Patient Engagement and the Doctor-Patient Relationship

In this episode, I talk with Me, Myself and I about patient engagement--what it is, why it's essential to positive outcomes in healthcare, the challenges in creating and maintaining it, and how we can overcome those challenges to improve the doctor-patient relationship and create a better path forward toward health and wellness.

I also ask a series of questions in the podcast, which you can find in a downloadable format here. I'm interested in your answers to them and would love it if you would email your responses to me at hello(at)drmarylouder(dot)com.

Intro for "Since you put it that way" podcast.

Outro for "Since you put it that way" podcast

Transcript

Mary Louder: 0:33

Hi, everybody, and welcome to today's podcast, the Since You Put It That Way podcast, which is hosted by me, Dr. Mary Louder. And today we're in conversation with again, me, myself and I. So I seem to be a frequent guest, so I have a lot of availability. So, it's great that I can show up and have these conversations with you, our listener. Today, we're discussing a topic that's very near and dear to me, and it's something at the heart of the doctor-patient relationship. This is something that is called Patient Engagement. Now, patient engagement is defined as both the manner and the extent to which the patient is showing up for their part or their responsibility in the doctor-patient relationship. And I know some of you may be thinking already, well, wait a minute, what about the doctor that's distracted when I'm in a room? What about when they're late? What about when I'm sitting there with a paper gown and it's drafty? What, what kind of engagement is that? How am I supposed to be able to have a conversation? You're right, you're identifying a lot of things, and there are many things that make this part of the doctor-patient relationship fraught with complications, hurdles, roadblocks, etc. But still, at the heart of every relationship, the extent to which both parties show up is key to the outcome. So I tried to come up with some catchy, quirky titles for today's podcast, hopefully maybe even a little funny. Like one title I had was called "Bad Doctors, Good Patients, or Good Doctors, Bad Patients. Another one was "Unmet Expectations and Other Misadventures In Medicine, we see that very frequently in engagement, not just only communication, but maybe in outcomes and procedures. And then this one was kind of my personal favorite, "Hey, What's Up Doc? ...besides my time with you, and, even though we just got started, and I don't have time to talk, and hurry, you got your, you know, hand on the doorknob there." But I think you get the picture. I think the engagement is a part that we need to understand a little bit more what it's about and what we can do from both sides of the exam table to put this together. Now, what's interesting is there are there companies that, that charge, you charge me, a physician thousands or tens of thousands to improve patient engagement. They work with hospital systems, large medical care systems, networks of physicians, to get patients to better engage. And so I maintain if we did a good job with it, we wouldn't need these companies, but patient engagement has been around and it's been a buzzword and buzz phrase for at least 25 of my 30 years of practicing. So this is not new. Not a new problem, and I'm not convinced that we've really come to a good solution just yet. So I think we're probably missing some things. So that's what I want to talk about today. I want to talk about how we can really approach this and understand this better. So here's a quote that surmises what my perception as a physician is, and an opinion of how important I feel patient engagement is to the doctor-patient relationship. And this quote comes from a company called PatientBond, which is a patient engagement strategy company. And they had nine best practices, which I'm not going to list here at this time, but they had nine best practices to get patients to better engage. So here's the quote: "As much energy as healthcare providers put in during a visit in an examination room, or during a long surgery in an operating room, a major contributing factor to a patient's long term well-being is actually determined in their own home." So let's think about that for a minute. You've got all the time set up for the exam room, you've got staff to help bring you back, staff to check you in, staff to prep you for the physician, the physician is there, he's got an assistant to help with what may be needed, such as labs, or imaging, or follow-up, or referrals. So all that energy that's put into that encounter, right, going to the doctor. That's a lot. And then let's look at the surgeon. They've got the surgical know how, they've got the preparation for the surgery. They've met you in the pre-op visit, there probably was a pre-op physical examination, there is the decision about the surgery, the scheduling, if you're having an orthopedic surgery, there could be equipment that has to be brought in such as implants for your