Полная расшифровка выпуска From Anatomy Lab to Rhinoplasty: A Surgeon’s Journey

00:04:59.796 --> 00:05:04.816 are board certified to do the procedures that they do, that's perfectly fine. 00:05:04.916 --> 00:05:06.776 But board certification is a minimum. 00:05:07.216 --> 00:05:10.976 Board certification just means that you have the minimum knowledge base and 00:05:10.976 --> 00:05:14.156 you've met a minimum standard to do those procedures. 00:05:14.456 --> 00:05:21.056 What differentiates one specialty from the other is the scope of your practice. 00:05:21.476 --> 00:05:28.836 And when you talk about the scope of, and I can only speak to my practice, rhinoplasty. 00:05:28.996 --> 00:05:34.816 I do rhinoplasty every week. It's a repetitive thing and over and over and over. 00:05:34.996 --> 00:05:41.056 And like anything else, when you repeat what you're doing, your misses become 00:05:41.056 --> 00:05:44.196 smaller and your details become greater. 00:05:44.396 --> 00:05:48.276 And so because of that, you're able to. 00:05:49.480 --> 00:05:52.820 Translate all that I believe into excellent results 00:05:52.820 --> 00:05:56.140 yeah and that's where where it all happens it's not that 00:05:56.140 --> 00:05:59.320 we're necessarily more intelligent or 00:05:59.320 --> 00:06:04.160 brighter than anybody else it's the repetitive nature of what we do and this 00:06:04.160 --> 00:06:08.720 this is all we do it's just one after another of the same thing or roughly the 00:06:08.720 --> 00:06:16.740 same thing well so so you get into you get into practice in north florida what year, 00:06:17.380 --> 00:06:21.940 In 2001, I started my practice two weeks, three weeks after 9-11. 00:06:22.280 --> 00:06:25.240 Yeah. October 1st, 2008. You know the start of it. 00:06:26.173 --> 00:06:34.413 So, you know, what did you, obviously, there weren't a lot of facial plastics guys doing work. 00:06:34.933 --> 00:06:41.593 No, what there were at that time were the general plastic surgeons who did everything. 00:06:41.773 --> 00:06:48.293 Yeah. And then you had some otolaryngologists who did facial plastic surgery. 00:06:48.493 --> 00:06:50.093 So a lot of these guys did. 00:06:50.333 --> 00:06:53.793 They might do a rhinoplasty. They might do a rhinoplasty every once in a while. 00:06:53.793 --> 00:06:57.793 Yeah, every great once in a while, they would do an aging face operation, 00:06:57.793 --> 00:07:03.693 but mostly they paid their bills by doing overlander gals, sinus surgery, 00:07:03.873 --> 00:07:05.893 tonsillectomies, those kinds of things. 00:07:05.893 --> 00:07:11.693 So that's where I think when I came into the community, I made a commitment 00:07:11.693 --> 00:07:19.393 to myself that I was only going to do facial plastic and reconstructive surgery. 00:07:19.793 --> 00:07:25.853 And it wasn't an easy commitment to make financially because at the time I was 00:07:25.853 --> 00:07:31.093 trying to develop a cosmetic surgery practice in the town where I was from, 00:07:31.253 --> 00:07:33.573 but nobody really knew who I was as Dr. 00:07:33.673 --> 00:07:37.873 Garcia, the facial. Well, nobody knew that a specialty called facial plastic 00:07:37.873 --> 00:07:39.033 surgery existed. Correct. 00:07:39.253 --> 00:07:46.473 I mean, I remember reading an article that back in 1992, 95% of all facial cosmetic 00:07:46.473 --> 00:07:50.553 surgeries were done by general plastic surgeons, board-certified plastic surgeons. 00:07:50.893 --> 00:07:57.953 And in 2003, they did the same study, and 94% were now done by facial plastic surgeons. 00:07:58.213 --> 00:08:00.593 Now, I'm going to speak on that for a second. 00:08:00.993 --> 00:08:07.133 You think about it. That's 180% turnaround and the volume of how things, 00:08:07.313 --> 00:08:08.973 it's a complete paradigm shift. 00:08:09.233 --> 00:08:15.333 But interestingly, the reason it happened was, you know, back when the board was created, right? 