Welcome And The Telehealth Shift

Dr Andrew Greenland 0:02

Welcome back to Voices in Health and Wellness. This is the podcast where we explore the real operational, clinical, and leadership challenges behind building and scaling modern healthcare practices. Today's episode is a particularly interesting one because we're diving into a topic that's evolving rapidly, how telehealth is being integrated into more complex care pathways and why many many many medical leaders are starting to rethink how it actually fits into their model. I'm joined today by Dr. Scott Rasso, founder of Recover Health, a company focused on surgery optimization, helping patients prepare for and recover from procedures with a more structured outcomes-driven approach. Scott brings a really valuable perspective here, sitting right at the intersection of clinical care, patient optimization, and operational delivery, especially as more practices try to balance in-person care with virtual touch points. So, with that, Scott, I'd like to welcome you to the show and thank you so much for joining me.

Dr Scott Russo 0:53

I appreciate the opportunity to be with you, Andrew.

Surgeon Background And Wake Up Call

Dr Andrew Greenland 0:55

Thank you. So can we start by you sharing a little bit about your background and what led you to focus on surgery optimization?

Recover Health’s Optimisation Method

Patient Story: From Angry To Ready

Dr Scott Russo 1:02

Well, certainly. So to go way back, I'm a graduate of Michigan State University with a degree in chemistry. From there, I went to a medical school in Detroit, Wayne State University. From Wayne State University, I went to Grand Rapids, Michigan, small town in Michigan, the second largest town in Michigan, where I became an orthopedic surgeon. From there, I went to Southern Illinois University, did a spine surgery fellowship, and then came back to Grand Rapids and practiced. For 33 and a half years, I was a practicing surgeon, took care of, probably operated on over 9,000 plus patients, both orthopedic and focused primarily on spine surgery. And in 2008, I had a particularly significant event in my life where I became very sick very quickly. Developed a staph infection in my heart, on my heart valve, in my spine, and I almost died. There was a point in time during that admission, I was in the hospital for eight days where I said, God, either take me or make me better. But don't leave me where I'm at right now. And so fortunately, the hospital and the team there saved my life. And uh I was discharged home after eight days, had an IV, long-term IV in my arm for antibiotics for six weeks, and a bag of antibiotics and two foul visits. But what I didn't get from the hospital is I didn't get a path forward to recovery. I wasn't sick enough to go to a rehab facility. And I'm not even convinced, had I gone to a rehab facility, they would have provided this the program that I created now since that time. So, long story short, that's when it made me very aware of the importance of recovery. So I had to learn how to fuel my body afterwards, different from what I did, how to mentally recover because of the stress of the illness, the serious illness, and being off work. What was my future? Would I have to have my chest open up, my heart valve removed? Would I ever return to being a surgeon? How would I, how would I um provide for my family? Those things that the average, the average individual across the world has when they get sick or when they need a major surgery. So after that, I did, I recovered. I've always promoted good nutrition, regular exercise, positive attitude. But in in 2014, I had a patient who had had a prior bypass surgery for obesity. And that's probably one of the most debilitating surgeries philosophically and physiologically, where it really leads to liver disease and to weak bones and just how a person processes their food. Long story short, we took her to surgery, and we after surgery, she came down with a very serious infection, had to take out the hardware, never completed the operation. So, what I learned from that particular case was that she needed to be prepared mentally. So, psychologically, she needed to be prepared, and then nutritionally, she needed to be optimized, and then physically, she needed to be trained. And it wasn't a realization in my mindset to the extent that she needed and that many patients need. And that led over the next several years to the concept of recover health. And so, our mission then, our goal is to prepare patients mentally, so psychologically, nutritionally, and physically. And it's not just for patients who are leading up to surgery, but it can be cut for patients like myself who had a serious illness, a serious injury, or an unplanned surgery. So the concepts are basically lifestyle medicine concepts advanced to the surgical patient preoperatively or to those people that need to recover after something serious has happened to them. And so basically, the mindset is a critical piece, right? We're very, as a as a world, we're very weak mentally in many, in many ways. We're, as