Ep. 55 | Luke Saunders, Pharmacy, SGMC Health

Transcript

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- When you're in the er, have you ever wondered who's helping make sure your medications are right, especially when seconds count.

- Welcome to What Brings You In Today, a podcast from SGMC Health.

- I'm Kara Hope Rockwell.

- And I'm Erika Bennett. And today we're joined by Luke Saunders who's a pharmacist at SGMC Health. So Luke, what brings you in today?

- Yeah, thanks for having me talking about inpatient pharmacy and how pharmacists interact with the care team and different parts of the hospital and maybe more specifically in the emergency department.

- Very good. So to start, tell us a little bit about your career, how you landed at SGMC Health and kind of your experience.

- Yeah, so I started at SGMC Health about almost eight years ago now. I started out working night shift after graduating pharmacy school. I worked night shift for about two and a half years. And when I was working there, we basically took care of all of the different patients in the hospital, took care of ICU patients, surg patients, ED patients. And with that really kind of enjoyed kind of helping the higher acuity patients out a lot more. And so I got the opportunity to move into the ER about four years ago. And so I've been working as an ER pharmacist for that amount of time. So,

- And doing a very good job. I might add, 'cause I've been in several board meeting, board meetings and committee meetings where your name has come up for different activities, initiatives that y'all leading on to improve pharmaceutical care within the organization. Thank you. So that's one of the reasons we wanted to bring you on so you could share a little insight of what that looks like. 'cause it's something that I don't think most patients or even a lot of employees might not understand how inpatient pharmacy truly impacts care that's being delivered. Yeah, I

- Was gonna say a lot of people might not even realize that pharmacists work in the hospital. So what's the difference in like a hospital inpatient pharmacist versus maybe the one that you see at a drug store?

- Yeah, it's true. Most of my colleagues work in the retail settings. They work in, you know, CVS, A Walgreens, a small independent pharmacy. But there's a a pretty good amount of, of folks that are working in the inpatient setting. You know, here at SGMC Health we have a lot of different pharmacy services that we provide. We have just our, our regular inpatient services. So those are again, kind of servicing all the patients here in the hospital. We have an some or pharmacy services as well. So that's helping out anesthesiologists with making sure that different medications are available. We also have oncology pharmacists that work very closely with our oncologist to ensure that patients are receiving accurate doses of chemotherapy. We have our, our, our retail space of course and we have kind of staff and clinical folks as well that are really kind of oriented to very specific kind of subsections of the hospital. Just like the emergency department, the ICU and, and med surg as well.

- So let's talk about the emergency department. When you come into the emergency department, I feel like one of the first things I ask is kinda like what kind of medications are you on as they're doing their assessment and how important is it to know that in the clinical assessment of the patient?

- Yeah, it's really helpful, you know, if patients or or care team members kind of have a, a good idea of what medications you're taking, you know, particular conditions can predispose patients to some possibly untoward, you know, issues if they're on, you know, particular medications. Like let's say that you come in with a fall and you're on a blood thinner, it's really important for us to know that you're on a blood thinning medication. Did you just finish some antibiotics? Did you, you know, start a new medication recently and maybe you're coming in with some sort of allergic reaction. Those, you know, that that bit of information is very helpful for us. So one thing that we always encourage patients is to try to keep an accurate medication list. We know that this can be very difficult to do, but the medium itself really doesn't matter if you have a handwritten list, if you have something electronic within MyChart, if you bring all of your bottles in, that's great too. You know, or if you have a family member that keeps track of all of that, it's very, very helpful I think to have that information. We know that it can be very difficult to maintain. Some patients are on a lot of different medications, they have really long confusing names and so we definitely empathize with that. But having that information is very helpful to us. And when you do come into the hospital, that is something that we as pharmacists will look at. We'll make sure that that list is accurate and then when you go home, that is something that we're kind of cleaning up as well. So each time that you encounter kind of our healthcare system, that medication list is revised and kind of cleaned up as well. So

- Is that what we refer to as that medication reconciliation?

- Yeah, exactly. Yeah.

- How often do you see thing patients on like drugs that are either, you know, just not necessary because they're either doing the same thing or counterproductive? Yeah, just because like over the years they've started taking them and never really had them assessed again.

- Yeah, pretty often. We, we definitely have a lot of patients that come in maybe with just some old information and you know, that could be information pulled in from another hospital that we had. And so that's where it, I think our job really helps to clarify a lot of that information. I think physicians and and nurses are very busy, you know, trying to work up patients and so to have a care team member kind of specifically dedicated toward those medications is really important. And I think being able to provide accurate information for the care team is, is, is very important. Very helpful. So,

- So what does a typical day look like for you as a pharmacist in the er?

