In this episode, we examine emerging trends in pediatric emergency medicine, including improving pediatric readiness and integrating care across systems. Drs. Deborah Hsu and Manish Shah highlight how innovation, data, and clinical mindsets are shaping practice while addressing ongoing challenges in caring for children. Topics include: * Where most children actually receive emergency care—and why that matters * The realities of practicing pediatric EM outside ideal resource settings * Where tools like AI and telemedicine are starting to change pediatric care * Balancing efficiency, testing, and clinical judgment on shift
In this episode, we examine emerging trends in pediatric emergency medicine, including improving pediatric readiness and integrating care across systems. Drs. Deborah Hsu and Manish Shah highlight how innovation, data, and clinical mindsets are shaping practice while addressing ongoing challenges in caring for children.
Topics include:
* Where most children actually receive emergency care—and why that matters
* The realities of practicing pediatric EM outside ideal resource settings
* Where tools like AI and telemedicine are starting to change pediatric care
* Balancing efficiency, testing, and clinical judgment on shift
Guests:
Dr. Deborah Hsu is Professor of Emergency Medicine and Pediatrics at Stanford and Division Chief of Pediatric Emergency Medicine. She is a nationally recognized leader in pediatric emergency care, medical education, and fellowship training, with prior leadership roles at Baylor College of Medicine and Texas Children’s Hospital.
Dr. Manish Shah is a professor of pediatric emergency medicine at Stanford whose work focuses on integrating pediatric evidence into EMS systems through research, education, and advocacy. He is a leader in pediatric prehospital care, serving in national research networks and leading major clinical trials and initiatives to improve pediatric readiness in EMS systems.
Host:
Dr. Matthew Strehlow is a Professor of Emergency Medicine at Stanford and serves as Vice Chair for Innovation and Clinical Improvement. His work focuses on improving patient care through system redesign, global health initiatives, and advancing emergency medicine education.
Dr. Matthew Strehlow: My guests today include Dr. Deborah Hsu, the inaugural chief of the Division of Pediatric Emergency Medicine at Stanford University. Her research focuses on competency-based medical education, assessment, curriculum development, and professional development. We are also joined by Dr. Manish Shah, a professor of pediatric emergency Medicine at Stanford, whose research focuses on integrating evidence-based pediatric care into pre-hospital EMS systems, including leading the EMS arm of PECARN, the world's largest pediatric emergency care research network.
This promises to be a great conversation and there will be a lot to take away. So, let's jump in. Welcome, Dr. Hsu, Dr. Shah. It's great to have you here. Let's kick things off with a big picture question. What are some of the developing trends in pediatric emergency medicine that you find especially exciting or game changing? Dr. Hsu, let's start with you.
Dr. Deborah Hsu: You know that I'm a recent transplant to Stanford, and before coming here, I worked in a really large children's hospital setting and took for granted all of the things that are available to us when we function within a large children's hospital setting where our concentration is completely on children. And then coming here, while we have a separate Peds ED, and all the resources that we would ever want most of the time in taking care of children, I think I've come to the realization that functioning within a hospital setting that is geared more towards adults…that's been an eyeopener for me.
And then to take that further, what happens when children go to less resource-rich areas and hospital settings that are critical access? It's not their fault that they live three hours away. Or even many more hours away from the nearest academic center. And so, to your question about changing trend or biggest trend and what I find so exciting about being here is being able to contribute to working on pediatric readiness in the critical access hospitals. When we think in terms of the children in this country, just this country alone, where do they get care? 80% of them actually get care in non-children's hospital settings. And there is definitely data out there that shows that if we can help these non-children's hospitals become more pediatric ready, we can decrease mortality for children 60 to 75%. And we can save thousands of lives. every year.
I think the onus is on us, those of us who care for children and in partnership with our colleagues, especially our general emergency medicine physicians who are trained to take care of children but may not have spent as much time concentrating on the emergency care of children.
What can we do to inform that process so that children, regardless of where they go to seek emergency care, get the care that they deserve?
Dr. Matthew Strehlow: Well, that's a great point. I think one of the things that we sometimes forget as physicians is that it's not just about whether the physician was trained to take care of children.
It's really all of these other things that you talked about the other staff and the resources and just the design itself can really impact that. So that is a really exciting area and I'm glad that you're focusing on it. Turning over to you, Manish, what do you find is really game-changing right now in pediatric emergency medicine?
