{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":5.25,"endTime":7.44,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":5.25,"endTime":7.44,"body":"upper hand podcast where Chuck"},{"speaker":"Charles Goldfarb","startTime":7.47,"endTime":8.85,"body":"and Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":9.51,"endTime":11.43,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":9.51,"endTime":11.43,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":11.43,"endTime":14.37,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":11.43,"endTime":14.37,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":14.37,"endTime":16.59,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":14.37,"endTime":16.59,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":17.13,"endTime":19.02,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":17.13,"endTime":19.02,"body":"subscribe, wherever you get your"},{"speaker":"Charles Goldfarb","startTime":19.02,"endTime":19.8,"body":"podcasts"},{"speaker":"Chris Dy","startTime":20.31,"endTime":22.8,"body":"in thank you in"},{"speaker":"Chris Dy","startTime":20.31,"endTime":22.8,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":22.8,"endTime":26.01,"body":"rating that helps us get the"},{"speaker":"Chris Dy","startTime":22.8,"endTime":26.01,"body":"word out, you can email us at"},{"speaker":"Chris Dy","startTime":26.04,"endTime":29.46,"body":"Handpodcast@gmail.com. So let's"},{"speaker":"Chris Dy","startTime":26.04,"endTime":29.46,"body":"get to the episode."},{"speaker":"Charles Goldfarb","startTime":30.18,"endTime":30.99,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":30.18,"endTime":30.99,"body":"Chris."},{"speaker":"Chris Dy","startTime":31.17,"endTime":32.25,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":31.17,"endTime":32.25,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":32.52,"endTime":34.32,"body":"I'm great. How"},{"speaker":"Charles Goldfarb","startTime":32.52,"endTime":34.32,"body":"are you?"},{"speaker":"Chris Dy","startTime":34.62,"endTime":37.71,"body":"I'm really, really"},{"speaker":"Chris Dy","startTime":34.62,"endTime":37.71,"body":"great. You know, I have this"},{"speaker":"Chris Dy","startTime":37.71,"endTime":41.55,"body":"fancy mic, as our guest just"},{"speaker":"Chris Dy","startTime":37.71,"endTime":41.55,"body":"pointed out, you know, trying to"},{"speaker":"Chris Dy","startTime":42.18,"endTime":44.25,"body":"keep up and up on the audio"},{"speaker":"Chris Dy","startTime":42.18,"endTime":44.25,"body":"quality."},{"speaker":"Charles Goldfarb","startTime":44.64,"endTime":45.75,"body":"You well,"},{"speaker":"Charles Goldfarb","startTime":44.64,"endTime":45.75,"body":"you're no doubt you're"},{"speaker":"Charles Goldfarb","startTime":45.75,"endTime":49.05,"body":"impressing the masses. And we do"},{"speaker":"Charles Goldfarb","startTime":45.75,"endTime":49.05,"body":"want to introduce our guests."},{"speaker":"Charles Goldfarb","startTime":49.05,"endTime":52.14,"body":"But you know, because we are not"},{"speaker":"Charles Goldfarb","startTime":49.05,"endTime":52.14,"body":"just a podcast. We are also a"},{"speaker":"Charles Goldfarb","startTime":52.23,"endTime":57.09,"body":"YouTube podcast, they can see"},{"speaker":"Charles Goldfarb","startTime":52.23,"endTime":57.09,"body":"the audio visual. So that's"},{"speaker":"Charles Goldfarb","startTime":57.09,"endTime":59.07,"body":"important that you impress I"},{"speaker":"Charles Goldfarb","startTime":57.09,"endTime":59.07,"body":"remember"},{"speaker":"Chris Dy","startTime":59.22,"endTime":61.2,"body":"early on in the"},{"speaker":"Chris Dy","startTime":59.22,"endTime":61.2,"body":"pandemic, when we were doing all"},{"speaker":"Chris Dy","startTime":61.2,"endTime":64.14,"body":"these webinars and whatnot. I"},{"speaker":"Chris Dy","startTime":61.2,"endTime":64.14,"body":"got this really cool gold"},{"speaker":"Chris Dy","startTime":64.14,"endTime":69.48,"body":"microphone as the Yeti that"},{"speaker":"Chris Dy","startTime":64.14,"endTime":69.48,"body":"attracted a lot of a lot of"},{"speaker":"Chris Dy","startTime":69.48,"endTime":73.68,"body":"comments that made me look like"},{"speaker":"Chris Dy","startTime":69.48,"endTime":73.68,"body":"a mid 90s rapper is what I was"},{"speaker":"Chris Dy","startTime":73.68,"endTime":75.09,"body":"told. So I was happy with that."},{"speaker":"Charles Goldfarb","startTime":76.02,"endTime":78.72,"body":"So I guess Can"},{"speaker":"Ryan Nunley","startTime":78.72,"endTime":80.64,"body":"I can I share it? I"},{"speaker":"Ryan Nunley","startTime":78.72,"endTime":80.64,"body":"should share a picture of you"},{"speaker":"Ryan Nunley","startTime":80.64,"endTime":83.58,"body":"and your your rapper outfit from"},{"speaker":"Ryan Nunley","startTime":80.64,"endTime":83.58,"body":"a woman's birthday? Oh,"},{"speaker":"Chris Dy","startTime":83.61,"endTime":86.94,"body":"yes, yes, yes, that's"},{"speaker":"Chris Dy","startTime":83.61,"endTime":86.94,"body":"something that might surface on"},{"speaker":"Chris Dy","startTime":86.94,"endTime":90.06,"body":"the interwebs at some point that"},{"speaker":"Chris Dy","startTime":86.94,"endTime":90.06,"body":"was told the residents were"},{"speaker":"Chris Dy","startTime":90.06,"endTime":93.51,"body":"happy that I gave them easy"},{"speaker":"Chris Dy","startTime":90.06,"endTime":93.51,"body":"fodder for the roast. I'm sure"},{"speaker":"Chris Dy","startTime":93.57,"endTime":93.72,"body":"we'll"},{"speaker":"Ryan Nunley","startTime":93.72,"endTime":96.48,"body":"I'll have to share"},{"speaker":"Ryan Nunley","startTime":93.72,"endTime":96.48,"body":"that with Chuck here."},{"speaker":"Charles Goldfarb","startTime":98.01,"endTime":100.14,"body":"I think I've"},{"speaker":"Charles Goldfarb","startTime":98.01,"endTime":100.14,"body":"seen it and I quickly tried to"},{"speaker":"Charles Goldfarb","startTime":100.38,"endTime":107.04,"body":"forget it. So the voice you hear"},{"speaker":"Charles Goldfarb","startTime":100.38,"endTime":107.04,"body":"is Ryan Nunley. Ryan is a"},{"speaker":"Charles Goldfarb","startTime":107.04,"endTime":110.37,"body":"reconstructive surgeon focused"},{"speaker":"Charles Goldfarb","startTime":107.04,"endTime":110.37,"body":"on the knee and he's one of our"},{"speaker":"Charles Goldfarb","startTime":110.37,"endTime":113.49,"body":"partners here at Washington"},{"speaker":"Charles Goldfarb","startTime":110.37,"endTime":113.49,"body":"University. His accomplishments"},{"speaker":"Charles Goldfarb","startTime":113.49,"endTime":116.7,"body":"are many and I mean that"},{"speaker":"Charles Goldfarb","startTime":113.49,"endTime":116.7,"body":"sincerely. I am not prepared to"},{"speaker":"Charles Goldfarb","startTime":116.7,"endTime":122.43,"body":"do a like a visiting professor"},{"speaker":"Charles Goldfarb","startTime":116.7,"endTime":122.43,"body":"introduction. Ryan did his"},{"speaker":"Charles Goldfarb","startTime":122.43,"endTime":125.28,"body":"residency here. Did you do your"},{"speaker":"Charles Goldfarb","startTime":122.43,"endTime":125.28,"body":"fellowship here too? Yeah, I"},{"speaker":"Charles Goldfarb","startTime":125.28,"endTime":126.87,"body":"did. His fellowship."},{"speaker":"Chris Dy","startTime":127.17,"endTime":129.81,"body":"Clearly not the"},{"speaker":"Chris Dy","startTime":127.17,"endTime":129.81,"body":"Visiting Professor introduction."},{"speaker":"Charles Goldfarb","startTime":132.03,"endTime":135.87,"body":"Yeah, well,"},{"speaker":"Charles Goldfarb","startTime":132.03,"endTime":135.87,"body":"anyways, and then he's been in"},{"speaker":"Charles Goldfarb","startTime":135.87,"endTime":138.06,"body":"practice with us. How many years"},{"speaker":"Charles Goldfarb","startTime":135.87,"endTime":138.06,"body":"is it now?"},{"speaker":"Ryan Nunley","startTime":138.99,"endTime":140.79,"body":"Since 2008, so I"},{"speaker":"Ryan Nunley","startTime":138.99,"endTime":140.79,"body":"guess 15"},{"speaker":"Charles Goldfarb","startTime":141.06,"endTime":143.28,"body":"Wow. And"},{"speaker":"Charles Goldfarb","startTime":141.06,"endTime":143.28,"body":"Chris, when did you join like"},{"speaker":"Charles Goldfarb","startTime":143.37,"endTime":144.27,"body":"2015?"},{"speaker":"Chris Dy","startTime":144.63,"endTime":149.04,"body":"Exactly. Thank you."},{"speaker":"Chris Dy","startTime":144.63,"endTime":149.04,"body":"I'm glad you know. Let's be"},{"speaker":"Chris Dy","startTime":149.04,"endTime":153.09,"body":"clear. Ryan Ryan's the man. He"},{"speaker":"Chris Dy","startTime":149.04,"endTime":153.09,"body":"is an amazing arthroplasty"},{"speaker":"Chris Dy","startTime":153.09,"endTime":156.81,"body":"surgeon. He is our go to person"},{"speaker":"Chris Dy","startTime":153.09,"endTime":156.81,"body":"at least I probably shouldn't"},{"speaker":"Chris Dy","startTime":156.81,"endTime":159.72,"body":"say this on the air, but he is"},{"speaker":"Chris Dy","startTime":156.81,"endTime":159.72,"body":"my go to person when I send"},{"speaker":"Chris Dy","startTime":159.72,"endTime":163.98,"body":"people for arthroplasty a"},{"speaker":"Chris Dy","startTime":159.72,"endTime":163.98,"body":"consideration. Although we have"},{"speaker":"Chris Dy","startTime":163.98,"endTime":167.52,"body":"fantastic partners. And Chuck,"},{"speaker":"Chris Dy","startTime":163.98,"endTime":167.52,"body":"he's your surgeon?"},{"speaker":"Charles Goldfarb","startTime":168.15,"endTime":170.94,"body":"Yes, well, he"},{"speaker":"Charles Goldfarb","startTime":168.15,"endTime":170.94,"body":"is my surgeon. And I think we've"},{"speaker":"Charles Goldfarb","startTime":170.94,"endTime":174.0,"body":"talked about this a little bit"},{"speaker":"Charles Goldfarb","startTime":170.94,"endTime":174.0,"body":"on the air. I am the time of"},{"speaker":"Charles Goldfarb","startTime":174.0,"endTime":176.76,"body":"recording. I'm two and a half"},{"speaker":"Charles Goldfarb","startTime":174.0,"endTime":176.76,"body":"weeks out from a computer"},{"speaker":"Charles Goldfarb","startTime":176.76,"endTime":181.35,"body":"navigated uni knee replacement,"},{"speaker":"Charles Goldfarb","startTime":176.76,"endTime":181.35,"body":"which is going incredibly well."},{"speaker":"Charles Goldfarb","startTime":181.35,"endTime":184.89,"body":"And we're going to sort of use"},{"speaker":"Charles Goldfarb","startTime":181.35,"endTime":184.89,"body":"that perhaps as a launch point"},{"speaker":"Charles Goldfarb","startTime":184.89,"endTime":188.1,"body":"for discussion. And we thought"},{"speaker":"Charles Goldfarb","startTime":184.89,"endTime":188.1,"body":"Ryan, you know, this is sort of"},{"speaker":"Charles Goldfarb","startTime":188.13,"endTime":192.84,"body":"part of a new perspective. We're"},{"speaker":"Charles Goldfarb","startTime":188.13,"endTime":192.84,"body":"bringing asking partners from"},{"speaker":"Charles Goldfarb","startTime":192.84,"endTime":195.6,"body":"different subspecialties to"},{"speaker":"Charles Goldfarb","startTime":192.84,"endTime":195.6,"body":"bring information which we"},{"speaker":"Charles Goldfarb","startTime":195.6,"endTime":198.72,"body":"believe will be helpful to the"},{"speaker":"Charles Goldfarb","startTime":195.6,"endTime":198.72,"body":"listeners. So we had Marshall"},{"speaker":"Charles Goldfarb","startTime":198.72,"endTime":202.62,"body":"Berkes on which was maybe more"},{"speaker":"Charles Goldfarb","startTime":198.72,"endTime":202.62,"body":"focused, we talked about"},{"speaker":"Charles Goldfarb","startTime":202.62,"endTime":206.31,"body":"clavicle fractures. But I think"},{"speaker":"Charles Goldfarb","startTime":202.62,"endTime":206.31,"body":"Ryan's expertise and seeing the"},{"speaker":"Charles Goldfarb","startTime":206.31,"endTime":209.61,"body":"tech advancements in"},{"speaker":"Charles Goldfarb","startTime":206.31,"endTime":209.61,"body":"arthroplasty will really serve"},{"speaker":"Charles Goldfarb","startTime":209.61,"endTime":210.45,"body":"the audience. Well,"},{"speaker":"Chris Dy","startTime":210.78,"endTime":212.94,"body":"Absolutely, just so"},{"speaker":"Chris Dy","startTime":210.78,"endTime":212.94,"body":"you know, Ryan Marshall actually"},{"speaker":"Chris Dy","startTime":212.94,"endTime":216.03,"body":"got a couple of emails based on"},{"speaker":"Chris Dy","startTime":212.94,"endTime":216.03,"body":"his appearance on the upper end."},{"speaker":"Chris Dy","startTime":216.03,"endTime":219.84,"body":"So perhaps your expertise will"},{"speaker":"Chris Dy","startTime":216.03,"endTime":219.84,"body":"be growing even more and your"},{"speaker":"Chris Dy","startTime":219.84,"endTime":223.89,"body":"reputation will be expanding."},{"speaker":"Chris Dy","startTime":219.84,"endTime":223.89,"body":"Before we jump into formally"},{"speaker":"Chris Dy","startTime":223.89,"endTime":227.31,"body":"having Ryan on I think we should"},{"speaker":"Chris Dy","startTime":223.89,"endTime":227.31,"body":"thank our our Practice Link"},{"speaker":"Chris Dy","startTime":227.31,"endTime":227.73,"body":"sponsor,"},{"speaker":"Charles Goldfarb","startTime":228.18,"endTime":229.74,"body":"perfect. The"},{"speaker":"Charles Goldfarb","startTime":228.18,"endTime":229.74,"body":"upper hand is sponsored by"},{"speaker":"Charles Goldfarb","startTime":229.77,"endTime":232.83,"body":"practicelink.com. The most"},{"speaker":"Charles Goldfarb","startTime":229.77,"endTime":232.83,"body":"widely used physician job search"},{"speaker":"Charles Goldfarb","startTime":232.83,"endTime":234.51,"body":"and career advancement resource."},{"speaker":"Chris Dy","startTime":234.72,"endTime":237.18,"body":"Becoming a physician"},{"speaker":"Chris Dy","startTime":234.72,"endTime":237.18,"body":"is hard finding the right job"},{"speaker":"Chris Dy","startTime":237.18,"endTime":239.82,"body":"doesn't have to be joined"},{"speaker":"Chris Dy","startTime":237.18,"endTime":239.82,"body":"practicing for free today at"},{"speaker":"Chris Dy","startTime":239.85,"endTime":242.55,"body":"www.practicelink.com/theUpperhand."},{"speaker":"Charles Goldfarb","startTime":243.84,"endTime":246.81,"body":"So Ryan, Chris"},{"speaker":"Charles Goldfarb","startTime":243.84,"endTime":246.81,"body":"and I talk a lot about"},{"speaker":"Charles Goldfarb","startTime":246.81,"endTime":251.91,"body":"efficiency. And being busy in"},{"speaker":"Charles Goldfarb","startTime":246.81,"endTime":251.91,"body":"our home in our humble little"},{"speaker":"Charles Goldfarb","startTime":251.91,"endTime":254.52,"body":"world. In our humble little"},{"speaker":"Charles Goldfarb","startTime":251.91,"endTime":254.52,"body":"mind, we think we're both pretty"},{"speaker":"Charles Goldfarb","startTime":254.52,"endTime":259.11,"body":"busy and pretty efficient. But I"},{"speaker":"Charles Goldfarb","startTime":254.52,"endTime":259.11,"body":"have to say I hold you out as"},{"speaker":"Charles Goldfarb","startTime":259.11,"endTime":263.43,"body":"someone who I absolutely know,"},{"speaker":"Charles Goldfarb","startTime":259.11,"endTime":263.43,"body":"is busier and has to be there"},{"speaker":"Charles Goldfarb","startTime":263.43,"endTime":269.13,"body":"for more efficient than Chris"},{"speaker":"Charles Goldfarb","startTime":263.43,"endTime":269.13,"body":"maybe not me a little bit. So"},{"speaker":"Charles Goldfarb","startTime":270.06,"endTime":272.16,"body":"tell us a little bit about your"},{"speaker":"Charles Goldfarb","startTime":270.06,"endTime":272.16,"body":"practice, if you will."},{"speaker":"Unknown","startTime":273.23,"endTime":275.72,"body":"Yeah, so first one"},{"speaker":"Unknown","startTime":273.23,"endTime":275.72,"body":"thing just to correct you so the"},{"speaker":"Unknown","startTime":275.75,"endTime":280.07,"body":"audience knows, yours was"},{"speaker":"Unknown","startTime":275.75,"endTime":280.07,"body":"computer. It wasn't computer"},{"speaker":"Unknown","startTime":280.07,"endTime":282.68,"body":"navigation, but yours was"},{"speaker":"Unknown","startTime":280.07,"endTime":282.68,"body":"robotic. So we'll get to that"},{"speaker":"Unknown","startTime":282.68,"endTime":285.26,"body":"maybe in the technology part"},{"speaker":"Unknown","startTime":282.68,"endTime":285.26,"body":"where it's gone from navigation"},{"speaker":"Unknown","startTime":285.26,"endTime":292.58,"body":"to robotics. But in terms of"},{"speaker":"Unknown","startTime":285.26,"endTime":292.58,"body":"efficiency, the The hard fact is"},{"speaker":"Unknown","startTime":292.58,"endTime":295.7,"body":"that if we look at the baby"},{"speaker":"Unknown","startTime":292.58,"endTime":295.7,"body":"boomer population as they"},{"speaker":"Unknown","startTime":295.73,"endTime":299.63,"body":"mature, there are more and more"},{"speaker":"Unknown","startTime":295.73,"endTime":299.63,"body":"patients this year than ever"},{"speaker":"Unknown","startTime":299.63,"endTime":302.51,"body":"that have to Number 65. And"},{"speaker":"Unknown","startTime":299.63,"endTime":302.51,"body":"naturally as they get older,"},{"speaker":"Unknown","startTime":303.11,"endTime":307.4,"body":"they require more orthopedic"},{"speaker":"Unknown","startTime":303.11,"endTime":307.4,"body":"procedures, specifically, hip"},{"speaker":"Unknown","startTime":307.4,"endTime":310.97,"body":"and knee replacement being some"},{"speaker":"Unknown","startTime":307.4,"endTime":310.97,"body":"of the most specific needs that"},{"speaker":"Unknown","startTime":310.97,"endTime":314.51,"body":"they have. So with that, you"},{"speaker":"Unknown","startTime":310.97,"endTime":314.51,"body":"have to figure out how do I see"},{"speaker":"Unknown","startTime":314.99,"endTime":318.08,"body":"the patients my waitlist to get"},{"speaker":"Unknown","startTime":314.99,"endTime":318.08,"body":"in for a new patient is six to"},{"speaker":"Unknown","startTime":318.08,"endTime":321.98,"body":"eight months, I get constantly"},{"speaker":"Unknown","startTime":318.08,"endTime":321.98,"body":"barrage of emails, calls to get"},{"speaker":"Unknown","startTime":321.98,"endTime":325.7,"body":"family members friends. 