113. Ripple of Change: Healing Burnout and Building Better Systems

You don't have to be doing some big magic thing. It can be some little effect that all of a sudden is a ripple effect, like the butterfly effect. Butterfly flaps its wing on one side of the world. On the other side of the world, a tsunami has been created. I'm hoping for a tsunami of positive change in the healthcare space.

Are you a woman in medicine, feeling overwhelmed and disconnected from the personal fulfillment that you desire? You're in the right place. Join doctors Joanne and Erin as they rewrite the rules for women in medicine. Let's begin. We have been so looking forward to this episode. This is going to be an unique and very special message. And we have a guest, Dr. Todd Otten, and he's going to be talking about all kinds of things that we are so aligned with and very ready for this message. He's a board certified family physician, decorated naval flight surgeon, and author of Ripple of Change. He is an advocate of health care reform and leads movements like Our Quadruple AIM and Medicine Forward to challenge the status quo and empower lasting patient centered change. There is so much that we can focus on and we're so grateful to have you here. And I'm gonna go straight into it because I'm so curious about so many things. You co authored the book Ripple of Change and you talked openly about many things including burnout. Tell us a little bit about the book and what's like one lesson that you want your audience to have.

Oh, sure, yeah. So maybe the short version of the book is I went through. And thanks for the, you know, really kind introduction by the way. I went through really horrendous burnout in 2019, which was related to a whole bunch of things. I was doing too much. I was seeing like 6,000 visits a year. I was chief of staff and. And then I had some pay withheld. Cause I had two open charts. Literally two boxes needed to be checked. I lost it. I was ready to quit. Ripple of Change came about about probably two years after that period and it was really the start of it was catharsis for myself. I wrote a poem called Medicine is a World of Gray. Kind of a. Kind of a dark look at really what goes on behind the scenes in primary care. But then my co author, Joshua got involved and you know, he was one of my patients at the time and he was struggling as a result of a medicine that I had written for him. Cymbalta Joanne, for neuropathic pain. And we had tried everything under the sun and I still take that medicine for my post concussive headaches because it treated me really well. Anyways, it turned into this beautiful. Well, obviously I'm biased because I was one of the authors, but this combined story of healing and through that we were really trying to inspire and empower in many ways everybody to play their part in fixing the mess that is US healthcare right now. The reality is we have 300 million plus people that are frustrated in some capacity with either cost or outcomes or access or whatever the case may be. And those voices, if we can harness that power, can really help us change things. And so I guess maybe one key lesson from the book is we all need to unlearn learned helplessness.

That's so powerful. And we actually did a session or an episode on that several episodes ago about learned helplessness. And I think we learned that as physicians and we address that and. And yet it seems very counter intuitive or, you know, doesn't seem like the right picture that you would have for a physician for learned helplessness. And I read the book. Well, I listened to it on Audible. It was amazing. And I loved how it wasn't just the physicians owning their part in broken medicine, but also your co author talking about the role of the patient and them not having learned helplessness either and advocating for themselves and him talking about probably the hundreds of hours he spent learning about his rare condition and his rare side effect. And that was one of the reasons I think he had a better outcome was because he did his part, you did your part and worked so together for this beautiful collaboration, doctor and patient.

I agree. I mean, I think Joshua was instrumental in getting to a better place. I think the catharsis of his writing was very helpful as well, you know, but the reality is, as a family physician, you know, I don't know everything. And I honestly think in my opinion the best clinicians, physicians, whatever the case may be, are those that are willing to admit where they have flaws or a lack of knowledge and ask for help. I'm digressing already, but patients advocating for themselves is critical, especially with the current landscape where patients leave an office setting or hospital or handed discharge instructions and then essentially it's like they're out, out to the throne of the wolves at times. Even like hope, hope for the best. Here you go. And so, yeah, I think, I think it's critical that patients, you know, speak up for themselves.

I have again, I'll be with you will be a little circumstantial. All for, for the best reasons in this process that I'm going through in, in transitioning jobs Like I have been saying goodbye to patients I've been seeing for seven, 17 years. And, and I know that because they'll tell me things like I remember when you were pregnant and that boy is almost 17. So right. Like that, that times are our relationship and I have like this sense of responsibility for their care. Even though a lot of them will stay in the practice and they're very good psychiatrists in the practice. And I find myself like saying like, you know, make sure that you say this when you see your, your next doctor. Right. Because they, they've known me for so long and that like wanting to continue to hold their hands and. Right. And then saying okay, you know, like go advocate for yourself. That's, that's so important. And we've talked about that here. We're so grateful that you're a voice for that. I do want to ask you a question. There's so much again that, that we can double click here. I love that phrase. One, how would you define that learned helplessness?