Dr. Manish Shah: One thing that I've observed is better integration of care. As an example, back in 2006, the Institute of Medicine, now the National Academy of Science, Engineering, and Medicine, published some reports on the state of emergency care in the United States.
One of those focused specifically on pediatric emergency care. Another one focused on emergency medical services. The third was just on general emergency medicine. And one thing that was highlighted in all three of these reports was the lack of integration and coordination of care. And what I've seen over time since those reports were published nearly two decades ago, is better integration of care across the continuum.
So, this concept that care doesn't start in the emergency department, but emergency care actually starts outside the hospital when a bystander witnesses an emergency. And how do we then integrate that care better with EMS into the hospital and then beyond into the inpatient setting. And then even for the patients who suffered critical illness and or injury and need to be rehabilitated.
And then how does that feedback into the public health system to improve overall care, to prevent emergencies as well. So that's something that I've seen that's exciting - a responsiveness of the field to integrate care. And especially more recently, I think utilizing certain technology and innovation that's available to us to drive that forward even more.
Dr. Matthew Strehlow: That idea, the old axiom that the chain of survival is only as strong as its weakest link, right? That seems to be such an overriding importance in our specialty and in getting that continuum of care for our patients. So, I really appreciate that.
Let me ask you, you mentioned innovation, Manish. Can you talk about how innovation, whether it's technology, care models or systems, is changing the way that we're approaching pediatric emergency care?
Dr. Manish Shah: Absolutely. I think that there are a few things that I have observed with the work that colleagues have done both on the local level and now being at Stanford or on a national level from what I've seen with people integrating innovation in ways that I really didn't see or didn't think about as much 10 years ago.
And so, I think a few of those are artificial intelligence. We have definitely seen the use of that in a lot of ways. I think with charting, and more recently, I think we're using AI to listen to the interactions that we're having with patients to help us be a more efficient in charting to really focus on the patient when we're having conversations with them.
But also, with research and using things like natural language processing to be able to analyze data, the narrative data from electronic records, both in the emergency department, and other parts of the hospital and in EMS to be able to glean data that can help inform care.
And then I think as well, using larger data sets that we have available to us to enhance our diagnostic accuracy to stratify certain diseases like sepsis and traumatic brain injury as examples. And also, to be able to use tools that we have available in the electronic record from the data that's acquired to help us even triage patients and to be more accurate and precise.
In doing that. I think that those are some ways that I've seen colleagues across the country using AI.
I think another way that innovation is being applied in pediatric emergency medicine is through the use of telemedicine and really seeing PEM colleagues across the country starting to use it as a means of consultation to provide support to general emergency medicine colleagues.
Especially in areas that don't have the resource of pediatric emergency medicine, to be able to keep patients in their own community to be able to equip them with expert advice that might help them make a disposition decision to keep that patient in the local area, which is better for families oftentimes. And to help avoid what could be an unnecessary transfer if they had that ability to have that conversation with a pediatric expert.
And then I think another way is with decision support, so being able to apply innovative tools within the electronic record to help guide the way that we manage patients, to be able to give us suggestions about clinical pathways of care that we know are evidence-based. And to equip us with the ability to order the right interventions for the right patient in a timely manner. And to do it in a way that is standardized. And is not relying on our memories, but it's built into the system to prompt us to do the right thing for patients.
And so, I think those are some several ways that I've seen innovation applied in the practice of pediatric emergency medicine.
Dr. Matthew Strehlow: I really hear that theme of data, AI, and the precision of our care coming through in some of those innovations that you're talking about. And turning to you, Deb, I know you have helped us integrate our pediatric emergency department across our adult and children's hospitals, which is fairly complicated. And you've also helped run one of the largest pediatric emergency medicine networks in the country out of Texas. So, you've seen the good and you've seen a lot of the challenges.
Tell us a little bit about some of the biggest challenges you see in the specialty right now.
Dr. Deborah Hsu: How about we start with at the most basic patient level beyond our control. You guys have heard me say what's within my control and what's not within my control. I mean, I think we are all worried about unvaccinated children. And I think there is a real, real concern for us in terms of children arriving to our ED with illnesses and disease processes that I personally haven't seen in over two and a half decades of practice.