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So we're same number"},{"speaker":"Unknown","startTime":338.63,"endTime":343.55,"body":"of physician providers, but"},{"speaker":"Unknown","startTime":343.58,"endTime":347.72,"body":"growing patient demand. So some"},{"speaker":"Unknown","startTime":343.58,"endTime":347.72,"body":"of that is using technology."},{"speaker":"Unknown","startTime":348.56,"endTime":352.58,"body":"Some of it is also figuring out"},{"speaker":"Unknown","startTime":348.56,"endTime":352.58,"body":"ways that you can be more"},{"speaker":"Unknown","startTime":352.58,"endTime":356.75,"body":"efficient both in the operating"},{"speaker":"Unknown","startTime":352.58,"endTime":356.75,"body":"room with the same team. I think"},{"speaker":"Unknown","startTime":356.75,"endTime":360.23,"body":"it's probably a little easier in"},{"speaker":"Unknown","startTime":356.75,"endTime":360.23,"body":"my world where I'm doing. One"},{"speaker":"Unknown","startTime":360.23,"endTime":363.5,"body":"room is going to do six primary"},{"speaker":"Unknown","startTime":360.23,"endTime":363.5,"body":"hips and the other room six"},{"speaker":"Unknown","startTime":363.5,"endTime":368.63,"body":"primary knees. So the the dis,"},{"speaker":"Unknown","startTime":363.5,"endTime":368.63,"body":"the change over the room, the"},{"speaker":"Unknown","startTime":368.66,"endTime":372.56,"body":"time between every team member"},{"speaker":"Unknown","startTime":368.66,"endTime":372.56,"body":"knows exactly what their skill"},{"speaker":"Unknown","startTime":372.56,"endTime":376.19,"body":"set and their job is that we can"},{"speaker":"Unknown","startTime":372.56,"endTime":376.19,"body":"become more efficient from that"},{"speaker":"Unknown","startTime":376.19,"endTime":380.6,"body":"perspective. A couple of things"},{"speaker":"Unknown","startTime":376.19,"endTime":380.6,"body":"that my practice, actually after"},{"speaker":"Unknown","startTime":380.6,"endTime":384.44,"body":"the pandemic really helped was"},{"speaker":"Unknown","startTime":380.6,"endTime":384.44,"body":"the use of telemedicine. Some"},{"speaker":"Unknown","startTime":384.44,"endTime":387.53,"body":"people love it, some people hate"},{"speaker":"Unknown","startTime":384.44,"endTime":387.53,"body":"it, again, maybe a little"},{"speaker":"Unknown","startTime":387.53,"endTime":390.32,"body":"easier, and the hip and knee"},{"speaker":"Unknown","startTime":387.53,"endTime":390.32,"body":"world and the hand world where"},{"speaker":"Unknown","startTime":390.86,"endTime":395.39,"body":"the physical exam is not as"},{"speaker":"Unknown","startTime":390.86,"endTime":395.39,"body":"important. Sometimes, you can"},{"speaker":"Unknown","startTime":395.39,"endTime":398.54,"body":"see from an x ray patient as a"},{"speaker":"Unknown","startTime":395.39,"endTime":398.54,"body":"terribly arthritic hip, or they"},{"speaker":"Unknown","startTime":398.54,"endTime":402.56,"body":"have a failed implant and doing"},{"speaker":"Unknown","startTime":398.54,"endTime":402.56,"body":"the telemedicine. So, to my"},{"speaker":"Unknown","startTime":402.56,"endTime":406.49,"body":"efficiency every morning, I"},{"speaker":"Unknown","startTime":402.56,"endTime":406.49,"body":"start with telemedicine at 620."},{"speaker":"Unknown","startTime":406.49,"endTime":410.69,"body":"And I see five patients before"},{"speaker":"Unknown","startTime":406.49,"endTime":410.69,"body":"my clinic starts at 730 or"},{"speaker":"Unknown","startTime":410.69,"endTime":414.14,"body":"before my hour starts. So four"},{"speaker":"Unknown","startTime":410.69,"endTime":414.14,"body":"days a week I'm doing that then"},{"speaker":"Unknown","startTime":414.17,"endTime":418.49,"body":"adds 20 more patients on and it"},{"speaker":"Unknown","startTime":414.17,"endTime":418.49,"body":"adds very little stress to my"},{"speaker":"Unknown","startTime":418.49,"endTime":420.59,"body":"team because they don't have to"},{"speaker":"Unknown","startTime":418.49,"endTime":420.59,"body":"check the patients and they"},{"speaker":"Unknown","startTime":420.59,"endTime":423.89,"body":"don't have to get there earlier."},{"speaker":"Unknown","startTime":420.59,"endTime":423.89,"body":"Patients absolutely love it."},{"speaker":"Unknown","startTime":424.46,"endTime":427.49,"body":"Because they can sit at home and"},{"speaker":"Unknown","startTime":424.46,"endTime":427.49,"body":"have a cup of coffee and I'm"},{"speaker":"Unknown","startTime":427.49,"endTime":430.13,"body":"running a few minutes late. It's"},{"speaker":"Unknown","startTime":427.49,"endTime":430.13,"body":"not like they're driving two"},{"speaker":"Unknown","startTime":430.13,"endTime":433.13,"body":"hours here to wait two hours in"},{"speaker":"Unknown","startTime":430.13,"endTime":433.13,"body":"my waiting room. So I've used"},{"speaker":"Unknown","startTime":433.13,"endTime":437.51,"body":"that to my advantage, especially"},{"speaker":"Unknown","startTime":433.13,"endTime":437.51,"body":"with our physician extenders,"},{"speaker":"Unknown","startTime":437.87,"endTime":442.04,"body":"nurse practitioners and"},{"speaker":"Unknown","startTime":437.87,"endTime":442.04,"body":"physician assistants who may"},{"speaker":"Unknown","startTime":442.04,"endTime":444.32,"body":"have worked up to patients or"},{"speaker":"Unknown","startTime":442.04,"endTime":444.32,"body":"other partners or sports"},{"speaker":"Unknown","startTime":444.32,"endTime":448.07,"body":"partners who have gotten x rays,"},{"speaker":"Unknown","startTime":444.32,"endTime":448.07,"body":"says Miss Jones has bone on bone"},{"speaker":"Unknown","startTime":448.07,"endTime":450.38,"body":"arthritis of their knee doesn't"},{"speaker":"Unknown","startTime":448.07,"endTime":450.38,"body":"need a sports procedure, but"},{"speaker":"Unknown","startTime":450.38,"endTime":453.47,"body":"needs to see Dr. Nunley since"},{"speaker":"Unknown","startTime":450.38,"endTime":453.47,"body":"they've already performed an"},{"speaker":"Unknown","startTime":453.47,"endTime":456.59,"body":"exam and have an x ray in the"},{"speaker":"Unknown","startTime":453.47,"endTime":456.59,"body":"system, I can review that and"},{"speaker":"Unknown","startTime":456.59,"endTime":459.77,"body":"quickly have the patient on my"},{"speaker":"Unknown","startTime":456.59,"endTime":459.77,"body":"schedule for surgery. If that's"},{"speaker":"Unknown","startTime":459.77,"endTime":463.67,"body":"the road, we're gonna go. So"},{"speaker":"Unknown","startTime":459.77,"endTime":463.67,"body":"that's sort of the efficiency"},{"speaker":"Unknown","startTime":463.67,"endTime":465.56,"body":"and the clinical side, that sort"},{"speaker":"Unknown","startTime":463.67,"endTime":465.56,"body":"of stuff."},{"speaker":"Chris Dy","startTime":465.72,"endTime":468.93,"body":"First off, I'm humbled"},{"speaker":"Chris Dy","startTime":465.72,"endTime":468.93,"body":"by that. So that's pretty"},{"speaker":"Chris Dy","startTime":468.93,"endTime":473.01,"body":"incredible. You know, kudos to"},{"speaker":"Chris Dy","startTime":468.93,"endTime":473.01,"body":"you for utilizing telemedicine"},{"speaker":"Chris Dy","startTime":473.01,"endTime":476.79,"body":"in that way. Yeah, there's so"},{"speaker":"Chris Dy","startTime":473.01,"endTime":476.79,"body":"much that you said that I want"},{"speaker":"Chris Dy","startTime":476.79,"endTime":480.3,"body":"to dive into the first thing I"},{"speaker":"Chris Dy","startTime":476.79,"endTime":480.3,"body":"want to ask is how do you handle"},{"speaker":"Chris Dy","startTime":480.33,"endTime":483.87,"body":"the you know, emails from"},{"speaker":"Chris Dy","startTime":480.33,"endTime":483.87,"body":"partners and from, you know,"},{"speaker":"Chris Dy","startTime":483.93,"endTime":486.27,"body":"acquaintances and other you"},{"speaker":"Chris Dy","startTime":483.93,"endTime":486.27,"body":"know, people at the medical"},{"speaker":"Chris Dy","startTime":486.27,"endTime":489.09,"body":"school saying, hey, hey, Ryan,"},{"speaker":"Chris Dy","startTime":486.27,"endTime":489.09,"body":"can you can you get this patient"},{"speaker":"Chris Dy","startTime":489.09,"endTime":492.3,"body":"in? You know, our I need to see"},{"speaker":"Chris Dy","startTime":489.09,"endTime":492.3,"body":"you or a family friend needs to"},{"speaker":"Chris Dy","startTime":492.3,"endTime":493.74,"body":"see you. How do you handle that?"},{"speaker":"Ryan Nunley","startTime":494.97,"endTime":497.07,"body":"Yeah, can add a"},{"speaker":"Ryan Nunley","startTime":494.97,"endTime":497.07,"body":"layer of stress? I mean, I think"},{"speaker":"Ryan Nunley","startTime":497.07,"endTime":503.19,"body":"one thing is that these patients"},{"speaker":"Ryan Nunley","startTime":497.07,"endTime":503.19,"body":"typically are already at a point"},{"speaker":"Ryan Nunley","startTime":503.19,"endTime":505.62,"body":"where they need something"},{"speaker":"Ryan Nunley","startTime":503.19,"endTime":505.62,"body":"surgical, it's not just they're"},{"speaker":"Ryan Nunley","startTime":505.62,"endTime":508.98,"body":"coming in, because they have a"},{"speaker":"Ryan Nunley","startTime":505.62,"endTime":508.98,"body":"little knee pain, too, I do"},{"speaker":"Ryan Nunley","startTime":508.98,"endTime":514.95,"body":"think that it helps with our"},{"speaker":"Ryan Nunley","startTime":508.98,"endTime":514.95,"body":"outreach to the community. So"},{"speaker":"Ryan Nunley","startTime":515.01,"endTime":518.52,"body":"other providers who can email"},{"speaker":"Ryan Nunley","startTime":515.01,"endTime":518.52,"body":"Yeah, and quickly get it in. And"},{"speaker":"Ryan Nunley","startTime":518.52,"endTime":521.19,"body":"then three is probably be just"},{"speaker":"Ryan Nunley","startTime":518.52,"endTime":521.19,"body":"being organized. If you get a"},{"speaker":"Ryan Nunley","startTime":521.19,"endTime":524.07,"body":"text message and email on my"},{"speaker":"Ryan Nunley","startTime":521.19,"endTime":524.07,"body":"chart, you know, it's coming in"},{"speaker":"Ryan Nunley","startTime":524.07,"endTime":528.54,"body":"from all these different angles."},{"speaker":"Ryan Nunley","startTime":524.07,"endTime":528.54,"body":"Having a point person, so one of"},{"speaker":"Ryan Nunley","startTime":528.54,"endTime":532.41,"body":"my nurses, she always calls it"},{"speaker":"Ryan Nunley","startTime":528.54,"endTime":532.41,"body":"the VIP service. She's like,"},{"speaker":"Ryan Nunley","startTime":532.44,"endTime":535.56,"body":"every week, I get 20 VIPs. And"},{"speaker":"Ryan Nunley","startTime":532.44,"endTime":535.56,"body":"they're not necessarily these"},{"speaker":"Ryan Nunley","startTime":535.56,"endTime":538.41,"body":"are VIPs. But these are people"},{"speaker":"Ryan Nunley","startTime":535.56,"endTime":538.41,"body":"who have directly contacted me."},{"speaker":"Ryan Nunley","startTime":539.49,"endTime":542.46,"body":"And so I think from that"},{"speaker":"Ryan Nunley","startTime":539.49,"endTime":542.46,"body":"perspective, one, it's being"},{"speaker":"Ryan Nunley","startTime":542.79,"endTime":546.3,"body":"efficient to respond back to"},{"speaker":"Ryan Nunley","startTime":542.79,"endTime":546.3,"body":"those individuals who are"},{"speaker":"Ryan Nunley","startTime":546.3,"endTime":549.87,"body":"reaching out to you, for"},{"speaker":"Ryan Nunley","startTime":546.3,"endTime":549.87,"body":"example, nursing, or give me a"},{"speaker":"Ryan Nunley","startTime":549.87,"endTime":554.01,"body":"sticker with their mom's name,"},{"speaker":"Ryan Nunley","startTime":549.87,"endTime":554.01,"body":"can you get my mom in, I just"},{"speaker":"Ryan Nunley","startTime":554.01,"endTime":557.01,"body":"quickly take a picture of it and"},{"speaker":"Ryan Nunley","startTime":554.01,"endTime":557.01,"body":"I text it or email it to my"},{"speaker":"Ryan Nunley","startTime":557.01,"endTime":559.92,"body":"team, otherwise I forget about"},{"speaker":"Ryan Nunley","startTime":557.01,"endTime":559.92,"body":"it so you can get lost in that."},{"speaker":"Ryan Nunley","startTime":560.52,"endTime":563.76,"body":"So having a protocol in place"},{"speaker":"Ryan Nunley","startTime":560.52,"endTime":563.76,"body":"that makes it efficient for you,"},{"speaker":"Ryan Nunley","startTime":563.76,"endTime":565.23,"body":"as well as for your team, it's"},{"speaker":"Ryan Nunley","startTime":563.76,"endTime":565.23,"body":"important."},{"speaker":"Charles Goldfarb","startTime":566.25,"endTime":570.0,"body":"That's really"},{"speaker":"Charles Goldfarb","startTime":566.25,"endTime":570.0,"body":"well said and I'm sure Chris"},{"speaker":"Charles Goldfarb","startTime":570.0,"endTime":573.21,"body":"gets some of those. I definitely"},{"speaker":"Charles Goldfarb","startTime":570.0,"endTime":573.21,"body":"don't get 20 a week, but I think"},{"speaker":"Charles Goldfarb","startTime":573.21,"endTime":576.75,"body":"your point of having a system"},{"speaker":"Charles Goldfarb","startTime":573.21,"endTime":576.75,"body":"and responding and or just"},{"speaker":"Charles Goldfarb","startTime":576.75,"endTime":582.48,"body":"checking it off your list. ASAP"},{"speaker":"Charles Goldfarb","startTime":576.75,"endTime":582.48,"body":"is vital. I'm really good with"},{"speaker":"Charles Goldfarb","startTime":582.48,"endTime":586.8,"body":"staying up with email. I you"},{"speaker":"Charles Goldfarb","startTime":582.48,"endTime":586.8,"body":"know, texting if someone texts"},{"speaker":"Charles Goldfarb","startTime":586.8,"endTime":590.16,"body":"me I try to text right back"},{"speaker":"Charles Goldfarb","startTime":586.8,"endTime":590.16,"body":"because if I don't, it just goes"},{"speaker":"Charles Goldfarb","startTime":590.16,"endTime":593.46,"body":"down the line and I lose it. And"},{"speaker":"Charles Goldfarb","startTime":590.16,"endTime":593.46,"body":"you're right. You're getting it"},{"speaker":"Charles Goldfarb","startTime":593.46,"endTime":599.01,"body":"from all sides verbally. Epic"},{"speaker":"Charles Goldfarb","startTime":593.46,"endTime":599.01,"body":"texted email. It's your system"},{"speaker":"Charles Goldfarb","startTime":599.01,"endTime":599.97,"body":"sounds really good."},{"speaker":"Ryan Nunley","startTime":601.319,"endTime":603.479,"body":"It's funny how you"},{"speaker":"Ryan Nunley","startTime":601.319,"endTime":603.479,"body":"said that you're good at email,"},{"speaker":"Ryan Nunley","startTime":603.479,"endTime":607.199,"body":"I'm the opposite. The text"},{"speaker":"Ryan Nunley","startTime":603.479,"endTime":607.199,"body":"messages, I don't have all the"},{"speaker":"Ryan Nunley","startTime":607.199,"endTime":610.049,"body":"spam, right? I come out of the"},{"speaker":"Ryan Nunley","startTime":607.199,"endTime":610.049,"body":"ER, and I'll have 200 new"},{"speaker":"Ryan Nunley","startTime":610.049,"endTime":612.479,"body":"emails. And so I'll try and"},{"speaker":"Ryan Nunley","startTime":610.049,"endTime":612.479,"body":"delete, delete, delete, and"},{"speaker":"Ryan Nunley","startTime":612.479,"endTime":615.449,"body":"there may be an important one,"},{"speaker":"Ryan Nunley","startTime":612.479,"endTime":615.449,"body":"get, but then I come out there"},{"speaker":"Ryan Nunley","startTime":615.449,"endTime":618.929,"body":"or there's more. And so then all"},{"speaker":"Ryan Nunley","startTime":615.449,"endTime":618.929,"body":"of a sudden, I feel the opposite"},{"speaker":"Ryan Nunley","startTime":618.929,"endTime":621.989,"body":"that text to me is much better."},{"speaker":"Ryan Nunley","startTime":618.929,"endTime":621.989,"body":"But guess maybe it's different"},{"speaker":"Ryan Nunley","startTime":621.989,"endTime":623.279,"body":"amount of inbox messages."