knees or hips, so you need to have a rep from the the medical supply place. They're there, they measure, they, they fit the joint, there's the surgical room preparation, this the scrub techs, the, the instruments that are sterilized, the room that is, so there's, get it? There's just so much right? Then the patient shows up having fasted, the patient shows up having known they're going in for a surgery, the patient comes in knowing that they've, you know, not taken their medication, they've not taken their supplements, they've been there on time, they haven't eaten anything, they're ready to go. They're ready for, you know, how long it may take to be in the hospital for their procedure, or what the follow-up is. So there's a lot of preparation. And yet, what this quote is saying is that a major contributing factor to the long term well-being is actually determined in their own home. When we spoke with Dr. Russo, Scott Russo, earlier in our podcast series, he talked about the prehabilitation, the patient getting ready for surgery, and he's a spine surgeon, very good at what he does. And his outcomes were better when there was better prehabilitation. And what prehabilitation defines is really an aspect of patient engagement. So very rarely is there just a linear process to caring for a patient. If they--in an acute situation, an emergent situation, yes. But if there's chronic disease, chronic diagnoses, chronic illness, it's going to be multiple factors, and this is where the engagement really is important to the long-term well-being. And I have to say, I've made continuous assumptions, wrongly, I might add, as a physician, that the patient cares about their outcome, their health, as much as I do. And this was, and still is sometimes, hard for me to understand, because I literally live in a world where I come to the encounter with a patient, open-hearted, open mind, open handed, and ready and willing to listen and engage with the patient. Because I believe if you listen to the patient, they will tell you what's wrong with them. And I've lived by that. I lived by that for over 30 years, and it has never failed me. Have I always been perfect at listening? No, but I think I'm in the very top percentile of, of being a very good and deep listener. And that's why we've had certain levels of success and clarity for, for patients. But what I found is, you know, patients come in, they have their own agenda, they might have their own thoughts. They're there because they have to be there. They're there because their insurance says they have to be there or get a medication refill. And so their level of engagement is where they're showing up, they do whatever the doctor says, which could entail, like we said, taking prescription medications, maybe over-the-counter supplementations, exercise, labs, testing, imaging, maybe seeing a specialist. The doctor knows best, though, and so I'm just going to do what the doctor says. But that's not really engagement. "Well, my doctor said I have to take this tablet for, forever." "Really? Well did the doctor talk to you about the side effects of long-term medication use specifically that, that prescription?" "Well, no, he just said take it and come back in six months." Okay, well, all those things are very common and true in the experience. But how do you engage as a patient when that occurs? Say, "Well, Doc, is this the best choice for me? Is this what I need long term? Are there options for long term care that may not include medication?" So there's ways that you can bring your curiosity, your questions, and it's not seen as questioning the doctor because we actually don't mind questions, and we actually want them because that's part of the engagement. And we'll find that shared decision-making is really at the heart of engagement. But in order to have shared decision making there's shared responsibility. So that means as the patient you have to show up with questions, the physician has to show up with a willingness to provide answers, insight, if they don't know go find the answers. I mean, I've lost count to how many times I've said "Well, gosh, that's a really good question. I don't know, but I will figure it out. Or I'll find someone who does know the answer." So we don't have to know everything as physicians, we have to know how to find things. It does help if we know a lot, though, I'll give you that. But it's important for us to bring that level of engagement. I mean, right now, what we have is a more paternalistic and a Western, which is considered a Western approach to medicine. And honestly, it was one of the draws for me to go into medicine. I could be the boss. I mean, well, I trusted myself, I was showing up 100% for the patients in the situation. I was good at what I did and do. I'm accurate my diagnosis. So why not simply tell folks what to do? It works. This model works, it works well, in a trauma situation, an urgent care situation, where you have quick decision-making. And these decisions, as I mentioned earlier, are linear, and they result in a direct patient outcome. You've got a fractured wrist, you, in