In this first episode of our 8-week series Why I Am My Loved One’s Keeper, Jamie sits down with Scott to unpack the emotional and spiritual realities of becoming a caregiver for your aging loved ones. Scott shares personal stories, hard-earned wisdom, and the biblical and practical reasons why stepping up as a caregiver matters now more than ever. From managing multiple doctors and medications to the difficult (but necessary) conversations around independence, driving, and daily care, this episode lays the foundation for what’s to come. Grab a copy of Parent Talk and follow along as we dive deeper into the conversations every family needs to have. This series is produced by Story Society Creative and proudly sponsored by Your Health Primary Care.
www.experiencinghealthcare.com
Music. Welcome to the disrupted podcast. My name is Jamie, and today we are starting episode one of why am I? My loved ones? Keeper. We're here with Scott Middleton, the author of Parent Talk, and we're so excited to do this. And we have eight episodes. This is the first one in this series. Scott, how are you doing today?
I'm doing great. Jamie, I'm telling you, there's just so much opportunity, you know, to take care of better care of senior adults in South Carolina, Georgia, Florida. I've talked to some folks about possibly going to Virginia, to Tennessee. Our model works. You know what we do for our patients and how we take care of them? It definitely works. This past year, we in one year, we were able to reduce the Medicare spend on our patients about 8% Wow, and and that's phenomenal, when you start thinking about that, our patients would have spent a billion dollars last year on health care, just our patients. Wow, a billion dollars of spend, and we're going to save 8% of that. So that is roughly $100 million right? Yeah, so it's crazy, that's exactly and there's only one reason that we did better savings because, and it was really because we implemented community health workers and visiting nurses last year, who, on average, complete 18,000 visits telehealth assist visits with our patients. So they go to the home, they they talk to the patients, they take their vital signs, they do what they need to do, and then they call the provider, so the provider can see the patient and and it's the combination of our providers seeing their patients more often, and these guys out there that are physically present with these older adults who aren't really good with with telehealth, right, right? And again, you also don't know all the truth of the folks, and which I think will lead us into our conversations today, because we're going to be talking about those initial conversations you have with your loved ones. And the first thing that everybody on this call needs to understand is that patients lie. Patients lie, they don't tell you the truth, right? So you're if you are a son or a daughter, and you're talking about your aging loved one, they are not telling you the truth. It's not always intentional, right? But they just don't, you know, we've talked about that before on the call, they lie about their alcohol intake, they lie about their medication consumption, they they live out. Did they exercise or work out, or they lie just and they just don't tell the whole story. But we all do that. Yeah, so the conversation has to come back. I need to know everything. Yeah?
I remember if I'm gonna take this? Yeah, I remember hearing a story of a nurse who was at a home. I think it was, it was during the hospice days when, when you had owned agape hospice and and the nurse was in a home, and she was asking the patient, how many cigarettes do you smoke a day? And she said, Oh, I have maybe one or two. And she the nurse looked up and the entire ceiling in the house was just yellow from cigarette smoke. She's like, I think you smoked more than one pack a day.
Well, it was interesting. After our last conversation on our podcast, somebody said to me, Scott, I just kept asking over and over again. This lady kept saying, I don't drink, I don't drink. And then what she found out was that she's drinking a pain of vodka day. Oh,
wow. Yeah, that's yeah, significant, yeah, that's a lot. So for sure, absolutely. Well, well, Scott, you've been caring for seniors for a long time now. You've you did it as a pastor in the United Methodist Church, you did it, you know, taking care of, you know, a congregation, other congregations, and you moved into assisted living and into health care. You've been doing it for a long time. So, you know, I want to go back to the kind of the topic of this episode and let you answer this, this question, because I think it ties in biblically. Why am I my loved ones keeper?
Yeah, you know, I think I shared the story last week about the lady who had not seen her dad since she was five years old and and now she was 50 years old, and she's having to take care of the dad, and how proud I was of her that she took up the responsibility. But yeah, ultimately, somebody has to care for people, and I know sometimes it's difficult, and there are some people who just can't take care of their own parents, but that you can do that around about you know, you can use other people. People to help. But at some point, I do believe that we are responsible. You know, it used to be that that people had eight, 910, kids, yeah, and the reason they did that were twofold. One was, I need somebody to take care of me when, till I was old, as we shared on the call last week, right social security didn't get again until 1939 and up, at that point, there was no old age pension, and so if you didn't have a child, son or a daughter, once you couldn't work, you couldn't take care of yourself. And so it was imperative that you have plenty of people who could take care of you. So we had lots of children. We also had lots of children because we were farm based, and, you know, we needed workers that didn't cost us a whole lot of money, but at the end of the day, I think our children cost us more money than hired workers.
