Dr. Nick, Chief Medical Officer at Basehealth

How Incremental Shifts can Have Exponential Results in Health with Dr. Nick, Chief Medical Officer at Basehealth, Inc. and CEO at Incremental Healthcare

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:20] Outcomes Rocket listeners welcome back once again to the outcomes rocket where we chat with today’s most inspiring and successful health care leaders. You know really want to thank you for tuning in again. And if you enjoy the show leave us a rating and review on Apple podcasts. Just go to outcomesrocket.health/reviews and you’ll be able to leave us 5star review or whatever you want to give us and give us some feedback. Love it when I hear from you guys and gals it just helps us put together our show with what you guys are looking for. So without further ado, I want to introduce my outstanding guest today. His name is Dr. Nick. Dr. Nick’s been in health care for quite some time with many different companies and really he’s a guy that wears a lot of hats. And what I wanted to do is rather than dive into the details of where and what he’s done. I wanted to open up the mic to Dr. Nick so he could fill that in. Dr. Nick, welcome to the podcast.

Dr. Nick: [00:01:23] Thanks for having me. Always a pleasure to join you and excited to share some of my experiences so you appreciate the opportunity. So as you said I’ve had many roles the primary one and the one that sort of drives me most frequently is as a physician but ultimately I’ve really focused on digital health and the enablement of people in the healthcare field with technology. Most recently I was the chief medical officer for Dell and founded a company called incremental healthcare that was really looking for those small changes that you find from other industries that add up to the big change that I think we’re looking for in healthcare and I try and find those and bring them into healthcare. But my most recent adventure is really the one that I’m most excited about and that’s working as the chief medical officer for Base Health and there are a comprehensive predictive analytics company that’s focusing on population health management in a completely unique way. They really try and tease out what we call the invisible patient the one that never gets to the healthcare system until it’s really too late or if it’s not too late it’s certainly going to be very significant in both impact on personal health and also impact and costs. And we can find those patients before they descend into this spiral of unhealthy medical experiences and allow the medical profession to play intervention before they would have seen them or been able to actually improve those health outcomes. And that for me is very exciting because that’s really the medicine that I went to medical school to practice.

Saul Marquez: [00:02:53] Now that’s really great. Dr. Nick and just focusing on those patients that I think is so special and so key so kudos to you and base health for taking an aim at that part of what population health. Why did you decide to get in a medical sector to begin with.

Dr. Nick: [00:03:09] You know it’s funny that question comes up a lot and it’s actually for me very easy to answer. I have a very specific event that occurred when I was still quite a young boy. I was with my brother we were walking in London walking out of a train station and a crowd had gathered at the side of a road and somebody had been run over and my brother was a doctor at the time and he pushed his way to the front of the crowd and you know asked people to let him through. Excuse me I’m a doctor and you know he was concerned for me so he had me sort of standing to one side because he was really taking care of me at the time. And I remember looking on as all these other people looked on this patient and my brother was playing intervention and offering care and treatment until the ambulance showed up and that was a seminal moment for me. I realized that I wanted to be him actually involved in delivering the care and supporting and you know being the active participant as opposed to the observer and that really sort of formed the main trajectory for me that made me decide that I wanted to do medicine so that I could play the most active role in contributing to people’s overall health and being able to deliver care in urgent circumstances and ultimately what I did most of my practicing clinical career was working in the emergency room where you see an awful lot of those kind of things as well.

Saul Marquez: [00:04:34] Very cool. Dr. Nick, that’s so cool and now thank you for sharing that story you know and you just took me back there kind of felt like I was part of the crowd and saw you walking through and you save the gentleman and now you’re just you fast forward and you created that for yourself and now you’re able to provide that help to the people. Very inspiring story and the like as leaders in this business we all get a reflect back onto that time that created that spark and why we’re here and that spark is what keeps us ignited and keeps us going when the going gets tough. You obviously have decided with your recent involvement with base health to focus on population health. Right. And so I always ask what a hot topic you believe should be on medical leaders agenda. But maybe you could take a step further. There within population health and dive into where should leaders be focused today.