you can see now, with obesity, we're very deconditioned, we're obese. We're relying on medications instead of relying on our own selves. And if you look back 30 or 40 years, when I was a child, we didn't have these illnesses like we do today. And so it's becoming very apparent that something's changed in our lifestyle. I think we see it more in America, in the United States rather, than you see in Europe. And I visited Italy this summer and I didn't see it as much there. So there's something different about how we live in the United States than in other places that have led to the behaviors we have, the lifestyle, and there's many different things, and we could probably go deep into that on for hours. But coming back to the surgical patient, the thing that I start with is what is their purpose for having surgery? What's their why? Is it because they're having their hip replaced, but they're very obese and they they're doing this to walk their daughter down the aisle or to be there for their grandchild being born? So that that purpose, that mindset drives the behavior. And I work with that. So I crystallize that with the patients, and then I advance a different technique. So what we do is we get that locked in, then we use breath practice, visualization, we teach them how to win in their mind before they enter the battlefield, the operating room. That's a critical piece. We also then move them, find out where they are medically. If they have diabetes, where are they in their diabetic process? Are they controlled or uncontrolled? If they're obese, how much do they need to lose weight to become healthier? So we work to change their metabolism through principles of diet, exercise, and appropriate medications. Now, I don't manage the medications. I'm an orthopedic spine surgeon. I rely on other team members, like their primary care doctor, their internist, heart doctor, whoever it is. Then I'll coordinate either their physical conditioning with very basic, simple things. We try to keep costs down. So we use simple environments, their home environment. Just going up and down stairs multiple times during the day, creating those behaviors, those simple habits. So we train them physically. If we need to, we put them in the hands of a physical therapist or an exercise physiologist, whoever it takes to get them to the right. Let me share a story with you. I had an 80-year-old gentleman, a little over 80. He had been, he needed another spine surgery. He had eight prior spine surgeries. He needed a ninth. He was at the at the Cleveland Clinic, he couldn't get cleared for surgery. He was right almost on the operating room table when they canceled him. He then came to the University of Michigan. Same thing happened there. And then he came to my hometown and one of our tertiary hospitals here. One of my partners sent him to me. So this gentleman I saw first day in practice, we had to help him from his car into my office. He was 247 pounds. He could only walk 20 steps before he had to sit down. He was very angry because why couldn't I be fixed? So we worked with him. We changed his mindset. We helped him remove the anger and see what he could become. And at the same time, we changed his diet, moving him towards a Mediterranean diet, less processed foods, more natural foods, less of everything. Creating that sense of momentum in his mind that transferred to his behaviors, how he ate. And then we started him conditioning. We had him go to pool therapy. So he was very weak, deconditioned. So we got him in with an excellent physical therapist who started him training in the pool. Then we started training him at home. And about five and a half months after that, he was walking 375 steps where he could only walk 20. 375 was a huge leap. He had gone from 247 pounds to 217 pounds. And his attitude was, I can win in surgery. I can survive the operation, and I can now have the operation. So my former partner took him to surgery, performed an excellent operation. I went into the hospital the next day, did a house call in the hospital to see how he was doing. He was sitting up in bed, smile on his face, leg pain gone, back pain strong. Back pain was less just a surgery pain. And he's been home, discharged, and he's been doing very well. So that's the kind of behavior and process that we want to do when we see patients before surgery. And think about it. Patients often have anywhere from eight to 12 weeks before they have an operation. And they're commonly not invited to have a training, a program like what we do. So their family doctor needs to step up to the plate, the surgeons need to step up to the plate. They need to understand that this is valuable time to prepare the patient. So they have lower complication rates. That's what the data shows. Lower risk of pulmonary complications, less likely to be readmitted to the hospital or end up in the emergency room for a post-op problem. So costs go down, attitude improve, patient and family satisfaction go up. It's a win-win-win across the board. The real question is, the real question is, why isn't it used more?