100% there's there's no doubt about that, absolutely. Now you You talked a little bit about this last week, so you don't have to go into a full definition. But why did you write the book, and what inspired you to write Parent Talk? It was really you talked a little bit. It was out of necessity, out of what you were already doing. Why did you What inspired and,
you know, I think we need to revive the book only because I'm back in the same hole. All my friends call me, well, what am I gonna do with my Alma and they and they wait till it's too late, you know, they're, they're, they're always calling in that crisis situation and and we, I was, I was looking at something that was presented dynamics, or was dynamic mobile energy. Now it's, I forget the name of the company, but they do all of our imaging at home. So if you if you need we, you know, we can do all the labs and all the energy and everything right in somebody's house. You don't need to go to a doctor's office, or you don't need to go to the hospital for that, we can send to the home. And so anyway, on the bottom of one of the sheets, it says to our providers, we don't do stat ultrasounds and and the point is this ultrasound isn't I found a problem, and I'm going to look at it. And ultrasound is really proactive. I'm scanning you to see if there are problems with you, and you could have a chief complaint. And we say, hey, let's run an ultrasound, but we beyond just the day that we're waiting around for chief complaints, right? You know, we need to see our patients often enough that we know more about them, but they know about themselves. And so I wrote the book because I was inundated with people calling me, hey, what do I do with my mama? And then they didn't listen to me. And you know, I would say, This is what I need you to do, and then they wouldn't do it. I remember so much one of my friends who called me, and it was 11 o'clock at night, and he called and he said, Hey, Scott, I'm not sure what to do. My mom just called and she took my dad to the emergency room, and this was about an hour away from where he lived. He said, like, what do I do? And I said, You go put your clothes on, get dressed, and you head to that emergency room right now, no old person needs to be left there alone, right? And your parents are over 80 years old, and they were in bad shape. And I said, they are not going to get here they needed and so I said, once you get there, you find out what they're doing with him, and then you call me, and then I coached him through the whole process. You know, today, back in those days, we were assisted living nursing homes. We didn't have people in the hospitals like we do today. Today, at your health we have a transitional care professional in every hospital in our regions, wherever we're at, they will come see you as soon as you land in the hospital, and they were going to go talk to case managers and doctors and nurses and make sure that they're doing what we need them to do to transition you back home as easily as possible. So I wrote the book because I said, how do how do I help people understand? People believe when you publish something, they'll believe you, even if it, even if it's not right. I mean, I read stuff all the time, and I'm thinking, people believe it in this day and age. I mean, even the news. I have a good friend of mine who was TD anchor person, and she finally just retired, and she had plenty of years left in her but she said, Scott, they literally told us the news has nothing to do with the truth. It has to do with what we are. We hear going on and we start reporting on things that really aren't truthful. And so what I realized is that, wow, that's kind of scary, because we usually believe what's on the news, yeah, out there, we believe what's in a book. So I wrote the book, you know, just to do that and also to spread the message among the people who work for us, who were working with us, so that they really understood what we're doing out there.
Now you in the book, you open with a powerful, powerful reflection on independence. How is your view of independence changed over time? Yeah.