Oh yeah. So that I think that's a fascinating two word phrase, if you will, that can go in many, many directions. I think I'm going to take this path with it. As a physician, you know, we're taught in medical school to be self reliant and work harder and do more and say yes and put the patient first, you know, often at the expense of our own well being. Through the course of my career, the external factors that have affected that autonomy and that ability to quote unquote, do the right thing have just escalated. You know, whether it's insurance, whether it's prior authorizations, whether it's non competes, just a whole host of things. And after a while you get kind of beaten down. It's like that experiment with the dogs, you know, long ago that were shocked and I'm not condoning that we, we do this to animals per se, but after a while they just felt like it didn't matter if the door was open where they could leave the area where they were getting shocked. It, it just didn't matter anymore. And that's how people feel now. They're like, well, I'm only one person, what can I do? I don't want to get fired, I don't want to lose my job. But I think the reality is there's lots of things we can do. And I'm not saying to people that they need to write a book or work on a documentary or you know, sometimes in my cases send passive aggressive emails to CEOs of hospitals or hospital Systems, which I have been known to do that. I mean, it can be as simple as asking a colleague if they're doing okay, are you okay? That's powerful and could change the trajectory of someone's day career. It could save a life. And that's the opposite of learned helplessness, where you feel like doesn't matter what you, doesn't make a difference. Right. That one question to that one person could be an incredible ripple effect, if you will. And I think we're getting to the point where our colleagues are realizing that we've got to learn to work together. Big organizations are realizing that we've got to get out of our silos, we've got to learn how to work together. Because there are big legacy institutional problems that exist. Lots of money, lots of power, lots of lobbying that's keeping things as is. And if we're trying to fight these battles by ourselves, we're not going to be successful. But if we can, Howard, excuse me, Harness the collective, well then, then I think there's gonna be some fun times ahead and moving in the right direction. I know that was a long winded answer and it kind of went all over the place, but lots of threads to pull on with that one, I suppose.

And I wanna highlight you said a couple of things. Number one, in learned helplessness, all you need to do is take one empowered act, ask one person how they're doing, take one positive step for self care or yourself. And as you are fond of saying in that ripple effect can be so powerful. And at the same time, you talk about the power of community. And where I talk about, you can't do math with one person with one number, but you put two people together, you put three people together, five people together, 12 people together. And now you can start a movement. And so I love how you stress on those, the one person is important and the collective can amplify their voices. And with the episode we did on learned helplessness is episode 98, in case you haven't listened to that one yet, go take a listen to help clarify even more about that learned helplessness. Todd, you talked about burnout and what that looked like for you in the book. And if you haven't read Ripples of Change, highly recommended. We'll put a link to how you can get that in the show notes. I would love to hear more from you, Todd, about what did your burnout look like for you and what helped you in the healing process.

Oh, wow. You know, burnout is an interesting word. And some people feel like it's overused. And there's obviously a continuum related to that. In my case, I think I was pretty far along the spectrum of burnout to where, you know, I was depressed, I was angry, my empathy was zero. I was short with patience at times. It's a raw, visceral, negative emotional experience. You know, in my case, it probably epitomized by the following. You know, I. I love seeing patients. I always have, always will. And I do a little bit of direct care now, but I distinctly remember sitting in the backyard in tears, hating my job, absolutely hating my job being a physician. And I had always loved it, you know, and to go from one end of the spectrum to the other end of the spectrum like that, I think encapsulates what burnout really is. And, you know, there's. There's several layers of it, in my opinion. Um, you know, again, I think it was far on the spectrum, but I think a lot of our colleagues are suffering. The, the. The recent statistics are about 50%. So think about that as a patient, and I'll get to how I got out of it in a second. You know, if you're a patient, there's a 50% chance the person you're seeing is not doing well. Those are not good odds, and we need to do better. Personally, how I came out of it was a multitude of things. I went to therapy and talked about it. I talked to my wife, I talked to friends. I had some time off. I called it a sabbatical, which was great to sort of reset, you know, ultimately, writing the book Ripple of Change was very cathartic for me to just get it out there. Um, but it took really probably two years to kind of recover to the young, confident physician that I had always been. I mean, when I came out of that three month sabbatical, I was broken. My confidence was shattered. You know, it was like I didn't remember how to use the emr. And so, yeah, I mean, but I think community is critical. I'm actually working on book number two, ironically, talking about trauma and how we all need to process our prior trauma. You know, as a physician, I got really good at stuffing things in a box for 40 years. For those of you listening to this, that is a very bad habit. I'm encouraging you. Find a counselor, find a therapist, start to work on that stuff, start to process it. If I had to give one piece of advice, that would be the piece of advice I would give to anybody listening. Our colleagues, patients, anybody. Because trauma's everywhere. It really is.