Dr Andrew Greenland 10:42

Thank you. Really helpful background and context. Thank you very much. So what does Recover Health look like today in terms of your team and your setup? And where do you sort of sit within the business day to day?

Dr Scott Russo 10:51

So I'm I have somebody who runs the operations. We're a small practice. We keep things down. I run the operation. So I'll see a patient, I'll spend up to an hour with them setting the foundation up. We'll see them roughly every other week. Depends how much time I have before surgery. But we'll see them every other week. I'll either see them in person, and I love the feel when I see them in person. I can really connect to what they're feeling. But I still will do it through telemedicine too, if they live far away. And so we get them in, we assess them medically, we do some very critical assessments for where they are mindful-wise, what's their resilience level, how are they sleeping, are they depressed or anxious? I asked a question what's your why? And we figure that out together. Then we go through, we do a history analysis of what it what foods do they like, how are they fueling their body? What are their challenges? And then we talk about what are they doing training-wise, conditioning training. So we get a foundational understanding of where they are. And then once we do that, after the first visit, we'll put a foundational plan. I have an online learning platform that we created. So they get introduced in that. The biggest challenge with online learning platforms are the senior patients. And I have to be careful because I'm a senior now, but on the senior patients who don't use technology regularly, they don't have access. So we build a binder for them and try to implement very specific strategies every time we visit and build on that. So they're getting stronger, mentally tougher, nutritionally healthier. And that's what we do. That's that's the critical nature of that. And so it's basically typical, you know, doctor's office, very straightforward, low stress, high touch.

Dr Andrew Greenland 12:47

Amazing. So really helpful hearing about the patient journey and how they sort of interface with your model. I'm trying to um gather some sense of where your patients are coming from in terms of what the awareness out there is for this kind of service, or are they coming through referrals? How do patients actually reach you and get to have the benefit of your expertise and your programs?

Dr Scott Russo 13:06

That's a great question. So I've been out talking to surgeons, primary care practitioners, hospital administrators, um, integrated network administrators, insurance companies. I don't think they understand. I honestly am confused on that. So mostly from practitioners who see the benefit, who recognize that their patients aren't healthy, that they're unlikely to be cleared for surgery, and then those are the ones who get sent to us. So they're very challenging patients. They're the least healthy of all patients. And then it's a true joy to work with them. I mean, to really see how they can transform their health and become the best version of themselves going into surgery. And then the real long-term benefit to the healthcare system and to the patient is if they embrace these principles of lifestyle health mindset, and they continue those on after surgery. So we really, it's part of our behavioral piece, we're engaging them in nature, right? So we want them to be out in nature. So we link nature to physical activity, just like walking or social connections. A big piece that's one of our lessons, our sessions, is social connection, building that social support network. It's not uncommon for elderly patients who have lost a lot of their support structure to become kind of cocooned in their own environment. And then they don't, they don't get out, they don't have, and who's going to take them to the hospital? So we help them build that process and work with their family members or friends to build a team around them. So the other thing we work on is detoxification. If they're smokers, we'll connect them with a cessation unit. We'll do some behavioral techniques ourselves. If they're heavy alcohol users, we'll help them wind down that behavior because we know that they'll heal better if they're not having those particular activities. But we know that people that smoke and have been doing it for a long time, it's like giving up two best friends. So you really have to approach that very gently and help them see, help them create a vision of themselves what it would look like for them to not be engaged with those types of toxic behaviors. And we're not critical. I mean, we recognize that this is we live, we have our free will. What we have to do is help them see a different path forward.

Dr Andrew Greenland 15:36

Thank you. So, from your vantage point, what major shifts are you seeing right now in how care is being delivered, especially around surgical pathways? And where are the points where we're we're missing opportunities and where the sort of the biggest drop-offs occur in traditional pathways?

