Ep. 11 | Pankaj Agrawal, MD, Chief Medical Officer, SGMC Health
Safety first! Join the insightful Pankaj Agrawal, MD, Senior Vice President and Chief Medical Officer at SGMC Health as he joins us on today's episode! The "Top Doc" sheds light on the evolution of hospital medicine, also known as hospitalists, and its benefits for both patients and primary care doctors. From sharing his own experiences as a resident physician to discussing critical topics like organ donation and patient safety, Dr. Agrawal offers a delightful blend of expertise and empathy that you need to hear!
Transcript
- Welcome to another episode of What Brings You in Today.
- I'm Erika Bennett.
- And I'm Taylor Fisher.
- And we just wanna start by thanking our listeners for all the support, for following and sharing with your friends and family, and encourage you to leave us a review if you can.
- And if there's any other topics you're interested in hearing us discuss, you can submit those on our website at sgmc.org/podcast. And we will try to get our guests to answer them on the show.
- And today we have Pankaj Agrawal, MD, Family Medicine and Hospitalist. But most importantly, he's our Senior Vice President and Chief Medical Officer here at SGMC Health. So Dr. Agrawal, what brings you in today.
- Thank you Erika, for having me here today. And you know, I'm, I'm excited to be here today. As we all know, the healthcare system is very complex. You know, it is very difficult to navigate and I'm, I'm trying to shed some light on what we do for our people, our patients, our community, and kind of make it a little bit more clear for everybody to understand now what the health system means, what's the physician play a role in there, and how do we connect to the patients and the community and the organization.
- Yeah, yeah. Healthcare, I mean, is probably the most complicated thing to understand. And even many people who work in healthcare, you know, only understand their little role, you know, their role in the big sphere of things. So we're super glad to have you here today in regards to just being a physician. Tell us a little bit about what led you to decide to be a doctor.
- And it's so interesting you ask Erika. I know, and, and I'm pretty sure every physician has a story to tell for got them in a medicine. You know, we, one thing, we are born with this body and the body's designed to get sick. And that's where you start feel like, okay, why does this happen? You know, when you are young, you get a lot of questions, why did this happen? Why did this happen? And you know, essentially this morning, my 10-year-old son is asking me about why these teats are called canine. So we spend 10 minutes explaining him why he's called canine. So you think through your mind is curious at that time. But you know, in my before, right before my high school, my mom was in hospital for almost two, three months. And every time I have a, she's not feeling well or she's coughing or something's going on, I'm running to a nurse to say, Hey, she's not feeling well. What's going on right the next day, then the doc's on around and I'm asking him and he said, yeah, everything is fine. Well, tell me something. I, so that that questions were constantly on the mind to say, can I, can I learn about it? Can I do something about it? You know? So that started a journey into say, you know, I gotta do something when I grow up. You know, why not medicine? So I think that was the first point to say, well, let's think about it. And then I had some, some support to go that side and more people to lead me that way. So, you know, and then fast forward 30 years later, here I am.
- Yeah, that's, I've heard that common thread. I've heard that from nurses too, that the reason they became a nurse is because experience they had with other nurses or they had to advocate for a family member in some way. And that kind of led them to the medical profession. So you took, you graduated medical school and then specialized in family medicine, but then you joined SGMC Health how long ago now?
