This Physiatry Day, we're celebrating the superpowers of PM&R physicians, the traits that unite us and showcase the power of PM&R. To celebrate, meet our new superhero, the Rehabilitation Avenger. Their superpowers include powers of healing. They have the ability to improve function and enhance quality of life using their knowledge of anatomy and rehabilitation techniques. Empathy Aura. This superhero radiates an aura of empathy, helping patients feel understood and supported throughout their journeys. Adaptive Technology. Equipped with the state-of-the-art tools that include adaptive devices and equipment, they can customize solutions for each patient, making rehabilitation accessible and effective. Team Leader. The Rehabilitation Avenger can summon and lead a multidisciplinary team of superheroes to tackle complex challenges collaboratively. Chronic Pain Shield. They help shield patients from chronic pain, helping people manage discomfort and regain control of their lives. Inspiration Boost. With the power to inspire resilience and positivity, they motivate patients to overcome obstacles and strive for their rehabilitation goals. Community Advocate. This superhero fights for the rights of individuals with disabilities, ensuring they receive the resources and support they need. The Rehabilitation Avenger embodies the dedication, compassion, and innovative spirit of PM&R physicians, making a real difference in the lives of those they serve. Happy Physiatry Day to all of the Rehabilitation Avengers who power our amazing specialty. Please welcome Program Planning Committee Chair, Dr. Sarah Wong. Good morning, everyone. On behalf of the American Academy of Physical Medicine and Rehabilitation, and as the chair of the Program Planning Committee, I'd like to extend a warm welcome to all of you to the 2024 Annual Assembly. To kick us off, I'd like to give a big thank you to the volunteers on the Program Planning Committee who were relentless in driving us forward. This meeting would not happen without you. Thank you for being an amazing group to work with. I would like all members of the PPC to please rise and wave so that we can thank you. To our class of early career physicians who are using their complimentary Annual Assembly registration that they have earned for maintaining their membership from residency into early practice, thank you for your loyalty to the academy and specialty. Your insights and fresh ideas will continue to help advance PM&R, and we're thrilled to have you as part of our community. We hope you feel welcome and included in this meeting and in our organization. This year's agenda is once again jam-packed. We prioritize and value our commitment to diverse representation in the program. Our volunteer faculty help make this possible. I cannot say thank you enough to our generous faculty who have worked so hard to create educational sessions for us. If you're a session director or faculty member, will you please stand or wave so that we can recognize you? Given the busy schedule this week, it's not humanly possible to participate in every session. That's why all attendees will receive access to the Annual Assembly Rewind on the online learning portal. Until this resource is released in February, you'll continue to have access to sessions on the assembly virtual platform. I'd like to take a moment to recognize industry and our partners. This event simply would not be fiscally possible for the academy if it were not for their educational grants and sponsorships. Their engagement with our specialty enhances the assembly experience and advances our knowledge and the knowledge of our attendees. The exhibitors and institutions provide financial support, but also provide us with valuable opportunities to increase our clinical and practice knowledge. I'd also like to provide special acknowledgement to the 27 Institutional Partners Council participants and six participants of the Industry Relations Council. Thank you for your sustained loyalty and support of our specialty. Please take some time this week to visit our PM&R Pavilion. We have sponsors and organizations that are providing hands-on demonstrations, as well as sponsored lunches and education that will hopefully help you solve some clinical and academic problems you might have in your organizations. This week is all about bringing our PM&R community together, sharing best practices, learning about the latest advancements, and renewing our passion for our amazing specialty. I hope that everyone has an enjoyable time. Thank you for joining us. And now, to introduce our Academy President, Dr. D.J. Kennedy, we have Dr. Michelle Gittler. Good morning, or afternoon. I'm delighted to introduce Dr. D.J. Kennedy. I'm delighted to introduce Dr. D.J. Kennedy, Professor and Chair of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center, where he's been since 2018. D.J. started his professional career at the University of Florida in Gainesville, and it was at that time, in 2010, that I met him when he was serving as a member-at-large at the Medical Education Committee, where I was the chair. As a baby physiatrist, D.J. was passionate about the safety and efficacy of interventional procedures. Being around him was like being around a Labrador puppy. He was full of energy and everything, everywhere, all at once. I recall having a stern discussion with D.J. at one point. We were having one of those escalator discussions at a meeting, and I said, you need to stop traveling so much. He was crisscrossing the world. He would go from Vienna to Orlando, back to Vienna, to Las Vegas, over to New Orleans, down to Melbourne, up to Seoul, over to San Francisco, hop to London, back to Vancouver, quick stop in South Korea, come to Chicago. Then he went to Germany. It was like watching a hockey match, but with just one person shooting the puck back and forth to himself. D.J. has done a number of extraordinary things, including researching and publishing on the safety and efficacy of interventional procedures. He teaches, he lectures, and goes to the extreme of actually taking care of patients. But very quickly I realized it was in more than his area of expertise that he showed extraordinary leadership. I recall recognizing throughout the many committee meetings we attended together that he did not just talk to hear himself speak, but he spent time considering how to add value to the conversation, and that is rare. Here is what I love most about D.J., beside being smitten by his work on the counterpoint articles in the Purple Journal. What I love about D.J. is that he always judges others favorably. It's said that the real way not to speak badly of others is not to think badly about them in the first place. And D.J., that's your superpower. D.J. is kind, self-deprecating, and consistently looking for the good or positive in others. He's always widening the tent door so everyone feels included. And this became evident as he assumed the role of the chair for the new I&E Strategic Coordinating Committee, whose specific charge changed the Academy's focus toward inclusion, diversity, and engagement of our members during a very difficult time. He is a cheerleader for rehabilitation and for us, the physiatrists that practice in our incredibly diverse field. D.J. is always wearing what I will refer to as his pair of judging others favorably glasses. And with those on, we all look really good. As the president of our Academy, he's created a milieu of open thought, a place safe from criticism, and a space where PM&R grows. At this time, I'd like you to help me welcome my friend, D.J. Kennedy, your president of the Academy. And most importantly for Arianna and Amelia, Our father! Thank you, thank you very, very much. That warms my heart more than you can know. Good morning, everyone, and welcome to the 2024 AAPMNR Annual Assembly. It truly warms my heart to see so many of us gathered. We're here united as physiatrists in our shared purpose to provide life-changing care for the patients we serve. Our patients are at the center of everything we do. And as we connect this week, we are focused on a mission that transcends differences and truly improves lives. This sentiment embodies this year's theme, the power of PMNR. It reflects not only the strength of our specialty, but also of our Academy's commitment to supporting each of you, our members, in advancing the field as a whole. In fact, the power of PMNR builds directly on my presidential theme of strengthening the specialty by supporting the physiatrist. It's no secret we're operating in challenging times. Constant reimbursement pressures, increasing administrative demands, burnout, and the encroachment on our roles from other specialties creates a difficult environment for us. So throughout this year, our Academy took a strong stance and has provided the resources, advocacy, and sense of community that we as physiatrists need to thrive to make an impact. Not only did we send members to Capitol Hill