I can completely relate to that, having worked 10 years in child abuse medicine, and I talk about the stories that I shove in a room in the back of my head and shut the door on, and then recognizing that there is a weight to that. And as you say, trauma is everywhere. And yet you talked about loving your work. And then in the throes of burnout, stating, I hate my job. And you've been able to come out of that. And what I love too, whether it's therapy, I've seen it with coaching my own clients, where I had a CL client saying, I hate my job. And a couple weeks later, with the support of a. A group coaching that I offered and some, some individual coaching went from I hate my job to we can really help a lot of people today. And the power of that mindset shift and one step of getting out of burnout, when you're hating your job, it's possible. And I think the other thing Joanne and I like to stress is that let's not lose hope. And when we're tripping up and falling, who's in our community, that can help lift us up and carry us forward, Whether that's colleagues, as you said, your. Your spouse, therapist is so important not to try to do it on our own.

Well, I agree. I think mindset's super important. I think one other thing that to consider is, is setting boundaries. You know, I mean, as physicians, you know, we can get jobs pretty much anywhere, depending on your specialty. And I think people feel trapped, whether it's the golden handcuffs, you know, the financial reasons, locations, et cetera. But there's help out there. You know, if you're struggling or you're a concern, you get a lawyer, you know, have somebody review your contract in advance, reach out to somebody more experienced and get a good mentor. I mean, there's lots of ways to set boundaries so that you're not feeling crushed by your, you know, your job.

In your, like, speaking our language. And the importance and part of why we started this podcast, it's to give voice and the understanding that we don't need to struggle in silence, but that it is difficult and, you know, like the fear of if I seek help, how is that going to affect my license and how we then. Or the shame or the guilt and the stigma. So many things that get in the way. And as a psychiatrist, I don't want to speak so, like, loud, like, scream so loud, like, we're here, we can help or write. It doesn't need to be a psychiatrist. Could be, like you said, like a counselor, a Good friend, a coach, so many resources. But in the moment, you're right. Right. Like, that's one of the, One of the problems when we're feeling overwhelmed, stressed out, burned out, depressed, anxious, then our brain starts to work differently. So then ideas that we have and resources that we would have no problem given to someone else, we don't see because literally our brain is not letting us see it. So thank you for. For saying that out loud, that there is hope and that. Yes. That it can take time and, and that it doesn't mean that there's a failure, that we're going to come crashing down and staying down. And that's definitely. I remember and I was thinking about it because I was looking at some videos that you sent us and saw Dyke Drummond and like, I did his program, I don't know, many years ago, right at the beginning of COVID And then I. I was again in. In my mission of mental health and, you know, coaching and all the things, and I wanted to do so much and receiving the resistance of like, oh, no, we don't write like. And I was even offering it for free. Like, I'm here. I like, I can feel so many doctors struggling. Let me help you. And it was like I was surprised of how much we were put down in. Even in offering help or. No, no, we have this app or we joke about the pizza parties or the yoga retreats and all of that. And knowing it's part of what you're all doing, of creating real change. It's not just, let's help downstream, but upstream. What are the things that we can do? And it's so amazing all that you're doing.

Well, actually, I'm glad you talked about upstream because I think burnout is emblematic of all the problems that are further upstream. Right. And being more resilient and mindfulness and all these things are amazing tools. Right. And can help you in the moment. But the reality is we have a lot, a lot of work to do way upstream with our sick system of healthcare delivery in the United States. And actually that's a. That's a big driver for why we're doing. What we're doing with the documentary is we feel like if we can. I don't necessarily want to completely give away the call to action, but get these groups working together to push the needle from a policy perspective, legislative changes, et cetera, then we can, we can really start to see positive movement. So with the documentary, the goal is we're going to pull the curtain back, not just for clinicians. And physicians, but for the American public as to what is really going on, because I don't think people really realize how bad things are in some parts of the country. I mean, there's whole sections of this country where there's like no access to care. You know, we have groups like Remote Area Medical delivering free care to hundreds and hundreds of people over a weekend.