Dr Scott Russo 15:51

Well, I think traditional pathways is people come to surgery and they go home, and uh they don't come prepared. So this is where this concept is personal ownership. I I've said this, uh I said this at several board meetings that the secret sauce to making healthcare affordable is making the patient responsible. And it's it's when as a surgeon, I always co-created a plan going forward. I didn't tell the patient what they needed, I tell them what I think is the best thing for them. And then within their life situation, they would say, yes, that makes sense, or no, I can't do that right now. Then I say, okay, these are other options. So having open dialogue with patients so they understand that they're responsible for their future is really critical. And then building that team around them. So I think that concept of team, team work around the patient, including their family, their primary care doctor, their surgeon, the hospital, physical therapist, nutritionist, whatever it takes to get them to the point where they're ready for surgery or when they need to recover after a surgery illness or injury. And I take care of a number of patients with cancer. And I think that that's really important. Those patients come with a really very firm mission about wanting to live. And so we we help with them, again, identifying their why, finding out where they're deficient, how physically they stop moving, they stop connecting with people. So people with serious illness, again, they kind of draw into themselves and they lose that emotional support structure. And so, Andrew, there's a you you're probably familiar with this, but there's this area called psychoneuroimmunology, how our psycho psyche links to our nervous system and links to our immune system. So if somebody's living with cancer, they're living, we we all have cancers in our bodies every day, are and for whatever reason, somebody who has a serious cancer, their body's immune system took a nap that day, didn't pay attention, didn't clear that cell. And then one cell became two, and two became four, and four became eight. So if we can help in some small way strengthen their psyche, strengthen their neurology and their immune system, lower stress, elevate happiness. It's just one tool in the toolbox of health and wellness that we can impact on a patient, that we can give them. And also bringing their family in and making their family now connected. I've had a number of patients who they get caught in the despair of this of an illness and they and they can't get out of bed anymore. So we just start to implement small things: mindset change, minimal activity, a little bit better nutrition, helping them sleep better. And before you know it, their life has changed.

Dr Andrew Greenland 18:48

Thank you. So telehealth has massively exploded in recent years, but now things are kind of settling down a bit. Where do you think it's really adding value? And also where do you think it's perhaps falling short and people are falling through the falling through the cracks?

Dr Scott Russo 19:02

It's a good question. In my practice, it's it's it falls short in the face of the elderly who don't have access or those individuals who don't understand how to work with it. That's becoming less and less these days. But where it really shines is when people can't get access to healthcare. So now they can, we can I can reach out to somebody 200 miles away. They might still be in the state of Michigan, but I can see them if they're a long distance away and I can still provide service to them. So the the beauty is that it can connect us over multiple states for that matter, or across countries, across oceans, if we're talking to somebody who's in England and I'm here. So I think the the real beauty is that it it provides uh opportunities to provide care to those individuals who don't have it, and it's pretty seamless. You lose that little bit of touch that to really feel the emotional state of a patient. But I think it it does expand care from that standpoint. So I think it's a very important part of the healthcare system. And my hope is that they they the insurance companies, the governments, see that it continues to be a benefit for those people who are who have less access uh to experts in different fields.

Dr Andrew Greenland 20:29

Thank you. So thinking of recover health as a business, because it is a business, what are you most proud of? What's working particularly well for you at the moment?