to advocate on our behalf, we also rallied together as an Academy to send more than 1,300 letters to members of Congress. The Academy also submitted over 40 comment letters to federal agencies, including CMS, advocating for the policies that benefit us all and the patients we treat. Recently, our advocacy has focused on three critical areas, defending the role of physiatrists against encroachment, fighting for fair reimbursement, and reducing the burdens imposed by prior authorization. Regarding prior authorization, we've seen several wins this year, including new CMS policies from Medicare Advantage plans to improve the speed of reviews. However, our work is not done, and we will continue to advocate on this important issue as we are the stewards of a specialty that uniquely combines science and compassion, and we must safeguard our ability to provide effective, patient-centered care. You can be part of these efforts by visiting our Advocacy Action Center at www.aapmnr.org slash action, or by simply scanning the QR code on the screen. After all, our goal should be to decrease unnecessary administrative burdens, further enhance the doctor-patient relationship, and simply let doctors be doctors. We also understand that the lack of awareness of the essential role PM&R physicians provide in improving healthcare outcomes is a major issue, and the Academy is taking it head-on. Through strategic media engagements, we continue to make significant strides in raising awareness for the value of PM&R early and throughout the care continuum, both nationally and around the globe. In fact, since 2021, we've had over 230 articles published in 120 major outlets showcasing the critical role of PM&R in improving outcomes. This doesn't even include many other prominent examples of the value of PM&R, such as during the recent Summer Olympic Games, where PM&R doctors were not only ubiquitous, but also had major positions of influence. They served crucial roles, including being the chief medical officer for the U.S. Olympics and Paralympic Committee, the team physicians for the gold medal-winning U.S. Women's Gymnastics and U.S. Women's Soccer, among many others. Anyone, and I mean anyone, who suggests a PM&R doctor isn't qualified to serve at the highest level of sports medicine is simply out of touch with reality. Additionally, our advocacy also extends beyond merely raising awareness. Promoting and defining PM&R is not just about increasing the number of physiatrists or enhancing the specialty's reputation. It's about ensuring that patients who can benefit from PM&R have access to our specialized care. It's also about ensuring we share our expertise with the healthcare community through which we can put a stake in the ground regarding the physiatric approach. For example, this year we published our 8th Long COVID Consensus Statement, a Curriculum for Orthobiologics, and a Consensus Guidance Statement for Spasticity, and we have guidelines coming out on the management of patients with cerebral palsy and for platelet-rich plasma injections for knee arthritis. We're here to define PM&R for a broader audience, to show that our work isn't just valuable, but indispensable. Unfortunately, the persistent challenge of physician burnout has cast a long shadow over all of us who dedicate our lives to healing. It is the result of a litany of issues, including the clear loss of autonomy in medical decision-making due to the business of medicine interfering with the doctor-patient relationship. The art and science of medicine, once entrusted to the discernment of trained practitioners, now faces interference from those who wield power without the requisite knowledge, leading to compromised patient outcomes and diminished job satisfaction for providers. We as physicians have weathered this storm while facing a stark reality. We've seen an 11% increase in the Medicare fee schedule for physicians since 2001, while the cost of running a medical practice has risen by 39% in the same time. Thus, over the last two decades, physicians have taken a 28% reduction in take-home pay when accounting for inflation, which has been made up by skyrocketing productivity expectations. So it should not be surprising that burnout is rampant in the setting of these ever-growing demands on our time and expertise. Addressing the burnout epidemic necessitates a comprehensive reevaluation of the health care system. Reinvesting in fair compensation structures, streamlining administrative processes with wins such as CMS prior authorization policy changes, and restoring autonomy to medical professionals are essential steps in mitigating this multifaceted crisis. Finally, by acknowledging and rectifying these root causes, can we help to preserve the well-being of our physicians, ensuring that they can continue to provide the high-quality care that patients deserve? Amid this myriad of issues, the Academy recognizes the unique challenges faced by physiatrists and is our unwavering voice for positioning us as essential leaders in health care. The AAPMNR not only supports a physiatrist, but strengthens a specialty, fostering a diverse environment that ensures that every member of our community feels included, valued, respected, and where physician satisfaction is not merely an afterthought, but a central focus in the pursuit of healing and well-being. By nurturing the satisfaction of doctors, we can foster a health care system that thrives on the passion and dedication of those who dedicate their lives to healing. The time for change is now, for the sake of both those who heal and those who are healed. On this important issue, I am proud to say we are not just moving forward. We are building momentum. This year, we launched new programs to support members in all different stages of practice types, from PGY-2 residents to medical directors, from sports medicine to spasticity. Our plans for next year include supporting all members, from medical students to seasoned practitioners. No matter your career stage, practice region, or background, you have a community and home in the AAPMNR. None of this can be done without you, and the Academy's work is a testament to each of you and the power of the specialty when we come together as a unified voice. Thank you to our over 600 volunteers. Thank you to our speakers and every single attendee and member for your unwavering dedication to our patients, our specialty, and our community. You are the heart and soul of this Academy, and this Assembly is for you. We have designed a meeting that empowers you with the best in education, which is the heartbeat of this Assembly. This week, we're bringing you unparalleled learning opportunities, from six advanced clinical focus areas to hands-on skills labs and pre-conference courses. These sessions are designed to help you stay at the forefront of PMNR so you can strengthen your skills, expand your knowledge, and enhance the care you provide. Our plenary speakers, including Dr. Glockham Fleckham and the popular PhysTalks, are here to share insights that challenge and will inspire us. Whether you're attending one of the 40 livestream sessions, engaging in a skills lab, or networking in the PMNR Pavilion, these opportunities are crafted with you in mind to further enrich your practice and, in turn, fortify the specialty as a whole. Another way we support each other is by connecting, sharing, and growing together. I am thrilled to say that this year's assembly has brought together more attendees than ever before. A record-breaking gathering of PM&R physicians united in purpose. In fact, this is the largest gathering of PM&R doctors in history. With nearly 4,000 attendees and 32 member community meetups, we're building lasting networks and forging connections that strengthen us individually and as a specialty. This community is our strength, and it's where we find the understanding, camaraderie, and support that helps us continue forward in challenging times. As we celebrate the power of PM&R, let's take a moment to recognize the achievements, our resilience, and the dedication we all share. We're here to acknowledge how far we've come together and the challenges we continue to meet with courage and resolve. This is a celebration of our specialty and the friendships that sustain us. As we embark on this assembly, let us also remember that the theme, the power of PM&R, is more than just a catchphrase. The power of PM&R is not only about the impact of a specialty, it is about each of you. It is the essence of who we are, what we do, and the legacy we are building together. Let's make these days memorable. Let's learn, connect, and take on the future of PM&R with purpose and resolve. Before concluding and introducing our esteemed plenary speaker, who I know is the real reason the room is packed, I do want to take a moment to express my deepest gratitude for the opportunity to serve as your president. This role has been the privilege of a lifetime, and I will be forever