Dr. Nick: [00:05:24] Well so I think the primary driver in terms of exciting opportunities in healthcare is data. And then the second most exciting area or topic that we should be focusing on is data. And I’m I’m joking it’s not to the exclusion of the patient or the personal aspects and that’s really the medicine that we all want. It’s also the medicine that clinicians want to deliver but we can’t do that without data and we haven’t had really good access to it. So for the longest time medicine was reasonably safe but not very effective. Over the course of the last several decades it’s become increasingly challenging to practice good medicine much more risky for the patient and very difficult for the physicians because they’re being overwhelmed with all of this information these various choices. And really the key asset that we want as a clinicians is to deliver the best possible care so that individual patients. And I think one of the things that we failed in the past is to sort of focus on the individual in all of this. And by that I mean calling out the details so we talk about diabetes type 1 and 2 but in fact as we’ve analyzed the data and now we know there’s at least three types of diabetes not just two. And that’s just based on the data. I can’t tell you exactly what the classification will break down but we can see it in the data maps that show these groupings of patients and in fact I think it’s even more refined than that. So as we analyze and start to take access to more and more data I think that’s going to become the magic 8 ball in healthcare. It’s going to allow us to understand our patients better. It’s going to improve the advancements and the changes that we can deliver to those patients that is customized to their particular circumstance. So your clinical condition albeit labeled the same way as somebody down the street will be different because of so many other aspects. I think the analysis of that and in particular I think the key asset that we have is artificial intelligence and machine learning that really go about to sort of add to this tool which is still one of the best processing tools on the planet. But it’s not good at certain tasks. It’s not good at processing huge amounts of data and being very consistent is very good at teasing out patterns that we have to present that information. So for me using advanced analytics to find the patients and to deliver the very specific care that’s appropriate for them what’s the one intervention that we can do. If you are going to focus on one thing and there’s probably lots that you can do that will change the trajectory for that patient. Let’s focus on that and then if we can add other things it’s a little bit like you know the steps of trying to lose weight. We don’t focus on losing losing 20 pounds although some people set that target the first target is that first half a pound or a pound. Every successful journey starts with these small steps and I think it’s that very much with data. And when you think about data it’s about the lens. How do you focus on the right pieces of data and allow the physician to see when you see this enormous tsunami of information. How do you tease out because a lot of patients all look the same. I don’t mean that physically but you know in terms of if you looked at them on paper gosh they’re as sick as each other similar data elements. But how do you tease out the differences in the ones that are significant and the ones that are not. There are people that walk around that never have any challenges live to 100. And then there are others that don’t. And we want to find those make sure that they get to the clinicians so that they get expert care as early as possible. So I think that capacity. And the other thing about data is we already have lots of it. There’s a hundred and fifty million articles in pub med scientifically validated literature and are we applying all of that knowledge to the point of care. You get the best possible care when you go and see your physician. Maybe not not because he doesn’t want to give it to you but he may not know how does he know at the point of time that he sees you that this is the right piece of evidence the right piece of science. And that’s where technology comes into play to support that so that you can present those options to the patient and the physician so that together you come to this consensus. This is the best path and the best choice because there’s no more than one yeah.

Saul Marquez: [00:10:03] Now Dr. Nick it’s obvious you’re very passionate about data and I’m just curious for the listeners can you give us an example of how you’ve used data and whether it be machine learning Iyer or just any basic analytics to improve outcomes. It was a specific thing that maybe other leaders in the field can apply.