I will never forget the first time I saw a pus coming out of a kid's LP needle. And this is in face of us doing the smallest number of LPs that we've ever done. Right? If you think about it, when I first came out of training, we were LP’ing every baby with fever less than three months of age. Right now, that automatic LP number has gone down to 21 days and younger,
All of that has resulted in less people being completely comfortable doing different procedures that we as emergency medicine physicians, pediatric emergency medicine physicians, are expected to know how to do. But then you add on top of that disease processes that frankly were eradicated.
And then us having to deal with those and then our healthcare systems - both adult and peds oriented organizations - are we ready to handle potential increases in volume and complexity of our patients if this truly comes to fruition? Legit concern.
Dr. Matthew Strehlow: Have you seen have you heard from your colleagues? I know you're both Texas transplants to California, but have you guys heard from your colleagues about folks that have been seeing the measles and measles outbreaks and how that's impacting their care?
Dr. Deborah Hsu: I would say that I'm not sure that our colleagues back at our former institution were directly affected by the measles outbreak that happened in Western Texas because we were on the eastern side.
But certainly, there was a lot of concern and preparations for potential disasters and stuff like that. I mean, there's no way of predicting what can happen. I know that at the various pediatric oriented organizations that Manish and I work with and provide service on behalf of, there's a lot of partnership building and advocacy for some of the decisions that have been made, obviously without our input. At the more local level though, what can I as an individual do when I'm practicing medicine and working my ED shift? I've chosen to do relatively simple things but maybe will make some impact on at least some families. Such as when patient's parents tell me that they've gotten their children completely vaccinated. And especially if the children are presenting to us in the emergency department with fever, and I get to give them the good news that we don't have to do a whole bunch of blood work because you, the parents or the caregivers have done what they could do to protect their children.
That's better than any test that I have available, and so I'm hoping that kind of positive messaging will spur people on to do the right thing, even though leadership may not be headed that way.
Dr. Matthew Strehlow: I love that positive approach. You could be sitting there focusing on the people that you're going to lecture to because they're unvaccinated but instead creating a community where they feel like they're doing a good job parenting because they have been vaccinated and telling them the positive impacts of what they've done and the choices they've made.
Manish, do you have any go-to techniques you use in the emergency department while practicing? Or in other areas how you support vaccination and the importance of vaccination among the community?
Dr. Manish Shah: I was going to touch on one thing that you just mentioned in terms of just instilling positive feedback for parents in terms of what they're doing for their kids.
And I think this is true, not just for in this situation of whether they're vaccinating their child or not. But in general, when parents bring their child to the emergency department or other family members bring a child into the emergency department, a lot of times they're nervous.
They're nervous about what's going on with their child. And what I try to do in my approach is I instill confidence. I try to instill confidence in them in terms of what they are doing right. And so, sometimes I find that parents don't know what they are doing right. Or underestimating that.
I do to instill that confidence by pointing those things out. So, for example, like if a child comes in with gastroenteritis, and they're worried that their child's not drinking enough, I point out the things that they're doing. Okay, well, clearly that your child' drinking enough. What you're doing is working because they're still making tears and their tongue is still moist and they're still having a sufficient number of wet diapers. So those are reassuring things. And so, when it comes to things where I may have a different perspective on, ways to prevent illness, I try to use that then as an approach.
So, for example you know, if a child comes in with an injury where they could have prevented injury by wearing a helmet or wearing a seatbelt, I try to find the common ground. Okay - you and I both want to do, what's best for your child, right? We care about your child. You love your child very much, and, and I care about them too, and I don't want them to get hurt.
So, based on my, my experience, I recommend that next time they're riding their bike or the next time they're in their car, wear a helmet or a seatbelt. And so, I think, I do think it is our role as experts in our fields in healthcare to also inform our patients.
When it comes to vaccination, I'll give an example. Just getting the influenza vaccine as an example. We know that children who have chronic pulmonary disease like asthma, if they get influenza, if they get an infection, they are at higher likelihood of complications from that then a child who does not.
And so, I mention that if I see a child who comes in for an asthma exacerbation, I bring it up. And is your child vaccinated for against influenza? Are they vaccinated against COVID? And I use that as an opportunity then to suggest okay, well, you know, if they get an infection like that, they could have a worse asthma exacerbation. And so, every year in the fall, go ahead and, and get that vaccination. And then if I sense there's concern, try to explore that. You know, any time a parent makes a decision for their child, there's usually good intention there. And so, I try to assume good intent. What is it that, that, that is concerning to you about not doing that thing and try to probe that deeper?