grateful. To my mentors and teachers, thank you for your invaluable guidance and support on this journey. I would not be here without you. To my co-residents and fellow trainees, you've consistently shown me that I chose the best profession, and your camaraderie has meant the world. To my colleagues, past and present, your support and friendship have been essential in every step of this role. And to my trainees, you are an ongoing inspiration. It has been an honor to play a part in your growth. To my lifelong friends in the Academy, thank you for making this journey so rewarding and helping me find a true professional home. To the incredible AAPMNR staff, thank you for your dedication and tireless efforts that make it all possible. To our past Academy presidents, thank you. You have taught me so much about leadership, and I am sincerely grateful for each of you. Please stand if you are able, and everyone, please join me in a round of applause. Thank you. To our outgoing class of Academy future leaders who began their journey with us in 2022, thank you for your commitment and your desire to learn and grow. Please stand and be recognized. Thank you. And finally, on a very personal note, to my family, to my in-laws, Pam and Sam, to my parents who couldn't be here, thank you for all you do in laying the foundation of a lifelong loving environment. To my wife, Lindsey, and to my two daughters, Ariana and Amelia, who you can see control my life in a wonderful way, you've been incredibly supportive, tolerating the frequent late nights, early mornings, weekend work and travel. You are the joy of my life, and coming home to your hugs is the highlight of every day. Without you, I would be lost, and I love you more than the world. I love you. Surprised I got through that without choking up too much. All right, so now, it is my absolute distinct pleasure to introduce our plenary speaker, someone many of you who will already be already be aware of, Dr. Will Flannery, aka Dr. Glaucon Fleckham. He has captivated audiences with thoughtful takes on the medical world through social media, where he uses wit to highlight the challenges, triumphs, and humanity in healthcare. As an ophthalmologist, he has become a voice for wellness, resilience, and the realities of a modern medical practice, sparking important conversations across specialties. Please see the brief video as an example. Knock, knock, hi, I'm the new med student. Oh, oh, you're a med student, okay. Uh-huh, very funny, you got me. No, really, I'm a med student. What? We don't get med students. Welcome, come in, what made you want to do this rotation? Well, I've always been interested in mental health. Okay, I get it. You know I'm a physiatrist, right? Not a psychiatrist. This is a PM&R rotation. Yeah, I know, okay. What interests you about PM&R? The P? What does the P stand for? Protein? Protein, you think I practice protein medicine. Hey, doc, I have a bag of thank you notes from your patients, do you want me to bring it in? Yeah, put it with the others. By the way, it's physical medicine and rehabilitation and patients love us. All right. So with that, please join me in welcoming Dr. Flannery to the stage. Thank you. Thank you. Appreciate it. Wow, that was a presidential address right there. Is it too late for me to become a physiatrist? Can I do it without going to residency again? I just don't want to do that. I'm a physician. This is my first PM&R conference, event, anything. Yes. And it just so happens to also be the first time I've ever seen an accessible stage at a conference. Well done. Yeah, right? Not only that, but it feels like you're boarding a cruise ship when you're walking up it. So that video, I'm so glad you played that because that was about three years ago when I made that video about PM&R. And I'm pretty sure I made it because so many of you were hounding me to make a video about PM&R. And so, you know, I did a little research and made that. And then I, since then, it's been about three years, I don't think I've learned anything new about PM&R. But I knew I was coming here to talk with all of you. And you've been so gracious and generous with bringing me and letting me be up here and talking to you that I was like, you know what, this is a big thing. This is a big event. Let's make another video. And so I spent, I did painstaking research. I spent the better part of an hour learning as much as I could about your specialty. And I have this series of videos that I've made, which is how to ace your residency interview. So I've done all the different specialties, pretty much almost all of them except PM&R. So I did it. I made a video, how to ace your PM&R residency interview. Now I'm debuting this, no one's seen this. You're literally the first people to see this video. It's not on social media. Don't clap yet. I'm a little, I don't normally do this. A little bit nervous. Let's see how, I just, I have to assume this is what it's like when you interview for a PM&R residency. So why are you interested in physical medicine and rehabilitation? Working to improve patient function and quality of life. Nothing could make me happier. You should know it's not all rainbows and sunshine over here. What do you mean? Most days I'm extremely happy with my job, but there are some days when I'm just a little bit happy. What's your biggest weakness? Adductor tone. What's your biggest strength? I drive slower than an 80-year-old grandmother. Well, of course, what better way to avoid a TBI or an SCI? What's your favorite phase of gait? Terminal stance. Heel off. Bold choice. You know, you strike me as a swing phase man. I do love a good swing phase. I knew it. You have a post-stroke patient with spasticity. Do you inject the soleus or the gastrocnemius? Neither. Posterior tibialis. Goodness. I'm gonna have to keep my eye on you. Hey, I gotta keep you on your toes, right? And risk Achilles tendinitis? No. Flat foot and wearing shoes with a supportive arch and plenty of traction. Thank you very much. Okay. Last question. What do you think overnight call looks like for a PM and an R resident? I'll sleep in my own bed at a reasonable hour, get woken up at 1 a.m. for a Tylenol morning, go back to sleep until morning. That's correct. I don't know. It gets better as the day goes on. Thank you. Thank you. So that'll be going up on social media probably later today so you can share it with everybody to give them a perfectly accurate depiction of what it's like in PM and R. All right, so today I'm gonna tell you a story about my life. I'm gonna tell you about some of the things I've been through, the challenges I've faced, and what those challenges have taught me about humor, medicine, the healthcare system, advocacy. But before we get to all the more serious stuff, I brought some questions that I usually get asked. So we're gonna have a little bit of time for Q and A at the end, but I brought some of the most frequently asked questions that I get as an internet comedian ophthalmologist. So I thought we'd just get these out of the way real quick. All right, so the first question I get asked a lot on social media, are you a real doctor? It's fair to ask this question because imagine you open up TikTok, the first thing you see is the neurologist. Or the psychiatrist, the emergency physician, or God forbid, the nephrologist. Fair to question my medical credentials, I would say, showing up like this on social media. The truth is obviously, yes, I'm a real doctor, technically. I just think there are other physicians who are just like more of a physician than me. This is an academic conference, so I brought data to show you. All right. Okay, so. So I got a lot smarter during med school and intern year. That last day of my intern year, that was the smartest I've ever been. Then I got to leave the hospital, begin my career in ophthalmology, and just forget everything I had just learned. And now, like I can tell you all about visual folks And now, like I can tell you all about visual photo transduction, how many photoreceptors are on your retina, but what does the spleen do? I don't know. Unless the spleen develops a cataract, I don't really care. So then I get asked, okay, really? Like you're an ophthalmologist? Except these are questions being written to me in the comment section on social media. So it's more like, wait, you're an ophthalmologist? It surprises people. They're not sure what type of doctor I am because I play all these doctors on social media. And then the question I get asked is, well, why? That's a weird specialty. Like you devote your career to like, you'd learn everything about the human body and then just eyeballs? Your whole career? Well, I find origin stories kind of fascinating. So let me tell you why I chose ophthalmology. You guys know, you watch my skits, you know I love making fun of surgeons. They're the low-hanging fruit of medical comedy. All of you, once a day, make fun of a surgeon, okay? It's wellness. But as hard as I am