Yeah, so, so here's the thing we I think we always want to make any person as independent as possible. You know, I can remember my mother raised me with this whole idea that I was going to be independent, that I would not have, and you can see how this is reflected in my life. So my mother wanted to make sure that, that she that I never had to depend on anybody else. I could depend on myself to be able to take care of myself and so and my dad. My dad was a little bit like that. My mother pushed me really hard on that. But you know, later, she used to get mad at me. I go off to college, and she would hear me, for me for for six or eight weeks at all, and then, and she didn't have any way to get a hold of me. I had a phone telephone in my room at school, but we didn't have voice mail and even voice recorders, so she would call all times, day and night. She never find me. So then I would finally call her, and she would get so pissed off, and I said, Listen, you raised me this way, so you kind of get what you want, but we want independence, and we want to be independent. So how do we give the person the most independence they can, even a quantriplegic, what can they do themselves? And now, with AI, with the technologies and stuff, people are able to do so much more because of that. So I just think it's important we always have to look, what can I do to help you become as independent as possible? What things can you do for yourself? So I think we always have to start there. So where does where as we're coming along as children, you know? What are some of the high and holy moments of our lives, you know. And really, once we're born, you know, we have annual birthdays, but starting school, you know, that's a huge, big thing. And then now we've made a big thing of when you start kindergarten and when you start first grade, or when you start middle school, or you start high school, you know, certainly when you go off to college. Big key points is, when, when do I drive? Right? 15, Boy, that's a great day, you know, 16, I get to drive at night. 21 I get to buy alcohol. 18 I get to vote. You know, there's all these things that are just really important for us, and as we get older, yeah, the milestones all went away as you start getting older. It used to be by the time you get 21 didn't matter anymore. Well then in 1920 39 when they instituted Social Security, the age of 65 which we talked about last week, is made up. But we said 65 is retirement, and all of a sudden there became a new age. That's the big thing everyone is, the only thing you're looking forward to next is, oh, I can retire at 60. I was just in one of our offices, and we have a case manager, and she's 80 years old, wow. And she said, I think I'm your oldest employee. And I said, huh, got one that's 83 so really? And I said, Yeah, so the ages isn't a matter and and like she said to me today, she said, I'm retired. And then six months later, I called and I said, I gotta have a job. I can't do this, you know, I can't be I can't do this anymore. I'm that way to, you know, if I retire, I'll probably die, because I get I'm driven with the passion of being able to make this system better and better and better for our patients. Yeah, out there, yeah. So
what emotional or spiritual challenges do people face when becoming a caregiver to a parent. I think of my sister. She's, you know, my dad passed away back in, you know, last year, in November. You know, my my mom moved in with my sister in Ohio and and my sisters, she's just been so gracious and just opened up her doors. And my mom will come down here and spend some time here in a bit, but, you know, you know, that's really, really, my sister's the one doing most of the care. What? What emotional or spiritual challenges do people face, you know, when they're becoming that caregiver to a parent, somebody who cared for them all their life?
You know? And I'll say this, we get, we get locked in, in relationships that are so intriguing to watch, like with siblings. For example. You know, we grow up with siblings, and we compete with them. We we we for our parents, love for our parents, attention, even if it's bad sometimes where we and we develop these kid relationships, and it's like, how do you move from that to having a real adult relationship with your brother or sister? Yeah, and I think most families don't, and most brothers and sisters have a lot of issues that go go on with them, you know? So because of that, because we build those. And I remember this time when I think Greg had my son had gone off to college, and he was back for the holidays, and and Sarah was probably 16, still in high school, and she'd been used to getting all of our attention, you know, she didn't always like it to get all of our attention at 16, but she did. And so he comes home, and I remember Christmas day they got into a fight at 18 and 16 rolling around on the carpet. So if you guys are listening to this, you can go tell Sarah Greg about this story, and Evelyn, just Evelyn got so upset, because, you know she is, she's the most faithful person, and she really sees Christmas is religious holiday. This is when we're honoring Jesus. And then all of a sudden, this has happened, and she just got so upset, and she said, I've canceled Christmas. We're not going to open presents. We're not doing anything, you know? She was just so frustrated. Of course, we ended up doing that, but I think about how that was the beginning of them having to learn to work together and to be and to be adults together. And so we really worked on moving forward after that. How do we help to parent our children? To do that? So what happens with our parents is the same way, we're in this relationship where they're our parent. We do what they tell us to do. We rebel against them and things, but then we get into this where I've got to take care of them, and it gets it's it's really tough. Last week I was at a facility, and I was talking to the director of their dementia unit, and she said, Oh, she said, last week I had a I had a gentleman who called me and wanted to talk to his mom. And so I got the phone, took it down to to his mother, and then I was listening to her, and you know the conversation, and all of a sudden I could hear him on the phone yelling at her mom. I told you, I can't come to see you. I'm busy. I've got things at work