And.

And this has been going on for 40 years. You know, we spend a ridiculous amount of money and have horrible outcomes compared to every other developed nation. I'll get off my soapbox. But we're not just going to talk about grievances and issues per se. You know, the second half of the film will be about courage and hope and inspiration and unlearning learn helplessness with a very evergreen call to action for people to get involved. So we don't see this product as being a one and done. We see this as potentially a launching point to really educate, activate and help people get involved with sustained transformation is what we're hoping for.

That. That's incredible. And I love how you talked about the positive disruption and Rylan and your. You said the working title, which actually I love the stuff. Suck it Up, Buttercup. And what else can we expect from the documentary and what can we do to assist and when is it going to be available to things?

Sure. So it's just been an amazing project, to be honest with you. You know, it started off as an angel investment with a couple of friends and Marianne Woolworth's dream of making a documentary, who Marianne's a gynaecologist, by the way, has become a project that clearly is bigger than any one person that's involved. And this isn't going to be just talking heads. This isn't going to just be physicians. We've interviewed nurses, we've interviewed patients, we've interviewed administrators, we've interviewed celebrities. I mean, yesterday I got to interview Mark Cuban for goodness sakes. And I think pretty much everybody knows who Mark Cuban is. And he's very interested in positively disrupting the healthcare space. And he already has done so with his pbm pharmacy benefits manager, for those who aren't familiar. And through that collective voice is really how we want to show change. So we were going to talk about mental health, we're going to talk about greed, we're going to talk about policy change. Granted, we are literally building the airplane as we're flying it. So I can't give you every little detail that's going to be in there, but it's going to. It's going to be a broad stroke for the American public in language that they can understand. We're anticipating some amazing other other individuals to include some comedy. There's been some discussion of maybe some comic book type themes being as I'm a comic book guy, being woven into this. So we want it to be fun and enjoyable and, but also so that the average person can walk away thinking, you know what, I can do something, and these are a whole bunch of things I can do.

I love that. And I think that not only is the public not aware of all the issues going on, many physicians aren't aware of what's going on if they're working. I mean, we, I think most would agree that the system is pretty broken and that whether, you know, whether I'm meeting with a business owner, a practice owner, or, or someone in leadership of a larger organization, you know, I don't know any of them that aren't struggling more now than we were, you know, especially pre pandemic in years past. And we interviewed another physician, Dr. Pamela Buchanan, who's a family doctor and does mostly emergency medicine. She's episode one 111 and she talked about in rural Missouri, I think is where she's at. Just the lack of, the lack of care, the lack of access. And it's disheartening in the US where we have such gaps and even in larger cities. I am part of a Facebook moms group in Oregon and they can't, the physicians there can't even get their own kids or their own family members into healthcare providers. It's crazy. So I so appreciate the advocacy and the work you did with your book Ripples of Changes, which was so unique in combining yours and your patient's perspective. But also this suck it up buttercup documentary that is coming out soon. I'd like to go back to these ripples of change that you often talk about, Todd, and it so meshes with the topics that Joanne and I talk about. You say that ripples can turn into waves. And I'd like to hear from you, what does that mean for physicians who feel small or stuck or silenced in the current system?

