Episode 18: The Worst 5 Minutes of Tammie’s Life

Embark on an emotional voyage with us as we explore the intricate world of bariatric surgery and the heartfelt journeys of those who traverse it. Tammie who is both a bariatric coordinator and a patient herself, provides an insider's look at the tangled web of feelings and fears that patients face, emphasizing the critical need for a compassionate healthcare environment. We delve into the significance of empathy and the essential role of post-operative support in shaping a patient's experience—because the road to wellness extends far beyond the operating room.

Dr. Iliakova and Tammie share their insights on the transformative power of respect and understanding, discussing the profound impact these gestures have on building trust and ensuring patients stay engaged with their post op journey long after they leave the hospital.

Tailoring the treatment to the tapestry of each patient's life, we discuss how personal circumstances and individual needs are the threads that, when woven together, produce the most successful outcomes in bariatric care. We invite listeners to weigh in with their experiences and perspectives on clinical environments, as we strive to create a supportive community attuned to the nuances of bariatric healthcare. Join us in this heartfelt conversation that's not just about shedding pounds, but also about shedding light on the path to a healthier, more understanding world.

Transcript

Speaker 1: 0:00

Welcome to Core Bariatrics Podcast hosted by bariatric surgeon Dr Maria Iliakova and Tami LaCose, bariatric coordinator and a patient herself. Our goal is building and elevating our community. The Core Bariatrics Podcast does not offer medical advice, diagnosis or treatment. On this podcast, we aim to share stories, support and insight into the world beyond the clinic. Let's get into it.

Speaker 2: 0:26

Tammy, how are you today?

Speaker 1: 0:28

How are you doing, Maria?

Speaker 2: 0:29

I'm pretty good. So I wanted to ask you about something that you told me now, a few months ago, and it's when you told me that worst five minutes of your life were the five minutes before you met me. That's so offensive. Five minutes of your life were the five minutes before you met me.

Speaker 1: 0:44

That's so offensive, Don't take it personally. It was just anxiety. There was a lot of what am I doing here? Not necessarily what am I doing here, but what am I about to experience Definitely. And what are people in this clinic thinking about me? Because I am obese in this clinic waiting to get a consult for bariatric surgery.

Speaker 2: 1:13

Part of the reason is I'm not a scary person usually and but you know, what we do definitely has a lot of stigma and fear and misunderstanding attached to it. So what you actually said resonated with me a lot.

Speaker 1: 1:37

I'm glad you said it, yes, and I think that a lot of people probably have that same feeling when they're sitting in that bariatric surgery waiting room waiting for their initial evaluation.

Speaker 2: 1:48

Exactly. You know, and it even made me think of, are we making the process harder than it needs to be? It's already pretty tough for someone to even get to the point where they know what bariatric surgery is or ever consider it. Even other doctors have a difficult time necessarily knowing what it is or when to talk to their patients about it. And so and certainly you know, it was brought to my attention not too long ago by a good friend of mine, who's been a friend of mine for years now. But even she was like okay, so what is bariatric surgery?

Speaker 1: 2:18

So I think that is definitely a big thing that people don't understand Right, look at it Okay, it's a weight loss surgery, but yeah, how are you losing the weight? Are you sucking the fat out?

Speaker 2: 2:29

Right or what. Right, and so a lot of people, I think, come into that setting for their very first appointment before seeing anyone in a bariatric program and really are skeptical or scared or unsure or really don't know. And I know that anytime I'm in that kind of situation I find it hard even to ask questions or know what to ask.

Speaker 1: 2:53

Absolutely, because you're scared. You're still getting the feeling of who this provider is, how this provider is nurse or MA is medical assistant.

Speaker 2: 3:06

Exactly, exactly.

Speaker 1: 3:08

How they're perceiving you.

Speaker 2: 3:09

Exactly, Even the receptionist, even like who's checking you in. I think it can be really scary. So what it made me think is you're a very strong woman. You are the mom of three boys and a professional and just a very inspiring and caring and strong person.