and all this stuff. And I don't know why you don't understand this. So the gal, the dementia director, took the phone away, and she said, Sir, let me just tell you this. Your mom doesn't know what day it is. She doesn't know when you came to see her last she has no recollection of any of these things. I need you tell a therapeutic fib, and you just say, Mom, I'll be there tomorrow. Well, I'm not coming tomorrow, he says. And then she's going to be upset because she won't know it's tomorrow. And so she coached him through talking to him. And so one of our biggest challenges, and with dementia patients, is is the change in behavior of and you have to redirect people to something else, versus telling them what to do because they can't see that. I've actually used that with my children and grandchildren learning about redoing it. So instead of yelling to them, don't touch the stove, just go find something else for them to do to attract their attention, somewhere else, right? You know, because you could say, oh, look, here's a shiny ball. And then it's, you know, they're running away from the stove. You're not going to teach them to not touch the stove by yelling and screaming at all there. It just doesn't work. So we've got so many issues. Like I was telling, I think I shared this maybe on a call, but we were we as we were talking, I said, you know, here's the here's the thing we had this the administrator who said, I really want to have a psych NP in my building so they can come by and change out medications for our dementia patients so that we can keep their behaviors down. And I said, No, ma'am, you don't want to psych. MP psych nurse practitioners and psychiatrists, they deal with with with labs, you know, imaging. They're looking at blood pressures and other things, and they're determining, based on that, what kind of medications, and you're actually saying to them, they have a bad behavior, throw a pill at them. A pill may be appropriate, but it may just be that we have issues like sundowners. It may be that we have we have staff members that agitate some of our residents, and we may have family members that are doing that. So I said, what you really need as a cognitive behavioral specialist who will come onto your unit observe people on a over a period of time, and then be able to report back to the psych NP, clinically, how what is going on with this patient, so that we know here are the behaviors, and this is the way we will treat them. Example would be, it's a standard, and I hate it is Ativan, which basically just kind of puts people to sleep. It also causes people to fall, but it will mellow people out, and that's all it does. It's an anti anxiety. It's reducing your stress, and it causes you but you also causes you to fall, right? I'm a bigger proponent with we got to figure out how to use THC, the the marijuana products. And I know some people have a heart attack about this, but the marijuana products, whether it's camp or marijuana, are going to be better for you. They're plant based. They reduce inflammation. They don't they don't cause addictions. And that would be a better, you know, response in mild dosages. But. Go give your mom a 20 milligram Delta nine gummy because she's gonna fall but she's gonna get high, and I'm saying but small doses, like one, two milligrams, with some CBD, that doesn't get you high, will relax that patient as well. So we've got to start thinking of alternatives. And again, we don't, and when do we give it? So if we just say, Hey, she's acting out, the provider is likely to put this give her three times a day, when the reality is she's only acting out at five o'clock in the afternoon. Could be because, for the her entire life, she ate supper at five o'clock, and now you're serving dinner at six. It could be that that she knows dinner is coming up, and she's not hungry because she used to eat at eight, you know? And we're trying to make her conform to our institutional rules, right? And that's not really what dementia people do. So again, changing the mentality of how you act and react and treat your patients or your family members, and it's how you respond to them with the behaviors that's really going to make the changes with a lot. But this is for anybody. Let's take somebody who's not demented. I heard somebody say, Yeah, I need to take the keys from my dad. And I said, well, and so she keeps arguing with him about it, and I said, No, just get in the car with him. One day. Let him get behind the wheel the car and saying, drive me to the store, and hopefully you're on the country road somewhere. And then are you comfortable? And then you look them in the eye and say, I'm not comfortable with being in the car with you. I need you to pull over the side of the road and I'm going to drive you nearly hit that car. Don't yell and scream. Don't go, Oh my God, you almost hit that car, you know, or look up in front just just calmly, say, hey, pull over. I don't feel comfortable right now, and I'm not going to stay in the car with you. And then you say, Okay, let's figure out what we need to do. And if, and if they're resistant, maybe you don't say anything. Maybe you just say, hey, pull over. I don't feel comfortable. Get the car. And you call a police officer friend of yours, and say, Hey, I need you to I'm going to make sure he's going somewhere at this time, and I want you to pull him over, and I want you to write in the book,
oh, wow, yeah, yeah. So
you've got to look at what are the issues, but you also have to look at their doctors. That's what I'm finding. Is that that people have, they're only going to the doctors when they want to, then they decide what they're going to take or not take. And that can be a huge, you know, issue for folks, yeah, and, and you've got to be on the top of that. That's why pharmacist is so important as part of the caregiving team. What are you taking? And generally, people be honest with their pharmacist. Yeah, I don't ever take that medicine, or I take it once in a while. Well, then that make an impact on somebody
absolutely Scott Why do so many families avoid these conversations? Though? What you know, it is tough. It is it's totally different than talking to your child, or, you know, or a friend, when you have to care for your parents. Why is it so hard, and why do people avoid these conversations so much?