Oh, yeah, I. Oh, wow. I'll get. You know what, I'm going to tell a story on that one. So. Oh, this was probably three or four years ago. And I won't say the insurer that put this quality metric out, but the quality metric related to medication reconciliation, which I think medication reconciliation is critical. Right. I mean, knowing what the patient's taking, patient knowing what they're taking et CETERA but the metric revolved around a survey of how well the patient thought we did with medication reconciliation. I have a lot of issues with compensation being tied to survey in the healthcare space. I think it leads. It's a dangerous slippery slope that can lead to very bad habits. And do I really want my pay being affected by somebody who takes the little white pill? The patient at times can't even tell us what medications they're taking, let alone they, they want our compensation to be tied to this. I had many, many issues with this. So I wrote an email to the particular insurer saying, I'm not doing this, this is insane. And I'm going somewhere with this about the ripples turning into waves. So I wasn't the only one, and I wasn't even like yelling and screaming at my local institution. But apparently hundreds of physicians sent similar emails to where the insurer realized that this was a, choose my words correctly, not the best idea per se, and they turned it off. That's a little, little example of a, you know, one pebble being thrown into pond, but by hundreds of people that created a little bit of a wave at the insurer going, oh my goodness, maybe this isn't a good idea. So that's just a simple example of how we can coalesce that energy and create synergy and hopefully scale it to create much, much bigger change. I mean, we've got some big things that need to be worked on. But imagine, you know, say there's. I'll give another example. Non competes, non competes are a big issue, right? And whether or not they're enforceable depends on where you're at and so on and so forth. Imagine if we put out a call to action to, let's say, bombard key individuals with emails every Monday until the, you know, the cows come home, if you will. After a while, that's going to be pretty annoying and maybe there'll be some, some change as a result of it. So that's maybe just a theoretical example, but it talks about the power of numbers is really where I'm going with that. And that's what we were trying to convey in the book. You know, like, again, you don't have to be doing some big magic thing. It can be some little effect that all of a sudden is a ripple effect, like the butterfly effect, right? A butterfly flaps its wing on one side of the world and creates all these subsequent interactions. And on the other side of the world, a tsunami has been created. I mean, I'm hoping for a tsunami of positive change in the healthcare space. And I'm not alone. I mean, we're in the majority. We just got to figure out how to bring those voices together.

What I hear is hope, and I love that. That's kind of the, the emotion that's coming to me when I, when I hear you talk of, of. Because it's easy to kind of externalize it. And then just like you said, like the learn, help, helplessness of, like, well, it's, this is the way it's always been. They're gonna say, no, it's a problem. They're stronger than us. I'm just a little pebble down the road. And then saying like, well, if we all have a voice and then we can use it and speak louder. I know, like, I've, I've had many conversations like that defending things about mental health because there's so many things that are unfair about mental health, including coverage. And I have no problem calling the insurance problem and say, what if this were you? And that's not like my personality, like, not confrontational like that. But it's so infuriating to be like, you are negating treatment because you need us to write all this information ahead of time anyways. Right. Like, we're not going to go there right now. But, but it, it, I have seen changes.

Right.

So it's, it's important to, to not keep it to ourselves and not just give up before we, we enter the fight. So in, and again, going back to the hope and the, creating the change that can create that ripple effect.

Well, and, and to double, to double click on this, which I, I, I'm a big fan of that, that phrase. I suppose I borrowed that from somebody else, but it, I don't know, it's just everybody kind of gets it like, oh yeah, let's double click on it. Anyways, so there's, we recent had recently had a big organization, the American Academy of Emergency Medicine, come on board as a sponsor for the documentary, as an executive producer. They've been fighting corporate medicine for 30 years at this point, and one of their wins was in the state of California. I won't get into all the specifics necessarily, but there was a group in vision that they created a lawsuit against related to the practice of corporate medicine. And the California Medical association got on board and asep, the American College of Emergency Physicians, got on board. There probably were more, but those are the three biggies that I'm aware of, got behind this process. And the next thing, you know, envision left the state of California and the lawsuit was essentially came to an end. That was a win, and that was a win because a group had the courage to stand up for what was right for physicians and patients and others saw what they were doing and got involved and won. I mean, that was the David and Goliath story, if you ever saw one perfect example of those little efforts coming together to make big, positive change. And I can't say all the other cool things that are happening in the background with the documentary, but I'm very optimistic that there might be some other very cool groups joining us in the near future. And there are some other amazing things in the works related to patients and advocacy that are soon to be coming out. And when you start to put all these pieces of the puzzle together, it's going to be like, oh, my goodness, there's like thousands or tens of thousands or hundreds of thousands of people involved in these endeavors. I think 2020, end of 2025, and going forward, we're going to see some very cool things. And I totally forgot to answer part of the question when the documentary was going to come out. So we've got some screenings coming up, but ultimately we think that the product will be finished November, plus or minus 2025, maybe some film festivals. But ultimately the biggest goal is to get it onto a streaming service so that as many eyeballs can see it as humanly possible.

I hear a movement. I love it. So cool to be here with you in this moment of time. And, you know, this is a perfect timing for a question that. That we love in the title of our podcast is Create Meaning of Medicine and Rewriting the Rules. And we like to ask, how are you creating meaning or rewriting the rules? I'm guessing that you'll go with the latter, given everything that you shared with us.