- So it was March of 2017, so it looks like yesterday, but it's over seven years ago. I joined here as a hospitalist program director, you know, that was kind of rebooting the system in the, the hospital of medicine and kind of tell a little bit more of what the hospital medicine looks like. You know, in early 2000, this new new concept came in to say what could be done differently. You know, and medicine has evolved over the last century in a decade and every five years and every year and every month you have a new medication, new technology, new procedures, you know, people are living longer, they have more medical problems. So medicine is not becoming easier anymore. It's becoming more complex. And when it, it became a little bit difficult for primary care physicians to be in an office and run to the hospital to see their patients and go back in office. So nobody's waiting for them. And it starts to stress them a little thin. And the concept came, can we have somebody who's be in the hospital 24 hours and be available to these patients who are getting sicker, you know, and be available right away for their needs. So when these patients better go home, their primary care doctor is available back in the office to see them once they go home. So, so we not stress the system further thinner, we support system. And that's where the term, the hospital based medicine, our hospital medicine, our hospitalist word came up in early 2000. And since then, pretty much I would say 80 or 90% healthcare system in a hospital has designed that, supported that. And now there's a dedicated group of doctor who essentially specialize in those acute care to provide the service for, you know, these individual in the hospital when people are sick and hurting. And they are in a, I would say the worst time of their life, you have physician available at their bedside in a matter of a couple minutes. So they don't have to wait for, you know, all the people in waiting in the office for the doctor to come back from the hospital. So I think it, it, it worked very well, you know, and then with the evolution of EMR, both primary care doctor and the hospital, they stay connected. They still be able to have a visibility, what happened to you in the hospital and what's gonna happen when you go home. So the concept evolved from just not the medicine part or internal medicine part to some other service lines. Eventually, because the system continued to evolve, you could see similar things coming up in a pediatrics to say, do you have a pediatric hospitalist? You know, which we start to have the service line to be able to provide care for a little bit more sick patients or a little bit more volume. If you start to, you know, go in their side, we start to provide similar services as an OB hospitalist. So when somebody's in the active labor and show up and they need immediate attention, we don't have somebody to drive in there, right there available for them to be able to provide the medical care those patients need in that moment. And, and similarly other service lines continue to evolve in a gastroenterology because there's, as we spoke, you know, patients are living longer, having more medical problems, you know, then on more medications and the side effects show up and the complications happen. So we start to go on to providing more acute gastroenterology care in the hospital when they're here. So again, these physicians available in a matter of few minutes to provide immediate care and, you know, again, another set of gastroenterologists available in office to help them when they go home and better and try to provide more preventative care services for their screening colonoscopy. And, you know, stuff like that.
- It's interesting that you mention gastroenterology 'cause my dad just had a experience recently here with one of our hospitalists in gastroenterology, and she was fantastic. I was very happy she was able to come into the ER where he was there, talk to us and, and take care of him. And it's, it's awesome that she was there and that we didn't have to just wait around for a doctor to be able to leave his patients and come.
- Yeah, I think about, so I know there's a few primary care physicians or phys or other specialists that still see patients in the hospital come around. And of course, Dr. Griner is a well-known physician in our community and also serves on our hospital board of directors. And I remember quite early in my career, you know, seeing him coming through the hallways, rushing up to the stairs, you know, and then I, my, I had my children and they were patients of him and I thought, how does he do it? Because he is literally always here at the hospital. Like how would he ever have time between being at the hospital and at the clinic and seeing patients. Then couple that with the lack of primary care providers in general in the nation. So if you don't have a primary care provider, if you didn't have the hospitalist, you mean you wouldn't have anybody to see you then in the hospital. And the fact that 70% of our people don't have primary care providers. So just the need I think of the hospitalist Correct. And then how it's evolved has really, you know, taken off. And then, and to my knowledge has been, you know, very successful and in the overall realm of medical care
- And, and it's the complement, the primary care provider. So, you know, well you could try to do everything yourself or we split it up and do very well, you know, and the, you can go look at the studies over the last 20 years been published about when, you know, hospital medicine has brought an a quality consistency of care, which in which, you know, certainly you can believe upon to say this service has become really ingrained in the health system and is here to stay.
- And you talk about like physician burnout too, as far as quality of life for the private practice physicians and then also for our hospitalist. I mean, that has to help. I mean, think about OBGYNs being on call all the time, having to come in to deliver babies all throughout, you know, and then emergencies happen all the time. And so I do think it probably provides that little bit of support for our community doctors.