Dr. Matthew Strehlow: I really love that. And I think that those are really valuable pediatric lens messages for our general emergency medicine physicians. I think that's where a lot of that value in your approach comes from and that pediatrics training and I really appreciate that positive approach.
We could obviously go down a pretty deep rabbit hole about vaccination, but I'm going to take a little bit of a turn. You’re both researchers. Manish, can you talk to us about where you see some promising research in pediatric emergency medicine coming down the tracks?
And then I’ll flip that question to you Deb, with a real focus on education and research.
Dr. Manish Shah: Sure. So first I'm going to give my biased answer because I'm a prehospital researcher. Clearly there’s a lot of opportunity to conduct more research in pediatric pre-hospital care. There's a lot of unanswered questions when it comes to the reasons why a person calls an ambulance for a child. Half the time it's for trauma.
The other half is for medical illness with the top two reasons being respiratory distress and seizures. So, are we doing the best we can when it comes to trauma care, specifically with hemorrhage? There's a lot of buzz right now in EMS and specifically with adults on the use of blood products to treat hemorrhage prior to arrival to the emergency department.
Those are unanswered questions when it comes to both adults and children. When it comes to certain medical illnesses like asthma or seizures, airway management, there's ongoing trial that I'm leading on dosing for seizures, dosing of midazolam.
But there are many unanswered questions when it comes to how to best manage seizures in the prehospital setting. How to best manage the airway. I'm also part of a trial called where we're comparing bag vessel ventilation to supraglottic airway placement. And trying to see what's the best way to manage that airway in the pre-hospital setting.
And there’s a study that's being led by Dr. Henry Wang out of the Ohio State University. And then I think there are other things that we sometimes study in adults and we prove we can do them and improve outcomes in adults, but we haven't ventured there in children.
So, for example, the concept of staying on scene in the setting of a cardiac arrest. And doing on scene resuscitation that has been proven to be associated with better outcomes in adults. That really has not been well studied in children. So that's my EMS lens.
I think the other thing is just studying system readiness in EMS, as well in terms of how equipped our EMS agencies are to care for children. But I wanted to go back to some things I was mentioning about innovation earlier, because I think even in the emergency department, some areas that are ripe for researchers.
Some of those things I mentioned about innovation - the use of AI to improve how we triage patients, how we diagnose patients, the use of telemedicine to help promote access to care to really bridge that gap in communities where a pediatric emergency medicine expert is lacking. And so can we use technology to help provide that service without having to transfer a patient to get that service.
And then the other thing I think is implementation science. How can we refine how we translate knowledge into practice by really using best practices about and evidence-based approaches in the way that we integrate things into the workflow of healthcare.
Dr. Matthew Strehlow: Those are obviously areas that, that we can really improve care. And I think one of the things that we think about is as we get these innovations that you're talking about, Manish, how do we educate our providers? What are those changes in how we train people?
Deb, I know you're an expert in this and you spend a lot of time thinking both about how we do that locally but also guiding us nationally in this space. Tell us a little bit about where you think education research is headed.
Dr. Deborah Hsu: I would say that’s fundamentally why do we do the research that we do - and that can be education related or any other research. And I'm so glad that people are now talking about how the work that we do in education is research.
Because I can tell you at the very beginning of my career path, education was service. Education was expected and there's no way that we could advance our careers to be educators and that that has changed so much in my time and in the development of my own career path. So Matt, thank you for talking about educational research. It's common now, right? I want the listeners to hear that they shouldn’t take it for granted. Because whatever research we choose to do is valuable and if we keep a focus on what are the outcomes that we want for the patients that we are taking care of on an everyday basis, what are the outcomes we want to achieve for them?
Then focusing in on that to then inform the projects that we do, the research that we do. And so, then from a PEM education research, PEM intersects both emergency medicine and pediatrics.
And we are really fortunate that emergency medicine and now, and in peds have really been working on how we move from time-based to competency-based education delivery, which is instruction. How do we develop curriculum? And how do we provide effective assessment and feedback to our trainees so that when they leave us, we can trust them to take care of our patients and ultimately maybe even take care of us. What do they need during the course of their training to make that happen?
And how can we do it in a way that they want to continue to learn. They see the value of learning so that when they leave formal training, they want to continue to learn. Because I think we all, the three of us would agree that how we practice medicine now is very different than when we practice medicine first coming out of training.