- It's hard to say. So there no different every day, I'm sure no two days that are, that are similar in the emergency department. But that's part of why I like it, I think is there's a lot of variety for me when I get to work, I normally will kind of go around and figure out kind of who may require, you know, the, the most amount of kind of medication intervention, who are the sickest patients there. So I'm reviewing their chart and making sure that, you know, the medications are dosed appropriately, trying to look back at old cultures just to see if, you know there's anything there. If we need to escalate antibiotics or maybe we can come down on them as well. Also, you know, looking at the drips, making sure everything is programmed correctly is a, is a big intervention that I do. The other thing that I do as well is kind of follow up on cultures when they go home from the emergency department. So let's say that you come in with, you know, complaints of like a urinary tract infection and we're sending your, your urine to the lab. I'm making sure that you're discharged on appropriate antibiotics. That's one thing that I, that I look at as well. I kind of work on some projects and things and then I'm helping out with any emergent conditions that come in. So, you know, anything, any cardiac arrest, any trauma, any intubation, like I'm in the room helping draw up medications and so it, it varies a lot. There's not really a, a set schedule I guess that I have, but that's, that's part of the fun of it. So,

- So speaking of the urinary tract infection and the antibiotic usage in those cases, tell us a little bit about that project that y'all did. 'cause I found that like fascinating Yeah. That y'all able to like target our specific area and population and basically deliver a more appropriate antibiotic for a sim or for a, not a disease, but a infection condition. Yeah,

- Yeah, for sure. So when I first started in the emergency department, that was, that was kind of one of my bigger interventions was kind of following up on those cultures. And I noticed that when we were prescribing a particular antibiotic, it seems like we had to switch therapy a whole bunch. That particular antibiotic we were using just didn't seem to be super effective. And I remember fielding a number of questions from some of our ER physicians, like, Hey, how well does this particular medication work for, you know, a a a young female with, with urinary complaints or something? And so the natural thing is to go to a hospital antibiotic, which is kind of a fancy name for, it just basically says like, how well do our antibiotics do against the, the organisms that we have in the hospital for us, you know, looking at that it's, it's good information but it aggregates data from blood cultures, from, from urine cultures, from wound cultures, basically. It kind of aggregates all of this data and spits it out. But the question that I always ask is more specifically, how well does this particular antibiotic work against, you know, someone who has a urinary tract infection? And so I got with our, our good folks over in the microbiology department and I got really specific data that would, that would kind of show us that essentially. And so we're able to create these weighted averages and basically make recommendations of what antibiotics work most effectively against the most commonly occurring organisms. Every place is a little bit different. You know, if you look at some of the guidelines for antibiotics, you know, they're, they're fantastic and they're, they're good for guidelines, but they, you know, have hospital information from all over the country, from all over the world as well. And so we know that, you know, here in South Georgia, wherever you're at, everybody's a little bit different. And so, you know, one thing with that particular intervention is we're actually able to reduce the amount of times that we called patients and had to change antibiotics. Normally when they go home, we send them home with an antibiotic and they're sitting at home hopefully taking that antibiotic, but we don't really know how well that antibiotic is performing until about 72 hours later. So there's a, a lag time there. With that being said, we're able to get not only specific data from main campus, but also for the Lanier Burien and Smith Northview campuses as well. So you don't have to come to the big hospital in order to get adequate care. You know, we, we got very specific information for those campuses as well and they kind of have their own antibiotic recommendations, which actually aren't that different from, from main campus. But that was something that we wanted to make sure of is that wherever you go within our health system, you're getting the best care possible. So

- That's

- Fascinating.

- Yeah, it's circle cool just to be able to do that, to localize it and to be able to do that research and that background. And I mean, you just wouldn't assume that our professionals are back there doing that. You just kind of think, oh, you're distributing medication based on whatever the guidelines are. So I thought that was really unique and really cool. So commend that entire team for Absolutely, they work on that

- And obviously medication safety is a really big deal for patients and their families. How does the pharmacy team help prevent medication errors?