},{"speaker":"Charles Goldfarb","startTime":625.01,"endTime":630.2,"body":"Yeah, for"},{"speaker":"Charles Goldfarb","startTime":625.01,"endTime":630.2,"body":"sure, for sure. So talk to us a"},{"speaker":"Charles Goldfarb","startTime":630.2,"endTime":636.74,"body":"little bit more about your use"},{"speaker":"Charles Goldfarb","startTime":630.2,"endTime":636.74,"body":"of APPS or physician extenders?"},{"speaker":"Charles Goldfarb","startTime":636.92,"endTime":640.46,"body":"Do you use them in the clinic?"},{"speaker":"Charles Goldfarb","startTime":636.92,"endTime":640.46,"body":"Do who helps you in the or"},{"speaker":"Charles Goldfarb","startTime":640.46,"endTime":644.39,"body":"besides residents and fellows?"},{"speaker":"Charles Goldfarb","startTime":640.46,"endTime":644.39,"body":"How do you balance? If you do"},{"speaker":"Charles Goldfarb","startTime":644.39,"endTime":647.51,"body":"I'm not even sure you do."},{"speaker":"Charles Goldfarb","startTime":644.39,"endTime":647.51,"body":"trainees? If that's the right"},{"speaker":"Charles Goldfarb","startTime":647.51,"endTime":648.77,"body":"term in 2024."},{"speaker":"Chris Dy","startTime":649.56,"endTime":650.43,"body":"learners learn?"},{"speaker":"Charles Goldfarb","startTime":652.38,"endTime":656.46,"body":"How do you"},{"speaker":"Charles Goldfarb","startTime":652.38,"endTime":656.46,"body":"balance learners and, you know,"},{"speaker":"Charles Goldfarb","startTime":656.46,"endTime":658.29,"body":"staff? Sure."},{"speaker":"Ryan Nunley","startTime":658.29,"endTime":660.24,"body":"So I think the"},{"speaker":"Ryan Nunley","startTime":658.29,"endTime":660.24,"body":"first thing is, you know, when"},{"speaker":"Ryan Nunley","startTime":660.24,"endTime":663.9,"body":"you look at a practice, while"},{"speaker":"Ryan Nunley","startTime":660.24,"endTime":663.9,"body":"you may be the captain of the"},{"speaker":"Ryan Nunley","startTime":663.9,"endTime":668.04,"body":"ship, every member of the team"},{"speaker":"Ryan Nunley","startTime":663.9,"endTime":668.04,"body":"touches and influences and has"},{"speaker":"Ryan Nunley","startTime":668.04,"endTime":671.58,"body":"contact points with your"},{"speaker":"Ryan Nunley","startTime":668.04,"endTime":671.58,"body":"patients. So it's like any great"},{"speaker":"Ryan Nunley","startTime":671.58,"endTime":674.64,"body":"relationship, if you have a good"},{"speaker":"Ryan Nunley","startTime":671.58,"endTime":674.64,"body":"relationship and you trust and"},{"speaker":"Ryan Nunley","startTime":674.64,"endTime":678.81,"body":"you and you're able to utilize"},{"speaker":"Ryan Nunley","startTime":674.64,"endTime":678.81,"body":"them, then it's meaningful. I'd"},{"speaker":"Ryan Nunley","startTime":678.81,"endTime":682.29,"body":"say there's a great book called"},{"speaker":"Ryan Nunley","startTime":678.81,"endTime":682.29,"body":"Traction by Gino Wickman. And it"},{"speaker":"Ryan Nunley","startTime":682.29,"endTime":685.47,"body":"talks a lot about putting the"},{"speaker":"Ryan Nunley","startTime":682.29,"endTime":685.47,"body":"right person in the right seat."},{"speaker":"Ryan Nunley","startTime":685.47,"endTime":689.01,"body":"So you could have a great"},{"speaker":"Ryan Nunley","startTime":685.47,"endTime":689.01,"body":"assistant, but maybe doesn't"},{"speaker":"Ryan Nunley","startTime":689.01,"endTime":691.62,"body":"interface with patients very"},{"speaker":"Ryan Nunley","startTime":689.01,"endTime":691.62,"body":"well, it's better in the back"},{"speaker":"Ryan Nunley","startTime":691.62,"endTime":696.03,"body":"office. So you may have somebody"},{"speaker":"Ryan Nunley","startTime":691.62,"endTime":696.03,"body":"who's really great at doing the"},{"speaker":"Ryan Nunley","startTime":696.03,"endTime":698.28,"body":"hands on stuff, but it's"},{"speaker":"Ryan Nunley","startTime":696.03,"endTime":698.28,"body":"terrible at the computer work."},{"speaker":"Ryan Nunley","startTime":698.28,"endTime":700.23,"body":"And so getting that right"},{"speaker":"Ryan Nunley","startTime":698.28,"endTime":700.23,"body":"person. And I think the same"},{"speaker":"Ryan Nunley","startTime":700.23,"endTime":705.63,"body":"goes for the advanced practicing"},{"speaker":"Ryan Nunley","startTime":700.23,"endTime":705.63,"body":"partners, we have great ones"},{"speaker":"Ryan Nunley","startTime":705.63,"endTime":708.87,"body":"that can really do a nice job"},{"speaker":"Ryan Nunley","startTime":705.63,"endTime":708.87,"body":"inject things, you know,"},{"speaker":"Ryan Nunley","startTime":708.9,"endTime":712.14,"body":"routinely, and you guys may"},{"speaker":"Ryan Nunley","startTime":708.9,"endTime":712.14,"body":"appreciate this, if you're not"},{"speaker":"Ryan Nunley","startTime":712.14,"endTime":714.48,"body":"doing all your own injections,"},{"speaker":"Ryan Nunley","startTime":712.14,"endTime":714.48,"body":"but you have somebody else Oh,"},{"speaker":"Ryan Nunley","startTime":714.48,"endTime":717.78,"body":"and when your nurse practitioner"},{"speaker":"Ryan Nunley","startTime":714.48,"endTime":717.78,"body":"did it hurt, it was miserable, I"},{"speaker":"Ryan Nunley","startTime":717.78,"endTime":720.21,"body":"only want you to do it. Well,"},{"speaker":"Ryan Nunley","startTime":717.78,"endTime":720.21,"body":"that's not really helping you."},{"speaker":"Ryan Nunley","startTime":720.21,"endTime":725.73,"body":"So getting a partner in that"},{"speaker":"Ryan Nunley","startTime":720.21,"endTime":725.73,"body":"sense that does it the same way"},{"speaker":"Ryan Nunley","startTime":725.73,"endTime":728.94,"body":"you do trust you as a"},{"speaker":"Ryan Nunley","startTime":725.73,"endTime":728.94,"body":"responsible, and they can be"},{"speaker":"Ryan Nunley","startTime":728.94,"endTime":732.12,"body":"great, because they really do"},{"speaker":"Ryan Nunley","startTime":728.94,"endTime":732.12,"body":"interface with the patients"},{"speaker":"Ryan Nunley","startTime":732.6,"endTime":735.3,"body":"quite a bit for the non urgent"},{"speaker":"Ryan Nunley","startTime":732.6,"endTime":735.3,"body":"stuff. So I see all my own"},{"speaker":"Ryan Nunley","startTime":735.3,"endTime":739.5,"body":"patients, but for annual follow"},{"speaker":"Ryan Nunley","startTime":735.3,"endTime":739.5,"body":"ups of X rays, one year, five"},{"speaker":"Ryan Nunley","startTime":739.5,"endTime":742.32,"body":"year 10 year, if they're doing"},{"speaker":"Ryan Nunley","startTime":739.5,"endTime":742.32,"body":"well, usually we'll send them to"},{"speaker":"Ryan Nunley","startTime":742.32,"endTime":745.83,"body":"our physician assistants or for"},{"speaker":"Ryan Nunley","startTime":742.32,"endTime":745.83,"body":"routine injections that come in"},{"speaker":"Ryan Nunley","startTime":745.83,"endTime":749.37,"body":"every three months. So it's a"},{"speaker":"Ryan Nunley","startTime":745.83,"endTime":749.37,"body":"great resource to have, as long"},{"speaker":"Ryan Nunley","startTime":749.37,"endTime":752.16,"body":"as you trust the person and they"},{"speaker":"Ryan Nunley","startTime":749.37,"endTime":752.16,"body":"do a nice job. I think that"},{"speaker":"Ryan Nunley","startTime":752.16,"endTime":756.54,"body":"helps terms of the learners, our"},{"speaker":"Ryan Nunley","startTime":752.16,"endTime":756.54,"body":"residents and fellows I my"},{"speaker":"Ryan Nunley","startTime":756.54,"endTime":760.35,"body":"clinic is busy I typically see"},{"speaker":"Ryan Nunley","startTime":756.54,"endTime":760.35,"body":"outside of telemedicine about 55"},{"speaker":"Ryan Nunley","startTime":760.35,"endTime":764.34,"body":"to 60 patients in clinic. And"},{"speaker":"Ryan Nunley","startTime":760.35,"endTime":764.34,"body":"part of it is they also have to"},{"speaker":"Ryan Nunley","startTime":764.34,"endTime":767.79,"body":"learn how to be efficient, the"},{"speaker":"Ryan Nunley","startTime":764.34,"endTime":767.79,"body":"orthopedic exam for hip and knee"},{"speaker":"Ryan Nunley","startTime":768.0,"endTime":770.07,"body":"a little different than hand,"},{"speaker":"Ryan Nunley","startTime":768.0,"endTime":770.07,"body":"it's a little different than"},{"speaker":"Ryan Nunley","startTime":770.07,"endTime":773.22,"body":"medicine. And they have to be"},{"speaker":"Ryan Nunley","startTime":770.07,"endTime":773.22,"body":"able to quickly go in and say is"},{"speaker":"Ryan Nunley","startTime":773.22,"endTime":776.58,"body":"this a patient who needs"},{"speaker":"Ryan Nunley","startTime":773.22,"endTime":776.58,"body":"services or is this a person who"},{"speaker":"Ryan Nunley","startTime":776.58,"endTime":779.76,"body":"needs their handheld after"},{"speaker":"Ryan Nunley","startTime":776.58,"endTime":779.76,"body":"surgery is this person who has a"},{"speaker":"Ryan Nunley","startTime":779.76,"endTime":783.6,"body":"complex problem. So you don't"},{"speaker":"Ryan Nunley","startTime":779.76,"endTime":783.6,"body":"need to spend 15 minutes with"},{"speaker":"Ryan Nunley","startTime":783.6,"endTime":786.21,"body":"each one, some need a minute,"},{"speaker":"Ryan Nunley","startTime":783.6,"endTime":786.21,"body":"somebody 10 minutes, some need"},{"speaker":"Ryan Nunley","startTime":786.24,"endTime":789.36,"body":"30 minutes and to get through"},{"speaker":"Ryan Nunley","startTime":786.24,"endTime":789.36,"body":"that and an efficient way and"},{"speaker":"Ryan Nunley","startTime":789.36,"endTime":793.05,"body":"having them make decisions. So I"},{"speaker":"Ryan Nunley","startTime":789.36,"endTime":793.05,"body":"really make them go in and see"},{"speaker":"Ryan Nunley","startTime":793.05,"endTime":797.07,"body":"the patient come up with a full"},{"speaker":"Ryan Nunley","startTime":793.05,"endTime":797.07,"body":"plan. And leave me the the notes"},{"speaker":"Ryan Nunley","startTime":797.07,"endTime":799.89,"body":"and let me sort of go in"},{"speaker":"Ryan Nunley","startTime":797.07,"endTime":799.89,"body":"independently. If we come up to"},{"speaker":"Ryan Nunley","startTime":799.89,"endTime":802.74,"body":"the same conclusion, then we sit"},{"speaker":"Ryan Nunley","startTime":799.89,"endTime":802.74,"body":"around and talk about ones where"},{"speaker":"Ryan Nunley","startTime":802.74,"endTime":806.22,"body":"there's discrepancy in the or"},{"speaker":"Ryan Nunley","startTime":802.74,"endTime":806.22,"body":"same thing. You know, it's a"},{"speaker":"Ryan Nunley","startTime":806.22,"endTime":810.15,"body":"graduated autonomy, they have to"},{"speaker":"Ryan Nunley","startTime":806.22,"endTime":810.15,"body":"at some point, have the reins"},{"speaker":"Ryan Nunley","startTime":810.15,"endTime":813.18,"body":"turned over to them. So making"},{"speaker":"Ryan Nunley","startTime":810.15,"endTime":813.18,"body":"sure that they are comfortable"},{"speaker":"Ryan Nunley","startTime":813.18,"endTime":817.14,"body":"with every step and knowing we"},{"speaker":"Ryan Nunley","startTime":813.18,"endTime":817.14,"body":"can outline these steps in"},{"speaker":"Ryan Nunley","startTime":817.14,"endTime":820.77,"body":"advance because a lot of what we"},{"speaker":"Ryan Nunley","startTime":817.14,"endTime":820.77,"body":"do is repetitive that they"},{"speaker":"Ryan Nunley","startTime":820.77,"endTime":822.78,"body":"should know it should take you"},{"speaker":"Ryan Nunley","startTime":820.77,"endTime":822.78,"body":"three minutes to get to this"},{"speaker":"Ryan Nunley","startTime":822.78,"endTime":825.03,"body":"part of the case. And this part"},{"speaker":"Ryan Nunley","startTime":822.78,"endTime":825.03,"body":"should only take you five"},{"speaker":"Ryan Nunley","startTime":825.03,"endTime":827.7,"body":"minutes. And I do encourage them"},{"speaker":"Ryan Nunley","startTime":825.03,"endTime":827.7,"body":"at the beginning of the rotating"},{"speaker":"Ryan Nunley","startTime":828.03,"endTime":831.24,"body":"stage. If you think about how"},{"speaker":"Ryan Nunley","startTime":828.03,"endTime":831.24,"body":"you can save one minute on every"},{"speaker":"Ryan Nunley","startTime":831.24,"endTime":835.2,"body":"single case, over the course of"},{"speaker":"Ryan Nunley","startTime":831.24,"endTime":835.2,"body":"six weeks, you should be 30"},{"speaker":"Ryan Nunley","startTime":835.2,"endTime":838.86,"body":"minutes faster by the end once"},{"speaker":"Ryan Nunley","startTime":835.2,"endTime":838.86,"body":"you've done it. So emphasizing"},{"speaker":"Ryan Nunley","startTime":838.86,"endTime":842.49,"body":"those points teaching the finer"},{"speaker":"Ryan Nunley","startTime":838.86,"endTime":842.49,"body":"details of how they don't have"},{"speaker":"Ryan Nunley","startTime":842.49,"endTime":845.4,"body":"to do every step of the case,"},{"speaker":"Ryan Nunley","startTime":842.49,"endTime":845.4,"body":"for example, putting every one"},{"speaker":"Ryan Nunley","startTime":845.4,"endTime":847.95,"body":"of the retractors in and then"},{"speaker":"Ryan Nunley","startTime":845.4,"endTime":847.95,"body":"turn around to do the next step."},{"speaker":"Ryan Nunley","startTime":847.95,"endTime":851.07,"body":"We have two other assistants"},{"speaker":"Ryan Nunley","startTime":847.95,"endTime":851.07,"body":"there myself and usually at"},{"speaker":"Ryan Nunley","startTime":851.07,"endTime":855.09,"body":"first assist from the hour. That"},{"speaker":"Ryan Nunley","startTime":851.07,"endTime":855.09,"body":"should each be doing our own"},{"speaker":"Ryan Nunley","startTime":855.09,"endTime":857.31,"body":"work so that it's very fluid and"},{"speaker":"Ryan Nunley","startTime":855.09,"endTime":857.31,"body":"efficient."},{"speaker":"Chris Dy","startTime":857.55,"endTime":859.29,"body":"Like God, you're"},{"speaker":"Chris Dy","startTime":857.55,"endTime":859.29,"body":"speaking Chuck's love language"},{"speaker":"Chris Dy","startTime":859.29,"endTime":859.65,"body":"right now."},{"speaker":"Charles Goldfarb","startTime":859.65,"endTime":861.06,"body":"It's your sort"},{"speaker":"Charles Goldfarb","startTime":859.65,"endTime":861.06,"body":"of efficiency."},{"speaker":"Chris Dy","startTime":861.0,"endTime":864.75,"body":"This is the the six"},{"speaker":"Chris Dy","startTime":861.0,"endTime":864.75,"body":"love language that isn't often"},{"speaker":"Chris Dy","startTime":864.75,"endTime":868.26,"body":"described. So I think your"},{"speaker":"Chris Dy","startTime":864.75,"endTime":868.26,"body":"points are really good about you"},{"speaker":"Chris Dy","startTime":868.26,"endTime":870.9,"body":"know, all of them, but"},{"speaker":"Chris Dy","startTime":868.26,"endTime":870.9,"body":"particularly the, you know,"},{"speaker":"Chris Dy","startTime":870.9,"endTime":874.92,"body":"coming in the learner and the"},{"speaker":"Chris Dy","startTime":870.9,"endTime":874.92,"body":"examination and coming out of a"},{"speaker":"Chris Dy","startTime":874.92,"endTime":878.64,"body":"room. You know, oftentimes, when"},{"speaker":"Chris Dy","startTime":874.92,"endTime":878.64,"body":"I start working with a new"},{"speaker":"Chris Dy","startTime":878.64,"endTime":881.28,"body":"learner, I give them the"},{"speaker":"Chris Dy","startTime":878.64,"endTime":881.28,"body":"Goldfarb speech about you know"},{"speaker":"Chris Dy","startTime":881.28,"endTime":883.74,"body":"how you have to come out of the"},{"speaker":"Chris Dy","startTime":881.28,"endTime":883.74,"body":"room with a plan. Well, even if"},{"speaker":"Chris Dy","startTime":883.74,"endTime":887.01,"body":"your plan is wrong, you need to"},{"speaker":"Chris Dy","startTime":883.74,"endTime":887.01,"body":"have a plan. And I remember"},{"speaker":"Chris Dy","startTime":887.07,"endTime":889.53,"body":"hearing that being on the"},{"speaker":"Chris Dy","startTime":887.07,"endTime":889.53,"body":"receiving ended that with Chuck,"},{"speaker":"Chris Dy","startTime":890.13,"endTime":892.41,"body":"you know, I think Chuck probably"},{"speaker":"Chris Dy","startTime":890.13,"endTime":892.41,"body":"wants to unpack a little bit of"},{"speaker":"Chris Dy","startTime":892.41,"endTime":894.12,"body":"what you talked about. We"},{"speaker":"Chris Dy","startTime":892.41,"endTime":894.12,"body":"probably should talk about some"},{"speaker":"Chris Dy","startTime":894.12,"endTime":896.85,"body":"of the technology stuff since"},{"speaker":"Chris Dy","startTime":894.12,"endTime":896.85,"body":"we're pretty far in right now."},{"speaker":"Chris Dy","startTime":897.99,"endTime":900.24,"body":"We should thank our sponsor,"},{"speaker":"Chris Dy","startTime":897.99,"endTime":900.24,"body":"Checkpoint Surgery. Well,"},{"speaker":"Chris Dy","startTime":900.51,"endTime":903.54,"body":"they're hosting a webinar in"},{"speaker":"Chris Dy","startTime":900.51,"endTime":903.54,"body":"April on selective and hyper"},{"speaker":"Chris Dy","startTime":903.54,"endTime":906.3,"body":"selective neurectomy. I don't"},{"speaker":"Chris Dy","startTime":903.54,"endTime":906.3,"body":"even know what that means, and"},{"speaker":"Chris Dy","startTime":906.3,"endTime":910.41,"body":"its role in managing extremity"},{"speaker":"Chris Dy","startTime":906.3,"endTime":910.41,"body":"spasticity. Dr. Scott Kozin, one"},{"speaker":"Chris Dy","startTime":910.41,"endTime":914.31,"body":"of chuck's bros will facilitate"},{"speaker":"Chris Dy","startTime":910.41,"endTime":914.31,"body":"the webinar and Dr. Katy Wu from"},{"speaker":"Chris Dy","startTime":914.31,"endTime":918.54,"body":"Mayo Clinic who has a friend of"},{"speaker":"Chris Dy","startTime":914.31,"endTime":918.54,"body":"WashU will share how her program"},{"speaker":"Chris Dy","startTime":918.54,"endTime":921.48,"body":"is expanding the utilization of"},{"speaker":"Chris Dy","startTime":918.54,"endTime":921.48,"body":"this strategy to the lower"},{"speaker":"Chris Dy","startTime":921.48,"endTime":922.26,"body":"extremities."