Dr. Nick: [00:10:23] So I’m going to focus on the invisible patient because that one’s very contextual to me. I think it’s really it’s a very narrow group of people. So when you look at a population you essentially have this typical distribution of risk that everybody understands that the percentiles the media the big bump in the middle and most people understand very clearly the ones at the top end the folks that are high risk chronic diseases recurring issues very expensive and lots of things going on. And then there’s all the folks at the bottom end who are low risk who very active doing lots of sports eating well all of those things and then this big group in the middle. The biggest collection we have trouble finding individuals in there that in fact in hindsight when we look back after a year of data we realized that there were certain folks in there that became very very sick. They’d show up in the emergency room they’d have my Cartland function they progressed to stenting and bypass and then ultimately have congestive heart all a terrible outcome from what we know is that if you could place some intervention earlier on based on science so based on the science of the PubMed database and all the published studies if you did one or perhaps some more things for that individual you could have changed that trajectory and prevented them from showing up in the emergency room and maybe prevented the disease from even occurring. That’s really exciting. We can do that and we can do it accurately in such a way that now it’s very much to me like the Boeing engineer that sits in Seattle at his computer screen and he’s looking at data coming from seven fifty seven that’s flying from San Francisco to Washington D.C. and he notices because of the eye and the artificial intelligence that there’s a problem. So what does he do he calls up the captain and says Hey I think you’ve got a problem with engine number two. They go troubleshoot and the logon eyes. The engineering team to be on standby and if the plane’s got issues and that’s proactive engineering but we don’t do that in healthcare we tend to wait until you know something catastrophic happens. And this is now the outreach that goes to that patient. And for some that’s a little bit unusual. And there’s a challenge of trust here in the healthcare system where can you imagine receiving a phone call if you’re like me you don’t answer your phone at 5:00. Is Not a chance in hell if my phone doesn’t know who you are then I’m not answering the phone and saying he’s innocent but round the foot to one side and say you know assuming there’s a trusting relationship you receive a call from a trust the vizor your physician or your healthcare team to say hey we think there’s a problem or we’d like to see you come in and apply some assessments and get some additional data get some lab tests get some vital signs and you feed that into the model and then either that patient is proven to be at risk. The following reasons and you present that to the physician and say we need to do the following things let’s put them on an ACE inhibitor for their blood pressure. They need to be on a Istat it or they prove to be healthy based on the data and you say well that’s great actually there’s no problem this is good news but we’ve done a good wellness. This wasn’t sick care this was wellness care and that for me is just a complete change in the way that we practice. When you think about why you went to medical school it wasn’t for the catastrophic interventions it was to prevent those. It was the humanity to say how can I extend people’s lives and their quality of lives as much as possible. That’s for me very very compelling as a message and a concept in terms of the data and the proof points.

Saul Marquez: [00:14:14] That’s a great example Dr. Nick and maybe we could take it a step further. You know maybe. Is there a particular type of condition that you guys have been able to let’s say pick out the crowd and say you know what. Thank God for this new way of doing things that we are able to identify. Do you have any stories like that yet.

Dr. Nick: [00:14:35] Yes so in fact it’s not necessarily a condition. I think that’s one of the historical aspects to health care although we do categorize so coronary artery disease as a classic example. Diabetes is another. What tends to happen is though those don’t occur in isolation. So if you’re a diabetic you quite often have coronary disease with it you might have peripheral vascular. So it tends to be a constellation of things. But I’ll give you a specific example. So we ran data or against a dataset from 2013 and 2014 blinded. So we had no idea about what had happened. This was after the fact and we got the data as if we were looking at it in 2013 we ran an analysis and we were able to identify patients with an accuracy around 97 percent that essentially were going to spiral into poor health and we look to one of those patients. Good example. And it was an individual that in February bearing in mind that January through to December is the typical timeframe for these insurance pools and the risk pools. Yes. And in February they presented in the emergency room and they had a heart attack and then they presented again and had another heart attack. Then they had some stenting ended up with coronary insufficiency. And on long term coronary support because they have congestive heart failure they’re challenged with exercise and based on the data they are if we’d seen that in December of 2012. So the you know the month before all of this kicked off we picked out that individual and said absolutely. High risk major challenge. And it wasn’t a big list. So it’s a rank ordered list that says here all the patients and here all the things we think are going to happen in order of both significance medical significance and cost. And then importantly taking account of patients. Our best estimate or guesstimate of their ability and willingness to participate and comply. So we look at all of the data associated with this and say Who are the people that are likely to respond because there’s no point in going to a patient that you know you say hey you got all these problems but they refuse to fill the prescription or they refuse to come into the clinic. And some of that can be social determinants of health. So you know nonmedical factors and if you can place an intervention you can do that as well so provide the boats to get them into the clinic and so forth. But in those instances where there’s just a wrong noncompliance that maybe not the highest priority. It’s not that we don’t care. But let’s focus on the people that are willing and able and engaged in the first instance and then with what we’ve got left will start will attract some of those others. But that’s a huge and that turns an at risk group from red ink to black ink. That’s typically the patients that will turn you into a loss making proposition on a risk pool in a Medicare Advantage program for example.

Saul Marquez: [00:17:35] Dr. Nick that’s a great great call. You’re not going to be able to impact positively every single patient out there. I mean let’s just be honest with ourselves. You know if you’re a payer and if you’re a provider looking to minimize your losses and maximize your outcomes I think it’s important to take note of what Dr. Nick just mentioned here. You know focus on those patients that are going to help themselves that are going to help themselves right. And so it’s a great call out. Dr. Nick can you give an example to the listeners of a time when you’ve had a setback and something that you learned from that setback.