- Yeah, for me, particularly in the emergency department, it can be somewhat of a, a chaotic environment at times. It's controlled chaos, you know, everybody you know, has kind of been in those situations before, but there's not always time to triple check and quadruple check some of these things. And so for me, you know, when we have a trauma come in or something, I'm getting medications that we anticipate that we would use and these are medications that I, I feel really comfortable with. It's medications that we use every single day. And so one of the nice things I think about having a pharmacist on the care team is the ability for the physicians kind of to cognitively offload a lot of their thoughts. They can focus on diagnoses, they can focus on, you know, treatments or procedures, things like that. They don't necessarily have to worry about, you know, medications and how they're dosed and things like that. Obviously that takes a lot of rapport to get there with the physicians. But you know, they can look at me and say, Hey, I want this particular medication for this patient and being in the room, I have the appropriate context for how we would use that particular medication. I know why we're using it and can kind of prepare that medication is most ready made form. So when I'm giving the medication to the, to the nurse, you know, they can feel confident they can go ahead and give it. It's not like a big package that they have to undo and prepare themselves. It's something that I've already prepared and they go ahead and give it. So that's a, a really nice thing that we do, particularly in the emergency department. I will say throughout the hospital we have pharmacists everywhere. We have pharmacists in the ICU med surg, we have some in central pharmacy and anytime that a physician orders something, you know, for you in the hospital, it's reviewed by a pharmacist. When the pharmacist is reviewing it, they're looking at your home medication list, they're making sure that the new medications that are ordered are not going to interact at all. With, with the things that you're taking at home, they're making sure that things are dosed appropriately, they're making sure that the context makes sense for whatever you're receiving. And they're also making recommendations for maybe altering therapy as well. You know, sometimes when an electrolyte value comes back abnormally or you know, maybe you have a positive blood culture and you need to be started on antibiotic, those are alerts that these pharmacists will get and that we can be able to action or, or act upon them very quickly. So we do a lot of, of quality assurance here in the hospital. I think our role is, is is very important and I think in ensuring that patients really get the best care here. Again, people are very busy, but I think having care members that are, you know, very focused on medication safety is very important. So

- This question just came to mind. If you are an inpatient and you have medications that you take daily, do you still have to take your external medications that you already had while you're in the hospital or does the inpatient care team kind of overtake that based on what their, the information they provided when they came in?

- Yeah, so that's why having like a a, a accurate medication list is really important. So if that's something that a pharmacist can provide that essentially gives that to the physician, they then can go through and figure out what medications need to be continued. Sometimes when patients are in the hospital, they can have certain conditions that maybe resuming something at home may not be appropriate, right? Maybe something they're taking at home is actually the reason why they're here in the hospital. And so those are something that it, it it's very situation dependent. Yeah. But I think having all of the information available and having accurate information really helps that physician and if go through things, resume things, being able to determine maybe they need to be started on something that they're not on or discontinue something that they've been taking as well. So

- How do you talk about medication names with patients? Like some of them have, you know, very long, hard to pronounce names and that's not what we know them by as the general public, but how do you educate people on, you know, this is this medication, here's why you're taking it.

- Yeah, it can be sometimes a little tricky for pharmacists too. I know some of these newer medications can have some kind of crazy names so we, we definitely understand it. But I think that's the, the great thing about hospital pharmacy is we're kind of uniquely positioned to be able to counsel patients because we have the context of why these patients are being prescribed these antibiotics or retail colleagues like, you know, pharmacists who are working at a small independent or, or one of the chains, they essentially receive a prescription maybe for an antibiotic, but it's not always clear why they're on that antibiotic. They essentially just kind of have that hard copy in their hands. And so it can be difficult for them to kind of counsel patients because we don't always know why they're taking a hospital. Pharmacist, I think are again kind of in a, in a good role to be able to understand why patients are being discharged on particular medications. You know, maybe they've been in the hospital a few days and one pharmacist has been kind of following their care throughout that time and you know, that, that I think clears up a lot of, of of why, you know, patients get put on these different medications and hopefully prevents a lot of representations to the, you know, emergency department. I think if you can really help patients understand why they're taking a particular medication, it helps kind of mitigate a lot of, you know, maybe untoward side effects. You know, it, it reiterates the importance of these particular medications and I think ultimately, you know, positively affects their care.

- We recently had an event where we had someone speaking to our, some members of our team about like opioid prescription and usage and how she actually had a family member that ended up passing away over time after becoming addicted to opioids after a hospital stay. Now this was 10 years ago I think that that happened, but her concern was that there was not enough like communication about that particular drug and how it would impact his care. Have you seen more of that education in your world now that we're kind of more aware of how those are used and what the impacts could mean later on?