00:08:15.453 --> 00:08:17.973 1986, right? After that skim milker. 00:08:18.737 --> 00:08:22.297 82 sorry and now all 00:08:22.297 --> 00:08:25.677 of a sudden facial plastics as a 00:08:25.677 --> 00:08:28.677 specialty became prominent at the academic level 00:08:28.677 --> 00:08:33.157 yeah and now every ent program not 00:08:33.157 --> 00:08:35.917 in the 80s but eventually over the course 00:08:35.917 --> 00:08:38.817 of the next decade 15 years had a guy 00:08:38.817 --> 00:08:41.657 trained in facial plastics yeah right yeah because there 00:08:41.657 --> 00:08:44.597 have been fellowships up until that point but there wasn't 00:08:44.597 --> 00:08:47.797 a board and so now all of a sudden you had facial 00:08:47.797 --> 00:08:51.237 plastics guys in the academic institutions taking on 00:08:51.237 --> 00:08:53.957 those facial cases where before they had gone to 00:08:53.957 --> 00:08:58.477 the general guys and now the general guys are graduating and they don't have 00:08:58.477 --> 00:09:03.537 the volume and now they get into practice and they don't feel comfortable with 00:09:03.537 --> 00:09:06.677 their practice they can't do it well yeah or they feel less comfortable yeah 00:09:06.677 --> 00:09:13.017 i think that a lot of that speaks to what you said about the, the, 00:09:13.037 --> 00:09:19.537 the, the turnaround in the, the percentage of cases that our specialty does 00:09:19.537 --> 00:09:21.397 as compared to 40 years ago. 00:09:22.397 --> 00:09:26.457 And you know, you're, when you, when you try to explain something like that, 00:09:26.677 --> 00:09:33.257 it's really not that there's the majority of people in this country are under 00:09:33.257 --> 00:09:36.937 some sort of mass delusion and we've been able to delude them and to think. 00:09:37.017 --> 00:09:38.977 No, that's the only thing that existed. That's correct. 00:09:39.277 --> 00:09:43.617 So, the only other alternative is results, right? 00:09:43.877 --> 00:09:50.117 The results are really what refers patients to you if you have your best results. 00:09:50.117 --> 00:09:52.557 And that's how I've been

able to build my practice. 00:09:52.697 --> 00:09:56.097 That's how, you know, everybody else in facial plastic surgery has been able 00:09:56.097 --> 00:10:00.017 to build their practice. better results with rhinoplasty, happier patients. 00:10:00.017 --> 00:10:02.317 They tell other patients and so on and so forth. 00:10:02.477 --> 00:10:07.937 So it's just the progression of the growth in our specialty. 00:10:08.257 --> 00:10:14.297 Yeah, and I can tell you that, you know, there has been over the course of years different... 00:10:15.299 --> 00:10:19.979 And I don't like to use the word, you talk to some of these gung-ho guys in 00:10:19.979 --> 00:10:23.139 our academy, and they call it encroachment into our specialty. 00:10:24.199 --> 00:10:27.199 Anybody's free to do, I don't have that, I'm not that militant guy. 00:10:27.539 --> 00:10:30.779 You know, if you do good work, I don't care what specialty you are, you do good work. 00:10:31.079 --> 00:10:35.339 Because even within our specialty, there's guys, and you can probably attest 00:10:35.339 --> 00:10:38.919 to this, you go to a meeting, and you're looking at the presentation, 00:10:39.099 --> 00:10:41.239 and you say, which one's the before, which one's the after? 00:10:41.399 --> 00:10:45.519 Many times. You know, and you know, they got the little Ivy league logo at the 00:10:45.519 --> 00:10:46.659 bottom or whatever it is. 00:10:46.799 --> 00:10:50.019 And, and you say to yourself, okay, well, that's not going to float in the real world. 00:10:50.399 --> 00:10:54.719 And so I have met very, very, I mean, Dick Webster was a general plastic surgeon, 00:10:54.719 --> 00:10:58.499 one of the best in the game. Well, he was the first president of the American 00:10:58.499 --> 00:11:02.319 Academy of Facial Plastic Surgery, but Dick Webster was an interesting guy because, 00:11:02.539 --> 00:11:04.779 first of all, he was a very gracious guy. 00:11:04.879 --> 00:11:10.199 Dick Webster was a plastic surgeon from Boston, and he was a very gracious individual. 