},{"speaker":"Charles Goldfarb","startTime":922.8,"endTime":924.66,"body":"To learn more"},{"speaker":"Charles Goldfarb","startTime":922.8,"endTime":924.66,"body":"about this course, and other"},{"speaker":"Charles Goldfarb","startTime":924.66,"endTime":927.45,"body":"upcoming educational programs"},{"speaker":"Charles Goldfarb","startTime":924.66,"endTime":927.45,"body":"supported by Checkpoint"},{"speaker":"Charles Goldfarb","startTime":927.45,"endTime":931.29,"body":"Surgical, including our own here"},{"speaker":"Charles Goldfarb","startTime":927.45,"endTime":931.29,"body":"at Washington University, please"},{"speaker":"Charles Goldfarb","startTime":931.29,"endTime":937.47,"body":"visit nervemaster.com Hyper"},{"speaker":"Charles Goldfarb","startTime":931.29,"endTime":937.47,"body":"selective neurectomy That"},{"speaker":"Charles Goldfarb","startTime":937.5,"endTime":940.86,"body":"immediately makes me nauseous."},{"speaker":"Charles Goldfarb","startTime":937.5,"endTime":940.86,"body":"So I don't I don't want to learn"},{"speaker":"Charles Goldfarb","startTime":940.86,"endTime":942.69,"body":"more about that. Oh, come on,"},{"speaker":"Charles Goldfarb","startTime":940.86,"endTime":942.69,"body":"don't"},{"speaker":"Ryan Nunley","startTime":944.37,"endTime":945.87,"body":"lose the nerve"},{"speaker":"Ryan Nunley","startTime":944.37,"endTime":945.87,"body":"master was"},{"speaker":"Chris Dy","startTime":947.64,"endTime":950.52,"body":"wonderful. I'm amazed"},{"speaker":"Chris Dy","startTime":947.64,"endTime":950.52,"body":"the Checkpoint got to that URL"},{"speaker":"Chris Dy","startTime":950.52,"endTime":955.98,"body":"before I did. That's dammit. No."},{"speaker":"Chris Dy","startTime":950.52,"endTime":955.98,"body":"So we have our peripheral nerve"},{"speaker":"Chris Dy","startTime":955.98,"endTime":960.06,"body":"course actually, the the the"},{"speaker":"Chris Dy","startTime":955.98,"endTime":960.06,"body":"plastic folks asked us to call"},{"speaker":"Chris Dy","startTime":960.06,"endTime":962.49,"body":"it the Washington nerve course"},{"speaker":"Chris Dy","startTime":960.06,"endTime":962.49,"body":"not the peripheral nerve course,"},{"speaker":"Chris Dy","startTime":962.49,"endTime":965.28,"body":"apparently, there's no"},{"speaker":"Chris Dy","startTime":962.49,"endTime":965.28,"body":"difference now. But we have our"},{"speaker":"Chris Dy","startTime":965.28,"endTime":968.37,"body":"Washington nerve course coming"},{"speaker":"Chris Dy","startTime":965.28,"endTime":968.37,"body":"up about three weeks from when"},{"speaker":"Chris Dy","startTime":968.37,"endTime":971.67,"body":"this episode drops at spots are"},{"speaker":"Chris Dy","startTime":968.37,"endTime":971.67,"body":"filling up fast, there's"},{"speaker":"Chris Dy","startTime":971.67,"endTime":973.95,"body":"actually only a few more spots."},{"speaker":"Chris Dy","startTime":971.67,"endTime":973.95,"body":"So by the time this airs, there"},{"speaker":"Chris Dy","startTime":973.95,"endTime":975.96,"body":"may not be any more spots you"},{"speaker":"Chris Dy","startTime":973.95,"endTime":975.96,"body":"can get on the waiting list. If"},{"speaker":"Chris Dy","startTime":975.96,"endTime":978.18,"body":"people don't show up. Ryan,"},{"speaker":"Charles Goldfarb","startTime":978.18,"endTime":980.22,"body":"there's"},{"speaker":"Charles Goldfarb","startTime":978.18,"endTime":980.22,"body":"there's space for you, you know,"},{"speaker":"Charles Goldfarb","startTime":980.22,"endTime":983.22,"body":"there's always room to expand?"},{"speaker":"Charles Goldfarb","startTime":980.22,"endTime":983.22,"body":"Well, you"},{"speaker":"Ryan Nunley","startTime":983.22,"endTime":985.83,"body":"know, there's the"},{"speaker":"Ryan Nunley","startTime":983.22,"endTime":985.83,"body":"uncomfortable pullout operative"},{"speaker":"Ryan Nunley","startTime":985.92,"endTime":991.56,"body":"nerve foot drop that occurs"},{"speaker":"Ryan Nunley","startTime":985.92,"endTime":991.56,"body":"occasionally. That's always very"},{"speaker":"Ryan Nunley","startTime":991.95,"endTime":995.28,"body":"gut wrenching moment when the"},{"speaker":"Ryan Nunley","startTime":991.95,"endTime":995.28,"body":"nerve doesn't function on the"},{"speaker":"Ryan Nunley","startTime":995.28,"endTime":998.73,"body":"first post op checker in the"},{"speaker":"Ryan Nunley","startTime":995.28,"endTime":998.73,"body":"morning. So I may have to attend"},{"speaker":"Ryan Nunley","startTime":998.73,"endTime":1000.05,"body":"them and see what there is no"},{"speaker":"Ryan Nunley","startTime":998.73,"endTime":1000.05,"body":"out there."},{"speaker":"Charles Goldfarb","startTime":1000.83,"endTime":1002.06,"body":"Let me know"},{"speaker":"Charles Goldfarb","startTime":1000.83,"endTime":1002.06,"body":"how it goes."},{"speaker":"Chris Dy","startTime":1002.18,"endTime":1006.26,"body":"I don't think you'll"},{"speaker":"Chris Dy","startTime":1002.18,"endTime":1006.26,"body":"have to attend. I told you so"},{"speaker":"Chris Dy","startTime":1006.26,"endTime":1010.22,"body":"you drew a distinction between"},{"speaker":"Chris Dy","startTime":1006.26,"endTime":1010.22,"body":"computer navigated versus"},{"speaker":"Chris Dy","startTime":1010.22,"endTime":1013.73,"body":"robotic knee replacement. And"},{"speaker":"Chris Dy","startTime":1010.22,"endTime":1013.73,"body":"you know, knowing that most of"},{"speaker":"Chris Dy","startTime":1013.73,"endTime":1016.58,"body":"our listeners are, you know,"},{"speaker":"Chris Dy","startTime":1013.73,"endTime":1016.58,"body":"orthopedic or plastic surgeons"},{"speaker":"Chris Dy","startTime":1016.58,"endTime":1019.76,"body":"and training, you know, hand"},{"speaker":"Chris Dy","startTime":1016.58,"endTime":1019.76,"body":"surgeons training or hand"},{"speaker":"Chris Dy","startTime":1019.76,"endTime":1022.1,"body":"therapists, can you just kind of"},{"speaker":"Chris Dy","startTime":1019.76,"endTime":1022.1,"body":"give some broad strokes about"},{"speaker":"Chris Dy","startTime":1022.1,"endTime":1024.65,"body":"you know, what, what does it"},{"speaker":"Chris Dy","startTime":1022.1,"endTime":1024.65,"body":"mean to have a robotic assisted"},{"speaker":"Chris Dy","startTime":1024.65,"endTime":1026.48,"body":"knee replacement? And what does"},{"speaker":"Chris Dy","startTime":1024.65,"endTime":1026.48,"body":"it mean to have computer"},{"speaker":"Chris Dy","startTime":1026.48,"endTime":1029.63,"body":"navigation used in arthroplasty,"},{"speaker":"Chris Dy","startTime":1026.48,"endTime":1029.63,"body":"or joint replacement?"},{"speaker":"Ryan Nunley","startTime":1030.89,"endTime":1033.32,"body":"Yeah, so I mean,"},{"speaker":"Ryan Nunley","startTime":1030.89,"endTime":1033.32,"body":"the goal of either of those is"},{"speaker":"Ryan Nunley","startTime":1033.32,"endTime":1037.82,"body":"really to make the surgery more"},{"speaker":"Ryan Nunley","startTime":1033.32,"endTime":1037.82,"body":"accurate. You know, when we look"},{"speaker":"Ryan Nunley","startTime":1037.82,"endTime":1041.12,"body":"at how you do some of your"},{"speaker":"Ryan Nunley","startTime":1037.82,"endTime":1041.12,"body":"surgeries, if you're going to do"},{"speaker":"Ryan Nunley","startTime":1041.12,"endTime":1044.48,"body":"an osteotomy, you sort of"},{"speaker":"Ryan Nunley","startTime":1041.12,"endTime":1044.48,"body":"preoperatively plan, you're"},{"speaker":"Ryan Nunley","startTime":1044.81,"endTime":1047.87,"body":"going to cut this and say the"},{"speaker":"Ryan Nunley","startTime":1044.81,"endTime":1047.87,"body":"old adage of you measure twice,"},{"speaker":"Ryan Nunley","startTime":1048.05,"endTime":1051.35,"body":"cut once to a principle, well,"},{"speaker":"Ryan Nunley","startTime":1048.05,"endTime":1051.35,"body":"that's a lot of what we're doing"},{"speaker":"Ryan Nunley","startTime":1051.38,"endTime":1055.34,"body":"every day with a hip or knee"},{"speaker":"Ryan Nunley","startTime":1051.38,"endTime":1055.34,"body":"replacement. So probably at this"},{"speaker":"Ryan Nunley","startTime":1055.34,"endTime":1059.9,"body":"point, now, almost 20 years ago,"},{"speaker":"Ryan Nunley","startTime":1055.34,"endTime":1059.9,"body":"navigation was a utilization of"},{"speaker":"Ryan Nunley","startTime":1059.9,"endTime":1063.74,"body":"technology to put pins at a"},{"speaker":"Ryan Nunley","startTime":1059.9,"endTime":1063.74,"body":"fixed point into the bone with"},{"speaker":"Ryan Nunley","startTime":1063.74,"endTime":1068.06,"body":"the rays that a sensor could"},{"speaker":"Ryan Nunley","startTime":1063.74,"endTime":1068.06,"body":"pick up that can tell motion and"},{"speaker":"Ryan Nunley","startTime":1068.06,"endTime":1072.2,"body":"angles, and then allowed"},{"speaker":"Ryan Nunley","startTime":1068.06,"endTime":1072.2,"body":"surgeons to try to reproduce the"},{"speaker":"Ryan Nunley","startTime":1072.2,"endTime":1078.02,"body":"cuts more accurately. And it"},{"speaker":"Ryan Nunley","startTime":1072.2,"endTime":1078.02,"body":"seemed to fade out over time was"},{"speaker":"Ryan Nunley","startTime":1078.02,"endTime":1081.8,"body":"very, for lack of a scientific"},{"speaker":"Ryan Nunley","startTime":1078.02,"endTime":1081.8,"body":"words, klutzy, there's sort of"},{"speaker":"Ryan Nunley","startTime":1081.83,"endTime":1086.87,"body":"difficulties with the data in"},{"speaker":"Ryan Nunley","startTime":1081.83,"endTime":1086.87,"body":"and the data out and then sort"},{"speaker":"Ryan Nunley","startTime":1086.87,"endTime":1091.64,"body":"of Fast forward to probably"},{"speaker":"Ryan Nunley","startTime":1086.87,"endTime":1091.64,"body":"about 12 years ago, the robotic"},{"speaker":"Ryan Nunley","startTime":1091.64,"endTime":1094.28,"body":"side. So as you saw in the"},{"speaker":"Ryan Nunley","startTime":1091.64,"endTime":1094.28,"body":"general surgery world with the"},{"speaker":"Ryan Nunley","startTime":1094.28,"endTime":1099.5,"body":"DaVinci utilization of robotics,"},{"speaker":"Ryan Nunley","startTime":1094.28,"endTime":1099.5,"body":"and for probably the first five"},{"speaker":"Ryan Nunley","startTime":1099.5,"endTime":1103.43,"body":"to seven years, there was slow"},{"speaker":"Ryan Nunley","startTime":1099.5,"endTime":1103.43,"body":"uptake. But with that a lot of"},{"speaker":"Ryan Nunley","startTime":1103.43,"endTime":1106.46,"body":"the major orthopedic companies"},{"speaker":"Ryan Nunley","startTime":1103.43,"endTime":1106.46,"body":"have put a ton of time and"},{"speaker":"Ryan Nunley","startTime":1106.46,"endTime":1109.73,"body":"resource into updating the"},{"speaker":"Ryan Nunley","startTime":1106.46,"endTime":1109.73,"body":"robotics making it simpler,"},{"speaker":"Ryan Nunley","startTime":1109.73,"endTime":1113.93,"body":"faster, more reproducible. And"},{"speaker":"Ryan Nunley","startTime":1109.73,"endTime":1113.93,"body":"with that, now, the growing"},{"speaker":"Ryan Nunley","startTime":1113.93,"endTime":1117.11,"body":"trend and total joints,"},{"speaker":"Ryan Nunley","startTime":1113.93,"endTime":1117.11,"body":"especially in the new world, is"},{"speaker":"Ryan Nunley","startTime":1117.11,"endTime":1122.39,"body":"that the large majority, if not"},{"speaker":"Ryan Nunley","startTime":1117.11,"endTime":1122.39,"body":"by the time, we get to the end"},{"speaker":"Ryan Nunley","startTime":1122.39,"endTime":1125.45,"body":"of the decade, here, probably"},{"speaker":"Ryan Nunley","startTime":1122.39,"endTime":1125.45,"body":"all of them will be done in some"},{"speaker":"Ryan Nunley","startTime":1125.45,"endTime":1128.93,"body":"form of a robotic assistance"},{"speaker":"Ryan Nunley","startTime":1125.45,"endTime":1128.93,"body":"just because it takes the human"},{"speaker":"Ryan Nunley","startTime":1128.93,"endTime":1134.36,"body":"factor out of it, the AI the"},{"speaker":"Ryan Nunley","startTime":1128.93,"endTime":1134.36,"body":"capture speed of the cameras. So"},{"speaker":"Ryan Nunley","startTime":1134.36,"endTime":1137.39,"body":"when we say robotics, it doesn't"},{"speaker":"Ryan Nunley","startTime":1134.36,"endTime":1137.39,"body":"mean that the you push a button"},{"speaker":"Ryan Nunley","startTime":1137.39,"endTime":1140.57,"body":"and you sit back and have a cup"},{"speaker":"Ryan Nunley","startTime":1137.39,"endTime":1140.57,"body":"of coffee, like are anesthesia"},{"speaker":"Ryan Nunley","startTime":1140.57,"endTime":1143.99,"body":"providers and read the paper,"},{"speaker":"Ryan Nunley","startTime":1140.57,"endTime":1143.99,"body":"it's more that you actually have"},{"speaker":"Ryan Nunley","startTime":1143.99,"endTime":1147.02,"body":"to take in design the knee and"},{"speaker":"Ryan Nunley","startTime":1143.99,"endTime":1147.02,"body":"three dimensions, three"},{"speaker":"Ryan Nunley","startTime":1147.02,"endTime":1149.51,"body":"dimensions, figure out where you"},{"speaker":"Ryan Nunley","startTime":1147.02,"endTime":1149.51,"body":"want the implant to go. And then"},{"speaker":"Ryan Nunley","startTime":1149.51,"endTime":1153.56,"body":"the robotic arm holds the saw."},{"speaker":"Ryan Nunley","startTime":1149.51,"endTime":1153.56,"body":"So you'd have to put mounting"},{"speaker":"Ryan Nunley","startTime":1154.04,"endTime":1157.07,"body":"blocks onto the bone to make the"},{"speaker":"Ryan Nunley","startTime":1154.04,"endTime":1157.07,"body":"cuts. And so it keeps the"},{"speaker":"Ryan Nunley","startTime":1157.07,"endTime":1162.44,"body":"accuracy by just allowing you to"},{"speaker":"Ryan Nunley","startTime":1157.07,"endTime":1162.44,"body":"pre plan that on the screen in"},{"speaker":"Ryan Nunley","startTime":1162.44,"endTime":1165.92,"body":"three dimensions with the CAD"},{"speaker":"Ryan Nunley","startTime":1162.44,"endTime":1165.92,"body":"models. And that is simulate"},{"speaker":"Ryan Nunley","startTime":1165.92,"endTime":1169.46,"body":"with the soft tissue tensions"},{"speaker":"Ryan Nunley","startTime":1165.92,"endTime":1169.46,"body":"would look like. And, again, the"},{"speaker":"Ryan Nunley","startTime":1169.46,"endTime":1172.79,"body":"advent of that has really made"},{"speaker":"Ryan Nunley","startTime":1169.46,"endTime":1172.79,"body":"it much more of a reproducible"},{"speaker":"Ryan Nunley","startTime":1172.79,"endTime":1175.64,"body":"surgery. And then it allows us"},{"speaker":"Ryan Nunley","startTime":1172.79,"endTime":1175.64,"body":"to sort of question some of the"},{"speaker":"Ryan Nunley","startTime":1175.64,"endTime":1180.08,"body":"original premise of what our"},{"speaker":"Ryan Nunley","startTime":1175.64,"endTime":1180.08,"body":"climate targets were now that we"},{"speaker":"Ryan Nunley","startTime":1180.08,"endTime":1182.33,"body":"have robotics where we can more"},{"speaker":"Ryan Nunley","startTime":1180.08,"endTime":1182.33,"body":"accurately do it. So you're"},{"speaker":"Ryan Nunley","startTime":1182.33,"endTime":1186.47,"body":"seeing a huge change and the"},{"speaker":"Ryan Nunley","startTime":1182.33,"endTime":1186.47,"body":"discussion of not just the"},{"speaker":"Ryan Nunley","startTime":1186.47,"endTime":1190.31,"body":"traditional type of implants but"},{"speaker":"Ryan Nunley","startTime":1186.47,"endTime":1190.31,"body":"now really the alignment and the"},{"speaker":"Ryan Nunley","startTime":1190.31,"endTime":1192.77,"body":"goals that we should to restore"},{"speaker":"Ryan Nunley","startTime":1190.31,"endTime":1192.77,"body":"the kinematics to the knee."},{"speaker":"Charles Goldfarb","startTime":1194.42,"endTime":1198.08,"body":"So okay,"},{"speaker":"Charles Goldfarb","startTime":1194.42,"endTime":1198.08,"body":"obviously I didn't have a clue"},{"speaker":"Charles Goldfarb","startTime":1198.08,"endTime":1202.97,"body":"because I screwed it up. What"},{"speaker":"Charles Goldfarb","startTime":1198.08,"endTime":1202.97,"body":"you do Uh, but my wife loves to"},{"speaker":"Charles Goldfarb","startTime":1202.97,"endTime":1206.45,"body":"like, it's so interesting. I'm"},{"speaker":"Charles Goldfarb","startTime":1202.97,"endTime":1206.45,"body":"so like precise and anal"},{"speaker":"Charles Goldfarb","startTime":1206.45,"endTime":1210.56,"body":"retentive about my life. But for"},{"speaker":"Charles Goldfarb","startTime":1206.45,"endTime":1210.56,"body":"this surgery and other things,"},{"speaker":"Charles Goldfarb","startTime":1210.83,"endTime":1214.67,"body":"like surgeries, I just sort of"},{"speaker":"Charles Goldfarb","startTime":1210.83,"endTime":1214.67,"body":"say, okay, you know, I know Dr."