on surgeons, I do have to hand it to the vascular surgeons. It's because of them that I chose ophthalmology as a career. So my first clinical rotation in med school was vascular surgery. I had to do eight consecutive weeks on that service. And let me just remind you what this was like, because I'm sure all of you probably remember some parts of your surgery rotations in med school. I had to wake up at 4 a.m. every day, already crying. That ever happen to you, right? You just like, you just know it's gonna be a bad day and your body just prepares itself accordingly. Then you go and pre-round. I had pre-round all my patients, which as we know is another term for wasting time. Then we round with the whole team. And at the end of that first week on the service, I'm just trying to survive. End of that first week, the chief resident pulls me aside and says, Will, we really need you to be hitting the automatic door buttons earlier on rounds. She said, it's vitally important the surgery team not have to slow down as we progress through the hospital. If we have to slow down to open the doors ourselves, people will die. I'm paraphrasing, that's basically what she's saying. And I just didn't know this was a core competency of this rotation. It's news to me. But I was a good med student, so I said, yes, of course, I'll time it perfectly. But those interactions stick with you, so much so that 15 years later, I made a TikTok about it. I got honors, by the way. So the thing is, I loved surgery, but I hated that rotation. And at the end of that rotation, the last day, I was standing in the operating room. These are long surgeries, vascular surgeries, like five, six-hour surgeries. And as a med student, 90% of the job is just... Except you gotta look like you're having a good time, so it's... And I'm wearing 20 pounds of lead, my back hurts, my legs hurt, and I'm thinking, there has to be a better way to do surgery than this. This can't be all there is. Then I left that rotation, immediately started a two-week elective in ophthalmology, and the first day, I walked into the operating room, somebody offers me a stool to sit on. And that was it, I chose ophthalmology. There's three questions you have to ask, three questions you have to ask yourself to know if you should be an ophthalmologist. Do you like surgery? Do you like eyeballs? Do you like to sit down? If you don't believe me, Google image search ophthalmologist unit, you're gonna find 40,000 photos of people sitting down. Look at that, three ophthalmologists, all sitting around one eyeball. So people find out I'm an ophthalmologist, a question I get a lot is, okay, well, how do you know so much about all these different areas of medicine to make all these videos? And well, let me let you in on a secret, I don't. I'm faking it. Let me remind you about this graph here, okay? This is, let me blow this part up. This is where I am now in my career, that area under the graph, that's all the medical knowledge I use to make all these videos. That area under the graph, that's all the medical knowledge I use in my skits. And so the last question that I've been getting asked a lot over the past year or so, what do you have against UnitedHealthcare? Yeah, okay. Well, to answer that, we gotta go back in time a little bit. So I grew up in Houston, Texas. I, yeah, and I started doing standup comedy pretty early, I was 17. This was the Laugh Stop in Houston, very famous comedy club, unfortunately, it's no longer around. But me and my friend, we'd go up to the window there by the door, we'd put our names on a list, then we'd walk around the corner and smoke weed. And we loved it. I loved the comedy. I loved the comedy. I was pretty much hooked immediately. I just, I love making people laugh. And I had some talent for it. And I had a decision to make. Do I try to make it in standup comedy? But I just remember seeing all these people in their 30s, 40s, 50s, or older, still trying to make it as a standup comic. I remember thinking, this seems really hard. So I just went the much easier route of becoming a doctor. So I met my wife in college. This is us at Texas Tech University. And we graduated and went on to Dartmouth. This is us at my white coat ceremony at Dartmouth. Only reason I show you this is to point out the most beautiful part of it, my hair. And I was still doing comedy in med school. Like up through college, in the first couple years of med school, I was still doing standup. It was just my hobby. I just, I loved doing it. And then I got away from it. Because life got busy. I was getting into clinical rotations. We got married. We had our first baby. Life was busy. And then toward the end of my third year of med school, I woke up one morning and I found a lump in my testicle. And I was top of my class in med school. I knew my testicle was not supposed to grow another testicle. I knew that. And so I went in and got checked out. And it took about 10 seconds to diagnose me with testicular cancer. And as we all know, if you catch testicular cancer early enough, it's imminently treatable, right? And mine was. I caught it early. All I had to have was an orchiectomy and surgery to remove the testicle. And then so physically, I was able to get my testicle out of the way. And I was able to get my testicle out of the way. And I was able to get my testicle out of the way. And then so physically, I was fine. A little off balance, but I was fine. But like mentally, emotionally, this was a huge deal for me. Because I was 26. I've been healthy all my life. All of a sudden I had this disease I associate with people who are three times my age. Yeah, I'm sitting in oncology waiting rooms. I'd look around and see people in their 60s, 70s. Nobody that looks like me. I didn't even have a smartphone to keep myself company. It was just AARP Magazine everywhere. It's a very isolating, very lonely experience to go through the healthcare system as a young adult. Especially in oncology, all the attention is paid to kids and older adults. You get this huge group of people in the middle. It's probably not just oncology too. It's probably so many areas of medicine. And so it's just very lonely, very isolating. And I had to deal with that, really the only way that I knew how at that point in my life, by telling jokes. So all of a sudden I felt the urge to start writing material again. Get out there and perform. So I was writing jokes about my experience as a cancer patient. Also about my experience as a med student. It was like Krebs cycle jokes. It never went well. And I'd take these jokes to comedy clubs in rural Vermont on a Tuesday at midnight telling jokes to an audience of three people and two of them were drunk. The third one was my wife. But it helped. It taught me the value of humor as a coping mechanism. Something that I still use a lot to this day as you can tell from my content. Because when things happen in life that are beyond our control, you get sick, family member gets sick, pandemic hits, you get your dream job but they use UnitedHealthcare insurance. You know, control of your own life you feel is taken away from you. And what comedy does, what humor does allows you to take that thing whatever it is and you make it yours again, right? You add jokes to it. You present it to others. You share a laugh about it, but it's now on your terms. That's why it's such a powerful coping mechanism. Why so many people in health care have wonderful senses of humor because you kind of have to. And it helped me. I graduated med school. I was cancer-free. I moved on to residency at the University of Iowa. Any Hawkeyes here? I loved Iowa. I mean, how can you not love a place with a state fair featuring a cow made entirely out of butter? Wonderful place. And things were going well. We had our second kid, and then four years after that initial cancer diagnosis, I woke up, now a senior resident. I found a lump in my other testicle. I learned two things that day. Number one, I was part of the less than 1% of people with a primary testicular cancer who get a primary in the second testicle. Extraordinarily rare. And number two, I am really good at finding my own testicular cancer. I could make a second career out of this. It'd be a weird thing to do as an ophthalmologist. I understand that. But it is all just balls. So in a way, it kind of makes sense. But this second time was much more devastating because now I had to face the prospect of losing my other testicle. And so what's that recovery going to be like? What about hormone replacement therapy? How much is that going to cost? Do I have to postpone residency graduation? What about our family? We had two kids at that point. Were we done? Do I need to bank sperm? And I did end up banking sperm. And can I just give you a little tip? If you ever find yourself in a situation where you need to bank sperm, take the day off from work. Trust me on this, okay? It's just, the eye clinic was connected to the rest of the hospital, and so I like, I