00:11:10.199 --> 00:11:14.159 He brought in people from all different kinds of specialties. 00:11:14.159 --> 00:11:19.339 He brought in otolaryngologists and, you know, some of the people from our lineage. 00:11:19.379 --> 00:11:25.299 He brought in people from our lineage into his practice to teach them how to 00:11:25.299 --> 00:11:27.319 do facial plastic surgery. 00:11:27.559 --> 00:11:32.639 But that was an exception in the world of plastic surgery. 00:11:32.999 --> 00:11:40.139 There were really no other Dick Websters out there. He was truly a gracious person. 00:11:40.399 --> 00:11:43.859 Well, with regards to sharing knowledge. With regards to sharing knowledge, right. 00:11:45.039 --> 00:11:47.099 The academy, like you said earlier, 00:11:49.679 --> 00:11:55.919 the board was born out of a $1.5 million lawsuit that Jack Anderson, 00:11:56.239 --> 00:11:59.239 one of the pioneers in our academy from New Orleans, 00:12:00.229 -->

00:12:05.989 One in a libel case against two general plastic surgeons in Atlanta who posted 00:12:05.989 --> 00:12:12.209 a series of articles in, I think, some kind of Georgia archives magazine. 00:12:12.469 --> 00:12:18.529 Yeah. And it might've been the, the, the journal for the Georgia medical society 00:12:18.529 --> 00:12:19.709 or something like that. Yeah. 00:12:19.829 --> 00:12:22.149 I, in my office, in one of those rooms, I have it. 00:12:22.289 --> 00:12:29.629 Yeah. And so they, they basically, they took a position that anybody who wasn't them was not real milk. 00:12:29.669 --> 00:12:32.249 It wasn't whole milk. It was skim milk that we were diluted. 00:12:32.429 --> 00:12:38.509 When in fact, you look at the history of facial plastic surgeon all the way back to Jacques Joseph. 00:12:39.425 --> 00:12:46.225 Who was one of the, if not the father of modern plastic surgery, 00:12:46.525 --> 00:12:50.205 he was an otolaryngologist from Germany who pioneered rhinoplasty. 00:12:50.605 --> 00:12:57.325 Even Harold Gillies, who was an English plastic surgeon, he was an otolaryngologist 00:12:57.325 --> 00:13:05.385 who took his practice to plastic surgery, but his original training was otolaryngology. 00:13:05.505 --> 00:13:10.805 And so when you go back to that whole history, it's really all otolaryngology 00:13:10.805 --> 00:13:16.105 based where the division happened is a group of people decided that they weren't 00:13:16.105 --> 00:13:20.225 going to be inclusive. And this was in the, in the interwar period. 00:13:20.565 --> 00:13:25.185 And they said, this is our territory and we're not going to share where we're 00:13:25.185 --> 00:13:30.165 going to create our own board, which was their right to, to create whatever 00:13:30.165 --> 00:13:31.705 group they, they wanted to, 00:13:31.925 --> 00:13:35.865 but we had to do our own thing. 00:13:36.185 --> 00:13:41.645 Our predecessors had to do our own thing because we were just as, 00:13:41.825 --> 00:13:45.125 if not more qualified to do these procedures that we do. 00:13:45.405 --> 00:13:51.505 Yeah. In that case, in the court case, they actually brought up examples of, 00:13:51.685 --> 00:13:53.045 you know, with a brow lift, 00:13:53.305 --> 00:13:59.385 an ENT is more qualified to do a brow lift because he has done osteoplastic 00:13:59.385 --> 00:14:01.845 flaps. He's done frontal sinus surgery. 00:14:02.045 --> 00:14:07.185 With a facelift they've done parotidectomies for years you know with eyelid 00:14:07.185 --> 00:14:11.665 surgery they've done trauma periocular trauma and with nasal surgery of course 00:14:11.665 --> 00:14:16.785 we've done sinus and internal uh internal nasal work so in fact. 00:14:17.757 --> 00:14:26.037 Our base, the otolaryngologic base, the ENT base, was better suited for this. Cosmetic surgery. 00:14:26.297 --> 00:14:29.597 Cosmetic surgery. It was a natural progression. Right. 00:14:29.697 --> 00:14:33.597 It's not a natural progression when you've been