So, this whole idea of growth mindset and learning and pivoting is really important. And I think that's something that we have to make sure that our trainees learn how to do. The flip side though is that there are accreditation standards that we have to meet. And that means turning in paperwork,
But how do we make the turning in paperwork, the accreditation requirements that that hold us accountable work in a way that goes beyond busy work? How can we make it meaningful? And so, a lot of the work that I've focused my own efforts on is in competency-based assessment and how do we provide feedback.
What is meaningful that our trainees can use that is timely without being too intrusive? And then to also get the people who are providing the assessments and evaluations to do them and minimize the amount of time that they have to spend doing it is not easy. And you can't do this kind of project all in one big bite, although we have planned projects so that all of these pieces are addressed. And hopefully if we have developed the project correctly, that end result will be that we get to the ultimate goal of taking care of our patients. Being able to trust our trainees to do so when they leave us. And then try to minimize the busy work as much as possible.
Dr. Matthew Strehlow: Thank you for that. I think a lot of people throw out the term competency-based education or assessment and a lot of us kind of struggle to understand the concept.
In a couple of sentences, as an expert, can you summarize it in, in plain language so that myself and others that aren't deep into this space can understand it?
Dr. Deborah Hsu: I'll try. Competency. What's needed for us to perform our everyday activities in the field that we've chosen to pursue? Those everyday activities - the whole catchment term is entrustable professional activity.
I think that word entrustable is really important - the public has to trust us to perform those activities well. Not just competently, although our accreditation bodies only require competence. So then how do we then break down our trainees’ abilities to perform those activities so that when we can identify easily or more easily what they know how to do already and do it well?
What are the pieces that they can still continue to use help with and how do we help them develop?
Dr. Deborah Hsu: or are you,
Dr. Matthew Strehlow: And so really focus there is on, could I trust you? Would I bring my family member to you? And what are the skills necessary to do that?
Well, that's a simple way of thinking about it, and I think useful for those of us that aren't quite as deep into the field. I just want to step back for a second and say, I appreciate both of you mentioning education and implementation as a science.
I feel like when I started, a lot of that was just kind of considered obvious, right? That we knew how people learned and we knew how to get things done. That there was no real science to that. And, and science could only be done in the lab. And I think now we've learned that the way that we teach, the way that people access and use and incorporate information to be competent and entrustable and the way that we actually implement that science is pretty challenging to do in a way that's effective and best practice and cost effective. So, mentioning those alongside with some of the other research that you do is great to hear.
Manish, I want to shift to you and talk about something more pragmatic and practical for our provider, that they can implement today. What practice mindset or innovation can providers employ today to make a difference in the near future?
And then, Manish, after you're done, Deb, please take it away.
Dr. Manish Shah: Sure. So, earlier I was talking about innovation and I'm also a big proponent of evidence-based practice and all that.
But what I'm going to offer to you in response to the question you just asked is a mindset tip that is, I think basic.
Listen to your patient story. And I say that especially because I think as our field has evolved to become more innovative and reliant on technology. I think what I have observed as well, is that sometimes we lose the importance of hearing the story.
And I say that because we work in emergency medicine in a fast-paced environment where people don't have scheduled appointments. You don't know what's going to happen. And so, you can get very busy, very quickly, especially at certain times of the day. And it's hard to take that time to hear the story unless you're being mindful about it.
And also, you are not jumping into a mode of, okay, they came in with this chief complaint, so I'm going to automatically do X, Y, and z. And I say that because hearing the importance of what the details are to the story, I think is essential to diagnosis. And I think that in some ways we're at risk of losing that art of medicine if we rely too much on jumping to technology.
And I ask this question of learners sometimes when they present the patients to me. Medical student, resident fellow, they'll tell me their history, they'll tell me their exam, and then they'll jump even before the assessment to their plan. They'll say, okay, so I want to go ahead and get this, and this.
I say, okay, let's back up. I have a couple of clarifying questions. Tell me a little bit more about this, you mentioned this symptom. Tell me more about how often that was happening and when was the last time that happened. Oh, I didn't ask that. Well, that's important because that is going to change your differential.
And so, I think going a little bit slower and taking a good history, a relevant focused history because we're working in emergency medicine. But at the same time, making sure we understand why they are here today. What's been going on, and then really being thoughtful about that assessment and letting that assessment guide the plan that you ultimately develop.
So, it may sound basic, but I think it's very important.