},{"speaker":"Charles Goldfarb","startTime":1214.7,"endTime":1217.28,"body":"Nunley's gonna take care of my"},{"speaker":"Charles Goldfarb","startTime":1214.7,"endTime":1217.28,"body":"surgery, I'm not delving into"},{"speaker":"Charles Goldfarb","startTime":1217.28,"endTime":1219.95,"body":"the detail. And she got really"},{"speaker":"Charles Goldfarb","startTime":1217.28,"endTime":1219.95,"body":"frustrated me that I didn't know"},{"speaker":"Charles Goldfarb","startTime":1219.95,"endTime":1223.31,"body":"what was going to happen when"},{"speaker":"Charles Goldfarb","startTime":1219.95,"endTime":1223.31,"body":"and where and why. And it gets,"},{"speaker":"Charles Goldfarb","startTime":1223.31,"endTime":1226.64,"body":"it's just a form of neglect, I"},{"speaker":"Charles Goldfarb","startTime":1223.31,"endTime":1226.64,"body":"don't know. But thankfully, I"},{"speaker":"Charles Goldfarb","startTime":1226.64,"endTime":1233.78,"body":"put my, my knee in good hands. I"},{"speaker":"Charles Goldfarb","startTime":1226.64,"endTime":1233.78,"body":"had x rays nine months ago. And"},{"speaker":"Charles Goldfarb","startTime":1233.78,"endTime":1237.17,"body":"then I don't know, three, four"},{"speaker":"Charles Goldfarb","startTime":1233.78,"endTime":1237.17,"body":"weeks before my surgery, a CT"},{"speaker":"Charles Goldfarb","startTime":1237.17,"endTime":1242.24,"body":"scan. And so what part? Are you"},{"speaker":"Charles Goldfarb","startTime":1237.17,"endTime":1242.24,"body":"adding work before the surgery?"},{"speaker":"Charles Goldfarb","startTime":1242.42,"endTime":1245.72,"body":"Or is all this done literally"},{"speaker":"Charles Goldfarb","startTime":1242.42,"endTime":1245.72,"body":"inter operatively, with the"},{"speaker":"Charles Goldfarb","startTime":1245.72,"endTime":1249.62,"body":"robot with the CT scan? And"},{"speaker":"Charles Goldfarb","startTime":1245.72,"endTime":1249.62,"body":"what's the preparation? And how"},{"speaker":"Charles Goldfarb","startTime":1249.62,"endTime":1252.05,"body":"long does that add as an add to"},{"speaker":"Charles Goldfarb","startTime":1249.62,"endTime":1252.05,"body":"the surgery? Just help us"},{"speaker":"Charles Goldfarb","startTime":1252.05,"endTime":1254.6,"body":"understand that process? Sure."},{"speaker":"Charles Goldfarb","startTime":1252.05,"endTime":1254.6,"body":"So"},{"speaker":"Ryan Nunley","startTime":1254.6,"endTime":1256.55,"body":"great question. The"},{"speaker":"Ryan Nunley","startTime":1254.6,"endTime":1256.55,"body":"X ray, as you know, is a two"},{"speaker":"Ryan Nunley","startTime":1256.55,"endTime":1259.67,"body":"dimensional image. So it gives"},{"speaker":"Ryan Nunley","startTime":1256.55,"endTime":1259.67,"body":"us sort of a screening"},{"speaker":"Ryan Nunley","startTime":1259.67,"endTime":1262.97,"body":"evaluation to know that you have"},{"speaker":"Ryan Nunley","startTime":1259.67,"endTime":1262.97,"body":"arthritis, what your sort of"},{"speaker":"Ryan Nunley","startTime":1262.97,"endTime":1267.32,"body":"basic alignment looks like the"},{"speaker":"Ryan Nunley","startTime":1262.97,"endTime":1267.32,"body":"CT image takes selective images"},{"speaker":"Ryan Nunley","startTime":1267.35,"endTime":1270.77,"body":"of your hip, very detailed of"},{"speaker":"Ryan Nunley","startTime":1267.35,"endTime":1270.77,"body":"the knee, and then selected"},{"speaker":"Ryan Nunley","startTime":1270.77,"endTime":1274.04,"body":"images of your ankle which can"},{"speaker":"Ryan Nunley","startTime":1270.77,"endTime":1274.04,"body":"give us alignment and rotation."},{"speaker":"Ryan Nunley","startTime":1274.67,"endTime":1277.61,"body":"From that point, that's all"},{"speaker":"Ryan Nunley","startTime":1274.67,"endTime":1277.61,"body":"uploaded into the system and"},{"speaker":"Ryan Nunley","startTime":1277.61,"endTime":1281.78,"body":"onto the robotic computer in"},{"speaker":"Ryan Nunley","startTime":1277.61,"endTime":1281.78,"body":"advance of your surgery done by"},{"speaker":"Ryan Nunley","startTime":1281.78,"endTime":1286.37,"body":"the by actually the company"},{"speaker":"Ryan Nunley","startTime":1281.78,"endTime":1286.37,"body":"representative. So no extra time"},{"speaker":"Ryan Nunley","startTime":1286.37,"endTime":1289.28,"body":"after there other than ordering"},{"speaker":"Ryan Nunley","startTime":1286.37,"endTime":1289.28,"body":"the CT and making sure for my"},{"speaker":"Ryan Nunley","startTime":1289.28,"endTime":1293.96,"body":"staff that that it gets"},{"speaker":"Ryan Nunley","startTime":1289.28,"endTime":1293.96,"body":"uploaded. Inside surgery, we use"},{"speaker":"Ryan Nunley","startTime":1293.99,"endTime":1298.22,"body":"a special instrument to touch"},{"speaker":"Ryan Nunley","startTime":1293.99,"endTime":1298.22,"body":"various points within the bone"},{"speaker":"Ryan Nunley","startTime":1298.25,"endTime":1301.43,"body":"to map it so that the CT scans"},{"speaker":"Ryan Nunley","startTime":1298.25,"endTime":1301.43,"body":"up on the screen. Now you have"},{"speaker":"Ryan Nunley","startTime":1301.43,"endTime":1307.07,"body":"to map it to where it is in"},{"speaker":"Ryan Nunley","startTime":1301.43,"endTime":1307.07,"body":"space, the actual knee. So using"},{"speaker":"Ryan Nunley","startTime":1307.1,"endTime":1311.51,"body":"a guide to tap several different"},{"speaker":"Ryan Nunley","startTime":1307.1,"endTime":1311.51,"body":"points on the knee, it validates"},{"speaker":"Ryan Nunley","startTime":1311.51,"endTime":1314.66,"body":"that you've now aligned it up."},{"speaker":"Ryan Nunley","startTime":1311.51,"endTime":1314.66,"body":"And with that, then you can take"},{"speaker":"Ryan Nunley","startTime":1314.66,"endTime":1317.84,"body":"the knee through functional"},{"speaker":"Ryan Nunley","startTime":1314.66,"endTime":1317.84,"body":"range of motion stress it to see"},{"speaker":"Ryan Nunley","startTime":1317.84,"endTime":1320.42,"body":"what the soft tissue tension"},{"speaker":"Ryan Nunley","startTime":1317.84,"endTime":1320.42,"body":"looks like. And from that you"},{"speaker":"Ryan Nunley","startTime":1320.42,"endTime":1323.54,"body":"have a full screen, that within"},{"speaker":"Ryan Nunley","startTime":1320.42,"endTime":1323.54,"body":"a couple minutes, you adjust"},{"speaker":"Ryan Nunley","startTime":1323.54,"endTime":1327.08,"body":"here, the angles, the slope, and"},{"speaker":"Ryan Nunley","startTime":1323.54,"endTime":1327.08,"body":"so you get a graph showing you"},{"speaker":"Ryan Nunley","startTime":1327.08,"endTime":1329.78,"body":"when you've sort of hit the"},{"speaker":"Ryan Nunley","startTime":1327.08,"endTime":1329.78,"body":"target that you're trying to"},{"speaker":"Ryan Nunley","startTime":1329.78,"endTime":1333.41,"body":"achieve. So that workflow adds"},{"speaker":"Ryan Nunley","startTime":1329.78,"endTime":1333.41,"body":"for somebody who's very"},{"speaker":"Ryan Nunley","startTime":1333.41,"endTime":1337.82,"body":"efficient, maybe two to five"},{"speaker":"Ryan Nunley","startTime":1333.41,"endTime":1337.82,"body":"minutes of time in the ER, but"},{"speaker":"Ryan Nunley","startTime":1337.82,"endTime":1340.64,"body":"it saves you on the back end,"},{"speaker":"Ryan Nunley","startTime":1337.82,"endTime":1340.64,"body":"because now you're not having to"},{"speaker":"Ryan Nunley","startTime":1340.64,"endTime":1344.27,"body":"mount the blocks onto the"},{"speaker":"Ryan Nunley","startTime":1340.64,"endTime":1344.27,"body":"patient and make cuts and then"},{"speaker":"Ryan Nunley","startTime":1345.17,"endTime":1348.44,"body":"take the screws out and remove"},{"speaker":"Ryan Nunley","startTime":1345.17,"endTime":1348.44,"body":"the blocks. So you as soon as"},{"speaker":"Ryan Nunley","startTime":1348.44,"endTime":1351.29,"body":"you approve the plan, you go to"},{"speaker":"Ryan Nunley","startTime":1348.44,"endTime":1351.29,"body":"the robotic arm and it just hold"},{"speaker":"Ryan Nunley","startTime":1351.29,"endTime":1354.62,"body":"your hand in those positions"},{"speaker":"Ryan Nunley","startTime":1351.29,"endTime":1354.62,"body":"that you're you've set to"},{"speaker":"Ryan Nunley","startTime":1354.62,"endTime":1358.1,"body":"achieve the goals. And then you"},{"speaker":"Ryan Nunley","startTime":1354.62,"endTime":1358.1,"body":"put your trials. And so after"},{"speaker":"Ryan Nunley","startTime":1358.1,"endTime":1361.4,"body":"the first couple cases, learning"},{"speaker":"Ryan Nunley","startTime":1358.1,"endTime":1361.4,"body":"curve short, probably doesn't"},{"speaker":"Ryan Nunley","startTime":1361.4,"endTime":1363.8,"body":"add a whole lot of time on to"},{"speaker":"Ryan Nunley","startTime":1361.4,"endTime":1363.8,"body":"the case, maybe less than a"},{"speaker":"Ryan Nunley","startTime":1363.8,"endTime":1367.82,"body":"couple of minutes. You know, the"},{"speaker":"Ryan Nunley","startTime":1363.8,"endTime":1367.82,"body":"negative as we were a little bit"},{"speaker":"Ryan Nunley","startTime":1367.82,"endTime":1370.76,"body":"outside of the technology world"},{"speaker":"Ryan Nunley","startTime":1367.82,"endTime":1370.76,"body":"is the cost associated with"},{"speaker":"Ryan Nunley","startTime":1370.76,"endTime":1373.25,"body":"things right, we're all very"},{"speaker":"Ryan Nunley","startTime":1370.76,"endTime":1373.25,"body":"sensitive to cost and new"},{"speaker":"Ryan Nunley","startTime":1373.25,"endTime":1377.03,"body":"technologies. Just to put it in"},{"speaker":"Ryan Nunley","startTime":1373.25,"endTime":1377.03,"body":"perspective. The robotic arm"},{"speaker":"Ryan Nunley","startTime":1377.48,"endTime":1382.1,"body":"runs the hospital about 1.4 to"},{"speaker":"Ryan Nunley","startTime":1377.48,"endTime":1382.1,"body":"$1.6 million. If you get all the"},{"speaker":"Ryan Nunley","startTime":1382.1,"endTime":1385.61,"body":"bells and whistles for the"},{"speaker":"Ryan Nunley","startTime":1382.1,"endTime":1385.61,"body":"capital charge, then there's a"},{"speaker":"Ryan Nunley","startTime":1385.61,"endTime":1389.27,"body":"service contract of your company"},{"speaker":"Ryan Nunley","startTime":1385.61,"endTime":1389.27,"body":"representative of your product"},{"speaker":"Ryan Nunley","startTime":1389.27,"endTime":1393.02,"body":"specialists that's between 100"},{"speaker":"Ryan Nunley","startTime":1389.27,"endTime":1393.02,"body":"to 200,000. And then there's the"},{"speaker":"Ryan Nunley","startTime":1393.02,"endTime":1395.6,"body":"disposables. It's a different"},{"speaker":"Ryan Nunley","startTime":1393.02,"endTime":1395.6,"body":"type of sawblade. It's a"},{"speaker":"Ryan Nunley","startTime":1395.6,"endTime":1399.11,"body":"different type of rays that go"},{"speaker":"Ryan Nunley","startTime":1395.6,"endTime":1399.11,"body":"on your probes and things that"},{"speaker":"Ryan Nunley","startTime":1399.11,"endTime":1403.07,"body":"are disposable, that can run"},{"speaker":"Ryan Nunley","startTime":1399.11,"endTime":1403.07,"body":"anywhere from five to $900. So"},{"speaker":"Ryan Nunley","startTime":1403.07,"endTime":1408.02,"body":"there is a cost born into the"},{"speaker":"Ryan Nunley","startTime":1403.07,"endTime":1408.02,"body":"healthcare system, which the CEO"},{"speaker":"Ryan Nunley","startTime":1408.02,"endTime":1413.42,"body":"and CFO don't really like. But"},{"speaker":"Ryan Nunley","startTime":1408.02,"endTime":1413.42,"body":"there there is efficiency or"},{"speaker":"Ryan Nunley","startTime":1413.42,"endTime":1416.15,"body":"there's improvement by"},{"speaker":"Ryan Nunley","startTime":1413.42,"endTime":1416.15,"body":"potentially reducing"},{"speaker":"Ryan Nunley","startTime":1416.15,"endTime":1418.79,"body":"readmissions reoperation. And"},{"speaker":"Ryan Nunley","startTime":1416.15,"endTime":1418.79,"body":"for you, Jack, obviously, you"},{"speaker":"Ryan Nunley","startTime":1418.79,"endTime":1421.22,"body":"want one surgery you want to"},{"speaker":"Ryan Nunley","startTime":1418.79,"endTime":1421.22,"body":"done well, once you don't want"},{"speaker":"Ryan Nunley","startTime":1421.22,"endTime":1425.15,"body":"the thought that, gosh, if I was"},{"speaker":"Ryan Nunley","startTime":1421.22,"endTime":1425.15,"body":"off by two or three degrees, you"},{"speaker":"Ryan Nunley","startTime":1425.15,"endTime":1428.15,"body":"have recurrent swelling and pain"},{"speaker":"Ryan Nunley","startTime":1425.15,"endTime":1428.15,"body":"you may not get, you may not"},{"speaker":"Ryan Nunley","startTime":1428.15,"endTime":1430.73,"body":"achieve the best goal possible."},{"speaker":"Ryan Nunley","startTime":1428.15,"endTime":1430.73,"body":"So I think that's what it is"},{"speaker":"Ryan Nunley","startTime":1430.73,"endTime":1434.63,"body":"helped us reduce the outliers."},{"speaker":"Ryan Nunley","startTime":1430.73,"endTime":1434.63,"body":"So we have lower reoperation,"},{"speaker":"Ryan Nunley","startTime":1434.66,"endTime":1437.54,"body":"higher patient satisfaction"},{"speaker":"Ryan Nunley","startTime":1434.66,"endTime":1437.54,"body":"scores, and that's a win to our"},{"speaker":"Ryan Nunley","startTime":1437.54,"endTime":1438.74,"body":"community. And"},{"speaker":"Chris Dy","startTime":1438.74,"endTime":1440.9,"body":"you are very good at"},{"speaker":"Chris Dy","startTime":1438.74,"endTime":1440.9,"body":"patient satisfaction scores from"},{"speaker":"Chris Dy","startTime":1440.9,"endTime":1443.18,"body":"what I recall so I guess"},{"speaker":"Ryan Nunley","startTime":1443.75,"endTime":1445.04,"body":"my wait time to get"},{"speaker":"Ryan Nunley","startTime":1443.75,"endTime":1445.04,"body":"in clinic."},{"speaker":"Chris Dy","startTime":1446.57,"endTime":1449.81,"body":"Get him a reason. So"},{"speaker":"Chris Dy","startTime":1446.57,"endTime":1449.81,"body":"in classic Chuck fashion, I want"},{"speaker":"Chris Dy","startTime":1449.81,"endTime":1453.05,"body":"to ask you, you know, say two"},{"speaker":"Chris Dy","startTime":1449.81,"endTime":1453.05,"body":"things. So you know, I guess the"},{"speaker":"Chris Dy","startTime":1453.05,"endTime":1456.35,"body":"first one is you've touched on"},{"speaker":"Chris Dy","startTime":1453.05,"endTime":1456.35,"body":"cost. In our last episode, Chuck"},{"speaker":"Chris Dy","startTime":1456.35,"endTime":1460.07,"body":"was talking a little bit about"},{"speaker":"Chris Dy","startTime":1456.35,"endTime":1460.07,"body":"some of the challenges with, you"},{"speaker":"Chris Dy","startTime":1460.07,"endTime":1464.03,"body":"know, the insurer approving"},{"speaker":"Chris Dy","startTime":1460.07,"endTime":1464.03,"body":"navigation, which clearly he was"},{"speaker":"Chris Dy","startTime":1464.03,"endTime":1466.67,"body":"wrong, because he wasn't"},{"speaker":"Chris Dy","startTime":1464.03,"endTime":1466.67,"body":"actually getting... So maybe"},{"speaker":"Chris Dy","startTime":1466.67,"endTime":1470.12,"body":"that's why they didn't approve"},{"speaker":"Chris Dy","startTime":1466.67,"endTime":1470.12,"body":"it. But one of the challenges on"},{"speaker":"Chris Dy","startTime":1470.12,"endTime":1472.04,"body":"your end in terms of getting"},{"speaker":"Chris Dy","startTime":1470.12,"endTime":1472.04,"body":"that approved, is there"},{"speaker":"Chris Dy","startTime":1472.04,"endTime":1474.83,"body":"additional work or a different"},{"speaker":"Chris Dy","startTime":1472.04,"endTime":1474.83,"body":"CPT that's associated with"},{"speaker":"Chris Dy","startTime":1474.83,"endTime":1478.37,"body":"navigation, or robotics or"},{"speaker":"Chris Dy","startTime":1474.83,"endTime":1478.37,"body":"technology in general for"},{"speaker":"Chris Dy","startTime":1478.37,"endTime":1480.89,"body":"arthroplasty? And the second"},{"speaker":"Chris Dy","startTime":1478.37,"endTime":1480.89,"body":"thing I wanted to ask is, you"},{"speaker":"Chris Dy","startTime":1480.89,"endTime":1483.89,"body":"know, I remember when, you know,"},{"speaker":"Chris Dy","startTime":1480.89,"endTime":1483.89,"body":"everybody turned to doing for"},{"speaker":"Chris Dy","startTime":1483.89,"endTime":1487.22,"body":"example, you know, lap appy, so"},{"speaker":"Chris Dy","startTime":1483.89,"endTime":1487.22,"body":"a laparoscopic appendectomy and"},{"speaker":"Chris Dy","startTime":1487.22,"endTime":1491.72,"body":"very few people are learning how"},{"speaker":"Chris Dy","startTime":1487.22,"endTime":1491.72,"body":"to do an open MP. So what do you"},{"speaker":"Chris Dy","startTime":1491.72,"endTime":1495.14,"body":"think this does for our learners"},{"speaker":"Chris Dy","startTime":1491.72,"endTime":1495.14,"body":"who are coming up in the age of"},{"speaker":"Chris Dy","startTime":1495.14,"endTime":1498.44,"body":"technology? Could they do a"},{"speaker":"Chris Dy","startTime":1495.14,"endTime":1498.44,"body":"primary hip a primary knee"},{"speaker":"Chris Dy","startTime":1498.44,"endTime":1501.65,"body":"without the bells and whistles"},{"speaker":"Chris Dy","startTime":1498.44,"endTime":1501.65,"body":"on of navigation and technology."