doing bowel surgery for a year, 00:14:33.597 --> 00:14:36.777 and then all of a sudden you're thrown into doing a rhinoplasty. 00:14:37.037 --> 00:14:40.477 Right? Because if you remember, and I do want to get to this point, 00:14:40.737 --> 00:14:46.677 if you remember, we didn't just jump into rhinoplasty as second-year residents. 00:14:46.697 --> 00:14:51.437 Right? We started off doing septoplasties, and we'd watch a lot of rhinoplasties, 00:14:51.557 --> 00:14:57.377 but it wasn't until my chief year that I was actually doing osteotomies and moving bones. 00:14:57.877 --> 00:15:02.857 And definitely in my fellowship, you learn more. And so that's one of my biggest 00:15:02.857 --> 00:15:06.977 fears that I have now with this younger crop of physicians that's coming up. 00:15:08.457 --> 00:15:13.137 They're going to have a longer period of fear. I think every young surgeon when 00:15:13.137 --> 00:15:17.537 they graduate from residency or fellowship has a period of fear, 00:15:17.697 --> 00:15:19.957 you know, like that, holy cow, I'm on my own now. 00:15:20.137 --> 00:15:22.637 Yeah. I'm slightly looking over my shoulder. I remember those days. 00:15:22.817 --> 00:15:24.377 Yeah. Losing sleep before you're ready. 00:15:24.877 --> 00:15:27.297 You know, you're sitting there like, what if I, what if this happens? 00:15:27.437 --> 00:15:28.257 What if that happens? Whatever. 00:15:28.617 --> 00:15:34.757 And so, but you got to realize we were doing that on the heels of 4,500, 00:15:35.237 --> 00:15:39.477 maybe 5,000 cases that we had done just in the face during residency. 00:15:39.477 --> 00:15:44.797 Well, now with all the resident restriction work hours, these kids are graduating 00:15:44.797 --> 00:15:47.797 with two-thirds of the cases low data. 00:15:48.097 --> 00:15:54.077 Yeah, I think that that's inherent in what is coming out of residency right now. 00:15:54.277 --> 00:15:59.237 I don't think that the way residencies were designed when you and I were in 00:15:59.237 --> 00:16:03.357 it, I don't know that that was the best way to educate. 00:16:03.357 --> 00:16:09.357 And all of that, I'm digressing here, but all of that was born from the father 00:16:09.357 --> 00:16:12.097 of modern surgery in the United States. 00:16:13.785 --> 00:16:18.485 There's a big statue of him at Hopkins. I can't remember his name now. I don't agree with that. 00:16:18.645 --> 00:16:22.525 Well, he was a cocaine addict. No, no, no. I'm not saying him. 00:16:22.605 --> 00:16:25.805 And he was up at ungodly hours of the day. He wouldn't sleep. 00:16:25.805 --> 00:16:29.485 And so his residents wouldn't sleep either. 00:16:29.485 --> 00:16:38.045 And that whole educational system in surgical education was born out of a cocaine addict. 00:16:38.045 --> 00:16:41.925 So it became very punitive. So it became punitive and it became this, 00:16:42.105 --> 00:16:45.445 it doesn't matter how much you don't sleep or how much you do sleep. 00:16:45.525 --> 00:16:48.865

Yeah, but there's the argument though, and I'm not totally disagreeing with 00:16:48.865 --> 00:16:55.965 you, but there's the argument that a Navy SEAL is the warrior that he is because 00:16:55.965 --> 00:16:59.265 he doubted his entire existence in his training, right? 00:16:59.365 --> 00:17:02.485 That he got taken to the brain. But he got pushed to the left. 00:17:02.485 --> 00:17:06.965 And if you don't take these kids and you don't push them and have the fear in 00:17:06.965 --> 00:17:10.045 there, because right now these residents don't have the fear of being fired. 