Episode 14: Jeremy Sunseri, MD

Don’t miss this episode to get the inside scoop on sunscreen and the prevention of melanoma. This important information is necessary for all of our outdoor lovers! 

Transcript

SPEAKER_00 0:14

Well, hello, and welcome again to the Medical Mastery Podcast, the podcast of the Emerald Coast Medical Association. I'm your Amaranthean host, Don Davis, and I am very happy to be here again with our returning champion, our friends, our leader, our former president of the Emerald Coast Medical Association, and perhaps our favorite podcast guest so far, Dr. Jeremy Sunseri. Dr. Sunseri, welcome back.

SPEAKER_02 0:40

Thank you. Thank you. Good to be back. Can we back up real quick? Yeah, let's do that. That word you used somewhere in there about your host, Peranthine.

SPEAKER_00 0:49

Who knows? I just looked it up right now and I don't even know. Emeranthine.

SPEAKER_03 0:53

Yes, what does that mean?

SPEAKER_00 0:54

Evergreen. Forever and ever here. Okay. Canonical, if you will. So uh now let's say a few words about um why we're doing this again here. First of all, you were an incredible guest. Secondly, um, for those of you that watched the very first podcast or listened to it um on your favorite podcast listening device, um you noticed that it cut off relatively abruptly at about the 45-minute mark. Well, uh, some inside baseball here is that that was our very first podcast day. And uh despite it being episode four, um we found our technical limitations on that day, and we have subsequently um revised our uh parameters and uh made things significantly better. So um mad props and credit to Chris and his team at Curiosity Marketing for um amending those details. But unfortunately, we lost um over half of the recording that we had there, which by the way was incredible, and we cured cancer. I remember that distinctly. Totally. Um so we'll have to recapitulate those ideas here now. But this is a continuation of that uh podcast and honestly a continuation of a conversation with um a friend of mine that I really enjoy talking to uh even off camera. So, with all that being said, Jeremy Sancerias, I live and breathe. Welcome back. Shoot, it's good to be back. Okay.

SPEAKER_02 2:09

Living and breathing.

SPEAKER_00 2:10

Living and breathing, as you do, as one does. Um I I also want to tell you that um, you know, my family I've been talking to about this podcast. Um, my older brother, he uh he called me and he was like seriously mad at the podcast cutting off. He was like, What happened? What did you do? What did you I want that back? I was like, I I know I want it too. And uh I had another member of my family who was um telling yet another member of my family to listen to the podcast and says, Oh, you've got to listen to the bull rider one. You have to listen to the bull rider ones. That's a lot of bulls. Uh no, it was it's it's really it was a great one. So episode four, make sure if you have not heard that one, you need to listen to that one first. Um, it'll be necessary listening uh lore for this one right here. The prequel. The prequel, if you will. So um now, as a matter of fact, um, in listening to our previous podcast and watching it, um, we had just finished talking a little bit about melanoma and kind of what it is and the scourge that it uh presents to us and our community and society and to humanity at large. And um, you know, you had talked about some of the aspects of how we would uh screen for it and remove it. I I think maybe um, you know, sometimes in the lay public there's some discussion about whether or not sunscreen is good for us or bad for us. And I wonder if uh from a dermatologist's perspective, you could maybe add some words and some thoughts towards that.

SPEAKER_02 3:38

Yeah, all I will say is uh I I do get a kick out of listening to it, the social media, the age of misinformation. Um and I hear people say sunscreen causes skin cancer, and all I will say is then brushing your teeth causes cavities because that is about the craziest thing I've ever heard. Um there are two main types of sunscreen: physical blockers and chemical blockers. So physical blockers do just what they say, it's a physical block using zinc or titanium. Yeah. And those are the ones that if people are worried about anything, I tell them just use something with that as the active ingredient. Chemical blockers are a chemical that breaks down with absorption of the sun, and so it's things like octeno octate or octanobenz weight as the active ingredient. And if you want to stop using sunscreen, you can stop using chemical blockers, but don't use physical blockers, and then uh don't sorry, don't not use physical blockers. Yeah, and also just cover things that you want to keep, like your nose and your ears, wear hats and that kind of stuff goes a long way too. Now you still get a lot of reflection, especially if you're on water or near water, you'll get a lot of um UV bouncing back up, so it doesn't cover everything, but it is helpful.

SPEAKER_00 5:04

Well, even snow, uh you can get reflection off that. I mean, you tend to be a little bit more covered on the side. But yeah, anything. Um, and you know, this is this is interesting. Uh let's let's take the contrapositive, let's give it the best uh possible um, I think it's called steel manning that we can. Um what is the argument against chemical blockers in general? What it what is the hubbub about?

SPEAKER_02 5:27

I don't know, but okay. I think um because it's a chemical and people are like, oh, chemicals, um your skin is made to be a barrier to the outside world and it does a good job of not absorbing things and holding things like water inside your body. Um and so again, I think that it's probably negligible, however, for those people that get worried and concerned about things like putting chemicals on your body. Yes, and uh for them I'd say, hey, look, then just use titanium or zinc, and you can't argue against that really. I mean, titanium and zinc never hurt anybody unless you ingest it in quite a bit of it.

SPEAKER_03 6:09

Yes, exactly, which which I wouldn't recommend.

SPEAKER_00 6:11

I wouldn't recommend either. We're making great recommendations here today. Uh absolutely and the the physiochemistry behind it is somewhat interesting as I understand. UV light is bringing in high energy intensity energy and maybe electrons that are coming down and are causing uh gamma radiation, etc. Yeah. Yeah. And so when we have chemical blockers, what that is, is typically um benzene carbon-sharing rings that can kind of share that's energy over uh safer space as opposed to sending that out to our DNA to cause more problems. Is that a way to think about it? Well he said stumbled through that. Okay, I needed some help there. Um but as opposed to physical blockers, which um uh physically create uh uh kind of a second skin on you that that keeps that from happening. And um now in your own personal life, do you pick one or the other or do you just go for it?

SPEAKER_02 7:10

So um for me uh so men in general aren't good at putting on lotion or cream. I think just by nature, women are much better at it, and I think that is a whole separate discussion as to why. Um we'll edit this out if we need to. That being said, um I think that it's important that you that the sunscreen that you put on is is comfortable. So not all sunscreens are created equal, some are have a really silky feel and don't feel like they're you know plug and pores as you put it on. So for me, I just like one that's that feels good, it doesn't feel real, I don't know, like Vaseline basically. So um I per my personal sunscreens, I do like physical blockers, but they also contain a little bit of a chemical blocker in them too. So yeah, uh, but I really just go based on feel and comfort of it, really. And the most important thing, which is the hardest thing about sunscreens, is reapplying it. You're supposed to reapply it every two hours. And I will tell you when my kids were little grown up here in Florida, we would set a timer, and every time that timer would go off, we'd be like, dang, it's already two hours, we just put it on like an hour ago. So um that's the hardest part I think about sunscreen is reapplying it. Yeah, especially getting in out of the water. Exactly.