},{"speaker":"Ryan Nunley","startTime":1503.449,"endTime":1505.609,"body":"Chris, you're"},{"speaker":"Ryan Nunley","startTime":1503.449,"endTime":1505.609,"body":"asking great questions. So the"},{"speaker":"Ryan Nunley","startTime":1505.609,"endTime":1510.709,"body":"first one about the insurance"},{"speaker":"Ryan Nunley","startTime":1505.609,"endTime":1510.709,"body":"and approvals. Like anything"},{"speaker":"Ryan Nunley","startTime":1510.709,"endTime":1513.379,"body":"different insurance companies"},{"speaker":"Ryan Nunley","startTime":1510.709,"endTime":1513.379,"body":"have different approval process."},{"speaker":"Ryan Nunley","startTime":1513.739,"endTime":1517.579,"body":"But yes, there is some pushback"},{"speaker":"Ryan Nunley","startTime":1513.739,"endTime":1517.579,"body":"from the private insurers with"},{"speaker":"Ryan Nunley","startTime":1517.579,"endTime":1520.429,"body":"regards to getting a CT scan"},{"speaker":"Ryan Nunley","startTime":1517.579,"endTime":1520.429,"body":"approved, even though it's a"},{"speaker":"Ryan Nunley","startTime":1520.429,"endTime":1526.039,"body":"pretty low cost imaging, since"},{"speaker":"Ryan Nunley","startTime":1520.429,"endTime":1526.039,"body":"it's not really, if you really"},{"speaker":"Ryan Nunley","startTime":1526.039,"endTime":1529.099,"body":"do it the right way. And you're"},{"speaker":"Ryan Nunley","startTime":1526.039,"endTime":1529.099,"body":"in surgery center, or imaging"},{"speaker":"Ryan Nunley","startTime":1529.099,"endTime":1531.319,"body":"center, you could probably do"},{"speaker":"Ryan Nunley","startTime":1529.099,"endTime":1531.319,"body":"without the professional fee,"},{"speaker":"Ryan Nunley","startTime":1531.319,"endTime":1533.989,"body":"since it's just looking for"},{"speaker":"Ryan Nunley","startTime":1531.319,"endTime":1533.989,"body":"alignment. But you still get"},{"speaker":"Ryan Nunley","startTime":1533.989,"endTime":1536.239,"body":"feedback. And that does"},{"speaker":"Ryan Nunley","startTime":1533.989,"endTime":1536.239,"body":"sometimes generate some peer to"},{"speaker":"Ryan Nunley","startTime":1536.239,"endTime":1540.979,"body":"peer calls. And most of the"},{"speaker":"Ryan Nunley","startTime":1536.239,"endTime":1540.979,"body":"time, there is additional code"},{"speaker":"Ryan Nunley","startTime":1540.979,"endTime":1545.149,"body":"for the surgeon for using"},{"speaker":"Ryan Nunley","startTime":1540.979,"endTime":1545.149,"body":"navigation or robotics. Rarely"},{"speaker":"Ryan Nunley","startTime":1545.149,"endTime":1547.909,"body":"is that paid for. So we just"},{"speaker":"Ryan Nunley","startTime":1545.149,"endTime":1547.909,"body":"sort of write it off, because we"},{"speaker":"Ryan Nunley","startTime":1547.909,"endTime":1550.639,"body":"think it's what's right for the"},{"speaker":"Ryan Nunley","startTime":1547.909,"endTime":1550.639,"body":"patient. In terms of your"},{"speaker":"Ryan Nunley","startTime":1550.639,"endTime":1554.989,"body":"question about Yes, going to"},{"speaker":"Ryan Nunley","startTime":1550.639,"endTime":1554.989,"body":"advanced technology and"},{"speaker":"Ryan Nunley","startTime":1554.989,"endTime":1559.789,"body":"utilization inside the surgical"},{"speaker":"Ryan Nunley","startTime":1554.989,"endTime":1559.789,"body":"decision making, what happens"},{"speaker":"Ryan Nunley","startTime":1559.789,"endTime":1563.209,"body":"when robotics or navigation goes"},{"speaker":"Ryan Nunley","startTime":1559.789,"endTime":1563.209,"body":"down and it does happen. We had"},{"speaker":"Ryan Nunley","startTime":1563.209,"endTime":1567.619,"body":"a case the other day, a 85 year"},{"speaker":"Ryan Nunley","startTime":1563.209,"endTime":1567.619,"body":"old patient, where the pins"},{"speaker":"Ryan Nunley","startTime":1567.619,"endTime":1570.769,"body":"going into the femur, the bone"},{"speaker":"Ryan Nunley","startTime":1567.619,"endTime":1570.769,"body":"was so soft, halfway through the"},{"speaker":"Ryan Nunley","startTime":1570.769,"endTime":1575.089,"body":"case, the pins had loosened"},{"speaker":"Ryan Nunley","startTime":1570.769,"endTime":1575.089,"body":"enough, where once it read, the"},{"speaker":"Ryan Nunley","startTime":1575.089,"endTime":1578.689,"body":"system recognizes that you're"},{"speaker":"Ryan Nunley","startTime":1575.089,"endTime":1578.689,"body":"out of the optimal range or that"},{"speaker":"Ryan Nunley","startTime":1578.689,"endTime":1582.409,"body":"it's not mapping correctly, your"},{"speaker":"Ryan Nunley","startTime":1578.689,"endTime":1582.409,"body":"whole coupling goes away. So you"},{"speaker":"Ryan Nunley","startTime":1582.409,"endTime":1586.759,"body":"do have to have a bailout. It's"},{"speaker":"Ryan Nunley","startTime":1582.409,"endTime":1586.759,"body":"interesting, as we interview our"},{"speaker":"Ryan Nunley","startTime":1586.789,"endTime":1590.539,"body":"fellow potential fellows for our"},{"speaker":"Ryan Nunley","startTime":1586.789,"endTime":1590.539,"body":"fellowship, that many of them"},{"speaker":"Ryan Nunley","startTime":1590.539,"endTime":1593.839,"body":"coming out of training, who have"},{"speaker":"Ryan Nunley","startTime":1590.539,"endTime":1593.839,"body":"only had robotics really want to"},{"speaker":"Ryan Nunley","startTime":1593.839,"endTime":1597.139,"body":"go to a program that teaches"},{"speaker":"Ryan Nunley","startTime":1593.839,"endTime":1597.139,"body":"them not just robotics, but also"},{"speaker":"Ryan Nunley","startTime":1597.469,"endTime":1600.829,"body":"conventional because of the"},{"speaker":"Ryan Nunley","startTime":1597.469,"endTime":1600.829,"body":"situation I just explained. Or"},{"speaker":"Ryan Nunley","startTime":1601.369,"endTime":1604.849,"body":"they may go to a job at a"},{"speaker":"Ryan Nunley","startTime":1601.369,"endTime":1604.849,"body":"hospital that promises divide"},{"speaker":"Ryan Nunley","startTime":1604.849,"endTime":1607.849,"body":"them a robot, but may not have"},{"speaker":"Ryan Nunley","startTime":1604.849,"endTime":1607.849,"body":"it for the first year or two. So"},{"speaker":"Ryan Nunley","startTime":1608.149,"endTime":1612.139,"body":"I do think that there is an art"},{"speaker":"Ryan Nunley","startTime":1608.149,"endTime":1612.139,"body":"form to knowing not only the"},{"speaker":"Ryan Nunley","startTime":1612.139,"endTime":1614.569,"body":"technology and how it makes"},{"speaker":"Ryan Nunley","startTime":1612.139,"endTime":1614.569,"body":"things better, but when it"},{"speaker":"Ryan Nunley","startTime":1614.569,"endTime":1617.599,"body":"doesn't go well or fails you in"},{"speaker":"Ryan Nunley","startTime":1614.569,"endTime":1617.599,"body":"the middle of something you have"},{"speaker":"Ryan Nunley","startTime":1617.599,"endTime":1620.929,"body":"to be able to bail out. So that"},{"speaker":"Ryan Nunley","startTime":1617.599,"endTime":1620.929,"body":"is a challenge that as we get"},{"speaker":"Ryan Nunley","startTime":1620.929,"endTime":1624.949,"body":"more dependent on the"},{"speaker":"Ryan Nunley","startTime":1620.929,"endTime":1624.949,"body":"technology, I think we still"},{"speaker":"Ryan Nunley","startTime":1624.949,"endTime":1626.269,"body":"have to remember the basics."},{"speaker":"Charles Goldfarb","startTime":1627.89,"endTime":1630.86,"body":"You Yeah, all"},{"speaker":"Charles Goldfarb","startTime":1627.89,"endTime":1630.86,"body":"really interesting. It's I think"},{"speaker":"Charles Goldfarb","startTime":1630.86,"endTime":1633.08,"body":"I was talking to Chris, I think"},{"speaker":"Charles Goldfarb","startTime":1630.86,"endTime":1633.08,"body":"it was on the podcast, I always"},{"speaker":"Charles Goldfarb","startTime":1633.08,"endTime":1634.82,"body":"get confused about what we"},{"speaker":"Charles Goldfarb","startTime":1633.08,"endTime":1634.82,"body":"talked about and what's on the"},{"speaker":"Charles Goldfarb","startTime":1634.82,"endTime":1638.87,"body":"pod. But I was really frustrated"},{"speaker":"Charles Goldfarb","startTime":1634.82,"endTime":1638.87,"body":"when I heard that the insurer"},{"speaker":"Charles Goldfarb","startTime":1638.87,"endTime":1642.32,"body":"was not going to pay for the,"},{"speaker":"Charles Goldfarb","startTime":1638.87,"endTime":1642.32,"body":"for the robot for my surgery."},{"speaker":"Charles Goldfarb","startTime":1642.32,"endTime":1646.4,"body":"And so I called the insurance"},{"speaker":"Charles Goldfarb","startTime":1642.32,"endTime":1646.4,"body":"company like AIG, it just hit me"},{"speaker":"Charles Goldfarb","startTime":1646.4,"endTime":1649.97,"body":"the wrong way. Like, because I"},{"speaker":"Charles Goldfarb","startTime":1646.4,"endTime":1649.97,"body":"just felt like it was wrong. And"},{"speaker":"Charles Goldfarb","startTime":1649.97,"endTime":1653.18,"body":"it was the classic Well, you"},{"speaker":"Charles Goldfarb","startTime":1649.97,"endTime":1653.18,"body":"know, it's experimental. And,"},{"speaker":"Charles Goldfarb","startTime":1653.42,"endTime":1656.36,"body":"and then I started doing the"},{"speaker":"Charles Goldfarb","startTime":1653.42,"endTime":1656.36,"body":"literature review, maybe on the"},{"speaker":"Charles Goldfarb","startTime":1656.36,"endTime":1660.29,"body":"wrong topic, I may have been"},{"speaker":"Charles Goldfarb","startTime":1656.36,"endTime":1660.29,"body":"looking at your theater net. But"},{"speaker":"Charles Goldfarb","startTime":1660.32,"endTime":1662.06,"body":"anyway, that talked to your"},{"speaker":"Charles Goldfarb","startTime":1660.32,"endTime":1662.06,"body":"staff, and they're like, yeah,"},{"speaker":"Charles Goldfarb","startTime":1662.06,"endTime":1664.73,"body":"it happens. Don't worry about"},{"speaker":"Charles Goldfarb","startTime":1662.06,"endTime":1664.73,"body":"it. But yeah, just super"},{"speaker":"Charles Goldfarb","startTime":1664.73,"endTime":1668.03,"body":"interesting how, and I get it"},{"speaker":"Charles Goldfarb","startTime":1664.73,"endTime":1668.03,"body":"from an insurance standpoint,"},{"speaker":"Charles Goldfarb","startTime":1668.03,"endTime":1670.97,"body":"and I get it the cost from a"},{"speaker":"Charles Goldfarb","startTime":1668.03,"endTime":1670.97,"body":"hospital system standpoint, it's"},{"speaker":"Charles Goldfarb","startTime":1670.97,"endTime":1676.04,"body":"a real consideration. And some"},{"speaker":"Charles Goldfarb","startTime":1670.97,"endTime":1676.04,"body":"people certainly talk about both"},{"speaker":"Charles Goldfarb","startTime":1676.04,"endTime":1679.01,"body":"computer navigation and robotics"},{"speaker":"Charles Goldfarb","startTime":1676.04,"endTime":1679.01,"body":"as a marketing tool. I"},{"speaker":"Charles Goldfarb","startTime":1679.04,"endTime":1683.48,"body":"personally and and I'm sure you"},{"speaker":"Charles Goldfarb","startTime":1679.04,"endTime":1683.48,"body":"agree, and may have far more"},{"speaker":"Charles Goldfarb","startTime":1683.48,"endTime":1686.15,"body":"intelligent things to say about"},{"speaker":"Charles Goldfarb","startTime":1683.48,"endTime":1686.15,"body":"it, it feels it feels really"},{"speaker":"Charles Goldfarb","startTime":1686.15,"endTime":1689.57,"body":"important for the future."},{"speaker":"Charles Goldfarb","startTime":1686.15,"endTime":1689.57,"body":"Because as I understand it, my"},{"speaker":"Charles Goldfarb","startTime":1690.14,"endTime":1692.81,"body":"medial compartment was the worst"},{"speaker":"Charles Goldfarb","startTime":1690.14,"endTime":1692.81,"body":"you've ever seen. The arthritis"},{"speaker":"Charles Goldfarb","startTime":1692.81,"endTime":1696.68,"body":"was horrible. And you probably"},{"speaker":"Charles Goldfarb","startTime":1692.81,"endTime":1696.68,"body":"have to have robot help, and it"},{"speaker":"Charles Goldfarb","startTime":1696.68,"endTime":1697.37,"body":"was so bad."},{"speaker":"Ryan Nunley","startTime":1698.87,"endTime":1701.96,"body":"Well, I would say"},{"speaker":"Ryan Nunley","startTime":1698.87,"endTime":1701.96,"body":"yours was bad. I've certainly"},{"speaker":"Ryan Nunley","startTime":1702.2,"endTime":1706.61,"body":"seen worse. But now yours was in"},{"speaker":"Ryan Nunley","startTime":1702.2,"endTime":1706.61,"body":"you really limped around for"},{"speaker":"Ryan Nunley","startTime":1706.61,"endTime":1708.53,"body":"quite some time. And I think you"},{"speaker":"Ryan Nunley","startTime":1706.61,"endTime":1708.53,"body":"were tired of your wife"},{"speaker":"Ryan Nunley","startTime":1708.53,"endTime":1711.5,"body":"complaining that you couldn't"},{"speaker":"Ryan Nunley","startTime":1708.53,"endTime":1711.5,"body":"keep up with her. So yeah, it"},{"speaker":"Ryan Nunley","startTime":1711.5,"endTime":1714.98,"body":"was the right decision. But to"},{"speaker":"Ryan Nunley","startTime":1711.5,"endTime":1714.98,"body":"your point, I think when you"},{"speaker":"Ryan Nunley","startTime":1714.98,"endTime":1720.23,"body":"look at technology, one of the"},{"speaker":"Ryan Nunley","startTime":1714.98,"endTime":1720.23,"body":"advantages of the board looking"},{"speaker":"Ryan Nunley","startTime":1720.23,"endTime":1723.65,"body":"or even knowing from the past is"},{"speaker":"Ryan Nunley","startTime":1720.23,"endTime":1723.65,"body":"that the costs will start to"},{"speaker":"Ryan Nunley","startTime":1723.65,"endTime":1727.52,"body":"come down. Right new technology,"},{"speaker":"Ryan Nunley","startTime":1723.65,"endTime":1727.52,"body":"ceramic heads were an upcharge"},{"speaker":"Ryan Nunley","startTime":1727.52,"endTime":1730.85,"body":"of $500. Well, then they"},{"speaker":"Ryan Nunley","startTime":1727.52,"endTime":1730.85,"body":"realized that everybody's using"},{"speaker":"Ryan Nunley","startTime":1730.85,"endTime":1733.82,"body":"it the contract, they just"},{"speaker":"Ryan Nunley","startTime":1730.85,"endTime":1733.82,"body":"renegotiated down. Same thing"},{"speaker":"Ryan Nunley","startTime":1733.82,"endTime":1737.87,"body":"with some Atlas technologies."},{"speaker":"Ryan Nunley","startTime":1733.82,"endTime":1737.87,"body":"But you know, the company's to"},{"speaker":"Ryan Nunley","startTime":1737.87,"endTime":1741.38,"body":"your point about marketing. The"},{"speaker":"Ryan Nunley","startTime":1737.87,"endTime":1741.38,"body":"companies certainly recognize"},{"speaker":"Ryan Nunley","startTime":1741.38,"endTime":1745.01,"body":"that selling robotic arms in the"},{"speaker":"Ryan Nunley","startTime":1741.38,"endTime":1745.01,"body":"disposables, helps their bottom"},{"speaker":"Ryan Nunley","startTime":1745.01,"endTime":1747.56,"body":"line. So they push it and they"},{"speaker":"Ryan Nunley","startTime":1745.01,"endTime":1747.56,"body":"definitely market there are"},{"speaker":"Ryan Nunley","startTime":1747.56,"endTime":1751.07,"body":"certain areas of the country,"},{"speaker":"Ryan Nunley","startTime":1747.56,"endTime":1751.07,"body":"whether it's robotic total"},{"speaker":"Ryan Nunley","startTime":1751.07,"endTime":1754.52,"body":"joints, or if it's who knows"},{"speaker":"Ryan Nunley","startTime":1751.07,"endTime":1754.52,"body":"some other specialized hand"},{"speaker":"Ryan Nunley","startTime":1754.52,"endTime":1758.54,"body":"procedure into scopic, carpal"},{"speaker":"Ryan Nunley","startTime":1754.52,"endTime":1758.54,"body":"tunnel. So you know, there is a"},{"speaker":"Ryan Nunley","startTime":1758.9,"endTime":1761.9,"body":"there is always a natural"},{"speaker":"Ryan Nunley","startTime":1758.9,"endTime":1761.9,"body":"tendency for some physicians to"},{"speaker":"Ryan Nunley","startTime":1761.9,"endTime":1767.15,"body":"use it as a marketing tool. And"},{"speaker":"Ryan Nunley","startTime":1761.9,"endTime":1767.15,"body":"there's billboards that will you"},{"speaker":"Ryan Nunley","startTime":1767.15,"endTime":1770.93,"body":"know, you'll see commercials on"},{"speaker":"Ryan Nunley","startTime":1767.15,"endTime":1770.93,"body":"TV, we at Washington University,"},{"speaker":"Ryan Nunley","startTime":1770.93,"endTime":1773.57,"body":"as you know, we have no"},{"speaker":"Ryan Nunley","startTime":1770.93,"endTime":1773.57,"body":"billboards we have no fancy"},{"speaker":"Ryan Nunley","startTime":1773.57,"endTime":1777.65,"body":"marketing. I think at the end of"},{"speaker":"Ryan Nunley","startTime":1773.57,"endTime":1777.65,"body":"the day, sure these technologies"},{"speaker":"Ryan Nunley","startTime":1777.65,"endTime":1781.73,"body":"can help you but if you're still"},{"speaker":"Ryan Nunley","startTime":1777.65,"endTime":1781.73,"body":"not a surgeon who takes the time"},{"speaker":"Ryan Nunley","startTime":1781.73,"endTime":1784.46,"body":"to make sure all the other"},{"speaker":"Ryan Nunley","startTime":1781.73,"endTime":1784.46,"body":"components are optimized the"},{"speaker":"Ryan Nunley","startTime":1784.46,"endTime":1787.64,"body":"patient have good outcomes. You"},{"speaker":"Ryan Nunley","startTime":1784.46,"endTime":1787.64,"body":"still have other issues with"},{"speaker":"Ryan Nunley","startTime":1787.64,"endTime":1791.39,"body":"readmissions that the robot does"},{"speaker":"Ryan Nunley","startTime":1787.64,"endTime":1791.39,"body":"not solve all your problems."