- Absolutely. You know, I mean, the way we talked about the medicines are getting difficult. Even our lives are getting complicated too. You know, you have to start to learn where to balance so you can have a longevity in your career and your own personal physical and mental health. You know, how can I continue to do this until I retire? You know, physician shortage is real and we need to be able to support that so we can continue to care for the community before people starts to say, it's just too much. I can't do it anymore.
- Yeah. I know we spoke with Dr. Hardy on a different podcast and he mentioned you're spending hour, hour, hundreds of hours a week, you know, in the hospital. And I mean, that is such a commitment. I mean, you under, you also oversee our graduate medical education and our physicians. But talk about a little bit maybe the path of becoming a physician and kinda what that really mean. I mean, you dedicate your lives to helping others, but I mean, it's a large investment that's undertaken on the forefront and then your entire career afterwards. What is that like?
- You know, you, you right Erika and, and, and I appreciate for the recognition because that's a commitment, that's a commitment for life. You know, it's hard for you to go half the way and I don't wanna do it, go back because you invested so much on it. You gotta do four years of pre-med, then you have four years of medical school and none of them is easy to begin with you the amount of hours you could put in the study. And, you know, we were, we were taking a tutor on a medical school yesterday and some of those books showed up on the library bookshelves. I was like, makes me nostalgic looking at those books because I remember how many hours I haven't spent that book, you know, and you know, and just like, I don't wanna look at this again, but I, I know that's the amount of time you have to dedicate yourself and you miss out on your family life and the social life and you just have one mission that I want to, I wanna be a doctor and I wanna be a good doctor. You know? And how do you do that? And once you have the medical school and you look for, okay, well what do I wanna practice into? You look into your choice of specialties and you start to decide my priorities and you decide to apply for a residency program, and that's across the country. You can, there are like thousands of options and you have to decide, where do I wanna go? What do I wanna do? Why do I wanna go? So the the journey constantly challenges you, what you wanna do and why you want to do just kind of self-reflect at every step, you know, am I gonna be successful in there? Can I, can I afford to do that? So I made a decision, I cannot do surgery. So I, I stayed out of that because I knew that I cannot spend 10 hours at bedside trying to do in a surgery like Dr. Hardy, what he's mentioning to some of those procedures last for 10 hours. So you, you had to know, you know, where do you stand? And then once you apply for the residency, you gotta start to pick a place where it's gonna be good fit for you. Go meet folks over there, try to find what's their training program looks like, what's their culture look like, and again, is it a fit for me or not? And, and then eventually you create your rank list. If I gone to 10 different places and I, this is my first choice and my second choice and third and fourth and similarly all the programs you go on DataBank their candidates. And then eventually the computerized matching process will go on to say the candidate's choice and the, and a the facility's choice go into a random pattern. And then you get to know where I'm gonna go and what I'm gonna do. So most, most, I would say most folks know what specialty they wanna go, so they not necessarily applying in a more than one specialty. Those parts are very clear before you get to that point. But what facility I'm going, what hospital I'm gonna go, what program I'm gonna go, that's kind of got your mind on that. And you know, again, the times have changed. The medicine have changed, you know, about 15, 13, 15 years ago, you would be working 36 hours straight every third day. So that's your normal day would look like, you know, and still remember on my first day you get an orientation from your senior resident and he said, there are three rules to, to graduate from here, eat when you can, sleep when you can, and study when you can. That's it.