your, in an urgent care and they come in holding in a towel, you gently take it out, you splint it, you hold it, you make appropriate referrals, it's just very linear."Well, you know, how do you feel about your fracture?" "Well, right now I can tell you it hurts like hell, Doc, so what do you mean, how do I feel? I feel stupid, I fell off the ladder." Okay, right. Okay, we get all those things, but you get that there's a straightforward outcome there. Versus, "Well, you know, Mrs. Jones, we've got, you know, your cholesterol is still elevated, and your blood pressure is right on the edge, and have you really followed through with the exercises? How can we help you? What if have you brought your exercise logbook? And then I can look at it and see what days of the week you've been able to get out and, and move about? And what type of exercise are you doing?" So that's a different type of engagement, because it requires a different type of communication and involvement of the patient versus just showing up, putting their arm out. So when it comes to chronic care and chronic illness, this paternalistic, direct approach, do what the doctor says, is not the strongest nor the most efficient model of care. Well, why is that? Well, few reasons. Number one, chronic illness has multiple causes and facets. Number two, rarely are the solutions for chronic care, chronic disease model, are they rarely ever linear. And we've discussed that today already. Number three, patients have usually struggled with outcomes, and so they feel left to their own devices. And oftentimes, this is where Dr. Google comes in as a key player. And then many trusted others are considered the consultants or specialists for this, for themselves. So they're at the gym and, you know, get input ideas about a supplement, they get in, you know, ideas about ways to lift weights, to do their exercises. They're in a book club, they're in a--some other type of club and the topic of health comes up and so everybody around the table is an expert, because they're an expert on what they're doing. And so they often feel as if they know more than the doctor. Well, it's interesting that that feeling comes about because that's often a reflection of not being validated as a patient. And so a conversation could go something like, "Well, I know I trust my doctor because he tells me what to do and I do it and everything works." "No, but he or she discusses with me the various treatment options, knowing specifically what my needs are how to personalize my care. And we come to a decision and work on solutions together. And oftentimes, this works really good, and sometimes we have to reevaluate and do different things. But we're working together." That's the engagement. That's the ongoing relationship that we're really looking for. But oftentimes, what patients experience is they're being told what to do, followed by being judged for not doing it, or being judged for not--for being who you are, I mean, seriously, and in who in your--in your circumstance. And you're being judged against well, which is a standardized outcome. That doesn't work well because you're not standard, everybody is unique. So, and in fact, the human being and the human body is not even designed that way. It's not designed to be standardized. We're standard, we're all unique and special. But we aren't standardized. We're standard because we're upright, we breathe oxygen, we have to eat food to live. So there's some level of standardization. But each person's blueprint, their genome is unique. And their ability to engage based upon the understanding of who they are, is what can drive the engagement. So what I'm getting at here, too, is not only is this a communication issue, this is a scientific issue, this is a clinical issue. How do we best engage with the physician with a health care provide, with who we are? That brings all of us to the table? Emotions, the fact that we're spiritual beings, we have feelings, the fact we're having a physical existence, physical symptoms, and then how do we understand clearly what is best for us, based upon our genomic blueprint, based upon the testing and understanding and knowledge we can have going forward to take care of ourselves? So it becomes really, really clear when this is happening. And our bodies respond to forces placed upon them. That's called Wolf's law, and that's actually physics. So for by example, by deciding that you're going to measure something in or on a human body, it changes that outcome, because you've put your intention there. So this is where we get the idea and the concept of the placebo theory. The placebo theory isn't really a theory, it's actually a fact. There's books written about it, there's studies done on it. And you can get anywhere from 30 to 65% improvement in a condition based upon placebo or hyper-placebo effect. And it's where we put our intention, which is our thoughts, which is our showing up, which is our emotions. Physically, we could be there or we could be across town. But the key is that we're still showing up for this with our intention. And