Speaker 1: 3:24

And when you told me oh, I appreciate that. Well, it's true.

Speaker 2: 3:27

It's true, but when you told me those are the five worst minutes of your life, I just thought that ain't right and we can do better.

Speaker 1: 3:37

And that's why I told you that. That's why I've also told you that post-op care and follow-up and support was crap. Yes, and that's why I ended up coming into the clinic professionally as a bariatric coordinator, because I wanted and still want all of this to not I agree with you entirely. I want people to be as comfortable going into their bariatric surgery appointment as comfortable as they are just going in and talking to a friend.

Speaker 2: 4:07

Well, right, exactly, and it made me really think about this worst five minutes experience and what we could do to make it better. But first I want to talk about what makes it scary and what makes it that worst experience, and some of the things that really came up in thinking about this were stigma and fear, the process being pretty intimidating to even get to that spot in the first place and then not really knowing what to expect out of it or how much it would cost, or being afraid that people would be judgmental or unfriendly. Does that sound like a pretty decent recap, or what else do you think is part of that?

Speaker 1: 4:42

Absolutely All of it, a hundred percent yeah.

Speaker 2: 4:49

You and I have talked about this a lot since then, so I'm glad that you're sharing some of those things too, and then it's made me think what do we want to do instead? If it were me in that chair, if it were you in that chair again? What are the things that we would want to accomplish for people and want other programs to accomplish?

Speaker 1: 5:07

Yeah, and so you know. You said the process or unclear patient is.

Speaker 2: 5:13

Yes.

Speaker 1: 5:14

It's an intimidating process to get there. So for me, I worked in the clinic space that the surgeon was in and I knew the medical assistant that the surgeon was in and I knew the medical assistant she's actually the one that was like yeah, calm down, just have a chat with the surgeon and see if this is something you want to do so that, even though some of my anxiety was still really intimidating, and so I could not imagine how someone who has never been in a clinic in that sphere or does not know anybody in the clinic, how intimidating and just feeling is yeah, and if you think about it like a lot of the medical settings in general are just intimidating and scary.

Speaker 2: 5:59

There's a lot of everything is pure, sterile, technical, very formal. Sometimes there's very little ability to laugh or feel inviting comfortable. A lot of times you're waiting. It just seems like we could be treating people in a more welcoming and respectful manner in general and providing more transparency, because I think that when people are coming in and they really don't know what to expect in terms of time or cost or what they're going to have to do, that really creates a lot of anxiety. Like you mentioned about not knowing and that's something that oftentimes you know this process of going through bariatric surgery, getting ready for it and even the care afterwards a lot of that is fairly predictable. It does not have to be this you know, mystical process that people don't know what to expect in the beginning. We can be more transparent about what it will entail.

Speaker 1: 6:58

Absolutely. And so yesterday I had orientation at a new job yeah, and one of their trainings was AIDIT. Have you ever heard of that? What's AIDIT? So it is A-I-D-E-T, and what this is is when you are first introducing yourself to a patient or coming in contact with a patient, acknowledge them, you introduce yourself and not only just say my name is Tammy, but my name is Tammy, I'm a respiratory therapist. I'm going to do your breathing test today. I've done hundreds of these breathing tests and I'm going to coach you along the way, the whole way, that way you know what you're doing. You coach you along the way, the whole way, that way you know what you're doing that right there, doesn't that already I'm breathing.

Speaker 2: 7:52

I'm breathing a fresh, fresh air breath right now, because that makes me feel so relaxed, it makes me understand you're going to be there for me, you know what you're doing and you care.

Speaker 1: 7:58

Yes, and then it's so AI, and then D is duration. Look, this breathing test is probably going to take an hour. It could take up to an hour and a half, and then we'll let you out. Nice Explanation.

Speaker 2: 8:10

Yes, of what you're doing. Yes.