Dr Scott Russo 20:38

Well, I think so I created a nutrition company on top of that. And that that nutrition company supports the surgical patient. So we have a surgical kit that we created. So I'm I'm proud of the integrated nature of Recover Health. Um, and the fact that we're kind of leading from the front. There are very few programs who do what we do. And I'm I'm pleased that our online program is evolving over time. So again, patients, if you were my patient and you're in another country, you have access to this program that has the behavioral modules, visualization videos, yoga therapy videos. We have the whole nutritional platform and then the whole physical training platform that talks about the basics of what we need to do to prepare. It's simple, uh very straightforward. So I think what we've we've evolved, we're we're doing the thing, what is right for patients. I think that's the most important thing. Providing a service that that is not yet provided. Many places in Michigan. I'm uh I'm only aware of one or two places that have it formally done in the way that we're doing it. So we're on the cutting edge of this. And again, we're just here to take care of patients. And I've always seen as a physician first, kind of as the healer mentality where I'm there for people who. Who don't have knowledge or access related to orthopedics or spine surgery first. And now that I'm not doing surgery anymore, to patients who are really in need. And the the volume of these individuals is massive. The number of people that could benefit from this are thousands. So I think that there is a real opportunity to expand on this and to build programs that will uh really serve a large larger majority of the population.

Dr Andrew Greenland 22:35

Thank you. And on the flip side of the coin, what's um what are the sort of challenges or bottlenecks that are most impactful for you in the business right now? And how are you kind of navigating those things?

Dr Scott Russo 22:44

That's a great question. I think the the biggest challenge is helping surgeons and primary care doctors understand the benefits. And I've met with many, many, I mean I would probably say close to 100 different practitioners, helping them understand and create a vision, and they just can't wrap their head around it. And so they're caught up in doing what they do on a day-to-day business. We really take over this aspect of care. So the biggest challenge is getting patients into the practice from surgeons and from um primary care practitioners. And the beauty is, though, is we have some very strong support of surgeons and primary care doctors. So those people who recognize the uh value of what we offer are very willing to share patients and get them going. The insurance companies, too. I think that's another thing. Uh their knowledge base is this much when it comes to pre-surgical optimization. And so my hope is that we can have a deeper conversation with them. I think the real opportunity for us is going to self-insured companies and saying, hey, we can see your patients, uh, your I'm sorry, your employees before an operation, and to really move the dial forward on their health and their wellness so that when they come back, they're a healthier employee. So ultimately, healthcare costs can be less. They're less as it is if this is implemented appropriately. But long-term behavior will really lower healthcare costs and improve the health and wellness of our world community, if it's done right.

Dr Andrew Greenland 24:29

Amazing. So if you had a magic wand and you could fix one thing in the business tomorrow, would that be one of the things you've just mentioned, or be something else which is more pressing for you?

Dr Scott Russo 24:39

No, I think it would be two things. I think what I just mentioned, and I think it was a great question, is getting patients, uh helping patients become aware of this, which starts with the healthcare system or the insurance system. And the second thing would be for patients to really be able to dig deep inside and to say, I am in charge of my health. It's my responsibility to say no to the less healthy behaviors, say yes to exercise, better sleep, less electronics, all those things that really move the dial forward from a health and wellness standpoint.

Dr Andrew Greenland 25:19

In terms of how you're tracking success metrics, what do you measure?

Dr Scott Russo 25:23

So we are really we struggle with that because patients, because we're such a new program, patients come in at different things. So if everybody came in at eight or 12 weeks, it'd be easier. But we measure, so from a behavioral standpoint, we measure their resiliency scale. Uh, we measure their sleep, so Pittsburgh Sleep Quality Index, we measure a GAD seven and a PHQ nine for depression for anxiety and depression. And then we we um nutritionally we'll assess them with the malnutrition universal screening tool. We'll do that, see where they're at there. We look at their albumin, total lymphocyte count, the basics, hemoglobin A1C for their, you know, where they are from that standpoint. Obviously, we look at their their BMI and and and that, we link that to behavior. And again, we're not we don't we're not punitive, we don't, we're not, we just support, we're just supportive, right? But we help them see a path forward. Physically, we we do a uh timed up and go, we do a um uh six-minute walk test, we um test their their grip strength, so for frailty, um, and then we we use those measures, implement an online, we used online MedBridge, which is an online physical training program that it's uh has all different exercises, so we'll pick the exercise, put the exercise plan in place for them. So that's basically what we look at. And then um we haven't followed uh post-operative stuff uh metrics yet, but that'll be the thing. Were they readmitted? Did they have a complication, those factors? Um, so it's really the the biggest challenge is is having the resources to do everything, be in a small group. But those are the metrics that we're working to.