lifestyle always is a key component with chronic illness What this is about is a doctor named Martin Ellingham. He's an or disease. And this is not a linear process either. What I MD he's a brilliant London-based surgeon, a vascular surgeon, who consider lifestyle medicine, I consider the patient's genome, I comes beset by the sight of blood--his own, and the blood of patients. And what he realizes is behind that curtain where he's doing the surgery, there's a person. And so you can imagine, as a surgeon, how this interfered with his career. So he departs London and goes to Cornwall, which is in the south of England, which is considered country, country bumpkin-esque, to become a GP, a general practitioner. Now, the British system sets up specialists as in very high regard. General practitioner, is what we would consider primary care here in consider exercise, nutrition status, sleep, job, spiritual America. And there's a big difference between earning potential in England, status, prestige, the whole thing. And to a great extent we have that in America, but maybe not to the same amount. But the change that Dr. Ellingham goes through, this change in status, position, career, leads him to feel that everything he has worked for is maybe slipping away from him. But he's not deterred. He's set to redo his life there in Cornwall, and he remains steadfast in many things, and life, and emotional health. So it stands to reason that the sometimes to the chagrin of people around him, the villagers and sometimes it's--it turns into a very heartwarming outcome for people and also his own experience. He has determined that down in Cornwall he continues to wear his London suits which are very fancy, he drives his Lexus. He is very brusque and very to the point and his brilliance and the brilliance and underlying of this plot is that the people of Cornwall also beset him. Just like the blood did, so do the people, with the villagers, with their seemingly simplistic only way lifestyle medicine would work at that point is lifestyle, their basic needs, and all things medically that Doc Martin firmly feels that should be just simply known about by these folks. So his frequent question to the different villagers here, in, in what's called Portwenn which is the name of the village, is,"Well, what did you do that for? Well, why would you do that? Well, what made you think you should do this?" And that's frequently asked by Doc Martin to his patients. Now, they affectionately call him Doc based upon the extent of the engagement, the acceptance, and Martin, which drives him crazy, because he should be Doctor Ellingham. So that gets under his skin as well. So both the blood and the villagers, as seen as antagonists in this story, and they both are triggers to his behavior. So we've got blood, and villagers, are his nemesis. But in the end, he becomes his own nemesis, because of his behavior, and how his behavior trips him up in various relationships, for sure the doctor-patient relationship, but also different relationships that he has with his relatives, his parents, and with people he comes into contact with. And the participation of the individual patient in while his personality is curt, it's direct, often seen as rude, his heart is pure, his loyalty is long, and his brilliance as a physician and individual is undeniable, because he has just cutting insight into what's going on with a person based upon his knowledge and his ability to highly listen. In relationship to that physician or health care provider. So in short, he's an amazing physician with not-so-good bedside manner. And Doc Martin, he's also affectionately called the tosser, which is what the villagers call him, which I think means like idiot, or, you know, not kind. He tells his patients to frequently be quiet, sit down, get out, stop being an idiot. And in fact, he goes so far that even in season eight, he declares it, the whole village, is really the village idiot. And I don't think you can get much more direct than that. I was fascinated by his behavior. And I get it, it's a our house, we're just finishing watching season 10 of an English story and it's made up. But the medical conditions he treated were, it was very, very accurate, above 90% accuracy and how they described and what they did. But his behavior demonstrated an attachment disorder, he had difficulty making relationships. And here, he had to make relationships as a physician, doctor-patient relationship. And he's probably even on the autism spectrum, having Asperger's Syndrome, even though he's very highly functioning. He's just often flat-out socially awkward. So on the surface, if you only consider his behavior, you would be aghast. You'd be like, series called Doc Martin. And many of you may have heard of seriously, why are we watching this? Why don't why doesn't this guy get this? However, as the series unfolds over the different seasons, we found--find out the reasons for his emotions. We find out the reasons for his emotional outbursts, and even his emotional withholdings. Looming questions are, how did he get to where he is, and how