SPEAKER_00 8:37

And uh dudes just aren't real good at it in general, they aren't. Um, and you know, um physical barriers in terms of clothing is also another important option.

SPEAKER_02 8:47

Uh I'm a huge proponent of covering up, yeah. You know, long sleeve shirts, they a lot of the fishing gear that's out now is really you'd think you would think, man, it's gonna make me so hot. Uh it really is almost cooling. It's very breathable. And the fabrics that are made or that are used in making some of this stuff is much more comfortable and cool than one would expect. So if you're gonna if I'm gonna be out in the sun all day fishing or something, if I'm going offshore, man, I cover up everything, put sunscreen on my for sure, cover up my nose and ears and everything else. And you know, I try to put it everywhere, of course, but it looks really bad when I go to work and tell people uh to practice sun safe behaviors and I got a sunburn. I mean, so I try to avoid it like the plague.

SPEAKER_00 9:39

There's a famous uh interventional cardiologist, Mason Soames, who there's pictures of him smoking in the cat lab, and it's just it's just this kind of uh you send a little bit of a dichotomous message there when they say. Yeah, that's right. Um but I have seen you at the water park before and you were wearing a long sleeve shirt, and I was very impressed by that. So I was practicing what you preach, so I I can I can respect that.

SPEAKER_02 10:01

I also have this uh Irish melanoma prone skin that it's not good for for uh it is good for dermatology business, but that's about it.

SPEAKER_00 10:14

Um well it also um bespeaks to another uh fact about medicine, which uh I think is really worth mentioning both to our professional colleagues and to the lay public, which is that prevention is so much better than treatment. Absolutely. And that goes pretty much across the board. I mean do you have some fancy things that you can do about really invasive melanomas? Yeah, I mean you can get in there, you can really get uh you've got better technology to get probably thinner margins that are, you know, more um uh aesthetically appealing whenever you go to fix them, and there's perhaps some other um chemotherapeutic or other interventional agents that we can utilize so much better to prevent this in the first place.

SPEAKER_02 10:56

For sure, for sure. Absolutely. Um get your skin checked if you're prone to it, have a his family history of it, and just I think the most important thing as far as that goes from a dermatology perspective is don't get a sunburn. Um so am I condoning a really good tan? No, uh not necessarily, but I would say uh tan is probably better than getting a bad burn, so that's I think causes the most damage.

SPEAKER_00 11:27

Yeah, you know, and I I I found myself recently um kicking myself for not having sunblock at things that I wouldn't have thought about, like sitting out for the Mardi Gras parade. And you know, you're gonna be outside for a while, and it's it's oh man, I should have thought about this. Uh, you know, to the beach is kind of you you feel like I'm going out to the pool, like I I can I can wear sunblock, but if you're gonna be exposed for any significant period of time outside, you should do this.

SPEAKER_02 11:51

For sure. Easier said than done. Yes, it is. And you should exercise every day.

SPEAKER_00 11:57

I'm so glad you brought this up, okay? Finally we can talk about this. Yeah. Uh so let's uh let's change gears for a second here because um you have been a business owner now for uh near on 10 years. Is that fair to say? Yep. Owning your own practice, and um, you know, what I've said before on this podcast, and I'll say again, is that I found out at some point that cardiology was actually the easiest part of my life. Right. It's the other stuff that you do. And so um, why don't you talk about opening your own business and what that has been like? Um, and that you know, we say practice, but it really is business.

SPEAKER_02 12:36

Yeah. Um I'm probably the last person that should be talking about any kind of business. I think I lose a lot of money and leave a lot of money on the table every day. Yeah. Um, but I just kind of set out with I'm gonna practice and just do a good job for patients and let the rest fall where it may. We're not gonna starve. Um that being said, I pulled my hair out today as I was at work doing administrative stuff, and my wife, who kind of does uh the office manager slash financial stuff for my business, came and said, she said, yeah, she's yeah, keep the glue. So uh she came to me and said, Hey, you know that Medicare's taken back a portion of our of our reimbursement and showed me all the numbers, like I don't know what percentage, but because we didn't uh submit our MIPS data or it wasn't a good score or something like this. So I try to go online and I mean on our electronic medical record, yes, and spent probably three hours, and I really wish I had it here to pull up and show you and describe some of the selection factors because you you need a lawyer present to talk about what the heck these things mean. And there's no way as a practice owner, I mean, you need a team for it. So they are effectively trying to get rid of the little guy by making it so difficult to run a practice that one cannot do it independently. That's right. And that is a problem and it's a scary problem. And if you think about the drivers behind that, it's even scarier to me as to why they wouldn't want independent private practice as far as uh I guess it's government. I don't know who's behind it, but it's a problem, I think, for sure.

SPEAKER_00 14:36

And it it may be um a feature of the system, not a bug. Um and and it's you know, uh, I I I love talking about this kind of topic with you just because I mean you've had a lot of experience with it. And you know, technically we're both kind of little guys in this field of trying to carve ourselves out in this niche and making sure that we're taking care of patients along the way. That's always been the priority. But for those that don't know about it, MIPS is basically it's a way to, it's a it's a quality improvement project for from the government. So for all CMS or Medicare patients, um, you have to check things like what is the patient's blood pressure? Are they smoking? Did you talk to them about stopping smoking? Are they depressed? Do they have um, are they living in a safe environment? A lot of screening issues that you may say are important, and they are, but it's not really in the wheelhouse of the dermatologist. I don't really want my dermatologist thinking about whether or not um the patient has, you know, uh their blood pressure control. I want them worried about, you know, their their lesions that they see on Right.

SPEAKER_02 15:42

But yet we have to do it and we have to check the box, or else, and the other six boxes or eight boxes or however many boxes that are required, or else uh they start pulling money back. So yes, so it's a stick, it's not a carrot here.

SPEAKER_00 15:57

Right. They pull money back that you have to pay in order to get to make sure that you maintain this. And my whole issue with this from the very beginning has been is this really improving any outcomes anywhere? Absolutely not. You know, I I'm talking with my patients about smoking in general. That's a good thing to talk to them about, especially in my field. As a cardiologist. Yeah, in general. Also their blood pressure. Trevor Burrus, Jr. It these are things every single time here, and that falls into my wheelhouse, and that's that's a purview. But it does create more legwork, more paperwork, more things that you have to do in order to maintain the same level of this amount that you're getting remunerated. Trevor Burrus, Jr. Right.

SPEAKER_02 16:38

So we should be getting a raise to pay our staff all this extra time that we have to pay our staff to do these things and check in just during the check-in patient process. And so, however, we're getting cuts. We're not getting raises. We're given more tasks and less pay.