Dr Andrew Greenland 27:08

It's a very impressive, very thorough, um, very thorough set of metrics, very objective. So you're you're front and center in this business. But what's your biggest time drain? Um, is it changing called operational admin? What are the things that pull you away from the things that you enjoy or would rather be doing?

Dr Scott Russo 27:25

Uh I think it's technical as it and charting, right? So just electronic health record, like many physicians, just charting the information, getting the knowledge down. I do think AI and some of these new AI tools that will take the conversation and bring it together in an ideal way, eliminating the fluff and that will really facilitate care. And so I think from that standpoint, and then I enjoy teaching. So I'll I teach doctors and residents and all that, and I enjoy interfacing with them and helping them understand the benefits of this. And I enjoy patient care. So I think you know, the business day-to-day practices, I'm I'm learning how to write content for um uh the social media and that just to help patients and and practitioners and people just in general be more aware of how if they control, if they take charge of their life and really take responsibility and look at these tools, they can see and feel life in a different manner. They can become the healthiest version of themselves. And that be driven what be driven by a very clear purpose for their overall health and wellness. And I think that will help them engage better with families, with friends. And so the benefits are immeasurable downstream.

Dr Andrew Greenland 28:55

I'm guessing you're wanting to scale your business, most businesses do, but if you did have a sudden influx of patients tomorrow, uh, would your system be able to handle it or would anything break? What would be your thoughts?

Dr Scott Russo 29:07

You know, I think the challenge would be just volume and the ability to handle volume. And I we always say that that's a good, a good problem to have. I think more than volume, it's the patients that want to be part of the program. I think that's a real critical thing. So when we see patients who are FERD, who don't have that desire to get healthy, who don't, they just want to be fixed, then those patients will not thrive in this type of process. But I think if the primary care doctor says this is a great opportunity for you to change your health, to get prepared for surgery, so have a great outcome. If the surgeon says, if you go through a program like this, you're gonna have a much better clinical experience, recover quicker, less complications, less likely to have a follow-up in the hospital. The hospital says, Well, this is really beneficial to me because if they don't have a complication and they're a Medicare patient, I'm not gonna be dinged for that in the United States and have to pay for that, you know, not be covered for that. So I think everybody in the patient comes out and their family, they're happier, stronger, healthier. So I think if we can achieve that across the board, the outcome is is, I mean, the sky's the limit on what can happen.

Dr Andrew Greenland 30:21

I'm thinking ahead to the next six to 12 months. What's in store for Recover Health? Where would you and you and the company, where would you like them to be in the next uh year or so?

Dr Scott Russo 30:29

Well, so I'd like to be more connected with a hospital system or multiple hospital systems. You asked me about scaling. I think the opportunity is uh for us to take the program, the digital online program, and to move that to whatever system needs it, and then go in and provide the training. So if it's in another state, I'm not licensed in that state, I can bring the program to the state, I can work with a physician, surgeon, hospital system, mid-level, teach them the process, the program, how I work with patients. And then just digitally bring the digital program in and let them do that. So that's the real opportunity for scaling. And I think the more people that do that, the more they're connected to health and wellness and look in their communities. How do we how do we connect them with fitness facilities? How do we integrate them with uh nutritionists? How do we do any other healthcare practices? So then now it becomes an ideal healthcare um ecosystem in their community.

Dr Andrew Greenland 31:32

And if you were to do, if you were to have your time again and to begin this journey again, would you do anything differently if you were starting in tomorrow?