- Eat, sleep, study. If
- You remember that,
- Don't do anything else,
- You'll be fine. You're wasting your time, you'll be fine. You know, so those are three rules to survive out of it. And, and I I think those were true. And yeah, that's still, you know, and, and then now as, as we know more about things, we have more, more studies behind it and we kind of know more how the human learning works and human behavior works. And then the A-C-G-M-E who controls the, I would say the learning environment for the residents have, you know, changed the regulations based on the historical evidence to limit the number of hours that you're not required. And not, you cannot work that long of hours as, as risk of making error or being tired or, you know, because now you're driving home after those 30 hours. Just remember how tiring that could be. So, and I, and I remember taking a nap across, you know, against the wall leaning in, just taking it because yeah, you're just so tired. So, so you know, things evolve as it goes, but you know, I think everything brings in a value, you know, what you learn that you could, you could remember for life and take good care of the patient. So the process is pretty rigorous and this design and this for a purpose. Yeah. That you're gonna be having somebody's life in your hand and your decision is gonna matter for them and their family and their loved one forever.
- And so that leads me, I think right into when you accepted the role as chief medical officer, did you know what you were getting into? But that's one question. But secondly, it led you, I mean, you already were involved in several quality improvement patient safety initiatives throughout your tenure here. So I know that wasn't necessarily new to you, but a lot of, I I would dare to say no one really understands what all that department does within a health system and how we do truly, or there's a team, pretty much any service line really evaluates almost every aspect of their service line for quality, for safety. And how do we get better? What are some of those metrics that y'all kinda look at to that impact our patients and our community members?
- That's a, that's a, you know, very heavy question. Like, I mean, you know, you know, I know Mr. Mr. Dean, our, our president and CEO, he always does impeachable credentials and that credential means the patient safety. So that's, that's in very forefront of all of us in our mind when we, we are approaching a patient, we're gonna do anything and everything. And remember, the system is very complex. Everything, every process, every tool, every medication, every patient has to go through several different hands and how we can make sure we close the loop and do it safely without harming the patient. Because, you know, patient harms are real. You know, Hippocrates was father of modern medicine, he said 3000 years ago, do no harm. He knew that it's gonna happen. And gradually as health system become more and more complex, it, it's becoming more and more evident until, I would say about 20 years ago, there was no much stress on patient safety and healthcare. But National Institute of Health in 1999 published a study showing how many people are dying every year due to healthcare related errors, medical errors. And so that, that becomes real. And historically in about over the last 20 years, the medical error has been staying number third or number fourth cause of death across the nation. So if you think about it, every fourth person had a cause of death related to medical error. You know, covid pushed it down a little bit, but then it's back up since C'S gone down. So as a healthcare system, everybody has a lot of way to go to make it a safe place for all of us and for a journey to a zero harm. So one of my, and you know, I, I think I'm still trying to figure out my role as a chief medical officer, I tried to have everything comes on my way to evaluate if I have any, anything I can assess and do it, you know, out of my four major departments, one of the, the heavy lifting we do is a patient safety and quality. You know, I got great team, Scarlet Rivera leads that team and she's phenomenal. And she's the guru on every aspect of her department. I mean, I, I cannot believe the knowledge. And she has, and, and I, I can, I can tell you in, in my role every, and I knew case management, social work, I knew, you know, residency, how it works because we all going through that one, you know, but the medical staff office is third department, which is, you know, more credentialing and allowing people to work. So that was a little bit learning, but the biggest learning I had for myself in last eight months is the patient safety and quality. Although I've been engaged, but I think I start to look at it as a different lens now. And you kind of trying to zoom in each time when something goes wrong to say, well, where is the, where is the problem? Right? So we, we need to be able to reproduce the same thing like an assembly line every day, every time, every second it comes out perfect. You know, you cannot assume a Toyota making cars with the leaky fuel tanks. And they don't realize for a hundred days that, come on, we made a million car with the leaky fuel. Now imagine the impact down the line. And you know, so we, we bring those back to, to healthcare to say, you know, everyone need to do every day and every time the processes needs to work, the policies needs to support that. And we need to be able to support PE people to be able to perform that.