- Yeah, definitely. So we have alerts picked built into our electronic medical record to review kind of what medications patients are already on that may kind of exacerbate, you know, the, the drowsiness and things that may, you know, patients may see with opioids, which is really important. We've also kind of made strides to reduce the quantities of, of some of the opioid prescriptions that we're sending. So we're really just kind of using these for acute pain until they can get plugged in with a primary care physician or maybe an orthopedist depending on what's going on with those patients. And again, when I'm counseling patients in the emergency department, when they go home on these, I re reiterate like, hey, you know, these medications can really make you drowsy. No driving, no operating machinery. I'll throw in a joke and say no skydiving, snowboarding or whatever. But you know, it, it is really important for patients to know, you know, how drowsy it can make them. Again, I'm looking at some of the medications they're taking at home just to make sure that that new opioid prescription is not going to, to make things worse potentially. So I think we've really tried to make strides to ensure safety with those high risk medications. Yeah, that's

- Good. And that is one thing that she talked about, you know, going home with three pills versus 30 pills. I mean that makes a big difference for sure in your, you know, likelihood. Yeah. How yeah. Of getting addicted to it. Yeah.

- Tell us about you a little bit, like what made you decide to become a pharmacist?

- Yeah.

- How did you

- Get to that career? So I, I guess growing up my, my, I had some family members and myself that kind of had some health issues and so I remember actually having to take kind of a number of medications growing up and so kinda had this primitive interest of like, oh, I, I wonder how I can like take this medication. It like makes me feel better. Like how does the pill know where to go? Yes. I always

- Have that

- Question. I like how

- Tylenol where to

- Go. Yes. Yeah. How does it, how does it know? You know? So I, I kind of had that primitive interest in it and kind of growing up through school, I, I took high school chemistry and I, I really loved kind of the, the chemistry aspect of it. And so I think kind of that primitive interest combined with, you know, enj enjoying science and things like that and of course wanting to help folks. Pharmacy kind of made a, a natural fit. It's funny, when I went into pharmacy I, I was very much okay with kind of helping patients from a distance. I didn't want to be like super hands on. I was completely fine being behind a computer. And the ironic part is I'm very involved in the emergency depart. I love it though. But yeah, I, I initially was very okay being, you know, kind of cerebral and thinking about things and now it's, I'm a lot more hands on and so, but yeah, I went to, went off to college and I, I knew I wanted to do pharmacy before going to college, which was nice. So I just did all the prerequisites for pharmacy school and, and got in and finished and found myself working in, in hospital pharmacy, which I really love. So

- Yeah. That's awesome. So now you gotta tell us how does the Tylenol know where to go? You gotta explain or do we gotta go to school to figure that out?

- Yeah, if you go to school it's, it's proprietary information. No, it's, it, the honest truth is it doesn't really know where to go. So when it gets absorbed it basically kind of goes throughout the body and is, you know, looking for receptors that would accommodate that particular medication. And so yeah, the the, the truth is kinda like, you know, you think like the pill knows where to go but it doesn't matter where it essentially just kind of gets dissolved and you know, is looking for receptor, have it works that works. Yeah, exactly. And then all of the downstream effects that you learn in pharmacy school and then probably put you guys to sleep and myself.

- Do you have your friends and family call you all the time asking medication questions? Because I have a friend that's a pharmacist and I have to say I do sometimes ask her like, Hey, what about this?

- Yeah, on occasion I do, I I think it, it tends to flare up during like flu season and things like that. I think kind of helping out with, with over the counter medications and I actually really don't mind those questions at all. Think, you know, for me there are a lot of, there's so many products at the pharmacy that you can pick up and it can be very overwhelming. And so I think trying to get some guidance through, you know, trying to like, I'm just trying to feel better kind of thing like should I take this medication? I'm on all of these other medications at home, can I take this cough and cold medication? And so I think that's, that's really a way that I can kind of help family and friends out and I really don't mind the questions but I do get them on occasion, you know. So

- Do you have any particular incident of where you felt like, wow I was able to like really help that patient or any memorable patient experience that you were, the pharmacy was able to impact their care?