Speaker 1: 8:12

Doing this breathing test because we want to see how well your lungs are working. This is not a pass or fail test. This is just to see where you're at.

Speaker 2: 8:20

Love it.

Speaker 1: 8:21

Love it. Thanking them, love it, and then thanking them, thanking them for their patience, seeing if they have any questions, all of that. So that's something I learned yesterday that I'm like oh my gosh, every single clinic provider, health care provider, needs to.

Speaker 2: 8:38

That's a great method and, honestly, if you think about it, there's a lot of that in customer service and I'm not saying all customer service is great or anything like that but I think in health care a lot of times we don't see our patients as also our customers or our clients, and I think that's a mistake actually, because people have choice in where they go.

Speaker 1: 8:58

They have the choice to be there or not be there and we don't necessarily treat people like they have a choice and like it's a privilege to take care of them, especially when it comes to bariatric surgery, elective surgery yeah, so they do not have to have the surgery like they would need to get their gallbladder come out, or something Exactly. Exactly Though it will help their quality of life. It's not going to make or break their life.

Speaker 2: 9:23

Right and also exactly. It's not like your gallbladder is coming out one way or another or else you're dying of sepsis, right, like that's not what's happening here. This isn't a cancer surgery. But what we don't realize is people have the right to, yeah, make a choice of whether or not to be there, and I think a lot of the problems sometimes there's a lot of worry that like, oh you know, people won't come to a bariatric surgery clinic or they won't get care for their weight because of all these stigma and all these other barriers but I think one of the biggest barriers is actually how we as providers and we as programs treat our patients and our customers. Because we don't, yeah, right.

Speaker 1: 10:00

We've had so many patients who said it wasn't going to come in today. But, tammy, that email that you sent me of this is what to expect. This is how things are going to go. This is what you guys are going to talk about Questions or concerns let me know, here's some resources. And so I eased that anxiety a little bit. And then, even when they were checking out for their first appointment, they did a lot of information, so much information. Nobody can take that much information. So I was always there to be like, look, I got a lot of information. So make sure you reach out to me if you do have any questions or forgot something. Just have a friendly checkout process.

Speaker 2: 10:45

Exactly.

Speaker 1: 10:45

A lot of patients said that's the reason why they came back. They knew it was such a friendly place.

Speaker 2: 10:52

Exactly, and that's probably the compliment that carried the most weight, because when people felt they were taken seriously, with respect, but also made to feel comfortable and like they really could reach out for help or support and like they would be treated like a person that meant they were going to stay and that meant they were going to then help their friends and family get in the door and they were going to trust us not only to take care of themselves but also of their loved ones, and I don't think there is a bigger compliment to be had in healthcare. Right, people trust you with their ones, so it really, I think, matters a lot, and I don't think making that five minutes before that first appointment better I don't think that's very highly valued, but I honestly think thinking about the process of how you make people feel welcome and how you make people feel included and supported as patients is maybe the most important aspect of shepherding people through the process overall.

Speaker 1: 11:56

Absolutely, especially when it comes to bariatric patients. Yes, when a bariatric patient even goes into their primary care doctor Right a bariatric patient even goes into their primary care doctor. Look, most of the time, even if they're there to talk about. Okay, let's just say for a woman that my menstrual cycles are super heavy. What's the first thing that they're going to say? Well, your BMI is super high, Take care of that. I understand that. That's what I loved about you is that it wasn't all about weight. It's not always about weight.

Speaker 1: 12:29

You're like you've lost 10 pounds this month after surgery. That's great, but how's your energy Right? How do you feel? How's your just all of?

Speaker 2: 12:51

remember, even way before I was a bariatric surgeon, having friends and family and others tell me basically about their health care experiences and going in for like an earache or a headache or a broken bone or whatever, and weight would come up as the primary reason for the visit, even if it really had nothing to do with what was going on and that being just really offensive to people and really once that trust is broken, where a person doesn't feel heard and doesn't feel like their reason for coming in the door is getting taken care of, that is someone that may lose trust for the overall health care system.