00:17:10.505 --> 00:17:14.045 That's correct. That's something that we have that fear. And every day you went 00:17:14.045 --> 00:17:17.005 into a case and if you weren't ready for it, you knew you were going to get blasted. 00:17:17.045 --> 00:17:20.865 I mean, I don't know, my fourth year of residency, one of my attendings, 00:17:21.025 --> 00:17:24.845 Rick Kelly, if you're listening to this, it was you and who I ended up loving. 00:17:24.945 --> 00:17:25.805 And he and I are good friends. 00:17:26.105 --> 00:17:29.965 He looked over at me and he goes, you might be Dr. Garcia, the dumbest person 00:17:29.965 --> 00:17:33.665 I've ever met in my life. And it was only because I didn't know one particular 00:17:33.665 --> 00:17:36.785 part of this laryngology procedure we were doing. 00:17:36.985 --> 00:17:39.705 And so you have a choice at that point. Yeah, yeah. And you can say, 00:17:39.885 --> 00:17:43.825 all right, does he really think I'm the stupidest? Like, really, the stupidest? 00:17:44.085 --> 00:17:47.425 There's guys with IQs of 50. That guy, BB? 00:17:48.302 --> 00:17:55.022 Or is he just saying it to challenge me, to make me really rethink something 00:17:55.022 --> 00:17:57.542 and never make this mistake again? And it's obviously the law. 00:17:57.802 --> 00:18:00.882 Yeah, yeah. We all know that you have to push the motor to the limit to know 00:18:00.882 --> 00:18:04.582 what the motor is capable of. I don't disagree with that part of it. 00:18:04.902 --> 00:18:11.482 The part that to me was the most distasteful part of residency was the hazing 00:18:11.482 --> 00:18:17.942 and the mental torture side of it. the, I went through this process and I'm 00:18:17.942 --> 00:18:19.342 going to make you go through this process. 00:18:19.642 --> 00:18:23.582 I thought that was totally unnecessary, but maybe it was, it was a little bit more malignant. 00:18:23.802 --> 00:18:29.122 My, my residency was malignant. It was in New York city and it was all in all. 00:18:29.262 --> 00:18:33.342 I do take away good memories from residency, but that, that was the way that 00:18:33.342 --> 00:18:36.522 the educational system was and that's, you just went through it. 00:18:36.582 --> 00:18:39.962 And it's a very important point that you brought up that, especially when I 00:18:39.962 --> 00:18:45.102 was an intern, I will, I, I'm every day that I was, I walked into the hospital, 00:18:45.362 --> 00:18:51.082 you are under fear or threat of being fired and you don't know. 00:18:51.282 --> 00:18:55.602 And if you're fired from internship, remember you're already accepted to residency, 00:18:55.602 --> 00:18:58.002 which is what you're going to do for the rest of your life. 00:18:58.142 --> 00:19:02.522 And if you're fired from that internship, there goes your entire career plan 00:19:02.522 --> 00:19:04.322 because you're no longer a resident. 00:19:04.422 --> 00:19:10.902 So you've now got, you, you've, you have to figure out. And I'll give you a quick anecdote. 00:19:11.142 --> 00:19:20.442 I got called in to the chairman of surgery's office one time because I was late to a conference. 00:19:20.862 --> 00:19:24.142 I was late because I was taking care of the patients on the floor. 00:19:24.262 --> 00:19:26.822 I mean, I had a valid reason. Somebody was crashing here. 00:19:27.342 --> 00:19:30.202 And I was late. He saw me walk in late. 00:19:30.442 --> 00:19:34.942 After the thing, he called me into his office. And I can tell you that I honestly 00:19:34.942 --> 00:19:39.842 thought I was going to get fired. and I was convinced this is it I'm done and. 00:19:41.442 --> 00:19:46.722 How much good that did to my fortitude and the creation of character. 