was a resident, I was like, I can't take time off for cancer. No, gotta keep working. And so I left morning clinic, I walked two departments down the hall, bank sperm, then went back to work. It throws your day off. It really does. Then there's the whole process. See, medicine when you're on the patient side, it puts you in these situations you never thought you'd be in. And like, I didn't know, when I went down there to do this, I did not know what to expect. You know, was it like a hospital bathroom? Was it like a little closet? I think at the VA, it's just the waiting room. I don't know. I don't know. I don't know. They made me very comfortable though. Anyway, so I did all that, had my second orchiectomy, and now riding a bike has never been more comfortable. But once again, I was looking for something to make me feel better, because at this point I was, I was down. I was really, it was a low point in my life. I was like, cancer again. When is this gonna end? And I couldn't exactly do stand-up comedy at this point, because I was in Iowa, which is not exactly a stand-up comedy hotbed. So I turned to social media. I started a Twitter account that I called Dr. Glockenflecken, and then I proceeded to tell painfully specific ophthalmology jokes to an audience of about six people. And I very quickly realized if I wanted to actually gain an audience, I had to like expand to other areas of medicine, and I did. I started to build a following. It was a lot of fun. Finished residency, went on to Portland, Oregon, where I began my career as a private practice ophthalmologist and learned all about the joys of private practice ophthalmologists, including working with a medical scribe for the first time. Amazing. People ask me, is Jonathan real? Jonathan, my loyal scribe. You guys like Jonathan? Yes. Yeah, he's great. He's great. I do have a medical scribe. His name is not Jonathan, but I will tell you about my favorite email I've ever received was from somebody. This is all it said. It said, Dr. G, I'm a medical scribe. My name is Jonathan. You have changed my life. Did not specify in which way it had been changed. Have to assume it was positive. But things were going well until the pandemic hit, and I found myself with a lot of extra free time on my hands. That's what this is. I had free time. What do you do during a respiratory pandemic? I dressed myself up as a clown and made videos. And our practice shut down. It was a terrible time. I had to do virtual ophthalmology, which is as fun as it sounds. There were a couple of times there at the beginning of the pandemic when I thought I might get redeployed to the hospital to help. Let's think about that for a second. Do you have any idea how bad a public health emergency has to be for critical care physicians to be like, let me get some ophthalmologists up here? Real bad. Real bad. No, so I didn't. So I ended up just filling that time with something that I thought was just as fun as it was for me to do. Real bad. Real bad. No, so I didn't. So I ended up just filling that time with something that I thought was just as important as saving lives during a respiratory pandemic, making TikToks. And so, you know, lockdown was going on. And then Mother's Day 2020. Now, four years after my second cancer diagnosis, I woke up and found a lump in my third testicle. No, I'm just kidding. It's my last testicle joke. I promise. That's it. No, we had that day. We had a wonderful day. We had a big, you know, family party in the backyard. We had water balloons. I was the kid's target with the water balloon fight. These were almost the last photos that were ever taken of me. Because later that night, I, at about 4.50 in the morning, my wife woke up to the sound of me gasping for breath. And she didn't know what was going on. She's not in medicine. But she knew something didn't sound right. My color didn't look right. She thought at first I was snoring, tried to get me to wake up. But she wasn't able to get me to wake up because I wasn't snoring. I was having a cardiac arrest in my sleep. And so she called 911. The dispatcher very calmly walked her through how to do chest compressions right there on the bed. I weigh like 100 pounds more than her. She couldn't move me. And then she did 10 consecutive minutes of high quality chest compressions to save my life. 10 minutes. Now, I'm an ophthalmologist. Yeah. I'm an ophthalmologist, but even I know that's a long time for chest compressions. And people always ask, what took so long? Well, this was the height of COVID. We had, it was chaos. We had no idea what was going on. So all those first responders, the paramedics, they had to put on like three layers of gear to protect themselves before they eventually busted through my back door. Never been so happy to have structural damage to my house, by the way. Came upstairs. They brought me downstairs. They shocked me five times. Gave me a bunch of medications. Not sure what they were. I'm an ophthalmologist. Eventually got a sinus rhythm back and whisked me off to the hospital where I was pretty much immediately admitted to the ICU and sedated. I was already sedated, but they they cooled my brain down, which is again as like specific as I'm probably going to be able to get accurately. Targeted hypothermia treatment. That's what it is. For 24 hours. And they just waited. And it was the longest 24 hours of my wife's life. Which is why whenever I tell this story, I always talk about the co-survivors of medical trauma. As physicians, we are so focused on the patient because we have to be, right? That's our job. But I encourage all of you to not forget about the ripple effects that medical trauma, medical events, hospitalizations have on the people around that patient. Because it is significant. I went to bed one night. I woke up in the ICU two days later. I didn't have any underwear on. I didn't know what the hell was going on. My wife lived through every single second. And we're asking people, the public, to learn how to do CPR. That's a traumatic thing to do. That's not. It's easy for us to say because we've all done it. But to ask someone in the public to do something like that, to try to save a life, usually it's a loved one's life. It's up to us to provide support for people. And sometimes it doesn't take much. How you doing? Can I get you anything? Do you need to talk to somebody? That's all it takes. Just to show the people around the patient, we see you. We recognize what you just went through, what you're going through with your loved one. It makes a difference. It makes a difference with how people perceive the healthcare system, how people perceive physicians and the rest of the medical team. As grateful as I am for the people that took care of me because I got excellent care, I'm just as grateful for these people that showed my wife compassion along the way. The first photo is the dispatcher, Lisa, who is instrumental in saving my life, walked her through, counted one, two, three, as she was doing chest compressions. The paramedic there in the middle is Lieutenant Greg. He was going up and down the stairs in our house, updating Kristen, letting her know what was happening next, where they were taking me, who she could call, you know, just facilitating things with her. And then my ICU nurse, Roger. He's the first person I remember after waking up in the ICU. He was asking me questions about my life, but also facilitating phone calls with Kristen because, again, COVID. It was all FaceTime. They couldn't be there in the hospital with me. He was also the first person throughout the cancer diagnoses, the cardiac arrest, the first person to ever ask Kristen how she was doing. Very grateful for him. So anyway, I have all this testing done. Again, my brain's like on ice. I don't know, whatever it is. And they do all this testing, and everything looks good. You know, my brain looks okay. Everything's structurally intact, and to this day, we still don't know why I had a cardiac arrest. I've had every test in the world, and we still don't know. Genetic testing, who knows? Which is not unusual for young adults who have an out-of-hospital cardiac arrest. It's if you survive, which is about a 10% chance, then often you don't get a great explanation for why it happened. But I remember one of my first memories is waking up in the ICU. I'm sitting on the edge of my bed, and someone comes in and hands me a box, and I open up the box, and I see a picture of this guy right here. You guys know what this is, right? Yeah, it's a life vest. This is an external wearable defibrillator. It's an electric bra, everyone. Now, normally someone like me has an out-of-hospital cardiac arrest, they just get a defibrillator before they ever go home. But because of COVID, all of that surgery got shut down. So I had to wear this thing for like three weeks before I could get my surgery for my defibrillator, and don't get me wrong, the man looks great. For an electric bra model, amazing, but he's