Dr. Nick: [00:18:13] So I thought about this a little bit. You were kind enough to share some of these questions ahead of time and you know the first thing I would say is that on a routine basis I consider myself failing in many aspects of my life and world. And not in a negative way. I think the key asset and thing to remember is not to take failure as the end point failure is just a learning opportunity to me and to be clear you know I’m preaching versus you know what I practiced. I’m sure I internalized a lot of this but I wouldn’t say that my most embarrassing failure is a personal one. So many many years ago my wife and I had our first child who was a boy born in Glasgow and my wife’s a very accomplished nurse midwife health visitor. I’m a physician and we went through hell on earth as many parents do with a very difficult child. Never settle. Valma you name it. Just all the things and I know lots of people will listen. Yes I was. Big deal. But here is the failure and this was the hidden data hidden patient. The fact that I couldn’t see it all my wife couldn’t see it. Despite extensive clinical experience my brother who’s a GP the one that you know inspired me to be he comes up to visit finally to see the family and he couldn’t have been in the house more than five minutes and he says Oh my God he’s got a milk allergy.

Saul Marquez: [00:19:39] Oh my goodness.

Dr. Nick: [00:19:40] I don’t know why. Yeah you know. Now you see I’m within a couple of days we had moved them off. You know regular milk put them on soy milk a man’s whole demeanor had changed. Amazing. And for me that encapsulates everything about Dator it doesn’t matter even if it’s staring you right in the face in a face. You don’t always have the capacity to see it and that’s where technology analytics machine learning all those things I think are contributors there are the supporting act. They’re not here to replace you. They’re here to you and allow you to do better work better jobs essentially better medicine.

Saul Marquez: [00:20:24] What a great example Dr. Nick. And I’m glad your brother showed up and that just goes to show right you spent enough time and you’re so passionate about something you could care so much about fixing it or getting it right. Sometimes it helps to just get around a group of people that have a fresh perspective know help you see the solution.

Dr. Nick: [00:20:49] Very much what we would call the curbside consult in the traditional form of right medicine. The thing that used to take place in the doctor’s mess as it was called in my time all the area where the clinical team used to gather. Now nobody gathers there nobody actually it turns out that that’s only used for putting terminals into people to access the electronic health health record which to me we’ve lost a little bit of that interaction. And I think one we should encourage more of it too. We should allow technology to be part of that Cope’s like cancer process.

Saul Marquez: [00:21:23] Now that’s such a great callout and a great story. Thank you for sharing that. Let’s take a look at the other side of this. Dr. Nick what’s one of the proudest medical leadership experiences that you’ve experienced to date.

Dr. Nick: [00:21:35] So I wanted to share a nonmedical one first. Yeah I know. So I actually I would say from a leadership standpoint the thing that I’ve learned the most from a leadership standpoint is has been from animals and children. And I would say that my capacity to understand or put myself in other people’s shoes to help me nurture and and move people’s views and opinions into a concerted direction particularly with training of my Labrador when she was around told me this tremendous amount. I wish I had a dog many many years ago because it taught me the true understanding of how you look at other people’s perspective. Because her perspective was much simpler for a different mind. And I had to insert myself and the other thing was with kids especially very very young kids that I used to train to soccer. Same principle not the dogs but they were very similar in some respects in terms of their behavior and allowing a means to understand their drivers and their perspective and all of that has really helped me over the course of time be better. I would call more of a nurturer versus a leader. And I’ve learned a lot. And when it comes to health care I would say for me the proudest time I had was working at Dell for Michael Dell in fact and one of the most inspirational people I’ve had the opportunity to meet who quite frankly given how successfully is and what he’s managed to establish such a humble gentleman really inspirational to see somebody of that stature just as an ordinary guy. And that for me was just a real joy to work with him work for him and the people that he inspires around him I think true LEADER I’m one I try and mimic certainly in my behavior.

Saul Marquez: [00:23:32] Thank you Dr. Nick. It’s pretty cool that you had that experience to work with Michael Dell and you know you definitely have had your fair share of success as well and I would put you in that gentleman category. And you know I think as as leaders I think your call out here that what you learn from animals and children I think is a good one right. To nurture and instead of just lead I think that goes back to the idea of putting that care into health care and what a great callout. So glad you brought that up. Maybe you can focus a little bit on a exciting project or focus that you’ve got going on.

