wells and the reflux. And once you start doing it, you get more comfortable with it, and parents will get more comfortable with it. Last thing I want to say, Just because you're doing virtual care doesn't mean that you can't bring them in to do additional. Right?

Yes.

Started as a virtual. And then if you're like, you know what? The stories really changed, and I need to listen to your heart, I need to put my hands on your belly. Then that's fine. Then tell them to come in.

That's awesome. So don't roll everything out at once. It's fine to start, and then scale as you go. And I think this is almost, you know, like, we learned how to do a physical exam. And I think as you do telemedicine, you learn to rely More on your power of observation and a delegated physical exam. Right. Like you're describing, mom is doing some stuff for you. So that's also a skill. It's not innate, per se. It's also a skill that we're learning. So the more you do it, the better you get at it, you know? So that's really cool. I love it. Now talk to me about your workflow. So how is this scheduled? How are copays being collected? Is there informed consents? They have to sign the whole. You know, because. Lovely. Till the workflow starts.

Right. So I'll talk to you about our workflow prior to Covid, because after Covid, it's like our entire operation has changed. And we're doing sick visits in the parking lot curbside. So we'll go prior to Covid. So we have one front desk person that is assigned to telemedicine for the day. That's not her sole responsibility, but she overheads it.

Got it.

And so our. So the platform. And we'll talk a little bit about the platforms in a minute, but the platform that we're using. And it depends. Your workflow depends on your platform. So we wanted to go with the simplest one. I didn't want my patients to download apps, and just because I wanted them to have a good experience and know what the virtual visits consisted of before. I asked them to do too many stuff to prep before. But I did that because of my patient population. If you have, you know, if you're living in suburbia where everybody's doing Uber Eats and Amazon whatever, then tell them to download an app and then they're good to go, right?

Yep. Because it's just one more app, right?

It's just one. Right. So we use Doxyme, and it actually get. We can text the patient a link. So there's no email involved. There's no app involved, there's no password involved. There's no username that you text it and then they click on it and it says, enable your camera and video. And you put the kid's name in, and that's it. Like, literally, it's like three steps.

Super beautiful.

So the front desk person. So there's a column in our schedule now that's telemedicine visit. Right. So, you know, you have your doc visits, and then there's a scheduling column for telemedicine visits. Okay. We've played around with it. We initially, we had specific days that we would do telemedicine only, but then that wouldn't work because it was really narrowing those options for those patients. So now what we do, we have it in a column. Every day, there's a telemedicine column, and our nurse is the one that's assigned to making those decisions as to whether those appointments can be telemedicine appointments. So the front has been trained and given a protocol. So all rashes go to telemedicine. Behavioral health goes to telemedicine. But if they have a question, then they'll route it to the rn, and the RN will be like, okay, yes or no. When there's an appointment in the telemedicine, it's counted as any other appointment. So insurance is verified the same way. Copay is taken the same way. So everybody in the front can do that. The two things that are different is consent and the link. Sending the link. So that's where you have your front desk. Telemedicine specialist.

Champions and specialists.

Okay, Champion. Yeah, Champions and specialists. And it empowers your staff because they love it. Right. Because they like to do new things to help out the whole team. And so we. A year ago, when we started, we were getting consents. There's a way that you can do consents in doximity. I can't. I don't know the details, but that's what we're getting. But as we knew we were going to do telemedicine, we actually added the consent to our office policy, and we have updating our office policy with signatures as all patients come.

That's brilliant. That makes your workflow so much better.

Exactly, exactly. So most of our patients have the consents already as part of their office policy, already signed in. And then when the patient gets the link and they arrive in the waiting room, that appointment is made ready for physician, because there's no nurse or anything like that. And then we know that there's an appointment ready for physician. And what we're doing before COVID what my sister and I were doing is we would see those patients within our scheduled appointments, right. Because they were like five a day.

Right.

And they were like, super easy. Like dipro, rash, tinya, impetigo. Super easy stuff that you can do. So that was our workflow. Right now we have two physicians that are doing telemedicine all day long.

Oh, that's great.

Yeah, yeah. So we have our. We probably have 12 in the morning, about 24 in the afternoon is what we're seeing now.