SPEAKER_00 16:57

And it should be a carrot, it shouldn't be a stick. Yeah. And and this falls into something you didn't say these exact words, but but the point is that this is regulatory capture. Yep. The big organizations, the big practices, the big hospitals, they've got an entire department that can do this. That's right. They can hire the number of people, they're remunerated appropriately so that they can do that kind of thing. We're not afforded the same luxury, so we just have to assimilate that into our general folks that that come along and Yeah, it's crazy. It is. And it makes me angry. It does. Well, I I think the things that really um make us angry are um, you know, we could say um the emotional kind of uh stress that this involves. I think it really aggravates us whenever this really has nothing to do with patients. This isn't gonna improve anything that we do. This isn't gonna improve the amount of care that we give. This is box checky owl bs. That that is not helping anybody. You're just going through the emotions here, and and that really is frustrating to us, I think.

SPEAKER_02 18:05

Very and again, if it was improving patient care, okay, fine. But we're basically collecting data for people to then go back and cut our reimbursement some more.

SPEAKER_00 18:16

That's right, that's right. To to crunch numbers to see if this is really even worthwhile. Right. Um, you know, and and the other side of that that that I often talk about is that being in private practice is that not only do you have the insurance remuneration difficulties that you have on one end, but you also have, I mean, we're employing people and we are paying their insurance, and their insurance premiums are going up. So we've had this frank discussion with insurers that say, you're not giving me any extra over here, yet you're increasing the premiums that we're paying over here. Tell me what gives.

SPEAKER_02 18:52

Every year that they pay us less and charge us more.

SPEAKER_00 18:56

Yeah, it's a double whammy. It's it's really frustrating. And and you know, none of this takes away from the the the altruism that we really want to help people. That's that's certainly what we want to do. But as I've said before here, we have to create an economic engine where this is sustainable. Where we can, you know, because I mean, how many employees have you had for the past 10 years? Uh 20. 20 at least. So that's 20 families, that's 20 people, that's 20 um denizens of our society that are having houses, that are going to schools, that are are uh, you know, have other families and and other downstream revenue that you're supporting there. And so you would think that we would want to kind of support small business and and private practice a little bit more.

SPEAKER_02 19:40

Yeah. That's frustrating. And the other frustrating thing is, I mean, who can you talk to about it? So what are you gonna do? Call Medicare and CMS and have them listen?

SPEAKER_00 19:53

Well, trying to call insurance companies is very frustrating now, too. I mean, or good luck, yeah, yeah. You know, uh I don't I don't want to go too far off in this diatribe, but but I do want to say that um I really want everything to be uh beneficial to everybody at the same time. I I want us that there's ways that we could get this to where, you know, i if you were making infinity billion dollars, yeah, you'd hire more people. Sure. Yes, you would increase the number of toys and lasers and other things that you would get. I mean this would be paid forward.

SPEAKER_02 20:26

Or even dermatology-specific metrics that are relevant instead of me screening for depression and blood pressure, which neither of which I can do nothing about anything about except for uh call my buddy, the cardiologist, Donnie, and say, hey, can you manage this guy's blood pressure? Which No, I can't. I'm out of I'm out of field here, but yeah, it's frustrating for sure.

SPEAKER_00 20:50

Yeah, so um so this dovetails nicely with something that I wanted to talk to you about, which is that um, you know, you've spoken uh very eloquently to our community and actually the Florida Medical Association about leadership and about how you've been able to navigate these issues because you know leadership is not just one rah-rah speech, it is about a persistent day-to-day presentation and how you how you maintain focus for your staff, even despite all these things. Um so maybe you can give some insights into some of the things that maybe you've learned or maybe you've gotten wrong starting off with that that you got better at.

SPEAKER_02 21:26

Yeah, I mean, I think um you are as a leader, you're constantly under the microscope. And so uh your example is always being watched, even if you think it's not. Um people are watching from everything from where you park to uh how late you stay, what days you work, et cetera. Um and I think uh that that's something I need to work at and probably do better at. Um I think that the biggest For me, I think the most important thing that I've learned is obviously communication is important, but having uh the communication be a two-way street instead of a top-down do-this, um, I think a group, any group, not just in a medical practice, but needs to be able to give feedback without fear of retribution and be able to. I mean, we get better when my staff points out issues and problems. And so I strongly encourage that, and we do that through regular meetings. But to me, that's been the single most important thing I feel like benefit to my practice is being able to have my staff kind of tell us what's wrong or give us feedback, whether it's good or bad. I think as a society, it is but for human beings, it's hard to accept negative criticism. Very hard. But I feel like it is the most important thing. You've got to get feedback and honest feedback. You don't want them, oh, you're doing a great job because you're my boss and I want to raise this year. Uh, you need it to be honest feedback of like, hey, uh, you're not communicating effectively what you think needs to be done. And so I feel like that's probably the most important thing as far as leadership that I've learned over the years of running the practice and still learning for sure.

SPEAKER_00 23:23

I think that is such sage wisdom there. Um, you know, I I say oftentimes positive feedback feels great, but negative feedback is really formative. That's where we're going to really change things and say, oh, and and you know, the majority of the time it's things you had no idea about. Right. You say, oh, geez, you know, uh, we're having a difficult time answering the phones. Okay, well now I need to kind of reiterate and try and find out how we can make this better.

SPEAKER_02 23:50

Right. And I feel like we do like a formal, we try to do them, a formal evaluation. And if you read those formal evaluations, like the questions I think are so trite, and like you're like, come on, this is so stupid. Uh and it really doesn't summarize somebody's work by answering these questions. But I do feel like the write in your criticisms and write in, and I encourage my staff to like, hey, tell me what I can do better, and I don't care if it's offensive or what. Obviously, you know, do it politely, but sure uh tell me what we can do better to make your job better, make this practice better, and we'll do our best to fix it. Now I can't uh take everyone to Port, you know, Port Vallta or something every week for vacation, but uh within reason we can try to work on things and get things better.

SPEAKER_00 24:49

Yeah. Well, I mean, uh you want your employees to be happy coming to work. For sure. You want them to find this work fulfilling. I mean, it's incredibly fulfilling to us, but we want everybody, I mean, you know, this is we're doing real stuff here. I mean, we're really helping people, and it does that's that's a great feeling if you can allow yourself to kind of get into it. And there's look, you could go see plenty of patients um by yourself. It'd be really hard to get to the scale that you're at without a great team that's behind you that could be answering phones and doing the billing and all the other stuff.

SPEAKER_02 25:24

And it's not just uh one person or one job. My my receptionist, I feel like it's such an important position that's undervalued or underappreciated, but man, they make a huge difference. It's the face here practice. The face first people that when you walk in the door, that's who patients see. So if you've got a miserable uh Karen at the front desk, she can wreck your world. And so it's important to make sure that their needs are all met, that they're being taken care of, and also that they hear of their value and that they know how important their job is, because then they try harder to do a better job at it and give you feedback. So it's a it's important.