},{"speaker":"Ryan Nunley","startTime":1791.69,"endTime":1794.21,"body":"It's just another tool like"},{"speaker":"Ryan Nunley","startTime":1791.69,"endTime":1794.21,"body":"anything else and you have to"},{"speaker":"Ryan Nunley","startTime":1794.27,"endTime":1799.1,"body":"use it that way. So I'm not"},{"speaker":"Ryan Nunley","startTime":1794.27,"endTime":1799.1,"body":"really big on using it as a"},{"speaker":"Ryan Nunley","startTime":1800.0,"endTime":1802.94,"body":"aren't getting more using for"},{"speaker":"Ryan Nunley","startTime":1800.0,"endTime":1802.94,"body":"what I think is best outcome for"},{"speaker":"Ryan Nunley","startTime":1802.94,"endTime":1803.51,"body":"our patients."},{"speaker":"Chris Dy","startTime":1804.32,"endTime":1806.3,"body":"Yeah, I mean, the"},{"speaker":"Chris Dy","startTime":1804.32,"endTime":1806.3,"body":"direct to consumer advertising,"},{"speaker":"Chris Dy","startTime":1806.3,"endTime":1808.79,"body":"especially in the arthroplasty"},{"speaker":"Chris Dy","startTime":1806.3,"endTime":1808.79,"body":"world is pretty real. You know,"},{"speaker":"Chris Dy","startTime":1808.79,"endTime":1811.13,"body":"people see it all the time. And"},{"speaker":"Chris Dy","startTime":1808.79,"endTime":1811.13,"body":"I think it generates a lot of"},{"speaker":"Chris Dy","startTime":1811.13,"endTime":1813.38,"body":"questions. I mean, the closest"},{"speaker":"Chris Dy","startTime":1811.13,"endTime":1813.38,"body":"thing we have in Hansard or"},{"speaker":"Chris Dy","startTime":1813.38,"endTime":1815.75,"body":"world is like you're saying, you"},{"speaker":"Chris Dy","startTime":1813.38,"endTime":1815.75,"body":"know, endoscopic or some of the"},{"speaker":"Chris Dy","startTime":1815.75,"endTime":1817.97,"body":"ultrasound guided carpal tunnel"},{"speaker":"Chris Dy","startTime":1815.75,"endTime":1817.97,"body":"stuff. And then also the"},{"speaker":"Chris Dy","startTime":1817.97,"endTime":1820.43,"body":"collagenases gets pretty"},{"speaker":"Chris Dy","startTime":1817.97,"endTime":1820.43,"body":"advertised pretty heavily."},{"speaker":"Chris Dy","startTime":1820.43,"endTime":1823.91,"body":"There's a John Elway commercial"},{"speaker":"Chris Dy","startTime":1820.43,"endTime":1823.91,"body":"for, for the collagenases that"},{"speaker":"Chris Dy","startTime":1823.91,"endTime":1826.64,"body":"often gets referenced when"},{"speaker":"Chris Dy","startTime":1823.91,"endTime":1826.64,"body":"patients come in. And it's good"},{"speaker":"Chris Dy","startTime":1826.64,"endTime":1830.24,"body":"because it does raise awareness."},{"speaker":"Chris Dy","startTime":1826.64,"endTime":1830.24,"body":"You know, just in general, as we"},{"speaker":"Chris Dy","startTime":1830.24,"endTime":1832.49,"body":"bring things to a close, I"},{"speaker":"Chris Dy","startTime":1830.24,"endTime":1832.49,"body":"wanted to ask you one question."},{"speaker":"Chris Dy","startTime":1832.49,"endTime":1834.74,"body":"I mean, you know, so obviously,"},{"speaker":"Chris Dy","startTime":1832.49,"endTime":1834.74,"body":"it's out there that you operated"},{"speaker":"Chris Dy","startTime":1834.74,"endTime":1837.89,"body":"on, Chuck, I mean, how do you"},{"speaker":"Chris Dy","startTime":1834.74,"endTime":1837.89,"body":"handle operating on, you know,"},{"speaker":"Chris Dy","startTime":1837.89,"endTime":1841.73,"body":"people that you know, pretty"},{"speaker":"Chris Dy","startTime":1837.89,"endTime":1841.73,"body":"well, either partners or spouses"},{"speaker":"Chris Dy","startTime":1841.73,"endTime":1844.61,"body":"or friends or family partners?"},{"speaker":"Chris Dy","startTime":1841.73,"endTime":1844.61,"body":"Is that the do anything"},{"speaker":"Chris Dy","startTime":1844.61,"endTime":1846.71,"body":"differently? Do you approach it"},{"speaker":"Chris Dy","startTime":1844.61,"endTime":1846.71,"body":"differently? Is that a sensitive"},{"speaker":"Chris Dy","startTime":1846.71,"endTime":1848.81,"body":"thing? Would you operate on the"},{"speaker":"Chris Dy","startTime":1846.71,"endTime":1848.81,"body":"family member, for example?"},{"speaker":"Charles Goldfarb","startTime":1848.87,"endTime":1852.14,"body":"And maybe I'll"},{"speaker":"Charles Goldfarb","startTime":1848.87,"endTime":1852.14,"body":"jump in before I actually talked"},{"speaker":"Charles Goldfarb","startTime":1852.14,"endTime":1855.98,"body":"about this not with Ryan?"},{"speaker":"Charles Goldfarb","startTime":1852.14,"endTime":1855.98,"body":"Because I'm curious to hear"},{"speaker":"Charles Goldfarb","startTime":1855.98,"endTime":1860.15,"body":"Ryan's response and who did my"},{"speaker":"Charles Goldfarb","startTime":1855.98,"endTime":1860.15,"body":"surgery but I specifically would"},{"speaker":"Charles Goldfarb","startTime":1860.15,"endTime":1863.93,"body":"never say I want as a surgeon, I"},{"speaker":"Charles Goldfarb","startTime":1860.15,"endTime":1863.93,"body":"would never say to you that I"},{"speaker":"Charles Goldfarb","startTime":1863.93,"endTime":1866.69,"body":"want you to do my surgery, I"},{"speaker":"Charles Goldfarb","startTime":1863.93,"endTime":1866.69,"body":"want things to go exactly like"},{"speaker":"Charles Goldfarb","startTime":1866.69,"endTime":1869.27,"body":"they always go and I think the"},{"speaker":"Charles Goldfarb","startTime":1866.69,"endTime":1869.27,"body":"three of us probably have I"},{"speaker":"Charles Goldfarb","startTime":1869.27,"endTime":1871.85,"body":"don't know Ryan's philosophy."},{"speaker":"Charles Goldfarb","startTime":1869.27,"endTime":1871.85,"body":"But it's a super interesting"},{"speaker":"Charles Goldfarb","startTime":1871.85,"endTime":1874.7,"body":"question. And like, there are"},{"speaker":"Charles Goldfarb","startTime":1871.85,"endTime":1874.7,"body":"some surgeons that hesitate to"},{"speaker":"Charles Goldfarb","startTime":1874.7,"endTime":1878.66,"body":"operate on partners, because I"},{"speaker":"Charles Goldfarb","startTime":1874.7,"endTime":1878.66,"body":"guess concern of outcomes and"},{"speaker":"Charles Goldfarb","startTime":1878.66,"endTime":1881.18,"body":"stuff. So yeah, it's a great"},{"speaker":"Charles Goldfarb","startTime":1878.66,"endTime":1881.18,"body":"question. I really look forward"},{"speaker":"Charles Goldfarb","startTime":1881.18,"endTime":1881.72,"body":"to the answer."},{"speaker":"Ryan Nunley","startTime":1883.19,"endTime":1886.13,"body":"Yeah, so I think"},{"speaker":"Ryan Nunley","startTime":1883.19,"endTime":1886.13,"body":"you're right, I probably"},{"speaker":"Ryan Nunley","startTime":1886.13,"endTime":1889.31,"body":"operated on, I don't know, maybe"},{"speaker":"Ryan Nunley","startTime":1886.13,"endTime":1889.31,"body":"20 of the nurses or their"},{"speaker":"Ryan Nunley","startTime":1889.31,"endTime":1893.66,"body":"spouses or their family members."},{"speaker":"Ryan Nunley","startTime":1889.31,"endTime":1893.66,"body":"And they are so you see them"},{"speaker":"Ryan Nunley","startTime":1893.69,"endTime":1898.04,"body":"daily. And I think one, you have"},{"speaker":"Ryan Nunley","startTime":1893.69,"endTime":1898.04,"body":"to recognize what your skill set"},{"speaker":"Ryan Nunley","startTime":1898.04,"endTime":1901.1,"body":"is, right? If it's something"},{"speaker":"Ryan Nunley","startTime":1898.04,"endTime":1901.1,"body":"that you don't routinely"},{"speaker":"Ryan Nunley","startTime":1901.1,"endTime":1905.3,"body":"perform, and somebody says, I"},{"speaker":"Ryan Nunley","startTime":1901.1,"endTime":1905.3,"body":"love Dr. Donnelly, I want him to"},{"speaker":"Ryan Nunley","startTime":1905.3,"endTime":1908.54,"body":"do hip resurfacing, and I"},{"speaker":"Ryan Nunley","startTime":1905.3,"endTime":1908.54,"body":"haven't done that in a long"},{"speaker":"Ryan Nunley","startTime":1908.54,"endTime":1912.02,"body":"time, I would say, you know, I'm"},{"speaker":"Ryan Nunley","startTime":1908.54,"endTime":1912.02,"body":"not probably the right person"},{"speaker":"Ryan Nunley","startTime":1912.02,"endTime":1915.08,"body":"for you. And you have to be able"},{"speaker":"Ryan Nunley","startTime":1912.02,"endTime":1915.08,"body":"to be willing to acknowledge"},{"speaker":"Ryan Nunley","startTime":1915.35,"endTime":1917.81,"body":"that we're not God's gift to"},{"speaker":"Ryan Nunley","startTime":1915.35,"endTime":1917.81,"body":"surgery. And there's some things"},{"speaker":"Ryan Nunley","startTime":1917.81,"endTime":1920.27,"body":"that we do well, some that"},{"speaker":"Ryan Nunley","startTime":1917.81,"endTime":1920.27,"body":"probably we somebody else can do"},{"speaker":"Ryan Nunley","startTime":1920.27,"endTime":1924.77,"body":"well, second is, you know,"},{"speaker":"Ryan Nunley","startTime":1920.27,"endTime":1924.77,"body":"making sure that everything goes"},{"speaker":"Ryan Nunley","startTime":1924.77,"endTime":1927.26,"body":"well, because you will see these"},{"speaker":"Ryan Nunley","startTime":1924.77,"endTime":1927.26,"body":"patients, but it's the same as"},{"speaker":"Ryan Nunley","startTime":1927.26,"endTime":1929.6,"body":"you would for anybody else. I"},{"speaker":"Ryan Nunley","startTime":1927.26,"endTime":1929.6,"body":"mean, I run into people in the"},{"speaker":"Ryan Nunley","startTime":1929.6,"endTime":1933.11,"body":"grocery store, or, you know, at"},{"speaker":"Ryan Nunley","startTime":1929.6,"endTime":1933.11,"body":"the airport that I've operated"},{"speaker":"Ryan Nunley","startTime":1933.11,"endTime":1936.02,"body":"on, so I try to treat every"},{"speaker":"Ryan Nunley","startTime":1933.11,"endTime":1936.02,"body":"person as if they're a family"},{"speaker":"Ryan Nunley","startTime":1936.02,"endTime":1940.16,"body":"member, you know, take the time"},{"speaker":"Ryan Nunley","startTime":1936.02,"endTime":1940.16,"body":"answer the questions. And to to"},{"speaker":"Ryan Nunley","startTime":1940.16,"endTime":1943.28,"body":"the efficiency standpoint of it,"},{"speaker":"Ryan Nunley","startTime":1940.16,"endTime":1943.28,"body":"if everybody has a job, then"},{"speaker":"Ryan Nunley","startTime":1943.28,"endTime":1947.33,"body":"everybody has a jobs. So, you"},{"speaker":"Ryan Nunley","startTime":1943.28,"endTime":1947.33,"body":"know, for Chuck's surgery, I did"},{"speaker":"Ryan Nunley","startTime":1947.33,"endTime":1949.4,"body":"the whole thing, but I also"},{"speaker":"Ryan Nunley","startTime":1947.33,"endTime":1949.4,"body":"close all of my wounds, because"},{"speaker":"Ryan Nunley","startTime":1949.4,"endTime":1952.97,"body":"I'm that super anal about that."},{"speaker":"Ryan Nunley","startTime":1949.4,"endTime":1952.97,"body":"I think that to me is the reason"},{"speaker":"Ryan Nunley","startTime":1952.97,"endTime":1955.85,"body":"I have such a super low"},{"speaker":"Ryan Nunley","startTime":1952.97,"endTime":1955.85,"body":"infection rate. It's not because"},{"speaker":"Ryan Nunley","startTime":1955.85,"endTime":1959.9,"body":"I'm such a great surgeon. But"},{"speaker":"Ryan Nunley","startTime":1955.85,"endTime":1959.9,"body":"for me, I spent a life time and"},{"speaker":"Ryan Nunley","startTime":1959.9,"endTime":1963.35,"body":"a lot of my research and"},{"speaker":"Ryan Nunley","startTime":1959.9,"endTime":1963.35,"body":"teaching on wound management,"},{"speaker":"Ryan Nunley","startTime":1963.38,"endTime":1966.62,"body":"because every orthopedic surgery"},{"speaker":"Ryan Nunley","startTime":1963.38,"endTime":1966.62,"body":"has a wound that needs to be"},{"speaker":"Ryan Nunley","startTime":1966.62,"endTime":1969.71,"body":"closed and sealed and a little"},{"speaker":"Ryan Nunley","startTime":1966.62,"endTime":1969.71,"body":"drainage is actually a disaster."},{"speaker":"Ryan Nunley","startTime":1969.71,"endTime":1974.21,"body":"So I do try and do things"},{"speaker":"Ryan Nunley","startTime":1969.71,"endTime":1974.21,"body":"exactly the same way every time."},{"speaker":"Ryan Nunley","startTime":1974.21,"endTime":1977.3,"body":"Because there's a reason we came"},{"speaker":"Ryan Nunley","startTime":1974.21,"endTime":1977.3,"body":"up with those protocols. There's"},{"speaker":"Ryan Nunley","startTime":1977.3,"endTime":1979.37,"body":"a reason that I felt like this"},{"speaker":"Ryan Nunley","startTime":1977.3,"endTime":1979.37,"body":"works well. And then when you"},{"speaker":"Ryan Nunley","startTime":1979.37,"endTime":1982.16,"body":"start to deviate, that's where"},{"speaker":"Ryan Nunley","startTime":1979.37,"endTime":1982.16,"body":"you I think can run into"},{"speaker":"Ryan Nunley","startTime":1982.16,"endTime":1985.61,"body":"problems. So from that"},{"speaker":"Ryan Nunley","startTime":1982.16,"endTime":1985.61,"body":"perspective, I think it's one"},{"speaker":"Ryan Nunley","startTime":1985.61,"endTime":1988.79,"body":"treat everybody like their"},{"speaker":"Ryan Nunley","startTime":1985.61,"endTime":1988.79,"body":"family member and that you'd"},{"speaker":"Ryan Nunley","startTime":1988.79,"endTime":1991.97,"body":"want the best for them, I would"},{"speaker":"Ryan Nunley","startTime":1988.79,"endTime":1991.97,"body":"not probably operate on my wife,"},{"speaker":"Ryan Nunley","startTime":1991.97,"endTime":1995.93,"body":"she's totally non compliance as"},{"speaker":"Ryan Nunley","startTime":1991.97,"endTime":1995.93,"body":"one of our partners operate on"},{"speaker":"Ryan Nunley","startTime":1995.93,"endTime":1999.44,"body":"her and said, no weight bearing"},{"speaker":"Ryan Nunley","startTime":1995.93,"endTime":1999.44,"body":"and I pulled up our rain camera"},{"speaker":"Ryan Nunley","startTime":1999.47,"endTime":2001.9,"body":"two days after surgery, she's"},{"speaker":"Ryan Nunley","startTime":1999.47,"endTime":2001.9,"body":"walking to the house with their"},{"speaker":"Ryan Nunley","startTime":2001.9,"endTime":2004.99,"body":"crutches, and I call her out on"},{"speaker":"Ryan Nunley","startTime":2001.9,"endTime":2004.99,"body":"it. So I would not offer for"},{"speaker":"Ryan Nunley","startTime":2004.99,"endTime":2008.38,"body":"somebody why. But I would"},{"speaker":"Ryan Nunley","startTime":2004.99,"endTime":2008.38,"body":"operate on either your wives"},{"speaker":"Ryan Nunley","startTime":2008.38,"endTime":2009.94,"body":"because I know they're much more"},{"speaker":"Ryan Nunley","startTime":2008.38,"endTime":2009.94,"body":"compliant."},{"speaker":"Charles Goldfarb","startTime":2011.11,"endTime":2013.36,"body":"I have one"},{"speaker":"Charles Goldfarb","startTime":2011.11,"endTime":2013.36,"body":"easy and one maybe harder"},{"speaker":"Charles Goldfarb","startTime":2013.36,"endTime":2017.02,"body":"question. And then we can bring"},{"speaker":"Charles Goldfarb","startTime":2013.36,"endTime":2017.02,"body":"it to a close, obviously, unless"},{"speaker":"Charles Goldfarb","startTime":2017.02,"endTime":2019.42,"body":"you have other things you'd like"},{"speaker":"Charles Goldfarb","startTime":2017.02,"endTime":2019.42,"body":"to mention. I should say though,"},{"speaker":"Charles Goldfarb","startTime":2019.42,"endTime":2022.33,"body":"not only is Ryan efficient, not"},{"speaker":"Charles Goldfarb","startTime":2019.42,"endTime":2022.33,"body":"only is his practice volume,"},{"speaker":"Charles Goldfarb","startTime":2022.33,"endTime":2025.45,"body":"incredible, you have been"},{"speaker":"Charles Goldfarb","startTime":2022.33,"endTime":2025.45,"body":"prolific in the research world,"},{"speaker":"Charles Goldfarb","startTime":2025.45,"endTime":2028.09,"body":"and and I mean, you really"},{"speaker":"Charles Goldfarb","startTime":2025.45,"endTime":2028.09,"body":"balanced a lot of things, which"},{"speaker":"Charles Goldfarb","startTime":2028.09,"endTime":2030.31,"body":"will be my getting into my"},{"speaker":"Charles Goldfarb","startTime":2028.09,"endTime":2030.31,"body":"second question. My first"},{"speaker":"Charles Goldfarb","startTime":2030.31,"endTime":2033.82,"body":"question is to the wound"},{"speaker":"Charles Goldfarb","startTime":2030.31,"endTime":2033.82,"body":"management. I don't really know"},{"speaker":"Charles Goldfarb","startTime":2033.82,"endTime":2038.44,"body":"what it's called, What's the"},{"speaker":"Charles Goldfarb","startTime":2033.82,"endTime":2038.44,"body":"mesh stuff on the skin? It's"},{"speaker":"Charles Goldfarb","startTime":2038.65,"endTime":2041.47,"body":"awesome. Like, if you told me,"},{"speaker":"Charles Goldfarb","startTime":2038.65,"endTime":2041.47,"body":"You got to spend an extra 50"},{"speaker":"Charles Goldfarb","startTime":2041.47,"endTime":2044.41,"body":"bucks to put this mesh stuff on"},{"speaker":"Charles Goldfarb","startTime":2041.47,"endTime":2044.41,"body":"and I would have to pay if you"},{"speaker":"Charles Goldfarb","startTime":2044.41,"endTime":2046.96,"body":"said do it, I would do it. But"},{"speaker":"Charles Goldfarb","startTime":2044.41,"endTime":2046.96,"body":"it seems like cost to the"},{"speaker":"Charles Goldfarb","startTime":2046.96,"endTime":2050.11,"body":"system. But it really is"},{"speaker":"Charles Goldfarb","startTime":2046.96,"endTime":2050.11,"body":"incredible. And it gives me"},{"speaker":"Charles Goldfarb","startTime":2050.11,"endTime":2053.83,"body":"confidence that my wound is not"},{"speaker":"Charles Goldfarb","startTime":2050.11,"endTime":2053.83,"body":"going to break down. So a That's"},{"speaker":"Charles Goldfarb","startTime":2053.83,"endTime":2057.43,"body":"my first question. And then the"},{"speaker":"Charles Goldfarb","startTime":2053.83,"endTime":2057.43,"body":"second question is, I'll use the"},{"speaker":"Charles Goldfarb","startTime":2057.43,"endTime":2062.98,"body":"2024 lingo, talks about work"},{"speaker":"Charles Goldfarb","startTime":2057.43,"endTime":2062.98,"body":"life integration, not balance"},{"speaker":"Charles Goldfarb","startTime":2063.04,"endTime":2063.82,"body":"integration."