Speaker 1: 13:24

After you just said that there's smoke coming out of my ears Right.

Speaker 2: 13:29

And I think it's also like where's the justice in that? Where's the health care in that? Where's the like good? Even if you don't treat people with and think of them as customers or clients or whatever, how are you doing your duty as a health care provider if you're ignoring the person's primary reason for being there? That doesn't make any sense to me, right. So I feel on your behalf and definitely I think this is an issue that affects sometimes women more than men, because there are some studies that show women coming in with health care concerns, oftentimes their primary concern is overlooked more than than for men. So it does. In our population, which is primarily women that come to get this kind of care, it's even more pronounced.

Speaker 1: 14:14

I think a lot of that has to do with things I feel. You know, men obviously having speech, but as women I feel like more so because we care about what people think more and yeah so yeah, I think that's another thing where men is. A lot of men are just trying to go with the flow right right but you know what I think?

Speaker 2: 14:35

obviously we are not doing a good job with men either, and here's how I think. Why I think that?

Speaker 1: 14:40

because we don't see very many there's none of them coming, exactly because there's none of them coming in, because men that we see coming in are the ones that their doctor has told them. You either go see this doctor or you're going to die next year.

Speaker 2: 14:53

Right, right. I hate that. Right or right. Or they've been scared into it or they're dragged by potentially a spouse. There that happens a lot, but the guy that comes in on his own is actually kind of a rare breed in our field, right they?

Speaker 1: 15:07

do so good. They do so good For the most part. They do what they're told and they yes they do.

Speaker 2: 15:14

Yeah, they do very well. That's true and I think that they're, yes, the soul. It's. It is interesting to me because we're clearly not getting it right with either men or with women and it it really affects people's ability to get the care they need and it's also like a bad business. So, even if you're thinking about this as a big hospital system or you know some chief executive or a business person that's looking at the numbers here, when we treat people well, when we care, when we show them in these sometimes little ways that add up to a big picture and people feel supported and respected, they stay, they come back, they get care through us and they are loyal. They want to bring their family and friends and they, you know, even in the situation where we were in, where the overall hospital system was having some financial and other struggles, people wanted to stay with us and they didn't care that there were overall bigger struggles and battles. They wanted to stay with us.

Speaker 1: 16:14

Which was such an eye-opener. We didn't know if an OR would be open and whatnot. People are still self-referring themselves.

Speaker 2: 16:25

And.

Speaker 2: 16:26

I was just like. This says something about us and that made me proud not to blindside people with what the costs were, what the realities were of getting medications for weight management. And as that practice grew, our surgery practice grew too, Because we were so, I think, honest, transparent and supportive and didn't tell people, oh, you just have to have surgery and that's the only way to go, but we were honest about, well, there's actually a lot of options and we can support you in all of them and you can take your time to decide what's right for you and we'll be there to support you along that path. It really resonated, I think, with people.

Speaker 1: 17:20

Yeah, there's so much as we've said in the past. There's so much like on education or not, about this topic. Right Words are hard yeah. I know words are hard, that when people came in, sometimes on their appointment it says med weight loss only does not want bariatric surgery and by the end of the appointment, after the provider educated, let them know all of their options, the pros and cons of all the option and everything, a lot of them did come out wanting surgery or at least wanting to explore that option more.

Speaker 2: 17:55

Definitely, definitely, and that's something that it definitely takes more time than just going through one option or the other, but ultimately it's also more accurate to do that. As a healthcare provider myself, I take a lot of pride in being able to do more than one thing and being able to give people a full spectrum of options even though it can take a little bit more time and actually help people get to the goals they set for themselves a lot better. And it's also maybe a goal that changes over time where people want to be in six months may be different than where they want to be in five or 10 years from now. So being able to support people as their mind changes, as their goals change, that's pretty cool. I think that's amazing that we don't just have a one size fits all approach to weight management anymore and we're starting to really learn that it takes a lifetime right.