- Yeah, that's big. I mean that's, you know, SGMC Health started a few years ago, this journey to become a high reliability organization which really focuses on safety and zero harm and really being accurate all of the time, every time, you know, not making it, but really creating a culture where our employees, every single person, no matter who you are within the patient experience, you know, takes responsibility for their role and, and, and taking responsibility for keeping the patient safe even if you're not a direct caregiver. Right. So it's been a nice on my as, I mean I don't touch a patient ever like, but even being a part of these trainings and kind of seeing what our team is going through, it's just eyeopening to me. It makes me feel a lot safer and a lot better knowing that there is such a focus on that within our organization. And that it's not like a taboo topic, it's something that should be talked about all the time and very often so that it's front of mind for all of our team members. 'cause not only do we not not wanna hurt, I mean no one wants to ever do anything wrong. So it also creates a better work environment for our team if they feel Yeah, like they can do their job.
- Well there's that everyone can do. I mean, I'm constantly seeing our team have set a great example by picking up trash in the hallway and wiping up spills. You know, we're not patient caregivers, but we can do things like that.
- But you're supporting there preventing a fall. Yes. Yes. Here you go. So that goes to safety, falls to everything for a reason, right? Yes. So, you know, I think the high reliability journeys, again, that was new to me, but has been again, an eyeopener. You know, again, healthcare is compared with airlines industry all the time.
- Yeah. So this came, yeah, this came from like the airline industry, right? Airline or the nuclear, the nuclear plants. Because I mean, those are very high risk situations, right? You don't, you know, I mean if airplanes start crashing out of the, if as many people died on airplanes, you know, it is like,
- Shut it down, it
- Should shut down, down right, shut down. Correct. We can't shut down the healthcare industry. So it's our job to mimic the, their results as good as they are and get better and better and better.
- Let's tell you a little bit more on the journey of HRO and from, you know, the clinical side. How does it matter how it impacts now? So these, you know, we have complete program of high reliability journey and every single individual is being trained on it. And you know, like you said, being bringing in a culture of transparency, we need to know what's going well, what's not going well, what we could do differently, and try to stop anything that could before hit the patient. You know, we, we want everybody to be able to speak up and feel comfortable to say, Hey, I see something that probably could go wrong with patient. Let's, let's fix it before it happens. You know? And the, the harm to a patient in healthcare is looked at a Swiss cheese model, you know, if all the holes align. And that's where there are multiple levels of, I would say safety nets to, to say if a physician orders a medication, pharmacists have to look at it to say is it safe to dose the right amount? Could it interact with any other medications? You know, then he will release it, then it goes to the nurse, nurse will still look at it and make sure, does it work? Does patient even take this at home or is something new or they're allergic to it, you know, before it touches the patient. So every process we have that can have multiple layers of safety checks before it goes to the patient, but when you start to lose those safety nets and all the holes align, that's where the harm reaches to the patient. And, and the purpose of HRO journey is to eliminate those holes from the Swiss teeth. So you have no holes, every process is strong enough. You have every employee, every healthcare worker is strong enough to say, nope, stop thing, review and act. So as you come up with this new culture that every single person is equally responsible and leading the patient's safety in the front end.
- Yeah, I think probably the most common thing that I can think of in healthcare that the patient would immediately recognize is the patient identifier. And you make sure you have two ways to identify and that they're reading those back, you know, confirming those. And then, I mean, correct me if I'm wrong, but did this not like come from, or what I know there's like the timeout with the surgeons that they have because of the, you know, with wrong side, wrong side, wrong person. You know, there's always this fears that you could go in and have like the wrong surgery and things like that. So just as many processes that can be in place because we recognize that everybody is human and humans make mistakes. So getting as many processes in line that can eliminate room for human error.