- Yeah, I, I can think of like a couple of close calls that we've, we've prevented for sure. I know this was maybe about a year ago, but we had a a little, like this baby was like maybe less than one month old. We were trying to get kind of the baby comfortable and we were in the process of drawing up a pain medication and the nurse drew it up and I was like, Hey what is that? And they told me the name of the medication and I was like, oh it's actually like 10 times the amount that we need to give to this kid. And so again, kind of in those really uncontrolled environments, like we always try to double check each other and I'm just as prone to errors as anyone else but you know, these medications are something that I'm pretty pretty familiar with and so I'm glad that, you know, it is something that we always do but you know, there have been some, some really big kind of catches that we've done and you know, just to ensure that you know, patients are getting the absolute best care possible and that's

- What makes your role so important to have pharmacists in there looking at that and that are at at attuned to that because like a lot of those medications, they look alike, sound alike. Yeah, for sure. And it could be so easy to pull the wrong one.

- Definitely. Yeah.

- Or the dosing, like you said. Yeah that's different for a baby than a child, than an adult. And yeah, it could,

- And especially imagine that's harder in the emergency room where time is like of essence a lot. You've got so many different things going on and unknown.

- Yeah. Yeah it can be, that's, that's kind of the really nice thing I think about having a pharmacist there is, we have a very diverse group of patients that come in. We have these little bitty babies come in to, you know, normal aged folks all the way up to, you know, to older folks And so, you know, learning about how medications kind of behave and, and those different patient populations I think is really good. I also think too, you know, another one of the projects that we've worked at or worked on is, you know, generally medications are kind of eliminated by your, your kidneys and so when your kidneys aren't working very well, generally those medications tend to accumulate and can be really, really high levels in your body. There is kind of a, a particular subset of the population that when your kidneys actually can work really, really well so like your body is basically just eliminating medication quicker, then you can actually get it to an effective concentration. And so we've really made strides to kind of identify those patients and dose those patients more appropriately either with higher doses or more frequent doses. We also have ways of like drawing levels to make sure that we're actually getting those proper therapeutic levels. And so there are a whole bunch of different things that we can look at as pharmacists to make sure that you know, patients are not only getting the right medication but it's also dosed appropriately as well. So

- I'm gonna be effective on that particular patient. Definitely based on their,

- I've noticed on my 23 and me account I did that and they have a section about whether or not you're a rapid metabolizer of certain drugs. Is that kind of the same thing?

- Yeah, it is. Yeah. It's probably more to do with like liver metabolism but there are some folks that, you know, certain medications depending on how it's metabolized can, can really go through

- Well they also say red heads and anesthesia. Yeah, yeah, well there's some kind of thing about heard. Yeah, I dunno, maybe that's what they meant. They just took your red hair and and marked you as that

- Probably maybe. Yeah. I require more anesthesia, I'm harder to put to sleep.

- Yeah,

- That is wild though. It is wild that you can have such a variety of impact on different people.

- Yeah.

- Well what are any misconceptions that people have about pharmacists, medications in general that you've seen frequently that we could help dispel while we have the microphone? Yeah,

- I don't know about misconceptions necessarily. I'll tell you what I generally advocate for. I generally advocate for when you go to the pharmacy, always pick up the generic. I think a lot of people are really tempted to go and buy brand name in particular. And I think for me, like branded generic or the exact same, it may not look as fancy but you end up saving quite a bit of money when you get the generic at the drugstore versus the brand name. It's the same active ingredient. So I generally tend to encourage patients that direction as well. I don't know, I think, you know, hospital pharmacist again are kind of, you know, in the background. I would certainly encourage patients that when they're here again we're, we're really trying to make sure that you get great care when you're here. I know it's a, can be a very scary thing when, you know, you look up and you see all the medications hanging on the pump and things like that, but you have a lot of really good folks that are looking after you. And so it's difficult because not every patient interacts with a hospital pharmacist. So there's this idea that if I don't see them then maybe they don't exist. But we're, we're really looking to, to make sure that you get great care here. So

- I love that. I do have one more technical question though before we wrap up. Antibiotic taking an antibiotic and taking it to completion.

- Yeah.

- What 'cause it is so tempting to not finish that antibiotic. It's when, I mean when you start feeling better Yeah. After like day two or three you're like I don't want need to take the rest of this. Yeah,

- Yeah. Speak for yourself. 'cause I always wanna finish.

- No I

- Don't,

- I dunno, I don't, I'm like, oh, okay, I'm good. I don't wanna have to take that unnecessarily, but I hear that it's so bad for you.

- It can be, yeah, kind of the general, the reason why we encourage patients to finish their antibiotic course obviously is to make sure that they're, you know, getting all of the drug in their system that they need to hopefully eradicate an infection if it's there. But it's also kind of to, to mitigate a lot of the antibiotic resistance that can happen too. So if you're taking it for a short course and you don't finish the actual, you know, medication itself, if that particular organism sticks around, it could actually develop resistance to that medication that you're taking. Right. And then we have to switch antibiotics and things like that. And so, see

- That makes me want to take it.