Speaker 1: 18:51

Absolutely, and we've even had patients that come in. They only want bariatric surgery. And you know they're like, okay, we're going to go towards the steps of bariatric surgery, but hey, why don't we just add a medical weight loss on there? While we're doing things that insurance and the program require.

Speaker 1: 19:08

Exactly doing all the things that insurance and the program require. She actually had a patient that was doing so well on medical weight loss and actually tapering herself off of it, decided not to go through with bariatric surgery because weight loss gave her the head start she needed.

Speaker 2: 19:25

Exactly, and I think that's the right answer for some people. Certainly that's not the answer for everyone, but that's kind of. The point is that this is not a one size fits all approach. You don't like. You know, you said a gallbladder surgery is done when you have a gallbladder problem because you only have one gallbladder and that's. There's no other real good treatment for gallbladder problems. Right? It's not a? You're pregnant, you have to have the baby and deliver them and then you're done. No, this is very different. This is weight and all the complexities that go with it, and also figuring out what's right for that person at that time. In order to go through surgery, you have to have financial resources. You have to have social resources. You have to have people around you who will support you. You have to really know what you're getting into to be successful and not everyone is at that point right, there's people.

Speaker 1: 20:15

Absolutely.

Speaker 2: 20:15

Right, because there's people changing jobs, for instance, that aren't able to take time off to recover from surgery, or people going through financial or family transitions, and actually we've had quite a few people who needed a little bit of extra time to get through some of those transitions or to get their life to a point where they were more ready. And guess what, those folks typically do a lot better than anyone who gets rushed through the process.

Speaker 1: 20:38

Absolutely. I 100% agree with you. That's why we had so much. I feel like we had a lot of pushback when we're like no, I think instead of just three appointments, we need to have maybe four or five, and we do need to look at everybody's situation separately. Everybody is going to take their own time. We got a lot of pushback from that, but I think some are co-workers and stuff. I think, then, from patients, even though it's the initial frustration of oh, I thought I was going to have surgery in three months.

Speaker 2: 21:09

Today, yeah.

Speaker 1: 21:10

At the end of the day they were like oh, I'm glad I took extra time to get my life stable my mental health a little bit better.

Speaker 2: 21:24

Yeah, exactly. And the other thing that really struck me was that there are some people and I know we've had these conversations and we've definitely had them with our dieticians and things too that you're like this person would be ready for surgery today, like they walk in the door, they've done their research ahead of time, they really know what they're getting into, they have fantastic support, they've got insurance coverage and you're like you know what, if there were a way to fast track this person and get them to surgery in a month or two, maybe that would be the right approach for some people.

Speaker 1: 21:50

That's how our dietician felt about me. She's like. I think you could almost teach me some things, not literally, but just like the little things I taught you of like how to be helpful, just like a clothing closet of people bringing in clothes that don't fit them anymore so that another patient can wear them while they go through that stage. So I sometimes talk to the dietician just little tips and tricks. But she's like, wow, done a lot of research and yeah, but then she personalized my nutrition plan and stuff.

Speaker 2: 22:25

Exactly. But, tammy, I think that your sort of bigger community picture of this and the bigger influence that this has is what makes you stand apart, and I think it's honestly what makes you such a great advocate for people who are going through bariatric care and for people who need to access it or want to access it, because you're not all the good, the bad yeah. Yeah.

Speaker 1: 22:51

What can happen? We need to look at picture case. You could have surgery and not know. Oh, it's sleeve cause acid reflux.

Speaker 2: 23:00

Exactly.

Speaker 1: 23:01

People don't know that.

Speaker 2: 23:02

They're a little upset.

Speaker 1: 23:04

So I think, just like before the first appointment, being transparent about all the things gains trust, yes, gains that community, yes.