also 85 years old. And I'm sitting there as a 34-year-old thinking, well, this isn't supposed to happen to me. Just another one of those gut punches you get as a young person having medical problems in the health care system. But I was a good patient. I faithfully wore my electric bra, and now I know how amazing it feels to take a bra off at the end of a long day. Incredible. Incredible. See, the other piece of discharge instructions I was given before I left the hospital was that I wasn't allowed to drive for six months, which I thought was kind of curious because I was allowed to do eye surgery. So, I don't know. Still trying to figure that one out. Still trying to figure that one out. But it left us with a bit of a problem to figure out because I needed to go back to work eventually, but I couldn't drive myself to work. So, you know who came to the rescue? My mom. She came to live with us for six months, which put us into very interesting situations. Yeah. Yeah. It was awesome. It was amazing. Oh, man. But, you know, people think that when you come home from something like this, like that's the end of the story. I mean, actually, you all are, if there's anybody that understands that's not the end of the story, just surviving, it's you all. Because there's so much more to recovery from something like this. And after I got home and finally got to hug my family again, see my wife and kids, that was when the real work of recovery began. We had a lot of challenges that we did not expect to go through, that we had to go through. You know, there was a lot of fear. I was afraid of being alone. I never would have come to a thing like this because I have to stay in a hotel room by myself. I was terrified of being alone where someone couldn't see me at all times. And that lasted for months. I would wake up in the middle of the night to find Kristen checking to make sure I was breathing, checking to make sure the kids were still breathing. I had this thing I'd never experienced before, empathy fatigue, where when I went back, like the first couple weeks, I found myself getting angry with patients coming in and having complaints of dry eye, thinking, how dare you? How could you possibly complain about this? Do you know what I went through? Like that was going on in my head, which is a scary thing to feel and think as a physician, right? It scared me. That lasted for a while. I had to deal with that. And then I had to go get my ICD placed. I had to go back to the same hospital I was admitted. And I remember sitting in pre-op, waiting for my surgery. And it was in that moment that the surgeon walks in and sits down. That's when you know things are about to get real, when your surgeon sits down in pre-op. And he says, Will, when we put your defibrillator in, we have to make sure it works. I was like, what does that mean? He said, we have to stop your heart to make sure that it fires appropriately. And I lost it. I have never been more scared in my life. I was like, do you have any idea how hard my wife just worked to get this thing going again? And you're going to do this. I was crying. I was a mess. Got through the consent. And then they were wielding me into the operating room. And I go through the doors and tears streaming down my face. And it was right then that the anesthesiologist looks at me and he says, Are you nervous? Yeah, a little bit. But I guess the defibrillator works because I'm still here, right? And then the biggest challenge we faced, honestly, what came a few weeks after that, because that's when the medical bill started coming in. If you've had a major medical event, you know it's never just one bill. That would be way too convenient for our health care system. It's like 30 bills. They come from different people, different places. Sometimes it's an explanation of benefits, but it kind of looks like a bill. But they say it's not a bill. I think it's actually a bill. It was confusing for me. And I'm a physician. They really drove home just how bad it is for people who have no experience in the health care system, our patients who have never experienced something like this, who are supposed to be recovering from some major illness, except no, we're also making you navigate this. It's terrible. And as I got all my bills together, I realized there's about $20,000 in medical charges that my insurance company was refusing to pay for. I knew that wasn't right. And the reason that this happened was because I made a mistake. I forgot to check that my doctors were in network before my cardiac arrest. That's on me. See, the ambulance took me to an in-network hospital, but the doctors in the hospital were out of network. There's a toll-free number on the back of your insurance card. Like, you've got to check. You've got to call you guys before you have something suddenly die or something. So it was a nine-month battle to try to rectify this and get them to pay what they're supposed to pay. And that experience changed my comedy. It was around that time I started making all these videos about the US military. And I started making videos about the US health care system that you guys have seen. Yeah, thank you. And so I'm going to play you probably, I think this is the first health care-related, health care system-related video that I made. And then we're going to talk about the response. Hey, man, how's it going? I had to do prior authorizations all afternoon. What are prior authorizations? Well, if a patient needs an expensive test or treatment, we have to ask the insurance before we do it. Why? You're the patient's doctor. Well, they want to make sure I'm ordering something the patient actually needs. Oh, so you're talking to another doctor that has your level of expertise? No, usually the person didn't go to med school. So they can say the patient can't get the treatment that you, their doctor, recommend? Yeah. So these insurance companies are practicing medicine without a medical license? Well, no, I'm making the medical decisions. Are you, though? Well, yeah. If insurance denies it, then the patient won't get the treatment, which means they won't get better. Well, maybe. Or the patient will get the treatment anyway, but be financially devastated by it. Yeah. Which could lead to even more mental and physical health problems that don't get treated. Yeah. Either way, the insurance company is making medical decisions that directly impact the health of a patient. Yeah. Which is also known as practicing medicine. Right? So I put that out there really just to express my own frustration, right? I was just venting. This is what I've been doing all my life. And just that's how I've tried to cope with all of this. I didn't really think much of it. I didn't know who would care about this. But the response I got from that video was incredible. I had millions of views. But what was interesting was the comments. On TikTok alone, over 30,000 comments on that video. It was like I opened up the floodgates. And all of a sudden, everybody had a place to go to vent their anger and frustration about the US health care system. It just so happened to be my TikTok comment section. And I realized, OK, I have something here. So I kept doing it. And every time I would make a new video about the health care system, I did a 30-day series. Every day, I posted a video about the US health care system. From everything from physician-owned hospitals to deductibles. And just trying to break it down. Explaining what PBMs are. All these things. All these subjects that are obfuscated from the public. People don't understand or know what some of these things are. And every time I'd post a video like this, the response was unbelievable. Just people commenting, talking about all the terrible things that have happened to them. It showed me the value of social media when it comes to advocacy. Because advocacy, there's two real big parts to it. One, you've got to know that there's a problem. And clearly, based on the reaction to these videos, the public knows there's a problem. There's something fundamentally wrong with the health care system. But then the second part is you've got to know what that problem is. There's an education piece to it. And that's where all of us can come in. Because we have the knowledge. We know what the pain points are in health care. We know what's making our lives miserable. And by extension, the lives of our patients miserable. But the general public doesn't really know because our healthcare system is so complicated. And so, education is such a vital, important part of advocacy. You don't have to know the answers. I don't know, we could try to figure out how to fix healthcare today if you want. We can lock the doors and just all hash it out. I don't know if we have time, but we don't have to know the answers. But we can tell people what the problems are. Because if people, if the public doesn't know what the problems are and why things are the way they are, who are they gonna blame? Us. They're