SPEAKER_00 26:05

Every single person my staff. Yeah, you know, um being the face of the practice means that if you start off on a bad foot walking into the door, it's gonna be hard for me to recover. If you start off on the right foot coming through the door, I'm gonna look like a rock star whenever they get into me. And so that's just it's it's setting yourself up for success at every point along the way. 100%. Yeah, yeah, and kind of like uh going over these values again with them. And you know, that's one of the things that Mark Noon has really um inculcated in me about that. Yeah, it's he's great. He's great, he's great, you know, uh mission values, uh your um kind of the purpose of why you're there. And you can that's one of the things that I think would be really valuable to any practicing members of our um the Emerald Coast Medical Association is you know, if you're having difficulty kind of finding that leadership and that that that mindset that you can get people to follow you, is is what is your purpose? What's the reason why you're here?

SPEAKER_02 27:01

Yeah, and it's important, I feel like, that not only you know and understand that, and I spent probably the first five years not having any idea, just kind of wandering aimlessly. But when you go look at that and say, and it sounds again kind of cheesy and trite, but what is our our core values as a practice? What is our mission? What like what is important to us? And if you ask my staff, they're gonna I think resoundingly say taking care of people like the the money and all that stuff comes second, but or third or whatever, but uh take care of people, do the right thing, be good to people, and the rest will take care of itself, you know. But I think my staff all gets what our goal is and what is important to us as a practice, which I think again was hard for me to um understand. And going through some of these leadership courses, I had to sit and do that. Okay, what is our mission? What is important to us? What I had to think about it for myself. Why am I doing this?

SPEAKER_00 28:04

Yeah, you know, and that's part of like, you know, our training is kind of prescripted. Totally medical school and then residency and then fellowship, and it's kind of it's hard to get into it and through all these things and do the application process for sure, but it is kind of set. The the ruts in the road are kind of set there. Right. And then you get out and you're like, well, now I need to kind of do these things that I was doing before. And then you realize, oh wait, there's a bigger aspect to this. Not muscles that we had flexed before.

SPEAKER_02 28:33

Not ever used. I mean, running a business is I mean, such a we got zero training in it. We get zero training in it. Um, and I think it would be a valuable thing to have in a medical school curriculum because I can tell you a lot of stuff I don't remember. Um but uh but having dermatology related, actually. Exactly. No, I'm shooting if I didn't go to residency in it. I what do we I think we got a uh two-week or one-week class in dermatology during our med school training.

SPEAKER_00 29:04

So if that uh but you're right, uh no-week class in terms of business. I mean, you you pull you picked up some nuggets here and there with your attendings, um, you know, maybe some that had come from the private practice world, but still, I mean, it's certainly no formal amount.

SPEAKER_02 29:19

Yeah. That's because they want us to be a cog in the machine, or is it just that they think it's not important? I don't know.

SPEAKER_00 29:26

I think it might be, again, a feature, not a bug. And it's just how the system is set up. I mean, yeah, you know, um many that have gone through training would testify to as you're jumping through the hoops, you kind of are being pushed towards academia. Yeah. That that's really, you know, um medical schools and residencies are really trying to push you towards academic training, much akin to what you're going through right there. That's that's kind of the system that they want you to do. Now, I mean, you know, they understand that you're gonna be spreading your wings and doing various different things. Not everybody's gonna come back to academics, but that seems to be the MO of where everybody's operating. And, you know, uh academics is very different from the private practicing world.

SPEAKER_02 30:11

Um but I think even academic academician, academia, uh whatever, academics, folks in academia. Doctors at schools, I don't know. I think that even they would benefit from knowing the importance of some of the business aspect of it.

SPEAKER_00 30:26

You know what I mean? 100% agree with this. Um, you know, how do you make a budget uh when you are the head of an entire your chairman of a department? I mean, like that's these are numbers with more commas than you and I ever see. I mean, those are really interesting things. Because, you know, I mean, hiring um doctors is one of your most expensive expenses that you will have whenever you you have a practice, um, and and sometimes one of some of the most finicky uh things that you have to deal with. For sure. Um apropos to that, um what do you think the biggest issue facing dermatology is um in the near future? So say over the next year and a half to two years, what do you think is the biggest issue that that your field is going to come against?

SPEAKER_02 31:20

I mean, as we've kind of alluded to already, obviously reimbursement is an issue for every physician. Um I think specific to dermatology. I don't know, maybe uh AI use and uh again, the thing about um dermatology with AI is that a lot of stuff you can so um we did telemedicine through the VA at one point, and we would look at these store and forward pictures that a clinic in some rural setting would take. Oh yeah. And they'd send us this picture as a resident we had to sit and do a half a day of this or something. So we would look at them and eight out of ten times we'd be like, yep, that needs a biopsy. So then you gotta still go and get the biopsy. But I think with AI and some of the images stuff, I think it's getting better at identifying kind of various stuff as either benign or requires a biopsy. But uh right now, at least a lot of what we do is hands-on technical as opposed to uh just looking and saying, yep, it's this, it's a squamous cell, it's a basal cell. And so I think that may be something that impacts our field down the road. Um, but in what how I'm not sure exactly how it's all gonna pan out. Because like I said, you still gotta cut the thing out, you still gotta or treat it somehow.

SPEAKER_00 32:56

Um so knowing what it is is only a small part of it. You know, I've been coming to um perhaps this realization that, you know, we had thought I think AI and robots, etc., were gonna come down at the basilar level that are gonna take care of the grunt work. Um and they will in some sense, you know, um doing the dirty work, cleaning sewers, um, building buildings, that kind of stuff. But they may actually go above us. And they may be to the point where they're saying, like, this is squamous cell and you need to biopsy that, and you're the biopsier. Right. Like you're going in and being like, okay, this is the thing to do here.

SPEAKER_02 33:33

So and and maybe I think uh as good as AI is, I think that we may get to a point where you scan your rash and it says it's this and here's your treatment, and uh there's no need for a dermatologist, you know, other than to sign the prescription.

SPEAKER_00 33:53

Uh you know, I mean, same thing with cardiovascular medicine. Right. I mean, we may get to the genesis of we've determined now how how atherosclerosis sclerosis works. We know how to prevent it. You take this injection every 10 years um and it just keeps that from happening. And smoke and drink and eat whatever you want. Uh you know, it's got it taken care of. And um I mean, honestly, you know, humanity gets a lot better there. Yeah if if we start to eliminate cardiovascular disease. I've said for a long time, if you know put me out of business because everybody's healthy, that would be uh great thing. Yeah, exactly. I'll figure out something else to do, I guess.

SPEAKER_02 34:31

So I'll start working as a dancer.

SPEAKER_00 34:36

That's uh reworking as a dancer. So it's go back to that one. Belly dancing. The bull right, yeah. Well, I mean, you had to make it through college somehow, right? I mean $20 is $20, okay, Jeremy.

SPEAKER_02 34:49

I mean like it's uh not getting cuts.

SPEAKER_00 34:55

Belly dancing was still no, it's it's it's it's keeping up with inflation, if anything. So uh now um you know you had alluded to uh well we had talked to you about uh you know the near future and kind of brought along with that the far future about where AI is probably gonna work. And I think that that's probably gonna be the biggest um uh mode change in our life and our existence and you know where that fits into our practice and much less our kids and humanity and everything else that we're gonna do. I don't fully know. Um but uh take us back to right now, okay? Tell us a fun fact about the skin that we don't know about, or something that uh, you know, I'm interested in something that um would just be kind of a fun quiz when we're sitting around the dinner table or something.