does he go from where he's at? Will he survive? Will Doc Martin change? Will he give up? Will he go back to the city? Will he get over his haemophobia, which is fear of blood? Will he quit being this or watched it. If you haven't seen it, I highly rude even though he is, he's criticized and he is punished by the medical board, and he's brought up on some disciplinary actions relative to his communication style? What's going to happen to Doc Martin? Well, clearly underneath the brusque exterior, there has to be reasons for what's going on, right? But do we pause and recommend it. Truth be told, and some of the early episodes were consider what they are? And do we then in turn, pause and consider the whys in our behavior? Or in the behavior of others we know? And if we're looking at patient engagement with the doctor-patient relationship, and looking at that as a behavior, what do we know underlying some of that? We know that a lot of the things in the doctor-patient relationship, when we look at engagement, might bring the patient to the point of needing to change something because the very reason they got into a situation, or the very thing they want to do in prevention, might require adjustments, a bit triggering for me, until I really saw the brilliance of the change, rethinking, re-approaching. And so deep change is difficult, but it's worth it. And Seth Godin, who's a marketing thought leader, talks about that, and he says everyone wants, or everyone acts always in accordance with their internal narratives. Those are the stories we tell ourselves. We're always acting out from what's internally driving us. And we can't get someone to do something that they don't want to do most of the time. And what people want to do is act, or not writing and the humor in the plots, and its various twists to act, in a way that reinforces their internal narrative or stories. So, I think this is at the heart of the conundrum with patient engagement. And the ability for patients to change, the ability for physicians to revisit things with patients time and time again, to encourage change, to look at readiness for change, to--to increase how they're able to engage with themselves and with the changes they need to make. and turns. Because I think the internal narratives and the stories are Brené Brown talks about in her book, The Atlas of the Heart, the key. again, it's a textbook that I use with my patients all the time, it is mandatory reading when you work with me. Brené Brown explains human emotions and experiences kind of in a cartography or a map type way. And it consists of layers of biology, biography, behavior, and backstory. So what she says is, when we have certain behaviors, and the emotions behind them, are what we've got to look at with these different layers. So if we look at our emotions, and our behaviors based upon our biology, it helps us to understand how emotions show up in our bodies, and why this is this somato-emotional feeling. The somato-emotional release, this is somatic medicine, this is finding the feelings in our body. And this is the heart of mind-body medicine. It's the somatics of our emotions. Then the other one is biography. Our emotions and our behaviors, we need to get curious about our biography, which is how our families and community shape our beliefs about the connection between our feelings, thoughts and behaviors. Where we come from. And then there's the aspect of our behaviors, it's the go-to actions, the words the things we do, don't do. But see that's only a component. So instead of saying, the behaviors driving this, it's emotions are driving the behavior. And I think that's very important. And then the final one is backstory. With our emotions, we recognize the context of which we were feeling or thinking, what brought this on. So if we then put that into the box, or the confinement in the definition of patient engagement, patients who become involved with their care, and play an active role in their treatment and recovery, they can then decide to invest in their wellness. But the extent to their engagement is ultimately up to each patient. And that's driven by their internal narrative that's driven by their story. So I think we might be getting an idea of the complexity of patient engagement, the complexity of the doctor-patient relationship. And when we put it that way, right, Since You Put It That Way, we can see that finding precision, finding clarity, is something that's very important, and coming to decisions together. And this is called shared decision-making, which is a key component of the patient engagement. Shared decision-making, and we put that in our current medical structure, it tends to go against the standard practice that's out there right now. But it provides more patient engagement and can help reduce hospital admissions and achieve greater patient outcomes. Some patients view shared decision making is where Dr. Google comes from. They've engaged with Dr. Google, they've found things online, and that's how they're going to engage. And sometimes, the shared decision-making is there because the