00:19:47.102 --> 00:19:52.542 That's tough to say. I don't know, but you're absolutely correct in your assessment 00:19:52.542 --> 00:19:55.222 about pushing that engine. Yeah. 00:19:55.722 --> 00:19:59.422 Well, and look, I mean, if we were to kind of wrap this up, I, 00:19:59.502 --> 00:20:02.042 and I wanted to, I do something really cool at the end. 00:20:02.182 --> 00:20:04.022 I don't know if I've told you this, but we'll talk about it in a minute, 00:20:04.122 --> 00:20:08.642 but 20 years, 25 years later. Okay. 00:20:10.482 --> 00:20:16.322 Now patients come seeking facial plastic surgeons. Right. They come seeking the specialty. Yeah. 00:20:17.122 --> 00:20:19.982 And, you know, it's something to be proud of. 00:20:20.182 --> 00:20:25.262 Yeah. It's something to be proud of that, you know, you and I have been steadfast 00:20:25.262 --> 00:20:29.242 in our commitment to the specialty in this community and in this part of the country. 00:20:29.562 --> 00:20:36.282 Yeah. And, you know, our reputation precedes us really as individuals that were, 00:20:37.031 --> 00:20:40.331 is characteristically driven towards a particular model. 00:20:40.751 --> 00:20:44.551 And, and I think that a lot of that, and this is going to lead me into our last 00:20:44.551 --> 00:20:46.031 segment, which is perfect. 00:20:46.391 --> 00:20:51.531 Okay. You guys all laugh at it every time I do it, this all leads us to lessons 00:20:51.531 --> 00:20:53.651 that we learned from dad, you know? 00:20:53.951 --> 00:20:58.671 And so, you know, dad died. My dad, I say this every week, but our dad died 00:20:58.671 --> 00:21:01.971 last year in June, June 16th, almost a year. 00:21:02.331

--> 00:21:09.411 And dad, uh, as well, you know, dad loved to teach dad loved to talk to us and 00:21:09.411 --> 00:21:13.051 he loved to talk to everybody and along the lines. 00:21:13.151 --> 00:21:18.931 And I think this is so appropriate for this conversation was the lesson or the, 00:21:18.931 --> 00:21:24.571 the, the kind of that, that ongoing message of in order for you to succeed, 00:21:24.911 --> 00:21:26.791 you have to fail countless times. 00:21:27.711 --> 00:21:32.331 And the, you know, the idea, the Thomas Edison concept of the light bulb, 00:21:32.471 --> 00:21:34.171 right? Failed, I don't know how many times. 00:21:34.651 --> 00:21:39.111 And I tell patients all the time, I said, you know, the surgeon that I was at 00:21:39.111 --> 00:21:42.051 the beginning of my career, it's a completely different surgeon than I am now. 00:21:42.411 --> 00:21:48.431 And really not only in the medical field, but in a personal, right? 00:21:48.811 --> 00:21:52.011 Interactions with my employees, interaction with friends, interaction with family. 00:21:52.971 --> 00:21:56.251 You, you learn, okay, that's not the right way to talk to that person. 00:21:56.411 --> 00:22:00.271 That's not the right thing to say. Let me correct that. And let me get a little bit better. 00:22:00.371 --> 00:22:07.491 But the difference in dad spoke about this, you can't be hubris. 00:22:07.931 --> 00:22:11.111 And when you make a mistake, you have to own it. 00:22:11.251 --> 00:22:15.991 You have to make a correction and you have to adjust and become a better person 00:22:15.991 --> 00:22:19.991 because the goal of this isn't a scoreboard at the end of life where, 00:22:19.991 --> 00:22:21.451 you know, where God says, or St. 00:22:21.611 --> 00:22:23.831 Peter at the gate says, all right, Roberto, good job. 00:22:24.031 --> 00:22:29.191 You won 5,650 times, but the people around you, the world around you hate you. 00:22:29.311 --> 00:22:32.211 You know, that's not how it is. There's no scoreboard. 00:22:32.511 --> 00:22:36.331 What matters is that as you're going along and you make a mistake, 00:22:36.331 --> 00:22:38.671 and to our point about our specialty. 00:22:39.516 --> 00:22:42.396 The details get tighter, right? 00:22:42.516 --> 00:22:46.676 And so now, you know, whenever there's something that you're seeing at three, 00:22:46.896 --> 00:22:51.596 six months after surgery, you can, in your mind say, I know exactly why that 00:22:51.596 --> 00:22:55.836 happened because your, your window of error is this tight. 