gonna blame physicians. And they do. Because we're the face of healthcare. That's who they see. So of course, who are they gonna blame? They're gonna blame us, the greedy doctors. And so, you don't have to have a huge platform. You don't have to have millions of followers. It could just be the people in your community on Facebook. But talking about prior authorizations, talking about the challenges that you're facing can have a huge impact on somebody that has no idea what a pharmacy benefit manager is. Or why their prescription prices are what they are. We can do that. We can educate. Huge part of advocacy. Do not underestimate it. I don't remember why I have this in here. I don't know, I just like it. Maybe that's one of those. Anyway, so I want to leave you with an example of social media advocacy that's been successful. Because I can feel the skepticism. Like, okay, these are billion dollar corporations. How much can we really fight against them? So I'm gonna take you back to 2022. Aetna, the company that I'm gonna talk about, in 2022, Aetna did a thing. Because all these companies, you guys, they're always doing things. Always got something going on. So what they decided to do was require prior authorizations for every single cataract surgery. Do you know who gets cataracts? Everybody. So when they started doing this, this was a huge deal. Massive administrative burden, which delayed surgeries and caused all these problems. Obviously, this was affecting me and my patients as well. So I was like, I gotta make a video about this. So I put this video out there. Hold on. Hey, Timothy. Yeah, boss, what's up? Why are we spending so much money on cataract surgery? It's a really common surgery. Can we not do that? Can we not cover cataract surgery? Yeah. No. People need to be able to see. Well, can we do that thing where we get to practice medicine without a medical license? Prior authorizations? Yeah, yeah. What if we require prior authorizations for every cataract surgery? Do you have any idea how many cataract surgeries there are every year? I don't know, like 100? Four million. This would be a huge burden on patients and doctors. Come on, doctors won't care. You're forcing eye doctors to ask a room full of business majors for permission to do eye surgery. I think they'll care. We have to do this. Why? Look, I don't want to alarm you, but I went through our finances. We only made eight billion in profit last year. Okay. So I was thinking, if we can just delay all the cataract surgeries for a few months, we can hold on to all the patient premiums and make more money. Can we just, for one day, not be evil? Jimothy, you knew what you signed up for when you started working here. Not evil. It's literally our mission statement, see? What happens when we keep denying cataract surgery for an 80-year-old? She can't see, she trips, falls, breaks her hip, now we're paying for hip surgery and cataract surgery. Oh, that's actually a good point. Thank you. We need to require prior authorization. That's literally how they think with these things, right? Thank you. Surprisingly, I have not received any kind of cease and desist. These insurance companies have not come after me even though I used their logo and literally called them evil. I think comedy helps me, helps protect me, but I put that out there, and again, just kind of trying to do my own part of educating people on why their cataract surgeries are being delayed, and then a couple weeks later, I got a response. I got a message from somebody. I'll just read it. The company's CMO saw the Glockenflecken video on PriorAuth and held a huge internal meeting about it. The CMO was angry about how the company was portrayed and wanted the video taken down. Not how the internet works, everybody. The PR folks told the CMO that they couldn't, and so the company decided to review their policies, though no one internally seems to believe there'll be significant change. I was blown away by this because what it told me is that these companies care about social media, right? They care about public perception. They can control Congress. They can buy off politicians or whatever, but they can't control social media. That's where people are getting their information now. It's not just shouting into the wind. We can actually make an impact and create change, and we have. No surprises act. There's been prior authorization reform in multiple states now. Oregon was just about to try to constrain the corporate practice of medicine. There are wins. We've had wins, but we gotta keep working, and that includes educating each other, educating our patients, and I think we can make a big difference on improving healthcare. So I wanna thank you all for your attention today. It's been wonderful being here. Thank you. Thank you. In preparing for this, I have learned so much about PM and R. I learned what a soleus is, and so thank you for that. I will never use any of this information again, but that's okay. You've been a wonderful audience. Please welcome back Dr. D.J. Kennedy. Had high expectations for the talk coming in, and you exceeded them. So as a reminder, if you do go to your app, I'll put people online, live streaming, and in person. You can ask questions, and they are coming to me live. Does that mean that you might invite another comedian ophthalmologist down the road? You know, when you find a partner that way, let us know. We'll be certain to do it. So we're getting hard-hitting questions here. Let's do it. Like hard-hitting questions. Okay, I'm ready. You've clearly developed a variety of personas. Which was your favorite to research and develop? I mean, ortho is always fun. I love ortho. Owen's bro. Ortho bro is great. So that was an easier, emergency medicine was an easier one because I've actually interacted with, believe it or not, an ophthalmologist does interact with emergency physicians from time to time. And probably, I like where the internist has gone too. Like in all the internal medicine sub-specialties, nephrology, cardiology. Like there's endless amount of content there between those two. Another hard-hitting one. How long does it take you to do your videos? So that one that I showed you at the beginning, the new PM&R one, I spent probably about an hour writing the script. And then it took, once I have the script written out, there wasn't a lot of costume changes because I didn't have much time. So I was like, what can I do to create a costume around like a physiatrist? And it was the laziest thing I've ever done. I found an exercise band and just wore it like a stethoscope. If you have a better suggestion, please. You know, unfortunately, I think some of us relate more to the family medicine doctor in terms of the workload and volumes we have, but that character is taken. So can you, two part question here. One, describe the origins of the name glaucoma. Oh, I'm so glad you asked. And follow up with very PM&R question. What is your favorite eye muscle? Oh. I can do my favorite and my least favorite eye muscle. Okay, we want both. So glaucoma is an actual ophthalmology term in a patient with angle closure glaucoma. Eye pressure gets really high, causes basically like the death of tissue inside the eye, including on the lens capsule. So you get these grayish white clumps of cells that coalesce under the high pressure that form on the surface of the lens. Those clumps are called glaucoma flecken. Hilarious, right? I'm so glad we got, that's CME right there, you guys. Look at that. You might have just done the equivalent of a spleen talk at an ophthalmology conference with that answer, but that's okay. All right, eye muscles, all right, eye muscles. I think my favorite one is the one that's easiest to treat and diagnose, which is the lateral rectus. The reason I like the lateral rectus, because how arrogant do you have to be as an eye muscle to have one cranial nerve all to yourself? Now, you might be thinking, well, what about the superior oblique? True, also quite a bit of arrogance, but I hate the superior oblique because it causes vertical intorsional diplopia, which is the reticulum, which is terrible to try to treat. So I just, I wish that muscle did not exist. Why should it, it's weird, too. It's got the trochlea, it's tors, I don't know. Anyway, I don't like that one. I don't like it. Fair enough, I'll take your word for it. Now I'm just talking. You know, I mean, just, I'll take your word for it. You know, clearly you represent medicine very well, and the challenges we face with insurance. Has anyone ever asked you to present to the politicians on Capitol Hill, not that they may listen? I have done that a couple times in ophthalmology, but I do get a lot of requests from people to take my videos and show it and send it to their politicians, which I absolutely encourage. Like, you guys use my content however you want. What, I'm not gonna say that. I'm not gonna say that. When it comes to advocating for change in healthcare, please, use my