You know, here's the question, why don't we start teaching our kids about sex before they're 14 and they come home pregnant? You know, because we let their their their friends around them, teach about that you're exactly right. We avoid those difficult conversations. And here's the point, have the conversations ahead of time. You don't wait until Dad's not good in the car. You constantly have that my dad is 90 years old, and I promise you, I will get in the car with him. And in fact, my my wife says she would rather ride with him than me, because he was a better driver and and so. But we've had we constantly. I started my first conversation with him when he was 20, when he was 65 about driving only because I was writing this book, and I needed some input about that, but also to start the conversation, to say there's going to be some point when you can't drive. What are we going to do? You know? So right now, I'm telling you, if you are over the age of 60, right now, maybe 50, but if you're 60, you better learn how to Uber. You need to just use it. Every once in a while, call it Uber. Learn how to use it, get in a car, ride to the grocery store, right? Uber back. Figure it out in your local area, or when you're traveling, and start using it on a regular basis, because that's going to give you your independence. Remember, our first real independence, I guess for me, was a bicycle, because then I could go anywhere. Quote that I wanted to go, but over time, that's going to be what's really important for us, is that we have that, that ability to to really keep going with those conversations. So having that conversation with your folks honestly, that my dad and I still do that probably once every two or three weeks, he'll say. Something and and I'll say, hey, you know, don't forget, you know, if you get in a wreck, you're going to be blamed because you're 90 years old. It has nothing to do with your ability, but they're going to look down see your driver's license, and somehow it's going to become your fault. So we keep having that conversation. He keeps limiting what he does in terms of driving, and how far he drives, and what time of day he drives, and so we have really constantly that conversation, what's going to happen to him? That's why he's he lives in an apartment next door to me. We're able. He takes care of us right now. I mean, my gosh, he feeds our dogs. He takes care of them when we're traveling. He cuts my grass. I mean, he this man just does everything for me. I'll be devastating if something happens to him just because I'm dependent upon him, I am dependent upon him, but over time, but I have to still play parent with him a lot of times. He was so funny. Came up to me the other day we were willing to play golf at the Players Club, and he said, Hey, I just need to have some conversations about my health. And, you know, went to the doctor last week, and I thought, oh gosh, I didn't read the notes. You know, they sent them to me. I didn't look at this and and he said, I'm in the, probably some of the best shape I've ever been in my life. At 90, he said, I have more energy now it's all back. He's doing hormone replacement. He's not doing Biot, but he's doing an injection. And so he said, I'm really doing really well. And so it was all positive, but I was kind of set up for, oh, god, did they find more cancer or something like that? Yeah. But again, I take the time I if I'm in town, my dad and I play golf every Friday afternoon. Sometimes he really doesn't want to play. Sometimes I might not want to play, but we go play, right? You know? And because we know that sometimes our only time that we really are together, even though we live next door, I travel a lot. I see him in the passing, which is kind of neat, you know? I just, we see each other all the time. He just comes down. He's watching, helping with the grandkids and and so you have to keep by being close, you can have those conversations. If you live far away from your parent, it's you got to have intentional opportunity to be in that conversation, right? The The other thing I think that's important, is that you don't have to do all of this. You have other people, and that's where your health is so different. You know, you can, you can say, I'm going to take you to your mom. I've taken your doctors as and I'm going to go in there and I'm going to tell them about this and this and this and this, and so you get her all agitated. Next thing you know, she's probably in the hospital before she goes to the doctor again, you can't do that. So we actually have just instituted a brand new program that we're not quite sure how we're going to handle it all, but we'll take you to your doctor. So if you need to go see your doctor, and we sent we're sending our MPs and our doctors out, but let's say you're going to a specialist, or let's say you have a primary care physician you've loved and gone to forever. That's what we did this week, the first time we had one of our nurse nurses meet the patient and and her son at the doctor's primary care doctor's office and and so the son called me, and he said, Oh my gosh, Scott. He said, this was fabulous. He said, when we walked in, then our the nurse, our nurse, Tiffany, she knew half the people in there, but she was, had been good friends with one of the nurses. They treated us like royalty. We were usher in fact, we didn't want to wake up because they knew she was there, and so she went back and she had the discussion with the primary care physician and the nurse, and said, Hey, we're