doctor or the healthcare provider doesn't have time to listen. So I'll figure this out myself, right? And then there's another one that's "Hey, look, there's a bandwagon and I'll jump on. So going for the light--latest fad trend or whatever smooth shiny object might be there is not always the best way to go. And then one of my personal favorite is, well, that seemed like a good idea at the time. You know, when we're doing shared decision making, we don't really want patients left up to their own devices. And yet, we also don't want to have things that we share and teach and lead in, be disregarded. So there's certainly ways to clean up both sides, and both ends of the communication. And what is frequently lost in that is how easy we physicians make medicine look. I mean, we've had over a decade of training, and yet, it still takes us years to practice, right? So we're still practicing medicine to the day we don't. And that's practicing. So I'm always improving, I'm always getting better. I'm always listening and learning and wanting to do things in a way that helps the patient engage more completely. So, assumptions that we run into, sometimes, with shared decision-making, since that--we assume as physicians that the patient doesn't get it, they aren't going to understand this, they aren't gonna want to do it, or they just won't do it. And so we, we tend to sidestep that. Patients, on the other hand, is like why I'm going to do this, the physician probably doesn't want me to do it, he's doesn't, he or she says, No, don't try these things, I can only take that medicine, and I've got these other thoughts. So I'm not going to communicate that, either. So that whole approach from either side of the table just blows up the relationship. And really, what we're after is we're after clarity, we're after precision, we're after outcomes and solutions for the specific needs of the patients, right? So I'm putting you guys on a quest, I'm on a quest here as a doctor, as I'm building my business here with a virtual medical clinic, and our Cairn Wellness Institute. Now that is an institute where we're rolling out the webinars, that's where the Hero's Genome comes from, that's where the Anxiety Code comes from, that's where our guest presenter, Lynn Swearingen, is with her work on our Energy Field and our Intuition. So that's an institute that's going to be driving education, to see the evolution of patient care. I have no less of a mission to impact the doctor-patient relationship, and make it better, and make it really what it truly can be, which is at the heart of a healing relationship. And that doesn't have to be high-tech, it might include high tech, but it's really intense listening, precision, understanding who the patient is, understanding who the doctor is, and how to bring that together. So here's my pitch as listeners, to you as listeners, that I would like your help in. And I mean this sincerely, I really want to hear from you. My pitch is this--is I'm working on my new clinic here. And the Wellness Institute, the Cairn Wellness Institute. I want to lead patients to engage in their own health and wellness, by using their genomic blueprint, by being precise in their decision making for their health and wellness with clear direction and then the understanding of why. Why did I get here? Why can I prevent this? How can I prevent that? How can I recover from this? So we want the precision in the decision-making to come in. So the patient knows who they are, they aren't guessing, we aren't getting on a bandwagon, we're not following a trend, we're not all jumping into keto, or Atkins or, you know, plant-based, or paleo, or whatever, we're finding out who we are as individuals, we're bringing the knowledge of ourselves and that--into the relationship. So in using that, it's going to lead the way into the--into your own healing, health, and wellness. We can use traditional medicine, but the best is a more integrative holistic approach where you're the hero of your own journey. You're making shared decisions with your physician based upon your choices, your known diagnosis and other elements of your care. So here's, here's a question. I have a series of questions, and I'm going to repeat these a couple times here towards the end of our podcast here. But I would like you to sincerely think of these and I would like you to reply to us. And the way you can reply to us is to use our email and the email is hello@drmarylouder.com. Again, that's hello@drmarylouder.com. So here's the questions for us. And I've answered these myself, because I'm really wanting to dial in on this. And I really, really want to hear from from you guys about this. Okay, number one. What is your experience with your--well, let me say that again. What is your experience with how you currently engage as a patient with your doctor or healthcare provider? What is your current experience, and how you currently engage with your doctor or healthcare provider? You can give me a quick list, you can write a paragraph, you could bullet-point it, doesn't mean--doesn't even need complete sentences.