That's great. That's really, really good. And I'm glad you guys, you know, got on it before, but you know, I knew you would. I know you. Yeah. So now how did you get your patients to be aware that we now do telemedicine? Right. So they're calling and this is what they're wanting. How did, how did the word.

Yeah, so we, we, we have a large followers on social media. So we started that, I don't know, like three years ago. So we have a Facebook page and Instagram page. So you have to have some sort of presence on social media. Right? That's the best way. I would think that's the best way. If you don't presence on social media, then emails and texts. So those are the three things. Right. So we texted patients and said, hey, we have virtual visits. We emailed everyone and said, hey, we have virtual visits. And then we posted it on social media as well. We actually had a company create a little video of what virtual visits are, and we posted that on social media and emailed that video as well. We couldn't text it, but we emailed it. That gives you. It's like a three minute video about like what is a virtual visit. And then we have TVs in all the rooms. So we use that for education and marketing as well. So we put that video on the TVs and then, and then when paid people made appointments, we just said, hey, you, you have a rush, there's no need to come into the clinic. We're going to do a virtual visit. So some of it was just through the daily workflow.

Okay, so I have. You did social media, you did emails, text, the TVs in the room, which is for education and ads, and then phone calls that were coming in. You converted some of those to telemedicine visits. So you're like five for five. So don't start telemedicine and think that people would just come. There actually has to be some work behind that.

Sure.

Okay. Sure.

Yes.

This is really good. All right, so now, so tell me about platform. So we've talked about the platform that you've used, which is doxy me. And we're not necessarily endorsing any platforms or anything like that, but, you know, just share some of them that are out there, maybe you've experimented with and stuff like that.

Yeah. So I think you have to look at the cost of whatever platform that you're choosing, but do not just focus on the cost as your main decision maker because we made that mistake and we are living it and I am not going to change it until the summer. Don't make that same mistake that we did. The second one is efficiency. How does that platform fit into your practice and with your patient population? We thought doxy was a lot more efficient for us because it's a link. You boom. I don't have to use emails, I don't have to get my patients. Teach my patients how to download the app. Right. And then usability, which kind of goes with like efficiency and usability. So we. So why. My plan personally for the summer, and this was even before COVID hit, was for the summer, we are going to go with Anytime Pediatrics, which is the pediatric specific platform. And I have had a lot of friends, pediatricians that have used it and are really happy with it. But what I have to do in my clinic is we are actually getting like an intern or a high school student to come, and every visit that comes in, they are going to go in and say, hey, we've got this great, awesome virtual platform. Let me help you download Anytime Pediatrics. Because you. I believe that the family has to sign up and put in their kits. So there's some involvement with data entry. So we're gonna help our patients, which is the same thing we did with our portal. Ours isn't as simple as go download the portal. Yeah, no, it's like, okay, let me show you. This is like you have to hold their hands. So we're gonna use kind of the same workflow in the summer and try to get a lot of patients on it. So I think we are getting a lot of issues with Doxy as far as either audio or video connection. So we tried Zoom as well. The issue that we had, which Zoom, which is what I thought we would have, is that you needed an email address. The link that sent to the email went into the spam. Some people didn't want to download it or their wi fi was too. So we went back to Doxy. What else? What I think there is Anytime Pediatric Zoom. There's a couple of more, right?

Yeah, there's a ton of them. And I think after Covid, a lot more came out.

Yeah, those are the ones that we've had experience with, but I think it's a personal decision, really. Look at the cost efficiency and usability of your platforms and decide based on that.

Yeah. Okay. And I like that you anticipate when you change platforms that you're going to have an issue with people registering and stuff like that. And you're like, I know this is going to be a problem, and this is the solution for the problems. As we roll it out, we'll roll out the solution as well. So that's. That's pretty cool. Good for the high schooler.

Yeah. It's all about the mindset. It's like, this is not. You are going to have issues. And it is. Okay. Okay, now let's start it.

Yeah. Yeah. I love it now. Okay, so we've talked about the platform. So what of the setup for the doctor? Do you have to have a mic? Do you have to get a headphone like I have on now? Do you need a beautiful background? Like, do you need to create a studio? Like what. What do you need to do?