Dr. Nick: [00:24:09] So I’ve talked a lot about base health. Maybe it’s worth talking a little bit about the incrementalism for me. One of the things that I realized some time back is that you know we’re all looking for this huge change. The eureka moment if you know the Eureka story and the origins of that with the Eureka measurement of displacement by water while they occur they tend to be infrequent and the majority of our learning opportunities are small incremental changes that add up. And that’s true in healthcare. When you think about patients it’s not that you can come in and be this fantastic clear and airway obstruction the Heimlich maneuver that most people can understand. That’s very gratifying. But that’s an unusual experience. It’s much more likely to be a complex long condition changes minor issues and teasing that out. So the small pieces of data and what I’ve discovered clearly is that other industries use this very effectively and there are so many learning opportunities in other places. This past year I presented at HIMMS in conjunction with Hilsen who do this Fent stick job of hospitality. And yet we in health care do a pretty poor job in most hospitals and healthcare systems. You know we tend to not give our patients the best possible experience. Why can’t we learn from them. Put in place some of the. So it’s bringing all of that together in this incremental approach that for me is really the best scope we have revolutionizing healthcare. This is not gonna be a quick fix but it will add up to something. And when you look at over if you look at the history and the timeline it’s lots of little small course corrections it wasn’t this big. Oh my God we’ve got to have ōba. Nobody thought that. Right. And I think the same is true in healthcare and you know those small changes that when you look at them you go well. That’s obvious. That may be true but it’s not being used and it wasn’t that obvious and implementing that I think is going to add up to the change we desperately need in Health.

Saul Marquez: [00:26:13] Dr. Nick. And I think that’s an awesome callout and I think an important ingredient in that recipe for big change is consistency. Right. Once you make that shift staying consistent with it seeing it through.

Dr. Nick: [00:26:27] Yeah. And the other thing I would add incremental changes is also insurance against risk. And why do I say that because if you make small changes and they don’t work you find out quickly you haven’t made a huge sort of financial jam into some direction and you’ve got the ability to course correct from there. So you’re right. Keeping consistent and building on is important but also that learning opportunity failure is not a failure it’s simply learning. And if they’re only small changes it’s much easier to recover from that and quicker to recover and that’s mitigation of risk in my mind.

Saul Marquez: [00:27:08] Awesome. I love that. Yeah. And this is such a great example Hakims Raggatt listeners and what you could do in your organization you know make those small changes that tie into your mission that tie into your goals and ultimately course correct as you go through. It’s insurance. You can make the small changes you’re not putting big dollars or big pounds into your decisions. So Dr. Nick let’s pretend you and I are building a medical leadership course and what it takes to be successful in medicine today. It’s the 101 course or the ABC of Dr. Nick. And so you and I are going to write out the syllabus. I’ve got four lightning round questions for you. And then we’re going to finish up with a book that you recommend to the listeners. You ready.

Dr. Nick: [00:27:49] Yep absolutely.

Saul Marquez: [00:27:50] Awesome. So what is the best way to improve health care outcomes.

Dr. Nick: [00:27:54] I think the best way to improve healthcare outcomes is to use the existing pool of information and data turned into knowledge supported by technology and enable the highly skilled individuals that we have working in the system to work importantly to the top of their license. And that’s not just physicians that all clinicians and it’s the enablement of that potential rather than asking them to do tasks that I think don’t actually deliver better care. They demean and reduce that capacity.

Saul Marquez: [00:28:31] What is the biggest mistake or pitfall to avoid.

Dr. Nick: [00:28:34] I think the biggest mistake we make is failure to understand other people’s perspectives. That’s one that is a big topic or a big issue for me. Let me pick something controversial vaccines. The idea that any parent comes into a pediatrician’s office with the intent of harming their child is for me with a very very tiny minority possibly is just preposterous. So the fact that they’re resisting the science based supported evidence of regular vaccine schedule is not malintent and we need to understand that position and help them understand why that’s wrong if we believe that’s wrong. The Swade not impose so the importance of understanding other people’s perspectives I think is the most compelling issue for me or the most important issue.

Saul Marquez: [00:29:24] I love that. How do you stay relevant as an organization. Despite constant change.