Dr Scott Russo 31:40

I would I would not do it on my own. So being a solo person doing all this, it's been a very interesting and challenging journey. And I did it because nobody else was interested. Right? My former practice partners, they weren't interested. But I think if I had to do it over again, I would partner with a big system, help create that vision for them of what it can be, and then just lead from the front in that respect.

Dr Andrew Greenland 32:09

With that, Scott, I'd love to thank you so much for joining me today. It's been such an insightful conversation, especially around how telehealth fits into more complex care models such as surgery, hearing about your model and how it you benefit your patients. I think a lot of practice owners and medical directors listening will really relate to that tension between access efficiency and quality of care. So thank you very much. Uh, it's been a pleasure to have you on the show. Appreciate that, Andrew. Thank you. Lovely. Really interesting. Thank you, Scott. Really good conversation. Um, it was a great episode. I'm really looking forward to getting that out there. Like I said on the thing before, very happy to give you the link for this when we're when we've got it ready to launch. So please feel free to use it in any way that you'll find helpful for your local promotion education. You were talking about there about trying to get doctors' heads around what you do. I think there's some great material in this podcast. You're very welcome to use and uh hopefully it will help with your messaging.

Dr Scott Russo 32:59

Yeah, thank you so much.

Dr Andrew Greenland 33:00

I think people hearing you to speak about this, you know, with your passion and interest, I think you'll be able to really convey the message that you're trying to get out there.

Dr Scott Russo 33:08

Appreciate that. What are you what are your thoughts about this concept?

Dr Andrew Greenland 33:11

I think it's amazing. I mean, I I I racked my brains after we had our last conversation to think if there's anything that exists in the UK, and I really don't think there is. Like you said, people turn up for the discussion about surgery, they come to a pre-op clinic one or two days before, and then bang, they have the surgery, and you know, not necessarily in the best condition. I'm not sure the level of optimization that you would achieve with your patients really exists in our health service. So I think there's definitely um room for this.

Dr Scott Russo 33:40

You know, it's honestly in my practice in others, you know, we a patient would have a complication, and then we would ask ourselves, well, was it was it the patient's fault? Was it our fault? Who's responsible? And all ultimately it's well, obviously their physiology wasn't ready for it. Or they did, and certainly patients behave after surgery and they they cause some problems. Um, and I I'll have to be up by way of disclosure. I just had a knee, a revision knee surgery for I had a partial joint replacement, but I was riding the exercise bike like pretty hard five days post-op and uh got a little wound infection, so I had to go on some antibiotics. So I misbehaved. So I understand that I mean, as a patient, we do things, so we have to be aware of that. What I do in in the practice is I really help them understand. I answer a lot of surgical questions for for that the that the surgeons don't have to worry with. That's the other benefit. So, and we'll talk about that. But we have all these different things. We we teach them how to set goals, Andrew. We how to work. So they've never set a goal in their life, these patients, and then we come up with a very basic foundation, have them set a goal, have them see how they're winning with that that behavior every other week or whatever. We'll do follow-up inner inner inner week calls just to check on them. So it's really it's it's a joy to work with them and to see the transformation uh that happens. And I mean, I don't I again, I think it's the sky's the limit on what can happen if if patients embrace it.

Dr Andrew Greenland 35:13

It's fantastic. I mean, one thing I forgot to ask on the show, I'm regretting it now, is um so that's that's really useful to know. Thank you.

Dr Scott Russo 35:20

Yeah, wonderful.

Dr Andrew Greenland 35:21

Well, look, thanks again, Scott. Let's keep stay in touch anyway. If you ever want something, just drop me a line and I will as soon as this is ready to go. I will drop you an email with the link. And um, like I said, please feel free to use it in any way that's helpful.

Dr Scott Russo 35:33

Yeah, thank you for reaching out, giving me the opportunity to share my my thoughts. I appreciate that deeply. Thank you very much. Thank you. Take care, Dan. Bye. You do all the best, all the best. Thank you.