SPEAKER_02 35:42

Um there's not that much fun stuff about the skin. If I'm being honest. Uh it takes 28 days to regenerate from top to bottom. I mean, there's kind of neat, I guess.

SPEAKER_00 35:57

There you go. That is neat.

SPEAKER_02 35:59

Um from the bottom layer to the top. I will tell you a really fascinating story about horses, though. Please. You never uh so horses out in the wild, like wild Mustangs. When a mare gets pregnant, she will How did they get pregnant by the way?

SPEAKER_00 36:22

Is it uh intercourse?

SPEAKER_02 36:23

Okay, good, thanks. Uh yeah. So birds meet bees uh and a foal is born. No, but so uh a mare, female horse, will then copulate to have intercourse with every other male in the herd so that when that baby is born the male doesn't stomp out and kill it. You want to talk about some preservation and some self-sacrifice? I mean, imagine. Yes. To me, it just is mind-blowing.

SPEAKER_00 36:59

So anyway, you know, it's it's you know first of all, it is a fun fact. Secondly, um it it it talks about the reproduction strategies in biological creatures are fascinating. Like how we found the way to get to where we're at. And you know, I mean it also there's there's something called the naturalistic fallacy, which is just because something's natural doesn't mean that it's good. Right. And so, you know, it it it gets you thinking about you know, um, our own strategies for how we're gonna propagate our species, and it's just really, really fascinating to think that that happens. And there's several different other strategies that are in there that are strangely named. So but what sacrifice, you know? It's great. I mean, coming from the bull rider here. I mean, you you would know about this thing, so I found it fascinating. Uh that's that's great. And you know what, we're gonna that's gonna count as your fun facts. It's not skin, but hey, it's not skin, but you know, I mean horse mode, right? We're gonna play along.

SPEAKER_01 37:56

Yeah.

SPEAKER_00 37:56

Um so young dermatologists that are coming out right now. Not to say that you're not young, but um, what advice do you give them that are coming out right now in their career?

SPEAKER_02 38:09

Oh man. I think um it's important to do what you love. I think, as you mentioned earlier about academia, we're geared towards encouraging academia. So when I was applying to dermatology residencies, my I knew I wanted to do MOES surgery. I really didn't want to do anything else. I knew that that was my where I wanted to end up and what I wanted to do. And everybody told me when I was applying, do not tell anyone you want to do cosmetics, and do not tell anyone that you want to do Moe's. Those two things are the big no-nos. And I again I really liked the surgical aspect, and so my whole resume was obviously geared towards surgery and whatnot. So I felt like the when they asked me, do you want to do Moe's? I said, Yeah, that's what I wanted, that's what I'm gonna do. Of course. And I felt like I was encouraged to not say that, but to me, they're gonna know anyway, so I think you just gotta be who you are and and do what you want to do and be unapologetic about it. I mean, yeah, it might ruin some of your chances of getting into some places because they want you to go into academics specifically. Um, but I think you just gotta go with your gut. I think the other thing, um dermatology is one of the few fields where you still can be independent. And again, that's that's kind of even as we mentioned earlier, fading as far as it's just getting more and more difficult. It can still be done, but it's it's getting really difficult to do that. Um, but I think it is if I could go back, uh I might join and stay with the group a little bit longer. You come out of residency or fellowship, and I feel like especially these days, but understandably people are entitled and think that they want, you know, I want to come out and just start doing 100% MO's in my own practice, which is not realistic. I feel like a lot of people coming out of training don't have realistic expectations of both pay and work, you know, loads, how much how many cases or how many patients you got to see a day. And um I think it is good to kind of learn it and see it from somebody else before you just jump in and start doing it for yourself like I did, which I made a lot of mistakes and learned a lot from it, but uh I probably should have taken lessons for a little longer before I jumped in and started my own, which for that being what it is.

SPEAKER_00 41:02

Yeah, I think I think you said two really sage things there. First of all, um be honest with yourself. Yeah, I mean you like what you like. Uh you know, I'm what I said for a long time about um doing surgery, I like surgery, which is that could I not do surgery? Right. If I could not do it, then that's not the lifestyle is not great for a lot of people. No, people have made a career out of it for sure. But it's do the thing that you can't not do. Exactly. If that's gonna be your raison d'etre, if that's gonna be your fire, if that's gonna be your passion whenever you get up and do it, then that's the thing to do wherever that lands. And that could be in academia, that could be in private practice, that could be wherever it is, but just shoot straight and honest with it and be honest with yourself about it. You know, sure. I think that's also a testament to your character because you're kind of more direct about things, and maybe you've learned that over time. Uh sometimes too dumb to know better. Well, um so uh so my wife, shout out my wife, um, she um has a saying which is money is out there. In other words, you can go make more money. Yeah. You know, I get cold calls three times a week about locums, positions. Um there's several different job opportunities out there. You can go make money. It's there, it's your balance, it's how you really want to do things. So don't worry about the money aspect so much. Worry about making getting your reputation up, being the kind of person that family and friends and other colleagues would refer to you. That's gonna give you more gold than anything else. Building the practice, building the leadership of people that want to come work with you, that see your vision and see your passion and want to see that through to the end. I mean, that's that's really how you make long-term commitment because you know you're you're not gonna remember how much money you made. Right. You will remember building a practice and keeping people employed and and having a life and raising your kids in a community. Those are the kind of things that you're gonna really remember. For sure.

SPEAKER_02 43:01

Um I think one thing I can as I reflect back in building my practice, I've kind of collected a lot of people who are similar similar in personality, yeah, which is a problem because I need those other contrarian voices, yes. Well, and people that are just better at uh different things, you know. And so I found myself trying to find, you know, the color test per personality test, finding those people that are not your same color, if you will. Yes, uh disk assessment that are different, uh, and try to find folks that are just opposite to you, even though it may be harder to understand and work with them. I think it's important to have everybody and on the team, you know.

SPEAKER_00 43:49

Yeah, you so so it's kind of um it's a different type of diversity. It's a it's a diversity of thought or problem approach or personality. Of kind of perspective on things that really it turns out, you know, because we've done the disk assessment, again, shout out Mark Noon, my wife and I are the exact opposite of each other. And that's not something that I could have put down and said, oh, I know that. But now having it, you know, we can see how we see things a little bit differently. You can you can cater to that. And I mean, we kind of do some amateur version of that with our patients. I mean, you know your patients that are like, look, I just want to get in and get out. And the other patients that, you know, lost. And you can kind of cater to that. But knowing the people that you're going to see every single day uh work in with them, that that's a great uh it's almost it's almost like a superpower to know how to talk to them. Totally agreed. Yeah, and and and it creates a more uh well-balanced view that's able to kind of get this different perspective when you have again people that look at things very concretely and other people that are very subjective and yeah, like your kids are you know, they're all different. They came out the mix that way too. Exactly. Exactly. Very strange. I mean, just totally different. I was like, I are you two genetically related? Exactly. Exactly. Um now um tell me about what you do for fun. What are your hobbies?