Dr. Nick: [00:29:29] Oh I think a welcome change is the key learning point for me. That’s easy for me I just can’t be any more excited. Think about all the changes happening to age maker. Yeah that happens in terms of it’s good news and if it doesn’t work that’s okay. Recognizing the risks and the challenges associated with loss of time and effort and so forth but setbacks and again the small changes try these things out and see if they work and if they don’t course correct but welcome it. This is an exciting time to be alive in healthcare and in life in general look at all the stuff that’s going on. This could not be more exciting.

Saul Marquez: [00:30:07] As brilliant I love it. I totally agree. And finally what’s one area of focus that should drive everything else in your company or organization.

Dr. Nick: [00:30:15] Oh that’s got to be the patient. I think the most impressive organizational chart that I ever saw for a hospital was one that I helped build in Glasgow 20 to 23 years ago. And instead of putting the CEO at the top they had the patient at the top and I bet they’ll. And you know it seems simple but my goodness you know focus the mind. Why are we here. I’m not here to deliver medicine I’m here to service the patient. I am not the most important person in the healthcare delivery system. The patient is it’s all about a patient and if we’re not delivering good care to them we’re not being successful in my mind.

Saul Marquez: [00:30:52] That’s a powerful visual thing you know just I love that I’ve not seen that before the visual. I’ve heard people talk to it but just having that organizational structure with the patient at the top. Wow. I love that Dr. Nick. You’ve obviously done some really cool things and you’ve read a lot of books but what would you say if you had to boil it down to one you’d recommend put on the syllabus for the listeners.

Dr. Nick: [00:31:14] You know this was probably the hardest question but it’s it’s one that sits by my bed albeit sometimes in the drawer but not you know it’s a short history of nearly everything by Bill Bryson. It’s not medical it’s not futuristic it’s scientific and I just want to read for you the first couple of lines from the preface. In fact it’s not even the opening yet. Welcome and congratulations. I’m delighted that you could make it. Getting here wasn’t easy. I know. In fact I suspect it was a little tougher than you realize to begin with. For you to be here trillions of drifting atoms had to somehow assemble into an intricate and intriguingly obliging manner to create you. It’s an arrangement so specialized in particular that it has never been tried before. And you will only exist this once and it goes on and it’s essentially everything about the world the universe everything down to Patre and atoms and beyond and then all the way up to the scale of the universe and to get a sense of how tiny and insignificant and particularly to put things in perspective. I like to read. I actually keep that on my desktop. I have another shot of that. And it goes on a little bit. If you read nothing else just read the preface of that book. I will blow your mind.

Saul Marquez: [00:32:37] I love it Dr Nick and so outcomes rocket listeners they have it check out that book and by the way don’t worry about pulling over writing it out. Don’t worry about stopping your run if you’re listening to this and you’re on the go. Just go to outcomesrocket.health/drnick D-R-N-I-C-K you’ll see all the show notes of our discussion today as well as a link to that book and a link to all the things that Dr Nick is up to including his websites and the best place to get a hold of them. So Dr Nick before we conclude let’s just hear you share one closing thought and then the best place where the listeners can get a hold of you.

Dr. Nick: [00:33:15] So my closing thought is for the most part the same. This is the most exciting time period it is the best possible intersection of healthcare and technology. I’m excited about it. It doesn’t faze me at all. I think technology has always been about enabling human potential and we have enormous opportunity in front of us. And I’m just delighted to be here at this time. As for reaching me pretty much if you can’t get to me the Internet is down. Least that’s my view. I feel like I’m reasonably well connected. You can find me on Twitter. @drnic1 on LinkedIn Facebook you name it. And in fact I did test this I was curious you can search for Nick Vantaa Heyden but if you can’t spell that Dr Nick and I do appear although I do get muddled up with the Simpsons Dr Nick and also Dr George Nikolopoulos who was the original Dr Nick he was Elvis’s physician. That is funny. So Ofeibea I am actually on the first page of Dr Nick so.

Saul Marquez: [00:34:24] I just pulled it up and there you are.

Dr. Nick: [00:34:26] Yeah which is pretty cool.

Saul Marquez: [00:34:29] Yeah that is cool. Awesome while our comms racket listeners a habit you got to the best way to get a hold of Dr Nick show Nochiya they’re ready for you to review and you can always listen to the episode again have something inside of it inspired you so Dr. Nick. Just want to say thank you so much for joining us today and looking forward to stand in touch with you.

Dr. Nick: [00:34:47] Likewise. Thanks very much for having me. I enjoyed it.

: [00:34:53] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes resources inspiration and so much more.