Speaker 2: 23:15

And encouraging people to know what they're getting into ahead of time, and that's something that I think you did really really well in our program and that's something that we continue to evolve. But even educating and supporting other health care providers, because we started to see a lot more referrals when we engaged other healthcare providers more, so, like we went out into the community and did teaching, we invited people to come and see what we were doing, we invited partnerships, we created the feedback loops basically of like hey, thanks so much for sending us this person and here's how they're doing and here's what's going on. And I think people really appreciated that. Because we're kind of siloed otherwise from each other, it's tough to have a lot of coordination, naturally between, like, the cardiology office and the bariatric surgery office and respiratory and their sleep clinic. But if you actually create some of those relationships and partnerships, that makes everything so much easier and it also, I think, really encourages people to work together and then notice when something's off track. So that was.

Speaker 1: 24:23

Absolutely agree and I think patients that are choosing their provider whether it be a bariatric surgeon, their primary care doctor, their specialty you know sleep cardiology doctor seeing how they communicate with your other providers, that's huge Like, and if you have a provider that isn't doing that, don't be afraid of finding another provider. Right your health overall and the ones that are willing to take the extra five minutes to communicate with your other provider, that's having a good team on your side.

Speaker 2: 24:55

Exactly, and it does mean that there's more than one set of eyes on whatever's going on, because we can't all I mean everyone knows our healthcare system is not perfect and things slip through the cracks more than we want them to because everyone is working on different systems, everyone has different schedules and communication could definitely be better. So when you have a team that works together, even if they're not in the physically same location, it's just such an easier process for everyone and I think everyone, even in a bad situation, for instance, can just really work together a lot better to help each other, help the patient, help everyone just overall, do better.

Speaker 1: 25:34

Yeah, and I think if everybody's on the same page, and how you've met with primary care doctors and let them know what you offer medical weight loss surgery, all of that when the primary care doctor is educated before sending that referral, they educate the patient, which then results in less anxiety.

Speaker 2: 25:55

Exactly, they know what's coming they?

Speaker 2: 25:56

know what to do Exactly. So it's sort of like if you're going into an interview process for a new job and you have no idea about anything about that company. You don't know anything about their culture. Yeah, it's scary, right. That's never a situation in which you're set up for success. Instead, if someone's referred to you there because they personally know someone and they really like that person, they can speak really highly about them and they know exactly what you're going to go through in that job interview or that process. You're going to really look forward to that and really know what to expect.

Speaker 1: 26:28

Setting people up for success.

Speaker 2: 26:30

Exactly, and I think that's really a key in changing that five-minute experience that you had from one that was the worst into one that is great and one that is not necessarily the best five minutes of your life.

Speaker 1: 26:46

But the five minutes that people could recommend to others it wasn't the worst, Like I don't know if I would have recommended people to come into our clinic after I felt what I felt now different. Now it's obviously different when I've worked down here and changed a few things.

Speaker 2: 27:04

But that's why because I think that is technically the first impression people get right the first impression that people get of a program or a provider is sitting in the waiting room oftentimes and if that experience is awful, if that experience sucks, then you're not setting yourself up as a provider for a good interaction and you're definitely not set up well as the person receiving the care to be open to it, to be open-minded and to know that that person's really going to care and give you a lot of respect through the appointment that that person's really going to care and give you a lot of respect through the appointment.

Speaker 1: 27:43

Yeah, part of that aid training was managing up.

Speaker 2: 27:45

So I managed you up.

Speaker 1: 27:46

A lot like saying if I roomed your patient, just letting them know like she is amazing. She listens to all of your problems. She honestly doesn't care so much about your weight. She wants to know how you're feeling, what goals you have, all of that.

Speaker 2: 27:59

I love that, tammy, that's so kind and I think honestly we did have a clinic atmosphere of very much talking each other up, and that was real because I think we all really respected and liked each other. But it was also helpful to you know. At some point we transitioned to actually going to reception and grabbing patients and initially I was like, oh my gosh, this is kind of difficult to do where it sort of disrupts your workflow.