SPEAKER_02 45:17

Uh I like hunting and fishing a lot. Um we wouldn't have expected that looking at you. I mean it's a good thing. Uh I like ballets and orchestras. Not really. I really do. Yeah, exactly. My wife's a lot of people. I'm like, oh, okay. Uh but um I guess I lack culture in that regard. Um, but I'm working on it. She's working on it. Um but I like that like riding buggies side by sides and getting stuck in the mud and you know, just I like horses, obviously, and farm and country life.

SPEAKER_00 45:55

Well, and simple. I think you and Jen decided to go to you you got some property a little bit further outside the city to uh what's the exact uh address for everybody to hear? No, it is 84. So you could go out there and really um live this life, which is a little bit more um it's not as planned, you're a little bit more wide open. Uh I'm sure you've got more projects than you'll ever be able to fit into your life. For sure.

SPEAKER_02 46:19

For sure. Way too many projects at the farm. But I like doing it. Uh I mean, even the work projects, it's so different from what we do on a daily basis. So, like feeding hay to the horses uh is mundane and basic, but when you're doing it, you're not thinking about anything but that. And I like that kind of ability to go to the farm and do stuff that you don't have to think about your everyday life. Patience that you missed something or you know, whatever.

SPEAKER_00 46:50

Well, and also when you're doing something deliberate, focused, it's mindfulness, and that is so good for us. I mean, you know, you're you're you're not worried about the thousands of other things that you're supposed to be doing. You're right there, you're doing that thing, and it it's almost like um, you know, when you're in the heat of surgery and you're doing something, you're not worried about what you're eating, you're not worried about your kids, you're not worried about the government or politics or TV or anything like you're right then and there and you're nowhere else. Yeah, I think that's why I love it so much. You get lost in it. You get lost into it. And then you kind of have to snap out whatever you get through with, and you're like, oh wait, just now I've got to catch up with all the other stuff. I missed a birthday and anniversary. Um But those are really great moments for us, and so it's kind of nice that you have this work-life balance now where you've you've found like this may be the formula for you that you can get in and you know help people, but then I need some time to kind of Yeah.

SPEAKER_02 47:48

I love golf too. This is a new thing.

SPEAKER_00 47:50

Just that's not something I would have had in my bingo card for you, so this is unexpected.

SPEAKER_02 47:55

I just started learning uh to play about a year or two ago because my son started taking lessons. And I thought, how am I gonna be able to spend time with him? I'll just have to drive them around and caddy them. So I started learning how to play or trying to learn how to play, and I'm a terrible golfer. I mean terrible. Not worse than me. Uh you might be surprised. Uh but I love it. Same reason, you know, when I'm golfing, I'm you're just in the moment thinking about that, not distracted. It does take a lot of time, but it's it's fun and it's it's healthy, I think, for me to get out there and do something like that.

SPEAKER_00 48:28

Yeah, you know, that's that's also uh a good mental exercise. I mean, you know, kind of um recapitulating the same movements um with your body. Your body is probably able to do that, but sometimes the brain doesn't really better that.

SPEAKER_02 48:44

And just being able to focus on the ball and not get distracted with my ADD. No, I I mean I think that that really um speaks to things that are good for us as humans, uh, you know, to kind of have very different interests and but it's kind of I think watching my golf swing is comical uh because of all my injuries. I'm like an 80-year-old man, so I'm stiff and like when I swing it's like, oh, there's 80-year-olds smoother than me for sure.

SPEAKER_03 49:16

It's like Charles Barclay swinging.

SPEAKER_00 49:18

Exactly, exactly. Two hitches. Oh man, that's the old man noises that I make, just sitting down and standing up now is really great. Just picking up the ball. I'm like, uh many kids do you have? Uh four. Four, okay.

SPEAKER_02 49:34

Do you know all their names? Um well, I don't even know all the kids I have, but I'm teething. Joke. No, it's Jenny. Two jokes, okay. I do know. I have uh my daughter Kaya is 19, and she's going to school at USF in Tampa, and she wants to be a doctor. Oh, yeah. And I've again we've had this discussion of like what are we doing? Listen, baby, don't do it. Don't do it. It is not a good time. However, um, I think she's it I just have the discussion, like, look, if you love it and you think that it's that's what you need to make you happy because of all the great things of medicine. Yes. Uh the altruism, all the things that are are really great in medicine, um, then do it. But don't do it because you think I want you to, or you think you're gonna make anybody proud, or anybody's gonna give a crap because nobody's gonna give a crap. You know what I mean? So at the end of the day, do it for the right reasons and fine, go ahead. Um, then my next daughter is Cody, she's 17, and she is uh an animal whisperer. Oh, yeah. She trains horses, and um she wants to be a professional equestrian and maybe go to vet school. Um I'm trying to get her to to she's debating taking time off to go ride, and I'm like, don't take time off of school, at least do uh online school or something like that. Um horse vet. Yeah, well, that's what she would be great at. Oh, that would be fantastic, yeah. That's what she's gonna probably end up doing. Oh good on her. Um and then I have two sons. Colton is my 12-year-old, and he is kind of my twin, and so it's really scary to parent him uh because he's he does things like I would, which worries worries me like no other. Believe you me, I know and it's scary. Um when you see them doing it like this.

SPEAKER_00 51:30

Take my trying to tell him.

SPEAKER_02 51:32

I'm trying to tell him you're gonna set yourself up for a bad time. You are a uh short trip away from prison or becoming a billionaire, but like you usually gotta choose wisely because uh it could take a wrong turn easily. Um and then my youngest son, Caden, he's 10, and uh he's he is the baby, and he's our sensitive guy. He is he's awesome, he's a good kid. Yeah, I got one of those two. They're all good kids. They're all good kids.

SPEAKER_00 52:04

And uh, you know, I think this is just so you've got a nine-year spread there with four different kids. Um and and I mean, there's really nothing better than to see your kids grow up and just how they become more and more people in and of themselves. Yeah, it's a wonderful reflection of you and Jim.

SPEAKER_02 52:19

In some ways it's hard because it happens so fast. Like my oldest is in college already and gone, and my next one is about to be gone, and then I mean, we're gonna be empty nesters soon. Now, what are you gonna do? I don't know.

SPEAKER_00 52:32

I don't know, it's scary, but it happens fast, and I know you've seen it in your own kids, but man, looking back, it's like there's no way it's just well, I think I think this lands on a um a point again that we had talked about before, which that mindfulness, that real joy in spending time with them. Yeah, um, I think is great. We just had a recent uh podcast guest uh that we interviewed here who was really great, Tom Mayer, um, which is an excellent episode. Um and uh he talked about um, you know, we've we've we've all heard about lifespan, and it's of growing popularity to talk about health span. Um he also mentioned something called joy span, which I thought was a really great term. That's what we're really trying to optimize here is getting as much joy as possible. And there's really great joy in just being with your kids and your family.