videos, send them to your legislators and your representatives because it's shocking to me, we are so insular in medicine, like we're all in our own bubble and we forget that people don't know anything about the healthcare system, even the people that make the laws, I bet a lot of them don't understand what DIR fees are in pharmacy, which is killing independent pharmacists and stuff like that, that's really in the weeds, and so I love trying to shed light on those complicated topics in a way that anybody can understand, and so you can take those videos and show them to your representatives just to say, hey, look, this is a problem as a way to trick people into learning about something, that's what I've learned, if I were to make a video where I'm just talking about pharmacy benefit managers, it would be incredibly boring, but if you add jokes to it, basically, I feel like I'm tricking people into learning about healthcare. I do the same with my trainees, so favorite, you know, since you're absolutely outstanding at making jokes, a favorite joke and or video? Let's see, a favorite video, I do have, I think one of my favorites has always been, I like the ones where I can bring in like an element of horror, like I did a video where the surgery resident decided to chart in the emergency department, and then all the emergency physicians were stalking the emergency, the surgery resident, so much so that he ends up transforming into an emergency physician, and is unable to leave, and so that jumps out as one of my favorites, I'd say some of my favorite jokes are the ones, the insults from the neurologist. I will say, when I thought of calling somebody a six-foot-tall white matter lesion, I giggled to myself for a while. So the irony is, I'm not joking here, this is true, the very next question is, any grief from neurology colleagues, because that's my favorite, so somebody actually submitted that question right then, so. No, you know, and you'd be surprised, but I really haven't gotten that much pushback from any specialty, and I think the reason is, and I've learned, like over, I've done this, been doing this for quite a while now, so I've certainly said things I've regretted, I've deleted tweets and videos because it didn't hit quite right the way I wanted to, but over the years, I have learned how to make fun of a specialty without, like, taking advantage and disparaging that specialty, if that makes sense. It's like you see a video about PM&R, and you're like, oh, he gets it, but I am making fun of you, don't get it wrong, like I'm making fun of you, but I'm, like, making you, trying to make you feel heard, as opposed to feeling like I'm punching down at you, you know, and that keeps people from trying to get me fired. Little important details. Yeah. Is there anything you've learned from your comedy and social media that you bring back to your practice and your patients? Yeah, you know, people ask me, like, what am I like with my patients, am I, I'm not with my patients. Part of that's because, like, most of my patients are in their 70s and 80s, not exactly the TikTok generation, but it's, I've learned how to do humor with patients and why that's important. You know, when you're telling jokes, like, in the lane, in the exam room, you've got to keep it really basic, like, dad jokey kind of stuff, right, because you don't, you don't know that person's values, you don't know their life experiences, you don't know anything about them. I mean, when you're first meeting them, you get to know them, right, but, so you can easily get yourself into trouble if you say the wrong thing to someone that just is not on the same wavelength as you. And so I have, like, canned jokes that I say, like, you know, a patient comes in after their second cataract surgery, and I'm like, all right, when are we going to do your third eye? You know, it's like, it's stupid, right, like, stupid jokes like that, but I always get like a, you know, it's, but the thing is, there is no faster way, I see 40 to 50 patients a day, but there's no faster way to create a bond with a patient than sharing a laugh. Honestly, you could spend two minutes with that patient, but if you laugh about something together, might as well be 30 minutes. It's incredible, the amount of bond that you make over a joke or something. So it's, it's, it's a big part of my practice, I try to bring that into it, but it is different than the skits. You outlined a scenario where you're a practicing physician, and you were, had a terrible event happen, and then were enlightened to medicine and all the problems that really come in, you know, the things that you may not have even known. So what advice do you have for our audience as to where to go educate themselves and what they should they be reading about to help make these policies that are affecting the patients we treat that we may not even be aware of? I think it starts in med school, like, I don't know how many of you had this, but I can't remember a single lecture or interaction about the healthcare system. We're so focused on like, learning the medicine, but that's, at this point, that feels like 25% of the job, right? And so I think we have to, so to all the educators, people who have med students, residents, like, when you experience a, like a bad prior author, or a peer to peer review or something like, like, talk about that with your trainees, because they're not, they're insulated from that, right? We don't make them do the peer to, maybe we should make them do the peer to peer reviews. But anyway, like, we need to stop insulating our trainees from the healthcare system. And yeah, we got to learn the medicine, but they're very smart. They can learn more things, I think. And so that's one thing is just, just being more proactive about education in med school and in residency. Also encouraging trainees to get involved in state societies and organizations like this. Like, the fact that we have med students here and trainees here, that's like the first step. Like, when you come to something like this, yeah. And so thank you all for being here, because this is where you're going to start hearing about the challenges that you talked about, that you're trying to fix. So you get a piece of it here, and then you can go and think about it, and then maybe you get involved in your state, because there's always legislative challenges that are going on. And just there has to be a little bit of motivation from the student or the trainee themselves. But I think if they get a taste of it and see the, the enthusiasm from all of you for creating change, that's going to be infectious, and it's going to, to just get it going. I've run out of words. Awesome. Well, you know, we have about 20 other questions, including prescany, when doing videos on prescany. Interesting thing about PM&R. But I'm going to take- Videos on what? Videos on, when are you going to do a video on prescany? Oh, prescany. I'm not going to ask you any of those things, because we're out of time. I get to take president's prerogative. So this is an important question to me, and it's stemming from one of ours. Do your wife and kids think you're funny? And if so, tell me the secret. Yes. Okay. Okay. Because you can tell me later. So here's the deal. My kids who are nine and 12, they, they do still think I'm funny. The 12-year-old, it's starting to fade. It's happening. I can see it. I can still get a chuckle out of her. They still like watching my videos. And so that's, that's, that's so much fun to like create something and then your kids will laugh at it and make your kids laugh. Because sometimes they can be really hard critics. My wife, she has heard everything I've said. And I, so it's much harder to make her laugh, which I actually really appreciate. Because I know that if I make a video and I'm like, I don't know if this is funny, like how are people going to, you know, if they're going to like it. So I will show a draft of my video to my wife. And if I get like a, I know it's going to go viral. I'm serious. Other way, if it's just like, I've got better things to do than watch this. If I just get nothing, then it's probably not going to be that great. But so that's how it goes. Okay, perfect. Well, thank you, Dr. Flannery. Thank you. Thank you so much. Thank you so much. This is spectacular. Thank you. Thank you all. So if you want a chance to meet Dr. Flannery up close and personal, please join us at the PM&R Welcome Reception in the PM&R Pavilion starting at 5 p.m. today. Hope you have a great assembly all week. They probably already cut you off. They do that. We can get close. I think I can probably get a photo with everybody. Everybody here. I think that'll work. It just, so, but join us and have a great assembly, everybody. Phenomenal week.

Physiatry Day

PM&R

Rehabilitation Avenger

AAPMNR Annual Assembly

Dr. Sarah Wong

Dr. D.J. Kennedy

advocacy

reimbursement

burnout

Dr. Will Flannery

healthcare awareness

social media