No, literally, when I'm at home, my background is in my bed, and it's like the headboard of my bed. That's great.

And people think that's a wall.

Yeah. Or like my office back here. That might be, you know, the backboard. So I will say at home, I use my. Because Doxy has an app. So I use my phone, and I have Doxy on my phone, and I connect with the patients, and then I have my laptop. So nothing is integrated with our ehr. Okay, so they're two separate hardwares, right? Yes. My laptop, which I can log into my EHR and type. And then I just look at the patient through my phone and we're connecting. And a lot of times I'm like, okay, let me just. Let me write down what you're telling me in a minute. And that's kind of how the conversation goes in the office. I have. Oh, and the. There's no. Like, my mic is on my laptop, my camera's on my laptop. There's no extra stuff that I bought.

Perfect.

In the office. We have my computer in the office, and then we added a second screen. And so I'm typing on my computer. Just. Or you can have a laptop. You don't even have to. As long as it has a mic and a camera built in, it doesn't have to be anything special. And then the second screen is where I put Doxy on. And then we. Which is a. It's a cloud URL. So that's how we connect with the patient. And then I'm typing. So two devices. You can use your phone or laptop or laptop or laptop or desktop and laptop. But you do need two screens. It's. You can toddle between on one screen. But I don't like it because then you keep telling the patient. Okay, hold on just a second.

Right, well, you don't like it because you're Ms. Efficiency and you want to be done with your notes, your Billing and your prescriptions by the time it's the end of the visit. I know you.

Yes, yes, that is the goal.

So that's the efficient way to do it. Yes, I love it. Now, how about reimbursements for these visits? So insurance paying for this? What's going on?

So it totally depends on your state. We are lucky enough that there is pay parity specifically for Medicaid and I want to say private interest. We have a lot of Medicaid, so I know a lot more about Medicaid than private. So pay parity means that they will pay you the same as a virtual visit versus an office visit.

Okay.

A lot of states do not. They drop it down to whatever percentage that is definitely changing as this pandemic hit. So I will check with your states and your insurers. But Texas had pay parity in October of 2018. So we're never really. Yeah, we're like, it's amazing. We're never ahead of anything. Right. It's the South. Everything trickles down like five years later. So someone must have advocated for us at some point or the telemedicine companies. So that works.

That's really good.

Yeah. So I would ask your interest or ask your state medical societies. Right. They should know as well.

Good. That's right.

Should know as well.

Yeah. And you know, in the times we're in, because we're at the time of this recording, we're literally in the middle of the COVID pandemic. It's changing day to day. So. So, you know, stay updated. Yes, I know you talked about your patients. Loving it. Tell me some of the things they've told you. They told me I'm what's up. But were you told you're the cool doctor.

So they say that they save money on gas.

Okay, I'll take it to your clinic.

That saves money on your gas. A lot of them say it. So what I've done for the behavioral kids, which has really worked well. Instead of the child missing half a day and being pulled out of school to come to your clinic, I've had parents go during the kids either lunchtime or their specials, which is like computer art, those non academic classes, check the child out of class. Some schools will allow the child and the mom to sit in a conference room and do the visit with me, which is like a lesson.

Yeah, that's great.

And if the schools don't allow that, they go sit in their car, they do the visit and the kid goes back to school.

Oh, that is amazing.

Some kids Love that. Because they don't want to miss school. Other kids are disappointed because they're like, I really wanted to have to go back.

Oh, man. So sometimes you're not the cool doctor, but okay, so what would you tell the doctor? Thinking like, okay, I know I'm supposed to do telemedicine. I've known for a while, and now Covid is here and I can't even get a lot of people to come into the office. I'm thinking about it. What will you tell them? Them, but they're nervous what we tell them.

So my motto in life is always, just do it. Just do it. Just don't overthink it. Just do it and do it. You don't have to see 20 telemedicine visits today. Do one. Baby steps. Change your mindset. Just do it. And baby steps, right? No one is delegating how many you have to see. But if you're not going to try it at all, then you are doing yourself a disadvantage. Right. The other thing I will say is try it on your kid or your aunt or your grandma or so or your teen.

Right.