Yeah, I. I suppose sometimes I'm a bit of a troublemaker at, you know, in. In a good way, I suppose. Or a positive disruptor, if you will. You know, I think rewriting the rules is something that we really need to think about. You know, the existing landscape, the rules that are in place, they're not working, granted. You know, in many cases, there are amazing things that happen and amazing care that is delivered. Don't get me wrong, right? And there are amazing clinicians and fantastic outcomes, but at the same time, we have layer upon layer upon layer upon layer of a mess that exists. I mean, in my career as a physician, I've had four colleagues die by suicide that I know, that I knew, a friend, a partner, a fellow when I was in residency. And a junior physician when I was chief of staff or vice chief of staff, I don't remember. But ultimately I think that speaks to, we are at a time where we have to think differently and challenge these status. I think one of the things that I'd like to maybe end on, at least on this line of thinking is when I was going through my networking journey and advocacy journey and figuring out like, okay, what is the second half of my career going to look like? What I found was there was all these amazing organizations out there, but at times they would have like almost the exact mission statement and couldn't figure out how to work together. Almost adversarial allies at times. And my brain was always like, wow, if we can't figure out how to work together just on these simple things, how are we going to move these mountains that are ahead of us that need to be moved? And so I think that's where I think rewriting the rules needs to be taken into consideration. At times you need to take a little bit of a calculated risk on things. You know, if you go through this two year long bureaucratic decision making process to, let's just say include your logo behind the documentary as an example. That's an easy one, right? You know, if you believe in what we're trying to accomplish, it should be, yeah, include our logo. At times it's like these layers of delay and I'm like, oh my goodness, no wonder why we can't get anything done. And so I think that's some of the summit where rewriting the rules might apply. Time to think differently, color outside of the lines, ask questions that are uncomfortable, stretch boundaries, push a little bit, you know, make people think, you know, not everybody's going to love to hear that, but that's who I am. I wear my heart on my sleeve. That's what I believe. And I think that's how we're going to really move the needle.

So powerful. And I know that when I started working with people outside of medicine, when I started on my personal growth and development journey, um, before that I had stayed in the little box of medicine, the way we solve problems. And for those of you who aren't looking, I'm making a little square with my fingers, little tiny box. This is how you solve problems. And then when I started interacting with entrepreneurs and authors and other business owners, they solved problems so much differently. And it really helped me see so many different ways that we're not always looking at in medicine and was very eye opening. And it sounds like you're saying the same thing, like, let's blow up the box. Let's get out of that box and search for answers. Because the answers inside that box are not serving the providers, the system, nor the patients. And I'm sure that our listener is just as fascinating as Joanne and I are with your stories and with the different things you're doing. Todd, if you can share with our listener, where can they find you and where can they learn more about these powerful missions that you are behind?

For sure. So the easiest way to get a hold of me, I'm very active on LinkedIn, so if you just look me up on LinkedIn, Todd R. Otten, send me a message. I'd be happy to get back to you. In terms of Ripple of Change, the book, it's RippleOfChange us, but it's on Amazon, it's on Google, Barnes and Noble, that kind of thing. But if you want a signed copy, website's probably the best way to go. In terms of the documentary, currently the website is suck it up, buttercup film.com so you got to add that film in there. Suck it up, buttercup film.com so and I'm also heavily involved with medicine forward.org which is an amazing group of change agents as well. So one other amazing organization that I work with and I'm now the, the quote, unquote lead catalyst, is Medicine Forward. It's an amazing group of it's not just physicians. It's nurses, physical therapists, patients, administrators, et cetera, just a whole host of wonderful people. But the mission statement is catalyzing positive change so that physician patient relationships can flourish. And we are fully aware that there is an entire ecosystem. And I would be remiss not to include the, you know, the nurses involved in that, but there's an entire ecosystem that supports that bond, and the trust in that bond has been eroded over the years by what's going on, and we need to restore that. It's critical.

Excellent. Well, I would encourage our listener, if you want to get involved in some of these activities. I know that I've gone to some support meetings for Medicine Forward. I've watched the trailer of Suck It Up, Buttercup. I would highly encourage you to do your part or at least investigate and see what's out there. And with that, we would love for you to go check out Todd Otten and all of his amazing activity and stay tuned because the next episode is coming right up.

Do do you want exclusive resources and the opportunity to connect with us? Then visit createmeaninginmedicine.com now where you'll dive deeper into how you can create meaning in medicine. And if you're serious about optimizing your results, take two quick steps now. Number one, connect with us on the website. And number two, tune in to the next episode.