Speaker 1: 28:21

But then it really you yelled at me through Microsoft Teams I can't do this, I cannot get my own patient.

Speaker 2: 28:27

But it really grew on me. I was totally wrong because, like completely, because I think you're trained as a provider, like as a surgeon, that you need to stay put and people need to come to you, and I think that was really short-sighted on my part because in that you know, 30-second interaction that I was getting to have, walking to reception helped me clear my mind a little bit. Now I was transitioning to the next person and I needed to focus on them. And then it also helped me walk people back to reception or to the next place they needed to go, which was typically a dietician, and it helped me create an introduction for them. It helped me, like you said, like talk up the next managing or leveling up basically Right.

Speaker 2: 29:09

It helped me establish that kind of positive expectation of the next step.

Speaker 1: 29:14

Eased anxiety 100%. So when you, the provider, are coming out to grab the patient, that walk to your office is not with another person.

Speaker 2: 29:25

Right.

Speaker 1: 29:25

The anxiety of who this provider is going to be, and then you actually walking them to the next person.

Speaker 2: 29:32

Right.

Speaker 1: 29:32

Again eased that anxiety of oh my gosh, what's next? Right?

Speaker 2: 29:37

Exactly Because it was such a nice way also to get introduced to people, because instead of people getting walked into my office and it feeling sort of like you're going to the principal's office or something which is I know how it can feel sometimes for people and instead, you know, my first interaction was like hi, how are you? And tell me about yourself a little bit. And we were walking down a hallway, not talking about wait, not talking about health care, literally learning whether, like how many dogs this person has, about their kids, about their trip down. Well, I mean, I love my dog the most, but Sasha forever, but no, but it just created such a different dynamic right off the bat with people and it really grew on me and I would not go back at this point, I think, to how we did things before, but it took, honestly, also me being wrong, me changing what I had been trained to do to what made more sense for the people I was taking care of.

Speaker 1: 30:39

And not bash on surgeons or anything, but surgeons have a hard time of being wrong.

Speaker 2: 30:45

Yes, Tammy, I don't know what you're talking about. No, I'm kidding. So that's where this community?

Speaker 1: 30:52

our core bariatrics. Not only do I want to reach out to, and touch and be supportive of patients, we also are going to be building community for even providers of how they can make their practice better.

Speaker 2: 31:08

Exactly. So that anybody listening here that still hasn't had bariatric surgery hopefully their provider's office has the same very welcoming, respectful and transparent office and arts and culture groups and really realizing that our reach is powerful within our clinics and our hospitals and our ORs. But really bariatrics lives in the real world, not in our healthcare facilities.

Speaker 1: 31:49

Absolutely.

Speaker 2: 31:49

Right and like kind of care that we're providing and the kind of results people are seeing, the kind of lives people are living. 99% of that happens out in the world, outside of medicine.

Speaker 1: 31:59

Absolutely, and I feel like if all programs are like how we were or how we were building to be, people long-term are going to be more successful as well. They're going to have encouragement to stay accountable and stay on track and they're going to want to come to their one-year follow-up Exactly that's what I'm hoping for to come to their one year follow up.

Speaker 2: 32:18

Exactly that's what I'm hoping for.

Speaker 1: 32:21

That's what we're here for.

Speaker 2: 32:21

Exactly I think, yeah, we're here to make the whole process better, and the process is better for people going through it as patients, people going through the process as providers or others within programs, because ultimately, the goal is for all of us to do better, not either or and not against each other by any means, but absolutely the tide that raises all boats.

Speaker 1: 32:44

Absolutely, absolutely Well, maria, let's wrap this up here For those that are listening. Please don't hesitate to comment, let us know what you think about this, let us know what your experience was in your clinic and if it was different than what we're explaining and if you would want an environment like we're explaining. So don't forget to comment, follow our podcast and we will see you next time.

Speaker 2: 33:12

Absolutely. Thanks, guys, great to talk with you. Bye-bye, bye.