It doesn't have to be. It could be fake patients or try it with patients. All physicians. The beautiful thing about physicians is they have the relationship and their connections with their parents. Right. Parents are willing to help you. So you know that one awesome family or few awesome families that are willing to bend over backwards for you, call them and say, hey, I'm trying to do this telemedicine thing, so can we try it out and connect? And they're more than willing to help you. So, you know, use your tribe that's around you, whether that's your friends or your family or, you know, your favorite patients. You don't have to do it alone. You're not alone out there. Yeah. And you can't mess it up, Right? You can't. Like, if you did it and you're like, I mean, the worst, it could. Not even the worst, but like, you know, I can't see your throat, but I'm really concerned about strep. Drive by, drop in. I'll swab you go home and I'll call you. Right?

Yeah.

Okay. I'm really thinking this might be appendicitis, but I can't feel your belly. So why don't you come into the office and I'll do the exam on you.

I love it. I love it. I didn't know. Just do it. Was your. That's mine too. I'm like, just Nike style. Just do it. I love it. That is so good. So just do it. Don't put yourself under pressure to do so many at once. You can start with one and you can do test runs with your tribe, whether that's your family, your staff, patients that love you. So that's so powerful.

And be flexible. Right? Flexibility is huge during these changes and these pandemics and these crisis situation is that some people tend to be very structured, and that is great. And you need that in life. But you have to be amenable to these waves that are coming through. Right? And so know that this is there. There's probably going to be some issues, and that's okay. And it's not my fault. And we'll learn through it.

I love it. We'll take it. All right, so this is really good. I'm gonna have. I'm gonna have you give us some, you know, resources people can check out or anything like that. And if you're listening and you're like, oh, I missed it, just go to the show notes. I'm gonna put all the links for every resource she gives in the show notes.

Okay. So if you are a pediatrician, the AAP has a huge number of resources as far as coding, billing, workflow. So I was used American Academy of Pediatrics. If you're not a pediatrician, there is something called a telehealth Resource center trc, and it's actually divided into different regions. So ours in the south is Texla, like Texas and Louisiana, which is that. I think it's a southwest or maybe just the south region. I just know ours that has a lot of resources and they do a lot of webinars. You can sign up for their webinars and you get a notification and email. And so that's a good way of just kind of educating yourself. Your medical societies are going to have a lot of information as well. So I will say if you. You specifics start with the telehealth Resource center and get a feel for, like, what is telemedicine. And then go down to, like, your state to look at the billing and the coding and the payments for each of those.

Great, great, great, great. And if you're on here, you're like, man, I hear you guys, or hear you ladies. And I want to do this, but I'm kind of nervous about it. And I created Telemedicine. Masterclass is literally 74 minutes and is divided in seven modules. So you're doing five minutes here, 11 minutes there. And the goal of that is if you just listen to the module follow the action step. In less than 24 hours, you should be up and running with telemedicine. Okay, this is your Just do it Telemedicine master. Okay, so it's entre md.com telemedicine. I'll put the link in the show notes as well. Go through it. We talk about workflow, marketing, all that stuff, all that good stuff. And the idea is this, this is your time to change. This is your time to reinvent your practice. This is the time to be more innovative. Yes, the pandemic is horrible. Yes, the health implications are horrible, but at least out of it you can get. I have a brand new practice. I have a better practice. You know, I went through the pain, but it's better. So don't not take the opportunity. Okay, so the whole idea behind this podcast and the free masterclass, all the resources Dr. Sogol has given is you to just start, just do it. And if you've already started, make it better. If you've already started, your patients aren't using it, send the word out, send the text, send the email, do some videos, but just do it. Awesome. Thank you, doctor.

So good.

Yeah, thank you. Because this is such great value, I believe everyone who's, especially those of us in private practice, they'll get a lot out of it. They can implement this and we'll all come back and say, oh my God. Dr. Sobel's episode, episode on the Entrepreneur.

Podcast was just, you know, I always joke, I've often joke about this is survival of the fittest at this point. So let's, let's put our. Let's, let's get comfortable with being uncomfortable because from that you will grow as a person.

I agree. I love it. Well, thank you so much for coming on and you know, I think we'll be getting you back on for repeat performance or something else for sure.

Awesome. Thank you so much for having me. Good luck everyone out there.

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