- You know, on the, on the other end we talk about the quality, you know, so yes, we want a patient to be safe, but on the other side we provide them a quality care. It needs to meet the standard of care, it needs to be the highest quality we could provide. And there are lot of metrics when you were asking about orally how do we measure it? So there are measurement for every single quality that we provide. Bunch of them has been designed by center of Medicare services and then other governing bodies. They regulate what happens in healthcare. You know, not being com not only a complex healthcare is also very highly regulated from different governing bodies. So we have to be able to produce all those quality data and a lot of them are publicly available on our website for anybody to be able to view that. So, you know, cms compare org that can help you compare what this hospital safety rating and a quality rating looks like compared to the hospital b, you know, CMS star rating. So all of those are quality metrics eventually rolls into there that how does CMS find us being good, safe, quality hospital compared to other similar sized hospital in the region or nation. You know, the leapfrog score rating is another way, you know, for encompassing all different things we do to provide a good quality care to the patient. Say, where do we stand compared to the other, other hospitals that provide similar service lines that we
- Do have? Right. I think that's gotta be something you think about too. It's, I mean obviously we wanna be the best of the best at everything. That's what we strive to be. But you know, you when you're comparing hospitals knowing that, I mean some hospitals are caring for much sicker, more intricate cases so that that could, sometimes there is a little bit of like vari in those quality metrics just because smaller hospitals may not have those specialties to care for like critical care patients or things. I mean I, I think that's what I've heard. Okay. Make sure I was right on that 'cause I'm not a hundred percent, but that's what I thought. So that is, you know, something to keep in mind sometimes that can track or trend things differently, but ultimately we still wanna be the very best
- That we can. And I, I enjoyed the quality since beginning because that's the one way we can hold ourselves accountable. Are we delivering a quality of care or not? You know, patients come to us trusting us that we are gonna do the best for them, but are we able to prove it? Yeah. Are we able to account for this? You know, are we able to stand and show the, show it to the community and other places to say we are doing the best thing that we can do for our patients. So it's, it's a great tool to self-reflect.
- Recently we did win or receive an award from the Georgia Hospital Association for the work with the organ donation procurement. And you'll, you can talk on this better than I can because you were involved in it, but it was enhancing processes for timely organ donation. I think we, we don't do organ transplants here, but securing organs for, from donors to go in my, I mean I have several family members who are in need of an organ. So that's definitely something that's very important. You wanna talk a little bit about that real
- Fast? So it's, you know, it's in, you know, again, I'm gonna compare with cars and airplanes. You can build another engine and put it in a plane, rest, everything could be the same and you can use it, you can change the tire and the car will go. But that doesn't apply to the human body. You know, there are some things you can use prosthesis and artificial things and dialysis for replacement of kidneys, but there are other things you just can't, you don't have it and you heavily rely and try, you know, that if, if somebody could donate to you sometime people, if you have a more than one like kidney or a bigger organ like liver, those could be donated from a live person and could be utilized. But most of the other organs we got, you just have one and you just, even if you have two, you can't live without it. Yeah. So you can't start to donate and you know, this is where, this is where the humanity goes to it peak where somebody has an untimely that and having healthy organs could those be donated to somebody who's in the need? So that's where it becomes very sensitive that those donation process has to go through a very good screening to figure it out. Is it gonna be viable or is it gonna harm the recipient or not? So, and as a, as a nation, as a health system, we all strive to say, can I notify people who do the organ transplant to say I might have a candidate. I might have a candidate. And so there are criteria and that's what the stride we made in last couple years to say, identifying those people in a timely manner and notifying the, the, I think it's called lifelink Life link of Georgia, Lifelink of Georgia. They are the coordinating agency to procure those organs. So we, I believe over the doubled amount of referrals to them by changing or simply changing in our processes to say we are gonna notify every time an X, Y, and Z happens. And we simply were able to help few more people in a timely manner just because putting the process in.