Okay, the next question is: 36:09

Do you see this engagement as separate or a part of your overall medical care? Meaning how do you understand that engagement?

The third question is: 36:25

How does this engagement with your physician or healthcare provider make you feel? How do you feel about it? What are your feelings? So that's getting into what are your emotions behind your ability to engage or not engage?

The fourth question is: 36:45

What else does this patient engagement impact in your life? This is, does this impact your business, your health, your relationships? How does it impact you?

The fifth question is: 37:01

What is the biggest challenge around your engagement in your doctor-patient relationship or your patient-provider relationship? What challenges you the most in that relationship? It may be one thing, it may be multiple things, and there isn't a right or wrong answer because these are all based on your experience. And it helps me to understand what people are thinking, but more importantly, what people are feeling about that engagement. Okay, the sixth question here is: What would you do to change anything in this engagement?

And the seventh question is: 37:45

If you could change that, how then would you feel?

And then the final question is: 37:54

What else would be possible if you had a good doctor-patient engagement? So the questions are gonna be listed in the podcast transcript, which is posted on our website, drmarylouder.com. And then remember to reply at hello@drmarylouder.com. And we're going to come back in a future podcast to discuss these, we're not going to use names, unless you want us to, but, I mean, rather, it's not going to be personally identify, we might say, Sarah said, but we aren't going to list doctors, we aren't going to list hospitals, so everybody's protected here. That's--that's right. Because I want to hear the good, the bad and the ugly. And it's all out there, believe me. So, dropping this week, as we get into a little bit of housekeeping here on today's podcast. Finally, it's here, the Hero's Genome has launched. And we here at drmarylouder.com and Cairn Wellness Institute are whooping and hooting and having a great time because this is an amazing program that we're rolling out. This is at the heart of the patient engagement and care. Knowing who you are, becoming the hero of your own journey by understanding your genomic blueprint, the follow-up steps for personalized testing and care that really gives precision decision-making about your health and wellness with the understanding of the why. Why did you get here? How did you get here? How do you get through this? How do you get better? Why do you get better? Why haven't things worked for you? So it's precision decision-making about your healthcare with the understanding of why. So, the Hero's Genome is a course, and includes our own--your own genomic testing. And we have an introductory price right now, that's listed on the website, but that's $498. And this includes testing, individualized consultation and recommendations for next steps, and follow-up. And you really only need to complete this testing once because your genome doesn't change, but yet your genome changes you because it is the blueprint. It is what influences your biochemistry, your physiology, dare I say your anatomy, your personality, your genome is a key to your personalized care. And when you sign up, you'll receive your test kit to complete. And then there's four modules that are going to be released to you about a week apart. And then when your test results come back here, review them with myself, and then we make next steps. And this is life-changing, life-altering. And it's a part of medicine in a way I've wanted to do medicine, a way I have done medicine since 2017-2018. So, a few action calls with today's podcast. Send us your thoughts on the questions to hello@drmarylouder.com. And the questions are here, in brief reminder: What is your experience with how you currently engage with your doctor or your health care provider? Do you see this engagement as separate or a part of your overall medical care? How does this engagement make you feel? And how does this engagement impact your life? What's the biggest challenge in this engagement with your doctor or your healthcare provider? What would you do to change anything if you could in the engagement? And if you could change that how would you feel? And what else would become possible if you had a good doctor patient or patient provider engagement? So thanks for being with us on this episode of Since You Put It That Way. The heart of the matter is the doctor-patient relationship and care. Our next podcast is going to be great. It's going to--we're going to be in conversation with Amanda Archibald, who is a registered dietitian who specializes in nutrigenomics. That's nutrition applied to your genomics. She's written this great book called The Genomic Kitchen. And she has a toolbox equipped, ready for you, how to put the genome and the results of your genome to work for the best food choices that support your overall health care and wellness. Not a bandwagon, but a genomic approach. And so I should say, well, that bandwagon you should probably get on, right? And yes, that does seem like a good idea at the time. And yes, that is a good idea at the time to go that way with the genomics. You won't want to miss this conversation. It's really--it's really a good and fun conversation. So get into the course, get into The Hero's Genome, send us your thoughts about the patient engagement, doctor-patient relationship. And oh, the other course that we've got too is Lynn Swearingen's about your Energetic Field, your Intuitive Field, we've had really good response, people that have signed up have had very good feedback with that. So that's available free on our website. Don't forget My Anxiety Code, that's free on the website as a masterclass. So lots of ways, guess what, for you to get engaged. I'm over here winking, you can't see that--get engaged as a listener to improving your health and wellness in your journey. So thanks for listening today and for being a part, we look forward to what you send into us so we can learn from you. And be well and we'll see you next time on Since You Put It That Way. Have a great day.