00:22:56.016 --> 00:22:59.876 Yeah. You pay attention to more details. The big stuff has worked itself out 00:22:59.876 --> 00:23:04.076 throughout your career and you pay attention to those little details a lot more. 00:23:04.076 --> 00:23:08.856 And it makes you better at being, being more effective and 00:23:09.056 --> 00:23:11.856 having better results but if if i may 00:23:11.856 --> 00:23:14.936 say something about dad the the 00:23:14.936 --> 00:23:17.796 thing that in in your segment the thing 00:23:17.796 --> 00:23:26.796 that i i still remember dad telling me is nobody owes you anything and i still 00:23:26.796 --> 00:23:35.176 remember multiple conversations about you know when i finished residency i finished fellowship. 00:23:35.756 --> 00:23:40.296 And, and I said, okay, dad, I'm ready to start my practice. 00:23:40.696 --> 00:23:46.296 And I remember dad saying, and now's when the work starts. 00:23:46.636 --> 00:23:53.476 And that's because he always taught me and I knew as well that you're only as 00:23:53.476 --> 00:23:55.076 good as what you did yesterday. 00:23:55.963 --> 00:23:59.823 Everything can come crashing to an end today. 00:24:00.183 --> 00:24:07.883 You have to have the humility to realize that and to understand that you're 00:24:07.883 --> 00:24:10.023 not owed anything in life, 00:24:10.243 --> 00:24:15.183 certainly in our field, in our specialty, in our practices. 00:24:15.583 --> 00:24:19.543 Nobody owes you anything. You have to work every day and you have to challenge 00:24:19.543 --> 00:24:23.123 yourself every day and, and always be attentive. 00:24:23.363 --> 00:24:27.383 Never take your eye off the ball because there's nothing here for granted. 00:24:27.663 --> 00:24:30.783 So that's my lesson from that. That's beautiful. 00:24:31.183 --> 00:24:36.983 That's exactly right. Yeah. Well, listen, man, it has been absolute honor having you here. 00:24:37.163 --> 00:24:40.663 I really appreciate you coming out here. I know you're busy and we, 00:24:40.783 --> 00:24:43.103 this is honestly, this may be the best one. 00:24:43.563 --> 00:24:48.103 Okay. I know we said that last week. It's because it's me. But it's my bro. Sorry, Patrick. 00:24:48.423 --> 00:24:51.703 But it's my brother. And I do think this one took the cake. 00:24:52.083 --> 00:24:57.323 So any of you thinking about watching the Confident Choice, you want to go to this one first. 00:24:57.743 --> 00:25:02.743 So next week, we're going to be talking about, let me get my card, revision surgery. 00:25:03.303 --> 00:25:08.083 And how is it that we accept not the best results? 00:25:08.323 --> 00:25:13.103 And where do we go as surgeons to that next step? Do we wait a little bit? 00:25:13.263 --> 00:25:15.863 Do we go ahead and get, do we intervene a little bit sooner? 00:25:16.263 --> 00:25:19.623 And how do we plan the proper revision surgery for whatever it is. 00:25:19.963 --> 00:25:22.043 And, folks, I'm going to tell you something. I'll get into this next week. 00:25:22.263 --> 00:25:24.983 Any surgeon who tells you he doesn't have revision surgeries, 00:25:25.363 --> 00:25:28.203 he's either lying to you or hasn't done enough of them. That's a fact. 00:25:29.063 --> 00:25:33.923 And it has nothing to do with the surgeon. It has to do with the way the cookie 00:25:33.923 --> 00:25:36.323 crumbles sometimes. Results happen. 00:25:37.283 --> 00:25:40.223 Biology is different between person A, B, C, and D. 00:25:40.543 --> 00:25:44.523 So we'll dive in a little bit deeper into that next week. And remember, 00:25:44.763 --> 00:25:45.943 Alyssa's going to get me here. 00:25:46.663 --> 00:25:50.383 Better decisions make better information. What is it? Good decisions always 00:25:50.383 --> 00:25:53.263 come from good and free. And good. 00:25:54.307 --> 00:25:58.407 Good decisions always come from good information. We're signing out. 00:25:58.507 --> 00:25:59.447 Have a great week, everybody.