- Yeah. And just to dispel any myths or anything out there while we're just on this topic real quick, is that, I mean I I do recall that I've heard someone they don't maybe not trust that you're gonna, if you're an organ donor, that the hospital will take care of you because they want your organs. I mean I definitely have heard that before. Yes. I know that's completely false, but tell us a little bit about how that process worked. 'cause that's not, that's never the
- Case. Now again, I'm not expert in the process, but it's a, it's a centralized process and we have not none to zero control on it. You know, once we identify somebody, the team will review that remotely and the team comes on site from, you know, Lifelink and they have their own team to procure the organ and they have priority list in a state where is gonna go first based on their need, based on how critical situations are. So that definitely goes for a good cause without any doubt. And those are used for to save some time more than couple people lives because different organ could be helpful to different people. And so the impact of that is, is just phenomenal. And I, I just can't, I can't thank those people who, who designed, you know, de decide to go that pathway and their family take the decision for them to say, I wanna help other folks.
- And it's always super cool when you can, when they find out like years like, because I think it takes a while before they can even release who the recipients, who those organs are and then they get to do meetups sometimes or connect with those families. And I always think that's super powerful today. I know this isn't the day that we are releasing this podcast, but the day that we're filming is actually actually national donate Life awareness day. So I just kind of wanted to bring that up, but I wouldn't never want anyone to fear registering as an organ donor because they would think that they get any less care. So I just wanted to dispel that, but
- And do wanna make it there, you know, we as a complete health system and healthcare workforce, we have a humongous amount of respect for those patient and individuals and their families for the decision what they're doing. You know, they are, it's never
- Forced on anyone
- Or Yeah. And they are looked at as utmost respect and, and, and you know, dignity when throughout this process, you know? Right. So we, we do do understand that, you know, we, we need to be respectful for them throughout the process.
- Yeah. It's a very difficult, difficult decision to make, but truly respected by everyone who Yes. Interacts with those families. I did that. I've gotten
- To be here for two honor walks I think since I started working here. And, and I didn't know what that was before I started here, but I remember the first one that we went to, it was just the, the patient had, the patient's family had asked if we would record. So we did that and it was just the most humbling and just emotional experience, you know, you really feel that this is a huge thing for them and just the amazing gratitude for, for them making that decision. And it's a, it's a really cool
- Thing. Now my, my, my father is not a medical person. He has no clue, but he's told me several times that he wants to donate his body or organ, whatever is possible for several years in a row. So, you know, I never asked. He himself offered. So there are, you know, people have the desire and we wanna fulfill the desire for them and other people who, who could help.
- Yeah, absolutely. Alright, well are we get, I think we're kind of getting, we're at time. Okay. I was shaking her head. Alright. You asked the last question. Oh
- Yes. We always have one last question that we ask and it's just universal. Most people have to eat here because they are here all the time. So what would your favorite meal be? Either in the cafeteria or in the spice?
- Put me on a spot. Jason is gonna find me. No, I I think we, we, we have done some, I think Healthy third, healthy Wednesday Wellness in cafeteria Wellness. Yeah. So on that day they were like a specialty counter and I, I seems to find a little bit more different, you know, that, you know, obviously you could bowl or buy the same item but they have a little bit more different and kind of changes weekly. So that station has remained my favorite for a long time. They kind of became creative with that one.
- Okay. And also, I'm just given this plug because I want to tease Kara Hope over there, but Dr. Agrawal also has a good fitness routine 'cause him and I both go to Orange theory and actually we are the capture the flag champions at Orange theory. We were partners and we beat out everybody else in our class to capture the flag one time. So if y'all ever wanna exercise and need a healthy option, orange theory Fitness is a, it is a good one to try, but we are the champs.
- Alright, that's a good one.
- All right, well I guess that's it. Yep. Okay. Well thank you very much Dr. Agarwal. We appreciate your knowledge, your dedication and ex expertise, and we're just glad to have you in the role that you're in because you're truly making a difference. And I feel good, I feel confident with I'm,
- I'm, I'm pleased, pleased to be here and I, I feel, I feel blessed to be here and thank you guys for inviting.
- Yeah, thank you. Alright, well until next time. Thank you guys for watching.