involved. We're going to see her at home. These are the things we're going to do. We can communicate all of that with you. If there's anything that you want out from us, just let us know. And we could even facilitate a telehealth with him and with that doctor if we wanted to, you know, but and, and the and the practice was thrilled. I think we'll get referrals out of these people, you know. So it was, it was a little bit difficult we, you know, of course, we could build community health initiative. We can also build chronic care management for for the time that the nurse spent while she's at the doctor's office. So we did get compensation for some of it, because technically we are her primary care that's doing all her care management. Now, if her doctor was trying to build care management on the side, you know, for even 1520, minutes a month, that could blow it, and we couldn't do that, but there's ways we can do that. So now guess what? So as as son and daughter talking about to Mom what things need to go on, they now have our whole staff. So if we're thinking, she can't be at home any longer, down the road, we've got our nurse practitioner, our Community Health Worker, our. As a nurse, our physical and occupational therapist, our providers, doctor, all of those folks can help you in having the conversation, yeah, so that we're the ones coming in and saying, Hey, you really need to do this, or you really need to do that. Yeah,
that's great. Scott, this has been great. I think there's so many people out there that need to hear this. And you know, if you're your health provider, you know you need to be walking families through this. You know you're not just, you know, working with a patient. A lot of times, you're working with the caregiver. You're working with the son, the daughter, the cousin, or whoever is caring for that, that person. So I think these are just great conversations that you know that we need to continue to have, pull the keys if you need to. We had to do that with my dad at one point. It was tough, because driving was huge to him. He loved to drive. He was he was he loved it. So those things are really hard, but they, man, they're, first of all, they probably saved somebody else's life,
yeah? And save Well, you know, one of us, the people who probably the other thing is that out of all these folks that may be involved with this patient, there's generally one person out of the group, and it's not, it could be any of the positions, but it's usually one person that really just clicks with this patient, yeah, or that patient clicks with them, and they will believe everything they say, you know, because they we've seen that with CNAs and medical assistants, you know, they just get attached because those are the people out there who are helping them. And so I think that's the key to it, is making sure that somebody is building that, that confident relationship, and they're going to help you as as children and family members really have handle and deal with the issues that are coming up. So making sure that that whole care team is involved is going to be so important down the road to make sure you know, one of the things, and also, just as I round out from the beginning, is, how do you get to the truth? As we said, everybody kind of telling you stories and maybe lying to you, intentionally or not intentionally. How do you get the truth? One of the biggest things I noticed when we were running assisted livings is when patients would come into the ALS, then all of a sudden, within a week, sometimes they would crash and and it and we started looking, and we first thing we start doing is going through all the medications. And the reason they were crashing is because they've been written prescriptions for years and they weren't taking them. So they'll say, hey, my blood pressure is bad, but if you only take your blood pressure medicine every other day at home, and then they keep upping your dosage because your blood pressure is still not under control. And then they move into an assisted living or a nursing home, and they're giving it to you every day as prescribed. Yeah, it's too much medicine. And so what we've said, and that's why I advise all of our staff out there, why it's so important that when you're coming out of the hospital or the nursing home, that we're trying to see you every single day as we can. So my goal is that we could see any patient in any home, any of our service areas, five times in seven days. So how do you staff accordingly to where we can see if we needed it? Not that we're going to go see everybody five days, but coming right out of the hospital four days for the first seven days, we should be in the house, you know. And that's our goal. We're not there yet, but we're hiring so that those things can happen again. That's going to be huge comfort to our families who are homebound, but get out there. Grab the book, read it, start having conversations, is what I know. Tell people, yeah,
it's on Amazon. You can go get it. It's called Parent Talk and written by G Scott Middleton, who you've been listening to, Scott. Thanks so much. And we'll, we'll talk to you next week. We're going to get in to specifically. We're going to dive deeper into what you're already talking about here a little bit is doctors and diagnosis, managing physicians and primary care, navigating multiple doctors and understanding the big picture. So we're going to get into that next week, so be listening and we'll we'll see you next week. Thanks, Scott,
great. Thanks, Jamie. Have a good one.