},{"speaker":"Unknown","startTime":2065.35,"endTime":2068.367,"body":"So the first question"},{"speaker":"Unknown","startTime":2065.35,"endTime":2068.367,"body":"is, yes, part of my philosophy"},{"speaker":"Unknown","startTime":2068.425,"endTime":2071.732,"body":"about wounds is that I hated"},{"speaker":"Unknown","startTime":2068.425,"endTime":2071.732,"body":"staples and drainage was the"},{"speaker":"Unknown","startTime":2071.79,"endTime":2075.271,"body":"albatross for the toe joint"},{"speaker":"Unknown","startTime":2071.79,"endTime":2075.271,"body":"surgeon in the infection because"},{"speaker":"Unknown","startTime":2075.329,"endTime":2078.868,"body":"now you're washing it out after"},{"speaker":"Unknown","startTime":2075.329,"endTime":2078.868,"body":"a long clinic or long Oh, our"},{"speaker":"Unknown","startTime":2078.926,"endTime":2082.35,"body":"day. So doing research and"},{"speaker":"Unknown","startTime":2078.926,"endTime":2082.35,"body":"that's a full hour dissertation."},{"speaker":"Unknown","startTime":2082.408,"endTime":2085.715,"body":"I'm glad to talk to you offline."},{"speaker":"Unknown","startTime":2082.408,"endTime":2085.715,"body":"But the mesh that you're"},{"speaker":"Unknown","startTime":2085.773,"endTime":2089.138,"body":"referring to is it's a using"},{"speaker":"Unknown","startTime":2085.773,"endTime":2089.138,"body":"product name. It's by Ethicon"},{"speaker":"Unknown","startTime":2089.196,"endTime":2092.678,"body":"it's Prineo and so it's using"},{"speaker":"Unknown","startTime":2089.196,"endTime":2092.678,"body":"the typical Dermabond glue but"},{"speaker":"Unknown","startTime":2092.736,"endTime":2096.391,"body":"the glue over a linear incision"},{"speaker":"Unknown","startTime":2092.736,"endTime":2096.391,"body":"like the knee when you start to"},{"speaker":"Unknown","startTime":2096.449,"endTime":2100.046,"body":"bend it with therapy puts a lot"},{"speaker":"Unknown","startTime":2096.449,"endTime":2100.046,"body":"of strain on adds a little bit"},{"speaker":"Unknown","startTime":2100.104,"endTime":2103.469,"body":"of glue wasn't substantial"},{"speaker":"Unknown","startTime":2100.104,"endTime":2103.469,"body":"enough. So the mesh is about an"},{"speaker":"Unknown","startTime":2103.527,"endTime":2106.719,"body":"inch and a half wide, so"},{"speaker":"Unknown","startTime":2103.527,"endTime":2106.719,"body":"dissipates that tension across"},{"speaker":"Unknown","startTime":2106.777,"endTime":2110.374,"body":"there. And the beauty of it is"},{"speaker":"Unknown","startTime":2106.777,"endTime":2110.374,"body":"that one, you can take a shower"},{"speaker":"Unknown","startTime":2110.432,"endTime":2114.029,"body":"right away, everybody feels more"},{"speaker":"Unknown","startTime":2110.432,"endTime":2114.029,"body":"human, they can take a shower"},{"speaker":"Unknown","startTime":2114.087,"endTime":2117.801,"body":"after surgery to going along the"},{"speaker":"Unknown","startTime":2114.087,"endTime":2117.801,"body":"philosophy of decolonizing. The"},{"speaker":"Unknown","startTime":2117.859,"endTime":2121.05,"body":"body now you've been in the"},{"speaker":"Unknown","startTime":2117.859,"endTime":2121.05,"body":"hospital, especially if you"},{"speaker":"Unknown","startTime":2121.108,"endTime":2124.241,"body":"stayed overnight, you potential"},{"speaker":"Unknown","startTime":2121.108,"endTime":2124.241,"body":"for nosocomial type of"},{"speaker":"Unknown","startTime":2124.299,"endTime":2128.012,"body":"contamination and colonization,"},{"speaker":"Unknown","startTime":2124.299,"endTime":2128.012,"body":"you get rid of bacteria when you"},{"speaker":"Unknown","startTime":2128.07,"endTime":2131.668,"body":"shower in three, it allows you"},{"speaker":"Unknown","startTime":2128.07,"endTime":2131.668,"body":"to just leave it on and take it"},{"speaker":"Unknown","startTime":2131.726,"endTime":2135.439,"body":"off with no sutures come out no"},{"speaker":"Unknown","startTime":2131.726,"endTime":2135.439,"body":"staples. So in the world when we"},{"speaker":"Unknown","startTime":2135.497,"endTime":2138.746,"body":"were in COVID, and you couldn't"},{"speaker":"Unknown","startTime":2135.497,"endTime":2138.746,"body":"get patients back in and"},{"speaker":"Unknown","startTime":2138.804,"endTime":2142.286,"body":"couldn't get them to therapy or"},{"speaker":"Unknown","startTime":2138.804,"endTime":2142.286,"body":"home therapists. It was also"},{"speaker":"Unknown","startTime":2142.344,"endTime":2145.825,"body":"nice because there's no home"},{"speaker":"Unknown","startTime":2142.344,"endTime":2145.825,"body":"maintenance or additional work,"},{"speaker":"Unknown","startTime":2145.883,"endTime":2149.48,"body":"that patient just takes it off"},{"speaker":"Unknown","startTime":2145.883,"endTime":2149.48,"body":"on their own in three weeks. So"},{"speaker":"Unknown","startTime":2149.538,"endTime":2152.788,"body":"it really has been great. The"},{"speaker":"Unknown","startTime":2149.538,"endTime":2152.788,"body":"downside is just for those"},{"speaker":"Unknown","startTime":2152.846,"endTime":2156.443,"body":"listeners that there is about a"},{"speaker":"Unknown","startTime":2152.846,"endTime":2156.443,"body":"2% allergic reaction, it tends"},{"speaker":"Unknown","startTime":2156.501,"endTime":2159.924,"body":"to be patients who have had"},{"speaker":"Unknown","startTime":2156.501,"endTime":2159.924,"body":"adhesive allergies. And so when"},{"speaker":"Unknown","startTime":2159.982,"endTime":2163.521,"body":"when that does happen, it looks"},{"speaker":"Unknown","startTime":2159.982,"endTime":2163.521,"body":"just like an infection. We've"},{"speaker":"Unknown","startTime":2163.579,"endTime":2166.887,"body":"never had one turned into an"},{"speaker":"Unknown","startTime":2163.579,"endTime":2166.887,"body":"infection, but it scares the"},{"speaker":"Unknown","startTime":2166.945,"endTime":2170.6,"body":"hell out of you because it turns"},{"speaker":"Unknown","startTime":2166.945,"endTime":2170.6,"body":"bright red, and so we treat it"},{"speaker":"Unknown","startTime":2170.658,"endTime":2174.081,"body":"with some oral steroids and"},{"speaker":"Unknown","startTime":2170.658,"endTime":2174.081,"body":"Benadryl, just from inside. For"},{"speaker":"Unknown","startTime":2174.139,"endTime":2177.853,"body":"anybody who does try and use it."},{"speaker":"Unknown","startTime":2174.139,"endTime":2177.853,"body":"I always put that out there. In"},{"speaker":"Unknown","startTime":2177.911,"endTime":2181.566,"body":"terms of work life integration."},{"speaker":"Unknown","startTime":2177.911,"endTime":2181.566,"body":"This is probably the part of my"},{"speaker":"Unknown","startTime":2181.624,"endTime":2184.815,"body":"life that I struggle with the"},{"speaker":"Unknown","startTime":2181.624,"endTime":2184.815,"body":"most, I will be frank and"},{"speaker":"Unknown","startTime":2184.873,"endTime":2188.297,"body":"honest. You're pulled in 100"},{"speaker":"Unknown","startTime":2184.873,"endTime":2188.297,"body":"different directions, patients"},{"speaker":"Unknown","startTime":2188.355,"endTime":2191.604,"body":"demands seeing because they"},{"speaker":"Unknown","startTime":2188.355,"endTime":2191.604,"body":"can't get in for six months,"},{"speaker":"Unknown","startTime":2191.662,"endTime":2195.259,"body":"patients having complications"},{"speaker":"Unknown","startTime":2191.662,"endTime":2195.259,"body":"after hours, you've got plans to"},{"speaker":"Unknown","startTime":2195.317,"endTime":2198.624,"body":"go to your children's basketball"},{"speaker":"Unknown","startTime":2195.317,"endTime":2198.624,"body":"game, you know, meetings"},{"speaker":"Unknown","startTime":2198.682,"endTime":2202.106,"body":"research trying to be on the"},{"speaker":"Unknown","startTime":2198.682,"endTime":2202.106,"body":"podium and do all of that. Jim"},{"speaker":"Unknown","startTime":2202.164,"endTime":2205.761,"body":"Urbanek was very close friend to"},{"speaker":"Unknown","startTime":2202.164,"endTime":2205.761,"body":"my my father worked under him"},{"speaker":"Unknown","startTime":2205.819,"endTime":2209.59,"body":"and he gave me some great advice"},{"speaker":"Unknown","startTime":2205.819,"endTime":2209.59,"body":"early in career he said my first"},{"speaker":"Unknown","startTime":2209.648,"endTime":2213.362,"body":"10 years in practice, I said yes"},{"speaker":"Unknown","startTime":2209.648,"endTime":2213.362,"body":"to everything. Absolutely. This"},{"speaker":"Unknown","startTime":2213.42,"endTime":2216.843,"body":"project. This means my last 25"},{"speaker":"Unknown","startTime":2213.42,"endTime":2216.843,"body":"years, I tried to find every"},{"speaker":"Unknown","startTime":2216.901,"endTime":2220.498,"body":"excuse in the book to say no. So"},{"speaker":"Unknown","startTime":2216.901,"endTime":2220.498,"body":"my point of that is that, you"},{"speaker":"Unknown","startTime":2220.556,"endTime":2223.98,"body":"know, burnout is real. I'm now"},{"speaker":"Unknown","startTime":2220.556,"endTime":2223.98,"body":"47 years old, I'm doing 1200"},{"speaker":"Unknown","startTime":2224.038,"endTime":2227.635,"body":"cases a year. You know, my back"},{"speaker":"Unknown","startTime":2224.038,"endTime":2227.635,"body":"starts to hurt, I feel guilty."},{"speaker":"Unknown","startTime":2227.693,"endTime":2231.29,"body":"My kids are getting older, that"},{"speaker":"Unknown","startTime":2227.693,"endTime":2231.29,"body":"I try to be finished every day"},{"speaker":"Unknown","startTime":2231.348,"endTime":2234.946,"body":"by 530. I try not to plan things"},{"speaker":"Unknown","startTime":2231.348,"endTime":2234.946,"body":"on the weekend, I try to Ford"},{"speaker":"Unknown","startTime":2235.004,"endTime":2238.601,"body":"look at important things and in"},{"speaker":"Unknown","startTime":2235.004,"endTime":2238.601,"body":"our lives, our family's lives,"},{"speaker":"Unknown","startTime":2238.659,"endTime":2242.14,"body":"to make sure I'm there for those"},{"speaker":"Unknown","startTime":2238.659,"endTime":2242.14,"body":"important things. But it is"},{"speaker":"Unknown","startTime":2242.198,"endTime":2245.389,"body":"probably the thing that I look"},{"speaker":"Unknown","startTime":2242.198,"endTime":2245.389,"body":"at every three year most"},{"speaker":"Unknown","startTime":2245.447,"endTime":2248.871,"body":"critically about how I want to"},{"speaker":"Unknown","startTime":2245.447,"endTime":2248.871,"body":"change and be more effective"},{"speaker":"Unknown","startTime":2248.929,"endTime":2250.96,"body":"both my home life and my work life."},{"speaker":"Chris Dy","startTime":2252.01,"endTime":2254.68,"body":"I can I can bring"},{"speaker":"Chris Dy","startTime":2252.01,"endTime":2254.68,"body":"things to a close a little bit."},{"speaker":"Chris Dy","startTime":2255.22,"endTime":2257.44,"body":"You know, I see you at the"},{"speaker":"Chris Dy","startTime":2255.22,"endTime":2257.44,"body":"games. I see you at the"},{"speaker":"Chris Dy","startTime":2257.44,"endTime":2261.31,"body":"practices. And I will say that"},{"speaker":"Chris Dy","startTime":2257.44,"endTime":2261.31,"body":"this week I was admittedly"},{"speaker":"Chris Dy","startTime":2261.31,"endTime":2265.24,"body":"removing a screw from somebody's"},{"speaker":"Chris Dy","startTime":2261.31,"endTime":2265.24,"body":"patella while I was doing their"},{"speaker":"Chris Dy","startTime":2265.51,"endTime":2268.09,"body":"tarsal tunnel release. And I"},{"speaker":"Chris Dy","startTime":2265.51,"endTime":2268.09,"body":"thought about you because I"},{"speaker":"Chris Dy","startTime":2268.09,"endTime":2271.39,"body":"couldn't remember what the name"},{"speaker":"Chris Dy","startTime":2268.09,"endTime":2271.39,"body":"of the of the of the skin"},{"speaker":"Chris Dy","startTime":2271.39,"endTime":2273.34,"body":"closure that you use. And I"},{"speaker":"Chris Dy","startTime":2271.39,"endTime":2273.34,"body":"looked at the resonance was that"},{"speaker":"Chris Dy","startTime":2273.34,"endTime":2276.22,"body":"thing that nunley uses, because"},{"speaker":"Chris Dy","startTime":2273.34,"endTime":2276.22,"body":"we had just talked about it when"},{"speaker":"Chris Dy","startTime":2276.22,"endTime":2280.0,"body":"we were hanging out aside next"},{"speaker":"Chris Dy","startTime":2276.22,"endTime":2280.0,"body":"to Dr. Aleem grill when you and"},{"speaker":"Chris Dy","startTime":2280.0,"endTime":2283.24,"body":"I are chatting, so you know, we"},{"speaker":"Chris Dy","startTime":2280.0,"endTime":2283.24,"body":"all struggle with it. I think"},{"speaker":"Chris Dy","startTime":2283.24,"endTime":2286.57,"body":"that you are clearly making an"},{"speaker":"Chris Dy","startTime":2283.24,"endTime":2286.57,"body":"effort. And we were spending"},{"speaker":"Chris Dy","startTime":2286.57,"endTime":2289.57,"body":"some good time together over the"},{"speaker":"Chris Dy","startTime":2286.57,"endTime":2289.57,"body":"weekend. So kudos to you for"},{"speaker":"Chris Dy","startTime":2289.57,"endTime":2291.43,"body":"everything you've done. And"},{"speaker":"Chris Dy","startTime":2289.57,"endTime":2291.43,"body":"thank you for joining us on the"},{"speaker":"Chris Dy","startTime":2291.43,"endTime":2291.85,"body":"upper hand."},{"speaker":"Ryan Nunley","startTime":2293.14,"endTime":2295.24,"body":"Thanks for having"},{"speaker":"Ryan Nunley","startTime":2293.14,"endTime":2295.24,"body":"me, guys. So great partners, and"},{"speaker":"Ryan Nunley","startTime":2295.24,"endTime":2297.46,"body":"I love the cross collaboration."},{"speaker":"Chris Dy","startTime":2297.91,"endTime":2298.21,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":2298.21,"endTime":2300.218,"body":"thanks a"},{"speaker":"Charles Goldfarb","startTime":2298.21,"endTime":2300.218,"body":"million. Thanks for joining us"},{"speaker":"Charles Goldfarb","startTime":2300.269,"endTime":2303.513,"body":"for a brief period after rounds"},{"speaker":"Charles Goldfarb","startTime":2300.269,"endTime":2303.513,"body":"on the Saturday morning. So now"},{"speaker":"Charles Goldfarb","startTime":2303.564,"endTime":2305.47,"body":"go home, hopefully and enjoy the"},{"speaker":"Charles Goldfarb","startTime":2303.564,"endTime":2305.47,"body":"fam."},{"speaker":"Charles Goldfarb","startTime":2305.47,"endTime":2308.65,"body":"Hey, Chris, that was fun. Let's"},{"speaker":"Charles Goldfarb","startTime":2305.47,"endTime":2308.65,"body":"do it again real soon."},{"speaker":"Chris Dy","startTime":2308.65,"endTime":2311.21,"body":"Sound good. Well, be"},{"speaker":"Chris Dy","startTime":2308.65,"endTime":2311.21,"body":"sure to email us with topic"},{"speaker":"Chris Dy","startTime":2311.263,"endTime":2314.89,"body":"suggestions and feedback, you"},{"speaker":"Chris Dy","startTime":2311.263,"endTime":2314.89,"body":"can reach us at handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2314.89,"endTime":2317.85,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2314.89,"endTime":2317.85,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2317.919,"endTime":2319.09,"body":"get your podcast."},{"speaker":"Chris Dy","startTime":2319.09,"endTime":2321.798,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":2319.09,"endTime":2321.798,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2321.851,"endTime":2322.33,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2323.05,"endTime":2325.6,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2323.05,"endTime":2325.6,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2325.6,"endTime":2326.95,"body":"music. And"},{"speaker":"Chris Dy","startTime":2326.95,"endTime":2329.05,"body":"remember, keep the"},{"speaker":"Chris Dy","startTime":2326.95,"endTime":2329.05,"body":"upper hand come back next time"}]}