Dr. Matthew Strehlow: You know, I'm a big basketball fan and in basketball we say be quick, but don't hurry. And I feel like that applies a lot to the emergency department. You know, I'll hear sometimes, especially junior residents talking to medical students, saying I want you in and out of the room in one minute.
And I'm like, wow. That is not going to get us anywhere. I think that there's a big difference between being efficient and being fast. And fast is dangerous in a lot of times, right? Whereas efficient can be effective and you get that history and you actually save time by getting a good history and learning that story from your patient.
So, thank you for sharing that. Deb?
Dr. Deborah Hsu: 100%. I think it's such a different, group of thinkers that we have in our trainees now. I remember when the whole idea of evidence-based medicine first came. Now I'm dating myself a lot, but our trainees back then weren't used to thinking in that way.
And now it's very obvious that our trainees have grown up in that environment. And especially in emergency medicine when we focus a lot on metrics, and time to dispo and that sort of stuff is taught to them. Sometimes I think has it translated into, well, if I get all of these tests, then I'm more likely to get all of the data that I need to then make a more timely dispo.
And so, in my personal practice I ask a lot about what's the pretest probability having this particular test that you want to do add more to the data that you need to make decisions compared to what you already know from the history and physical.
That's utilizing evidence that they've collected and empowering them to maybe make a decision about not doing tests, which can have a of potential positive impact in managing healthcare expenses. So, I guess that's an immediate application that costs no money.
Dr. Matthew Strehlow: Right. And I think it goes along with what you were saying, Manish, that more data is not necessarily helpful. A good history can actually prevent the need for more data if you really understand your patient's story.
I want to end our podcast on a lighter note. So one final question to each of you. What's one small thing that brings you joy in your day-to-day work? Especially because both of you are two of the nicest, most smiley people that I know. So, share your wisdom please.
Dr. Manish Shah: I love being in an environment where I'm interacting with people who are learning: medical students, residents, fellows. And so, one thing that brings me joy are those aha moments where I feel like my interactions with them contributed to something new. Like they left that shift with new knowledge gained or new confidence in performing a certain procedure or skill. And so that brings me joy.
And then the other thing I would say is, in interacting with patients and families. Seeing the reassurance that I can provide when they come in worried and they leave. That brings me joy because I also view my role in interacting with patients and families as an educator role as well, to equip them to take care of, of themselves as the patient or their child as the parent or caregiver.
And so, if I can equip them to do that better and be more confidently that they feel like they have the knowledge to take care of themselves at home or their child at home better, because I imparted some reassurance or some wisdom to them, then that, that brings me joy as well.
Dr. Deborah Hsu: When I first started and was trying to develop a career path or figure out my career path, I definitely was considering emergency medicine versus pediatrics. And in the end, Matt, you've heard me say this, I couldn't let go of the children. I wanted to be an expert in children, and so that's why I went the pediatric residency route before doing a chem fellowship.
And to this day, it still gives me joy to be able to carry a baby around in our emergency department. I just got to do that yesterday when I was on my shift. You know, mom needed to go to use restroom. Well, I'm happy to carry your baby around and the best thing is that I got those few minutes of cuddling, but then I got to give that baby back.
And some people have also asked me why I chose to go the administrative route.
Early on in my career, I said, there's no way ever that I would ever do a division chief position. And now I've done it a couple of times. And I would say this. Most of us pick career paths because of passions and things we like to do.
But what keeps us going, I think, and keeps us relatively happy is being able to do stuff every day that we don't like to do and still be happy with the choices that we've made.
And so, in emergency medicine, peds or otherwise I think we're so good at flexing and coming up with a Band-Aid solution to just get stuff done, right? At some point though, those Band-Aids can, can just really be wearing, at least on me.
So, when opportunities came up for administrative positions, that allowed me to work at a systems level to try to minimize the Band-Aids that we have to come up with on an everyday basis…I think I get a lot of satisfaction out of that too. And yes, we all know that there are days where nothing goes right, especially when we're trying to make systems level changes.
But man, when something works, that's worth happy for a few weeks and, and I choose to focus on that and continue to work on the stuff that needs working on.
Dr. Matthew Strehlow: Well, thank you both for sharing that.
That's a wrap for today's episode. Huge thanks to Dr. Hsu and Dr. Shah for their sharing their insight.
We'll see you next time. Until then, keep taking care of anyone with anything at any time.