SPEAKER_02 53:23

For sure.

SPEAKER_00 53:24

Yeah, it's my favorite thing. Yeah, so uh, I mean, again, to keep your head balanced around being a leader, running a practice, being a dermatologist, staying up to date, fighting against government overreach, and at the same time still staying balanced with your family is really, again, a just a testament to the many hats and plates that you spin.

SPEAKER_02 53:44

Well, what I do is juggle them all, and when one ball falls, I'm like, oh, I need to do that. Oh yes, exactly. Oh, I need to do my MIPS. Oh yeah. Personal MIPS. But I feel like it's always, you know, you're always focused on one more so than the other, and you gotta sometimes redirect. And then but to me the important one is family and and to some degree taking care of yourself, but more taking care of family, and to me that's more outweighs success of my practice or anything else. Of course, of course. It's also uh you feel like sometimes you can't you don't have the time or the I can't beat all my kids every single thing, which I hate. I want to care for them, but it's frustrating. Yeah. Um and you know, parenting is not easy for anyone.

SPEAKER_00 54:32

It's a full-time job. Um, it's worth it. But uh and and I think most parents would testify towards that end. Um, but it it's again, it's it's nice to see that you're you're finding some balance in the things that I prioritize and kind of hearing other smart people recapitulate that is really uh refreshing.

SPEAKER_02 54:50

Yeah, you try, you feel like you're always failing at something, but just I just keep trying to do. Like I said, pick up whatever one starts to fall. Yeah, try to fail less when you go on to reiterate. Yes, just try, which is a full-time job. So and sometimes I'll be like, man, I'm a crappy parent or I'm a crappy husband. And it may be just one to keep to one kid, you know. I feel like, oh, I haven't been spending enough time with that kid, and so I'll try to refocus and but it's hard.

SPEAKER_00 55:19

I I feel like you're in my head, and I have half the number of kids that you have, but it's the same basic idea where I feel like, man, I'm really dropping the ball over here. I've got to make this thing a priority here. Um so well now let's go to um everybody's favorite part, which is the rapid fire questions. You think you're ready for this? I'm definitely not.

SPEAKER_03 55:40

Okay, well let's buckle in.

SPEAKER_00 55:41

Okay, we're just let's do it. Your sparkling water too? No, I'm ready. This is uh sparkling tea. Sparkling tea, yeah. It looks like it. It smells strong. This is crazy. Um my wife's favorite question. Who's the smartest person in history?

SPEAKER_02 56:06

Um I mean, smart, smart like Stephen Hawking smart, or like you can take it any direction that you want to.

SPEAKER_00 56:17

I mean, I'll go with Jesus. You can't go wrong with Jesus. Yeah, you know, that's a pretty good pick. I don't I don't think too many people would uh fight me on that one. No, nobody's gonna fight you. One thing that I really like about um Jesus as a pick is that you will even have pretty hardcore atheists that will say, like, he had some good messages. He had some good things to say. He was a wise dude. We should probably listen to some of those things and you know, um, to come philosophically from like a stoic philosophy, which had come before that to Christianity, where all of a sudden, you know, you you start to say um you should turn the other cheek and do unto others as you'd have done unto you. Um, pretty powerful messages, I think, that cut across culture and and all things. So yeah. I like that choice. It's a pretty good one. Easy. Yeah. Um if we can live to a thousand years old, should we do it?

SPEAKER_02 57:09

I guess I would ask the question of what's the quality of life of that thousand years? If 900 are gonna be uh decrepit in a wheelchair in a retirement home, no. But if it's uh meaningful and we're still able to function well, then yeah, why not?

SPEAKER_00 57:26

Yeah, I I think something similar in the sense that, you know, again, if we're if we're still enjoying the joy span, yeah, then I think we should probably do that.

SPEAKER_02 57:35

Um most of my 90-year-old patients are over it at 90. Yeah, that's right. But mostly because of chronic health issues that plague us. Exactly. Are frustrating and if we can keep that from happening.

SPEAKER_00 57:52

And and you know, um many times I'll I'll take this brief sojourn in here. Um you know, many of my patients that I have the end-of-life talk on or with, and that we talk about palliative care and other stuff, they understand. They're with it. Yeah, they're they're kind of sick of the struggle. Right. They just they just want to feel better and not suffer. And once you kind of relinquish that and you talk straight with them about it, um they're not only accepting, they're they're kind of glad. They start to get perhaps a little bit more of that joy span in there. Um so so I encourage all of our physicians uh have that talk with your patients if if they need to. Um you know, it's it's a really it's a fulfilling um thing in our lives to be able to guide people into the most restful um passing that they can possibly get for sure. So um all right. Do you want it too cold or too hot at night? Too cold. Too cold. This is the only right answer, okay? What is one thing that you would tell yourself if you could go right now and talk to yourself as soon as you started medical school? Don't do it.

SPEAKER_02 59:05

No, uh I think as uh I guess as I reflect on kind of uh my career and uh education, I really don't have regrets. Um I guess I would just say maybe like I said earlier, join a practice for a couple of years and get a good nest egg before you go broke trying to start your own. Which ask me how I know.

SPEAKER_00 59:35

Exactly. Um okay. Um what is one current medical treatment or therapy that we are gonna shudder that we used in 15 years? Uh sentinel lymph node biopsy. Say more about that. I just think um Let's let's take one step back. Uh for perhaps our lay audience, uh, what is the sentinel lymph node?

SPEAKER_02 59:58

So if you have uh melanoma or other types, but melanoma in in my life specifically, um we inject a dye, a tracer dye into the site where the melanoma is, and it drains into the lymph system to your first lymph node, which is your sentinel lymph node, and so they use a detector that detects that dye, and they find where that lymph node is that is draining from that site, so that they can then pluck that lymph node out, cut it into little slices, and look at it under the microscope to see if tumor has gotten there. And if tumor's gotten there, the horse is out of the barn, and it's now changes how we manage and treat.

SPEAKER_00 1:00:44

So, so how cancers spread is lymph angiographically. They there are are yeah, they move through the lymph system first more than anything. They're they're they're not, I mean, yes, they can spread outside their capsule and kind of get to surrounding tissues, but really how they're spreading to distant sites and really where we change the stage and basically our our curative intents of many cancers is going to be their ability to get past that first lymph node. So if we can find it in that first lymph node, then that totally changes our approach to how we do that.

SPEAKER_02 1:01:17

So so I think um with a lot of the genetic profiling that we're doing of tumors and cancers now, I think that uh sentinel node is probably going to be obsolete in 20 years. Uh I just it's so good and so predictive the genetic profiling of tumors that it can tell you whether you're at high risk for metastasis of that melanoma, just as I mean, the the data correlates really, really closely, if if not much better than a sentinel lymph node. The problem with sentinel lymph nodes is you're taking this little marble-sized lymph node, you're cutting it into slices and looking at it under the microscope, and it is easy to miss a single melanocyte or melanoma cell uh in the lymph node if you don't look at the exact precise location. If it's if we're talking a few. Now, if it's chuck full of it, yeah, you're probably gonna see it. But um, I think that we miss stuff because we can't see it all microscopically. And so I think just the that innate error will make it so we tend to lean on genetic profiling more so than cutting it out after and saying, oh yeah, there's tumor there.