- We do in general moderate if I can understand how absolutely, you know, finish those, those antibiotics. I will say if there's ever a question, you know, on whether or not you should, you should finish, I would definitely reach out to your primary care doctor, whomever prescribes it because there are some rare scenarios where it may be okay to stop after, you know, three to five days and things like that. But in general, we very much kind of encourage patients to finish that course and, and reach out if you're having side effects. I mean, you know, that's probably the biggest reason why folks don't want to finish it is, you know, like I, I'm just starting to feel bad kind of thing. And so, you know, there are other medications that we can possibly use to treat those side effects or maybe we need to switch antibiotics or, you know, we would encourage like more yogurt intake or taking it with food or maybe you should take it on an empty stomach. There are all kinds of different things that we can kind of modify, not necessarily with medications that can hopefully help that course be a little bit easier. So

- I thought of something else too. I read something recently that the United States is one of only like two countries in the world that has medication commercials like advertised on tv.

- Yeah.

- What do you think about that?

- Just curious. Yeah, I I I am generally not a fan I guess of the commercial advertising of medications. I mean I, I, I understand that it's kind of a necessary part of the, you know, research and development of a particular medication, but you know, a lot of, a lot of money is spent toward medication advertising in general. You know, I, I guess it's good to kind of get the word out about a new medication. I think that's kind of how we kind of understand how things are. But you know, in general, like just because it's on the TV or it's advertised doesn't mean it's great for every patient. Right. Yeah. I think that's great. Well,

- Obviously because they have to lose those side effects, which is like yeah. Side effects likely death or, you know, every side effect possible. Yeah. Yeah. It's like, hmm, who would ever want to take that medication?

- Yeah. Yeah. It's, it's likely only applicable to a very, very small percent of the population. And so, I don't know, it seems, it seems a bit weird. Not very effective.

- I mean, from the marketing perspective to us that's like wild. But

- Yeah,

- Like you're gonna go into the doctor and be like, Hey, I saw this on tv, that's what I want.

- Right? Yeah.

- Strange. But

- It

- Is what it is.

- Well, if there was one piece of advice you could give to patients or families to provide to help, you know, you provide the safest care possible, what would that be?

- I think the biggest thing is asking questions. I think, I think a lot of folks are pretty nervous to ask. I think you can make an argument that pharmacists really anywhere, particularly in the retail setting, are likely some of the most accessible healthcare providers. You know, a lot of times you call the doctor's office and you're probably not gonna get the doctor on the phone. Maybe it's hard to get a nurse on the phone too, you know, but you show up at your local pharmacy and you can pretty readily get a pharmacist available. And so, you know, with that, like obviously our training is more specific about medications, but you know, we, we do have a little bit of education on hey, maybe when you should go to the emergency department or when like, you know, this particular issue that you're having is concerning. And so I think the biggest thing is, is asking questions. We talked about it earlier, but accurate medication lists are very important as well. I would try to fill all of your medications at one pharmacy if it's possible. It's not possible always with things like insurance and things, but it is a little bit easier when you get everything from one place because you know that particular pharmacist has all of the information there. But yeah, accurate medication list and ask questions,

- Good tips. Yeah. Just one final question. This is something we ask everybody that comes on the podcast. Okay. But what is your favorite meal to eat here at SGMC Health? Favorite meal in the, the cafeteria or in the spice?

- Let's see. The salads honestly are pretty good. I do like the salads. I'll be honest, it very much depends on the shift in the emergency department. I get to eat it off sometimes. I, I'm, I'm, I'm doing the chicken tenders, which are really good. I love the burgers. I think the burgers are quite nice. But yeah, it kind of depends on how the shift's going. Makes total sense. I

- Are you saying you stressy like it's been a really hard day. I need some chicken tenders. Yeah. Yeah. I

- Feel that

- Ive

- Said that before. Yeah, definitely. All right. Well we just wanna thank you so much for coming on with us. I think we learned a lot. Absolutely. And I'm sure our listeners will too. And we just appreciate the role that y'all play in the success of our health system, but the health and wellness of our patients. Yeah.

- Thanks for having me. Appreciate

- That.

- Yeah. And if you have any questions or topics you're interested in hearing about, you can let us know at sgcm.org/podcast. And don't forget to like and subscribe.