SPEAKER_00 1:02:41

This is such a wonderful answer here because um, you know, even the most precise slices, one millimeter or something along those lines, I mean, you can hide a house in that. Right. So so if we're having a positive sentinel lymph node, then that's gonna be very specific. If we catch something there, then it's definitely been spread, but it's not very sensitive. Exactly. We're not gonna be able to catch all the different spreads that could be microscopic, like you said. And now it turns out our genetic markers, when we do a genotype of these cancers, can predict the spread with greater accuracy than what we have here, which I mean a testament to human knowledge that we can we have found out your likelihood, your propensity towards spreading of these cancers is dictated by their genes. What else could it be dictated by, to be honest with you? But either way, and so that's going to be more predictive than the kind of all respect to our pathologic colleagues who are doing absolutely the best that they can and are really, really excellent clinicians. But having to roughly cut up this tissue in order to look at it under a microscope.

SPEAKER_02 1:03:44

And that's if you can find the right sentinel lymph node, which I've had patients where they couldn't find the node, um, but there's it's just wrought with issues. I've had um so for melanoma, we use a cutoff in depth. How deep is it that determines everything in terms of treatment? So once it gets past a certain depth, then we say, okay, you're getting a sentinel lymph node. Um but I've had it where we did the genetic profiling and it hadn't reached that border for an adequate depth of a sentinel. So they didn't qualify for a sentinel lymph node, but the genetic profile said this is a really, really risky melanoma. Aggressive, yeah, yeah. And so I brought it to my good buddy, general surgeon, and I said, Hey, let's can we do that? And he said, No, we can't, uh, for obvious reasons, insurance, etc., doesn't qualify. Um, and then this guy comes back three months later, has a second melanoma, uh different, totally distinct. Second primary, but it qualified for a sentinel lymph node. So we do the sentinel lymph node, and he had metastatic melanoma, and it was probably from the first. Um, so, anyways, I think that eventually we'll probably it'll take some time, but we'll phase out.

SPEAKER_00 1:05:06

Yeah. Well, that's why I really like this idea because it's thinking on a bit of a different level, and it's it's not just falling into the well, we this is how we've always done it kind of thing. It's well, what's a better way to do that? Because I don't care how I stumble onto the right answer. I don't care how patients get better as long as they get better. I'd rather be lucky than good any day of the week, okay? So so um so really fantastic answer, and I think that elucidates um perhaps to many in our audience that may not be aware of it, but about this mechanism about how um things work like that. So um how about um tell me what is the best song of all time?

SPEAKER_02 1:05:49

Uh let's go with uh thinking between David Ellenko. Which one?

SPEAKER_00 1:06:03

That ain't country. We'll just leave it that way and discuss.

SPEAKER_02 1:06:08

Let's see. Yeah, I guess we could go with um David Allan Coe, you never even call me by name. Fair enough. I was drunk the day my mom got out of prison. I mean, what a great song. These are wedding battles that we're talking about here. It's rain.

SPEAKER_00 1:06:28

Tell me what books you're reading.

SPEAKER_02 1:06:31

I don't know how to read very well.

SPEAKER_00 1:06:34

Difficult to believe. Hey, it's tough to get Chris Joseph to laugh.

SPEAKER_03 1:06:39

There you go doing it, okay?

SPEAKER_02 1:06:40

I'm I'm reading uh Greenlights. Oh yes. Matthew McConaughey. Matthew McConaughey, which is uh it's a good book, and um I relate to him and the book a lot.

SPEAKER_00 1:06:55

Yeah. Um I think it begs a big question about him is that do you have to have conflict to have a successful artist? Or um, you know, because he's uh I I don't want to say too tumultuous, um, but but a fair amount of issues growing up and and relationship issues and family issues, um, is that what made him so successful and so great at what he does?

SPEAKER_02 1:07:22

I mean I'd say yeah. It might be. I I think it yeah, it's a good question. I don't know, but it definitely doesn't hurt.

SPEAKER_00 1:07:29

Look, there's a saying that no comedians come from good homes. That's right. Yeah. Um that's uh you know unfortunately that's a that it becomes a truism. So you gotta laugh to survive. Yeah, you got to. That's that's the only way you can sometimes make it through. Um well, um I want to close with a story here, and it's one that um, you know, you certainly wouldn't talk about, but I will. Which uh I think testifies to your character and your family, um, which is that um you had a patient that um had a pretty severe um lesion that uh was going to their eye, if I remember correctly, and um you spent a lot of time trying to get this patient appropriately triaged and disposed of, and couldn't really find any resources um to get that taken care of on a local basis. But uh there was an emergency clinic in Miami that was able to handle this kind of issue, uh, but the patient didn't have a whole lot of means. So um, as I understand, you and your wife paid for a plane ticket, uh, two plane tickets, as a matter of fact, three plane tickets as well as a hotel room, um, just really out of the goodness and altruism of your heart, in order to make sure that this patient got what they needed uh desperately in order to get the right thing done. And um I think that is really a testament to you because you don't talk about this. Uh it's not something that you would advertise. I am happy to do this because you wouldn't say that. But um, but I think it it really says a lot about you and your character and and your wife too, uh, for for where y'all said, Well, this is the right thing to do, so of course we're gonna do it. There's there's we don't have any other choice but to do the right thing.

SPEAKER_02 1:09:20

Right. Yeah, I told them not to call ahead. We're not gonna ever every other university I called with a picture of it, they're like, nope, we don't do it, we can't do it. So when it came to that last one, I was like, I'm not calling. You're gonna go get on a plane and you're gonna go to this clinic. And they did, and they took care of him, fortunately, and uh he's doing great now. So fun times.

SPEAKER_00 1:09:42

Talk about making a difference in somebody, talk about um increasing their joy span. I think you would do the same. I don't know. I don't know. Depends on how expensive the plane flights are. Um well uh Jeremy Censeri, um tell everybody where they're gonna find you.

SPEAKER_02 1:09:59

Uh Sun Dermatology. Uh we are now on off of Highway 231, so 645 North, Highway 231. Awesome. Uh right under the water tower.

SPEAKER_00 1:10:09

Right under the water tower. Um so um happy to have you in this community. So happy to have you as a friend, so happy to have you having seen me naked um in order to check me for moles and other lesions. And you will do that again. Um I blocked that out, so I don't really so uh anyhow. Um we just we thank you so much for uh your leadership, your commitment to all the things that you for patients, and um thank you for helping us make medicine better together.

SPEAKER_02 1:10:38

Thank you, sir, for all you do. We appreciate you.

SPEAKER_00 1:10:41

I'll stop that you